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Assisting in Geriatrics. Chapter 47. 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. - PowerPoint PPT PresentationTRANSCRIPT
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 3
Older Population by Age, 1900-2030
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 4
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 5
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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 6
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 7
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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 8
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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 9
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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 10
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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 11
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 12
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?
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 13
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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 14
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?
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 15
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?
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 16
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?
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 17
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
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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?
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 19
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?
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 20
Nutritional Status
Comprehensive interview should consider:– Oral health
– GI complaints
– Sensorimotor changes
– Financial considerations
– Disease-related diet restrictions
– Alcohol consumption
– Depression
– Support systems
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 21
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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 22
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 23
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 24
Nutritional Status
The nutritional status of older patients involves:
oral health
gastrointestinal (GI) complaints
sensorimotor changes
diet influences
social and mental influences
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 25
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 26
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 27
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 28
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 29
MA Role (cont’d)
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 30
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 31
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 32
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 33
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 34
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.