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Sorrentino: Mosby’s Essentials for Nursing Assistants, 3rd Edition
Instructor’s Resource Manual
Chapter 7: Caring For the Older Person
Instructor’s Preparation
Read Chapter 7 in the textbook.
Review chapter objectives, key terms, and review questions for Chapter 7 in the text-book.
Read the outline and classroom activities in Chapter 7 of this Instructor’s Resource Manual.
Review the student assignment and the quiz in Chapter 7 of this Instructor’s Resource
Manual.
V.
Review the PowerPoint slides for Chapter 7.
VI.
Review Electronic Images for Chapter 7.
VII.
If you are using the accompanying Student Workbook, review the activities for Chapter 7.
VIII.
Collect all necessary supplies and equipment for the classroom activities and student
assignments.
A. Collect PowerPoint slides.
B. Prepare appropriate flip charts.
C. Prepare index cards.
D. Collect colored markers.
E. Collect any other items that will be needed for classroom activities.
F. Assemble items in the order they will be used.
IX.
Make sure that the necessary equipment is available and in good working order.
X.
Contact guest speakers to confirm the day, date, time, and location that each speaker is
expected.
A. Ask each speaker if he or she requires any special equipment or supplies. Make sure these
are available.
I.
II.
III.
IV.
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Objectives
Define the key terms listed in this chapter
Identify the developmental tasks of each age group
Identify the social changes common in older adulthood
Describe the physical changes from aging and the care required
Describe the gains and losses related to long-term care
Describe the sexual changes and needs of older persons
Explain how to deal with sexually aggressive persons
Key Terms
development
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Instructor’s Resource Manual
developmental task
geriatrics
gerontology
growth
menopause
old
old-old
ombudsman
sexuality
young-old
Outline and Classroom Activities
I. INTRODUCTION
A. People live longer than ever before.
B. Most older people live with a partner, children, or other family.

Write the following terms on the chalkboard:
o Young-old
o Old
o Old-old
 Call on students to provide the age ranges for each term. Write in the correct
answers.
C. Late adulthood involves these age ranges:
1. Young-old—between 65 and 74 years of age
2. Old—between 75 and 84 years of age
3. Old-old—85 years of age and older
D. Gerontology is the study of the aging process.
E. Geriatrics is the care of aging people.
F. Aging is normal.

Invite an older person or persons to speak to the class about aging. Ask them to:
o Discuss the physical, psychological, and social changes they have experienced.
o Discuss how they have coped with the changes.
o Share both positive and negative experiences related to aging.
 Encourage students to ask questions.
 Provide time after the presentation for the guests and the students to socialize.
Provide a beverage and a healthy snack.
1. Normal changes occur in body structure and function.
a. They increase the risk for illness, injury, and disability.
2. Psychological and social changes also occur.
3. Most changes are slow.
a. Most people adjust well to these changes.
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II. GROWTH AND DEVELOPMENT

Call on students to explain the difference between growth and development.
A. Growth is the physical changes that are measured and that occur in a steady and orderly
manner.
B. Development relates to changes in mental, emotional, and social function.
C. Growth and development occur in a sequence, order, and pattern.
1. Certain skills must be completed during each stage.
a. A developmental task is a skill that must be completed during a stage of
development.
2. A stage cannot be skipped.
3. Each stage has its own characteristics and developmental tasks.
a. See Box 7-1 on p. 83 in the textbook.

Review the contents of Box 7-1 on p. 83 in the textbook with students.
o Allow time for questions and discussion.
III. SOCIAL CHANGES


Divide students into three groups. Provide each group with several sheets from a flip
chart and colored markers.
o Assign each group to make a list of the social changes that occur with aging.
o Allow them 5 minutes to complete the list. Then call on one student from each group
to display a portion of the groups list and review it with the class.
 Allow time for discussion.
Ask students to share any personal experiences with change and loss.
o What factors influenced how they adjusted to the change and/or loss?
o What support systems did they use?
A. The following social changes occur with aging:
1. Retirement
a. Retirement is a reward for a lifetime of work.
b. Some people retire because of poor health or disability.
c. Some retired people have part-time jobs or do volunteer work.
2. Reduced income
a. Retirement often means reduced income.
(1) Social Security may provide the only income.
(2) The retired person may still have expenses.
b. Some people have income from savings, investments, retirement plans, and
insurance.
3. Social relationships
a. Social relationships change throughout life.
b. Most older people have regular contact with family and friends.
c. Others are lonely.
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(1) Involvement with family, friends, and community help prevent loneliness.
4. Children as caregivers
a. Some children care for older parents.
b. Parents and children change roles.
(1) This helps some older persons feel secure.
(2) Tensions may occur.
5. Death of a partner
a. When a partner dies, the loss is crushing.
(1) The person loses a friend, lover, companion, and confidant.
(2) Serious physical and mental problems can result.
(a) Some attempt suicide.
IV. PHYSICAL CHANGES
A. Physical changes occur over many years.
1. Body functions slow down.
2. Energy level and body efficiency decline.

Write these systems on individual index cards: Integumentary, Musculoskeletal,
Nervous, Circulatory, Respiratory, Digestive, and Urinary.
o Divide students into seven groups. Have each group pick one index card.
o Allow each group 10 minutes to:
 Describe the age-related changes that occur in the system on their card.
 Describe how these changes might affect the person’s life.
o Ask one person from each group to report to the class.
 Allow time for questions and discussion.
B. The integumentary system
1. The skin loses its elasticity and fatty tissue layer.
a. The skin thins and sags.
b. Folds, lines, and wrinkles appear.
2. Oil and sweat secretion decreases.
a. Dry skin occurs.
b. The skin is fragile and easily injured.
(1) Skin breakdown and pressure ulcers are risks (Chapter 21).
3. Brown spots appear on the skin.
4. The skin has fewer nerve endings.
a. This affects sensing heat, cold, and pain.
(1) Protect the person from drafts and cold.
5. Dry skin causes itching.
a. It is easily damaged.
(1) A shower or bath twice a week is enough for hygiene.
(2) Mild soaps or soap substitutes are used.
(3) Lotions, oils, and creams prevent drying and itching.
b. Deodorants usually are not needed.
6. Nails become thick and tough.
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a. Feet usually have poor circulation.
(1) A nick or cut can lead to a serious infection.
7. Hot water bottles and heating pads are not used.
a. Burns are great risks.
8. White or gray hair is common.
9. Hair loss occurs in men.
a. Hair thins on men and women.
10. Facial hair (lip and chin) may occur in women.
11. Hair is drier from decreases in scalp oils.
a. Shampoo frequency depends on personal choice.
C. The musculoskeletal system
1. Muscles atrophy (shrink).
2. Muscles decrease in strength.
3. Bones lose strength, become brittle, and break easily.
4. Joints become stiff and painful.
5. Vertebrae shorten.
6. Hip and knee joints flex (bend) slightly.
a. There is gradual loss in height and strength.
b. Mobility decreases.
7. Activity, exercise, and diet help prevent bone loss and loss of muscle strength.
8. Bones can break easily.
a. Protect the person from injury and prevent falls (Chapter 8).
b. Turn and move the person gently and carefully.
c. Provide help and support as needed.
D. The nervous system
1. Brain cells are lost over time.
2. There is reduced blood flow to the brain.
3. Changes in the nervous system can:
a. Cause dizziness
b. Increase the risk of falls
c. Affect personality and mental function
d. Slow responses
e. Cause confusion and fatigue
4. Many older people are mentally active and involved in current events.
a. They show fewer personality and mental changes.
5. Less sleep is needed.
a. Older people may rest or nap during the day.
b. Their sleep periods are shorter.
6. The senses
a. Hearing and vision losses occur (Chapter 24).
b. Taste and smell dull.
c. Touch and sensitivity to pain and pressure and heat and cold are reduced.
(1) These changes increase the risk for injury.
d. You need to:
(1) Protect older persons from injury (Chapter 8).
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E.
F.
G.
H.
(2) Follow safety measures for heat and cold (Chapter 21).
(3) Give good skin care (Chapter 13).
(4) Prevent pressure ulcers (Chapter 21).
The circulatory system
1. The heart muscle weakens.
a. It pumps blood with less force.
2. Arteries narrow and are less elastic.
a. Poor circulation occurs in many body parts.
3. Sometimes circulatory changes are severe.
a. Rest is needed during the day.
b. Doctors may order certain exercises and activity limits.
The respiratory system
1. Respiratory muscles weaken.
2. Lung tissue becomes less elastic.
a. Difficulty breathing (dyspnea) may occur with activity.
b. The person may lack strength to cough and clear the airway of secretions.
c. Respiratory infections and diseases may develop.
3. Normal breathing is promoted.
a. Avoid heavy bed linens over the chest.
b. Turning, repositioning, and deep breathing are important.
c. Breathing usually is easier in semi-Fowler’s position (Chapter 12).
d. The person should be as active as possible.
The digestive system
1. Salivary glands produce less saliva.
a. This can cause difficulty swallowing (dysphagia).
2. Taste and smell dull.
a. This decreases appetite.
3. Secretion of digestive juices decreases.
4. Loss of teeth and ill-fitting dentures cause chewing problems.
5. Peristalsis decreases.
a. Flatulence and constipation can occur (Chapter 16).
6. These measures are needed:
a. Dry, fried, and fatty foods are avoided.
b. Oral hygiene and denture care improve taste.
c. Persons with chewing problems or constipation often need foods providing soft
bulk.
The urinary system
1. Kidney function decreases.
2. The kidneys shrink (atrophy) and blood flow to the kidneys is reduced.
a. Waste removal is less efficient.
3. Bladder muscles weaken.
4. Bladder size decreases.
a. Urinary frequency or urgency may occur.
(1) Many older persons have to urinate during the night.
b. Urinary incontinence may occur (Chapter 15).
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5. In men, the prostate gland enlarges.
a. Difficulty urinating or frequent urination occurs.
6. Urinary tract infections are risks.
a. Adequate fluids are needed.
(1) Most fluids should be taken before 1700 (5:00 PM).
I. The reproductive system
1. Female
a. The ovaries produce less estrogen and progesterone.
(1) Changes usually begin around age 40.
(2) Most women complete menopause by their mid-50s.
(a) Menopause is the time when menstruation stops and menstrual cycles end.
b. The ovaries and uterus decrease in size.
c. External genitalia shrink and lose elastic tissue.
d. Vaginal walls become thinner, dryer, and lose elastic tissue.
(1) This can cause itching and painful intercourse.
e. Breasts are less firm and sag.
2. Male
a. Fewer healthy sperm are produced.
b. The force of ejaculation is decreased.
c. Testosterone levels decrease.
d. The testes become less firm and smaller.
e. The prostate gland enlarges.
(1) In severe cases, surgery is needed.
f. Erections develop more slowly.
g. It takes longer to regain an erection after intercourse.
V. NEEDING NURSING CENTER CARE
A. Most older persons are healthy and live in their own homes.
B. Nursing centers are designed to meet the needs of older and disabled persons.
1. A safe, secure, caring setting is provided.
C. Persons entering nursing centers may experience some or all of these losses:

Ask students to make a list of the roles, possessions, and activities that give meaning to
their lives. Then ask them to cross off the roles, possessions, and activities they would
need to give up or change if they were ill or injured and needed to enter a nursing
center. Ask them to consider these factors:
o They may need to share a room with a person they do not know.
o They may be in a wheelchair.
1. Loss of identity as productive members of families and communities
2. Loss of possessions
3. Loss of independence
4. Loss of real-world experiences
5. Loss of health and mobility
D. Losses may cause a person to feel useless, powerless, and hopeless.
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1. You must:
a. Treat residents with dignity and respect.
b. Practice good communication skills.
c. Follow the person’s care plan.
VI. SEXUALITY
A. Sexuality is the physical, psychological, social, cultural, and spiritual factors that affect a
person’s feelings and attitudes about his or her sex.
1. It involves the personality and the body.
B. Love, affection, and intimacy are needed throughout life.
C. Attitudes and sex needs change as a person grows older.
1. Sexual relationships remain important to older persons.
2. They love and fall in love, hold hands, embrace, and have sex.
3. Frequency of sexual activity often decreases; reasons include:
a. Weakness and fatigue
b. Pain
c. Reduced mobility
a. The illness or injury of one or both partners
4. Some older people do not have sexual intercourse.
a. This does not mean sexual needs or desires are lost.
b. They can express their needs in other ways.
5. Sexual partners are lost by:
a. Death
b. Divorce and ending a relationship
c. A partner in a hospital or nursing center
D. Meeting sexual needs

Ask students to discuss:
o The importance of sexuality in their lives.
o How they might feel if illness, injury, or surgery changed their sexual function
o How they might cope with changes in sexual function
1. The nursing team allows and promotes the meeting of sexual needs.
a. The measures in Box 7-2 on p. 87 in the textbook may be part of the person’s care
plan.


Review the measures in Box 7-2 on p. 87 in the textbook with students.
o Allow time for questions and discussion.
Use a round table discussion format. Ask students to discuss:
o Their role in promoting the meeting of sexual needs of patients and residents
o Their comfort level in promoting the meeting of sexual needs of patients and
residents
o How they might deal with their feelings
2. Married couples in nursing centers are allowed to share the same room.
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a. They can share the same bed if their health permits.
E. The sexually aggressive person
1. Often there are reasons for the person’s behavior.
a. For men: illness, injury, surgery, or aging often threatens feelings of manhood.
b. Some sexually aggressive behaviors are from confusion or disorientation.
(1) Common causes are:
(a) Nervous system disorders
(b) Drugs
(c) Fever
(d) Dementia
(e) Poor vision
c. Sometimes touch serves to gain attention.
d. Some persons touch and fondle the genitals for sexual pleasure.
(1) This is called masturbation.
(a) Masturbation can be:
(i) A sexually aggressive behavior
(ii) A result of urinary or reproductive system disorders
(iii) A result of poor hygiene or being wet or soiled from urine or feces
(iv) The result of a health problem
2. Sexual advances may be intentional.

Using a round table discussion format, ask students to discuss any issues related to the
sexually aggressive person. Ask them to share any experiences they may have had
dealing with sexually aggressive persons.
o The purpose is to:
 Help students identify some of the reasons for sexually aggressive behaviors.
 Help students to develop approaches for dealing with the behaviors.
a. You need to be professional about the matter.
(1) Ask the person not to touch you.
(a) State the places where you were touched.
(2) Tell the person that you will not do what he or she wants.
(3) Tell the person what behaviors make you uncomfortable.
(a) Politely ask the person not to act that way.
(4) Allow privacy if the person is becoming aroused.
(a) Provide for safety (Chapter 8).
(b) Tell the person when you will return.
(5) Discuss the matter with the nurse.
3. The care plan has measures to deal with sexually aggressive behaviors.
VII.

OMBUDSMAN PROGRAM
Invite your local Ombudsman to visit the class. Ask him or her to explain the role of the
ombudsman in long-term care centers.
o Allow time for questions and discussion.
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A. The Older Americans Act is a federal law.
1. It requires a long-term care ombudsman program in every state.
a. An ombudsman is someone who supports or promotes the needs and interests of
another person.
(1) Long-term care ombudsmen work for a state agency.
(a) They act on behalf of nursing center and assisted living residents.
B. Ombudsmen protect the health, safety, welfare, and rights of residents.
1. They do the following:
a. Investigate and resolve complaints
b. Provide services to assist residents
c. Provide information about long-term care services
d. Monitor nursing center care and conditions
e. Provide support to resident and family groups
C. Residents have the right to:
1. Voice grievances and disputes
2. Communicate privately with anyone of their choice
D. Nursing centers must post the names, addresses, and phone numbers of local and state
ombudsmen.
1. This information must be posted where residents can easily see it.
E. You must know state and center policies and procedures for contacting an ombudsman.
F. Ombudsman services are useful when:
1. There is concern about a person’s care or treatment
2. Someone interferes with a person’s rights, health, safety, or welfare
VIII. FOCUS ON THE PERSON
A. Health care agencies must meet certain standards.
1. Standards are set by federal and state governments and by accrediting agencies.
2. Surveys are done to see if the agency meets set standards.
B. Focus on the person: care of the older person
1. Providing comfort
a. A safe, clean, and comfortable setting is a common standard.
2. Ethical behavior
a. The survey team listens to what you say and do.
(1) Always practice good work ethics (Chapter 3).
(2) Do not use the survey team to share personal complaints.
b. The focus of the survey is on the standards for quality care.
3. Remaining independent
a. Check the person’s care plan for how and when to assist the person.
(1) Assist only as needed.
(2) Do not do things that the person can do alone.
4. Speaking up
a. The survey team may ask you questions about the agency and the care you give.
(1) You must answer questions completely and honestly.
5. OBRA and other laws
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a. Nursing centers and hospitals with long-term care units must meet OBRA
standards.
b. A survey team will:
(1) Review policies, procedures, and medical records
(2) Interview staff, patients and residents, and families
(3) Observe how care is given
(4) Check for cleanliness and safety
(5) Make sure staff meets state requirements
c. If standards are met, the agency receives a certification.
d. If problems are found, the agency must correct them.
6. Nursing teamwork
a. Surveyors observe the nursing team.
(1) They expect the nursing team to work together to provide quality care.
(2) You must:
(a) Provide quality care
(b) Protect the person’s rights
(c) Provide for safety
(d) Help keep the agency clean and safe
(e) Act in a professional manner
(f) Have good work ethics
(g) Follow agency policies and procedures
Homework Assignment
Ask students to answer the questions at the end of Chapter 7 in the textbook. Tell them the
date and time this assignment must be completed and turned in.
If the accompanying Student Workbook is being used, assign the Chapter 7 workbook
exercises. Tell students the date and time this assignment must be completed and turned in.
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Chapter 7 Student Assignment
Name: ____________________
Date: ____________________
Caring For the Older Person
Fill in the Blanks
1. The developmental tasks of late adulthood are:
A. _______________________________________________________________
B. _______________________________________________________________
C. _______________________________________________________________
D. _______________________________________________________________
E. _______________________________________________________________
2. Gerontology is ____________________________________________________.
3. List four changes that occur in the senses with aging that increase a person’s risk for
injury.
A._______________________________________________________________
B._______________________________________________________________
C._______________________________________________________________
D._______________________________________________________________
4. ______________________________________________________________ is the time
when menstruation stops and menstrual cycles end.
5. Some persons touch and fondle the genitals for sexual pleasure. This is called____
_________________________________________________________________.
6. Long-term care ombudsmen work for __________________________________. They
act on behalf of _______________________________________________.
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Chapter 7 QUIZ
Name: ____________________
Date: ____________________
Caring For the Older Person
True or False
Mark T for true or F for false.
1. _________Gerontology is the study of the aging process.
2. _________Growing old is only a physical process.
3. _________ Quality of life always declines as people age.
4. _________ As people age, muscles atrophy and strength decreases.
5. _________ The senses of smell and taste decrease with age.
6. _________ As people age, lung tissue becomes more elastic.
7. _________ Older persons are at risk for urinary tract infections.
8. _________ Nursing centers provide care for persons who cannot care for themselves.
9. _________Attitudes about sex and sex needs stay the same as a person ages.
10. _________Injury and illness can affect sexual function.
11. _________All sexually aggressive behaviors are intentional.
12. _________The nursing team has an important role in promoting the person’s sexuality
needs.
13. _________Every nursing center must hire a long-term care ombudsman.
Multiple Choice
Circle the BEST answer.
14. Retirement usually means
A. The person is ill or disabled.
B. The person moves in with children.
C. The person needs adult day care.
D. The person has reduced income.
15. Changes in the integumentary system occur with aging. Which statement is true?
A. The skin is fragile and easily injured.
B. Tub baths or showers are needed daily.
C. Hot water bottles are used to keep the person warm.
D. There is an increased sensitivity to pain.
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16. Aging requires certain dietary changes. Which is true?
A. Older people need more calories than younger people.
B. Fewer fluids are needed.
C. High protein foods should be avoided.
D. Older persons need foods that prevent constipation.
17. Changes in the circulatory system occur with aging. Which statement is false?
A. The heart muscle becomes less efficient.
B. Arteries narrow are less elastic.
C. The heart muscle pumps with greater force.
D. Poor circulation may occur in many body parts.
18. Female hormones decrease with menopause. Which is not an effect of reduced hormone
levels?
A. The uterus, vagina, and external genitalia atrophy.
B. Intercourse may be uncomfortable.
C. Menstruation stops.
D. Sexual desire is lost.
19. Sexual activity
A. Always involves intercourse
B. Is not allowed in nursing centers
C. Involves handholding, touching, and embracing
D. Is unhealthy for older persons
20. The time when menstruation stops is called:
A. Menopause
B. Impotence
C. Orgasm
D. Testosterone
21. A patient touches you inappropriately. You should:
A. Say nothing and leave the room.
B. Politely ask the patient to stop and talk to the nurse.
C. Tell the patient’s family about the behavior.
D. Call the patient’s doctor
22. Reproductive organs change with aging. In men
A. The hormone testosterone increases.
B. An erection takes longer.
C. Orgasm is more forceful.
D. The time between erections is shorter.
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23. Some older persons live with adult children. Which is false?
A. This arrangement provides companionship.
B. Living with an adult child is a social change.
C. Everyone in the home must adjust.
D. All older persons like living with their children.
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