Geriatrics Study Notes
Chapter 39: Geriatrics
Introduction
This chapter discusses various aspects of geriatrics, including the impact of the older adult population on healthcare, changes associated with aging, roles of medical assistants, and common illnesses that affect this demographic.
Objectives
General Skills
Spell and define, using the glossary, all the Words to Know in this chapter.
Describe how the older adult population is impacting health care.
Describe how the body changes as people age.
List the cognitive changes that occur during the aging process.
Describe the role of the medical assistant when working with older adults.
Describe communication challenges faced by older adults.
Specific Skills
Describe adaptive measures the medical assistant can take to facilitate communication with older adults.
Describe safety measures that the medical assistant can teach older adults and their caregivers.
Describe common illnesses that occur in older adults.
Describe how polypharmacy affects older adults.
Describe housing options for older adults.
Older Population’s Impact
The impact of the increasing older adult population on health care includes:
Increasing need for resources: Requires more healthcare services, staff, and facilities.
Growing number of obese patients: Obesity increases comorbidities among older adults.
Shortage of healthcare providers: Insufficient healthcare professionals to meet growing demands.
Mismatch between caregiver diversity and diverse patient population: Providers often lack appropriate cultural competency.
Lack of sustainability of federal programs: Programs like Medicare and Social Security face financial challenges.
Geriatric Patient Overview
Definition: Geriatrics is the branch of medicine focusing on the medical care of older adults, specifically individuals aged 65 years or older.
Demographic Data: Women generally live approximately five years longer than men.
Health Condition Statistics: 85% of older adults have at least one chronic health condition, with 60% having at least two chronic health conditions.
Aging-Related Changes
Physical Changes
Various physical alterations occur with aging, and Table 39-1 provides a detailed overview.
Cognitive Changes
Cognitive abilities such as conceptual and perceptual reasoning, memory, and processing speed tend to decline gradually over time. This decline may be related to medication use.
Physical Changes in Aging & Health Promotion
Cardiovascular: Aging leads to stiff blood vessels, reduced heart efficiency, and poor circulation.
Promotion: Regular exercise, a healthy diet, quitting smoking, adequate sleep, and effective stress management.
Musculoskeletal: Changes include muscle weakness, reduced flexibility, and bone loss (osteoporosis).
Promotion: Increase calcium and Vitamin D intake, engage in physical activity, and avoid harmful substances.
Digestive: Older adults may experience constipation and decreased taste/appetite.
Promotion: Adopt a healthy diet, maintain regular exercise, and establish consistent bowel habits.
Urinary: Increased frequency of urination and incontinence are common.
Promotion: Regular voiding practices, maintaining a healthy weight, Kegel exercises, and avoiding irritants.
Sensory: Changes include difficulty focusing on close objects, cataracts, light sensitivity, and loss of hearing (especially high frequencies).
Promotion: Encourage regular screenings, use of sunglasses, and ear protection.
Integumentary: Skin may become thin, dry, less elastic, and susceptible to bruising and wrinkles; nails may become thickened.
Promotion: Advise warm water bathing, use of sunscreen, protective clothing from the sun, and discouraging smoking.
Reproductive:
Women may experience vaginal dryness and painful intercourse, while men may face prostate enlargement and erectile changes.
Promotion: Regular exercise, maintaining open communication with the provider, and consulting about treatments.
Endocrine: There is decreased hormone production, leading to weight gain and increased risk of diabetes.
Promotion: Encourage a healthy diet and regular exercise.
Nervous: Older individuals may have balance issues, slower reflexes, and decreased sensation.
Promotion: Suggest physical activity, abstaining from tobacco, ensuring quality sleep, and maintaining a healthy diet. The shingles vaccine is also recommended.
Respiratory: Aging can lead to reduced lung capacity and strength.
Promotion: Avoid smoking, limit exposure to secondhand smoke, incorporate a balanced diet and exercise, and receive vaccinations (flu/pneumonia).
Patient Education Goals for Older Adults
Goals
Maintain or increase independent function.
Improve self-care abilities.
Expand social networks.
Challenges
Mobility limitations, social isolation, cognitive decline, and multiple chronic conditions can hinder these goals.
Cognitive Changes in Aging
Normal Cognitive Changes
Cognitive decline tends to occur gradually, impacting conceptual and perceptual reasoning, memory, and processing speed. However, some abilities, such as vocabulary, may improve with age.
Onset: Changes can be sudden or gradual, temporary or permanent.
Causes: Cognitive changes may be due to hormone issues, vitamin deficiencies, substance abuse, infections, or side effects from medications.
Medications Causing Cognitive Issues
Opioids: Often used for pain management, they can lead to cognitive impairment, dullness, and sedation, increasing the risk of falls.
Anticholinergics: Prescription and over-the-counter medications like Benadryl, Elavil, and Ditropan block acetylcholine, leading to poor reasoning, confusion, memory loss, and in severe cases, irreversible dementia. Risks include accumulation from multiple medications, necessitating patient consultation with providers before taking OTC medications.
Medication Management Best Practices
Patients should:
Bring all current medications to every appointment.
Keep an accurate, up-to-date medication list.
Carry a written medication log at all times.
Review medications during every visit to identify potential interactions or errors.
Dementia vs. Normal Forgetfulness
Dementia
Definition: Dementia is characterized as NOT being a standard aspect of aging but involves progressive cognitive symptoms that affect daily functioning.
Statistics: Approximately 50 million individuals worldwide have dementia, with about 10 million new cases arising each year.
Common Causes: Include Alzheimer's disease, head injuries, stroke, Parkinson’s disease, and brain tumors.
Early Signs:
Short-term memory changes.
Mood fluctuations.
Difficulty in word retrieval.
Repetition of stories or questions.
Confusion in familiar surroundings.
Struggles with routine tasks.
Role of Medical Assistant in Geriatric Exams
Scheduling: Assist with booking appointments for additional testing (hearing, vision, radiology, cardiology).
Transportation: Arrange travel to specialist visits.
Support: Aid patients with ambulation and collect lab specimens.
Communication Challenges with Older Adults
Older patients often struggle to express themselves due to memory issues, medication side effects, physical decline, and fatigue. Vision and hearing impairments also present significant communication barriers.
Adaptive Communication Measures
Scheduling: Book older patients for earlier appointments to reduce stress.
Greeting: Introduce yourself using your name and title, making patients feel valued and comfortable.
Environment: Seat patients in quiet areas, provide easy-to-read materials, and be prepared to assist them physically.
Check-in: Regularly follow up with the patient during their visit for comfort.
Closure: End visits by giving a proper goodbye to reinforce rapport.
Safety Measures
Fall Prevention: Educate about strategies for reducing fall risk, such as:
Exercise to improve balance and coordination.
Regular medication reviews by providers or pharmacists to identify sedative properties.
Annual vision checks.
Gradual rising from sitting or lying positions.
Appropriate footwear inside and outside the home.
Enhanced lighting around the house.
Using contrasting colors on stair edges to improve visibility.
Common Illnesses in Older Adults
Major Health Issues:
Heart disease, diabetes, arthritis, hypertension, depression, sleep disorders, weight loss, and delirium.
Detailed Illness Descriptions
Heart Disease: Characterized by coronary artery blockages due to fatty deposits, reducing blood supply and potentially leading to angina, heart failure, or stroke.
Type 2 Diabetes: The most prevalent form among the elderly, resulting from increased insulin resistance tied to impaired pancreatic function.
Arthritis (Osteoarthritis): Involves cartilage degradation at joints, presenting symptoms such as inflammation, pain, weakness, and limited motion.
Hypertension: Commonly seen with age-related arterial stiffness, characterized by elevated systolic pressure while diastolic pressure may remain normal or low.
Depression: Affects feelings, thought processes, and daily activities; extends beyond temporary sadness, severely disrupting sleep, appetite, and work.
Sleep Disorders: Typically caused by age-related changes leading to longer sleep durations but less deep sleep, resulting in fatigue and higher fall risks.
Weight Loss: Often related to changes in smell and taste, with cancer being a significant unintentional cause.
Delirium: An acute disorder characterized by sudden confusion and disorientation, often triggered by medications, infections, or organ failures.
Polypharmacy
Concept: Refers to the use of multiple medications where generally five or more prescriptions define the term.
Management: Conduct thorough medication reviews during each visit to eliminate duplicates, assess interactions, reduce hospitalizations, and enhance patient safety.
Housing Options for Older Adults
Senior Housing/Independent Living Facilities:
Target Population: Individuals aged 55 and older, fully independent.
Setting: Typically consists of apartments or condominiums.
Services Provided: Generally does not include meals but may offer transportation and social activities.
Best Suited For: Those needing minimal to no assistance.
Assisted Living Facilities:
Target Population: Those requiring medical or personal care assistance.
Setting: Feature shared spaces or private apartments.
Goal: To help maintain independence, offering services like meals, transportation, housekeeping, wellness checks, medication assistance, and staffing.
Best For: Individuals who do not require continuous nursing care.
Nursing Homes (Skilled Nursing/Long-Term Care):
Definition: Provides the highest level of care outside hospital settings.
Services Include: Assistance with Activities of Daily Living (ADLs) such as ambulation, feeding, bathing, dressing, high-level medical care, 24-hour nursing care, and therapy.
Best Suited For: Patients who require constant medical supervision.
Medical Provider’s Role: Recognize the challenges patients and families face in decision-making; provide accurate information and connect to local resources.
Chapter Summary
Key Points
The demographic of individuals aged 65 and older is on the rise due to increasing life expectancy and lower fertility rates.
This increase will burden the healthcare system with more treatments and hospitalizations for older adults.
All body systems experience physical changes as they age, leading to health issues.
Cognitive functioning, such as memory and processing speed, generally declines with age.
Awareness of ageism and biases is crucial in providing care to older adults. Avoid making assumptions based on age.
A strong understanding of medications is necessary as older patients often take multiple prescriptions.
Effective communication is essential when interacting with older adults facing sensory impairments or cognitive challenges.
Medical assistants must assist older adults with ambulation as necessary and ensure regular health checkups focusing on fall risks and medication management.
Implementing safety measures, having a list of emergency contacts, and ensuring proper home safety can mitigate risks for older adults.
The most common diseases among older patients include heart disease, diabetes, arthritis, hypertension, and more. Polypharmacy can complicate medication management, necessitating thorough reviews.
Several housing options exist, including independent living, assisted living, and nursing homes, each catering to different levels of care required by older individuals.