Introduction to Geriatric Nursing,Theory

Unit 1
Introduction to Gerontology
and Geriatric Nursing
Nabina Paneru

Definitions
Geriatrics: The term geriatrics comes from the
Greek word “geron” meaning, “old man”, and
iatros meaning “healer”. However, geriatrics is
sometimes called medical gerontology
Gerontology: The branch of medicine or social
science dealing with the health and care of old
people. (-physiological, pathological,
psychological, sociological and economical
point of view of age 60yrs and above)
“Geron”- old man
“Logy” – study of

Contd.
Specialty that concerns itself with
the provision of nursing services
to geriatric or aged individuals.
Concerned with assessment of the health
and fundamental status of older adults;
diagnosis, planning, and implementing
health care and services to meet the
identified needs and evaluating such
care
Geriatric
Nursing
Gerontological
Nursing

Gerontic Nursing Geriatric medicine
- Seldom used
- Considers nursing care of
older adults to be the art
and practice of nurturing
caring, and comforting
rather than merely the
treatment of disease
- Sub specialty of internal
medicine and family medicine
that focuses on health care of
elderly people
- Promotes health by preventing
and treating diseases and
disabilities in older adults
Contd.

Gerontologists Aging
Specialists who study the
biological, psychological,
and social aspects of aging
to improve the quality of
life for older adults.
Natural process of becoming
older, characterized by
gradual physiological
changes
Contd.

Ageism Age
Ageism refers to the stereotypes
(how we think), prejudice
(how we feel) and
discrimination (how we act)
towards others or oneself
based on age.
- Biological age
- Social age
- Primary age
- Secondary age
- Psychological age
- Cognitive age
- Functional age
Contd.

Contd.
Mental and physical decline
associated with aging
process
Used rarely to denote
physical and emotional
deterioration
60 and above
Senescence
Senility
Senior citizen

Pace of population ageing is much faster than in past
Contd.
By 2050, proportion of over 60 years will double from 12% to 22%
Data (According to WHO)
In 2020, the number of people aged 60 years and older outnumbered children younger than
5 years

Life expectancy
- Refers to the number of years a person can expect to live.
Contd.

Source: World Health Organization 2026 data.who.int, Nepal

Historical Perspective on
Gerontology, Geriatrics and
Elderly

Global history
- Emerged and developed in different countries based on their
culture, environment and development in technology,
education and knowledge
- Hippocrates noted conditions common in later life
- Aristotle offers a theory of aging based on loss of heart
- In Islamic world – physician wrote on issues related to
Gerontology.

Contd.
- Arabic physician Ibn A-Jazzar wrote on medicine and health
of the elderly (covers sleep disorders, forgetfulness, how to
strengthen memory and causes of mortality.)
- Early pioneers such as Michel Eugene Chevreul (lived up to
102yrs), believed aging should be a science to be studied

Contd.
- Industrial revolution – ideas shifted in favor of a societal
care system.
- In 19th
century – care homes emerged
- Term ‘Geriatrics’ invented by Ignatz Leo Nascher and his
initiative provided a stimulus for social and biological
research on aging. (Father of geriatrics)

Contd.
- During 1936, Dr. Marjory Warren (Mother of geriatrics)
reviewed several old workhouse wards and upgraded and
matched care to their need through system of
classification.
- Advocated creating a medical specialty of geriatrics,
providing special geriatrics units, and care provided by
those who have specialization in geriatrics

Contd.
- Geriatric nursing begins from the time of Florence
Nightingale. At that time care to elderly people were
served by family members

Significant changes
- 1902: First geriatric article published by medical doctor
in American Journal of Nursing (AJN)
- 1904: AJN published first geriatric article by RN
- 1925: AJN considered geriatric nursing as potential
speciality and created column “care of the aged”
- 1935: Social Security Act was designed to increase the
independence of aged – formulation of nursing homes.

Contd.
- 1940s: Organized gerontology into its own field
- 1945: Gerontological society was formed in US
- 1950: First geriatric nursing textbook, first masters thesis done
on geriatric nursing. Geriatric became specialized in nursing
- 1952: first geriatric nursing study published in Nursing
Research

Contd.
- 1960 – 1985: Birth of modern gerontological nursing
(From book)

National History
- In Nepal, concept emerged when nursing started
- Topic related to elderly used to study as older adult in
adult nursing (Medical Surgical Nursing).
- Later “Geriatric Nursing” was used and included in
curriculum of CTEVT, TU, PU and other universities.
- Included as a separate subject in PCL, BN, BSC

Contd.
- Bir hospital, Mahabouddha – first geriatric OPD started
- Government is planning to start a geriatric hospital

Demographics of Aged Population
The number of people aged 60 and older worldwide is
projected to increase from 1.1 in 2023 to 1.4 billion by
2030. This trend is particularly evident and rapid in
developing regions.

Contd.
The UN Decade of Healthy Ageing (2021 – 2030) defines
the following four action areas:
combatting ageism – changing how we think, feel, and act
towards age and ageing;
age-friendly environments – ensuring that communities
foster the abilities of older people;

Contd.
integrated care – delivering person-centered integrated care
and primary health services responsive to older people;
and
long-term care – providing access to long-term care for
older people who need it.

Contd.
According to Nepal Demographic Profile, 2020, Life
expectancy at birth is 71.8 years, where male’s 71.1
years, female’s 72.6 years.
The percentage of age group 55 – 64 years is 6.64% (male
954,836/ female 1,059,360) and age group 65 years and
over is 5.69% (male 852, 969/ female 874,092). Elderly
dependency ratio is 8.9

Aging Process
- Aging: Not a disease but developmental process
- Change from internal process (although undesired) –
normal and sometimes called pure aging.
- Process: Expected and generally unavoidable, which is
normal

Contd.
- For e.g.: Presbyopia occurs as people age because the lens
of the eye thickens, stiffens and becomes less able to
focus on close objects, such as reading materials. This
occurs in all older people and is considered normal aging

Contd.
- Changes with normal aging make people more likely to
develop certain disorders.
- However, people can sometimes take actions to compensate
for these changes.
- E.g.: with proper dental care, visiting dentist regularly, eating
fewer sweets, brushing and flossing regularly may reduce the
chances of tooth loss.

Contd.
- Functional decline which is part of aging sometimes seems
similar to functional decline that is part of a disorder.
- E.g.; With advanced age: mild decline in memory – normal
(difficulty learning new languages, ↓ attention span, ↑
forgetfulness). In contrast, the decline that occurs in
dementia is much more severe. SO dementia is considered
disorder, even though it is common in late life.

Contd.
- Changes related to normal aging can be anticipated &
adapted so that the older person can live happy, healthy
and active life.

Characteristics of Aging
(Physiological and Psychological
Changes of Aging)

Concept of healthy aging
- Reduction in the undesired effects of aging
- Goals:
 Maintaining physical and mental health
 Avoiding disorders
 Remaining active and independent

Contd.
- Every person should have opportunity to live a long and
healthy life but our surrounding environment favor health
or can be harmful
- Environment  influence behavior, exposure to health
risks, access to quality health and social care

Contd.
- Healthy aging: creating the environments and
opportunities that enable people to be and do what they
value throughout their lives.
- WHO defines healthy aging as “the process of
developing and maintaining the functional ability that
enables wellbeing in older age.”

Contd.
- Healthy aging includes a person’s ability to:
 Meet their basic needs
 Learn, grow and make decisions
 Be mobile
 Build and maintain relationships
 Contribute to society

Contd.
- Functional ability consists of the intrinsic capacity (all
mental and physical capacities) of the individual, relevant
environmental characteristics and the interaction between
them.
- Level of Intrinsic capacity is influenced by several
factors such as the presence of diseases, injuries and age
related changes.

Contd.
- Key considerations for Healthy aging
 Diversity: Some 80 year olds have levels of physical and
mental capacity that compare favorably with 30 year
olds. Other of the same age may require extensive care
and support for basic activities. Policy should be framed
to improve the functional ability of all older people,
whether they are robust, care dependent or in between.

Contd.
 Inequity: A large proportion of the diversity in capacity
and circumstance observed in older age is the result of
the cumulative impact of advantage and disadvantage
across people’s lives.

Needs of elderly people for the
promotion and maintenance of health

1. Nutritional Need
Nutrition is the sum total of the processes involved in the
taking in and the utilization of food substances by which
growth, repair and maintenance of the body are
accomplished.
It involves ingestion, digestion, absorption and assimilation.

Contd.
Different factors affect nutritional intake in elderly such as:
 Age related changes: which affects absorption
 Psychosocial factors: lead to lack of interest in eating
and/or cooking
 Economic factors: affects food preparation and storage
 Cultural factors: eating habits
 Other: Anorexia caused by side effects of medicines,
substance use

Contd.
Ways of improving nutrition
 Health challenge assessment
 Appealing food preparation (appearance plus flavors)
 Declined ability to detect thirst. So give at least eight
glasses of water in a day.
 Establish healthy eating schedule; use of visual and
verbal reminders

Contd.
 Limit saturated, fats and cholesterol. High fiber diet with
plenty of vegetables, fruits and grain products. Moderate:
sugar and salt.
 Switch between varieties of foods.
 Careful use of supplements to accommodate need. (may
sometimes cause toxicity)

Contd.
 Encourage to visit dentist regularly (for ill fit dentures,
jaw pain, sores, missing teeth etc.)
 Monitor effects of medicines (change in taste, reduce
appetite) and notify doctor immediately.
 Maintain healthy food storage
 Provide adequate time to eat
 Help to maintain healthy weight

2. Physical Activities and Exercise
- Plays major role in maintaining good health, enhances
sleep, improve digestion, reduce constipation, lower
cholesterol level and blood pressure, maintain weight and
lower the risk of cardiovascular diseases.
- Aging  sedentary or less active life due to
physiological changes  predisposes to different health
issues

Contd.
- Sensory stimulation involved in activities can promote
elderly’s physical health and enhance their cognitive
function, social skills and emotional control.
- Also helps to enhance their self – worthiness.

Contd.
Choice of activity in older adults
Cognitive
activity
• Playing chess
• Computer game
• Reality orientation
activities
• Reading newspaper
etc.
Physical
activity
• Fitness class
• Jogging
• Walking etc.
Social
activity
• Tea time
gathering
• Group game
• Visit group
• Picnic etc.

Contd.
Choice of activity in older adults contd.
Self-care
activity
• Grooming
• Food preparation etc.
Leisure
activity
• Outdoor activity
• Watching
television
• Reading books
• Painting etc.
Work
related
activity
• Volunteering
• Assisting other in
shopping,
teaching
• Simple cleansing
etc.

Contd.
Benefits of activity and exercise

Contd.
Ways to improve activity and exercise in older adults
 Plan activities that do not cause fatigue. Consider physical,
cognitive, social, emotional state of elderly including interest
and preference
 Choose safe area
 Encourage to continue performing activities such as
swimming, walking, jogging, stretching, ROM exercises,
physical therapies

Contd.
 Have frequent rest periods
 Let the older adults wear comfortable cloths and shoes
 Avoid outdoor activities in extremes temperatures
 Activities should not last for long time as most of the
older adults may have problem with concentration

Contd.
WHO recommends:
 At least 150 minutes of moderate intensity aerobic
physical activity throughout the week or do at least 75
minutes of vigorous intensity aerobic physical activity
throughout the week or an equivalent combination of
moderate and vigorous intensity activity

Contd.
 Aerobic activity should be performed in limited period of
time of at least 10 minutes’ duration
 For additional benefits: increase moderate intensity
aerobic physical activity to 300 minutes per week or
engage in 150 minutes of vigorous intensity aerobic
physical activity per week, or combination

Contd.
 Older adults with poor mobility should perform physical
activity to enhance balance and prevent falls on 3 or more
days per week
 Muscle strengthening activities, involving major muscle
groups, should be done on 2 or more days a week
 If medically compromised, they should be physically active

Contd.
ADLS (Activities of Daily Living)
• Basic Activities of Daily Living: Eating and drinking,
Bathing, Dressing, Toileting, Continence, Walking and
transferring
• Instrumental Activities of Daily Living: Preparing meals
and clean up, Maintaining the home, Shopping, Using the
telephone, Managing medications, Managing finances

3. Rest and Sleep
Rest: Feeling of peace, relief and relaxation after exercise or
activities
Sleep: Complex biological rhythm intricately related to rest
and other biological rhythms.

Contd.
Rest and sleep is important for conserving energy, providing
organ rest, restoring the mental alertness and neurological
efficiency.
Older adults: take longer time to fall asleep, frequent
awakening  day time napping  poor day time
functioning.

Contd.
Factors causing sleep problems in elderly
 Environment, Dietary habits,
 Chronic/ Co-morbid illness
 Pain
 Medication
 Lack of exercise, Retirement, Day time napping
 Psychological problems such as stress, anxiety

Contd.
Ways of improving sleep
o Create calm and quiet environment
o Make the bed room not too hot or too cold
o Use comfortable beddings
o Keep the bedroom dark
o Manage pain and other symptoms of chronic/co-morbid
illness.

Contd.
o Encourage for regular exercise and activities
o Limit day time napping to 30min
o Avoid heavy meals, spicy food, and tobacco at bed time
o Avoid caffeine containing drinks such as cola, coffee, tea
o Avoid alcohol intake
o Keep the bedroom free from television

Contd.
o Set bed time rituals
o Suggest to eat three to four hours before bed time, limit
fluid intake after 7pm
o Encourage for active retirement life
o Provide counseling as needed to relive psychological
problems such as anxiety

4. Safety and Security
- Major concern as old age people are more susceptible to
accidents and injuries due to age related physiological
changes
- Falls, burns, poisoning and automobile accidents
- Constant vigilance is needed to safeguard the elderly,
both at home and in patient care facilities

Contd.
Safety measures for elderly
 Stay healthy (Regular exercise, diet etc.)
 Correct deficits: Using assistive devices properly
 Well lightening (bedside light, availability of nighlight)
 Manage floors (even, non skid, well anchored rugs, non
slip mats etc.)

Contd.
 Manage proper foot wears
 Modify habits (getting up slowly after sitting or lying
down and making balance before walking)
 Store and use medications safely
 Manage furniture:
- Limit furniture in room

Contd.
- Keep bed attached to the wall
- Adjust height of bed
- Have firm chair, with arms, to sit and dress
- Check the internal door locks, use locks that can be open
from both sides
- Replace door knobs with handles that need only to be
pushed up and down, rather than turned

Contd.
 Follow kitchen safety
- Avoid wearing long sleeves or loose clothing while
cooking
- Keep fire extinguisher next to the stove
- Eliminate need for stepping stools
- Clean up any spills immediately

Contd.
- Repair damaged floor tiles
- Make sure electrical cords plugged into sockets are far
from sinks
- Mark “on” and “off” positions on appliances clearly and
with bright colors
- Store sharp knives in a rack

Contd.
 Promote bathroom safety
- Install a raised toilet seat if needed
- Hand – held shower is preferable for elderly
- Make sure hot or cold is clearly marked
- Install grab bars and handrails (throughout the home if
possible)

Contd.
 Care of electricity
- Check the condition of electrical appliances, cords and
plugs regularly
- Avoid any non – insulated wiring
- Do not place cords under carpeting and across walkways
- Keep all electrical appliances unplugged unless they are
in use to prevent electric shock

5. Regular/Periodical Health Checkup
Importance of periodical medical check up
Helps to;
• assess their level of well being
• identify the health risk factors in elderly
• detect the diseases at an earlier stage and hence decrease
the risk of complication
• reinforce positive promoting and protecting behaviors

Contd.
1. Routine annual physical examination
2. Regular dental assessments
3. Opthalmologic assessment (Macular degeneration,
glaucoma, cataract etc.)
4. Screening for cardiovascular diseases

Contd.
5. Screening for cancer
a. Skin cancer
b. Breast cancer (BSE, clinical breast examination and
mammography every one to two years for women above
40yrs)

Contd.
c. Uterine and cervical cancer (Annual examination with
pap smear test every three years. If a women is above 65
with three negative pap test in a row, then after it is not
necessary)
d. Colorectal cancer (Annual stool test for occult blood,
sigmoidoscopy every 5 years after age 50, Colonoscopy
every 10 years after age 50)

Contd.
e. Prostate disease and cancer (Yearly rectal examination
and blood test for prostate specific antigen in men over
age 50)
f. Testes cancer (monthly testes self examination)
g. Screening for lung disease (medically compromised
should do annual check up for tb, chest x rays)

Contd.
6. Screening for thyroid problems (once every 5 years, esp
for women)
7. Screening for osteoporosis (annual bone density test for
women over age of 60)
8. Immunization (as recommended such as influence
vaccine, pneumococcal vaccine etc.)

6. Psychosocial Needs
- Sense of self worth, confident and sense of productivity
- Adequate support system

7. Religious/Spiritual Need
Religious activities: directly or indirectly related to religion
and which reflect the cultural practices, beliefs, tradition,
customs, norms, rituals, values and are transferred from
generation to generation.

Contd.
Religious activities performed by elderly people
- Bathing early in the morning
- Going to temple, worshipping god, praying and
meditation, Pilgrimage
- Celebrating festivals
- Fasting
- Reciting holy books
- Teaching rituals to new generation

Contd.
Importance of religious activities:
 Provides source of religious activity
 Enables older people to deal with painful and
unexpected life events and to be more productive and
adaptive in threatening conditions
 May provide meaning and identity to the older people

Contd.
 Also necessary for emotional, physical and mental
wellbeing, satisfaction with life, happiness, sense of
energy.
 Observing different feast and festivals and particular type
of food included contributes to increase nutritional
requirement for e.g. quanti in Janai Purnima and ghee
chaku in maghe sankranti

Contd.
Nursing Intervention
֍Nurse should know that being older does not mean that
they are being religious, so a nurse should not enforce an
older people to do religious activity without knowing
him.
֍Nurse should know the types of religious activities,
patient follows

Contd.
֍Whenever possible, interested patient should be enable to
attain religious activities according to individual
preference by providing transportation to religious group
or gathering or alternative methods of religious
fulfillment
֍Nurse can enhance aged person’s self esteem by showing
recognition of contribution he/she had done to others

Contd.
֍If elderly follow religious belief and laws that are no
longer adherence to current majority member of religion,
person must be respected and no attempt must be made to
change them.
֍Be alert to subtle cues which indicates desire to talk
about spiritual matter, need for expression of love and
hope and desire for silence, acceptance of behavior when
patient label self as bad.

8. Stress Management
Stress is simply a reaction to events or stimuli that makes us
feel threatened and disturbs our physical and mental
equilibrium
Stress is a state produced by a chance in the environment
that is perceived as challenging, threatening or damaged
to person’s dynamic equilibrium.

Contd.
Stress (According to Hans Selye): "non-specific response
of the body to any demand for change".
Causes of stress in elderly
• Physiological changes
• Changes in roles and responsibilities towards family and
society

Contd.
• Chronic diseases
• Physical dependence in others
• Retirement from job and low income
• Death of spouse or loved one
• Long term drug therapy
• Generation gap between family members
• Feeling of isolation, neglect/separation from family,
loneliness, etc.

Management of stress
Stress management works on two levels
- The first is about maintaining a harmonious lifestyle so
that stress does not get out of control. This involves
having outlets that allow you to release the stress.
- The second strategy involves learning how to get relax
yourself or change mood if stress is having a negative
impact on life.

Contd.
Measures of stress management in elderly
 Stay active
 Stay involved in the community
 Establish a new purpose of life (Leisure activities- to
focus mind and body on)
 The cure of stress is effectively about changing the state
of our body: the body responds in a certain way if it
believes that it is experiencing stress

Contd.
 Relaxation techniques
- Progressive relaxation
- Relaxation with guided imagery
- Meditation
- Yoga
- Others (Humor and laughter, Listening to music, Writing,
Engaging in art activities, Dance and sports.)

Contd.
 Nutrition
 Sleep and rest
 Support system

Contd.
Role of nurses in management of stress in hospital
setting
 Help the client identify his personal strengths. Focus on
positive, ignore negatives
 Provide an atmosphere of trust and warmth
 Listen to the client attentively

Contd.
 Inform the family about the prognosis of disease and
treatment
 Tell them the truth as mush as possible; do not give false
reassurance
 Encourage them to face the crisis
 Encourage client participation in his/her own care of plan

Contd.
 Encourage to do stress management activities
 Consider the client cultural, socio economic and ethnic
values
 Encourage them to take part in religious activities
 Advise them to plan for retirement planning; involving in
social services, renovation of home, pilgrimages etc.

Contd.
 Encourage them to take part in social interaction to
maintain self – esteem
 Demonstrate patience and loving care while teaching and
performing other activities. Show loving and caring
behavior to the elderly.
 Teach the client the health promoting behaviors that
enhances the coping mechanism.

Developmental tasks of elderly
people
The following developmental task are to be achieved by the
aging couple as a family as well as by the aging person
alone
According to Havinghurst
 Adjusting to decreasing physical strength and health
 Adjusting to retirement and reduce income

Contd.
 Adjusting to death of spouse
 Establish an explicit affiliation with one’s age group
 Meeting social and civic obligation
 Establishing satisfactory physical living arrangement
 The individual will be left with feelings of bitterness and
despair. Those who feel proud of their accomplishments
will feel a sense of integrity

Developmental Crisis of Older Adulthood: Ego Integrity vs
Despair (According to Erik Ericson)

A. Biological (Stochastic and Non Stochastic) Theory
B. Sociological Theory
C. Psychological Theory
D. Developmental Theory
E. Environmental Theory

Biological Theories of aging
It can be:
i. Stochastic theories: Based on random
events that cause cellular damage that
accumulates as the organism ages
ii. Non stochastic theories: Based on
genetically programmed events that
cause cellular damage that accelerates
aging of the organism.
It describes the structural and
functional state of the cells,
tissues and organ system of the
body. That determines the
changes, longevity and death.

Biological Theories:
1. Free radical theory
2. Connective tissue theory/ cross- linkage theory
3. Orgel’s error theory
4. Wear and tear theory
5. Biologic clock
6. Auto-toxication theory
7. Physiological theory
a. Neuroendocrine control or pacemaker theory
b. Immunological/ Autoimmune theory

1. Free Radicals Theory
• Accumulated oxygen radicals (by product of normal metabolism produced when
cells turn food and oxygen into energy) cells stop functioning  organ stop
functioning
• Free radical takes an electron from another molecule, which becomes unstable
• Superoxide and other free radicals damage molecular components of the cell
(nucleic acid, lipids, sugars, proteins, membranes, DNA, organelles)
• Accelerators of free radicals (diet, tobacco, alcohol, radiation, pesticides etc)

2. Connective Tissue Theory/ Cross
Linking Theory
• Accumulation of cross linked proteins damages cells and tissues,
slowing down bodily processes
• Also called Glycosylation Theory of Aging
• Glucose (simple sugars) binds to protein (a process that occurs
under the presence of oxygen), that causes various problems

Contd.
• Protein becomes impaired and unable to function
• Tissues toughens  Stiffening of connective tissue,
hardened arteries, loss of nerve functions, less efficient
kidneys
• Similar cross links alter the structure and shape of the
enzyme molecules and becomes unable to function
properly in the cell

Contd.
• So living a longer life is going to lead to the increased
possibility of oxygen meeting glucose and protein
• Known cross linking disorders include senile cataract,
wrinkled skin, the appearance of tough and yellow skin
which leads to appear age related changes.

3. Orgel’s Error Theory
This theory states errors in protein translation that reduce
the accuracy of the protein-translating enzymes
(ribosomes) would lead to a feedback loop of
increasingly inaccurate and dysfunctional protein
synthesis (in corporation of wrong amino acids)
terminating in the death of the organism.

Contd.
Accuracy is reduced due to:
- Mutations
- Certain antibiotics (e.g. aminoglycosides)
- Cellular stress or chemical agents

4. Wear and Tear Theory
• Compares human body and aging as a machine
• Continued use of cells cause cells to wear out
• “Infant mortality” – we might expect some immediate problems
(similar to when buying new automobiles, there may be defect)
• Service life – may expect frequent problems
• With advancing age or with repeated injury, the capacity for
repair is exceeded by “wear and tear”
• Aging is the accumulation of injuries and damage to parts of the
body

Contd.
• In addition to mechanical wear, accumulation of
oxidation and other chemical (molecular damage) are
included in the “wear and tear” concept.
• Use, accidents, disease, radiation, toxins and other
detrimental factors adversely affect different parts of the
body.

Contd.
• Years of damage to cells, tissues and organs eventually
wear them out, killing them and, the body like a machine,
loses its function.

• Aging is the result of sequential switching on and
off of certain genes.
• T lymphocytes or B lymphocytes have the
receptors for self-antigens by which they undergo
programmed cell death or apoptosis, thus reducing
number.
5. Gene/ Biological Clock Theory

Contd.
• Genetically pre determined program in which after a set
of number of reproduction (human fibroblast have the
capacity to double about 50 times), the cell gets old and
dies.

6. Autotoxication Theory
Basic metabolic process of the cells produce waste product
called “lipofucin” or known as “age pigment” that
accumulates until they reach a critical level and cause
dysfunction of cells that causes aging and eventually
death.

7. Physiologic Theory
According to this theory changes occur outside the
molecules and cells i.e. in the tissues and organs.
The effects occur in an immunology and endocrine system
within the body function.

• Whenever problems arise with the hypothalamus-pituitary-
endocrine gland feedback system, causes disease.
• Hypothalamus instructs glands to release their hormone and also
responds to the body hormone levels
• As we age, the endocrine system becomes less efficient and
eventually leads to aging.
• ↓ GH, Sex hormones like estrogen and testosterone levels
• ↓ estrogen  bone thinning  disability
a. Neuro Endocrine Control or Pacemaker
Theory

• Immune system programmed to decline over time  Increased
vulnerability to infectious disease  aging and death
• With age, antibodies lose their effectiveness, and fewer new
diseases can be combated effectively by the body, which causes
cellular stress and eventual death
b. Immunological Theory

Living Theory or Rate of Living
Theory
• Aging is the by product of metabolism
• The greater an organism’s rate of oxygen basal metabolism, the
shorter its life span and vice versa.
• Creatures with faster oxygen metabolisms die younger.
*Lack of evidence

Psychological Theories of aging
Explain aging in terms of mental processes, emotions,
attitudes, motivation, cognition, behavior and personality
development that is characterized by life stage
transitions.

Psychological Theories of Aging
1. Maslow’s hierarchy of human needs
2. Jung’s theory of individualism
3. Erikson’s eight stages of life/ personality development
4. Peck’s expansion of Erikson’s theory
5. Selective optimization with compensation

1. Maslow’s Hierarchy of Human Need
• Each individual has an innate internal hierarchy of needs
that motivates all human behaviors.
• Five basic needs motivate human behavior in a lifelong
process toward need fulfilment.

2. Jung’s Theory of Individualism
• Signifies coherent whole, unifying both the consciousness and unconscious
mind of a person.
• According to Jung the self, is realized as the product of individuation, which
is defined as the process of integrating one’s personality.
• Self realization is the goal of personality development as individual ages,
each individual is capable of transforming into a more spiritual being.
• It focuses that personality develops over a life time and is composed of an
ego or self – identity that has personal and collective unconsciousness.

Jung’s Theory of Individualism Contd.
• As individual age, they begin to reflect on their beliefs and life
accomplishments, when one ages successfully he or she accepts the past,
adapts to physical decline, and copes with the loss of significant others.

3. Personality Development
• According to Erikson’s personality develops in eight sequential stages with
corresponding life tasks.

Integrity vs Despair Role play

Contd.
• “Ego integrity vs Despair”
• Integrity is characterized by evaluating life
accomplishments; struggles include letting go,
acceptance of one’s life as meaningful, accepting care
and detachment, accepting physical and mental decline,
viewing death as part of life.

Contd.
• While, despair looks like failure to accept the
meaningfulness of one’s life, along with fear of death.
• Satisfaction leads to integrity, while dissatisfaction
creates a sense of despair.

Contd.
Older adults face additional challenges or life tasks
including physical and mental decline, accepting the care
of others and detaching from life, creating meaningful
life after retirement, dealing with an “empty nest” as
children move away, and thinking about inevitability of
death.

4. Peck’s Expansion of Erikson’s
Theory
- Expanded and focused more on later developmental
stages. The elderly goes through three developmental
stage to reach full psychosocial development.
a. Ego differentiation vs work role preoccupation
b. Body transcendence vs body preoccupation
c. Ego transcendence vs ego preoccupation

Contd.
a. Ego differentiation vs work role preoccupation:
- As a person matures, that person moves from “Work
Role Preoccupation” which is a concept that describes
defining oneself through work or an occupation.
- A person finds new meaning and value in his or her life.
This process is called “Ego Differentiation”.

Contd.
b. Body transcendence vs Body Preoccupation
- A person either accepts the limitations that accompanies
the aging process (Body Transcendence) or dwells on
diminishing abilities (Body Pre occupation).
- It is a phase concerned with enjoyment of life in the face
of physical discomforts associated with aging.

Contd.
c. Ego Transcendence vs Ego Pre occupation
- In this phase self – examination occurs. If a person
believes his or her life was worth and “life contributions”
will live on after death, the person experiences “Ego
Transcendence”.
- Otherwise, the person may feel that he or she has lived a
useless life and experience “Ego Preoccupation.”

5. Selective Optimization with Compensation
• According to this, individuals cope with the aging losses through the process
of activity/role selection, optimization, and compensation.
• Aging individuals adjust activities and roles as limitations present
themselves, at the same time, they choose those activities and roles that are
most satisfying.
• Coping with illness and functional decline may lead to greater or lesser risk
of mortality.
• It is a positive coping process that facilitates successful aging.

Contd.
• Selection: Increasing restriction of one’s life to fewer domains of functioning
• Optimization: People engage in behaviors to enrich their lives
• Compensation: Developing suitable, alternative adaptations

Sociological Theory of Aging
This focuses on changing roles and relationships, status,
changes in behavior, personality and attitude that accompany
aging and challenges with various life stages. These theories
discuss how these changes impact the older individual’s
ability to adapt. Sub categories:
a. Activity Theory
b. Disengagement Theory
c. Continuity Theory

Contd.
Sub categories contd:
d. Subculture Theory
e. Age Stratification Theory
f. Gerotranscendence Theory

a. Activity Theory
• Remaining occupied and involved is necessary to satisfy
late life.
• Activity engagement leads to positive adaptation, supports
the maintenance of regular activities, roles and social
pursuits.
• People who achieve optimal age are those who stay active.
• Activity can be physical or intellectual in nature, but mainly
refers to maintaining active roles in society.

Activity Theory Contd.
• To maintain positive self image; older person must
develop new interests, hobbies, roles and relationships.
• This theory proposes that an older person should continue
their middle-aged lifestyle, denying limitations of old
age. As possible.

Contd.
Weakness of this theory:
Some aging person cannot maintain a middle aged lifestyle,
due to functional limitations, lack of income, or lack of a
desire to do so.
Many older adults lack the resources to maintain active
roles in society. On a flip side, some elders may insist on
continuing activities in late life that pose a danger to
themselves.

b. Disengagement Theory
• Asserted that aging is characterized by gradual
disengagement from society and relationships.
• Views aging as a process of gradual withdrawal between
society and the older adult which is natural acceptable and
universal process.
• Gradual withdrawal from society and relationships
preserves social equilibrium and promotes self reflection
for elders who are free from societal roles.

Contd.
• Aging is an inevitable, mutual withdrawal or
disengagement, resulting in decreased interaction
between the aging person and others in the social system
he/she belongs to.
• It furnishes on orderly means for the transfer of
knowledge, capital, and power from the older generation
to the young.

Contd.
Weakness:
There is no base of evidence or research to support this
theory. Additionally, many older people desire to remain
occupied and involved with society.
Imposed withdrawal from society may be harmful to elders
and society alike. This theory has been largely discounted
by gerontologists.

c. Continuity Theory
• Proposed in reaction to disengagement theory.
• It says “ Basic personality, attitudes, and behaviors remain constant
throughout the life span”. Personality influences role and life satisfaction.
• The later part of life is simply a continuation of the earlier part of life, a
component of entire life cycle.
• Patterns developed over a lifetime determine behavior, traditions, and beliefs
in old age.

Contd.
• Past coping strategies recur as older adults adjust to the challenges of aging
and facing death.
• It encourages young people to consider that their current behaviors are laying
the foundation for their own future old age.
• What one becomes in late life, is a product of a lifetime of personal choices.

d. Subculture theory
Theorize that older adults form a unique sub culture within
society to defend against society’s negative attitude toward
aging and the accompanying loss of status.
This theory proposed that there is a growing awareness among
many older people that they are not merely members of a
social category, but are members of a social group with
common problems and a distinctive subculture.

Contd.
Health and mobility are key determinants of social status.
Older persons are accepted by and more comfortable
among their own age group.
A component of this theory is the argument for social
reform and greater empowerment of the older populations
so that their rights and needs can be respected.

e. Age Stratification theory
• Refers to the hierarchical ranking of people into age groups within a society.
• Age stratification based on social status is a major source of inequality, and
thus may lead to ageism.
• Age stratification within a population can have major implications, affecting
things such as workforce trends, social norms, family structures, government
policies, and even health outcomes.
• Society is stratified by age groups that are the basis for acquiring resources,
roles, status and deference from others.

Contd.
According to this theory, older adults born during different time
periods form cohorts that define “age strata”. There are two
differences among strata: chronological age and historical
experience. This theory makes two arguments.
- Age is a mechanism for regulating behavior and as a result
determines access to positions of power
- Birth cohorts play an influential role in the process of social

f. Gerotranscendence theory
- One of the newest sociological aging theories
- This proposes that aging individuals undergo a cognitive
transformation from a materialistic, rational perspective
toward “oneness” with the universe.

Contd.
Characteristics of successful transformation include a more
outward or external focus, accepting impending death
without fear, sense of connectedness with preceding
generations and spiritual unity with the universe.

Developmental Theories of Aging
- Major non – evolutionary theory of ageing.
- Links development to ageing
- The concepts of this theory based on the identification of
traits and characteristics that may be developed early in
life or may change emphasis at different stages of
development.

Contd.
Developmental theories of aging
1. Life course theory
2. Havighurst’s theory
3. Newman’s theory
4. Erikson’s eight stages of life
5. Peck’s expansion of Erikson’s theory
6. Jung’s theory of individualism

1. Life Course Theory
• Is concerned with the understanding the group norms and
their characteristics.
• Aging occurs from birth to death.
• The central theme of life course is that, life course in
stages that are structured according to one’s role,
relationships, internal values, and goals.

Contd.
• Goal achievement is linked to life’s satisfaction but
people’s goal achievements are limited by external
factors.
• Individual adapt to changing roles.
• Successful adaptation may require revising one’s beliefs
to be consistent with society’s expectations.

Contd.
• Each of us live through different events, we make
choices, we face the consequences of policies and
systems, and intersecting forms of discrimination that
influence our lives.
• As we grow older, the impact on us of these different
experiences accumulates.

2. Havighurst’s Theory
Developmental tasks

3. Newman’s Theory
Identifies the task of aging as:
• Coping with the physical changes of aging
• Redirecting energy to new activities and roles including
retirement, grand parenting and widowhood
• Accepting one’s own life and
• Developing a point of view about death

Environmental Theories of Aging
Focuses on effects of environment on the cellular structure
of the human which leads to be old.
Factors in the environment e.g. industrial carcinogens,
mercury, lead, arsenic, pesticides, sunlight, air pollutants,
trauma and infections etc. bring about changes in the
aging process.

Contd.
Impact of environment is a secondary rather than the
primary factor of aging.
Environment Theories of Aging
1. Radiation Theory
2. Stress Theory
3. Person environment fit Theory

1. Radiation Theory
Excessive exposure to the radiation of sun puts the skin at
risk during the somatic mutation of organism

2. Stress Theory
Human aging is a disease syndrome arising from struggle
between environmental stress and biological resistance
and relative adaptation to the effects that include air
pollutants, chemical, psychological and sociological
stress or events.

3. Person Environment Fit Theory
• Proposed that capacity to function in one’s environment
is an important aspect of successful aging, and that
function is affected by the ego strength, motor skills,
biologic health, cognitive capacity and sensory perceptual
capacity, as well as external conditions imposed by the
environment.

Contd.
• Functional capacity influences an older adults ability to
adapt to his or her environment.
• Those individuals functioning at lower levels can tolerate
fewer environmental demands.

Physical assessment
To become proficient in geriatric assessment, geriatric nurse
need to understand the physiologic changes unique to this
population, as well as the differences between normal
aging related changes and health alterations caused by
illnesses and social changes.

Contd.
• Gather baseline data
• Obtain a complete medical history
• General survey of the client
• Complete physical assessment
 Head to toe
 Includes vital signs

General considerations
• Follow the usual sequence of physical examination:
history, inspection, palpation, percussion, and
auscultation.
• Limit the time the patient is in the supine position as this
may cause back pain for persons with osteoarthritis or
kyphoscoliosis and shortness of breath for those with
cardiopulmonary disease.

Contd.
• Having several pillows on hand for these patients will be
greatly appreciated. Multiple sessions may be required
for a complete physical exam due to patient fatigue.
• While they are important, the rectal and pelvic exams
may be deffered to a later session, if not urgently
required.

Contd.
• Before starting physical examination, introduce yourself
to the patient, explain the procedure. Be organized and
systematic in assessment. Use appropriate listening and
questioning skills.
• Ensure patient’s privacy and dignity. Assess ABCCS
(airway, breathing, circulation, consciousness, safety).

Contd.
• Apply principles of asepsis and safety, and complete all
necessary focused assessments.
• The examination begins with assessment of the patient’s
weight, height, temperature, pulse, respirations and blood
pressure.

General Survey
• Your “across the room” assessment
• What’s their general appearance?
 Obvious distress
 ABCs
 Pain
 Anxiety
 Level of Hygiene
 Skin integrity

Follow the procedures for physical examination

Evaluating patient’s fall risk

Polypharmacy
Older patient are often prescribed multiple medications,
placing them at increased risk of drug interactions abd
adverse medication events.
The best method of detecting potential problems with
polypharmacy is to have patients provide all medications
(prescription and non – prescription) in their packaging.

Contd.
Older people should also be asked about alternative medical
therapies like herbal medicine use, etc.

Psychosocial Assessment
Assess elderly for cognition, mood and anxiety, fears, care
preferences, spirituality, social support and networks,
environment/living situations

Contd.
Total Score: 30
Scoring:
 24 – 30: No cognitive impairment
 18 – 23: Mild cognitive impairment
 0 – 17: Severe cognitive impairment

Paranoia in the Elderly
Paranoia is defined as an unreasonable fear that they are in
danger.
It may be one of the symptoms of psychosis, depression, or
dementia.

Contd.
The GAD-7 GAD score range is as follows:
0-4 Minimal Anxiety
5-9 Mild Anxiety
10-14 Moderate Anxiety
15-21 Severe Anxiety

Social support and Financial Assessment
A brief screen of social support includes taking a social
history and determining who would be available to help if
they become ill.
Early identification of problems with social support can
help planning and timely development of resource
referrals.

Spiritual/ Religious Preferences/
Hobbies and Interests

Environment or Living Situation

Reporting and Documentation
Report and document assessment findings and related health
problems. Accurate and timely documentation and
reporting promote patient safety.

Contribution of the elderly to the
young generation
Connecting generation will:
 Strengthen the community
 Encourage positive exchanges between the generations

Benefits of bringing Generations together
 Understand and embrace their similarities and differences
 Encourage learning about other group
 More family time
 More help with household matters
 Financial advantage
 Strengthen communities through mutual understanding

Contd.
 Encourage learning through mentoring
 Connections with a younger generation can help older
adults feel a greater sense of fulfilment
 Provide an opportunity for both to learn new skills
 Give the child and older adult a sense of purpose
 Help to alleviate fears children may have of the elderly

Contd.
 Help children to understand and later accept their own
aging
 Invigorate and energize older adults
 Help reduce the likelihood of depression in the elderly
 Reduce the isolation of older adults
 Children who do not have grandparents available to them
may feel avoidance

Contd.
 Help keep family stories and history alive
 Aid in cognitive stimulation as well as broaden social
circles, young introduce technology into the life of senior

Activities that initiate, build and
strengthen intergenerational
relationship
- Story telling
- Learning skills
- Reading to each other
- Planning/ Preparing a meal (if applicable)
- Scrapbooking

Contd.
- Talking about ethnic heritage, sharing ethnic customs.
- Planting seeds and gardening
- Discussing hobbies and sharing examples
- Having the child teach the senior a new technology, etc.

Scope of geriatric nurse
The scope of geriatric nursing (also known as
gerontological nursing) encompasses a specialized field
of healthcare dedicated to the holistic physical, mental,
and social well-being of older adults, typically those aged
65 and older.

Contd.
Geriatric nurses function as caregivers, advocates, and
educators, managing the "5 Ms" of geriatric care: Mind,
Mobility, Medications, Multicomplexity, and Matters
Most.

Contd.
Comprehensive Assessment: Evaluating physical health,
cognitive function (e.g., screening for dementia or
delirium), and emotional status.
Chronic Disease Management: Caring for patients with
conditions like Alzheimer’s, diabetes, arthritis,
hypertension, and osteoporosis.

Contd.
Medication Management: Supervising complex
medication regimens to prevent adverse drug interactions
and managing polypharmacy.
Safety & Mobility: Implementing fall prevention strategies
and assisting with activities of daily living (ADLs) such
as bathing, dressing, and feeding.

Contd.
Patient & Family Advocacy: Serving as a liaison between
the patient, family, and multidisciplinary healthcare team
to ensure the patient's wishes are respected.
End-of-Life Care: Providing compassionate palliative and
hospice care for terminally ill patients and support for
their grieving families.

Contd.
Diverse work setting
- Hospitals: Specialized geriatric or acute care units.
- Long-Term Care: Nursing homes, assisted living
facilities, and retirement communities.
- Home Healthcare: Providing skilled nursing and
rehabilitation in a patient's private residence.

Contd.
- Hospice & Palliative Care: Centers focused on comfort
for patients with terminal illnesses.
- Community Services: Adult daycares, senior centers,
and outpatient rehabilitation clinics.

Contd.
Career Growth & Specializations
The field offers various levels of practice based on
education:
Registered Nurse (RN): General bedside care and case
management.
Geriatric Nurse Practitioner (GNP): An advanced
practice role with the authority to diagnose, treat, and
prescribe medications.

Contd.
Clinical Nurse Specialist (CNS): Focusing on improving
clinical standards and staff education within a facility.
Leadership Roles: Opportunities as facility administrators,
nursing directors, or case managers.

Roles and responsibility of nurse to
care elderly population
Roles of the Gerontological Nurse
 Healer
 Care Giver
 Teacher/ Educator
 Manager
 Advocate

Contd.
 Innovator
 Researcher / Evidence based clinician
 Supportive role
 Restorative
 Life enhancer
 Communicator

Contd.
 Counselor
 Case Manager
 Coordinator
 Collaborator

Contd.
Responsibilities of Gerontological Nurse
 Integrate advanced knowledge and experience in
delivering safe, effective quality care to geriatric clients
in primary care.
 Demonstrate competence in managing the health/ illness
status of geriatric clients.

Contd.
 Monitor and ensure quality health care for geriatric
clients.
 Demonstrate leadership and competence in implementing
the role of the primary care nurse practitioner.
 Incorporate an understanding of trends in aging in
planning and providing primary health care for clients.

Contd.
 Engage in counseling, communication, collaboration and
teaching in a manner that reflects caring, advocacy, ethics
and professional standards.
 Conceptualize one’s individual role as a primary care
nurse practitioner and one’s personal philosophy or
primary care practice.

Contd.
 Administering medications to patients based on a care
plan.
 Teaching family members about a patient’s condition and
how to promote self-care skills.
 Maintain efficient interpersonal communication with the
patient as well as the patient’s family for moral support
and decision making.

Self-care model in Gerontology and
Geriatric Nursing
Self – care model is the conceptual model based on the self-
care deficit theory developed by Dorothea Orem.
Orem’s self care deficit theory includes:
1. Self-care: consists of actions that individuals freely and
deliberately initiate and perform on their own behalf in
maintaining life, health, and well-being.

Contd.
2. Self – care deficit: An inability of a person to perform
self – care. It occurs when the elderly person suffers from
different health conditions. The requirement for nursing
arises when an adult is unable to maintain the amount and
quality of self-care necessary to sustain health and
recover from injury or illness.

Contd.
Health Care Requisites:
 Physical, mental and socioeconomic abilities to take
action to meet the life demand
 Knowledge, experience, and skill to perform the action
 Desire and decision to take the action

Contd.
3. Nursing Systems: Methods used by nurses to assist
patients, including:
Wholly Compensatory: The nurse provides all care for a
patient who is completely unable to care for themselves.
Partially Compensatory: Nurse and patient share
responsibility for care.

Contd.
Supportive-Educative: The patient can perform tasks but
requires guidance, teaching, or support from the nurse.

Application of self – care model in
caring older adults
1. First phase: Diagnostic Phase
a. The first step includes identifying and prioritizing the
client’s unmet self – care needs (deficit)
b. Nurse evaluates a person’s condition and his/her
functional profile and then considers different self – care
deficits.

Contd.
- A mild therapeutic self – care deficit
- A moderate therapeutic self – care deficit
- A severe or complete therapeutic self – care deficit

Contd.
2. Second Phase: Intervention Phase
a. The second step consists of selecting methods of
assisting the client to compensate for or overcome his
self – care deficits.
b. Select nursing intervention according to diagnosed self –
care deficit. Nursing intervention included are:

Contd.
i) Wholly compensatory:
- Elderly unable to carry out needed self – care actions
- Self – care need provided by nurse
- Such conditions arises if the patient is in coma and is
unable to engage in self – care, or has vertebral fracture
and is aware about self – care but cannot perform by self.

Contd.
ii) Partial compensatory:
- Care provided to the elderly is s/he can meet some self –
care need but requires a nurse to help to meet other self –
care needs.
- For e.g.: Assisting post operative client to ambulate,
providing meal tray to the elderly who can feed himself.

Contd.
iii) Supportive educative:
- Elderly person can meet self – care requisites but needs
assistance with decision making, behavior control or
knowledge acquisition skills.
- For e.g. Providing lifestyle modification teaching to
elderly with different health issues.

Revision
1. Gerontology is the study about
a. Human body
b. Children
c. Senior citizens
d. Genetics

2. Who coined the term ‘geriatrics’
a. Nascher
b. Lenther
c. Checkov
d. Mechinikov

3. The physical and mental decline associated with the
aging process is:
a. Dimentia
b. Delirium
c. Senescence
d. None

4. According to WHO, who are senior citizens
a. People 70 years and above
b. People 65 years and above
c. People 60 years and above
d. People 50 years and above

5. When was senior citizen act formulated in Nepal?
a. 2060 BS
b. 2061 BS
c. 2062 BS
d. 2063 BS

6. Any act that causes mental torture to the elderly through
humiliation and isolation is called:
a. Neglect
b. Physical abuse
c. Emotional
d. Abandonment

7. Healthy aging refers to:
a. Postponement of or reduction in the undesired effects of
aging
b. Remaining young physically
c. Remaining free of disease
d. Taking needed action for health issues

8. Developmental task of elderly include all except
a. Adjusting to declining physical health
b. Adjusting to reduced income
c. Establishing satisfactorily physical living arrangements
d. Maintaining contact with children and grandchildren

9. Developmental crisis of older adult is:
a. Generativity vs Stagnation
b. Ego integrity vs Despair
c. Intimacy vs Isolation
d. Trust vs Mistrust

10. Wear and tear theory is:
a. A sociological theory of aging
b. Physiological theory of aging
c. Psychological theory of aging
d. Developmental theory of aging

11. Stochastic theories include those of the following
EXCEPT:
a. Cross linking theory
b. Wear and tear theory
c. Free radical theory
d. Genetic cellular theory

12. Non stochastic theories include those of the following
EXCEPT:
a. Apoptosis
b. Physiological system theories
c. Evolutionary
d. Radiation theories

13. “The genetic mutations are responsible for aging by
causing organ decline”. Which theory says this
statement?
a. Error theory
b. DNA damage theory
c. Biological clock theory
d. Free radical theory

CREDITS: This presentation template was created by
Slidesgo, and includes icons by Flaticon, and
infographics & images by Freepik
Thanks!
Do you have any questions?

Introduction to Geriatric Nursing,Theory

Introduction to Geriatric Nursing,Theory

More Related Content

Similar to Introduction to Geriatric Nursing,Theory

More from nabina paneru

Recently uploaded

Introduction to Geriatric Nursing,Theory

Editor's Notes