Care of the Older Adult

CARING FOR OLDER PERSONS WITH

CHRONIC ILLNESS: DEMENTIA,
DEPRESSION, VISION AND HEARING
PROBLEMS, AND URINARY AND
BOWEL ELIMINATION PROBLEMS
MODULE 5

ERLINDA M. GUZMAN RN, MAN

Instructor
OVERVIEW/INTRODUCTION:
 Nationwide, approximately 85 percent of older adults have at least
one chronic health condition, and 60 percent have at least two
chronic conditions (Centers for Disease Control and Prevention,
2020). For many older people, coping with multiple chronic
conditions is a real challenge. Learning to manage a variety of
treatments while maintaining quality of life can be problematic.
 People with chronic conditions may have different needs, but they
also share common challenges with other older adults, such as
paying for care or navigating the complexities of the healthcare
system.
 Nurses can play an important role in educating patients and families
about chronic health conditions and can connect them with
appropriate community resources and services.
OVERVIEW/INTRODUCTION:
 Try to start by appreciating that people living with chronic
disease are often living with loss, the loss of physical function,
independence, or general well-being.
 Empathize with patients who feel angry, sad, lost, or
bewildered. Ask, "Is it hard for you to live with these problems?"
From there you can refer patients to community resources
that may meet their needs or, when available, recommend a
disease management program or case managers in the
community.
LEARNING OUTCOMES:
At the end of the module, students should be able to:
1. Describe the normal functions and processes of the different
body systems.
2. Examine age-related changes in the different body systems
of the older persons. .
3. Explain methods for assessment, diagnosis and management
of different chronic illnesses.
4. Utilize the nursing process in the implementation of care of
the elderly with chronic illnesses.
5. Apply the concepts and principles of elderly care in different
chronic illnesses and clinical situations.
CARE OF OLDER PERSONS
WITH DEMENTIA
DEMENTIA
 longer to learn new things and to recall information.
 struggle to remember a name, a word or an event, that this could be
the first sign of Alzheimer’s disease or a related dementia.
 one per cent of people with age-related memory loss develop
dementia.
 Dementia is a medical term for a set of symptoms. Whatever the
cause of the dementia, symptoms may include:
1. memory loss
2. loss of understanding or judgment
3. decreased ability to make decisions
4. changes in how the person expresses their emotions
5. changes in personality
6. problems coping with daily living
7. problems with speech and understanding language
8. problems socializing
DEMENTIA
 Dementia is not a normal part of aging. It is an abnormal
degeneration of the brain that leads to changes in a person’s ability
to think, speak, socialize and take part in normal daily activities.
 Detecting dementia early, and identifying the specific type, is crucial
for providing proper care. An early diagnosis also gives the patient,
family and friends time to prepare and connect with the right
resources in the community to help maintain independence.
 While there is no cure for dementia, and no sure way to avoid it,
keeping the brain active may help to delay or lessen the initial
effects of dementia and prolong independence.
 Reading, learning a new skill and staying physically active and
socially connected are all concrete steps to staying mentally and
physically healthy for as long as possible.
DEMENTIA
 As a dementia progresses, different parts of the brain are affected
leading to a range of changes and diminishing abilities.
 Abilities that are lost do not then return.
 Memory-enhancing drugs may, however, be able to maintain
memory for a period of time.
 There are four main types of dementia:
1. Alzheimer’s disease is the most common
2. Vascular dementia
3. Lewy bodies
4. Frontotemporal lobe dementia.
 The risk of developing a dementia increases with age.
What are the signs of dementia?

 The early signs of dementia are often very subtle—often not

involving memory loss—and hard to detect. The signs of
dementia can also be caused by other things, such as:
 depression,
 medication problems,
 nutritional disorders
 number of medical conditions.
WHAT ARE THE SIGNS OF DEMENTIA?
 Dementia have at least a few of the following signs:
1. forgetting appointments or a friend’s name and not being able to remember
them later
2. losing their way in familiar places, not knowing what time of day it is
3. having difficulty finding words, using the wrong words in a sentence
4. experiencing problems with familiar tasks like making a meal
5. exhibiting poor or impaired judgment, such as dressing inappropriately for the
weather
6. losing abstract thinking skills, such as not knowing how to read a bank statement
7. misplacing familiar objects or putting them in the wrong place
8. experiencing changes in mood, such as quickly shifting from laughter to tears to
shouting
9. exhibiting changes in personality, such as becoming uncharacteristically irritable,
suspicious or fearful
10.losing the desire to carry out simple but important day-to-day activities
WHAT CAN BE DONE IF DEMENTIA IS DIAGNOSED?
 Steps you can take to help the patient or the family member continue to
enjoy life:
1. Focus on the things you can do, rather than on the things you can
no longer do.
2. Stay involved in activities that give pleasure and that have meaning
for you.
3. Stay physically active and eat a healthy diet.
4. Plan for the future so that your wishes can be respected.
5. Reach out for support, both from family, close friends and from
community services that help people maintain their independence
and dignity.
6. Learn about dementia to find out what to expect and about
strategies that can help you to live the fullest life possible.
7. Acknowledge that living with dementia can be difficult.
REMINDERS…
ESSAY:
Answer the questions below.
1. Why is specialized and focused assessment techniques and
principles vital in screening and evaluating an older
persons? Explain.
2. What makes an elderly assessment distinct and how it differs
from the general assessment of an adult? Explain.
3. As a nurse, what other aspects of the geriatric assessment
that you want to focus or improve? Why? What other areas
that you want to focus? Discuss.
Deadline: March 15, 2021 – 8 AM via Canvas
ACTIVITY:
Research on:
Expected Output: COMPREHENSIVE GERIATRIC ASSESSMENT
The following components should be present in your output
but not limited to:
1. functional ability,
2. physical health,
3. psychological, cognition and mental health, and
4. socio-environmental (community/family/living
arrangement)
Deadline:
CARE OF A CLIENT WITH DEMENTIA
OR ALZHEIMER’S DISEASE
 Dementia care is daunting, but may not be as challenging
as anybody would expect — the right attitude is crucial to
success.
 Educating about dementia and maintaining a positive but
realistic attitude allows to maintain an element of control as
a caregiver. It can take the burden of surprising challenges
that can be encountered and also improve the care
provided to the patient.
1. ACCEPT SUPPORT
 Whether you are caregiving for someone in your family, or whether
you provide care professionally, never be afraid to ask for help.
 support groups immensely helpful. Support groups allow
caregivers to vent in a group setting with people who
understand what one another is going through. It also allows
caregivers to hear what is working for other caregivers and learn
about local Alzheimer’s and dementia resources.
 professional caregivers should not be reluctant to ask a
colleague for support when facing an exceptional challenge or
difficult time. Caregiving for someone with dementia is not easy
and there will certainly be moments when professional
caregivers need a hand or someone to talk to.
2. ACTIVELY EMPATHIZE
 Care starts with compassion and empathy.
 People with dementia are prone to becoming confused
about their whereabouts and even the time period in
which they are living. For instance, imagine how you felt
and would want to be treated if you suddenly found
yourself disoriented in an unfamiliar place, not even sure
of the year or even your own identity. Orientation and
re-orientation is very vital.
3. BE A REALISTIC CAREGIVER
 Be realistic about what constitutes success during the progression of
the disease. Success is helping to assure that the person you are
caring for is as comfortable, happy and safe as possible.
 Most experienced dementia caregivers will tell you that the person
they care for has good days and bad days. Try your best to foster
the good days and even the good moments for the person with
dementia, do not try to force them.
 Be realistic about the course of the disease. Remember that most
types of dementia, including Alzheimer’s, are irreversible and
progressive.
 Dementia will tend to get worse over time and there is no known
cure. (A prominent exception is dementia induced by medications,
which can be reversed when medications are withdrawn.)
4. DEMENTIA IS MORE THAN MEMORY LOSS
 Memory loss is a classic dementia symptom. But some types of dementia,
particularly frontotemporal dementia, manifest as personality changes
rather than memory loss.
 The symptoms depend on the areas of the brain that is affected by the
disease. Even when memory loss is the most apparent symptom, the person
with dementia is experiencing a neurological decline that can lead to a
host of other issues. A patient may develop difficult behaviors and moods.
 For example, a prim and proper grandmother may begin to curse. Or a
formally trusting gentleman may come to believe that his family is plotting
against him or experience other delusions and hallucinations.
 In the latest stages of most types of dementia, patients become unable to
attend to activities of daily living (such as dressing and toileting)
independently.
 Become non-communicative, unable to recognize loved ones and even
unable to move about.
5. PLAN FOR THE FUTURE.
 The only inevitable is change when you are caring for someone
with dementia. Never get too used to the status quo. That means
that family caregivers should prepare for a time when their loved
one may need professional memory care in a residential setting.
This involves both financial planning and identifying the most
appropriate care options in your area.
 Professional caregivers and memory care providers also need to
plan ahead. They should continually reassess the care needs and
health status of patients with dementia. Remember that care
needs will inevitably increase and plan ahead for any transitions
that the patient may require in the future.
CARE OF OLDER PERSONS
WITH DEPRESSION
DEPRESSION AND OLDER ADULTS
 Depression is more than just feeling sad or blue. It is a
common but serious mood disorder that needs
treatment. It causes severe symptoms that affect how a
person feel, think, and handle daily activities, such as
sleeping, eating, and working.
 Trouble with daily life for weeks at a time. Doctors call this
condition “depressive disorder” or “clinical depression.”
 Depression is a real illness. It is not a sign of a person’s
weakness or a character flaw.
 Most people who experience depression need treatment
to get better.
DEPRESSION IS NOT A NORMAL
PART OF AGING
 Depression is a common problem among older adults, but it is
NOT a normal part of aging. In fact, studies show that most
older adults feel satisfied with their lives, despite having more
illnesses or physical problems. However, important life changes
that happen as we get older may cause feelings of
uneasiness, stress, and sadness.
 For instance, the death of a loved one, moving from work into
retirement, or dealing with a serious illness can leave people
feeling sad or anxious. After a period of adjustment, many
older adults can regain their emotional balance, but others do
not and may develop depression.
RECOGNIZING SYMPTOMS OF
DEPRESSION IN OLDER ADULTS
 Depression in older adults may be difficult to recognize because they may
show different symptoms than younger people.
 For some older adults with depression, sadness is not their main symptom.
They may have other, less obvious symptoms of depression, or they may not
be willing to talk about their feelings. Therefore, doctors may be less likely to
recognize that their patient has depression.
 Sometimes older people who are depressed appear to feel tired,
have trouble sleeping, or seem grumpy and irritable. Confusion or attention
problems caused by depression can sometimes look like Alzheimer’s
disease or other brain disorders.
 Older adults also may have more medical conditions, such as heart
disease, stroke, or cancer, which may cause depressive symptoms. Or they
may be taking medications with side effects that contribute to depression.
TYPES OF DEPRESSION
There are several types of depressive disorders.
 Major depression involves severe symptoms that interfere with
the ability to work, sleep, study, eat, and enjoy life. An episode
can occur only once in a person’s lifetime, but more often, a
person has several episodes.
 Persistent depressive disorder is a depressed mood that lasts for
at least 2 years. A person diagnosed with persistent depressive
disorder may have episodes of major depression along with
periods of less severe symptoms, but symptoms must last for 2
years to be considered persistent depressive disorder.
 Other forms of depression include psychotic depression,
postpartum depression, and seasonal affective disorder.
CAUSES AND RISK FACTORS FOR
DEPRESSION
Several factors, or a combination of factors, may contribute to
depression.
1. Genes—People with a family history of depression may be more
likely to develop it than those whose families do not have the
illness.
2. Personal history—Older adults who had depression when they
were younger are more at risk for developing depression in late
life than those who did not have the illness earlier in life.
3. Brain chemistry—People with depression may have different
brain chemistry than those without the illness.
4. Stress—Loss of a loved one, a difficult relationship, or any
stressful situation may trigger depression.
VASCULAR DEPRESSION
 For older adults who experience depression for the first time later
in life, the depression may be related to changes that occur in
the brain and body as a person ages. For example, older adults
may suffer from restricted blood flow, a condition called
ischemia. Over time, blood vessels may stiffen and prevent
blood from flowing normally to the body’s organs, including the
brain.
 If this happens, an older adult with no family history of
depression may develop what is sometimes called “vascular
depression.” Those with vascular depression also may be at risk
for heart disease, stroke, or other vascular illness.
DEPRESSION CAN CO-OCCUR
WITH OTHER ILLNESSES
 Depression, especially in older adults, can co-occur with
other serious medical illnesses such as diabetes, cancer,
heart disease, and Parkinson’s disease.
 Depression can make these conditions worse and vice versa.
 Medications taken for these physical illnesses may cause side
effects that contribute to depression.
 All these factors can cause depression to go undiagnosed or
untreated in older people. Treating the depression will help
an older adult better manage other condition.
COMMON SYMPTOMS OF DEPRESSION
Several of these symptoms for more than 2 weeks:
1. Persistent sad, anxious, or "empty" mood
2. Feelings of hopelessness, guilt, worthlessness, or helplessness
3. Irritability, restlessness, or having trouble sitting still
4. Loss of interest in once pleasurable activities, including sex
5. Decreased energy or fatigue
6. Moving or talking more slowly
7. Difficulty concentrating, remembering, making decisions
8. Difficulty sleeping, early-morning awakening, or oversleeping
9. Eating more or less than usual, usually with unplanned weight gain or loss
10. Thoughts of death or suicide, or suicide attempts
11. Aches or pains, headaches, cramps, or digestive problems without a clear
physical cause and/or that do not ease with treatment
12. Frequent crying
TREATMENTS FOR DEPRESSION
A. DIAGNOSIS:
1. Physical exam, interview/ history taking, and lab tests –
subjective and objective data collection
2. Psychological evaluation
3. The most common forms of treatment for depression are
medication and psychotherapy.
THERAPY FOR DEPRESSION
1. Psychotherapy, also called "talk therapy," can help people
with depression. Some treatments are short-term, lasting 10 to
20 weeks; others are longer, depending on the person's
needs.
2. Cognitive behavioral therapy is one type of talk therapy used
to treat depression. It focuses on helping people change
negative thinking and any behaviors that may be making
depression worse.
3. Interpersonal therapy can help an individual understand and
work through troubled relationships that may cause the
depression or make it worse.
4. Other types of talk therapy, like problem-solving therapy, can
be helpful for people with depression.
MEDICATIONS FOR DEPRESSION
 Antidepressants are medicines that treat depression. They
may help improve the way your brain uses certain
chemicals that control mood or stress.
 Antidepressants take time, usually 2 to 4 weeks, to work.
Often symptoms such as sleep, appetite, and
concentration problems improve before mood lifts, so it is
important to give the medication a chance to work before
deciding whether it works.
 Strict compliance is very important. Stopping
antidepressants abruptly can cause withdrawal symptoms.
PREVENTING DEPRESSION
 What can be done to lower the risk of depression? How
can people cope?
Try to prepare for major changes in life, such as
retirement or moving from your home of many years.
Stay in touch with family. Let them know when you
feel sad.
 Regular exercise may also help prevent depression or lift
your mood if you are depressed. Pick something you like
to do. Being physically fit and eating a balanced
diet may help avoid illnesses that can bring on disability
or depression.
 CARE OF OLDER
PERSONS WITH VISION
AGE-RELATED VISION LOSS
 It is normal in age of 40s that vision is changing or not
like they used to. These are normal parts of aging that
can be easily adapt to.
 According to the National Eye Institute (2017), there
are certain eye diseases that can put an individual at
risk for more permanent and severe vision loss,
including:
AGE-RELATED VISION LOSS
1. Age-related macular degeneration (AMD).
 AMD affects the middle of vision, causing:
 A blurry, dark patch directly in line of sight
 An overall foggy appearance to what is seen
 What appears to be waves in straight objects
2. Cataracts.
 At the front of the eyeball is a clear lens and cataracts occur when this
lens becomes cloudy. Usually, the symptoms are gradual, but individuals
with cataracts will notice:
 Bright lights needed to be able to see
 Difficulty with night driving
 Overall blurry vision
 Trouble recognizing colors
AGE-RELATED VISION LOSS
3. Diabetic eye disease.
 Poorly controlled diabetes can cause a form of blindness called diabetic
retinopathy. What happens is that the tiny blood vessels at the back of
the eye can rupture. This can lead to dark patches or areas of vision that
are gone.
4. Dry eyes.
 As we age, our tear glands often produce fewer tears, creating dry eyes.
Dry eyes in themselves are not harmful but the eye can become irritated
and scratched if there is not enough moisture to wash out anything that
gets in the eye.
5. Glaucoma.
 At the back of the eye, the optic nerve connects to our
brains. Glaucoma is when there is unusually high pressure on this nerve.
The pressure can then break down the nerve leading to blind spots.
HOW TO PREVENT VISION LOSS
 The method of preventing long-term damage or vision
loss is to have regular eye exams by an optometrist or
ophthalmologist.
 You can also keep eyes healthy by:
Avoiding smoking
Eating a nutrition rich diet
Wearing protective sunglasses when outdoors
HOW TO TREAT VISION LOSS IN THE
ELDERLY
 Able to discuss laser eye surgery.
 Offered a surgery consultation.
 Prescribed eye drops.
 Prescribed new glasses.
 Recommended changes to a diet.
 Scheduled for regular follow up. Treating the chronic
conditions.
 It is normal for vision to change as you age, but losing your
vision is not normal. Taking steps to safeguard sight is a vital step
to continue to enjoy an active and independent life.
KEEPING AN EYE ON VISUAL
HEALTH
 Caregivers can help by looking for an increase in:
Squinting or tilting their head when trying to focus.
Bumping into things or knocking objects over.
Discontinuing everyday vision-based activities like reading
or writing.
Missing objects when reaching for them.
Falling or walking hesitantly.
 If a loved one is still driving, an increase in accidents and risky
maneuvers may also indicate visual changes.
TIPS AND PRODUCTS FOR HELPING
A SENIOR WITH LOW VISION
 It is best for caregivers to learn as much as possible
about their care recipients’ visual condition and the
limitations they experience. This information will help you
suggest appropriate modifications to their environment
and behavior as well as products that can enhance
their functional abilities.
 While individual conditions affect eyesight differently,
the following tips are an excellent starting point for
helping a blind or visually impaired senior safely maintain
their independence:
GOOD LIGHTING IS KEY
 Keep surroundings well-lit but be mindful of glare. Use
specialized lamps/bulbs to increase contrast and
reduce glare and cover reflective surfaces when
possible. Ensure that appropriate lighting is provided for
all activities that patient engages in.
 Avoid large discrepancies in lighting, such as a bright
lamp shining into a dark room. As task lighting is
increased, the surrounding room lighting should also be
increased. Keeping lights on during daytime hours helps
to equalize lighting from both indoor and outdoor
sources.
TAKE STEPS TO MINIMIZE FALL RISKS
 Use nightlights in bedrooms, hallways and bathrooms to reduce the risk
of tripping and falling at night.
 Eliminate clutter and remove hazards such as throw rugs and electrical
cords.
 Consider replacing or relocating short or difficult to see furniture, such as
a glass coffee or side table.
 Create wide, clear and level walking paths that lead to all areas of the
home for easy and safe navigation.
 You may have to reposition some furnishings to make the home easier
to navigate. This can be disorienting initially, so make sure to provide the
patient with extra assistance getting around until they have memorized
the new layout.
 Larger-scale rearrangements may be inadvisable for some seniors,
especially those with memory issues.
IMPROVE HOUSEHOLD ORGANIZATION
 Designate spots for commonly used items and be sure to return
objects to the same place every time so that patient always knows
where things are.
 Combining tactile and visual systems can help seniors more easily
navigate their environment. Tactile systems are helpful for those with
limited or no vision, or for those whose visual abilities change from
day to day.
 An example of a tactile system is placing rubber bands, felt, raised
plastic dots or sandpaper cut-outs on items to mark their placement
or differentiate similar objects.
 Visual systems make use of any remaining vision to identify and
organize things. Common examples include large labels or colored
stickers or tapes to differentiate individual items or identify
collections of items.
EMBRACE CONTRASTING COLORS
 The juxtaposition of light and dark colors can make daily activities
much easier for a person who still has some remaining vision. Like
colors can make it difficult for those with visual impairments to
detect doorways, stairs and furniture and especially smaller objects
that blend into their surroundings.
 For example, providing a white cutting board for preparing darker
foods like apples and a dark board for lighter foods like onions can
help extend independence and promote safety. This concept
especially applies in settings like bathrooms, which tend to be
monotone. Choose towels, washcloths and bath mats that contrast
sharply with the color of the tub/shower, counters and flooring.
Painting door jambs a contrasting color and using brightly colored
tape to highlight the edges of steps are other modifications that can
be used to improve safety in the home.
THINK BIGGER
 Magnification is an essential tool for those with low vision, and
magnifying devices range from very simple to technologically
advanced. Look for items that come with larger print/buttons,
such as books, checkbooks, calendars, calculators, remote
control units, clocks, watches, appointment books and playing
cards.
 For items that do not come in low-vision versions, magnifiers can
be very helpful. Electronic magnification units use a camera to
capture an image and project it onto a built-in monitor, a
television screen or a computer screen. These units can be used
to read bills and write checks, read books, look at photos, and
complete intricate tasks like filling an insulin syringe.
WORK WITH A LOW VISION
SPECIALIST
 Low vision specialists have the knowledge and experience
to devise personalized solutions for a visually impaired
individual's specific needs. Vision rehabilitation can help
with mobility training as well as methods of organizing,
marking and labeling household items. These specialists are
also familiar with resources for obtaining low vision aids and
can instruct their clients on how to use them properly. Many
vision rehabilitation programs even offer mental health
services to help participants cope with the anxiety
or depression that often accompanies vision loss.
PROVIDE MORAL SUPPORT
 Create a strong support system for those with new or
worsening visual impairments.
 Encourage patient to remain active with friends and stick with
the hobbies and pastimes they enjoy.
 Offer to accompany or assist them with these things so they
can be more confident in their ability to participate.
 Seniors often worry that sight impairments will affect their
ability to live independently. Put patient at ease by suggesting
resources that will allow them to remain independent, and
help them implement the tips above to improve their ability to
complete day-to-day tasks on their own.
CARE OF OLDER PERSONS
WITH HEARING PROBLEMS
HEARING LOSS: A COMMON
PROBLEM FOR OLDER ADULTS
 Hearing loss is a common problem caused by noise, aging,
disease, and heredity.
 People with hearing loss may find it hard to have conversations
with friends and family.
 They may also have trouble understanding a doctor’s advice,
responding to warnings, and hearing doorbells and alarms.
 Approximately one in three people between the ages of 65 and
74 has hearing loss, and nearly half of those older than 75 has
difficulty hearing.
 Older people who cannot hear well may become depressed, or
they may withdraw from others because they feel frustrated or
embarrassed about not understanding what is being said.
HEARING LOSS: A COMMON
PROBLEM FOR OLDER ADULTS
 Hearing problems that are ignored or untreated can get
worse. Hearing aids, special training, certain medicines, and
surgery are some of the treatments that can help.
 Studies have shown that older adults with hearing loss have a
greater risk of developing dementia than older adults with
normal hearing.
 Cognitive abilities (including memory and concentration)
decline faster in older adults with hearing loss than in older
adults with normal hearing.
SIGNS OF HEARING LOSS
1. Have trouble hearing over the telephone
2. Find it hard to follow conversations when two or more
people are talking
3. Often ask people to repeat what they are saying
4. Need to turn up the TV volume so loud that others
complain
5. Have a problem hearing because of background noise
6. Think that others seem to mumble
7. Can’t easily understand conversations
TYPES OF HEARING LOSS
There are two general categories of hearing loss:
1. Sensorineural hearing loss occurs when there is
damage to the inner ear or the auditory nerve. This type
of hearing loss is usually permanent.
2. Conductive hearing loss occurs when sound waves
cannot reach the inner ear. The cause may be earwax
buildup, fluid, or a punctured eardrum. Medical
treatment or surgery can usually restore conductive
hearing loss.
AGE-RELATED HEARING LOSS
(PRESBYCUSIS)
 Presbycusis, or age-related hearing loss, comes on
gradually as a person gets older. It seems to run in
families and may occur because of changes in the inner
ear and auditory nerve. Presbycusis may make it hard for
a person to tolerate loud sounds or to hear what others
are saying.
 Age-related hearing loss usually occurs in both ears,
affecting them equally. The loss is gradual, so someone
with presbycusis may not realize that he or she has lost
some of his or her ability to hear.
RINGING IN THE EARS (TINNITUS)
 Tinnitus is also common in older people. It is typically
described as ringing in the ears, but it also can sound like
roaring, clicking, hissing, or buzzing. It can come and go. It
might be heard in one or both ears, and it may be loud or
soft. Tinnitus is sometimes the first sign of hearing loss in older
adults. Tinnitus can accompany any type of hearing loss and
can be a sign of other health problems, such as high blood
pressure, allergies, or as a side effect of medications.
 Tinnitus is a symptom, not a disease. Something as simple as
a piece of earwax blocking the ear canal can cause tinnitus,
but it can also be the result of a number of health conditions.
CAUSES OF HEARING LOSS
 Loud noise is one of the most common causes of hearing
loss. Noise from loud music, etc can damage the inner ear,
resulting in permanent hearing loss. Loud noise also
contributes to tinnitus.
 Earwax or fluid buildup can block sounds that are carried
from the eardrum to the inner ear. If wax blockage is a
problem, may suggest mild treatments to soften earwax.
 A punctured ear drum can also cause hearing loss. The
eardrum can be damaged by infection, pressure, or putting
objects in the ear, including cotton-tipped swabs. Note if
there is presence of pain or fluid draining from the ear.
CAUSES OF HEARING LOSS
 Health conditions common in older people, such
as diabetes or high blood pressure, can contribute to hearing
loss. Viruses and bacteria (including the ear infection otitis
media), a heart condition, stroke, brain injury, or a tumor may
also affect your hearing.
 Hearing loss can also result from taking certain medications.
“Ototoxic” medications damage the inner ear, sometimes
permanently. Some ototoxic drugs include medicines used to
treat serious infections, cancer, and heart disease.
 Heredity can cause hearing loss, as well. Some forms can show
up later in life. For example, in otosclerosis, which is thought to
be a hereditary disease, an abnormal growth of bone prevents
structures within the ear from working properly.
HOW TO COPE WITH HEARING LOSS
1. Let people know you have a hearing problem.
2. Ask people to face you and to speak more slowly and
clearly. Also, ask them to speak louder without shouting.
3. Pay attention to what is being said and to facial
expressions or gestures.
4. Let the person talking know if you do not understand what
he or she said.
5. Ask the person speaking to reword a sentence and try
again.
6. Find a good location to listen. Place yourself between the
speaker and sources of noise and look for quieter places
to talk.
TIPS: HOW TO TALK WITH SOMEONE
WITH HEARING LOSS
 In a group, include people with hearing loss in the conversation.
 Find a quiet place to talk to help reduce background noise, especially in
restaurants and at social gatherings.
 Stand in good lighting and use facial expressions or gestures to give clues.
 Face the person and speak clearly. Maintain eye contact.
 Speak a little more loudly than normal, but don’t shout. Try to speak slowly,
but naturally.
 Speak at a reasonable speed.
 Do not hide your mouth, eat, or chew gum while speaking.
 Repeat yourself if necessary, using different words.
 Try to make sure only one person talks at a time.
 Be patient. Stay positive and relaxed.
 Ask how you can help.
DEVICES TO HELP WITH
HEARING LOSS
 Hearing aids are electronic, battery-run devices that make
sounds louder. There are many types of hearing aids.
 Assistive-listening devices, mobile apps, alerting devices,
and cochlear implants can help some people with hearing
loss. Cochlear implants are electronic devices for people
with severe hearing loss. Alert systems can work with
doorbells, smoke detectors, and alarm clocks to send you
visual signals or vibrations. For example, a flashing light can
let you know someone is at the door or the phone is ringing.
Some people rely on the vibration setting on their cell phones
to alert them to calls.
CARE OF OLDER PERSON WITH
URINARY INCONTINENCE
URINARY INCONTINENCE IN OLDER
ADULTS
 Urinary incontinence means a person leaks urine by accident.
While it may happen to anyone, urinary incontinence is more
common in older people, especially women. Incontinence
can often be cured or controlled.
 What happens in the body to cause bladder control
problems? The body stores urine in the bladder. During
urination, muscles in the bladder tighten to move urine into a
tube called the urethra. At the same time, the muscles around
the urethra relax and let the urine pass out of the body. When
the muscles in and around the bladder don’t work the way
they should, urine can leak. Incontinence typically occurs if
the muscles relax without warning.
CAUSES OF URINARY INCONTINENCE
 Weak bladder muscles
 Overactive bladder muscles
 Weak pelvic floor muscles
 Damage to nerves that control the bladder from diseases such
as multiple sclerosis, diabetes, or Parkinson’s disease
 Blockage from an enlarged prostate in men
 Diseases such as arthritis that may make it difficult to get to the
bathroom in time
 Pelvic organ prolapse, which is when pelvic organs (such as the
bladder, rectum, or uterus) shift out of their normal place into
the vagina. When pelvic organs are out of place, the bladder
and urethra are not able to work normally, which may cause
urine to leak.
CAUSES OF URINARY INCONTINENCE
Most incontinence in men is related to the prostate
gland. Male incontinence may be caused by:
 Prostatitis—a painful inflammation of the prostate
gland
 Injury, or damage to nerves or muscles from surgery
 An enlarged prostate gland, which can lead
to Benign Prostate Hyperplasia (BPH), a condition
where the prostate grows as men age.
DIAGNOSIS OF URINARY INCONTINENCE
 Physical exam and take your medical history.
 Symptoms and the medicines taken
 Sick recently or had surgery
 Diagnostic tests. These might include:
Urine and blood tests, imaging studies
Tests that measure how well you empty your
bladder – ultrasound, imaging studies
 Daily diary of when you urinate and when you leak
urine.
TYPES OF URINARY INCONTINENCE
There are different types of incontinence:
1. Stress incontinence occurs when urine leaks as pressure is put on the
bladder, for example, during exercise, coughing, sneezing, laughing, or
lifting heavy objects.
2. Urge incontinence happens when people have a sudden need to
urinate and cannot hold their urine long enough to get to the toilet. It
may be a problem for people who have diabetes, Alzheimer’s
disease, Parkinson’s disease, multiple sclerosis, or stroke.
3. Overflow incontinence happens when small amounts of urine leak from a
bladder that is always full. A man can have trouble emptying his bladder
if an enlarged prostate is blocking the urethra. Diabetes and spinal cord
injuries can also cause this type of incontinence.
4. Functional incontinence occurs in many older people who have normal
bladder control. They just have a problem getting to the toilet because
of arthritis or other disorders that make it hard to move quickly.
TREATMENT FOR URINARY INCONTINENCE
 Bladder control training may help in getting better
control of your bladder. May suggest to try the
following:
Pelvic muscle exercises (also known as Kegel
exercises) work the muscles that you use to stop
urinating. Making these muscles stronger helps
you hold urine in your bladder longer.
Biofeedback uses sensors to make you aware of
signals from your body. This may help you regain
control over the muscles in your bladder and
urethra. Biofeedback can be helpful when
learning pelvic muscle exercises.
BLADDER CONTROL TRAINING
Step-by-step bladder-training technique:
1. Keep track. For a day or two, keep track of the times
you urinate or leak urine during the day.
2. Calculate. On average, how many hours do you wait
between urinations during the day?
3. Choose an interval. ...
4. Hold back. ...
5. Increase your interval.
TREATMENT FOR URINARY INCONTINENCE
 Timed voiding may help you control your bladder. In timed
voiding, you urinate on a set schedule, for example, every
hour. You can slowly extend the time between bathroom trips.
When timed voiding is combined with biofeedback and
pelvic muscle exercises, you may find it easier to control urge
and overflow incontinence.
 Lifestyle changes may help with incontinence. Losing
weight, quitting smoking, saying “no” to alcohol, drinking less
caffeine (found in coffee, tea, and many sodas),
preventing constipation and avoiding lifting heavy objects
may help with incontinence. Choosing water instead of other
drinks and limiting drinks before bedtime may also help.
INCONTINENCE AND ALZHEIMER’S DISEASE
People in the later stages of Alzheimer’s disease often have
problems with urinary incontinence. This can be a result of not
realizing they need to urinate, forgetting to go to the bathroom,
or not being able to find the toilet. To minimize the chance of
accidents, the caregiver can:
 Avoid giving drinks like caffeinated coffee, tea, and sodas,
which may increase urination. But don’t limit water.
 Keep pathways clear and the bathroom clutter-free, with a
light on at all times.
 Make sure you provide regular bathroom breaks.
 Supply underwear that is easy to get on and off.
 Use absorbent underclothes for trips away from home.
 MANAGING URINARY INCONTINENCE
 Medicines can help the bladder empty more fully during urination. Other drugs
tighten muscles and can lessen leakage.
 Some women find that using an estrogen vaginal cream may help relieve stress
or urge incontinence. A low dose of estrogen cream is applied directly to the
vaginal walls and urethral tissue.
 A doctor may inject a substance that thickens the area around the urethra to
help close the bladder opening. This can reduce stress incontinence in women.
This treatment may need to be repeated.
 Some women may be able to use a medical device, such as a urethral insert, a
small disposable device inserted into the urethra. A pessary, a stiff ring inserted
into the vagina, may help prevent leaking if you have a prolapsed bladder or
vagina.
 Nerve stimulation, which sends mild electric current to the nerves around the
bladder that help control urination, may be another option.
 Surgery can sometimes improve or cure incontinence if it’s caused by a
change in the position of the bladder or blockage due to an enlarged prostate.
 CARE OF OLDER PERSON WITH
BOWEL ELIMINATION PROBLEMS
CONSTIPATION
 Constipation is defined as having fewer than three bowel movements a
week (Mayo Clinic, 2019). Constipation also encompasses the passing of hard,
dry bowel motions (stools) that are infrequent, difficult to pass, or both (Better
Health Channel, 2014).
 Constipation can usually be prevented and treated by maintaining a high fiber
diet, increasing water intake and exercising regularly (Better Health Channel,
2014).
 Constipation is a medical issue to be taken seriously, particularly when present
in the older adult. Older adults are considered to be a primary at-risk group for
chronic constipation. It is estimated that older adults are five times more likely
to develop constipated-related problems (Mandal, 2019).
 The process of digestion is as follows: when food is consumed, it breaks down in
the stomach and passes through the intestine. The walls of the intestine then
absorb nutrients from the food. The waste that remains is then passed through
the colon and rectum. At times this process is disturbed, and waste becomes
lodged in the colon, this is known as fecal impaction of the colon (Khan, 2017).
SYMPTOMS OF CONSTIPATION
 Needing to move bowels less frequently;
 Hard, dry stools that might be hard to pass;
 Painfully straining to pass a bowel motion;
 Feeling as though there is a blockage preventing bowel
movement;
 Having to sit on the toilet for long periods of time;
 A sensation that the bowel has not fully emptied after a
motion;
 Having a bloated abdomen; and
 Abdominal cramps.
CONSTIPATION IN ELDERLY PEOPLE
 There are many reasons why constipation affects older adults. One is as a
side-effect of certain medications such as medications for pain,
antidepressants, anticonvulsants, and antihistamines, or a result of
medical conditions such as strictures, hypothyroidism, tumors or
Parkinson’s disease. Prolonged bed rest resulting in a decrease in
movement (Mandal, 2019)
 Other reasons include:
 A possible lack of interest with regard to eating (frequently seen in
single or widowed older people) resulting in the consumption of low-
effort food, which is typically low in fiber.
 Slowing or weakening of the digestive system as a result of aging
and/or frailty.
 Poor diet or lack of adequate fluids in diet, and/or a lack of exercise.
 Absence of teeth can make it difficult to eat regular meals.
(Daily Caring, 2019)
COMMON TYPES OF
CONSTIPATION IN THE ELDERLY
1. Normal transit constipation: a common type of primary
constipation. Though a stool passes through the colon at a
regular pace, patients perceive difficulty in passing bowel
motions.
2. Slow-transit constipation: Bowel movements are infrequent,
limited in their urgency or straining is involved.
3. Pelvic floor dysfunction: patients are experiencing difficulty in
coordinating pelvic floor muscles or muscles around the anus
during defecation. This often creates a feeling of an
incomplete bowel motion(Mandal 2019).
RISK FACTORS FOR CONSTIPATION
Being older than 65 is a major risk factor for chronic
constipation. Other risk factors include:
 Being ill;
 Dehydration;
 Insufficient fiber intake;
 Lack of physical activity;
 Mental health issues such as depression or having an eating
disorder;
 Taking regular medication for which constipation is a side-
effect(Better Health, 2014).
COMPLICATIONS OF CONSTIPATION
1. Hemorrhoids: swollen or damaged blood vessels in the anus;
2. Anal fissure: torn skin in the anus, this can be caused by a
hard or large stool;
3. Fecal impaction: fecal matter in the lower bowel that
cannot be passed;
4. Rectal prolapse: a section of the intestine protrudes from the
anus;
5. Fecal incontinence: the inability to control bowel
movements;
6. Urinary incontinence: constant straining can weaken pelvic
floor muscles (Mayo Clinic, 2019).
DIAGNOSIS
 Diagnosis can involve a detailed medical history, a
physical examination, questions relating to diet, exercise
and lifestyle habits, a colonoscopy or a combination of
these (Better Health, 2014).
 From this examination, the cause of constipation – such
as drug-induced constipation, constipation as a result of
prolonged inactivity, and changes in diet and fluid
intake – can be identified (Mandal, 2019).
CONSTIPATION TREATMENT
 Foods to Encourage:
 Soluble fibers: fruits, nuts, seeds and vegetables; and
 Insoluble fibers: wheat, wholegrain bread and cereals (Mayo
Clinic, 2019).
 Foods to Limit:
 Processed foods;
 Dairy;
 Refined grains (such as white rice); and
 Red meat(Mayo Clinic, 2019).
 Drinking adequate amounts of water is a known strategy for
preventing and aiding constipation. Water softens stools and
stimulates the bowel (Daily Caring, 2019).
 If a person’s diet is lacking in fibre and they are reluctant to eat
certain foods, consider advising the intake of a fiber supplement
(Better Health Channel, 2014).
 Laxatives are a treatment option for constipation if diet and lifestyle
modifications do not provide a solution. (Better Health, 2015)
CONSTIPATION TREATMENT
 Exercise
 Regular exercise is known to aid and regulate digestion. The
minimum amount of exercise recommended is 30 minutes per
day. In the case of an older person and/or where mobility issues
are apparent, activity should be encouraged. Every small bit of
exercise makes a difference (Better Health, 2014).
 Manage Stress
 It has been shown that depression and mood disorders can
trigger constipation. Yoga, meditation or other relaxation
techniques may aid this (Medicine Network, 2018).
 Create a Routine
 Try to establish a regular bathroom time in which an older adult
tries to empty their bowels each day. In addition to this routine,
they should be encouraged to go as soon as they feel the urge
(Daily Caring, 2019).
PREVENTION
Maintaining a high-fiber diet;
Avoiding processed foods;
Drinking plenty of water;
Exercising;
Managing stress;
Having a regular schedule for bowel
evacuation; and
Not ignoring the urge to pass stools.
FECAL IMPACTION
 A fecal impaction is a large, hard mass of stool that gets
stuck in the colon or rectum that cannot be pushed out.
 This problem can be very severe. It can cause grave
illness or even death if it is not treated. It is more
common among older adults who have bowel
problems.
CAUSES
 Constipation.
 Laxatives. Taking laxatives too often may lead the body
from “knowing” when is the time to have a bowel
movement. The body will be less likely to respond to the
urge to go, and stool may build up in your colon or rectum.
 Other medicines. Some opioid drugs that treat pain can
slow down the digestion, making stool more likely to build
up in the colon.
 Activity level. If not active, it is likely to be constipated and
have a fecal impaction than people who move around
during the day.
 Bathroom habits. Holding the bowel movement.
SYMPTOMS
Unable to pass stools
Very watery diarrhea that leaks or explodes out
Diarrhea or stool that leaks out when
you cough or laugh
Nausea or vomiting
Back or stomach pain
Distended belly
Sweating
Fever
DIAGNOSIS
 Medical history. Bathroom habit, last bowel movement, and
characteristic. Episodes of constipation and how often use of
laxatives. Other questions: How much water and other liquids do you
drink, how much fiber do you eat, and what medications do you
take?
 Physical exam. Overall health and perform a digital rectal exam. To
do this, your doctor will put on gloves, add lubricant (a slippery gel)
to one finger, then insert his finger into your rectum to feel for a fecal
impaction or other problems.
 X-ray. Spot a fecal impaction by taking X-ray images.
 Sigmoidoscopy. During this test, a sigmoidoscope (a thin, tube-like
instrument with a light and a lens) to look for problems inside the
lower colon in the area closest to the rectum. Inspect the colon for a
fecal impaction or something else that is causing the symptoms.
TREATMENT
The hard mass of stool should be removed from
the colon or rectum.
The most common treatment for a fecal
impaction is an enema, which is special fluid
that is inserted into the rectum to soften the
stool.
Manual Exploration and Extraction
PREVENTION

Take any stool softeners as prescribed

Stay active
Drink plenty of water and eat high-fiber foods
Ask about the medication’s side effects
FECAL OR BOWEL INCONTINENCE
 Bowel incontinence is the inability to control bowel
movements. It is a common problem, especially among
older adults.
 Accidental bowel leakage is usually not a serious
medical problem. But it can seriously interfere with daily
life. People with bowel incontinence may avoid social
activities for fear of embarrassment.
 Many effective treatments can help people with bowel
incontinence. These include:
medicine
surgery
minimally invasive procedures
CAUSES OF BOWEL INCONTINENCE
 The most common cause of bowel incontinence is damage to the muscles
around the anus (anal sphincters). Vaginal childbirth can damage the anal
sphincters or their nerves. That is why women are affected by accidental
bowel leakage about twice as often as men.
 Anal surgery can also damage the anal sphincters or nerves, leading to
bowel incontinence.
 There are many other potential causes of bowel incontinence, including:
 Diarrhea (often due to an infection or irritable bowel syndrome)
 Impacted stool (due to severe constipation, often in older adults)
 Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
 Nerve damage (due to diabetes, spinal cord injury, multiple sclerosis, or
other conditions)
 Radiation damage to the rectum (after treatment for prostate cancer)
 Cognitive (thinking) impairment (such as after a stroke or
advanced Alzheimer's disease)
DIAGNOSIS OF BOWEL INCONTINENCE
 History. During a physical examination, a doctor may check the strength of the
anal sphincter muscle using a gloved finger inserted into the rectum.
 Stool testing. If diarrhea is present, stool testing may identify an infection or other
cause.
 Endoscopy. A tube with a camera on its tip is inserted into the anus. This identifies
any potential problems in the anal canal or colon. A short, rigid tube (anoscopy)
or a longer, flexible tube (sigmoidoscopy or colonoscopy) may be used.
 Anorectal manometry. A pressure monitor is inserted into the anus and rectum.
This allows measurement of the strength of the sphincter muscles.
 Nerve tests. These tests measure the responsiveness of the nerves controlling the
sphincter muscles. They can detect nerve damage that can cause bowel
incontinence.
 MRI defecography. Magnetic resonance imaging of the pelvis can be
performed, potentially while a person moves her bowels on a special commode.
This can provide information about the muscles and supporting structures in the
anus, rectum, and pelvis.
TREATMENTS FOR BOWEL INCONTINENCE
 Diet. These steps may be helpful:
 Eat 20 to 30 grams of fiber per day. This can make stool more bulky and easier to
control.
 Avoid caffeine. This may help prevent diarrhea.
 Drink several glasses of water each day. This can prevent constipation.
 Medications.
 Imodium
 Lomotil
 Hyoscyamine
 Exercises. Begin a program of regularly contracting the muscles used to control urinary
flow (Kegel exercises). This builds strength in the pelvic muscles and may help reduce
bowel incontinence.
 Bowel training. Schedule bowel movements at the same times each day. This can help
prevent accidents in between.
 Biofeedback. A sensor is placed inside the anus and on the abdominal wall. This
provides feedback as a person does exercises to improve bowel control.
TREATMENTS FOR BOWEL INCONTINENCE
 The types of surgery include:
 Sphincter surgery. A surgeon can stitch the anal muscles more tightly
together (sphincteroplasty). Or the surgeon takes muscle from the pelvis
or buttock to support the weak anal muscles (muscle transposition).
These surgeries can cure many people with bowel incontinence that is
due to a tear of the anal sphincter muscles.
 Sacral nerve stimulator. A surgeon implants a device that stimulates the
pelvic nerves. This procedure may be most effective in people with
bowel incontinence due to nerve damage.
 Sphincter cuff device. A surgeon can implant an inflatable cuff that
surrounds the anal sphincter. A person deflates the cuff during bowel
movements and reinflates it to prevent bowel incontinence.
 Colostomy. Surgery to redirect the colon through an opening created in
the skin of the belly. Colostomy is only considered when bowel
incontinence persists despite all other treatments.
TREATMENTS FOR BOWEL INCONTINENCE
 Newer, nonsurgical procedures are also available to treat bowel
incontinence, such as:
 Radiofrequency anal sphincter remodelling. A probe inserted
into the anus directs controlled amounts of heat energy into the
anal wall. Radiofrequency remodelling creates a mild injury to
the sphincter muscles, which become thicker as they heal.
 Injectable biomaterials. Materials such as silicone, collagen, or
dextranomer/hyaluronic acid can be injected into the anal
sphincter to boost its thickness and function.
 These minimally invasive procedures can reduce bowel
incontinence in some people, without the risks of surgery.
Because they are relatively new, their long-term effectiveness
and safety are not as well-known as other treatments.
RESOURCES:
Textbooks:
Kane, Robert L., Resnick, Barbara, Essentials of Clinical Geriatrics 6th Edition (2009),
Mc-Graw-Hill Companies, Inc.
Mauk, Kristen L., Gerontological Nursing: Competencies for Care 2nd edition (2010),
Jones and Barlett Publishers
Natividad, J. N., Kuan, L. G., S. R. Bonito, A. O. Balabagno, et. al., Caring for the
Older Person (2005), University of the Philippines, Office of Academic Support and
Instructional Services
Tabloski, Patricia A., Essentials Of Gerontological Nursing 1st Edition (2006), Pearson
education Inc.
Walker, Lynne, Patterson, Elizabeth, et. al., General PRACTICE Nursing (2010), Mc-
Graw-Hill Companies, Inc.
Internet Sources:
http://www.info@jbpub.com/
http://www.doh.gov.ph/