assisting in geriatrics

Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.

Assisting in Geriatrics

Chapter 47

Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 2

Aging Population

In the 2000 census, 12.4% of the U.S. population was older than 65 years of age.

The “oldest old” (people older than 85) comprise the most rapidly growing age group.

It is projected that people older than 65 will represent 16% of the population in 2020 and increase to 20% by 2030.


Older Population by Age, 1900-2030


Services for the Aging

The aging process includes physical and sensory changes in older people.

The healthcare professional recognizes the special needs of the aged and develops effective management and communication skills for better service for the older client.


Myths about Aging

Senility inevitable

Disease unavoidable

Older workers less productive

Long-term care inevitable

No interest in or ability for sexual relations

Resistant to change

Cannot learn new things


Aging Changes

Table 47-1 in your textbook summarizes the changes in anatomy and physiology associated with aging in all body systems.

Normal age-related changes can be expected and compensated for, but these become more serious in the presence of poor health habits and chronic disease.


Aging Changes (cont’d)

General changes include: – An increase in arteriosclerosis

– An increase in time needed to learn new material

– A sharp decline in estrogen for women and increased risk of osteoporosis

– An increase in malabsorption problems and constipation

– A decrease in muscle mass

– Less elasticity in lungs and gradual stiffening of chest wall

– A tendency to gain weight


Aging Changes (cont’d)

– A deterioration of joint cartilage

– Presbycusis and presbyopia

– An enlargement of the prostate and weakened bladder muscles

– Impotence not a symptom of normal aging

– Menopause causes vaginal narrowing and dryness


Management of Changes

Age-related changes can be managed through: – Regular aerobic exercise and strength training

– Weight control

– A diet rich in fruits, vegetables, and whole grains and low in fat

– Avoidance of sun damage to skin

– Pelvic muscle exercises

– Annual physical examinations with health screening


Health Issues

The major health issues for aging people are related to an increase in atherosclerosis and potential cardiovascular disease.– Hypertension

– Type 2 diabetes mellitus

– Tendency to hyperthermia and hypothermia

– Seborrheic keratosis

– Arthritis

– Osteoporosis

– Increased risk of injury from falls


Cardiovascular System and Aging

Most frequent cause of death, illness, and disability.

CHF most common reason for hospitalization.

Aging causes structural changes in the heart.

Heart rate decreases.

Heart has to work harder to circulate blood through calcified vessels.

Increased incidence of orthostatic hypotension.


Endocrine System

Most common problem is diabetes type 2

10% over 60

Causes increased risk for multiple health problems

Patients display different symptoms because of insidious onset—weight loss, slow wound healing, recurrent infections, changes in mental state, cataracts, macular disease, muscle weakness, angina, foot ulcers, uremia

Patient education essential

What teaching adaptations may be needed?


Gastrointestinal System

Decrease in HCl affects digestion of calcium and and iron

Decrease in intrinsic factor causes fatigue

Increased rate of passage through small intestine causes poor absorption of vitamins and minerals

Poor eating habits, reduced fluid intake, and some medications contribute to constipation

Liver size decreases in size and weight after age 70

Increase incidence of GI diseases such as GERD, peptic ulcers, diverticulosis, cholelithiasis, and colorectal cancer


Integumentary System Age-related changes and sun exposure combine to cause changes

in appearance and function.

Terms: seborrheic keratosis and alopecia.

Epidermis reproduces more slowly, so skin appears thinner, tends to tear; increased bruising, infections.

Why is there decreased vitamin D synthesis and increased photosensitivity?

Dermis loses 20% of mass:– Vascular supply and SC layer decrease

– Hypothermia and hyperthermia

– Increased pain tolerance

– How can elderly prevent and treat dry skin?


Musculoskeletal System

Muscular changes related to activity level.

How can the MA help prevent falls?– Why are aging people at greater risk for injuries from

falls?

Osteoporosis causes hip and vertebral fractures.– What are common risk factors?

– What are methods of prevention and treatment?


Nervous System

What affects cognitive ability?

Is dementia inevitable?

What can cause signs and symptoms of dementia?

What is the best method for maintaining mental function?

What are risk factors for cognitive decline?


Alzheimer’s Disease

Progressive deterioration of the brain because of amyloid plaques and neurofibrillary tangles

First rule out other organic causes

What medications are used for treatment?

Stages:– First—2-4 years before diagnosis; memory loss,

confusion, disorientation, withdrawal

– Second—2-10 years after diagnosis; increased symptoms, restless, repetitive statements, mood changes, motor problems.

– Third—lasts 1-3 years; weight loss, doesn’t recognize family, incontinent, requires complete care


Vision Changes Presbyopia Cataracts Decreased lacrimation Glaucoma Macular degeneration Color blindness Decreased depth perception Nyctalopia Need six times as much light and have difficulty with glare How can the MA help?


Hearing Changes

Presbycusis and depression

Tinnitus

How can the MA interact effectively with hearing-impaired aging person?

What type of questions are asked in the Geriatric Depression Scale?


Nutritional Status

Comprehensive interview should consider:– Oral health

– GI complaints

– Sensorimotor changes

– Financial considerations

– Disease-related diet restrictions

– Alcohol consumption

– Depression

– Support systems


Additional System Issues

– Pneumonia, aspiration, and reactivation of tuberculosis

– Malnutrition

– Increased urinary tract infections, incontinence, and prostate enlargement

– Menopausal changes in the vaginal mucosa

– Sleep disorders such as apnea and periodic limb movement disorder (PLMD)

– Impact of medications on general health


MMSE

A commonly used screening tool for dementia is the Folstein Mini Mental Status Exam

It is a 5-minute screening test to evaluate basic mental function in the patient’s ability to recall facts, to write, and to calculate numbers, to determine if more in-depth testing is needed.


Depression

To screen for depression the physician may use the Geriatric Depression Scale short form that questions the patient about daily activities, interests, and feelings.

Nutritional status can be assessed through a comprehensive patient interview that considers all potential barriers to adequate nutrition.


Nutritional Status

The nutritional status of older patients involves:

oral health

gastrointestinal (GI) complaints

sensorimotor changes

diet influences

social and mental influences


Sleep Problems

Complaints of sleeping difficulties increase with age.

Sleeping time may be slightly longer, but the quality of sleep decreases.

Older people are often light sleepers and have periods of wakefulness in bed.

Other factors influencing sleep patterns are medications, caffeine, alcohol, depression, and environmental or physical changes.

Common sleep problems in older adults include PLMD and sleep apnea.


Caregivers

Aging persons prefer to remain in their homes as long as possible.

Adult day care centers can provide supervision for older adults who are taken care of by family members in the evening. They also provide respite for a caregiver.


Assisted Living

Assisted-living facilities are appropriate for older adults who need assistance with some activities of daily living, such as bathing, dressing, and walking.

Skilled nursing facilities provide 24-hour medical care and supervision.

In addition to medical care, residents receive physical, personal, occupational, and speech therapy.


MA Role

Develop effective communication skills reflective of age-related sensorimotor changes.

For independence to be reinforced, aging patients require more time and should be scheduled for longer appointments.


MA Role (cont’d)


Elder Care Considerations

Provide adequate lighting in the waiting room, with forms in large print

Make certain the examination room is equipped with furniture, magazines, and treatment folders especially designed for the elderly patient

Invite a professional in the management of the elderly patient for in-service training to improve the quality of elder care.


Interviews

Ask the patient directly what is wrong rather than discussing the patient with family members.

Give the patient your full attention rather than continuing with multiple tasks while he or she is speaking.

Older people may take a little longer to process information, but they are capable of understanding.


Interviews (cont’d)

Don't hurry through explanations or questions, but take time to review a form or give instructions.

Use referrals and community resources for patient and family support.


Communications

Address the patient with an appropriate title.

Introduce yourself and the purpose of a procedure before touching the patient.

Establish eye contact and get the patient’s attention before beginning to speak.

Use expanded speech, gestures, demonstrations, or written instructions in block print.


Communications (cont’d)

Repeat the message as needed for understanding.

Observe the patient’s nonverbal behaviors as cues to indicate if he or she understands.

Allow time to process information.

Avoid distractions.

Involve family members as needed.

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