Geriatric Radiographic
Considerations
Chapter 11
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Geriatric Patient
• The number of people over 65 years of age in the United
States is predicted to be more than 70 million people by
the year 2030.
• With 85 million baby boomers, the largest population,
reaching 60 years of age, one out every five Americans is
projected to be over 65 by 2030.
• The radiographer must understand that age 65 is an
arbitrary age that has been designated for convenience
as the age at which a person is eligible for Medicare
benefits, Social Security benefits, and retirement.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cont.
• Elderly patients are burdened with chronic illness rather
than acute.
• 80% of deaths in persons over the age of 65 are caused
by Heart disease, Cancer, and Strokes.
• Long term care is caused by hypertension, arthritis,
diabetes, pulmonary disease, visual and hearing
impairment.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Depression
• Depression is a common and debilitating emotional
problem of the aged person. This condition can be due
to the following reasons:
– Burden to the family
– The fear of losing one’s good health
– Giving up independent lifestyle
– Chronic illnesses
• Symptoms of depression in the elderly person are often
confused with “Dementia.”
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Alzheimer Disease
• Persons with Alzheimer disease present with symptoms
of dementia, which usually occur in persons over age 65,
although it may occur at an earlier time.
• Recent studies have indicated that of people over the age
of 65 years about 50% suffer from Alzheimer disease at
various stages.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• When an examination of the geriatric patient is complete,
you must assist the patient with returning to the dressing
room, caretaker, or waiting room.
• The elderly patient must not be left alone in the
radiographic imaging room, because he or she may
become confused and may be in danger of falling from
the radiographic table.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Changes Associated with Aging
• Older adults may have nonspecific symptoms such as:
– Dizziness
– Falls for no apparent reason
– Infections without fevers
– Urinary Incontinence
• As a radiographer, you must be able to differentiate what
is a normal from what is pathological.
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Integumentary System
• Normal Changes
– The skin wrinkles, becomes lax, and loses turgor
– The vascularity of the dermis decreases, and the skin
of white people begins to look paler and more
opaque
– Brown macules called “Lentigines” appear on the
back of the hands, on the forearms, and face
– Seborrheic keratoses and “Actinic keratoses” may
develop
– Nails lose their luster and may yellow and thicken
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implications for the Radiographer
• The skin of the geriatric is fragile and thus more easily
traumatized.
• You must ensure that the skin of the elderly patient is
not damaged during the exam.
• Lying on a hard radiographic table may be especially
painful for the geriatric patient; place a full table pad for
comfort.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Changes in the Head and Neck
• Normal Changes of Aging
– There is mild loss of visual acuity, particularly
“Presbyopia”
– Tear production is either reduced or increased
– Sensory, neural, and conductive changes occur in the
ear
– Hearing loss is common
– There is loss of muscle mass in the neck
– Kyphosis
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implications for the Radiographer
• Assist the patient at all times. Sudden change in lighting
may cause momentary blindness.
• You must ascertain that the patient is able to hear your
directions and speak loudly enough for the patient to
understand.
• Be especially careful to clearly state instructions and
check for understanding.
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Pulmonary System
• Normal Changes of Aging
– Lung capacity diminishes
– The cough reflex becomes less effective
– The normal respiratory defense mechanism lose
effectiveness
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Implications for the Radiographer
• Patients with chronic pulmonary disease cannot be
expected to lie flat for more than brief periods of time,
since this position increases dyspnea.
• During chest radiographic examination, when possible,
ask the patient to hold his or her breath on the second
full inhalation to ensure full lung expansion.
• During an UGI, position the patient in an upright position
to prevent aspiration.
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The Gastrointestinal System
• Normal Changes of Aging
– Gastric secretion, absorption and motility decreases
– The abdominal muscles weaken
– Many patients are edentulous (without teeth), have
dentures or partial plates
– Esophageal motility declines
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Implications for the Radiographer
• Due to patient fasting, schedule the exam early in the
morning so that the patient can have breakfast close to
usual time.
• You must instruct the patient to drink slowly to avoid
choking.
• Position the patient in an upright position to prevent
aspiration.
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The Patient Who Has Had Arthroplastic
Surgery
• Total joint replacement has become a common procedure
in hospitals throughout the United States
• Arthroplasty is indicated for patients for the following
reasons:
– Severe degenerative joint disease
– Joint deformities
– Trauma
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Cont.
• Most common Arthroplasty in geriatrics: Hip and Knees
• Take extra care when doing portable radiography on
patients with post surgical Arthroplasty
• The most common complication after hip replacement is
dislocation of the prosthesis
• You must understand the needs of the patient who has
had an arthroplasty so that he or she will not be injured
while being cared for in radiographic imaging
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Cultural Considerations and Aging
• One must take culture differences when imaging
patients.
• Some elderly patients are accepting of whatever
treatment is offered, whereas others require a detailed
explanation from the family members.
• Whatever the culture of the patient, you must take these
differences into consideration with sensitivity.
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Elder Abuse
• It is estimated one out of every 20 seniors experience
elder abuse.
• Elder abuse is: The neglect, mistreatment or exploitation
of anyone age 65 or older (or any disabled dependent
adult).
• There are 3 categories of elder abuse:
1. Domestic elder abuse
2. Institutional elder abuse
3. Self-neglect or Self-abuse
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Recognizing the Warning Signs of Abuse
• Physical abuse
• Sexual abuse
• Emotional or Psychological abuse
• Neglect
• Financial abuse
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Avoiding Elder Abuse or Neglect During
Imaging Procedures
• Avoid pinching patient’s skin when moving or transferring
the patient from gurney or wheelchair onto the
radiographic table.
• When immobilizing elderly patients, utilize the standards
of care for immobilizing the geriatric patient as
prescribed by your institution during radiographic
procedures.
• Assist the geriatric patient when they ask for help.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins