Health Care Of The Elderly

Geriatrics is the branch of medicine that focuses on health care of the elderly. This is the study of the aging process itself. The term comes from the Greek geron meaning “old man” and iatros meaning “healer”.

Geriatrics is the branch of medicine dealing with the aged and the problems of the aging.The field of gerontology includes illness prevention and management, health maintenance,and promotion of the quality of life for the aged. The ongoing increase in the number of elder person.The experiences of aging result from interaction of physical,mental,social and cultural factors. Aging as well as the treatment of the elderly, is often determined the way elder person views the process of aging, as well as the manner in which he or she adapts to growing older. A more heterogeneous elderly population than any generation that preceded it can be expected.

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The majority of elderly seen in the health care setting have been diagnosed with at least 1 chronic condition. Individuals who in the 1970s would not have survived a debelitating illness, such as cancer or a castastrophic health event leki hearth attack, can now life more period of sometimes with a variety of concurrent debilitating conditions. Although age is most consistent and strongest predictor of risk for cancer and for the death from cancer, a mangement of elder cancer patient becomes complex because the choronic conditions, such as osteoarthritis, diabetes,

Aging is a broad concept that includes physical changes in people’s bodies over adult life, psychologic changes in their mind and mental capacities, social pyschologic changes in they think and believe, and social changes in how they are viewed, what they expect, and what is expected of them. Aging is constantly evolving concept. Notions that biologic age is more critical than chronologic age when determing health status of the alderly are valid

Aging is an individual and extremely variable process. The functional capacity of major body organs varies with advancing age. As one grows older, environmental and lifestyle factors affet the age-related functional changes in body organs

GERIATRICS ASSESSMENT & CARE MANAGERS

A Care Plan is an outcome of a geriatric assessment, and is essentially an action plan for future care. A Care Plan lists all identified problems, suggests specific interventions or actions required and makes specific recommendations regarding resources needed to provide the necessary support services.

What is geriatric assessment?

A geriatric assessment is a comprehensive evaluation designed to optimize an older person’s ability to enjoy good health, improve their overall quality of life, reduce the need for hospitalization and/or institutionalization, and enable them to live independently for as l ong as possible.

An assessment consists of the following steps:

An examination of the older person’s current status in terms of:

Their physical, mental, and psycho-social health

Their ability to function well and to independently perform the basic activities of daily living such as dressing, bathing meal preparation, medication management, etc.

Their living arrangements, their social network, and their access to support services.

An identification of current problems or anticipated future problems in any of these areas.

The development of a comprehensive “Care Plan” which addresses all problems identified, suggests specific interventions or actions required, and makes specific recommendations regarding resources needed to provide the necessary support services.

The management of a successful linkage between these resources and the older person and that person’s family so that provision of the necessary services is assured.

An ongoing monitoring of the extent to which this linkage has, or has not, addressed the problems identified, and the modification of the Care Plan as needed.

When is a geriatric assessment needed?

A request for a geriatric assessment would be appropriate when there are persistent or intermittent symptoms such as:

memory loss,

confusion,

or other signs of possible dementia.

DEMENTIA :

Global impairment of intellectual function (cognition) interfering with social and occupational activities.

Often, what looks like Alzheimer’s or dementia can be the result of medication interactions or other medical or psychiatric problems. Because of the thoroughness of the geriatric assessment, it is one of the best ways to determine what the actual problem and cause is or is not.

Who performs a geriatric assessment?

A geriatric assessment can be done in many different settings such as:

a hospital,

a nursing home,

an outpatient clinic,

a physician’s office or

the patient’s home.

It is an assessment that is comprehensive in scope, involving a complete review of the current status of the older person in all of its complex dimensions, and because it is so comprehensive, it can only be successfully conducted by a multi-disciplinary team of experts. This team might include:

physicians,

ancillary personnel,

social workers,

physical and/or occupational therapists,

dieticians, psychologists,

pharmacists, and

geriatric nurse practitioners.

You can request a referral for a geriatric assessment from a primary care physician. Also, check with any large hospital or university to see whether they have a geriatric assessment unit.

Geriatric care managers

A geriatric care manager (GCM) is a professional with specialized knowledge and expertise in senior care issues. Ideally, a GCM holds an advanced degree in gerontology, social work, psychology, nursing, or a related health and human services field. Sometimes called case managers, elder care managers, service coordinators or care coordinators, GCMs are individuals who evaluate your situation, identify solutions, and work with you to design a plan for maximizing your elder’s independence and well being.

Geriatric care management usually involves an in-depth assessment, developing a care plan, arranging for services, and following up or monitoring care. While you aren’t obligated to implement any part of the suggested care plan, geriatric care managers often suggest potential alternatives you might not have considered, due to their experience and familiarity with community resources. They can also make sure your loved one receives the best possible care and any benefits to which they are entitled.

Help provided by geriatric care managers

Geriatric care managers facilitate the care selection process for family members who live at a distance from their elderly relatives, as well as for those who live nearby but do not know how to tap into the appropriate local services.

You can hire a care manager for a single, specific task, such as helping you find a daily caregiver, or to oversee the entire caregiving process. Geriatric care managers can help families or seniors who are:

new to elder care or uncomfortable with elder care decision-making;

having difficulty with any aspect of elder care;

faced with a sudden decision or major change, such as a health crisis or a change of residence;

dealing with a complex situation such as a psychiatric, cognitive, health, legal, or social issue.

In addition to helping seniors and their families directly, geriatric care managers can act as your informed connection with a range of other professionals who are part of your elder care network, including any of the following service providers:

Attorneys or trust officers. A care manager can serve as both elder advocate and intermediary with financial and legal advisors. The GCM is often a good source of referrals if a family needs services from these professionals.

Physicians. The GCM is an ideal liaison between doctors and other health professionals, and the elder patient and family members.

Social workers. It is useful for hospital and nursing home social workers and discharge planners to know that their senior patient will have someone to coordinate their care and assist them on a long-term basis.

Home care companies. The GCM will know local agencies and be able to explain options, costs, and oversight of home care workers. The care manager can also assist in dealing with patients’ social issues, help link to other community resources, and suggest possible placement options.

Residential facilities. The GCM can help identify types of care facilities and assist you in selecting an appropriate one for your situation. The GCM may also be able to streamline the transition into or out of a senior community, for both the elderly resident, family members and staff.

Finding a geriatric care manager

In addition to the many References and resources available, a good place to start your search for a geriatric care manager is with your family physician. Other sources for referrals include:

local hospitals and health maintenance organizations

senior or family service organizations

senior centers

religious affiliations

Medicaid offices

private care management companies

While geriatric care managers are frequently licensed by the state within their respective fields of expertise, there are no state or national regulations for professional care managers per se. For this reason, anyone can use the title case or care manager. Membership in a professional organization and/or certification in care management are good indicators of appropriate background. The National Association of Professional Geriatric Care Managers recognizes the following designations for a “Certified Care Manager”: CMC, CCM, C-ASWCM and C-SWCM. Each of these requires testing and continuing education.

Geriatrics syndroms

Dementia, Delirium, Urinary Incontinence, Osteoporosis, Falls/ Gait Disorders, Decubitus Ulcers, Sleep Disorders, Failure to Thrive

Organ specific disease/syndrome

Ear, Eye, Cardiovascular, Musculoskeletal, Neurological, Communicable Diseases, Respiratory, Oral, Gastrointestinal, Endocrinological, Sexual Dysfunction and Gynecology, Hematology and Oncology, Kidney/Prostate, Skin Diseases

Geriatric psychiatry

Mood Disorders, Anxiety Disorders, Personality Disorders, Substance Related Disorders, Memory Disorders (non-dementia)

Patient care

Geriatric Assessment, Hospitalization, Emergency Medical Services, Surgical Procedures, Long-Term Care, Preventive Health Services, Rehabilitation, Pain Management/ Palliative Care

Aging

Age Distribution/Demography, Basic Sciences, Pharmacology/ Polypharmacy

Patient care of the elderly

Tips for working with the eldery patient

Take time to edudcate the patient and his or her family. Speak lower and closer treat the patient with dignity and respect.Give the patient time to rest between projections and procedures. Avoid adhesive tape: elderly skin thin and fragile. Provide arm blankets in cold examination rooms. Use table pads and hand nails. Always access the patient’s medical history before contrast media is administered.

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Patient and family education

Educating all patient, especially the elderly ones, about imaging procedures is crucial to obtain their confindence abd compliance. More time with elderly patient may be necessary to accommodate their decreased ability is rapidly process information. The majority of elderly have been diagnosed with at least one chronic illness.They typically arrive at the clinical imaging environment with the natural anxiety because they are like to have lilttle knowledge of the procedure or highly technical modalities employed for their procedure. Moreover, a fear concerning consequences resulting from the examination exacerbates their increased level of anxiety. Taking time to educate patient and their family or signification caregivers in their support system about the procedures makes of a less stressfull experiences and improved patient compliances and satisfaction.

Communication

Good communication and listening skills create a connection between the radiographer and his or her patient. Older people are unique and should be treated with dignity and respects. Each elderly person is a wealth of cultural and historical knowledge that is turn becomes a learning experiences for the radiographer. If it is a evident that the patient cannot hear or understand the verbal directions. It is appropriate to speak lower and closer. Background noise can be disrupting to an older person and should be eliminated of possible when giving precise instructions. Giving instruction individual gives the elder person time to process a request. An empathetic, warm attitude and approach to the geriatric patient will result in a trusting and compliant patient.

Transportation and lifting

Balance and coordination of the elderly patient can be affected by normal aging changes. Their anxiety about falling can be diminished by assistance in out of a wheelchair and to and from the examination table. Many elderly patient have decreased height perception resulting from some degree of vision impairment. Hesitition of the elderly person may be due to previous falls. Assiting an older patient when there is need to step up or down throughout the procedure is more than a reassuring gesture. Preventing opportunities for falls is a necessity for the radiographer. The elderly patient will often experiences vertigo and dizziness when going from a recumbent postion to a sitting position. Giving the patient time to test between position will mitigate these disturbing, frightening, and uncomfortable sensations. The use of table handgrips and proper assistance from the radiographer creates a sense of security for the elderly patient. A sense of security will result in a compliant and trusting patient throughtout the imaging procedure.

Skin care

Acute age-related changes in the skin will cause it to become thin and fragile.The skin becomes more susceptible to bruising, tears, abrasion, and blisters. All health care professional should use caution in turning and holding the elderly patient.Excessive pressure on the skin will cause it to break and tear .Adhesive tape should be avoided because it can be irritating and can easily tear the skin of an older person. The loss of fat and makes it painfull for the elder patient to lie in a hard surface and can increase the possibility developing ulceration. Decubitus ulcers, or pressure sores, are commonly seen in bedridden people or those will decreased mobality.Bony areas such as the heels, angkle, elbow and the lateral hips are frequent side for pressure sores. A decubitus ulcer can develop in 1 to 2 hours. Almost with out exception, table use for imaging procedures are hard surface and cannot be avoided.However the use of table pad can reduce the friction between the hard surface of the table and the patient fragile skin. Sponges,Blankets and the positioning aids will make the procedures much more bearable and comfortable for the elderly patient.Because skin plays a critiscal role in maintaining body temperature, the increasingly thinning process associated with aging skin renders the patient less able to retain normal body heat. Thus the regulation of body temperature of the elderly person varies from that to a younger person. To prevent hypotamia in room where the ambient ier temperature is comfortable for the radiographer, it may be essential to provide blankets for the elderly patient.

Contrast administration

Because of age related changes in kidney and liver function, only the amount, the type of contrast media is varied when performing radiographic procedures on the elderly patient. The number of functioning nephrons in the kidneys steadily decreases from middle the throughout the life span. Compromised kidney function contributes to the elderly patient being more prone to electrolcyte and fluid imbalance. This can create life-threatening consequences. They are also more suspectible to the effect of dehydration because of diabetes and decreased renal or adrenal function. The decision if type and amount of contrat media used for the geriatric patient usually follow some sprt of routine protocol. Assessment for contrast agent administration accomplished by the imaging technologist must include

age and history of liver, kidney or thyroid disease;

history of hypersensitivity reactions and previous reaction to medications or contrast agent ;

sensitivity to asprin;

over the-counter and prescription drug history including acetotaminophen (Tylenol);

and history of hypertension.

The imaging technologist must be selective in locating an appropriate vein for contrast administration on the elderly patient. They should consider the location and condition of the vein, decrease intergrity of the skin, and the duration of the theraphy.Thin superficial veins, repeatedly used veins,and veins located area where the skin is bruised or scarred should be avoided. Assess the patient for any swallowing impairments, which could lead to difficulties with drinking liquid contrast agents. The patient should be instructed to drink slowly to avoid choking, and an upright position will help prevent aspiration.

The Radiographers Role

The role of radiographers is no different than that of all other health professionals.The whole person must be treated, not just the manifested symptoms of an illness or injury. Medical imaging and therapeutic procedures reflect the impact of ongoing systemic aging in documentable and visual forms. Adapting procedures to accommodate disablilities and diseases of geriatric patient is a critical responsibility and a challenge based almost exclusively on the radiographers knowledge, abilities and skills. An understanding of the physiology and pathlogy of aging, in addition to an awareness of the social, physiologic, congnitive and economic aspects of aging, are required to meet the need of elderly population. Condition typically associated with elderly patient invariably requires adaptations or modifications of routine imaging procedures. The radiographers must be able to differentiate between age-related changes and disease processes. Production of diagnostic images requiring professional decision making to compensate for physiologic changes, while maintaining the campliances,safety and comfort of the patient, is the foundation of the contract between the elderly patient and the radiographers.

Radiographic positioning for geriatric patient

The preceding discussion and understanding of the physical,cognitive,and physchology effect on aging can help radiographers adapt the positioning challenges of the geriatric patient.In some cases routine examination need to be modified to accommodate the limitation,safety and comfort of the patient.Communicating clear instruction with the patient is important.The following discussion addresses positioning suggestion for various structures.

Chest

The positioning of choice of the chest radiography is the upright positions, however the elderly patient may not able to stand without assistance for this examination. The tradisional posterioranterior (PA) position as to have the ‘back of hand on hips. This may difficult for someone with ampaired balanced and flexiblelity. The radiographer can allow the patient to wrap his or her arm around the chest stand as a means of support and security. The patient may not able to maintain his or her arms over the head for the lateral projection of the chest.Provide extra security and stability while moving the arms up and forward.

When the patient cannot stand, the examination may be done seated in whellchair, but some issue will be effect the radiographic quality. First the radiologist need to be aware that the radiograph is an anterior-posterior (AP) instead of a PA projection, which may make obscure the lung bases, in a sitting position, respiration may be instructed on the importance of a deep inspiration.

Positioning of the image receptor for the kyphotic patient should be higher than normal because the shoulder and apices are in a higher position. Radiographic landmark may change with age and the centering may need to be lower if the patient is extremely kyphotic. When positioning the patient for the sitting lateral chest projection.The radiographer should place large sponge behind the patient to lean hind or her forward.

CHEST (Portable)

Exam Rationale:

– Cassette size: 35Ã-43cm

– Non-grid

– 72 kVp, 6 mAs

– AP projection (upright or supine)

Spine

Radiographic spine examination may be painful for the patient suffering from osteoporosis that is lying on the bucky table. Positioning aids such as radiolucent, sponges, sandbags, and a mattress may be used as long as the quality of the images is not compromised. Performing upright radiographic examination may also be appropriate if a patient can safety tolerate this position. Performing upright radiographic examination may also be appropriate if a patient can safely tolerate this position. The combination of cervical lardosis and thoracic kyphosis can make positioning and visualization of the cervical projection can be done with the patient standing, sitting, or lying supine. The AP projection in the sitting position may not visualize the upper cervical vertebrae because the chin may abscure this anatomy. In the supine position the head may not reach the table and result in magnification. The AP and openmouth projection are difficult to do on a wheelchair.

The thoracic and lumbar spines are sites for compression fractures. The use of positioning blocks may be necessary ho help the patient remain in position. For the lateral projection, a lead bloker or shield behind the spine should be used to absorb as much scatter radiation as possible.

Pelvis/Hip

Osteoarthiritis, osteoprosis and injuries as the result of falls contribute to hip pathologies. A common fracture in the elderly is the femoral neck. An AP projection of the pelvis should be done to examine the hip. If the indication is trauma, the radiographers should not attempt to rotate the limbs. The second view taken should be cross-table lateral of the effected hip. If hip pain is the indication, assist the patient to internal rotation of the legs with use of sandbags if necessary.

Upper Extremity

Positioning the geriatric patient for projection of the upper extremities can present its own challenges. Often the upper extremities have limited flexiblelity and mobality. A cerebrovascular accident or stroke may cause contractures of the affected limb, Contractures of the affected limb, Contracted limbs cannot be forced into position, and cross-table views may need to be done. The inability of the patient to move his or her limbs should not be interpreted os a lack of cooperation. Supinated is often a problems in patient with constructures, fracture and paralysis. The routine AP and lateral projections can be supported with the use of sponges, sanbags, and blocks to raise and support the extremities being image. The shoulder is also a site of decreased mobality, dislocation, and fratures.The therapist should assess how much movement before the patient can do before attempting to move the arm. The use of finger sponges may also help with the contractures if the finger.

Lower extremity

The lower extremities may have limited flexibility and mobality. The ability to dorsiflex the ankle may be reduced as a result of neurologi disorder. Imaging on the x-ray table may need to be modified when a patient cannot turn on his or her side. Flexion of the knee may be impaired and require a cross-table lateral projection. If a tangential projection of the pattela, such as the settegast method, is necessary and the patient can turn on his or her side, place the image receptor superior to the knee and direct the central ray perpendicular throught the pattela-femoral joint. Projection of the feet and ankles may be obtained with the patient sititng in the whellchair. The use of positioning sponges and sanbags support and maintain the position of the body part being imaged.

Technical Factors.

Exposure factors also need to be taken into considerarion when image the geriatric patient. The loss of bone mass, as well as atrophy of tissue, often requires a lower kilovoltage (kVp) to maintain sufficient contrast. kVp also a factor in chest radiographs when there may be a large heart and pleural fluid to penetrate. Patient with emphysema require a reduction in technical factors to prevent overexpose of the lungs fields. Patient assessment can help with the appropriate exposure adjustment.

Time may also be a major factor. Geriatric patient may have problems maintaining the positions necessary for the examinations. A short exposure time will help reduce any voluntary and involuntarymotion and breathing. Ensure that the geriatric patient clearly hears and understands the breathing instructions.

Conclusion

The imaging professional will continue to see a changes in the health care delivery system with the dramatic shift in the population of person older than age 65. This shift in the general population is resulting in an ongoing increase in the number of medical imaging procedures performed on elderly patient. Demographic and social effect on aging determine the way which the eldely adapt to and view the process of aging. An individuals family size and perceptions of aging, economic resources, gender, race, athnicity, social class, and the availability and delivery of health care will affect the quality of the aging experiences. Biological age will be much more critical than chronologic aging when determining the health status of the elderly. Healthier lifestyles and advancement in medical treatment will create a generation of successfully aging adults, which in turn should decrease the negative stereotypes of the elderly person. Attitude of all health care professionals, whether positive or negative, will affect the care provided to the growing elderly population. Education about the mental and physiologic alteration associated with aging, along with the cultural, economic, and social influences accompanying aging, enables the radiographers to adapt imaging and therapeutic procedures to the elderly patients disablities resulting from age-related changes.

The human body undergoes a multiplicity of physiologic changes and failure in all organ systems.the aging experiences is affected by heredity, lifestyle, choices, physical health, and attitude making it highly individualized. No individuals agign process is predictable and is never exactly the same as that of any other individuals. Radiologic technologist must use their knowledge.abilities and skills to adjust imaging procedures to accommodate for disabilities and disease encountered with geriatric patients. Safety and comfort of the patient is essential in maintaining compliances throughtout imaging procedures. Implementation of skills such as communication, listening, sensitivity, and empathy, all lead patient compliances. Knowledges of age-related changes and disease process will anchance the radiographers ability to provided diagnostic imformation and treatment when providing care that meets the needs if tge increasing elderly patient population.

GERIATRICS