FINAL EXAM - Geriatrics

demographics and social effects of aging

Heart disease, cancer and stroke account for 7 of every 10 deaths over 65.

By 2025, 2/3 of US health care budget devoted to services for elderly.
Physical changes in bodies
Psychological changes in minds & mental capacities
Social psychological changes in what we think and believe
Age is most consistent factor for cancer and death from cancer

geriatrics

branch of medicine dealing with the aged and problems of aging individuals.

gerontology

illness prevention and management, health maintenance, and promotion of quality of life for aging individuals

Why should radiographers be concerned with the number of aging people increasing?

• The number of imaging procedures on older adults will increase.

• must be prepared for the challenges.

• understanding of geriatrics can make a positive interaction between the radiographer and elderly

How does economic status affect medical treatment?

• impacts health & well-being

• Most have adequate income

• A substantial number don’t and fall below poverty line

• Economic hardships, especially for women

• Reluctant to spend money bc health care is expensive

• Make decisions based on finances, not need

what types of things are extending the life expectancy of geriatric pts?

1. Medical advances

2. People are healthier

3. Health promotion

4. lifestyle factors - diet/exercise

what are the 10 chornic conditions of people over 65?

1. arthritis

2. Deformity / ortho impairment

3. Hypertension

4. Chronic sinusitis

5. Hearing impairment

6. Diabetes

7. Heart disease

8. Visual impairment

9. Cataracts

10. Varicose Veins

how common is elder abuse?

estimate of 2.1 million cases are reported

1 in 5 cases is reported to authorities

It is thought it is as common a child abuse

elder abuse

The knowing, intentional, or negligent act by a caregiver or individual that causes harm / serious risk of harm to a vulnerable person.

list the forms of elder abuse 5

physical

sexual

neglect / self neglect

exploitation

emotional abandonment

victims spouse of elder abuse

50%

victums children of elder abuse

23%

nonfamily caregivers of elder abuse

17%

Describe warning signs of elder abuse.

Bruises, pressure marks, broken bones, abrasions, and burns.

Unexplained withdrawal from normal activities, sudden change in alertness, and unusual depression may be indicators of emotional abuse.

Bruises around the breasts or genital area may occur from sexual abuse.

Sudden changes in financial situations may be the result of exploitation.

Bedsores, unattended medical needs, poor hygiene, and unusual weight loss may be indicators of possible neglect.

Behavior such as belittling, threats, and other uses of power and control by a caregiver may be an indicator of verbal or emotional abuse.

Strained or tense relationships, frequent arguments between caregiver and older adult

Give examples of ageism.

• Avoiding contact and care with older patients.

• It emphasizes that older adults are perceived to be repulsive and that distaste for the aging process itself exists

• It suggests that most older adults are senile, miserable and dependent.

• The media influence this stereotype with the targeting of wrinkle creams and laxatives.

• TV portrays older adults as stubborn and eccentric

What elements have been linked to successful aging?

Greater social contact
Health satisfaction
Low vulnerable personality traits
Fewer stressful life events

What types of situations should the radiographer be sensitive to regarding the physical, cognitive and psychological effects of aging?

Be sensitive to the fact that patient may be dealing with a number of losses

Learn to communicate & interact effectively

Radiographer’s care of elderly may be minimal

Respect patient

Aging leads to:

Preference for slower-paced activities

Taking longer to learn new tasks

Becoming more forgetful

Lost portions of sensory processing skills

Aging & disease are not synonymous

What are the most common health complaints of older adults? 5

Weight gain

Fatigue

Loss of bone mass

Joint stiffness

Loneliness

what specific physical changes occur with aging?

Elderly show decrease in attention skills

Balance, coordination, strength & reaction time all decrease

Falls associated with balance are common

Hesitation to follow instructions may be a fear from a previous fall

Sight, hearing, taste & smell decline

Have more difficulty with bright lights & tuning out background noise

Some become adept at lip reading to compensate for hearing loss

What specific cognitive changes occur with aging?

caused by disease, aging and disuse

Dementia is progressive cognitive impairment that eventually interferes with daily functioning

Aging doesn’t always include dementia

Fears of cognitive loss, especially Alzheimers are widespread among elderly

Majority of elderly work to keep mental functions through mental games, exercises and regular conversations

What are effects of aging on the integumentary system?

Skin membranes flatten, susceptible to abrasions & blisters

More sensitive to UV light, skin cancer

Skin thins and wrinkles

Loss of function of sweat glands & skin receptors

Increases threshold for pain stimuli

What are effects of aging on the integumentary system?

Vulnerable to heat stroke

Atrophy to skin in face, hands & feet

Many get feet conditions

Hair grays, thins and is lost

Major problem is exposure to sun

What are effects of aging on the nervous system?

Loss of nerve impulse velocity due to loss of myelin

Vulnerable to atherosclerosis

Can lead to brain tissue damage

Slows down time to carry motor & sensory impulses,

performance is slowed

Again, higher risk for falls

What are effects of aging on the sensory system?

Focusing eye is difficult

Changes in retina affect the ability to adapt to changes in

lighting, night vision is difficult

Hearing loss is very common

Speech discrimination is a problem in noise

Decline in taste and smell

Decrease in saliva leads to dry mouth

What are effects of aging on the musculoskeletal system?

Osteoporosis significant

Degenerative joint disease / osteoarthritis in weight-bearing

joints

Fat is stored, muscle mass declines

Decreased strength, endurance and reaction

What are effects of aging on the cardiovascular system?

Most common cause of death

Heart rate decreases with exercise and age

Become short of breath quickly

Arteries lose elasticity

Results in increased BP

Risk of stroke

Arteriosclerosis lead to emboli, heart attack or stroke

What are effects of aging on the GI system?

• Ulcers, bleeding, pancreatitis, diverticulosis, obstruction, constipation, incontinence

• Mouth and teeth pain, dry mouth

• Gastric acid decreases

What are effects of aging on the GI system?

• Malignancies, peptic ulcer disease, GI bleeding, pancreatitis, difficulty swallowing, diverticulitis, gastric outlet obstruction, esophageal foreign bodies, constipation, and fecal incontinence.

• Mouth and teeth pain, decreased saliva and dry mouth

• Decrease in acid production

• Decreased motility of muscle in large intestine

• Gallstone, hepatitis and dehydration common

What are effects of aging on the immune system?

• System declines with age

• Unable to fight infection

• Vulnerable to diseases and diabetes, pneumonia and nosocomial infections

• Influenza, pneumonia, TB, meningitis, urinary tract infections

• Infections, cancer, autoimmune disease

What are effects of aging on the respiratory system?

• Lungs lose elasticity, trap air in alveoli

• Decrease of oxygen entering & carbon dioxide leaving

• Breathing is rigid

• Emphysema, bronchitis, pneumonia & lung cancer

• Association with low lung function and coronary artery disease

What are effects of aging on the hematological system?

• Anemia, pale skin, short of breath, fatigue

• Bone marrow does not keep up with blood cell production

• Anemia also caused by insufficient diet & inflammation

• Other physiological stresses increase incidence of variety of

• blood disorders

What are effects of aging on the GU system?

• Incontinence

• Changes in bladder capacity & muscle

• Nephrons in kidneys decrease

• Decreases reserve capacity

• Trouble regulating water balance

• Can lead to renal failure, eventually

• BPH in men, and prostate cancer

What are effects of aging on the endocrine system?

• Changes in thyroid function

• Diabetes mellitus is evident

• Increases with age

Relate some tips for working with the elderly

1. take time to educate patient and family

2. Speak lower and closer

3. Treat patient with dignity & respect

4. Give patient time to rest between projections & procedures

5. Avoid using tape; skin is thin and fragile

6. Provide blankets in cold rooms

7. Use table pads and handrails

8. Always look at patient history before giving contrast

How should a radiographer educate the patient and family?

• Gains confidence and compliance

• More time may be necessary to accommodate decreased

• ability to process

• Arrive with anxiety, do have illness

• Don’t know procedures & technology

• Fear about consequences of exam

• Take time to educate; less stress for patient

What are good communication skills with the elderly?

• Includes good listening skills

• Creates a connection

• Treat with dignity & respect

• adapt to each patient, may need to get close when talking

• Background noise is disturbing

• precise instructions

• time to process request

• Empathetic, warm attitude will gain trust

How should elderly patients be lifted and transported?

1. Balance & coordination are affected

2. Anxious about falling, can be diminished by assistance

3. Decreased height perception

4. Assist when need to step up or down

5. Prevent opportunities to fall

6. Experience vertigo & dizziness when sitting up

7. Give time to rest between positions

8. Use handgrips

Describe how to care for the skin of a geriatric patient

1. Skin susceptible to bruising and tearing

2. Use caution in turning and holding patients

3. Excessive pressure on skin should be avoided

4. Avoid tape, is irritating

5. Hard to lie on flat surfaces, use table pad

6. Sponges, blankets, positioning aids

7. Pay attention to room temperature, keep them warm

What considerations should a radiographer have when administering media to a geriatric pt?

• Kidney & liver function changed

• Amount of contrast used is varied

• Loss of nephrons leads to electrolyte and fluid imbalance, can be life threatening

• More susceptible to dehydration

• Are protocols for type and amount of contrast

Check: Liver, kidney, thyroid disease

Reactions to medication & contrast

History of diabetes & hypertension

Select appropriate vein: Avoid thin superficial veins, repeatedly used veins and areas of bruising or scarring

Describe Joint Commission criteria regarding geriatric patients

Must demonstrate age-based communication competencies,

including elderly

Demonstrating competence in meeting physiological &

psychological needs

Intent to ensure competency in technical & clinical matters,

not limited to equipment & technical performance

“When appropriate, the hospital considers special needs and

behaviors of specific age groups in defining qualifications,

duties and responsibilities of staff members who do not have

clinical privileges but who have regular clinical contact with

patients”