Care of elderly (gerontology) by Dr Shazia Iqbal

1. Geriatric Care
Dr Shazia Iqbal FCPS, M.Sc Medical Education (UK)
Assistant Professor (Obstetrics & Gynaecology)
Head of Medical Education Unit
Curriculum and Faculty Developer
Faculty of Medicine
AlFarabi College of Medicine, Riyadh

2. 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

3. • Older people are lonely and unhappy
• Elderly do not want to work
• “Old Age” begins a 65
• Retirement ends your active life

4. 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.

5. • 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

6. Integumentary System
Changes
• Production of new skin cells decreases
• Oil and Sweat glands become less active
• Circulation decreases

7. • 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)

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

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

10. • 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

11. • Because of the need for oxygen and nutrients
the elderly may experience:
– Weakness
– Dizziness
– Numbness in hands & feet
– Rapid heart beat

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

13. • Prevent the formation of a blood clot (thrombus)
– Support stockings, anti-embolism hose
– DO NOT wear garters or tight bands around legs
– If confined to bed
• ROM

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

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

16. • 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

17. • 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

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

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

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

21. • 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

22. • 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

23. • 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

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

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

26. • Dysphagia is frequent complaint
– Less saliva
– Slower gag reflex
– Loss of teeth
– Poor fitting dentures
• Slower digestion of food
– indigestion

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

28. Digestive Care
• Good oral hygiene
• Repair or replace damaged teeth
• Relaxed eating atmosphere
• High-fiber high-protein foods with
different tastes and textures
• Seasoning to improve taste
• Increased fluid intake

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

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

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

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

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

34. – 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

35. • 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

36. Reproductive Care
• Understand physical and psychological sexual
needs of the elderly
– Allow married couples to be in the same room
– Give privacy to consenting elderly

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

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

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

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

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

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

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

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

45. • Acute dementia
– When the symptoms are caused by temporary
reason:
• High fever, dehydration, hypoxia
• Chronic dementia
– When symptoms are caused by permanent,
irreversible damage to brain cells

46. Alzheimer’s Disease
• Form of dementia that causes progressive
changes in brain cells

47. Early Stages:
• Memory loss
• Mood & personality changes
• Depression
• Poor judgment
• Confusion regarding time & place
• Inability to plan and follow through
with ADLs

48. Middle Stages:
• Nigh time restlessness
• Mood swings increase
• Personal hygiene ignored
• Weight fluctuates
• Paranoia & hallucinations
• Full time supervision needed

49. Late Stages:
• Total disorientation
• Incoherent
• Unable to communicate with words
• Loses control of bladder & bowel functions

50. • Develops seizures
• Loses weight despite eating a balanced diet
• Becomes totally dependent
• Lapses into a coma
• Dies

51. • Certain aspects of care should be followed
with any confused or disorientated
individual. Provide a/an safe and secure
environment, follow the same routine, keep
activities simple and last for short periods
of time.

52. Avoid loud noises, crowded rooms, and excessive
commotion. Promote awareness of person,
time, and place by providing reality orientation
(RO)

53. Reality Orientation:
• Address person by name preferred
• Avoid: sweetie, baby, honey
• State your name, correct elderly if calls you by the
wrong name
• Make reference to day, time, place
• Use clocks, calendars, bulletin bd.

54. • Keep individual oriented to day night cycles:
– Regular clothes during the day
– Open curtains during the day]
– Close curtains at night
– Pajamas at night

55. • Speak slowly, clearly / ask clear & simple
questions
• Never rush or hurry the individual
• Repeat instructions patiently, allow time for ind.
to reaspond
• Encourage conversations about familiar things or
current events

56. • Encourage use of tv, radio without
overstimulating them
• Be sure ind. uses sensory aids
• Keep familiar objects in view Avoid moving
furniture & belongings
• Do not agree with incorrect statements

57. • Do not hesitate to touch communicate with
person
• Avoid arguments
• Encourage independence and self help
whenever possible

58. Meeting the Elderly Needs
• Culture:the values, beliefs, ideas, customs, and
characteristics that are passed from one
generation to the next.

59. • Areas affected by an individual’s culture:
– Language
– Food habits
– Dress
– Work
– Leisure activities
– Health care

60. • The spiritual beliefs and practices of an
individual is called their religion. It is
important to accept an individual’s belief
without bias, and that health care workers not
force their own religious beliefs on the ind.
being cared for.

61. • Respect and Consideratin of a persons religious
beliefs
– Proper treatment of religious articles
– Allow person to practice religion
– Honor request for special food
– Provide privacy during clergy visits

62. • Abuse
– Physical
– Verbal
– Psychological
– Sexual

63. • Report any abuse observed to proper
agency
• Reasons elderly do not report abuse
– Feel they deserve the abuse
– Want to protect abuser

64. • Ombudsman is a specially trained individual
who works with the elderly and their
families, health care providers, and other
concerned individual. To improve quality of
care and quality of life.