HOSA 2024: Geriatrics, End of Life, and Grief (15%)

Old age

above the age of 65-67 (seniors>elderly)

Senescnece

period in older adults life where body begins to age and weakens, final stage

Advanced old age

age 75

Geriatrics

study of aging people

Goal in Geriatrics

maximize function and independency in a persons life and decrease illness and disability period

Process of aging factors

genetic lifespan of cells, past lifestyle, level of activity, dietary practices, social support

Free Radical

when ion breaks off and is not paired

Biological clock

decides menopause and contributes to the body changes that result in death

Wear and Tear

body starts to wear down

Immune theory

body find it harder to recognize healthy and ill cells it will attack both

Bones and Cartilage - loss of body water/bone mass

Decreases height while aging

Bones and Cartilage - estrogen

decreases ability to use calcium to keep bone density = osteoporosis

Blood vessels - arterial walls

thicken with fatty deposits and connective tissue causing narrow arteries

Blood vessles - coronary arteries

give less oxygenated blood to heart muscles

Lungs

lose elasticity and muscles work harder to breathe, can't cough or breathe deeply, more vulnerable to respiratory infections

Kidneys and Bladder

rate of filtration slows causing medication and substances to take longer to pass

Metabilism

slows, can cause retetnion of flucose and lipids, more at risk for elecated serum lipids

Digestion

low mobility of the gastrointestinal system causing slower emptying of the stomach, cause poor appetite and digestive disturbance

Teeth

tooth loss is common, remaining teeth aren't good for cutting or chewing

Skin

skin cells take longer to repair, losing subcutaneous fat and collagen causes skin to thin

Eyes

limited cells in optic nerve, pupils open and close slower, seeing in dark environments is harder

Ears

degenerative changes in the bones in the middle of the ears decrease hearing ability and hair cells in the corti reduce making high frequencies hard to hear

Nervous System

neurons shrink and transmission of impulses to brain slow, motor responses and reaction time is delayed

Sexual Responses: Women

menopause/climacteric doesn't decrease sexual response, dry vaginal mucosa, hot flashes, fluctuating hormones

Sexual Responses: Man

testosterone decreases between 40-60, reduces size, firmness, production, motility and lifespan of penis/sperm, decrease in function = male climacteric

Sex: Prostate Cancer

risk and periodic preventative screenings for men is recommended

Sex: Heart Attacks

diet and habits change

Psychological Changes

personal appearance have high value, coping and adaptation are evident, role in family changes, losing people = lonliness

Demential

involve cognitive impairments results in dependence on others

Major tasks

mastering crisis of immortality, reflecting on accomplishments and legacies, adjusting to retirement, adapting to aging requirements

Changes in aging

physiological, psychological, social, economic, cultural factors

Focus of healthcare workers

understanding developmental tasks of advanced old age, knowing the physiological and psychological changes and challenges

Common Fear with Death

fear of pain and fear of burdening the family

Therapeutic presence with Death

be near the patient and family, hold a hand, saying the wrong thing at the wrong time

Psychological death Beginning

diagnosis of terminal illness

Physical death Beginning

body declines in function

Psychological responses

disbelief, grief, mourning and sadness

Therapeutic presence after death

providing comfort by accepting emotions,

Family Response to Death

helplessness and guilt

Guilt

cause people to insist on everything being done regardless of outcome or level of suffering the dying person may have to endure

Acute care of death

continuing full life support like ventilators, intravenous medications and full cardiopulmonary resuscitation

Removing life support

topping all life-sustaining support and drugs except that provides sedation and relief of pain

Hospice

supports patient/family through dying process, involves palliative care

Kennedy Institute of Ethics

laws, ethics and bioethics

Advance health care directives

inform health-care providers, family members of the patient's wishes are related to the level of lifesaving measures to be used when patient is near death

Durable power of attorney health

advanced directive that transfers the health-care decision-making power to a person designated by the patient

Assisted suicide

a person other than the patient to facilitate suicede

Euthanasia

intentional act like injecting lethal drugs that cause death

Role of Health Care Worker

needs to understand death, offer support/empathy, assist family in support, educate family, informed consent

Understanding death: children

discussion of life and death should be part of growth and development from a young age

Truthfulness

supportive, nonthreatening discussion about the best approach in the care of a terminally ill child

Stage 1: Awareness

labeling themselves as the sick child

View of Death: Toddler

separation is temporary because they are learning to separate from their parents

View of Death: Preschooler

death is reversible, employing magical thinking and fear of abandonment

View of Death: School-age

death is permanent but doesn't understand their own mortality

View of Death: Adolescent

mourns and understands effect of death, will often deny mortality and do risky activities

Physical Care after Death

works through transportation and religious practices

Adapting to loss

learn to cope with disappointments which is learnt through maturity and personal growth

Legacy

being satisfied with the legacy or family one has left to the world may give the person a feeling of immortality (i.e., grandchild, propert, culture, writings, et.c)

Grief

understanding the dynamics of loss, dying and grief

Mourning

outward expression of grief

Bereavement

grief and mourNING

Grief symptoms

physical, emotional, cognitive and behavioral

Stages of Grief

Initial shock and disbelief, numbness and overwhelming sadness with yearning and protest, reflection in search of meaning and eventual acceptance

Dysfunctional Grieving

failing to follow course of process which leads to abnormal/maladaptive coping strategies

Dysfunctional grieving/symptoms

expression of unresolved issues/symptoms, insomia, emotional lability, change in appetite, withdrawl from friends/social support system

Preganancy/Death

stillbirth can cause grief reaction, getting pregnant again is a positive milestone and is important to know about

Death as Infant

respond to loss after establishing an attachment, might resurface in adulthood and manifest in attachment issues

Death as Children

react in a manner reflecting their developmental stage, immaturity prevents them from feeling/experiencing feelings

Death as Adolescent

establishing sense of identity might mourn loss of sharing accomplishments, might feel need to take on the role of the deceased to help family members

Death as Young Adult

respond with rage at lost opportunities

Reintegration and Adjustment

people remain in emotional pain for years after a loss

Covering up Grief

can be buried but last a lifetime, adds to social isolation, emotional pain and confusion, leads to unresolved issues and mental/physical illness

Help Grieving Survivors

condolence, offer comfort, support the bereaved