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
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
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
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
Shelter/housing keeping in view the life style of older persons.
Emphasis upon education, training and information needs for older
Priority attention to vulnerable groups such as the destitute,
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
This is a science dealing with ageing process.
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.
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
N (Noticing): Noticing health hazards that may happen in old age and try to
T (Teaching): Teaching how to take care of old people, for those who are caring
for them (family members, friends, community health worker, voluntary
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
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 invaluable asset of
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
Factors Affecting Ageing
Hereditary diseases, the capacity for longevity and physical capacities
influence the ageing process.
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
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
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
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
4. Genito-Urinary System
The kidney function may be impaired
Fluid and electrolyte imbalance
Capacity of urinary bladder decreases
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
More susceptible to cold
Secretion of testosterone, oestrogen, progesterone decreases.
Less secretion of insulin by pancreas
8. Neurological System
Sensitivity becomes less/reaction is delayed
Change in sleeping habits
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
state is affected. Person feels the sense of 'uselessness'. Social and
psychological changes of old age are as follows
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.
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.
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.
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.
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
and prepare them properly. For this, a three-point programme (TIC programme)
may be adopted:
In this, teaching of caring techniques, safe use of medicines and identification
of abnormal signs are included.
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.
Proper rest, exercise, nutrition, health management and socialization, of the
old people should be taken care of and they themselves should be trained for
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:
- Beating and physical punishment
- Sexual abuse
- Restraining or locking them in the house
- Teasing them for physical conditions or diseases
- Giving mental torture
- Abusive language
- Calling by names (disrespectful words like old man etc.), making fun of
them, threaten them.
- Forced isolation
- Treat them as children
- Snatching their property illegally
- Economic exploitation
- Misuse or wasting their property for personal pleasures
- 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
- Become lazy or neglecting the care of old people. Neglect may be due to
- 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
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.
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
2. near Phase
When retirement is very near, making imaginary plan for it (day dreaming)
3. Honeymoon Phase
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
6. Termination Phase
This happens either by taking up some work again or due to illness or
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
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.
Because of retirement and reduced socio-economic activities person's
financial resources become less. Hence the old persons should start
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.
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
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
The nurse may have to perform different functions in relation to the above
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
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.
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
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
- Care manager and family counselor of chronic old patients in the
- Pre admission assessor of nursing homes hospitals.
- Nurse Director of old age care giving training centre, old age day
- Counselor of old patients in surgical wards.
- Pre-retirement counselor / educator.