nursing management of the elderly, Geriatrics, Gerontology, assessment of elderly, ageing process, common ageing changes, psychological changes, assessment of disabilities, helping elderly person in promoting wellness and self care, home and institution care of elders.

1. Unit-14
Nursing Management of the elderly
PRESENTED BY: MISS. JYOTI BHAGAT

2. Terminology
 1. Aging- aging is a normal part of human development. The word
aging is defined as the time from birth to the present for a living
individual as measured in specific units.
 2. Geriatrics- the branch of medicine dealing with the physiological
aspects of aging with diagnosis and treatment of diseases affecting older
adults
 3. Gerontology- it is the study of all aspects of the aging process and its
consequences.
 4. Gerontology-nursing- it is concerned with assessment of health and
functional status of older adults, diagnosis, planning, implementing
health care and served to meet the identified needs and evaluating the
effectiveness of such care.
 Young old age- 65-75 years
 Old age- 75-85 years
 Older- 85-100 years.

3. Assessment of elderly
 Comprehensive geriatric assessment (CGA) is defined as a
multidisciplinary diagnostic and treatment process that identifies
medical, psychosocial, and functional capabilities of an older adult
in order to develop a coordinated plan to maximize overall health
with aging.
 Assessing the health needs of elderly patients can reduce their
hospitalization rate and enhance their quality of life and
independence. Information you obtain from an accurate
assessment serves as the foundation for age-appropriate nursing
care.

4. History collection
 Solitude, lack of productivity and negligence.
 Symptoms of disease
 Family history
 Diet history
 Medication history
 Previous surgical history

5. Past medical history
 General health and strength.
 Diseases of youth and childhood
 Surgery of serious accidents.
 Emotional level.
 Previous treatment for any medical suffering.
 Strengthens and coping abilities.

6. Personal and family history
 Place of birth
 Domestic environment
 Marriage
 Socioeconomic status
 Education
 Cultural background
 Position of family
 Interests and different aspects of general life.

7. Present illness
 Its assessment may vary with the individual and there may be one
or more reason for it. Enquire from patient.
 When did it start / how long has it been going on?
 Is this a new problem / first time having this problem?
 Intermittent or constant?
 What makes it worse •
 Any other symptoms that you have?
 Current use of any medications.

8. Chief complaints
 Chief complaints should be assessed so that priorities may be
decided in implementation of care.
 Ask the patient about health condition due to which he needs
immediate medical care.
 A chief complaint (CC) is a concise statement that describe
symptom, problem, condition, diagnosis, physician recommended
return or other factor that is the reason for the patient encounter.

9. Ageing process
 The most scientists have opinion that aging cannot be prevented.
 It is an ultimate end result of life and it is essential part of it but
duration of ageing and its intensity can be Decreased.
 Factors affecting aging.
 Hereditary factors- some families have longer life than others
under the same environmental circumstances.
 This is related with genetic factors.
 This gene is not only the ageing gene but could also be a
cancer gene.
 Environmental factors-
Abiotic factors- the factors affecting ageing process like
climate, radiation, chemical, physical elements of pollution
etc. Are included in this category.

10. Cont...
Biotic factors- living organisms present in environment
like pathogens, quality of food, etc are included. They all
influence the ageing of person
Socioeconomic factors
 Disabilities of old people
• Inability to perform as expected in the socio-economic
and cultural context- e.g. Poor self care, family role and
social role, improper interpersonal relationships.
• All these causes a burden to family. So care had to be
planned accordingly-
 1. Individualized needs
• Family needs
• Available resources and facilities

11. Common ageing changes
 Ageing changes differs from one person to another.
 It depends on hereditary, nutritional, general health, tension
related factors.
 These changes are classified into-
• 1. Physical changes
• 2. Psychological changes

12. Physical changes
 Changes which occur in different systems of the body are called
as physical changes.
1. Integumentary system
1. Decrease in elasticity of skin and dryness.
2. Wrinkles appears.
3. Age spot appears.
4. Hair of head, axilla or pubic region becomes scanty,
grey/white.
5. Hair growth on woman’s face.
6. Thickening of nasal hair and hair on ears.

14. Cont…
2. Cardiovascular system
1. Elastic tissue loss, increased collagen and muscle fibres gets
deposited with pigment of fat and protein called LIPOFUSIN and
it causes the loss of elasticity in the arteries.
2. Increased blood pressure.
3. Flexibility of heart valves diminishes.
4. Blood vessels of head, neck, hands and legs become prominent.
3. Respiratory system
 With ageing inspiratory and expiratory muscle strength is
reduced, the lungs loose elasticity so efficiency in breathing is
reduced.
 This causes decreased vital capacity causing decline in O2
consumption.
 The capacity of lungs is reduced.

15. Cont...
 Ineffective gas exchange.
 The chance of cough increases.
 More chances of respiratory infections.
4. Genitourinary system
• Kidney functions may be impaired.
• Fluid and electrolyte imbalance.
• Capacity of urinary bladder decreases.
• Incontinence.
• Enlargement of prostrate in males.
• Atrophy of reproductive organs in females.

16. Cont…
5. Gastrointestinal system
 Falling of teeth.
 Less secretion of saliva and gastric juice.
 Complaints of constipation.
 Digestion become weak.
6. Musculoskeletal system
 Height reduces.
 Kyphosis, swelling in joints.
 Bones become weak.
 Mobility decreases if proper exercise is not done.

18. Cont...
7. Endocrine system
 Thyroid gland become less active.
 Alertness decreases.
 More susceptible to cold.
 Secretion of testosterone, estrogen, progesterone decreases.
 Less secretion of insulin by pancreas.
8. Neurological system
 Sensitivity become less.
 Change in sleeping habits.
 Frequent awakening.

19. Cont...
9. Sensory system
 Eyes become weak.
 Hearing capacity decreases.
 Complaint of presbyopia.
 Ability to smell is reduced.
 Tactile sensations are affected.
10. Immune system
 Ageing process makes immune system defective and attacking
not just foreign proteins, bacteria and viruses but also
producing antibodies against itself, e.g. Cancer, diabetes and
rheumatoid arthritis.
 It also leads to slower down wound healing process.

20. PSYCHOLOGICAL CHANGES
1. Personality
 Changes may occur in personality due to life partner death,
decreased or end of self dependence, loss of source of income.
2. Memory
 Memory power may decrease with age.
 Tendency to repeat facts and information increases.
 Confused memory may also be found.
3. Intelligence
• Intelligence is not affected if person is not sick.
4. Sexuality
 Physical incapacity, less secretion of hormones, degeneration of
reproductive organs, lack of privacy.
 In old age attachment, warmth, intimacy and emotions are more
important than physical act.

21. Assessment of Disabilities
 Assess physical, physiological, psychological, social and sexual
disabilities or impairments.
 Assess problem in climbing the stairs, sitting, movement, opening
jar, holding small objects, maintaining posture.
 Assess their daily living activities, they feel helpless in cooking,
domestic work, shop keeping, taking medicine, managing money,
changing clothes, going to toilet, having bath, taking food etc.
 Assess self sufficiency of older person.

22. Helping, elderly person in promoting wellness and self care
 Nurse’s primary focus should be on client’s wellness.
 Nurse should help the client to achieve their highest possible level of wellness.
 Consider client’s strengths, assets, resources as well as weakness, liabilities of
client to take a personal inventory.
 Nurse should set goals and develop a plan of action-
 Mobilizing resources.
 Provide safe and adaptable environment.
 Assisting the client to learn about his/her health problem and treatment.
 Helping and teaching the client to perform activity for promoting wellness.
 Anticipating problems and recognising potential crises.
 Evaluating the plan and progress toward goals with client and family.

23. Conditions associated with ageing
1. Vision
 Increase impairment of vision.
 A progressive far sightedness (presbyopia) is common.
 Age- cataract, macular degeneration, glaucoma, diabetic
retinopathy is seen.
 Approximately 92% of elder adults older than 65 years use
eye glasses.
2. Auditory
 Presbycusis, gradual, progressive bilateral sensorineural
hearing loss is commonly seen.
 Cerumen collection is also seen.

24. Cont…
3. Nutrition
 Factors associated with malnutrition in older community
include-
 Physical illness
 Lack of hydration
 Social isolation
 Oral health problems
 Limited mobility
 Limited vision
 Poverty
 Dementia
 Depression
 alcoholism

25. Cont...
 Metabolic rate decreases so calorie requirement is also reduced.
 There is decreased in acuity and differentiation in taste, smell which
contribute to anorexia and malnutrition.
 Loss of gingiva, loss of teeth, ill fitting dentures, potential mouth ulcers.
 Relaxed cardiac sphincter cause older people feel easily fullness.
 Slow peristalsis in colon cause increased flatulence and diverticula.
 Weight changes.
 1. Under weight
Loss of smell affects taste and enjoyment, loss of appetite may be from
depression.
 2. Overweight
For elders who are obese generally limit intake of 1500 to 1800 kcal per
day.

26. Cont...
 3. hydration
All elderly are vulnerable to variations in fluid volume.
Concentrated urine, decreased output, sunken eyeballs, coated
tongue, dry mucus membrane.
 4. Sleep
 Change in sleep pattern.
 Insomnia, initial insomnia or terminal inspmnia.
 Hypersomnolence.
 5. Elimination
 Urinary- stress, urge and overflow incontinence are the common
problems.
 A neurogenic bladder is associated with urinary retention. It often
requires an indwelling catheter.
 Faecal- Diarrhoea- susceptible to infection.
• Constipation- poor bowel habits, lack of dietary fibres, poor fluid
intake, inadequate exercises, use of medications.

27. Cont...
 Mobility- brief period of immobility increases the risk for falls
and injury.
 Falls- accidents are the leading cause of death among elders. It
also contributes to functional decline, depression, helplessness
and social isolation.
 Osteoporosis- it increases fracture occurrence while doing
activities of daily living.
 Postmenopausal women are affected easily.
 The vertebral bodies, proximal femur, distal bones are
common fracture.

28. Cont...
 Communication
 Language disorders are seen.
 Common causes are strokes, dementia.
 Cognition
 Confusion- due to delirium, dementia and depression.
 Dementia
Lowered level of consciousness, deterioration in memory,
persormances, speed of cognitive processing and executive
functions.

29. Cont...
 Depression
 It may be exogenous due to poor performance, disability,
loneliness, social isolation.
 It may be endogenous- due to physical illness, pain medication or
both.
 Suicide among elders
 The elders having depression are at highest risk of suicide.
 It may be due to physical illness, functional losses, finances, family
relationships.
 The methods include guns, hanging, drug overdose, cutting,
slashing.

30. Home and institution care of elders
 Aims
• To restore the health to a degree for independent living.
• To achieve quality of life.
• Nurse should enhance skill and knowledge acquired during
general training In order to meet the special needs of the elderly.
 Role of nurse
 Acute care
• History collection.
• Physical examination.
• Explain diagnosis and treatment to the patient and family.
• Maintain hydration, nutrition and aeration and comfort.
• Administer emergency treatment when necessary.

31. Cont…
 Long term care
• Promote atmosphere to promote quality living, not disease
dying.
• Ensure patient receives medical, dental and eye care.
• Provide medications, treatments, rehabilitative exercises and
evaluate response.
• Treat and advise patient and family.
 Comment care
• Identify health, social and economic needs.
• Use clinic and home visits for health promotion.

32. Cont...
 Promotion of comfort
• Care of the skin
• Care of the body structures
• Maintain nutrition status
• Maintain fluid balance
• Maintain body temperature
 Safety
• Unpolished floor, good lighting the absence of impediments
ease movements and inability.
• Correct height of bed and chairs, extra comforts with cushions,
the provision of walking aids like walker, walking sticks or
wheel chairs.
• Constant personal observation and support.

33. Cont...
 Promotion of independence
• Patient is encouraged to do self care at the maximum possible
level and make decisions of lif.
 Promotion of movement and mobility
• The patient is encouraged to be out of bed as much as possible
according to the capabilities and needs.
 Promotion of mental activity and interests
• Engage elders in intellectual and recreational needs of all patients.
 Rehabilitation
• It includes those activities which aim at restoring the patient to the
highest possible degree of independent living of which he is
capable.