Ice Skating on Golden Pond: The Elements of Normal and Successful Aging 2 nd Annual Elder Care Conference 9/7/2017 Kathleen Fletcher DNP Who are the Elderly? 46.2 million > 65 years (14.9%) of the population and by the year 2050 this will ^ to 22%. States with the greatest number 65+ are #1 Maine (17.8%), Vermont, New Hampshire, West Virginia, & Florida. The fastest growing is in those 85 years + (25% of those > 65 years). Growing diversity of the older group: whites grew .5% while Asian American grew by 3%, African American, 1.2%, Hispanic by 2%. http://www.census.gov/prod/2014pubs/p25-1140.pdf .) Jean Calment: Oldest living woman 1875-1997, 122 years and 164 days 1
Me at 20 Me at 63 Moms Mabley "You just wake up one morning, and you got it!" 2
State of Aging and Health in America, 2013 Cost of health care for older adults is 3-5X higher than those below 65. 2 of 3 older adults have multiple chronic conditions and treatment for these account for 66% of country’s health care budget. (https://www.cdc.gov/aging/pdf/state-aging-health-in- america-2013.pdf ) “Normal means you are in good shape as long as you have the same diseases as everyone else.” Rudolph Ballentine PHYSICAL CHANGES IN THE Skin thins SYSTEM Watch for tears when WHAT OBSERVATIONS TO moving patients MAKE Look for skin breakdown Care with transfers IMPLICATIONS FOR THE CAREGIVER Special tape may be needed Use pull sheet and lift, not drag 3
PHYSICAL CHANGES IN THE Sweat glands diminish SYSTEM Dry skin WHAT OBSERVATIONS TO Monitor temperature MAKE Patient may complain of itching Less frequent bathing may IMPLICATIONS FOR THE CAREGIVER be indicated Cleanse off soap PHYSICAL Loss of blood supply to skin CHANGES IN THE SYSTEM Skin that is cool to touch WHAT OBSERVATIONS TO Loss of hair on lower MAKE extremities Mottling or color changes in skin Evidence of skin breakdown IMPLICATIONS FOR Once skin breaks it takes THE CAREGIVER longer to heal PHYSICAL CHANGES IN THE Loss of fat SYSTEM Redness over bony areas WHAT OBSERVATIONS TO MAKE Patient complains of cold more often IMPLICATIONS FOR May need extra THE CAREGIVER clothing for better insulation 4
PHYSICAL Nails thicken and turn yellow CHANGES IN THE SYSTEM Thickening and length of nails WHAT OBSERVATIONS TO cause problems in walking MAKE Monitor for pain, redness, swelling in nails IMPLICATIONS FOR Keep nails clean and dry THE CAREGIVER Clean socks (cotton preferable) Proper footwear PHYSICAL CHANGES IN THE Rib cage thickens SYSTEM Difficulty in breathing signs WHAT OBSERVATIONS TO MAKE Barrel chest appearance IMPLICATIONS FOR Breathing effort harder in a THE CAREGIVER supine position PHYSICAL Breathing muscles weaken CHANGES IN THE SYSTEM Patient pausing more often WHAT while walking, rate of OBSERVATIONS TO MAKE breathing, pattern of breathing change Wheezing or rattles Patient complains of dyspnea Cough IMPLICATIONS FOR Allow rest periods between THE CAREGIVER periods of exertion 5
PHYSICAL CHANGES IN THE Heart valves get thicker SYSTEM WHAT Breathing problems OBSERVATIONS TO MAKE Swelling IMPLICATIONS FOR THE CAREGIVER PHYSICAL Pacemaker gets thicker CHANGES IN THE SYSTEM Irregular pulse rate WHAT Weaker pulses OBSERVATIONS TO MAKE Patient complaints of flutters or dizziness IMPLICATIONS FOR Check pulse for pattern THE CAREGIVER Check symmetry of pulse points, volume, and amplitude PHYSICAL Vessels get thicker and more CHANGES IN THE SYSTEM twisted Blood pressure fluctuations WHAT Gap between the systolic and OBSERVATIONS TO MAKE diastolic pressure widens Patient may complain of chest discomfort Be familiar with patient’s baseline IMPLICATIONS FOR blood pressure readings THE CAREGIVER Pump up the cuff sufficiently to obtain accurate blood pressure readings 6
PHYSICAL Baroreceptors less sensitive CHANGES IN THE SYSTEM Dizzy with changing position WHAT Blood pressure drops when changing OBSERVATIONS position (report a change of anything TO MAKE over 10 mm hg) Observe for falls and near falls Use proper technique to check IMPLICATIONS FOR THE positional blood pressure (take in one CAREGIVER position, have the patient change position, wait 1-2 min and take the BP) Change position slowly: dangle first and stabilize PHYSICAL CHANGES IN THE Dental enamel thins SYSTEM WHAT Loss of shine to teeth OBSERVATIONS TO MAKE Tooth decay, redness of gums Missing teeth Patients complain of dental discomfort IMPLICATIONS FOR THE CAREGIVER Frequent oral hygiene PHYSICAL CHANGES IN THE Gums recede SYSTEM WHAT More of tooth is visible OBSERVATIONS TO MAKE Gums red or tender Swelling IMPLICATIONS FOR Frequent oral hygiene THE CAREGIVER 7
PHYSICAL CHANGES IN THE Esophagus tightens SYSTEM Trouble with swallowing WHAT OBSERVATIONS TO Patient may choke MAKE IMPLICATIONS FOR Proper food consistency THE CAREGIVER Elevate head during eating and for 10 minutes after Be familiar with Heimlich maneuver PHYSICAL CHANGES IN THE Muscles weaken SYSTEM WHAT Changes in bowel habits: OBSERVATIONS TO constipation or diarrhea MAKE Change in the pattern of elimination Stomach pain Make sure patient is taking IMPLICATIONS FOR fluids as directed, THE CAREGIVER exercised as directed, and eating the diet as prescribed PHYSICAL CHANGES IN THE Saliva is less SYSTEM Trouble with chewing and WHAT OBSERVATIONS TO eating solid foods MAKE Prone to choking IMPLICATIONS FOR May need some liquid during THE CAREGIVER solid intake 8
PHYSICAL CHANGES IN THE Less kidney cells SYSTEM WHAT Change in urine amount, OBSERVATIONS TO color, and odor MAKE Maintain a voiding schedule IMPLICATIONS FOR THE CAREGIVER with the high risk patient (i.e., cognitively impaired) Assure adequate intake of fluids as directed PHYSICAL Less bladder tone and amount CHANGES IN THE SYSTEM of urine to fill the bladder WHAT Incontinence of urine: dribbling, OBSERVATIONS TO wetting self with cough or MAKE sneezing, wetting often but in small amounts Maintain a voiding schedule for the high risk patient Adequate fluid intake as IMPLICATIONS FOR prescribed THE CAREGIVER Avoid using incontinence briefs as a substitute for a voiding schedule PHYSICAL CHANGES IN THE Loss of hormone SYSTEM WHAT Vagina area is more dry and OBSERVATIONS TO prone to bleeding MAKE May have pain with intercourse Gait problems Bones get more brittle, more IMPLICATIONS FOR prone to fracture with falls THE CAREGIVER Assure adequate perineal care 9
PHYSICAL CHANGES IN THE Prostate gets larger SYSTEM WHAT Men may have difficulty passing OBSERVATIONS TO MAKE urine (urgency, frequency, hesitancy) Distended perineal area Report changes in color, odor, quality, quantity of urine output IMPLICATIONS FOR Maintain a voiding schedule THE CAREGIVER with the high risk patient PHYSICAL CHANGES IN THE SYSTEM Loss of muscle and bone WHAT Smaller in size OBSERVATIONS TO MAKE Muscles weaken Gait problems Changes in range of motion Pain with joint or muscle movement Assure range of motion exercises as IMPLICATIONS FOR performed as directed THE CAREGIVER Exercise the patient as prescribed PHYSICAL CHANGES IN THE SYSTEM Loss of nerve cells Fluctuations in mental status WHAT OBSERVATIONS (alteration in consciousness, TO MAKE disorganized thinking, short attention span, rambling incoherent speech) Be alert to balance or gait problems Report any changes in sensation in the lower extremities and redness or lesions Sensation may be impaired IMPLICATIONS FOR THE CAREGIVER Slower to respond Longer to rehabilitate 10
PHYSICAL Changes in sleep CHANGES IN THE SYSTEM Changes in the sleep wake WHAT cycle: i.e., sleeping less or more, OBSERVATIONS TO MAKE early morning awakening, confusion upon awakening IMPLICATIONS FOR Help to facilitate sleep in THE CAREGIVER patients: i.e., minimize disruptions Offer backrub to sleep or warm fluids (avoiding caffeine) as indicated PHYSICAL Visual problems CHANGES IN Changes in ability to see or balance THE SYSTEM using side vision WHAT OBSERVATIONS Unable to see in certain positions TO MAKE Halos or flashes Difficulty going from light to dark room Ask the patient if he/she wears IMPLICATIONS glasses, provide these making sure FOR THE the lens is clean CAREGIVER Keep a night light on in the room Avoid glare PHYSICAL Hearing problems CHANGES IN THE SYSTEM Changes in the ability to hear or WHAT balance OBSERVATIONS TO MAKE Ignoring you Reporting that people are talking about them Patient’s complaints of fullness, pain or pressure in the ears Ask if the patient wears a hearing IMPLICATIONS FOR THE CAREGIVER aid and make sure that it works and encourage the patient to use it 11
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