PROGRAMME: DIPLOMA IN COMMUNTY HEALTH

COURSE TITLE: CARE OF THE OLDER PERSONS CODE: CHE 251

SEMESTER: FIFTH (5) SEMESTER
DURATION: 15 HOURS UNITS: 1.0

COURSE DISCRIPTON
The increasing number of people living longer and longer lives has sparked worldwide debate
over how to ensure that senior citizens age with dignity and are well cared for all over the world.
Hence, the needs to ensure that Community Health Extension Workers are equipped to handle
this all-important aspect of healthcare should never be over emphasized.

GOALS
This course is designed to equip students with the knowledge and skills to provide health care
services to the aged.

LEARNING OBJECTIVES
At the end of the unit, the learners should be able to:
1.0 Describe the concept of ‘the older persons’
2.0 Discuss the resources and facilities available in the community and health facility
to help older persons
3.0 Discuss appropriate strategies and how resources and facilities can be utilized to
care for the aged
4.0 Discuss the international conventions on the care of older persons

1.0 INTRODUCTION: Care of the older person, this refers to services given to older
persons in order to maintain and promote their healthy living. Old person is said to start at the
age of 68 years. The older persons are also referred to as the senior citizen.

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Old person could either be chronological (age respect) or physiological (signs of age respect)
physiological as opposed to chronological means that person can have all grey hairs and wrinkles
plus other signs at any age less than 65 years . Physiological Ageing is also known as biological
Ageing.

1.1 DEFINITION OF THE OLDER PERSON: Simple means any person that under goes
the effect of time or a state of being old.

Older person could also refer to as multidimensional process of physical, psychological and
socio-economic changes occur in an individual over a period of time.

1.2 PROCESS OF AGEING: Ageing is a natural process; exact cause of Ageing is

unknown, as we grow up our bodies changes in many ways that affects functions both the cell
and entire body system.

Ageing process is determined by the following factors:

 Genetic/Environmental Factors: As human beings our unique genetic make-up and

environment interact with each other. Some specific genetic disorder speed up Ageing
process e.g Weiner’s syndrome Down syndrome etc. However, many environmental
conditions e.g quality of health care received, lifestyle, conduciveness or un-
conduciveness of an environment one’s lives among others can equally speed up an
Ageing process.

 Cellular Factors: Ageing causes functional changes in human body cells, at which cells
multiplies to slow down as we are Ageing. Studies shown that the microscopic changes
that occur in all living cells as organisms age is one of the Ageing factor. Human cell can
duplicate up to 50 times before they stop; when cell division stops the organism start
Ageing. Scientist has been searching for why cell stop dividing and thus age.

One theory is based on the assumption that Ageing, and diseases that occur more
frequently with advancing age, are caused by structural damage to cells, this damage

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 accumulates in tiny amounts each time cell divides, eventually preventing the cell from
carrying out normal functions.

One cause of this damage may be free radicals, which are chemical compounds found in
the environment and also generated by normal chemical reaction in the body. Free
radicals contain unpaired electronics and so carry an electric charge that makes them
highly reactive. Researchers have observed that free radicals exist in smaller amount, in
those species with relatively long life span.

 Physical Changes: Our bodies normally changes in appearance as we are Ageing the
body weight, height, posture, growth of vertebrate, decrease of joint spaces, forward
vending of the spine, compression of body disc, joint, as well as changes in the feet and
flattering of the arches.
 Changes in the body Composition: The proportion of the body that is made up of fats
doubles between the ages of 35 – 75 years. Physical exercise programmes may prevent or
revers much of the proportional decrease in muscles mass and increase in the total body
fat. This change in the body composition is important to consider in the natural planning
and the level of our physical activity.

 Pathological Factor: Normal Ageing and disease are related in subtle and complain
ways like cardiovascular diseases are more common in people who eat meats and fats,
cataract formation, is the largely depends on the amount of exposure to direct sunlight.
 Changes in the body regulation system: This refer to the way our body regulates
certain system changes with ages, e.g body temperature regulation is regular and better
when we are young than we become old, the ability to lose body fluid from the body is
faster in younger age than in old age, the ability to accommodate senile dimension
temporary loss of memory as a result of aged.

CHARACTERISTICS OF OLDER PERSON

i. Failing memory
ii. Failing senses (sight, hearing, feeling, smell and test)
iii. Graying of hear

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 iv. Painful joint and limbs
v. Self-neglect
vi. Lack of interest in social activities and withdrawal
vii. Decreased libido
viii. Wrinkled skin
ix. Altered posture
x. General weakness

1.3 MEDICAL CLASSIFICATION OF THE OLDER PERSONS: It’s categorized into four
(4) Perspectives:

 Promotive Care
 Preventive Care
 Curative Care
 Rehabilitative Care

I. Promotive Care: is the initial care services expected to adequately render to older
persons. Psychosocial care means older person should be provided with good shelter/ safe
environment, security, food, suitable regular exercise, rest of mind and other social
amenities. Establishment of cordial relationship with the older person by securing them
membership with social and religious societies.
II. Preventive Care: Elderly or aged people are expected to be prevented from anything
that will worsen their aged condition. Hence that can be achieved through Health
Education on various health and health related issues and regular medical check-up,
personal and environmental hygiene, lifestyle, nutritional advice, adequate physical and
mental rest and relaxation among others.
III. Curative Care: Older persons needs more medical attention than adolescent and adult
e.g
a) Presumptive diagnosis: Regular medical check-up, Visual acuity and other eye
examination, Oral health examination and assessment of mental status.
b) Deferential diagnosis or laboratory test: Urinalysis, Hb estimation, Stool analysis and
other test as may be determined by the condition of the client.

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IV. Rehabilitation Care: In a situation when deformity/disability occur as a result of old age
is important in order to either bring the ability to restore normal or near normal
examples:- Chronic arthritis, Fracture, Dislocation, Sprain Muscle ach etc.

1.4 COMMON HEALTH PROBLEMS OF THE OLDER PERSONS

1. Problems due to the Ageing process:

a) Senile cataract
b) Glaucoma
c) Nerve deafness
d) Osteoporosis affecting mobility
e) Emphysema
f) Failure of special senses
g) Changes in mental outlook.
2. Problems associated with long term illness:
a) Degenerative disease of heart and blood
b) Cancer
c) Accidents
d) Diabetes
e) Disease of locomotor system
f) Respiratory illness
g) Genitourinary system

3 Psychological problems:

a) Mental changes

b) Sexual adjustment

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 c) Emotional disorder

Percentage of older persons reporting various ailments

SN AILMENT REPORTED %
1 Visual impairment/complaint 88.0
2 Locomotor, Joint and Muscles disorders 40.0
3 Neurological complaints 18.7
4 Cardiovascular diseases 17.4
5 Respiratory disorder 16.1
7 Skin conditions 13.3
8 Gastro-intestinal/abdominal disorder 9.0
9 Psychiatric problem 8.5
10 Hearing loss 8.2
11 Genitourinary disorder 3.5

1.5 PREVENTIVE MEASURES AND TREATMENT

The following may describe the simple preventive measures of some health problems of the
older persons;

1) Sight problems: Preventing sight problem of older person could be achieve through
health education on;
i. Nutrition counseling
ii. Personal hygiene
iii. Vitamin A supplement

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 iv. Regular medical check-up

2) Hearing problems: The following may alleviate hearing problem of older person:
i. Avoid use of the sharp object to clean the ear
ii. Proper use of PPD e.g ear muffler
iii. Replacement of noisy machines with silence ones
iv. Regular medical check-up
v. Wax removal
vi. Avoid crude treatment and self-medication
vii. Ensure adequate health education on hearing problem
3) Poor dentition:
i. Health education
ii. Ensure good oral hygiene
iii. Regular medical check-up
iv. Consumption of food in rich with calcium
v. Avoidance of accommodating of excess carbohydrate
4) Loss of weight:
i. Provision of adequate nutrition
ii. Dietary advice
iii. Adequate safe water intake
iv. Regular nutritional assessment
v. Infection prevention e.g Tuberculosis, HIV and AIDS
5) Joint pain:
i. Regular moderate exercise
ii. Avoid physical stress
iii. Ensure good food intake in rich with calcium, phosphate and phosphorus

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 iv. Adequate physical and mental rest
v. Regular consultation of gymnastic expert
vi. Physiotherapy
6) Senile dementia:
i. Adequate mental rest
ii. Institutes good social rehabilitation
iii. Provision of recreational facilities
iv. Adequate and regular monthly payment of pension

MANAGEMENT:

 Early diagnosis and management according to revised standing orders

 Timely referral of complicated cases and follow-up

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 Areas potential amenable to preventive health care of the older persons

SN PRIMARY SECONDARY TERTIARY

1 Health habits: Screening for: Rehabilitation:
 Smoking  Hypertension  Physical deficits
 Alcohol abuse  Diabetes  Cognitive deficits
 Obesity  Periodontal disease  Functional deficits
 Nutrition  Dental caries
 Physical activity  Sensory impairment
 Sleep  Medication side effects
2 Coronary heart disease Colo-rectal cancer Caretaker support
risk factors Breast cancer Introduction of support
Prostatic cancer necessary to prevent loss of
autonomy
3 Immunization: Nutritionally-induced:
 Influenza  Anaemia
 Pneumovax  Depression
 Tetanus  Stress
 Urinary incontinence
 Podiatric problems
4 Injury prevention Fall risk
Latrogenesis prevention  Tuberculosis (high risk)
Osteoporosis prevention  Syphilis (high risk)
 Stroke prevention
 Myocardial infection

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1.6 FAMILY AND COMMUNITY ATTITUDES TOWARDS MEETING THE NEEDS
OF OLDER PERSONS

 Family Members and Relatives: The members of the family should demonstrate kind
behaviour to older person and provide adequate physical, mental and psychosocial
support for well beings of the elderly.
 Friends and the Community Members: Friends should exercise respect and also
provide care in form of gift especially during the traditional ceremonies and festivities to
older persons. However regular visit to elderly by friends and community members may
means a lot towards boosting psychosocial status of the older persons.
 Social and Religious Groups: these groups should acknowledge the potential and
wisdom of the older person by engaging them in problem solving in some light conflict,
this will make aged people feel so happy and relevant important members of the
community.

1.7 FACTORS INFLUENCING HEALTH OF THE OLDER PERSONS

1. Lifestyle

2. Cultural practices

3. Financial status

4. Social support

5. Communication

2.1 RESOURCES AND FACILITIES AVAILABLE IN THE COMMUNITY AND

HEALTH FACILITIES THAT SUPPORT/HELP THE OLD PERSON

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Resources: Simply means anything that can be used in the process of problem solving.

Community resources: In this context refers to the places specifically designed in the
community reserved for the purpose of helping the elderly/older persons.

Examples;

a. Vocational Institutions - places that are constructed and equipped by Government in

order to train hand capped or aged people on simple vocational entrepreneurship in order
to support their living.
b. Recreational and Sport Centres – these are places that designed and reserved in order
to provide sporting and exercise facilities that are made available for the purpose of
improving the older persons’ health.
c. Gymnastic Centre – are places specially designed and equipped with more than
gymnastic machines were older persons are going for mild or moderate exercise for the
betterment of their health.
d. Town Hall – are environment were elderly people are having their meeting during which
critical issues concerning the community are discuss and addressed.
e. Civic Centre – is an institution comprises of social multipurpose facilities for the older
persons in a given community to have fun thereby getting relief from social
psychological stress e.g cinema house.

2.2 HEALTH FACILITIES RESOURCES

Under normal circumstances in the care of aged there should be a provision of the following unit
in one of the available health facility in the community.

 Neuropsychiatric Unit – this is the unit that composes specialists and other trained
health care providers for effective Promotive, Preventive, Curative and Rehabilitative

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 Services to mentally older persons, example people suffering from senile dementia,
schizophrenia, mania, and depression.
 Ophthalmology Unit – this is the unit within the health facilities that comprises of a
specialists e.g consultant ophthalmologist, ophthalmic Nurses, Community Health
Practitioners and other paramedical that are trained in that discipline.
 Ear Nose and Throat (E.N.T) Unit – is a unit in the health facilities that comprises the
number of specialists which include consultant E.N.T Surgeon, E.N.T Nurse, and other
paramedical that have discipline in this unit on how to diagnose, treat, and solved all
problems to the older persons.
 Clinical Psychology Unit – this is a unit in the health facilities that comprises people
who are specially trained in clinical psychology, as well as medical sociology for the
purpose of the addressing all problem that are related to strange behaviour, aged person
and people with personality disorder.

3.1 STRATEGIES ON HOW RESOURCES COULD APPROPRIATELY BE USED

The strategies to guide how facilities and resources can be utilized for the care of the aged could
be developed during the meeting of the under listed groups:

i. Development committees
ii. Religious groups
iii. Friends and Family meetings
iv. Local associations
v. Forum of older persons

Also to:

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  Ensure proper utilization of the facilities
 Ensure regular maintenance
 Renovation/Modernization
 Employ trained and qualified personnel
 Ensure good security to the facilities
 Provision of both human and material resources

COUNSELING TECHNIQUES OF OLDER PERSONS

Counseling - this refer to the process of assisting older persons with professional advice in order
to decide and recommends positive actions.

Techniques – this is the procedure followed during the process of assisting the older persons.

Counseling Techniques – is the procedure used while assisting the older persons with
professional advice and recommends positive actions.

FACTORS MAY LEAD TO COUNSELLING OF OLDER PERSONS

- Psychological stress
- Chronic disease or illness
- People with stress behaviour
- Delay in pension payment
- Dieting advice in case of diabetic patient
- Exercise counseling according the age etc.

4.1 INTERNATIONAL CONVENTIONS ON THE CARE OF OLDER PERSONS

 Madrid International Plan of Action on Aging

The Madrid International Plan of Action on the Ageing and the Political Declaration adopted at
the Second World Assembly on Ageing ion April 2002 mark a turning point in how the world
address the key challenge of “building a society for all ages”.

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The world changed almost beyond recognition since the first World Assembly on Ageing in
1982 where once population Ageing was mostly a concern of developed countries, today it is
gaining real momentum in developing countries as well. And where once Ageing may have been
thought by some to be a stand–alone issue or afterthought, today we understand that such a
dramatic demographic transformation has profound consequences for aspect of individual,
community, national and international life.

The Madrid Plan of Action offers a bold new agenda for handling the issue of Ageing in the 21 st
Century. It focuses on three priorities areas: older persons and the development; advancing
health and well-being into old age; and ensuring enabling and supportive environments. It is a
resource for policy making, suggesting for Governments, non-governmental organizations, and
other actors to reorient the ways in which their societies perceive, interact with and care for their
older citizens. And it represent the first time Government agreed to link questions of Ageing to
other frameworks for social and economic development and human rights, most notably those
agreed at the United Nations conferences and summit of the past decade.

Part of the recommendation for action (Priority direction I: Older persons and development)
says older persons must be full participants in the development process and also share in its
benefits. No individual should be denied the opportunity to benefit from development. The
impact of population Ageing on the socio-economic development of society, combined with the
social and economic changes taking place in all countries, engender the need for urgent
action to ensure the continuing integration and empowerment of older persons. In addition,
migration, urbanization, the shift from extended to smaller, mobile families, lack of access to
technology that promote independence and other socio-economic changes can marginalize
older persons from the mainstream of development, taking away their purposeful economic
and social roles and weakening their traditional sources of support.

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PART 2

CARE OF THE OLDER PERSONS

UNIT NUMBER: 1.0

Topic: Care of older persons

Instructional Materials:

 Audio visuals
 Video
 Internet

Teaching Methods

 Explanation
 Questioning

Types of Assessment

 Shorts Quizzes
 Written Assignment

Learning Objectives

At the end of the unit the learners should be able to:

 Define Older Persons

 Discuss process of aging

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  Explain medical classification of older persons.
 Discuss the common problems affecting older person
 Give preventive measures and treatment

Introduction:

Elderly care emphasizes the social and personal requirements of senior citizens who need some
assistance with daily activities and health care, but who desire to age with dignity. , Most
developed world countries have accepted the chronological age of 65 years as a definition of
'elderly' or older person,

Definition:

According to W.H.O [world Health Organization] an older person is a person whose age is 60
years and above.

Process of Aging

The ageing process is of course a biological reality which has its own dynamic, largely beyond
human control. However, it is also subject to the constructions by which each society makes
sense of old age. In the developed world, chronological time plays a paramount role. The age of
60 or 65, roughly equivalent to retirement ages in most developed countries is said to be the
beginning of old age. In many parts of the developing world, chronological time has little or no
importance in the meaning of old age the aging process happens during all stages of an
individual’s life span. We are all involved in this process and none of us can escape it. When we
are young, aging is associated with growth, maturation, and discovery. Many human abilities
peak before age 30, while other abilities continue to grow throughout a person’s life. The great
majority of people over age 65 today are healthy, happy, and fully independent. In spite of this,
some individuals may begin to experience changes that are perceived as signs of deterioration or
decline. We must try to forget the stereotypes and look at older individuals as unique persons,

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each with a particular set of resources and challenges.

The changes aging individuals experience are not necessarily harmful. With age, hair thins and
turns gray. Skin thins, becomes less elastic, and sags. There is a slowing down of a function
which goes forward throughout adulthood, such as decreasing function of bodily organs (for
example, in the gastrointestinal system production of digestive enzymes can diminish, reducing
the body’s ability to break down and absorb nutrition from food). However, other losses may not
be noticeable until later in life.
Medical classification of older person

From medical view point, old people are classified as those over 65years. Loss of hearing acuity,
especially sounds at the higher end of the spectrum (high-pitched voices, i.e. women and
children) is extremely common, as is decreasing ability to distinguish sounds when there is
background noise.

Medical classification used for old people are:

 Elderly-fit to manage their own lives

 Elderly infirm- aged people with some physical defect preventing them from managing
their own affairs.
 Elderly sick- acute needing hospitalization and possible return to community chronic
requiring hospitalization till their death
 Elderly psychiatric
 Special group’s e.g. blind and deaf

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 Remember:

ELDERLY ELDERLY
ELDERLY
INFIRM SICK

ELDERLY SPECIAL
PSYCHIATRIC GROUPS

Common problems affecting older persons are:

 Physical [failing sight and hearing, poor dentition etc.]Loss of hearing acuity,
especially sounds at the higher end of the spectrum (high-pitched voices, i.e. women and
children) is extremely common, as is decreasing ability to distinguish sounds when there
is background noise
Loss of peripheral vision and decreased ability to judge depth may affect daily activities
such as reading, watching television, and especially driving (Read more about seniors and
driving here.) You may also experience a decreased clarity of color perception.
Many common problems of the mouth are due to poor oral hygiene and poor nutrition.
[March, 2010 N.S.O.] Gums may pull back (recede) from your teeth with age. Certain
medicate can also cause dry mouth, leaving your teeth and gums vulnerable to decay and
infection.

Mental problem: Loss of mental ability is a common problem among the elderly. They a
time have trouble remembering things. They may forget names or conversations. Some of
them with long standing history of alcohol, cigarette and snuff consumption may have

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 addictions problems which family members may be pressuring them to stop. March 2010,
[N.S.O. National standing order for Community Health Officers And Community
Health Extension Workers.] Mental illnesses that are prevalent in the elderly include
depression, dementia, Alzheimer's disease, anxiety, bipolar disorder and schizophrenia. .May
6, 2015

 www.cmsschicago.org › news-blog › four-early-warning...

 Psychological problem: These psychological problems are studied under the umbrella
of geriatric psychology. Four common problems that can affect elderly patients are
depression, anxiety disorders, substance abuse and psychotic disorders.

study.com › academy › lesson › problems-associated-w..

According to the World Health Organization, psychological conditions like dementia and
depression affect 15% of people aged 60 and over, and that percentage is expected to rise as the
global population continues to age.

 Social problems: Social issues (such as living arrangements or type of daily activities)
influence an older person's risk and experience of illness, family and marital or
companion status, Living arrangements, Financial status, Typical daily activities (for
example, how meals are prepared, what activities add meaning to life, and where
problems may be occurring)etc.
 Economic problems: Raising retirement age, Pensions for those on low incomes,
Increase importance of private sector providing pensions and health care (encourage private
pensions), increase income tax to pay for pension costs.

As compiled by the Mayo Clinic. Expanded on by the Caregiver Foundation

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 measures treatment
preventive
and include

 Provision of well balanced meals in clubs or centers run for old people
 Health visitors and welfare officers
 Dental care to prevent interference with enjoyment of full diet
 Regular visit to old people living alone and advice on clothing and diet.[ Essentials of
community Health Care and Health management By Wole Alakija.]
 Use of sunscreen and protective clothing outdoors.

 Stop smoking, daily physical exercise to improve lung function, and avoiding lying in
bed or sitting for long periods, which allows mucus to collect in the lungs, especially
right after illness or surgery.

 Intake of Calcium and Vitamin D supplements will promote healthy bones, muscles, and
joints.

 Regular vision exams for everyone over the age of 60 are recommended.

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  Social interaction can also keep old people mentally stimulated.

 Brush and floss daily and keep regular checkups with your dental hygienist etc.
TREATMENT IS ACCORDING TO STANDING ORDER

Test Item:

 Demonstrate on how to take care of the older person

Student Activity

Learning Outcome:

 Apply skills on how to take care for the older person

Task:

 Role-play on how to apply friendly care for older persons.

 In pairs brainstorm on the problems affecting older persons.

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