Care of elderly person

ELDERLY POPULATION-FACTS
 Aging of population is an end product of demographic transition.
 The number of elderly people in developing countries is almost 3-4 times of that of
developed countries.
 The developed countries have already experienced the consequences of this
transition.
 World population of 6.1 billion at the dawn of 21st century is likely to become 9.3
billion in 2050 (UN 2004).
 Global aged population from 595 million to 2 billion – a fourfold rise-by 2050!
Mr.Adithya.S. Asst.Professor, SNC, SVDU.

 In terms of proportion -10% in 2000, 15% by 2025, and rising to 21.6% by 2050.
 73 % of deaths in the elderly are related to heart diseases, smoking and cancers.
 20% of doctor’s visits, 30 % of hospital days and 50% of bedridden days are
ascribed to elderly patients.
 ‘Expansion of morbidity’ even though increased life expectancy due to chronic
non-communicable diseases.

 80% are in rural areas
 40% are below poverty line
 Over 73 per cent are illiterate.
 About 90 % of the old people have no official social security
(i.e., without PF, Gratuity and Pension etc).

TERMINOLOGIES
1. Geriatric: the branch of medicine dealing with the physiological and
psychological aspects of aging and with diagnosis and treatment of
diseases affecting older adults.
2. Gerontology: The scientific study of the biological, psychological, and
sociological phenomena associated with old age and aging.

TERMINOLOGIES
1. Rehabilitation: The process of restoration of skills by a person who has had an
illness or injury so as to regain maximum self-sufficiency and function in a
normal or as near normal manner as possible. For example, rehabilitation after
a may help the patient walk again and speak clearly again.
2. Rehabilitation Services: Therapeutic care services for persons with
disabilities, usually physical, occupational, or speech therapy.

TERMINOLOGIES
1. Abuse: Abuse is defined as the systematic pattern of behaviors in a
relationship that are used to gain and/or maintain power and control over
another.
2. Training: It is a learning process that involves the acquisition of
knowledge, sharpening of skills, concepts, rules, or changing of attitudes
and behaviors to enhance the performance of employees.

TERMINOLOGIES
1. Supervision: Supervision is observation and providing feedback to ensure the
quality of the program and to enable the staff to perform to their maximum
potential.
2. Welfare: The concept of welfare is very comprehensive and is basically
related to quality of life.
3. Caregiver: is defined as one who provides unpaid, informal care to an older
adult who requires help with ADLs and personal need.

CARE OF ELDERLY

AIM OF GERENTOLOGICAL CARE
To promote, maintain & restoring the health of the elderly people
To achieve optimal independence
To maintain dignity
To maximize autonomy despite physical , social, & psychological losses
To provide holistic approach to care
To attain positive physical & mental health

OBJECTIVES OF GERIATRIC
CARE
Maintenance of health function.
Detection of disease at early stage.
Prevention of deterioration of any existing problem.

GOAL OF NURSING CARE
1. To assist older person and provide care to elderly in achieving optional
health, well being and quality of life as determined by them.
2. To provide need based comprehensive health care to frail, sick and
dying elderly to promote comfortable and dignified living and death.

GENERAL PRINCIPLES OF GERIATRIC CARE

CLINICAL ISSUES

PROMOTION OF COMFORT
 Physical and mental comfort and relaxation has to be achieved. There are many
factors that contribute to the comfort of the elderly patient.

CARE OF ELDERLY
 Safety: constant personal observation and support has
to be provided for frail, ambulant patients, for those
with some degree of confusion and for the restless bed
ridden patients.
 Promotion of movement and mobility: The patient is
encouraged to be out of bed as much as possible
according to the capabilities and needs.

CARE OF ELDERLY
 Promotion of mental activity and interests:
The diseases and disabilities and social problems of the
elderly are such that the time spent in hospital may be an
extended one.
 Promotion of independence: patient is encouraged to
the maximum possible level of self care and decision
making.

CARE OF ELDERLY
 Rehabilitation: Rehabilitation for the elderly includes all the activities
which aim to restoring the patient to the highest possible degree of
independent living of which he is capable which should also include
physiotherapy and speech therapy.
 Role of community and family: The ultimate aim of treatment and
rehabilitation is to achieve for the person a normal social setting.

PREVENTION OF COMMON
PROBLEMS
• Dietary inadequacies should be corrected
• Tobacco and alcohol use should be minimized
 glaucoma should be screened.
 visual and auditory impairment should be corrected.
 Dentures should be assessed
 serum levels of thyroid-stimulating hormone should be measured

PREVENTION OF COMMON PROBLEMS
 All older women should be screened for osteoporosis
 Exercise should be encouraged
 Immunizations for influenza, pneumococcal pneumonia, and tetanus should be current.
 Hypertension, whether isolated systolic hypertension or combined systolic and diastolic
hypertension, should be treated.
 Serum cholesterol should be measured.
 Cancer screening is warranted

LEVELS OF PREVENTION
I. PRIMORDIAL PREVENTION
• It is a new concept, which is receiving special attention in the
prevention of chronic diseases.
• Prevention of the emergence or development of risk factors.
• In primordial intervention, efforts are directed towards
discouraging adapting harmful lifestyles.

II. PRIMARY PREVENTION
• Exercise
• Nutrition and aging
• Stress management
• Avoiding falls and accidents
• Immunization

HEALTH BENEFITS OF EXERCISE IN ELDERLY
PHYSICAL BENEFITS
 Improvement of cardiorespiratory function.
 Lowering of blood pressure
 Correction of dyslipidemia and impaired glucose tolerance
 Increase in muscle strengthened flexibility of joints.
 Improved equilibration and mobility, retards osteoporosis.
 Improved cognitive function
 Improved sleep
 Reduction of body weight and enhanced fat metabolism

HEALTH BENEFITS OF EXERCISE
IN ELDERLY
PSYCHOLOGICAL BENEFITS
 Sense of well-being and self-esteem.
 Improved mood and delayed depression
 Increased sociability and social interaction.

NUTRITION AND AGING
Dietary guidelines for elderly:
 Calories:1800 kcal (men);1400 kcal (women) (source: ICMR)
 Protein: 0.6 to 1 gm kg/day from both animal and vegetable source
 Fats: restricted fat less than 30 gm per day.
 Saturated and Trans fatty acids should be discouraged.
 Carbohydrates:complex Carbohydrates instead of refined sugars.
 Encouraged the intake of fiber containing food, like coarse cereals,
vegetables instead of refined cereals to avoid constipation &
flatulence.

NUTRITION AND AGING
 Vitamins and minerals: Vitamin A, E, C as antioxidants,
anti- oncogenetic
 Calcium and vitamin D in the form of milk, curd,
cheeses.
 Others: fruits and vegetables
 Salt should be restricted
 Water intake should increased.

STRESS MANAGEMENT
 Both physical and social stress adversely affect the health
of the individual.
 Hence counselling, bio feedback, relaxation exercise,
meditation are important.

AVOIDING FALLS AND ACCIDENTS
 Slip resistant flooring materials, especially in bathrooms.
 Path ways outside the house should be hard with level surface.
 Non slip tread cap in stairs.
 Handrails on both sides of corridor, staircase, in bathroom and toilet.
 Well lit rooms, objects like doors handles, electric switches should be
colored.
 Staircase having contrasting colors at the beginning and end of stairs.
 Lever type of handles for arthritic fingers.
 Sound absorbing materials like carpets, curtains to reduce reverberation
of sound and make normal speech audible.
 Western type of toilet installed at least 45cm above ground level.

IMMUNIZATION
• Influenza vaccine: Influenza vaccine every year, trivalent inactivated vaccine is
administered in a dose of 0.5 ml intramuscularly.
• Pneumococcal pneumonia: A dose of 0.5ml intramuscularly once in a life time
• Tetanus and diphtheria: Full course of tetanus toxoid with booster dose every 10
year.
• varicella: If not suffered with varicella in young age.
• Selective immunization: Hepatitis B, hepatitis A, meningococcal meningitis,
Japanese encephalitis, typhoid fever.

PRIMARY PREVENTION (CONTD.,)
• . Chemoprophylaxis to prevent coronary artery disease
• Cholesterol lowering agent, antiplatelet drugs
• Screening of disease:
• Breast cancer, BPH, cataract cervical cancer, hypertension, DM.

III. SECONDARY PREVENTION
It significance of early diagnosis and treatment of disease conditions
originating or detected in old age.

TERTIARY PREVENTION
• Detection and treatment of established and incapacitating chronic
disease with the aim of minimizing residual disability, and
rehabilitation.

TRAINING AND SUPERVISION OF
CARE GIVERS

DEFINITION OF CAREGIVER
• “Usually refers to informal, unpaid assistance for
the physical and emotional needs of another person.
• Family members or friends frequently provide this
type of care. In the child care field, however, the term
caregiver refers to people who are paid for providing
child care services.”

DEFINITION OF CAREGIVER
• A generic term referring to a person, either paid or voluntary, who helps
an older person with the activities of daily living, health care, financial
matters, guidance, companionship and social interaction. A caregiver can
provide more than one aspect of care. Most often the term refers to a
family member or friend who aids the older person.”
• (Department of Health and Human Services)

OBJECTIVES OF CARE GIVER
SUPERVISION
1. To promote optimum functioning of care givers.
2. To help the care giver to do their job skillfully and effectively to
give maximum output with minimum resources.
3. To safeguard care givers from making mistake and there by
protect elderly.
4. To improve the attitude of the caregiver towards the care.

COMMON PROBLEMS
FACED BY CARE GIVERS
o Chronic emotional and physical fatigue.
o Internalized guilt.
o Issues of death, dying, and other end of life concerns.
o Not fully understanding the course or prognosis of the illness.
o Anger towards self, the elder, and other caregivers.

COMMON PROBLEMS
FACED BY CARE GIVERS
 Social isolation.
 Sadness and grief.
 Unexpected and increasing financial burdens.
 Complex legal issues.
 Stress on one’s own immediate family and relationships.
 Denial and lack of preparation for the possibility of a difficult course of illness.

CERTIFIED PERSONAL CARE ASSISTANT (CPCA):
Trained to assist the elderly and disabled with meals, toileting
and items needed for daily living.
Usually around 40 hours of training, often this level of care is
referred to as companion care.

CERTIFIED HOME HEALTH AIDE (CHHA):
 Entry-level training to begin working in the healthcare field and prepares
individuals for training as a Certified Nursing Aide.
 Training includes: assisting patients with bathing, toileting, dressing,
nutrition education and meal preparation and exercise regimens.
 Usually around 75 hours of training.

CERTIFIED NURSING AIDE (C.N.A.)
 Training to assist a registered nurse in a nursing home or hospital to administer
the hands-on care, including both the emotional and physical aspects of care.
 Training includes proper transfers, bathing, dressing, vital signs, and catheter
care, feeding tube care, hospice care and how to maintain cleanliness for all
care procedures.
 Usually 150 hours of training both in a classroom and clinical setting.

PATIENT AND CAREGIVER ISSUES

TIPS FOR CARE GIVERS
 Caregiving is a job and respite is your earned right. Reward yourself with respite breaks
often.
 Watch out for signs of depression, and don’t delay in getting professional help when you
need it.
 When people offer to help, accept the offer, and suggest specific things that they can do.
 Educate yourself about your loved one’s condition and how to communicate effectively
with doctors.
 There’s a difference between caring and doing. Be open to technologies and ideas that
promote your loved one’s independence.

TIPS FOR CARE GIVERS
 Trust your instincts. Most of the time they’ll lead you in the right direction.
 Grieve for your losses, and then allow yourself to dream new dreams.
 Stand up for your rights as a caregiver and a citizen.
 Seek support from other caregivers. There is great strength in knowing you are not
alone.
 Stress management: counseling, caregivers meeting, and relaxation therapies.
 Education: disease prevention health promotion, nutrition, exercise, good
environment, prevention of fall and injury, immunization, stress management.

ROLE OF A NURSE
 Act as a liaison for families living at a distance.
 This includes regular visits, attending physician appointments and notifying
families of changes or potential problem.
 Assess ability to safe drive.
 Explain and suggest medical and health care options based
 on expertise in the health care and residential housing field.
 Extend support to client and family members.

ROLE OF A NURSE
 Help the client designate a health care proxy and compose a living will.
 Hire, screen, coordinate, and monitor in home health care and help services.
 Identify problems and services necessary to rectify them.
 Intervene during a crisis.
 Offer a professional, objective point-of –view regarding senior care options.
 Provide community education and client advocacy.

ROLE OF A NURSE
 Recommend resources, support groups, and references for elderly client’s
and their families.
 Save families time and money by eliminating duplicative and unnecessary
service.
 Utilize trusted resources to make physician, mental health, attorney, trust
officers, and residential housing referrals.

JOURNAL PRESENTATION- 1
• Exercise for reducing fear of falling in older people living in the community.
• Kendrick D, Kumar A, Carpenter H, Zijlstra GA, Skelton DA, Cook JR, et al.
• Objectives: To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of
falling in older people living in the community.
• Authors' conclusions:
Exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent
immediately after the intervention, without increasing the risk or frequency of falls. There is insufficient
evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention
or their effect on other outcomes. Although further evidence from well-designed randomised trials is required,
priority should be given to establishing a core set of outcomes that includes fear of falling for all trials
examining the effects of exercise interventions in older people living in the community.

JOURNAL PRESENTATION- 2
• Physical rehabilitation for older people in long-term care.
• Crocker T, Forster A, Young J, Brown L, Ozer S, Smith J, Green J, Hardy J, Burns E,
Glidewell E, Greenwood DC.
• Objectives: To evaluate the benefits and harms of rehabilitation interventions directed at
maintaining, or improving, physical function for older people in long-term care through the
review of randomised and cluster randomized controlled trials.
• Authors' conclusions: Physical rehabilitation for long-term care residents may be effective,
reducing disability with few adverse events, but effects appear quite small and may not be
applicable to all residents. There is insufficient evidence to reach conclusions about improvement
sustainability, cost-effectiveness, or which interventions are most appropriate. Future large-scale
trials are justified.

BIBLIOGRAPHY
1. Allender JA, Rector C, Warner KD. Community health nursing: Promoting &
protecting the public’s health. 7th ed. Philadelphia; Wolters Kluwer, 2010; 675- 702.
2. Charltte E. Gerontological Nursing. 7th ed. Philadelphia; Lippincott, 2010;
3. Colledge NR, Walker BR, Ralston SH. Davidson’s Principles and practice of
medicine. 21st ed. Edinburgh; Churchill Livingstone, 2010; 164- 176.
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health. 5th ed. New York; Oxford, 2009; 1496- 1514.
5. Eliopoulos C. Gerontological Nursing. 7 ed. Philadelphia: Wolters Kluwer; 2010;

BIBLIOGRAPHY (CONTD.,)
6. Gulani KK. Community health nursing: Principles & practices. 1st ed. Delhi; Kumar
publishing house, 2012; 469- 478.
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ed. London: Jones & Bartlett; 2005;
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BIBLIOGRAPHY
11. Kishore J. National health programme of India: national policies and legislations
related to health. 10th ed. New Delhi; Century publications, 2002; 537- 545, 794- 796.
12. Lal SA, Pankaj. Textbook of community medicine: Preventive and social medicine.
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Elseveir, 2009; 10-27.

INTERNET REFERENCES
1. Crocker T, et al. Physical rehabilitation for older people in long-term care.
2. Iavarone A, Ziello AR, Pastore F, Fasanaro AM, Poderico C. Caregiver burden and
coping strategies in caregivers of patients with Alzhemier’s disease.
3. Kendrick D, Kumar A, Carpenter H, Zijlstra GA, Skelton DA, Cook JR, et al.
Exercise for reducing fear of falling in older people living in the community.
4. www.caregiver.org/caregiver
5. http://www.euro.who.int/data/assets/pdffile/0018/102267/e81554.pdf
6. http://www.ijcm.org.in

INTERNET REFERENCES
• 6. www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=439
• 7. http://www.euro.who.int/data/assets/pdffile/0018/102267/e81554.pdf
• 8. http://www.ijcm.org.in
• 9. http://www.ncbi.nlm.nih.gov/pubmed/18521885
• 10. http://www.effectiveelderpeoplecare.org
• 11. http://www.geriatricsyllabus.com
•

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