Gerontology

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Gerontology

  1. 1. GERONTOLOGY Jan Leynard Camposagrado, RN
  2. 2. Imagine yourself 50 years from now Will you look like…
  3. 4. Demographics of Aging <ul><li>Life expectancy </li></ul>-> Average number of years that a person can be expected to live. In 1900, the average life expectancy was 47.3 years . By 1998, the figure had increased to 76.7 years .
  4. 5. Epidemiological Transition <ul><li>Control of infectious diseases </li></ul><ul><li>Improvements in environmental and social conditions </li></ul><ul><li>Technological innovations in medicine </li></ul><ul><li>Increase survival rates among the old </li></ul>
  5. 6. Gerontology vs. Geriatrics Gerontology - the comprehensive study of aging and its effects. Geriatrics - deals with the problems and diseases of old age and aging people. (illnesses)
  6. 7. Common Biologic Theories of Aging
  7. 8. Wear-and-Tear Theories <ul><li>Proposes that humans, like automobiles, have vital parts that run down with time, leading to aging and death. </li></ul><ul><li>Proposes that the faster an organism lives, the quicker it dies. e. g. gastrotrich </li></ul><ul><li>Proposes that cells wear out through exposure to internal stressors, including trauma, chemicals, and buildup of natural wastes. </li></ul>
  8. 9. Endocrine Theory <ul><li>Proposes that events occurring in the hypothalamus and pituitary are responsible for changes in hormone production and response that results in the organism’s decline. </li></ul>
  9. 10. Free-radical Theory <ul><li>Proposes that unstable free radicals result from the oxidation of organic materials such as carbohydrates and proteins. </li></ul>These chemicals cause biochemical changes in the cells. Cells cannot regenerate themselves
  10. 11. Genetic Theories ¹ <ul><li>Proposes that the organism is genetically programmed for a predetermined number of cell divisions , after which the cell/organism dies. </li></ul>
  11. 12. Cross-linking Theories <ul><li>Proposes that the irreversible aging of proteins is responsible for the ultimate failure of tissue and organs. </li></ul>Therefore reduce sugar
  12. 13. Immune Theories ¹ <ul><li>immune system becomes less effective </li></ul>viruses that have incubated the body become ABLE damage to body organs
  13. 14. <ul><li>decrease in immune function </li></ul>Immune Theories ² increase in autoimmune responses body produces antibodies that attack itself
  14. 15. Physical Aspects of Aging
  15. 16. Cardiovascular System <ul><li>Heart valves become thicker & stiffer </li></ul><ul><li>Heart muscles & arteries lose their elasticity </li></ul>-> both results to…
  16. 17. <ul><li>Maximum cardiac output decreases by 25% </li></ul>-> CO ~ 5-5.6 L/min (1.25L/min) ↓ Cardiac Output ↓ cerebral perfusion ↓ renal perfusion
  17. 18. Take note: hypertension Shown to be a serious risk factor at all ages for cardiovascular disease and stroke. Only confirmed by TWO SUBSEQUENT READINGS Classified as: 1. Isolated systolic hypertension 2. Primary hypertension 3. Secondary hypertension
  18. 19. heart failure <ul><li>Number one cause of hospitalization </li></ul>Major cause of morbidity & mortality manifestations: Younger persons Older patients ∆ exertional dyspnea ∆ orthopnea ∆ peripheral edema ∆ men are more prone Φ fatigue Φ nausea Φ abdominal discomforts Φ greater number of women develop it
  19. 20. ‡ overview: congestive heart failure ‡ Left & Right sided heart failure ‡ goals: ‡ current standard of therapy for HF <ul><li>Reduce cardiac workload </li></ul><ul><li>Increase force of myocardial contraction </li></ul><ul><li>Reduce circulatory blood volume </li></ul>
  20. 21. Cardiovascular health promotion: <ul><li>Regular exercise </li></ul><ul><li>Proper diet </li></ul><ul><li>Weight control </li></ul><ul><li>Regular blood pressure measurement </li></ul><ul><li>Stress management </li></ul><ul><li>Smoking cessation </li></ul>
  21. 22. <ul><li>Avoid straining when having bowel mov’t </li></ul><ul><li>Consider having 5 or 6 small meals each day </li></ul><ul><li>Avoid hot showers & whirlpool bath </li></ul><ul><li>Yard work should be limited to no more than 20 minutes on hot summer days </li></ul><ul><li>Use elastic compression stocking to ↓ edema d/t venous pooling </li></ul>
  22. 23. Respiratory System <ul><li>Decreased cough efficiency </li></ul><ul><li>Reduced ciliary activity </li></ul>} Result in… <ul><li>Increased anteroposterior chest diameter </li></ul>
  23. 24. <ul><li>Diminished efficiency of the respiratory muscles </li></ul><ul><li>Increased lung rigidity </li></ul><ul><li>Increased residual volume </li></ul><ul><li>Decreased vital capacity </li></ul><ul><li>Calcification of the costal cartilages </li></ul><ul><li>Reduced mobility of the ribs </li></ul>
  24. 25. Health Promotion Activities <ul><li>Regular exercise </li></ul><ul><li>Appropriate fluid intake </li></ul><ul><li>Pneumococcal vaccination </li></ul><ul><li>Yearly influenza vaccination </li></ul><ul><li>Avoidance of people who are ill </li></ul><ul><li>Smoking cessation </li></ul>
  25. 26. Integumentary System <ul><li>Subcutaneous fat diminishes </li></ul><ul><li>Decreased number of capillaries in the skin </li></ul><ul><li>Hair pigmentation decreases </li></ul><ul><li>Thinning & graying of scalp, pubic & axillary hair </li></ul><ul><li>Decreased activity of the subcutaneous and sweat glands </li></ul><ul><li>Epidermis & dermis become thinner </li></ul>
  26. 27. Strategies to Promote Healthy Skin <ul><li>Avoiding too much exposure to sun </li></ul><ul><li>Using a lubricating skin cream </li></ul><ul><li>Avoiding long soaks in the tub </li></ul><ul><li>Maintaining adequate intake of water </li></ul>
  27. 29. Reproductive System <ul><li>♀ Changes occurring in the female repro system </li></ul>a. Thinning of the vaginal wall b. Narrowing in vaginal size & elasticity c. Decreased vaginal secretions d. Atrophy of the uterus & ovaries e. Decreased pubococcygeal muscle tone -> these changes contribute to…
  28. 30. <ul><li>♂ Changes occurring in older men </li></ul>a. Penis & testes decrease in size b. Levels of androgen decrease c. Erectile dysfunction  sexual desire & activity decline but do not disappear.  use of water-based lubricants can help prevent painful intercourse.
  29. 31. For erectile dysfunction: <ul><li>1. Vacuum penile pumps </li></ul>
  30. 32. 2. Placement of vasostimulating drugs <ul><li>urethral agents (suppositories) </li></ul>-> alprostadil (muse) -> pellet, the size of a grain of rice -> placed 1 inch into the urine channel 3. Use of Sildenafil citrate (viagra) 4. For both, daily physical exercise promotes enhanced sexual performance
  31. 33. Genitourinary System 1. Changes in kidney function -> Decreased filtration rate -> Diminished tubular function 2. Older women suffer from stress & urge incontinence 3. Common finding in men is BPH
  32. 34. benign prostatic hyperplasia/hypertrophy
  33. 35. Healthy habits <ul><li>Adequate consumption of fluid </li></ul><ul><li>Have available toilet facilities </li></ul><ul><li>Voiding q 2-3 hours </li></ul><ul><li>Avoid bladder irritating substances </li></ul><ul><li>Pelvic floor exercise (Kegel Exercise) </li></ul>-> Makes use of pubococcygeal muscle -> pelvic muscle is first tightened, then relaxed -> done for 30-80 repetitions each day
  34. 36. Prevalence of UTI (common in older women) <ul><li>Possibly d/t: </li></ul>↓ water consumption ↓ poor bathroom hygiene 2 nd to impaired mobility
  35. 37. Gastrointestinal System <ul><li>Salivary flow diminishes </li></ul><ul><li>Gastric motility decreases </li></ul><ul><li>Diminished secretion of acid & pepsin </li></ul><ul><li>Constipation </li></ul>☼ More serious complications include fecal impaction & obstruction
  36. 38. Predisposing factors for constipation: <ul><li>a. Prolonged use of laxatives </li></ul>b. Use of some medications c. Inactivity d. Decrease fluid intake e. Ignoring urge to defecate
  37. 39. Health Promotion Practices (GIT) <ul><li>1. Receiving regular dental care </li></ul>2. Eating small frequent meals 3. High fiber, low fat diet 4. Adequate amount of fluids 5. Establishing regular bowel habits
  38. 40. Musculoskeletal System <ul><li>1. Loss of bone mass/density </li></ul>Osteoporosis -> Usually associated with: a. Inactivity b. Inadequate calcium intake c. Loss of estrogen d. Cigarette smoking 2. Muscle diminishes in size & loses strength, flexibility and endurance.
  39. 41. <ul><li>3. Cartilages of joints progressively deteriorates </li></ul>
  40. 42. Recommendations for Skeletal Health <ul><li>1.High calcium intake </li></ul>2. Low phosphorous diet Dairy products & dark green vegetables Calcium supplements Avoid 3. Weigh-bearing exercises 4. Reduction of caffeine & alcohol
  41. 43. <ul><li>5. Smoking cessation </li></ul>6. Selective estrogen receptor modulator 7. Biphosphate drugs 8. Regular exercise
  42. 44. Nervous System
  43. 45. <ul><li>Nerve cells transmit messages more slowly </li></ul><ul><li>Waste products collect in the brain tissue causing plaques & tangles </li></ul><ul><li>Reduced reflexes d/t nerve breakdown </li></ul><ul><li>Confusion may really be caused by an illness </li></ul>What condition is this?
  44. 46. Prevention 1. Moderate physical & mental exercise 2. Reading 3. Doing crossword puzzles
  45. 47. Sensory System <ul><li>1. VISION </li></ul>-> pupil dilates slowly & less completely -> due to… -> as a result… Recommend: -> sunglasses & hats -> yearly check-ups -> optical aids
  46. 48. <ul><li>2. HEARING </li></ul><ul><li>Loss of ability to hear high-frequency tones </li></ul><ul><li>Especially consonants like… </li></ul><ul><li>Causes the older person to respond inappropriately, misunderstood conversation and avoid social interaction </li></ul><ul><li>Hearing aids can be helpful </li></ul>3. TASTE & SMELL <ul><li>Sweet tastes are dulled </li></ul><ul><li>Blunted tastes contribute to… </li></ul><ul><li>Herbs, onions, garlic & lemon </li></ul>
  47. 49. PSYCHOSOCIAL ASPECTS OF AGING
  48. 50. Stress & coping in the older adult <ul><li>Experiencing success in younger adulthood </li></ul>Develops a positive image even until old age Common stressors of old age <ul><li>Impaired physical function, activities & appearance </li></ul><ul><li>Disabilities from chronic illness </li></ul><ul><li>Social & environmental losses r/t loss of income </li></ul><ul><li>Death of significant others </li></ul>☼ older adult rely strongly on their spiritual beliefs for comfort during stressful times.
  49. 51. Developmental Theories of Aging <ul><li>Either to achieve ego integrity or suffer despair </li></ul>Ego integrity ♠ accepting one’s lifestyle ♠ believing that one’s choices were best ♠ being in control of one’s life Despair ♣ feels dissatisfied ♣ disappointed with life ♣ would live differently if given another chance ♠ using past experiences to assist others
  50. 52. Cognitive aspects of Aging Ф intelligence- progressive decline beginning midlife <ul><li>Environment & health affect spatial perception, and retention of non-intellectual information. </li></ul>(+) effects on intelligence score Cardiovascular health Stimulating environment High levels of education Occupational status routine/non-routine Income
  51. 53. strategies <ul><li>Supply mnemonics to enhance recall </li></ul><ul><li>Encourage on-going learning </li></ul><ul><li>Link new information with familiar information </li></ul><ul><li>Use visual, auditory & other sensory cues </li></ul><ul><li>Wear prescribed glasses & hearing aids </li></ul><ul><li>Provide glare-free lighting </li></ul><ul><li>Keep teaching periods short </li></ul><ul><li>Pace learning task accordingly </li></ul><ul><li>Reinforce successful learning in a positive manner </li></ul>
  52. 54. Pharmacologic Aspects of Aging Medications capable of altering nutritional status a. antacids b. cathartics c. Antibiotics & phenytoin d. Phenothiazines, estrogen & corticosteroids
  53. 55. Altered pharmacokinetics Age-related changes and their effects 1. absorption <ul><li>reduced gastric acid </li></ul><ul><li>reduced GIT motility </li></ul>2. distribution <ul><li>decreased albumin sites </li></ul>-> e.g. warfarin, OHA, calcium channel blockers, NSAIDs <ul><li>reduced cardiac output </li></ul><ul><li>impaired peripheral blood flow </li></ul><ul><li>increased body fat </li></ul>-> e.g. barbiturates, diazepam, morphine
  54. 56. 3. metabolism <ul><li>decreased perfusion of the liver </li></ul>4. excretion <ul><li>decreased renal blood flow </li></ul><ul><li>decreased renal efficiency </li></ul>Nursing implications <ul><li>Often dosages must be reduced </li></ul><ul><li>Medications with a narrow safety margin must be administered cautiously </li></ul><ul><li>Check the mouth for possible “cheeking” </li></ul><ul><li>For self-administration, return demonstration & asking may be necessary </li></ul>
  55. 57. Steps to improve compliance a. Explain the action, side effects, & dosage b. Write out medication schedule & review periodically c. Destroy old, unused medications d. Discourage OTC medications & herbal agents Medication dispenser
  56. 58. Herbal Alternatives Most individuals buy herbal medicines in stores without the consultation of a health care professional Herbal medicines can be in the form of Tablets, Capsules, Teas, Elixirs <ul><li>Studies identifying the appropriate dosage of herbal medicines to use are almost non-existent </li></ul><ul><li>Because there are no standards for production of herbal medicines, there is no way to know what else may be in the product </li></ul><ul><li>There are no tests to prove safety or effectiveness of these herbal products </li></ul>
  57. 59. Physical Health Problems in Older Population 1. Impaired mobility -> Caused by: Parkinson’s disease, osteoarthritis, osteoporosis -> encourage to stay active as possible -> when bed rest cannot be avoided, do aROM -> frequent turning
  58. 60. 2. Increased susceptibility to infection -> possibly due to -> influenza vaccines -> vitamin and dietary supplements
  59. 61. 3. Altered pain & febrile response -> response to pain is lessened -> pain may be absent in older patients experiencing MI & appendicitis -> baseline body temperature = 1°F lower Be alert for other subtle signs: <ul><li>mental confusion </li></ul><ul><li>increased respiration </li></ul><ul><li>tachycardia </li></ul><ul><li>change in facial appearance </li></ul>
  60. 62. Depression in the Elderly <ul><li>One of the conditions most commonly associated with suicide </li></ul>What are risk factors for depression in the elderly? 1. Being a female 2. Being unmarried 3. Lack of supportive social network 4. Stressful life events
  61. 63. Additional risk factors: 1. Certain medicines or combination of medicines 2. Damage to body image (from amputation, cancer surgery, or heart attack) 3. Family history of major depressive disorder 4. Living alone, social isolation 5. Recent bereavement
  62. 64. Depression self-help for seniors 1. Getting out in to the world 2. Connecting to others 3. Participating in activities you enjoy 4. Taking care of a pet 5. Exercising 6. Make sure all medications are taken as instructed

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