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Geriatric considerations in nursing

  1. 1. GERIATRIC CONSIDERATIONS IN NURSING Presented By: Abhishek Yadav M SC Nursing 1st Year
  2. 2. LEARNING OBJECTIVES  Introduction of Geriatric Consideration in Nursing.  Definition of Geriatrics.  Theories of Aging.  Changes associated with Aging.  Common problems in old age.  Important considerations in care of geriatric clients.  Resources for care of older adults.  Steps taken by government.
  3. 3. INTRODUCTION • Declining fertility rates combined with steady improvement in life expectancy over the 20th century produced dramatic growth in the world’s elderly population. • People aged 65 and over now comprise a greater share of the world’s population than ever before. • Population aging refers to an increase in the percentage of elderly people ( > 65 ).
  4. 4. Demography: • The no. of elderly increased more than 3 fold since 1950, from approximately 130 million (4% of global population) to 419 million (6.9%) in 2000. • The no. of elderly is now increasing by 8 million per year ; by 2030, this increase will reach 24 million per year.
  5. 5. Indian Scenario: • Current population of India is more than 1.21 billion ( acc. to Census of India 2011 ). • The total population of nation is growing at the rate of 1.41%. • In India , elderly population is over 82 million and it is expected to reach the mark of 177 million almost double by the year 2025.
  6. 6. GERIATRICS DEFINITON: • It is a sub-speciality of internal medicine that focuses on health care of elderly people. • It aims to promote health by preventing and treating disease and disabilities in older adults.
  7. 7. Meaning: • The term Geriatrics Came from the Greek word “geron” meaning “old man” and “iatros” meaning “healer”. • However , geriatrics is sometimes called medical gerontolgy.
  8. 8. THEORIES OF AGING (A) Biological Theories of aging: 1) Programmed / Non- Stochastic Theories. - Programmed Senescence Theory. - Endocrine Theory. - Immunology Theory. 2) Error Theories. - Wear & Tear Theory . - Cross Linking Theory. - Free-radical Theory. - Error Catastroph Theory. - Somatic Mutation Theory.
  9. 9. (B) Psychological Theories: 1) Personality Theory. 2) Developmental Task Theory. 3) Disengagement Theory. 4) Activity Theory. 5) Continuity Theory.
  10. 10. 1) Programmed Theories: Programmed Senescence Theory / Hayflick Limit Theory: – In 1950’s Hayflick Suggested that the human cell is limited in no. of times it can divide, he theorized that it can divide 50 times, after which they simply stop dividing ( and hence die). He showed that nutrition has an effect on cells, with overfed cells dividing much faster than underfed cells, as cells divide to help repair and regenerate themselves. – The Hayflick Limit indicates that there is a need to slow down the rate of cell division if we want to live long lives. Cell division can be slowed down by diet and lifestyles etc..
  11. 11. Endocrine / Neuro-endocrine Theory: – First proposed by Prof. Vladimir Dilman & Ward Dean MD. – The Endocrine theory states that , as we age , the endocrine system becomes less efficient and eventually leads to the effects of aging. – Hormones level are affected by factors such as stress and infection.
  12. 12. Immunologic Theory: – According to this theory , the rate of aging is controlled by the immune system . – This theory states that , as we age the no. of cells start to decrease becoming less functional.
  13. 13. 2) Error Theories: Wear & Tear Theory: – Early Theory on aging proposed that there is a fixed storage of energy available to the body . As time passes , the energy is depleted and because it can not be restored , the person dies. – Later, other theories emerged. The wear & tear theory stated that the body is like a machine that wears out its parts with repeated use. The effects of aging are caused by progressive damage to cells and body systems over time. This was not widely accepted.
  14. 14. Crossed linked theory: – It also referred to as the glycosylation theory of aging , was proposed by Johan Bjorksten in 1942. – Acc. To this theory , an accumulation of cross- linked proteins damages cells and tissues, slowing down bodily processes resulting in aging.
  15. 15. Free radical Theory: – Proposed by Denham Harman in 1956. – It states that organisms age because cells accumulate free radical damage over time . – A free radical is any atom or molecule that has a single unpaired electron in an outer shell. – Free radical are unstable, short lived and highly reactive, as they attack nearby molecules in order to steal their electrons and gain stability, causing radical chain reactions to occur.
  16. 16. Error catastrophe theory: – Proposed by Leslie Orgel in 1963. – It states that aging is the result of the accumulation of errors in cellular molecules that are essential for cellular function and reproduction that eventually reaches a catastrophic level that is incompatible with cellular survival. – Catastrophe means a sudden event causing damage or suffering.
  17. 17. Somatic theory or Gene mutation theory: – It states that an important part of aging is determined by what happens to our genes after we inherit them. From the time of conception, our body’s cells are continually reproducing. Additionally , exposures to toxins, radiation or UV light can cause mutations in the body’s genes . – The body can correct or destroy most of the mutations, but not all of them. Eventually , the mutated cells accumulate, copy themselves and cause problems in the body’s functioning related to aging.
  18. 18. (B) Psychological Theories: 1) Personality Theory: – These theories address aspects of psychological growth without delineating specific tasks or expectations of older adults. – Some evidence suggests that personality characteristics in old age are highly correlated with early life characteristics.
  19. 19. 2) Development task Theory: – The developmental tasks are activities and challenges that one must accomplish at specific stages in life to achieve successful aging. – Erikson (1963) described the primary task of old age as being able to see one’s life as having been lived with integrity . – In the absence of achieving that sense of having lived well, the older adult is at risk for becoming preoccupied with feelings of regret or dispair.
  20. 20. 3) Disengagement Theory: – It describes the process of withdrawal by older adults from societal roles and responsibilities. – Acc. to this theory , this withdrawal process is predictable , systemic , inevitable, and necessary for proper functioning of a growing society. – The benefit to society is thought to be an orderly transfer of power from old to young.
  21. 21. 4) Activity Theory. – This theory occurs when individuals engage in a full day of activities and maintain a level of productivity to age successfully . – It says , the more you do , the better you will age . – People who remain active and engaged tend to be happier , healthier , and more in touch with what is going on around them.
  22. 22. 5) Continuity Theory. – Also called developmental theory. – This theory is the follow up to the disengagement and activity theories . – It emphasizes the individual previously established coping abilities and personal character traits as a basis for predicting how the person will adjust to changes of aging.
  23. 23. CHANGES ASSOCIATED WITH AGING (NORMAL AGING PROCESS) • A no. of physiological changes occur as we grow older. It is important to be able to recognize the changes of normal aging versus the effects of disease. • Untreated disease can result in “excess disability” and reduce the quality of life of individuals.
  24. 24. a) Biological aspects of aging: Cardiovascular Changes: – Heart rate decreases. – Respiration decreases. – Systolic BP increases (aorta & other arteries thickened/stiffened). – Valves b/w the chambers of heart thickened /stiffened. – Baro-receptors which monitor BP become less sensitive . Quick changes in position may cause dizziness from orthostatic hypotension.
  25. 25. Changes in Pulmonary system: – Lungs become stiffer , muscle strength diminishes, and chest wall become more rigid. – Total lung capacity remains constant but vital capacity decreases and residual volume increases. – Alveolar surface area decreases by up to 20%. Alveoli tend to collapse sooner on expiration. – There is an increase in mucus production and a decrease in the activity and no. of cilia. – Body becomes less efficient In monitoring and controlling breathing.
  26. 26. Changes in genito-urinary system: – Kidney mass decreases by 25-30% and the no. of glomeruli decrease by 30-40%. These changes reduce the ability to filter and concentrate urine and to clear drugs. – With aging there is a reduced hormonal response (vasopressin) and an impaired ability to conserve salt which may increase risk for dehydration.
  27. 27. Changes in gastro- intestinal system: – Decrease in strength of muscles of mastication, taste and thirst perception. – Decreased gatric motility with delayed emptying . – Atrophy of protective mucosa. – Malabsorption of CHO, vit B12 , vit D, folic acid and calcium. – Impaired sensation to defecate. – Reduced hepatic reserve. – Decreased metabolism of drugs.
  28. 28. • Stomach : – Atrophic gastritis. – Achlorhydria (insufficient production of stomach acid). – Gastric ulcers (after the age of 60 years, and can be benign of malignant). • Liver: – Reduced blood flow. – Altered clearance of some drugs. – Diminishing the capacity to regenerate damaged liver cells.
  29. 29. • Intestine: – Prevalence of diverticulitis increases with age. – Reduced peristalsis (intestinal muscle contractions) of large intestine.
  30. 30. – Increased vulnerability to infections, tumors and immune disease. – Less production of antibodies. – Mortality rate from infection is much higher than in young. (example: pneumonia or sepsis, UTI.) Changes in Immune system:
  31. 31. – Muscles generally decrease in strength , endurance, size and weight. – Loss of about 23% of muscle mass by age 80 as both the no. and size of muscle fibers decrease. – Loss of an average of about 2 inches of height. – Compression of vertebrae, etc. Changes in musculo-skeletal system:
  32. 32. Skin: – Wrinkling , pigment alteration and thinning of skin. – Elastin and collagen decrease. – Reduction in size of cells. – Loss of subcutaneous layer of fatty deposits. – Inability of skin to retain moisture.  Changes in Integumentary system :
  33. 33. Hair: – by age 50 years, the hair of more than half of all is 50% gray. It is due to decrease in the production of melanin. ( can be hormonal and hereditary ).
  34. 34. Vision: – Most common, about 95% of people aged 65 years or more report wearing glasses or need glasses to improve their vision. – Lens of eye become yellowed, cloudy. Hearing: – Membrane in middle ear including the eardrum become less flexible with age. – Vestibular begins to degenerate with age leading hearing loss. Changes in sensory system:
  35. 35. Smell: – No. of functioning smell receptors decreases. – There is an increase in the threshold for smell. Taste: – Taste also diminishes with age. – Atrophy of tongue occurs with age and this may diminishes sensitivity to taste. Touch: – Sense of touch and response to painful stimuli decreases. – Actual no. of touch receptors decreases which results in a higher threshold for touch.
  36. 36. Pancreas: – Muscle cells become less sensitive to the effects of insulin produced in body. – The normal fasting glucose level rises 6-14 mg/dl every 10 years. – Type 2 Diabetes mellitus occurs when the body develops resistance to insulin. Changes in Endocrine system:
  37. 37. Adrenal glands: – Aldosterone levels are 30% lower in adults aged 70 to 80 years than in younger adults. Lower aldosterone levels may cause orthostatic hypotension. – Secretion of cortisol diminishes by 25% with age.
  38. 38. b) Psychological aspects of aging:  Memory functioning: – Age related memory deficiencies have been reported in literature. – Short term memory and long term memory does not show similar changes.
  39. 39. – These abilities of older people do not decline but do become obsolete (out of date). – The age of their formal educational experiences is reflected in their intelligence scoring.  Intellectual functioning:
  40. 40.  Learning abilities: – The ability to learn is not diminished by age. – Studies however, have shown that some aspects of learning do change with age.
  41. 41. Adaptation to the tasks of aging: – Loss of grief. – Attachments to others. – Maintenance of self identity. – Dealing with death.
  42. 42. Psychiatric disorders in later life: – Delirium. – Dementia. – Depression. – Schizophrenia. – Anxiety disorders. – Personality disorders & sleep disorders.
  43. 43. c) Socio-cultural aspect of aging: Old age brings many important socially induced changes, some of which have the potential for negative effect on both the physical & mental wellbeing of older persons.
  44. 44. d) Sexual aspects of aging: Sexuality and the sexual needs of elderly people are frequently misunderstood, repressed and ignored.
  45. 45. Special concerns of the elderly population:  Retirement: – Sadock & Sadock (2007) reported that, of those people who voluntarily retire, most re-center the work force with 2 years. – The reasons they give for doing this include negative reactions to being retired , feelings of being unproductive , economic hardship , and loneliness. – Retirement has both social and economic implications for elderly individuals
  46. 46.  Elder abuse : – Abuse of elderly individuals may be psychological , physical or financial . And the Neglect may be intentional or unintentional. – Psychological abuse includes yelling, insulting, harsh commands, threats, silence and social isolation. – Physical abuse is described as striking. Shoving, beating or restraints. – Financial abuse refers to misuse or theft of finances, property to fulfill the physical needs of an individual who can not do so independently. – In addition, elderly individuals may be the victims of sexual abuse .
  47. 47. • Factors that contribute to abuse: – Longer life (>75 of age). – Dependency. – Stress. – Learned violence.
  48. 48.  Suicide: – People older than 65 years (12 % of population) represent disproportionately high percentage of individuals who commit suicide. – Of all the suicides, 16% are committed by this age group . The group especially at risk appears to be white men. Predisposing factors may include loneliness, financial problems, physical illness, loss, depression, widowed, divorced . – Components of intervention with suicidal elderly person should include demonstration of genuine concern, interest , and caring , solving their issues, prevent isolation.
  49. 49. COMMON PROBLEMS IN OLD AGE • Alzheimer’s Disease: – It is a slow and gradual disease that begins in part of brain that controls memory. – It affects a greater no. of intellectual and emotional and behavioral abilities , it has no known cause for this disease. – As person grows older, he is at greater risk of developing Alzheimer’s . After 60, the risk is one in 20, but after 80 it is one in 5.
  50. 50. • Strokes: – About 15 million people have stroke , each year it is a 2nd leading cause of death for older than 60yrs of age . • Heart disease: – Hypertension (silent killer). • Osteoarthritis : – It is most common form of arthritis . • Rheumatoid Arthritis: – Inflammation of joint lining in the synovial (free moving ) joints.
  51. 51. • Diabetes: – Due to lack of movement or work in old aged people. • Urinary incontinence: – About 1/3rd of women and 10% of all men above age of 60 have incontinence. – In this people loose control over their bladder and bowel movements. • Social isolation.
  54. 54. STEPS TAKEN BY GOVT. o National Policy for Older Persons: It was announced in 1999 by the. Ministry of Social Justice & Empowerment Objectives are: – To enable and support voluntary organizations and NGO ’s to supplement the care provided by family. – To provide care and protection to vulnerable groups.
  55. 55. – To provide health care facility to elderly and to promote research & training facilities to care givers. – To create awareness among elderly persons to develop themselves in to fully independent citizen.
  56. 56. o Revision of national policy on older persons: It was created in March 14, 2010. Age of senior citizen is different for different benefits , such as: – 60 years for concession in railways. – 60 years by banks for extra 0.5% interest to senior citizen. – 63 years for concession in air journey by Indian airlines. – 65 years for benefit to senior citizens under income tax.
  57. 57. CONCLUSION To overcome the geriatric problem and to ensure a good , healthy and quality life , the elderly members of society can move a long way with support of the family members.
  58. 58. SUMMARY Introduction of Geriatric Consideration in Nursing. Definition of Geriatrics. Theories of Aging. Changes associated with Aging. Common problems in old age. Important considerations in care of geriatric clients. Resources for care of older adults. Steps taken by government.
  59. 59. RESEARCH INPUT Nursing considerations in the geriatric surgical patient: the perioperative continuum of care. Author- Mamaril ME, et al. 2006. Although aging is a natural process, caring for an older person is not the same as caring for a middle - aged adult person. The peri-operative and peri-anesthesia nurses need to be competent in geriatric nursing care and posses specialized knowledge and skills related a myriad of geriatric issues. This article focuses on the special needs of elderly population and how the peri-operative nursing team may address their care best.
  60. 60. REFERENCES  Brar KN, Rawat CH, A Textbook of Advanced Nursing Practice, 1st Ed. , 2015, Published by Jaypee Brothers Medical Publishers (P) Ltd., Page -1058-71.  Kaur L, Kaur M, A Textbook of Nursing Foundation , 2nd Ed. , Published by S. Vikas & Company , Page- 69.  Townsend MC, A Textbook of Psychiatric Mental Health Nursing, 7th Ed. ,2012, Published by Jaypee Brothers, Page- 826-849.  https://www.ncbi.nlm.nih.gov/m/pubmed/16698344/
  61. 61. Thank you