Geriatric Care

1. Geriatric Care Prepared by :Dr.Latifa Mari’e

2. Geriatrics means • the branch of medicine or social science dealing with the health and care of old people.

3. 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

4. Older people are lonely and unhappy • Elderly do not want to work • Retirement ends your active life

5. Geriatric age > 65

6. 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

7. Instrumental Activities of Daily Living (IADLs) • Managing finances • Managing transportation • Shopping and meal preparation. • Housecleaning and home maintenance. • Managing communication, • Managing medications

8. 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.

9. 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

10. Integumentary SystemChanges • Production of new skin cells decreases • Oil and Sweat glands become less active • Circulation decreases

11. 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)

12. Fatty tissue layer of skin diminishes • Lines and wrinkles appear • Nails become thick, tough, and brittle • Increased sensitivity to temperature

13. Care of Skin • Use mild soap • Bath oils or lanolin lotion • Bath or Shower once or twice a week • Brush Hair daily

14. 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

15. 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.

16. aortic valvular stenosis and mitral valvular insufficiency  • decrease in intrinsic heart rate

17. Cardiac output at rest is unaffected • orthostatic hypotension

18. Circulatory System Care • With circulatory changes: • Avoid strenuous exercise or over exertion • Periods of rest • Moderate exercise, according to individual’s tolerance

19. Prevent the formation of a blood clot (thrombus) • Support stockings, anti-embolism hose • DO NOT wear tight bands around legs

20. High Blood Pressure = • Diet low in salt • Decrease fat intake • Exercise as recommended by physician

21. Respiratory Changes • Respiratory muscles become weaker • Rib cage more rigid • Alveoli thinner & less elastic which decreases exchange of gases - emphysema

22. 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

23. 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

24. Respiratory Care • Alternate activity with periods of rest • Proper body alignment & positioning • Sleep in semi-fowlers position • Use 2 or 3 pillows

25. Avoid polluted air • Breath deeply & cough frequently • May need continuous oxygen therapy

26. Nervous System Changes • Blood flow to brain decreases & there is a progressive loss of brain cells - - Interferes with • Thinking - Reacting • Interpreting - Remembering

27. 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

28. 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

29. 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

30. Decreased sensation to pain & other stimuli = more susceptible • Burns • Frostbite • Cuts • Fractures • Muscle strain and other injuries

31. Digestive Changes • Fewer digestive juices and enzymes produced • Muscle action becomes slower & peristalsis decreases • Teeth are lost • Liver function decreases

32. Dysphagiais frequent complaint • Less saliva • Slower gag reflex • Loss of teeth • Poor fitting dentures • Slower digestion of food • indigestion

33. Decrease peristalsis • Increase flatulence (gas) • Constipation • Decrease sensation of taste • Poor appetite • Poor diet

34. 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

35. Urinary Changes • Kidneys decrease in size & become less efficient • Bladder becomes less efficient • May not hold as much • May not empty completely • incontinence

36. Urinary Care • Increase fluid intake • Decrease before bedtime • Regular trips to bathroom • Easy to remove clothing • Absorbent pads

37. Endocrine Changes • Increased production of some hormones and decreased of others • Immune system less effective • BMR decreases • Intolerance to glucose

39. Endocrine Care • Proper exercise • Adequate rest • Medical care for illness • Balanced diet • Healthy lifestyle

40. Reproductive System Changes • Decrease of estrogen / progesterone in female • Thinning of vaginal wall • Decrease vaginal secretions • Inflammation of vagina common

41. 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

42. 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

43. Psychocosocial Changes • Some individual cope with psychosocial changes, and others experience extreme frustration and mental distress

44. Fears of a sick person: • Death • Chronic illness • Loss of function • Pain

45. Dealing with fears created by an illness: • Listening • Patience • Understanding • Provide support

46. Confusion and Disorientation • Six signs: • Talking incoherently • Not knowing their name • Not recognizing others • Wandering aimlessly • Lacking awareness of time or place

47. Displaying hostile and combative behavior • Hallucinating • Regressing in behavior • Paying less attention to personal hygiene • Inability to respond to simple commands or instructions

48. Causes of temporary confusion / disorientation • Stress and/or depression • Use of alcohol or chemicals • Kidney disease • Respiratory disease • Liver disease • Medication

49. Diseases: • CVA • Arteriosclerosis • Atherosclerosis • Cause TIA’s ministrokes which result in temporary periods of diminished blood flow to the brain.

50. Dementia • Loss of mental ability characterized by a decrease in intellectual ability, loss of memory, impaired judgement, personality change, and disorientation