Patient care

Although all patients benefit from respectful, dignified, and professional care, and generalizations about older patients’ needs may not apply to every patient, some special needs of some older patients are addressed here. Sensory problems (self-reported) are fairly prevalent in older adults. For example hearing impairments are present in about a third of 65 to 74 year olds and half those 75 and older, and vision problems are present in a seventh of those age 65 to 74, and in a fifth age 75 and older. Tooth loss, which influences both chewing and clarity of speech, occurs in more than a fifth of individuals over the age of 65. Age-related changes in heart and kidney function make older adults more vulnerable to shifts in water balance that can result in dehydration, e.g., in hot weather, when left alone, or while waiting for medical or surgical procedures. In older adults, adequate fluid intake is associated with fewer falls, less constipation, lower rates of laxative use, and better rehabilitation outcomes in orthopedic patients. In older adults dehydration can precipitate emergency hospitalization and increase mortality. The decline in renal function that occurs with aging means that the kidneys are less able to concentrate urine, so more water is lost in an older person than would be in a younger individual. Institutionalized adults should be ensured of access to something to drink at all times, with fluid offered regularly since thirst may not prompt older individuals to drink. Fasting should be minimized. Ambulatory adults should be reminded to increase their fluid intake during exercise, hot weather, and illness, and healthy older adults should be taught to monitor urine color as one indicator of dehydration — darker urine often represents incipient dehydration, while clear, watery urine is seen in well-hydrated adults. Individuals with urinary incontinence should be advised not to limit their intake in an effort to prevent incontinence episodes; 1500 to 2000 ml (1½ to 2 quarts) of fluid daily is required to maintain hydration for most individuals.

When communicating with the elderly, caregivers in all settings should remember to encourage the patient’s use of hearing aids and/or eyeglasses; use the patient’s name, make eye contact, and use touch as appropriate; enunciate clearly; allow time for the patient to respond; ask only one question at a time, develop a signaling system for “yes” and “no” answers, and post it clearly for all caregivers and visitors to see and use; use gestures that relate to the information being conveyed verbally; and write questions/options so that the patient can see them as they are read aloud for the patient to hear. Other critical elements of the care of the elderly include providing physical therapy to improve balance and prevent falls; limiting the use of medications that may contribute to cognitive dysfunction, confusion or delirium; ensuring adequate nutrition; screening for cancers, dementia, depression, and other diseases that become more common with advancing age; remaining aware of “atypical” presentations of illnesses and infections; protecting the skin from ulceration; and maintaining healthful participation in the community.