medical surgical nursing , nursing care of elderly patient with disease conditions and different care given to them,it contain introduction , definition, nursing care, patient teaching, diet management, research.

1. Nursing Care of the
Name of the evaluator:
Mrs. Mamta Toppo
Associate Professor
College of Nursing
RIMS, Ranchi
Name of the student:
Priyanshu Sainy
Roll no.-24
Basic B.Sc. Nursing 3rd year
College of Nursing, RIMS
MEDICAL- SURGICAL NURSING- II
Date :11/08/2020

2. ■ Introduction to care of elderly
■ Terminology
■ Geriatric Nursing
■ Assessment of the older adult
■ Biological aspects of aging
■ Psychosocial aspects of aging
■ Sociocultural aspects of aging
■ Sexual aspects of aging
■ Theories of Aging
■ Elder Abuse
■ Uses of Aids and prosthesis
Role of Nurse in Geriatric care
New research done
Summary
Evaluation
Bibliography

3. THE NORMAL AGING PROCESS

4. Introduction to care of elderly
o ELDERLY is an individual over 65 years old who have a functional impairments.
o Elderly care is the fulfilment of the special needs and requirements that are unique
to senior citizens. This broad term encompasses such services as assisted living,
adult day care, long term care, nursing homes, hospital care, and In-Home care.
o Providing nursing care for older people is a major area of responsibility in the
caseloads of nurses in almost all health care settings.
o Nurses are accustomed to a multidisciplinary approach in giving care. In the field
of geriatrics and gerontology, nurses will undoubtedly continue to assume
multidisciplinary roles, particularly in home care and long term care settings.
o When caring for older patients, we need to take into account the physiologic and
biologic changes that normally occur during aging and to understand older adults’
special health requirements. Also, the effects of drugs on older patients should be
understood.

5. TERMINOLOGY
Geriatrics- Geriatrics come from the Greek word GERAS- Old age and IATRIKQS-
Branch of Medical.
Hence, it is defined as “the branch of medicine concerned with medical problems and
care of old people.”
Gerontology: Gerontology is the study of all aspects of the aging process and its
consequences in humans. Gerontology achieves a level of wellness consistent with the
changes of aging.
Aging: It is defined as a maturational process that creates the need for individual
adaptation because of physical and psychological declines that occur during a lifetime.

6. Geriatric
Nursing
Geriatric Nursing is the specialty that
concerns itself with the provision of
nursing services to geriatric or aged
individuals.
This is an outline of the state of art for
geriatric care that are useful to a nurse
practitioner who encounters aging
person in practice.
Due to their complexity, aged people
always deserve personal attention.
Nurses address physical, psycho-social,
cultural and family concerns as well as
promoting health and emphasizing
successful aging.

7. Assessment of the older adult
Careful assessment is the foundation of care for all patients, regardless of age. To
identify the problems and needs of older adults, nurse must integrate a sound
theoretical knowledge of the geriatric population with best assessment skills.
■ Components of geriatric assessment
1) Functional Assessment – it is the measurement of patient’s ability to complete
functional tasks and are used to evaluate the older adult’s overall well-being & self
care abilities.

8. a) KATZ INDEX
b) BARTHEL INDEX
c) LAWTON SCALE
d) OARS
Social
Resources
Scale
To rank the patient’s
ability to perform 6
functions:
• Bathing
• Dressing
• Toileting
• Transfer
• Continence
• Feeding
To evaluate their needs to
support independent living:
• Use telephone
• Shop
• Do laundry
• Manage finances
• Take medications
• Prepare meals
To assess a patient’s self care
capacity such as :
• Feeding
• Moving here and there
• Bathing
• Going up and down the
stairs
• Dressing
• Controlling bladder, etc.
It is a multidimensional
assessment tool to
evaluate 5 areas:
• Social resources
• Economic resources
• Physical health
• Mental health
• ADL

9. 2) Physical Examination- It is the second component of the health assessment.
It focuses on several aspects:
 Obtaining health history
 Current health status
 Medical history
 Review of body systems
3) Nutrition Assessment: It includes evaluation of medical diagnosis, measurements of
anthropometric parameters and biochemical indices, and review of medications.
Clinical data
•Coexisting
medical
diagnoses
•Bio-chemical
indices
•medications
a.Nutritional
history
•Usual food
choices
•Use of alcohol
•Vitamin/mineral
supplements
•Drug-nutrient
interactions
•Weight history
•Calorie intake
and nutrient
needs
Other
components
•Activity/ exercise
•Psychological
issue
•Knowledge of
nutrition

10. Normal aging has four aspects:
1. Biological aspects of aging
2. Psychological aspects of aging
3. Sociocultural aspects of aging
4. Sexual aspects of aging

12. Individuals are unique in their psychological and physical aging process. As the individual ages,
there is a quantitative loss of cells and changes in many of enzymatic activities within cells. Age
related changes occurs at different rate in different people.
NERVOUS SYSTEM
• Decreased speed of neural conduction
• Decreased number of brain cells
• Decrease in cell of the nerve fibers
• Decreased neurotransmitters
• Decline in memory for recent events
• Decreased rapid eye movement sleep
• Decreased cerebral circulation

13. SENSORY CHANGES
Eye:
• Diminished ability to focus on close objects.
• Decreased visual acuity
• The eye’s external changes give evidence of
advancing age. These changes result from loss
of orbital fat, loss of elastic tissue and
decreased muscle tone.
• The cornea flattens which reduces the
refractory power
• The retina of older individual becomes thinner
because of fewer neural cells and receives only
1/3rd of the amount of light that of a younger
person. Due to this problem in reading, not
able to see in dim light and also have difficulty
in color perception.
• The lens of the eye loses its elasticity and
increases in density.

14. Ear:
• Hearing problem
• Cerumen gland are reduced in number dry and
hard ear wax, along with itching.
• Degenerative changes occur in ossicles
contributing to hearing loss
• Presbycusis is the term used to describe hearing
loss associated with normal aging.
Taste and Smell:
• Decreased ability to taste and smell
• Very rarely the capacity to smell diminishes.
• Taste perception and taste discrimination
decreases as the age advances.

15. CARDIOVASCULAR SYSTEM
• Decreased physical demands and activity of heart.
• Slower heart rate and reduce cardiac output
• Decreased contractility
• Impaired coronary artery blood flow
• Less oxygen and blood supply to organ so that it
affects the function of organ
• Decreased altered preload and after load
• Increased atherosclerotic plaques and blood
pressure
• Diminished ability to respond to stress

17. MUSCULOSKELETAL SYSTEM
• Decreased bone density
• Decreased muscle size and strength
• Decreased joint cartilage
• In aging, the increased parathyroid
hormone, decreased vitamin D and
calcitonin also play role in calcium loss in
older people.
• In women, estrogen deficiency, calcium
malabsorption, lifestyle factors can result
in bone loss.
• Aging brings decline in numbers of
muscles resulting in reduced muscle
mass.
• The muscle strength also reduces
especially due to lack of exercise.

19. Memory Functioning
 Short term memory deteriorate with age, long term memory does not show similar
changes.
 A well educated and mentally active person does not exhibit such changes in faster
rate.
 The time required for memory scanning is longer for both recent and remote recall
among older people.
 This can be attributed to social or health factors (stress, fatigue, illness), but it can
also occur with certain physiological changes due to aging.

21. Intellectual functioning
■ Fluid abilities or abilities involved in solving novel
problems, tend to decline from adult period to old
age.
■ High degree of regularity in intellectual function
present on most of the old age people.
■ Intellectual abilities of older people do not
decline, but do become obsolete.
■ Their formal educational experience is reflected
in their intelligence performance.

23. Learning ability
 The ability to learn is not decline by age.
 The slowing of reaction time with age and over arousal of
CNS are noted in old age. It may lead to lower levels of
performance in tasks which requires high efficiency.
 Ability to learn continue throughout the life, although
strongly influenced by personal interests and preferences.
 Accuracy of performances diminishes,

25. Loss and grief
o By the individuals reach 60-70 yrs of age, they have experienced numerous losses
and mourning has become a life long process.
o It is impossible for some of the older age people to complete the grief process in
response to one loss before the other loss occurs.
o This can further predispose to depression.
Dealing with death
• Death anxiety among the elderly is more of a myth than reality.
• The feeling of abandonment, pain and loss may lead to fear or anxiety
in elderly.

26. SOCIOCULTURAL
ASPECTS OF AGING

27. • Old age brings many important socially induced changes.
• Some of them have potential for negative effect on both the physical
and mental well-being of older persons.
• They want protection from hazards and weariness of every day tasks
• They want to be treated with respect and dignity and also want to die
with respect and dignity.
• In developing countries and Asian countries the aged are awarded a
position of honour, that place emphasize on family cohesiveness.
• In industrialized countries many negative stereotyped perspectives on
aging still persisting, aged are always tires or sick, slow and forgetful,
isolated and lonely, unproductive, etc.
• The status of elderly may improve with time as the number of elder
person increases world wide.

29. Changes in females
♀ Menopause may begin anytime during the 40s or early 50s.
♀ Gradual decline in the functioning of the ovaries and subsequent reduction in the
production of estrogen.
♀ The walls of the vagina become thin and inelastic and vaginal lubrication decreases.
♀ Orgasmic uterine contractions become spastic.
♀ All these changes result in vaginal burning, pelvic aching, irritability, etc
♀ In some women these changes result in avoidance of sexual intercourse.
♀ These symptoms are more likely to occur with infrequent intercourse of only one time
a month or less
♀ Regular and more frequent sexual activity result in a greater capacity for sexual
performance.

30. Changes in males
♂ Testosterone production decline gradually as the age increases
♂ As a result of these hormonal changes the erection takes place slowly and requires
more genital stimulation to achieve.
♂ The volume of ejaculate decreases and the force of ejaculate lessens
♂ The testis become smaller, but most men continue to produce viable sperm well in to
old age.

32.  The aging process depends on a combination of both genetic and
environmental factors. Recognizing that every individual has his or her
own unique genetic makeup and environment, which interact with each
other, that is why the aging process can occur at such different rates in
different people.
 Environmental stress associated with exposure to excessive heat and
light trigger the activity of aging genes.

33. • Behaviors of a healthy lifestyle:
― Not smoking
― Drinking alcohol in moderation
― Exercising
― Getting adequate rest
― Eating a diet high in fruits and vegetables
― Coping with stress
― Having a positive outlook
• Aging process in men is mainly brought about by over consumption of alcohol and
heavy smoking. Lack of exercise, inadequate rest or sleep, mental stress show
symptoms of early aging.
• Others factors like regular consumption of excessive spicy food and caffeine
renders an old look. Sloth and sluggish lifestyle makes one feel old.
• However, many environmental conditions, such as the quality of health care that
you receive, have a substantial effect on aging.A healthy lifestyle is an especially
important factor in healthy aging and longevity.

34. • Aging and disease are related in subtle and complex ways. Several
conditions that were once thought to be part of normal aging have now
been shown to be due to disease processes that can be influenced by
lifestyle.
• Osteoporosis and arthritis are the main factors governing aging process
in women.
• The toxins produced in Parkinson’s disease degenerate the neurons
that hinders the memory of brain.
• In Alzheimer’s disease, a substance known as amyloid is produced that
destroys the brain cells.All these interferes with the normal aging
process.

35. Theories of Aging
BIOLOGICA
L
THEORIES
Free-
radical
theory
Cross-
link
theory
Immunologi
cal theory
Wear & Tear
theory
Error
theory
Somatic
mutation
theory
DNA damage
theories
Programmed
cellular
aging theory

36. Psychological
theories
Disengagement
theory
Continuity
theory
Activity
theory
Adjustment
theory
Contt.

37. Elder abuse is any form of mistreatment that results in harm or loss to an older person.
Elder abuse tends to take place where the senior lives: most often in the home where
abusers are apt to be adult children; other family members such as grandchildren; or
spouses of elders.
The personal losses associated with abuse can be devastating and include the loss of
independence, homes, life savings, health, dignity, and security.
Victims of abuse have been shown to have shorter expectancies than non-abused older
people.

38. RISK FACTORS for Elder Abuse
• Poor health and functional impairment in older person
• Cognitive impairment
• Substances abuse or mental illness
• Dependence of the abuse on the victims
• Shared living arrangement
• Social isolation
• History violence
RISK FACTORS among Caregivers
Among caregivers, significant risk factors for elder abuse are:
o Inability to cope with stress
o Depression {common}
o Lack of support from other potential caregivers
o Substance abuse
o The caregiver’s perception that taking care of the elder is burden some and without
psychological reward.

39. TYPES
PHYSICAL EMOTIONAL FINANCIAL SEXUAL NEGLECT

40. TYPES
■ Physical Abuse- Use of physical force against an older adult that may result in bodily
injury, physical pain or impairment.
■ Emotional abuse- Infliction of anguish, pain, or distress on an older adult through
verbal or nonverbal acts.
■ Financial abuse- Illegal or improper use of an older adult’s funds, property or assets.
■ Sexual abuse- Non-consensual sexual contact of any kind with an older adult.
■ Neglect- Refusal or failure to fulfil any part of a person’s duties to an older adult.
•Anguish-severe mental pain
•Infliction- cause
•Non- consensual= not agreed to by one

41. Use of Aids and Prosthesis
■ Prosthesis: It is an artificial device used to replace a
missing body part, such as a limb, tooth, eye or heart
valve.
■ It refers to the replacement of a missing body part
with such a device.
■ In medicine, prosthesis is an artificial extension that
replaces a missing body part.
■ Dental prosthesis is an artificial appliance which is
used as a substitution for the replacement of teeth.
A CAST PARTIAL
DENTURE

42.  Hearing aids: It is an electroacoustic body worn apparatus
which typically fits in or behind the wearer’s ear, and is
designed to amplify and modulate sound for the wearer.
 They are incapable of truly correcting a hearing loss; they
are an aid to make sounds more accessible.
Behind the ear In the ear aid Pocket model

43. Role of Nurse in Geriatric care
1) Acute Care
• Gather medical, family and psychological history
• Perform patient assessment
• Explain diagnosis and treatment to the patient and family
• Work closely with patient, family and other health care professionals
• Maintain hydration, nutrition, aeration and comfort
• Provide medications and treatment and evaluate response
• Administer emergency treatment when necessary
• Initiate discharge planning & coordinate referral to community agencies
• Serve as patient advocate
• Inform doctor of any change in patient’s condition

44. 2) Long term Care
• Gather medical, family and psychological history
• Perform patient assessment
• Involve patient and family in preparation & implementation of nursing plan
• Promote the atmosphere that emphasizes quality living, not disease and dying
• Ensure that patient receives medical, dental, eye care
• Maintain hydration, nutrition, aeration and comfort
• Provide medications, treatment, rehabilitative exercises and evaluate response
• Teach and advise patient and family
• Perform emergency measure when necessary
• Serve as patient advocate
• Inform doctor of any change in patient’s condition

45. 3) Community Care
• Identify health, social or economic needs.
• Refer elderly person to professional or agency best able to meet needs.
• Explain diagnosis and treatment to the patient and family
• Evaluate compliance with and response to treatment.
• Use clinic and home visits for health promotion.
• Teach and advise patient and family
• Evaluate elderly person’s ability to live independently
• Become advocate for elderly persons
• Encourage elderly to become advocate on his own self.

46. Older patients’ perception of engagement in
functional self-care during hospitalization: A
qualitative study:
Highlights
• Vital to raise awareness on importance of functional self-care and empower older patients to break from passive role.
• Important to promote care philosophies and design age-friendly care facilities that facilitate functional self-care.
• Functional self-care engagement can be included in mutual goal setting with patients.
• Fall prevention needs to balance between decreasing movements and letting patients ambulate to participate in self-care.
a. Department of Nursing, Tan Tock Seng Hospital, 11 Tan Tock Seng, Singapore
b. Alice Lee Centre of Nursing Studies, National University of Singapore, Singapore
Received 18 July 2019, Revised 8 November 2019, Accepted 11 November 2019,
Available online 29 November 2019
NEW RESEARCH

47. Abstract
Background
Participation in functional self-care can delay functional decline during older adults’ hospitalization.
Aims
To explore facilitators and barriers to older adults’ participation in self-care during hospitalization, in an
Asian setting.
Methods
Qualitative descriptive study using in-depth interviews, in a Singaporean hospital. Older
adults were recruited using purposive sampling. Interviews were recorded and transcribed
verbatim. Thematic analysis was used.
Results
Data saturation was reached with 17 participants. Three themes were identified:
patient factors, healthcare provision and hospital environment. Facilitators included:
patients' positive mindset, nurses’ encouragement, and age-friendly environment.
Barriers included: patients’ and nurses’ attitudes towards functional self-care,
patients’ and nurses’ fear of inpatient falls, healthcare-imposed restrictions. Patients’
notion of a ‘good patient’ can either facilitate or hinder their self-care engagement.
Conclusion
This study offers insights from older adults in an Asian hospital setting. The
findings can be used to develop strategies, care models, and facilities to promote
functional self-care during hospitalization.

48. Improving care for older adults in the Emergency
Department warrants greater investment in geriatric
nursing—Stat!a. Department of Physiological Nursing, University of California, 2 Koret Way, Box 605N, San Francisco, CA 94143, United
States
b. Global Brain Health Institute, University of California, San Francisco, United States
Available online 13 April 2020.
Keywords:
Emergency Department
Geriatrics
Nursing
Care delivery
Innovations
The recent COVID-19 pandemic, with its high infection and death rates among older adults, has
underscored just how critical the role of the Emergency Department (ED) is in the care of older adults.
But even in “normal” times, older adults–particularly the oldest old and those with underlying health
conditions–frequently rely on the ED for care. In the United States (U.S.), older adults account for over
15% of the almost 150 million visits to the ED annually. Older adults in the ED tend to have a higher level
of medical urgency, are more likely to undergo extensive diagnostic testing, have longer stays in the ED,
and are more likely to be admitted to the hospital subsequent to the ED visit. These statistics are even
more stark for older adults with additional vulnerabilities, such as older adults with dementia.
Research 2

49. Despite their high utilization of the ED, the traditional ED environment is poorly suited to
address the complex needs of older adults. Both the physical design and the processes of
care in the ED are designed for the purpose of rapid triage and diagnosis—goals which are
not necessarily aligned with the characteristics and needs of older adults. For example,
equipment crowded into a small exam area and slippery linoleum floors increase fall risk for
older adults. Constant beeping of equipment, lack of space for caregivers to accompany
patients, and bright fluorescent lights on all night may increase risk of delirium. Providers
are expected to assess patients in mere minutes, but it is difficult if not impossible to assess
the complex medical conditions and subtle presentations of older adults under such
circumstances. As a result of the mismatch between care delivery in the ED and needs of
older adults, older adults often experience poor outcomes as a result of ED visits. These
poor outcomes are well-documented, and include falls, delirium, functional decline, and
increased mortality.
Trailblazing initiatives over the past couple of decades have highlighted the importance of
improving care for older adults in the ED, and we see new care models emerging. In 2014,
multiple professional organizations–including the American College of Emergency
Physicians and the Emergency Nurses Association among others–came together to create
the Multidisciplinary Geriatric Emergency Department Guidelines. The purpose of these
guidelines was to create standardized recommendations to guide the optimization of care of
older adults in the ED. The guidelines include recommendations on structure and processes
of care, including staffing, care transitions, infrastructure and policies and procedures,
among many others. In 2018, the American College of Emergency Physicians began
accrediting facilities as geriatric Emergency Departments.

50. ■ Due to these and other efforts, geriatric Emergency Department
interventions and innovations (GEDI's) are becoming more
common.6 The gold standard of these innovations is the
standalone geriatric ED unit. These units are modeled upon
similar approaches to pediatric and psychiatric ED's and have
designated areas designed specifically for the special needs of
older adults. Physical spaces incorporate the needs of older
adults, including nonskid floors, handrails, lighting that follows
diurnal patterns, and pressure-reducing air mattresses. All staff
are educated in geriatric principles and specialized geriatrics
providers are available for consult. Processes are implemented
for screening older adults for dementia, delirium, and other
geriatric syndromes.
■ Nursing has been at the forefront of these efforts to improve care
for older adults in the ED across the spectrum of education,
practice, and research. The Nurses Improving Care for
Healthcare Elders (NICHE) has designed resources for patients
and caregivers to help them navigate the ED,7 while the
Emergency Nurses Association has developed a comprehensive
course on Geriatric Emergency Nursing Education aimed at
training nurses to improve outcomes for older adults in the
ED. Another resource is the newly formed Geriatric Emergency
Department Collaborative, which focuses on interdisciplinary care
of the older adult in the ED. A number of research studies have
examined nurse-led multidisciplinary GEDI's. For example, a
study of a Transitional Care Nurse model, in which an ED nurse
was trained to facilitate care transitions for older adults, reduced
subsequent inpatient admissions by 5%–16%.9 However, other
studies have shown mixed results on the impacts of nurse-led
interventions, demonstrating there is still more work to do to
understand the best models of care.
■ As frontline providers, nurses offer a unique perspective on
caring for older adults in the ED. Nurses are the most numerous
health professionals in the ED and often the first and most
frequent point of contact for patients. Given their vantage point,
nurses bring critical ideas for improving care for older adults in
the ED, as well as help us understand when interventions fail.
Bedside nurses have emphasized the need for interdisciplinary,
evidence-based protocols to help prevent, detect, and manage
geriatric syndromes. Put simply, there is no way to improve care
for older adults in the ED without the engagement of nursing.
■ How else can nurses take an active role in improving care for older
adults in the ED? While there may not be resources to develop a
standalone Geriatric ED in their institutions, nurses can advocate
for smaller scale interventions that can still have a big impact. For
example, institutions could implement a geriatric practitioner
model, where a clinician geriatric expert, such as a geriatric nurse
and/or advanced practice nurse, are available for consultations for
individual patients, as well as responsible for leading education
efforts on the unit. Moreover, nurse educators should ensure that
they are teaching principles of geriatric care to all of their staff and
students.
■ Nurses can also help push for more financial investment in
research, education, and training specific to geriatric nursing
through policy advocacy. While the National Cancer Institute
receives $600 billion in appropriations each year, the National
Institute of Nursing Research receives a mere $300 million.
Funding for the NINR should be increased and efforts should focus
on testing and implementing nurse-led multidisciplinary GEDI's.
Moreover, fewer than 1% of registered nurses specialize in
geriatrics, and this number is declining. We need more funding to
increase the number of registered and advanced practice nurses
pursuing a focus on geriatrics, but it is also critical that geriatric
curriculum is infused into the training of all nurses.
■ An older adult with an active COVID-19 infection should not also
have to worry about falls and delirium when presenting to the ED. It
is past time to increase efforts to improve care for older adults in
the ED. As the junction between the outpatient and inpatient
settings, there is tremendous opportunity to improve care older
adults receive not only in the ED itself, but across the spectrum of
care. With increased recognition of the importance of improving
care for older adults in the ED and the emergence of GEDI's, we
have made some strides. But there is still a long way to go.
Nursing, in particular geriatric nursing, has been and needs to
continue to be at the forefront of these efforts, and funding efforts
should reflect the importance of geriatric nursing to the care of
older adults in the ED.
■ Funding
■ Dr. Hunt is supported through the National Institutes of
Health ; UCSF Pepper Center; a National Palliative Care Research
Center Career Development Award; and the Global Brain Health
Institute/Atlantic Philanthropies.

51. ■ Elderly care is the fulfilment of the special needs and requirements that are unique to
senior citizens.This broad term encompasses such services as assisted living, adult day
care, long term care, nursing homes, hospital care, and In-Home care.
■ Components of geriatric assessment are:
 Functional assessment
 Physical Examination
 Nutrition Assessment
■ Normal aging has four aspects:
1. Biological aspects of aging
2. Psychological aspects of aging
3. Sociocultural aspects of aging
4. Sexual aspects of aging
■ Role of nurse includes acute care, long term care and community care.

52. Evaluation
■ What is elderly care?
■ What is geriatric nursing?
■ What are the assessment tools of functional assessment?
■ What are the changes that occur in nervous system?
■ Point out the psychosocial theories of aging.
■ Name the different types of hearing aids.

53. Bibliography
■ Ansari Javed,ATextbook of Medical Surgical Nursing-II, PV publications, Page no-
1067-1108
■ Suddarth’s and Brunner,Textbook of Medical Surgical Nursing,Vol-II, SouthAsian
Edition,Wolters Kluwer
■ www.wikipedia.com
■ www.journals.elsevier.com
■ www.slideshare.com