1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 10 Care of the Older Person

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  People live longer than ever before.  Chronic illness is common in older persons. Disability often results. Disability often results.  Most older persons have at least one disability.  Most older people live in a family setting.  Some live alone or with friends.  Some live in nursing centers. The need for nursing center care increases with aging. The need for nursing center care increases with aging.

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  Late adulthood involves these age ranges: Young-old—between 65 and 74 years of age Young-old—between 65 and 74 years of age Old—between 75 and 84 years of age Old—between 75 and 84 years of age Old-old—85 years of age and older Old-old—85 years of age and older  Gerontology is the study of the aging process.  Geriatrics is the care of aging people.  Aging is normal. Normal changes occur in body structure and function. Normal changes occur in body structure and function. Psychological and social changes also occur. Psychological and social changes also occur.

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  PSYCHOLOGICAL AND SOCIAL CHANGES  Physical reminders of aging can threaten self- esteem and independence.  Social roles change.  How people cope with aging depends on: Health status Health status Life experiences Life experiences Finances Finances Education Education Social support systems Social support systems

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  Retirement is a reward for a life-time of work. It usually means reduced income. It usually means reduced income.  Social relationships change throughout life.  Children may become caregivers.  Death of a partner is common.  PHYSICAL CHANGES  These happen to everyone. The rate and degree of change vary with each person.  Quality of life does not have to decline.

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  The integumentary system The skin loses its elasticity, strength, and fatty tissue layer. The skin loses its elasticity, strength, and fatty tissue layer. Secretions from oil and sweat glands decrease. Secretions from oil and sweat glands decrease. Blood vessels decrease in number. Blood vessels decrease in number. Brown spots appear on the skin. Brown spots appear on the skin. Loss of the skin’s fatty tissue layer makes the person more sensitive to cold. Loss of the skin’s fatty tissue layer makes the person more sensitive to cold. Dry skin causes itching and skin is easily damaged. Dry skin causes itching and skin is easily damaged.

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7 Nails become thick and tough. Nails become thick and tough. Feet usually have poor circulation. Feet usually have poor circulation. The skin has fewer nerve endings. The skin has fewer nerve endings. White or gray hair is common. White or gray hair is common. Hair loss occurs in men. Hair loss occurs in men. Hair thins on men and women. Hair thins on men and women. Facial hair may occur in women. Facial hair may occur in women. Hair is drier from decreases in scalp oils. Hair is drier from decreases in scalp oils. Skin disorders increase with age. Skin disorders increase with age.

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  The musculoskeletal system Muscle cells decrease in number. Muscle cells decrease in number. Muscles atrophy and decrease in strength. Muscles atrophy and decrease in strength. Bones lose minerals, especially calcium. Bones lose minerals, especially calcium. Bones lose strength, become brittle, and break easily. Bones lose strength, become brittle, and break easily. Vertebrae shorten. Vertebrae shorten. Joints become stiff and painful. Joints become stiff and painful. Mobility decreases. Mobility decreases. Activity, exercise, and diet help prevent bone loss and loss of muscle strength. Activity, exercise, and diet help prevent bone loss and loss of muscle strength.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  The nervous system Nerve cells are lost. Nerve cells are lost. Nerve conduction and reflexes slow. Nerve conduction and reflexes slow. Blood flow to the brain is reduced. Blood flow to the brain is reduced. Changes occur in brain cells. Changes occur in brain cells. Sleep patterns change. Sleep patterns change. Touch and sensitivity to pain and pressure are reduced. Touch and sensitivity to pain and pressure are reduced. Sensing heat and cold are reduced. Sensing heat and cold are reduced. Taste and smell dull. Taste and smell dull.

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10 Changes occur in the eye. Changes occur in the eye.  Eyelids thin and wrinkle.  Tear secretion is less.  The pupil becomes smaller and responds less to light.  Clear vision is reduced.  The lens of the eye yellows.  Older persons become more farsighted (presbyopia). Changes occur in the ear. Changes occur in the ear.  Changes occur in the auditory nerve.  Eardrums atrophy.  Wax secretion decreases.  Wax becomes harder and thicker.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  The circulatory system The heart muscle weakens. The heart muscle weakens. Arteries narrow and are less elastic. Arteries narrow and are less elastic. Sometimes circulatory changes are severe. Sometimes circulatory changes are severe.  Rest is needed during the day.  Over-exertion is avoided.  The respiratory system Respiratory muscles weaken. Respiratory muscles weaken. Lung tissue becomes less elastic. Lung tissue becomes less elastic. The person may lack strength to cough and clear the airway of secretions. The person may lack strength to cough and clear the airway of secretions.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  The digestive system Salivary glands produce less saliva. Dysphagia is a risk. Salivary glands produce less saliva. Dysphagia is a risk. Taste and smell dull. Taste and smell dull. Secretion of digestive juices decreases. Secretion of digestive juices decreases. Loss of teeth and ill-fitting dentures cause chewing problems. Loss of teeth and ill-fitting dentures cause chewing problems. Peristalsis decreases. Peristalsis decreases. Fewer calories are needed. Fewer calories are needed.

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  The urinary system Kidney function decreases. Kidney function decreases. The kidneys atrophy. The kidneys atrophy. Blood flow to the kidneys is reduced. Blood flow to the kidneys is reduced. The ureters, bladder, and urethra lose tone and elasticity. The ureters, bladder, and urethra lose tone and elasticity. Bladder muscles weaken. Bladder muscles weaken. Bladder size decreases. Bladder size decreases. In men, the prostate gland enlarges. In men, the prostate gland enlarges. Urinary tract infections are risks. Urinary tract infections are risks.

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  The reproductive system In men, the hormone testosterone decreases. In men, the hormone testosterone decreases.  It affects strength, sperm production, and reproductive tissues.  An erection takes longer.  The phase between erection and orgasm is longer.  Orgasm is less forceful than when younger.  Erections are lost quickly.  The time between erections is longer.

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15 Menopause occurs in women. Menopause occurs in women.  Menstruation stops.  The woman can no longer have children.  Female hormones (estrogen and progesterone) decrease.  The uterus, vagina, and genitalia atrophy.  Vaginal walls thin and there is vaginal dryness.  Arousal takes longer.  Orgasm is less intense.  The pre-excitement state returns more quickly.

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  HOUSING OPTIONS  Living with family Adult day care centers Adult day care centers  Elder cottage housing opportunity (ECHO)  Apartments  Residential hotels  Congregate housing Senior citizen housing Senior citizen housing

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17  Homesharing  Assisted living residences  Board and care homes  Adult foster care  Continuing care retirement communities (CCRCs)  Nursing centers Hospital long-term care units Hospital long-term care units

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18  RESIDENT RIGHTS  OBRA is a federal law.  Residents have rights: As United States citizens As United States citizens Relating to their everyday lives and care in a nursing center Relating to their everyday lives and care in a nursing center  Nursing centers must inform residents of their rights: Orally and in writing Orally and in writing Before or during admission to the center Before or during admission to the center In the language the person uses and understands In the language the person uses and understands

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19  Residents have the following rights: To information To information To refuse treatment To refuse treatment To privacy and confidentiality To privacy and confidentiality To personal choice To personal choice To voice disputes and grievances To voice disputes and grievances Not to work Not to work To take part in resident and family groups To take part in resident and family groups To care and security of personal items To care and security of personal items To freedom from abuse, mistreatment, and neglect To freedom from abuse, mistreatment, and neglect To freedom from restraint To freedom from restraint To quality of life To quality of life

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20  OMBUDSMAN PROGRAM  The Older Americans Act is a federal law. It requires a long-term care ombudsman program in every state. It requires a long-term care ombudsman program in every state.  An ombudsman is someone who supports or promotes the needs and interests of another person.  Long-term care ombudsmen act on behalf of nursing center and assisted living residents. They protect the health, safety, welfare, and rights of residents. They protect the health, safety, welfare, and rights of residents.