3. GERONTOLOGY
Fromthe Greek word
Geron, “old man
The scientific study of
the process of aging
and the problems of
aged persons; includes
biologic, sociologic,
physiologic,
psychologic, and
economic aspects
4. “Gero” – old age;
“Ology” - study of
Older Age Group:
Young Old – ages 65-74
Middle Old – ages 75-84
Old Old – 85 and up.
5. TERMINOLOGIES
Gerontophobia – fear
of aging. Inability to
accept aging adults in
the society.
Age Discrimination –
emo-prejudice among
the older adult.
Ageism – dislike of the
aging and the older
adult.
6. Geriatrics– generic term relating to the
aged, but specifically refers to medical
care for the aged.
SocialGerontology – concerned mainly
with the social aspects of aging versus
the biological or psychological
Geropsychology – refers to the
specialists in psychiatry whose
knowledge, expertise and practice are
with the older population.
7. Geropharmaceutics – also called
Geropharmacology is a unique branch in
which pharmacists obtain special training
in geriatrics.
Financial Gerontology – combines
knowledge of financial planning and
services with a special expertise in the
needs of older adults.
8. Gerontological Rehabilitation Nursing –
combines expertise in Gerontologic nursing
with rehabilitation concepts and practice.
Gerontological Nursing – the aspect of
gerontology that falls within the discipline of
nursing and the scope of nursing practice.
9. ROLES OF THE GERONTOLOGIC
NURSE
Provider of care
Teacher
Manager
Advocate
Research Consumer
10. DEMOGRAPHICS OF OLD
PEOPLE
“Graying of America” -
a phenomenon faced
by all nations, not only
the U.S.
Demographic Tidal
Wave or A pig in a
Python – a bulge in the
population moving
slowly through times.
(1946-1964 : Baby
Boomer)
11. DEMOGRAPHICS OF OLD
PEOPLE
By year 2010, the number of persons 65
and older in the United States is at 39
million: 13% of the population. By 2010-
2030, it is expected that 65 year olds will
be more than 79 million.
Women comprise the majority of the
older population in all nations (55%), and
the majority of these women (58%) live in
developing countries.
12. Marital Status
An important determinant of health and
well- being, it influences income,
mobility, housing, intimacy, and social
interaction.
13. Gender
Women live longer than men due to
reduced maternal mortality, decreased
death rate from infectious diseases, and
increase death rate in men from chronic
diseases.
Women are likely to poor, alone, and
greater degree of functional impairment
and chronic diseases.
14. Living Arrangement and
Housing
A person’s overall degree of health and
well-being greatly influences the
selection of housing in old age. Ideal
housing promotes functional
independence while emphasizing safety
and social interaction needs.
16. Education
The educational level of older adult
clients affects the nurse-client health
teaching process and an important
consideration in health promotion
and disease prevention.
17. Income and Poverty
Major source of income is SSS, and
other supplemental income like
assets, public and private
pensions, earnings and public
assistance.
Income affects health and lifestyle –
people are unable to meet basic
needs and typically reduced the
amount of spending in health-related
matters.
18. Employment
Two-thirds of older, self-
employed workers were men.
The labor force participation
of older men has remained
fairly constant
20. Functional ability – the capacity to
carry out the basic self-care activities
that ensure overall health and well-
being.
ADLs: Bathing, Dressing, eating,
transferring and toileting;
InstrumantalADLs: shopping,
cooking, housekeeping, laundry and
handling money.
21. Nurseshould determine the plan of
action on impact of chronic diseases.
Improvement and Prevention are the
keys.
22. Implications to Health Care
Delivery
Create roles that meet the needs of the
older people, across the continuum of
care
Develop models of care directed at all
levels of prevention with emphasis on
primary prevention and health
promotion services in the Community-
Based Setting.
Assume leadership, in health care and in
political arena.
23. SETTINGS OF CARE
Acute Care Setting
Only few hospitals can adequately
manage acute conditions by
preventing functional decline:
IMPLICATION persons.: hospital setting
continues to be one of the most
dangerous for older
24.
25. The point of entry to the health care
systems for older adults.
Inthis setting, Gerontologic Nurses focus
on treatment and nursing care of acute
problems such as those occurring from
trauma, accidents, orthopaedic
injuries, respiratory ailments or serious
circulatory problems.
26. Long Term Care/Nursing Facilities
Include Assisted Living,
Intermediate care, subacute or
transitional care skilled care and
Alzheimer’s unit.
27.
28. Assisted Living / Home Care
Provides an alternative for those
older adults who do not feel safe
living alone, who wish to live in a
community setting or who need
some additional help with the
activities of daily living.
29. Intermediate Care
Level of care provides 24 hour per
day direct nursing contact and
may be considered to be the
entry level into the nursing home
care.
30. Subacute or Transitional Care
generally for patients who require
more intensive nursing care than the
traditional nursing home can
provide but less than the acute
care hospital.
31. Nurses Requirement
Understanding of the normal and
abnormal aging
Strong assessment skills to detect subtle
changes that may indicate impending,
serious problems
Excellent communication skills especially
with DDD patients.
Keen understanding of rehabilitation
principles
Sensitivity and patience.
32. LEADING CAUSE OF MORTALITY
Heart Diseases
Malignancies
Cerebrovascular disease
Chronic lower respiratory diseases
Influenza and Pneumonia
Diabetes Mellitus
33. LEADING CAUSE OF MORBIDITY
Arthritis
Hypertension
Heart Diseases
Hearing Impairments
Cataracts
Orthopedic impairments
Sinusitis
Diabetes
34. Theories of Aging
Biological
Stochastic and Non-stochastic
Sociological
Psychological
35. THEORIES OF AGING:
I.
STOCHASTIC THEORIES
Based on random events that cause
cellular damage that accumulates as the
organism ages.
II.
NON STOCHASTIC THEORIES OF AGING
Based on the genetically programmed
events that cause cellular damage that
accelerates aging of the organism.
36. I. STOCHASTIC THEORIES
Free Radical Theory
Membranes, Nucleic acids
and proteins are damaged by
free radicals which causes
cellular injury,
Exogenous Free radicals:
Tobacco smoke, Pepticides,
organic solvents, Radiation,
ozone and selected
Medications.
37.
38. Health Teaching
Decrease calories in order to lower
weight
Maintain a diet high in nutrients using
anti-oxidants
Avoid inflammation
Minimize accumulation of metals in
the body that can trigger free
radicals reactions.
Older adults are more vulnerable to
free radicals.
40. Wear and Tear Theory
Cells wears out and cannot function
with aging.
Like a machine which losses function
when its parts wears off.
41.
42.
43. Connective Tissue Theory /
Cross-linkage theory
With aging, proteins impede metabolic
processes and cause trouble with
getting nutrients to cells and removing
cellular waste products.
44. II. NON STOCHASTIC THEORIES
OF AGING
Programmed Theory/ Haylick
Limit Theory
Cells divide until they are no longer
able to and this triggers to apoptosis or
cell death.
Shortening of the TELOMERES – the
distal appendages of the
chromosomes arm.
TELOMERASE – an enzyme, “cellular
fountain of youth”
46. Neuroendocrine control or
pacemaker theory
Problems with the hypothalamus-
pituitary-endocrine gland feedback
system causes disease.
Increased insulin growth factor
accelerates aging.
49. SOCIOLOGICAL THEORIES
changing roles, relationship, status
and generational cohort impact
the older adult’s ability to adapt.
50. Activity theory
Havighurst and Albrecht
(1953)
Remaining occupied
and involved is
necessary to satisfy late
life.
Activity engagement
and positive adaptation.
51. Disengagement Theory
Cumming and Henry (1961)
Gradual withdrawal from society and
relationships serves to maintain social
equilibrium and promote internal
reflection.
52. Continuity Theory
Havighurst(1960)
also known as Development
Theory
Personality influences role and life
satisfaction and remains
consistent throughout life.
53. Age Stratification Theory
Riley (1960)
Society is stratified by age
groups that are the basis
for acquiring resources,
roles, status and
deference from others.
54. Lawton (1982)
Function is affected by ego strength, mobility,
health, cognition, sensory perception and the
environment.
Person-Environment Fit Theory
55. PSYCHOLOGICAL THEORIES OF AGING
Explain aging in terms of mental
processes, emotions, attitudes,
motivation, and personality
development that is characterized
by life stage transitions.
56. Human needs
Maslow’s (1954)
Five basic needs motivate human
behaviour in a lifelong process
toward need fulfilment.
Self – Actualization
57.
58. Individualism Theory
Jung (1960)
Personality consists
of an ego and
personal and
collective
unconsciousness
that views life from a
personal or external
perspective.
59. Stages of Personality
Development
Erikson(1963)
Personality develops in eight
sequential stages with corresponding
life tasks. The eighth phase, integrity
versus despair, is characterized by
evaluating life accomplishments;
struggles include letting
go, accepting
care, detachment, and physical and
mental decline.
62. GERONTOLOGIC ASSESSMENT
Learning Objective: Explain the relationship
between physical and psychosocial aspects of
aging as it affects the assessment process.
Special Considerations affecting assessment
Interrelationship between Physical and
Psychosocial aspects of aging.
Nature of Disease and disability and their effects
on functional status
Tailoring the nursing assessment to the older
person
The health history
Additional assessment measures
63. PRINCIPLES OF ASSESSMENT
Use of an individual, person-centered
approach
View of clients as participants in health
monitoring and treatment
An emphasis on clients’ functional
ability
Note: Nursing-Focused Assessment should be
scientifically based-knowledge and always practice to
acquire the art of assessment.
66. Variable Effect
Apathy
Confusion
Visual and Auditory Loss Disorientation
Dependency
Loss of Control
Confusion
Agitation
Multiple strange and Dependency
unfamiliar environments Loss of control
Sleep disturbance
Relocation Stress
Mobility impairment
Dependency
Loss of Control
Acute medical Illness
Sleep Disturbance
Pressure Ulcer
Inadequate food intake
Persistent confusion
Drug Toxicity
Potential for further mobility impairment
Loss of function
Altered pharmacokinetics Altered patterns of bowel and bladder elimination
and pharmacodynamics Loss of Appetite: affects healing, Bowel function,
energy level; dehydration
Sleep disturbance
67. Problem Classic Presentation Elderly patients
Urinary Tract Dysuria, frequency, Dysuria often absent,
Infections
urgency, nocturia frequency, urgency, nocturia
sometimes present.
Incontinence, delirium, falls,
and anorexia are other signs
Myocardial Severe substernal Sometimes no chest pain,or
Infections
chest pain, atypical pain location: jaw,
diaphoresis, nauseam neck, shoulder, epigastric
dyspnea area. Dyspnea, may or may
or may not be present.
Tachypnea, arrtyhmia,
hypotension, restlessness,
syncope, and
fatigue/weakness. Fall
Bacterial Productive cough and Cough: productive, dry or
Pneumonia
purulent sputum, chills absent; chills and fever and or
and fever, pleuritic chest ↑ WBC may be absent.
pain, ↑WBC Tachypnea, slight cyanosis,
delirium, anorexia, NV,
tachycardia.
68. CHF ↑ dyspnea,fatigue, ALL and/or anorexia, restlessness,
weight gain, pedal delirium cyanosis, and falls.Cough.
edema, nocturia,
bibasilar crackles
Hyperthyroidis Heat intolerance, fast slowing down (apathetic hypo), lethargy,
m pace, exophthalmos, weakness, depression, atrial defibrillation,
↑ pulse, hyperreflexia, and CHF
tremor
Hypothyroidism Weakness, fatigue, Often w/o over symptoms. Majority of
cold intolerance, Cases Subclinical. Delirium, dementia,
lethargy, skin dryness, depression/lethargy, constipation, weight
and scaling, loss, muscle weakness/unsteady gait are
constipation common.
Depression Dysphoric Mood and Classic symptoms may or may not be
thoughts, withdrawal, present.
crying, weight loss, Memory and concentration problems,
constipation, cognitive and behavioural changes,
insomnia increased dependency, anxiety and
sleep.
Be alert for CHF, CA, DM, infectious
diseases, and anemia. Cardiovascular
agents. Anxiolytics, amphetamines,
narcotics and hormones can also play a
role.
69. 2.2 NATURE OF DISEASE AND
DISABILITY AND THEIR EFFECTS
ON THE FUNCTIONAL STATUS
70. Aging does not necessarily result in
diseases and disability
Chronic diseases increases older
adults’ vulnerability to functional
decline
Common Mistake: Nurses and adults
attribute vague signs and symptoms as
normal signs of “growing old”.
71. A comprehensive assessment of
physical and psychosocial
function is important because it
can provide valuable clues to a
diseases’ effect on functional
status.
72. NursingAction: Identify NORMAL
VS. ABNORMAL: dependable
benchmarks of health are
previous laboratory findings
Watch out for vague signs and
symptoms: do not ignore and
look for non-specific signs.
73. 2.2.1 Decreased Efficiency of
homeostatic Mechanisms
The older persons’ adaptive reserves are
reduced- results in decreased ability to
respond to physical and emotional stress.
Immunocompetence is affected by
multiple factors.
74. Adults repeatedly encounters
losses: needs time to recover
between losses and recuperation.
The shorter time interval between
losses, the lesser ability to respond
and return to baseline stage of
health compared to younger
people.
75. Nursing Action
Assess older adults for presence of
physical and psychological
stressors and their physical and
emotional manifestations.
76. Lack of Standards of Health
and illness
Difficultyarises on identifying the health
status of older adults due to:
Norms or standards are always redefined
Polypharmacy and state of illness and
disease may affect laboratory data.
No aging norms for many pathologic
conditions
There are few landmarks for stages of
development for the older adulthood
compared to other age groups.
77. Nursing Action:
Assume heterogeneity rather
homogeneity: uniqueness of personal
health standards.
Look for previous health history and
related matters: previous
work, residence, lifestyle etc.
Compare presenting signs and
symptoms with the older adults’ normal
baseline.
79. Confusion, mental status changes,
cognitive changes and delirium –
used to describe one of the most
common manifestations of illness in old
age.
80. Acute Confusional State (ACS)-
an organic brain syndrome
characterized by transient, global
cognitive impairment of abrupt onset
and relatively brief duration,
accompanied by diurnal fluctuation of
simultaneous disturbances of the sleep-
wake cycle, psychomotor behavior,
attention, and affect”( Foreman, 1986)
81. Dementia – a global, sustained
deterioration of cognitive function in
an alert client.
Other manifestations: memory
impairment, aphasia, apraxia,
agnosia, or disturbance in executive
functioning; planning, organizing,
sequencing and abstracting.
82. Primary dementia
Senile dementia of Alzheimer’s
type, Lewy body disease, Pick’s
Disease, Creutzfeldt-Jakob
Disease and multi-infarct
dementia
83. Secondary Dementia
Normal pressure Hydrocephalus,
intracranial masses or lesions,
pseudodementia, and Parkinson’s
dementia.
84. Differentiating Dementia and
ACS
FEATURE ACS DEMENTIA
Acute/subacute; depends Chronic, generally insidious;
on cause; often occurs at depends on cause
ONSET twilight
Short, diurnal fluctuations, Long, no diurnal effects,
worse at night, dark and symptoms progressive, stable
COURSE awakening
Hours to less than 1 month Months to years
DURATION
Fluctuates, generally Generally Clear
AWARENESS reduced
85. Fluctuates, reduced or Generally normal
ALERTNESS increased
Impaired, often fluctuates Generally normal
ATTENTION
Fluctuates, in severity, May be impaired
ORIENTATION impaired
Recent and immediate Recent and remote
memory impaired; unable to memory impaired; loss of
register new information or recent memory is 1 st sign;
MEMORY recall recent events some loss of common
knowledge
Disorganized, distorted, Difficulty with abstract and
THINKING fragment, slow, or word finding
accelerated
Distorted, illusions, delusions, Misperceptions often
PERCEPTION or hallucinations absent
Disturbed, cycle reversed Fragmented
SLEEP-WAKE
CYCLE
86. TAILORING THE NURSING
ASSESSMENT TO THE OLDER
PERSONS
Environmental suggestions during assessment of
the older adults
Provide adequate space, especially if client uses
mobility aids
Minimize noise and distractions
Set a comfortable, warm temperature with no
drafts.
Use diffuse lighting.
Avoid glossy or highly polished surfaces.
87. Place client in a comfortable
position
Maintain proximity to the bathroom
Keep water and other preferred
fluids available
Provide a place to hang or store
garments and belongings
Maintain absolute privacy
88. Plan the assessment: consider client
status
Be patient, relaxed and unhurried.
Allow client plenty of time to respond
to questions and directions. Maximize
use of silence.
Be alert to signs of increasing fatigue.
Conduct assessment during client’s
peak energy time.
89. THE HEALTH HISTORY
The first phase of a
comprehensive, nursing-focused health
assessment, provides a subjective
account of the older adults’ current and
past health.
The nursing history should include
assessment of
functional, cognitive, affective, and
social well-being.
The interviewer should adapt the styles
and techniques of interview in the
90. THE INTERVIEWER
Factors to consider during nurse-client
communication during assessment
Attitudeof nurse
Myths and Stereotypes about older
people
Nurse’s own anxiety and fear of
personal aging
91. Guide to an effective interview
State reason for the interview
Let client accomplish a pre
interview form
A goal-directed interview
process
Setting of time limit
92. Secure permission to take down
notes
Observe most effective and
comfortable distance and
position, and personal space for
the session
Appropriate use of touch
Take advantage of
opportunities such as meal time,
game, hobby, and other social
activity.
93. THE CLIENT
There are factors the nurse should consider
while interviewing an older adult such as:
Sensory-perceptual deficits
Anxiety
Reduced energy level
Pain
Multiple and interrelated health problems
The tendency to reminisce
94. THE HEALTH HISTORY FORMAT
Client Profile/ Biographic data
Family Profile
Occupational Profile
Living Environment profile
Recreation/Leisure Profile
Resources/Support systems used
95. THE HEALTH HISTORY FORMAT
Description of typical day
Present health status
Medications
Immunization and health Screening Status
Allergies
Nutrition
Past Health Status
Family History
Review of Systems
96. SYMPTOM ANALYSIS FACTORS
Dimensions of a Symptom
Location
Quality
Quantity
Timing
Setting
Aggravating or Alleviating factors
Associated symptoms
97. THE PHYSICAL EXAMINATION
APPROACH AND SEQUENCE
Should be systematic and deliberate
Determine client strengths and
capabilities; disabilities and limitations
Verify and gain objective support
Gather objective data not previously
known
98. GENERAL GUIDELINES
Recognition of no previous experience
with the nurse conducting physical
examination by the adult
Be alert on the clients energy level
Respect the client’s modesty
Keep the client comfortably draped
Sequence examination to keep position
changes to a minimum
99. Develop an efficient sequence for
examination that minimizes nurse and
client movement
Ensure comfort for the client
Warn of any discomfort that may occur. Be
gentle
Probe painful areas last
Share findings with the client when possible
Take advantage of teachable moments
Develop a standard format on which to
note selected findings.
100. EQUIPMENT AND SKILLS
Check proper function and
readiness of all equipment
Place equipment within reach
Use of Inspection, Auscultation,
Palpation, and Percussion.
101. ADDITIONAL ASSESSMENT
MEASURES
Functional Status Assessment – refers to
the measurement of the older adults’
ability to perform basic self-care tasks, or
ADLs, and task that require more
complex activities for independent living
referred to as IADLs.
102. KATZ Index of ADLs –
Determines results of treatments
and the prognosis in older and
chronically ill people.
103.
104. Barthel Index – tool for measuring
functional status, rates self-care
abilities in the areas of
feeding, moving
toileting, bathing, walking, propelling
a wheelchair, using stairs, dressing
and bowel and bladder control
105. Lawtonand Brody’s IADLs – a range
of activities more complex than
KATZ and Barthel. Usage of
telephone, shopping, preparing
food, housekeeping, laundry, meds,
transporting and finances.
108. Short Portable Mental Status
Questionnaire (SPMSQ) –
used to detect the presence and
degree of intellectual impairment to
assess orientation, memory in relation to
self-care ability, remote memory and
mathability.
109.
110. MiniMental State Examination – tests
the cognitive aspects of mental
function: orientation, registration,
attention, and calculation, recall and
language
111.
112. Mini-Cog - an instrument that
combines a simple test of memory
with a clock drawing test.
Geriatric
Depression Scale - a score
of five (5) or more may indicate
depression
113. Social Assessment –
(1) Social function is correlated with
physical and mental function, (2) an
individual’s social well-being can
positively affect his or her ability to
cope with the physical impairments
and ability to remain independent, and
(3) a satisfactory level of social function
is a significant outcome in and of itself.
114. Family APGAR – Stands for:
Adaptation, Partnership, Growth,
Affection and Resolve.
Older Adult Resources and Services
(OARS) Multidimensional Functional
Assessment Questionnaire - a social
resource scale, one of the better-
known measures of general social
function for older adults