PHYSICAL AND PSYCHOLOGICAL CARE OF THE OLDER ADULT

Physical Care of the Elderly

The body gradually changes over time as we age. These changes are expected and usually
depend on family patterns of aging or lifestyle choices made throughout the lifespan. Changes
that are a result of a pre-existing medical condition are not considered to be a part of healthy
aging. Most of the time, normal age-related changes on the physical level include the following:
Table of Contents
 Age-Related Changes in Skin, Hair and Nails
 Effects of Age-Related Changes in the Skin, Hair, and Nails
 Age-Related Changes in Oral Mucus Membranes
 Systemic Effects of Aging Concerning Oral Mucus Membranes
 Age-Related Changes in Elimination
 Changes in the Kidneys and Bladder
 Activity and Exercise Among Elderly Adults
 Energy Consumption in Older Adults
 Aerobic Performance in Older Adults
 Metabolic Function in Aging
 Risks of Exercise
 Age-Related Changes in Sleep and Rest
Age-Related Changes in Skin, Hair and Nails
Changes in the skin are the most visible signs of aging. Since it serves as a barrier from the
external environment, skin protects us and keeps our internal organs intact. However,
environmental factors, nutrition and genetic makeup cause the skin to sag and lose elasticity as
we age. Through time, the outer layer of called the epidermis thins and the pigment-containing
cells called melanocytes decrease. This makes aging skin look pale, clear and thin. Large
pigmented spots may appear on areas exposed to the sun and the skin’s elasticity will be
reduced, making it leathery and saggy. Bruising, bleeding and cherry angiomas are also
common among older adults because of fragile blood vessels. Even a simple blow to the skin
can tear or bruise it. Older adults are advised to be extra careful in their everyday tasks,
especially when dealing with heavy objects.
The skin has several layers, each with various functions. The sebaceous glands that produce oil
for skin moisture gradually decrease, usually beginning after a woman’s menopause and for
men over the age of 45-50. Dryness and itchiness are very common, resulting in a greater
susceptibility to different skin disorders. The subcutaneous fat layers will become thinner over
time. This increases the risk of skin injury because of less insulation and padding that
subcutaneous fat provides.
Effects of Age-Related Changes in the Skin, Hair, and Nails
Skin injury is common among older adults, along with thinning hair and nails. Since the
protective fat layer gradually lessens and becomes more fragile, every wrong move an
individual makes can significantly affect his/her integumentary system. Other than skin tears,
bruising and bleeding, hair loss is apparent, and nails tend to become brittle. It is very common
to see older adults who are bald and have broken nails.
Consequently, rubbing or pulling the skin, hair and nails can cause minor injuries to older adults.
Since aging skin repairs slowly, pressure sores are common among the disabled or those with a
sedentary lifestyle. Because these changes can affect the sense of touch, vibration, pressure,
heat, and cold, it is no wonder that the elderly experience various skin problems throughout their
later years.
Age-Related Changes in Oral Mucus Membranes
As an individual ages, several body functions start to decline. Cellular reproduction, blood
microcirculation, metabolic rate and tissue repair all tend to slow down. These essential life
processes can affect different parts of the body including the oral mucus membranes. As for the
oral soft tissue, the epithelium, mucosa, and submucosa thin. Taste bud function declines as
does the size and number of sebaceous glands on the cheeks. Furthermore, foliate papillae and
lingual varices increase. These are the main reasons why nutritional deficiencies among the
elderly are so common.
According to recent studies, a decrease in salivary flow is not purely the result of aging.
However, certain medications can affect salivary output, leading to digestive upsets, poor
retention of dentures and the diminished ability to chew. The dryness of the mucosa makes it
more susceptible to frictional irritation from dentures. Most elderly have a toothless mucosa that
is frequently thin and blanches quickly. This is a reflection of a systemic disease, a nutritional
disturbance or a side effect of a maintenance medication.
Moreover, the tooth enamel of an elderly person becomes less permeable over time. Although
older adults, teeth become brittle, and the rate of the secondary dentine formation still continues
at a slower rate. Tooth wear is a normal age-related phenomenon, often caused by
parafunction, erosion or abrasion, mostly gastric, dietary or environmental factors.
Systemic Effects of Aging Concerning Oral Mucus Membranes
A decline in cell-mediated response and the number of circulating lymphocytes leads to an
increased risk of autoimmune diseases and a decrease in the defense against infection. Any
steroid treatment for an autoimmune disease can complicate a dental treatment. Aging also
involves a degenerative arterial disease which is visible in the vessels of the oral mucosa,
making wounds heal slowly. A decrease of muscle tone even affects chewing strokes and
results in a longer chewing time. Several reports showed that this phenomenon causes an
abnormal lower jaw movement and a resulting loss of one’s natural teeth.
As an individual ages, several mucosal diseases take place. This includes oral cancer,
pemphigus, candida or a yeast infection, lichen planus, herpes zoster and benign mucous
membrane pemphigoid. Nutrition is often a huge factor in the occurrence of these diseases.
Since some older adults have decreased access to nutritious foods, nutritional deficiency can
significantly affect the oral mucosa.
Age-Related Changes in Elimination
Digestive and urinary disorders are the usual health problems faced by older adults. Despite the
fact that elderly individuals have more time to relax and enjoy their lives, problems with
digestion tend to occur all of a sudden. One of the most common problems with aging
individuals is constipation. As people get into their 60s, bowel habits change. Painful and
infrequent bowel movements are associated with hard and dry stools that can lead to
hemorrhoids and other health-related concerns. These variations in the digestive system are
brought on by a decline in muscle contractions, which causes the food to move more slowly
through the colon. When food movement slows down, waste absorbs more water, leading to
constipation and difficulty removing waste from the bowel.
Constipation among older adults is also caused by daily medications. Anti-hypertension drugs
are just some of the drugs that can slow down bowel movement. Aside from this, inactivity can
exacerbate constipation, in particular in those elderly individuals with existing medical conditions
like diverticular disease, ulcers, arthritis and many others. A sedentary lifestyle can make a
person feel constipated and allows other complaints like bloating, cramps and abdominal pain to
occur. The best thing to do in this situation is to keep digestion running smoothly through proper
diet, exercise, hydration and frequent visits to the doctor.
Changes in the Kidneys and Bladder
The kidneys and the bladder are the two major organs in the urinary system. The kidneys filter
blood and remove waste or extra fluid from the body. They also help control the chemical
balance of the body to make other organs more functional and efficient. However, as time
passes, these organs change and their ability to function effectively declines. There will be a
gradual decline of kidney tissue, along with the number of filtering units called nephrons.
Nephrons are responsible for filtering waste materials from the blood, and they have a huge role
in keeping it clean and free of pathogens. If they decrease in size and the blood vessels harden,
the kidneys will not be able to perform their function as well, causing some health issues.
Furthermore, changes in the bladder wall will become apparent as we age. The bladder
becomes less elastic and cannot hold as much of urine as before, causing urinary incontinence.
The urethra in women can become blocked due to weakened muscles that cause the vagina or
bladder to fall out of their normal position. Men with an enlarged prostate gland may also have a
blocked urethra. The only way to solve this problem is to undergo a common surgery to promote
proper urine output.
Activity and Exercise Among Elderly Adults
A number of factors cause an older individual to limit his/her physical activity. The most common
concern in the aging is brittle bones in both the arms and legs. Basically, as we reach 30, bone
marrow gradually disappears and calcium production is reduced. Bone marrow is the soft and
spongy tissue found inside the large bones responsible for the production of platelets, and red
and white blood cells. Changes in bone mass and bone marrow structure can put an elderly at
the risk for infection, osteoporosis and other bone-related health issues. In fact, it can change
his/her performance of routine day-to-day activities since the bones become frail and brittle over
time. However, by limiting daily activities, an older adult becomes more sedentary and
experiences its negative impact as well.
Energy Consumption in Older Adults
An individual’s minimum daily energy need comes from the resting metabolism rate or BMR
(basal metabolic rate). However, BMR changes over time depending on gender, age and
lifestyle choices. BMR starts to decline already after the age of 20 and continues to do so until
we die, at a gradual pace of 1-2% per decade. The reason for the declining BMR is the
reduction of active muscle mass and increased inert fat deposits. This is caused by the overall
decline in cellular metabolism. Thus, food intake must be adjusted accordingly. Diet supervision
is crucial as we age because we still need to ingest the necessary vitamins, minerals, and
micronutrients, but from fewer calories as before to avoid weight gain.
Aerobic Performance in Older Adults
Older adults often have problems with aerobic performance due to the fact that the maximal
oxygen intake of the body declines, especially around the age of 65 onwards. This gradual
decline can be caused by limited physical activity, as older adults become more sedentary over
time. However, even athletes experience a reduction of vigor as they age.
Metabolic Function in Aging
Several hormonal control mechanisms work less efficiently in older individuals. For instance, the
thyroid and pancreas are affected by a decreasing number of secreting cells, and the ventricular
muscles experience a decrease in catecholamine receptors. These hormonal changes can
result in diabetes and myxedema, which can then be a path to obesity, depression, and poor
cold tolerance.
Risks of Exercise
The risk of a cardiac emergency is high when an older person is exercising without previous
experience and an active lifestyle. Some physicians believe that the elderly who intend to start
exercising at an older age should go through an exhaustive preliminary screening such as an
exercise electrocardiogram. This is desirable, especially when the individual plans to embark on
strenuous competitive training. However, every older individual who wants to exercise should
observe certain precautions. The recommended dose of exercise should not leave an elderly
overwhelmingly tired because the normal recovery process is slow. Some exercises like running
or jogging should be substituted with walking to minimize stress on the knees.
Age-Related Changes in Sleep and Rest
Sleep patterns change as we get older. Other than physical changes, people in their later
adulthood tend to have a difficult time falling asleep, and they have a harder time staying asleep
as they age. Although research tells us that sleep does not decline with age, several seniors are
still complaining because of changes in their sleeping pattern.
Sleep has multiple stages including deep sleep, dreamless periods of light sleep and occasional
periods of active dreaming or REM sleep. This cycle is continuously repeated several times at
night, but older people spend more time in the lighter stages than in deep sleep. With aging
individuals, continuous sleep tends to become harder, making them stay awake at night and
getting up early in the morning. Total sleep time is slightly decreased from 8-9 hours to 6.5 to 7
hours per night. It is also harder to fall asleep and spend more time in bed. In fact, the transition
between sleeping and waking becomes more abrupt, making the older people feel that they are
they are sleeping lighter than before. The elderly also wake up more often at night and spend
less time in deep sleep because of anxiety, nocturia, discomfort or pain from chronic illnesses.
Difficulty in sleeping can be very annoying. Chronic insomnia is often the cause of depression
and auto accidents. Since older adults sleep lighter and wake up more often at night, they feel
sleep deprived, even if the total sleep time does not change that much. Moreover, sleep
deprivation can cause confusion and other types of mental issues like restless legs syndrome,
hyper insomnia, narcolepsy and sleep apnea.
Older adults who experience such problems should consult a sleep specialist before taking any
medications on their own. Antidepressant medicines can be helpful in alleviating depression,
and this can also relieve sleeping problems, but they should only be taken under the strict
supervision of a licensed physician. This is also applicable to a mild antihistamine.
Nevertheless, a healthy diet and regular exercises can also have a huge impact on improving
the quality sleep for older individuals.

Psychological Care of the Elderly

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In the U.S., like everywhere in the world, the population aged 65 years and above is growing
rapidly. These older adults have different special needs some with mental and behavioral health
problems. Mental health disorders including depression and anxiety are affecting an elderly’s
ability to perform various physical tasks. They hinder their daily routine, and even more when
the older adult is also suffering from a medical condition or a family problem caused by the
death of a loved one. Addressing these problems is important to alleviate emotional suffering
and improve physical and mental health and promote a better quality of life.
Table of Contents
 Cognition and Perception
 Self Perception and Self-concept
 Roles and relationships
 Inter-generational Relations
 Coping with Stress
o Signs of Stress
o Preventing and Coping with Stress
 Values and Beliefs
o What is a value?
o What is a belief?
o Considering the Personal Values and Beliefs of an Elderly
 Sexuality and Aging
o Factors that Affect Sexuality in Men and Women
o Stress
o Depression and Low Self-Esteem
 o Lack of sleep
o Erectile dysfunction
o Hormone imbalance
o Medical conditions
o Caregivers and Sexuality of Older Adults
o Sexual Health and Sexual Orientation
 End of Life Care for the Elderly
o The Need for an End of Life Care
o Providing Emotional Support
o Death & Funeral arrangements
Cognition and Perception
The molecular and cellular mechanisms of the aging body and mind are poorly understood even
today. Age-related changes are not only limited to physical aspects but also to metabolic,
urogenital, digestive and neurological processes. Most older adults have problems with
cognitive function and speech perception as the years pass by.
Cognitive function is defined as the intellectual process by which an individual becomes aware
of, comprehends and perceives ideas. It includes all aspects of reasoning, thinking, perception
and remembering.
According to clinical studies, there is a correlation between aging and cognitive decline.
Evidence indicates that neural stem cells located in certain brain regions have a major
role in cognitive functions like memory, learning and emotional behavior. These neural
stem cells proliferate over time, causing a reduced ability to learn as well as memory
performance.
Furthermore, older adults also experience a change in their speech perception. They usually
complain that talkers mumble or talk too fast and they cannot hear clearly because of
background noise. This change is attributed to deteriorating cognitive processes like memory,
attention span, language comprehension and lower level sensory plasticity. Studies reveal that
declining cognitive function affects speech perception among older adults. The way they
process information is slower than younger individuals. Healthcare workers who provide care to
the elderly should always consider their speech perception and cognition. A better
understanding of their patients’ current physical and mental states is needed to make sure that
care is provided without conflict and misunderstanding.
Self Perception and Self-concept
Depression is, unfortunately, a common occurrence among older adults. The fact that their
activities and social interactions are more limited, and their nearest and dearest are often living
far away, makes the adjustment to old age harder. Thus, most elderly face problems with self-
perception and self-concept.
The theory of self-perception suggests that individuals infer opinions, attitudes, and internal
states mostly through observing the behavior and circumstances in which they occur. On the
other hand, self-concept is defined as the way an individual thinks, evaluates and perceives his
self.
These two concepts change as an individual ages. It has been observed that healthy older
adults have more positive self-perception and self-concept compared to those who are lonely
and suffer from health issues. Consequently, healthcare providers, especially those who are the
primary caregiversm should encourage seniors to have a positive attitude towards aging. This
can help them increase their desire to live and make them more resilient to disease and mental
illness.
Promoting a positive self-perception and self-concept entails a lot of effort on the part of the
caregiver. An older adult should be immersed in various social activities to regain a sense of
hope and excitement about life. This can be done by making strong social connections within
the locality and allowing the elderly to be involved in activities organized by various support
groups. Most older adults placed in assisted living facilities interact with and meet other
residents who share similar interests. For those who are living in their own home, joining church
meetings, local gathering and social celebrations are helpful ways to foster positive aging.
Nonetheless, a healthy aging process involves meaningful relationships with the family and
significant others. Older adults should not be left at home doing nothing. They should be
encouraged to engage in family activities and gatherings that minimize isolation. Self-perception
and self-concept are directly affected by what the person does every day, so planning in
advance is essential to make various activities possible.
Roles and relationships
Most of us are lucky enough to live in a family setting. It provides us with the necessary
resources needed to become independent as children and stay independent as we age. Other
than financial support, our families are also a source of physical and emotional care. Elderly
individuals who have been with their families for years, and sometimes decades, understand
their value. But we must take into account that an aging person and the family are only a small
part of a much larger society. Society as a whole has an impact on the resources and services
made available to all older adults and families.
In discussing aging, generation and cohort are two of the most frequently used terms. A
generation is a group of individuals having the same step or line of family. Children, parents,
grandparents and even great-grandparents mirror different generations. Individuals who belong
to the same generation often have similar roles, responsibilities or expectations. They have
different ideas about family and the personal responsibilities that need to be done.
On the other hand, the word cohort is used when society as a whole is described. It defines a
group of individuals born at the same time in history, who share common beliefs and
experiences. For instance, baby boomers or those born in 1946 to 1964 are a cohort. They have
had an experience of a traditional family where the father works for their family and the mother
stays at home for the children. Every individual belongs to a certain cohort. Clashes between
these cohorts take place when individuals fail to recognize the differences in their lifestyle and
experiences.
Inter-generational Relations
We often see the ideal image of a perfect family in the print media, television, movies and online
resources. Family members help one another and rarely argue about anything, but when they
do so, they solve it in a peaceful manner. However, arguments and disagreements between
family members in real life are much more complex and difficult to resolve. Disagreements are
often due to the differences between generations. Children, parents and grandparents have
complex inter-generational relationships. Some of them are emotionally close while others are
very distant. Hence, researchers use three dimensions to better understand families, especially
the aging adult: emotional closeness, frequency of contact and social support.
Emotional closeness and frequency of contact have an enormous impact on inter-generational
relationships. It allows us to understand why some family members are very close with one
another, despite the huge age gap and living conditions, while others remain distant and
shallow. In the context of geriatric nursing, social support is provided by one or several adult
children in spite of distance, time and competing responsibilities. Older adults usually rely on
family members, especially when they have chronic illnesses.
Depending on their upbringing and family ties, there are adult children who have a strong sense
of commitment and responsibility towards their aging parents, while others have lost all contact
and the ability to provide any social support for their parents and/or grandparents. However, no
matter what the individuals’ circumstances, all elderly need support, including emotional and
informational as well as instrumental, financial and housing.
The majority of our disabled elderly seek help from their immediate families. Some prefer to
receive help from their children, spouses and immediate relatives, especially when it comes to
driving, buying food and medicine and routine daily activities. However, there some older adults
who prefer not to burden their loved ones and seek the help of healthcare professionals. This
allows the family to place the elderly in a long-term care facility where professionals can look
after them. When this decision is made, it is still important for the family members to provide
emotional support and attention to ensure quality of life. No healthcare professional, no matter
how committed, can truly replace family support.
Coping with Stress
During emergency situations, stress and anxiety are the natural fight and flight instincts of our
body. These stressors can either be external (an intruder crawling through your window) or
internal (a financial problem within the family or worry over an older adult with a mental or
physical problem). Thus, when stressful challenges occur, our body senses danger and
releases stress hormones into the bloodstream which increases heart rate, breathing, and other
processes that prepare you to respond quickly. This natural reaction is also known as a stress
response.
According to research, long-term activation of the stress response can diminish the immune
system’s ability to fight disease and may also increase the risk of physical and mental health
issues. For instance, studies show that stress and anxiety that occur in older adults are
associated with physical problems like difficulty in carrying activities of daily living and other
health problems like coronary artery disease and a decreased sense of well-being.
Furthermore, stress is linked to causing or aggravating cancer, Alzheimer’s disease, and
multiple medical conditions like diabetes, heart disease and arthritis, chronic pain and cognitive
changes like declining short-term memory.
Signs of Stress
Although there are differences in how an individual responds to stress; most of the time, he/she
may feel the following symptoms.
 Anxiety or panic attacks
 Worry
 Sadness or depression
 Irritability and moodiness
 Feeling pressured or hurried
 Difficulty concentrating or making decisions
 Sleeping problems
 Physical symptoms like headaches, chest pain, and stomach problems
 Feeling overwhelmed and helpless
 Sexual dysfunction
 Drinking too much alcohol, misusing drugs or smoking a lot
 Not eating enough or eating too much
  
Preventing and Coping with Stress
Coping with stress or preventing it from overwhelming us is often easier said than done.
However, if you make an extra effort to deal with it, you can always smooth the aging process.
For families with an older adult, especially those with disabilities, it is very important to be part of
his/her daily routine. Encouraging the elderly to participate in community activities and social
gatherings will allow him or her to divert attention and enhance self-esteem and alleviate stress.
Older adults obviously have different interests than young people, so take time to find out what
will minimize the stress of the older person in your care and guide them towards it! Whether it is
ballroom dancing, church activities, or camaraderie with friends or relatives, the end outcome is
the same: reduced levels of stress hormones in the body and a better quality of life.
Healthy dietary habits and regular exercise will also help the elderly cope with stress better.
Taking a walk in the park or outside the house should be a part of his/her daily routine to
promote proper blood circulation and improve their psychological well-being. However, if it
becomes apparent that nothing you say or do works and the older adult cannot handle stress
well, seeking help and talking to a psychologist may be beneficial. This healthcare professional
will teach the elderly to manage their stress through various different relaxation techniques and
mental exercises that you may not be familiar with. If the problem is more severe, they may
refer the older adult to a psychiatrist able to relieve their symptoms of stress and depression
with medication.
Values and Beliefs
Each of us has our own values and beliefs developed over time. The sense of who we are and
how we perceive the world is influenced by our family, friends, and experiences. As healthcare
workers, we are often exposed to patients with different life experiences and views. It is our duty
and responsibility to be aware of personal values and beliefs and ensure to empower the patient
fully to make them functional in their families and community.
What is a value?
Values are standards, principles or qualities that a person upholds. Values serve as a guide in
our lives to make decisions and live the way we think we should. A value is usually formed by a
particular belief related to a person’s behavior. It can influence our judgments and behavior- that
is why healthcare workers have to be aware of a person’s values when taking care of them.
What is a belief?
Beliefs come from real life experiences, but are often forgotten and start to influence us
subconsciously. They can significantly affect the quality of our work and personal relationships
with colleagues and friends, and they plays a major role in our identity. Beliefs may be
influenced by our morals, culture and religious affiliations. Healthcare staff working with the
elderly often have their own pre-existing beliefs and stereotypes about issues like sexuality,
health, alcohol, drug abuse, aging and disabilities, people’s rights and many others. This
stereotyping can affect the way we interact and work with older adults because of assumptions
about their actions.
Considering the Personal Values and Beliefs of an Elderly
One of the responsibilities of a healthcare provider is to control one’s own values and beliefs
about the older adult he is working with. This means that he or she does not provide options or
services based on what he feels is right, but what is right for the client. Older adults often have
an impaired ability to decide for himself, which is why healthcare workers should consider
personal values and beliefs. If we try to impose our own moral values on the elderly, it is likely
that we will judge the person rather than help him. Healthcare workers should be a role model to
their clients, regardless of behavior. A good client-worker relationship can be achieved by
setting aside personal interests, values and beliefs, and making his or her needs a priority while
respecting beliefs as well.
Sexuality and Aging
As adults age and change so does their sexual behavior. Sex may not be the same as it was in
their 20’s, but it can still be fulfilling if sexual health is preserved. Older adults who live with their
partners can enjoy and maintain a satisfying sexual life through proper communication. Setting
aside time to be sexual and sensual together is necessary for fulfilling intimacy. Partners should
share thoughts on their lovemaking and help each other understand the needs that have to be
met.
The key to a lasting relationship and intimacy is communication. Hence, becoming honest in
sharing sexual feelings is necessary to make it work.
Nonetheless, testosterone plays a significant role in a man’s sexual experience. This male
hormone is at its greatest during the younger years, while for older men, testosterone levels
start to decline. Studies show that after the age of 30, there is a one percent decline in
testosterone levels each year. This means that the penis may take a little bit longer to become
erect and erections may not be as hard as they used to be. Full arousal, orgasmic and
ejaculatory experiences may take longer to achieve as well. Similarly, when a woman
approaches her postmenopausal period, her estrogen levels will also decrease, leading to
slower sexual arousal and vaginal dryness. Though they can enjoy sex without the worry of
getting pregnant, changes in body shape and size may cause women to feel sexually less
desirable.
Aging couples should be sure to address every sexual concern encountered and talk about it as
freely as possible. Agreeing on decisions helps to boost the relationship, especially if one is ill or
has a medical condition that affects sexual health. Older adults often experience various
medical problems as they age, but proper communication can ease the physical, emotional and
sexual problems encountered.
Factors that Affect Sexuality in Men and Women
Sexuality in men and women is affected by several physiologic, emotional as well as lifestyle
factors.
Stress
Stress is the primary reason for decreased libido. Time and time again, individuals who are
stressed from work, family and personal matters experience this. Older adults retiring at home
are usually stressed with their caregivers, financial status, and family members. These stressors
enhance the release of adrenaline and cortisol which can restrict or narrow blood circulation in
the body, leading to decreased libido or sexual desire. This can cause depression in both
partners, especially if the sexual needs are not met, yet both are still sexually active.
Depression and Low Self-Esteem
It is hard to feel sexy when an individual is depressed or his/her self-confidence is low. At some
point, older adults feel unattractive because of the change in their body shape and size. They
have fears of rejection and decreased sexual desire due to their physical appearance.
Individuals who tend to consume a lot of alcohol have difficulty feeling aroused. Due to
depression, some older adults get into drinking and drug abuse that can impair their nervous
system and lower the sex drive. Although this provides an immediate high, alcohol and
substance abuse can affect libido negatively.
Lack of sleep
A good night sleep may be hard to come by, but it is essential if you want to keep a healthy
body, a sharp mind, and an active libido as you age. Older adults who lack sleep are often
exhausted during the day. This can elevate cortisol levels and furthermore decrease libido. A
recent study shows that a lack of sleep may lead to restless leg syndrome, a neurological
disorder that places an individual at a higher risk of erectile dysfunction.
Erectile dysfunction
Decreased libido is a typical emotional side effect of erectile dysfunction. Once a man
experiences erectile dysfunction, he beccomes anxious, and his confidence is shaken, making
his libido shut down. Lower levels of testosterone and decreased flexibility while having sex can
also aggravate the problem.
Hormone imbalance
A hormonal imbalance among men and women has a huge impact on libido. A low testosterone
level in men and a low estrogen level in women can decrease sexual desire. It can also cause
physical issues like vaginal dryness and erectile dysfunction that have a negative psychological
impact on older adults.
Medical conditions
Chronic systemic illnesses like cancer, diabetes, and kidney disease can suppress testosterone
levels and decrease sperm production. It can also limit the physical activity of an individual,
thereby reducing the desire to make love.
Caregivers and Sexuality of Older Adults
Sexuality in older adults changes due to various factors. Health is often the main reason why
sexual life is affected. Older adults who lack openness about their medical condition and its side
effects are often left feeling frustrated, isolated and guilty about their lack of sexual ability.
Because they cannot meet their spouse’s sexual needs, they are often depressed and stressed.
As caregivers, it is our responsibility to respect the sexuality of older adults. Stereotyping is very
common in the healthcare field because of pre-existing values and beliefs, but anyone working
with the elderly, especially those who have medical conditions, should be sure to respect and
provide privacy for the individual.
Encouraging the older adult to stay open with his partner is very helpful to make the relationship
work, regardless of the sexual changes. Discussing certain concerns like hormonal imbalance
can also help ease the stress that the elderly are experiencing.
No matter how old an elderly is, assuming they are not sexual leaves them feeling inferior.
Research shows that most seniors remain interested in sex, although the physical changes of
aging will affect their desire to have sex. Healthcare workers have to educate older patients
about sexuality changes they will go through and discuss their needs and concerns along the
way. This can relieve anxiety and depression as well as feelings of inadequacy. Overall, an
awareness of sexual health is essential to caregivers involved in the care of the elderly. Biases
and stereotypes should be avoided to address sexual issues professionally.
Sexual Health and Sexual Orientation
As we go from childhood to adolescence and adulthood, our bodies develop and change,
together with our emotions and feelings. During the teenage years, the physical and hormonal
changes of puberty cause individuals to increase their sexual feelings. These feelings vary
depending on sexual orientation, which can either be heterosexual, homosexual, bisexual and
asexual.
Older adults under the care of healthcare professionals have different sexual orientations. We
may not be able to notice it at first glance, but once we get into their lives and communicate with
them properly, these sexual feelings will surface. Historically, gays, lesbians and bisexual
people have a negative connotation in society, but healthcare professionals should respect
every individual’s sexual preference. Older adults who have an attraction to the same sex
should not be reprimanded for his/her admiration and gesture. Acceptance and respect are the
keys to a healthy relationship with an older client. This may not be easy for someone with pre-
existing beliefs on sexuality, but it is a necessity for healthcare providers to be fair to clients who
have a different sexual orientation.
End of Life Care for the Elderly
In the final stages of a terminal illness, the type of care provided usually changes. In spite of the
best care, treatment, and attention given to an older adult approaching the end of life, curative
measures are modified to palliative care to relieve pain, ease symptoms and alleviate emotional
stress. Caregivers often find the last stages of life challenging because the daily provision of
care is combined with complex end of life decisions and feelings of bereavement. It requires a
lot of support and emotional strength to ensure that an elderly is satisfied and happy with his
last few days, weeks or months.
The Need for an End of Life Care
Basically, there is no particular point in time or event when end of life care begins. It usually
depends on the individual and the illness he is suffering from. For instance, in the case of
Alzheimer’s disease, the doctor will likely provide information on the stages of the diagnosis.
This will serve as a guide to understand the progression of Alzheimer’s and an indication that an
appropriate care plan must be made. The need for end of life care starts when the patient has
made multiple trips to the emergency room, the illness progresses significantly, symptoms
worsen, the patient wishes to remain at home and he stops receiving treatment for his disease.
Furthermore, a terminally ill patient with a deteriorating medical condition has increased physical
safety needs. The family, along with the caregivers, should seek additional health services
through local healthcare facilities or hospice if needed. A hospice is an option for older adults
whose life expectancy is six months or less. Palliative care is given to enable the person to live
his final days with as good a quality of life as possible. If hospice care is done at home, the
family members will act as the primary caregivers, with supervision from the doctor and hospice
medical staff. Regular visits from the hospice team will then take place to assess the patient and
provide care and other services.
Providing Emotional Support
The emotional needs of patients differ in their final stages of life. Many older adults worry about
their loss of dignity or loss of control as their physical abilities deteriorate. It is common for them
to feel fearful of becoming a burden to loved ones. Thus, caregivers have to provide emotional
support regardless of how complicated the patient’s condition may be. This can be done by
being with the elderly and providing support in performing the activities of daily living.
Expressing fear of death is normal, but it is important to refrain from discussing various feelings
that can lead to sadness and depression. Honoring the elderly’s wishes can also be a very good
idea, but never forget to support and comfort him or her in this final stage of life.
Death & Funeral arrangements
Whenever an older adult dies, family members can become overwhelmed by the responsibilities
needed to arrange a funeral, especially when it happens unexpectedly. There are a lot of things
that must be attended to that require attention to detail. However, to make things as smooth as
possible, it is important to divide the tasks between relatives and friends who are arranging the
funeral.
First, updating the immediate family members should be done as soon as possible. Bringing
them together or contacting them by phone, email or social media is an opportunity to comfort
one another and share the decisions that must be made such as funeral arrangements and
burial wishes. If the person has made arrangements to donate his organs or body to a medical
institution, the family must respect these wishes. An individual’s advance directive, health proxy
or living will may guide the family through bequeathal instructions.
Funeral preparations can be quite stressful, especially if the deceased person did not leave any
instructions. To make things easier, the immediate family should assess the available options
and choose a funeral home they can afford. Funeral homes usually transport the body from the
morgue to the funeral facility and provide the necessary equipment for the bereavement. They
are also responsible for the cremation or embalming process done to the deceased. If there are
religious practices that need to be observed, be sure to inform the funeral director.
Death and funeral arrangements also include preparation of documents like death certificates,
birth certificate, marriage certificate, insurance policies, social security card, stock certificates,
bank passbooks, income tax forms, deeds and titles of properties, and many others. These
documents are needed when the deceased person has several children to divide estate
properties. Know that insurance policies can be obtained only after death. Once the burial is
over, claims from insurance and employment benefits can be processed. If the deceased has
pending debt from banks and other establishments, it is important to inform them about the
death and how it will be settled. Credit cards, bank accounts, and insurance policies should be
closed to avoid further premium payments and additional obligations.
 References<br />South Plains College (n.d.). REESE vocational nursing program: Course
syllabus. Retrieved from [Link]
occupation/nursing/VNSG_1126_241_Strawn_SP11.pdf<br />SuperTeacherTool (2011).
Classroom Update [Video]. Retrieved from [Link] />University
of California, Los Angeles. (n.d.). Let’s Play Geriatric Jeopardy. Retrieved from
[Link]/agrp/docs/[Link]<br />31<br />
 31. References<br />Wallace, M., Lange, J., Grossman, S. (2005). Isolation followed by
integration: <br /> A model for development of a separate geriatric course. Journal of <br />
Nursing Education, 44(6), 253-256. <br />Weymannk, C. (2010). A day in the life of a
gerontological nurse [video clip]. Retrieved from [Link]
search_query=a+day+iin+the+life+of +gerontological+nursing&aq=f<br />32<br />
 32. Course Lesson Plan for Geriatric Nursing<br />Mary Huelskamp RN/BSN<br />Student
MN/Nurse Educator<br />Kaplan University<br />Contact Information<br />Land phone: 1-
920-544-4625<br />Cell phone: 1-920- 366-4653<br /> Email Address:
mhuelskamprn@[Link] <br />33<br />