This is one of four courses dealing with Age Specific Criteria. The four courses are for Children, Adolescents, Adults and Geriatrics.  It is advised that each of these be reviewed when possible.

INTRODUCTION:

Each patient is an individual. However, developmental similarities can be recognized and used to assist us in caring for these patients at a specific time in their growth and development. Growth occurs proximodistally from the center out and development refers to the acquisition of skills and abilities that take place throughout life. As we grow and mature, most of us will pass through similar growth and developmental stages.

The best way to care for patients will differ as people pass through the different growth and development stages. The way you care for an infant will differ from your care for and communication with children, teenagers, adults and the geriatric population.

At each level, you will learn:

1. "Normal" and common "problems" associated with each developmental stage.

2. How to care for and communicate effectively with each stage of growth and development.

AGE GROUP DIVISION.

Although, this is a general division of age groups, it is important to recognize that this is not a specific universal division and that people may pass in and out of these developmental stages as they grow and develop.

CHILD:

There are three stages to child-hood.

Infant is defined as birth to one year of age.

Toddler / Preschooler is defined as one year to five years of age.

School age child is defined as six years to 12 years of age.

ADOLECENT:

Adolescents are defined as Thirteen years to 19 years of age.

ADULT:

Adult is defined as 19 to 64 years of age.

GERRIATRIC:

Geriatric is defined at 64 years of age to death.

GERIATRIC: AGES 65 TO DEATH

Today more than ever people are living longer due to advances in health care, nutrition and medication. By the year 2000, more than 75% of the elderly population will be over age 75. By the middle of the next century, the population of people aged 85 and older is expected to increase five times. More than 80% of the elderly population will suffer from at least one chronic health problem. Studies show that the elderly account for more than 30 % of all hospitalizations and 36% of all health care expenditures. It is imperative as health care workers that we examine our own feelings and biases in regards to aging and the elderly before we take on the monumental task of caring for them. In the United States, we are a society that values youth and productivity. Many people perceive older adults as senile, unhealthy and having little value to contribute to society. However, these myths are being dispelled as the population of elderly adults grows and roles of the older person in our society are changing.

PHYSIOLOGICAL AFFECTS OF AGING:

The body goes through many changes as we age. Elasticity of skin decreases, cell growth slows, lean body mass and bone mineral contents usually diminish. The older body tends to work less effectively than the younger body. Metabolism is slowed requiring fewer calories. However, protein, mineral calcium needs remain the same. Decrease in organ function and metabolism will cause the older body increased risk for dehydration, formation of renal calculi. The process of waste and medications is much slower, and there is an increased difficulty in maintaining body temperature. Gastrointestinal changes lead to intolerance to spicy foods, decreased sense of taste due to decreased salivary flow, decreased gag reflex, decreased GI motility leading to constipation and fecal incontinence. Generalized muscle degeneration leads to overall weakness and respiratory problems. Finally, we must consider the degeneration of eyesight and hearing ability in the elderly patient to effectively treat and promote health care in this population.

RISKS:

There are many risks associated with this stage of growth and development.

The elderly person is at risk for falls and injury.

They consume twice the number of medications then those people under the age of 64. With decreased organ function, they are unable to metabolize the medications, which may lead to toxic levels, increased confusion and disorientation.

As organ function decreases, they are at an increased risk for infection and illness.

Decreased sensory ability.

Increased risk of malnutrition.

Increased risk of falls and injury.

Immobility.

Isolation.

Urinary and Fecal Incontinence.

HEALTH CARE PROFESSIONAL CONSIDERATIONS:

It is imperative that we know and understand potential toxic effects of medications commonly taken by the elderly and that we observe for these symptoms of:

Increased heart / respiratory rate.

Decreased heart / respiratory rate.

Increased confusion or lethargy.

Bizarre behavior, delusions or thought disorders.

Recent memory impairment.

Disorientation and or agitation.

Hypotension.

How do you know if this in a change in the patient from previous behavior? Complete a history with family members or primary caregiver is present, complete a thorough head to toe assessment. Obtain medical records if possible and obtain a list of all medications. If possible have family or caregiver bring the medication patient is currently taking with them for you to assess.

Prevent exposure to illness and infection.

Wash hands between each patient.

Discourage contact with people who have colds, fever or recent exposure to people with an infectious illness.

Encourage and teach proper nutrition.

Have patient discuss with their physician if they should receive a Flu Vaccination each year.

MALNUTRITION AND NUTRITION IN THE ELDERLY:

There can be several causes of malnutrition in the elderly. We as health care workers must assess our patients closely for and symptoms of malnutrition and the possible causes of malnutrition in the elderly.

Nutrition Needs:

Because metabolism is slowed with age, an elderly person will require fewer calories now then at any other time of his life.

Encourage patient to include adequate amounts of fiber and fluid in his diet to prevent dehydration, formation of renal calculi and constipation.

Fewer calories do not mean less vitamins, minerals and calcium.

Explain that calcium needs are higher due to loss of calcium absorption, which increases their risk for osteoporosis.

Explain the need to decrease fat from the diet to decrease the risk of heart disease. Advise them to substitute dairy products such as milk and cheese for low fat dairy products that are now available to them.

Malnutrition signs and symptoms:

Weight loss, dry skin, weakness, frequent diarrhea and muscle wasting

Weight-height ratio 60% - 90% below standard.

HEALTH CARE PROFESSIONAL CONSIDERATIONS:

Obtain a complete history from patient

Complete a head to toe assessment including height and weight

Ask patient if there has been a weight loss if so how much?

Complete a nutrition assessment form. If this is not available to you contact the Dietitian in your facility to assist you.

Obtain normal height and weight chart and compare with patient's actual height and weight.

Assess patient's ability to perform activities of daily living.

Can they perform the task of shopping for groceries?

Can they prepare food?

Do they drive? If not, how do they get to the grocery store?

What kind of medications is the person taking?

Do any of these medications affect appetite?

What are their financial rescues?

Consider the need for Social Service and dietary consultation.

IMMOBILITY:

This is a common side effect of arthritis and muscle wasting. To help minimize the effects of immobility encourage your elderly patients to exercise regularly. There are a lot of active senior groups and functions available to the elderly in most communities today. Discuss with your elderly patient what they like to do for fun. Encourage them to join a walking club, social club bingo etc. Combating immobility may keep the elderly patient from institutionalization. Contact the physical therapy department of your institution for exercises you can safely perform with the immobilized patient.

SENSORY LOSS:

Aging commonly affects hearing, sight, and sense of smell and taste. If your patient is hearing or visually impaired you must find ways to communicate with them that will be effective for both your teachings and understanding the needs of your elderly patients.

As health care workers we must teach the elderly to both protect these senses and compensate for any loss or decrease in function they are experiencing.

HEARING CONSIDERATIONS:

Assess patient’s ability to hear you when you are speaking with them. Ask if they understood. Can they repeat what you just told them?

Consider the need for intervention by physician for an order of a hearing test.

Ask if they use a hearing aide.

Does the hearing aide have batteries? Is it turned on?

Express the need for professional intervention if hearing loss is suspected. Encourage them to seek professional assistance Otolaryngologist, Audiologist, or ENT physician.

SIGHT CONSERATIONS:

Assess the patient’s ability to see printed and written material.

Provide large print information when possible.

Encourage routine annual eye exams for the detection of Glaucoma, cataracts and to update their eyeglass prescription.

TASTE CONSIDERATIONS:

Research has shown that taste decreases as we age.

Poor enjoyment of food can lead to malnutrition.

Explore likes and dislikes of food with patient.

Encourage a varied diet rich in protein, calcium, vitamins and minerals.

Explore seasonings with patient to enhance food taste.

PREVENTING INFECTIONS IN THE ELDERLY:

Influenza and pneumonia are the leading causes of death in the elderly.

Increased risk of death to those people suffering from chronic illness.

Death rate for people are 2.5 times greater in people ages 64 to 74 and 10 times higher in people ages 75 to 84 then for the rest of our population.

Explain that chronic health problems make them less able to tolerate infections

Encourage them to talk with their physicians about vaccinations against the influenza and pneumonococal pneumonia viruses.

Teach them measures to prevent infection such as frequent hand washing, avoiding crowds during cold and flu season and to seek medical attention if they catch cold or fever not to wait and see if it goes away.

MALNUTRITION AND NUTRITION IN THE ELDERLY:

There can be several causes of malnutrition in the elderly. We as health care workers must assess our patients closely for and symptoms of malnutrition and the possible causes of malnutrition in the elderly.

Nutrition Needs:

Because metabolism is slowed with age, an elderly person will require fewer calories now then at any other time of his life.

Encourage patient to include adequate amounts of fiber and fluid in his diet to prevent dehydration, formation of renal calculi and constipation.

Fewer calories do not mean less vitamins, minerals and calcium.

Explain that calcium needs are higher due to loss of calcium absorption, which increases their risk for osteoporosis.

Explain the need to decrease fat from the diet to decrease the risk of heart disease. Advise them to substitute dairy products such as milk and cheese for low fat dairy products that are now available to them.

Malnutrition signs and symptoms:

Weight loss, dry skin, weakness, frequent diarrhea and muscle wasting

Weight-height ratio 60% - 90% below standard.

Nursing Considerations:

Obtain a complete history from patient

Complete a head to toe assessment including height and weight

Ask patient if there has been a weight loss if so how much?

Complete a nutrition assessment form. If this is not available to you contact the Dietitian in your facility to assist you.

Obtain normal height and weight chart and compare with patient's actual height and weight.

Assess patient's ability to perform activities of daily living.

Can they perform the task of shopping for groceries?

Can they prepare food?

Do they drive? If not, how do they get to the grocery store?

What kind of medications is the person taking?

Do any of these medications affect appetite?

What are their financial rescues?

Consider the need for Social Service and dietary consultation.

IMMOBILITY:

This is a common side effect of arthritis and muscle wasting. To help minimize the effects of immobility encourage your elderly patients to exercise regularly. There are a lot of active senior groups and functions available to the elderly in most communities today. Discuss with your elderly patient what they like to do for fun. Encourage them to join a walking club, social club bingo etc. Combating immobility may keep the elderly patient from institutionalization. Contact the physical therapy department of your institution for exercises you can safely perform with the immobilized patient.

SENSORY LOSS:

Aging commonly affects hearing, sight, and sense of smell and taste. If your patient is hearing or visually impaired you must find ways to communicate with them that will be effective for both your teachings and understanding the needs of your elderly patients.

As health care workers we must teach the elderly to both protect these senses and compensate for any loss or decrease in function they are experiencing.

HEARING NURSING CONSIDERATIONS:

Assess patient’s ability to hear you when you are speaking with them. Ask if they understood. Can they repeat what you just told them?

Consider the need for intervention by physician for an order of a hearing test.

Ask if they use a hearing aide.

Does the hearing aide have batteries? Is it turned on?

Express the need for professional intervention if hearing loss is suspected. Encourage them to seek professional assistance Otolaryngologist, Audiologist, or ENT physician.

SIGHT NURSING CONSERATIONS:

Assess the patient’s ability to see printed and written material.

Provide large print information when possible.

Encourage routine annual eye exams for the detection of Glaucoma, cataracts and to update their eyeglass prescription.

TASTE NURSING CONSIDERATIONS:

Research has shown that taste decreases as we age.

Poor enjoyment of food can lead to malnutrition.

Explore likes and dislikes of food with patient.

Encourage a varied diet rich in protein, calcium, vitamins and minerals.

Explore seasonings with patient to enhance food taste.

PREVENTING INFECTIONS IN THE ELDERLY:

Influenza and pneumonia are the leading causes of death in the elderly.

Increased risk of death to those people suffering from chronic illness.

Death rate for people are 2.5 times greater in people ages 64 to 74 and 10 times higher in people ages 75 to 84 then for the rest of our population.

Explain that chronic health problems make them less able to tolerate infections

Encourage them to talk with their physicians about vaccinations against the influenza and pneumonococcal pneumonia viruses.

Teach them measures to prevent infection such as frequent hand washing, avoiding crowds during cold and flu season and to seek medical attention if they catch cold or fever not to wait and see if it goes away.

COMMUNICATION WITH THE ELDERLY:

Effective communication with the elderly is essential to providing good safe care. Remember they have a lifetime of experiences and they know what they like and dislike. Never talk to elderly patients as though they were children. Use adult language and terminology. Remember they may have had this illness for a long time and know a lot about it. As people grow older, they have many concerns and worries that they did not have as an adult. They are faced with many life changes at this stage. A common difficulty they face is loss. At this stage, it is not uncommon to interact with someone who has lost friends, family members and spouses. These losses and the associated feeling of isolation, loneliness, can cause stress that has implications both physiologically and psychologically. It is estimated that 25% of all elderly suicides is a result of these unresolved feelings. We as health care workers must take the time to listen to our elderly patients' feelings of loss and loneliness. A few moments of your time and respect can prevent many psychological and physical difficulties.

MEDCEU Continuing Education Courses CEU for Nurses and Healthcare Professional

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