VN057 Gerontology 9
• Addendum to last week-look in Angel for the
Kubler-Ross stages of grief. I forgot to put on
the ppt.
Chapter 16
Sexuality and Aging
3
Factors that Affect Sexuality of
Older Adults
5
Normal Changes in Women
• changes in the reproductive system related to
decreased levels of progesterone and estrogen
6
Changes in Women
• The good
– More relaxed about sexuality
• Experience/assertiveness
• No pregnancy worries
• Less life stress
Changes in Women (cont.)
• The not so good
• Increased STD risk
– Tissue thinning
– No pregnancy worry=no condom
• discomfort or pain during intercourse
– Irritation of the external genitals
– Thinning and dryness of the vaginal walls
– Alteration in vaginal flora
• increased risk for vaginal yeast infections
8
Erectile Dysfunction in Men
• orgasm takes longer to achieve and has a
shorter duration than at a younger age
• Ejaculation less forceful-smaller volume of
seminal fluid is released
• Loss of erection occurs quickly after orgasm
• The time between orgasms increases, and
orgasm may not occur with every episode of
sexual intercourse
9
Illness and Decreased Sexual Function
• Many disease processes & medications
interfere with normal sexual function 
– Some medications enhance sexual function, even
some that aren’t designed to do so 
• Incontinence does not interfere with sexual
relations but may cause some people to avoid
sex because of the risk of embarrassment
10
Illness and Decreased Sexual Function
(cont.)
• Joint pain resulting from arthritis can interfere
with sexual activity
• Cardiac problems can interfere with normal
sexual activity-more from fear than from
actual danger
– Circulation problems affect ALL organs…..
11
Illness and Decreased Sexual Function
(cont.)
• Stroke need not prevent sexual activity
• Neither hysterectomy nor mastectomy
changes sexual functioning
– BUT.. They often cause body image problems
• Depression- can decrease sexual interest &
lead to decreased response to intimacy
– Many antidepressants cause sexual side effects
12
Alcohol and Medications
• Excessive alcohol intake
– delayed orgasm in women
– loss of the ability to achieve or maintain erection in
men
• Digitalis, tranquilizers, diuretics, antihypertensives,
antihistamines, antidepressants, and even some
medications used to treat GERD are likely to cause
sexual problems for men and women
13
Loss of Partner
• Single older women experience more of a
problem than single older men
• By age 85, there are 100 single women for
every 39 single men
14
Loss of Partner (cont.)
15
Marriage and Older Adults
16
Marriage
• many different responses- particularly from families
• Pensions, insurance benefits, and other financial
concerns may be contingent on the person’s
remaining single
• Some choose to live together without marrying
– can be a difficult decision for them and their families
17
Caregivers and the Sexuality of
Older Adults
18
Caregivers
• Young people often uncomfortable with the
thought of sexual activity
• health care professionals may be unaware of
or uncomfortable about addressing the sexual
needs of older adults
• Fear, shame, or embarrassment causes many
older people to hide their sexual interests and
activity, even from health care professionals
20
Sexual Health and
Sexual Orientation
21
Sexual Health
• Older adults often are not considered when
sexually transmitted diseases are discussed,
yet 10% of acquired immunodeficiency
syndrome (AIDS) cases occur in people older
than 50 years
• All sexually active individuals, no matter what
their age, should use safe sex practices
• The risk for sexually transmitted disease does
not disappear with age
22
Sexual Orientation
• People may be more comfortable expressing
sexual orientation as they age
• Health care providers must be careful to
recognize the sexual needs and concerns of
older lesbian, gay, and transgendered people
24
Privacy and Personal Rights of Older
Adults
• Obtaining adequate privacy may be difficult
even for married couples who reside in the
same institution, particularly if regular
medical or nursing care is necessary
• Touching, hand-holding, and cuddling are
encouraged
• A closed door must be respected when privacy
for intimacy is desired
25
Touch and Affection
26
• Touch and affection are human needs, even
when sexual expression isn’t possible
Chapter 17
Care of Aging Skin
and Mucous Membranes
28
Skin Color
• Examination- good, preferably natural, light
– Compare one side of the body with the other
– Use touch for skin temperature or the presence of
rashes or irritation
• Color changes-can indicate many problems
– Pallor
– cyanosis
– jaundice
-erythema
29
Dry Skin
• most common problem of aging
– itching (pruritus)
– Burning
– cracking of the skin
• Common- habit of scratching or picking dry or
cracked skin
– increasing their risk for further tissue damage and
infection
30
Assessing Skin Impairment
31
Dry, Scaly Skin
32
Rashes and Irritations
• Common causes: Medications, communicable
diseases, contact with chemicals
• Allergic response to medications
– diffuse rashes over the body
• Scabies-superficial infection caused by a
parasitic mite (Sarcoptes scabiei) that burrows
under the skin
33
Scabies Lesions
34
Pigmentation
• Changes in pigmentation common with aging
• Some, like acne rosacea can be treated with
topical medications
• Changes in the size or pigmentation of moles
greater significance
– changes may = presence of a precancerous or
cancerous condition that needs immediate
medical attention
35
Tissue Integrity
• Wounds of any size increase risk for infection
often need costly treatments
• Skin tears, abrasions, lacerations, and ulcers
most often result from friction, shearing force,
moisture, and pressure
36
Pressure Ulcers
• Risk: compromised circulation, restricted
mobility, altered level of consciousness, fecal
or urinary incontinence, or nutritional
problems
• Excessive pressure on tissues, particularly over
bony prominences, can quickly lead to skin
breakdown
37
Pressure Ulcers (cont.)
• Ulcer development depends on the amount of
pressure, length of time pressure is exerted,
and underlying status of the tissues involved
• Pressure ulcers are categorized or staged
based on their appearance and depth of tissue
penetration
38
Risk Factors for Pressure Ulcers
•
•
•
•
•
Immobility
Inactivity
Incontinence
Malnutrition
Diminished sensation, decreased mental
status
• Impaired skin integrity
40
Braden Scale for Predicting Pressure
Sore Risk
• The Braden Scale takes into consideration the
following factors when assessing for pressure
ulcer risk
– Sensory perception
– Moisture
– Activity
– Mobility
– Nutrition
41
Bony Prominences and Common
Pressure Ulcer Sites
42
Pressure Ulcers
43
A common complaint in older adults that may
be caused by dryness, irritation, or infection of
the skin is:
A. decubitus.
B. bruising.
C. pruritus.
D. alopecia.
44
Amount, Distribution, Appearance,
and Consistency
of Hair
• Hair -men & women becomes thinner and
more fine
• Men-lose more hair than women, although
some men retain a full head of hair
throughout life
• Male pattern baldness-progressive loss of
hair at the temples and back of the head
45
Hair (cont.)
• Sudden &excessive loss (alopecia) or
breakage can indicate a systemic problem
• Decreased or lack of hair on lower legs—
especially with very dry, scaly, discolored or
flaky skin with weak or absent pedal
pulses—indicates decreased blood supply
to the lower extremities
48
Feet
• many people are unable to bend to view feet,
a family member or friend can perform
inspection for independent older adults
• Many neglect their feet simply because they
cannot see or reach [or feel] them
• Unless foot inspection is done on a regular
schedule, severe problems can occur before
anyone is aware of them
49
Common Foot Problems
50
Foot ulcers
Foot ulcers
Nails
• Aging results in hyperkeratosis of the nails,
particularly the toenails
• Thick, hard nails are difficult to cut using
normal foot care equipment
• The strength and effort required to cut these
nails may exceed an older person’s abilities,
resulting in overgrowth
• Fungi cause the nails to become thick, brittle,
misshapen, and discolored
56
nails
Other Common Foot Problems
• Corns, calluses, blisters, and bunions-years of
poorly fitted footwear
• Many use OTC foot remedies or attempt to
remove corns or calluses
– Dangerous-increases risk for infections
– Can cause breaks in skin-combined with poor
circulation can lead to ulcers
– may necessitate amputation of a toe, toes, or
entire foot/leg
61
Nursing Interventions for Impaired
Skin Integrity
• Assess level of impairment and contributing
factors
• Institute measures to reduce risk for skin and
tissue breakdown
• Institute measures to promote tissue healing
• Provide good foot care
62
Treatment Options
• Treatment options for pressure ulcers are
dependent on the stage
63
A superficial infection caused by a parasitic mite
that burrows under the skin is:
A. lice.
B. scabies.
C. ringworm.
D. leukoplakia.
64
Objectives
• Identify-who are most at risk for problems
related to the skin and mucous membranes
• Describe interventions that assist older adults
in maintaining intact skin and mucous
membranes
65
Nursing Process for Impaired
Oral Mucous Membranes
66
Dental Caries
• Tooth decay, loose teeth, and lost teeth are
ongoing problems in the population
• Poor nutrition and decreased appetite can
often be attributed to dental problems
• Decay, or caries-caused by bacteria that
penetrate through the enamel shield of the
tooth and cause destruction
67
Periodontal Disease
• A less obvious but potentially more serious
complication of poor oral care
• Food debris & plaque build up in the mouth
and on the teeth when oral hygiene is
inadequate
• Activity of bacteria on debris cause bad
breath, or halitosis.
– often disturbing to the older person and to
anyone in close contact
68
Periodontal Disease (cont.)
• Gingivitis causes gum swelling, tenderness,
and bleeding and eventually leads to recession
of the gum tissue away from the tooth
69
Pain
• Dental caries and periodontal disease
– most common reasons for oral pain
– oral lesions such as stomatitis or altered
sensations in the mouth are also reported
• Pain may be limited to the oral cavity or may
affect the face and jaw
• Oral pain can cause loss of appetite,
decreased food intake, a negative effect on
the overall quality of an older person’s life
70
Dentures
• Partial plates tend to catch particles of food
and may weaken healthy teeth
• Complete dentures-difficult to fit
• Dentures may not fit properly if a significant
amount of weight is gained or lost
• Dentures can cause irritation, inflammation,
and ulceration of gums and oral mucous
membranes
71
Dry Mouth
• Xerostomia, or dry mouth is common
– may result from normal age-related reduction in saliva
secretion, medication side effects inadequate hydration,
or diseases such as diabetes
• Makes chewing and swallowing more difficult,
promotes tooth decay, and alters the sense of taste
72
Leukoplakia
• White patches in the mouth
• Often are precancerous and require prompt
medical attention
• Can also be med s/e or thrush
• Lesions on the posterior third or sides of the
tongue often are abnormal and should be
brought to the attention of the physician
73
Leukoplakia (cont.)
74
A disease that is suspected to play a role in
thromboembolic disorders, bacterial
endocarditis, and myocardial infarction is:
A. dental caries.
B. halitosis.
C. gingivitis.
D. periodontal disease.
75
Cancer
• Oral or pharyngeal cancer have poor prognosis
• Early recognition and treatment before mets
to other tissues offer the best hope
• Symptoms- include leukoplakia or
erythroleukoplakia, sores in the mouth that do
not heal, oral bleeding, pain or difficulty
swallowing, difficulty wearing dentures,
swollen lymph nodes in the neck, earache
76
Disorders Caused by Vitamin
Deficiencies
• Certain deficiencies of riboflavin, niacin, and
vitamin C can affect oral mucous membranes
• A smooth purplish sore tongue may be related
to riboflavin deficiency
• Complaint of a burning sensation or soreness
of the mouth may indicate niacin deficiency
77
Superinfections
• Superinfections of the mouth are relatively
common in older individuals who receive
broad-spectrum antibiotic therapy for some
other infection
• Antibiotics destroy the normal mouth flora
and allow opportunist bacteria or yeast
colonies to become established and grow
78
Superinfections (cont.)
• A hairy tongue is the result of enlargement of
the papillae on the tongue; this often follows
antibiotic therapy
• Black or brown discoloration on the tongue
may be caused by tobacco use or by a
chromogenic (color-producing) bacterium
79
Alcohol- and Tobacco-Related
Problems
• Alcohol and tobacco, even in small amounts,
can harm the mucous membranes
• Alcohol- chemically irritating and drying to the
mucous membranes
• Tobacco, whether smoked, chewed, or taken
as snuff, increases the risk for oral cancer
80
Problems Caused by Neurologic
Conditions
• Neuro conditions such as stroke, multiple
sclerosis, or Parkinson’s disease decrease
coordination and strength
– difficult for the person to manipulate the
equipment needed for oral hygiene
– Can be difficult to open mouth
81
Problems Caused by Neurologic
Conditions (cont.)
• severe arthritis may find equipment difficult
to manipulate
– May be difficult to open the mouth adequately for
good, thorough cleaning
• medication for seizure or other neuro
disorders need to use special precautions
– medications often cause gum problems
82
Nursing Interventions for Impaired Oral Mucous
Membranes
• Complete a thorough assessment of the oral
mucous membranes
• Initiate referral to a dentist or dental hygienist
• Provide oral hygiene
83
Nursing Interventions for Impaired Oral Mucous
Membranes (cont.)
• Promote adequate intake of nutrients and
fluids
• Provide lozenges or topical analgesics as
prescribed
• Communicate suspected oral side effects of
medication therapy to the physician and
dentist
84
Dental care
• Access to dental care is often an issue for
people with impaired mobility