Aging: Common Problems and Care

Aging: Common Problems and Care II:

Heart, Blood, Digestion (GI), Urine Tract, and Nervous System


4 Inservice or Class Hours






At the end of this class, you should be able to:


  1. Discuss common problems of the heart and blood vessels, blood, digestion, urinary tract, and nervous system
  2. Detail ways that you can prevent these problems and care for the aging person with these problems.




There are more aging people in the United States than every before. Many people say it is the “Graying of America”. We have learned a lot about these people and their needs in the last few years. Many old people are young in body and mind. All old people are not all the same. They are different. They all have different needs.


This class will teach you about some of the common problems and care that are NOT a normal part of aging. To learn about the normal changes, take our class called “Aging: What It Is and What It is NOT”.


You will learn about problems of the:


·         Heart and Blood Vessels

·         Blood

·         Digestion (GI)

·         Urine

·         Nervous System



Heart and Blood Vessels



Some of the normal heart changes among the aged are:


·         Loss of heart muscle tone.

·         Increased size of the heart.

·         A larger left side of the heart.

·         A decrease in the elasticity of the heart and blood vessels.

·         Lower output from the heart.

·         Greater deposits in the blood vessels.

·         Slower pulse.


Some of the common problems are:


·         High blood pressure

·         Coronary artery disease (angina)

·         Heart attack

·         Heart valve problems

·         Heart failure

·         Peripheral vessel problems


High blood pressure (Hypertension)


Normally, infants and children have a lower blood pressure than adults. Blood pressure usually gets higher as a person gets older. Blood pressure is also normally higher when a person is exercising. It is normally lower when they are resting and lowest when the person is sleeping. Blood pressure can also be different at different times of the day. It is usually lowest during the night time hours and it gets higher as the morning comes.


High blood pressure is a common cardiac disorder. High blood pressure can lead to heart attack, stroke, kidney damage and other health problems.


Blood pressure can be high for a number of reasons. It will be high when:


·         the heart is pumping with great force, or

·         the arteries from the heart become narrow and stiff (atherosclerosis) and they do not expand normally when the blood flows through. This makes the heart work harder to move the blood along, or

·         there is far too much fluid in the circulatory system, as is the case when a person's kidneys are not working the way they should.


High blood pressure can also be caused by:


·         kidney problems, including tumors and infections,

·         hormone disorders,

·         some medications, like oral birth control pills,

·         alcohol abuse,

·         smoking,

·         drug abuse,

·         poor eating habits that increase cholesterol and triglycerides,

·         other causes, such as pregnancy and lead poisoning,

·         stress,

·         a lot of salt in the diet, and

·         being overweight.


Blood pressure is considered high when:


  • the systolic blood pressure (top number) is more than 140 at rest, and/or
  • the diastolic blood pressure (bottom number) is 90 or more at rest.


Most people with high blood pressure have both numbers high. A person can lower their high blood pressure by NOT using alcohol or cigarettes, by eating foods low in salt and cholesterol and by managing their stress.


Exercise and a healthy weight are also important in keeping the blood pressure at a good level. A patient's doctor may order medications, such as a diuretic (water pill) and/or a cardiac medication to lower a person's blood pressure.


Some people may not have any signs of high blood pressure. Others do. Some of the signs of high blood pressure are:


  • a headache,
  • nose bleeds,
  • nausea,
  • vomiting
  • dizziness,
  • shortness of breath,
  • a flushed face,
  • restlessness
  • fatigue, and
  • blurry vision.




This condition happens when the insides of the arteries that nourish the heart muscle itself (coronary arteries) become too narrow for the oxygen rich blood to feed them. They get narrow when fatty deposits build up on the inside of these arteries. This build up and narrowing is called atherosclerosis.


Angina and a heart attack occur when the narrowing of the coronary arteries becomes severe. A person with angina will have chest pressure and pain when the heart muscle is not getting enough oxygen.


Coronary artery disease is most common among people who:


  • eat a high-fat diet,
  • smoke, and
  • do not exercise.


Again, some people do not have the signs of angina. They have what is called "silent ischemia". Others, however, do have signs. The signs of angina include:


  • pressure or pain under the breast bone,
  • left shoulder pain,
  • pain down the inside of the left arm, and
  • sometimes pain in the jaw, teeth, throat, back and even the right arm.


Some people have angina pain only with activity. Others have angina pain even at rest. When a person has angina pain with activity, they should rest. Some people have more pain when the weather is cold, when they are under stress or after they have just finished a meal.


The treatment of angina often involves the use of several drugs, including nitro, which the person places under their tongue during an attack. Some people will also get bypass surgery to repair it.


Heart Attack


Heart attack, also known as myocardial infarction, is when the oxygen supply to the heart is suddenly cut off, thus causing the heart muscle itself, and the person, to die unless treated immediately. An irregular heart beat during a heart attack can lead to cardiac arrest unless it can be treated. A heart attack is a medical emergency. It needs immediate treatment. People who live in their own homes should be told to call for 911 as soon as the symptoms of a heart attack begin.


The risk of heart disease and heart attack increases with high levels of LDL, or bad cholesterol. And, the risk of heart disease decreases with high HDL, or good cholesterol. A person with low LDL and high HDL is less likely to have heart disease than a person with high LDL and low HDL.


Heart attacks most often happen when a coronary artery is cut off by a blood clot in a narrowed vessel. The signs of a heart attack are:


  • shortness of breath, chest pain and a feeling of being tired, sometimes for days before the heart attack,
  • chest pain that spreads to the left arm, back and/or jaw and/or even the right arm,
  • stomach pain that the person may think is just indigestion,
  • feeling faint,
  • heavy palpitations or pounding of the heart,
  • sweating,
  • restlessness,
  • loss of consciousness,
  • disorientation,
  • a blue color on the lips, feet and/or hands.


Like angina, some people having a heart attack have no signs or symptoms at all. These heart attacks are called "silent heart attacks".


Heart attacks are treated with rest, oxygen, a number of different medications, including aspirin, which thins the blood, and pain medications to help the pain and to ease the amount of work that the heart has to do as a result of the pain.


The person will also get medications to prevent constipation and a urinary catheter, if needed. Some doctors order one baby aspirin a day to lower the risk of future heart attacks.


People who have had a heart attack are usually up in the chair after a couple of days. After, they will begin more and more activity and cardiac rehabilitation. Many will also be instructed to change some things in their life. For example, they may be told to stop smoking, to lose some weight and to get some regular exercise.


The nursing assistant can help the person to prevent a heart attack by:


  • giving them a healthy diet;
  • encouraging them to exercise; and
  • reminding them to take their heart pills.


Heart Valve Disorders


The heart has four (4) valves. These heart valves can sometimes leak or NOT open correctly.


Surgery is done to repair a valve that is not working well enough to keep the person in good health. A pig valve or a mechanical valve is placed in the person’s heart to replace the valve that is not working well.


Heart Failure


Heart failure is also called congestive heart failure. Heart failure is a very serious condition. The oxygen and nutrients pumped by the heart is not enough to keep the body and its parts in proper condition. The heart can not keep up with the body’s demands. It is found more often among the elderly.


This cardiac disorder can be caused by a number of things, such as:


  • coronary artery disease,
  • heart valve disease,
  • high blood pressure
  • an infection of the heart muscle, and
  • and an irregular beating of the heart


Some of the signs of heart failure are:


  • fatigue
  • swelling of the feet, ankles, abdomen and liver (right sided heart failure)
  • fluid buildup in the lungs and shortness of breath (left sided heart failure)


This heart disorder is treated by treating the cause of it, and by taking away some of the things that make the disorder worse, like losing weight, stopping smoking and lowering the amount of salt, or sodium, in the diet.


Nursing assistants who are asked to take care of people with heart failure may be asked to:


  • Limit the amount of fluids that the person gets.
  • Give the person a low salt diet. Salt holds water and fluids. A low salt diet is often given to the person with heart failure in order to lower the amount of fluid in a person's body.
  • Take daily body weights. These weights should be done in the morning before breakfast, after the person has voided and using the same scale. A gain of 2 or more pounds in one day means that the person is building up body fluid. It must be reported. 
  • Measure intake and output.
  • Position the person in a sitting position when they are short of breath.
  • Elevate the person's leg when they have fluid build up (edema).


The person’s doctor order “water” pills so the person can get rid of the extra fluid via the urine.


Peripheral Vessel Problems


This happens when the arteries get clogged and blocked up with plaque (atherosclerosis), which can break off, and travel as a clot. These clots can block vessels leading to pain, numbness, and tissue damage in the affected part of the body because the blood cannot flow thru them. The person’s leg may have to be cut off in very serious cases.


These are the risk factors:


·         Smoking

·         Old age

·         Diet with a lot of fat and salt

·         A stroke (CVA) in the past

·         Other diseases or conditions (diabetes, high blood pressure)


It can be prevented by:


·         NOT smoking

·         Eating a healthy diet with low fat and low salt

·         Regular, daily exercise

·         Managing diabetes and high blood pressure


The signs are:


·         pain, heavy and aching legs;

·         foot and leg cramps that come and go away with rest;

·         poor leg and feet pulses;

·         sores that do not heal; and

·         cool skin.


The nursing assistant can care for the person by:


·         Encouraging the person to walk and then to rest if pain begins

·         Checking the feet and toes regularly for any signs of a sore

·         Giving the person good foot care

·         Encouraging the person to stop smoking if they do so

·         Giving the person a good diet with a lot of fruit, vegetables and whole grains rather than fats and salt


Heart disease is a very common problem in our country, especially among the elderly. Nursing assistants play a very important role in caring for these patients and residents. They provide direct care and observe the patient for signs of heart disease. All observations, especially those that indicate a medical emergency, like chest pain, must be reported to the nurse.




Some of the normal blood changes are:


·         The blood gets thicker.

·         A small drop in the red blood cells and white blood cells.

·         The T cells become less effective.


Some of the common problems are:


·         Anemia

·         Leukemia

·         Melanoma




This occurs when there are not enough red blood cells. It can happen when the person:


·         Does NOT eat a good diet with iron and vitamin B12

·         Is a chronic alcohol abuser

·         Has problems like Crohn’s disease


The nursing assistant should encourage the person to eat a good diet with iron and vitamin B12 , The person should also stop any alcohol use.



Most people get leukemia after 50 or 60 years of age. It is a cancer of the blood cells. It starts in the bone marrow, the insides of the bones that make red blood cells (carries oxygen to cells), white blood cells (fights infections) and platelets (clots blood).

When the person gets this problem, the bones make abnormal white blood cells. These cells then take over the other healthy cells in the body.

The signs of it are:


·         fevers,

·         being tired,

·         a lot of infections (poor white cells),

·         loss of weight,

·         large lymph nodes,

·         headache,

·         vomiting,

·         confusion, and

·         easy bleeding and bruising (low platelets).


Illustration of the lymphatic system.Myeloma


Myeloma is also a cancer of the blood that is also seen more among old people, and men. It is the 2nd most seen cancer of the blood.


No one is very sure why some people get leukemia and myeloma, but there are some risk factors. These are:


·         Old age

·         Being a man

·         Being white

·         Smoking

·         Some chemicals

·         Radiation


There are several things that can be done for these people, including chemotherapy drugs.


The nursing assistant caring for the person with a cancer of the blood should:


·         Provide a good diet

·         Support the person with their activities of daily living.


Digestion (GI)


Some of the normal GI changes are:


·         The gums pull back from the teeth so the teeth may get loose.

·         Increase in the number of cavities.

·         Lower feelings of thirst.

·         Poor gag reflex.

·         Lower muscle tone at the end of the esophagus to the stomach.

·         Lower saliva.

·         Lower stomach digestion.

·         Slower movement of the GI tract.

·         Smaller liver size.

·         Lower stomach mucus production.


Some of the common GI problems among older people are:


·         Hiatal hernia

·         Gastritis and ulcers

·         Diverticulosis

·         Colon cancer

·         Hemorrhoids

·         Incontinence

·         Constipation

Hiatal hernia


This hernia is upward movement of the stomach into the esophagus. Men have it more than women. It is most common among the elderly. About 40% – 60% of men over 60 years of age have it. It is a problem because the person may choke on the stomach contents.


The signs happen right after the person eats, especially if they live down. Some of the signs are:


·         Stomach pain

·         “Gas”

·         Feeling of indigestion

·         “Heartburn”


The nursing assistant should do these things for the person.


·         Smaller meals spread out during the day.

·         Sit up after a meal, rather than lying down.

·         Provide a good diet with low fat and caffeine.


The person will be given a drug by their doctor to treat it.


Gastritis and ulcers


Gastric ulcers are quite common in old people. Some of the risk factors are:


·         Smoking

·         Drinking alcohol

·         Stress

·         Some drugs like NSAIDS


The signs are:


·         Pain

·         Poor appetite

·         Weight loss

·         Vomiting

·         Signs of anemia


The nursing assistant should do these things for the person.


·         Provide a good diet with no foots that tend to irritate the person (caffeine, for example)

·         Encourage the person to NOT drink or smoke

·         Help the person to cope with their stress




Tiny sacs develop in the weak parts of the bowel with this problem. Almost 40% of people over 50 years of age, have it.


Most people have no signs but some may have blood from the rectum. The person may have to go into the hospital for “bowel rest” if an infection builds up.

Some may also need surgery.


The nursing assistant should watch the person and their stools for any signs of bleeding. Any blood must be reported right away.


Colon cancer

This cancer is found in both men and women, mostly after 50 years of age. It can be cured about 90% of the time if it is found early.


Some things that may lead to it are:


·         Age. Over the age of 50

·         Polyps. Bumps in the colon

·         Diet. Not enough fiber, fruits and vegetables and too much fat.

·         Lack of exercise

·         Smoking

·         It runs in families

·         Other things like colitis and breast cancer

The signs are:

·         The number of times a person moves their bowels

·         Diarrhea

·         Constipation

·         A full feeling

·         Red or dark stool

·         Narrow stool

·         Gas

·         Cramps

·         Weight loss

·         Vomiting

·         Being tired

It can be prevented when the person, 50 years old and older, has tests for hidden blood in the stool and a scope to look at their colon.

It is treated with one or more of these things.

·         Surgery

·         Radiation

·         Anti-cancer drugs


The nursing assistant caring for the person with a cancer of the colon should observe the person, their stool and their bowel patterns. They must report anything that is not normal.




Many older people get these when they are constipated or very obese. The person may have pain and bright red blood.


The person should be encouraged to use stool softeners or bulk fiber additives. The nursing assistant should report any pain or bleeding.




The person may not have or know that they have to have a BM as the person gets older. They may lose the feeling or they may be too confused to connect the feeling to a BM. They may also not have good control over their bowels because they have another problem.


Some of these problems are:

  • diarrhea
  • constipation
  • poor anal muscles or nerves
  • damage to the nerves of the anal sphincter muscles or the rectum
  • loss of storage ability in the rectum

Loose, watery stools (diarrhea) are much harder to control than normal stool, so the person can be helped by finding, and treating, the cause of the diarrhea. Constipation is one of the biggest causes because when hard stool get stuck in the rectum, the loose stool leaks out around it. Again, treating this may help the person.

Muscle damage may happen after hemorrhoid surgery and among women who have given birth to babies. Nerve damage can be caused by childbirth, straining on stool, diseases such as diabetes and MS and a problem such as a stroke.

Normally, the rectum stretches to hold stool until you can get to a bathroom. The storage ability of the rectum may become less after the person has had surgery to the area, bowel disease and radiation. Again, these problems can lead to incontinence of stool.


The treatment of this problem depends on the cause. It may be bowel training, diet changes, surgery or drugs. For example, fiber may be added to the diet and things like coffee, tea, dairy products, spicy foods, and grease may be held.


Bowel training helps some people to control their bowel movements. This training may be muscle tightening exercises and/or moving the bowels at specific times each day.

Drug and surgery may be done when other things do not work.

When the nursing assistant cares for a person with incontinence, the area must be washed with a no rinse skin cleanser, alcohol free wipes, or a bath or shower. Alcohol wipes and rubbing will damage the skin. The area should be air dried or with gentle patting. A special cream should also be used on clean dry skin to prevent skin breakdown and to keep all stool away from the skin. Cornstarch can also be used. Remember, pads, briefs and other items are NOT a way to cleanse the person promptly.


Constipation leads to dry, small, and hard stool that is hard for the person to pass. The person may have a feeling of fullness or pain. They have to strain when they are having a BM. Most passes with time. At other times, it continues for a long time.

Some of the causes are:

  • some drugs
  • too little fiber in the diet (the most common cause)
  • too much fat in the diet
  • too little physical activity, especially in the elderly
  • dehydration
  • ignoring the urge to have a BM
  • some things like a stroke or a problem with the rectum or colon

Many drugs that old people take lead to constipation. Some of these are:

  • pain drugs
  • blood pressure pills
  • drugs for Parkinson’s disease
  • water pills (diuretics)
  • iron

The most common causes of constipation are too little fiber and too much fat. Fiber in found in whole grains, beans, vegetables and fruit. The person should eat a large amount of fiber and little fat to avoid this problem. Non caffeine fluids should also be taken on a regular basis. These fluids make the stool softer and easier to pass. Coffee and cola dry the body out and can lead to this problem.


Older people often are constipated because their bowel muscles lose tone (normal change of aging) and they do not have regular exercise and activity. Still more ignore the need to have a BM, so, after a long time of this, the person will no longer have the urge to have a BM. People with problems like a stroke, cancer of the colon are also at risk for this problem.


Again, the treatment depends on the cause. Prevention is also important because ongoing constipation may lead to impaction, a prolapse and the total lack of bowel function.

The nursing assistant should do these things.

·         Give the person at least 20 to 40 grams of fiber every day. Give the person fruit, vegetables, beans, bran and whole grains.

·         Give the person plenty of fluids such as water and juice.

·         Have the person exercise on a daily, regular basis. Walking is good for the older person if they are not able to do other things.

·         Help the person know about the urge to have a BM and then give the person enough time to do so. 

At times, the MD may order laxatives, a stool softener pill, or an enema.

Urine System


Some of the normal urinary changes are:


·         The kidneys get smaller.

·         The kidneys lose some of their function.

·         Lower blood flow to the kidneys.

·         The concentration of the urine decreases.

·         The bladder gets smaller.

·         Less holding power of the bladder.

·         Loss of bladder muscle tone.

·         Loss of bladder elasticity.

·         Slower and/or lower feeling of the need to void.

·         More urine at night.

·         Prostate in men gets larger.


Some of the common problems are:


·         Urine infections

·         Incontinence

·         Kidney failure




People of all ages can get these infections, but they are much more common in older people. Women are more at risk than men.


Things that add to risk are:


·         Poor hygiene and cleansing after using the toilet

·         Slower and incomplete bladder emptying

·         Using antibiotics a lot

·         More exposure to infection in group housing and hospital settings

·         Catheters

·         Other things like diabetes and stroke


The nursing assistant can help prevent this problem with good hygiene, hand washing and encouraging the person to have water in their diet.




This happens when a person loses control over their bladder and urine. It can be a small problem or a big problem. For example, a person may lose a small amount of urine when they cough, sneeze or laugh or a person may lose all of their urine without any of these things. Women have it more than men. It is NOT a normal part of aging.

Some of the causes are:

·         Diabetes

·         Weak muscles (child birth and other causes)

·         Prostate problems (men)

·         Some drugs

·         Urine infections

·         Being over weight

·         Confusion

Again, the treatment depends on the cause. The person can do special exercises (Kegal), have bladder training, or get drugs or surgery. Kegel exercise makes the muscles stronger. The steps are:


  1. Stop the urine flow and hold it for 10 seconds. This helps the person to know exactly how to strengthen the muscles so Kegal exercise can be done any time and in any place.
  2. Once the person knows the muscles, have the person hold them tight for 10 second and then relax the muscles for 10 seconds 10 to 20 times three times a day.


Bladder training is done by having the person void every ½ to 2 hours whether or not they have to go. Later, extend the period of time to 3 or 4 hours in a slow manner. If the person feels that they have to void more frequently, have the person do Kegal exercise or deep breathing until the urge goes away.  Have the person then void 5 minutes after the urge goes away and then increase these minutes gradually until control is gained.


Medicine and surgery is done, in some cases, when other things do not work.


Kidney failure

Kidney disease and failure cause the kidneys to no longer be able to filter the blood as they should.

It can be caused by high blood pressure, constant urine infections, diabetes, heart disease and other conditions and things, like some drugs. People must control their heart disease, high blood pressure and diabetes in order to prevent kidney failure. They should also get regular lab tests to make sure that the kidneys are working well.


Many people in the early stages have no signs. Later, these signs may be seen:


  • Low urine output
  • Nausea
  • Vomiting
  • Edema
  • Muscle weakness


Nursing assistants must observe for and report any of these signs so that the person can be treated by the doctor. At times, the person may need drugs, dialysis or a kidney transplant. Other treatments are:


·         Smaller meals

·         Control of the diabetes, heart disease and high blood pressure

·         Drugs for any urine infections

·         Low salt in the diet

·         Less protein in the diet so the kidneys do not have to work so hard

Nervous System


Some of the normal aging nervous system changes are below.


·         The brain gets smaller.

·         The brain weighs less.

·         Blood flow to the brain gets lower.

·         Reflexes get slower.

·         A decrease in the number of nerves in the brain and the entire body.


Some of these common problems are:


·         Parkinson’s disease

·         Dementia

·         Alzheimer’s disease

·         Stroke (CVA)


Parkinson’s disease


This disease is a brain disorder. Many people over 60 years of age have it. The risk of getting it increases as the person gets older. Also, it gets worse and worse as time goes on. It affects men more than women. The cause of it is really not known, but some people think that it runs in families (inherited).


The signs of it are:


·         Stiff limbs

·         Tremors on one or both sides of the body

·         Slow movements

·         Poor balance and posture

·         Trouble getting started to walk

·         Rapid shuffling while walking

·         A “mask like”, blank face

·         Swallowing problems

·         Constipation

·         Changes in speech

·         Urine problems


The signs may get worse when the person is tired or under stress. The signs go away when the person is sleeping. It cannot be cured, but it can be treated with drugs and other things.


People with this disorder have several major needs. The nursing assistant must maintain safety, insure good nutrition, enable as much independence as possible and support the person because they may get depressed about this problem and their lack of ability to do simple things like eating and getting dressed.


These people are at great risk for falls because they are stiff, have tremors, and have a loss of balance. Some of the things that you must do to prevent falls are below.


·         Low beds

·         Chair alarms

·         Bed alarms

·         Frequent monitoring

·         Gym mats near beds and chairs to break any fall

·         Gait, balance and range of motion exercise

·         Things like canes and walkers within reach

·         High toilet seats

·         Good lighting

·         NO clutter

·         NO scatter rugs

·         Dry and skid proof floors or no skid socks/shoes/slippers

·         Grab bars

·         Call bell or regular bell within reach 

·         Promptly answering call bells

·         Bedside commode at night


Take our class “Preventing Falls” to learn more about falls and falls prevention.




Dementia is NOT a normal part of aging. It is an organic disorder that progresses. It can result from:


·         Trauma

·         Drugs

·         The lack of some vitamins

·         Lack of hormone balance

·         Other things and unknown things


The signs are:


·         Confusion

·         Loss of orientation

·         Poor memory and judgment

·         Poor impulse control

·         Changes in personality


The most common forms of it are Alzheimer’s disease and bleeding or the lack of oxygen to the brain.


Alzheimer’s disease


Alzheimer’s disease is a very common problem among older adults. It is sometimes found in younger adults but it is most often seen in older adults.

This disease continues to get worse after it starts. There is no cure for it. People with Alzheimer’s disease can not think and act in a normal way when they get to the last or worst stage of this disease. Some very known people, like former U.S. President Ronald Reagan, have had it.

Some people become completely dependent on others for their care. Basic safety needs become very great. When this happens, the patient can no longer live on their own. They need the help of healthcare workers, like a nursing assistant. Some patients live in their own homes with the help of home health care aides and a home health agency. Others live in a nursing home or in an assisted living home because they need the care that they will get in these places.

The 3 stages of Alzheimer’s disease are the:

  • Early stage
  • Middle stage
  • Late stage

The early stage signs are below.


·         A short-term memory loss. They can remember things that have happened a long time ago but they may not be able to remember what they had for lunch or dinner the day before.


  • The person may repeat what they have already said. They forget what they have already said when they are speaking with other people.
  • They may forget the word they want to use. These people just can not find the right word to use in a sentence. They may even use a word that makes no sense at all.
  • The person may forget how to do some simple things. Some may forget how to make their favorite stew, for example.
  • The person may not be able to do some “hands on” things. They may no longer be able to knit or drive a car as well as they did in the past.
  • The person may have personality changes. They may become angry, aggressive, depressed and “moody”.
  • They may become disoriented. They may forget what day of the week it is.

Some of these changes are very small and hard to notice. It is often the family that notices it. The person may not even know they are having trouble.


The middle stage signs are below.


As it continues to progress, the person will become more forgetful, confused and disoriented. They will have both short-term and long-term memory loss. The early stage signs get worse during the middle stage and the patient may also:

  • Be restless and confused at night. This is often called “sun downer’s”.
  • Have trouble reading and writing.
  • Repeat actions over and over again. These acts have no purpose but they are done over and over again anyway.
  • Wander and get lost. This is a big safety concern.
  • Be at risk for harm. Falls, self harm and getting lost are a problem. These patients no longer see and stay away from danger. They do not have good judgment and common sense.
  • Become very angry. These behaviors may place the patient, staff and other patients at risk for harm.
  • Not recognize family, friends and familiar place.
  • No longer be able to take care of themselves without the help of others.
  • Have hallucinations and delusions.
  • Personality changes. They may be sad and depressed, have fears, anxiety and other personality changes.

  • Lose social skills. These patients may stop spending time with others and doing things that you used to like doing.

During the late stage, the patient can no longer care for himself or herself. They need complete care. All of the early and late stage signs continue to get worse and the patient also:

  • Loses control of urine. They become incontinent of urine.
  • Loses control of stool. They become incontinent of stool.
  • Can no longer eat without a lot of help or a feeding tube. Patients may have eating and swallowing problems..
  • Becomes underweight and thin. These patients are at risk for malnutrition, dehydration, infections and aspiration.
  • Is highly irritable.
  • Very sleepy and not responsive.

Nursing assistants and others in healthcare provide care to Alzheimer’s and other dementia patients according to their own needs. For example, if a patient in the early stage of the disease is able to dress and bath without help, we should help them to remain as active and as independent as possible. If the patient is at risk for falls, we must make sure that their room and the nursing unit is safe, secure, neat and uncluttered.


Below are some Alzheimer’s disease health problems and ways that nursing assistants must provide care for these problems.



  • Keep the patient care area bright.
  • Keep stimulation and noise to a minimum.

  • Use large clocks, calendars and other things to orient the patient. Spend time with the patient. Remind them about the date, time of day and where they are.

Falls and other safety risks.

  • Keep the patient care area safe. Safety is VERY important. Keep the patient’s room and the patient care area. Take away all clutter and dangerous chemicals, like medicines and cleaning liquids. Use non skid slippers and shoes for those at high risk for falls.

  • Answer call bells promptly.
  • Follow patient identification procedures. Very careful patient identification must be used to prevent medical errors and mistakes.

Wandering risk.

  • Use and attend to alarms. Bed alarms, alarms that ring when a wandering person tries to leave the building help keep patients safe. Listen for and respond to alarms immediately.
  • Try to re-direct wandering. Some nursing homes have wandering or exercise tracks so that people can safely wander outside the building and in a big circle that ends in another entrance to the same building.

Lack of rest.

  • Alternate rest periods with activity. Tired patients may act out with behaviors that are disruptive, unacceptable or dangerous.
  • Encourage sleep and rest by keeping a regular bed time. Give the patient a quiet room for rest. Have the person change into pajamas and keep a regular routine so that the person is able to sleep at night.

Eating problems.

  • Encourage as much independence as possible.
  • Know what the patient can and can not have. Some patients with a swallowing problem can not have plain water or other liquids. They may need honey thick fluids instead.

Behavior problems.


The best way to manage poor behavior is to prevent it. The best way to manage it is to stop it before it starts. The prevention of poor behavior needs the help of the whole team, including nursing assistants.


PREVENT poor behaviors.

  • Know your patients and residents. Know what kinds of things lead to poor behavior. Know the things that help your patient to behave correctly. For example, give the patient a bath in the morning if they are less confused and agitated in the morning. A bath during the afternoon or evening may make this patient angry and resist care completely. Very often, poor behavior happens while care is being given to a patient or resident. Try to calm a patient during care. Keep things the same and keep things simple to prevent poor behavior. Know the best routine for the person and stick to it.
  • Know what triggers poor behavior and try to keep the person from these triggers. Eliminate all physical, emotional, environmental, communication and care triggers. Meet the person's needs so they do NOT react with disturbed behavior.
  • Give simple instructions and repeat instructions if needed.
  • Listen to the patient or resident. Many patients and residents will act out with poor behavior when they can't make their needs known. Spend time with your patient. Let them ask you questions. Help them tell you about their feelings. Help them tell you what they want. Use pictures if needed. Repeat back to them what you think they said or wanted to make sure you have really heard and understood them. Be clear and calm when communicating with these patients.
  • Observe your patients and how they act with others. If another easily annoys a patient, encourage both patients to go to a different place for an activity or event.
  • Approach a very confused patient from the side and speak face to face. Speak slowly, calmly and use simple words. Ask simple 'yes', 'no' questions.
  • Keep the patient care area simple. Keep noise down. Make sure that there is enough light. Keep schedules and routines the same for people who act out when things are changed. Limit choices if needed. Some patients and residents get nervous and frustrated if they have too many choices. Encourage patients and residents to go to well supervised and structured activities if they are at risk for poor behavior when things are not structured.
  • Keep your attention on the person and not the task. It is the person and how they are feeling that is important. If a person gets angry during an activity of daily living, break the task down into small parts. Encourage the person to be as independent as possible. Praise the person for their self care efforts.
  • Provide activities that meet the patients' and residents' needs and prevents poor behaviors. Clocks and a large calendar or poster with the day of the week, the date, the season and the day's weather often help to orient people to time and current reality. Other socialization and activity groups, like reality orientation groups, holiday parties and reminiscence groups are often helpful.
  • Relieve stress. Promote relaxation and other things that lower stress. Pet therapy, music therapy and socialization or exercise groups can lower stress.
  • Report all patient changes to the nurse in charge. If a patient condition or behavior changes they may be at risk for acting out behaviors. Report all patient changes.
  • Be a team member. Follow the patient's behavior management plan of care. Everyone on the team must be consistent. They must all say and do the same things with the patient.

MANAGE disruptive, unacceptable or dangerous behaviors when they occur.

  • Stay calm, speak softly and show respect. If inappropriate, dangerous or disruptive behavior occurs, speak to the patient(s) calmly, slowly and with respect. Have them sit to chat. Sit next to them.
  • Stop the task you are doing.
  • Call for help if you need it.
  • Protect all the residents from injury. Stay far enough away from a person so that they can't hit you. Try to sit the person down. Put a pillow on your chest if a person is trying to punch you in the chest. Do NOT fight back. Do NOT pull away if you are grabbed. Stay calm and talk with the person. Remove the person(s) from harm if your words and instructions do not stop the dangerous behavior.
  • Meet patient needs. If a person is making noise, find out if they are hungry, thirsty, wet, dirty, in pain, too hot, too cold or tired. Meet these needs. Feed the person that is hungry. Give water to the person who is thirsty, etc.
  • Report any disturbed behavior. What triggered the behavior? What happened? When time was it? Where did it happen? How long did the poor behavior continue? Was the behavior mild, moderate or very severe? Who else was involved? What did you do to stop the behavior? Did it work?

Stroke (CVA)

Stroke is the third highest cause of death in America. It is also the highest cause of a disability in the United States. A stroke is also called a CVA.

Strokes stop the flow of oxygen to the brain cells. The blood flow is stopped when a blood clot enters the brain or when bleeding occurs in the brain. Brain cells die when the brain does not get the oxygen it needs to stay healthy and to work properly.

A body function done by a certain part of the brain is affected when this part of the brain dies or is hurt with a stroke.

For example, when the speech center of the brain is hurt by a stroke, the person may not be able to speak. Some people may not be able to walk when the part of the brain that controls walking is hurt with a stroke. Others may not be able to lift their arm.

Some people die as a result of a stroke. Many more live but they also have to change their life after they have had a stroke. Many people who were once able to drive a car, walk to the store, cook their own meals, dress themselves and talk to others may not be able to do any of these things after a stroke. They may also not even be able to do the most basic of life’s jobs, like walking, going to the bathroom and bathing. These problems often make a person go into a nursing home or an assisted living facility after their stroke. They can not take care of themselves in their own home. They need others to take care of them.

The most common signs of a stroke are:


  • A numb, weak or paralyzed face, leg or arm. This can come on very quickly. It often happens to only one side of the body. For example, the person may not be able to use their right arm and their right leg.
  • The person can not speak.
  • The person can not understand what other people are saying to them.
  • Their eyes change. The person may have blurred vision.
  • Trouble swallowing.
  • Loss of balance.
  • Dizziness.
  • A very bad headache.

These signs can get worse over a day or more, as it gets worse. Some people may not have any signs of a stroke at all.


At times, people may have some of these signs but when they last only a few minutes. These people are having a TIA or “mini stroke” and not a stroke. TIAs do not cause lasting damage to the person, but TIAs are a warning sign that a person may have a stroke soon.


Some of the things that increase the chance of getting a stoke are:

  • Age. The older one gets, the greater the risk of stroke. Elderly people are at greatest risk of stroke.
  • History of Stroke in the Family. A person is at risk for stroke if the person has a family member that has had a stroke or a TIA.
  • Race. African Americans are more likely to have a stroke than other groups of people. The reason for this is because diseases, such as diabetes and high blood pressure, are found at a high rate in this race and these diseases lead to strokes.
  • Gender. Men are more likely to have a stroke than a woman before the age of 55. After age 55, men and women are at the same risk.
  • Things Like High Blood Pressure and Diabetes. Some of the same things that lead to high blood pressure and diabetes are the same for stroke. For example, people that weigh too much, those who do not eat a good diet and those who do not have regular exercise are at high risk for high blood pressure, diabetes and stroke.

  • Life Style. People that have poor habits are more likely to have a stroke. Cigarette smoking, drug use, alcohol abuse, a poor diet with a high intake of foods with fat, a lack of exercise and being over weight add to the risk of stroke.
  • A History of a TIA. People that have had a TIA are at risk for a stroke.


Risk factors like race, gender and family history cannot be changed by a person to lower their chances of getting a stroke. But, a person can control life style habits like diet, exercise and cigarette smoking.


About 20 percent of the people who get a stroke will die in the hospital as a result of it. Many people who have had a stroke will get better and be able to enjoy a full and happy life. Still more are not able to function as well as they used to. Others may never be able to speak, walk, or eat on their own after a stroke.


A patient may have oxygen and an intravenous line (IV) right after their stroke. They may also get medicine to lower brain swelling.


Soon after the stroke, nursing care restores function and prevents complications. For example, rehabilitation, bladder and bowel function and the prevention of pressure sores become nursing care priorities shortly after a stroke.


A loss of function or weakness to the left side of the body occurs when a person has a stroke to the right side of the brain. Likewise, when a person has a stroke on the left side of the body, losses of function will occur on the right side of the body. Paralysis and weakness to one side of the body is called hemiplegia.

About 20% of stroke patients have aphasia. Aphasia gives the stroke patient trouble with speaking, reading, writing and understanding others.


Other functions, such as bladder, bowel, swallowing, breathing, balance and vision, may be affected with both right sided and left sided brain damage as a result of a stroke.


Rehabilitation aims to restore some function by promoting the body’s ability to have a new part of the brain take over the lost function. It helps the person to increase their muscle strength, balance, gait, speech, confidence and communication abilities. It also helps to prevent pressure sores and contractions.


Rehabilitation usually begins right after a stroke. It continues for weeks or months after a stroke. It is given in a rehab center, in the patient’s own home, in a hospital and in a nursing home.


Occupational therapists, physical therapists, speech and language therapists, recreation therapists, dietitians, doctors, nurses, nursing assistants, restorative and rehabilitation aides are members of the rehab team for stroke patients.


Some people may need special assistive devices after a stroke. They use special forks, plates and devices to pick items up from the floor. These things help with the activities of daily living.


Nursing assistants who take care of people after a stroke should help the person with their activities of daily living as planned by the occupational therapist and other members of the rehab team. They should help them with dressing, brushing their teeth and using any assistive devices that they have.


Physical therapists help stroke patients with moving about in bed, ambulation, balance, gait and muscle strength.


Physical therapists use heat and cold treatments, massage, weight training, assistive devices, orthotic devices, range of motion exercise and other kinds of exercise to improve the patient’s level of functioning.


Some of the assistive devices that are used to help the person walk are:

  • Canes
  • Walkers
  • Gait belts

Some of the orthotic devices that a physical therapist uses to support, align and prevent bodily deformities are:

  • Braces
  • Splints


Speech and language therapists assist their patients with communication. They also help patients with a swallowing disorder, something that often happens after a stroke.


These therapists also use assistive devices. For example, they may use a word board so that a patient can communicate their needs to others with out the spoken word.


Dietitians provide good diets to patients. They adjust diets when a patient has a swallowing disorder. They also work with nursing staff members to prevent and treat pressure sores after a stroke.


They help to plan restorative dining groups. These groups help patients to feed themselves, with some cues or help, using assistive devices, like a food guard plate, an easy hold cup and heavily padded forks, knives and spoons.


Nursing assistants must:


·         Prevent falls and make sure that the patient is safe. (Take our class called “ Preventing Falls” for more information about falls and falls prevention.)

·         Encourage and support the patient. It is important for all health care providers to give the stroke patient and their family members encouragement and support. This is a very difficult time for them. Rehab is also mentally and physically exhausting.

·         Encourage as much independence as possible.

·         Feed hemiplegia patients by placing the food on the good side of the mouth. (Take our class called “Feeding Residents and Patients” for more information feeding after a stroke.)

·         Provide good skin care. (Take our class called “Preventing Pressure Ulcers” for more information about skin care after a stroke)

·         Assist the patient with their assistive and supportive devices.

·         Follow the ordered bowel and bladder retraining program.

·         Help the person with their activities of daily living. Help them bathe, get dressed and eat.

·         Assist the patient with mobility and ambulation.

·         Do range of motion exercises with the person.

·         Encourage and support the patient after the stroke.




National Institute on Aging, U.S. National Library of Medicine
National Institutes of Health, and U.S. Department of Health & Human Services.
(2011). NIH: Senior Health.

US Administration on Aging. (2010). A Profile of Older Americans: 2010.


Word, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Mosby, Inc.


Copyright © 2011 Alene Burke