Geriatric care


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Geriatric care

  2. 2. GERIATRIC ORGERONTOLOGICAL NURSING-Childhood, youth, adulthood and old age are differentstages of life. With increasing age we become old. Birth,development, decline and death are the laws of life. Whetherwe want it or not, we have to pass through these stages. Oldage is also one part of this cycle.What is ageing?Old age or ageing expresses the continuous pressureand effect of time on our body, senses and skin. Due tocontinuous functioning, the cells, tissues and organs of ourbody degenerate. In the later part of life, we have to face manyphysical and mental problems. Hence old age is the result ofphysical and psychological fatigue caused by continuousfunctioning. Just like problems or defects occur in machinesdue to continuous functioning, or workload, with increasingage, problems also arise in human body.
  3. 3. Ageing and Demography Large number of aged people in the population is theresult of demographic change. The number of people above 60 years is assessed tobe over 49 crores in world. By 2040, their numberwill be 140 crores. (According to the prediction of(W.H.O). As compared to old men, there are more old women. Because of the increasing number of old people,many socio-economic problems are arising. The mainproblems are of housing, their livelihood and medicaltreatment. French doctor Jean Martan Carcot was the firstperson who had studied about old age diseases, in theyear 1881.
  4. 4. National Policy for Older PersonsThe Government of India in January-1999announced the National Policy for older persons. Theprinciple areas of intervention and action strategiessuggested in the policy sector include the following: Financial security for older persons working in theformal sector as well as those working in the informalsector. Health care and nutrition to enable older persons to copewith the health, associated with ageing, with particularemphasis on prevention. Shelter/housing keeping in view the life style of olderpersons. Emphasis upon education, training and information needsfor older persons. Priority attention to vulnerable groups such as thedestitute, widows and disabled older
  5. 5.  Establishment of welfare fund for older persons. Protection of life and property of older persons. Concessions, rebates and discounts to older persons. Participation of NGOs in the care of aged. Strengthening the family and reinforcing inter-generational relationship between children and olderpersons. Formation of self-support group of older persons. Development of the manpower for the caring ofaged. Creative use of media in the sector for care of oldpersons. Establishment of a separate bureau for older personsin the
  6. 6. GerontologyThis is a science dealing with ageingprocess.Geriatric CareThis is related to the disease process ofold age and it aims at keeping old persons at astate of self-dependence as far as possible and toprovide facilities to improve their quality of life.Gerontoiogical Nurse-A nurse who has specialization in geriatricsor in the care of old people is called geriatricnurse or gerontoiogical
  7. 7. Functions of Gerontoiogical Nurse- G (Guiding): Giving guidance to people of all agesregarding ageing process. E (Eliminating): Eliminating ageism or considering oldage as disease. R (Respecting): Respecting the rights of old people. O (Observing): Observing the facilities provided to oldpeople and improving them. N (Noticing): Noticing health hazards that may happenin old age and try to reduce them. T (Teaching): Teaching how to take care of old people,for those who are caring for them (family members,friends, community health worker, voluntaryorganization, etc.). O (Opening Channels): Opening the channels ofdevelopmental activities for the care of the
  8. 8.  L (Listening): Listening attentively to the problems of old people andgiving due importance to them. 0 (Offering): Offering positivism – Presenting different possibilitiesof life. G (Generating): Generating energy for the participation in the care ofaged and researches for new supporting techniques. I (Implementing): Implementing activities for rehabilitation and re-adjustment. C (Co-coordinating): Co-coordinating different services related to thecare of the aged. A (Assessing): Assessing the needs and health of the old people. L (Linking): Linking, contacting services according to need. N (Nurturing): Preparing future nurses for the care of the aged U (Understanding): Understanding every old person as an invaluableasset of the society. R (Recognizing): Recognizing the moral and religious aspects of old ageand giving them recognition. S (Supporting): Supporting the old people in accepting realities andpreparing them mentally for impending death. E (Education and Encouraging): Educating and encouraging old peoplefor self
  9. 9. Factors Affecting Ageing Hereditary FactorsHereditary diseases, the capacity for longevityand physical capacities influence the ageing process. Environmental FactorsThree types of environmental factors affect ageing:a) Abiotic FactorsFactors affecting ageing process like climate, radiation, chemical andphysical elements of pollution, etc. are included in this.b) Biotic FactorsIn this, living organisms present in the environment like pathogens,parasites, the availability and quality of food etc. are included. Theyall influence the ageing of the person.C) Socio-economic FactorsSeveral socio-economic factors responsible for creating adverse livingor working conditions increase "the wear and tear" of life. Suchtensions make people grow old
  10. 10. Common Ageing ChangesPhysical Changes-Changes, which may occur in different systems, are as follows:1. Integumentary System Decrease in elasticity of skin and dryness appears Wrinkles appear Age spots appear Hair of head, axilla or pubic region become scanty grey/white Hair growth on womens face Thickening of nasal hair and hair on ears2. Cardiovascular System Less blood circulation in heart Increased blood pressure Flexibility of heart valve diminishes Blood vessels of head, neck, hands and legs become prominent.3. Respiratory System The capacity of lungs becomes less. Ineffective gas exchange The chances of cough increases More chances of respiratory
  11. 11. 4. Genito-Urinary System The kidney function may be impaired Fluid and electrolyte imbalance Capacity of urinary bladder decreases Incontinence Enlargement of prostate in males Atrophy of reproductive organs in females Vaginal secretion decreases5. Gastro-intestinal System Falling of teeth Less secretion of saliva and gastric juice Complaints of constipation Digestion becomes weak6. Musculo-Skeletal System Height reduces (In most of persons above 70 years height decreasesunto two inches) Kyphosis, swelling in joints Bones become weak Mobility decreases, if proper exercise is not
  12. 12. 7. Endocrine System Thyroid gland becomes less active Alertness decreases More susceptible to cold Secretion of testosterone, oestrogen, progesterone decreases. Less secretion of insulin by pancreas8. Neurological System Sensitivity becomes less/reaction is delayed Change in sleeping habits Frequent awakening9. Sensory System Eyes become weak Hearing capacity decreases Complaint of presbyopia Ability to smell is reduced Ability to taste is reduced Tactile sensations are affected10. Immune System Ability to prevent diseases or resistance power decreases Probability of infections increases
  13. 13. 2. Psychosocial ChangesThe psychosocial changes occurring in old age cannot beseparated from physical changes. Because of decreasedactivity of sensory organs, person is not able to work with fullefficiency in his environment. Due to this, psychosocial stateis affected. Person feels the sense of uselessness. Social andpsychological changes of old age are as followsa) PersonalityBecause of the experiences and happenings of life, personspersonality is affected. But in old age, no remarkable changesoccur in the basic personality structure. Changes may occur inthe personality due to death of life partner, decreased or end ofself-dependence, loss of source of income, incapacity, etc.b) MemoryMemory power may decrease with increasing age.Recalling of less frequently used information is difficult. Insome old people, the tendency to repeat facts and informationincreases. Confused memory also may be
  14. 14. Some Forms of Old Age AbuseOld people may have to undergo a lot of neglect. Some mainforms of neglect or abuse are following:Physical Abuse Beating and physical punishment Sexual abuse Restraining or locking them in the house Teasing them for physical conditions or diseasesPsychological Abuse Giving mental torture Abusive language Calling by names (disrespectful words like old man etc.), makingfun of them, threaten them. Forced isolation Treat them as childrenMaterial Abuse Snatching their property illegally Economic exploitation Misuse or wasting their property for personal
  15. 15. Active Neglect Not providing food purposely or giving less food Neglecting their likes and dislikes Spoiling or removing their dentures, glasses, hearing aidetc. Forbid them to play with grand children Encouraging grand children to insult grand parentsPassive Neglect Become lazy or neglecting the care of old people.Neglect may be due to ignorance also.Social Abuse Neglecting their advice Overlooking their experiences Not providing them proper place orhonour on social occasions.
  16. 16. Adjustment in Ageinga. Family Changes :Family is such a unit through which maximum satisfactionmay be obtained. But in old age the persons family status ischanged. A father, who was the chief of the family till now,may have to become dependent on his children. A mothermay have to subject herself to the rule of daughters-in-law. Ifone of the partners is dead, the other has to face loneliness.The decision making process in the family changes and thecontrol is transferred.b. RetirementIn Indian context, retirement is a symbol of old age. In theretirement process, the person may pass through the followingphase:1. Remote PhaseEven when retirement is near or approaching, person does notget ready for it.2. Near PhaseWhen retirement is very near, making imaginary plan for it(day dreaming)
  17. 17. 3. Honeymoon PhaseJust after retirement person wants to do all thosethings, which he could not do so far or was alwaysdesirous of doing. But health and financial resources maycause problems (not in all people) in fulfilling his dreamsor imaginations.4. Disenchantment PhaseThe problems/realities of retired life may dispirit theperson. His excessive dream regarding retired life mayresult in more disappointments. At this stage, person maybegin to come out of false imaginations.5. Stability PhasePerson understands the realities of retired life. Hemakes adjustments to his new roles.6. Termination PhaseThis happens either by taking up some work again ordue to illness or incapacity.
  18. 18. Responsibilities of Nurse in Ageing Care giver Health educator Coordinator of health services Counselor and guardian (Those people whoprotect the old person or take responsibilitiesas his guardian, spokesman or responsibleperson)
  19. 19. Health Assessment Daily activities of living (bathing, excretion,clothing, urinary control, ability to eat etc.). Activities related to use of equipment (Telephone,bank account, food preparation, etc., his ability inthese activities). Health Screening: Ability to see and hear, dentalproblems, blood pressure, examination of breasts anduterus, cancer testing, examination of skin, etc.should be done. In laboratory tests; blood examination, urineanalysis, cholesterol, blood sugar, thyroid, etc. testsshould be conducted
  20. 20. 2.Arranging / Promoting Good Nutrition3.Promoting Activity and Exercise4.Preventive Care of Elderly5.Providing Psychological
  21. 21. Ageing: New Nursing Challenges Gerontological psychiatric nurse specialist in old agehome and nursing homes. Care manager and family counselor of chronic oldpatients in the community. Pre admission assessor of nursing homes hospitals. Nurse Director of old age care giving training centre,old age day care centre. Counselor of old patients in surgical wards. Pre-retirement counselor /
  22. 22. Theories of Aging: Biological Theories: Intrinsic Factors: Several theories assume that individuals inherit agenetic program that determines their specific life expectancy. In fact,various studies have shown a positive relationship between parentalage and filial life span. Genetic mutations are also thought to beresponsible for aging, a pattern depicted below, laboratory experimentswhich have accelerated mutation rates have not produced proportionateincreases in the rate of aging, thus reducing support of this theory.Some theorists believe that a growth substance fails to be producedcausing the cessation of cell growth and reproduction. Extrinsic Factors: Disease producing organisms are often associatedwith biological aging. Bacteria, fungi, viruses, and other organisms arethought to be responsible for certain physiological changes during theaging process. Although no conclusive evidence presently exists to linkthese pathogens with the aging process, interest in this theory has beenstimulated by the fact that humans and animals have been shown tolive longer with the control or elimination of certain pathogens viaimmunization and the use of antimicrobial
  23. 23.  Psychological Theories:Psychological and social changes during the agingprocess are closely united, and they have a significant impacton each other. It is difficult to explain mental processes,behavior and feelings without the perspective of social roles,positions and norms. A theory of aging that is purely social orpsychological would be most unusual, and it is moreappropriate to approach these aging factors as psychosocialtheories. Probably the most controversial and widelydiscussed is the disengagement theory, developed by Elainecumming and William Henry. This theory views aging as aprocess whereby society and individual gradually withdraw ordisengage, from each other, to the mutal satisfaction andbenefit for both. The benefit to individual is that they canreflect and be centered on themselves, having been freed fromsocietal roles. The value of disengagement for society is thatsome orderly means is established for the transfer of powerfrom old to young, making it possible to society to continuefunctioning after its individual members have
  24. 24. Bibliography: Springhouse, mastering geriatric care, USA.1997.1-447. Charlotte Eliopoulos, Geriatric nursing, UK.1-335. Park.k, Preventive and social medicine, 19th edition,India (Jabalpur).2007; 475. Gulani k, Community health nursing principles andpractices. Delhi; 469-472.