Geriatric Care

Prepared by :Dr.Latifa Mari’e

Geriatrics means

• the branch of medicine or

social science dealing with

the health and care of old

people.

MYTHS

• Elderly people are incompetent

and incapable of making decisions

or handling their own affairs.

• Most elderly live in nursing homes

• All elderly people live in poverty

• Older people are lonely and

unhappy

• Elderly do not want to work

• Retirement ends your active life

• Geriatric age > 65

• The five ADLs:

• Bathing: personal hygiene and grooming

• Dressing: dressing and undressing

• Transferring: movement and mobility

• Toileting: continence-related tasks

including control and hygiene

• Eating: preparing food and feeding

Instrumental Activities of

Daily Living (IADLs)

• Managing finances

• Managing transportation

• Shopping and meal preparation.

• Housecleaning and home

maintenance.

• Managing communication,

• Managing medications

Physical Changes of Aging

• Most physical changes that

occur with aging are gradual and

take place over a long period of

time. In addition, the rate and

degree of change varies among

individuals.

• Factors such as disease can increase

the speed and degree of the changes.

Lifestyle, nutrition, economic status,

and social environment can also have

effects.

• If an individual can recognize the

changes as a/an normal part of aging,

the individual can usually learn to

adapt to & cope with change

Integumentary System Changes

• Production of new skin cells

decreases

• Oil and Sweat glands become

less active

• Circulation decreases

• Hair losses color, and hair loss occurs

• Skin becomes less elastic & dry

• Itching is common

• Dark yellow or brown colored spots appear

–Senile lentigines (liver spots)

• Fatty tissue layer of skin

diminishes

• Lines and wrinkles appear

• Nails become thick, tough, and

brittle

• Increased sensitivity to

temperature

Care of Skin

• Use mild soap

• Bath oils or lanolin lotion

• Bath or Shower once or twice a

week

• Brush Hair daily

• Shampoo as often as needed for

cleanliness and comfort

• Care for sore or injuries

immediately

• Socks, sweaters, lap blankets,

and layers of clothing will help

alleviate the feeling of coldness

Cvs changes

• increase in heart mass with

aging, for the most part, is

due to an increase in the

average myocyte size,

whereas the number of

myocardial cells declines.

• aortic valvular stenosis and

mitral valvular insufficiency

• decrease in intrinsic heart

rate

• Cardiac output at rest is

unaffected

• orthostatic hypotension

Circulatory System Care

• With circulatory changes:

–Avoid strenuous exercise or over

exertion

–Periods of rest

–Moderate exercise, according to

individual’s tolerance

• Prevent the formation of a

blood clot (thrombus)

–Support stockings, anti-embolism

hose

–DO NOT wear tight bands

around legs

• High Blood Pressure =

–Diet low in salt

–Decrease fat intake

–Exercise as recommended by

physician

Respiratory Changes

• Respiratory muscles become

weaker

• Rib cage more rigid

• Alveoli thinner & less elastic

which decreases exchange of

gases - emphysema

• Bronchioles lose elasticity

• Changes in larynx lead to

higher pitched & weaker voice

• Chronic diseases may decrease

the efficiency of the respiratory

system even more severely

• Changes may cause the elderly

to experience:

–Dyspnea

•Breathing increases in rate

•Difficulty coughing up secretions

• Increases susceptibility to

infections such as a cold or

pneumonia

Respiratory Care • Alternate activity with periods

of rest

• Proper body alignment &

positioning

• Sleep in semi-fowlers position

–Use 2 or 3 pillows

• Avoid polluted air

• Breath deeply & cough

frequently

• May need continuous oxygen

therapy

Nervous System Changes

• Blood flow to brain decreases

& there is a progressive loss of

brain cells - - Interferes with

–Thinking - Reacting

–Interpreting - Remembering

• Senses of taste, smell, vision, &

hearing are diminished

• Nerve endings less sensitive

–Decreased ability to respond to

pain and other stimuli

• Decrease in taste& smell

frequently affects appetite

• Changes in vision

–Problems reading small print

–Seeing objects at a distance

–Decrease in peripheral vision

–Decrease in night vision

–Increased sensitivity to glare

–Cataracts

–Glaucoma

• Changes in hearing

–Hearing loss usually gradual

–Person may speak louder than usual

–Ask for words to be repeated

–Not hear high frequency sounds

–May not hear well in crowded places

• Decreased sensation to pain &

other stimuli = more susceptible

–Burns

–Frostbite

–Cuts

–Fractures

–Muscle strain and other injuries

Digestive Changes

• Fewer digestive juices and enzymes produced

• Muscle action becomes slower & peristalsis decreases

• Teeth are lost

• Liver function decreases

• Dysphagia is frequent complaint

–Less saliva

–Slower gag reflex

–Loss of teeth

–Poor fitting dentures

• Slower digestion of food

–indigestion

• Decrease peristalsis

–Increase flatulence (gas)

–Constipation

• Decrease sensation of taste

–Poor appetite

–Poor diet

Digestive Care • Good oral hygiene

• Repair or replace damaged teeth

• Relaxed eating atmosphere

• High-fiber high-protein foods with different tastes and textures

• Increased fluid intake

Urinary Changes

• Kidneys decrease in size &

become less efficient

• Bladder becomes less efficient

–May not hold as much

–May not empty completely

–incontinence

Urinary Care

• Increase fluid intake

–Decrease before bedtime

• Regular trips to bathroom

• Easy to remove clothing

• Absorbent pads

Endocrine Changes

• Increased production of some

hormones and decreased of

others

• Immune system less effective

• BMR decreases

• Intolerance to glucose

Endocrine Care

• Proper exercise

• Adequate rest

• Medical care for illness

• Balanced diet

• Healthy lifestyle

Reproductive System Changes

• Decrease of estrogen /

progesterone in female

–Thinning of vaginal wall

–Decrease vaginal secretions

–Inflammation of vagina common

–Weakness in supporting tissue:

•Uterus sags downward

(Uterine prolapse)

–Breasts sag when fat redistributed

• Decrease in Testosterone

–Slow production of sperm

–Response to sexual stimuli slower

–Testes smaller less firm

• Male and Female

–Sexual desire may or may not

decrease

• Advantages of sex in elderly

–Improves muscle tone &

circulation

–Pain from arthritis seems to

decrease

Psychocosocial Changes

• Some individual cope with

psychosocial changes, and

others experience extreme

frustration and mental distress

• Fears of a sick person:

–Death

–Chronic illness

–Loss of function

–Pain

• Dealing with fears created by

an illness:

–Listening

–Patience

–Understanding

–Provide support

Confusion and Disorientation

• Six signs:

–Talking incoherently

–Not knowing their name

–Not recognizing others

–Wandering aimlessly

–Lacking awareness of time or place

–Displaying hostile and combative behavior

–Hallucinating

–Regressing in behavior

–Paying less attention to personal hygiene

–Inability to respond to simple commands or instructions

• Causes of temporary confusion / disorientation

–Stress and/or depression

–Use of alcohol or chemicals

–Kidney disease

–Respiratory disease

–Liver disease

–Medication

• Diseases:

–CVA

–Arteriosclerosis

–Atherosclerosis

•Cause TIA’s ministrokes which

result in temporary periods of

diminished blood flow to the brain.

• Dementia

–Loss of mental ability

characterized by a decrease in

intellectual ability, loss of

memory, impaired judgement,

personality change, and

disorientation

• Acute dementia

–When the symptoms are caused

by temporary reason:

•High fever, dehydration, hypoxia

• Chronic dementia

–When symptoms are caused by

permanent, irreversible damage to

brain cells

Alzheimer’s Disease

• Form of dementia that causes

progressive changes in brain

cells

Early Stages: • Memory loss

• Mood & personality changes

• Depression

• Poor judgment

• Confusion regarding time & place

• Inability to plan and follow through with ADLs

Middle Stages:

• Nigh time restlessness

• Mood swings increase

• Personal hygiene ignored

• Weight fluctuates

• Paranoia & hallucinations

• Full time supervision needed

Late Stages:

• Total disorientation

• Incoherent

• Unable to communicate with words

• Loses control of bladder & bowel functions

• Develops seizures

• Loses weight despite eating a

balanced diet

• Becomes totally dependent

• Lapses into a coma

• Dies

• Certain aspects of care

should be followed with any

confused or disorientated

individual. Provide a/an safe

and secure environment,

follow the same routine, keep

activities simple and last for

short periods of time.

Avoid loud noises, crowded

rooms, and excessive

commotion. Promote

awareness of person, time, and

place by providing reality

orientation (RO)

Reality Orientation:

• Address person by name preferred

• Avoid: sweetie, baby, honey

• State your name, correct elderly if

calls you by the wrong name

• Make reference to day, time, place

• Use clocks, calendars, bulletin bd.

• Keep individual oriented to day

night cycles:

–Regular clothes during the day

–Open curtains during the day]

–Close curtains at night

–Pajamas at night

• Speak slowly, clearly / ask clear & simple questions

• Never rush or hurry the individual

• Repeat instructions patiently, allow time for ind. to reaspond

• Encourage conversations about familiar things or current events

• Encourage use of tv, radio

• Keep familiar objects in view Avoid moving furniture & belongings

• Do not agree with incorrect statements

• Do not hesitate to touch

communicate with person

• Avoid arguments

• Encourage independence and

self help whenever possible

• Abuse

–Physical

–Verbal

–Psychological

–Sexual

• Report any abuse observed to

proper agency

• Reasons elderly do not report

abuse

–Feel they deserve the abuse

–Want to protect abuser

• Thank you