kuliah uniba geriatric2 11-4-12 care geriatrics2
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Geriatric Care
dr Putra Hendra SpPD
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MYTHS
Elderly people are incompetent and incapable
of making decisions or handling their own affairs.
Most elderly live in nursing homes
All elderly people live in poverty
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Older people are lonely and unhappy
Elderly do not want to work
Old Age begins a 65
Retirement ends your active life
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General Pathophysiology, Assessment, andManagement
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Pathophysiology
The body becomes less efficient with age.
The elderly often suffer from more than
one illness or disease at a time.
The existence of multiple chronic diseasesin the elderly often leads to the use of
multiple medications.
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Factors such as disease can increasethe speed and degree of the changes.
Lifestyle, nutrition, economic status, andsocial environment can also haveeffects.
If an individual can recognize thechanges as a/an normal part of aging,the individual can usually learn to
adapt to & cope with change
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Integumentary Systemhanges
Production of new skin cells
decreases
Oil and Sweat glands
become less active Circulation decreases
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Hair losses color, and hair loss occurs
Skin becomes less elastic & dry
Itching is common
Dark yellow or brown colored spots appear Senile lentigines (liver spots)
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Fatty tissue layer of skin diminishes
Lines and wrinkles appear
Nails become thick, tough, and brittle Increased sensitivity to temperature
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are of Skin Use mild soap Bath oils or lanolin lotion
Bath or Shower once or twice a week
Brush Hair daily
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Shampoo as often as needed for cleanlinessand comfort
Care for sore or injuries immediately
Socks, sweaters, lap blankets, and layers of
clothing will help alleviate the feeling of
coldness
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Because of the need for oxygen and nutrientsthe elderly may experience:
Weakness
Dizziness
Numbness in hands & feet
Rapid heart beat
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Cardiovascular Disorders
Angina pectoris
Myocardial infarction
Heart failure Dysrhythmias
Aortic dissection/aneurysm
Hypertension Syncope
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irculatory System are
With circulatory changes:
Avoid strenuous exercise or over exertion
Periods of rest Moderate exercise, according to individuals
tolerance
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Prevent the formation of a blood clot (thrombus)
Support stockings, anti-embolism hose
DO NOT wear garters or tight bands around legs\ If confined to bed
ROM
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High Blood Pressure =
Diet low in salt
Decrease fat intake Exercise as recommended by physician
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Respiratory hanges Respiratory muscles become weaker
Rib cage more rigid
Alveoli thinner & less elastic which decreases
exchange of gases - emphysema
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Bronchioles lose elasticity
Changes in larynx lead to higher pitched &
weaker voice Chronic diseases may decrease the
efficiency of the respiratory system even more
severely
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Respiratory Disorders
Pneumonia
COPD
Pulmonary embolism Pulmonary edema
Lung cancer
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Changes may cause the elderly to
experience:
Dyspnea
Breathing increases in rate
Difficulty coughing up secretions
Increases susceptibility to infections such as a cold orpneumonia
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Respiratory and cardiac problems
can cause dyspnea.
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Respiratory are Alternate activity with periods of rest
Proper body alignment & positioning
Sleep in semi-fowlers position
Use 2 or 3 pillows
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Avoid polluted air
Breath deeply & cough frequently
May need continuous oxygen therapy
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Nervous System hanges
Blood flow to brain decreases & there is a
progressive loss of brain cells - - Interferes
with Thinking - Reacting
Interpreting - Remembering
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Senses of taste, smell, vision, & hearing are
diminished
Nerve endings less sensitive Decreased ability to respond to pain and other
stimuli
Decrease in taste& smell frequently affects
appetite
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Changes in vision Problems reading small print
Seeing objects at a distance
Decrease in peripheral vision
Decrease in night vision
Increased sensitivity to glare Cataracts
Glaucoma
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Cataracts diminish eyesight
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Blindness
Position where patient might be
able to see you.
Explain procedures before doingthem.
If patient has glasses make surethey are wearing them.
Never pull blind patient.
Walk at their side and hold theirarm.
Let them know about obstacles.
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Changes in hearing Hearing loss usually gradual
Person may speak louder than usual
Ask for words to be repeated
Not hear high frequency sounds
May not hear well in crowded places
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Deafness
Never assume the patient is
deaf.
If patient is wearing a
hearing aid, make sure it ison.
Determine if the patient
can lip-read.
Note writing.30
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Speak into a stethoscope with
the hearing-impaired.
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Decreased sensation to pain & other stimuli =
more susceptible
Burns Frostbite
Cuts
Fractures
Muscle strain and other injuries
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Digestive hanges Fewer digestive juices and enzymes produced
Muscle action becomes slower & peristalsisdecreases
Teeth are lost Liver function decreases
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Dysphagiais frequent complaint Less saliva
Slower gag reflex
Loss of teeth
Poor fitting dentures
Slower digestion of food indigestion
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Decrease peristalsis
Increase flatulence (gas)
Constipation
Decrease sensation of taste
Poor appetite
Poor diet
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Constipation common.
Smooth muscle contraction diminished.
Deterioration of structures in mouthcommon.
Decline in efficiency of liver.
Reduced ability to aid in digestion andmetabolism of certain drugs
Impaired swallowing.
Stomach sphincter valve loss. Increase in heartburn
Malnutrition due to deterioration of small
intestine.
Decrease in nutrient absorption. 36
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GI Disorders
GI hemorrhage
Upper GI bleed
Lower GI bleed
Bowel obstruction Mesenteric infarct
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Digestive are
Good oral hygieneRepair or replace damaged
teeth
Relaxed eating atmosphere
High-fiber high-protein foods
with different tastes and texturesSeasoning to improve taste
Increased fluid intake
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Urinary hanges Kidneys decrease in size & become less
efficient
Bladder becomes less efficient
May not hold as much May not empty completely
incontinence
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Problems with incontinence &elimination are common in the
elderly.
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Urinary are Increase fluid intake
Decrease before bedtime
Regular trips to bathroom
Easy to remove clothing Absorbent pads
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Endocrine hanges Increased production of some hormones anddecreased of others
Immune system less effective
BMR decreases
Intolerance to glucose
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Metabolic & Endocrine Disorders
Diabetes mellitus
Thyroid disorders
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Endocrine are
Proper exercise Adequate rest
Medical care for illness
Balanced diet Healthy lifestyle
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Reproductive System hanges
Decrease of estrogen / progesterone in
female
Thinning of vaginal wall Decrease vaginal secretions
Inflammation of vagina common
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Weakness in supporting tissue: Uterus sags downward
(Uterine prolapse)
Breasts sag when fat redistributed Decrease in Testosterone
Slow production of sperm
Response to sexual stimuli slower
Testes smaller less firm
M l d F l
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Male and Female
Sexual desire may or may not decrease
Advantages of sex in elderly
Improves muscle tone & circulation
Pain from arthritis seems to decrease
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Reproductive are Understand physical and psychological
sexual needs of the elderly Allow married couples to be in the same room
Give privacy to consenting elderly
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Psychocosocial hanges
Some individual cope with psychosocial
changes, and others experience extreme
frustration and mental distress
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Fears of a sick person:
Death
Chronic illness
Loss of function
Pain
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Dealing with fears created by an illness:
Listening
Patience
Understanding
Provide support
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onfusion and DisorientationSix signs:
Talking incoherently
Not knowing their nameNot recognizing others
Wandering aimlessly
Lacking awareness of time orplace
Ch i l d l
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Change in altered mental status can
denote serious underlying problems.
N l i l Di d
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Neurological Disorders
Cerebrovascular disease
(stroke)
Seizures
Dizziness/vertigo Parkinsons disease
Delirium, dementia,
Alzheimers
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Displaying hostile and combative behavior
Hallucinating
Regressing in behavior Paying less attention to personal hygiene
Inability to respond to simple commands orinstructions
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Causes of temporary confusion /disorientation Stress and/or depression
Use of alcohol or chemicals
Kidney disease
Respiratory disease
Liver disease
Medication
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Diseases: CVA
Arteriosclerosis
Atherosclerosis
Cause TIAs ministrokes which result in temporary periods ofdiminished blood flow to the brain.
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Dementia
Loss of mental ability characterized by a
decrease in intellectual ability, loss of memory,impaired judgement, personality change, anddisorientation
A t d ti
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Acute dementia
When the symptoms are caused by temporaryreason:
High fever, dehydration, hypoxia
Chronic dementia
When symptoms are caused by permanent,irreversible damage to brain cells
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Alzheimers Disease
Form of dementia that causes progressive
changes in brain cells
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Early Stages:
Memory lossMood & personality changes
DepressionPoor judgment
Confusion regarding time &place
Inability to plan and follow
through with ADLs
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Middle Stages:
Nigh time restlessness Mood swings increase
Personal hygiene ignored
Weight fluctuates
Paranoia & hallucinations
Full time supervision needed
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Late Stages:
Total disorientation Incoherent
Unable to communicate with words
Loses control of bladder & bowel functions
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Musculoskeletal System:
Osteoporosis common.Mineral loss.
Bones become brittle.
Narrowing disks causes kyphosis.
Curving of the spine.
Osteoarthritis common.
Affects joints.
Cause of falls.
Immobility can lead to death. 64
Stretching and weight bearing exercises
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Stretching and weight-bearing exercises
help prevent osteoporosis.
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Trauma in the Elderly
Specific Injuries
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Specific Injuries
Orthopedic injuries
Burns Head and spine injuries
Orthopedic Injuries Common
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Orthopedic InjuriesCommonFractures in the Elderly
Hip or pelvis fractures
Proximal humerus
Distal radius
Proximal tibia
Thoracic and lumbar bodies
S b it l f l k f t
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Subcapital femoral neck fracture
Serious head injuries sometimes
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Serious head injuries sometimes
denote geriatric abuse.
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Many states have laws that requireEMS personnel to report suspected cases
of Geriatric abuse and/or neglect.
Burns
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Burns
People age 60 and older are more likelyto suffer death from burns than any othergroup except neonates and infants.Factors include:
Slower reaction time
Pre-existing diseases
Age-related skin changes
Immunological/metabolic changes
Reductions in physiological function
Toxicological Emergencies
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Toxicological Emergencies
Lidocaine
Beta-blockers
Antihypertensives/diuretics
ACE inhibitors Digitalis (digoxin, Lanoxin)
Antipsychotropics
Parkinsons disease medications
Analgesics
Corticosteroids
Transport Considerations
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Transport Considerations
M difi ti i iti i i bili ti d
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Modifications in positioning, immobilization, and
packaging may be necessary in the elderly patient.
Blister-packs are easier
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Blister-packs are easier
for the elderly.
Home safety for the elderly
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Home safety for the elderly
Common age-related systemic changes
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Common age related systemic changes
Sensory changes in the elderly
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Sensory changes in the elderly
Changes in the body systems
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Changes in the body systems
of the elderly