Geriatric Considerations in Nursing | ANP | Juhin J Aging, the normal process of time related change, begins with birth and continues throughout the life. Geriatrics is a subspecialty of internal medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating disease and disabilities in older adults.

2. JUHIN J
1ST Year Msc Nursing

4. OBJECTIVES
At the end of this session, you will be able to get clear
understanding about;
• Geriatrics – Introduction
• History
• What are the normal age related changes
• Enumerate the physical aspects of aging
• Explain the psychosocial aspects of aging
• List down the common problems of old age
• Enlist the nursing management
• List down the roles of geriatric nurse

5. INTRODUCTION
Aging, the normal
process of time related change,
begins with birth and continues
throughout the life. Geriatrics is a
sub speciality of internal medicine
that focuses on health care of
elderly people. It aims to promote
health by preventing and treating
disease and disabilities in older
adults.

6. KEY FACTS
● 104 million elderly population in India - 2011
● 727 million elderly population in the world- 2020
● Number of people above 60 years is assessed to be
over 2.1 billion in world by the year 2050
● Hypertension - 58%
● Arthritis - 31%
● Coronary Heart Disease - 29%
● Diabetes - 27%
● Chronic Kidney disease - 18%
● Heart failure - 14%
● Depression - 14%
● Alzheimer’s disease & Dementia - 11%

7. HISTORY
● Hippocrates and Aristotle
contributed to the theory of aging
● Nascher was the father of
geriatrics and Marjory Warren
was its mother.
● The 1st Geriatric service was
started in UK in 1947.
● Geriatric department at
Government Hospital, Chennai
was established in 1978.

8. NORMAL AGE RELATED CHANGES
INTRINSIC AGING EXTRINSIC AGING

9. PHYSICAL ASPECTS OF AGING
CARDIOVASCULAR SYSTEM
● Heart valves become thicker and
stiffer
● Heart muscles and arteries lose their
elasticity
● Calcium and fat deposits accumulate
within arterial walls and veins
● Decreased cardiac output
● Heart failure
● Diuretics, ACE inhibitors, Digoxin
● Low dose beta blockers &
Spironolactone
● Regular exercise
● Proper diet
● Weight control
● Regular blood pressure
measurements
● Stress management
● Smoking cessation
Changes Care

10. CARDIOVASCULAR SYSTEM
● To avoid light-headedness, fainting and possible falls caused by orthostatic
hypotension, the old person should be advised to raise slowly.
● To avoid straining when having bowel movement, advise to have 5 or 6 meals
a day rather than 3.
● Extreme temperature should be avoided, including hot showers.
● Yard work should be limited to not more than 20 minutes on hot summer
days.
● Exposure to winter or cold weather also should be avoided because of the risk
of dizziness or falling associated with slower adjustments of blood pressure.
● If a person experiences dependent edema as the day progress, the use of
elastic compression stockings helps to minimize venous pooling.

11. RESPIRATORY SYSTEM
● Calcification of costal cartilages
● Reduced mobility of ribs
● Diminished efficiency of respiratory
muscles
● Increased lung rigidity
● Decreased alveolar surface area
● Gas exchange and diffusing capacity
are also diminished
● Regular exercise
● Appropriate fluid intake
● Pneumococcal vaccination
● Smoking cessation
● Frequent hand hygiene
Changes Care

12. INTEGUMENTARY SYSTEM
● The epidermis and dermis become thinner.
● Elastic fibers are reduced in number
● Collagen becomes stiffer
● Subcutaneous fat diminishes.
● Decreased number of capillaries in the skin results
in decreased blood supply.
● Loss of elasticity, wrinkling and sagging of skin
present
● Hair pigmentation decreases, resulting in gradual
greying
● Skin becomes drier and susceptible to irritations
● Reduce tolerance to extremes of temperature and
exposed to sun
Changes
● Avoid exposure to sun,
using lubricated skin
cream.
● Maintain adequate
intake of water (8-10
glass per day)
Care

13. REPRODUCTORY SYSTEM
● Ovarian production of estrogen and
progesterone ceases with menopause.
● Thinning of vaginal wall, narrowing in size
and loss of elasticity
● Decreased vaginal secretions, resulting in
vaginal dryness, itching and decreased
acidity
● Involution (atrophy) of uterus and ovaries
● Decreased pubococcygeal muscle tone,
results in relaxed vagina and perineum
● Vaginal bleeding and painful intercourse
● Water based lubricants can be
used to prevent painful
intercourse
● Local estrogen replacement
intra vaginally enhance
vaginal tissue
● Maintenance of daily physical
exercise routine promotes
enhanced sexual
performance.
Changes in Female Care

14. REPRODUCTORY SYSTEM
● The penis and testes decrease in size
● Levels of androgens diminish
● Erectile dysfunction may develop
● Sexual desire and activity decline
but not disappear
● Use of vacuum penile pumps, local
injection or placement of vaso-
stimulating medication into urethral
opening and use of an oral
medication, sildenafil citrate(viagra)
have proved effective for some
patients.
● Sildenafil citrate is contraindicated
in patients who are taking oral
nitrates.
● Maintenance of daily physical
exercise routine promotes enhanced
sexual performance.
Changes in Male Care

15. GENITOURINARY SYSTEM
● Decreased filtration rate
● Diminished tubular function
● Slower restoration of acid-base
balance
● Stress or urge incontinence is present
in older women due to menopause
● BPH is commonly found in older men
● Prostate cancer is most often seen in
70+ years of age men
● Constipation
● UTI is prevalent in older women.
● Adequate consumption of fluids
● Void every 2-3 hours while awake
● Avoid bladder irritating substances
like caffeinated, carbonated and acid
beverages.
● Doing pelvic floor exercises helps in
reducing the symptoms of stress and
urge incontinence.
● By doing biofeedback- assisted pelvic
muscle exercise, an individual can
successfully regain bladder function.
● Encourage person to eat high fiber
diet.
● Advice the person to maintain good
bathroom hygiene
Changes Care

16. GASTROINTESTINAL SYSTEM
● Tooth decay and loss of teeth is
common
● Salivary flow diminishes, causes dry
mouth
● Decrease of taste receptors
● Dysphagia
● Aspiration of food or fluid
● Feeling of fullness, heartburn &
indigestion
● Gastric motility may decrease, resulting
in delayed emptying of stomach
contents
● Absorption of nutrients get diminished
● Constipation is common
● Receive regular dental care
● Eat small – frequent meals.
● Avoid heavy activity after eating
● Advice to take high fibre, low fat diet.
● Advice to take adequate amount of
fluids
● Establish regular bowel habits
● Avoid the usage of laxatives and
antacids
● Caregivers should understand that
there is a direct correlation between
loss of smell and taste perception and
food intake.
Changes Care

17. Nutritional Health
● The social, psychological and
physiological functions influence the
dietary habits
● Decreased physical activity and slower
metabolic rate reduce the number of
calories needed.
● Apathy, immobility, depression,
loneliness, poverty, inadequate
knowledge, lack of oral health and lack
of taste discrimination also contribute in
nutritional intake
● Budgetary constrains and physical
limitations may impair food shopping
and meal preparation
● Encourage a diet that is low in sodium
and saturated fats; high in vegetables,
fruits and fish.
● Reducing salt intake is advised
● Protein intake should remain same as
earlier years.
● Simple sugars should be avoided and
complex carbohydrates should be
encouraged
● Potatoes, whole grains, brown rice and
fruits provide minerals, vitamins and
fibres and should be encouraged
● Drinking 8-10 glass of water is advised
● Advice to take a multivitamin/ day.
Changes Care

18. SLEEP
● Sleep disturbances frequently occur in
older people
● Elderly often experience variations in
their normal sleep- wake cycles.
● Lack of quality sleep at night
● Advice the person to avoid daytime
napping
● Advice the person to eat a light snack
before bed time
● Advice the person to void before going
to bed
Changes Care

19. MUSCULOSKELETAL SYSTEM
● Loss of bone density
● Danger of fracture is high
● A loss of height occurs in later life as a
result of kyphosis, flexion of hips and
knees
● Muscles diminish in size and lose
strength & flexibility.
● Back pain is common
● Degenerative joint disease is found in 70+
years of age persons.
● Calcium supplements, vitamin D,
fluoride, estrogens and weight bearing
exercises are often prescribed for
persons with osteoporosis.
● A high calcium intake, 1500 mg/ day is
adviced
● Advice the person to take dairy
products and dark green vegetables
● Low calcium and high phosphorous
diets like red meat, cola drinks should
be avoided
● Advice the person to reduce caffeine
and avoid alcohol
Changes Care

20. NERVOUS SYSTEM
● Cerebral blood flow reduces
● Loss of nerve cells contributes to
progressive loss of brain mass
● As nerve impulses are conducted more
slowly, old people take longer to respond
and react
● Mental function is threatened by
physical or emotional stresses.
● A slowed reaction time places older
person at the risk of falls and injuries,
including driving errors.
● Advice the person to allow longer time
to respond a stimulus
● Mini mental status examination
should be done in regular intervals to
evaluate the mental status.
● Advice the person not to drive.
Changes Care

21. SENSORY SYSTEM
● Presbyopia is common
● Formation of yellow and cloudy lens
causes light to scatter and sensitive to
glare
● Pupil dilates slowly
● Age related macular degeneration maybe
present.
● People may feel difficult to differentiate
blue from green.
● Advice the person to wear reading
glasses
● Advice the person to wear sunglasses
while going outside
● Advice the person to go for regular eye
check ups.
Changes Care
Vision

22. SENSORY SYSTEM
● Presbycusis is present
● Hearing loss maybe present
● A properly prescribed and fitted
hearing aid maybe useful in reducing
hearing deficits.
Changes Care
Hearing
● Sweet taste is dulled in older people
● Blunted taste may be present for salty
● Onions, garlic and lemon should be
encouraged as substitutes for salt to
flavour food.
Changes Care
Taste

23. PSYCHOSOCIAL ASPECTS OF AGING
● Successful psychological aging is reflected in the older person’s ability to
adapt to physical, social and emotional losses and to achieve life
satisfactions.
● A positive self image enhances risk taking and participation in new,
untested roles.
● Our society is having a untrue negative image on old age persons.
● Fear of aging and the inability to fight with their own aging process may
trigger ageist beliefs.
● Retirement and perceived non productivity are also responsible for negative
feelings.
● Only through an understanding of the aging process and respect for each
other as an individual can the myths of aging can be removed.
● If the elderly are treated with dignity and encouraged to maintain autonomy,
the quality of their lives will improve.

26. STRESS & COPING IN OLDER ADULT
● Coping patterns and the ability to adapt to stress are developed over the
course of life time and remain consistent later in life.
● Experiencing success in younger adulthood helps a person to develop a
positive self image during their old age.
● A person’s ability to adopt to situations, make decisions and respond
predictably are also determined by past experiences.
● Many older adults rely strongly on their spiritual beliefs for comfort during
stressful times.
● Common stressors of old age include;
▪ Normal aging changes that impair physical function,
activities and appearance
▪ Disabilities due to chronic illness
▪ Social and environmental losses related to loss of income
▪ Decreased abilities to perform previous roles and activities
▪ Death of significant others

27. COMMON PROBLEMS OF OLD AGE
● Alzheimer’s disease
● Rheumatoid arthritis
● Osteoarthritis
● Heart diseases
● Diabetes
● Stroke
● Urinary incontinence
● Social isolation

28. ALZHEIMER’S
DISEASE
RHEUMATOID
ARTHRITIS

29. OSTEO ARTHRITIS
HEART
DISEASE

30. DIABETES STROKE

31. URINARY INCONTINENCE
SOCIAL
ISOLATION

32. NURSING MANAGEMENT
● Supporting cognitive function
● Promoting physical safety
● Reducing anxiety and agitation
● Improving communication
● Promoting independence in self-care
activities
● Providing for socialization and intimacy
needs
● Promoting adequate nutrition
● Promoting balanced activity and rest
● Supporting home and community based
care

33. SUPPORTING COGNITIVE FUNCTION
● As the patient’s cognitive ability declines, the nurse should provide a
calm, predictable environment that helps the person interpret his/ her
surroundings and activities.
● A quiet, clear and simple explanations help to minimize confusion
● Prominently displayed clocks and calendars may enhance orientation
to time
● Colour coding the doorway may help the patient locating his/ her room.
● Active participation helps to maintain cognitive and social interaction
PROMOTING PHYSICAL SAFETY
● A hazard free environment allows the patient independence and sense
of autonomy.
● To prevent falls and other injuries, all obvious hazards are removed.
● Restrains are avoided, because they increase agitation
● Night lights are helpful for better vision

34. REDUCING ANXIETY AND AGITATION
● The patient will need a constant emotional support that reinforces a
positive self image.
● The environment should be kept familiar and noise free.
● When patient gets agitated, measures such as listening to music,
stroking or distraction may quiet the patient.
● Becoming familiar with the patient’s predicted responses to certain
stressors helps care giver to avoid similar situations.
IMPROVING COMMUNICATION
● Nurse usually uses clear, easy to understand sentences to convey
messages.
● To promote patient’s interpretation of messages, the nurse should
remain unhurried, reduce noises and distractions
● Sometimes patient may point out an object or use nonverbal language to
communicate.

35. PROMOTING INDEPENDENCE IN SELF CARE ACTIVITIES
● The nurse should simplify daily activities of a patient by organizing
them into short, achievable steps. So they experience a sense of
accomplishment.
● Direct patient supervision is sometimes necessary, but maintaining
personal dignity and autonomy is also important for the person.
● The nurse should encourage the patient to make choices when
appropriate and to participate in self care activities as much as possible.
PROVIDING FOR SOCIALIZATION AND INTIMACY NEEDS
● Socialization with old friends can be comforting. Visits, letters and
phone calls can be encouraged.
● Hobbies and activities such as walking, exercising can improve the
quality of life.
● The spouse should be encouraged to talk about any sexual concerns and
sexual counselling may be suggested if necessary.

36. PROMOTING ADEQUATE NUTRITION
● Patients usually prefers familiar foods that look appetizing and taste
good.
● Offer one dish at a time for patient
● Food should be cut into small pieces to prevent chocking
● Hot food should be served warm
● If patient is willing to eat with their fingers, apron should be used to
protect the clothing
PROMOTING BALANCED ACTIVITY AND REST
● If the patient’s sleep is interrupted or unable to fall asleep, music, warm
milk or back rub may help the person to relax.
● During the day time, patient should be given sufficient opportunity to
participate in exercise activities.
● Long period of day sleeping are discouraged.

37. ROLES OF GERIATRIC NURSE
● Be patient, kind and sympathetic
● Consider individuality
● Assist elderly to achieve emotional
stability
● Maintain privacy
● Handle them gently
● Make them feel comfortable
● Provide them diversional or
occupational therapy
● Make elderly people’s stay in home
lively and interesting

38. SUMMARY

39. ANY DOUBTS

40. ASSIGNMENT
COMMON PROBLEMS OF OLDAGE

41. REFERENCES
Book:
Shebeer. P. Basheer , S. Yaseen Khan.(2013). A Concise Text Book of
Advanced Nursing Practice . P.742-751
Internet:
https://www.scribd.com/408428633/

43. THANK
YOU