Chapter 41 Assisting in Geriatrics PDF

Preview

Summary

Geriatrics...

Description

Chapter 41: Assisting in Geriatrics

Our Aging Population     



Fastest-growing segment of U.S. population are those age 85 and older Most older people have at least one chronic medical condition Increased need for health services for older people By 2030, almost 1 of every 5 Americans (about 72 million people) will be 65 or older. To provide better services to the aging patient, the medical assistant must understand the aging process, which includes the physical and sensory changes with which older people must cope. Old age is not an illness but a normal life process that people experience in different ways.

Stereotypes and Myths about Aging         

Most aging people will develop dementia Disease is a normal and an unavoidable part of the aging process Older workers are less productive than younger ones Most older people end up in long-term care facilities Most aging people have no interest in or capacity for sexual relations Damage to health because of lifestyle factors is irreversible A healthy lifestyle is very effective in preserving one’s health into older age. 50% of those over age 85 are diagnosed with dementia issues. Procedure 41-1 describes role-playing an older adult to better understand the sensorimotor changes of aging.

System Changes with Age 





Normal age-related changes are expected, and the individual can compensate for them o These changes do intensify with poor health habits and chronic disease Age-related changes can be managed through regular exercise, a healthy diet, prevention of sun damage, and annual physical examinations with health screening Refer students to Table 41-1, which summarizes the changes associated with aging that occur across all body systems.

Cardiovascular System  

Cardiovascular disease is the most frequent cause of illness and disability in the aging population Effects of aging on cardiovascular system: o Myocardial cells enlarge, deposits of fat and connective tissue increase, cardiac output declines o Hypertension increases workload of the left ventricle o Walls of veins weaken and stretch





o Arteriosclerosis Edema and varicose veins of the lower extremities are common in the elderly, increasing the risk of phlebitis and the formation of thrombi in the deep veins or deep vein thrombosis (DVT). Why do older adults have a higher incidence of orthostatic hypotension? (To maintain an adequate blood supply throughout the body, the heart must work harder to overcome the resistance caused by stiffened vessels. Such a decrease typically is caused by a drop in the volume of circulating blood, and it can be an important diagnostic sign in aging patients.)

Normal Changes in Cardiac Output with Age  

Table 41-2 shows normal changes in cardiac output with age. Discuss how age is associated with the blood pumped by the resting heart and the maximum heartbeat during exercise.

Aging Effects on Endocrine System   







General decrease in hormone production Changes in tissue receptor binding Diabetes mellitus (DM) type 2 is the most common endocrine disorder Discuss some of the diseases elderly patients with diabetes are at increased risk of developing. (Vascular disease, including renal disorders, retinopathy, neuropathy, myocardial ischemia, angina, myocardial infarction, cerebrovascular accidents, and peripheral vascular disease, such as lower extremity ulcers) The treatment protocol for aging patients with diabetes is the same as for other age groups; however, special consideration must be given to the patient’s ability to understand and comply with the therapeutic plan. Be aware of any sensory abnormalities, such as diminished vision or problems with fine motor skills, which may interfere with the patient’s ability to follow treatment guidelines.

Factors that Can Affect Diabetes Management in Older People 

Modifying lifestyle risk factors may be more difficult



    

Previously diagnosed health conditions such as hypertension and heart disease, in addition to an age-related decline in kidney and liver function, increase the challenge of treating diabetes More likely to be prescribed with multiple medications Elderly patients with diabetes are more prone to hypoglycemia and may not recognize and respond quickly to low blood glucose levels. Diabetic complications can develop quickly because of a long history of prediabetes before diagnosis. Older people may have decreased physical and/or mental abilities that make it difficult for them to adhere to a complicated treatment regimen. Older patients may not be able to afford the medications and supplies needed to maintain health.

Aging Effects on Gastrointestinal System       

Dentals problems, a decrease in taste buds and production of saliva, and a diminishing sense of smell Reduced appetite, dysphagia Reduced digestibility of calcium and iron, decrease in vitamin B absorption Poorer absorption of vitamins and minerals in the small intestine Decreased colon peristalsis; constipation and diverticular disease Reduced liver function Aging individuals have a higher incidence of several gastrointestinal system diseases, such as gastroesophageal reflux disease (GERD), peptic ulcers, diverticulosis (related to lack of dietary fiber and constipation), cholelithiasis, and colorectal cancer.

Aging Effects on Integumentary System       

Wrinkles, age spots, blotches, and leathery, dry, loose skin Skin becomes more prone to tearing and blistering Risk of infections increases, healing process slows, and more susceptible to bruising Vitamin D synthesis significantly declines A decrease in the number of melanocytes increases photosensitivity. The dermis loses 20% of its mass during the aging process, resulting in the paper-thin or transparent skin seen in older adults. Ask the person if he or she is too cold or too hot and take the necessary steps to make the patient feel more comfortable.

Treating Dry Skin in Older People      

Use a room humidifier Bathe less frequently in warm, not hot, water Use mild soap Wear protective clothing in cold weather Apply moisturizers after getting out of the bathtub What happens to the pain threshold as one ages? (Because of age-related changes in the receptors, older people have a higher pain threshold. They



may not notice a cut or burn as quickly as a younger person would, so a more serious burn may occur before it is noticed. In addition, wound healing becomes a problem because of decreased blood flow to dermal tissues.) It is not unusual for nails to split, making them more susceptible to fungal infections.

Seborrheic Keratoses 

Seborrheic keratoses, as shown in Figure 41-1, usually referred to as “age spots,” are one of the most common benign skin disorders found in the aging population.

Shingles Risk Reduction 







After an active chickenpox infection, the virus lies dormant in a nerve dermatome As people age, their risk increases that the virus will reactivate and cause shingles Zostavax, a live virus vaccine, boosts immunity against the varicella-zoster virus Studies have shown that the vaccine reduces the number of shingles cases by about 51% in all individuals over age 60, but it is most effective in those aged 60 to 69.

Aging Effects on Musculoskeletal System    

Cartilage loss and degeneration, joint range of motion decreases Breakdown in the joint and intervertebral spaces Decrease in strength and speed of muscle contractions, related to activity level How does exercise affect muscular changes due to aging? (Muscular changes in the aging patient are directly related to the individual’s activity level. Research shows that musculoskeletal disease is not an inevitable result of the aging process; however, 40% to 50% of women over age 50 have a serious problem with bone demineralization.)

Suggestions for Helping the Older Adult with Mobility, Dexterity, and Balance      

Use assistive devices Assist with gripping devices as needed Slow down time for task completion Support stroke victims on weak side Recommend physical therapy for rangeof-motion exercises Encourage activity



What are some examples of assistive devices? (Adaptive silverware, tub seat or shower chair, electric razor, and reaching devices)

Osteoporosis  

 

Primary cause of hip fractures, can cause spinal vertebrae to collapse Risk factors include female gender, small-boned frame, family history, estrogen deficiency before age 45, racial background (Caucasian and Asian), aging, extended use of certain drugs, sedentary lifestyle, smoking, excessive alcohol intake, lack of calcium and vitamin D Weight-bearing exercises, calcium and vitamin D supplements; may also require medication Sometimes bones break because of the sheer weight of the body on them.

Aging and Falls    

Greater risk of falling due to sensorimotor changes in vision and mobility, osteoporosis, and cerebrovascular accidents Usually result in fractures because a large percentage of the elderly have osteoporosis Debilitating complications like decubitus ulcers, pneumonia, the need for long-term care, and even death Falls cause the greatest number of injuries in people over age 70.

Preventing Falls           

Have regular hearing and vision tests Understand side effects of medications, especially those that cause vertigo If you experience orthostatic hypotension, rise slowly and stand still for a moment Limit the use of alcohol If needed, consistently use assistive devices, such as a cane or walker Wear low-heeled, rubber-soled shoes; avoid going outside in icy weather Engage in regular weight-bearing exercise for muscle and bone strength Keep hallways, stairs, and bathrooms well lit Assess home for possible danger areas You can play an active role in helping family members and patients with fall prevention. Recommend that patients remove throw rugs, use handrails on steps and grab bars in bathrooms, keep emergency numbers handy.

Aging Effects on Nervous Systems     

Brain begins to get smaller at approximately age 50 and continues to do so Transmitting messages from one neuron to the next becomes more difficult Older neurons process information more slowly Reaction time also slows Dementia is not an inevitable part of aging but the result of an organic disorder

 

Recent research shows that the loss of brain cells is minimal and that the older brain is still capable of generating new neurons. Many conditions can cause signs and symptoms of dementia, including depression; reactions to prescription and over-the-counter drugs; alcoholism; malnutrition; thyroid, liver, heart, and vascular disorders; and Parkinson’s disease.

Maintaining Mental Function         

Exercise improves memory and thinking because it increases oxygen to the brain Keep socially active Practice stress-reduction activities Quit smoking Drink alcohol in moderation Use hearing aids and glasses if needed Treat health issues The best way to ensure mental functioning in later life is to remain mentally and physically stimulated. What are some risk factors for cognitive decline? (Hypertension, diabetes, heart disease, high stress levels, sedentary lifestyle, low education level, smoking, and substance abuse)

Screening Tool for Dementia 

 

Mini-Mental State Examination o A 5-minute test designed to evaluate basic mental function in a number of different areas o It assesses the patient’s ability to recall facts, write, and calculate numbers o It gives the physician a quick way to determine whether more in-depth testing is needed Refer students to Figure 41-2 for an example of this test. The medical assistant may be expected to administer this examination.

Alzheimer’s Disease (AD)    

Progressive deterioration of the brain caused by the destruction of central nervous system (CNS) neurons Leads to problems with memory, language, thinking, and behavior Caused by buildup of amyloid plaques and neurofibrillary tangles in the brain Alzheimer’s disease (AD) has no definitive diagnostic test because it can be confirmed only through examination of the brain at autopsy.

Signs and Symptoms of AD   

Repeatedly asking the same questions Inability to remember common words or mixing up words when describing something Inability to complete simple tasks and misplacing items

   



Becoming lost when driving familiar routes Sudden mood swings for no apparent reason Difficulty following simple directions The course the disease takes and how fast changes occur vary among individuals, but on average, patients live for 8 to 10 years after they are diagnosed. Currently, no treatment can stop the progression of the disease.

Treatment Options for AD    

  

Goal of treatment is to maintain normal activities as long as possible Cholinesterase inhibitors may be prescribed to improve the production of neurotransmitters in the brain Medications may be prescribed to help control sleeplessness, agitation, wandering, anxiety, and depression Supportive care for family members is absolutely essential because they are faced with caring for a loved one who is experiencing progressive memory loss. You can be especially helpful in recommending educational workshops, support groups, and stress management skills for caregivers. Refer to Table 41-3 for medications approved for the treatment of Alzheimer’s disease. How many stages of AD are there? (Three – Stage 1 [mild AD] covers the 2 to 4 years leading up to the diagnosis and includes the mood or personality changes, withdrawing from others, and losing things; stage 2 [moderate AD] covers the 2 to 10 years after diagnosis and includes the patient making constant, repetitive statements and increased memory loss and confusion; stage 3 [severe AD] lasts 1 to 3 years and includes the patient not recognizing family and the inability to care for one’s self)

Aging Effects on Pulmonary System      

 

Maximum lung function decreases with age Lungs lose elasticity because of changes in elastin and collagen; become smaller and flabbier Alveoli enlarge, walls become thinner, number of capillaries is reduced Respiratory muscles weaken and chest wall may stiffen Larynx also changes; voice gets quieter and slightly hoarse What causes the chest wall to stiffen? (The chest wall may stiffen from osteoporosis of the ribs and vertebrae and calcification of the costal cartilage.) Pulmonary function tests reveal a decrease in vital capacity and an increase in residual volume. The incidence of sleep apnea and sleep disorders increases, causing a potential problem with nocturnal hypoxemia.

Aging Effects on Vision

          



By age 50, structural and functional changes in the eye become noticeable Cornea increases in thickness and has reduced refractive power Lens becomes flatter, thicker, less elastic, and more opaque Reduction in size of pupil occurs, limiting amount of light available to reach retina Decreased tear production causes irritation and excessive tearing The skin around the eyelids wrinkles, and the loss of orbital fat allows the eye to sink deeper into the orbit. Presbyopia develops in the 40s, making it hard to see up close Ability to refocus from far to near decreases Decreased ability to see some colors, affecting depth perception Increased sensitivity to glare and decreased response to going from light to dark or dark to light What causes the ability to see colors to change as one ages? (The yellowing of the lens causes it to act like a filter, making it difficult to distinguish certain color intensities. Blues, greens, and violets are hard to differentiate, whereas yellows, reds, and oranges are easier to identify.) Glare is probably one of the most painful experiences for the aging eye.

Cataracts, Glaucoma, and Macular Degeneration    

 

Cataracts are cloudy or opaque areas in the lens that cause blurring of vision Glaucoma is a result of blockage of outflow of aqueous humor, which causes an increase in intraocular pressure and damage to the optic nerve Macular degeneration causes progressive loss of the central field of vision How are cataracts treated? (Surgical lens extraction and implantation with an artificial lens improves vision in 95% of the cases. The procedure is performed in an outpatient facility using a small incision to remove the lens, laser therapy, or phacoemulsification [ultrasonic vibrations], which breaks up the lens and removes it without the need for an incision.) If not treated, glaucoma can cause progressive loss of peripheral vision and ultimately lead to blindness; however, it can be treated with medication. Macular degeneration is the leading cause of blindness in aging people, and at this time there is no effective treatment or cure.

Suggestions for Helping the Visually Impaired Older Adult       

Allow patient to place hand above your elbow to follow your movements and feel secure Use high levels of even, glare-free light Ask pharmacist to use large lettering on medicine bottles Use nonglare paper and large print for forms and educational materials Make distinct differences for pills that are similar in size and color Place all objects within visual field and prevent clutter Discuss these helpful suggestions in how to best aid a visually impaired older adult.

Aging Effects on Hearing



   



Lack of attention when addressed, inappropriate responses, asking to have statements repeated, and speaking too loudly or too softly often are signs of hearing loss Can have a profound psychological effect on aging people, causing depression, social withdrawal, and feelings of isolation Presbycusis is associated with normal aging and causes a decreased ability to hear high frequencies and to discriminate sounds Tinnitus is a ringing or buzzing in the ear Hearing impairment is compounded by impacted cerumen, otitis media, otosclerosis, Ménière’s disease, long-term exposure to intense noise, and certain ototoxic drugs, such as aspirin. Hearing loss, with its resultant isolation, is directly related to the development of depression in older adults.

Geriatric Depression Scale    

Screening tool for depression Includes questions for the patient about daily activities, interests, and feelings to help diagnose depression in the ambulatory setting Refer students to Figure 41-3 for the short form of the Geriatric Depression Scale. The medical assistant may be able to contribute to information about depression in elderly patients through conversations with the individual and family members.

Suggestions for Helping the Hearing-Impaired Older Adult        

Stand in patient’s direct line of vision and gently touch person to get his or her attention Use gestures; pictures; and large, bold print to communicate Talk in short sentences into the ear with better hearing Do not increase the volume of your speech; this also raises the frequency of the voice, which is the hearing most impaired in aging people Avoid background noise Use expanded speech; lower the tone of your voice and talk in distinct syllables. Give instructions in a quiet room with the door closed. If the patient has a hearing aid, make sure it is on.

Aging Effects on Taste and Smell     

Abilities to taste and s...