Chapter :2
Health care of Older Adult
The “Normal” Aging Process
And some suggestions of how to
support people through these
changes
Think about aging clients/family
members for a moment
When Does Aging Begin?
Aging begins the day we are born
No single measure of how “old” a person is
Aging is highly individualized
Aging proceeds at different rates in different
people, and within different systems of the body
Why Do People Age?
Many theories to include:
• Hereditary Factors
• Loss of cellular mass and ability of cells to
divide and replicate
• Accumulation of waste materials that clog
cells and cause them to die
• Changes in structure of connective tissue
But no single theory adequately describes the
aging process
Social Theories of Aging
 Disengagement Theory
 Activity Theory
 Social breakdown Reconstruction Theory
Disengagement Theory
 As older adults slow down, they gradually withdraw
 from the society.
Disengagement is a mutual activity in which the elderly
not only disengaged in the society, but the society
disengages from the older adult.
The elderly develops greater self-preoccupation and
decrease emotional ties with people and reduced interest in
social activities. Such social withdrawal and increased selfabsorption was thought to increase life satisfaction among
them.
Activity Theory
 As opposed to the disengagement theory,
this theory argues that the more active and
involved the elderly are, the more likely that
they are satisfied with their lives.
 It is therefore important to find substitute
activities for them after their retirement.
Social Breakdown -Reconstruction
Theory
 This theory states that aging is promoted
through negative psychological functioning
brought about by the negative views of the
society about elderly and inadequate
provision of services for them.
 Social reconstruction can occur by changing
the society’s view of the elderly and by
providing adequate social services for them.
Normal Changes of Aging
Physical changes related to “Normal” aging ARE
NOT disease
Changes occur in most body systems to include:
Sensory System
Brain and Central Nervous System
Muscles and Bones
Digestion
Heart/Circulatory System
Respiratory System
SENSORY SYSTEM
Changes in Vision
Decreased peripheral vision
Decreased night vision
Decreased capacity to distinguish color
Reduced lubrication resulting in dry, itchy
eyes
Supporting Changes in Vision
Approach people directly not from the side
Proper lighting can make a big difference
Assist with choosing clothes if needed
Use of natural tear products
Use blinds or shades to reduce glare
Changes in Hearing
Sensitivity to loud noises
Difficulty locating sound
More prone to wax build up that can affect
hearing
Supporting Changes to Hearing
Reduce extra noise when trying to have a
conversation
Place yourself so the person can see you and fairly
close- increased volume not always helpful
Make sure you have the person’s attention before
speaking
Have doctor check for and remove wax if needed
Arrange for hearing assessment and provide
support to use a hearing aid if needed.
Changes in Smell and Taste
Decreased taste buds and secretions
Decreased sensitivity to smell
Supporting Changes in Smell and
Taste
May enjoy smaller attractive meals-helps to
be able to smell food preparation
At risk of eating spoiled food
Changes in Skin
Decrease in moisture and elasticity
More fragile- tears easily
Decrease in subcutaneous fat
Decrease in sweat glands -less ability to
adjust body temperature.
Tactile sensation decreases- not as many
nerves
May bruise more easily
Supporting Changes in Skin
Use moisturizers, bath oils can make bath tub
slippery
As a care provider keep nails short
Pat gently when helping to dry after bathing
Bottom of feet may be sore, pay attention to
footwear
May feel cooler than others but be more at risk of
sun stroke
Use sun screen, hats, long sleeves
Be careful with such things as hot water bottles
Changes in Metabolic System
Decrease in ability to adapt to stress
Decrease in metabolic rate
Decrease in thyroid-gland related to calcium
absorption and energy level
Supporting Changes in the
Metabolic System
May feel cold so provide what is necessary
for the person to feel comfortable but avoid
overheating
May need calcium and vitamin D
supplements to prevent osteoporosis
Changes in Elimination
Bladder atrophy- inability to hold bladder
for long periods
Constipation can become a concern because
of slower metabolism
Men can develop prostate problems causing
frequent need to urinate
Incontinence make occur because of lack of
sphincter control
Supporting Changes in
Elimination
Maintain routines
Plan ahead-know where washrooms are when you
go out
Decrease caffeine intake
Eat lots of fiber and do some exercise
Put bowel elimination protocols in place if needed
Provide appropriate supplies and emotional
support
Changes to the Respiratory
System
Decreased volume and expansion of lungs
may lead to decreased function
Susceptible to lung infections, increases if
someone is inactive
Swallowing impairments can cause
aspiration
Supporting Changes in the
Respiratory System
Planning activities with shorter duration
May need more rest periods
Reposition person frequently if they are
unable to move on they own.
Consult a doctor if person consistently
coughs during or after a meal
Changes in the Cardiovascular
System
Heart works harder to maintain oxygen
levels in the body
Cholesterol may accumulate on the walls of
the arteries
Decreased ability to replace fluids lost
while breathing
Supporting Changes in the
Cardiovascular System
People may become fatigued more easily because
of the above changes, may need more rest
Blood pressure should be monitored as
recommended by health care professionals
Reposition person frequently if unable to move on
their own so fluids don’ t build up.
physiotherapy may be needed
Assure adequate fluid intake and seek medical
help quickly if you think the person may be
dehydrated
Changes in Bones and Joints
Decreased height due to bone changes
Bones more brittle – risk of fracture
Changes of absorption of calcium
Pain from previous falls or broken bones
Joints less lubricated – may develop
arthritis
Supporting Changes in Bones
and Joints
Need light exercise including some weight
bearing if possible
Take precautions to prevent falls
May need calcium and Vitamin D
supplements- ensure a balanced diet
Monitor and treat pain appropriately
Allow more time as the person may need to
do things more slowly
Changes to the Nervous System
 Physical reactions are slowed due to
increased “lag” time of neurons transmitting
information :Slowing manifests itself in the
learning process
Unfamiliar or high stress activities cause an
older person to perform more slowly
Throughout adulthood, there is a gradual
reduction in the weight and volume of the
brain. This decline is about 2% per decade.
people get about 20% less oxygen to the
brain which affects balance
Supporting Changes to the
Nervous System
Discourage long naps and caffeinated
products later in the day – encourage the
same patterns and rituals at bedtime
Measures for Accommodating
Poor balance
Using a rocking chair can help compensate
Use walkers and canes properly
Do some exercise to maintain leg muscles
Encourage the person to avoid lifting,
stretching and reaching when it can not be
done safely
Have the person get up gradually so that
they don’t get dizzy
Changes in Cognitive Ability
Don’t lose overall ability to learn new
things but there are changes in the learning
process
Harder to memorize lists of names and
words than for a younger person
Sensory and motor changes as well as
cognitive ability may affect ability to
respond – hard to know which is which
Supporting changes in Cognitive
Ability
Learning new information may take longer
for an older person and they may need cues
to help to retrieve information stored in
memory
When given a choice of answers it may be
easier for the person to give correct answer
rather that retrieving directly from memory
Some Possible
Psychological/Social Issues
Decreased social contact – friends and family dieperson may withdraw
Reconciliation with past-resolving conflicts,
losses, acceptance,
Changes in physical appearance may be difficult
Changes in roles/tasks that people can manage can
make them feel they have less to contribute
Managing leisure time-more “free time”
Depression relatively common
Supporting some possible
Social/Psychological Issues
Provide grief support and encourage existing friendships
Do life review work/life story book and use photographs to
help person talk about the past
Help person with grooming and clothes so they can look
their best
Help person participate in meaningful ways in daily
activities, find new roles and have as much control and
choice as possible. Help structure time.
Facilitate participation in leisure activities the person likes
Facilitate assessment for and treatment of depression
Increased Physical Stress
Handling physical stress becomes more difficult as
you get older
People are less able to adjust to such stresses as
heat, cold, physical exertion, and illness
Have the person do things they enjoy but help
them to pace themselves – provide a rest day after
an extra busy day if possible or at least a quieter
day
Importance of Exercise for
elderly
Important to exercise to prevent muscle
tissue from turning to fat
Exercise helps maintain bone density
Exercise helps prevent depression
Encourage walking and other exercise as
suggested by medical doctor or
physiotherapist
Measures to improve Meals and
Nutrition
In general older people need fewer calories
so provide foods rich in nutrition but lower
in calories.
Sense of thirst decreases so help people to
drink enough. Kidneys may also be filtering
more medication
Weight loss or gain of 10 pounds in six
months needs to be looked into medically
Measures to improve Speech and
Communication
May be slightly harder and take a bit longer
to say what they want to say not usually
apparent but more likely to happen in
stressful situations
For example when the doctor is in a hurry
and wants to speak with the person
accompanying the individual they may need
support to speak for themselves
Issues Facing the Elderly
ABUSE
•It can happen in the family
•It can happen in nursing homes
•It could be physical or psychological
(like verbal abuse) – when they are
named called or threatened, or taken
advantage
because of their memory
problems.
•One form is NEGLECT! When people
who are suppose to care for them ignore
their needs and concerns
Issues Facing the Elderly
LONELINESS
•Death of a husband or wife and many friends.
•
•Children are busy with work and may not even come
to visit them. Grandchildren are busy with school.
•Physically weak elderly may feel that they are burden so
they try to stay away even if people are around.
•Loneliness leads to depression – they feel alone and
unproductive.
Issues Facing the Elderly
POVERTY
•They cannot earn anymore and they do not
have money.
•May receive retirement pension but may not
also be enough because of their increasing
medical needs.
•As such many even try to continue working
even after reaching the retirement age.
Issues Facing the Elderly
HEALTH
•diminished sensory and motor abilities
•tendency to acquire various illnesses such
as heart disease, Alzheimer's, cancer, etc.
Issues Facing the Elderly
DISCRIMINATION
•Job discrimination – employers
prefer younger applicants because
….inexperienced workers have cheaper salaries
…employers believe that the elders could only stay in work
for a short time because of their declining physical condition
….elderly are thought of as slower and less capable.
Issues Facing the Elderly
• Social
discrimination
–
maybe excluded from family or
community services because they
are seen as incapable.
• Medical Discrimination Some doctors treat them without
much care because they think they
don’t deserve such because they are
already old.
Summary
Not every person will experience all of
these changes.
Organizations concerned with a particular
syndrome or condition may be helpful in
providing information helpful for certain
individuals.
Aging is a spiritual and psychological
journey as well as a physical one.
REFERENCE
McCracken Intervention Matrix –McCracken College of Nursing and Health, University of
Cincinnati and Lotteman Children, Inc.
Covington, KY
A Focus on Geriatrics Sharing the Learning St
Vincent Hospitals part of Providence Health Care
Age Changes and what to do about it Phyllis
Kultgen and Peggy Hotz
Compiled by Dr. J.C. Helen Shaji