Lesson 1, Topic 1
In Progress

Closing Comments

April 11, 2024

Patient Coaching
The medical assistant must keep in mind the sensorimotor changes that accompany aging and also must consider respectful patient communication when conducting patient education with older patients. Remember, the aging process does not affect a person’s ability to learn; it just may take longer for the older patient to process the information, and the material may need to be repeated for understanding. Showing sensitivity to the needs of aging learners ensures successful patient education and improves compliance with prescribed treatment plans. The current aging population generally is respectful toward authority; therefore, if the medical assistant cannot gain the patient’s cooperation, the provider may be able to provide authoritative reinforcement of the material. Here are some general guidelines for effective patient education with older adults:
               • The patient may have short-term memory loss, so you may need to repeat the information using different words.
               • The patient may be distracted more easily, so learning in a group may be difficult.
               • The patient may take longer to process information, so teach at a pace that matches the patient’s needs.
               • Provide the patient with handouts that have large print and block letters for reviewing information at home.
               • Involve family members as needed for continuity of care; supply provider-approved websites for reference.


Legal and Ethical Issues
One legal issue in the care of aging patients is the possibility of elder abuse, neglect, and exploitation. Mistreatment of aging people occurs at all social, racial, and economic levels. The abuse may be physical, mental, sexual, material, or financial; it may involve neglect or failure to provide adequate care, or it may involve self-neglect when aging people are unable or refuse to care for themselves. Abuse, neglect, and exploitation of elders by their caregivers may be difficult to identify. The aging victim could feel embarrassed, guilty, or afraid to report the abuse. Here are some indications that a patient may be the victim of elder abuse, neglect, or exploitation:
               • Poor general appearance and poor hygiene
               • Pattern of changing doctors and frequent emergency department visits
               • Skin lesions, signs of dehydration, bruises (signs of new and old bruising together), abrasions, welts, burns, or pressure sores
               • Recurrent injuries caused by accidents
               • Signs of malnutrition and weight loss without related illness
               • Any injury that does not fit the given history
      If abuse, neglect, or exploitation is suspected, interviewing the caregiver and questioning the demands of care and self-reported perceptions of stress levels may help the provider detect the problem. Many states now have laws that require reporting of suspected elder abuse, neglect, or exploitation. Check your state laws to determine the requirements for healthcare workers.


Patient-Centered Care
When working with this patient population, it is important to include the patient and that individual’s support system in the decision-making process. Although many geriatric patients are still making their own healthcare decisions, there are some who have others involved in the process. It might be a partner, family member, or a trusted friend. The medical assistant needs to be aware of HIPAA concerns about privacy and confidentiality. This means making sure that the patient has signed all of the appropriate forms regarding who can receive information about the patient’s healthcare status. The disclosure authorization form will allow the healthcare facility to provide information to the designated representative. An advance directive will name the person who will make decisions for the patient when she or he is no longer able to.
      Some patients just want another set of ears listening to what the provider says and any directions for care that may be given. The medical assistant will ask if the patient is comfortable with someone else being in the room, and when verbal consent is given, the visit can proceed. It can be comforting for patients to know they have someone they trust hearing the information. This person or persons may provide their opinion about the treatment but the patient will ultimately make the decision, unless the advance directive has been activated.
      For certain situations, a meeting with the provider may need to be scheduled in a conference room setting to accommodate all that may need to attend. It is important to remember that we treat the whole patient, not just the patient’s medical condition.


Professional Behaviors
Your future employers will expect you to use problem-solving techniques, including recognizing and defining a problem, analyzing the issue, and developing a plan of action. Older adult patients typically have multiple health problems that are frequently complicated by physical, psychological, and environmental factors. To provide quality care for these individuals, you must look at their health issues in a holistic way, taking into consideration all the factors that affect their eventual ability to follow treatment plans and improve their health status. Part of the process involves identifying resources that might help the aging person be better equipped to take care of himself or herself. Consistently using community and online resources may mean the difference between an aging person being able to stay in the home or having to go to a long-term care facility. The professional medical assistant can play a crucial role in providing assistance to aging clients.


Summary of Scenario

Bill has learned to understand the special needs of aging patients. He used to think that most older people were chronically sick and would ultimately end up in long-term care facilities. Now he understands that most aging people lead healthy, active lives and that the disorders that occur in later life are usually the result of lifestyle factors, such as diet and lack of exercise. Bill also has learned how to communicate effectively with older patients and conduct patient interviews to evaluate the patient’s physical, mental, emotional, and nutritional health.


Summary of Learning Objectives

1. Examine the changes in anatomy, physiology, and diseases of the cardiovascular and pulmonary systems.

TABLE 30.1 summarizes changes associated with aging that occur in the cardiovascular and pulmonary systems. Cardiovascular disease is often the cause of illness and disability in the geriatric patient population. The myocardial wall becomes stiffer due to structural changes, including enlarged myocardial cells, fat deposits, and an increase in connective tissue. Blood pressure typically increases, causing the heart to work harder. There is also damage to the blood vessels with the valves in the veins, causing edema and varicose veins of the legs. Arteriosclerosis impacts the arteries’ ability to dilate and contract, causing the heart to work harder to pump the blood throughout the body.

In the pulmonary system, the maximum lung function decreases as we age. The lungs lose their elasticity, resulting in less area for gas exchange to occur. Osteoporosis may cause the chest wall to stiffen, making it harder to move air in and out of the lungs. Weakening of the respiratory muscles makes it harder to cough deeply. There is also an increase in the incidence of sleep apnea. All those factors put the older adult at greater risk for pneumonia and aspiration.

2. Examine the changes in anatomy, physiology, and diseases of the endocrine and gastrointestinal systems.

TABLE 30.2 summarizes changes associated with aging that occur in the endocrine and gastrointestinal systems. The most common endocrine system disorder seen in geriatric patients is diabetes mellitus (DM) type 2. Insulin production decreases and insulin resistance increases. DM type 2 increases the risk of developing vascular disease throughout the body.

Within the gastrointestinal system, changes usually begin in the mouth. There is a decrease in taste buds and saliva, along with a diminished sense of smell. All of those factors can contribute to a lack of interest in eating, which can lead to nutritional issues. Also contributing to the nutritional status are the changes in the small intestine with poorer absorption of vitamins and minerals.

3. Examine the changes in anatomy, physiology, and diseases of the integumentary and musculoskeletal systems.

TABLE 30.3 summarizes changes associated with aging that occur in the integumentary and musculoskeletal systems. Many changes in the integumentary system are the result of exposure to ultraviolet light from the sun over time, such as wrinkles, age spots, and leathery skin. Skin regeneration becomes slower, causing skin to appear thinner and more prone to tearing or blistering. Atrophy of the subcutaneous layer decreases the natural lubrication and causes dry skin. Hair color, growth, and distribution change as we age. Nails take longer to grow and are more brittle.

Shingles is a condition that can develop if the patient has had chicken pox, and it is commonly seen in the older patient population. There is a vaccine available, Shingrix, which can prevent shingles and postherpetic neuralgia.

Within the musculoskeletal system, we see cartilage loss and degeneration producing osteoarthritis. There is also a decline in overall muscle endurance. Osteoporosis is a common concern, especially for small-boned, thin women. There are several medications that can be used to prevent or treat osteoporosis.

4. Examine the changes in anatomy, physiology, and diseases of the nervous system and sensory organs.

TABLE 30.4 summarizes changes associated with aging that occur in the nervous system and sensory organs. Dementia is not an inevitable part of aging but is caused by an organic disorder. There are many conditions that have the same signs and symptoms as dementia and should be investigated as the cause of the new behavior.

Alzheimer disease (AD) is a progressive disease the involves the destruction of the central nervous system neurons. The major changes that occur with AD are: amyloid plaque formation, neurofibrillary tangles clumping together, and the loss of the connection between neurons responsible for memory and learning. Recently a new drug was approved for the treatment of AD, and there are several drugs that are used to treat the symptoms.

Aging can impact vision, hearing, taste, and smell. Cataracts are not uncommon in this age group and is easily corrected with surgery. Glaucoma can be treated with medication.

Hearing loss can have a big impact on aging people. It can cause depression, social withdrawal, and feelings of isolation. Hearing aids may be helpful but can also amplify background noise, making it hard to hear clearly and creating sensory overload.

As we age, we lose taste buds, and our ability to smell also decreases. This can impact the patient’s interest in eating and can therefore affect the person’s nutritional status. The decrease in the sense of smell can impact the safety of patients, as they may not smell smoke or natural gas leaks. They may not be able to smell when food has gone bad. Dating food that is put in the refrigerator can help.

5. Examine the changes in anatomy, physiology, and diseases of the urinary and reproductive systems.

TABLE 30.7 summarizes changes associated with aging that occur in the urinary and reproductive systems. As we age, our kidneys become less efficient at filtering waste from the blood. Medication will remain in the body longer, creating an increased risk for toxic levels in the bloodstream. The bladder wall becomes thickened, reducing its ability to expand and its capacity, meaning that the patient will have to urinate more frequently at all times of the day and night. Due to urinary retention, an older adult is at increased risk for urinary tract infections.

In the reproductive system of women, the vagina diminishes in width and length and becomes less elastic. Vaginal secretions decline, resulting in vaginal dryness. In men, there are changes in the prostate. It can enlarge and press on the urethra, causing difficulty with urination.

6. Examine the role of the medical assistant in caring for aging patients.

The medical assistant’s role in caring for the older patient is to develop effective communication skills that accommodate age-related sensorimotor changes, allow time for longer appointments, provide adequate lighting and forms in large print, and develop appropriate in-service training as requested by the provider. Examination rooms should have furniture and treatment folders specifically designed for older adult patients. Referrals and community resources should be used for patient and family support.

Effective communication with aging patients includes addressing the patient with an appropriate title; introducing yourself and explaining the purpose of a procedure before touching the patient; establishing eye contact and getting the patient’s attention before beginning to speak; using expanded speech, gestures, demonstrations, or written instructions in block print; repeating the message as needed for understanding; observing the patient’s nonverbal behaviors for cues that indicate whether the patient understands; allowing time for the patient to process information; preventing distractions; involving family members as needed.

Aging people prefer to remain in their home environment for as long as possible. Adult daycare centers can provide supervision for older adults who may be taken care of by family members in the evening but need care during the day. Assisted living facilities are appropriate for older adults who need assistance with some activities of daily living. Skilled nursing facilities provide 24-hour medical care and supervision.

 

Procedure 30.1  Understand the Sensorimotor Changes of Aging
Task
Role-play as an older adult to better understand the needs of aging people.
Equipment and Supplies
               • Yellow-tinted glasses, ski goggles, or laboratory goggles
               • Pink, white, yellow “pills” (e.g., various colors of Tic Tac mints)
               • Petroleum jelly (e.g., Vaseline)
               • Cotton balls
               • Eye patches
               • Tape
               • Utility gloves
               • Tongue depressors
               • Elastic bandages
               • Medical forms in small print
               • Pennies
               • Button shirts
               • Walker


Procedural Steps
1. Role-play vision and hearing loss.

               • Put two cotton balls in each ear and an eye patch over one eye. Follow your partner’s instructions.
               • Partner: Stand out of the line of vision (to prevent lip-reading). Without using gestures or changing your voice volume, tell your partner to cross the room and pick up a book.
2. Role-play yellowing of the lens of the eye.

               • Line up “pills” of different pastel colors.
               • Partner: Pick out the different colors while wearing the yellow-tinted glasses.
3. Role-play difficulty with focusing.

               • Put on goggles smeared with petroleum jelly and follow your partner’s directions.
               • Partner: Stand at least 3 feet in front of your partner and motion for them to come to you (your partner is deaf, so talking will not help).
4. Role-play loss of peripheral vision.

               • Put on goggles with black paper taped to the sides.
               • Partner: Stand to the side, out of the field of vision, and motion for your partner to follow you.
5. Role-play aphasia and partial paralysis.

               • You are unable to use your right arm or leg. Place tape over your mouth. Let your partner know you need to go to the bathroom.
               • Partner: Stand at least 3 feet away with your back to your partner and wait for instructions.
6. Role-play problems with dexterity.

• Put thick gloves on your hands and try to sign your name, button a shirt, tie your shoes, and pick up pennies.
7. Role-play problems with mobility.

               • Use the walker to cross the room.
               • Partner: After your partner starts to use the walker, hand them a book to carry.
8. Role-play changes in sensation.

• Put on a rubber utility glove; turn on very warm water; test the difference in temperature between the gloved hand and the ungloved hand.
9. Summarize and share your impressions of the effects of age-related sensorimotor changes with the group.