Geriatric Radiographic Considerations

1. Geriatric Radiographic Considerations Chapter 11

2. The Geriatric Patient • The number of people over 65 years of age in the United States is predicted to be more than 70 million people by the year 2030. • With 85 million baby boomers, the largest population, reaching 60 years of age, one out every five Americans is projected to be over 65 by 2030. • The radiographer must understand that age 65 is an arbitrary age that has been designated for convenience as the age at which a person is eligible for Medicare benefits, Social Security benefits, and retirement.

3. Cont. • Elderly patients are burdened with chronic illness rather than acute. • 80% of deaths in persons over the age of 65 are caused by Heart disease, Cancer, and Strokes. • Long term care is caused by hypertension, arthritis, diabetes, pulmonary disease, visual and hearing impairment.

4. Depression • Depression is a common and debilitating emotional problem of the aged person. This condition can be due to the following reasons: • Burden to the family • The fear of losing one’s good health • Giving up independent lifestyle • Chronic illnesses • Symptoms of depression in the elderly person are often confused with “Dementia.”

5. Alzheimer Disease • Persons with Alzheimer disease present with symptoms of dementia, which usually occur in persons over age 65, although it may occur at an earlier time. • Recent studies have indicated that of people over the age of 65 years about 50% suffer from Alzheimer disease at various stages.

6. When an examination of the geriatric patient is complete, you must assist the patient with returning to the dressing room, caretaker, or waiting room. • The elderly patient must not be left alone in the radiographic imaging room, because he or she may become confused and may be in danger of falling from the radiographic table.

7. Changes Associated with Aging • Older adults may have nonspecific symptoms such as: • Dizziness • Falls for no apparent reason • Infections without fevers • Urinary Incontinence • As a radiographer, you must be able to differentiate what is a normal from what is pathological.

8. Integumentary System • Normal Changes • The skin wrinkles, becomes lax, and loses turgor • The vascularity of the dermis decreases, and the skin of white people begins to look paler and more opaque • Brown macules called “Lentigines” appear on the back of the hands, on the forearms, and face • Seborrheic keratoses and “Actinic keratoses” may develop • Nails lose their luster and may yellow and thicken

9. Implications for the Radiographer • The skin of the geriatric is fragile and thus more easily traumatized. • You must ensure that the skin of the elderly patient is not damaged during the exam. • Lying on a hard radiographic table may be especially painful for the geriatric patient; place a full table pad for comfort.

10. Changes in the Head and Neck • Normal Changes of Aging • There is mild loss of visual acuity, particularly “Presbyopia” • Tear production is either reduced or increased • Sensory, neural, and conductive changes occur in the ear • Hearing loss is common • There is loss of muscle mass in the neck • Kyphosis

11. Implications for the Radiographer • Assist the patient at all times. Sudden change in lighting may cause momentary blindness. • You must ascertain that the patient is able to hear your directions and speak loudly enough for the patient to understand. • Be especially careful to clearly state instructions and check for understanding.

12. Pulmonary System • Normal Changes of Aging • Lung capacity diminishes • The cough reflex becomes less effective • The normal respiratory defense mechanism lose effectiveness

13. Implications for the Radiographer • Patients with chronic pulmonary disease cannot be expected to lie flat for more than brief periods of time, since this position increases dyspnea. • During chest radiographic examination, when possible, ask the patient to hold his or her breath on the second full inhalation to ensure full lung expansion. • During an UGI, position the patient in an upright position to prevent aspiration.

14. The Gastrointestinal System • Normal Changes of Aging • Gastric secretion, absorption and motility decreases • The abdominal muscles weaken • Many patients are edentulous (without teeth), have dentures or partial plates • Esophageal motility declines

15. Implications for the Radiographer • Due to patient fasting, schedule the exam early in the morning so that the patient can have breakfast close to usual time. • You must instruct the patient to drink slowly to avoid choking. • Position the patient in an upright position to prevent aspiration.

16. The Patient Who Has Had Arthroplastic Surgery • Total joint replacement has become a common procedure in hospitals throughout the United States • Arthroplasty is indicated for patients for the following reasons: • Severe degenerative joint disease • Joint deformities • Trauma

17. Cont. • Most common Arthroplasty in geriatrics: Hip and Knees • Take extra care when doing portable radiography on patients with post surgical Arthroplasty • The most common complication after hip replacement is dislocation of the prosthesis • You must understand the needs of the patient who has had an arthroplasty so that he or she will not be injured while being cared for in radiographic imaging

18. Cultural Considerations and Aging • One must take culture differences when imaging patients. • Some elderly patients are accepting of whatever treatment is offered, whereas others require a detailed explanation from the family members. • Whatever the culture of the patient, you must take these differences into consideration with sensitivity.

19. Elder Abuse • It is estimated one out of every 20 seniors experience elder abuse. • Elder abuse is: The neglect, mistreatment or exploitation of anyone age 65 or older (or any disabled dependent adult). • There are 3 categories of elder abuse: 1. Domestic elder abuse 2. Institutional elder abuse 3. Self-neglect or Self-abuse

20. Recognizing the Warning Signs of Abuse • Physical abuse • Sexual abuse • Emotional or Psychological abuse • Neglect • Financial abuse

21. Avoiding Elder Abuse or Neglect During Imaging Procedures • Avoid pinching patient’s skin when moving or transferring the patient from gurney or wheelchair onto the radiographic table. • When immobilizing elderly patients, utilize the standards of care for immobilizing the geriatric patient as prescribed by your institution during radiographic procedures. • Assist the geriatric patient when they ask for help.