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Geriatrics

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Chapter 40. Geriatrics. Concepts of Aging. Established concepts about the aging ... Geriatrics. Branch of medicine that deals with the elderly population ... – PowerPoint PPT presentation

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Title: Geriatrics


1
Chapter 40
  • Geriatrics

2
Concepts of Aging
  • Established concepts about the aging process have
    changed
  • Gerontologists
  • Specialists who study aging process
  • Geriatrics
  • Branch of medicine that deals with the elderly
    population

3
Reinforcing Medical Compliance in the Elderly
  • Establish good rapport with elderly clients to
    ensure compliance
  • Write instructions in easy-to-understand terms
  • Use large print
  • Have patient repeat instructions
  • Ask patient to perform a procedure
  • Give patient appointment calendar

4
Reinforcing Medical Compliance in the Elderly
(continued)
  • At every visit, take complete account of all
    medications
  • Prescribed
  • Over-the-counter
  • Herbal supplements or vitamins
  • Have patients bring all medications to office

5
Checkpoint Question 1
  • What are some reasons that a patient may not be
    compliant with a prescribed treatment plan?

6
Answer
  • Elderly patients may not comply with following
    treatment plans due to a memory loss from normal
    aging processes or because they are growing tired
    of the constraints imposed by illness on their
    lives. Some patients may have financial
    difficulties that force them to choose between
    medication and food on the table.

7
Reinforcing Mental Healthin the Elderly
  • Correlation between mental and physical health
  • Be aware of mental health status in patients with
    physical conditions

8
Reinforcing Mental Health in the Elderly
(continued)
  • Maintain open communication
  • Help patient express feelings of guilt or anger
  • Encourage positive self-image
  • Assist family in positive support system
  • Dont be discouraging or offer false hope
  • Direct to support groups

9
Checkpoint Question 2
  • How can you help promote good mental health in
    your elderly patients?

10
Answer
  • You can help your elderly patients maintain good
    mental health by encouraging open communication,
    helping them deal with their feelings, promoting
    a positive self-image, helping family members to
    be supportive, and suggesting support groups as
    needed.

11
Coping with Aging
  • Most elderly people are generally healthy and
    satisfied
  • But some feel overwhelming stress and grief
  • Stress
  • Compromises immune system
  • Raises blood pressure and blood sugar levels
  • Strains heart and lungs

12
Coping with Aging (continued)
  • Help patients cope with stress by
  • Listening to their fears
  • Respecting their right to have these feelings
  • Helping them reduce the stressors in their lives

13
Alcohol
  • Alcohol abuse may be mistaken for
  • Dementia
  • TIAs
  • CNS impairment
  • Medications may react badly with alcohol
  • Identifying these patients can be difficult
  • Refer to mental health professional or community
    resource

14
Suicide
  • With ill health, multiple losses, deep
    depression, suicide may seem preferable to life
  • Generally well planned and successful
  • Often involve white men over 65, who have
    recently lost a spouse

15
Suicide (continued)
  • Watch for
  • Deepening confusion
  • Increasing anger
  • Increase in alcoholism
  • Loss of interest in health
  • Secretive behavior
  • Sharp mood swings
  • Giving away favored objects
  • Take seriously those who express intent to commit
    suicide

16
Checkpoint Question 3
  • What are some signs of suicidal intent?

17
Answer
  • The signs of suicidal intent may include
    deepening confusion, increasing anger, increased
    alcohol or narcotic use, lack of interest in
    health, secretive behavior, sharp mood swings,
    and giving away personal possessions.

18
Long-Term Care
  • Three types
  • 1. Group homes or assisted living facilities
  • 2. Long-term care facilities
  • 3. Skilled nursing facilities

19
Checkpoint Question 4
  • How are long-term facilities and skill nursing
    facilities different?

20
Answer
  • Long-term care facilities are for individuals who
    need help with personal care and some medical
    supervision. Skilled nursing facilities are for
    gravely or terminally ill individuals who need
    constant supervision.

21
Elder Abuse
  • As prevalent as child abuse
  • Common risk factors
  • Multiple, chronic illnesses that stress familys
    resources
  • Senile dementia
  • Incontinence
  • Sleep disturbances
  • Dependence on caretaker for daily living

22
Elder Abuse (continued)
  • Several forms
  • Passive neglect
  • Active neglect
  • Psychological abuse
  • Financial abuse
  • Physical abuse
  • If you suspect abuse or neglect, bring to
    attention of physician

23
Signs of Abuse
  • Wounds of suspicious origin
  • Signs of restraints
  • Neglected pressure ulcers
  • Poor hygiene or nutrition
  • Dehydration
  • Untreated injuries or medical conditions
  • Excessive agitation or apathetic resignation

24
Checkpoint Question 5
  • What are the different types of elder abuse?

25
Answer
  • Elder abuse may take passive or active neglect or
    it can be psychological, financial, or physical.

26
Medications and the Elderly
  • Bodys systems slow down
  • GI system has decrease in peristalsis
  • Circulatory system does not absorb or deliver
    medications quickly
  • Liver does not biotransform as well
  • Kidneys dont filter as well

27
Medications and Elderly (continued)
  • Guidelines
  • 1. Explain side effects, precautions,
    interactions, expected actions
  • 2. Explain proper dosage and how to measure it.
  • 3. Write out schedule and suggest methods to help
    patient remember

28
Medications and Elderly (continued)
  • 4. Tell patient to take most important medication
    first
  • 5. Encourage patient not to rush
  • 6. Tell them to ask pharmacist for large print on
    label

29
Checkpoint Question 6
  • How can you help your elderly patients follow the
    medication regimen prescribed by the physician?

30
Answer
  • To help your elderly patient follow the
    prescribed medication regimen provide full
    explanation of the medication in a way that the
    patient understands explain the proper dosage
    and techniques for measuring

31
Answer (continued)
  • develop written schedule for taking medication
    instruct patient to take most important
    medication first tell patient not to rush when
    taking medication have patient ask pharmacist
    for large print on label explain appropriate use
    of medication and encourage patients to take an
    active role in their therapy.

32
Systemic Changes in the Elderly
  • Longevity is largely hereditary
  • When cells have reached a specific reproduction
    level, they either will not replace themselves or
    they will replicate more slowly or ineffectively

33
Diseases of the Elderly
  • Parkinsons disease
  • Alzheimers disease

34
Parkinsons Disease
  • Slow, progressive neurologic disorder that
    affects specific cells of the brain
  • Affects men more than women
  • Cause unknown

35
Parkinsons Disease (continued)
  • Signs and symptoms
  • Muscle rigidity
  • Bradykinesia
  • Difficulty walking
  • Forward bending posture
  • Laryngeal rigidity
  • Pharyngeal rigidity
  • Facial muscle rigidity
  • Small tremors in fingers

36
Parkinsons Disease (continued)
  • Parkinsons has no cure
  • Treatment is symptomatic, supportive, and
    palliative
  • Medications
  • Deep brain stimulation

37
Parkinsons Disease (continued)
  • Patients retain cognitive functions
  • They require psychological support
  • Encourage participation in all activities of
    daily living
  • Promote independence
  • Suggest increased fluid intake and balanced diet

38
Parkinsons Disease (continued)
  • Encourage patient to use eating aids, raised
    toilet seats, handrails
  • Listen to patient
  • Educate patient about safety factors
  • Enlist help of support groups

39
Checkpoint Question 7
  • How can you assist a patient with Parkinsons
    disease?

40
Answer
  • To assist a patient with Parkinsons disease,
    encourage activity and independence, promote good
    nutrition and hydration, caution the patient
    about the potential for choking, educate the
    patient about safety, use therapeutic
    communication skills, and enlist the help of
    support groups for the patient and their
    caregivers.

41
Alzheimers Disease
  • Roughly half the cases of dementia can be traced
    to Alzheimers disease
  • Symptoms may be similar to
  • TIAs
  • Cerebral tumors
  • Dementias
  • Symptoms may begin as early as age 40

42
Alzheimers Disease (continued)
  • When caring for Alzheimers patients
  • Remember that anger and hostility are symptoms of
    the disease
  • Respond with patience and compassion
  • Speak calmly and without condescension

43
Alzheimers Disease (continued)
  • Never argue with patient
  • Reintroduce yourself at each visit
  • Explain common procedures
  • Approach quietly and professionally
  • Speak in short, simple sentences
  • Keep list of support contacts for family members

44
Maintaining Optimum Health
  • It is possible to maintain a good level of health
    after age 70
  • Exercise with physicians approval
  • Good nutrition

45
Exercise
  • Guidelines for starting an exercise program
  • 1. Always warm up cold muscles for at least 10
    minutes
  • 2. Begin by exercising for brief time periods
  • 3. Stop if you feel pain, shortness of breath, or
    dizziness

46
Exercise (continued)
  • 4. Breathe deeply and evenly
  • 5. Rest when tired
  • 6. Keep record of progress
  • 7. Exercise with a friend, group, or to music
  • 8. Make exercise part of daily routine

47
Diet
  • Elderly patients often have difficulty
    maintaining good nutrition
  • Smaller, more frequent meals may be easier to
    digest
  • Water should be encouraged to maintain hydration
  • Consider a service such as Meals on Wheels

48
Safety
  • Alert patient and caregivers to hazards in the
    home
  • Remove scatter rugs
  • Never allow electrical cords to cross passageways
  • Remove or reduce clutter
  • Strengthen handrails

49
Safety (continued)
  • Install telephone by bedside and favorite chair
  • Install and maintain smoke alarms and carbon
    monoxide detectors
  • Establish system to call and check on patient
    every day
  • Use community programs
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