Overview of Geriatrics

1. OLDER ADULT LIFE
STAGES
AGES 65+
JACEY MITCHELL, RDH, MS
FALL 2018

2. OBJECTIVES
1. Define the term gerontology and identify the myths of aging.
2. Describe biological, social, environmental, and psychological processes that
affect the older adult.
3. Relate importance of the dental hygienist’s role in health promotion for the
older adult with the characteristics of the aging population.

3. OVERVIEW-GERONTOLOGY
1. Older adults profile
• Biological, social, psychological, environmental processes
2. Health issues affecting older adults
• Polypharmacy
• Dental implications
• Access to care issues
3. Dental issues affecting older adults
• Age related changes
• Disease states

4. INTRODUCTION TO GERONTOLOGY
• Gerontology: the study of aging
• Ageism: prejudice against older people
• How do you feel about the aging process? How do
you see yourself when you are 70 years old?

5. WHAT DO YOU THINK?
CIRCLE WHAT YOU THINK MIGHT BE TRUE
• Most old people:
• Are senile
• Live alone, isolated from family
• Are ill
• Are victims of crime
• Live in institutional settings
• Are stubborn and cannot learn
• Are unhappy
• Are less productive than younger workers
• Have no interest in sex
• Live at or below the poverty level

6. OLDER AMERICANS PROFILE
• Demographics
• Marital Status
• Living arrangements
• Racial and ethnic
composition
• Geographic distribution
• Income
• Employment
• Health and health care
• Health insurance
• Disability
Information provided by the Administration
on Aging, “Profile of Older Americans”

7. DEMOGRAPHICS
• Constantly changing
• Chronological age often unreliable indicator of
mental, physical, social well-being
• Older adults, fastest growing segment
• 2014-
• 46.2 million older adults make up14.1% of the population
• 2040 –
• 22% or 82.3 million
• Male vs. Female ratio:

9. MARITAL STATUS

10. LIVING ARRANGEMENTS

11. PROFILE: RACIAL AND ETHNIC COMPOSITION
• Many minorities in the aging population
• African Americans:
• Hispanic origin:
• Asian or Pacific Islander:
• American Indian or Native Alaskan:
• Which is the largest ethnic minority group in the aging population?

13. Median Income:
Males; $31,165
Females: $17,375
Household: $54,838

14. PROFILE: INCOME
• Income sources
• Major source – Social Security
• Assets
• Pensions
• Earnings
• Poverty level:

15. PROFILE: EMPLOYMENT/EDUCATION
• Many older Americans still in the work force
• 8.9 million 18.9%) of those 65+
• 5.6% of U.S. Labor force
• Education level of older population is increasing
• Completion of high school: 89% of Whites, 74% of Asians, 75% of African-
Americans, 54% of Hispanics
• More with a bachelor’s degree or higher

16. PROFILE: HEALTH AND HEALTH CARE
• Health perceptions: most non-institutionalized older
adults characterized their health as “excellent” or “very
good”
• Health conditions
• Uncontrolled hypertension
• Arthritis
• Heart diseases
• Cancer
• Diabetes
• Sinusitis
• Expenditures on health care

17. PROFILE: HEALTH INSURANCE

18. PROFILE: DISABILITY

19. DESCRIBE THE FOLLOWING BIOLOGICAL PROCESSES
• Young old:
• Old:
• Very old:
• Life expectancy:
• Life span:
http://www.independent.co.uk/news/people/oldest-person-alive-
italian-emma-morano-celebrate-117th-birthday-a7444951.html

20. DESCRIBE THE FOLLOWING BIOLOGICAL PROCESSES
• Height and weight
• Musculoskeletal:
• Cardiovascular:
• Respiratory:

21. DESCRIBE THE FOLLOWING BIOLOGICAL PROCESSES
• Gastrointestinal system:
• Integumentary system:
• Skin loses elasticity and subcutaneous adipose tissue
• Hair grays, hair loss in men
• Higher risk for skin cancers

22. DESCRIBE THE FOLLOWING BIOLOGICAL PROCESSES
• Sensory system:
• Presbyopia:
• Opacity of lens
• Cataracts:
• Glaucoma:
• Presbycusis:
• Tinnitus:
• Loss in taste discrimination

23. HEALTH PERCEPTIONS
• Health promotion is as important in later
adulthood as it is in childhood
• Need to separate age related changes from
pathological changes
• Important to maintain motivation
• What motivates the older adult? How do they
learn?

24. ENVIRONMENTAL PROCESSES
• Accidents
• Falls #1 cause of morbidity and mortality
• Neuromuscular dysfunction, osteoporosis, stroke, sensory impairment
• Motor vehicles
• Suffocation, fires, poisoning
• Biological agents
• Influenza, pneumonia
• Tuberculosis –rise in TB due to poverty, homelessness, drug & alcohol abuse among
elderly

25. ENVIRONMENTAL PROCESSES
• Drug use
• Changes in body systems affects absorption and
metabolization of drugs
• Drug-drug interactions
• Alcohol use – underestimated, hidden
• Symptoms masked as signs of aging, i.e. balance, speech
clarity, forgetfulness, acuity.
• Tobacco use
• Can benefit from cessation after 65 YOA
• Cancer – 50% diagnosed in elderly pop.
• Lung, prostate and breast cancers most prevalent
• See chart 24-3

26. SOCIAL PROCESSES
• Environments of care – see Figure 24-5; Table 24-4
• Chronic/ acute illnesses, decline in functional status, economic status, family structure
change affect living situations.
• Hospice care – underutilized
• Goal – facilitate a “good death”
• Continuing care retirement communities
• Assisted living facilities

27. SOCIAL PROCESSES
• Health Care Delivery system
• Insurance
• Medicare: little coverage for preventive care.
• Medicare budget under review –effects on our clinic?
• Medigap – pays for health care not covered by Medicare,
including prescriptions; 9 different policies – varying
coverages.

28. SOCIAL PROCESSES
• Financial planning – important before illness onset, but many are not prepared.
• Advanced directives
• Limited income
• Food stamps, supplemental medication payments
• Medicaid – designed to supplement those on public assistance. Funded by both state
and federal.
• Must have limited income to qualify.
• Covers long-term stays, transportation, prescription drug services. More extensive than
Medicare – covers only in limited and medically acute situations.

29. SOCIAL PROCESSES
• Long-term care insurance
• Premiums paid allow for long-term care at home, assisted living,
day care or long-term care in a facility
• Option to hire a personal care giver
• Political movements
• population shift toward the elderly provides a larger voting
block and influence on policies.
• Organizations – AARP
• Research - increasing need for dementia studies, as well as
diagnosis, treatment of common elderly illnesses/diseases.

30. ACTIVITY AND EXERCISE
• Benefits include
• Better sleep
• Reduced constipation
• Lower cholesterol
• Lower blood pressure
• Better digestion
• Weight loss
• Socializing opportunities

31. SLEEP AND REST
• High prevalence of sleep disorders
• Decrease in total hours of sleep
• Increase in nocturnal awakenings
• Shorter periods of sleep
• Good sleep can lead to
• Increase in energy
• Motivation to continue a high quality of life
• Other health benefits

32. NUTRITION
• Weight maintenance is important
• Factors affecting nutrition
• Social:
• Culture:
• Religion:
• Disability:
• Carbohydrates=60%
• Proteins=12%
• Fats=no more than 30%
• Fiber: about 25-35 mg per day
• High fluid intake

33. COGNITION
• Mild cognitive impairment:
• Dementia: disturbance of function, calculation, learning capacity, language and
judgment
• Multi-infarct dementia
• Alzheimer’s disease
• Symptoms:

34. COGNITION
• Healthy older adults maintain their cognitive abilities
• Genetics, education, socioeconomic status, background,
state of health
• New material is learned more slowly
• Learning and perception may be affected by age related
changes
• Reaction time slows
• Short term memory loss
• Factors affecting mental abilities:

35. PSYCHOLOGICAL PROCESSES
• Erikson: ego integrity vs. despair
• Integrity:
• Ego differentiation vs. work role preoccupation
• Body transcendence vs. body preoccupation
• Ego transcendence vs. ego preoccupation

36. PSYCHOLOGICAL PROCESSES
• Challenges to achieving ego integrity:
1. Changes in body image
2. Changes in family roles
3. Changes in work and leisure
4. Changes in sexuality

37. PSYCHOLOGICAL PROCESSES
• Older adult has played many roles in life
• Self concept may be influenced by:
• Lowered income
• Loss of friends
• Disease
• Disability
• Death

38. SUMMARY
• Look back at the list of statements about older adults that you completed. Now
circle which ones you still believe to be true or false.
• What has been your experience with elderly patients?

39. REFERENCES
• Leifer, Hartston; Growth and Development Across the Lifespan:Saunders;2004
• Polan, Taylor; Journey Across the Lifespan; F.A.Davis; Fourth edition;2011
• Edelman; Health Promotion throughout the Life Span; Elsevier; 2009