Geriatric assessment

1. Sr.
no
Time Specific
objectives
Content Teaching
learning
objectives
Av aids Evaluation
1 To explain about
demography. Demography:
The no. of elderly increased more
than 3 fold since 1950, from
approximately 130 million (4% of
global population) to 419 million
(6.9%) in 2000. • The no. of elderly is
now increasing by 8 million per year ;
by 2030, this increase will reach 24
million per year.
• Declining fertility rates combined
with steady improvement in life
expectancy over the 20th century
produced dramatic growth in the
world’s elderly population. • People
aged 65 and over now comprise a
greater share of the world’s
population than ever before. •
Population aging refers to an increase
in the percentage of elderly people ( >
65 ).
Indian Scenario: • Current population
of India is more than 1.21 billion (
acc. to Census of India 2011 ). • The
Lecture cum
discussion
PPT Explain
about
demography
of india.

2. total population of nation is growing
at the rate of 1.41%. • In India ,
elderly population is over 82 million
and it is expected to reach the mark of
177 million almost double by the year
2025.
2 To define
geriatric.
GERIATRICS DEFINITON: • It 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.
Lecture cum
discussion
leaflet Define
geriatric?
3 To explain the
meaning of
geriatric.
Meaning: • The term Geriatrics Came
from the Greek word “geron”
meaning “old man” and “iatros”
meaning “healer”. • However ,
geriatrics is sometimes called medical
gerontolgy.
Lecture cum
discussion
leaflet Explain the
meaning of
geriatric?
4 Enumerate the
theories of aging.
THEORIES OF AGING
A) Biological Theories of aging:
1) Programmed / Non- Stochastic
Theories. - Programmed Senescence
Theory
 Endocrine Theory.
 Immunology Theory.
2) Error Theories. –
 Wear & Tear Theory .
Lecture cum
discussion
OHP Enumerate
the theories
of aging?

3.  Cross Linking Theory.
 Free-radical Theory.
 Error Catastroph Theory.
 Somatic Mutation Theory.
(B) Psychological Theories:
1) Personality Theory.
2) Developmental Task Theory.
3) Disengagement Theory.
4) Activity Theory.
5) Continuity Theory.
5 To explain the
Programmed
Senescence
Theory / Hayflick
Limit Theory.
Programmed Senescence
Theory / Hayflick Limit
Theory: – In 1950’s Hayflick
Suggested that the human cell
is limited in no. of times it can
divide, he theorized that it can
divide 50 times, after which
they simply stop dividing ( and
hence die). He showed that
nutrition has an effect on cells,
with overfed cells dividing
much faster than underfed cells,
as cells divide to help repair
and regenerate themselves. –
The Hayflick Limit indicates
that there is a need to slow
Lecture cum
dscussion
PPT Explain the
Programmed
Senescence
Theory /
Hayflick
Limit
Theory?

4. down the rate of cell division if
we want to live long lives. Cell
division can be slowed down
by diet and lifestyles etc..1)
Programmed Theories:
6 To explain the
Endocrine /
Neuro-endocrine
Theory.
Endocrine / Neuro-endocrine
Theory: – First proposed by
Prof. Vladimir Dilman & Ward
Dean MD. – The Endocrine
theory states that , as we age ,
the endocrine system becomes
less efficient and eventually
leads to the effects of aging. –
Hormones level are affected by
factors such as stress and
infection.
Lecture cum
discussion
PPT Explain the
Endocrine /
Neuro-
endocrine
Theory?
7 To explain the
Immunologic
Theory.
Immunologic Theory: –
According to this theory , the
rate of aging is controlled by
the immune system . – This
theory states that , as we age
the no. of cells start to decrease
becoming less functional.
Lecture cum
discussion
PPT Explain the
Immunologic
Theory?
8 To explain the
Error Theories:
& Tear
Theory:
Error Theories: & Tear
Theory: – Early Theory on
aging proposed that there is a
fixed storage of energy
Lecture cum
discussion
PPT Explain the
Error Theories:
& Tear Theory?

5. available to the body . As time
passes , the energy is depleted
and because it can not be
restored , the person dies. –
Later, other theories emerged.
The wear & tear theory stated
that the body is like a machine
that wears out its parts with
repeated use. The effects of
aging are caused by progressive
damage to cells and body
systems over time. This was
not widely accepted.
9 To explain the
Crossed linked
theory.
Crossed linked theory: – It also
referred to as the glycosylation
theory of aging , was proposed
by Johan Bjorksten in 1942. –
Acc. To this theory , an
accumulation of cross- linked
proteins damages cells and
tissues, slowing down bodily
processes resulting in aging.
Lecture cum
discussion
PPT Explain the
Crossed linked
theory?
10 To explain the
Free radical
Theory.
Free radical Theory: –
Proposed by Denham Harman
in 1956. – It states that
organisms age because cells
accumulate free radical damage
Lecture cum
discussion
PPT To explain the
Free radical
Theory

6. over time . – A free radical is
any atom or molecule that has a
single unpaired electron in an
outer shell. – Free radical are
unstable, short lived and highly
reactive, as they attack nearby
molecules in order to steal their
electrons and gain stability,
causing radical chain reactions
to occur.
11 To explain the
Error
catastrophe
theory.
Error catastrophe theory: –
Proposed by Leslie Orgel in
1963. – It states that aging is
the result of the accumulation
of errors in cellular molecules
that are essential for cellular
function and reproduction that
eventually reaches a
catastrophic level that is
incompatible with cellular
survival. – Catastrophe means a
sudden event causing damage
or suffering.
Lecture cum
discussion
PPT Explain the
Error
catastrophe
theory?
12 To explain the
Somatic theory
or Gene
mutation
Somatic theory or Gene
mutation theory: – It states that
an important part of aging is
determined by what happens to
Lecture cum
discussion
PPT Explain the
Somatic theory
or Gene
mutation

7. theory our genes after we inherit them.
From the time of conception,
our body’s cells are continually
reproducing. Additionally ,
exposures to toxins, radiation
or UV light can cause
mutations in the body’s genes .
– The body can correct or
destroy most of the mutations,
but not all of them. Eventually ,
the mutated cells accumulate,
copy themselves and cause
problems in the body’s
functioning related to aging.
theory?
13 To explain the
Personality
Theory.
(B) Psychological Theories:
1) Personality Theory: – These
theories address aspects of
psychological growth without
delineating specific tasks or
expectations of older adults. –
Some evidence suggests that
personality characteristics in
old age are highly correlated
with early life characteristics.
Lecture cum
discussion
PPT Explain the
Personality
Theory ?
14 To explain the
Development
Development task Theory: –
The developmental tasks are
Lecture cum
discussion
PPT Explain the
Development

8. task Theory. activities and challenges that
one must accomplish at specific
stages in life to achieve
successful aging. – Erikson
(1963) described the primary
task of old age as being able to
see one’s life as having been
lived with integrity . – In the
absence of achieving that sense
of having lived well, the older
adult is at risk for becoming
preoccupied with feelings of
regret or dispair.
task Theory?
15 To explain the
Disengagement
Theory.
Disengagement Theory: – It
describes the process of
withdrawal by older adults
from societal roles and
responsibilities. – Acc. to this
theory , this withdrawal process
is predictable , systemic ,
inevitable, and necessary for
proper functioning of a
growing society. – The benefit
to society is thought to be an
orderly transfer of power from
old to young.
Lecture cum
discussion
PPT Explain the
Disengagement
Theory?
16 To explain the Activity Theory. – Lecture cum PPT Explain the

9. Activity
Theory.
This theory occurs when
individuals engage in a full day
of activities and maintain a
level of productivity to age
successfully . – It says , the
more you do , the better you
will age . – People who remain
active and engaged tend to be
happier , healthier , and more in
touch with what is going on
around them.
discussion Activity
Theory?
17 To explain the
Continuity
Theory.
Continuity Theory. – Also
called developmental theory. –
This theory is the follow up to
the disengagement and activity
theories . – It emphasizes the
individual previously
established coping abilities and
personal character traits as a
basis for predicting how the
person will adjust to changes of
aging.
Lecture cum
discussion
PPT Explain the
Continuity
Theory.
18 To Discuss
The Changes
Associated
With Aging
(Normal Aging
A no. of physiological changes occur
as we grow older. It is important to be
able to recognize the changes of
normal aging versus the effects of
disease. • Untreated disease can result
Lecture cum
discussion
PPT Explain The
Changes
Associated
With Aging?

10. Process) in “excess disability” and reduce the
quality of life of individuals.
1. Cardiovascular Changes:
– Heart rate decreases.
– Respiration decreases.
– Systolic BP increases
(aortaa) Biological aspects of
aging: & other arteries
thickened/stiffened)
. – Valves b/w the chambers of
heart thickened /stiffened.
– Baro-receptors which
monitor BP become less
sensitive . Quick changes in
position may cause dizziness
from orthostatic hypotension.
2. Changes in Pulmonary system:
– Lungs become stiffer ,
muscle strength diminishes,
and chest wall become more
rigid.
– Total lung capacity remains
constant but vital capacity
decreases and residual volume
increases.
– Alveolar surface area
decreases by up to 20%.

11. Alveoli tend to collapse sooner
on expiration.
– There is an increase in
mucus production and a
decrease in the activity and no.
of cilia.
– Body becomes less efficient
In monitoring and controlling
breathing.
3. Changes in genito-urinary
system:
– Kidney mass decreases by
25-30% and the no. of
glomeruli decrease by 30-40%.
These changes reduce the
ability to filter and concentrate
urine and to clear drugs.
– With aging there is a reduced
hormonal response
(vasopressin) and an impaired
ability to conserve salt which
may increase risk for
dehydration.
4. Changes in gastro- intestinal
system: – Decrease in strength
of muscles of mastication, taste
and thirst perception.

12. – Decreased gatric motility
with delayed emptying .
– Atrophy of protective
mucosa.
– Malabsorption of CHO, vit
B12 , vit D, folic acid and
calcium.
– Impaired sensation to
defecate.
– Reduced hepatic reserve.
– Decreased metabolism of
drugs.
5. Stomach :
– Atrophic gastritis.
– Achlorhydria (insufficient
production of stomach acid).
– Gastric ulcers (after the age
of 60 years, and can be benign
of malignant).
• Liver:
– Reduced blood flow.
– Altered clearance of some
drugs
. – Diminishing the capacity to
regenerate damaged liver cells.
6. • Intestine:
– Prevalence of diverticulitis

13. increases with age.
– Reduced peristalsis (intestinal
muscle contractions) of large
intestine.
7. Changes in Immune system:
– Increased vulnerability to
infections, tumors and immune
disease.
– Less production of
antibodies.
– Mortality rate from infection
is much higher than in young.
(example: pneumonia or sepsis,
UTI.)
8. . Changes in musculo-skeletal
system:
– Muscles generally decrease in
strength , endurance, size and
weight.
– Loss of about 23% of muscle
mass by age 80 as both the no.
and size of muscle fibers
decrease.
– Loss of an average of about 2
inches of height.
– Compression of vertebrae,
etc.

14. 9. Changes in Integumentary
system :
Skin: – Wrinkling , pigment
alteration and thinning of skin.
– Elastin and collagen
decrease.
– Reduction in size of cells.
– Loss of subcutaneous layer
of fatty deposits.
– Inability of skin to retain
moisture.
10.Hair:
– by age 50 years, the hair of
more than half of all is 50%
gray. It is due to decrease in the
production of melanin. ( can be
hormonal and hereditary ).
11.Changes in sensory system:
Vision: – Most common, about
95% of people aged 65 years or
more report wearing glasses or
need glasses to improve their
vision.
Lens of eye become yellowed,
cloudy. Hearing:
– Membrane in middle ear
including the eardrum become

15. less flexible with age.
– Vestibular begins to
degenerate with age leading
hearing loss.
Smell:
– No. of functioning smell
receptors decreases.
– There is an increase in the
threshold for smell.
Taste:
– Taste also diminishes with
age.
– Atrophy of tongue occurs
with age and this may
diminishes sensitivity to taste.
Touch:
– Sense of touch and response
to painful stimuli decreases.
– Actual no. of touch receptors
decreases which results in a
higher threshold for touch.
12. Changes in Endocrine system:
Pancreas:
– Muscle cells become less
sensitive to the effects of
insulin produced in body.
– The normal fasting glucose

16. level rises 6-14 mg/dl every 10
years.
– Type 2 Diabetes mellitus
occurs when the body develops
resistance to insulin.
13.Adrenal glands:
– Aldosterone levels are 30%
lower in adults aged 70 to 80
years than in younger adults.
Lower aldosterone levels may
cause orthostatic hypotension.
– Secretion of cortisol
diminishes by 25% with age.
Psychological aspects of aging:
1. Memory functioning:
– Age related memory
deficiencies have been reported
in literature.
– Short term memory and long
term memory does not show
similar changes.
2. Intellectual functioning:
– These abilities of older
people do not decline but do
become obsolete (out of date).
– The age of their formal
educational experiences is

17. reflected in their intelligence
scoring.
3. Learning abilities:
– The ability to learn is not
diminished by age.
– Studies however, have shown
that some aspects of learning
do change with age.
4. Adaptation to the tasks of
aging:
– Loss of grief.
– Attachments to others.
– Maintenance of self identity.
– Dealing with death.
5. Psychiatric disorders in later
life:
– Delirium.
– Dementia.
– Depression.
– Schizophrenia.
– Anxiety disorders.
– Personality disorders & sleep
disorders.
c) Socio-cultural aspect of
aging: Old age brings many
important socially induced
changes, some of which have

18. the potential for negative effect
on both the physical & mental
wellbeing of older persons.
d) Sexual aspects of aging:
Sexuality and the sexual needs
of elderly people are frequently
misunderstood, repressed and
ignored.
19 To describe the
Special
concerns of the
elderly
population:
1. Retirement:
– Sadock Special concerns of
the elderly population: &
Sadock (2007) reported that, of
those people who voluntarily
retire, most re-center the work
force with 2 years. – The
reasons they give for doing this
include negative reactions to
being retired , feelings of being
unproductive , economic
hardship , and loneliness. –
Retirement has both social and
economic implications for
elderly individuals
2. Elder abuse :
– Abuse of elderly individuals
Lecture cum
discussion
Chart Describe the
Special
concerns of the
elderly
population?

19. may be psychological , physical
or financial . And the Neglect
may be intentional or
unintentional. – Psychological
abuse includes yelling,
insulting, harsh commands,
threats, silence and social
isolation. – Physical abuse is
described as striking. Shoving,
beating or restraints. –
Financial abuse refers to
misuse or theft of finances,
property to fulfill the physical
needs of an individual who can
not do so independently. – In
addition, elderly individuals
may be the victims of sexual
abuse .
20 To Describe
the common
problems in
oldage.
COMMON PROBLEMS IN
OLD AGE
1. • Alzheimer’s Disease: – It
is a slow and gradual
disease that begins in part of
brain that controls memory.
– It affects a greater no. of
Lecture cum
discussion
Describe the
common
problems in
oldage?

20. intellectual and emotional
and behavioral abilities , it
has no known cause for this
disease. – As person grows
older, he is at greater risk of
developing Alzheimer’s .
After 60, the risk is one in
20, but after 80 it is one in
5.
2. Strokes: – About 15 million
people have stroke , each
year it is a 2nd leading
cause of death for older than
60yrs of age . • Heart
disease: – Hypertension
(silent killer). •
Osteoarthritis : – It is most
common form of arthritis . •
Rheumatoid Arthritis: –
Inflammation of joint lining
in the synovial (free moving
) joints.
3. Diabetes: – Due to lack of
movement or work in old aged
people. • Urinary incontinence:
– About 1/3rd of women and
10% of all men above age of 60

21. have incontinence. – In this
people loose control over their
bladder and bowel movements.
4. Social isolation.
1. STEPS TAKEN BY GOVT. o
National Policy for Older
Persons: It was announced in
1999 by the. Ministry of Social
Justice & Empowerment
Objectives are:
– To enable and support
voluntary organizations and
NGO ’s to supplement the care
provided by family.
– To provide care and
protection to vulnerable groups.
– To provide health care
facility to elderly and to
promote research & training
facilities to care givers.
– To create awareness among
elderly persons to develop
themselves in to fully
independent citizen.
Revision of national policy on older
persons: It was created in March 14,

22. 2010. Age of senior citizen is
different for different benefits , such
as: – 60 years for concession in
railways. – 60 years by banks for
extra 0.5% interest to senior citizen. –
63 years for concession in air journey
by Indian airlines. – 65 years for
benefit to senior citizens under
income tax.
20 Summary We have seen the following points in
the seminar:
To explain about demography.
To define geriatric.
To explain the meaning of geriatric
Enumerate the theories of aging.
To explain the Programmed
Senescence Theory / Hayflick Limit
Theory.
To explain the Immunologic Theory.
To explain the Error Theories: &
Tear Theory
To explain the Crossed linked theory
To explain the Free radical Theory.
To explain the Error catastrophe
theory.
To explain the Somatic theory or

23. Gene mutation theory
To explain the Personality Theory.
To explain the Development task
Theory
To explain the Disengagement
Theory.
To explain the Activity Theory
To explain the Continuity Theory.
To Discuss The Changes Associated
With Aging (Normal Aging Process)
To describe the Special concerns of
the elderly population:
Bibliography
21 Bibliography Bibliography:
Basheer. P, shabeerkhan .
Yasmeen S. A concise textbook
of advanced nursing practice
first edition; EM-ESS medical
publisher; page no . 455-460
• Kaplan, shaddok “ Concise
Text Book of Psychiatry”, page
no: 300-4315.

24. • Barbara Kozier “Fundamentals
of Nursing” Pearson Education.
7th edition.Page no.987-961
• Taylor, Lillis, Lemone
“Fundamentals of Nursing-art
and science of Nursing Care”
lippincott, 4th edition.Page
no.1222-1226 
• Ruth F Craven,J Hirne
“Fundamentals of Nursing”
lippincott, 3rd edition.Page
no.1173-1187