anp 2 geriatric consideratioPPT.pptx

PRESENTATION ON
ADVISOR:-
Mrs. .SARITA
SHOKHANDHA
ASSISSTANT
PROFESSOR.
PRESENTED BY:-
Ms. VERSHA CHAUHAN
Msc(Nsg) 2nd year.
UNIT 3- GERIATRIC

CONTENT
 INTRODUCTION
 MEANING/DEFINITION
 CONCEPTS
 TRENDS & ISSUES
 THEORIES OF AGEING
 HEALTH PROBLEMS AND NEEDS
 PSYCHO PHYSIOLOGICAL STRESSORS AND
DISORDERS
 MYTHS AND FACTS OF AGING
 HEALTH ASSESSMENT.

INTRODUCTION
 Declining fertility rates combined with steady
improvements in life expectancy over the
20th century produced dramatic growth in the
world’s elderly population .People aged 65
yrs and over now comprise a greater share of
the world’s population than ever before. Since
1950 there is a tremendous increase more
than three fold.
 The number of elderly is now increasing by 8
million /day :by 2030 this increase will reach
24 million /year.

DEMOGRAPHY
As we enter twenty first century, population aging has
emerged as a major demographic trend world wide.
High birth rates and low death rates led to two
unpredicted changes in the demography of humans.
Indian Scenario
 Current population of India is more than 1.21
billion (according to census of India 2011)
 The population of the nation is growing at the rate
of 1.41%
 In India, elderly population is over 82 million and
this figure is expected to reach the mark of 177
million, almost double by the year 2025.

GERIATRICS
 The term geriatrics comes from the Greek
‘’geron’’ meaning “old man” and “iatros”
meaning “healer.” However, geriatrics is
sometimes called medical gerontology.
 Geriatric nursing is the specialty that
concerns itself with the provision of nursing
services to geriatric or aged individuals.

GERIATRICS
Definition
 Geriatrics is a sub-specially of internal medicine
that focuses on health care of elderly people. It
aims to promote health by preventing and treating
diseases and disabilities in older adults.

THEORIES OF AGEING:-
2 theories are there ……
1.Programmed theories
1.Error theories
1.Programmed senescence theory
2.Endocrine theory
3.Immunology theory.
1.Wear and tear theory
2..cross-linking theory
3.Free radical theory
4.Error catastrophic theory
5.Somatic mutation theory
A. BIOLOGICAL
THEORIES:-

B.PSYCHOLOGICAL
THEORIES
 1.Personality theory
 2.Developmental task theory
 3.Disengagement theory
 4.Activity theory
 5.Continuity theory

1.PROGRAMMED THEORIES OR
NON-STOCHASTIC THEORIES
1.Programmed Senescence Theory/Hay flick
Limit Theory
 In this theory, it is proposed that there is
impairment in the ability of the cell to continue
dividing.
 The Hay flick limit theory of aging(So called after
its discover Dr. Leonards Hay flick) suggest
that the human cell is limited in the number of
times it can divide. Dr. Hay flick Theorized that the
human cells ability to divide is limited to
approximately 50 times after which they simply
stop dividing ( and hence die).

 He showed that nutrition has an effect on cells
with overfed cells dividing much faster the an
underfed cells. As cells divide to help repair and
regenerate themselves we may consider that the
DNA and genetic theory of aging may play a role of
here.
 The Hay flick limit indicates that there is a need to
slow down the rate of cell division if we want to live
long lives. Cell division can be slowed down by diet
and lifestyle, etc.

2.Endocrine Theory or Neuro-
endocrine Theory
 First proposed by Professor Vladimir Dilman and
Ward Dean MD
 The theory states ,as we age ,the endocrine system
becomes less efficient and eventually leads to the
effects of aging.
 The endocrine system secretes hormones from
glands that deliver messages to cells containing
information and instructions .
 The cells are programmed to receive specific
messages from the many hormones that circulate
through the body.
 Hormone levels are affected by factors such as
stress and infection.

3.Immunologic Theory
 It proposes declining functional capacity of
immune system as the basic for the aging
process. It suggests that aging is not passive
wearing out of systems but an active self-
destruction mediated by immune system.
 This theory is based on observing an age
associated decline in T-cell functioning
accompanied by a decrease in resistance and
increase in autoimmune disease with
aging.

 Studies reveal that cell division suggest that cells of
the immune system become more diversified with
age and demonstrate a progressive loss of self-
regulatory patterns. The result is an autoimmune
phenomena in which cells normal to the body are
mistaken as foreign and are attacked by the person’s
own immune system

2.ERROR THEORIES
 Wear and Tear Theory
 Early theory on aging proposed that there is a
fixed store of energy available to the body
as time passes, the energy is depleted and
because it cannot be restored, the person
dies
 Later, other theories emerged. The wear and
tear theory stated that the body is like a
machine that wears out its parts with
repeated use and comes to a grinding valt.
This is not widely accepted.

 Cross-linked Theory
 Proposed by Johan Bjorksten in 1942.
 According to this theory the aging of living
organisms depends on casual formation of
chemical bonds or across links between
protein molecules .Repair enzymes of the
cell cannot break those bonds.
 Protein molecules are more particularly binds
one to another by means of glucose molecule

 The process of cross links formation between
protein molecules in a human organism is very
similar to the process that takes during leather
tanning.
 As we age ,progressive accumulation of cross
links occurs in most tissues of our organism –in
arteries cartilages ,muscles. The main
consequence of this process is the decline in
the tissue elasticity,

Free-radical Theory
 Proposed by Denham Harman in 1956
 It states that organisms age because cells
accumulate free radical damage over time .
 A free radical is any atom or molecule that
has a single unpaired electron in an outer shell

 Free radical are unstable, short lived and highly
reactive, as they attack nearby molecules in
order to steal their electrons and gain stability,
causing radical chain reactions to occur.
 Free radicals are known to attack the structure of
cell membranes, which then create metabolic waste
products such toxic accumulations interfere with cell
communications.
 Further disturbing DNA ,RNA and protein
synthesis ,lower energy levels and generally
impede vital chemical processes.

Error catastrophe
 Proposed by Leslie Orgel in 1963.
 This theory states that over time an error or
mistake occurs in our DNA map or proteins
and it begins to produce cells that are not
correct
 It’s like going from producing a high quality
product to producing a lesser quality product.
This deterioration results in ageing and
eventually over a lifetime &death .

 Somatic theory or gene
mutation theory
 The somatic mutation and intrinsic
mutagenesis theories postulates that aging is
a result of lifelong genetic damage which
may include the progressive accumulation of
faulty copying in divining or accumulation of
errors in information containing molecules

PSYCHOSOCIAL CHALLENGES
OF OLDER ADULTHOOD
Widowhood
 It’s a state or period of being widow or widower
Common additional consequences include the
following:
 Loss of companionship and intimacy
 Loss of helper
 Loss of sexual partner Feelings of grief,
loneliness, and emptiness
 Increased responsibilities
 Increased dependence on others

 Loss of income and less efficient financial
management
 Changes in relationships with children, married
friends, and other family members.
 The impact of the loss can be tremendous, and the
feelings of grief, loneliness, and emptiness may be
overwhelming.

Ageist Attitudes
 Ageism can lead to prejudices, fear of aging, and
feelings of devaluation and degradation.
 Negative age-based stereotypes include impaired
memory and decreased cognitive performance,
declining will to live and diminished positive affect,
negative effects on physical health, and behavioral
changes such as decreased walking speed and
shaky handwriting .
 When negative ageist stereotypes are pervasive in
a society, people with a good self-acceptance of
being old may feel that it is socially unacceptable to
admit that it is okay to be old.

Retirement
 The age of 60 years is the traditional
retirement age; however, there is a growing
trend toward “bridge employment” involving a
transition from full-time to part-time
employment before retirement.

 When people retire, they inevitably cope with a
change in social status, and the psychosocial
challenge may be the greatest for people whose self-
esteem and self-concept are based on job status.
 The following factors commonly influence the
decision to retire: health, financial assets, job
conditions, pension availability, family
circumstances, opportunities for continued
employment, and continued ability to perform
job responsibilities.

Chronic Illness and Functional
Impairments
 Another major life adjustment for many older
adults is coping with chronic illnesses and
functional limitations, particularly limitations
that curtail their independence.
Other consequences of chronic illnesses
include the following:
 Threats to self-esteem and altered self-
concept

 Changes in lifestyle
 Unpredictability about one’s ability to do what one
wants
 Expenditures for assistance, medications, and
medical care
 Frequent trips to health care providers
 Adverse medication effects, which sometimes cause
further functional impairments
 Increased vulnerability to personal crimes and fear of
crime

Relocation
 Another common psychosocial adjustment
for older adults is the decision to move from
the family home.
 Increased dependence on others because of
health problems.
 Older adults whose adult children have
moved to another location may relocate to be
closer to them.

 Problems also arise for older homeowners
 Relocation to a nursing home is a significant life
event for some older adults. Nurses caring for older
adults in hospitals and nursing homes have
important roles in assisting older adults and their
families with relocation decisions and adjustments.
 Nurses can ensure that older adults are involved as
much as possible in decisions and that these
decisions are periodically reviewed as the older
adult’s needs change.

Death of Friends and Family
 The loss of friends and family becomes
inevitable with each year because meaningful
social relationships are an important predictor
of well-being for older adults, loss of family
and friends is likely to have a negative impact
on psychosocial wellness.

 However, older adults who are able to adjust their
expectations and do not feel a sense of social
isolation may fare better than those who perceive
themselves as socially isolated and disconnected .
 Nurses have many opportunities to promote
healthy psychosocial function during the usual
course of caring for older adults. For example, they
can incorporate communication techniques and
other interventions to enhance self-esteem,
promote a sense of control, and fostering social
support

Nursing interventions to
promote healthy psychosocial
function
1.Enhancing Self-Esteem
 Self-esteem enhancement is an essential
component of nursing care for older adults
because self-esteem is an important coping
resource and a factor that influences well-
being. Self-esteem refers to the feelings one
has about one’s self.

 Many factors that are threats to self-esteem are
associated with staff and environments of
institutional settings and can be addressed through
relatively simple nursing interventions.:-
 Ensure easy access to their usual assistive devices
 Provide privacy.
 Asking food preferences.

 Asking open-ended questions, such as, “Is
there anything that we can do to help you
manage better while you’re here?”
 Asking, “Is there anything you’re worried about
that I can help you with?”
 Ensuring that staff members address persons
by their preferred names
 Involving older adults as much as possible in
decisions that affect them

2.Promoting a Sense of Control
 Nurses address psychosocial needs of older
adults with interventions that promote a
sense of control and that involve older adults
in decisions.
 Nursing interventions to promote a sense of
control for older adults include involving them
as much as possible in organizing their
schedule and providing information about
their plan of care.

 Nursing interventions also address factors that can
threaten perceived control, such as lack of privacy
and loss of individuality, which commonly occur in
institutional settings.
 Nurses can show respect for privacy by knocking on
bedroom doors and asking permission before
entering, by closing doors when privacy is
desired, by asking permission before pulling bed
curtains open, and by being careful about
moving personal belongings without permission
from the older person.
 Encouraging the person to have personal belongings

3.Fostering Social Supports
 Nurses have many opportunities to foster the
development of social networks for older
adults, and this is an appropriate intervention
for addressing social isolation.
 Social isolation is likely to occur because of
any of the following factors that commonly
occur in older adulthood:
 Hearing impairments and other communication
barriers

 Chronic illnesses that limit activity or energy
 Lack of social opportunities because of care giving
responsibilities
 Mobility limitations, including the inability to drive a
vehicle
 Mental or psychosocial impairments that interfere
with relationships
 Loss of spouse, friends, or family through death,
illness, or physical distance.
 In long-term care settings, nurses can foster
positive social interactions in group settings, such
as dining and activity rooms.

 A very simple intervention, such as positioning
chairs (including wheelchairs) so that people can
interact with each other, can significantly influence
social contacts, either positively or negatively.
 In home settings, nurses can identify community
resources, such as volunteer friendly visitor and
meal programs, to decrease social isolation.
 Support and education groups that primarily focus on
coping with a chronic illness (e.g., stroke clubs, or
better breathing groups) also provide excellent
opportunities for social contact and the development
of friendships with people who are in similar
situations.

PHYSIOLOGICAL CHANGES
ASOCIATED WITH AGING
1.Cardiovascular changes
 Heart rate diseases and it takes longer for heart
rate and blood pressure to return normal after
exertion
 The aorta and other arteries become thicker and
stiffer which may bring a moderate increase in
systolic blood pressure with aging
 The valves between the chambers of the heart
thicken and become stiffer
 The baroreceptors which monitor blood pressure
become less sensitive. Quick changes in position
may cause dizziness from orthostatic hypotension

Parameters of Cardiovascular Assessment
 Cardiac assessment: ECG; heart rate, rhythm,
murmurs, heart sounds
 Assess BP (lying, sitting, standing) and pulse for
symmetry.
 Palpate carotid artery and peripheral pulses for
symmetry.
Nursing care Strategies for cardiovascular problems
 Safety precautions for orthostatic hypotension
 Encourage lifestyle practices to attain a healthy body
weight (BMI 18.5-24.9 kg/m2). And normal blood
pressure
 Healthful diet
 Physical activity

2.Changes in the
Pulmonary System
 The lungs become stiffer, muscle strength
diminishes, and the chest wall becomes more
rigid
 Total lung capacity remains constant but vital
capacity decreases and residual volume
increases
 The alveolar surface area decreases by up to 20
percent. Alveoli tend to collapse sooner on
expiration
 There is an increase in mucus production and a
decrease in the activity and number of cilia

Parameters of Pulmonary Assessment
 Assess respiration rate, rhythm, regularity, volume,
depth, exercise capacity. Auscultate breath sounds
throughout lung fields
 Inspect thorax, symmetry of chest expansion. Obtain
smoking history
 Monitor secretions, breathing rate during sedation,
positioning, arterial blood gases, pulse oximetry
 Assess cough, need for suctioning

Nursing care strategies
 Maintain patent airways through upright positioning/
repositioning, suctioning, and bronchodilators
 Provide oxygen as needed
 Maintain hydration and mobility.
 Incentive spirometry as indicated, particularly if
immobile or declining in function
 Education on cough enhancement, and smoking
cessation.

3. Changes in the
Genitourinary system
 Kidney mass decreases by 25-30% and the
number of glomeruli decrease by 30 to 40%.
These changes reduce the ability to filter and
concentrate urine and to clear drugs
 With aging there is reduced hormonal
response and an impaired ability to conserve
salt which may increase risk for dehydration

 Bladder capacity decreases and there is an increase
in residual urine and frequency
 These changes increase the chances of urinary
infections, incontinence, and urinary obstruction
Parameters of Renal and genitourinary
assessment
 Assess the renal function (creatinine clearance)
 Assess need/dose of nephrotoxic drugs

 Assess for fluid/ electrolyte and acid/ base
imbalances
 Evaluate nocturnal polyuria, urinary incontinence,
BPH. Assess UTI symptoms.
Nursing-care Strategies
 Monitor nephrotoxic and renal cleared drug levels
 Maintain fluid/electrolyte balance. Minimum 1.5-
2.5mL/day from fluids and foods for 50 to 80 kg
adults to prevent dehydration
 For nocturnal polyuria: limit fluids in evening, avoid
caffeine, use prompted voiding schedule.

4.Changes in
gastrointestinal system
 Decreased in strength of muscles of
mastication, taste and thirst perception
 Decreased gastric motility with delayed
emptying. Atrophy of protective mucosa
 Malabsorption of carbohydrates, vitamin B12
and D, folic acid , calcium
 Impaired sensation to defecate
 Reduced hepatic reserve
 Decreased metabolism of drugs

Stomach
 Atrophic Gastritis
 Achlorhydria refers to an insufficient production of
stomach acid
 Gastric ulcers (ulcers in the stomach) are more
common after the age of 60 and can be benign or
malignant.
Liver
 Reduced blood flow
 Altered clearance of some drugs,
 A diminished capacity to regenerate damaged
liver cells.

Intestines
 The prevalence of diverticulosis increases with age
 Studies of motility in older adults show reduced
peristalsis (intestinal muscle contractions) of the
large intestine.
Parameters of Gastrointestinal Assessment
 Assess oral cavity; chewing and swallowing capacity,
dysphagia (coughing, choking with food/fluid intake) ,
 Monitor weight, calculate BMI, compare to
standards.
 Determine dietary intake, compare to nutritional
guidelines.
 Assess for GERD, constipation and fecal
incontinence; fecal impaction by digital examination

 Monitor drug levels and liver function tests if on
medications metabolized by liver
 Assess nutritional indicators
 Educate on lifestyle modifications
 Educate on normal bowel frequency, diet,
exercise, recommended laxatives
 Encourage mobility; provide laxatives if on
constipating medications.
 Encourage participation in community-based
nutrition programs; educate on healthful diets.

5.Changes in the
Muscular Skeletal System
 Muscles generally decrease in strength, endurance, size
and weight
 Loss of about 23 percent of muscle mass by age 80 as
both the number and size of muscle fibers decrease
 Lose of an average of about 2 inches of height
 Compression of vertebrae, changes in posture, and
increased curvature of the hips and knees.
Bones: Bone mass begins to gradually decline as aging
disrupts the balance between the cells that produce
bone and the cells that absorb bone. Bones become
thin and become more porous. Women have a more
rapid rate of bone loss than men, with 1 most rapid
losses occurring in the 5 years following menopause.

Parameters of Musculoskeletal
system Assessment
 Assessment includes general observation of
posture, stance, and walking. Observations
focus on whether a patient is favoring one side
of the body or another while walking.
 The Timed Up-and-Go Test provides a quick
assessment of an older adult’s overall mobility
and function.

 For patients with existing disabilities, an inquiry is
made to assure the patient has been evaluated in
physical therapy for the correct fitting and teaching of
the proper use of existing and assessment for any
new assistive devices.
 Osteoporosis can be assessed by additional
questioning of the patient regarding any back pain,
joint pain, and loss of height. Bone mineral
density (BMD) testing can also be completed, with
results comparing the patient’s bone mass to
individuals in their age range, or previous results if
the patient has had a previous baseline BMD test

 Regular exercise like ..

6.Changes In
Integumentary System
Skin
 Wrinkling, pigment alteration and thinning of the skin
 A thinning of the area between the dermis and
epidermis by about 20%
 Elastin and collagen decrease
 Reduction in size of cells
 Loss of subcutaneous layers of fatty deposits
 Inability of skin to retain moisture

Hair

Hair grays because of a gradual decrease in the
production of melanin, the pigment cells in the hair
bulbs. The graying of hair is also influenced by
heredity and hormones
• Fewer hair follicles on the scalp and the growth rate
of hair decreases
• Older women often have an increase in facial hair
as their estrogen levels decrease.

Parameters of Integumentary
System Assessment
Identifying Opportunities for Health Promotion
 Assessment questions are aimed at identifying the
person’s perception of any problems, any risk
factors that may contribute to skin problems, and
the person’s personal care behaviors that
influence hair and skin status.
 Nurses obtain information about medications and
other risk factors as part of the overall
assessment, and they incorporate this information
into the skin assessment.
 Comprehensive assessment, such as information
about fluid intake, nutritional status, and
mobility and safety, is applicable to the
assessment of the skin.

Observing Skin
, Hair, and Nails
 Close inspection of the skin in a warm, private, and
well-lit environment is an essential component of
skin assessment. Examination of the skin is
particularly important because older adults may
focus on benign conditions, such as xerosis, but not
notice more serious conditions such as skin cancer.
 Nurses observe skin color, turgor, dryness, overall
condition, and any growths or pathologic conditions.

 Nurses also observe and document cultural
variations.
 Also, when assessing for erythema or pressure
areas, nurses should keep in mind that early skin
changes may be difficult to detect in people with
darkly pigmented skin.
 Assessment includes inspecting the skin for brown
actinic keratosis precancerous lesions, commonly
found on the face, neck, and upper extremities.
Untreated, these lesions may progress to squamous
cell carcinomas, which are reddish dome-shaped
lesions.

Nursing-care
Strategies
Promoting Healthy Skin
 Because the condition of the skin depends largely on
the overall health of the person, the maintenance of
optimal nutrition and hydration is an important
intervention in the skincare of older adults.
 Other factors, including smoking, dehydration, sun
exposure, low environmental humidity, and the use
of harsh cleansing products, are likely to contribute
to xerosis in older adults.

Preventing Skin Wrinkles
 Avoiding too much exposure to sunlight and using
a sunscreen with a sun protection factor (SPF) of
15 or higher when exposure to sunlight is
unavoidable.
 Topical products containing alpha- or beta-
hydroxy acids may be beneficial in reversing
wrinkles and promoting the regression of solar
keratoses.
 Nurses need to be alert to the possibility that
older adults might develop an allergic or sensitivity
reaction to some of the ingredients in topical
products.

Preventing Dry Skin
 Petroleum and other emollients are effective in alleviating
dry skin discomfort, because they moisturize and lubricate
the skin.
 An emollient agent is most effective when it is applied to
moist skin immediately after bathing.
Detecting and Treating Harmful Skin Lesions
 Early detection and treatment of cancerous or precancerous
skin lesions are key factors in preventing serious functional
consequences, because the cure rate for most skin cancers
approaches 100% with early excision.
 The nurse’s role is to detect any suspicious-looking lesions
and to encourage or facilitate further evaluation.
 Nurses can encourage all older adults to use the following
guide to identify for themselves any skin changes that
require further evaluation:

 require further evaluation
“ABCDE” SIGNS FOR SKIN LESIONS”

7.Changes in the
Sensory System
Vision
•. About 95% of individuals aged 65 and older report
wearing glasses or need glasses
to improve their vision
• The pupil decreases in size, by age 60, it is
about 1/3 the size it was at 20
• The lens of the eye becomes yellowed, more
rigid, and slightly cloudy
• The iris, colored part of the eye, becomes more
rigid overtime.

Parameters of Vision Assessment
 Interviewing About Vision Changes
 Identifying Opportunities for Health Promotion
 Observing Cues to Visual Function
 Using Standard Vision Tests

Some activity tips to promote productive aging with
older adults with low vision may include:
 Color contrasting various areas for easier
identification of transitions or hazards in the home
 Maintaining good lighting in pathways and stairways
 Using labels and various other organizational
methods to identify small items
 Keeping commonly used items in easy-to-access
locations
 Avoiding moving quickly into a dark room or lighted
area; giving the eyes time to adjust to changing light
levels
 Using large-print books, checkbooks, or magnifying
glasses for reading

Hearing
• It contributes significantly to social isolation
• Membranes in the middle ear, including the
eardrum, become less flexible with age
• Small bones in the middle ear, the ossicles,
become stiffer. Weakening sense of balance
• The vestibular apparatus begins to degenerate
with age

 Equilibrium becomes compromised and older
individuals may complain of dizziness and find it
difficult to move quickly
without losing their balance
• Presbycusis, literally "old man's hearing", is the
most common form of hearing loss with aging
• It is characterized by a decrease in perception of
higher frequency tones and a decrease in speech
discrimination. The magnitude of presbycusis varies
widely and it is hard to determine how much of the
hearing loss is due to aging and how much is due to
exposure to environmental noise, ototoxic drugs, or
chronic age-related conditions such as
hypertension and diabetes.

Parameters of Hearing
Assessment
 Interviewing About Hearing Changes
 Observing Behavioral Cues
 Using Hearing Assessment Tools
 Nursing- Strategies
 Promoting Hearing Wellness for All Older Adults
 Preventing and Alleviating Impacted Cerumen
 Compensating for Hearing Deficits
 Assistive Listening Devices
 Hearing Aids
 Speak slowly and clearly

Smell
• The number of functioning smell receptors
decreases
• There is increase in the threshold for smell. It takes
a more intense smell for it to be identified and
differentiated from other smells.
Taste
• Taste also diminishes with age. A reduced ability to
taste is called hypogeusia. The rare inability to
detect any tastes is called ageusia;
• Atrophy of the tongue occurs with age and this may
diminish sensitivity to taste.

8.Changes in the
Nervous System
• Older nerve cells may have fewer dendrites
(branches) and some may become de
myelinated (lose its coating) which can slow
the speed of message transmission
• Impairment in cognitive capacity can threaten
autonomy and the ability to manage our daily
activities
The incidence of cognitive impairment
increases with age so that by age of 85, up to
I/3rd of older persons have some degree of
cognitive impairment

 Memory
 Poor recall of verbal words
 Perform less well on tasks involving encoding,
retention, and retrieval of information.
 Conceptualization, mental flexibility and the capacity
for abstraction decline with age.
 General intelligence
 Performance scores which measure problem solving
ability tend to decline

Parameters of Nervous system assessment
 Collect health history of past and present
 Assess deep tendon reflexes
 Assessment Cranial nerves : sensory and motor to
rule out any abnormality
 Mini Mental Status Examination
Nursing-Strategies
 Assist in performing activity of daily living.
 Keep all their needed things in their reach.
 Teach fall prevention technique.

Cognitive changes
 Cognitive function, deterioration leads to a
decline in the ability to perform activities of
daily living:-
 Delirium: Delirium or acute confusion state, is
a potentially reversible cognitive impairment
that is due to physiological cause.
 Dementia : Dementia is generalized
impairment of intellectual functioning that
interferes with social and occupational
functioning .Un like delirium, dementia is
characterized by gradual, progressive
irreversible, cerebral dysfunction.

It presents following symptoms:
 Deficits of memory
 Deficits of language
 Disturbed perception
 Impaired learning and problem-solving
 Impaired judgement
Depression: - 20% older adults may experience late
life depression. Depression reduces happiness and
well –being. It contributes to physical and social
limitations. It increases the risk of suicide.

Changes in the
Endocrine System
 The endocrine system undergoes many changes
during aging, and these changes affect other body
systems and processes.
 Age-related changes in the thyroid gland affect
almost all body functions and include the following:
 Decreased secretion and plasma levels of
triiodothyronine (T3), especially in men
 Increasingly common hypothyroidism
 Decreased secretion of thyroid-stimulating
hormone (TSH)
 Decreased responsiveness of plasma TSH
concentration to thyrotropin-releasing

 Androgen and estrogen secretions diminish with
aging. Declining estrogen levels result in atrophy of
the ovaries, uterus, and vaginal tissue in older
women, which may make sexual intercourse
painful.
 Older men may develop firmer testes and
hypertrophy of the prostate gland. These changes,
together with other physical and psychosocial
changes, may decrease sexual capacity.

 Pancreas: Insulin response. Insulin continues to be
produced in sufficient quantities in older adults but
their muscle cells may become less sensitive to the
effects of insulin. The “normal” fasting glucose level
rises 6 to 14 milligrams per deciliter every 10 years.
Type II diabetes occurs when the body develops
resistance to insulin.
 Adrenal glands: Aldosterone levels are 30% lower
in adults aged 70 to 80 years than in younger adults.
Lower aldosterone levels may cause orthostatic
hypotension. Secretion of cortisol diminishes by 25%
with age.

Parameters of endocrine assessment
Assessment of endocrine function includes a
physical examination, patient history, blood tests
to check hormonal levels, and assessment of
patient symptoms.
•Sexual function may be assessed with a
physical exam and patient-reported signs and
symptoms .
•libido may be affected by non-physiologic
causes including depression, stress, and other
emotional concerns.

Nursing-strategies
 Endocrine conditions, such as hypothyroidism, may
be treated with medications to replace the hormones
that are deficient in the body. Correcting
hypothyroidism in people over 60 requires a lower
dose of replacement thyroid hormone than in
younger people.
 Replacement should be initiated slowly, particularly
in those with coronary artery disease, to prevent
angina and myocardial infarction.

COMMON PROBLEMS IN OLD
AGE
There are certain medical problems which are very
common in old age:
 Alzheimer’s Disease
Alzheimer’s disease is a brain disorder and a slow
and gradual disease that begins in the part of the
brain that controls the memory
 It affects a greater number of intellectual,
emotional and behavioral abilities. There is no
known cause for this disease.
 As a person grows older, he is at greater risk of
developing Alzheimer's.

Rheumatoid Arthritis
 • Rheumatoid arthritis (RA) is caused by
inflammation of the joint lining in synovial (free
moving) joints
 • It can affect any joint, but is more common in
peripheral joints, such as the hands, fingers and
toes. RA can cause functional disability, significant
pain and joint destruction, leading to deformity and
premature mortality.

Osteoarthritis
 • Osteoarthritis (OA) is the most common form
of arthritis. It is a chronic, irreversible and
degenerative condition ranging from very mild
to very severe. It is characterized by the
breakdown of cartilage in joints, which
causes affected bones to rub against each
other leading to permanent damage.

Heart Diseases
 • Hypertension has been called the "silent
killer" because it usually produces no
symptoms. Untreated hypertension increases
slowly over the years.
 Hypertension can cause certain organs
(called target organs), including the kidney,
eyes, and head deteriorate overtime

Diabetes
 Diabetes in old age is a serious sickness
 Old people in fact are more prone to suffer from
diabetes primarily because of lack of movement
and work
 Inability in reduction in weight of the elderly, since
they cannot be made to undergo hard strenuous
exercises
Stroke
 There are 15 million people who have a stroke
each year. Stroke is the second leading cause of
death for people above the age of 60, and the fifth
leading cause in people aged 15 to 59 years.

Urinary Incontinence
 About one-third of women and 10% of all men above
60 years have incontinence. There are four
principal types of incontinence: urge, stress,
overflow, and functional .

Social Isolation
 • Isolation may be a choice, the result of a desire
not to interact with others
 • May also be a response to conditions that inhibit
the ability or the opportunity to interact with
others.
 Causes of Isolation
 Loss of work role
 Health problems, i.e. impaired hearing, diminished
vision and reduced mobility
 Feeling of rejection
 Feeling of unattractiveness

PSYCHOLOGICAL
PROBLEMS
 1.DEPRESSION
 2.ANXIETY DISORDERS
 GENERALIZED ANIETY DISORDER
 PHOBIA
 PANIC DISORDER
 PTSD
 OBSESSIVE COMPULSIVE DISORDER
 3.BIPOLAR DISORDERS
 4.EATING DISORDERS

ELDER ABUSE
 Also called "elder mistreatment", "senior abuse",
"abuse in later life", "abuse of older adults", "abuse of
older women", and "abuse of older men" is "a single,
or repeated act, or lack of appropriate action,
occurring within any relationship where there is an
expectation of trust, which causes harm or distress to
an older person."
 It includes harms by people the older person knows,
or have a relationship with, such as a spouse, partner
or family member, a friend or neighbor, or people that
the older person relies on for services. Many forms of
elder abuse are recognized as types of domestic
violence or family violence since they are committed
by family members. Paid caregivers have also been
known to prey on their elderly patients.

Causes of Elder Abuse
 Ageism, retaliation, caregiver stress, caregiver
unemployment , environmental condition,
increased life expectancy, resentment of
dependence, lack of community resources,
lack of financial resources, lack of close family
ties, violence as a way of life, a history of
personal and mental problems and a history of
alcohol and drug abuse.

Prevention
 Avoid isolating elders.
 Stay in touch with your elders.
 Keep elders active.
 Encourage elders to attend religious
services and community activities.
 Don’t allow elders to live with someone
who is known to be abusive or violent.

 Be wary of caregivers or friends
needing financial help, or those who have issues
with illicit drugs.
 Elders should be aware of their own financial
affairs. .
 Don’t allow a caretaker or family member to
impulsively alter an elder’s will, or add their
names to financial accounts or land titles. .
 Inform elders to be wary of solicitations from the
telephone, internet or mail.

IMPORTANT CONSIDERATIONS
IN THE CARE OF GERIATRIC
CLIENTS
Assessing the Needs of Older Adults
 The inter-relationship between physical and
psychological aspects of life
 The effects of disease and disability
 The decreased efficiency of homeostatic
mechanisms
 The lack of standards for health and illness
norms
 Altered presentation and response to specific
diseases.

 Physiological Concern
 Promotion of healthy lifestyle
 This includes exercise, sleep and stress
management. All these are needed to be promoted
in life of elderly people. It will prevent the occurrence
of certain medical illnesses common in this age.
 Preventive: measures that nurse can recommend
 Regular exercise.
 Weight reduction, if overweight.
 Management of HTN
 Smoking cessation
 Immunization for influenza, pneumococcol
pneumonia and tetanus.

Diet In Elderly
The energy requirements of a person decrease with
increase in age. This is because of a lowered
basal metobolic rate and lessened physical
activity. There is an 8% reduction per decade from
55-75 years.
 Composition of diet:
 Proteins: In the elderly, up to 12-14% of the total
calories should be from proteins. But, due to
decreased appetite and poor digestion, the elderly
tend to consume less protein.
Fat: Avoid diet with high content of saturated fatty
acids (ghee, butter, coconut oil, unrefined oils)
tends to increase the level of cholesterol in the
blood

 Carbohydrates: The body needs carbohydrate because
it cannot make it for itself from other nutrients. So, it
should be not less than 100 grams per day.
 Certain important minerals need to be included in
diet which are as follows:
 Calcium: It is very essential for an average elderly
person. As people become older, the bones become
demineralized. So calcium intake should be not less than
400 mg per day.
 Iron: Iron deficiency leads to anemia. So the diet of the
elderly should contain sufficient amount of iron. The
recommended daily allowance is 30 mg per day.
 Water: The fluid intake should be at least 1.5-2 liters per
day in a normal elderly person.
 Roughage or dietary fiber: The elderlies require
sufficient fiber or roughage in their diet to avoid
constipation.
 The tender fiber of vegetables, fruits and whole-grain
cereals will encourage normal bowel movements

 Foods to avoid
 High fat foods:.
 High sodium foods:
 Refined sugar: Cakes, cookies or candy.
 Pressure Injuries
 The older people have an aged skin and the skin
appears thin and fragile. The age-related changes
may lead to ulceration. All clinicians working with
older people at risk for, or suffering from pressure
ulcers must be mindful of these varying
relationships in consideration to plan and
implement individualized, comprehensive care.

Medication In Geriatric Clients
The elderly are at increased risk of adverse effects with
certain drugs. Increased risk may result from age-related
changes in pharmacokinetics or pharmacodynamics.
Risk of an adverse effect increases exponentially with
the number of drugs used, partly because multiple drug
therapy reflects the presence of many diseases and
increases risk of drug-disease and drug-drug
interactions.
Causes of increased risk are:
Decreased body mass
Decreased hepatic mass
Decreased clearance
Decreased GFR.

Nurse's Role
 Ensure safe and appropriate use of all
medications
 Older adults should be taught the names of all
drugs being taken
 When and how to take them, desirable and
undesirable effects of drugs
 Examine for potential interaction with food or
other drugs.

Communication
 One important aspect of elderly nursing is
communicating effectively with the patient or with
family members.
 Therapeutic touch
 Gentle touch conveys affection and friendliness
 It helps comfort the older adult
 Provide sensory stimulation
 Induce relaxation
 Provide physical and emotional comfort
 Convey warmth
 Communicate interest.

 Communication technique for visual
impairment
 Sit or stand in front of the client in full view
 Face the older adult while speaking, do not cover your
face
 Provide diffuse, bright, non-glare lighting
 Encourage the older adult to use his or her familiar
assistive devices such as glasses.
 Communication technique for hearing impaired
 Speak directly to the client, do not cover your mouth
 Speak in clear, low-pitched tones
 Reduce background noises
 Ask if there is a good ear and speak toward that ear
 Encourage to use assistive devices.
 Check the ear canal for cerumen impaction.

Reality Orientation
 It is a communication technique used to make an older adult
more aware of time, place and person.
 Purposes
 Restoring sense of reality .
 Promoting socialization .
 Improving the level of awareness
 Elevating independent functioning.
 Nurse's Role
 Frequent reminders of person, time and place
 Use of environmental aids such as clocks, calendars,
personal belongings
 Therapeutic communication
 Answer questions simply and honestly with sensitivity and a
caring attitude.

HOUSING AND ENVIROMENT
 Changes in social roles, family
responsibilities and health status influence
older adult's living arrangements. Some
choose to live with family members, other
prefer their own homes or apartments near
their families.
 Management
 Color contrast should be good
 Furniture should be comfortable
 Furniture should provide back support
 Bed should be comfortable and getting out of bed
should be easier and safer.

Nurse's Role
 Assess environment, to promote
independence and functional ability
 Assess safety, find risks in the environment
and older adult ability to recognize and
respond to the risks
 Risk includes factors leading to injury, within
house, such as water heaters set at
excessively hot temperature, throw rugs that
could cause a fall.

RESOURCES FOR
THE CARE OF OLDER ADULTS
 Association of Gerontology, Banaras Hindu
University, Varanasi, India
 It was founded in 1982.
 Objectives
 To promote advancement of knowledge both by
research and training in biological, clinical and
psycho-social aspects of gerontology
 To organize scientific meetings, either under its
own auspices or jointly with other organizations,
and
 To publish journals, reviews, abstracts, newsletter,
etc. on gerontology.

Activities
 It Works to insure high standards of research
and practice in gerontology, and to maximize
Conducts research in biological, clinical and
psychosocial aspects of gerontology, e
availability of gerontological services.
 Indian geronotological association
 All india senior citizens confederation.

STEPS TAKEN BY
GOVERNMENT
 National Policy for Older Persons (NPOP)
 It was announced in 1999 by the Ministry of Social
Justice & Empowerment.
 Objectives
 To enable and support voluntary organizations and
NGOs to supplement the care provided by the family
 To provide care and protection to the vulnerable group
 To provide healthcare facility to elderly and to promote
research and training facilities to the care givers
 To create awareness amongst elderly persons to
develop themselves in to fully independent citizen.
 Features

 Financial Security
 Healthcare and Nutrition
 Shelter
 Welfare
 Basic facilities
 NGOs (Non governmental Organizations)
 Supporting NGOs

GOVERNMENT INITIATIVE PROGRAMME FOR
GERIATRIC CONSIDERATIONS IN INDIA ARE:-
1.Ppradha
n mantra
vaya
vandhana
scheme
2.Indira
Gandhi
national old
age pension
scheme
3national
programme
for health
care of
elderly.
4.Varish
ta
medicla
m policy
5.Ras
htriya
vayos
hri
yojan
a

6. Varistha pension bima yojana
7.Senior citizen’s welfare fund
8.Vayoshrestha samman
9.Reverse mortage scheme
10.Pradhan mantra jan arogya yojana

NGO FOR THE WELFARE OF
GERIATRIC POPULATION IN INDIA
 1.AISCCON- all India Senior Citizen’s
Confederation
 2.FESCOM-The Federation of Senior
Citizens
 3.Help Age India set up in 1978
 4.Dignity Foundation
 5.Harmony

1.AISCCON- All India Senior
Citizen’s Confederation
The All India Senior Citizens’ Confederation (AISCCON) is a
national level organization of senior citizens with affiliate
federation members and individual members numbering more
than 10 lakhs in various states and union territories of the country.
AISCCON VISION
To be a prime organisation in India ensuring purposeful and
dignified life with care and love for Senior Citizens and
To help organise the Senior Citizens in the country and to get
them affiliated through Associations and Federations to the

AISCCON MISSION
 To be a Civil Society for all ages in India for
welfare of Senior Citizens and in particular to
ensure sustainable quality and dignity of their
life
 To create an environment where seniors live
with self-respect dignity and confidence and
participate in overall progress of the society
 To utilise rich experience and vast knowledge
of seniors to improve the life style of public in
general and Senior Citizens in particulars both
in rural and urban areas

RESEARCH
Comparing Models of Frailty: The Health
and Retirement Study
Abstract
 OBJECTIVES: To operationalize and compare
three models of frailty, each representing a
distinct theoretical view of frailty: as
deficiencies in function (Functional Domains
model), as an index of health burden (Burden
model), and as a biological syndrome (Biologic
Syndrome model).
 DESIGN: Cross‐sectional analysis

 SETTING: 2004 wave of the Health and Retirement
Study, a nationally representative, longitudinal health
interview survey.
 PARTICIPANTS: Adults aged 65 and older
(N=11,113) living in the community and in nursing
homes in the United States.
 MEASUREMENTS: The outcome measure was the
presence of frailty, as defined according to each
frailty model. Covariates included chronic diseases
and socio demographic characteristics.

RESULTS: Almost one‐third (30.2%) of respondents
were frail according to at least one model; 3.1% were
frail according to all three models. The Functional
Domains model showed the least overlap with the other
models. In contrast, 76.1% of those classified as frail
according to the Biologic Syndrome model and 72.1%
of those according to the Burden model were also frail
according to at least one other model. Older adults
identified as frail according to the different models
differed in sociodemographic and chronic disease
characteristics. For example, the Biologic Syndrome
model demonstrated substantial associations with older
age (adjusted odds ratio (OR)=10.6, 95% confidence
interval (CI)=6.1–18.5), female sex (OR=1.7, 95%
CI=1.2–2.5), and African‐American ethnicity (OR=2.1,
% CI=1.0–4.4

CONCLUSION:-
Different models of frailty, based on different
theoretical constructs, capture different groups of
older adults. The different models may represent
different frailty pathways or trajectories to adverse
outcomes such as disability and death.

CONCLUSION
 Current trends in demographic show rapid
urbanization and lifestyles changes that have led to an
emergence of a host of problems faced by the elderly
in India.Certain Lacunae in the field of research on
gerontology have been identified ,such as the lack of
attention given toward the aged in rural india ,failure to
view elderly people as active participants in the
economy, the perception of older persons as being
mere recipients of social welfare services and a lack
of focus on policy recommendations,etc.To overcome
these problems and to ensure a good healthy and
quality life,the elderly members of the society can
move a long way with the support of the family
members as well as the other society members

BIBLIOGRAPHY
 Brar KN. Rawat CH. Textbook of advanced nursing practice,
Delhi: Jaypee; 2015. p. 1057-1070
 Miller A, Carol. Nursing care of older adults: theory & practice,
Philadelphia; 1999. p. 613 , 616
 Suzzanne SC Brunner & Siddarth’s textbook of Medical
Surgical Nursing.10th edition vol 1,Lippincott publisher
,2004,pp 189-90.
 Phipps ,long ,woods “Medical Surgical N ursing’,7TH
Edition,published by Bi Publication,New Delhi
 https://www.nursinghomeabusecenter.com/elder-
abuse/prevention/
 https://en.wikipedia.org/wiki/Elder_abuse
 https://wildirismedicaleducation.com/courses/older-adult-
care-ceu

ANY QUESTIONS ?
 LETS RECALL
 1.DEFINE GERIATRICS
 2.WHAT ARE THE THEORIES RELATED TO
AGEING?
 3.LIST DOWN SOME GOVERNMENT
INITIATIVE PROGRAMMES FOR
GERIATRIC CONSIDERATIONS IN INDIA.

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