ENSURING QUALITY CARE NORMAL AGING IMPLICATIONS FOR CARE September - - PowerPoint PPT Presentation

ENSURING QUALITY CARE

NORMAL AGING IMPLICATIONS FOR CARE

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PURPOSE AND KEY TERMS

The purpose of this section is to help the learner understand the physical changes that occur during the aging process. This section will inform the AFH provider how to accommodate those changes when providing care for the resident.

• Long-Term memory
• Memory loss
• Hearing loss
• Visual acuity
• Bladder capacity
• Incontinence

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OBJECTIVES

The learner will be able to:

Identify 11 physical functions that change during the aging process Define the changes of the physical functions and how that affects the resident Describe how changes in physical function will affect how the AFH provider will support the residents; changing physical needs

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BRAIN, INTELLIGENCE, LEARNING AND MEMORY

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CHANGES

The aging brain takes longer to search for and retrieve information. Intellectual capacity, judgement, comprehension, accuracy, retention of well-learned material does not usually change with age. Creativity and the ability to solve problems increases with age.

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CONSEQUENCES

Learning is more difficult

• Under stress
• If the task is complex; or
• Requires a quick response

Memory

• Long –term memory usually remains intact
• Recently learned material is harder to recall

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CONSEQUENCES CONTINUED

Older persons

• May take longer to make decisions or respond to questions
• May avoid risk or mistakes by relying on past solutions; and
• Learn something new, they perform as accurately as younger persons

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IMPORTANT NOTE

Forgetfulness is not the same as memory loss. The rate of forgetfulness is about the same among younger as older people:

• Forgetfulness is a temporary problem in remembering a persons name - a

phone number, keys or glasses, and other recently learned information; these items are usually remembered later and the person is aware of what is forgotten

• Most people learn to cope with forgetfulness and use “tricks” such as a note

pad to help them remember

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IMPORTANT NOTE CONTINUED

Memory loss is the inability to recall events such as a family wedding, recognize familiar people and places. Memory loss is not a normal part of aging. It is most often associated with diseases such as Alzheimer’s disease or other types of dementia. It can also be caused by other illnesses, reactions to medications, untreated infections, allergies, depression or extreme stress.

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IMPLICATIONS FOR CARE

Reduce stress of learning situations (e.g., adjusting to new routine, filling out forms):

• Keep the atmosphere calm and the pace relaxed
• Present information both verbally and visually to reinforce the message

Provide opportunities to use their minds, learning interesting things and feel useful

• Memory improves with practice

Notify physician of any sudden changes in memory

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TASTE AND SMELL

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CHANGES

Decline in sense of taste. Fewer taste buds on tongue; sensation of bitter and sour remain intact. Decline in sense of smell.

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CONSEQUENCES

Food may taste “funny” or not taste “right”:

• May stop eating because food has no flavor
• Many use excess sugar, salt or other seasons on food in an attempt to get

flavor

More vulnerable to malnutrition. May not smell smoke, bathroom or body odors.

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IMPLICATIONS FOR CARE

Consider adding herbs, spices and salt substitutes to enhance food flavor. Offer foods the resident enjoys. Offer a variety of different foods.

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MOUTH, TEETH AND DIGESTION

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CHANGES

Decrease in production of saliva, enzymes and acids Stomach digests food more slowly Intestines move stool more slowly Tissues of the mouth are dryer Gums shrink

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CONSEQUENCES

Some foods are harder to digest. Stomach discomfort and gas after eating may be more common. Medications are absorbed more slowly. Dental or denture problems make eating more difficult.

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IMPLICATIONS FOR CARE

Avoid serving foods that are difficult to digest or chew. To prevent constipation, offer a well-balanced diet, with plenty of fresh vegetables and fruit. Include whole grain cereals and breads. Encourage fluid intake and exercise. Encourage daily brushing and flossing, rinsing mouth and regular visits to the dentist.

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HEARING

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CHANGES

Speech may be distorted

• High-pitched consonants such as S, Z, T, F and G are difficult to understand

Sounds may be muffled

• Due to wax build-up
• Other obstruction that keeps sound waves from reaching the inner ear

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CONSEQUENCES

Difficulty understanding speech. Difficulty hearing if speaker cannot be seen or with background noise. Difficulty communicating with others, especially in group situations. Hearing loss can lead to isolation, anxiety, depression and suspicion of

• thers
• May seem confused, embarrassed, nervous or frustrated.

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IMPLICATIONS FOR CARE

Speak clearly and distinctly in the person’s good ear

• Speak in a low tone of voice
• Do not shout

Face the person

• Do not exaggerate lip movements - be sure he or she can see your lips
• Remove food, gum, etc. from your mouth

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IMPLICATIONS FOR CARE CONTINUED

Do not place your hand in front of your mouth. If possible place yourself at same height. Use facial expressions, gestures, touch and objects to help clarify what you are saying. Encourage use of hearing aids. Reduce background noise. Turn off TV and radios.

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IMPLICATIONS FOR CARE CONTINUED

Write and speak important things. For the resident to better enjoy music, increase the bass tones. Stand so the light shines above or toward you rather than behind you. Be sure the resident understands what you say:

• If they don’t understand, choose different words to say the same thing.

Allow plenty of time for the resident to respond.

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IMPORTANT NOTE

People need sensory stimulation to stay healthy. Hearing loss can be the most serious of the sensory impairments:

• Approximately 30-50 percent of all older people suffer a significant loss that

effects their communication and relationship with others.

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VISION

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CHANGES

Decreased visual acuity – Ability to see clearly. Changes in color perception. Corneal lens may become cloudy. Increased sensitivity to glare; decreased adaptability to light. Visual field becomes smaller. Eye problems such as cataracts, glaucoma and macular degeneration are common.

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CONSEQUENCES

Increased difficulty with reading, watching TV, or doing handwork or hobbies. It is more difficult to judge distance. Shiny objects such as eyeglasses or clear drinking glassed may be more difficult to see, especially against polished furniture or near a lamp or window.

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CONSEQUENCES

Less able to distinguish one color from another. May be more difficult to choose the right color of clothing to wear together. Less able to adjust to changes in light. Need three times the light of a younger person. May need to turn head to see to the side. Mobility, orientation and safety may be negatively affected due to vision loss.

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IMPLICATIONS FOR CARE

Modify lighting to promote safety and comfort for example, night lights. Tell residents before you move furniture. Avoid clutter. Reduce glare caused by the sun, lighting and reflective light from mirrors and highly polished floors. Make large print/talking books available.

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IMPLICATIONS FOR CARE CONTINUED

Use large print written material. Increase light for reading and doing handwork. Use contrasting colors between:

• Doorways and walls
• Dishes and tablecloths
• The risers and the flat surface of steps

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IMPLICATIONS FOR CARE CONTINUED

Identify yourself and tell them what you are doing or planning to do. Offer the person your arm when walking so the resident feels more independent and secure. Encourage annual eye exams, use of glasses and keep glasses clean.

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NERVOUS SYSTEM AND IMMUNE SYSTEMS

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CHANGES

Nerves react more slowly to stimulation. Sleep patterns change. Decreased ability to fight infections. Reduced sensitivity to pain and extreme hot and cold.

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CONSEQUENCES

Difficulties with activities requiring fine hand movements. Decreased coordination makes activities of daily living (ADL’s) more difficult. May be more prone to illness and slower to recover. Slower reflexes and reaction time. Decreased sense of balance. Less deep sleep, and less dream sleep.

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IMPLICATIONS FOR CARE

Watch for cuts, scratches, bruises and rashes. Watch for signs that something is wrong - fever, decreased appetite, listlessness, poor color, change in sleep patterns and mood. Accommodate individual sleeping patterns whenever possible. Offer rest times.

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SKIN, HAIR AND NAILS

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CHANGES

Circulation to skin is decreased. Skin is drier, thinner, less elastic, more fragile and there is less fatty tissue beneath the skin. Number of oil glands is reduced. Changes in pigmentation (color). Fewer pigmentation cells function. Hair changes color and can become sparse. Finger/toe nails thicken and become brittle. Sweating decreases.

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IMPLICATIONS FOR CARE

Encourage use of lanolin-based lotions or creams. Discourage the use of deodorant soaps and alcohol-based personal care products. Keep skin dry. After bath pat skin dry. Encourage or assist residents to shift positions frequently (every 2 hours).

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IMPLICATIONS FOR CARE CONTINUED

Encourage daily exercise to improve circulation. Watch closely for signs of skin breakdown. Consult with a doctor/nurse immediately if there is any redness or swelling. Encourage use of special shampoos/conditioners to reduce scalp dryness. Consult a physician or podiatrist before cutting nails.

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HEART AND LUNGS

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CHANGES

Heart rate tends to be slower and adjusts more slowly to changes. Irregular heart beat is common. Blood flow decreases and less oxygen is delivered to all body parts. Lungs and chest wall become less elastic, reducing all air flow. Breathing capacity decreases.

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CONSEQUENCES

More time is needed to return to normal after exercise. Healing is slowed, especially in the legs/feet, where the circulation tends to be the poorest. Feel colder due to decreased circulation. Increased heart-related problems such as heart attack, congestive heart failure (CHF) and high blood pressure. Lung and bronchial diseases are more common.

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IMPLICATIONS FOR CARE

Allow more time for older persons to ambulate and accomplish tasks. Watch for signs of shortness of breath or tiring. Encourage residents to rise or change positions slowly to prevent fainting. Keep residents warm by increasing heat or adding an extra layer of bedding and clothing.

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KIDNEYS, LIVER AND BLADDER

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CHANGES

Decrease in bladder capacity:

• At age 65, the bladder holds an average of one cup urine, as compared to two
• r more cups at age 25

The prostate gland in men often enlarges. Bladder muscle weakens. Renal (kidney) function decreases reducing ability to filter out waste products.

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CONSEQUENCES

Increase frequency of urination. A greater urgency to urinate and less control. Dribbling or failure to get to the bathroom in time is more common.

• Such problems can effect self-esteem. The older person may become

depressed and afraid to go anywhere.

Incontinence can lead to serious skin breakdown.

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CONSEQUENCES CONTINUED

Decreased ability of the liver to filter out toxins. Increased risk of bladder infections due to urine left in the bladder after voiding. Medications can build up in older person as medications are metabolized slower. Increased risk of dehydration.

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IMPLICATIONS FOR CARE

Encourage intake of fluids/water. Watch for symptoms of bladder infection - low-grade fever, blood in the urine, frequent need to urinate or pain upon urination. Watch for signs of incontinence. Encourage regular/frequent toileting. Encourage personal hygiene. Suggest incontinent pads, if necessary. Beware of problems which may be related to medications.

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TOUCH AND PAIN

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CHANGES

Reduced sensitivity to pain, including extreme hot and cold temperatures.

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CONSEQUENCES

Reduced sensation especially in feet and fingers. Injuries are more likely to go undetected because of reduced awareness of pain and discomfort.

• At risk for burns from exposure to sun and heat.

May have delayed reaction to being touched.

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IMPLICATIONS FOR CARE

Lower temperature of hot water heater (120 degrees F maximum). Turn

• n cold water first, and then add hot water:
• Test the water temperature before resident uses bath or assists with washing

dishes;

• Consider reducing temperature of hot beverages and food.

Watch for injury to legs, arms, hands and feet.

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MUSCLES, BONES, TENDONS AND LIGAMENTS

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CHANGES

Bones tend to be more porous and brittle. Muscles lose tone and strength. Joints become stiff, less flexible. Spinal discs compress with time.

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CONSEQUENCES

Bones tend to break more easily and mend closer. Ability to move arms and legs and turn neck is limited. Gait may be slower. Individual may shuffle, increasing the risk of falling. Loss of height and stooped posture is common.

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IMPLICATIONS FOR CARE

Remove barriers such as furniture or scatter rugs that could be hazardous. Encourage mild exercise, such as range of motion, stretching or walking. Avoid rushing residents when helping them walk or transfer. Encourage residents to use handrails/supports.

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DISCUSSION/QUESTIONS

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