Geriatrics

1
Chapter 40

• Geriatrics

2
Concepts of Aging

• Established concepts about the aging process have
  changed
• Gerontologists
• Specialists who study aging process
• Geriatrics
• Branch of medicine that deals with the elderly
  population

3
Reinforcing Medical Compliance in the Elderly

• Establish good rapport with elderly clients to
  ensure compliance
• Write instructions in easy-to-understand terms
• Use large print
• Have patient repeat instructions
• Ask patient to perform a procedure
• Give patient appointment calendar

4
Reinforcing Medical Compliance in the Elderly
(continued)

• At every visit, take complete account of all
  medications
• Prescribed
• Over-the-counter
• Herbal supplements or vitamins
• Have patients bring all medications to office

5
Checkpoint Question 1

• What are some reasons that a patient may not be
  compliant with a prescribed treatment plan?

6
Answer

• Elderly patients may not comply with following
  treatment plans due to a memory loss from normal
  aging processes or because they are growing tired
  of the constraints imposed by illness on their
  lives. Some patients may have financial
  difficulties that force them to choose between
  medication and food on the table.

7
Reinforcing Mental Healthin the Elderly

• Correlation between mental and physical health
• Be aware of mental health status in patients with
  physical conditions

8
Reinforcing Mental Health in the Elderly
(continued)

• Maintain open communication
• Help patient express feelings of guilt or anger
• Encourage positive self-image
• Assist family in positive support system
• Dont be discouraging or offer false hope
• Direct to support groups

9
Checkpoint Question 2

• How can you help promote good mental health in
  your elderly patients?

10
Answer

• You can help your elderly patients maintain good
  mental health by encouraging open communication,
  helping them deal with their feelings, promoting
  a positive self-image, helping family members to
  be supportive, and suggesting support groups as
  needed.

11
Coping with Aging

• Most elderly people are generally healthy and
  satisfied
• But some feel overwhelming stress and grief
• Stress
• Compromises immune system
• Raises blood pressure and blood sugar levels
• Strains heart and lungs

12
Coping with Aging (continued)

• Help patients cope with stress by
• Listening to their fears
• Respecting their right to have these feelings
• Helping them reduce the stressors in their lives

13
Alcohol

• Alcohol abuse may be mistaken for
• Dementia
• TIAs
• CNS impairment
• Medications may react badly with alcohol
• Identifying these patients can be difficult
• Refer to mental health professional or community
  resource

14
Suicide

• With ill health, multiple losses, deep
  depression, suicide may seem preferable to life
• Generally well planned and successful
• Often involve white men over 65, who have
  recently lost a spouse

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Suicide (continued)

• Watch for
• Deepening confusion
• Increasing anger
• Increase in alcoholism
• Loss of interest in health
• Secretive behavior
• Sharp mood swings
• Giving away favored objects
• Take seriously those who express intent to commit
  suicide

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Checkpoint Question 3

• What are some signs of suicidal intent?

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Answer

• The signs of suicidal intent may include
  deepening confusion, increasing anger, increased
  alcohol or narcotic use, lack of interest in
  health, secretive behavior, sharp mood swings,
  and giving away personal possessions.

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Long-Term Care

• Three types
• 1. Group homes or assisted living facilities
• 2. Long-term care facilities
• 3. Skilled nursing facilities

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Checkpoint Question 4

• How are long-term facilities and skill nursing
  facilities different?

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Answer

• Long-term care facilities are for individuals who
  need help with personal care and some medical
  supervision. Skilled nursing facilities are for
  gravely or terminally ill individuals who need
  constant supervision.

21
Elder Abuse

• As prevalent as child abuse
• Common risk factors
• Multiple, chronic illnesses that stress familys
  resources
• Senile dementia
• Incontinence
• Sleep disturbances
• Dependence on caretaker for daily living

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Elder Abuse (continued)

• Several forms
• Passive neglect
• Active neglect
• Psychological abuse
• Financial abuse
• Physical abuse
• If you suspect abuse or neglect, bring to
  attention of physician

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Signs of Abuse

• Wounds of suspicious origin
• Signs of restraints
• Neglected pressure ulcers
• Poor hygiene or nutrition
• Dehydration
• Untreated injuries or medical conditions
• Excessive agitation or apathetic resignation

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Checkpoint Question 5

• What are the different types of elder abuse?

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Answer

• Elder abuse may take passive or active neglect or
  it can be psychological, financial, or physical.

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Medications and the Elderly

• Bodys systems slow down
• GI system has decrease in peristalsis
• Circulatory system does not absorb or deliver
  medications quickly
• Liver does not biotransform as well
• Kidneys dont filter as well

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Medications and Elderly (continued)

• Guidelines
• 1. Explain side effects, precautions,
  interactions, expected actions
• 2. Explain proper dosage and how to measure it.
• 3. Write out schedule and suggest methods to help
  patient remember

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Medications and Elderly (continued)

• 4. Tell patient to take most important medication
  first
• 5. Encourage patient not to rush
• 6. Tell them to ask pharmacist for large print on
  label

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Checkpoint Question 6

• How can you help your elderly patients follow the
  medication regimen prescribed by the physician?

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Answer

• To help your elderly patient follow the
  prescribed medication regimen provide full
  explanation of the medication in a way that the
  patient understands explain the proper dosage
  and techniques for measuring

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Answer (continued)

• develop written schedule for taking medication
  instruct patient to take most important
  medication first tell patient not to rush when
  taking medication have patient ask pharmacist
  for large print on label explain appropriate use
  of medication and encourage patients to take an
  active role in their therapy.

32
Systemic Changes in the Elderly

• Longevity is largely hereditary
• When cells have reached a specific reproduction
  level, they either will not replace themselves or
  they will replicate more slowly or ineffectively

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Diseases of the Elderly

• Parkinsons disease
• Alzheimers disease

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Parkinsons Disease

• Slow, progressive neurologic disorder that
  affects specific cells of the brain
• Affects men more than women
• Cause unknown

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Parkinsons Disease (continued)

• Signs and symptoms
• Muscle rigidity
• Bradykinesia
• Difficulty walking
• Forward bending posture
• Laryngeal rigidity
• Pharyngeal rigidity
• Facial muscle rigidity
• Small tremors in fingers

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Parkinsons Disease (continued)

• Parkinsons has no cure
• Treatment is symptomatic, supportive, and
  palliative
• Medications
• Deep brain stimulation

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Parkinsons Disease (continued)

• Patients retain cognitive functions
• They require psychological support
• Encourage participation in all activities of
  daily living
• Promote independence
• Suggest increased fluid intake and balanced diet

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Parkinsons Disease (continued)

• Encourage patient to use eating aids, raised
  toilet seats, handrails
• Listen to patient
• Educate patient about safety factors
• Enlist help of support groups

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Checkpoint Question 7

• How can you assist a patient with Parkinsons
  disease?

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Answer

• To assist a patient with Parkinsons disease,
  encourage activity and independence, promote good
  nutrition and hydration, caution the patient
  about the potential for choking, educate the
  patient about safety, use therapeutic
  communication skills, and enlist the help of
  support groups for the patient and their
  caregivers.

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Alzheimers Disease

• Roughly half the cases of dementia can be traced
  to Alzheimers disease
• Symptoms may be similar to
• TIAs
• Cerebral tumors
• Dementias
• Symptoms may begin as early as age 40

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Alzheimers Disease (continued)

• When caring for Alzheimers patients
• Remember that anger and hostility are symptoms of
  the disease
• Respond with patience and compassion
• Speak calmly and without condescension

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Alzheimers Disease (continued)

• Never argue with patient
• Reintroduce yourself at each visit
• Explain common procedures
• Approach quietly and professionally
• Speak in short, simple sentences
• Keep list of support contacts for family members

44
Maintaining Optimum Health

• It is possible to maintain a good level of health
  after age 70
• Exercise with physicians approval
• Good nutrition

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Exercise

• Guidelines for starting an exercise program
• 1. Always warm up cold muscles for at least 10
  minutes
• 2. Begin by exercising for brief time periods
• 3. Stop if you feel pain, shortness of breath, or
  dizziness

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Exercise (continued)

• 4. Breathe deeply and evenly
• 5. Rest when tired
• 6. Keep record of progress
• 7. Exercise with a friend, group, or to music
• 8. Make exercise part of daily routine

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Diet

• Elderly patients often have difficulty
  maintaining good nutrition
• Smaller, more frequent meals may be easier to
  digest
• Water should be encouraged to maintain hydration
• Consider a service such as Meals on Wheels

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Safety

• Alert patient and caregivers to hazards in the
  home
• Remove scatter rugs
• Never allow electrical cords to cross passageways
• Remove or reduce clutter
• Strengthen handrails

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Safety (continued)

• Install telephone by bedside and favorite chair
• Install and maintain smoke alarms and carbon
  monoxide detectors
• Establish system to call and check on patient
  every day
• Use community programs