Kuliah Uniba Geriatric2 11-4-12 Care Geriatrics2

8/12/2019 Kuliah Uniba Geriatric2 11-4-12 Care Geriatrics2

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Geriatric Care

dr Putra Hendra SpPD


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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


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Older people are lonely and unhappy

Elderly do not want to work

Old Age begins a 65

Retirement ends your active life


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General Pathophysiology, Assessment, andManagement


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Pathophysiology

The body becomes less efficient with age.

The elderly often suffer from more than

one illness or disease at a time.

The existence of multiple chronic diseasesin the elderly often leads to the use of

multiple medications.


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Factors such as disease can increasethe speed and degree of the changes.

Lifestyle, nutrition, economic status, andsocial environment can also haveeffects.

If an individual can recognize thechanges as a/an normal part of aging,the individual can usually learn to

adapt to & cope with change


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Integumentary Systemhanges

Production of new skin cells

decreases

Oil and Sweat glands

become less active Circulation decreases


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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)


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Fatty tissue layer of skin diminishes

Lines and wrinkles appear

Nails become thick, tough, and brittle Increased sensitivity to temperature


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are of Skin Use mild soap Bath oils or lanolin lotion

Bath or Shower once or twice a week

Brush Hair daily


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Shampoo as often as needed for cleanlinessand comfort

Care for sore or injuries immediately

Socks, sweaters, lap blankets, and layers of

clothing will help alleviate the feeling of

coldness


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Because of the need for oxygen and nutrientsthe elderly may experience:

Weakness

Dizziness

Numbness in hands & feet

Rapid heart beat


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Cardiovascular Disorders

Angina pectoris

Myocardial infarction

Heart failure Dysrhythmias

Aortic dissection/aneurysm

Hypertension Syncope


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irculatory System are

With circulatory changes:

Avoid strenuous exercise or over exertion

Periods of rest Moderate exercise, according to individuals

tolerance


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Prevent the formation of a blood clot (thrombus)

Support stockings, anti-embolism hose

DO NOT wear garters or tight bands around legs\ If confined to bed

ROM


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High Blood Pressure =

Diet low in salt

Decrease fat intake Exercise as recommended by physician


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Respiratory hanges Respiratory muscles become weaker

Rib cage more rigid

Alveoli thinner & less elastic which decreases

exchange of gases - emphysema


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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


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Respiratory Disorders

Pneumonia

COPD

Pulmonary embolism Pulmonary edema

Lung cancer


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Changes may cause the elderly to

experience:

Dyspnea

Breathing increases in rate

Difficulty coughing up secretions

Increases susceptibility to infections such as a cold orpneumonia


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Respiratory and cardiac problems

can cause dyspnea.


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Respiratory are Alternate activity with periods of rest

Proper body alignment & positioning

Sleep in semi-fowlers position

Use 2 or 3 pillows


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Avoid polluted air

Breath deeply & cough frequently

May need continuous oxygen therapy


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Nervous System hanges

Blood flow to brain decreases & there is a

progressive loss of brain cells - - Interferes

with Thinking - Reacting

Interpreting - Remembering


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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


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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


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Cataracts diminish eyesight


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Blindness

Position where patient might be

able to see you.

Explain procedures before doingthem.

If patient has glasses make surethey are wearing them.

Never pull blind patient.

Walk at their side and hold theirarm.

Let them know about obstacles.

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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


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Deafness

Never assume the patient is

deaf.

If patient is wearing a

hearing aid, make sure it ison.

Determine if the patient

can lip-read.

Note writing.30


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Speak into a stethoscope with

the hearing-impaired.


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Decreased sensation to pain & other stimuli =

more susceptible

Burns Frostbite

Cuts

Fractures

Muscle strain and other injuries


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Digestive hanges Fewer digestive juices and enzymes produced

Muscle action becomes slower & peristalsisdecreases

Teeth are lost Liver function decreases


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Dysphagiais frequent complaint Less saliva

Slower gag reflex

Loss of teeth

Poor fitting dentures

Slower digestion of food indigestion


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Decrease peristalsis

Increase flatulence (gas)

Constipation

Decrease sensation of taste

Poor appetite

Poor diet


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Constipation common.

Smooth muscle contraction diminished.

Deterioration of structures in mouthcommon.

Decline in efficiency of liver.

Reduced ability to aid in digestion andmetabolism of certain drugs

Impaired swallowing.

Stomach sphincter valve loss. Increase in heartburn

Malnutrition due to deterioration of small

intestine.

Decrease in nutrient absorption. 36


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GI Disorders

GI hemorrhage

Upper GI bleed

Lower GI bleed

Bowel obstruction Mesenteric infarct


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Digestive are

Good oral hygieneRepair or replace damaged

teeth

Relaxed eating atmosphere

High-fiber high-protein foods

with different tastes and texturesSeasoning to improve taste

Increased fluid intake


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Urinary hanges Kidneys decrease in size & become less

efficient

Bladder becomes less efficient

May not hold as much May not empty completely

incontinence


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Problems with incontinence &elimination are common in the

elderly.


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Urinary are Increase fluid intake

Decrease before bedtime

Regular trips to bathroom

Easy to remove clothing Absorbent pads


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Endocrine hanges Increased production of some hormones anddecreased of others

Immune system less effective

BMR decreases

Intolerance to glucose


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Metabolic & Endocrine Disorders

Diabetes mellitus

Thyroid disorders


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Endocrine are

Proper exercise Adequate rest

Medical care for illness

Balanced diet Healthy lifestyle


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Reproductive System hanges

Decrease of estrogen / progesterone in

female

Thinning of vaginal wall Decrease vaginal secretions

Inflammation of vagina common


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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

M l d F l


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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


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Reproductive are Understand physical and psychological

sexual needs of the elderly Allow married couples to be in the same room

Give privacy to consenting elderly


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Psychocosocial hanges

Some individual cope with psychosocial

changes, and others experience extreme

frustration and mental distress


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Fears of a sick person:

Death

Chronic illness

Loss of function

Pain


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Dealing with fears created by an illness:

Listening

Patience

Understanding

Provide support


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onfusion and DisorientationSix signs:

Talking incoherently

Not knowing their nameNot recognizing others

Wandering aimlessly

Lacking awareness of time orplace

Ch i l d l


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Change in altered mental status can

denote serious underlying problems.

N l i l Di d


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Neurological Disorders

Cerebrovascular disease

(stroke)

Seizures

Dizziness/vertigo Parkinsons disease

Delirium, dementia,

Alzheimers


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Displaying hostile and combative behavior

Hallucinating

Regressing in behavior Paying less attention to personal hygiene

Inability to respond to simple commands orinstructions


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Causes of temporary confusion /disorientation Stress and/or depression

Use of alcohol or chemicals

Kidney disease

Respiratory disease

Liver disease

Medication


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Diseases: CVA

Arteriosclerosis

Atherosclerosis

Cause TIAs ministrokes which result in temporary periods ofdiminished blood flow to the brain.


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Dementia

Loss of mental ability characterized by a

decrease in intellectual ability, loss of memory,impaired judgement, personality change, anddisorientation

A t d ti


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Acute dementia

When the symptoms are caused by temporaryreason:

High fever, dehydration, hypoxia

Chronic dementia

When symptoms are caused by permanent,irreversible damage to brain cells


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Alzheimers Disease

Form of dementia that causes progressive

changes in brain cells


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Early Stages:

Memory lossMood & personality changes

DepressionPoor judgment

Confusion regarding time &place

Inability to plan and follow

through with ADLs


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Middle Stages:

Nigh time restlessness Mood swings increase

Personal hygiene ignored

Weight fluctuates

Paranoia & hallucinations

Full time supervision needed


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Late Stages:

Total disorientation Incoherent

Unable to communicate with words

Loses control of bladder & bowel functions


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Musculoskeletal System:

Osteoporosis common.Mineral loss.

Bones become brittle.

Narrowing disks causes kyphosis.

Curving of the spine.

Osteoarthritis common.

Affects joints.

Cause of falls.

Immobility can lead to death. 64

Stretching and weight bearing exercises


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Stretching and weight-bearing exercises

help prevent osteoporosis.


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Trauma in the Elderly

Specific Injuries


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Specific Injuries

Orthopedic injuries

Burns Head and spine injuries

Orthopedic Injuries Common


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Orthopedic InjuriesCommonFractures in the Elderly

Hip or pelvis fractures

Proximal humerus

Distal radius

Proximal tibia

Thoracic and lumbar bodies

S b it l f l k f t


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Subcapital femoral neck fracture

Serious head injuries sometimes


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Serious head injuries sometimes

denote geriatric abuse.


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Many states have laws that requireEMS personnel to report suspected cases

of Geriatric abuse and/or neglect.

Burns


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Burns

People age 60 and older are more likelyto suffer death from burns than any othergroup except neonates and infants.Factors include:

Slower reaction time

Pre-existing diseases

Age-related skin changes

Immunological/metabolic changes

Reductions in physiological function

Toxicological Emergencies


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Toxicological Emergencies

Lidocaine

Beta-blockers

Antihypertensives/diuretics

ACE inhibitors Digitalis (digoxin, Lanoxin)

Antipsychotropics

Parkinsons disease medications

Analgesics

Corticosteroids

Transport Considerations


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Transport Considerations

M difi ti i iti i i bili ti d


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Modifications in positioning, immobilization, and

packaging may be necessary in the elderly patient.

Blister-packs are easier


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Blister-packs are easier

for the elderly.

Home safety for the elderly


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Home safety for the elderly

Common age-related systemic changes


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Common age related systemic changes

Sensory changes in the elderly


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Sensory changes in the elderly

Changes in the body systems


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Changes in the body systems

of the elderly

Documents

Kuliah Uniba Geriatric2 11-4-12 Care Geriatrics2