VN057 Gerontology 9

1. VN057 Gerontology 9

2. Addendum to last week-look in Angel for the Kubler-Ross stages of grief. I forgot to put on the ppt.

3. Chapter 16 Sexuality and Aging

5. Factors that Affect Sexuality of Older Adults

6. Normal Changes in Women • changes in the reproductive system related to decreased levels of progesterone and estrogen

7. Changes in Women • The good • More relaxed about sexuality • Experience/assertiveness • No pregnancy worries • Less life stress

8. Changes in Women (cont.) • The not so good • Increased STD risk • Tissue thinning • No pregnancy worry=no condom • discomfort or pain during intercourse • Irritation of the external genitals • Thinning and dryness of the vaginal walls • Alteration in vaginal flora • increased risk for vaginal yeast infections

9. Erectile Dysfunction in Men • orgasm takes longer to achieve and has a shorter duration than at a younger age • Ejaculation less forceful-smaller volume of seminal fluid is released • Loss of erection occurs quickly after orgasm • The time between orgasms increases, and orgasm may not occur with every episode of sexual intercourse

10. Illness and Decreased Sexual Function • Many disease processes & medications interfere with normal sexual function  • Some medications enhance sexual function, even some that aren’t designed to do so  • Incontinence does not interfere with sexual relations but may cause some people to avoid sex because of the risk of embarrassment

11. Illness and Decreased Sexual Function (cont.) • Joint pain resulting from arthritis can interfere with sexual activity • Cardiac problems can interfere with normal sexual activity-more from fear than from actual danger • Circulation problems affect ALL organs…..

12. Illness and Decreased Sexual Function (cont.) • Stroke need not prevent sexual activity • Neither hysterectomy nor mastectomy changes sexual functioning • BUT.. They often cause body image problems • Depression- can decrease sexual interest & lead to decreased response to intimacy • Many antidepressants cause sexual side effects

13. Alcohol and Medications • Excessive alcohol intake • delayed orgasm in women • loss of the ability to achieve or maintain erection in men • Digitalis, tranquilizers, diuretics, antihypertensives, antihistamines, antidepressants, and even some medications used to treat GERD are likely to cause sexual problems for men and women

14. Loss of Partner • Single older women experience more of a problem than single older men • By age 85, there are 100 single women for every 39 single men

15. Loss of Partner (cont.)

16. Marriage and Older Adults

17. Marriage • many different responses- particularly from families • Pensions, insurance benefits, and other financial concerns may be contingent on the person’s remaining single • Some choose to live together without marrying • can be a difficult decision for them and their families

18. Caregivers and the Sexuality of Older Adults

20. Caregivers • Young people often uncomfortable with the thought of sexual activity • health care professionals may be unaware of or uncomfortable about addressing the sexual needs of older adults • Fear, shame, or embarrassment causes many older people to hide their sexual interests and activity, even from health care professionals

21. Sexual Health and Sexual Orientation

22. Sexual Health • Older adults often are not considered when sexually transmitted diseases are discussed, yet 10% of acquired immunodeficiency syndrome (AIDS) cases occur in people older than 50 years • All sexually active individuals, no matter what their age, should use safe sex practices • The risk for sexually transmitted disease does not disappear with age

24. Sexual Orientation • People may be more comfortable expressing sexual orientation as they age • Health care providers must be careful to recognize the sexual needs and concerns of older lesbian, gay, and transgendered people

25. Privacy and Personal Rights of Older Adults • Obtaining adequate privacy may be difficult even for married couples who reside in the same institution, particularly if regular medical or nursing care is necessary • Touching, hand-holding, and cuddling are encouraged • A closed door must be respected when privacy for intimacy is desired

26. Touch and Affection

27. Touch and affection are human needs, even when sexual expression isn’t possible

28. Chapter 17 Care of Aging Skin and Mucous Membranes

29. Skin Color • Examination- good, preferably natural, light • Compare one side of the body with the other • Use touch for skin temperature or the presence of rashes or irritation • Color changes-can indicate many problems • Pallor -erythema • cyanosis • jaundice

30. Dry Skin • most common problem of aging • itching (pruritus) • Burning • cracking of the skin • Common- habit of scratching or picking dry or cracked skin • increasing their risk for further tissue damage and infection

31. Assessing Skin Impairment

32. Dry, Scaly Skin

33. Rashes and Irritations • Common causes: Medications, communicable diseases, contact with chemicals • Allergic response to medications • diffuse rashes over the body • Scabies-superficial infection caused by a parasitic mite (Sarcoptesscabiei) that burrows under the skin

34. Scabies Lesions

35. Pigmentation • Changes in pigmentation common with aging • Some, like acne rosacea can be treated with topical medications • Changes in the size or pigmentation of moles greater significance • changes may = presence of a precancerous or cancerous condition that needs immediate medical attention

36. Tissue Integrity • Wounds of any size increase risk for infection often need costly treatments • Skin tears, abrasions, lacerations, and ulcers most often result from friction, shearing force, moisture, and pressure

37. Pressure Ulcers • Risk: compromised circulation, restricted mobility, altered level of consciousness, fecal or urinary incontinence, or nutritional problems • Excessive pressure on tissues, particularly over bony prominences, can quickly lead to skin breakdown

38. Pressure Ulcers (cont.) • Ulcer development depends on the amount of pressure, length of time pressure is exerted, and underlying status of the tissues involved • Pressure ulcers are categorized or staged based on their appearance and depth of tissue penetration

40. Risk Factors for Pressure Ulcers • Immobility • Inactivity • Incontinence • Malnutrition • Diminished sensation, decreased mental status • Impaired skin integrity

41. Braden Scale for Predicting Pressure Sore Risk • The Braden Scale takes into consideration the following factors when assessing for pressure ulcer risk • Sensory perception • Moisture • Activity • Mobility • Nutrition

42. Bony Prominences and Common Pressure Ulcer Sites

43. Pressure Ulcers

44. A common complaint in older adults that may be caused by dryness, irritation, or infection of the skin is: • decubitus. • bruising. • pruritus. • alopecia.

45. Amount, Distribution, Appearance, and Consistency of Hair • Hair -men & women becomes thinner and more fine • Men-lose more hair than women, although some men retain a full head of hair throughout life • Male pattern baldness-progressive loss of hair at the temples and back of the head

48. Hair (cont.) • Sudden &excessive loss (alopecia) or breakage canindicate a systemic problem • Decreased or lack of hair on lower legs—especially with very dry, scaly, discolored or flaky skin with weak or absent pedal pulses—indicates decreased blood supply to the lower extremities

49. Feet • many people are unable to bend to view feet, a family member or friend can perform inspection for independent older adults • Many neglect their feet simply because they cannot see or reach [or feel] them • Unless foot inspection is done on a regular schedule, severe problems can occur before anyone is aware of them

50. Common Foot Problems