Chapter :2 Health care of Older Adult The Normal Aging Process And some suggestions of how to support people through these changes Think about aging clients/family members for a moment When Does Aging Begin? Aging begins the day we are born No single measure of how old a person is Aging is highly individualized Aging proceeds at different rates in different people, and within different systems of the body Why Do People Age? Many theories to include: Hereditary Factors Loss of cellular mass and ability of cells to divide and replicate Accumulation of waste materials that clog cells and cause them to die Changes in structure of connective tissue But no single theory adequately describes the aging process Social Theories of Aging Disengagement Theory Activity Theory Social breakdown Reconstruction Theory Disengagement Theory As older adults slow down, they gradually withdraw from the society. Disengagement is a mutual activity in which the elderly not only disengaged in the society, but the society disengages from the older adult. The elderly develops greater self-preoccupation and decrease emotional ties with people and reduced interest in social activities. Such social withdrawal and increased self- absorption was thought to increase life satisfaction among them. Activity Theory As opposed to the disengagement theory, this theory argues that the more active and involved the elderly are, the more likely that they are satisfied with their lives. It is therefore important to find substitute activities for them after their retirement. Social Breakdown -Reconstruction Theory This theory states that aging is promoted through negative psychological functioning brought about by the negative views of the society about elderly and inadequate provision of services for them. Social reconstruction can occur by changing the societys view of the elderly and by providing adequate social services for them. Normal Changes of Aging Physical changes related to Normal aging ARE NOT disease Changes occur in most body systems to include: Sensory System Brain and Central Nervous System Muscles and Bones Digestion Heart/Circulatory System Respiratory System SENSORY SYSTEM Changes in Vision Decreased peripheral vision Decreased night vision Decreased capacity to distinguish color Reduced lubrication resulting in dry, itchy eyes Supporting Changes in Vision Approach people directly not from the side Proper lighting can make a big difference Assist with choosing clothes if needed Use of natural tear products Use blinds or shades to reduce glare Changes in Hearing Sensitivity to loud noises Difficulty locating sound More prone to wax build up that can affect hearing Supporting Changes to Hearing Reduce extra noise when trying to have a conversation Place yourself so the person can see you and fairly close- increased volume not always helpful Make sure you have the persons attention before speaking Have doctor check for and remove wax if needed Arrange for hearing assessment and provide support to use a hearing aid if needed. Changes in Smell and Taste Decreased taste buds and secretions Decreased sensitivity to smell Supporting Changes in Smell and Taste May enjoy smaller attractive meals-helps to be able to smell food preparation At risk of eating spoiled food Changes in Skin Decrease in moisture and elasticity More fragile- tears easily Decrease in subcutaneous fat Decrease in sweat glands -less ability to adjust body temperature. Tactile sensation decreases- not as many nerves May bruise more easily Supporting Changes in Skin Use moisturizers, bath oils can make bath tub slippery As a care provider keep nails short Pat gently when helping to dry after bathing Bottom of feet may be sore, pay attention to footwear May feel cooler than others but be more at risk of sun stroke Use sun screen, hats, long sleeves Be careful with such things as hot water bottles Changes in Metabolic System Decrease in ability to adapt to stress Decrease in metabolic rate Decrease in thyroid-gland related to calcium absorption and energy level Supporting Changes in the Metabolic System May feel cold so provide what is necessary for the person to feel comfortable but avoid overheating May need calcium and vitamin D supplements to prevent osteoporosis Changes in Elimination Bladder atrophy- inability to hold bladder for long periods Constipation can become a concern because of slower metabolism Men can develop prostate problems causing frequent need to urinate Incontinence make occur because of lack of sphincter control Supporting Changes in Elimination Maintain routines Plan ahead-know where washrooms are when you go out Decrease caffeine intake Eat lots of fiber and do some exercise Put bowel elimination protocols in place if needed Provide appropriate supplies and emotional support Changes to the Respiratory System Decreased volume and expansion of lungs may lead to decreased function Susceptible to lung infections, increases if someone is inactive Swallowing impairments can cause aspiration Supporting Changes in the Respiratory System Planning activities with shorter duration May need more rest periods Reposition person frequently if they are unable to move on they own. Consult a doctor if person consistently coughs during or after a meal Changes in the Cardiovascular System Heart works harder to maintain oxygen levels in the body Cholesterol may accumulate on the walls of the arteries Decreased ability to replace fluids lost while breathing Supporting Changes in the Cardiovascular System People may become fatigued more easily because of the above changes, may need more rest Blood pressure should be monitored as recommended by health care professionals Reposition person frequently if unable to move on their own so fluids don t build up. physiotherapy may be needed Assure adequate fluid intake and seek medical help quickly if you think the person may be dehydrated Changes in Bones and Joints Decreased height due to bone changes Bones more brittle risk of fracture Changes of absorption of calcium Pain from previous falls or broken bones Joints less lubricated may develop arthritis Supporting Changes in Bones and Joints Need light exercise including some weight bearing if possible Take precautions to prevent falls May need calcium and Vitamin D supplements- ensure a balanced diet Monitor and treat pain appropriately Allow more time as the person may need to do things more slowly Changes to the Nervous System Physical reactions are slowed due to increased lag time of neurons transmitting information :Slowing manifests itself in the learning process Unfamiliar or high stress activities cause an older person to perform more slowly Throughout adulthood, there is a gradual reduction in the weight and volume of the brain. This decline is about 2% per decade. people get about 20% less oxygen to the brain which affects balance Supporting Changes to the Nervous System Discourage long naps and caffeinated products later in the day encourage the same patterns and rituals at bedtime Measures for Accommodating Poor balance Using a rocking chair can help compensate Use walkers and canes properly Do some exercise to maintain leg muscles Encourage the person to avoid lifting, stretching and reaching when it can not be done safely Have the person get up gradually so that they dont get dizzy Changes in Cognitive Ability Dont lose overall ability to learn new things but there are changes in the learning process Harder to memorize lists of names and words than for a younger person Sensory and motor changes as well as cognitive ability may affect ability to respond hard to know which is which Supporting changes in Cognitive Ability Learning new information may take longer for an older person and they may need cues to help to retrieve information stored in memory When given a choice of answers it may be easier for the person to give correct answer rather that retrieving directly from memory Some Possible Psychological/Social Issues Decreased social contact friends and family die- person may withdraw Reconciliation with past-resolving conflicts, losses, acceptance, Changes in physical appearance may be difficult Changes in roles/tasks that people can manage can make them feel they have less to contribute Managing leisure time-more free time Depression relatively common Supporting some possible Social/Psychological Issues Provide grief support and encourage existing friendships Do life review work/life story book and use photographs to help person talk about the past Help person with grooming and clothes so they can look their best Help person participate in meaningful ways in daily activities, find new roles and have as much control and choice as possible. Help structure time. Facilitate participation in leisure activities the person likes Facilitate assessment for and treatment of depression Increased Physical Stress Handling physical stress becomes more difficult as you get older People are less able to adjust to such stresses as heat, cold, physical exertion, and illness Have the person do things they enjoy but help them to pace themselves provide a rest day after an extra busy day if possible or at least a quieter day Importance of Exercise for elderly Important to exercise to prevent muscle tissue from turning to fat Exercise helps maintain bone density Exercise helps prevent depression Encourage walking and other exercise as suggested by medical doctor or physiotherapist Measures to improve Meals and Nutrition In general older people need fewer calories so provide foods rich in nutrition but lower in calories. Sense of thirst decreases so help people to drink enough. Kidneys may also be filtering more medication Weight loss or gain of 10 pounds in six months needs to be looked into medically Measures to improve Speech and Communication May be slightly harder and take a bit longer to say what they want to say not usually apparent but more likely to happen in stressful situations For example when the doctor is in a hurry and wants to speak with the person accompanying the individual they may need support to speak for themselves Issues Facing the Elderly ABUSE It can happen in the family It can happen in nursing homes It could be physical or psychological (like verbal abuse) when they are named called or threatened, or taken advantage because of their memory problems. One form is NEGLECT! When people who are suppose to care for them ignore their needs and concerns Issues Facing the Elderly LONELINESS Death of a husband or wife and many friends. Children are busy with work and may not even come to visit them. Grandchildren are busy with school. Physically weak elderly may feel that they are burden so they try to stay away even if people are around. Loneliness leads to depression they feel alone and unproductive. Issues Facing the Elderly POVERTY They cannot earn anymore and they do not have money. May receive retirement pension but may not also be enough because of their increasing medical needs. As such many even try to continue working even after reaching the retirement age. Issues Facing the Elderly HEALTH diminished sensory and motor abilities tendency to acquire various illnesses such as heart disease, Alzheimer's, cancer, etc. Issues Facing the Elderly DISCRIMINATION Job discrimination employers prefer younger applicants because .inexperienced workers have cheaper salaries employers believe that the elders could only stay in work for a short time because of their declining physical condition .elderly are thought of as slower and less capable. Issues Facing the Elderly Social discrimination maybe excluded from family or community services because they are seen as incapable. Medical Discrimination - Some doctors treat them without much care because they think they dont deserve such because they are already old. Summary Not every person will experience all of these changes. Organizations concerned with a particular syndrome or condition may be helpful in providing information helpful for certain individuals. Aging is a spiritual and psychological journey as well as a physical one. REFERENCE McCracken Intervention Matrix McCracken - College of Nursing and Health, University of Cincinnati and Lotteman Children, Inc. Covington, KY A Focus on Geriatrics Sharing the Learning St Vincent Hospitals part of Providence Health Care Age Changes and what to do about it Phyllis Kultgen and Peggy Hotz Compiled by Dr. J.C. Helen Shaji