Chapter 11

1. Chapter 11 Geriatric Care

2. 11:1 Myths on Aging • Aging for everyone begins at at birth and ends at death • Gerontology: scientific study of aging and the problems of the old • Geriatric care: care of the elderly • Health care worker must distinguish fact from myth

3. Myths and Facts • Myth: most elderly individuals are cared for in institutions (nursing homes), or long-term care facilities • Fact: most older people are living at home, with family, or in retirement communities or facilities (continues)

4. Myths and Facts(continued) • Myth: all elderly people live in poverty • Fact: less than 10 percent of people over 65 are living at poverty level • Myth: the older generation are unhappy and lonely • Fact: many elderly individuals socialize by being involved in charity or volunteer work (continues)

5. Myths and Facts(continued) • Myth: anyone over 65 is old • Fact: many elderly are active and productive into their 80s and beyond • Myth: elderly people are not able to manage their finances • Fact: older people have lots of experience and knowledge (continues)

6. Myths and Facts(continued) • Myth: elderly individuals do not want to work; their goal is to retire • Fact: there are many elderly who prefer to work into their 70s and 80s • Myth: retired people are bored and have nothing to do with their lives • Fact: retirees are busy with hobbies, church, family, and community

7. Summary • There are many myths about aging • Needs of elderly individuals vary • Even though only 5% of the elderly live in long-term care facilities, this still means that 3 million people will be in these facilities by the year 2020 • Recognizing normal changes allows the individual to adapt and cope

8. 11:2 Physical Changes of Aging • Physical changes are a normal part of the aging process • Rate and degree of change varies • Usually related to a decreased function of body systems

9. Integumentary System • Production of new skin cells decreases • Sebaceous (oil) and sudoriferous (sweat) glands become less active • Circulation to skin decreases • Hair loses color; hair loss may occur • Methods to adapt and cope with changes • Measures to slow or decrease changes

10. Musculoskeletal System • Muscles lose their tone, volume, strength • Osteoporosis • Arthritis • Coping with changes • Measures to slow or decrease changes • Providing a safe environment

11. Circulatory System • Heart muscle becomes less efficient at pushing blood into the arteries • Blood vessels narrow and become less elastic • Blood flow may decrease to brain and other vital organs • Methods used to adapt and cope with changes

12. Respiratory System • Respiratory muscles become weaker • Rib cage becomes more rigid • Bronchioles lose elasticity • Changes in larynx affect voice • Methods to cope with changes • Measures to slow or decrease changes

13. Nervous System • Progressive loss of brain cells • Senses diminish • Nerve endings are less sensitive • Methods to adapt and cope • Measures to slow or decrease changes

14. Digestive System • Fewer digestive juices and enzymes are produced • Muscle action becomes slower; peristalsis decreases • Teeth are lost • Liver function is reduced • Methods that are used to adapt and cope with changes

15. Urinary System • Kidneys decrease in size; not as efficient at producing urine • Decreased circulation to kidneys • Bladder function weakens • Methods to adapt and cope with ongoing changes • Measures to slow or decrease changes

16. Endocrine System • Increased production of hormones • Decreased production of hormones • Measures to slow or decrease changes

17. Reproductive System • Female: vaginal walls thin and secretions decrease; uterus can drop; breasts sag • Male: sperm decreases; sexual stimuli is slower; ejaculation takes longer; testes become smaller; seminal fluid becomes thinner and less is produced • Measures to cope with changes

18. Summary • Aging causes physical changes in all body systems; rate and degree vary • Adapting and coping means fuller enjoyment of life • Health care workers need to assess individuals’ needs • Tolerance, patience, and empathy are essential

19. 11:3 Psychosocial Changes of Aging • Elderly individuals also experience psychological and social changes • Some cope well, while others experience extreme frustration and mental distress • Health care workers must be aware of this and assess changes and stresses

20. Work and Retirement • Most adults spend a large portion of their days working • Retirement is often viewed as an end to the working years • Many enjoy retirement • Some feel a major sense of loss

21. Social Relationships • Change occurs throughout life • In elderly individuals, it may occur more rapidly • Some elderly people adjust to changes • Some elderly people cannot cope

22. Living Environments • Changes in living environments create psychosocial changes • Many elderly people prefer to stay in their own homes • Some individuals leave their home by choice • Moving to a long-term care facility often creates stress

23. Independence • Most individuals want to be independent and self-sufficient • Elderly people learn that independence can be threatened with age • Factors that can lead to decreased independence include physical disability, illness, and decreased mental ability (continues)

24. Independence(continued) • Individuals may need assistance, but the health care worker needs to allow the elderly maximum independence and personal choice

25. Disease and Disability • Elderly people are more prone to disease and disability • Diseases sometimes cause permanent disabilities • When functioning is affected, psychological stress is experienced • Sick people often have fear of death, illness, loss of function, and pain

26. Summary • Psychosocial changes can be a major source of stress • As changes occur, individuals must learn to accommodate the changes and function in new situations • With support, understanding, and patience, workers can assist individuals as they learn to adapt

27. 11:4 Confusion and Disorientation in the Elderly • Most remain mentally alert until death • Signs of confusion or disorientation • It is sometimes a temporary condition • Disease and/or damage to the brain

28. Dementia • Term used to describe a loss of mental ability • Characteristics include decrease in intellectual ability, loss of memory, and personality change • Acute dementia • Chronic dementia

29. Alzheimer’s Disease • One form of dementia • Causes progressive changes in the brain cells • Lack of neurotransmitter • Frequently occurs in 60s, but can occur as young as 40 years of age • Cause is unknown (continues)

30. Alzheimer’s Disease(continued) • Terminal incurable brain disease; usually lasting 3–10 years • Early stage • Middle stage • Terminal stage

31. Caring for the Confused or Disoriented Patient • Provide safe and secure environment • Follow the same routine • Follow “reality orientation” guidelines

32. Summary • Caring for a confused or disoriented individual can be frustrating and even frightening at times • Perform continual assessments • Design program to maximize function • Practice patience, consistency, and sincere caring

33. 11:5 Meeting the Needs of the Elderly • Geriatric care can be challenging but rewarding • Elderly people have the same needs as others • Cultural needs • Religious needs • Freedom from abuse • Respect patient’s rights

34. Summary • Needs of the elderly do not vary that much from needs of others • Sensitive to individual cultural and religious differences • Important to respect and follow all of the patient’s rights • Must ensure that the patient is free from abuse