Chapter 10 Geriatric Care Copyright 2014 Cengage Learning

Chapter 10 Geriatric Care Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Introduction • Aging boom – By 2050, 21 percent of U. S. population will be over age 65 • Most individuals can expect to live into 70 s • Over-65 age group uses health care services frequently Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 1 Myths on Aging • Aging begins at birth and ends at death • Gerontology – Scientific study of aging and associated problems • Geriatric care – Care of the elderly • Health care workers must distinguish fact from myth Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 1 Myths on Aging (continued) • Myth: most elderly individuals are cared for in institutions or long-term care facilities • Fact: most older people live at home or with family; only 5 percent live in long-term care facilities Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 1 Myths on Aging (continued) • Myth: anyone over 65 is old • Fact: “old” is determined by how one thinks, feels, and behaves • Myth: elderly people are not capable of managing their affairs • Fact: elderly have experience and knowledge Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 1 Myths on Aging (continued) • Myth: all elderly people live in poverty • Fact: less than 16 percent of people over 65 live at poverty level • Myth: older people are unhappy and lonely • Fact: many elderly socialize by being involved in charity or volunteer work Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 1 Myths on Aging (continued) • Myth: being old means being sick or disabled • Fact: most elderly are in good health • Myth: elderly people do not want to work; their goal is to retire • Fact: many elderly prefer to work into their 70 s and 80 s Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 1 Myths on Aging (continued) • Myth: retired people are bored and have nothing to do with their lives • Fact: retirees are busy with hobbies, travel, church, family, and community Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 1 Myths on Aging (continued) • Needs of elderly individuals vary • Though only 5 percent of elderly live in longterm care facilities, this still means that more than 3. 5 million people will be in these facilities by the year 2030 Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 2 Physical Changes of Aging • Physical changes are a normal part of the aging process • Changes are usually gradual • Rate and degree of change vary • Usually involve decreased function of body systems Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 • Skin loses elasticity, senile lentigines appear Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Musculoskeletal System Muscles lose tone, volume, strength Osteoporosis Arthritis Gradual loss of height, decreased mobility, weakness • Exercise encouraged • • Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Circulatory System • Heart muscle becomes less efficient at pushing blood into the arteries • Blood vessels narrow and become less elastic • Blood flow to brain and other vital organs may decrease Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Respiratory System • • • Respiratory muscles become weaker Rib cage becomes more rigid Alveoli become thinner and less elastic Bronchioles lose elasticity Changes in larynx affect voice Chronic conditions decrease respiratory efficiency Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Nervous System • • • Blood flow to brain decreases Progressive loss of brain cells Senses diminish Nerve endings are less sensitive Short-term memory loss may occur Vision changes: cataracts, glaucoma Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Digestive System • Fewer digestive juices and enzymes produced • Muscle action becomes slower; peristalsis decreases • Teeth are lost • Liver function is reduced • Dysphagia Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Urinary System • Kidneys decrease in size; less efficient at producing urine • Decreased circulation to kidneys • Bladder function weakens – Nocturia – Incontinence Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Endocrine System • • Increased production of some hormones Decreased production of other hormones Causes physical changes Basal metabolic rate decreases Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Reproductive System • Female – Vaginal walls thin and secretions decrease; uterus can drop; breasts sag • Male – Decreased sperm production; slower sexual stimuli; ejaculation takes longer; testes become smaller; seminal fluid thins, less is produced Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 2 Physical Changes of Aging (continued) Aging causes physical changes in all body systems Rate and degree of change vary Adapting and coping means enjoyment of life Health care workers need to assess individuals’ needs • Tolerance, patience, and empathy are essential • • Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 3 Psychosocial Changes of Aging • Elderly individuals also experience psychological and social changes • Some cope well, others experience frustration and mental distress • Health care workers must be aware of these changes and stresses Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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 Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Social Relationships • Change occurs throughout life • In elderly individuals, relationships may change rapidly • Some elderly people adjust to changes • Some elderly people cannot cope and become withdrawn or depressed Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Living Environments • Changes in living environments create psychosocial changes • Many elderly prefer to stay in their homes • Some individuals leave their homes by choice • Moving to a long-term care facility often creates stress Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Independence • Most individuals want to be independent and self-sufficient • Elderly learn that independence can be threatened with age • Physical disability, illness, and decreased mental ability affect independence Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Disease and Disability • Elderly people more prone to disease and disability • Disease – Condition that interferes with normal function • Disability – Physical or mental defect that interferes with normal function • Psychological stress can result Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Summary • Psychosocial changes can be a major source of stress • Individuals must learn to accommodate changes and function in new situations • Offer support, understanding, and patience to assist elderly persons as they learn to adapt Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 4 Confusion and Disorientation in the Elderly • • Most elderly remain mentally alert until death Signs of confusion or disorientation Sometimes a temporary condition Disease and/or damage to the brain Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Causes of Confusion and Disorientation • Delirium – Temporary confusion/disorientation • Chronic confusion/disorientation – Stroke or cerebrovascular accident – Arteriosclerosis – Atherosclerosis – TIAs Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Causes of Confusion and Disorientation (continued) • Dementia or brain syndrome – Decrease in intellectual ability, memory loss, impaired judgment, personality change, disorientation – Delirium, acute dementia, chronic dementia Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Causes of Confusion and Disorientation (continued) • Alzheimer’s disease (AD) – One form of dementia that causes progressive changes in brain cells – Lack of neurotransmitter – Frequently occurs in 60 s– 70 s, can occur as young as 40 years of age – Cause is unknown Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Causes of Confusion and Disorientation (continued) • Alzheimer’s disease (AD) (continued) – Terminal, incurable brain disease – Usually lasts 3– 10 years – Diagnosis is difficult – Use of MRS and KATP for diagnosis and treatment Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Caring for Confused or Disoriented Individuals Provide safe and secure environment Follow the same routine Use of GPS trackers Practice reality orientation (RO) activities in early stages • Continual assessment of patient is required • • Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

10: 5 Meeting the Needs of the Elderly • Geriatric care can be challenging but rewarding • Elderly have same physical/psychological needs as others • Cultural needs • Religious needs • Freedom from abuse • Respect patient’s rights (ombudsman) Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.