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Geriatrics is a branch of medicine dealing with the aged and the problems of the aging. The field gerontology includes of illness prevention and management, health maintenance, and promotions of quality of life for the aged. Research on a wide variety topic raging from family aspects of aging economic resources, and the delivery of long-term care states that gender, race, ethnicity, and social class consistently influenced the quality of the experience of aging. The experience of aging results from interaction of physical, mental, social and cultural factors. Aging varies across cultures. Culturally, aging as well as the treatment of the elderly, is often determined by the values of an ethnic group. Culture also may determine the way the older person views the process of aging as well as the manner in a more heterogeneous elderly population than any generation that proceed it can be expected. Health care professionals will need to know not only diseases and disorders common to a specific age group but those common to a particular ethnic group as well. An appreciations of backgrounds can help the health care professional provide a personal approach when dealing with and meeting the needs of elderly patients. Aging is a board concept that includes physical changes in people’s bodies over adult life, psychological changes in their minds and mental capacities, social psychological changes in what they think and believe, and social changes in how they are viewed, what they expected of them. Aging is constantly evolving concept. Notions are a biologic age is more critical than chronologic age when determining health status of the elderly is valid. Aging is an individual and extremely variable process. The functional capacity of major body organs varies with advancing age. As one grows older, environmental and lifestyle factors affect the age-related functional changes in the body organ. The majority of the elderly seen in the health care setting have been diagnosed with at least one chronic condition. Individuals who in the 1970s would not be able to survives a debilitating illness, such as cancer or a catastrophic health events like a heart attack, can now live for more extended periods of time, sometimes with a variety of concurrent debilitating conditions. Although age is the most consistent and strongest predictor of risk for cancer and
for death from cancer, Management of the elderly cancer patient becomes complex because other chronic conditions, such as osteoarthritis, diabetes, chronic obstructive pulmonary disease (COPD), and heart disease, must also be considered in their care. The attitude of health care providers towards older adults affect their health care. Unfortunately, research indicates that health care professionals are significantly more negative in their attitudes towards older patients than younger ones. This attitude must change if the health care provider is to have a positive interaction with the elderly patient. These attitude appear to be related to the pervasive stereotyping of the elderly, which serves to justify avoiding care and contact with them, as well as being reminders of our own mortality. Ageism is a term used to describe the stereotyping of and discrimination against elderly persons and is considered to be similar to that of the racism and sexism. It emphasized that frequently the elderly are perceived to be repulsive and that a distaste for the aging process itself exists. Ageism suggests that he majority of elderly are senile, miserable most of the time, and dependent rather than independent individuals.
The media have also influenced on going stereotypical notions about the elderly. Health care providers must learn to appreciate the positive aspects of aging so that they can assists the elderly in having a positive experience with their imaging procedure.
PHYSICAL, COGNITIVE, AND PSYCHOSOCIAL EFFECTS OF AGING
The human body undergoes a multiplicity of physiologic change second by second. Little considerations is given regarding these changes unless they are brought on by sudden physical, psychological, or cognitive events. Radiographers must remember that each elderly person they encounter is a unique individual with distinct characteristics. These individual have experienced a life filled with memories and accomplishment.
Young or old, the definition of quality of life is an individual and personal one. Research has shown that health status is an excellent predictor of happiness. Greater social contact, health satisfaction, low vulnerable personality traits, fewer stressful life events have been linked to successful aging. Self-efficacy can be defined as the level of control one has over one’s future. Many elderly people feel they have no control over medical emergencies and fixed incomes. Many have fewer choices about their personal living arrangements. These environmental factors can lead to depression and decreased self-efficacy. An increase in illness will usually parallel a decrease in self-efficacy.
The elderly may experience changing roles from life of independence. The family role of an adult caring for children and grandchildren may evolved into the children caring for their caring aging parents. It is also a time of loss. Losses may include the death of a spouse and friends, as well as loss of income due to retirement. The loss of health may be the reason for the health care visit. The overall loss control may lead to isolation and depression in the elderly. Death and dying is also an imminent fact of life.
The aging process alone does not likely alter the essential core of human being. Physical illness is not aging, and age-related changes in the body are often modest in magnitude. As one ages, the tendencies to prefer slower-paced activities, take longer to learn new tasks, become more forgetful, and lose portions of sensory processing skills increase slowly but perceptibly. Health care professionals need to be reminded that aging and disease are not synonymous. The more closely a function is tied to physical capabilities, the more likely it is to decline with age, whereas the closer a function depends on experience, the more likely it will increase with age.
Joint stiffness, weight gain, fatigue and loss of bone mass can be slowed through proper nutritional interventions and low-impact exercise. The importance of exercise cannot be overstated . Exercise has been shown increase aerobic capacity and mental speed. Exercise programs designed for the elderly should emphasized increased strength, flexibility, and endurance. One of the best predictors of good health in later years is the number and extent of healthy lifestyles that were established in earlier life.
The elderly person may shown decreases in attention skills during complex tasks. Balance , coordination, strength and reaction time all decrease with age. Falls associated with balance problems are common in the elderly population, resulting in a need to concentrate on walking. Not overwhelming them with instructions is helpful. Their hesitation to follow instructions may be fear instilled from a previous fall. Sight, hearing, taste and smell are all sensory modalities that decline with age. Older people have more difficulty with bright lights and tuning out background noise. Many elderly people become adept at lip reading to compensate for loss of hearing. For radiographers to assume that all elderly patients are hard of hearing is not usual; they are not talking in a normal tone, while making volume adjustments only if necessary, is a good rule of thumb. Speaking slowly, directly, and distinctly when giving instructions allows older adults an opportunity to sort through directions and improves their ability to follow them with better accuracy.
Cognitive impairment in the elderly can be caused by disease, aging, and disuse. Dementia is defined as progressive cognitive impairment that eventually interferes with daily functioning. It includes cognitive, psychologic, and functional deficits including memory impairment. With normal aging comes a slowing down and a gradual wearing out of bodily systems bit it does not include dementia . Yet the prevalence of dementia increases with age. Persistent disturbances in cognitive functioning, including memory and intellectual ability, accompany dementia. Fears of cognitive loss, especially Alzheimer’s disease, are widespread among older people. Alzheimer’s disease is the most common form of dementia. Therefore health care professionals are more likely to encounter people with this type. The majority of elderly people work at maintaining and keeping their mental functions by staying active through mental games and exercises and keeping engaged in regular conversation. When caring for patients with any degree of dementia, verbal conversation should be inclusive and respectful. One should never discuss the patients as through they are not in the room or are not active participants in the procedure.
One of the first questions asked of any patient entering a health care facilities for emergency service “Do you know where you are and what day it is?” The health care providers need to know just how alert the patient is. Although memory does decline with age, this is experienced mostly with short-term memory tasks. Long-term memory or subconscious memory tasks show little change over time and with increasing age. There can be a variety of reasons for confusion or disorientation. Medication, psychiatric disturbance, or retirement can confuse the patient. For some older people, retirement means creating a new set routines and adjusting to them. The majority of elders like structure in their lives and have familiar routines for approaching each day.
PHYSIOLOGY OF AGING
Health and well- being depend largely on the degree to which organ systems can successfully work together to maintain internal stability, With age, there is apparently a gradual impairment of these homeostatic mechanisms. Elderly people experience nonuniform, gradual, ongoing organ function failure in all systems. Many of the body organs gradually lose strength with advancing age. These changes place the elderly at risk for disease or dysfunction, especially in the presence of stress. At some point the likelihood of illness, disease and death increases. Various physical diseases and disorder affect both mental and physical health of people of all ages. They are more profound among elderly people because diseases and disorders among older people are more likely to be chronic in nature. Although aging is inevitable, the aging experience is highly individual and is affected by heredity, lifestyle choices physical health, and attitude. A great portion of usual aging risks can be modified with positive shifts in life style. In elderly, the aging of the organs systems is one of the process where they need to understands and there are as list below:
Integumentary systems disorders
Nervous systems disorders
Sensory systems disorders
Musculoskeletal systems disorders
Cardiovascular systems disorders
Gastrointestinal system disorder
Immune system decline
Respiratory system disorder
Hematologic system disorders
Genitourinary systems disorders
Endocrine systems disorders.
THE RADIOGRAPHER’S ROLE
The role of the radiographer is no different than that of all other health professionals. The whole person must be treated, not just the manifested symptoms of an illness or injury. Medical imaging and therapeutic procedures reflect the impact of ongoing systemic aging in documentable and visual forms. Adapting procedures to accommodate disabilities and disease of geriatric patients is a critical responsibility and a challenge based almost exclusively on the radiographer’s knowledge, abilities, and skill. An understanding of the physiology and pathology of aging, in addition to an awareness of the economic the social, psychologic, cognitive, and economic aspects of aging, are required to meet the needs of the elderly population. Conditions typically associated with elderly patient invariably require adaptations or modifications of routine imaging procedures. The radiographer must be able to differentiate between age related changes and disease processes. Production of diagnostic images requiring professional decision making to compensate for physiologic changes, while maintaining the compliance, safety, and comfort of the patient, is foundation of the contract between the elderly patient and the radiographer.
RADIOGRAPHIC POSITIONING FOR GERIATRIC PATIENTS
The preceding discussions and understanding of the physical, cognitive, and psychosocial effects of aging can help radiographers adapt to the positioning challenges of the geriatric patient. In come cases routine examinations need to be modified to accommodate the limitation, safety, and comfort of the patient. Communicating clear instructions with the patient is important. The following discussion addresses positioning suggestion for various structures. The common radiography examinations for geriatrics are:
The position of choice for the chest radiograph is the upright position; however, the elderly patient may not be able to stand without assistance for this examination. The traditional posteroanterior (PA) position is to have the “backs of hands on hips.” This may be difficult for someone with impaired balance and flexibility. The radiographer can allow the patient to warp his or her arms around the chest stands as a means of support and security. The patient may not be able to maintain his or her arms over the head for lateral projection of the chest. Provide extra security and stability while moving the arms up and forwards.
When the patient cannot stands, The examination may be done seated in a wheelchair, but some issues will affected the radiographic quality. First, the radiologist need to be aware that the radiograph is an anteroposterior (AP) instead of a PA projection, which may make comparison difficult. Hyperkyphosis can result in the lung apices being obscured, and the abdomen may obscure the lung bases. In sitting position, respiration may be compromised, and the patient should be instructed on the importance of a deep inspiration.
Positioning of the image receptor for kyphotic patient should be higher than normal because the shoulder and apices are in a higher position. Radiographic landmarks may change with age, and the centering may need to be lower, if the patient is extremely kyphotic. When positioning the patient for the sitting lateral chest projection, the radiographer should place a large sponge behind the patient to lean him or her forward.
Sitting Chest PA Chest Standing
Radiographic spine examinations may be painful for the patient suffering from osteoporosis who is lying on the x-ray table. Positioning aids such as radiolucent sponge, sandbags, and a mattress may be used as long as the quality, of the image is not compromised. Performing upright radiographic examination may be also appropriate if a patient can safely tolerate this position. The combination of cervical lordosis and thoracic kyphosis can make positioning and visualization of the cervical and thoracic spine difficult. Lateral cervical projections can be done with the patient standings, sitting, or lying supine. The AP projection in the sitting position may not visualized the upper cervical vertebrae because the chin may obscure this anatomy. In the supine position the head may not reach the table and result in magnification. The AP and open-mouth projection are difficult to do in wheelchair.
The thoracic and lumbar spines are sites for compression fractures. The use of positioning blocks may be necessary to help the patient remain in position. For the lateral projection, a lead blocker or shield behind the spine should be used to absorb as much scatter radiation as possible.
Osteoarthritis, osteoporosis, and injuries as the result of falls contribute to hip pathologies. A common fracture in the elderly is the femoral neck. An AP projection of the pelvis should be done to examine the hip. If indication is trauma, the radiographer should not attempt to rotate the limbs. The second view taken should be a cross-table lateral of the affected hip. If hip pain is the indication, assist the patient to internal rotation of the legs with the use of sandbags if necessary.
Immobilization device are place to the patient foot.
Positioning the geriatric patient for projections of the upper extremities can present its own challenges. Often the upper extremities have limited flexibility and mobility. A cerebrovascular accident or stroke may cause contractures of the affected limb. Contracted limbs cannot be forced into position, and cross-table views may need to be done. The inability of the patient to move his or her limb should not be interpreted as a lack of cooperation. Supination is often a problem in patients with contractures, fractures, and paralysis. The routine AP and lateral projections can be supported with the use of sponges, sandbags, and blocks to raise and support the extremity being imaged. The shoulder is also a site decreased mobility, dislocation, and fractures. The therapist should assess how much movement the patient can do before attempting to move the arm. The use of finger sponges may also help with the contractures of the fingers.
Hand Projection Lateral Wrist
The lower extremities may have limited flexibility and mobility. The ability to dorsiflex the ankle may be reduced as a result of neurologic disorders. Imaging on the x-ray table may need to be modified when a patient cannot turn on his or her side. Flexion of the knee may be impaired and required a cross-table lateral projection. If tangential projection of the patella, such as the Settegast method, is necessary and the patient can turn on his or her side, place the image receptor superior to the knee and direct to central ray perpendicular through the patellofemoral joint. Projections of the feet and ankles may be obtained with the patient sitting in the wheelchair. The use of positioning sponges and sandbags support and maintain the position of the body part being imaged.
AP Ankle Projection Lateral Ankle Projection
Patient care must be apply to geriatric patient because they all are all fragile where their bone can easily broke or they can be easily fainted during the examination. For communications, take time to educate the patient and his or her family, speak lower and closer, and treat the patient with dignity and respect. Transportation and lifting patient are also be need because geriatrics patient is not stronger than normal person. If possible, give the patient time to rest between projection and procedures. Avoid adhesive tape because elderly skin is thin and fragile. Provide warm blankets in cold examination rooms, use table pads and hands rails and always access the patient’s medical history before contrast media is administered.
Take time with the patient Immobilization Device
The imaging professional will continue to see a change in health care delivery system with the dramatic shift in the population of persons older than age 65. This shift in the general population is resulting in an ongoing increase in the number of medical imaging procedures preformed on elderly patients. Demographic and social effects aging determine the way in which the elderly adapt to and view the process of aging. An individual’s family size and perceptions of aging, economic resources, gender , race, ethnicity, social class, and the availability and delivery of health care will affect the quality of the aging experience. Biologic age will be much more critical than chronologic aging when determining the health status of the elderly. Healthier lifestyles and advancement in medical treatment will create a generation of successfully aging adults, which in turn should decrease the negative stereotyping of the elderly person. Attitudes of all health care professionals, whether positive or negative, will affect the care provided to be growing elderly population. Education about the mental and physiologic alterations associated with aging, along with the cultural, economic and social influences accompanying aging, enables the radiographer to adapt imaging and therapeutic procedures to the elderly patient’s disabilities resulting from age-related changes.
The human body undergoes a multiplicity of physiologic changes and failure in all systems. The aging experience is affected by heredity, lifestyle choices, physical health, and attitude, making it highly individualized. No individual’s aging process is predictable and is never exactly the same as that of any other individual. Radiologic technologists must use their knowledge, abilities, and skills to adjust imaging procedures to accommodate for disabilities and disease encountered with geriatric patients. Safety and comfort of the patient is essential in maintaining compliance throughout imaging procedures. Implementation of skills such as good communication, listening, sensitivity, and empathy, all lead to patient compliance. Knowledge of age-related changes and disease process will enhance the radiographer’s ability to provide diagnostic information and treatment when providing care that meets the needs of the increasing elderly patient population.
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