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1. NORMAL CHANGES IN THE -This makes it harder to keep cool. Your risk for
INTEGUMENTARY SYSTEM
Skin changes are among the most visible signs of aging.
Evidence of increasing age includes wrinkles and
sagging skin. Whitening or graying of the hair is another
obvious sign of aging.
AGING CHANGES
With aging, the outer skin layer (epidermis) thins, even
though the number of cell layers remains unchanged.
The number of pigment-containing cells
(melanocytes) decreases.
-The remaining melanocytes increase in size. Aging skin
looks thinner, paler, and clear (translucent). Large
pigmented spots, including age spots, liver spots, or
lentigos, may appear in sun-exposed areas.
Changes in the connective tissue reduce the skin's
strength and elasticity.
-This is known as elastosis. It is more noticeable in sun-
exposed areas (solar elastosis). Elastosis produces the
leathery, weather-beaten appearance common to farmers,
sailors, and others who spend a large amount of time
outdoors.
The blood vessels of the dermis become more fragile.
-This leads to bruising, bleeding under the skin (often
called senile purpura), cherry angiomas, and similar
conditions.
Sebaceous glands produce less oil as you age. --Men
experience a minimal decrease, most often after the age
of 80. Women gradually produce less oil beginning after
menopause. This can make it harder to keep the skin
moist, resulting in dryness and itchiness.
The subcutaneous fat layer thins so it has less
insulation and padding.
-This increases your risk of skin injury and reduces your
ability to maintain body temperature. Because you have
less natural insulation, you can get hypothermia in cold
weather.
Some medicines are absorbed by the fat layer. -
Losing this layer changes the way that these medicines
work.
The sweat glands produce less sweat.
overheating or developing heat stroke increases.
Growths such as skin tags, warts, rough patches
(keratoses), and other blemishes are more common in
older people.
EFFECT OF CHANGES
As you age, you are at increased risk for skin injury.
Your skin is thinner, more fragile, and you lose the
protective fat layer. You also may be less able to sense
touch, pressure, vibration, heat, and cold.
Rubbing or pulling on the skin can cause skin tears.
Fragile blood vessels can break easily. Bruises, flat
collections of blood (purpura), and raised collections of
blood (hematomas) may form after even a minor injury.
Pressure ulcers can be caused by skin changes, loss of
the fat layer, reduced activity, poor nutrition, and
illnesses. Sores are most easily seen on the outside
surface of the forearms, but they can occur anywhere on
the body.
Aging skin repairs itself more slowly than younger skin.
Wound healing may be up to 4 times slower. This
contributes to pressure ulcers and infections. Diabetes,
blood vessel changes, lowered immunity, and other
factors also affect healing.
COMMON PROBLEMS
Skin disorders are so common among older people that it
is often hard to tell normal changes from those related to
a disorder. More than 90% of all older people have some
type of skin disorder.
Skin disorders can be caused by many conditions,
including:
 Blood vessel diseases, such as arteriosclerosis
 Diabetes
 Heart disease
 Liver disease
 Nutritional deficiencies
 Obesity
 Reactions to medicines
 Stress
Other causes of skin changes:
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 Allergies to plants and other substances
 Climate
 Clothing
 Exposures to industrial and household chemicals
 Indoor heating
 Sunlight can cause:
 Loss of elasticity (elastosis)
 Noncancerous skin growths (keratoacanthomas)
 Pigment changes such as liver spots
 Thickening of the skin
 Sun exposure has also been directly linked to
skin cancers, including basal cell cancer,
squamous cell carcinoma, and melanoma.
PREVENTION
B. How the change affects the older adult?
Because most skin changes are related to sun exposure,
prevention is a lifelong process.
Prevent sunburn if at all possible.
Use a good quality sunscreen when outdoors, even in the
winter.
Wear protective clothing and a hat when needed.
Good nutrition and adequate fluids are also helpful.
Dehydration increases the risk of skin injury. Sometimes
minor nutritional deficiencies can cause rashes, skin
lesions, and other skin changes, even if you have no
other symptoms.
 Inflammation, which occurs when
the body responds to an injury or
disease, may increase
shrink in volume, particularly in the
frontal cortex. As our vasculature
ages and our blood pressure rises the
possibility of stroke and ischaemia
increases and our white matter
develops lesions.
 Memory decline also occurs with
ageing and brain activation becomes
more bilateral for memory tasks.
This may be an attempt to
compensate and recruit additional
networks or because specific areas
are no longer easily accessed.
 positive cognitive changes. People
often have more knowledge and
insight from a lifetime of
experiences.:
 Learn new things
 Create new memories
 Improve vocabulary and language
skills

Keep skin moist with lotions and other moisturizers. DO

NOT use soaps that are heavily perfumed. Bath oils are
not recommended because they can cause you to slip and
fall. Moist skin is more comfortable and will heal more
quickly.

2. NORMAL CHANGES IN THE BRAIN

AMONG OLDER PERSONS
A. What are the normal changes in the brain
that happen in older adults?
 Certain parts of the brain shrink,
especially those important to
learning and other complex mental
activities.
 In certain brain regions,
communication between neurons
(nerve cells) can be reduced.
 Blood flow in the brain may also
decrease.
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3. Delirium and Dementia
Bond paper written d. Assessment
a. What are these illnesses?
 Dementia brain disorder characterized by
impaired cognitive functioning that can affect Delerium
learning and memory, mood and behaviour, as
well as the ability to conduct daily activities and
high level functions such as management of
other chronic conditions.” Dementia develops
gradually and is progressive, but its
manifestation and course can vary considerably,
depending on the disease

 Delirium a complex neuropsychiatric syndrome

marked by an acute onset, fluctuating course,
altered level of consciousness, inattention, and
disorganized thinking.

 Depression spectrum of mood disorders

characterized by a sustained disturbance in
emotional, cognitive, behavioural, and/or
somatic regulation that is associated with both
significant functional impairment in daily living  Cognitive orientation/re-orientation
and often loss of one’s capacity for pleasure and  Environmental aids:
enjoyment (anhedonia). adequate lighting
clear signage
b. Who is at risk for developing the clock
illnesses? calendar
 Risk factors are: age over 65 years  Avoid unnecessary room changes
 People with cognitive impairment  Therapeutic or cognitively stimulating activities:
and depression have a higher risk of personally valued activities and familiar
developing delirium background stimulation
 Delirium may increase a person’s reminiscenceG
risk of developing dementia family/friend visits
 People with a diagnosis of dementia  Note: avoid unnecessary isolation, sensory
have a high prevalence of depressive deprivation, and sensory overload
symptoms  Optimize sensory function by:
 ensuring hearing and visual aids are available and
working
c. Predisposing factors to the illness/es ensuring adequate lighting
 advanced age, resolving reversible causes of impairment (e.g.,
 cognitive impairment, and impacted ear wax)
 depression,
 Older age. Brain disorders such as Depression
dementia, stroke or Parkinson's ASESSMENT
disease. SIGECAPS:
 >Multiorgan failure. Polypharmacy  Sleep Disorder (increased or decreased)
(having more than one drug)  Interest deficit (anhedonia)
 Dehydration. Electrolyte  Guilt (worthlessness, hopelessness, regret)
disturbance.  Energy deficit
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 Concentration deficit
 Appetite disorder (increased or decreased)
 Psychomotor retardation or agitation
 Suicidality
 Additional symptoms: chronic pain, constipation
and
 musculoskeletal disorders
INTERVENTION
General
 Psychotherapy is recommended together with
antidepressants in primary care
 Psychological interventions with antidepressants
can
 Behavioural therapy appears to have comparable
effectiveness with alternative psychotherapies
 Interpersonal therapy is recommended for
treating mild or moderate depression
 Problem-solving therapy s
 Exercise
 Psychological and Social Intervention
Reminiscence
Reminiscence may have therapeutic benefits in
long-term care settings (socialization), but should be
facilitatedby a trained practitioner
Behavioural activation
Behavioural activation was recommended in two
clinical guidelines
Mindfulness
Mindfulness-based cognitive therapy, when
practiced in a group setting, may help reduce relapse
in people with
recurrent depression
Peer support or self-help
Peer support or self-help may be appropriate for
mild to moderate depression and those with a
chronic physical health problem.
Music therapy
Music therapy may reduce anxiety and depression,
but must be individualized
Animal therapy
There is insufficient evidence to recommend
animal therapy, but it may have beneficial effects on
the severity ofdepressive symptoms in older adults
living in long-term-care or psychiatric institutions.
Dementia
ASSESSMENT
 memory problems, particularly remembering
recent events
 increasing confusion
 reduced concentration
 personality or behaviour changes
 apathy and withdrawal or depression
 loss of ability to do everyday tasks.
 Memory
 Communication and language
 Ability to focus and pay attention
 Reasoning and judgment
 Visual perception
TREATMENT
 Music therapy
 Effective communication strategies and
person centred approaches to care
 Sensory interventions include massage,gentle
touch or therapeutic touch, and stimulation of
the senses (visual, auditory, touch)
 Group activities include any activities offered
to residents (e.g., animal-assisted therapy,
dance, cooking, etc.).
 Art Therapies Examples include visual arts,
drama/movement, songwriting, poetry, etc.
 promoting engagement in meaningful and
purposeful activities/recreation that align
with the person’s particularinterests;
 promoting social engagement; modifying the
home/environment to support independent
activities of daily living and promote safety;
 addressing issues of safety, such as
wandering and driving;
 maintaining a healthy lifestyle (e.g.,
supporting nutrition, sleep, and regular visits
to health-care providers);
 providing routines, reminders, and other
strategies to support cognitive challenges;
 providing education about dementia and
information about community resources
F. DIFFERENCES OF DEMENTIA AND
DELIRIUM
 Dementia develops over time, with a slow
progression of cognitive decline. Delirium
occurs abruptly, and symptoms can fluctuate
during the day. The hallmark separating delirium
from underlying dementia is inattention. The
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individual simply cannot focus on one idea or
task.

 Delirium often is unrecognized by healthcare

professionals because changes in behavior in
persons with dementia (such as agitation or sun
downing) may be attributed to the dementia
disease process, versus an acute problem.
 Delirium may be the first and perhaps only clue
of medical illness or adverse medication reaction
in an individual with Alzheimer’s.

References:
Registered Nurses’ Association of Ontario. (2016).
Delirium, Dementia, and Depression in Older
Adults: Assessment and Care. Toronto, ON:
Registered Nurses’ Association of Ontario.
T. A. Jackson, S. H. Naqvi and B. Sheehan. (2013).
Screening for dementia in general hospital
inpatients: a systematic review and meta-
analysis of available instruments. Age and
ageing, 42(6), 689-95.
N. Mukadam, C. Cooper, N. Kherani and G.
Livingston. (2015). A systematic review of
interventions to detect dementia or cognitive
impairment. International journal of geriatric
psychiatry, 30(1), 32-45.