Caring for the Elderly

Caring for the Elderly

Objectives:

After you take this class, you will be able to:

  1. Discuss the normal changes that occur during the aging process.
  2. Describe the characteristics, needs and special tasks of the older adult.
  3. Provide care to the older adult that is modified to meet their special needs and characteristics.

INTRODUCTION

Nursing assistants and other health care workers care for old patients and residents all over the world. In the United States today there are more old adults than any other age group. There are more old adults now than ever before.

The elderly are also living longer and longer. They are getting older and older. In the past there were not too many people who lived to 100 years old. Now there are more 100 year old people than ever before.

Nursing assistants, nurses and many others get a lot of joy as they care for older adults. They also have a lot of challenges and things that they must know about the old adult age group. The old adult age group has its own needs. We must provide care to the old adult that meets each patient's needs. These needs are best met when nursing assistants, nurses and many other health care providers know about the normal aging process. We must know how aging affects the care we give.

The Normal Changes of the Aging Process

As the human body ages, it slows down and it does not work as well as it did in the past. For example, digestion slows down. Foods that are eaten take longer to digest. It also takes longer to burn the calories that we eat.

Old adults do not have the same appetite that they had when they were younger. Their need for large amounts of food and calories is lowered. They may also not want to eat. If the sense of taste and smell are gone, they may not enjoy food as much as they did when they were younger.

Vision and hearing may also get poor as a person gets older. Many old patients and residents eyeglasses, hearing aids and devices as they get older.

The old adult may also have weak muscles, unstable joints and poor balance. These things can make an old person fall or slip. Falls and slips can break bones and even lead to death.

Many elderly people also have long-term diseases that affect how we care for them. Many older people have diabetes, arthritis, Alzheimer’s disease, heart, lung and kidney disease. They are also not able to fight off infections as well as they did when they were young. Old patients are at great risk of getting an infection, like pneumonia or a urinary tract infection, because their immune system has slowed down.

The aging process also affects their skin. The skin gets dry and easily irritated; it breaks down and tears very easily for many patients and residents. Also, the body temperature is not controlled as well as it was in the past. Old patients feel extremes of hot and cold more than younger people.

Mental ability also changes as one gets older. Mentally, many old residents and patients are confused. They forget things quickly. They are not able to remember recent events. They may not know the time of day, the day of the week or even the current year. Some do not know, or cannot remember, where they are and who they are. They are disoriented. They are not oriented to person, place and time. They may also be agitated and use poor judgment. Others may have delirium, dementia and depression.

All of these normal aging changes affect the kind of care we must provide to our aging patients.

The Age Groups

Age Group Age Span

Infant

Birth to 1 year

Toddler

1 to 3 years

Preschool child

3 to 5 years

School age child

5 to 12 years

Adolescent

12 to 18 years

Young Adult

18 to 45 years

Middle Age Adult

45 to 65 years

Old Adult

Over 65

Although an old adult is 65 years of age and older, it is not always clear when one age group ends and the next one begins. Some people in the old adult age group may be typical of the age group and others may not. Some people have the needs of their age group. Others do not. I am sure that you have seen some 90-year-old patients or residents that look and act like they are 50. These people do not show the needs of the old adult age group.

So, please remember that not all old adults are same. All patients and residents should be cared for based on their own needs. However, knowing about the aging process helps us to guide care.

Some Tasks for the Elderly

Erik Erikson, a psychologist, is the expert who listed the 8 major developmental tasks that every person must accomplish during their life.

Nursing assistants and other health care providers must know about these major tasks for each age group that they are taking care of. For example, nursing assistants who take care of adolescents must know that adolescents have to cope with identity formation- “Who am I?”. A hospital stay can affect an adolescent's sense of self, it can also keep them from their friends or peer group, a group that is much more important to them than their own family. Their peer group helps them to define who they are.

Older adults, according to Erikson, have to share their wisdom, maintain their sense of self, have integrity and be happy with their life and what they have done. Old adults who can NOT do these tasks may be sad, depressed and unhappy. They may view their life as worthless and without meaning. They may think that they are useless. Some may feel that they are a burden to their family, friends and health care workers.

Old adults also have to deal with losses. They may lose their husband or wife, their friends and other people who they loved. They may feel lonely and not loved. They can also be very sad and depressed. As they get older and lose their own mental and physical health, they may NOT be able to care for themselves any more. This may make the patient or resident sad or angry.

All of these losses tell the old person that they, too, will die. Many old people plan for their own death. They write their will and their advance directives. They give their own things and prized possessions to their family and loved ones. Some older adults may think silently about these losses and their own death. They may also review their own life and what they have done in silence. Other old adults may speak about their losses to nurses, nursing assistants, social workers, family and others.

As a health care provider, we should listen to the older patient when they talk about their losses and their thoughts about death. These thoughts should also be reported to the nurse on the unit.

Thinking and Learning Abilities

The thinking and learning abilities of the older adult affect how we communicate, instruct and teach them and their family members. Older adults need special care during communication and education. They often have a physical and mental problem that can interfere with learning and thinking.

Older adults may have:

  • A short attention span. Old adults may not be able to understand long and detailed information. They may do better with short instructions.
  • Less learning ability. Old people may not be able to learn new things as well as they did in the past.
  • Less ability to understand. Many older adults are confused and not able to understand.
  • An inability to communicate. Older adults may not be able to speak and ask questions. After a stroke, many patients have aphasia, a lack of ability to speak.
  • Poor hearing and sight. Vision and hearing gets poor as humans age. Nursing assistants and others must give a patient their eyeglasses and/or their hearing aid so they can communicate with you and others.

When nursing assistants are communicating with an older patient, they should:

  • Give the person their eyeglasses and hearing aid, if they have one
  • Speak slowly and clearly while facing the person
  • Keep information simple
  • Use words that the person can understand
  • Use pictures and large print material when you can
  • Provide enough light if the patient will be reading
  • Keep sessions short
  • Repeat your communication as often as needed so that the patient can understand it and remember it
  • Allow enough time for the patient. Some patients need more time than others.
  • Make sure that the area or room is quiet
  • Allow the person to talk and ask questions
  • Include the husband, wife, and other loved ones in the communication and instruction process

Safety Needs

The need for safety is one of our most basic of human needs. Safety is very important for all age groups but safety needs are the greatest for young children and the elderly. For example, infants put small objects in their mouths. These small things can be dangerous. They can eat pills, poisons and even choke on something small.

The old adult who has a mental, sensory (eyes, ears) or a physical loss, like poor balance and weak muscles, is a safety risk. These losses and the aging process make older adults prone to accidents. An old patient that has poor vision and hearing, is confused and has poor judgment can:

  • Slip
  • Fall
  • leave the facility and get hit by a car
  • drink a gallon of a cleaning chemical
  • cut their hand off with an electric saw that was left on the unit
  • chew all the pills in the medication cart

Physical problems, confusion, loss of hearing and vision, poor judgment and the inability to see danger when it exists are some of the reasons why healthcare providers must maintain a safe environment for the elderly. Safety is everyone's responsibility. Safety needs must ALWAYS be a priority even when you have a lot of work to do and you feel rushed. ALL patients and patient care areas must be safe and free of all dangers.

Food and Fluid Needs

Food and nutritional needs also change as a person gets older and older. The need for a lot of calories decreases when a person gets older. These needs were highest when the person was an infant, a teen and when they were pregnant or breast feeding their baby.

Old patients and residents need the least calories of all age groups. They do not burn calories and food as quickly as they did when they were younger and more active. This doesn't mean, however, that the elderly do not need a good diet. Older patients do need a good diet just like the other age groups.

The appetite and the digestive process also slow down as the human body ages. Old adults do not feel as hungry as they did when they were young. Also, when they eat meals they feel full and they may not want to eat another meal for a long time. They may even skip a meal. Old adults often do better with small snacks during the day rather than large meals three times a day.

In terms of fluid needs (hydration), a patient or resident may not be able to swallow fluids. They may not even feel thirst when they should under normal conditions. We must, therefore, offer fluids very often to older people. Nursing assistants should ask their patients and residents if they want a drink of water every time they speak to them unless they are not allowed to drink.

Some other old people may not be able to safely drink liquids unless they are thick. They may choke with water, juice and other thin fluids like tea or coffee. Nursing assistants are often asked by nurses to give the patient water and fluids that are made as thick as honey. These thick fluids help provide fluids to patients who have trouble swallowing.

Aging people may also not be able to use a spoon or a fork. They may be too confused to know how to feed themselves. Their lack of ability to eat or drink often makes it necessary to go to an assisted living facility or a nursing home so that they can be helped with eating, a basic ADL. It is the nursing assistant that most often provides the necessary food and fluids to these patients and residents

Other things that can decrease the amount and kinds of food and fluids that an elderly person will eat are:

  • Money. An old person will not get a good diet if they do not have the money to pay for it.
  • Physical health. If a person is not able to drive or walk to the store, if they are not able to make and cook good meals, if they are not able to use a fork or a spoon, they will need the help of others to get a good diet and enough fluids.
  • Mental ability. If a person is confused they may not be able to buy, cook and eat meals. Again, the help of others is need so that they get a good diet.
  • Teeth. If a person has no teeth, poor dentures or is not given their dentures before a meal, they will probably not get a good diet.
  • The ability to swallow. It is dangerous when a person chokes on food or fluids. It can cause death. Unless they get a tube feeding or special care, like thick fluids, these people will not get enough food and fluid.

Some of the other things that nursing assistants can do to help the patient or resident get a good diet and enough fluids include giving the aging adult:

  • dentures, as needed
  • a pleasant and nice dining environment
  • nice looking, tasty and foods that the patient or resident chooses
  • help with foods and fluids as needed
  • plates, forks and other special items that help the patient or resident feed themselves
  • smaller meals and fluids more often
  • proper positioning for safe eating and drinking
  • close monitoring, reporting and documentation of how much food or fluid is taken and sometimes how much urine is put out (intake and output)
  • extra nutritional supplements, if ordered
  • offers of food and fluid as often as needed when the diet and fluid intake is poor

How to Care for the Elderly Patient

There are many parts of care that must be changed to meet the needs of the older patient. Some of these special care items include how we:

  • talk to the patient
  • instruct the patient
  • help them with the activities of daily living (ADLs), including eating, bathing and personal care
  • keep the patient or resident room safe and free of dangers
  • respond to nurse call bells right away
  • make sure the patient gets enough food and fluids

When caring for the older patient, the nursing assistant must show respect and call the patient by their name and not "mom", "honey" or "grandma". We must respect their rights and maintain their dignity. We must let them make their own choices, help them to be as independent as they can be, and keep them safe.

Summary

Nursing assistants and others who care for the old adult must give care that meets their special needs. We must meet the patient's or resident's needs and wishes, like the special needs that older adults have.

References


Alspach JG. (1996). A Framework for Assessing Age Related Competency: Distinguishing Attributes of Various Age Groups. Pensacola, Florida: National Nursing Staff Development Organization.

Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.

 

Erikson E. (1963). Childhood and Society 2nd Edition. New York: WW Norton.

Kee, Joyce LeFever and Evelyn Hayes. (2009). Pharmacology: A Nursing Process Approach 6th Edition. Saunders Elsevier

 

Monahan, Frances Donovan and Wilma J. Phipps (2007). Phipps’ Medical-Surgical Nursing: Health and Illness Perspectives. 8th Edition. Elsevier Mosby.

Nettina, Sandra M. (2009). The Lippincott Manual of Nursing Practice. 7th Ed. Lippincott, Williams and Wilkins.

Schuster C and Ashburn S. (1992). The Process of Human Development: A Holistic Life Span Approach. Boston: Lippincott, Williams and Wilkins.

Sheehy Gail. (1995). New Passages: Mapping Your Life across Time. New York: Ballantine Books.

Wold, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Elsevier Mosby.

 

Copyright © 2010 Alene Burke



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