assisting in geriatrics

geriatrics

• field of medicine concerned with the problems of aging

• patients over 65

• have more and unique health concerns

• special concerns of the elderly

• growing field due to longer health spans

what do medical assistants need to note about geriatrics?

• 50% of practice is caring for older patients

• need a knowledge of their unique needs

what are the physical changes of aging?

• make the elderly more prone to diseases and disorders

• experience cognitive-intellectual, psycho-social, and emotional changes

• all body systems begin to show signs of aging

• not all people experience all changes

• changes occur at different rates

what are the changes that occur in the integumentary system with age?

• thinning and wrinkling skin

• decreased collagen

• atrophy, or degeneration, of the subcutaneous layer of skin

• lentigos or “liver spots”

• decreasing inflammatory response, resulting in slower healing

what are the changes that occur in the musculoskeletal system with age?

• osteoporosis

• osteoarthritis

• kyphosis

what are the changes that occur in the nervous system with age?

• decreased blood flow to the brain due to arteriosclerosis

• shortened attention span and difficulty handling several tasks at one time

• weaker signals to the brain for processing

• impairment of fine motor activities like writing

• memory loss

what are the changes that occur in the special sense with age?

• impaired vision (presbyopia)

• impaired hearing (presbycusis)

• decreased sense of taste

what are the changes that occur in the respiratory system with age?

increased shortness of breath

what are the changes that occur in the cardiovascular system with age?

• atherosclerosis

• hypertension

• hypotension

• myocardial infarction

• stroke

what are the changes that occur in the immune system with age?

increased susceptibility to infectious diseases

what are the changes that occur in the digestive system with age?

• constipation

• fecal incontinence

what are the changes that occur in the genitourinary system with age?

urinary incontinence

psycho-emotional development

• transition into retirement

• loss of spouse, friends

• increasing dependence

social development

• increased spirituality

• remain in homes if able

• volunteer in the community

cognitive-intellectual development

• possess capacity for learning, but slower to process information

• long-term memory is not affected

• short-term memory often affected

maintaining health

• daily exercise

• balanced nutrition

• good sleeping patterns

• social contact 

• regular health checkups

• keep brain active

• regular screenings and preventative care

alzheimer’s disease

• severely debilitating brain disorder

• no cure

• loss of short-term memory

osteoporosis

• loss of bone density

• increased chance of fractures

• hormone replacement therapy

osteoarthritis (DJD)

• chronic inflammatory disease of joints

• degenerative joint disease

cataracts

clouding of the lens affecting vision

presbycusis

gradual loss of hearing in both ears

presbyopia

gradual loss vision due to age

type II diabetes mellitus

• high blood sugar levels

• modify diet, increase exercise, and lose weight

hypertension

• blood pressure elevated over 140 systolic and 90 diastolic

• usually asymptomatic

atherosclerosis

plaque, cholesterol, and fatty substances build up in arteries causing narrowing

arteriosclerosis

• stiffening or hardening of the arteries

• plaque blocks the wall of arteries due to aging

hyperlipidemia

high cholesterol and triglycerides

kyphosis

curvature of the spine

assisting in geriatrics

• observe for physical limitations

• communicate effectively (written instructions, speak clearly with low tones)

• patient may have denial or confusion

  • perception of state of health

  • may over or underestimate abilities

  • may not realize they are confused

• educate patient on the importance of preventative measures

  • regular checkups

  • digital rectal exams

  • immunizations

  • colonoscopy

  • mammograms

  • pap smears

  • osteoporosis screening

• ensure patient compliance with medications

  • forgetful 

  • difficulty swallowing

  • patient education improves compliance

  • simplification of medications is beneficial:

    • print list, write instructions for easy reading, offer medication reminder boxes, timers, or medication organizers

• collecting urine specimens:

  • may need assistance in providing a specimen

  • give clear instructions

  • give written instructions

  • offer special equipment

• blood drawing procedures

  • take extra precautions

    • frail patients and may not withstand blood-drawing procedures. 

    • more difficult to collect enough blood for an adequate sampling. 

    • prone to bruising, loosen tourniquet

• hot and cold therapy

  • decreased tolerance 

  • stay with a patient during application

  • check skin frequently

preventing falls in the elderly

• osteoporosis - leads to fractures 

  • risk factors

    • vision problems

    • slowed reflexes

    • equilibrium issues

    • medications 

safety checklist

• help patients on and off exam tables

• check for symptoms of syncope

• ensure good lighting 

• wear well-fitting shoes

• no loose rugs or clutter

• handrails in bathroom

depression

• symptoms may mimic other symptoms of other conditions

• know what to look for including

  • does not enjoy life

  • difficulty in concentrating

  • appetite changes

  • sleep disturbances

  • worthlessness

elder abuse and neglect

• occurs in all racial, socioeconomic, and religious groups

  • take a careful history

  • observe for nonverbal signs of problems such as grimacing, foul odors, or bruising

  • bruises from falls and other accidents can be mistaken for abuse

  • notify provider if suspected or observed

• signs of neglect

  • foul odors

  • poor skin color

  • inappropriate or soiled clothing

  • concerns about money

age-related changes can affect…

• absorption 

• metabolism 

• distribution 

• excretion

geriatric patients have an increased risk of…

• drug toxicity

• adverse effects

• lack of therapeutic effects

how do you reduce risk of drug-drug interactions?

• obtain an accurate list of current medications at every visit

• include patient and family education

• simplifying medication schedule

• provide written instructions

at which age is a patient considered geriatric?

• 55

• 60

• 65

• 70

65

which physical change happens in the elderly person’s respiratory system?

• atherosclerosis

• hypertension

• myocardial infarction

• shortness of breath

shortness of breath

which physical change happens in the elderly patient’s nervous system?

• arteriosclerosis

• hypertension

• myocardial infarction

• shortness of breath

arteriosclerosis

why is it important to speak slowly and clearly using a lower tone of voice with geriatric patients?

• to help keep their attention

• to relax them

• many older people are hard of hearing

• they live alone and aren’t used to talking to another person

many older people are hard of hearing

what disorder often occurs in elderly women due to a loss of bone density?

• arteriosclerosis

• hypertension

• myocardial infarction

• osteoporosis

osteoporosis

which symptom is a sign of neglect in the elderly?

• foul odors

• edema

• wearing perfume

• slurred speech

foul odors