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After completing this chapter, students will be able to: Relate developmental changes in geriatric patients to medical assisting practice; describe common geriatric diseases and disorders and their treatment; identify variations of care for geriatric patients during examinations, screening procedures, diagnostic tests, and treatments; explain special health concerns of geriatric patients.
CHAPTER 41 Assisting in Geriatrics © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-2 Learning Outcomes (cont.) 41.1 Relate developmental changes in geriatric patients to medical assisting practice 41.2 Describe common geriatric diseases and disorders and their treatment 41.3 Identify variations of care for geriatric patients during examinations, screening procedures, diagnostic tests, and treatments 41.4 Explain special health concerns of geriatric patients © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-3 Introduction • Geriatrics – Special concerns of the elderly – Specialists ~ geriatricians – Growing field due to longer health spans • Medical assistants – 50% of practice is caring for older patients – Need a knowledge of their unique needs © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-4 The Geriatric Patient • Physical changes of aging – Make the elderly more prone to diseases and disorders – Not all people experience all changes – Changes occur at different rates © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-5 Physical Changes of Aging • Integumentary system – Thinning skin, with atrophy of subcutaneous layer – “Liver spots” ~ lentigos – Graying, thinning hair – Brittle nails – Decreased inflammatory response © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-6 Physical Changes of Aging (cont.) • Nervous system – Slower reaction time and thought processing – Shortened attention span – Impairment of fine motor activities – Memory loss © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-7 Physical Changes of Aging (cont.) • Special senses – Impaired vision and hearing – Altered taste sensations • Musculoskeletal system – Osteoporosis – Osteoarthritis – Decreased numbers of musculoskeletal fibers © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-8 Physical Changes of Aging (cont.) • Cardiovascular system cardiac output – Arteriosclerosis – Postural hypotension risk of heart disease © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-9 Physical Changes of Aging (cont.) • Respiratory system elasticity of the lungs – Calcification of intercostal cartilage and kyphosis shortness of breath © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-10 Physical Changes of Aging (cont.) • Immune system – susceptibility – Infectious diseases – Autoimmune diseases • Digestive system – Constipation – Fecal incontinence © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-36 Preventing Falls in the Elderly (cont.) • Safety checklist – Install handrails in bathroom – Use nonslip mats – Minimize clutter – Keep items use frequently with in easy reach © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-37 Depression • Symptoms may mimic other symptoms of other conditions • Know what to look for including – Does not enjoy life – Difficulty in concentrating – Appetite changes – Sleep disturbances – Worthlessness © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-38 Elder Abuse • No comprehensive definition • Disabilities defenseless against abuse • Observe for nonverbal signs © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-39 Elder Abuse • Types of abuse • Categories – Domestic – Physical, sexual, psychological – Institutional – Neglect – Self-abuse – Abandonment – Exploitation © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-40 Elder Abuse (cont.) • Occurs in all racial, socioeconomic, and religious groups • Take a careful history • Report suspicions © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-41 Elder Abuse (cont.) • Risk factors – History of alcoholism, drug abuse, or violence – History of mental illness – Isolation of the victim – Recent stressful events © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-42 Elder Abuse (cont.) • Signs of neglect – Foul odors – Poor skin color – Inappropriate or soiled clothing – Concern about money © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-43 Polypharmacy • Age-related changes alter – Absorption – Metabolism – Distribution – Excretion © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-44 Polypharmacy • Increased risk – Drug toxicity – Adverse effects – Lack of therapeutic effects • Often have complex illnesses © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-45 Polypharmacy • Taking several medications concurrently • Reduce risk of drug-drug interactions – Obtain an accurate list of current medications – Patient and family education – Simplifying medication schedule – Provide written instructions © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-46 Apply Your Knowledge Why is it difficult to identify abuse in the elderly? ANSWER: There is no uniform and comprehensive definition of this type of abuse The elderly patient may not be able to communicate with you verbally Bruises from falls and other accidents can be mistaken for abuse The signs of neglect can be similar to the signs of some chronic medical conditions © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-47 In Summary 41.1 Geriatrics is a subspecialty of internal medicine or family practice Geriatricians typically care for patients over the age of 65 These patients have multiple physical changes as well as psycho-emotional, cognitiveintellectual, and social development variations to consider when working as a medical assistant © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-48 In Summary (cont.) 41.2 Common aging-associated diseases and disorders include cardiovascular disease, hypertension, cancer, arthritis, cataracts, diabetes mellitus, Alzheimer’s disease, constipation, diarrhea, and osteoporosis Understanding these will help you prepare to care for geriatric patients © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-49 In Summary 41.3 When working with geriatric patients, you must treat them with respect and dignity Be aware of their physical and mental changes so that you can adapt your care to meet their needs 41.4 Each of the following special concerns should be handled appropriately when caring for the elderly: falls, elder abuse, depression, and polypharmacy © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 41-50 End of Chapter 41 "Not everyone grows to be old, but everyone has been younger than he is now.“ ~ Evelyn Waugh © 2014 by McGraw-Hill Education This is proprietary material solely for authorized instructor use Not authorized for sale or distribution in any manner This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part .. .41- 2 Learning Outcomes (cont.) 41. 1 Relate developmental changes in geriatric patients to medical assisting practice 41. 2 Describe common geriatric diseases and disorders and their... Physical Changes of Aging • Integumentary system – Thinning skin, with atrophy of subcutaneous layer – “Liver spots” ~ lentigos – Graying, thinning hair – Brittle nails – Decreased inflammatory response... website, in whole or part 41- 25 Assisting with Geriatric Care (cont.) • Incontinence – Embarrassing • Preventive Medicine – Notify physician – May not be aware of the importance – May drink less