nursing process

1. Geriatrics
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2. Geriatrics
 It is a sub specialty 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.
 The term Geriatrics Came from the Greek word
“geron” meaning “old man” and “iatros”
meaning “healer”.
 However , geriatrics is sometimes called medical
gerontology.
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3. Theories of aging
1) Programmed
 Programmed Senescence
 Endocrine
 Immunology
2) Error
 Wear & Tear
 Cross Linking
 Free-radical
 Error Catastrophe
 Somatic Mutation
 Personality
 Developmental Task
 Disengagement
 Activity
 Continuity
Biological
Theories
Psychological
Theories
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4. Programmed Senescence / HayflickLimit Theory/
 In 1950’s Hayflick Suggested that the human cell is limited in
number 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 down
the rate of cell division if we want to live long lives.
 Cell division can be slowed down by diet and lifestyles etc..
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5. 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.
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6. Immunologic Theory
 According to this theory , the rate of aging is
controlled by the immune system .
 This theory states that , as we age the number
of cells start to decrease becoming less
functional.
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7. Wear & Tear Theory
 Early Theory on aging proposed that there is a fixed
storage of energy 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.
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8. Crossed linked theory
 It also referred to as the glycosylation theory of
aging , was proposed by Johan Bjorksten in
1942.
 According to this theory , an accumulation of
cross linked proteins damages cells and tissues,
slowing down bodily processes resulting in
aging.
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9. 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.
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10. 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.
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11. Changes Associated With Aging
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12. Biological aspects of aging
 Heart rate decreases, Respiration decreases
 Systolic BP increases
 Valves b/w the chambers of heart thickened /stiffened
 Lung becomes stiffer, alveoli capacity decreases
 The number of glomeruli decreases
 GI motility and absorption decreases
 Antibody production decreases
 Muscle endurance, size and strength decrease
 Wrinkling and thinning of the skin
 Decrease in sensory function (ear, eye, nose, tounge)
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13. Psychological aspects of aging
 Memory functioning decreases /short, long/
 Intellectual functioning (These abilities of older
people do not decline but do become obsolete
(out of date)).
 Learning abilities not diminished with age (but
some aspects do change)
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14. Geriatric Syndromes
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15. Geriatric Syndromes
 Disability
 Dementia and Delirium
 Falls
 Poly-pharmacy
 Pressure Ulcers (prolonged sleeping)?
 Urinary Incontinence (BPH, Muscle weakness)?
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16. Disability
 Are we living healthier as well as longer lives, or
are our additional years spent in poor health?
 Disability is part of the human condition.
 Almost everyone will be temporarily or
permanently impaired at some point in life, and
those who survive to old age will experience
increasing difficulties in functioning.
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17. Disability
 Disability is the umbrella term for impairments,
activity limitations and participation restrictions,
referring to the negative aspects of the
interaction between an individual (with a health
condition) and that individual’s contextual
factors (environmental and personal factors).
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18. Disability
 Disability encompasses the child born with a
congenital condition such as cerebral palsy or
the young soldier who loses his leg to sport
trauma, or the middle-aged woman with severe
arthritis, or the older person with dementia,
among many others.
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19. Disability & Human Rights Issues
 People with disabilities experience inequalities
 People with disabilities are subject to violations
of dignity
 Some people with disability are denied
autonomy
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20. Disability (causes)
 Communicable diseases ..poliomyelitis,..
 Non communicable disease ...DM,
 Injuries ...
 Mental health problems
 Some unknown,...
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21. Disability (management)
 Rehabilitation
 Assistive technologies /devices/
 Health education
 CBT
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22. Dementia
 Is a syndrome due to disease of the brain usually of a
chronic or progressive nature in which there is
disturbance of multiple higher cortical functions,
including memory, thinking, orientation, comprehension,
calculation, learning capacity, language, and judgment.
 Consciousness is not clouded.
 The impairments of cognitive function are commonly
accompanied, and occasionally preceded, by
deterioration in emotional control, social behavior, or
motivation.
 This syndrome occurs in a large number of conditions
primarily or secondarily affecting the brain.
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23. Dementia
 The cause of most dementia is unknown, but the
final stages of this disease usually means a loss of
memory, reasoning, speech, and other cognitive
functions.
 The risk of dementia increases sharply with age
and, unless new strategies for prevention and
management are developed, this syndrome is
expected to place growing demands on health and
long term care providers as population ages.
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24. Dementia
 The disease is not easy to diagnose, especially in its
early stages.
 The memory problems, misunderstandings, and
behavior common in the early and intermediate
stages are often attributed to normal effects of
aging, accepted as personality traits, or simply
ignored.
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25. Dementia (Common types)
 Alzheimer’s disease (common types, about 4/5)
 Vascular dementia=Post-stroke dementia
 Frontotemporal lobar degeneration (FTLD)
 Mixed dementia
 Parkinson’s disease (PD) dementia
 Normal pressure hydrocephalus
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26. Dementia (burdens)
 The total number of people with dementia worldwide in
2010 is estimated at 35.6 million and is projected to
nearly double every 20 years, to 65.7 million in 2030
and 115.4 million in 2050.
 The total number of new cases of dementia each year
worldwide is nearly 7.7 million, implying one new case
every four seconds.
 The total estimated worldwide costs of dementia were
US$ 604 billion in 2010.
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27. Dementia
 The complexity of the disease and the wide variety
of living arrangements can be difficult for people
and families dealing with dementia, and countries
must cope with the mounting financial and social
impact.
 The challenge is even greater in the less developed
world, where an estimated two-thirds or more of
dementia sufferers live but where few coping
resources are available.
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28. Dementia(possible causes)
 Degenerative neurological disorders
 Vascular disorders (strokes,...)
 Infections (like HIV,...)
 Long term drug / alcohol / use
 Depression
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29. Dementia(C/M)
 Forgetting recent information /events/
 Repeating comments / questions/
 Not knowing date / time
 Changes in mood / interest/
 Talking becomes more difficult
 Sleeping pattern changed
 Anxiety
 Hallucination
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30. Dementia(Management)
 Surgery (if the cause is tumor)
 Cholinesterase inhibitors (donepezil, rivastigmine,
galantamine, ...)
 NMDA receptor antagonist (memantine,...)
 Prevention:
 Stop smoking
 Exercise
 Rely on Mediterranean diets (fruits, vegs, grains,.)
 Stay socially active
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31. Geriatric Falls
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32. Geriatric Falls
 Falls are the leading cause of external injuries.
 Most common in children less than 5 years old and adults 65
and older.
 Trauma is the 5th cause of death in those >65 years
 Falls are responsible for 70% of accidental deaths in people
over 75 years old.
 1/4 of the elderly people who fracture their hips die within 6
months of the injury.
 35%-40% of people 65+ fall each year.
 Those who fall are 2-3 times more likely to fall again.
 10%-20% of falls cause serious injuries.
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33. Geriatric Falls
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34. Geriatric Falls
 Consequences of Geriatric Falls
 Death
 Injury
 Fractures 10-15%
 Fear of Falling
 Reduced Activity/Independence (25%)
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35. Geriatric Falls
 Increased age
 Living alone
 Previous falls
 Use of a walker
 Acute illness
 Reduced vision
 Foot problems
 CVA
 Arthritis
 Alcohol
 Some medications
 Risky behaviors
 Hearing problems
 Neurologic changes
 Muscle weakness (very
common)
Risk factors for falls
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36. Geriatric Falls (Management)
 Exercise programs
 Rehabilitation
 Avoiding hazardous environment
 Medications
 Treatment of vitamin D deficiency
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37. Poly-pharmacy
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38. Poly-pharmacy
 Polypharmacy is the use of four or more medications
by a patient, generally adults aged over 65 years.
 Polypharmacy (ie, the use of multiple medications
and/or the administration of more medications than
are clinically indicated, representing unnecessary drug
use) is common among the elderly, affecting about
40% of older adults living in their own homes.
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39. Poly-pharmacy
 Although polypharmacy can be appropriate, it is
more often inappropriate.
 Concerns about polypharmacy include increased
adverse drug reactions, drug interactions,
prescribing cascade, and higher costs.
 Polypharmacy is often associated with a decreased
quality of life, decreased mobility and cognition.
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40. Poly-pharmacy (risky groups)
 Elderly,
 Psychiatric patients,
 Patients taking five or more drugs concurrently,
 Those with multiple physicians,
 Recently hospitalized patients,
 Individuals with concurrent comorbidities,
 Low educational level, and
 Those with impaired vision
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41. Poly-pharmacy
 Older adults comprise 12% of the U.S. population, but
use 35% of the prescription medications and 50 percent
of the over-the-counter medications.
 The average medication usage for persons over 65 is:
 2 to 6 prescription drugs, plus …
 1 to 3.4 over-the-counter medicines.
 In 2011, 58 percent of adults 65 years or older reported
taking 5 or more medications and 18% reported taking
10 or more (Slone Epidemiology Center).
 The average American senior spends $870 annually for
pharmaceuticals.
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42. Poly-pharmacy (causes)
 Age
 Community elders- 90% > 1med; 40% > 5meds;
12% > 10meds.
 Chronic Diseases
 Drug Regimen Changes
 New meds, different doses…
 Providers – Patients Relationship
 The more the physician visits, the more the number
of medications patients take
 2/3 of all physician visits end with a prescription
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43. Polypharmacy-complications
 More adverse drug reactions.
 Decreased adherence to drug regimens.
 (Unnecessary) drug expenses.
‘’client distress and poorer quality of life’’
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44. Solutions To Polypharmacy
 Review medication
 Anticipate Adverse Drug Events ( ADEs)
 Avoid errors- prescribe carefully
 Give verbal and written instructions
 Simplify
 Understand obstacles (cost, memory loss…)
 Enlist family/nursing/
 Make sure there is good follow up
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45. Thank you!
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