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 impacts of ongoing systemic aging in documentable and visual forms. Adapting procedures to accommodate disabilities and diseases of geriatric patients is a critical responsibility and a challenge based almost exclusively on the radiographer’s knowledge, abilities, and skills. An understanding of the physiology and pathology of aging, in addition to an awareness of the social, psychological, cognitive, and economics of aging are required to meet the needs of the elderly population. There are conditions typically associated with elderly patients that invariably required adaptations or modifications of routine imaging procedures. The radiographer must be able to differentiate between age’s related changes and disease processes. Production of diagnostic images requiring professional decision making to compensate for physiological changes, while maintaining the compliance, safety, and comfort of the patient, is the foundation of the contract between the elderly patient and the radiographer.
Physical, Cognitive, and Psychological Effects of Aging
The human body undergoes a multiplicity of physiological changes second by second.
Little consideration is given regarding these changes unless they are brought on by sudden physical, psychological, or cognitive events. It is important for radiographers to remember that each elderly person we encounter is a unique individual with distinct characteristics. These individuals have experienced a life filled with memories and accomplishments.
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, and 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 there 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.
A positive attitude is a very important aspect of aging. Many older people have the same negative stereotypes about aging that young people do. For them, feeling down and depressed becomes a common consequence of aging. One of five people older than age 65 in a community will show signs of clinical depression. Yet we, as health care professionals, know that depression can affect both young and old. In general, research has show the majority of elderly people rate their health status largely depends on their successful adaptation to disabilities. Radiographers need to be sensitive to the fact that an elderly person may have had to deal with a number of losses, both social and physical, in a very short period of time. More importantly, they must recognize symptoms resulting from these losses in order to communicate and interact effectively with this patient population.
Although, as health care providers, the radiographer’s contribution to a patient’s quality of life may be minimal, it is not in significant. It is necessary to remember that each elderly person is unique and deserves respect for his or her own opinions.
One of the first questions asked of any patient entering a health care facility for emergency service is, “Do you know where you are and what day it is?” the health care providers need to know just how alert the patients 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 confuse or disorientation. Medication, psychiatric disturbance, or retirement can confuse the patient. Retirement to some older people means creating a new set of routines and adjusting to them. The majority of elders like structure in their lives and have familiar routines for approaching each day.
AGING OF THE ORGAN SYSTEMS
Integumentary system disorders
The integumentary system is one of the first apparent signs of aging. With age comes flattening of the skin membranes making it vulnerable to abrasions and blisters. The number of melanocytes decrease making ultraviolet light more dangerous and the susceptibility to skin cancer increase. Wrinkling and thinning skin are very noticeable among the elderly. This is attributable to decrease in collagen and elastic in the dermis. There is a gradual loss of functioning sweat glands and skin receptor, which increases the threshold for pain stimuli, making the elderly person vulnerable to heat strokes. With age comes atrophy or thinning of the subcutaneous layer of skin in the face, back of the hands, and soles of the foot conditions in the elderly. The most striking age-related changes to the integumentary system are graying, thinning, and loss of hair. With age, the number of hair follicles decreases and those follicles that remain grow at a slower rate with less concentration of melanin, causing the hair to become thin and white. A major problem with aging skin is chronic exposure to sunlight. The benefits of protecting one’s skin with sunscreen and protective clothing cannot be over emphasized and will be more evident as one grows older.
Nervous system disorders
The nervous system is the principle regulatory system. Central nervous system disorders are one of the most common causes of disability in the elderly accounting for almost 50% of disability in those older than age 65. Loss of myelin in axons in some of the nervous system contributes to the decrease in nerve impulse velocity that is noted in aging. Like any other organ system, the nervous system is vulnerable to the effects of atherosclerosis with advancing age. When blood flow to the brain is blocked, brain tissue is damaged. Repeated episodes of cerebral infraction can eventually lead to multi-infract dementia. Changes in the blood flow and oxygenation to the brain slows down the time carry motor and sensory tasks requiring speed, coordination, balance, and fine motor hand movements. This decrease in the function of motor control puts the elderly person at higher risk for falls. Healthy changes in lifestyles can reduce the risk of disease. High blood pressure, for example, is a noted risk and can be decreased with medication, weight loss, proper nutritional diet, and exercise.
Sensory system disorders
All of the sensory systems undergo changes with age. Beginning around the age 40, the ability to focus on near objects becomes increasingly difficult. The lens of the eye becomes less pliable, starts to yellow, and becomes cloudy resulting in farsightedness (presbyopia); distorted color perception and cataracts also begin. Changes in the retina affect the ability to adapt to changes in lighting and there are decreased abilities to tolerate glare, making night vision more difficult for the elderly. Hearing impairment is very common in the elderly. The gradual progressive hearing loss of tone discrimination is called presbycusis. Men are affected more often than are women and the degree of loss is more severe for high-frequency sounds. Speech discrimination is problematic when in noisy surroundings such as a room full of talking people.
Immune system decline
Age takes its toll on the immune system. To be immune to an infection implies protection from that infection. The ability of our body to remain free of infections requires the immune system to distinguish our own healthy cells from invading microorganisms or altered cancer cells. The age-related decline of the immune system functioning makes the elderly more vulnerable to diabetes rises in adulthood. Prevalent among the aged would be influenza, pneumonia, and tuberculosis, meningitis, and urinary tract infections. The three general categories of illness that preferentially afflict the elderly are infections, cancer and autoimmune disease.
Genitourinary system disorder
Familiar age-related genitourinary (GU) changes are those associated with incontinence. Changes in bladder capacity and muscle structure predispose the elderly to this problem. Along with these structural changes in the GU system the number of nephrons in the kidneys decreases dramatically following the onset of adulthood. This decreased reserve capacity of the kidneys could cause what would otherwise be a regularly prescribed dose of medication to be an overdose in the elderly. The role of the kidneys to maintain the body’s water balance and regulate the concentration according to the body’s need diminishes with age. Acute and chronic renal failure can affect many elderly in their later years.
Patient Care of the Elderly and the Radiographer
Box 29-3 lists some quick tips for working with elderly. These tips are discussed in the context
following the table.
BOX 29-3 Tips for working with the elderly patient
Take time to educate the patient and his or her family
Speak lower and closer
Treat the patient with dignity and respect
Give the patient time to rest between projections and procedures
Avoid adhesive tape: elderly skin is thin and fragile
Provide warm blankets in cold examinations room
Use table pads and hand rails
Always access the patient’s medical history before contrast media is administered
PATIENT AND FAMILY EDUCATION
Education about imaging procedures to obtain their confidence and compliance is crucial for all patients, especially for elderly patients. More time with the elderly patient may be necessary to accommodate their decreased ability to rapidly process information. The majority of elderly have been diagnosed with at least one chronic illness. They typically arrive at the clinical imaging environment with a natural anxiety because they are likely to have little knowledge of the procedure or the highly technical modalities employed for their procedures. Moreover, a fear concerning consequences resulting from the examination exacerbates their increased levels of anxiety. Taking time to educate patients and their families or significant caregivers in their support system about the procedures makes for a less stressful experience and improved patient compliance and satisfaction.
Good communication and listening skills create a connection between the radiographer and his or her patient. Older people are unique and should be treated with dignity and respect. Each elderly person is a wealth of cultural and historical knowledge that in turn becomes a learning experience for the radiographer. If it is evident that they cannot hear or understand verbal directions, it is appropriate to speak lower and closer. Background noise can be disrupting to an older person and should be eliminated if possible when giving precise instructions. Giving instruction individually gives the elder person time to process your request. An empathetic, warm attitude and approach to the geriatric patient will result in a trusting and compliant patient.
TRANSPORTATION AND LIFTING
Balance and coordination of the elderly patient can be affected by normal aging changes. Their anxiety about falling can be diminished by assistance in and out of a wheelchair, and to and from the examination table. Many elderly have decreased height perception resulting from some degree of vision impairment. Hesitation of the elder person may be as a result of previous falls. Assisting them when there is a need to step up or down throughout the procedure is more than a reassuring gesture. Preventing opportunities for falls is a necessity for the radiographer. The elderly patient will often experience vertigo and dizziness when going from a recumbent position to a sitting position. Giving the patient time to rest between positions will mitigate these disturbing, frightening, and uncomfortable sensations. The use of table handgrips and proper assistance from the radiographer creates. A sense of security will result in a compliant and trusting patient throughout the imaging procedure.
The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) is the accrediting and standards-setting body for hospitals, clinics, and other health care organizations in the United States. Employees in institutions accredited by the JCAHO must demonstrate age-based communication competencies, which include the elderly. The standards were adopted as a means of demonstrating competence in meeting the physiological and psychological needs of patients in special populations. These populations include infants, children, adolescents, and the elderly.
Standard HR.5 of the Human Resources section of the JCAHO manual states, “When appropriate, the hospital considers special needs and behaviors of specific age groups in defining qualifications, duties, and responsibilities of staff members who do not have clinical privileges but who have regular clinical contact with patient (for example radiologic technologist and mental health technicians).” The intent of the standard is to ensure age-specific competency in technical and clinical matters but is not limited to equipment and technical performance. Knowledge of age-related changes and disease processes assist all the health care professionals, including those in the radiation sciences, in providing care that meets of the elderly patient.
The imaging professional will continue to see a change in the health care delivery system with the dramatic shift in the population of elderly persons over the age of 65. This shift in the general population is resulting in an ongoing increase in the number of medical imaging procedures performed on elderly patients. Demographic and social effects of 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 impact the quality of the aging experience. Biological age will be much more critical than chronological 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 impact the care provided to the growing elderly population. Education about the mental and physiological alterations associated with aging, along with the cultural, economical, 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 physiological changes and failure in all organ systems. The aging experience is affected by heredity, lifestyle choices, physical health, and attitude, making it highly individualized. No one individual’s aging process is predictable and is never exactly the same as that of any other individual. Radiologic technologist must use their knowledge, abilities, and skills to adjust imaging procedures to accommodate for disabilities and diseases encountered with geriatric patients. Safety and comfort of the patient is essential in maintaining compliance throughout imaging procedures. Implementation of skills such as communication, listening, sensitivity, and empathy all lead to patient compliance. The JCAHO, recognizing the importance of age-based communication competencies for the elderly, requires documentation of achievement of these skills by the employees of accredited health care organizations. Knowledge of age-related changes and disease processes will enhance the radiographer’s ability to provide diagnostic information and treatment in providing care that meets the needs of the increasing elderly patient population.