Introduction

This module is devoted to learning about the special needs facing elderly patients. We will begin by looking at social factors that change as people age and societal attitudes about the aging process. We will then explore all the different body systems and look at how the body and mind changes as a person ages throughout the lifespan. Finally, we will look at special diseases such as cerebrovascular accidents (stroke), Alzheimer’s and Parkinson’s Diseases and then discuss how to work with people who suffer from these disorders.

What is Aging?

Aging and the Individual

Aging is a normal physical and psychological process that all humans go through as they move throughout the lifespan. It includes all the changes which occur over the course of a person’s life (U.S. Department of Health and Human Services, National Institutes of Health, National Institute, 2011). Lifespan means the length of time that a person or living thing can be expected to live (Oregon Department of Human Services, 2012). As people age, or get older, there are many changes that occur within their bodies (physical changes) and within their minds and behavior (psychological changes). These changes are known as human growth and development (Leahy, Fuzy & Grafe, 2013).

While all humans go through the same stages of development as they age, no two humans will have the same exact experience of development. People vary greatly in the rate and extent which their body ages (Mauk, 2008). Everyone has different experiences as they move throughout the lifespan. Psychological, environmental and social factors such as stress and financial situations impact the pattern of people’s development. Biology or genetics (a person’s genes) also has a strong influence on how people develop and the physical changes that will occur. Diseases such as heart disease, infections, strokes, and the use of substances such as alcohol and drugs all affect physical changes that occur in the human body.

Each person will have different experiences of development throughout their lifespan, which result in development being a unique and highly individualized process for each person. It is important to understand the general physical and psychological changes and stages of development that humans go through. And, it is even more important to understand that no two people will go through these stages in exactly the same way. Keep in mind that each person is a unique individual.

Social Factors and Aging

As people develop and change through the lifespan, there are many social factors that affect their development. Social factors include family structure and roles within the family, gender roles, and culture.

Changes in family structure and the role that one has in the family occur throughout the lifespan. While an elderly person may still be considered to be at the head of the family, their role may have changed now that they are older. For example, an elderly person may now not be able to provide for their family financially and physically. Younger members of the family may take on the role of financial provider or as caretaker. Families must make adjustments to the changes that occur throughout the lifespan. These can be emotionally and physically difficult. They can put great strain on members of the family and on the elderly patient.

The communication skills from Module Two are good tools to help people deal with new emotions. Home Health Aides/Personal Care Aides must be sensitive to the adjustments their patient’s family must make. They must perform their job well and refer any issues that they cannot competently handle to their supervisor. Also, they should empathize with family members. If a family member comes to them with a problem, listen to their concerns. Sometimes just talking about a problem can make a person feel better about it. Home Health Aides/Personal Care Aides must be supportive and encouraging. Paraphrasing what the person says and summarizing the feelings they are conveying (what they are trying to express) is most helpful. They should demonstrate empathy and positive regard toward their patient and their family members.

Be aware of cultural values and differences. As discussed in Module Two, members of African American, Asian, Latino, and Middle Eastern cultures place a strong emphasis on the role of family and may be very involved with the elderly patient’s care. They may prefer to take on caretaking responsibilities at home, rather than place their elderly loved one into a long-term care facility. Gender differences also exist within the various cultures. Middle Easterners may prefer to have their health care provided by a member of the same gender. As discussed in Module Two, the concept of machismo for Latinos means male members of the family feel a certain amount of responsibility to provide for other family members. When a male member of a Latino family becomes ill, it can have a heavy emotional and financial burden on that person and their family. If they were the sole bread winner, there will be a financial strain upon the family. The eldest son or the wife may need to take on employment in order to support the family. This shift in family role can be very unsettling and emotionally taxing for all family members.

Within the United States, the head of the household and primary bread winner has traditionally been the male. Even with the shift in gender roles within the United States where most women are now employed and have fulfilling careers, gender stereotypes still exist. An elderly male who can no longer provide for his family physically or financially may have a difficult time adjusting to this shift within the family. He may feel his masculinity is being questioned if he now must be cared for by another person, such as a Home Health Aide/Personal Care Aide. These psychological adjustments are difficult, but with the support and empathy of a Home Health Aide/Personal Care Aide, the patient and family can better make adjustments to developmental changes. Religious beliefs also influence how people practice health care rituals, prepare for death and care for loved ones after death. Refer back to Module Two for a review of various cultural and religious beliefs and how they impact health care a person wishes to receive.

Observing and Reporting Changes

As Home Health Aides/Personal Care Aides work with elderly patients, they may come to have first-hand knowledge of the physical and psychological changes that occur during the aging process. They may also come to recognize and be the first to notice signs of a new disorder or disease process that is not related to the aging process, but which can be mistaken for and disregarded as “just aging.”

For example, it is not a normal part of aging to have dementia. If a patient suddenly begins to show signs of forgetfulness, difficulty concentrating, or disorientation (an inability to recognize themselves, where they are, what year or season it is or events that are occurring), the HHA/PCA should immediately report these signs to their supervisor. These signs are not necessarily due to “just aging”. They could be signs of a stroke or dementia related to Alzheimer’s or a vascular (blood vessel) problem, such as changes in oxygenation within the brain. Confusion and delirium could also be the result of side effects from medications, drug-drug interactions, dehydration, or infection (Mauk, 2008). It is important to remember that aging in and of itself is normal, and not part of a disease (Leahy, Fuzy & Grafe, 2013).

It is also not a normal part of aging for older adults to experience incontinence (loss of control of bowel or bladder). These could be signs ofmedication side effects, urinary tract infections or imbalances of electrolytes in the body (Mauk, 2008). It is also not a normal part of aging for adults to fall. Falls can be the result of medication side effects, medication interactions, or a sign of an acute (sudden) illness (Mauk).

If Home Health Aides/Personal Care Aides notice any of the following, especially if they occur suddenly, they should immediately report them to their supervisor:

• Disorientation (to self, place, time, event)
• Difficulty concentrating
• Difficulty speaking
• Difficulty chewing/swallowing
• Depression
• Suicidality (statements of wanting to die or hurt oneself)
• Mood changes or sudden shifts in mood from happy to depressed
• Insomnia (difficulty getting to or staying asleep)
• Anorexia (lack of appetite/eating)
• Inability to use a limb (arm or leg)
• Drooping of the face, either one side or both sides of the face or mouth
• Lack of balance or coordination
• Changes in grooming or self-care
• Incontinence (loss of bladder or bowel)
• If something just doesn’t seem “right” to them based on what they know of the patient

Confidentiality

It is important for Home Health Aides/Personal Care Aides to remember to protect their patient’s privacy at all times. This means providing privacy during self-care such as bathing, toileting, and dressing. It can be easy to forget to do this if they are rushed, or if family caretakers are around. But remember, Home Health Aides/Personal Care Aides are there to care for and protect their patient.

It is also important to remember to maintain confidentiality of what their patient tells them and about their health care. Only share information with family and friends whom the patient wishes to share with. Just because a patient is elderly does not mean that they do not have the right to privacy and confidentiality. Do not be dismissive of their wishes, even if they are forgetful. It is up to the Home Health Aide/Personal Care Aide to protect them.

Self-Check Activity m3-4

Attitudes Towards Aging

Ideas about the elderly are often based upon stereotypes and depictions of older adults in the media. Older people are often shown to be helpless, forgetful, slow, have dementia, to be incontinent (unable to hold their bladder), unable to live on their own, and to be unable to engage in physical inactivity. In actuality, research shows that the majority of older people are active and very involved in life activities.

In the media, elderly people are often referred to as “cute” with younger people calling them “honey”, “dear” and “sweetheart.” These terms are often condescending and should never be used to refer to an elderly patient. Home Health Aides/Personal Care Aides should always address their patient with their last name and title, such as Mr. or Mrs., unless they request otherwise. Speak with elderly patients with respect and allow them to make their own decisions and choices as much as possible. Do not treat them like a child. Just because they may be dependent on others for their care as a child is does not mean they are children. It just means they need a little extra help.

Magazine and television advertisements focus on youth and often equate it with beauty. Numerous products advertising their use will result in a more youthful appearance or help a person live longer is nearly an obsession in many cultures (US Department of Health and Human Services, National Institutes of Health on Aging, 2011).

This leaves the impression that young=beautiful and good, while old=ugly and bad. These stereotypes result in what is called ageism. Racism as we discussed in Module Two is discrimination based on someone‘s race. Ageism is discrimination against someone based on their age. Ageism is harmful to older people and can result in depression, anger, loss of employment, loss of housing, and loss of emotional support.

Myths of Aging

According to Mauk (2008), by the year 2030, about 20% (71 million people) of the U.S. population will be over the age of 65. As many of the patients with whom the Home Health Aide/Personal Care Aide will be working will be elderly, it is important to learn about the aging process and to avoid engaging in ageism.

Check your stereotypes about the aging process! This activity has been adapted from the Oregon Department of Human Services’ Myths and Stereotypes of Aging booklet, which can be found at:

http://www.oregon.gov/dhs/apd–dd–training/EQC%20Training%20Documents/Myths%20and%20Stereotypes%20of%20Aging.pdf

Aging and the Body

It is important to remember that aging is a normal process and is not a disease or a sentence that a person will end up with a disability. As Home Health Aides/Personal Care Aides will likely work with many elderly patients, it is important for them to have a general understanding of the physical and mental changes that occur during the aging process.

Immune System

The immune system becomes weaker as we age, which increases our risk for infection. This also means that it takes older people a longer time to recover from an infection. There are two parts to our immune system: the innate immune system and the adaptive immune system. As we age, changes occur in both systems. The innate immune system consists of barriers that protect us from infection, such as our skin, mucous membranes, and stomach acid (U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Aging (2011). The cough reflex and the ability to develop a fever are also part of the innate system. During the aging process, our skin becomes drier, thinner, and more fragile. More fragile skin may lead to skin tears and openings which allow bacteria to enter and cause infection. Drier skin also leads to an increased risk of cracks and openings from itching, which can allow bacteria to enter.

The adaptive immune system is more complex, and includes the spleen, thymus, tonsils, bone marrow (which makes white blood cells, which are needed to fight infection), circulatory and lymphatic systems (U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Aging (2011). T cells are a type of white blood cell that helps our bodies fight infection. As we age, our body produces fewer T cells (U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Aging). This leads to a diminished ability to fight off bacteria and viruses. Lymph nodes reduce in size and number which makes it harder for the body to develop a fever. A fever is one way our body fights infection. An older adult may not necessarily have a fever, which is the typical sign of infection. Home Health Aides/Personal Care Aides must be aware of even slight changes in temperature as this could indicate that there is an infection (Leahy, Fuzy & Grafe, 2013).

Changes in the respiratory system also lead to an increased risk of respiratory infections. As we age, our lungs have less alveoli which are needed for the exchange of oxygen and carbon dioxide. This leads to less oxygen in the blood, which means breathing may be compromised. If an older person is not able to breathe as well as they did when they were younger, they will be more at risk to contract a respiratory infection. The cough reflex may also be diminished and an older person may have a harder time coughing up mucus, which means it stays in the lungs, leading to more bacteria (Leahy, Fuzy & Grafe, 2013).

Home Health Aides/Personal Care Aides must always remember to practice good hand hygiene. It is the best way to prevent the spread of bacteria and viruses. They should assist their patient with practicing good hand and personal hygiene, and encourage and provide proper nutrition and help to keep their patient hydrated. They should encourage their patient to receive vaccinations such as a yearly influenza vaccination, and encourage them to talk to their nurse or doctor about the vaccinations they could receive to protect themselves from infection.

Respiratory System

As the body ages, there are less alveoli present in the lungs. Alveoli are small sacs at the bottom of the lungs where oxygenation takes place. The lungs take in air which contains oxygen. In the alveoli, oxygen enters the blood to oxygenate the rest of the body. Carbon dioxide, which is a waste, leaves the alveoli. Since there are less alveoli the older person has a diminished ability to remove carbon dioxide from their lungs.

Lung tissue also becomes less elastic as a person ages. This means that the lungs will not expand during breathing as well as they did when the patient was younger. The rib cage may also not expand as well as it did when the person was younger because the bones become thinner and change shape with age. The diaphragm, which is a muscle below the lungs and supports breathing also becomes weaker, so the elderly person may have a more difficult time taking deep breaths. The cough reflex may be diminished and an older person may have a harder time coughing up mucus, which means it stays in the lungs, leading to more bacteria.

When working with an older adult, Home Health Aides/Personal Care Aides should allow them to take frequent rest periods as they may become easily fatigued or short of breath. If ordered in the Care Plan, they should encourage and assist with performing deep breathing exercises. A patient may also be working with a Respiratory Therapist who will assist them with practicing deep breathing andusing tools such as an incentive spirometer. An incentive spirometer is used by having the patient breathe in deeply into a small machine. This helps to keep the alveoli in the lungs open. If the alveoli are open, there will be better oxygenation of the body, and unwanted carbon dioxide can leave the body. It is also a great way to help prevent pneumonia in elderly and bedridden patients.

Some patients may benefit from staying in a higher sitting position, known as Fowler’s Position. This helps people to breathe better than if they were lying down. Home Health Aides/Personal Care Aides can adjust the patient’s bed if it is adjustable to help keep them sitting in a high position. Pillows may also be used propped behind the patient’s back to help keep them upright. They must remember to practice proper hand washing at all times.

If Home Health Aides/Personal Care Aides are sick, they should talk to their supervisor about whether they should go to work or if a mask should be worn while working with patients. If they need to cough, cough away from others into the crook of the arm. Don’t cough into the hands without washing them afterward. It is important to keep the patient away from cigarette smoke and polluted air. During cold weather, ensure the patient is warmly dressed and has a scarf to cover their nose and mouth. This helps to prevent cold air from entering the lungs.

Cardiovascular System

The cardiovascular system consists of the heart and all the blood vessels of the body. As we age, fatty deposits or plaque deposit in our blood vessels. These fatty deposits cause the blood vessels to become stiff and blood does not flow through them as well. If there is a large amount of plaque build-up, the flow of blood can become blocked. Coronary artery disease (narrowing of the arteries that supply blood to the heart) or heart attacks can occur due to blocked blood flow. Some people take medication to lower cholesterol levels and to prevent chest pain. Home Health Aides/Personal Care Aides should report statements of chest pain, shortness of breath, or a feeling of tightness in the chest to their supervisor immediately. The largest artery of the heart, the aorta also becomes thicker and stiffer with age (Aging changes in the heart and blood vessels, 2012). This results in many elderly people having a higher blood pressure. Monitor the patient’s blood pressure as directed in the Care Plan and report changes.

As we age, the normal rhythm of our heart also changes. Heart rate tends to decrease as we age. It is not uncommon for an elderly person to develop an arrhythmia, or an abnormal heart rhythm. In many cases this can be controlled by medications. Some patients may develop heart failure, which means the heart can no longer pump blood through the body as effectively as it used to. Patients may become short of breath, even when walking short distances or develop edema, which is a swelling of a body part, often the legs due to a build-up of water.

Medications and diet changes are used to try to control the symptoms of heart failure. Home Health Aides/Personal Care Aides should report any statements made by their patient of chest pain or shortness of breath or if they notice an increase in swelling or a sudden weight gain to their supervisor immediately. These are signs that heart failure is worsening. Patients with heart failure may be told to avoid lifting heavy objects, not to engage in strenuous exercise, and to take more rest breaks while doing physical activity. Help the patient maintain as healthy a lifestyle as possible by monitoring their diet and assisting with exercise as directed in the Care Plan. Home Health Aides/Personal Care Aides should monitor for any physical changes that occur and report them to their supervisor.

Integumentary System (Skin)

Changes in the integumentary (or skin) system may be the most visible changes of aging (Aging changes in skin, 2012). Hair becomes grey and thins, and skin becomes wrinkled. Nails become harder and more brittle. The skin is the largest organ of our body. Skin serves to protect us from bacteria entering into our bodies, helps regulate our body temperature, helps us to regulate our fluid balance, and allows us to feel sensations such as heat or touch due to the nerve receptors within the skin. As we age, our skin becomes thinner, drier, and more fragile. Changes in the blood vessels within our skin also lead to the skin becoming more easily bruised and to bleeding.

As we age, sebaceous glands, which produce oil, become less active (Aging changes in skin, 2012), so skin is drier, less moist, may be itchy, and is more likely to break, leading to possible infections. To protect the skin, moisture must be added, such as in the form of body lotions. It is also important to encourage older people to stay hydrated by drinking plenty of fluids. Sweat glands also become less active, so older people perspire less. They may not need a complete bath as often, but should receive a sponge bath at least daily with a complete bath about twice per week (Leahy, Fuzy, Grafe, 2013). When we sweat, it is the body’s way to keep cool. Since older people will sweat less, they are more at risk for overheating or getting heat stroke.

The subcutaneous or fat layer of the skin also thins. This leads to more difficulty with temperature regulation. Older people may become cold faster and are more at risk for developing hypothermia (Aging changes in skin, 2012). Care should be taken to ensure they are properly clothed and kept warm. Thinning of the fatty layer of the skin also means that older people have less padding to protect them from injury (Aging changes in skin, 2012). They may have bony areas that are at higher risk for developing pressure sores (Aging changes in skin, 2012). Care should be taken to turn and position bedridden patients every two hours and to protect bony areas with pillows. In addition, it takes about 4 times longer for aging skin to heal than younger skin (Aging changes in skin, 2012). In addition to the changes that occur from aging in the skin, an older patient may also have diseases and disorders such as diabetes that also prolong (lengthen) the period of time it takes for their skin and wounds to heal (Aging changes in skin, 2012).

Musculoskeletal System

The skeleton is made up of the bones within the body. It provides support for muscles, protection for organs, and helps people to move. Muscles provide strength for the body to move. Joints are spaces in between bones, which are cushioned by cartilage and what is called synovial fluid. As people age, bones lose mass and calcium. Bones may become thinner and more likely to break. The spinal column may become curved, resulting in some elderly people having a stooped or bent over appearance. The spine is made up of vertebral disks which have fluid in between each disk. As we age, the fluid between these disks become thinner, and some people may actually lose height as this fluid thins and the vertebrae move closer together.

As people age, their muscles also weaken and lose tone. Elderly people may not have the same strength or range of motion or ROM (ability to move joints in different directions) as before and may have more difficulty with movement.Joints may become stiff, and the fluid between joints decreases, resulting in cartilage between the bones rubbing together. This makes it harder for a person to move which can be very painful.

Some people have arthritis, which is painful inflammation in the joints. If safe and directed in the Care Plan, Home Health Aides/Personal Care Aides should encourage patients to perform range of motion exercises and walk as much as possible. This helps to strengthen bones and muscles, which also helps to prevent osteoporosis (Leahy, Fuzy, Grafe, 2013). Osteoporosis results in thin and brittle bones, which increases a person’s risk of fractures. Home Health Aides/Personal Care Aides can assist with range of motion (ROM) exercises as directed in the Care Plan, and can encourage patients to complete as many activities as possible to keep their muscles and bones active.

Home Health Aides/Personal Care Aides may assist with performing range of motion exercises only as directed in the Care Plan (Leahy, Fuzy, Grafe, 2013). They should never perform these types of activities without proper training and direction from their supervisor, as it could result in injury to the patient. Patient’s joints should always be supported during these types of activities. Joints can be supported by holding above and below the joint. For example, when performing exercises involving the knee, the HHA/PCA can hold the area below and above the knee joint during the activity. Patients should never be forced to do exercises that hurt. Joints should be moved slowly and gently during these exercises. Any pain should be reported to the supervisor. Remember, you must NOT perform these exercises unless you have been properly trained and directed to do so.

Range of Motion Movements:

• Abduction: moving a body part away from the midline of the body. For example, abducting the leg involves moving the entire leg away from the middle of the body.
• Adduction: moving a body part towards the midline of the body. For example, adducting a leg means the entire leg is moved towards the middle of the body.
• Flexion: bending a body part. For example, flexing a bicep involves bending it as if to make a muscle.
• Extension: straightening a body part. For example, extending a bicep involves straightening the arm.
• Pronation: turning downward. For example, the forearm and hand are turned so the palm of the hand faces downward.
• Supination: turning upward. For example, the forearm and hand are turned so the palm of the hand faces upward.
• Dorsiflexion: bending backward. For example, the toes are gently pushed towards the body to stretch the foot.
• Plantar flexion: pressing downward. For example, the toes are gently pressed down toward the sole of the foot.
• Opposition: touching the thumb to each finger. In opposition, each finger of the hand is gently moved toward the thumb to provide a gentle stretch of the hand and finger joints.
• Circumduction: making a circle with the joint. For example, circumduction of the shoulder involves the entire arm and shoulder moving in a large circle to gently exercise the joint and improve a person’s ability to move their arm and shoulder.

Many patients may be on supplements such as calcium and vitamin D, which help to support healthy muscles and bones. Be aware of fall risks by keeping items out of the patient’s path of walking, using assistive devices such as canes and walkers correctly, ensuring the patient has on non-skid shoes, and is wearing glasses and hearing aids so the person can see and hear what is going on around them.

Sensory System

The sensory system consists of our sense of vision (eyes), hearing (ears), smelling (nose), taste (tongue), and touch. Changes in vision can result in an increased risk of falls. Home Health Aides/Personal Care Aides must be aware of fall hazards. They should ensure their patient wears eyeglasses and keep rooms well lit. This will also help their patient to enjoy activities in which vision is important, such as reading. There are visual aids available that can enhance a patient’s reading experience such as books on tape, reading materials with large print, and magnifying glasses. They can also read to their patient if they would like.

For patients who have trouble hearing, they should speak in a low pitched voice without shouting, and ensure that they are directly in front of them when speaking. If they wear hearing aids, ensure they are in good working order with working batteries and that the patient uses them correctly. Remember, not every older patient will have vision or hearing problems.

Our sense of smell also diminishes as we age. This puts elderly people at a risk for not smelling fumes such as gas or in the case of fire, smoke. Home Health Aides/Personal Care Aides should ensure smoke detectors and carbon monoxide detectors are in good working order. As we age, we also lose taste buds. Combined with a decreased sense of smell, this can result in a poor appetite and weight loss. Provide food choices that are appealing to the patient and find out what their preferences are about favorite foods.

The sense of touch also diminishes as we age. It is important to be cautious about extreme temperatures as an elderly patient may not be able to tell if something is too hot or too cold. Home Health Aides/Personal Care Aides should always use ice packs and heating pads as directed by the Care Plan. Never leave them on for long periods of time as it could result in frostbite or burns. They must watch the temperature of foods and drinks they serve their patient and ensure they are not too hot which could result in burns and scalds. Some older people and those with special conditions such as diabetes may also have poor circulation. This can result in lack of feeling in their feet. Inspect the patient’s feet on a regular basis and ensure they wear proper footwear to protect them from injury.

Digestive System

The digestive system starts with the mouth where we take in food and begin the process of digestion by chewing. Food moves down the esophagus into the stomach, then into the small intestine, then into the large intestine, and finally, it is eliminated through the anus through peristalsis.

Some elderly people may have a problem with chewing or swallowing food. This could result in a safety risk if the patient chokes. If Home Health Aides/Personal Care Aides notice their patient has any difficulties with chewing or swallowing, they should report these to their supervisor. Some patients may need to be on soft or pureed diets. If a patient wears dentures, ensure they are in place prior to meals. This will help them with chewing and properly digesting their food.

The movement of food through the digestive tract may also be slowed in some older adults. This could result in constipation.Constipation means a lack of bowel movements, or a decrease in the number of bowel movements that are normal for that particular person. It may not be uncommon for some elderly people to only have a bowel movement every couple of days.

Home Health Aides/Personal Care Aides should report the frequency of bowel movements to their supervisor. Some older people may need to be on a bowel regimen to help them have regular bowel movements. This may mean they need increased fiber, which is found in foods such as fruits, vegetables and whole grains, or even medications such as stool softeners. Fluid intake and exercise are also important to maintain good bowel health.

Urinary System

The urinary system consists of the kidneys (which make urine by filtering blood), ureters (which are tubes that carry urine from the kidneys to the bladder), the bladder (which stores urine), and the urethra (where urine passes through to the outside of the body). As we age, our kidney’s ability to filter blood decreases. Nephrons are the filtering units of the kidney. They filter waste material and make urine. The number of nephrons decreases with age. This means the ability to filter waste products decreases. Some older people may have problems with their kidneys and have to have their kidney function monitored.

The muscle tone of the bladder becomes weaker and some elderly people may have difficulty holding the same amount of urine as they did when they were younger. They may need to urinate more frequently and wake during the night to do so (Leahy, Fuzy & Grafe, 2013). Since the bladder is weaker, it may also not empty completely. This leads to urine remaining stagnant in the bladder, which makes the person more at risk for a urinary tract infection. Home Health Aides/Personal Care Aides should report any changes in urination, such as in frequency, incontinence, inability to start the flow of urine, and reports of pain or burning while urinating to their supervisor.

Encourage patients to drink plenty of fluids. Some elderly people hesitate to drink enough water because they fear they will have “an accident” or become incontinent. Home Health Aides/Personal Care Aides should encourage them to not do this as it will only lead to dehydration and a higher chance of getting a urinary tract infection. Remember, incontinence is not a normal part of aging. They should report incidences of incontinence to their supervisor.

Endocrine System

The endocrine system consists of hormones and organs such as the thyroid, parathyroid glands pancreas, and reproductive organs (Aging changes in hormone production, 2012).The thyroid is important for metabolism. Metabolism begins to slow as we age, beginning around the age of 20 (Aging changes in hormone production, 2012).Some older people may develop nodules on their thyroid gland and have to take medications for a thyroid gland that is overactive or underactive. The parathyroid glands, which are located near the thyroid are important to help with calcium balance. As people age, parathyroid hormone release increases (Aging changes in hormone production, 2012). This results in too much calciumin the bloodstream and not enough calcium in the bones. This can result in weaker and more brittle bones such as that found in osteoporosis.

Insulin, which is produced by the pancreas, and important for glucose (sugar) metabolism also decreases. Older patients may need to watch their sugar intake. Some elderly patients may develop diabetes. This means that the body is not producing enough insulin to allow the glucose (sugar) which we get from the food we eat to be used correctly. Some symptoms of diabetes include: excessive thirst, hunger, frequent urination, weight gain, and elevated blood glucose levels. A supervisor and the Care Plan will direct Home Health Aides/Personal Care Aides as to whether their patient should be on a low sugar diet and if they need to monitor their blood glucose prior to meals.

The adrenal glands are located one on top of each kidney. The adrenal glands produce cortisol, which is the stress response hormone, and aldosterone, which is the hormone that regulates our fluid balance in the body. While cortisol level release decreases as we age, the amount of the hormone stays the same in the bloodstream (Aging changes in hormone production, 2012). Elderly people are just as susceptible to stresses as any other person. High levels of stress can result in a weakened immune system and cause other physical problems, such as high blood pressure. Home Health Aides/Personal Care Aides should help their patient to eliminate stresses from their life and provide them with time to talk about what is bothering them.

As we age, aldosterone release decreases. This can result in an elderly patient having a drop in blood pressure and feeling light-headed since the body is not able to regulate its blood pressure as well (Aging changes in hormone production, 2012). Watch for signs of light headedness anytime a patient moves from a lying down to a sitting and then standing position. Allow them a few minutes to sit and dangle their legs before they stand. This will allow their body to adjust to the changes in blood pressure.

Neurological System

The neurological system or nervous system consists of the brain and spinal cord. Aging can result in memory loss and concentration difficulties. There is generally a slowing of nerve firing, which results in a slowing of processing information or performing tasks. Elderly people may not be able to think or perform tasks as quickly as they could before. Remember, this is not necessarily a part of aging that occurs for everyone, and it varies from person to person. Home Health Aides/Personal Care Aides should encourage their patient to make decisions and choices and to be as independent as possible. Encourage a patient to make lists to help them remember tasks. Home Health Aides/Personal Care Aides should provide plenty of time for their patient to process information and to complete tasks.

While the brain loses some nerve cells, brain connections do continue to develop. Encourage patients to think about good times by asking them about their life stories and to show photographs. Encourage and assist with activities to keep their minds active such as jigsaw puzzles, reading, crosswords, and other activities to stimulate their mental processes.

Some patients who have short–term memory loss or loss of memory about recent events can become agitated and anxious about this. Home Health Aides/Personal Care Aides should provide reassurance to them and report any changes to their supervisor so that the healthcare team is aware. If their patient shows signs of forgetfulness or confusion, they should report these to their supervisor immediately.

Reproductive System

Changes occur in the reproductive system as people age. Changes occur in both the female and male reproductive systems.

Females

In females, a process called menopause occurs. During this time, hormone levels change as ovaries stop making estrogen and progesterone and stop releasing ova (eggs) (Aging changes in the female reproductive system, 2012). Menstruation (otherwise known as a monthly “period”) stops during this time. This typically occurs between the ages of 45-55 (Aging changes in the female reproductive system, 2012). Women can no longer become pregnant. As the hormone levels decrease, the vagina becomes thinner, drier, and less elastic. The labia (the external genital tissue) also becomes thinner, drier, and less elastic (Aging changes in the female reproductive system, 2012). These changes may be painful for some women. If a patient complains of pain in the vaginal area, Home Health Aides/Personal Care Aides should inform their supervisor.

A loss of estrogen also leads to an increased risk of osteoporosis (Aging changes in the female reproductive system, 2012), which is a condition in which bones become more brittle and are more at risk for fractures or breaks. There may also be an increased risk for urinary tract infections due to loss of bladder muscle tone. Loss of muscle tone in the pubic area could potentially lead to prolapsed bladder, vagina, or anus (Aging changes in the female reproductive system, 2012), which is a condition in which these organs drop from their original position to the outside of the body. If Home Health Aides/Personal Care Aides notice this condition, they should inform their supervisor. She will direct them about how best to care for this particular patient.

There may be a diminished sexual drive due to changes in hormones and physical changes within the vagina, but this is not necessarily the case. Many elderly women continue to have sexual desires and engage in sexual activity.

Males

In males, testicular tissue decreases with age and there may be a decrease in testosterone, which is the male sex hormone (Aging changes in the male reproductive system, 2012). Testes do continue to produce sperm, but at a slower rate than before. Some men may experience erectile dysfunction, which is an inability for the penis to obtain or maintain an erection (Aging changes in the male reproductive system, 2012).

The prostate gland becomes enlarged. The prostate gland is at the base of the bladder and around the urethra, which carries urine to the outside of the body. As it enlarges, it presses on the urethra. This can result in difficulty during urination. Men may experience dribbling, only urinating small amounts at a time, or difficulty starting or stopping the flow of urine. This is called Benign Prostatic Hypertrophy (BPH), which occurs in about 50% of men (Aging changes in the male reproductive system, 2012). The risk for prostate cancer increases as men age (Aging changes in the male reproductive system, 2012). In some instances, an enlarged prostate may indicate prostate cancer.

It is a good idea for men to be screened for prostate cancer yearly by their health care professional.This is done by what is called a DRE or Digital Rectal Exam, where the physician feels the prostate for bumps with a finger entered into the anus. Men are also screened for prostate cancer by having blood work drawn to measure levels of PSA or prostate specific antigen. Higher levels could indicate that a man has BPH or possibly prostate cancer. Decreases in sex drive may occur in some men, but this is not a definitive part of aging (Aging changes in the male reproductive system, 2012).

Aging and the Mind

As we age there is generally a slowing of nerve firing, which results in a slowing of processing information or performing tasks. Elderly people may not be able to think or perform tasks as quickly as they could before. Older adults may show signs of forgetfulness, which can be normal. However, when there seem to be many memory problems and forgetfulness seems to increase, this may be a sign of a more significant problem.

There may be temporary changes in mental function that come about suddenly. Sudden changes in mental functioning and personality can be indicative of a disease process. Changes in mental function that may appear suddenly and which may be temporary can be the result of dehydration, a urinary tract infection, fever, brain infection such as meningitis, a head injury, stroke, low blood sugar levels, alcohol or substance use, and interactions or side effects from medications. If their patient has any sudden changes in their mental function, mood, or behavior, Home Health Aides/Personal Care Aides should immediately report these to their supervisor.

Working with Patients who have Suffered from a Stroke

Other mental function changes that are more permanent may occur in some elderly people. A stroke, or a cerebrovascular accident can occur when there is a blockage in a cerebral artery in the brain, or if a blood vessel in the brain ruptures. Signs and symptoms of a stroke include numbness or weakness in the face or in the arms or legs, especially on one side of the body, difficulty speaking, using inappropriate words such as the wrong words for objects, and blurred vision. It may be helpful to remember the acronym FAST (Facial drooping, Arm weakness, Speech difficulties, and Time). If Home Health Aides/Personal Care Aides notice any of these signs, they should call for emergency help and inform their supervisor immediately. Time is of the essence. Their patient may need to receive immediate medical attention.

Sometimes, the effects of a stroke are temporary and the person may regain normal functioning. In other cases, there may be permanent changes within the brain and body. Careful attention must be paid while caring for a patient after a stroke. If their patient has lost the ability to use one side of the body, they should encourage use of the stronger side by placing eating and writing utensils on the strongest side. If their patient has developed speech or swallowing problems, a Speech Therapist may become involved in the patient’s care. They will evaluate the patient’s ability to speak and to swallow. Home Health Aides/Personal Care Aides should be patient while communicating. If their patient has swallowing problems, a special diet will need to be followed and liquids may need to be thickened to prevent choking. A patient who has suffered a stroke may also have vision problems. They may only be able to see half of what is in their field of vision. Approach the patient from their stronger side, place items they need on the side they can see from, and ensure they always know what is in front of them, especially when walking.

Working with Patients with Alzheimer’s Disease

Alzheimer‘s disease is a disease affecting the brain which causes permanent and progressive (continuing to get worse) changes in the brain. It is the most common cause of dementia (the loss of the ability to think, remember, reason, and plan tasks) in the elderly.

Symptoms of Alzheimer’s start out typically with memory loss. As it progresses, the person becomes very confused and may forget their family, who they are, and become unable to care for themselves. They may lose the ability to communicate and may have personality changes such as aggression and withdrawal. A person with Alzheimer’s needs special care.

It is important for Home Health Aides/Personal Care Aides to provide a safe environment. They may wander and end up in an unknown place with no memory of who they are, how they got to where they are, or how to go back home. It is also important to try to prevent things such as fires as a person with Alzheimer’s may begin to cook and forget they have food on the stove. Writing lists and labeling objects throughout the house may also be helpful to remind a patient with Alzheimer’s disease what the objects are. It may even be helpful to place a note on the mirror with the patient’s name or a label such as “Myself” if they are at the point where they no longer remember who they themselves are. Home Health Aides/Personal Care Aides should remember to be patient and encouraging, and find the things that seem to bring the most comfort and do these things with their patient. Many patients with Alzheimer’s enjoy music and Home Health Aides/Personal Care Aides can try playing some to help their patient relax and find enjoyment.

Working with Patients with Parkinson’s Disease

Parkinson‘s disease is also a progressive and incurable disease of the mind with permanent changes. People with Parkinson’s have difficulty initiating movement, such as walking and have tremors which make it difficult to perform daily tasks such as feeding and dressing themselves. Muscles will become stiff and the person may have a shuffling gait or eventually not be able to walk at all. Dementia may occur with Parkinson’s as it progresses. When caring for a patient with Parkinson’s, Home Health Aides/Personal Care Aides should remember to be patient and encouraging. It is frustrating for them to be unable to care for themselves. Encourage them to do as much as possible, and assist them with ADL’s as needed. When preparing food, keep in mind to prepare food that is easier for the patient to handle. Using adaptive eating utensils, plates, and cups can help make the eating experience more pleasurable and successful for the patient.

Stress

A stressor is anything that causes stress. Even positive life events such as the birth of a baby or a wedding can cause people stress. Life events such as weddings, divorce, death, births of children, and retirement can cause people stress. Additional stressors affecting the elderly may include financial problems, death of a spouse, family, or close friends, physical changes, pain, and loss of independence.

When we feel stress, adrenaline is released by the endocrine system. It causes our blood pressure, heart rate, and respiratory rate to increase. Stress that is not relieved can result in long-term physical problems such as high blood pressure. It can also cause anxiety, depression, aggression, and mood swings. Some people manage stress by engaging in unhealthy behaviors such as overeating, smoking, yelling at those near them, or drinking alcohol.

If Home Health Aides/Personal Care Aides observe unhealthy coping behaviors from their patient and high levels of stress, they should discuss their concerns with their supervisor and work with him or her to develop healthy coping strategies for the patient.

How to Help a Patient Effectively Manage Stress

• Encourage and provide healthy, nutritious food
• Encourage and work with the patient on maintaining physical activity or an exercise plan
• Promote good sleep by providinga peaceful sleeping environment
• Find activities the patient enjoys such as reading, listening to music, watching movies, or spending time with friends
• Teach the patient relaxation techniques such as deep breathing
• Provide a warm bath and back massage for the patient
• Apply lotion to the patient’s legs and hands
• If the patient wishes, pray with them or organize a clergy visit
• Allow the patient space to be alone for short periods to relax and think
• Provide space and time for the patient to talk and encourage them to express their thoughts and feelings

Post-test:

1. True or False: All people have the same experience as they age.
2. True or False: All people, even those who are forgetful or have dementia have a right to confidential and respectful health care.
3. True or False: Dementia is a normal part of aging. All older people have trouble remembering things and are forgetful.
4. True or False: Handwashing is the best way to prevent the spread of infectious disease.
5. When people have trouble breathing, which is the best position to place them?
   1. Lying flat on their back
   2. Lying on their side with their knees bent
   3. Sitting upright in a high Fowler’s position
   4. Lying on their back with their knees bent
6. True or False: Signs of possible worsening of heart failure include increased shortness of breath, sudden weight gain, edema of the legs, and chest pain.
7. Which of the following are signs and symptoms of a cerebrovascular accident (stroke)? Select all that apply.
   1. Numbness in the arms or legs on 1 side of the body.
   2. Sudden inability to see or blurred vision.
   3. Sudden inability to lift or move an arm or leg.
   4. Sudden inability to speak.
   5. Facial drooping, especially on one side of the face.
8. True or False: Patients should be allowed to sit at the edge of the bed and rest before moving to a standing position to allow adjustment to changes in blood pressure and prevent falls.
9. True or False: To protect the skin and prevent skin breakdown, pressure ulcers, and skin tearing, immobile patients should be turned and positioned every two hours with pillows used to protect bony areas.
10. True or False: Incontinence is a normal part of aging. All older people have urinary problems.
11. Which is a way to help people control incontinence?
    1. Limit the patient’s fluid intake to prevent incontinence.
    2. Instruct patients to “hold” their bladder as long as they can to help strengthen their bladder muscle tone.
    3. Offer the bedpan or use of the toilet every two hours.
    4. Delay answering patient calls for help to use the bathroom.
    5. Offer the use of the toilet or bedpan every four to six hours.
12. When working with a patient who has Alzheimer’s, the HHA/PCA should do which of the following? Select all that apply.
    1. Allow the patient to use the stove unsupervised.
    2. Take special precautions for the safety of the patient by providing close supervision.
    3. Use notes to help the patient remember the names of objects and people.
    4. Allow the patient to go to the supermarket alone.
    5. Lock the patient in a room for their safety.

References

Aging changes in hormone production. (2012, September 2). In A.D.A.M. Medical Encyclopedia. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/004000.htm

Aging changes in skin. (2012, September 4). In A.D.A.M. Medical Encyclopedia. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/004014.htm

Aging changes in the heart and blood vessels. (2012, September 4). In A.D.A.M. Medical Encyclopedia. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/004006.htm

Aging changes in the female reproductive system. (2012, November 8). In A.D.A.M. Medical Encyclopedia. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/004016.htm

Aging changes in the male reproductive system. (2012, September 4). In A.D.A.M. Medical  Encyclopedia. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/004017.htm

Leahy, W., Fuzy, J., & Grafe, J. (2013). Providing home care: A textbook for home health aides (4th ed.). Albuquerque, NM: Hartman.

Mauk, K. L. (2008, June/July). Myths of aging. ARN Network, 6-7. Retrieved from http://www.rehabnurse.org/pdf/GeriatricsMyths.pdf

Oregon Department of Human Services. (2012, June). Myths and stereotypes of aging (Publication DHS 9570). Retrieved from http://www.oregon.gov/dhs/apd-dd-training/EQC%20Training%20Documents/Myths%20and%20Stereotypes%20of%20Aging.pdf

U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Aging. (2011, November). Biology of aging: Research today for a healthier tomorrow (Publication No. 11-7561). Retrieved from http://www.nia.nih.gov/sites/default/files/biology_of_aging.pdf