Geriatric or gerontological nursingDocument Transcript
1www.drjayeshpatidar.blogspot.comGERIATRIC OR GERONTOLOGICAL NURSINGChildhood, youth, adulthood and old age are different stages of life. Withincreasing age we become old. Birth, development, decline and death are thelaws of life. Whether we want it or not, we have to pass through these stages.Old age is also one part of this cycle.What is ageing?Old age or ageing expresses the continuous pressure and effect of time on ourbody, senses and skin.Due to continuous functioning, the cells, tissues and organs of our bodydegenerate. In the later part of life, we have to face many physical and mentalproblems. Hence old age is the result of physical and psychological fatiguecaused by continuous functioning. Just like problems or defects occur inmachines due to continuous functioning, or workload, with increasing age,problems also arise in human body.Usually ageing occurs after the age of 60-65. But in some cases ageing start justafter the age of 50. According to scientists, the source of youth is our cells andgenes-DNA. According to some scientists, by identifying the gene stimulatingageing, ageing can be prevented, whereas most of the scientists are of thisopinion that ageing cannot be prevented. Ageing is the ultimate end-result oflife and is an essential part of it; but the duration of ageing and its intensity canbe decreased. All quests for external youth and efforts to prevent ageing areso far unsuccessful.Ageing and Demography-Large number of aged people in the population is the result ofdemographic change.
2www.drjayeshpatidar.blogspot.comThe number of people above 60 years is assessed to be over 49 crores inworld. By 2040, their number will 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-economicproblems are arising. The main problems are of housing, their livelihood andmedical treatment.French doctor Jean Martan Carcot was the first person who had studiedabout old age diseases, in the year 1881.This is to be remembered that old age is natural part of human development; oldage is not a disease but just a stage of life cycle. The internal strength andresources of the old person helps him to make adjustments to the change thathas occurred due to ageing in his life.National Policy for Older PersonsThe Government of India in January-1999 announced the National Policy forolder persons. The principle areas of intervention and action strategiessuggested in the policy sector include the following:Financial security for older persons working in the formal sectoras well as those working in the informal sector.Health care and nutrition to enable older persons to cope with thehealth, associated with ageing, with particular emphasis onprevention.Shelter/housing keeping in view the life style of older persons.Emphasis upon education, training and information needs for olderpersons.Priority attention to vulnerable groups such as the destitute,
3www.drjayeshpatidar.blogspot.comwidows and disabled older persons.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-generationalrelationship between children and older persons.Formation of self-support group of older persons.Development of the manpower for the caring of aged.Creative use of media in the sector for care of old persons.Establishment of a separate bureau for older persons in the ministry.Reviewing the policy every three years.Establishment of a National Association of older persons.Establishment of National Council for older persons.Use of social justice committee and experts of publicadministration to coordinate and monitor the implementation ofthe policy.GerontologyThis is a science dealing with ageing process.Geriatric CareThis is related to the disease process of old age and it aims at keeping oldpersons at a state of self-dependence as far as possible and to provide facilitiesto improve their quality of life.Gerontoiogical Nurse-
4www.drjayeshpatidar.blogspot.comA nurse who has specialization in geriatrics or in the care of old people is calledgeriatric nurse or gerontoiogical nurse.Functions of Gerontoiogical Nurse-The junctions of GERONTOLOGICAL NURSE are mentioned here, on the basis of spellingof the word:G (Guiding): Giving guidance to people of all ages regarding ageing process.E (Eliminating): Eliminating ageism or considering old age as disease.R (Respecting): Respecting the rights of old people.O (Observing): Observing the facilities provided to old people and improvingthem.N (Noticing): Noticing health hazards that may happen in old age and try toreduce them.T (Teaching): Teaching how to take care of old people, for those who are caringfor them (family members, friends, community health worker, voluntaryorganization, etc.).O (Opening Channels): Opening the channels of developmental activities for thecare of the aged.L (Listening): Listening attentively to the problems of old people and givingdue importance to them.0 (Offering): Offering positivism – Presenting different possibilities of life.G (Generating): Generating energy for the participation in the care of agedand researches for new supporting techniques.I (Implementing): Implementing activities for rehabilitation and re-adjustment.C (Co-ordinating): Co-ordinating different services related to the care of theaged.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
5www.drjayeshpatidar.blogspot.comU (Understanding): Understanding every old person as an invaluable asset ofthe society.R (Recognizing): Recognizing the moral and religious aspects of old age andgiving them recognition.S (Supporting): Supporting the old people in accepting realities and preparingthem mentally for impending death.E (Education and Encouraging): Educating and encouraging old people for selfcare.Factors Affecting Ageing Hereditary FactorsHereditary diseases, the capacity for longevity and physical capacitiesinfluence the ageing process. Environmental FactorsThree types of environmental factors affect ageing:a) Abiotic FactorsFactors affecting ageing process like climate, radiation, chemical and physicalelements of pollution, etc. are included in this.b) Biotic FactorsIn this, living organisms present in the environment like pathogens, parasites, theavailability and quality of food etc. are included. They all influence the ageing ofthe person.C) Socio-economic FactorsSeveral socio-economic factors responsible for creating adverse living orworking conditions increase "the wear and tear" of life. Such tensions makepeople grow old early.On the basis of factors of ageing, different theories of ageing are prevalent,important among them are classified into biological theories and psychological
6www.drjayeshpatidar.blogspot.comtheories. This is to be remembered that no single factor or theory can beconsidered responsible forCommon Ageing ChangesThe types of changes in ageing, category and intensity vary from person toperson. Hereditary, nutritional, health or tension related factors might beresponsible for this.The changes in ageing may be classified into (1) Physical and (2) Psychologicaltheir short description is given below:1. Physical Changes-Changes, which may occur in different systems, are as follows:1. Integumentary SystemDecrease in elasticity of skin and dryness appearsWrinkles appearAge spots appearHair of head, axilla or pubic region become scanty grey/whiteHair growth on womens faceThickening of nasal hair and hair on ears2. Cardiovascular SystemLess blood circulation in heartIncreased blood pressureFlexibility of heart valve diminishesBlood vessels of head, neck, hands and legs become prominent.3. Respiratory SystemThe capacity of lungs becomes less.Ineffective gas exchangeThe chances of cough increasesMore chances of respiratory infections
7www.drjayeshpatidar.blogspot.com4. Genito-Urinary SystemThe kidney function may be impairedFluid and electrolyte imbalanceCapacity of urinary bladder decreasesIncontinenceEnlargement of prostate in malesAtrophy of reproductive organs in femalesVaginal secretion decreases5. Gastro-intestinal SystemFalling of teethLess secretion of saliva and gastric juiceComplaints of constipationDigestion becomes weak6. Musculo-Skeletal SystemHeight reduces (In most of persons above 70 years height decreases upto two inches)Kyphosis, swelling in jointsBones become weakMobility decreases, if proper exercise is not done7. Endocrine SystemThyroid gland becomes less activeAlertness decreasesMore susceptible to coldSecretion of testosterone, oestrogen, progesterone decreases.Less secretion of insulin by pancreas8. Neurological System
8www.drjayeshpatidar.blogspot.comSensitivity becomes less/reaction is delayedChange in sleeping habitsFrequent awakening9. Sensory SystemEyes become weakHearing capacity decreasesAbility to smell is reducedAbility to taste is reducedTactile sensations are affected10. Immune SystemAbility to prevent diseases or resistance power decreasesProbability of infections increases2. Psychosocial ChangesThe psychosocial changes occurring in old age cannot be separated fromphysical changes. Because of decreased activity of sensory organs, person isnot able to work with full efficiency in his environment. Due to this, psychosocial
9www.drjayeshpatidar.blogspot.comstate is affected. Person feels the sense of uselessness. Social andpsychological changes of old age are as followsa) PersonalityBecause of the experiences and happenings of life, persons personality is affected.But in old age, no remarkable changes occur in the basic personality structure.Changes may occur in the personality due to death of life partner, decreased orend of self-dependence, loss of source of income, incapacity, etc.b) MemoryMemory power may decrease with increasing age. Recalling of less frequentlyused information is difficult. In some old people, the tendency to repeat factsand information increases. Confused memory also may be found.3. IntelligenceIf the old person is not sick, usually his intelligence is not affected. Because ofold age person neither becomes more intelligent, nor less intelligent; yetbecause of the increase in knowledge and experience, the persons status ofintelligence becomes more fertile.4. SexualityPhysical incapacity, less secretion of hormones, degeneration ofreproductive organs, lack of privacy, hesitation or death of life partner, ignorancerelating to sexuality in old age, etc. affects the sexuality of persons in old age. Thisis to be remembered that in old age sexuality, attachment, warmth, intimacy andemotions are more important than physical act.Gerontological nurse has to know that many changes may occur in old agebut most of the old people live a normal and happy life. This is also to be notedthat old people are the heritage and riches of our society.Ageing Family
10www.drjayeshpatidar.blogspot.comOld age is not personal subject or state, but is a family matter. When any persongets aged, it affects the relations and environment of the whole family. In a familywith an old person, the routine and functions of the family changes due to theneeds of the old person. In the family, following matters related to old peoplemust be taken care of:- Ensure the fulfillment of the physical needs of the old person.- Provide emotional support and facilities to them.- Maintain their contact with family and community.- Keep their life meaningful.- Solve their problems.Family Relationship and Old AgeFamily relations can produce positive or negative impact in old. Respectfulrelationship in the family, act as a life tonic for the old person, whereas neglectand disrespectful relationships break the old person, and they become moreold. Old people get great satisfaction and pleasure from grand parenting."Interest is more important than capital", that is grand children are moredear to them than there own children. It is a common saying in Indianculture. By old age, most couples become closer to each other. In Indiansociety divorce is unimaginable in old age. Even the children separating oldparents from each other can cause mental pain and problems in the aged.Married daughters often become more attached to parents and may participateactively in caring for them. Many daughters-in-law also become the caregivers ofold in-laws. In some families gerontocracy or the rule of the old people, mayremain till the end.Thus, in taking care of the old people, the role of family is very significant.The gerontological nurse has to identify the caregivers of old people in the family
11www.drjayeshpatidar.blogspot.comand prepare them properly. For this, a three-point programme (TIC programme)may be adopted:TrainingIn this, teaching of caring techniques, safe use of medicines and identificationof abnormal signs are included.LeavingIn between, the care of the old people should be discontinued so that theyget comfort and feel normal. The old people should be made to feel that theyare capable of leading normal lives.CareProper rest, exercise, nutrition, health management and socialization, of theold people should be taken care of and they themselves should be trained forself care.Some Forms of Old Age AbuseOld people may have to undergo a lot of neglect. Some main forms of neglect orabuse 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
12Leavingwww.drjayeshpatidar.blogspot.com- Abusive language- Calling by names (disrespectful words like old man etc.), making fun ofthem, threaten them.- Forced isolation- Treat them as childrenMaterial Abuse- Snatching their property illegally- Economic exploitation- Misuse or wasting their property for personal pleasuresActive Neglect- Not providing food purposely or giving less food- Neglecting their likes and dislikes- Spoiling or removing their dentures, glasses, hearing aid etc.- 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 toignorance also.Social Abuse- Neglecting their advice- Overlooking their experiences- Not providing them proper place or honor on social occasions.Above mentioned abuses or neglect can wreck the old persons physicallyand mentally. Their personality may be disorganized. Hence, gerontologicalnurse and the caregiver should avoid the tendency to abuse or neglect old people.Adjustment in Ageing
13Leavingwww.drjayeshpatidar.blogspot.comAgeing is not an easy process. In this stage of life cycle, person has to passthrough many physical, mental and psychological changes. Hence, old peoplehave to adjust too many changes and situations. Here some changes aredescribed. By adjusting to these changes, old age may be made pleasant:a. Family ChangesFamily is such a unit through which maximum satisfaction may be obtained.But in old age the persons family status is changed. A father, who was thechief of the family till now, may have to become dependent on his children.A mother may have to subject herself to the rule of daughters-in-law. If oneof the partners is dead, the other has to face loneliness. The decision makingprocess in the family changes and the control is transferred.Under such circumstances, the old person should leave the desire for power andshould avoid unnecessary interferences. They may give advice, when needed.They should also try to adjust their own needs and daily living activities to theroutine of family. By adjusting with the generation gap and moderntrends as far as possible, old age can be made pleasant. Though ashramsystem is not possible now days, an old person can adopt the attitudes of avanprastha and make his own life more pleasant and rewarding.b. RetirementIn Indian context, retirement is a symbol of old age. In the retirement process,the person may pass through the following phase:1. Remote PhaseEven when retirement is near or approaching, person does not get ready forit.2. near PhaseWhen retirement is very near, making imaginary plan for it (day dreaming)3. Honeymoon Phase
14Leavingwww.drjayeshpatidar.blogspot.comJust after retirement person wants to do all those things, which he could not do sofar or was always desirous of doing. But health and financial resources may causeproblems (not in all people) in fulfilling his dreams or imaginations.4. Disenchantment PhaseThe problems/realities of retired life may dispirit the person. His excessive dreamregarding retired life may result in more disappointments. At this stage, personmay begin to come out of false imaginations.5. Stability PhasePerson understands the realities of retired life. He makes adjustments to hisnew roles.6. Termination PhaseThis happens either by taking up some work again or due to illness orincapacity.Looking to the above-mentioned stages, we may say that in different stages ofretired life different types of adjustments are necessary. Hence gerontological nurseshould train the old person about techniques of getting himself adjusted toretired life.Awareness of MortalityDeath of life partner, friends, the decreasing physical capacities etc. Createan awareness regarding death in the person, but he may be unable to accept thereality of death. Under such conditions, by religious and spiritual activitiesperson starts accepting the certainty of death. His behavior may be changedaccordingly. For better adjustments, old person may be encouraged tounderstand the secret and realities of life. The help of religious leaders like padri,maulvi, guru or saints, etc. also may be taken, as per need.Reduced IncomeBecause of retirement and reduced socio-economic activities personsfinancial resources become less. Hence the old persons should start
15Leavingwww.drjayeshpatidar.blogspot.comfuture financial management well ahead of retirement. The welfareprogrammes of government or voluntary agencies also might help the oldperson financially. The old persons get mental peace and a sense ofsecurity, through financial adjustment.Social PrejudiceThe evil trend of considering old people as useless, incapable, less intelligent, etc.may be found in the society. These feelings or trends are equivalent to abuse ofold people.In short the old people should develop adjustment capacities, in order to makeold age pleasant and satisfying.Responsibilities of Nurse in AgeingThe main objective of gerontological nursing is to improve the quality of life ofold people. Because of individual variations and the special needs of old age,gerontological nursing is a challenging job. The nurse has to fulfill the followingroles in gerontological nursing:- Care giver- Health educator- Co-ordinator of health services- Counselor and guardian (Those people who protect the old person ortake responsibilities as his guardian, spokesman or responsibleperson).The nurse may have to perform different functions in relation to the aboveroles:1 Health AssessmentA nurse should have a detailed examination of the old person and thenassess his health. This includes assessment of physical, mental, social and
16Leavingwww.drjayeshpatidar.blogspot.comeconomic resources. In the health assessment of the old person, thefollowing should be included.- Daily activities of living (bathing, excretion, clothing, urinarycontrol, ability to eat etc.).- Activities related to use of equipment (Telephone, bank account, foodpreparation, etc., his ability in these activities).- Health Screening: Ability to see and hear, dental problems, bloodpressure, examination of breasts and uterus, cancer testing,examination of skin, etc. should be done.- In laboratory tests; blood examination, urine analysis, cholesterol, bloodsugar, thyroid, etc. tests should be conducted.2. Arranging / Promoting Good NutritionLess financial resources, change in taste, disinterest in food, loss of appetite,trouble of preparing food, non-availability of foodstuff, inability to eat, necessity tochange food (due to disease), etc. affect the nutrition of old people.Hence a complete nutritional assessment of the old person should bedone and he should be protected from malnutrition and deficiencies by givingbalanced and modified diet.3. Promoting Activity and ExercisePhysical exercises and activity are the basic keys to health in old age. Throughthis in addition to keeping up physical ability, emotional and mental balancealso is maintained.There are many problems in keeping up exercise and activities in oldage. Stiffness of joints, arthritis, lack of energy, low blood pressure, lackof motivation or lack of facilities are some of the important ones. Ingerontological nursing, it is essential to include exercise in their daily activities.
17Leavingwww.drjayeshpatidar.blogspot.comSimilarly old people should be encouraged to participate in artistic,cultural, educational or games activities.4. Preventive Care of ElderlyIn case of the elderly, their physical and mental safety is very important.Gerontological nurse and caregivers should pay special attention to thefollowing safety measures:- Protection from unhealthy environment- Protection from mental tensions- Special care of personal health- Protection from physical and mental injuries, threats and fatigue- Providing rehabilitation services5. Providing Psychological SupportThe mental health of old aged person depends upon his mental status in hisentire life. Loneliness, neglect, sense of uselessness or being a burden and socialinactivity may create imbalance of mind in the old person. The nurse should playan important role in reducing those problems.The problem of loneliness of the old people can be solved by familycounseling or by encouraging them to participate in cultural and socialactivities or by forming old age groups. Creating a state to utilise their experienceor increasing their spiritual interests and activities are also helpful in providingmental support to the old people.Different programmes should be organized for old people and their participation inthe same should be ensured. Through them, they get mental satisfaction andfacility to prove the usefulness of their lives and improvement of socialstatus.
18Leavingwww.drjayeshpatidar.blogspot.comAgeing: New Nursing ChallengesNurses should also know the various aspects of aged care and National Policyfor older persons.Because of the increase in the number of old people and theunderstanding of the importance of old age care; there is a probability thatgerontological nursing will undergo remarkable changes. Gerontological nurseshould be prepared for the following roles:- Gerontological psychiatric nurse specialist in old age home and nursinghomes.- Care manager and family counselor of chronic old patients in thecommunity.- Pre admission assessor of nursing homes hospitals.- Nurse Director of old age care giving training centre, old age daycare centre.- Counselor of old patients in surgical wards.- Pre-retirement counselor / educator.