Physical reminders of aging include graying hair, wrinkles, and slow movements. Adjusting to the death of a partner, family members, and friends is common. The person faces his or her own death.
Many people enjoy retirement. Others must retire because of illness or disability. Most older people have regular contact with children, grandchildren, family, and friends. Some older people are lonely. Review the Focus on Communication: Social Changes Box on p. 128 in the textbook. Review the Caring About Culture: Foreign-Born Persons Box on p. 128 in the textbook. Sometimes parents and children change roles. This helps some older persons feel more secure. Others feel unwanted, in the way, and useless. When the death of a partner occurs, the loss is crushing. The person loses a lover, friend, companion, and confidant. Review the contents of Box 10-2 on p. 129 in the textbook.
Nursing centers must provide care in a manner and in a setting that maintains or improves each person’s quality of life, health, and safety. If a resident is incompetent, a responsible party or legal representative exercises his or her rights. Resident rights are posted throughout the center.
A person who does not give consent or who refuses treatment cannot be given the treatment. Report any treatment refusal to the nurse. The person’s body is not exposed unnecessarily. No one can punish the person in any way for voicing a grievance. The person does not work for care, care items, or other things or privileges. Nursing centers must investigate suspected or reported cases of abuse. Centers cannot employ persons who were convicted of abusing, neglecting, or mistreating others. Restraints are not used for staff convenience or to discipline a person. Review the contents of Box 10-6 on p. 139 in the textbook.
Nursing centers must post where residents can easily see them the names, addresses, and phone numbers of local and state ombudsmen. You must know state and center policies and procedures for contacting an ombudsman. Ombudsman services are useful when: There is concern about a person’s care or treatment Someone interferes with a person’s rights, health, safety, or welfare Review the Focus on Ethics and Laws: Freedom from Abuse, Mistreatment, and Neglect Box on p. 138 in the textbook.
Aging is not a disease. The changes that occur in body structure and function increase the risk for illness, injury, and disability. Most people adjust well to these changes. To provide good care, you need to know the facts about older persons and aging. Review the contents of Box 10-1 on p. 126 in the textbook.
Older people are healthier and more active than ever before. Widow-hood is more common in older women than in older men. Disabilities increase and become more severe with aging. Disabilities can interfere with many activities of daily living and leisure and recreational activities.
Skin breakdown, skin tears, and pressure ulcers are risks. Bruising and delayed healing are risks. You need to protect the person from drafts and cold. A shower or a bath twice a week is enough. Partial baths are taken at other times. Lotions, oils, and creams prevent drying and itching.
A nick or a cut can lead to a serious infection. Burns are great risks. Hot water bottles and heating pads are not used. Brushing hair promotes circulation and oil production. Shampoo frequency depends on personal choice. The risk of skin cancer increases with age. Skin changes can affect self-esteem and body image.
Walking is good exercise. Exercise groups and range-of-motion exercises are helpful. A diet high in protein, calcium, and vitamins is needed. You need to: Protect the person from injury and prevent falls. Turn and move the person gently and carefully. Help and support the person getting out of bed as needed. Help the person with walking as needed.
Dizziness may occur. It increases the risk for falls. Practice measures to prevent falls. Remind the person to get up slowly from a bed or chair. Changes may affect personality and mental function. Memory is shorter. Forgetfulness increases. Responses slow. Confusion, dizziness, and fatigue may occur. The person may not notice painful injuries or diseases. You need to: Protect older persons from injury. Follow safety measures for heat and cold. Check for signs of skin breakdown. Give good skin care. Prevent pressure ulcers.
Vision is poor at night or in dark rooms. The eyes take longer to adjust to lighting changes. It is harder for the eye to shift from far to near vision and from near to far vision. Changes in the eye increase the risks of falls and accidents. Eyeglasses are worn as needed. Keep rooms well lit. Night-lights help at night. High-pitched sounds are hard to hear. A hearing aid may be needed. It must be clean and correctly placed in the ear. Earwax wedged in the ear can cause hearing loss. A doctor or nurse removes the wax.
The heart pumps blood with less force. A weak heart must work harder to pump blood through narrowed vessels. Exercise helps maintain health and well-being. Older persons need to be as active as possible. Persons who stay in bed need range-of-motion exercises. Doctors may order certain exercises and activity limits. Difficult, labored, or painful breathing (dyspnea) may occur with activity. Respiratory infections and diseases may develop. Normal breathing is promoted. The person should be as active as possible.
Flatulence and constipation can occur. Oral hygiene and denture care improve taste. High-fiber foods help prevent constipation. Persons with chewing problems or constipation often need foods that provide soft bulk. Foods are needed to prevent constipation and bone changes. High-protein foods are needed for tissue growth and repair.
Waste removal is less efficient. Urine is more concentrated. Urinary frequency or urgency may occur. Many older persons have to urinate during the night. Urinary incontinence (inability to control the passage of urine from the bladder) may occur. An enlarged prostate can cause difficult or frequent urination. Adequate fluids are needed. Most fluids should be taken before 5:00 PM. Persons with incontinence may need bladder training programs. Sometimes catheters are needed.
Older men may need the penis stimulated for arousal. Fatigue, overeating, and drinking too much alcohol affect erections.
Menopause occurs between 45 and 55 years of age. Thinning of vaginal walls and vaginal dryness may make intercourse uncomfortable or painful.
Most older people live in their own homes. Many function without help. In-home and community-based services assist older persons with activities of daily living. Review the contents of Box 10-3 on p. 132 in the textbook. Leaving a home is often very hard. Moving brings many losses. A new home setting could maintain or improve the person’s quality of life. Review the Focus on Long-Term Care and Home Care: Housing Options Box on p. 133 in the textbook. Living with an adult child is a social change. Everyone in the home must adjust.
Assisted living residences are for persons who need help with daily living. Health care and 24-hour oversight are provided. Nursing centers are options for older persons who cannot care for themselves. Some people stay in nursing centers until death. Some stay until they can return home. Review the contents of Box 10-4 on p. 136 in the textbook. Most nursing centers receive Medicare or Medicaid funds. They must meet OBRA (Omnibus Budget and Reconciliation Act of 1987) requirements. Review the contents of Box 10-5 on p. 136 in the textbook. Many hospitals have long-term care units for persons who still need skilled care but not at the level once required.