VN057 Gerontology 9
ch 16-sexuality, 17-skin
Addendum to last week-look in Angel for the Kubler-Ross
stages of grief.
These stages are not only common with people who are
dying, but with their families
Also commonly seen with diagnosis of significant illness
Don’t forget to read over the last few slides of the
lecture
Chapter 16
Sexuality and Aging
3
Factors that Affect
Sexuality of
Older Adults
5
Normal Changes in Women
changes in the reproductive system
decreased levels of progesterone and estrogen
Vaginal dryness
6
Changes in Women
The good
More relaxed about sexuality
Experience/assertiveness
No pregnancy worries
Less life stress [in general, not always the case]
Changes in Women (cont.)
The not so good
Increased STD risk
Tissue thinning
No pregnancy worry=no condom
If newly single, may not be assertive about condom use
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
Changes in Men
orgasm takes longer to achieve & has shorter duration
Ejaculation less forceful
smaller volume of seminal fluid is released
Loss of erection occurs quickly after orgasm
The time between orgasms increases
orgasm may not occur with every episode of sexual
intercourse
Erectile dysfunction
9
Illness and Decreased Sexual
Function
Many health problems & medications cause problems
with normal sexual function
Some medications enhance sexual function, even some that
aren’t designed to do so
Incontinence does not interfere with sex
may cause some people to avoid sex because of
10
Illness and Decreased Sexual
Function (cont.)
Pain from arthritis can interfere with sexual activity
DIABETES
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- often decreases sexual interest & lead to
decreased response to intimacy
Many antidepressants cause sexual side effects
12
Alcohol and Medications
Excessive alcohol intake
Delayed/lack of orgasm, especially 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
health professionals-often unaware of or uncomfortable
about addressing sexual needs of older adults
Fear, shame, or embarrassment cause many people to
hide sexual interests & 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
10% of AIDS cases are in people older than 50
Everyone, 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
May also be more restrained due to their generational
cohort
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
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
Visual: Compare one side of the body with the other
Touch: skin temperature; rashes or irritation
Color changes-can indicate many problems
Pallor
erythema
cyanosis
jaundice
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
increases 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 common with aging
Some, can be treated with topical medications [rosacia]
Changes in the size or pigmentation of moles
greater significance
may = presence of a precancerous or cancerous condition
needs immediate medical attention
35
Tissue Integrity
Wounds of any size increase risk for infection
Treatment can be very expensive
Skin tears, abrasions, lacerations, and ulcers
friction, shearing force, moisture, and pressure
37
Pressure Ulcers
Risk:
compromised circulation
restricted mobility
altered level of consciousness
fecal or urinary incontinence
nutritional problems
Excessive pressure on tissues
38
Pressure Ulcers (cont.)
Ulcer development depends on
the amount of pressure
length of time pressure is exerted
underlying status of the tissues involved
Pressure ulcers are categorized or staged based on their
appearance and depth of tissue penetration
39
Risk Factors for Pressure Ulcers
Immobility
Inactivity
Incontinence
Malnutrition
Diminished sensation, decreased mental status
Impaired skin integrity
41
Braden Scale for Predicting Pressure
Sore Risk
The Braden Scale asseses the following factors
Sensory perception
Moisture
Activity
Mobility
Nutrition
42
Bony Prominences and Common
Pressure Ulcer Sites
43
Pressure Ulcers
44
A common complaint in older adults that may be caused by
dryness, irritation, or infection of the skin is:
45
A.
decubitus.
B.
bruising.
C.
pruritus.
D.
alopecia.
Hair
Hair -men & women-thinner and more fine
Men-lose more hair than women
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
46
Hair (cont.)
Sudden excessive loss (alopecia) or breakage can mean 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
49
Feet
Must be checked regularly
many people are unable to bend to view feet
family member or friend can check for independent older
adults
Many neglect feet because they cannot see or reach [or
feel] them
severe problems can occur before anyone is aware of
them
50
Common Foot Problems
51
Foot ulcers
Foot ulcers
Nails
hyperkeratosis of the nails, especially the toenails
Thick, hard nails- difficult to cut using regular cutters
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
57
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
62
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
63
Treatment Options
Treatment options for pressure ulcers are dependent on
the stage
64
A superficial infection caused by a parasitic mite that
burrows under the skin is:
65
A.
lice.
B.
scabies.
C.
ringworm.
D.
leukoplakia.
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
66
Nursing Process for
Impaired Oral Mucous
Membranes
67
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
68
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
69
Periodontal Disease (cont.)
Gingivitis causes gum swelling, tenderness, and bleeding
and eventually leads to recession of the gum tissue
away from the tooth
70
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
71
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
72
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
73
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
74
Leukoplakia (cont.)
75
A disease that is suspected to play a role in
thromboembolic disorders, bacterial endocarditis, and
myocardial infarction is:
76
A.
dental caries.
B.
halitosis.
C.
gingivitis.
D.
periodontal disease.
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
77
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
78
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
79
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 (colorproducing) bacterium
80
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
81
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
82
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
83
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
84
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
85
Dental care
Access to dental care is often an issue for people with
impaired mobility
