3.2: Observing and Reporting Changes

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Page ID: 67574

Erin O'Hara-Leslie, Amdra C. Wade, Kimberly B. McLain, SUNY Broome

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As Home Health Aides/Personal Care Aides work with elderly patients, they may come to have first-hand knowledge of the physical and psychological changes that occur during the aging process. They may also come to recognize and be the first to notice signs of a new disorder or disease process that is not related to the aging process, but which can be mistaken for and disregarded as “just aging.”

For example, it is not a normal part of aging to have dementia. If a patient suddenly begins to show signs of forgetfulness, difficulty concentrating, or disorientation (an inability to recognize themselves, where they are, what year or season it is or events that are occurring), the HHA/PCA should immediately report these signs to their supervisor. These signs are not necessarily due to “just aging”. They could be signs of a stroke or dementia related to Alzheimer’s or a vascular (blood vessel) problem, such as changes in oxygenation within the brain. Confusion and delirium could also be the result of side effects from medications, drug-drug interactions, dehydration, or infection (Mauk, 2008). It is important to remember that aging in and of itself is normal, and not part of a disease (Leahy, Fuzy & Grafe, 2013).

It is also not a normal part of aging for older adults to experience incontinence (loss of control of bowel or bladder). These could be signs of medication side effects, urinary tract infections or imbalances of electrolytes in the body (Mauk, 2008). It is also not a normal part of aging for adults to fall. Falls can be the result of medication side effects, medication interactions, or a sign of an acute (sudden) illness (Mauk).

If Home Health Aides/Personal Care Aides notice any of the following, especially if they occur suddenly, they should immediately report them to their supervisor:

Disorientation (to self, place, time, event)
Difficulty concentrating
Difficulty speaking
Difficulty chewing/swallowing
Depression
Suicidality (statements of wanting to die or hurt oneself)
Mood changes or sudden shifts in mood from happy to depressed
Insomnia (difficulty getting to or staying asleep)
Anorexia (lack of appetite/eating)
Inability to use a limb (arm or leg)
Drooping of the face, either one side or both sides of the face or mouth
Lack of balance or coordination
Changes in grooming or self-care
Incontinence (loss of bladder or bowel)

If something just doesn’t seem “right” to them based on what they know of the patient

Self Check Activity \(\PageIndex{1}\)

True or False?

1. Forgetfulness, disorientation, incontinence, and mood changes are signs of aging. True or False. _________

2. It is normal for older adults to fall. True or False. _________

Answer

1. False

2. False

FEEDBACK:

1. Forgetfulness, disorientation, incontinence, and mood changes are not signs of aging. They may indicate a serious underlying issue to which the health care team should be alerted.

2. It is not a normal part of aging for older adults to fall. This could be a sign of a problem with a medication or an illness.

Confidentiality

It is important for Home Health Aides/Personal Care Aides to remember to protect their patient’s privacy at all times. This means providing privacy during self-care such as bathing, toileting, and dressing. It can be easy to forget to do this if they are rushed, or if family caretakers are around. But remember, Home Health Aides/Personal Care Aides are there to care for and protect their patient.

It is also important to remember to maintain confidentiality of what their patient tells them and about their health care. Only share information with family and friends whom the patient wishes to share with. Just because a patient is elderly does not mean that they do not have the right to privacy and confidentiality. Do not be dismissive of their wishes, even if they are forgetful. It is up to the Home Health Aide/Personal Care Aide to protect them.

Self Check Activity \(\PageIndex{1}\)

True or False?

1. Even people who are forgetful have a right to confidential and respectful treatment. True or False. _________

2. It is important to protect patient privacy at all times, especially when bathing, toileting, or dressing. True or False. _________

Answer

1. True

2. True

Feedback:

1. Every person has the right to confidential and respectful treatment. Just because a person is forgetful or elderly does not mean they lose these rights.

2. It is always important to protect a patient’s privacy. This is especially true when patients are vulnerable and exposed, such as times of dressing, bathing, and toileting.