Ch10 care of the older pt

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 10Chapter 10

Care of the Older PersonCare of the Older Person

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2

?? What are characteristics of ?? What are characteristics of normal aging??normal aging??

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

?? As a person ages changes in musculoskeletal system occur. ?? As a person ages changes in musculoskeletal system occur. What can you do to reduce the risk of falls & injury???What can you do to reduce the risk of falls & injury???

Slide 3

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Late adulthood agesLate adulthood ages

Young-old: 65-74Young-old: 65-74 Old: 75-84Old: 75-84 Old-old: >85Old-old: >85

Slide 4

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Activity- Think about it?Activity- Think about it?

Divide into groups:Divide into groups: Make a list of psychological & social changes that Make a list of psychological & social changes that

occur with agingoccur with aging 5 minutes to discuss 5 minutes to discuss Present to classPresent to class

Share any personal experiences with change and Share any personal experiences with change and lossloss• How did you adjust to the change or loss?How did you adjust to the change or loss?

• What support systems helped you?What support systems helped you?

Slide 5

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6

PSYCHOLOGICAL AND SOCIAL PSYCHOLOGICAL AND SOCIAL CHANGESCHANGES

Threatens self-esteem & independence.Threatens self-esteem & independence. Social roles change.Social roles change.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Psychological changesPsychological changes

Retirement:Retirement:

-Age 65-Age 65

-relax-relax

-travel-travel

-ill/disability-ill/disability

-↑ bills-↑ bills- Loss of friends from workLoss of friends from work

- volunteer- volunteer

Slide 7

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8

Retirement Retirement

- a reward for a life-time of work.- a reward for a life-time of work. reduced income.reduced income.

Social relationships change Social relationships change Children become caregivers.Children become caregivers. Death of a partner is common.Death of a partner is common.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Enjoy being with others their own Enjoy being with others their own ageage

Slide 9

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

RetirementRetirement

Slide 10

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

↓ ↓ incomeincome

- still have expenses ( rent, insurance, food, - still have expenses ( rent, insurance, food, clothing)clothing)

- may need to change life style- may need to change life style - some plan for retirement, some don’t- some plan for retirement, some don’t

Slide 11

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Social relationshipsSocial relationships

-children move out-children move out -grandchildren-grandchildren -loss of friends-loss of friends -Lonely-Lonely -Hobbies-Hobbies

Slide 12

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

GrandchildrenGrandchildren

Slide 13

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Family timeFamily time

Slide 15

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Children as caregiversChildren as caregivers

Loss of dignityLoss of dignity - reverse roles- reverse roles --↑ tension b/t family↑ tension b/t family -lack of privacy-lack of privacy

Slide 16

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Death of spouseDeath of spouse

-women live longer-women live longer -never prepared-never prepared -loss of friend, companion, lover-loss of friend, companion, lover -grief-grief -physical &psychosocial changes can occur-physical &psychosocial changes can occur

Slide 17

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Enjoying gardeningEnjoying gardening

Slide 18

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19

RESIDENT RIGHTSRESIDENT RIGHTS

-OBRA-OBRA

-rights:-rights:As U.S. citizenAs U.S. citizen

In nsg. homeIn nsg. home

Must be informed:Must be informed:• Orally & in writingOrally & in writing

• @ admission to the center@ admission to the center

• In language the person uses In language the person uses

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Right to communicate privatelyRight to communicate privately

Slide 20

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

A nursing center is as home like A nursing center is as home like as possibleas possible

Slide 21

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Home – like nursing centerHome – like nursing center

Slide 22

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Confidential communications that resident Confidential communications that resident can usecan use

Slide 23

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Right to pick clothesRight to pick clothes

Slide 24

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 25

RightsRights

• To informationTo information

• To refuse treatmentTo refuse treatment

• To privacy and confidentialityTo privacy and confidentiality

• To personal choiceTo personal choice

• To voice disputes and grievancesTo voice disputes and grievances

• Not to work Not to work

• To take part in resident and family groupsTo take part in resident and family groups

• To care and security of personal itemsTo care and security of personal items

• To freedom from abuse, mistreatment, and neglectTo freedom from abuse, mistreatment, and neglect

• To freedom from restraintTo freedom from restraint

• To quality of lifeTo quality of life

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Center VolunteersNursing Center Volunteers

Slide 26

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Residents Rights ActivityResidents Rights Activity

Create a picture page with each of the residents Create a picture page with each of the residents rights.rights.

Demonstrate how to create using power pointDemonstrate how to create using power point

Slide 27

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 28

OMBUDSMAN PROGRAMOMBUDSMAN PROGRAM

- in every state.- in every state.

-someone who supports residents-someone who supports residents

-act on behalf of residents. -act on behalf of residents. • protect the health, safety, welfare, & rights of protect the health, safety, welfare, & rights of

residents.residents.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Think about itThink about it

Complete residents rights handoutComplete residents rights handout

Slide 29

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 30

Gerontology Gerontology

Aging is normal.Aging is normal.-Normal changes occur in body structure and function.-Normal changes occur in body structure and function.

-Psychological and social changes also occur.-Psychological and social changes also occur.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 31

Recognizing changes in body Recognizing changes in body functioningfunctioning

People live longer People live longer Chronic illness is common Chronic illness is common

• Disability may occurDisability may occur

Most elderly have at least one disability.Most elderly have at least one disability. Most older people live in a family setting.Most older people live in a family setting. Some live :alone or Some live :alone or

with friends.with friends.

nursing centers.nursing centers.

Need for nsg. homes increase with age.Need for nsg. homes increase with age.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

ActivityActivity

Create a page that shows at least five changes for Create a page that shows at least five changes for each of the following body systems.each of the following body systems.

-Integumentary-Integumentary

-Musculoskeletal-Musculoskeletal

-Nervous-Nervous

Circulatory Circulatory

-Respiratory-Respiratory

-Digestive-Digestive

UrinaryUrinary

Reproductive- male & femaleReproductive- male & female

Slide 32

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 33

The integumentary systemThe integumentary system

-Loses elasticity, strength, & fatty tissue .-Loses elasticity, strength, & fatty tissue .

-Decrease secretions from oil & sweat glands -Decrease secretions from oil & sweat glands

-Blood vessels decrease -Blood vessels decrease

-Brown spots appear -Brown spots appear

-Lose fatty tissue -more sensitive to cold.-Lose fatty tissue -more sensitive to cold.

-Dry skin itchy -Dry skin itchy

-Easily damaged.-Easily damaged.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 34

-Nails become thick & tough.-Nails become thick & tough.

- Poor circulation.- Poor circulation.

- fewer nerve endings.- fewer nerve endings.

-White or gray hair -White or gray hair

-Hair loss - men.-Hair loss - men.

-Hair thins –men /women.-Hair thins –men /women.

-Facial hair - women.-Facial hair - women.

-Hair is drier -Hair is drier

-Skin disorders -Skin disorders

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 35

The musculoskeletal systemThe musculoskeletal system

-Muscle cells -Muscle cells ↓↓

-Muscles atrophy -Muscles atrophy

--↓↓strength.strength.

-Bones lose calcium.-Bones lose calcium.

-Bones lose strength, become brittle-break easily.-Bones lose strength, become brittle-break easily.

-Vertebrae shorten.-Vertebrae shorten.

-Joints become stiff & painful.-Joints become stiff & painful.

-Mobility decreases-Mobility decreases

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

DisordersDisorders

• OsteoporosisOsteoporosis

Slide 36

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 37

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 38

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 39

The nervous systemThe nervous system

• Nerve cells are lost.Nerve cells are lost.

• Nerve conduction & reflexes slow.Nerve conduction & reflexes slow.

• Blood flow to brain reduced.Blood flow to brain reduced.

• Changes in brain cells.Changes in brain cells.

• Sleep patterns change.Sleep patterns change.

• Touch & sensitivity to pain/pressure reduced.Touch & sensitivity to pain/pressure reduced.

• Sensing heat & cold reduced.Sensing heat & cold reduced.

• Taste & smell dull.Taste & smell dull.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 40

• EyeEye Eyelids thin & wrinkle.Eyelids thin & wrinkle. Tear secretion less.Tear secretion less. The pupil becomes smaller & responds less to light.The pupil becomes smaller & responds less to light. Clear vision reduced.Clear vision reduced. The lens yellows. The lens yellows. Farsighted (presbyopia).Farsighted (presbyopia).

• Ear.Ear. Changes in auditory nerve.Changes in auditory nerve. Eardrums atrophy.Eardrums atrophy. Wax secretion decreases.Wax secretion decreases. Wax becomes harder & thicker.Wax becomes harder & thicker.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 41

Circulatory systemCirculatory system• Heart muscle weakens.Heart muscle weakens.

• Arteries narrow are less elastic.Arteries narrow are less elastic.

Circulatory changes could be severe.Circulatory changes could be severe. Increase restIncrease rest

Respiratory systemRespiratory system• Respiratory muscles weaken.Respiratory muscles weaken.

• Lung tissue less elastic.Lung tissue less elastic.

• May lack strength to cough & clear the airway of May lack strength to cough & clear the airway of secretions.secretions.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 42

Digestive systemDigestive system• Salivary glands produce less saliva. Salivary glands produce less saliva.

• Dysphagia a risk.Dysphagia a risk.

• Taste & smell dull.Taste & smell dull.

• Secretion of digestive juices decreases.-Flatulence, Secretion of digestive juices decreases.-Flatulence, poor digestionpoor digestion

• Loss of teeth & ill-fitting dentures cause chewing Loss of teeth & ill-fitting dentures cause chewing problems.problems.

• Peristalsis decreases.Peristalsis decreases.

• Fewer calories needed.Fewer calories needed.

• Loss of sphincter controlLoss of sphincter control

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Care of digestive disordersCare of digestive disorders

Special diet-low spice, high fiberSpecial diet-low spice, high fiber Special form of food- soft, pureedSpecial form of food- soft, pureed Supplemental feedingSupplemental feeding Long time to eatLong time to eat Wgt.Wgt. Position when eatingPosition when eating HydrationHydration

Slide 43

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 44

The urinary systemThe urinary system• Kidney function decreases.Kidney function decreases.

• Kidneys atrophy.Kidneys atrophy.

• Blood flow to kidneys reduced.Blood flow to kidneys reduced.

• Ureters, bladder, & urethra lose tone & elasticity.Ureters, bladder, & urethra lose tone & elasticity.

• Bladder muscles weaken.Bladder muscles weaken.

• Bladder size decreases.Bladder size decreases.

• In men, prostate gland enlarges.In men, prostate gland enlarges.

• Urinary tract infections a risk.Urinary tract infections a risk.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 45

The reproductive systemThe reproductive system• In men, testosterone decreases. In men, testosterone decreases.

↓↓strength, sperm production, & reproductive tissues.strength, sperm production, & reproductive tissues. Erection takes longer.Erection takes longer. phase between erection/orgasm longer.phase between erection/orgasm longer. Orgasm less forceful .Orgasm less forceful . Erections lost quickly.Erections lost quickly. Time between erections longer.Time between erections longer.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

• Menopause Menopause Menstruation stops.Menstruation stops. Can’t reproduceCan’t reproduce

Female hormones (estrogen/progesterone) Female hormones (estrogen/progesterone) ↓↓.. uterus, vagina, & genitalia atrophy.uterus, vagina, & genitalia atrophy. Vaginal walls thin Vaginal walls thin Vaginal dryness.Vaginal dryness. Arousal takes longer.Arousal takes longer. Orgasm less intense.Orgasm less intense. Pre-excitement state returns more quickly.Pre-excitement state returns more quickly.

Slide 46

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Reproductive disordersReproductive disorders

VaginitisVaginitis Inflamed vaginal liningInflamed vaginal lining -foul odor-foul odor -drainage-drainage -irritation-irritation

BPH ( benign prostate BPH ( benign prostate hypertrophy)hypertrophy)

Enlarged prostateEnlarged prostate -trouble urinating-trouble urinating -trouble starting flow-trouble starting flow

Slide 47

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 48

HOUSING OPTIONS HOUSING OPTIONS Living with familyLiving with family

• Adult day care centersAdult day care centers

Elder cottage housing opportunity (ECHO)Elder cottage housing opportunity (ECHO) ApartmentsApartments Residential hotelsResidential hotels Congregate housingCongregate housing

• Senior citizen housingSenior citizen housing

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 49

HomesharingHomesharing Assisted living residencesAssisted living residences Board and care homesBoard and care homes Adult foster careAdult foster care Continuing care retirement communities (CCRCs)Continuing care retirement communities (CCRCs) Nursing centersNursing centers

• Hospital long-term care unitsHospital long-term care units

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

AssignmentAssignment

In groups review assigned housing option. In groups review assigned housing option.

DefineDefine

What is benefits?What is benefits?

What are concerns?What are concerns?

Share with classShare with class

Slide 50

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

? An 86 year old man moved to South Shore ? An 86 year old man moved to South Shore Nsg. Home 2 weeks ago. He was living on a Nsg. Home 2 weeks ago. He was living on a

farm alone, 5 miles from the closest city. He has farm alone, 5 miles from the closest city. He has diabetes & arthritis. He needs assistance with diabetes & arthritis. He needs assistance with his meds, meals, & bathing. He can no longer his meds, meals, & bathing. He can no longer safely drive a car. He can’t keep up with the safely drive a car. He can’t keep up with the

house work. house work. -What are the gains of moving into the -What are the gains of moving into the

nsg.home?nsg.home?-What are the losses?-What are the losses?

Slide 51

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Watch video – the Aging ProcessWatch video – the Aging Process

Slide 52