geriatrics

1. COMMON HEALTH
PROBLEMS IN ELDERLY
Advent Caregiver School,
Incorporated

2. CONSTIPATION
Is defined as having infrequent bowel movements or
having hard, dry stools that are difficult and painful to
pass.
Sometimes however, the problem may develop into fecal
impaction, a severe form of constipation in which a large
mass of stool cannot be passed. When this happens, you
need to inform the physician to have the stool removed
manually or by a mild enema.
The frequency of bowel movement in healthy people can
vary 3xa day to 3x a week.
Constipation can cause people to strain when having a
bowel movement.
This straining can lead to complication HEMORRHOIDS
(swollen and painful veins around the anus and lower
rectum) and FISSURES (small tear in the lining of the
anus that cause pain, bleeding and itching).

3. CAUSES OF CONSTIPATION
Not eating enough fiber, not drinking enough fluids
and not exercising regularly.
Certain medication and vitamins can cause stools
to become hardened and difficult to pass. (antacids,
calcium channel blockers, calcium supplements,
analgesic, and anti histamine)
Readily ignoring the urge to have a bowel
movement
Disorders and diseases like thyroid problem,
colorectal cancer, diabetes, Parkinson’s disease
and depression.

4. SYMPTOMS OF CONSTIPATION
Straining to move bowels
Dry or hard stools, bloating of the abdomen
(belly).
Pain or bleeding from the rectum during or after
a bowel movement.
 Feeling that the bowel movement wasn’t
enough.

5. TREATMENT
Eat more fiber foods such as whole grain bread and
fresh fruits and vegetables.
Drink plenty of water at least 8 glasses of water a
day.
Request for laxatives to be given to the patient.
If the patient develops fecal impaction, doctors would
recommend an enema.
Get moving. Exercise helps stimulate activity of the
bowel.
Never resist to urge to have a bowel movement.

6. LAXATIVE HABIT A BREAK
 Most people who are constipated do not need laxatives.
In fact, laxatives are one of the leasing cause of
constipation. Here’s why: If you use laxatives regularly,
your body may become dependent on them. You will need
to take increasing amounts of the laxative to keep from
becoming constipated.
 Experts recommend taking laxatives as a last resort after
all the self- efforts have failed.
 They should be taken only under the supervision of a
physician.

7. FOOT COMPLAINTS
Our feet change, as we grow older
Our toenails get thicker and more brittle
Our skin become drier
The pads that cushion the bottom of our feet
become thinner and less protective
As we age we tend to put more weight, which adds
extra stress to the bones and ligaments of our feet
Our feet tends to spread although we often
continue to cram them into some old shoe size
Foot ailments come in different forms. Some are
inherited, but most are a result of years of neglect
or abuse.

8. BUNIONS
An enlargement at the joint of the big or
small toe.
Swelling
Redness
Pain at the joint of the big and small toe
Cause: Some people get bunion because
of the years of wearing tight poorly fitting
shoes. Heredity, however is the main
reason people get bunions. People with low
arches (flat feet) are more likely to develop
the problem. Bunions have also been linked
to arthritis in older people.

9. HAMMERTOE
 A toe, usually the second toe bends up
permanently at the middle of the joint.
HEEL PAIN
 Pain either below or behind the heel of the foot.
INGROWN TOENAIL
Pain and redness around the toenail, especially
on the big toe

10. CORNS AND CALLUSES
Corns
are smaller than calluses and have a hard
center surrounded by inflamed skin. Corns tend
to develop on parts of your feet that don't bear
weight, such as the tops and sides of your toes
and even between your toes. They can also be
found in weight-bearing areas. Corns can be
painful when pressed.
Calluses
are rarely painful. They usually develop on the
soles of your feet, especially under the heels or
balls, on your palms, or on your knees. Calluses
vary in size and shape and are often larger than
corns.

11. COMMON CONDITIONS OF ELDERLY
FOOT
Neuropathy
Reduced flexibility
Foot sores
Gouging toenails
Shoes that don’t fit properly
Pressure sores
Loss of circulation in legs & feet
Edema & swelling of feet and ankles

12. PROPER FOOT AND NAIL CARE
Check the Color and Temperature of the foot
Examine the Sole of the foot
Proper trimming or cutting of toe nails
Proper Sock and Shoes
Application of Moisturizing Lotion
Proper foot exercise
Proper Diet
Check the foot sensation

13. SLEEP PROBLEMS
Sleep problems are very common, particularly
among older people. As we age we tend to
sleep more lightly and for a shorter period of
time. But we still need to get a good night sleep.
Not getting enough sleep can leave us feeling
tired and irritable during the day. Judgement
and reaction time are also lessened making us
more prone to accidents.
Sleep problems often begin during the middle
age. Experts estimate that half of all people
over 65 have frequent sleep problems may be a
normal part of aging. Often, however, sleep
problems are the result of other Or medications
used to treat these illnesses. Most sleep
disorders can be treated.

14. INSOMNIA
 Difficulty falling or staying sleep
 It is the most common sleep complaint.
SYMPTOMS
Difficulty falling asleep
Difficulty staying asleep
Early walking
Daytime sleepiness

15. CAUSES
Stress
Change in habit or schedule
Depression
Arthritis
Heartburn
Menopause
Diabetes
Thyroid problems
COPD – Chronic Obstructive Pulmonary Disease
Parkinson’s Disease
Alzheimer’s Disease
Alcohol
Drug abuse
Medications

16. TIPS FOR GETTING A GOOD NIGHT
SLEEP
Get up about the same time every day
Go to bed when you are sleepy
Establish a relaxing pre sleep ritual such as a warm
bath, a light bedtime snack, or 10 minutes of reading.
Maintain a regular schedule . Regular time of eating
meals, taking medications, doing chores and
performing other activities that help the inner clock run
smoothly.
Don’t eat or drink anything containing caffeine within 6
hours before bedtime. Don’t drink alcohol several
hours of bedtime or when you are sleepy. Tiredness
can intensify the effect of alcohol.
Avoid smoking close to bedtime.
If client takes naps, try to do so at the same time
every day.
Avoid sleeping pills, or use them conservatively.
Never drink alcohol when taking sleeping pills.

17. URINARY INCONTINENCE
 Incontinence is loss of bladder control or
involuntary leakage of urine. It can happen to
people at any age but is very common
among older people. At least 1 in 10 people
over the age of 65 have some type of urinary
incontinence. Women are more affected than
men are.
 Incontinence can range from mild to
leakage of urine to severe and uncontrollable
wetting. It can sometimes lead to bladder and
UTI. The leakage can also cause skin
rashes. Despite its rather mild symptoms,
urinary incontinence is considered a major
health problem because it can lead to
disability and dependence. This is particularly
true among older people.
 Fortunately, most cases of urinary
incontinence are curable, or at least treatable

18. CAUSES OF URINARY INCONTINENCE
Infection
Constipation
Weak or overactive bladder muscles
Nerve damage
Large fibroid or ovarian tumor
Decline in estrogen that occurs after menopause
Enlargement of the prostate gland
Diabetes
Stroke
Parkinson’s Disease
Multiple sclerosis
Alzheimer’s Disease

19. TREATMENT AND CARE
Bladder training, to delay urination after you get the urge to go. You may start by trying to hold off
for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between
trips to the toilet until you're urinating only every 2.5 to 3.5 hours.
Double voiding, to help you learn to empty your bladder more completely to avoid overflow
incontinence. Double voiding means urinating, then waiting a few minutes and trying again.
Scheduled toilet trips, to urinate every two to four hours rather than waiting for the need to go.
Fluid and diet management, to regain control of your bladder. You may need to cut back on or
avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing
physical activity also can ease the problem.

20. Kegels exercise
Medications (anticholinergic and Alpha blockers)
Electrical stimulation(Electrodes are temporarily inserted into your rectum or vagina to
stimulate and strengthen pelvic floor muscles).
Medical Insert (Urethral inserts and pessary)
Surgery
Absorbent Pads
Catheterization

21. SKIN CONCERNS
Our skin changes with age. It becomes less flexible,
thinner, drier and more wrinkled. Spots and growths may
appear. Older skin also takes longer to heal. Many of
these changes are natural and unavoidable. Some
however, can cause pain or discomfort. A few such skin
cancer pose a serious health problem and require
immediate medical attention.
AGE SPOTS
A medical name for these small, flat, brown spots. Many
people call them “liver spots” although they have nothing
to do the liver. They usually occur in the face, back,
hands and feet. Almost everyone over the age of 55 have
them.
CAUSE AND TREATMENT
Age spots, are caused by the sun. They develop over
many years and are a sign of sun damage. Age spots are
harmless and do not need to be treated. If client dislike
their appearances it can be lightened or removed.

22. DRY SKIN
Dry skin is a common problem for older
adults, especially those who live in cool dry, windy
climates. In fact about 85% of older people develop
“winter itch” a condition caused by dry, overheated
indoor air. Because dry skin can be easily irritated, it
often itches. Severe itching can make client anxious
and interfere with their sleep. Repeated scratching can
also lead to infections.
CAUSE
The skin become drier as we age because it
loses some of its sweat and oil glands. Other factors
can also contribute to the problem. These include
overusing soaps, antiperspirants, and perfumes or
bathing in overheated water.
TREATMENT
Using a moisturizer after bathing while the skin is still
damp can help relieve dry skin.
Moisturizers containing petroleum and lanolin are
particularly effective.

23. Bathe less often and using a milder soap or a
soap substitute
Use warm water rather than hot water
If in a dry climate, use a humidifier to keep the
air inside moist
Drink plenty of water

24. COMMON DISEASES IN ELDERLY
DEMENTIA
Is a clinical syndrome of cognitive deficit that
involves both memory impairments and a
disturbance in at least one other area of
cognition such as aphasia, agnosia, and
disturbance in executive functioning.
The most common forms of progressive
dementia are Alzheimer’s disease (AD),
vascular dementia, and dementia with Lewy
bodies; the pathophysiology for each is poorly
understood.

25. RISK FACTORS
Advanced age
Mild cognitive impairment
Cardiovascular disease
Genetics(family history of dementia,
Parkinson’s disease, stroke, presence of Apo
E4 allele on chromosome 19)
Environment (head injury and alcohol abuse)

26. PARAMETERS OF ASSESSMENT
No formal recommendation for cognitive screening are indicated in asymptomatic
individuals. Clinicians are advised to be alert for cognitive and functional decline in older
adults to detect dementia and dementia like presentation in early stages. Assessment
domains include cognitive, functional, behavioral, physical, caregiver and or environment.
Cognitive Parameters
1. Orientation: person, place, time
2. Memory: ability to register, retain, recall information
3. Attention: ability to attend and concentrate on stimuli
4. Thinking: ability to organize and communicate ideas
5. Language: ability to receive and express a message
6. Praxis: ability to direct and coordinate movements
7. Executive function: ability to abstract, plan, sequence, and use feedback to
guide performance

27. B. Functional Assessment
Test that assess functional limitations such as the Functional Activities Questionnaire (FAQ)
can detect dementia. They are also useful in monitoring the progression of functional decline.
The severity of disease progression in dementia can be demonstrated by performance
decline in activities of daily living (ADL) and instrumental activities of daily living (IADL) tasks
and is closely correlated with mental-status scores.
C. Behavioral Assessment
Assess and monitor for behavioral changes; in particular, the presence of agitation,
aggression, anxiety, disinhibitions, delusions, and hallucinations.
Evaluate for depression because it commonly coexist in individuals with dementia. The
Geriatric Depression Scale (GDS) is a good screening tool.

28. D. Physical Assessment
 A comprehensive physical examination with a focus on the neurological and cardiovascular
system is indicated in individuals with dementia to identify the potential cause and/or
existence of a reversible form of cognitive impairment.
 A thorough evaluation of all prescribed, over-the-counter, homeopathic, herbal, and
nutritional products taken is done to determine the potential impact on cognitive status.
Laboratory test are valuable in differentiating irreversible forms of dementia. Structural
neuroimaging with non contrast computed tomography (CT) or magnetic resonance imaging
(MRI) scans are appropriate in the routine initial evaluation of patient with dementia.

29. E. Caregiver/Environment
 The caregiver of the patient with dementia often has as many needs as the patient with
dementia; therefore, a detailed assessment of the caregiver and the caregiving environment
is essential.
 Elicit the caregiver perspective of patient function and the level of support provided.
 Evaluate the impact that the patient’s cognitive impairment and problem behavior have on
the caregiver (mastery, satisfaction, and burden). Two useful tools include the Zarit Burden
Interview (ZBI) and the Caregiver Strain Index (CSI) tool.
 Evaluate the caregiver experience and patient-caregiver relationship.

30. NURSING CARE STRATEGIES OF
INDIVIDUALS WITH DEMENTIA
Monitor the effectiveness and potential side effects of medications given to improve
cognitive function or delay cognitive decline.
Provide appropriate cognitive enhancement techniques and social engagement.
Ensure adequate rest, sleep, fluid, nutrition, elimination, pain control, and comfort
measures.
Avoid the use of physical and pharmacological restraints.
Maximize functional capacity: maintain mobility and encourage independence as long
as possible; provide graded assistance as needed with ADL and IADL; provide
scheduled toileting and prompted voiding to reduce urinary incontinence; encourage an
exercise routine that expands energy and promote fatigue at bedtime; establish bedtime
routine and rituals.

31. F. Address behavioral issues
 identify environmental triggers, medical condition, caregiver-patient conflict that may be
causing the behavior; define the target symptom (i.e., agitation, aggression, wandering) and
pharmacological (psychotropics) and nonpharmacological (manage affect, limit stimuli, respect
space, distract, redirect) approaches, provide reassurance; and refer to appropriate mental
health care professionals as indicated.
G. Ensure a therapeutic and safe environment
provide an environment that is modestly stimulating, avoiding overstimulation that can cause
agitation and increase confusion, and under stimulation that can cause sensory deprivation
and withdrawal. Utilize patient identifiers (name tags), medic alert systems and bracelets,
locks, and wander guard. Eliminate any environmental hazards and modify the environment to
enhance safety.

32. H. Encourage and support advance care planning
 Explain trajectory of progressive dementia, treatment options, and advance directives.
I . Provide appropriate end-of-life care in terminal phase
 Provide comfort measures including adequate pain management; weigh the benefits/risks of
the use of aggressive treatment (e.g., tube feeding, antibiotic therapy).
J. Provide caregiver education and support
 Respect family system/dynamics and avoid making judgements; encourage open dialogue,
emphasize the patient’s residual strengths; provide access to experienced professionals; and
teach caregivers the skills of caregiving.

33. STAGES OF DEMENTIA
1. Early stage dementia
- caregiver focus is encouraging the patient to remain independent and do their tasks.
2. Mid stage dementia
- is often most stressful for caregivers because the patients are still mobile and may
harm themselves. They get disoriented and confused and agitated.
3. Late stage dementia
- the patient is dependent for all activities.

34. PARKINSON’S DISEASE
A chronic neurological condition that develops
slowly over many years.
• Currently incurable, but good symptomatic
therapies are available.
• More than 1 million Americans live with PD,
60,000 new cases each year.
• More than 10 million people with PD worldwide.
• Reported that number of people with PD will
double by year 2040.

35. SIGNS AND SYMPTOMS OF
PARKINSON’S DISEASE
Classic Motor Symptoms
Tremor of the limbs when at rest
Slow movement (bradykinesia)
Muscular stiffness (rigidity)
Change in walking and balance

36. NON MOTOR SYMPTOMS OF PARKINSON’S
DISEASE
 Loss of smell
 Fatigue, excessive daytime sleepiness
 Apathy
 Depression/ Anxiety
 Problems with memory, concentration
 Acting out dreams while asleep
 Lightheadedness when standing
 Constipation
 Urinary frequency or urgency
 Oily skin and dandruff

37. DIAGNOSIS
No specific blood or imaging test
available to diagnose PD.
 Diagnosis based on medical history, a
neurological examination and response
to dopamine- based medications.
 Sometimes blood test, brain MRI or DAT
scan may be performed to rule out other
conditions that have similar symptoms

38. Less than 10% of cases of Parkinson’s
disease are directly inherited (due to
specific gene mutations).
Directly inherited genes -
Alphasynuclein, Parkin and LRRK2
genes
In most inherited cases, there is a
strong
family history (more than one family
member) and most start at a young
age
(under age 40).

39. ENVIRONMENTAL EXPOSURES AND PD
1. Head Injury- repeated or associated with altered consciousness
2. Heavy Metals Exposure-higher incidence of PD in welders
3. Chronic amphetamine use Solvents
4. Long term- pesticide/herbicide exposure

40. TREATMENT
MOTOR SYMPTOMS
Levodopa
Dopamine
NON-MOTOR SYMPTOMS
Mood Disorder- Anti depressant/Benzodiazepines
Impaired Thinking and Dementia- Acetylcholinesterase Inhibitors
Sleep Disorders- Melatonin and Anti- depressant drugs
• Establishing regular bedtimes and rising times
• Reducing caffeine and alcohol intake
• Limiting daytime naps
• Avoiding food and drink within several hours of bedtime

41. Orthostatic Hypotension
•Change positions slowly, particularly when rising from a seated to
standing position. Pause for several seconds between each move.
Walking with an assisted device (cane or walker) may also be helpful.
•Increase fluids, salt and caffeine in the diet.
•Wear support stockings and elevate legs periodically during the day.
Gastrointestinal Symptoms
Domperidone (Motilium)-Nausea and Vomiting Treatment
Constipation
• Drink plenty of water and fluids.
• Regular exercise
• Consume lots of dietary fiber in the form of fruits, fruit juices,
vegetables and cereals.
• Use appropriate fiber additives

42. Drooling (Sialorrhea)
Anticholinergic medicine
Botulinum toxin injections
Urinary Symptoms
Anti cholinergic drugs
Sexual Dysfunction
Seborrheic Dermatitis and Excessive Sweating
Pain
anti-inflammatories, muscle relaxants, gabapentin, tricyclic
Antidepressants