GERIATRICS

2.) Emotional and Social changes of aging

Social involvement

Participating in family and community activities is a major source of personal satisfaction. Being
involved plays an important role in improving self-esteem and giving meaning to life. This is
true for people of all ages, but is especially important for older adults.

Becoming more involved and finding ways to contribute to the broader world can improve
overall well-being. There are many ways to get involved, including providing family assistance
(eg, baby sitting), participating in group activities, volunteering, and even taking a job. Social
involvement also helps to fight depression, which is more common among those who withdraw
from their friends, family, and community. Social isolation is a strong risk factor for health
problems and early death.

Social status

Many social factors affect how we think about ourselves and how others think about us. Our sex,
race, and economic status all affect our real and perceived social status. These factors also can
affect the resources that are available to us to help cope with aging and health. For example, it’s
difficult for poorer people to use support programs or community activities that cost money.
Ethnic or cultural backgrounds may also have a major effect on our outlook and how we deal
with situations. For example, women from some cultures do not feel comfortable exercising in
public.

Many people are uncomfortable discussing some illnesses. Others may agree to only those
treatments that are acceptable in their culture. Some cultures view hospice care as a wish to bring
about the death of the person. Similarly, a procedure like autopsy may strongly violate certain
cultural or religious beliefs.

3.) Spiritual Changes

Spiritual or religious involvement

Religion plays an important part in the lives of many older adults, who are generally more
actively involved than younger people in religious services and practices. More than 50% of all
older adults report frequent attendance at religious events. This involvement generally has
overall benefits. Religious activity contributes to social interaction and encourages involvement.
4.) Elder Abuse, maltreatment and violence

Elder mistreatment means that someone either does something or fails to do something that
harms an elderly person or threatens the health and welfare of an elderly person.
Research suggests that 700,000 to 1.2 million elderly people (ie, 4% of all adults older than 65)
are subjected to elder mistreatment in the United States and that there are 450,000 new cases
annually.

. Risk Factors for Elder Mistreatment

Many factors can increase the risk of elder mistreatment. These risk factors include the
following:
Dependency issues
Dependency of the elderly person for caregiving needs
Dependency of another person on the elderly person
Mental impairment in the dependent person or the caregiver (or both)
Isolation of the dependent person, the caregiver (or both)
Living arrangements inadequate for the needs of the dependent person
Inability to perform daily functions
Frailty
Family issues
Family conflict
Family history of abusive behavior, alcohol or drug abuse, mental illness, or mental retardation
Stressful family events, eg, death of a loved one, loss of employment
Financial issues
Poverty
Financial stress or lack of money for new health care needs
Institutional concerns
Socioeconomic factors within nursing homes, including poor working conditions, low salaries,
inadequate staff training and supervision, prejudiced attitudes
Frail or debilitated older people may at times be incapable of helping themselves at all. In these
situations, they many need more care than the caregiver is able to provide. In particular, mentally
disturbed people who may behave in difficult ways (eg, hitting, spitting, or screaming) can
greatly add to the stress their caregiver feels, possibly causing the caregiver to respond with
some form of elder mistreatment.
Forms of Elder Mistreatment
Elder mistreatment can take a number of different forms, including the following:
o physical abuse
 o emotional abuse
o neglect(intentional or unintentional)
o financial exploitation
o abandonment
o a combination of these
5.) Different Nutrition among elderly

NUTRITION

Numerous changes in body composition and physiology are associated with advancing
age. Compounding these changes are the accompanying lifestyle, social, economic and medical
conditions that often impact the amount and quality of food that elderly people have available to
them. To maximize their resources, the elderly must make an extra effort to choose nutrient-
dense foods and avoid empty-calorie snacks.
Elderly people are at increased risk for nutrient deficiencies, and should ensure adequate intake
of calcium, vitamin D, folic acid, vitamin E, vitamin C, vitamin B12, vitamin B6, magnesium,
potassium and fiber. Here are some specific recommendations to ensure they get the most from
their diets.
Seniors should increase antioxidants and fiber in their diet
As our bodies' own natural antioxidant systems become less effective, we must increase our
intake of antioxidant and potassium-rich fruits and vegetables, such as artichokes, blackberries,
blueberries, broccoli, Brussels sprouts, cranberries and plums. In addition, many seniors fall
short on dietary fiber. In addition to helping maintain optimal cholesterol levels, fiber improves
irregularity. Good sources of fiber include beans, oats, oranges, raspberries and green peas. A
bonus of eating lots of fruits (such as pineapples and cherries) and vegetables is that they're rich
in a compound called bromelain, which may alleviate joint pain.
Eating foods rich in protein and B12 is especially important as we age
Protein is another macronutrient that the elderly may fall short on. A safe protein intake for
elderly adults is 1.0-1.25 grams of protein per kilogram of body weight per day. The body's
ability to absorb vitamin B12 declines with age (found mostly in meats), so it makes sense to
consume foods rich in both protein and vitamin B12, such as salmon, sardines, albacore tuna,
sardines and flounder. The added bonus to these foods is that they are a source of omega-3 fats
(as are walnuts, avocados and seeds), which may help improve brain function and reduce
inflammation.
The senior diet: often deficient in calcium, vitamin D and vitamin B6
Good nutrition planning is needed to reach the recommended levels of calcium and vitamin D
(for bone health), and vitamin B6 (for energy metabolism and heart health). Riboflavin
deficiency in the elderly is actually quite common, at about 24% not meeting the RDA for this
vitamin; while approximately 10% do not meet the RDA need for vitamin B6. Foods rich in
these nutrients include bananas, yogurt, chicken, spinach, fortified cereal, milk, beans (such as
lentil and pinto), fish (yellowfin tuna and snapper) and whole grains.
Limit sodium intake
It is common for the elderly to have a diminished sense of taste and smell. This may be why they
readily add salt to their meals. The new dietary guidelines suggest limiting our sodium intake to
less than 1 teaspoon per day to reduce the risk of developing high blood pressure. These
individuals should try adding curcumin (a compound in curry that may protect against
Alzheimer's disease), Mrs. Dash® salt-free seasonings, and other herbs and spices to meals.
Watch vitamin A intake
Vitamin A intakes in the elderly are generally below the current standard of 1,000 milligrams per
day for men and 800 milligrams for women. Despite these low intakes, liver stores of vitamin A
are well preserved with advancing age so supplementation would be more detrimental in elderly
persons than in younger persons because of a diminished ability to clear this vitamin from the
body. If retinyl esters build up, they transfer into low -density lipoproteins (LDLs) in the
bloodstream, remaining for several weeks to act as potential toxins.
As we age our caloric needs decrease, but body fat may increase
One of the most noticeable changes is that we lose lean body mass (muscle) and gain body fat.
Between the ages of 30 and 80, lean body mass declines by about 15% in people who are
sedentary. Because of these changes, we need about 10% fewer calories as each decade of life
passes. However, our nutrient needs generally stay the same. When declining energy
requirements are not matched by decreased caloric intake, total body fat increases.
Different stages of our life require different health strategies
At every stage of life, our bodies change. As a result, certain nutrients become important for
optimal health at different times. Always keep in mind that there are specific nutrition
considerations that, if addressed properly, can help each of us function at our peak.

6.) Pain management among elderly

PAIN MANAGEMENT

Pain affects many people. Acute pain happens suddenly. Chronic pain lasts for awhile, or comes
and goes over a long period of time and so becomes a part of day-to-day life. Pain can come
from many conditions such as old accidents, long-standing arthritis, some medical illnesses, low
back problems, amputations, or can follow a stroke. Although the problems that can cause pain
may increase as you get older, pain is not normally a part of “just getting old”. If you suddenly
get new pain, or your old aches get worse, you should see your health care provider.
The aim of pain management in the elderly is to relieve pain and improve your quality of life.
Controlling pain may allow you to work or do your usual activities. Caregivers may need to treat
your pain and its cause by giving you medicines. These medicines work by blocking pain signals
going to the brain or by changing how the brain interprets pain signals. Almost all types of pain
can be controlled. Work together with your caregiver to decide the best pain control treatment for
you. You may need one or more of the following:
• Analgesics: This is a group of medicines that includes most painkillers.

o Narcotic analgesics: These medicines, which include morphine, contain opium. A

narcotic analgesic is used for moderate to severe (very bad) pain. This may be used to
control cancer pain or after having surgery or other procedures.
 o Non-narcotic analgesics: These work by changing the way the body senses pain and
by cooling the body. Non-narcotic analgesics are used to relieve mild to moderate
pain from headaches, muscle aches, colds, and fever.

o Non-steroidal anti-inflammatory drugs: This family of medicine, also called

NSAIDs, helps decrease pain and inflammation (swelling). Some NSAIDs may also
be used to decrease a high body temperature.

• Anesthesia: This numbing medicine is used to control pain and make you comfortable
during a procedure or surgery.