CHAPTER 41 Assisting in Geriatrics 2014 by Mc

CHAPTER 41 Assisting in Geriatrics © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -2 Introduction • Geriatrics – Special concerns of the elderly – Specialists ~ geriatricians – Growing field due to longer health spans • Medical assistants – 50% of practice is caring for older patients – Need a knowledge of their unique needs © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -3 The Geriatric Patient • Physical changes of aging – Make the elderly more prone to diseases and disorders – Not all people experience all changes – Changes occur at different rates © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -4 Physical Changes of Aging • Integumentary system – Thinning skin, with atrophy of subcutaneous layer – “Liver spots” ~ lentigos – Graying, thinning hair – Brittle nails – Decreased inflammatory response © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -5 Physical Changes of Aging (cont. ) • Nervous system – Slower reaction time and thought processing – Shortened attention span – Impairment of fine motor activities – Memory loss © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -6 Physical Changes of Aging (cont. ) • Special senses – Impaired vision and hearing – Altered taste sensations • Musculoskeletal system – Osteoporosis – Osteoarthritis – Decreased numbers of musculoskeletal fibers © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -7 Physical Changes of Aging (cont. ) • Cardiovascular system – cardiac output – Arteriosclerosis – Postural hypotension – risk of heart disease © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -8 Physical Changes of Aging (cont. ) • Respiratory system – elasticity of the lungs – Calcification of intercostal cartilage and kyphosis – shortness of breath © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -9 Physical Changes of Aging (cont. ) • Immune system – susceptibility – Infectious diseases – Autoimmune diseases • Digestive system – Constipation – Fecal incontinence © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -10 Physical Changes of Aging (cont. ) • Genitourinary system – nephrons – tolerance for stress – Loss of voluntary control • Endocrine system – thyroid function – estrogen and aldosterone – response to insulin © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -11 The Geriatric Patient (cont. ) • Cognitive-Intellectual Development – Longer to process information – Can continue to learn – Long-term memory remain intact – Less acute short-term memory © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -12 The Geriatric Patient (cont. ) • Psycho-Emotional Development – Transition into retirement – Loss of spouse, friends – Increasing dependence © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -13 The Geriatric Patient (cont. ) • Social development – Increased spirituality – Remain in homes if able – Volunteer in the community © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -14 Aspects of Care • Exercise • Social contact • Balanced nutrition • Continue regular health checkups • Sleeping patterns • Keep brain active © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -15 Apply Your Knowledge ANSWER: Matching: C specialists that care for the elderly A. Kyphosis E liver spots C. Geriatricians A curvature of the spine D. Osteoporosis B degenerative joint disease E. Lentigos B. Osteoarthritis D decreased bone density VERY GOOD! © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Diseases and Disorders of Geriatric Patients Condition 41 -16 Description Alzheimer’s Severely debilitating brain disorder; disease no cure; maintain comfort and safety Arthritis Chronic inflammatory disease of joint tissues Cancer Abnormal growth of cells that are able to invade other tissues © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Diseases and Disorders of Geriatric Patients Condition 41 -17 Description Cardiovascul Arrhythmias – abnormal heart rates ar diseases Coronary artery disease – blockages of the arteries surrounding the heart Valvular diseases – abnormalities of the heart valves Congestive heart failure Cataracts The lens of the eye becomes cloudy and opaque, causing decreased vision © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Diseases and Disorders of Geriatric Patients 41 -18 Condition Constipation / diarrhea cycle Description Due to a lack of fiber and liquids to maintain healthy bowel function; alternating use of harsh laxatives and antidiarrheal medications Diabetes High blood sugar levels; need to mellitus modify diet, increase exercise, and Type II lose weight Hypertension Blood pressure elevated over 140 systolic and 90 diastolic; usually asymptomatic © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Diseases and Disorders of Geriatric Patients 41 -19 Condition Description Hyperlipidemia Lipid (fat) levels are above normal; includes cholesterol and triglycerides; more common and serious with age Osteoporosis Endocrine and metabolic disorder of the musculoskeletal system. Loss of bone density that occurs over time. Increases chance of fractures. © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -20 Apply Your Knowledge True or False: ANSWER: F Alzheimer’s is a chronic inflammatory disease of joints. Arthritis T Coronary artery disease involves blockage of arteries surrounding the heart. F Cataracts result in clearer lenses. Cloudy and opaque T Hyperlipidemia is the elevation of lipid levels in the blood. Excellent! © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -21 Assisting with Geriatric Care • Exams, screening, diagnostic procedures and treatments are similar to younger adults • Be aware of differences in capabilities • Treat with respect • Communicate effectively © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -22 Assisting with Geriatric Care (cont. ) • Patient Education – Prevent or manage health problems – Remain independent – Tips • • Speak clearly Treat as an individual Put instructions in writing Adjust procedures as necessary © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -23 Assisting with Geriatric Care (cont. ) • Denial or confusion – Perception of state of health – May over or underestimate abilities – May not realize they are confused • Importance of touch – Improves health and wellbeing – Communicates caring © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -24 Assisting with Geriatric Care (cont. ) • Incontinence – Embarrassing • Preventive Medicine – Notify physician – May not be aware of the importance – May drink less to avoid leakage – Education the patient © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -25 Assisting with Geriatric Care (cont. ) • Lack of patient compliance with medications – Forgetful – Difficulty swallowing – Patient education about medications © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -26 Assisting with Geriatric Care (cont. ) • Collecting urine specimens – For 24 hour specimens consider • • Urine retention Nocturia Incontinence Uterine prolapse – May need assistance in providing a specimen – Repeat explanations © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -27 Assisting with Geriatric Care (cont. ) • Blood Drawing Procedures – Prone to bruising – Difficult to obtain adequate sample • Hot and cold therapy – Decreased tolerance – Stay with a patient during application – Check skin frequently © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -28 Nutritional Guidelines • Calories – by 10% if over 50 years old – by another 10 -15% over 75 years old • Protein – no change • Supplements © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -29 Nutritional Guidelines (cont. ) • fiber • Adequate water • Fat – 20% of total calories © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -30 Nutritional Guidelines (cont. ) • Impairments to proper nutrition – Physical factors • Tooth loss • Loss of appetite – Medications – Social factors • Depression • Grief • Loneliness – Economic factors • Homelessness • No money © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -31 Immunizations • Influenza and pneumonia • Misconceptions • Patient education – Cost usually covered – Symptoms are short lived – Illness more risky © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -32 Apply Your Knowledge What may keep the elderly from eating properly? ANSWER: The elderly may have problems chewing or swallowing foods. They may not have an appetite or care if they eat due to depression. Medications may interfere with intake. They may not have enough money for food or a way to get groceries. Correct! © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -33 Geriatric Patient Special Concerns • Preventing Falls in the Elderly – Osteoporosis ~ leads to fractures – Risk factors • Vision problems • Poor health • Slowed reflexes • Equilibrium issues • Medications © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -34 Preventing Falls in the Elderly (cont. ) • Safety checklist – Use good lighting – Wear well-fitting shoes – Use a cane or walker – Secure rugs © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -35 Preventing Falls in the Elderly (cont. ) • Safety checklist – Install handrails in bathroom – Use nonslip mats – Minimize clutter – Keep items use frequently with in easy reach © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -36 Depression • Symptoms may mimic other symptoms of other conditions • Know what to look for including – Does not enjoy life – Difficulty in concentrating – Appetite changes – Sleep disturbances – Worthlessness © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -37 Elder Abuse • No comprehensive definition • Disabilities defenseless against abuse • Observe for nonverbal signs © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -38 Elder Abuse • Categories • Types of abuse – Domestic – Physical, sexual, psychological – Institutional – Neglect – Self-abuse – Abandonment – Exploitation © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -39 Elder Abuse (cont. ) • Occurs in all racial, socioeconomic, and religious groups • Take a careful history • Report suspicions © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -40 Elder Abuse (cont. ) • Risk factors – History of alcoholism, drug abuse, or violence – History of mental illness – Isolation of the victim – Recent stressful events © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -41 Elder Abuse (cont. ) • Signs of neglect – Foul odors – Poor skin color – Inappropriate or soiled clothing – Concern about money © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -42 Polypharmacy • Age-related changes alter – Absorption – Metabolism – Distribution – Excretion © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -43 Polypharmacy • Increased risk – Drug toxicity – Adverse effects – Lack of therapeutic effects • Often have complex illnesses © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -44 Polypharmacy • Taking several medications concurrently • Reduce risk of drug-drug interactions – Obtain an accurate list of current medications – Patient and family education – Simplifying medication schedule – Provide written instructions © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -45 Apply Your Knowledge Why is it difficult to identify abuse in the elderly? ANSWER: There is no uniform and comprehensive definition of this type of abuse. The elderly patient may not be able to communicate with you verbally. Bruises from falls and other accidents can be mistaken for abuse. The signs of neglect can be similar to the signs of some chronic medical conditions. Right! © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -46 In Summary 41. 1 Geriatrics is a subspecialty of internal medicine or family practice. Geriatricians typically care for patients over the age of 65. These patients have multiple physical changes as well as psycho-emotional, cognitive-intellectual, and social development variations to consider when working as a medical assistant © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -47 In Summary (cont. ) 41. 2 Common aging-associated diseases and disorders include cardiovascular disease, hypertension, cancer, arthritis, cataracts, diabetes mellitus, Alzheimer’s disease, constipation, diarrhea, and osteoporosis. Understanding these will help you prepare to care for geriatric patients. © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -48 In Summary 41. 3 When working with geriatric patients, you must treat them with respect and dignity. Be aware of their physical and mental changes so that you can adapt your care to meet their needs. 41. 4 Each of the following special concerns should be handled appropriately when caring for the elderly: falls, elder abuse, depression, and polypharmacy. © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

41 -49 End of Chapter 41 "Not everyone grows to be old, but everyone has been younger than he is now. “ ~ Evelyn Waugh © 2014 by Mc. Graw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.