so let's really dive into caring for the elderly we live in an aging Nation now this is from 2017 so it's starting to get a little bit dated but the overall concept has not changed generally speaking there are an increasing number of elderly people and a decreasing number of children overall the proportion of Americans 65 years of age and older has tripled in the last 100 years with 65 being a cut off for being elderly life expectancy varies by gender and race there are racial disparities and gender disparities that are still needing to be addressed in health care and life expectancy has risen dramatically only in the last 100 years and if you think about just time overall that's a really short period of time so in 1900 average life expectancy 47 now it's around 80. so what is the leading cause of death in older adults today heart disease that's a a very common chronic condition let's get down to COPD that's another common chronic condition stroke or vascular issues Alzheimer's disease because the longer we live the more we experience decreased cellular reserve and the brain is not an exception and then of course malignant neoplasm so cancers and that's a another area where we're seeing more and more diagnoses of malignant cancers because as we age we are more likely to develop those kinds of conditions so just as a quick reminder The Who definition of health is the state of complete physical mental and social well-being and not merely the absence of disease and infirmity but what does that really mean across the lifespan how does that change in the elderly population so first let's talk about overall Wellness Wellness can be applied to Elders dealing with chronic illnesses of course and it involves one's entire being so it involves a holistic approach it's physical it's spiritual mental and emotional not just focusing on that physical piece so we look at the definition of emotional health emotional health later in life in the elderly that definition changes to essentially being satisfied to where one is in their stage of life so if you think about Erickson's stages of development and then also their current situation Financial Health social support Etc now I want to talk about some physiologic changes in the elderly and you will have or you do have a table in your textbook that goes into a lot of details so don't spend a lot of time memorizing each and every individual change and every system but I want to talk really briefly about a few of these with the general understanding that as we age we experience a decrease in physiologic reserve or a decrease in cellular number and function so it makes sense that as we age our cardiovascular and respiratory system becomes less compliant and less responsive to change because there is a sclerosis or a hardening of the tissues our skin becomes thinner we have reduced elasticity less subcutaneous fat pigment changes such as spots hair loss this can relate to the inability to use elderly skin as a means to assess tiger for hydration it's also something to consider when we're going to give insulin injections if we have less subcutaneous fat in various types of medications overall deterioration of musculoskeletal of the musculoskeletal system and specifically certain um types of muscles or certain groups of muscles such as quadriceps those tend to go very quickly genital urinary less effective filtration and acid-base balance provided by the kidneys now that does not mean that all elderly are in renal failure it's generally less effective but it doesn't mean that it's failing and that's a really important distinction and of course in men BPH is very common or benign prostatic hyper or yeah prosthetic sorry hyperplasia where the prostate essentially grows and can constrict the urethra and then the female we see more relaxed perineal muscles or urinary incontinence foreign decreased sense of thirst that's a big one an elderly that's why a lot of elderly end up with issues of dehydration especially in the summer decreased sense of smell taste salivation secretion of digestive enzymes you see a lot of elderly with persistent dry mouth maybe you've had someone in your family that has cooked something for you that had way too much spice in it because their sense of taste has has diminished so to them it tastes fine but to maybe someone younger it's very very intense they may have difficulty chewing swallowing and processing food through really the entire GI tract a lot of that comes down to dentition and the health of their teeth do they have any issues with dysphagia maybe some slowed GI motility throughout the tract the nervous system also becomes less responsive so overall homeostasis is difficult to maintain and that becomes a big issue when we have elderly patients who have electrolyte imbalances and heart failure and fluid imbalance and maybe an oxygenation issue in PH it's just harder for the body to compensate and just also maintain homeostasis it's a health changes and health assaults affect elderly much more quickly and much more in a much more pronounced way because of the the inability of the nervous system to basically bounce back from an assault so loss of brain mass reduce speed and nerve conduction and cerebral circulation so a lot of balance issues now this does not necessarily mean that they're going to have Alzheimer's not all elderly are confused but we do generally see a loss in speed and balance and there may also be an increased rate of confusion with physical illness key thing is with physical illness loss of environmental cues so maybe less sensation in relation to heat or cold um wet dry those kinds of things and really globally all senses experience a loss in function taste sight smell hearing all senses tend to diminish the reproductive system changes as well typically sexual activity and function overall declines nutrition becomes a really big issue they require fewer calories but more nutrient-rich and healthy diet as their body is requiring more nutrition in order to repair and build tissues and plus we tend to see more of a sedentary lifestyle in the elderly because of mobility and balance problems and the nutritional issues also come down to just Financial restraints and physical limitations do they have the earning power to buy healthy food as we know really healthy food is really expensive physical limitations are they just unable to maybe lift a pot of water is it hard for them to stir maybe they have Parkinson's maybe they have lack of sensation or visual issues so it's hard to see when something is is finished cooking or maybe if it's still raw and sleep sleep is also affected by aging and usually this is because of some other type of condition like a respiratory problem maybe this patient has orthopna it has to sleep sitting up we just took care of a patient in clinical the other week with that issue nocturia or urination at night pain dementia can really upset the the day and the night rhythms and of course the consequences of poor sleep is then further cognitive decline increased risk for Falls and fatigues and reduce quality of life and other overall physical and mental health so there are a lot of physiologic changes in the elderly again in relation to the decreased physiologic Reserve or decrease in cellular number and function so this is a great uh like it's called a memory node and there's several of these available to you in the ns107 resources page these are a list of special considerations for older adults so as you can see Handle With Care as we age we do become more fragile we have less tolerance to medications and sedation is a big one much more likely to experience sedation we need to decrease that IV rate to avoid fluid overload they become very um could become fluid overloaded very quickly there's an increased risk of respiratory depression developing pneumonia disorientation skin breakdown problems with circulation nutrition constipation fluid and electrolyte balance and now I do want you to look down here at the bottom the increase in balance and decrease in Falls that is an error that has been acknowledged by the author it should be a decrease in balance and an increase in Falls so classic conditions where elderly experience a sudden not gradual increase in confusion but a sudden increase meaning over the course of hours maybe a day UTI is pretty classic or urinary tract infection hypoxia and electrolyte balance primarily sodium or fluid imbalance that may be causing an electrolyte imbalance the key thing about this is this is a sudden increase in confusion not overall slow development with say Dimension Alzheimer's we're talking about sudden increase in confusion that you may see a patient admitted for or you may see in the inpatient setting so how can we support elderly patients we need to support cognitive function whether that's medication challenging with your crossword puzzles or supporting maybe still volunteering at a local organization that that relationships are incredibly important to maintaining cognitive function finding what kind of home and community-based care they have available to them do they need Home Health Services maybe uh like in Cape we have the the cape transfer what is it CTA Cape Transit Authority that can maybe take people around because we don't really have great public transportation we need to promote their safety as we've already discussed maximizing their independence and self-correctivities per their health status making sure they're getting good nutrition maybe per their dentition making sure that maybe they have something like ensure shakes or taking a multivitamin right and that they balance activity and rest that they may not be as energetic as they used to be but they still have to get some activity to maintain muscular strength and coordination helping them reduce anxiety and agitation especially with mental status changes helping them improve communication especially with healthcare providers in today's system where it's really not as patriarchal as it used to be and now patients are expected to do more self-care and so maybe improving their communication with their providers and not just providers but you know family and nurses and friends as well and then lastly making sure that they have good relationships adequate socialization and intimacy needs a lot of elderly struggle with feeling alone and and being very lonely which can definitely decrease cognitive function and physical mental and spiritual health thank you