This document discusses age-related problems in geriatrics. It begins with definitions of aging, geriatrics, and gerontology. It then covers theories of aging and normal physical, psychosocial, cognitive, and pharmacological changes that occur with aging. Common health problems in older adults are also discussed, including depression, substance abuse, delirium, dementia, geriatric syndromes, and increased susceptibility to infection. The document concludes with sections on the medical and nursing management of various aging-related conditions.

1. AGE RELATED
PROBLEMS IN
GERIATRICS
RAKCON
Bsc. H NURSING

2. INTRODUCTION
AGING - The normal process of time-related changes, begins with
birth & continues throughout the life. Whenever nurses work with
an adult population, they are likely to encounter older adult
patients. This topic presents normal age changes, aspects of aging
and health problems related to aging & ways that nurses can
address the health issues of older adults.
GERIATRICS- is a field of practices that focuses on the physiology,
pathology, diagnosis, management of disorder & diseases of older
adults.
GERONTOLOGY- is combined biological, psychological &
sociological study of older adults in their environment.

3. Aging is the normal process of time related
changes begins with birth & continues throughout
the life. Although there are specific changes which
are identified as a part of normal aging process,
each person ages in his own.
DEFINITION

5. A set of biological, psychological & developmental theories
of aging have been developed & no single theory is
universally accepted.
THEORIES OF AGING
1. BIOLOGICAL THEORIES - These theories attempt to
explain physical aging as an involuntary which eventually
leads to cumulative changes in cells ,tissues & fluids.

6. * INTRINSIC BIOLOGICAL THEORIES - say that age changes arise
from internal pre-determined causes.
* EXTRINSIC BIOLOGICAL THEORIES - tell that the environmental
factors lead to structural changes which inturn causes degenerative
changes.
 CROSS LINK THEORY
 FLUID RADICAL THEORY
 IMMUNOLOGIC THEORY
 WEAR AND TEAR THEORY

7. 2. PSYCHOSOCIAL THEORIES - Psychosocial theories try
to explain age-related changes or cognitive function such as
intelligence , memory , learning & problem solving.
 ACTIVITY THEORY
 CONTINUITY THEORY
 DISENGAGEMENT THEORY
 SOCIAL EXCHANGE THEORY

8. 3. DEVELOPMENTAL THEORY - This theory describes specific
life stages and the task associated with each stage.
4. ENVIRONMENTAL THEORY - Acc. to this theory , factors in
the environment such as industrial carcinogens, sunlight,
infection etc. brings changes in the aging.
5. METABOLIC THEORY - This theory focuses on the
relationship between metabolic rate and aging.
6. GENETIC LIFE SPAN THEORY - This theory states that life is
genetically programmed i.e., an organism life span is part of its
genetic makeup.

9. 7. SOMATIC MUTATION THEORY -
This theory maintains that damage to or mutations in the DNA
of somatic cell impair protein manufacture & therefore alter
the structure & function of cells, tissue & organs.
The modern society is slowly beginning to view aging as a
normal part of the developmental process, a lifelong
continuum that begins at conception & culminates with death.

10. AGE RELATED CHANGES / ASPECTS OF AGING
The well-being of older people depends on physical,
psychosocial, mental , social , economic & environmental
factors. A total assessment includes an evaluation of cell
major body system, social & mental status and person’s
ability to function independently.

11. PHYSICAL ASPECT OF AGING
CHANGES SUBJECTIVE AND
OBJECTIVE FINDINGS
HEALTH PROMOTION
STRATEGY
CARDIOVASCULAR SYSTEM -
Decreased cardiac output , heart
rate & stroke , volume do not
increase with maximum demand
, decreased B.P
C/O Fatigue with increased
activity , increased heart rate
recovery time.
optimum BP < 120/80 mmHg
hypertension > 140/90 mmHg
Exercise regularly , avoid smoking
, eat low fat and salt diet , check
BP regularly , weight control.
RESPIRATORY SYSTEM -
Increased residual lung volume
Fatigue and breathlessness with
sustained activity , decreased
lung expansion , difficulty in
coughing
Healthy lifestyle , recieve yearly
immunization , avoid exposure to
URTI
INTEGUMENTARY SYSTEM -
Decreased subcutaneous fat :
interstitial fluid : glandular
activity and sensory receptors
Thin , wrinkled & dry skin
complaints , injuries, bruises &
intolerance to prominent bone
structure.
Limit sun exposure to Vit. D (10-
15min) : stay hydrated; maintain
a safe indoor temperature;
lubricate skin with lotions contain
petroleum & mineral oil.

12. REPRODUCTIVE SYSTEM -
FEMALE: Vaginal narrowing;
decreased elasticity; decreased
vaginal secretions.
MALE: Decline infertility; decreased
sperm production.
MALE & FEMALE: Slower sexual
response
FEMALE: Painful intercourse ;
vaginal bleeding; after
intercourse vaginal itching &
irritation.
MALE: Delayed erection &
achievement of orgasm
May require vaginal estrogen
replacement; gynecology/ urology
follow-up; use a lubricant with
sexual intercourse.
MUSCOSKELETAL SYSTEM - Loss
of bone density , loss of muscle
strength & size.
Height loss , prone to fractures ,
kyphosis , back pain , joint pain
, loss of muscle strength
Regular exercise , eat high Ca 2+
diet , limit phosphorus intake.
GENITOURINARY TRACT -
Decreased in detrusor muscle
contractility , bladder capacity ,
flow rate
Urinary retention , feeling of
incomplete bladder emptying ,
irritative voiding symptoms
Drink adequate water but limit
alcohol drinking , donot wait
longer period for bladder voiding
,perform pelvic floor exercises
GIT - Decreased sense of thirst ,
smell and taste , decreased
salivation , delayed esophageal &
gastric emptying
Dehydration , electrolyte
imbalance , dry mouth , heart
burn , ingestion , constipation ,
abdominal discomfort.
mouth wash , limit antacids , eat
high fibers , low fat diet ,
adequate fluids , avoid heavy
exercise after eating

13. NERVOUS SYSTEM - Reduced
speed in nerve conduction;
increased confusion; loss of
environmental cues.
Learning takes long , become
confused with hospital
admission; faintness;
frequent falls; slow response
Enhance sensory stimulation
;encourage slow rising from a
resting position teaching
SPECIAL SENSES -
VISION - Decreased ability to
focus on close objects ,
distinguish colour , adjust
change to light intensity
HEARING - Decreased ability to
hear , typanic membrane
thinning
TASTE AND SMELL - Decreased
ability to smell and taste.
C/O confusion in colour ,
poor night vision , give
inappropriate responses , ask
people to repeat ,takes
excessive salt and sugar
Wear eyeglasses , avoid abrupt
changes from dark to light ,
use adequate lightening.
Reduce background noise ,
take hearing examination ,
enunciate clearly , encourage
use of lemons , cessation of
smoling

15. PSYCHOSOCIAL ASPECTS OF AGING
STRESS AND COPING IN OLDER ADULTS
They have fewer choices & diminished resources to deal with stressful events.Many
older adults rely strongly on their families & spiritual beliefs for comfort during stressful
times.
LIVING ARRANGEMENT
Living at home or family have strong emotional significance for them. It can also be
stressful depending on family dynamics.
• Continuing care retirement , communities offers 3 levels of living arrangements:-
independent single dwelling houses, assisted living apartments & skilled nursing
services as per need.
• Long term facilities offer continues nursing care including physical
therapy,occupational therapy, respiratory therapy & cognitive therapy.

16. ROLE OF FAMILY
The family has been continuing to be an important source of
support for older people; similarly, older family members
provide a great deal of support to younger ones.Family
reduce distress & enhance wellbeing.

17. COGNITIVE ASPECTS OF AGING
 INTELLECTUAL FUNCTIONING - Fluid abilities or abilities involve in
solving novel problems tend to decline from adulthood to old age. Their
formal educational past experience is reflected in their intellectual
performance.
 MEMORY FUNCTIONING - Short term memory deteriorate with age ,
long-term memory does not show similar changes. This can be attributed
to social health or physiological factor.
 LEARNING ABILITY - Ability to learn continue throughout life, good
health & motivation.

18. PHARMACOLOGICAL ASPECTS OF AGING
DRUG INTERACTION & ADVERSE EFFECT
Polypharmacy or the prescription, use or administration of more medication than is
clinically indicated is common in elderly, potential for drug- drug interaction increases
with increase medications use & with multiple co-existing disease that affect
pharmacokinetics of medication.
Medications can affect the appetite , cause nausea , vomiting, constipation, etc (Eg. -
Antacid may cause thiamine deficiency)
ALTERED PHARMACOKINETICS
Alteration in absorption (decreases gastric acid, decreases GI mobility); distribution
(decreases albumin site, decrease cardiac output , etc.); metabolism (decreases
perfusion of liver) & excretion (decreases renal blood flow, decreases renal efficiency)
occur as a result of normal aging & may also result from drug & food interaction.

20. MENTAL HEALTH PROBLEMS IN OLDER ADULTS
1. DEPRESSION : Most common affective or mood disorder of old age.
Depression among older adults can follow a major precipitating event or loss &
is often related to chronic illness or pain.
SIGN - feelings of sadness diminished memory & concentration, feeling of
worthlessness, sleep disturbance, suicidal ideas, etc. Form mild depression non
pharmacological measures (exercise increased IPR) are effective.
For major depression, atypical antidepressants (bupropion, mirtazapine , etc.)
as well as selective serotonin reuptake inhibitors such as paroxetine (peril) are
effective.

21. 2. SUBSTANCE ABUSE : Substance abuse case caused by misuse of alcohol
and drug maybe related to depression.
 Alcohol abuse while rare is especially dangerous in older people because of
age related change in renal and liver function as well as high risk of
interaction with prescription medication & resultant adverse effect .
 Assessing for drug and alcohol use with direct question in a non accusatory
manner should be part of routine physical assessment.

22. 3. DELIRIUM : Often called ‘ACUTE CONFUSIONAL STATE', begins with the
confusion & progress to disorientation
 Patients may experience an altered level of consciousness ranging from stupor
(hypoalert hypoactive) to excessive activity (hyperalert hyperactive) or both.
SIGNS: Hallucination, fear, anxiety, paranoia, disorganized thickness etc.
 If Delirium goes unrecognized irreversible brain damage or death can follow.
PREVENTION STRATEGIES - Controlling pain prevent sleep deprivation fluid electrolyte
balance minimizes use of psychoactive drug, etc.

23. 3. DEMENTIA : Cognitive, functional & behavioral change that characterize
“dementia” eventually destroy a person’s ability to function.
TYPES OF DEMENTIA - Alzheimer & vascular dementia
OTHER NON - ALZHEIMER DEMENTIA - Parkinson’s disease , AIDS related
dementia , pick’s disease.
ALZHEIMER’S DISEASE VASCULAR DISEASE
ETIOLOGY Early onset (familial , genetic)
Late onset (sporadic)
Cardiovascular & cerebrovascular
disease , hypertension
COURSE Chronic , irreversible , progressive ,
regular
Chronic ,irreversible , fluctuating,
stepwise progression
OCCURENCE 50-60% of dementia 10-20% of dementia
PHYSICAL SIGN Forgetfulness, depressed , loss of
voluntary activity.
Focal neurologic signs , seizures ,
motor deficits

24. GERIATRIC SYNDROME
Older adults tend to acquire multiple problem and illness as they age. some
problems commonly experienced by older adults are becoming recognized
as geriatric syndrome.
Geriatric syndromes are associated with reduced life expectancy.
IMPAIRED MOBILITY
 Common causes of decreased mobility include strokes , Parkinson’s disease,
cardiovascular compromise, osteoarthritis, osteoporosis.
 To avoid immobility , older people should be encouraged to stay as active as
possible.
 During illness bed rest should be kept to a minimum, even with hospitalized patient
because brief period of bedrest quickly leads to deconditioning and consequently to
a wide range of complication.
 Patient should perform active range of motion exercises on unaffected extremities &
passive ROM exercises on affected extremities.

26. DIZZINESS
 Order adults frequently seek help for dizziness, which presents a
particular challenge because there are numerous possible causes.
 The problem is complicated by an inability to differentiate b/w true
dizziness (a sensation of disorientation in relation to position) and
vertigo(a spinning sensation)
 The cause of these sensations range in a variety of severity
MINOR (e.g.,buildup of ear wax)
MAJOR (e.g.,dysfunction of cerebral cortex, cerebellum, brain stem)

27. FALLS AND FALLING
 Falls are the most common cause of non-fatal injuries and hospital admissions.
 Incidence of falls rises with Increasing age.
 One out of five falls in older adults results in serious injury such as broken bones
or a head injury.
 Hip fracture is a common type of fracture that can occur as a result of a fall.
URINARY INCONTINENCE
 Urinary incontinence maybe acute occurring during an illness or many develop
chronically over a period of years.
 Detrusor hyperactivity with impaired contractility is a type of urge incontinence
i.e., seen predominantly in the older age adults.

28. INCREASED SUSPECTIBILITY TO INFECTION
ATYPICAL RESPONSE
 Increased susceptibility to infection means infectious diseases present a significant
threat of morbidity and mortality to older adults in part because of blunted
response of host defenses caused by a reduction in both cell-mediated and
humoral immunity.
 e.g. Influenza and pneumococcal infection.
 Many altered physical , emotional & systemic reaction to disease are attributed to
age related change in older adults.
 Physical indicators of illness that are useful and reliable in young but in middle
aged people cannot be relied on for the diagnosis of potential life threatening
problem in older adults.

29. ALTERED EMOTIONAL IMPACT
 E.g. - older adults who are experiencing a myocardial infarction may not have
chest pain but present with confusion hiatal hernia or upper gastrointestinal
distress is often the cause of chest pain.
 Older adults admitted to the hospital are at high risk of disorientation,
confusion, change in level of consciousness (LOC) and other symptoms of
delirium as well as anxiety and fear.
 In addition ,economical concerns & fear of becoming a burden to families
often leads to high anxiety and dependency in older patients.

30. ALTERED SYSTEMIC RESPONSE
The decline in organ function that occur in every system of the aging
body eventually , depletes the body’s ability to respond at full capacity.
Older adults maybe unable to respond effectively to an acute illness or
if a chronic health condition is present , they may be unable to sustain
appropriate responses over a long period. Furthermore, their ability to
response to definitive treatment is impaired.

31. ETHICAL AND LEGAL ISSUES AFFECT THE OLDER ADULTS
Apply legal and ethical principal in the analysis of complex issues related to care of
older adults : informed consent, refusal of treatment and advance directives.
1. DECISION MAKING CAPACITY –
• Implies the ability to understand the nature and consequences of different
option, make a choice among those option & communicate that choice.
• Competency-legal determination by a judge as to mental disability or
incapacity, whether a person is legally fit and qualified to give testimony or
execute legal documents.
• The law presumes that all adults are competent and have decision making
capacity to make healthcare decisions.

32. 2. RIGHT TO REFUSE TREATMENT
• Even if refusal results in death
3. INFORMED CONSENT
• Patient’s autonomous decision about whether to undergo surgical procedure or
any other treatment.
4. ADVANCED DIRECTIVE
• A formal, legally endorsed document that provides instructions for care (living
well) or name a proxy decision making.

33. MEDICAL MANAGEMENT
DEPRESSION
• MILD : Cognitive therapy and reminiscene therapy
• MAJOR : Antidepressants (bupropion , venlafaxine) short term psychotherapy
DELIRIUM
• Treatment of underlying cause is important
ALZHIMER,S DISEASE
• Cholinesterase inhibitors (hydrochloride) enhance acetylcholine uptake. Behavioral &
psychological therapies.
VASCULAR DEMENTIA
• Measures to decrease BP & lower cholestrol level , may prevent future infarcts.
URINE INCONTINENCE
• Anticholinergics are given.

34. NURSING MANAGEMENT
40%
10%
1%
60%
LOREM IPSUM
Click here to add the text.
NURSING DIAGNOSIS
I. Altered mental status delirium & dementia related to physiological changes in old age.
GOAL – Supportive cognitive function
INTERVENTION –
• Supply mnemonics to enhance recall of related data
• Use visual, auditory & other sensory cues & encouraging on going learning.

35. 40%
10%
• Provide a quiet, non-distracting movement.
• Set short-term goals with input from learner & encourage verbal participation.
• Reinforce successful learning in a positive manner.
NURSING DIAGNOSIS
II Risk of injury: falls related to change in mental status & decreased coordination
GOAL : Promoting physical safety
INTERVENTION –
• Remove all obvious hazards & install hand rails in the home.

36. 40%
10%
• Adequate lighting with minimum glare especially in halls, bathroom & strain is
necessary.
• Prohibit driving by elderly people.
• Avoid restraints because they increase agitation.
• Teach older adults to grab bars during bath tub shower & toilet
• Avoid loose clothing , improperly fitting shoes , scatter rugs , etc.
NURSING DIAGNOSIS
III Self-care deficit: related to cognitive changes.
GOAL : Promoting independence in self care activities

37. 40%
10%
1%
60%
INTERVENTION –
• Simple daily activities by organizing them into short, achievable steps.
• Encourage participation in self-care activities as much as possible.
• Identify the physical and psychological need of the patient.
• Ensure adequate sleep and physical rest.
• A regular pattern of activity & rest enhances night time sleep.
• Assist patient to remain functionally independent for as long as possible.
NURSING DIAGNOSIS
IV Anxiety related to lack of motivation and confidence.
GOAL : Reducing anxiety & agitation

38. 40%
10%
60%
INTERVENTION –
• Environment should be kept familiar & noise free.
• Measure such as moving to a familiar environment, listening to music or
distraction may quiet the patient.
• Use of clear, easy to understand sentences to convey message. Tactile
stimuli such as hugs or hand pats are interpreted as signs of affection &
concern.
• Socialization with friends can be comforting, visitors, letters & phone calls
are encouraged.
• Care of plants or a pet can also be satisfying & outlet for energy.

39. 40%
10%
NURSING DIAGNOSIS
V Imbalanced nutrition related to polypharmacy & changes in food habits
GOAL : Promoting adequate nutrition
INTERVENTION –
• Meal time should be kept simple & calm without confrontations.
• Prefer familiar foods that look appreciating & taste good.
• Offer one dish at a time & food is cut into pieces to prevent choking.
• Liquid may be easier to swallow if they are converted to gelatin.
• Hot food & beverages are served warm & temp. of food should be checked to
prevent burns.

40. 40%
10%
1%
60%
NURSING DIAGNOSIS
VI Urge urinary incontinence related to delirium, restricted mobility, infection & pharmaceuticals.
GOAL : Avoid bladder irritants such as caffeine, alcohol & aspartame.
INTERVENTION –
• Patient keeps a pattern of predictable voiding.
• Take steps to avoid constipation, drink adequate fluids, eat balanced diet high in
fibers, exercise regularly
• Void regularly, 5-8 times/day i.e., about 2-3 hrs.
• Perform all pelvic floor muscle exercises as prescribed everyday
• Avoid taking diuretics agents after 4pm

41. 40%
10%
1%
60%
NURSING DIAGNOSIS
VII Increased susceptibility to infection related to inadequate nutrients in the diet, alterations in
the immune system of the body.
GOAL : Patient remain free from infection & maintains personal hygiene.
INTERVENTION –
• Buildup general health to increase immune. Make sure that dietary intake is
adequate of various nutrients.
• Avoidcrossinfection.
• Restrict visitors, if anyone is suffering from contagious disease, protect the client
through barrier nursing.
• Have regular medical checkup to diagnose diseases in their early stage.

42. 40%
10%
1%
60%
NURSING DIAGNOSIS
VIII Impaired skin integrity related to aging process, malnutrition, poor hygiene, chronic illness, mobility
deficits
GOAL : Patient will not have skin breakdown.
INTERVENTION –
• Frequent change of position giving special attention to pressure points.
• Adequate nutrition & fluid intake.
• Always keep the skin dry & clean.
• Thorough cleaning of the skin. eg - daily bath , frequent back care.

43. SUMMARY & CONCLUSION
• Today we have discussed definition, theories & aspects of aging, mental
health problems of aging, geriatric syndrome, ethical & legal issues &
nursing and medical management of various age related problems. Aging is a
universal & natural phenomenon which is associated with various kinds of
social, mental & physical problems.
• Preventive strategies & management of these problems help in improving
life quality of elderly.

44. BIBLIOGRAPHY
1. Brunner & Suddharth’s, ‘textbook of medical Surgical nursing (VolI) ; 13TH
Edition.
Page no.182, 183, 186,191-205, 207, 1586.
2. http://www.Slideshare.net/mobile/stepipoule/geriatric-care- 55925240.
3. Stephanie’s principles & practice of nursing (VolI), 6th edition, Page-no.
570-573, 578-581.
4. https://www.researchgate.net/publication/315914851_Care_p
lan_for_elderly_people_at_nutritional_risk

45. THANK YOU