Third year community health nursing chapter.

1. Class presentation
On
Geriatric health

2.  Introduction
Development begins with conception and continues until death.
It is gradual and continuous process and involve many complex
changes in all dimensions of person through lifespan. Aging is a
natural process. In the words of Seneca; “Old age is an incurable
disease”, but more recently, Sir James Sterling Ross commented: “You
do not heal old age. You protect it; you extend it”. These are in fact the
basic principle of preventive medicine. Old age should be regarded as a
normal, inevitable biological phenomenon.

3.  Definition
Geriatrics is the branch of medicine dealing with the psychological aspect of aging,
with diagnosis and treatment of diseases effecting older adult.
Gerontology is the study of the physical and psychological changes which are
incident to old age.
The care of the aged is called clinical gerontology or geriatrics.
Another aspect of gerontology is Social gerontology which was born on the one
hand out of the instincts of humanitarian and social attitudes and on the other out of the
problems set by the increasing number of old people.

4. CON…
Experimental Gerontology is concerned with research into the
basic biological problem of ageing, into its physiology,
biochemistry, pathology and psychology.
Geriatric Gynaecology is fast opening up with the lengthening
span of life - a new chapter in gynaecology. More patients are
coming for repair of prolapse of varying degrees, non - specific
vaginitis, ovarian tumours, psychic aberrations and sexual problem.

5.  Geriatric nursing is concerned with assessment of health and
functional status of older adult, diagnosis, plan and
implementation of health care service to meet the identified needs
and evaluating the effectiveness of such care. It is the nursing
care and the services provided to older adults. The aim of
geriatric nursing is ‘to safeguard and increase health to the extent
possible and to provide comfort and care to the extent necessary’.

6.  Senior citizen in World
Discoveries in medical science and improved social conditions
during past few decades have increased the life span of man. The
expectation of life at birth in developed countries is over 80 years. The
age structure of the population in the developed countries has so
evolved that the numbers of old people is continually on the increase.
These trends are appearing in all countries where medical and social
services are well developed and the standard of living is high.

7.  Senior citizen in World
Discoveries in medical science and improved social conditions
during past few decades have increased the life span of man. The
expectation of life at birth in developed countries is over 80 years.
The age structure of the population in the developed countries has so
evolved that the numbers of old people is continually on the
increase. These trends are appearing in all countries where medical
and social services are well developed and the standard of living is
high.

9.  Senior citizen in India – an Indian scenario:
Population ageing is one of the most discussed global phenomena in the
present century. Countries with a large population like India have a large number
of people now aged 60 years or more. The population over the age of 60 years has
tripled in last 50 years in India and will relentlessly increase in the near future.
As per WHO health statistics, 2015 at present 95 million people in India are
above the age of 60. It’s estimated that neaar about 8 million people are currently
above the age of 80 years. For the year 2019 the estimates are 9.3 percent of total
population were above the age of 65 years.
The Indian express, 2012 had published the USA census bureau report
which states that India’s older population is projected to quadruple by mid –
century, while that of the world is expected to triple.

11.  Reasons for Aging Population
The prolongation of life is the outcome of reduction in overall
mortality rates. This is mainly because of –
i. Decline in premature mortality from infectious and chronic
diseases during this century.
ii. Improvement in sanitation, housing, nutrition and
iii. Medical innovations including vaccination and the discovery of
antibiotics.
All these factors contributed to the steep increase in the number
of people reaching older age. Today many more people live into
their 70s and 80s.

12.  Theories of Aging
Aging is the normal process of human development. Patterns of
aging is what happens, how and when that present vary greatly among
older people. Various theories have been proposed to explain the
process of normal aging.
 Biological Theories
Biological theories attempt to explain physical ageing as an
involuntary process which leads to cumulative changes in cells, tissues
and fluids. Intrinsic biological theories changes arise from internal
predetermined causes. Extrinsic biological theories tell that
environmental factors lead to structural changes which in turn cause
degenerative changes. The important biological theories are –

13.  Telomeric Theory
This is an extension of the ‘Hayflick Limit’. Telomeres are specialized DNA
sequences at the end of chromosomes. They shorten with each cell division. When the
telomeres become too short, the cell enters the senescence stage. In the normal process of
DNA replication, the end of the chromosome is not copied exactly which leaves an un-
replicated gap. The enzyme, telomerase, fills the gap by attaching bases to the end of the
chromosomes. As long as the cells have enough telomeres to do the job, they keep the
telomerase long enough to prevent any important information from being lost as they go
through each replication. With time, telomerase level decrease. With decreasing telomerase
levels, the telomeres become shorter and shorter. Shortened telomeres are found in –
 Atherosclerosis
 Heart diseases
 Hepatitis
 Cirrhosis

14.  Endocrine Theory
 Cross Link Theory
 Free Radical Theory
 Immunological Theory
An aging immune system is less able to distinguish body cells from foreign
cells. As a result it begins to attack and destroy body cells as if they were of
foreign origin. This leads to diseases such as diabetes mellitus, rheumatic heart
disease, arthritis.
Wear and Tear Theory
Wear and Tear Theory says due to the repeated injury or over use, internal
and external stressors(physical, psychological, social and environmental)
including trauma , chemicals and build - up of naturally occurring wastes, body
cells structures and functions wear out or are over used.

15.  Psychosocial Theories
It tries to explain age- related changes in cognitive function such as
intelligence, memory learning and problem solving. Sociological theory attempts
to explain changes that affect socialization and life satisfaction
Types of Psychosocial Theories
There are mainly two types of psychological theories , these are:
1. Full-Life Development Theories ( Erikson’s Theory will be the only one
discussed.
2. Mature – Life Theories
- Robert Peck’s Theory
- The activity Theory (Neugarten’s Theory will be the only one discussed).
- The General Theory of Disengagement.

16.  Full-life Development Theory: Eric Ericson was one of the first psychological
theorists to develop a personality theory hat extends to old age.
 Major Concepts
According to the theory, the ego is a positive driving force for development. By
which the ego’s job is to establish and maintain identity and a lack of identify
leads to lack of direction and non-productivity. There are stages of personality and
ego development. The last stages are ‘Adulthood’ and ‘Late Life Stage’.
Adulthood is characterized by a struggle between ‘Generativity’ and ‘Stagnation’.
 ‘Generativity indicates here -
 Giving back to society by raising children
 Being productive at work
 Being involved in the community
 Guiding, parenting, and monitoring the next generation.
 ‘Stagnation’ means being unproductive, feeling anger, hurt and self absorption.

17. Robert Peck’s Mature Life Theories
Robert Peck stated that the elderly go through three
developmental stages to reach full psychosocial development.
 Stage I – Ego Differentiation vs. Work Role Preoccupation
 Stage II – Body Transcendence vs Body Preoccupation
 Stage III – Ego Transcendence vs Ego Preoccupation

18.  Mature Life Theories (The Activity Theory by Neugarten)
Bernice Neugarten describes tasks that must be accomplished
for successful aging. Some of these tasks include accepting reality
and the imminence of death. Coping With physical illness.
Accepting the necessity of being dependent on outside support while
still making independent choices that can give satisfaction. A person
must remain as active as possible.

19.  Mature Life Theories (The General Theory of disengagement)
This theory says both older people and society mutually
withdraw from each other. A person gradually disconnects from
other people in anticipation of death. Intrinsic changes in personality
occur which allow a person to psychologically withdraw from
society’s expectations. This is the opposite of ‘Activity Theory’.

20.  Factors which Influence Aging
Ageing proceeds due to number of hereditary and environmental
factors.
 Hereditary Factors
The possibility of survival in to old age is determined by hereditary
factors. Some families are more long lived than others, given the
same circumstances. A preposition to certain disease and physical
strength determines health and vitality and have genetic basis.
 Environmental Factors

21. Three types of environmental factors which can influence rate of aging in human
and they are:
 Abiotic Factors – Those physical and chemical components of environment,
such as climatic influences, pollutants and radiation.
 Biotic Factors – Which results from the influences of the living organism,
these organism share man’s environment. The aging process is affected by such
things like pathogens, parasites and quality or availability of food products.
 Socioeconomic Factors – Sometimes responsible for adverse living or
working condition which increase wear and tear stressful living conditions are
accelerate the process of ageing.

22.  Aging Process and the Changes
Concept – The rising trend in aging population all over the world has sought the
attention of international organizations. It is being realized that “Old age” can no
longer be ignored. Ageing in and ageing by is not a health problem. Rather it is a
gradual, life long biological process affecting irreversible changes. The natural
ageing process is termed as “Senescence” and it implies that changes take place in
the body as time goes by in the absence of recognized disease. Thus “Natural
ageing refers to inexorable and universal physiological changes that occur with
ageing”. These changes are genetically programmed.

23.  Physical Changes
Physical changes are usually noted first. These include loss of
bone tissues, muscles tissues resulting in changed body structure and
posture, weakening of muscles, greying of hair, loss of teeth,
retraction of gums, difficulty in control of body temperature, night
cramps, osteoarthritis causing pain and difficulties in mobility. There
is reduced circulatory and cardiac efficiency, slowing of digestive
process, alteration in functions of endocrine system, decrease in the
size of kidney, reduced lung capacity etc’

24.  Psychological and Mental Changes
Psychological changes of normal ageing include loss of self
esteem, acceptance or nonacceptance of physical changes, coping
with personal loss, slower process of information and possible
depression. Mental changes include gradual mental dysfunction due
to gradual decline in intelligence, memory, sensory changes
resulting in inaccurate communication, disruption of sleep etc.

25.  Sociological Changes
Some of the sociological changes that come with increasing life span include
reduced income, change in life style, widowhood, loss of other family members
and friends, failed relationship, social isolation, isolation from services and
activities.
 Spiritual Changes
All these changes may cause feeling of rejection, hopelessness, helplessness,
depression, powerlessness, loneliness, anxiety and insecurity. These sense of
psychological loss decreases vitality and increases vulnerability to psycho-
physical problems

26.  Health Problems of the Aged
Problem due to the aging process:
No one knows when old age begins. The “Biological age” of a person is not
identified with his “chronological age”. It is said that nobody grows old merely by
living a certain number of years. Years wrinkle the skin, but worry, doubt, fear, anxiety
and self - distrust wrinkle the soul.
 However, the following are some of the disabilities considered as incident to it –
 Senile cataract
 Glaucoma
 Nerve deafness
 Osteoporosis affecting mobility
 Emphysema
 Failure of special senses
 Changes in mental outlook

27.  Problem associated with long-term illness:
Certain chronic diseases are more frequent among the older people than in the
younger people. These are -
 Degenerative diseases of the heart and blood vessels
 Cancer - The danger of the cancer looms large past middle life. In the
developed countries,
 Accidents
 Diabetes
 Diseases of the Locomotor System
 Respiratory Illness
 Genito urinary system

28.  Psychological Problems
 Mental Change
 Alzheimer’s Disease
 Parkinson’s Disease
 Sexual Adjustment
 Emotional Disorders

29.  Lifestyle and Healthy Ageing
 Diet and Nutrition: A good diet reduces the chances of developing the
diseases of old age. The diet should be balanced with less saturated fats and
oils, should contain lots of fruits and vegetables, salt and sugar should be less,
include plenty of calcium reach food and eat high fiber diet.
 Exercise: Exercise helps maintain good health, as it helps to control weight,
improves emotional well-being and relieves stress. Improves blood circulation,
increases flexibility, lowers blood pressure, increases energy level, improves
balance and thus reduces the danger of falls, lowers blood sugar levels, thus
helps in diabetes, improves bone density and prevent osteoporosis.

30.  Weight: Overweight and obesity have become major problem worldwide and it
contributes to many diseases or later life. Obesity is an important factor in heart
disease, stroke, hypertension, diabetes, arthritis.
 Smoking: It is estimated that 22 percent of men and 18 percent of women aged 65
to 74 years are smokers and have chronic diseases.
 Alcohol: Drinking beyond a specified amounts contributes to a number of later
life diseases. Older people achieve a higher blood alcohol concentration, than
younger people after consumption of equal amount of alcohol. Drinking is linked
to liver diseases, stomach ulcers, stomach ulcer, gout, osteoporosis, heart disease,
breast cancer etc.

31.  National Programme for Health care of the Elderly
 Government of India has launched the “National Programme for Health
Care of the Elderly” (NPHCE) to address health related problems of
elderly people, in 100 identified districts of 21 states during the 11th
plan period. 8 regional geriatric centres as referral units have also been
developed in different regions of the country under the programme.
 The basic aim of the NPHCE Programme is to provide separate, specialized
and comprehensive health care to the senior citizens at various level of state
health care delivery system including outreach services. Preventive and
promotive care, management of illness, Health manpower development for
geriatric services, medical rehabilitation and therapeutic intervention and
Information, Education and Communication (IEC) are some of the strategies
envisaged in the NPHCE.

32.  Geriatric Care
Concept and Objectives
Geriatric care refers to care of elderly when he or she is not well. Geriatrics is the
branch of health science concerned with the study and treatment of problems and
diseases associated with ageing.
 The objectives of geriatric care are:
 Maintenance of health function.
 Detection of disease at an early stage.
 Prevention of deterioration of any existing problem

33.  General Principles of Geriatric Care
1) Consider individuality. Consult his preferences. Their potentialities should be
utilized. Do not attempt to alter lifelong character and behavior. Give time to
listen, to learn and to adapt. Help him cope with thought of death.
2) Be patient, kind and sympathetic. Communicate effectively, demonstrate
respect.
3) Assist elderly to achieve emotional stability. Support him during his periods of
anxiety. Give the person time to express his feelings. Praise their even minimal
achievement. Encourage contact with others.
4) Stimulate mental activity and sensory input and physical activity to uplift their
self esteem, self concept and confidence.

34. Cont…
5) Make elderly’s stay at home interesting and lively. Arrange to
have small library, indoor games, religious place for worship,
celebrate festivals.
6)Provide diversional/occupational therapy
7) Maintain privacy.
8)Handle the gently.
9)Make them comfortable by providing comfortable bed, bed linen
etc.
10)Encourage them to maintain body hygiene, body temperature.
11)Assist them to take care of visual, auditory and dental aids.

35. Cont…
12) Protect from injuries, falls and accidents etc.
13) Ensure adequate nutrition.
14) Facilitate elimination.
15) Encourage them to do active range of motion exercise.
16) Help elderly to establish good sleep patterns.
17) Have them physically examined annually and whenever needed.
18)Observe any psychophysical changes which alter their body image
and behavior.

36.  Health Assessment of Geriatric
People are very essential for rendering need based care. The geriatric
assessment is a multidimensional, multidisciplinary diagnostic instrument designed
to collect data on the medical, psychosocial and functional capabilities and
limitations of elderly patients. Various geriatric practitioners use the information
generated to develop treatment and long-term follow-up plans, arrange fore primary
care and rehabilitative services, organize and facilitate the intricate process of case
management, determine long-term care requirements and optimal placement, and
make the best use of healthcare resources.

37.  The purposes of comprehensive assessment of elderlies are:
 To assess health and functional status.
 Identify potential and actual problems.
 Identify strengths and weaknesses
 To determine the health needs and develop program of action to be
implemented to meet their needs.

38.  The objectives of comprehensive assessment of elderlies are:
 To prevent breakdown of independent living.
 To deal with potentials problems of breakdown for independent living.
 To deal with actual problems of independent living
 To support and rehabilitate.

39.  Assessment Levels
The assessment of older adults by primary level, Secondary level, and
Tertiary level. The nature and objectives of assessment may vary at each level
depending upon the nature of services rendered at each level.
 The primary level Assessment
The primary level assessment can be done within the framework of primary
health care team comprising of physician community health nurse or health
visitor and a social worker. In India there is no organized system of assessment
of older population in the primary health care system.

40.  Methods and techniques of Assessment
The data for assessment can be gathered using different methods such as direct
questioning, observation, examinations and investigations. The techniques which
can be used are interviewing, self - reporting, making observation, doing
systematic examination and investigations. The instruments which can be used
include interview schedule, questionnaire, observation check list, various
examination and investigational devices, etc. There are certain specific skills, i.e.
inspections, auscultation, palpation, percussion etc. are involved while doing
systematic examination.

41. Cont…
 There are some difficulties in interviewing and taking history
from an old person due to impaired cognition, auditory or visual
sensory loss, fear of the possible consequences of the evaluation
or poor physical endurance. For these reasons the elderly clients
may fail to give desirable information about themselves. It is
therefor useful to have relative or some significant person present
at the time of health assessment, so that they can confirm,
supplement and give the missing information.

42.  The assessment areas are –
 Information by the interview
 Information by Observation and Examination
 Making Assessment and Planning Action

43.  Gerontological Nurse
A nurse who has specialization in geriatrics or in the care of old people is
called geriatric nurse or gerontological nurse.
 Functions of Gerontological Nurse
 Guiding – Giving guidance to people of all ages regarding ageing process.
 Eliminating – Eliminating ageism or notion of old age as disease.
 Respecting – Respecting the rights of old people.
 Observing – Observing the facilities provided to old people and improving them.
 Noticing – Noticing health hazards that may happen in old age and try to reduce them.
 Teaching – Teaching how to take care of old people, for those who are caring for them.
 Opening Channels – Opening the channels of developmental activities for the care of
the aged.

44. Cont…
 Listening – Listening attentively to the problems of old people and giving due importance to them.
 Offering – Offering positivism – presenting different possibilities of life.
 Generating – Generating energy for the participation in the care of aged and researches for new
supporting techniques.
 Implementing – Implementing activities for rehabilitation and readjustment.
 Coordinating – Coordinating different services related to the care of the aged.
 Understanding – Understanding every old person as an invaluable asset of the society.
 Recognizing – Recognizing the moral and religious aspects of old age and giving them recognition.
 Supporting – Supporting the old people in accepting realities and preparing them mentally for
implementing death.
 Education and Encouraging – Educating and encouraging old people for self care.

45.  Nurses role in health care of the elderly
 Health Assessment
 Arranging or Promoting good Nutrition
 Promoting Activity and Exercise
 Preventive care of Elderly
 Providing Psychological support
 Health Teaching

46.  Rehabilitation of Older People in Community setting
Contemporary rehabilitation practice occurs in the community and other
setting s outside hospital, as well as in traditional inpatient rehabilitation units.
Home rehabilitation is increasingly an option for older people. Studies in patients
with stroke or hip fracture, and in group of patients with a mix of disabilities,
suggest that outcomes of home rehabilitation are at least equivalent to those after
traditional inpatient rehabilitation. In these programmes multidisciplinary
rehabilitation is provided in the home., generally with the general practitioner
supervising the patient’s medical care.

47.  Welfare Programmes for the Old People in India
It is the fundamental obligation of the state in terms of Article 41 of our Constitution to
provide assistance to the aged and pension benefits to the employees after their retirement
by their employers. In India context, retirement is a symble of old age.
Welfare programmes for Aged
Old Age Homes: The old age home is a residential Unit for poor destitute aged person of
60 years and above.
 Mobile Medicare services for the Aged
 Noninstitutional Services for the Aged
 Pensionary Benefits and other Public Assistance

48.  Voluntary Organizations for the Welfare of the Aged
 Help Age India
It was established in 1978 for the cause and care of the elderly people with its head office
in New Delhi. It sometimes uses the services of NSS volunteers for events like painting
competition, debates etc. and collection of funds to provide facilities to the elders.
 Age care India
It is a premier national voluntary organization for the welfare for the aged people in the
country registered on 18th November, 1980. As nonpolitical, non profit, secular, Charitable,
educational, cultural and social welfare organization.
 Government Scheme for Aged
A ministry of social Justice and Empowerment is implementing a Central Scheme of
Assistance for the programmes relating to the aged from November 1992. Under the
Scheme, financial assistance is provided to the voluntary organizations for establishing and
maintaining of Day Care Centers, Old Age Homes,and mobile Medicare Units.

49.  The National Policy of Senior Citizens,2011
The foundation of the new policy based on several factors. These includes the
demography explosion of elderly, the changing economy and social milieu, advancement in
medical research, science and technology and high level of destitution among the elderly
rural poor.
 Areas of intervention
The concerned ministries at central and state level as mentioned in the “Implementation
Section” would implement the policy and take necessary steps for senior citizens as under:
Income security in old age
A major intervention required in old age relates to financial in security as more than two
third of the elderly live below the poverty line.
It would increase with age uniformly across the country.

50.  Indira Gandhi National Old Age Pension Scheme
 Public Distribution System
 The public distribution system would reach out to cover all senior citizens living below
the poverty line.
 Income Tax
 Taxation policies would reflect sensitivity to the financial problems of senior citizens
which accelerate due to very high costs of medical and nursing care, transportation and
support services needed at homes.
 Microfinance
 Health care
 Safety and Security
 Safety and Security

51.  Conclusion
At the end of the discussion, we can conclude that, old age should be
regarded as a normal, inevitable, biological phenomenon. As the global population
of elderly increases we all should aware of concept of health and active ageing. As
a nursing personnel we need to understand the impact of positive approach to
ageing which would promote meaningful and enjoyable life for older people.

52. Thanking you