1. geriatic nsg nursing care and older clients f - copy


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1. geriatic nsg nursing care and older clients f - copy

  1. 1. Geriatric Nursing1
  2. 2. Stages of growth anddevelopment New born Infant Toddler Pre-schooler Schooler Adult Young adult Middle age Old adult (Elderly)2
  3. 3. 3
  4. 4. INTRODUCTION “GERONTOLOGY”(= geron- old man ; logy – study) This term was coined by Mechnikov in 1903“It is the specialized branch of medical science dealing with thecomprehensive study of the elderly adult”. “GERONTOLOGIC NURSING” - is the care of elderlyadults. Care of elderly needs skilled assessment and creativeadaptations of nursing interventions.4
  5. 5.  Geriatrics is a term of Greek originfrom the word "geras" meaning "oldage" and “iatros” meaning " healer"or "physician", and it means a branchof medicine that deals with theproblems and diseases of old age andaging people. (Webster, 1985).5
  6. 6.  Gerontology--study of all aspects ofindividual aging and its consequences Geriatrics--subdivision of medicinethat is concerned with old age and itsdiseases6
  7. 7. Landmarks 1950 – First geriatric textbook published 1952 – First geriatric nursing study published 1961 – ANA recommends specialty group forgeriatric nurses 1966 – Duke opens first Master‟s program 1970 – ANA Standards of Practice 1973 – First certification exam 1975 – Journal of Gero Nursing by Slack, Inc. 1979 – First national gero nursing conference
  8. 8. Landmarks Cont‟d. 1981 – ANA scope of practice 1988 – First PhD program 1996 – John A. Harford Foundation Instituteof Geriatric Nursing established 1998 – ANA certification available forAdvanced Practitioner Nurse
  9. 9. Demographic Profile of OlderAdult Population Clinical definition is 65 years ofage or older. Older-old adults are 85 or older. Rapidly growing.9
  10. 10. WHO, 200210
  11. 11. 11Human life expectancy.YEAR Life Expectancy2000 BC 18500 AD 221400 > 331790 361850 411900 501946 671991 76
  12. 12. AGED POPULATIONOver 60 yrs % Over 65 yrs %1870 1,937 5 1,154 2.91880 2,822 5.6 1,723 3.41890 3,887 6.2 2,417 3.81900 4,860 6.4 3,080 41910 6,225 6.8 3,950 4.31920 7,925 7.5 4,933 4.61930 10,358 8.4 6,633 5.41940 13,694 10.4 9,019 6.81950 18,328 12.1 12,270 8.11960 23,772 13.1 16,679 9.21970 28,682 14.1 20,177 9.912
  13. 13. UN, 2001 13
  14. 14. 14
  15. 15. “One in Seven Canadianssoon to be One in Four”15
  16. 16. 05101520251970 1990 2025Time period & Region%ofTotalPop.AsiaAfricaEuropeWorldCanadaProportion of PopulationWorldwide Over 65 Years of Age16
  17. 17. Demographic Imperative Persons >65 = Fasting growing age group By 2030, geriatric patients will: Comprise 22% of population
  18. 18. “Sandwich Generation”18
  19. 19. 19
  20. 20. 20Common Problems of elderly people:1. Cataract: vision loss2. Uterine prolapsed3. Hearing loss4. COPD/Asthma5. UTI/urinary retention6. Loose tooth: problem of chewing7. Cancer: lung, breast, colorectal, prostate etc8. Osteoporosis9. Arthritis10. Nutritional problems11. Sleep disturbance12. Multiple drug use13. Dementia and multiple drug use14. Economic insecurity15. Others:
  21. 21. WHO, 200221
  22. 22. Active AgeingHealthWhen the risk factors for chronic diseases andfunctional decline are kept low while the protectivefactors are kept high, people will enjoy both a longerquantity and quality of lifeParticipationWhen labor market, employment, education, healthand social policies and programs support their fullparticipation in socio-economic, cultural and spiritualactivities, people will continue to make a productivecontribution to societySecurityWhen policies and program address the social,financial and physical security needs and rights ofpeople as they age, elderly are ensured of protection,dignity and care in the event that they are no longerable to support and protect themselves22
  23. 23. …Fears of the PatientFear of IsolationFear of PainFear of DependenceFear of Death Itself23
  24. 24. Purposes of geriatric nursing To provide opportunity for continuousdevelopment throughout the lifespan. To support for maximum levels ofindependence. To enhance the quality of life for aged personsthrough the promotion of health. To make their lifestyle less restrictive. To provide for peaceful death24
  25. 25. Scope of Geriatric Nursing: As evident, the aged population continuesto rise and is the population group whorequire and use the greatest amount ofhealth services. Geriatric nursing within institutionsprovides acute, sub-acute and long termcare.25
  26. 26. Scope: Acute Care Setting: Fifty percentage of theelderly age 75 and over account for 21% ofall inpatient days. Geriatric Nurse Practitioner: A geriatricnurse practitioner can manage 80- 90% ofthe health problems that occur amonghospitalized clients.26
  27. 27.  Gerontologic Clinical Nurse Specialist:GCNS is prepared at the master‟s level andis specialist prepared as a : educator,advocate, counselor, researcher andconsultant. In-Service Educator/ Staff Developer: Thisfilled by a nurse with master‟s degree ineducation and a sound base inteaching/learning strategies27
  28. 28.  Counsellor and Health Educator Case Management Nurse: holistic care incommunity Home Care Case Management Nurse: Highlyexpert nurse are needed to assist in themanagement of specific problems e.g. dialysisetc. Certified Rehabilitation Nurses: Telephone Advice Nurse28
  29. 29.  Administratror Director of Nursing Services In NursingHomes Court Investigation Nurse29
  30. 30. Theories of Ageing30
  31. 31. Theories of aging31
  32. 32. Cont….A. Biologic theories: Celluler theory Programmed aging theory Somatic mutation theory Wear and tear theory Error theory Auto immune theory Free-radical theory Crosslinkage theory32
  33. 33. Cont…B. Psychological theories:Disengagement theoryActivity theoryContinuity theorySocial exchange theory33
  34. 34. Cont….C. Environmental theories: Radiation theory Stress theory Pollution theory Exposure theoryD.Nursing theoryE. Developmental theories34
  36. 36. 1.CELLULAR THEORY Cells has been subject of muchscientific inquiry in exploring agingphenomena. Cell has three distinct components:Cells that can reproduce.Cells that can not reproduce.Intercellular substance/materials.36
  37. 37. Cont…Cells that can reproduce: Reproduction of cells occur. Some new cells become nonfunctioning or lesseffective than the others that arereplaced(Busse,1971). Three systems in human body are continuouslyreplaced(skin, lining of the intestine, circulatorysystem). 37
  38. 38. Cont…. With the progress in the aging process thereis accumulation of these inefficient and non-functioning cells. Organism functional ability becomeapparent. Visible changes occur in the aging process.38
  39. 39. Cont…Cells that cannot reproduce: Eg:CNS, Kidney With age cells progressively wear and tear out andor destroyed. Develop an accumulation of non-functioning cells . Systems became less efficient and difficult tohandle.39
  40. 40. Cont….Intercellular substance/materials: Gradual deterioration of intracellular material with aging(Busse, 1971). Reduce ability of the cells to provide necessary nutrientsand oxygen for respective tissue. Directly interfere the functioning abilities of each system.40
  41. 41. 2.PROGRAMMED AGING THEORY:Aging and death, according to thistheory, are not a result of wear and tearor exposure, but are a programmed,natural and necessary part of genetics.In short, we are programmed to ageand die.41
  42. 42. 3. ERROR theory: Mistranscription and mintranslationof certain genes products. Results in self amplifying errorporoducing derrangements(Strchler ,1977) Initial error will , most likely result infurther errors of similar types.42
  43. 43. Cont… The productions of faulty products ofother genes which accumulate with aging.Eg. Enzyme with decrease catalyticactivity in the later life.43
  44. 44. 3.SOMATIC MUTATION THEORY Similar to error theory.Cells exposed to x-ray radiation or chemicalsCell by cell alteration in DNA occursIncrease the incidence of chromosomal abnormalitiesOccurs more at youth and its deleterious effect are seen inlater life44
  45. 45. 4.WEAR ANDTEAR THEORY: Postulates that an organisms” wears out” with use. Damage begins at the level of molecules in ourcells. DNA that make up our genes sustains repeateddamage from toxins.45
  46. 46. Cont… Bodies have the capacity to repair the damagebut not all are accurately corrected. Damage cells progressively accumulates46
  47. 47. 5.AUTO IMMUNE THEORYPostulates that with age, the immunesystem produces auto-anti-bodies thatcauses cell death or cell changes thatfosters the aging process(WALFORD,1969)47
  48. 48. 6.Free radical theory:Free radical is a molecule with anunpaired ,highly reactive electron.One type of free radical generated in ourbody is oxygen free radical.48
  49. 49. Cont…. This free radical grabs the molecule fromany other molecule and damage the othermolecule Molecules that are damaged by freeradicals are : Fat , proteins andDNA.(both of nucleus and mitochondria)49
  50. 50. Cont…. Under normal condition natural defensemechanism prevent most of the oxidativedamage. This theory purpose that little by littlesmall damage accumulate and contributeto detoriation of tissues and organs.50
  51. 51. 7.CROSS LINKAGE THEORY: Also called as collagen theory.With age, our proteins, DNA and otherstructured molecules develop inappropriatecross links to one anotherThis unnecessary links decreases theelasticity of proteins and other molecules.51
  52. 52. Cont…..Protein that are damaged are no longer needed and arebroken down by protease enzyme.Presence of cross linkage inhibits the activity of protease.Damaged and unneeded proteins ,stick around and cancause problemEg:wrinkling of skin at aging, age related cataract formation.52
  54. 54. 1.DISENGAGEMENT THEORY:One of theearliest theories.Developed byElaine Cummingand WilliamHenry (Cummingand Henry 1961)54
  55. 55. Cont…This theory viewed aging as a processthrough which society and the individualgradually withdraw or disengage fromeach other.Fail to explain the phenomenon :Many older person desire to remainengaged and don’t want their place tobe taken away by those younger thanthemselves.55
  56. 56. “Nobody grows oldmerely by living anumber of years. Wegrow old by desertingour ideals. Years maywrinkle the skin, but togive up enthusiasm 56
  57. 57. 2.ACTIVITY THEORY:Proposed byHAVIGHRUST(1963).Suggest that agedpeople shouldcontinue an activemiddle-agedlifestyle and shouldremain as activeas possible.57
  58. 58. Cont….. It suggests that obstacles are to be resisted and thatproblems involving declining health, loss of roles andresponsibilities , reduction in income and diminishingcircle of friends are to be overcome. It suggests many ways for older people to maintain anactive life.58
  59. 59. Cont….. For most elderly people when physicalactivity is much reduced, intellectualactivities should be emphasized. When old friends and relatives are dying orotherwise lost, the establishment of newfriendship would be encouraged.59
  60. 60. 3. Continuity theory: Negatron , 1964 In spite of aging process , personality andbasic patterns of behavior are considered tobe constant in the individual.60
  61. 61. Cont….. Patterns and activity levels develop over alife time will largely determine whether anindividual remain engaged and active ordisengaged and inactive as they age. This theory encourages young people toconsider their current activities as afoundation for their own future agingprocess.61
  62. 62. 4. Social Exchange theory:Postulates thatsocial interactionbetweenindividuals andgroups continuesas long aseveryone profitsfrom theinteraction.62
  63. 63. Cont….When there is no longer profit from thesocial exchange, imbalance occurs in theinteraction and one individual is perceivedas having more power than the other.The decrease in the social interaction ofthe aged is the result of exchangerelationship that gradually erode thepower of the aged.63
  65. 65. Cont…..The elements in the environment havebeen considered by the researchers tohave an effect on aging phenomena.Biologist have considered the effects of theenvironment on the cellular structure ofthe human organism.65
  66. 66. Cont….Radiation Theory:Excessive exposure to the suns radiationputs the skin at risk during the somaticmutation process.66
  67. 67. Cont…..Stress theory:According to Perlman (1954), „Human agingis a „disease syndrome‟ arising from astruggle between environmental stress andbiological resistance and relative adaptationto the effects of stressor agents. thesestressor agents might include air, pollutants,chemical , and psychological and sociologicalevents.‟67
  68. 68. D. Nursing Theory of agingMiller (2004) has developed the functionalconsequences theory.Older adults experiences functional consequencesbecause of age related changes and additional riskfactors.68
  69. 69. Cont…Without interventions, many functionalconsequences are negative; with them, however,functional consequences can be positive.The role of gerent logic nurse is to identify thefactors that causes negative functionalconsequences and to initiate interventions that willresult in positive ones.69
  70. 70. Cont….Normal age related changes and factors maynegatively interfere with patient outcomesand actually interfere with patients activityand quality of life.The nurse must differentiate between normalage related changes that can be reversedand risk factors that can be modified.70
  71. 71. E. Developmental theoriesErikson (1963) theorized that persons lifeconsists of eight stages.Each stages represent a crucial turning pointin life stretching from birth to death, with itsown developmental conflicts to be resolved.According to him, the major developmentaltask of old age is either to achieve egointegrity or to suffer despair.71
  72. 72. Cont….Combination of theory of Havighrust and Eriksongives the following developmental tasks for olderadults: Maintenance of self-worth Conflict resolution Adjustment to the loss of dominant roles. Adjustments to the deaths significant others Environmental adaption Maintenance of optimum levels of wellness.72
  73. 73. Importance to Nurses: Each theoryprovides frameworkand insight into thedifferences amongelderly patients. Nurses play asignificant role inhelping agingperson experiencehealth fulfillment andsense of well being73
  74. 74. Cont…Nurses attitude towards aging can have anenormous impact on patients.It makes the nurse aware whether thechanges are related to aging or diseasecondition.It helps to differentiate normal aging from theabnormal one.74
  75. 75. Cont… It helps to provide specific care keeping in mind about thevarious changes in their biological and psychological aspect. It can be tested, changed or used to guide research or toprovide base for evaluation. It guides the nurses in helping the old people adapt to variouschanges. It helps the older people in rebalancing the relationship.75
  76. 76. Forty is the old age of youth;fifty the youth of old age….76
  77. 77. Its sad to grow old, but niceto ripen……77
  78. 78. Major Theories of Aging:Biological Somatic Mutation Theory (Changes associated with agingare the result of decreased function and efficiency of cellsand organs) Programmed Aging Theory (Genetic clock determinesspeed of aging) Cross-linkage, or Collagen, Theory (Loss of flexibilityresults in diminished functional motility) Immunity Theory (Diminishing of thymus results in impairedimmunologic function) Stress Theory (Stress causes structural and chemicalchanges that eventually result in irreversible tissue damage).78
  79. 79. Major Theories of Aging:Psychosocial Activity Theory (Life satisfaction depends onmaintaining an involvement with life by developingnew interests, hobbies, roles, and relationships). Disengagement Theory (Decreased interactionbetween older person and others in the socialsystem is inevitable, mutual, and acceptable to boththe individual and society). Continuity Theory (Successful methods usedthroughout life for adapting and adjusting to lifeevents are repeated.Traits, habits, values, associations, and goalsremain stable, regardless of life changes). 79
  80. 80. Activity theory illustrated80
  81. 81. Structural Damage TheoriesStructural damage theories of aging are based on theview that the molecular components of cells, overtime, begin to malfunction and break down:1. Wear and Tear Theory:2. Waste Accumulation Theory:3. Faulty Reconstruction Theory:4. Immuno-suppression Theory:5. Errors and Repair Theory:6. Molecular Cross-linkage Theory:7. Mitochondrial Damage Theory:81
  82. 82. Modern Theories of Aging“Aging is a disease. The human lifespansimply reflects the level of free radicaldamage that accumulates in cells. Whenenough damage accumulates, cells can‟tsurvive properly anymore and they justsimply give up.”— Earl StadtmanNational Institutes of Health82
  83. 83. Myths about Aging Senility is a result of aging. Incontinence is a result of aging. Older adults are no longer interested insexuality. Most people spend their last years innursing homes. All elderly persons are financiallyimpoverished.83
  84. 84. Realities of Aging Dementia is disease-related, not age-related. Incontinence is not present among allaged. Sexuality is a lifelong need. 10% to 40% of elderly in the U.S. mayspend some time in extended carefacilities.84
  85. 85. Normal Aging Despite stereotype most of the elderlyage well!85
  86. 86. Physiologic Changes Associatedwith Aging: Overview Respiratory System CardiovascularSystem GastrointestinalSystem ReproductiveSystem: Female ReproductiveSystem: Male Endocrine System MusculoskeletalSystem IntegumentarySystem Nervous System Urinary System Sensory Changes86
  87. 87. Physiological ChangesProcess in Elderly87
  88. 88. Respiratory System: Changes Muscles of respirationbecome less flexible. Decrease in functionalcapacity results indyspnea on exertion orstress. Effectiveness of coughmechanism lessens,increasing risk of lunginfection. Alveoli thicken anddecrease innumber and size. Structural changesin the skeleton candecreasediaphragmaticexpansion.88
  89. 89. Respiratory Increased energy ofbreathing Increased airwaysresistance Increased in dead-space89
  90. 90. Cardiovascular System:Changes Cardiac output andrecovery time decline.The heart requires moretime to return to normalrate after a rate increasein response to activity. Heart rate slows. Blood flow to all organsdecreases. Arterial elasticitydecreases,causing increasedrise in bloodpressure. Veins dilate andsuperficial vesselsbecome moreprominent.90
  91. 91. Cardiovascular System: Changes……. The aorta and other arteries becomes thicker andstiffer which may bring a moderate increase insystolic blood pressure with aging. The valves between the chambers of the heartthicken and become stiffer. The blood flow to the kidneys may decrease by 50percent and to the brain by 15 to 20 percent. The pacemaker of the heart loses cells anddevelops fibrous tissue and fat deposits.91
  92. 92. Cardiovascular System: Changes……. The baroreceptors,which monitor the bloodpressure and adjust ourblood pressure when wechange position becomeless sensitive with aging. This can causeorthostatic hypotension92
  93. 93. Gastrointestinal System:Changes Tooth enamel thins. Periodontal diseaserate increases. Taste buds decreasein number, and salivaproduction diminishes. Effectiveness of thegag reflex lessens,resulting in increasedrisk of choking. Arterial elasticitydecreases, causingincreased rise inblood pressure. Veins dilate andsuperficial vesselsbecome moreprominent.93
  94. 94. The Digestive System• StomachmotilitypH• Sm. Intestineabsorption• Large Intestinemotility• Liver•blood flow94
  95. 95.  Liver: Reduced blood flow Altered clearance ofsome drugs Decreased weight ofliver Reducedregenerativecapacity of liver Liver metabolizesless efficiently95
  96. 96.  Intestines: As we age the smallintestines absorb lesscalcium and vitamin D. Therefore, we needmore calcium toprevent bone mineralloss and osteoporosisin later life.96
  97. 97.  Some enzymes, such as lactase whichaids the digestion of lactose (a sugarfound in diary products) decline with age. Reduced peristalsis of the colon canincrease risk for constipation97
  98. 98.  The ability to recognize sweet, sour, bitter,or salty foods diminishes over time, alteringsatisfaction with food. There is decreased salivation, so there isdifficulty in swallowing food. Reduced gastrointestinal motility results indelayed emptying of stomach contents andearly satisfaction( feeling of fullness).98
  99. 99. Reproductive System:Female: Changes Estrogen productiondecreases with onset ofmenopause. Ovaries, uterus, andcervix decrease in size. Vagina shortens,narrows, becomes lesselastic; vaginal liningthins. Supporting musculatureof the reproductiveorgansweakens, increasing riskof uterine prolapse. Breast tissue diminishes. Libido and the need forintimacy andcompanionship in olderwomen remainsunchanged.99
  100. 100. Reproductive System: Male:Changes Testosterone productiondecreases, resulting indecreased size of testicles. Impotency may occur. Although more time is requireto obtain erection, the olderman often finds that he andhis partner can enjoy longerperiods of lovemaking prior toejaculation. Prostate gland mayenlarge. Libido and need forintimacy andcompanionship remainunchanged in oldermales. Sperm count andviscosity of seminal fluiddecrease.100
  101. 101. Reproductive systemCOMPONENT CHANGES CLINICAL FINDINGS1. Malea. Penisb. Testesc. Prostated. Breasts•Decreased subcutaneous fat.•Decreased testosterone production•Enlargement•Increased subcutaneous fat•Reduced size, easilyretractable foreskin.•Urinary symptoms•Gynecomastia2. Femalea. Breastsb. Vaginac. Uterusd. Ovaries•Decreased subcutaneous fat•Atrophy of tissue•Decreased thickness ofmyometrium•Reduced function•Decrease in size, morependulous•Dry mucosa, narrower andshorter vagina•Decrease in size, uterineprolapsed.•Menopause101
  102. 102. Endocrine System: Changes Alterations occur in both the reception andthe production of hormones. Release of insulin by the beta cells of thepancreas slows, causing an increase inblood sugar. Thyroid changes may lower the basalmetabolic rate.102
  103. 103. Musculoskeletal System:Changes Muscle mass and elasticity diminish, resultingin decreased strength, coordination, andincreased reaction time. Bone demineralization occurs,causing skeletal instability andshrinking of intervertebral disks. Joints undergo degenerative changes,resulting in stiffness, pain, and loss of range ofmotion.103
  104. 104. Musculoskeletal system By the time wereach age 80,most of us willlose an averageof about 2 inchesof height.104
  105. 105.  The primary factorscontributing to thisreduction in heightinclude compression ofvertebrae changes in posture, and increasedcurvature of the hipsand knees.105
  106. 106.  Weight increases until about age 60 andthen declines This pattern of weight change is morelikely the result of reductions in activityand changes in eating rather than agingitself. Bone mineral content diminished106
  107. 107.  As we age, our muscles generally decreasein strength, endurance, size and weight. Typically, we lose about 23 percent of ourmuscle mass by age 80 as both thenumber and size of muscle fibers decrease. Body fat mass can double, lean musclemass is lost107
  108. 108. Integumentary System:Changes (i) Subcutaneous tissue and elastin fibersdiminish, causing skin to become thinner andless elastic. Hyperpigmentation or liver spots. Diminished secretions and moisturization. Body temperature regulation diminishes. Capillary blood flow decreases, resulting inslower wound healing. Blood flow decreases, especially to lowerextremities. 108
  109. 109. Integumentary System:Changes (ii) Vascular fragility causes senile purpura. Cutaneous sensitivity to pressure andtemperature diminishes. Melanin production decreases, causing gray-white hair. Scalp, pubic, and axillary hair thin, andwomen display increased facial hair. Nail growth slows, nails become more brittle,and longitudinal nail ridges form.109
  110. 110. Integumentary system One of the mostcommon physicalchanges thatpeople associatewith aging is wrinkling Pigment alteration Thinning of theskin.110
  111. 111.  The most common changes in the skininclude: Thinning of the area between thedermis and epidermis by about 20% Elastin and collagen decrease Reduction in size of cells Inability of skin to retain moisture111
  112. 112.  The skin becomes less able to retainfluids and is more easily dry and cracked. As a result, both the thickness andelasticity of skin decrease. Therefore, sunscreens and moisturizingcreams play an important part inprotecting aging skin.112
  113. 113.  In addition to changes inthe skin itself, thesubcutaneous layers offatty deposits decreaseswith age. This gives some veryold people an emaciatedappearance.113
  114. 114. 114
  115. 115. Hair Hair becomes gray. Hair grays because of agradual decrease in theproduction of melanin,the pigment cells in thehair bulbs. The graying of hair isalso influenced byheredity and hormones.115
  116. 116.  There are also fewer hair follicles on thescalp and the growth rate of hair decreasesin the scalp, armpits, and pubic areas. However, hair growth actually acceleratesand thickens in places like nostrils, ear andeyebrows, especially in men. Older women often have an increase infacial hair as their estrogen levels decrease.116
  117. 117.  Alopecia/baldness: hair lossis the norm117
  118. 118. Skin and Aging118
  119. 119. Genitourinary system After 40 renal functiondecreases By 90 lose 50% of function Filtration and reabsorptionreduced Size and number ofnephrons decrease119
  120. 120.  Bladder muscles weaken Kidney mass decreases by 25-30 percentand the number of glomeruli decrease by30 to 40 percent. These changes reduce the ability to filterand concentrate urine and to clear drugs.120
  121. 121.  With aging, there is a reduced hormonalresponse (vasopressin) and an impairedability to conserve salt which may increaserisk for dehydration. Bladder capacity decreases and there is anincrease in residual urine and frequency. These changes increase the chances ofurinary infections, incontinence, and urinaryobstruction.121
  122. 122.  In males, BenignProstatic Hyperplasia(BPH) is morecommon. In females, perinealmuscles relax, thereis urge incontinenceand stress urinaryincontinence.122
  123. 123. Nervous system Neurons of central andperipheral nervoussystem degenerate Loss of brain mass Synthesis andmetabolism of themajorneurotransmittersreduced123
  124. 124.  Nerve transmission slows so, older peopletake longer to respond and react. Hypothalamus less effective in regulatingbody temperature Reduced REM sleep, decreased deepsleep After 50yrs lose 1% of neurons each year Waste products collect in brain, causingplaques and tangles124
  125. 125. Nervous System: Changes Neurons in the braindecrease in number. Cerebral blood flow andoxygen utilizationdecrease. Time required to carryout motor and sensorytasks requiringspeed, coordination, balance, and fine-motor handmovements increases. Short-term memory maysomewhat diminishwithout much change inlong-term memory. Night sleep disturbancesoccur due to morefrequent and longerwakeful periods. Deep-tendon reflexesdecrease, althoughreflexes at the kneesremain fairly intact.125
  126. 126. Dementia An organic brain pathologycharacterized by losses in intellectualfunctioning. The clinical manifestations associatedwith dementia are never considerednormal aging changes.126
  127. 127. Urinary System: Changes Nephrons in the kidneysdecrease in number andfunction. Glomerular filtrationdecreases. Blood urea nitrogenincreases. Sodium-conserving abilitydiminishes. Bladder capacity decreases. Renal function increaseswhen the older client liesdown. Bladder and perinealmuscles weaken. Incidence of stressincontinence increases inolder females. Prostate may enlarge inolder males, causingurinary frequency anddribbling.127
  128. 128. Sensory Changes: Vision The lens becomes lesspliable and less able toincrease its curvature inorder to focus on nearobjects. Accommodation of pupilsize decreases, resultingin both decreasedadjustment to changes inlighting and decreasedability to tolerate glare. Vitreous humorchanges inconsistency, causingblurred vision. Lacrimal glandssecrete less fluids,causing dryness anditching. Lens yellows,causing distortedcolor perception.128
  129. 129. Sensory systemVision: Visual impairment isthe most commonsensory problem ofolder people. Not all older peoplehave impaired vision Loss of ability to seeitems that are closeup begins in the 40‟s129
  130. 130.  Size of pupil grows smallerwith age: focusing becomesless accurate Lens of eye yellows making itmore difficult to see red andgreen colors Sensitivity to glare increases Night and depth vision less Eyelids baggy and wrinkled Eyes deeper in sockets Conjunctiva thinner andyellow130
  131. 131.  Lens enlarges Lens becomes lesstransparent Can actuallybecome clouded Results in cataracts.131
  132. 132.  Quantity of tearsdecreases About 95% ofindividuals age 65and older reportwearing glassing orneeding glasses toimprove theirvision.132
  133. 133. Sensory Vision The lens tends to opacify,which influences colorperception. There is a decrease in lightand dark adaptation. The lens tends to loseelasticity, which increases thedistance of focusing. There is a decline in contrastsensitivity and an increase insensitivity to glare.133
  134. 134. Hearing Hearing loss is verycommon with aging. Auditory changesbegin to noticed atabout 40 years ofage. 30% people > 65have significanthearing impairment134
  135. 135.  Membranes in the middle ear, including theeardrum, become less flexible with age. In addition, the small bones in the middleear, the ossicles, become stiffer. Both these factors somewhat decreasehearing sensitivity but are not thought tocause significant impairment. Men more affected than women135
  136. 136.  The vestibular apparatus begins todegenerate with age in a similar way tothe hearing apparatus. Equilibrium becomes compromised andolder individuals may complain ofdizziness and lose their balance.136
  137. 137. Sensory Changes: Hearing The pinna becomes less flexible, hair cells ininner ear stiffen and atrophy, and cerumen(earwax) increases. Number of neutrons in the cochlea decreaseand blood supply lessens, causingdegeneration. Presbycusis, the impairment of hearing inolder adults, is often accompanied by a lossof tone discrimination.137
  138. 138. Sensory Hearing Hair cells tend to be lost in theorgan of Corti. Cochlear neurons tend to be lost. Stiffening, thickening, andcalcification occur in multiplecomponents of the auditoryapparatus. Taste Older persons may havedecreased sensitivity to taste.138
  139. 139. Taste Taste alsodiminishes with age Some atrophy of thetongue occurs withage and this maydiminish sensitivity totaste.139
  140. 140. Smell The number of functioningsmell receptors decreases. After the age of 50 the senseof smell decreases rapidly. By age 80, the sense ofsmell is reduced by abouthalf.140
  141. 141. Immune system Decline inimmune function Fatty marrowreplaced redbone marrow141
  142. 142.  As we grow older, our bodies are lessable to produce antibodies which areimportant in fighting infections. As a result older adults are at greater riskfor infections and the mortality rate frominfection is much higher than in the young. Decreased production of thymic hormonesdue to shrinkage of thymus gland leads toinfections.142
  143. 143. Endocrine system Estrogen levels decrease in women. Other hormonal decreases includetestosterone, aldosterone, cortisol,progesterone. The normal fasting glucose level rises 6-14mg/dL every 10 years after age 50. Probably due to loss in number of insulinreceptor sites in cells.143
  144. 144. Neuromuscular Reduced sensory input Delayed nerve conduction Reduced numbers of motor neurones Reduced muscle massTherefore vulnerability to falls!144
  145. 145. Osteoporosis and Fractures Low dietary intake of Calcium Loss of endocrine protection Reduced endogenous productionof Vitamin D Disuse Disease – Chronic RenalDisease, Rheumatoid Arthritis,Thyroid Disease Medications – Steroids,Thyroxine145
  146. 146. Oral Health Problem146
  147. 147. Oral health is an importantcomponent of „Active Ageing‟and is included in policyproposals related to health, oneof the three basic pillars.147
  148. 148. Reduce risk factors associated with majordiseases and increase factors that protecthealth throughout the life course- Tobacco - Physical activity- Nutrition - Healthy eating- Oral Health - Psychological factors- Alcohol and drugs - Medication148
  149. 149. Oral Health Problem in ElderlyTooth loss1Denture related condition2Coronal and root caries3Periodontal disease4Xerostomia5Cancer and precancer6149
  150. 150. 150
  151. 151. Infections Among Elderly151
  152. 152. Breaking the Chain of InfectionInfectious agentReservoirPortal of exitMode of transmissionPortal of entrySusceptible host152
  153. 153. Signs and Symptoms ofInfection Confusion, dizziness, sudden onset of falls Fever Fast breathing or fast heart beat Pain or tenderness of the affected area orall over Loss of energy Loss of appetite Nausea Vomiting153
  154. 154. Signs and Symptoms ofInfection Diarrhea Rash Sores on mucus membranes Redness and swelling of a body part Discharge or drainage from the infectedarea Cloudy and/or foul/thick urine Painful and/or difficult urination Foot blisters, cracks, change in color154
  155. 155. Pressure Ulcer155
  156. 156. EpidermisDermisSubcutaneous fatty tissueSweat glandsBlood vesselsNervesHair follicleSkin Layers156
  157. 157. Blood FlowNormal blood flow through tinyblood vessels called capillariesInterrupted blood flow throughcapillaries caused by pressure157
  158. 158. Infection BacteriaUlcer deepensDamage to underlying structuresWidening infectionPressure Decreased blood flowLack of nutrients/O2Cell deathShed cells UlcerPressure Ulcer Snake158
  159. 159. Locations for Pressure Ulcers159
  160. 160. 160
  161. 161. Braden Scale Nurses will use Braden Scale to assess forpressure ulcer risk in the following sixareas: Sensory-perception (touch, hot, cold, pain) Moisture Activity Mobility Nutrition Friction and shear161
  162. 162. 162
  163. 163. Safe Use of Restraints Restraints require a doctor‟s order and mustbe used only to treat a medical condition.Never use restraints: As a permanent means of control As a form of punishment For the convenience of the staff As a substitute for activities or treatments163
  164. 164. Seven Cs of Care of Terminally Ill patientConcern : Compassion, worth, tender and involvement.Competence: Skill and knowledge about illnessmanagement eg pain, nausea, shortness of breath,insomnia.Communication: allowing patient to speakChildren: Allowing children to visit patient , bringsconsolation.Cohesion: Family cohesionCheerfulness: Gentle and appropriate sense of human. Humor can be palliative.Consistency: Continuing, persistent attention andinvolvement till the end.
  165. 165. Summary Aging of the population will result in 25% of thepopulation being over 65 by 2030 The majority (?) of the elderly are well and enjoy areasonable socio-economic status (Nepal?) A small but significant subset of frail (delicate),vulnerable elderly account for an excess ofadverse socio-economic and health careoutcomes. (Nepal: Common) More suffers: very old, female, living alone, withmultiple chronic diseases and taking multiplemedications.165
  166. 166. Thank You Your geriatricpatients rely onyou to provide thebest care possibleand promotingcomfort in patientcare166
  167. 167. Thank you167
  168. 168. ThankYou!!!168
  169. 169. Health promotion strategies169
  170. 170. CVS Exercise regularly, pace activities Avoid smoking Eat low fat diet, low salt diet Participate in stress reduction activities Check blood pressure regularly Medication compliance Control weight.170
  171. 171. Respiratory Exercise regularly Avoid smoking Take adequate fluids to liquefy secretions Avoid exposure to upper respiratory tractinfections.171
  172. 172. GI Use mouthwash, brush, floss and receiveregular dental care. Sit up and avoid heavy activity after eating Limit antacids and laxatives. Eat a high fiber, low fat diet, drink adequatefluids. Eat small, frequent meals. Toilet regularly.172
  173. 173. SKIN Avoid solar exposure(clothing, sunscreen,stay indoors). Dress appropriately for temperature. Maintain a safe indoor temperature Lubricate skin.173
  174. 174. Genito-urinary Seek referral to urology specialist. Have ready access to toilet Wear easily manipulated clothing Drink adequate fluids Avoid bladder irritants (caffeinatedbeverages, alcohol) Pelvic floor exercises.174
  175. 175. Reproductive system Females may require estrogenreplacement therapy. To use a lubricant with intercourse.175
  176. 176. Muskulo-Skeleton Exercise regularly. Eat a high calcium diet, limit phosphorusintake. Take calcium and vitamin D supplements. Encourage use of assistive devices ifindicated Modify environment to reduce fall risk Encourage activity- take walks etc.176
  177. 177. Nervous system Allow longer time to respond to stimulusand move more deliberately. Encourage slow rising from a restingposition.177
  178. 178. Sensory Eye Wear eyeglasses, use sunglasses outdoors. Avoid abrupt changes from dark to light. Use large print books. Use magnifier for reading. Avoid night driving. Use contrasting colors for color coding. Avoid glare of shiny surfaces and directsunlight.178
  179. 179. Sensory Hearing Recommend a hearing examination. Reduce background noises. Encourage to face person and use nonverbal cues. Speak with a low pitched voice.179
  180. 180. Thank You180
  181. 181. 181