Assisting in Geriatrics

1. Assisting in Geriatrics Chapter 47

2. Aging Population • In the 2000 census, 12.4% of the U.S. population was older than 65 years of age. • The “oldest old” (people older than 85) comprise the most rapidly growing age group. • It is projected that people older than 65 will represent 16% of the population in 2020 and increase to 20% by 2030.

3. Older Population by Age, 1900-2030

4. Services for the Aging • The aging process includes physical and sensory changes in older people. • The healthcare professional recognizes the special needs of the aged and develops effective management and communication skills for better service for the older client.

5. Myths about Aging • Senility inevitable • Disease unavoidable • Older workers less productive • Long-term care inevitable • No interest in or ability for sexual relations • Resistant to change • Cannot learn new things

6. Aging Changes • Table 47-1 in your textbook summarizes the changes in anatomy and physiology associated with aging in all body systems. • Normal age-related changes can be expected and compensated for, but these become more serious in the presence of poor health habits and chronic disease.

7. Aging Changes (cont’d) • General changes include: • An increase in arteriosclerosis • An increase in time needed to learn new material • A sharp decline in estrogen for women and increased risk of osteoporosis • An increase in malabsorption problems and constipation • A decrease in muscle mass • Less elasticity in lungs and gradual stiffening of chest wall • A tendency to gain weight

8. Aging Changes (cont’d) • A deterioration of joint cartilage • Presbycusis and presbyopia • An enlargement of the prostate and weakened bladder muscles • Impotence not a symptom of normal aging • Menopause causes vaginal narrowing and dryness

9. Management of Changes • Age-related changes can be managed through: • Regular aerobic exercise and strength training • Weight control • A diet rich in fruits, vegetables, and whole grains and low in fat • Avoidance of sun damage to skin • Pelvic muscle exercises • Annual physical examinations with health screening

10. Health Issues • The major health issues for aging people are related to an increase in atherosclerosis and potential cardiovascular disease. • Hypertension • Type 2 diabetes mellitus • Tendency to hyperthermia and hypothermia • Seborrheic keratosis • Arthritis • Osteoporosis • Increased risk of injury from falls

11. Cardiovascular System and Aging • Most frequent cause of death, illness, and disability. • CHF most common reason for hospitalization. • Aging causes structural changes in the heart. • Heart rate decreases. • Heart has to work harder to circulate blood through calcified vessels. • Increased incidence of orthostatic hypotension.

12. Endocrine System Most common problem is diabetes type 2 • 10% over 60 • Causes increased risk for multiple health problems • Patients display different symptoms because of insidious onset—weight loss, slow wound healing, recurrent infections, changes in mental state, cataracts, macular disease, muscle weakness, angina, foot ulcers, uremia • Patient education essential • What teaching adaptations may be needed?

13. Gastrointestinal System • Decrease in HCl affects digestion of calcium and and iron • Decrease in intrinsic factor causes fatigue • Increased rate of passage through small intestine causes poor absorption of vitamins and minerals • Poor eating habits, reduced fluid intake, and some medications contribute to constipation • Liver size decreases in size and weight after age 70 • Increase incidence of GI diseases such as GERD, peptic ulcers, diverticulosis, cholelithiasis, and colorectal cancer

14. Integumentary System • Age-related changes and sun exposure combine to cause changes in appearance and function. • Terms: seborrheic keratosis and alopecia. • Epidermis reproduces more slowly, so skin appears thinner, tends to tear; increased bruising, infections. • Why is there decreased vitamin D synthesis and increased photosensitivity? • Dermis loses 20% of mass: • Vascular supply and SC layer decrease • Hypothermia and hyperthermia • Increased pain tolerance • How can elderly prevent and treat dry skin?

15. Musculoskeletal System • Muscular changes related to activity level. • How can the MA help prevent falls? • Why are aging people at greater risk for injuries from falls? • Osteoporosis causes hip and vertebral fractures. • What are common risk factors? • What are methods of prevention and treatment?

16. Nervous System • What affects cognitive ability? • Is dementia inevitable? • What can cause signs and symptoms of dementia? • What is the best method for maintaining mental function? • What are risk factors for cognitive decline?

17. Alzheimer’s Disease • Progressive deterioration of the brain because of amyloid plaques and neurofibrillary tangles • First rule out other organic causes • What medications are used for treatment? • Stages: • First—2-4 years before diagnosis; memory loss, confusion, disorientation, withdrawal • Second—2-10 years after diagnosis; increased symptoms, restless, repetitive statements, mood changes, motor problems. • Third—lasts 1-3 years; weight loss, doesn’t recognize family, incontinent, requires complete care

18. Vision Changes • Presbyopia • Cataracts • Decreased lacrimation • Glaucoma • Macular degeneration • Color blindness • Decreased depth perception • Nyctalopia • Need six times as much light and have difficulty with glare • How can the MA help?

19. Hearing Changes • Presbycusis and depression • Tinnitus • How can the MA interact effectively with hearing-impaired aging person? • What type of questions are asked in the Geriatric Depression Scale?

20. Nutritional Status • Comprehensive interview should consider: • Oral health • GI complaints • Sensorimotor changes • Financial considerations • Disease-related diet restrictions • Alcohol consumption • Depression • Support systems

21. Additional System Issues • Pneumonia, aspiration, and reactivation of tuberculosis • Malnutrition • Increased urinary tract infections, incontinence, and prostate enlargement • Menopausal changes in the vaginal mucosa • Sleep disorders such as apnea and periodic limb movement disorder (PLMD) • Impact of medications on general health

22. MMSE • A commonly used screening tool for dementia is the Folstein Mini Mental Status Exam • It is a 5-minute screening test to evaluate basic mental function in the patient’s ability to recall facts, to write, and to calculate numbers, to determine if more in-depth testing is needed.

23. Depression • To screen for depression the physician may use the Geriatric Depression Scale short form that questions the patient about daily activities, interests, and feelings. • Nutritional status can be assessed through a comprehensive patient interview that considers all potential barriers to adequate nutrition.

24. Nutritional Status The nutritional status of older patients involves: • oral health • gastrointestinal (GI) complaints • sensorimotor changes • diet influences • social and mental influences

25. Sleep Problems • Complaints of sleeping difficulties increase with age. • Sleeping time may be slightly longer, but the quality of sleep decreases. • Older people are often light sleepers and have periods of wakefulness in bed. • Other factors influencing sleep patterns are medications, caffeine, alcohol, depression, and environmental or physical changes. • Common sleep problems in older adults include PLMD and sleep apnea.

26. Caregivers • Aging persons prefer to remain in their homes as long as possible. • Adult day care centers can provide supervision for older adults who are taken care of by family members in the evening. They also provide respite for a caregiver.

27. Assisted Living • Assisted-living facilities are appropriate for older adults who need assistance with some activities of daily living, such as bathing, dressing, and walking. • Skilled nursing facilities provide 24-hour medical care and supervision. • In addition to medical care, residents receive physical, personal, occupational, and speech therapy.

28. MA Role • Develop effective communication skills reflective of age-related sensorimotor changes. • For independence to be reinforced, aging patients require more time and should be scheduled for longer appointments.

29. MA Role (cont’d)

30. Elder Care Considerations • Provide adequate lighting in the waiting room, with forms in large print • Make certain the examination room is equipped with furniture, magazines, and treatment folders especially designed for the elderly patient • Invite a professional in the management of the elderly patient for in-service training to improve the quality of elder care.

31. Interviews • Ask the patient directly what is wrong rather than discussing the patient with family members. • Give the patient your full attention rather than continuing with multiple tasks while he or she is speaking. • Older people may take a little longer to process information, but they are capable of understanding.

32. Interviews (cont’d) • Don't hurry through explanations or questions, but take time to review a form or give instructions. • Use referrals and community resources for patient and family support.

33. Communications • Address the patient with an appropriate title. • Introduce yourself and the purpose of a procedure before touching the patient. • Establish eye contact and get the patient’s attention before beginning to speak. • Use expanded speech, gestures, demonstrations, or written instructions in block print.

34. Communications (cont’d) • Repeat the message as needed for understanding. • Observe the patient’s nonverbal behaviors as cues to indicate if he or she understands. • Allow time to process information. • Avoid distractions. • Involve family members as needed.