1. Care of the Older Person
Chapter 11
Care of the Older Person
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. The Older Person Gerontology-is the study of the aging process.
Geriatrics-is the care of aging people.
Aging is normal.
Normal changes occur in body structure and function.
Psychological and social changes also occur-we will review these today
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 11-1 on p. 136 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

3. Psychological-Social Changes
Physical reminders of growing old can threaten self-esteem and independence.
Social roles change-some are now being cared for by their children
How people cope with aging depends on:
Health status
Life experiences
Finances
Education
Social support systems
Physical reminders of growing old 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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

4. The Older Person People live longer than ever before.
Retirement is the reward for a life time of working.
Not all people are lucky enough to have the money or health to enjoy it.
Chronic illness is common in older persons.
Disability often results
Many have at least one disability
Older people are healthier and more active than ever before.
Late adulthood ranges from 65 years of age and older. The oldest-old are 85 years of age and older.
Disabilities increase and become more severe with aging.
Disabilities can interfere with many activities of daily living and leisure and recreational activities.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

5. Housing Options-only 5% of the 65+ elderly live in nursing homes!
Live with family
Adult day-care centers during the day
Nursing centers
Assisted living residences
Continuing care retirement communities (CCRCs)-have all levels
Board and care homes
Congregate housing
Senior citizen housing
Most older people live in their own homes.
Many function without help. Others need help from family, home care, or community-based services for activities of daily living.
Review the contents of Box 11-3 on p. 142 in the Textbook.
Many housing options meet the needs of older people. 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. 142 in the Textbook.
Living with an adult child is a social change. Everyone in the home must adjust.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

6. Physical Changes Physical changes occur with aging.
These happen to everyone.
The rate and degree of change vary with each person.
They depend on diet, health, exercise, stress, environment, heredity, and other factors.
Quality of life does not have to decline.
Body processes slow down. Energy level and body efficiency decline.
Changes are slow over many years. Often they are not seen for a long time.
Normal aging does not mean loss of health.
Review the contents of Box 11-2 on pp in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

7. Getting Older Is Hard Work!
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

8. Integumentary System
The skin loses its elasticity, strength, and fatty tissue layer.
Secretions from oil and sweat glands decrease- don’t need baths as often
Blood vessels are fragile-bruise easily
Brown spots appear on sun-exposed areas.
Loss of the skin’s fatty tissue layer affects body temperature-tend to be cold
Dry skin causes itching and skin is easily damaged-use mild soap and apply lotion
Fragile blood vessels increase the risk for:
Skin breakdown
Skin tears
Pressure ulcers
Bruising
Delayed healing
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 and creams prevent drying and itching.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

9. Skin Changes
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10. Integumentary System Nails become thick and tough.
Feet usually have poor circulation.
The skin has fewer nerve endings-less able to feel pain
White or gray hair is common.
Hair loss occurs in men.
Hair thins on men and women.
Facial hair may occur in women.
Hair is drier from decreases in scalp oils.
Skin disorders increase with age.
A nick or cut can lead to a serious infection.
Burns are great risks. Do not use hot water bottles and heating pads.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

11. Skin changes
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

12. Musculo-skeletal system
Muscle cells decrease in number.
Muscles atrophy (shrink) and decrease in strength.
Bones lose minerals, especially calcium.
Bones lose strength, become brittle, and break easily.
Vertebrae shorten.
Joints become stiff and painful.
Mobility decreases.
Activity, exercise, and diet help prevent bone loss and loss of muscle strength.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

13. Musculo-skeletal system
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14. Nervous System Nerve cells are lost.
Nerve conduction and reflexes slow.
Blood flow to the brain is reduced.
Changes occur in brain cells.
Sleep patterns change.
Touch and sensitivity to pain and pressure are reduced.
Taste and smell dull.
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.
Brain cell 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 skin tears and pressure ulcers.
Older people often complain that food has no taste or tastes bitter. They like more salt and sugar on food.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

15. Eye Changes Blue and green colors are hard to see
Eyelids thin and wrinkle.
Tear secretion is less.
Blue and Green colors are difficult to see
The pupil becomes smaller and responds less to light.
Clear vision is reduced.
The lens of the eye yellows.
Older persons become more farsighted- unable to see close items
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. Nightlights 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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

16. Eye changes
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17. Ear changes Changes occur in the acoustic nerve.
Eardrums atrophy-high pitched sounds are hard to hear
Wax secretion decreases.
Wax becomes harder and thicker.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

18. Circulatory System The heart muscle weakens.
Arteries narrow and are less elastic.
Sometimes circulatory changes are severe.
Rest is needed during the day.
Overexertion is avoided.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

19. Respiratory System Respiratory muscles weaken.
Lung tissue becomes less elastic.
The person may lack strength to cough and clear the airway of secretions.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

20. Digestive System
Salivary glands produce less saliva. Dysphagia (difficulty swallowing) is a risk.
Taste and smell dull.
Secretion of digestive juices decreases.
Loss of teeth and ill-fitting dentures cause chewing problems.
Peristalsis decreases.
Fewer calories are needed.
Oral hygiene and denture care improve taste.
Flatulence and constipation can occur.
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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

21. Urinary System Kidney function decreases. The kidneys atrophy.
Blood flow to the kidneys is reduced.
The ureters, bladder, and urethra lose tone and elasticity.
Bladder muscles weaken-incontinence occurs
Bladder size decreases.
In men, the prostate gland enlarges.
Urinary tract infections are risks.
Waste removal is less efficient.
Urinary frequency or urgency may occur.
Many older persons have to urinate (void) during the night.
Urinary incontinence (the loss of bladder control) 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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

22. Men Reproductive System
In men, the hormone testosterone decreases slightly.
It affects strength, sperm production, and reproductive tissues.
An erection takes longer.
The phase between erection and orgasm is longer.
Orgasm is less forceful than when younger.
Erections are lost quickly.
The time between erections is longer.
Older men may need the penis stimulated for arousal.
Fatigue, overeating, and drinking too much alcohol affect erections.
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23. Women Reproduction Menopause occurs in women. Menstruation stops.
The woman can no longer have children.
Female hormones (estrogen and progesterone) decrease.
The uterus, vagina, and genitalia atrophy.
Vaginal walls thin and there is vaginal dryness.
Arousal takes longer.
Orgasm is less intense.
The pre-excitement state returns more quickly.
Menopause occurs between 45 and 55 years of age.
Thinning of vaginal walls and vaginal dryness may make intercourse uncomfortable or painful.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

24. What is it like to get old?
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.