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Geriatric or gerontological nursing


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  • 1. GERIATRIC OR GERONTOLOGICAL NURSING Childhood, youth, adulthood and old age are different stages of life. With increasing age we become old. Birth, development, decline and death are the laws 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 our body, senses and skin. Due to continuous functioning, the cells, tissues and organs of our body degenerate. In the later part of life, we have to face many physical and mental problems. Hence old age is the result of physical and psychological fatigue caused by continuous functioning. Just like problems or defects occur in machines 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 just after the age of 50. According to scientists, the source of youth is our cells and genes-DNA. According to some scientists, by identifying the gene stimulating ageing, ageing can be prevented, whereas most of the scientists are of this opinion that ageing cannot be prevented. Ageing is the ultimate end-result of life and is an essential part of it; but the duration of ageing and its intensity can be decreased. All quests for external youth and efforts to prevent ageing are so far unsuccessful. Ageing and Demography- Large number of aged people in the population is the result of demographic change.
  • 2. The number of people above 60 years is assessed to be over 49 crores in world. 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-economic problems are arising. The main problems are of housing, their livelihood and medical treatment. French doctor Jean Martan Carcot was the first person who had studied about old age diseases, in the year 1881. This is to be remembered that old age is natural part of human development; old age is not a disease but just a stage of life cycle. The internal strength and resources of the old person helps him to make adjustments to the change that has occurred due to ageing in his life. National Policy for Older Persons The Government of India in January-1999 announced the National Policy for older persons. The principle areas of intervention and action strategies suggested in the policy sector include the following: Financial security for older persons working in the formal sector as well as those working in the informal sector. Health care and nutrition to enable older persons to cope with the health, associated with ageing, with particular emphasis on prevention. Shelter/housing keeping in view the life style of older persons. Emphasis upon education, training and information needs for older persons. Priority attention to vulnerable groups such as the destitute,
  • 3. widows 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-generational relationship 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 public administration to coordinate and monitor the implementation of the policy. Gerontology This is a science dealing with ageing process. Geriatric Care This is related to the disease process of old age and it aims at keeping old persons at a state of self-dependence as far as possible and to provide facilities to improve their quality of life. Gerontoiogical Nurse-
  • 4. A nurse who has specialization in geriatrics or in the care of old people is called geriatric nurse or gerontoiogical nurse. Functions of Gerontoiogical Nurse- The junctions of GERONTOLOGICAL NURSE are mentioned here, on the basis of spelling of 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 improving them. N (Noticing): Noticing health hazards that may happen in 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, voluntary organization, etc.). O (Opening Channels): Opening the channels of developmental activities for the care of the aged. L (Listening): Listening attentively to the problems of old people and giving due importance to them. 0 (Offering): Offering positivism – Presenting different possibilities of life. G (Generating): Generating energy for the participation in the care of aged and 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 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
  • 5. U (Understanding): Understanding every old person as an invaluable asset of the society. R (Recognizing): Recognizing the moral and religious aspects of old age and giving them recognition. S (Supporting): Supporting the old people in accepting realities and preparing them mentally for impending death. E (Education and Encouraging): Educating and encouraging old people for self care. Factors Affecting Ageing  Hereditary Factors Hereditary diseases, the capacity for longevity and physical capacities influence the ageing process.  Environmental Factors Three types of environmental factors affect ageing: a) Abiotic Factors Factors affecting ageing process like climate, radiation, chemical and physical elements of pollution, etc. are included in this. b) Biotic Factors In this, living organisms present in the environment like pathogens, parasites, the availability and quality of food etc. are included. They all influence the ageing of the person. C) Socio-economic Factors Several socio-economic factors responsible for creating adverse living or working conditions increase "the wear and tear" of life. Such tensions make people 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
  • 6. theories. This is to be remembered that no single factor or theory can be considered responsible for Common Ageing Changes The types of changes in ageing, category and intensity vary from person to person. Hereditary, nutritional, health or tension related factors might be responsible for this. The changes in ageing may be classified into (1) Physical and (2) Psychological their short description is given below: 1. Physical 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 women's face Thickening of nasal hair and hair on ears 2. 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 infections
  • 7. 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 decreases 5. Gastro-intestinal System Falling of teeth Less secretion of saliva and gastric juice Complaints of constipation Digestion becomes weak 6. Musculo-Skeletal System Height reduces (In most of persons above 70 years height decreases up to two inches) Kyphosis, swelling in joints Bones become weak Mobility decreases, if proper exercise is not done 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 pancreas 8. Neurological System
  • 8. Sensitivity becomes less/reaction is delayed Change in sleeping habits Frequent awakening 9. Sensory System Eyes become weak Hearing capacity decreases Ability to smell is reduced Ability to taste is reduced Tactile sensations are affected 10. Immune System Ability to prevent diseases or resistance power decreases Probability of infections increases 2. Psychosocial Changes The psychosocial changes occurring in old age cannot be separated from physical changes. Because of decreased activity of sensory organs, person is not able to work with full efficiency in his environment. Due to this, psychosocial
  • 9. state is affected. Person feels the sense of 'uselessness'. Social and psychological changes of old age are as follows a) Personality Because of the experiences and happenings of life, person's 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 or end of self-dependence, loss of source of income, incapacity, etc. b) Memory Memory power may decrease with increasing age. Recalling of less frequently used information is difficult. In some old people, the tendency to repeat facts and information increases. Confused memory also may be found. 3. Intelligence If the old person is not sick, usually his intelligence is not affected. Because of old age person neither becomes more intelligent, nor less intelligent; yet because of the increase in knowledge and experience, the person's status of intelligence becomes more fertile. 4. Sexuality Physical incapacity, less secretion of hormones, degeneration of reproductive organs, lack of privacy, hesitation or death of life partner, ignorance relating to sexuality in old age, etc. affects the sexuality of persons in old age. This is to be remembered that in old age sexuality, attachment, warmth, intimacy and emotions are more important than physical act. Gerontological nurse has to know that many changes may occur in old age but most of the old people live a normal and happy life. This is also to be noted that old people are the heritage and riches of our society. Ageing Family
  • 10. Old age is not personal subject or state, but is a family matter. When any person gets aged, it affects the relations and environment of the whole family. In a family with an old person, the routine and functions of the family changes due to the needs of the old person. In the family, following matters related to old people must 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 Age Family relations can produce positive or negative impact in old. Respectful relationship in the family, act as a life tonic for the old person, whereas neglect and disrespectful relationships break the old person, and they become more old. Old people get great satisfaction and pleasure from grand parenting. "Interest is more important than capital", that is grand children are more dear to them than there own children. It is a common saying in Indian culture. By old age, most couples become closer to each other. In Indian society divorce is unimaginable in old age. Even the children separating old parents from each other can cause mental pain and problems in the aged. Married daughters often become more attached to parents and may participate actively in caring for them. Many daughters-in-law also become the caregivers of old in-laws. In some families gerontocracy or the rule of the old people, may remain 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
  • 11. and prepare them properly. For this, a three-point programme (TIC programme) may be adopted: Training In this, teaching of caring techniques, safe use of medicines and identification of abnormal signs are included. Leaving In between, the care of the old people should be discontinued so that they get comfort and feel normal. The old people should be made to feel that they are capable of leading normal lives. Care Proper rest, exercise, nutrition, health management and socialization, of the old people should be taken care of and they themselves should be trained for self care. Some Forms of Old Age Abuse Old people may have to undergo a lot of neglect. Some main forms 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 diseases Psychological Abuse - Giving mental torture
  • 12. - Abusive language - Calling by names (disrespectful words like old man etc.), making fun of them, threaten them. - Forced isolation - Treat them as children Material Abuse - Snatching their property illegally - Economic exploitation - Misuse or wasting their property for personal pleasures Active 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 parents Passive 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 or honor on social occasions. Above mentioned abuses or neglect can wreck the old persons physically and mentally. Their personality may be disorganized. Hence, gerontological nurse and the caregiver should avoid the tendency to abuse or neglect old people. Adjustment in Ageing
  • 13. Ageing is not an easy process. In this stage of life cycle, person has to pass through many physical, mental and psychological changes. Hence, old people have to adjust too many changes and situations. Here some changes are described. By adjusting to these changes, old age may be made pleasant: a. Family Changes Family is such a unit through which maximum satisfaction may be obtained. But in old age the person's family status is changed. A father, who was the chief 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 one of the partners is dead, the other has to face loneliness. The decision making process in the family changes and the control is transferred. Under such circumstances, the old person should leave the desire for power and should avoid unnecessary interferences. They may give advice, when needed. They should also try to adjust their own needs and daily living activities to the routine of family. By adjusting with the generation gap and modern trends as far as possible, old age can be made pleasant. Though ashram system is not possible now days, an old person can adopt the attitudes of a vanprastha and make his own life more pleasant and rewarding. b. Retirement In Indian context, retirement is a symbol of old age. In the retirement process, the person may pass through the following phase: 1. Remote Phase Even when retirement is near or approaching, person does not get ready for it. 2. near Phase When retirement is very near, making imaginary plan for it (day dreaming) 3. Honeymoon Phase
  • 14. Just after retirement person wants to do all those things, which he could not do so far or was always desirous of doing. But health and financial resources may cause problems (not in all people) in fulfilling his dreams or imaginations. 4. Disenchantment Phase The problems/realities of retired life may dispirit the person. His excessive dream regarding retired life may result in more disappointments. At this stage, person may begin to come out of false imaginations. 5. Stability Phase Person understands the realities of retired life. He makes adjustments to his new roles. 6. Termination Phase This happens either by taking up some work again or due to illness or incapacity. Looking to the above-mentioned stages, we may say that in different stages of retired life different types of adjustments are necessary. Hence gerontological nurse should train the old person about techniques of getting himself adjusted to retired life. Awareness of Mortality Death of life partner, friends, the decreasing physical capacities etc. Create an awareness regarding death in the person, but he may be unable to accept the reality of death. Under such conditions, by religious and spiritual activities person starts accepting the certainty of death. His behavior may be changed accordingly. For better adjustments, old person may be encouraged to understand 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 Income Because of retirement and reduced socio-economic activities person's financial resources become less. Hence the old persons should start
  • 15. future financial management well ahead of retirement. The welfare programmes of government or voluntary agencies also might help the old person financially. The old persons get mental peace and a sense of security, through financial adjustment. Social Prejudice The 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 of old people. In short the old people should develop adjustment capacities, in order to make old age pleasant and satisfying. Responsibilities of Nurse in Ageing The main objective of gerontological nursing is to improve the quality of life of old people. Because of individual variations and the special needs of old age, gerontological nursing is a challenging job. The nurse has to fulfill the following roles in gerontological nursing: - Care giver - Health educator - Co-ordinator of health services - Counselor and guardian (Those people who protect the old person or take responsibilities as his guardian, spokesman or responsible person). The nurse may have to perform different functions in relation to the above roles: 1 Health Assessment A nurse should have a detailed examination of the old person and then assess his health. This includes assessment of physical, mental, social and
  • 16. economic resources. In the health assessment of the old person, the following should be included. - 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 in these activities). - Health Screening: Ability to see and hear, dental problems, blood pressure, examination of breasts and uterus, cancer testing, examination of skin, etc. should be done. - In laboratory tests; blood examination, urine analysis, cholesterol, blood sugar, thyroid, etc. tests should be conducted. 2. Arranging / Promoting Good Nutrition Less financial resources, change in taste, disinterest in food, loss of appetite, trouble of preparing food, non-availability of foodstuff, inability to eat, necessity to change food (due to disease), etc. affect the nutrition of old people. Hence a complete nutritional assessment of the old person should be done and he should be protected from malnutrition and deficiencies by giving balanced and modified diet. 3. Promoting Activity and Exercise Physical exercises and activity are the basic keys to health in old age. Through this in addition to keeping up physical ability, emotional and mental balance also is maintained. There are many problems in keeping up exercise and activities in old age. Stiffness of joints, arthritis, lack of energy, low blood pressure, lack of motivation or lack of facilities are some of the important ones. In gerontological nursing, it is essential to include exercise in their daily activities.
  • 17. Similarly old people should be encouraged to participate in artistic, cultural, educational or games activities. 4. Preventive Care of Elderly In case of the elderly, their physical and mental safety is very important. Gerontological nurse and caregivers should pay special attention to the following 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 services 5. Providing Psychological Support The mental health of old aged person depends upon his mental status in his entire life. Loneliness, neglect, sense of uselessness or being a burden and social inactivity may create imbalance of mind in the old person. The nurse should play an important role in reducing those problems. The problem of loneliness of the old people can be solved by family counseling or by encouraging them to participate in cultural and social activities or by forming old age groups. Creating a state to utilise their experience or increasing their spiritual interests and activities are also helpful in providing mental support to the old people. Different programmes should be organized for old people and their participation in the same should be ensured. Through them, they get mental satisfaction and facility to prove the usefulness of their lives and improvement of social status.
  • 18. Ageing: New Nursing Challenges Nurses should also know the various aspects of aged care and National Policy for older persons. Because of the increase in the number of old people and the understanding of the importance of old age care; there is a probability that gerontological nursing will undergo remarkable changes. Gerontological nurse should be prepared for the following roles: - Gerontological psychiatric nurse specialist in old age home and nursing homes. - Care manager and family counselor of chronic old patients 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 / educator.