ainorb.com). The best approach to preventing skin infections is to keep the skin scrupulously clean. The bathing and toileting of the elderly can be a tricky matter. In addition to making sure that your loved one is fully clothed and warmly covered, be aware that some older people may have an aversion to regular bathing and a strong dislike of having their hair washed. Keep their bathroom clean with a well-worn washcloth or dishtowel. Check for sores and red areas of skin (see Chapter 12) before you give a bath, and treat them as soon as you notice them. In addition, the elderly person should change their soiled clothing as often as possible and wash their hair daily. Dried sweat can develop in the hair and on the head. Be sure to remove all the hair from the pillow. When necessary, the use of body lotion is also an important measure for preventing a skin rash or infection. In addition, seniors should be particularly careful to protect their skin from the sun. In most areas of the country there are sunscreens available with no FDA approval and labeled "not tested on animals." As mentioned in Chapter 3, exposure to the sun can contribute to thinning of the skin and changes in pigmentation. It can also cause wrinkling, sagging, and loss of elasticity in the skin. Sunscreen can protect the skin, though it cannot prevent wrinkling. Even those who have never been exposed to the sun need to be particularly careful not to get burned, as the sun's rays have a cumulative effect. When sun exposure is necessary, the following are recommended guidelines to protect the skin: * Sunglasses help protect the eyes, especially if used to go from the light to dark or from a dark room into the bright light. * Wear a broad-brimmed hat or use a sunscreen with a minimum SPF 15 or 30 if one is not available. Wear an additional hat if necessary to protect the ears. * Select waterproof sunscreen for swimming or boating. * Seek shade by going to an air-conditioned room, going indoors, or taking a midday siesta. Pneumonia and flu are another source of concern for the elderly. The immune system becomes weaker with age and can be further weakened by disease and age-related conditions such as stroke, diabetes, and cancer. The elderly person is more likely than younger adults to develop a severe course of pneumonia and influenza and can become severely ill from the infection. If it develops in the elderly person, pneumonia and flu can be difficult to treat. If it is contracted by the elderly, treatment of the disease may require the use of antibiotics. The elderly person should be encouraged to stay in bed at least a few days, drink plenty of liquids, and consult with his or her physician. #### **The Elderly's Emotional Well-Being** Coping with health problems is difficult enough for an adult without the added burden of emotional and psychological changes. For some people who have lost loved ones, the illness and death of their spouse or parent can be confusing and painful, leading to confusion, anxiety, depression, and even deep fear and anger. As people get older, it is more difficult for them to cope with these emotional reactions. The emotional health of the elderly is affected by many changes. Perhaps the most obvious is the fact that they lose many of their friends as they age. If the person has been living alone, a great deal of the emotional support and companionship will be missed. It may also be very confusing for the elderly person to find that he or she now has an increased need for care. When the elderly person is experiencing emotional difficulties, it is often very difficult to reach out for help. If not properly addressed, these problems may lead to depression, anxiety, loss of appetite, and even suicide. Loneliness is another problem that often affects the elderly. Loneliness causes much distress in a person's life. It can lead to many forms of emotional and mental problems, as well as the physical symptoms of depression and anxiety. Some people may react by refusing to let others help them or by becoming aggressive or withdrawn. It is critical that everyone in the home be aware of changes in behavior and mood. If elderly members of the family do not confide in friends and others, they are more likely to suffer in silence, which can result in many health problems. To determine if this is the case, one needs to ask questions and listen carefully to the responses. When the elderly person is upset, she or he may stop eating or may begin to complain that food is too rich or too salty. This may indicate poor diet and changes in taste. When the elder continues to deny problems, it is recommended that she or he be referred to a therapist or physician. Counseling may be a great benefit for some older people. However, it is important to make sure that the counseling provided is not seen as punitive and is not used as a substitute for help with the physical difficulties the elderly person is experiencing. #### **Mentally Ill Elderly** Losing a spouse or parent to a terminal illness can be especially difficult for a person who has always lived and worked as a family unit. The elderly person may be able to acknowledge and accept the loss in a rational way. However, some may remain angry, depressed, and isolated. Although depression can occur as a natural response to the changes in one's life, it is important to ensure that there are no underlying medical or emotional problems. Depression and anger may appear in the form of agitation, restlessness, agitation, or even hostility. This may occur as the person is alone or may be brought about by family members who attempt to manipulate the situation by taking a caregiver role. Agitation, restlessness, and loss of sleep can also cause a senior to become dehydrated. In turn, dehydration can cause symptoms that resemble more serious problems. For example, people with Alzheimer's disease who refuse food may be experiencing problems with hydration. Because of this, it is essential that the elderly person be monitored to make sure that they are eating properly and drinking enough fluids. In addition, the use of a "soft" or liquid diet is highly recommended for people who are losing weight because of dehydration. This usually indicates that the person is retaining fluid. People who have Alzheimer's disease may also experience "wandering" or "night wandering" (also called nocturnal wandering), which is a frightening and unpredictable experience for both the person with the disease and his or her caregiver. These symptoms may appear only during the day or may also involve episodes during the night. These episodes may include going out of the house, walking on the street or highway at night, or being found asleep in a strange location. Wandering may be triggered by stress, pain, or confusion. Wandering can also cause injury. Wandering should not be confused with simple nighttime bathroom visits. If the problem continues, it may be necessary to place the person in a home where someone can sit with him or her at night. #### **Avoiding Falls in the Elderly** One of the greatest causes of death in older adults is falling. As the elderly person grows older, he or she is more likely to fall. Falling can also cause severe injury or even death. In fact, the elderly person who has had a hip replacement may be more at risk for falling than the individual who has never had hip surgery. This is because once a person has surgery, he or she usually has a temporary reduction in muscle tone, which may be followed by an increased tendency to fall. The most frequent cause of falls among the elderly is inadequate supervision when the person leaves the house, gets in or out of the car, or uses the bathroom or kitchen. The elderly are more likely to sustain a fall in the bathroom than any other location in the home. Many older adults feel safer if a roomy bathtub is placed next to the bedroom. It is also important that the bathroom have sturdy wall-mounted grab bars near the toilet, sink, and shower. Grab bars should be placed on both sides of the toilet and on both sides of the bathtub as well as near the shower. The side rails of the bathtub are also an important safety feature and should be at least 26 inches (66 cm) high. If the person should fall, a strong bar or railing should be installed near the tub. #### **Palliative Care** Families can best take care of a senior at home by being aware of and taking steps to avoid dangerous falls. A fall can turn a minor health problem into a dangerous situation. It is important to have a plan for when to call 911 for a home health care worker to help. When death has occurred, the family's work has only begun. Most elderly people with serious illnesses receive hospice care from doctors or nurses who specialize in palliative care. However, the emotional toll is significant. Family caregivers who help the elderly person get through the process of dying by showing love and respect can make an important contribution to the quality of the dying experience. This may mean being with the person, offering him or her comfort, taking turns with the caregiver, accepting the natural process of dying, and allowing the patient to die. This is especially important if a disease is progressing. The process of dying may include: • Changing breathing patterns • Delays in breathing • Sudden apnea or breathing pauses • Difficulty swallowing and eating • Nausea and vomiting • Blo