In old age various changes take place in the body as a result of the strain of living. The chief changes are in the walls of the blood-vessels, and there is a great deal of truth in the saying that " man is as old as his arteries." The bloodvessels in youth are elastic, but as age advances they gradually become converted into inelastic tubes due to a hardening of the walls. Thus the tissues do not get the same supply of fresh arterial blood, and they gradually deteriorate. This process can be retarded for many years by a hygienic mode of life. Elderly people, also, can have their energies preserved and their condition made much more comfortable by proper care and attention.
So that an article dealing with the care of elderly people, especially when they are sick, may be of service in many households.
The chief illnesses of old age are bronchitis and other ailments of the respiratory passages, rheumatism, and various affections of the joints. These are associated very often with weakness of the veins, and heart affections may be secondary to bronchitis. The circulation is poor, and so the skin becomes dry and wrinkled, and is liable to eczema and other skin ailments.
Many old people suffer from bronchitis every winter, and need to have a few days, at least, in bed. The one important thing in these cases is to protect the patient against chill, and this is especially necessary if they are going about. In the very cold weather old people should be careful to guard against sudden changes of temperature, as they may contract chill even from going out of a warm room into cold passages and bedrooms.
In any sharp attack of bronchitis the patient should be put to bed and carefully looked after by the nurse. She should keep the room at a temperature of about 70°, and so long as the cough is troublesome bronchitis kettle may be needed, so that the patient is breathing hot. moist air all the time. Linseed meal poultices should be applied across the back of the chest and changed frequently.
Old people often require to have brandy every four hours if the pulse is irregular and weak, whilst even in cases of chronic bronchitis a certain amount of alcoholic stimulant will generally be ordered by the doctor. The chest may be rubbed with liniment, and covered with a cotton-wool jacket. Owing to poor circulation, the nurse must be careful to keep the patient warm, and supply hot bottles if there is any chilliness of the feet.
In nursing elderly people care must be taken to prevent any burning of the feet with a hot bottle, which should always be wrapped in flannel. Wounds and burns heal much more slowly in old age, and any injury may be the starting-point of bed-sores. Medicated lozenges are often very useful for elderly people suffering from chronic bronchitis, one of the best being the benzoic lozenge.
The nurse in charge of an elderly sick person should pay special attention to the question of diet. Old people, especially when they are ill, require to have the strength kept up by giving meals very frequently, and in a more easily digested form than is the case with younger people. Their digestion is unable to deal satisfactorily with the sort of diet that a man in full, vigorous health can assimilate with facility. They require, like children, to have a good deal of milk, eggs, and such easily digested foods as arrowroot, gruel, custard puddings, and stewed fruit. Old people crave for fat, and should have it in some easily digested form, such as cream, butter, or fat of freshly cooked meat, etc.
Between breakfast and luncheon, which should consist of light, nicely served food, a glass of milk and a biscuit may be given. Butcher's meat should only be served once a day, the best being under-done mutton cut up finely, chicken, pigeon, and occasionally a little freshly cooked beef. Raw meat juice is very useful, and pounded raw meat sandwiches are nourishing and easily digested.
The following are a few recipes which should be found useful for a nurse in charge of elderly people whose strength has to be kept up by nourishing, easily digested diet.
Egg Whey. A pint of milk is boiled with fresh lemon-juice, and is then put in a little muslin bag. The whey is squeezed through, and five ounces beaten up with a new-laid egg and a little brandy added.
Milk Jelly. Add a little isinglass to half a pint of hot milk, and serve this with cream if desired. Peptonisation is often necessary for old age to aid the stomach, especially if there is pain and flatulence after food. Somatose is a useful peptonised food, and full directions are given with the pepto-nising powders which are bought at the chemist's.
Blancmange for an Invalid. This is best made by dissolving an ounce of isinglass in a pint of milk, and straining it through muslin. This is then put in an enamel saucepan with an ounce of pounded sugar and the thin peel of a lemon. The lemon peel should be taken out before the milk reaches boiling point, and the milk is then poured into a mould.
Egg Flip. The yolk of an egg is beaten with an ounce of milk, then a wineglassful of port wine is added to this, with a lump of sugar and grated nutmeg.
Milk Gruel. Two tablespoonfuls of fine oatmeal is mixed in a little water, then half a pint of boiling milk is added, and the mixture boiled for fifteen minutes.
Milk and Suet. Mince finely half an ounce of fresh beef suet. Boil this with a tumblerful of milk until the suet is melted. Skim carefully and strain. Serve very hot.
To make milk gruel the milk must be boiling when poured on to the oatmeal, previously mixed with a little water
Chicken and mutton broths, beef tea, cocoa made with milk, scrambled eggs, wine and fruit jellies are all useful foods, and provide variety in the diet.
Mints on the Nursing of Joint and Rheumatic
In nursing joint and rheumatic affections liniments will be found very useful, and when the joint is very painful it should be kept wrapped in cotton-wool.
Massage should be performed once or twice a day, as it improves the circulation, takes away stiffness, and is useful in all cases of nursing elderly people, acting as a stimulant, and at the same time soothing the nervous system and inducing sleep.
Whether or not associated with gout, eczema is apt to be troublesome in elderly people. The nurse should cleanse any part affected with olive oil, and then apply zinc or boracic ointment. When the eczema is acute, special care must be taken that the water never comes in contact with the irritated surface. Calamine lotion applied with cotton-wool is quite sufficient for cleansing purposes.
Numbness and pain, moreover, are symptoms often complained of by elderly people owing to changes in the circulation and in the nerves. The nurse cannot do better than apply gentle massage. Electrical treatment also, if the doctor recommends it, will probably give relief. The battery can be bought and used in the sick-room, but the doctor will have to explain carefully to the nurse how the electricity should be applied. His orders must be carried out exactly. The nurse will be told, for example, to see that the connections of the battery are tightly screwed on, that the sponges are thoroughly wet before use, and removed and dried afterwards. The nurse must give confidence to the patient, and, to avoid unnecessary shock, she should always try the battery on herself first, Electricity is also useful in various nervous cases, such as paralysis and after apoplexy, for instance. Massage and electricity are the chief methods of treatment of any paralysed part.
The nurse should always attend to clothing and bed-clothing, as old people feel cold very readily, and any chill will retard their recovery. A light woollen nightdress should be worn, and two or three blankets in addition to the sheets and cover will generally be required.