1. geriatic nsg nursing care and older clients f - copy

Stages of growth and
development
 New born
 Infant
 Toddler
 Pre-schooler
 Schooler
 Adult
 Young adult
 Middle age
 Old adult (Elderly)
2

INTRODUCTION
 “GERONTOLOGY”
(= geron- old man ; logy – study)
 This term was coined by Mechnikov in 1903
“It is the specialized branch of medical science dealing with the
comprehensive study of the elderly adult”.
 “GERONTOLOGIC NURSING” - is the care of elderly
adults.
 Care of elderly needs skilled assessment and creative
adaptations of nursing interventions.
4

 Geriatrics is a term of Greek origin
from the word "geras" meaning "old
age" and “iatros” meaning " healer"
or "physician", and it means a branch
of medicine that deals with the
problems and diseases of old age and
aging people. (Webster, 1985).
5

 Gerontology--study of all aspects of
individual aging and its consequences
 Geriatrics--subdivision of medicine
that is concerned with old age and its
diseases
6

Landmarks
 1950 – First geriatric textbook published
 1952 – First geriatric nursing study published
 1961 – ANA recommends specialty group for
geriatric nurses
 1966 – Duke opens first Master‟s program
 1970 – ANA Standards of Practice
 1973 – First certification exam
 1975 – Journal of Gero Nursing by Slack, Inc.
 1979 – First national gero nursing conference

Landmarks Cont‟d.
 1981 – ANA scope of practice
 1988 – First PhD program
 1996 – John A. Harford Foundation Institute
of Geriatric Nursing established
 1998 – ANA certification available for
Advanced Practitioner Nurse

Demographic Profile of Older
Adult Population
 Clinical definition is 65 years of
age or older.
 Older-old adults are 85 or older.
 Rapidly growing.
9

11
Human life expectancy.
YEAR Life Expectancy
2000 BC 18
500 AD 22
1400 > 33
1790 36
1850 41
1900 50
1946 67
1991 76

AGED POPULATION
Over 60 yrs % Over 65 yrs %
1870 1,937 5 1,154 2.9
1880 2,822 5.6 1,723 3.4
1890 3,887 6.2 2,417 3.8
1900 4,860 6.4 3,080 4
1910 6,225 6.8 3,950 4.3
1920 7,925 7.5 4,933 4.6
1930 10,358 8.4 6,633 5.4
1940 13,694 10.4 9,019 6.8
1950 18,328 12.1 12,270 8.1
1960 23,772 13.1 16,679 9.2
1970 28,682 14.1 20,177 9.9
12

“One in Seven Canadians
soon to be One in Four”
15

0
5
10
15
20
25
1970 1990 2025
Time period & Region
%ofTotalPop.
Asia
Africa
Europe
World
Canada
Proportion of Population
Worldwide Over 65 Years of Age
16

Demographic Imperative
 Persons >65 = Fasting growing age group
 By 2030, geriatric patients will:
 Comprise 22% of population

20
Common Problems of elderly people:
1. Cataract: vision loss
2. Uterine prolapsed
3. Hearing loss
4. COPD/Asthma
5. UTI/urinary retention
6. Loose tooth: problem of chewing
7. Cancer: lung, breast, colorectal, prostate etc
8. Osteoporosis
9. Arthritis
10. Nutritional problems
11. Sleep disturbance
12. Multiple drug use
13. Dementia and multiple drug use
14. Economic insecurity
15. Others:

Active Ageing
Health
When the risk factors for chronic diseases and
functional decline are kept low while the protective
factors are kept high, people will enjoy both a longer
quantity and quality of life
Participation
When labor market, employment, education, health
and social policies and programs support their full
participation in socio-economic, cultural and spiritual
activities, people will continue to make a productive
contribution to society
Security
When policies and program address the social,
financial and physical security needs and rights of
people as they age, elderly are ensured of protection,
dignity and care in the event that they are no longer
able to support and protect themselves
22

…Fears of the Patient
Fear of Isolation
Fear of Pain
Fear of Dependence
Fear of Death Itself
23

Purposes of geriatric nursing
 To provide opportunity for continuous
development throughout the lifespan.
 To support for maximum levels of
independence.
 To enhance the quality of life for aged persons
through the promotion of health.
 To make their lifestyle less restrictive.
 To provide for peaceful death
24

Scope of Geriatric Nursing:
 As evident, the aged population continues
to rise and is the population group who
require and use the greatest amount of
health services.
 Geriatric nursing within institutions
provides acute, sub-acute and long term
care.
25

Scope:
 Acute Care Setting: Fifty percentage of the
elderly age 75 and over account for 21% of
all inpatient days.
 Geriatric Nurse Practitioner: A geriatric
nurse practitioner can manage 80- 90% of
the health problems that occur among
hospitalized clients.
26

 Gerontologic Clinical Nurse Specialist:
GCNS is prepared at the master‟s level and
is specialist prepared as a : educator,
advocate, counselor, researcher and
consultant.
 In-Service Educator/ Staff Developer: This
filled by a nurse with master‟s degree in
education and a sound base in
teaching/learning strategies
27

 Counsellor and Health Educator
 Case Management Nurse: holistic care in
community
 Home Care Case Management Nurse: Highly
expert nurse are needed to assist in the
management of specific problems e.g. dialysis
etc.
 Certified Rehabilitation Nurses:
 Telephone Advice Nurse
28

 Administratror
 Director of Nursing Services In Nursing
Homes
 Court Investigation Nurse
29

Cont….
A. Biologic theories:
 Celluler theory
 Programmed aging theory
 Somatic mutation theory
 Wear and tear theory
 Error theory
 Auto immune theory
 Free-radical theory
 Crosslinkage theory
32

Cont…
B. Psychological theories:
Disengagement theory
Activity theory
Continuity theory
Social exchange theory
33

Cont….
C. Environmental theories:
 Radiation theory
 Stress theory
 Pollution theory
 Exposure theory
D.Nursing theory
E. Developmental theories
34

1.CELLULAR THEORY
 Cells has been subject of much
scientific inquiry in exploring aging
phenomena.
 Cell has three distinct components:
Cells that can reproduce.
Cells that can not reproduce.
Intercellular substance/materials.
36

Cont…
Cells that can reproduce:
 Reproduction of cells occur.
 Some new cells become nonfunctioning or less
effective than the others that are
replaced(Busse,1971).
 Three systems in human body are continuously
replaced(skin, lining of the intestine, circulatory
system). 37

Cont….
 With the progress in the aging process there
is accumulation of these inefficient and non-
functioning cells.
 Organism functional ability become
apparent.
 Visible changes occur in the aging process.
38

Cont…
Cells that cannot reproduce:
 Eg:CNS, Kidney
 With age cells progressively wear and tear out and
or destroyed.
 Develop an accumulation of non-functioning cells .
 Systems became less efficient and difficult to
handle.
39

Cont….
Intercellular substance/materials:
 Gradual deterioration of intracellular material with aging
(Busse, 1971).
 Reduce ability of the cells to provide necessary nutrients
and oxygen for respective tissue.
 Directly interfere the functioning abilities of each system.
40

2.PROGRAMMED AGING THEORY:
Aging and death, according to this
theory, are not a result of wear and tear
or exposure, but are a programmed,
natural and necessary part of genetics.
In short, we are programmed to age
and die.
41

3. ERROR theory:
 Mistranscription and mintranslation
of certain genes products.
 Results in self amplifying error
poroducing derrangements(Strchler ,
1977)
 Initial error will , most likely result in
further errors of similar types.
42

Cont…
 The productions of faulty products of
other genes which accumulate with aging.
Eg. Enzyme with decrease catalytic
activity in the later life.
43

3.SOMATIC MUTATION THEORY
 Similar to error theory.
Cells exposed to x-ray radiation or chemicals
Cell by cell alteration in DNA occurs
Increase the incidence of chromosomal abnormalities
Occurs more at youth and its deleterious effect are seen in
later life
44

4.WEAR ANDTEAR THEORY:
 Postulates that an organisms” wears out” with use.
 Damage begins at the level of molecules in our
cells.
 DNA that make up our genes sustains repeated
damage from toxins.
45

Cont…
 Bodies have the capacity to repair the damage
but not all are accurately corrected.
 Damage cells progressively accumulates
46

5.AUTO IMMUNE THEORY
Postulates that with age, the immune
system produces auto-anti-bodies that
causes cell death or cell changes that
fosters the aging process
(WALFORD,1969)
47

6.Free radical theory:
Free radical is a molecule with an
unpaired ,highly reactive electron.
One type of free radical generated in our
body is oxygen free radical.
48

Cont….
 This free radical grabs the molecule from
any other molecule and damage the other
molecule
 Molecules that are damaged by free
radicals are : Fat , proteins and
DNA.(both of nucleus and mitochondria)
49

Cont….
 Under normal condition natural defense
mechanism prevent most of the oxidative
damage.
 This theory purpose that little by little
small damage accumulate and contribute
to detoriation of tissues and organs.
50

7.CROSS LINKAGE THEORY:
 Also called as collagen theory.
With age, our proteins, DNA and other
structured molecules develop inappropriate
cross links to one another
This unnecessary links decreases the
elasticity of proteins and other molecules.
51

Cont…..
Protein that are damaged are no longer needed and are
broken down by protease enzyme.
Presence of cross linkage inhibits the activity of protease.
Damaged and unneeded proteins ,stick around and can
cause problem
Eg:wrinkling of skin at aging, age related cataract formation.
52

1.DISENGAGEMENT THEORY:
One of the
earliest theories.
Developed by
Elaine Cumming
and William
Henry (Cumming
and Henry 1961)
54

Cont…
This theory viewed aging as a process
through which society and the individual
gradually withdraw or disengage from
each other.
Fail to explain the phenomenon :
Many older person desire to remain
engaged and don’t want their place to
be taken away by those younger than
themselves.
55

“Nobody grows old
merely by living a
number of years. We
grow old by deserting
our ideals. Years may
wrinkle the skin, but to
give up enthusiasm 56

2.ACTIVITY THEORY:
Proposed by
HAVIGHRUST(196
3).
Suggest that aged
people should
continue an active
middle-aged
lifestyle and should
remain as active
as possible.
57

Cont…..
 It suggests that obstacles are to be resisted and that
problems involving declining health, loss of roles and
responsibilities , reduction in income and diminishing
circle of friends are to be overcome.
 It suggests many ways for older people to maintain an
active life.
58

Cont…..
 For most elderly people when physical
activity is much reduced, intellectual
activities should be emphasized.
 When old friends and relatives are dying or
otherwise lost, the establishment of new
friendship would be encouraged.
59

3. Continuity theory:
 Negatron , 1964
 In spite of aging process , personality and
basic patterns of behavior are considered to
be constant in the individual.
60

Cont…..
 Patterns and activity levels develop over a
life time will largely determine whether an
individual remain engaged and active or
disengaged and inactive as they age.
 This theory encourages young people to
consider their current activities as a
foundation for their own future aging
process.
61

4. Social Exchange theory:
Postulates that
social interaction
between
individuals and
groups continues
as long as
everyone profits
from the
interaction.
62

Cont….
When there is no longer profit from the
social exchange, imbalance occurs in the
interaction and one individual is perceived
as having more power than the other.
The decrease in the social interaction of
the aged is the result of exchange
relationship that gradually erode the
power of the aged.
63

Cont…..
The elements in the environment have
been considered by the researchers to
have an effect on aging phenomena.
Biologist have considered the effects of the
environment on the cellular structure of
the human organism.
65

Cont….
Radiation Theory:
Excessive exposure to the suns radiation
puts the skin at risk during the somatic
mutation process.
66

Cont…..
Stress theory:
According to Perlman (1954), „Human aging
is a „disease syndrome‟ arising from a
struggle between environmental stress and
biological resistance and relative adaptation
to the effects of stressor agents. these
stressor agents might include air, pollutants,
chemical , and psychological and sociological
events.‟
67

D. Nursing Theory of aging
Miller (2004) has developed the functional
consequences theory.
Older adults experiences functional consequences
because of age related changes and additional risk
factors.
68

Cont…
Without interventions, many functional
consequences are negative; with them, however,
functional consequences can be positive.
The role of gerent logic nurse is to identify the
factors that causes negative functional
consequences and to initiate interventions that will
result in positive ones.
69

Cont….
Normal age related changes and factors may
negatively interfere with patient outcomes
and actually interfere with patients activity
and quality of life.
The nurse must differentiate between normal
age related changes that can be reversed
and risk factors that can be modified.
70

E. Developmental theories
Erikson (1963) theorized that persons life
consists of eight stages.
Each stages represent a crucial turning point
in life stretching from birth to death, with its
own developmental conflicts to be resolved.
According to him, the major developmental
task of old age is either to achieve ego
integrity or to suffer despair.
71

Cont….
Combination of theory of Havighrust and Erikson
gives the following developmental tasks for older
adults:
 Maintenance of self-worth
 Conflict resolution
 Adjustment to the loss of dominant roles.
 Adjustments to the deaths significant others
 Environmental adaption
 Maintenance of optimum levels of wellness
.
72

Importance to Nurses:
 Each theory
provides framework
and insight into the
differences among
elderly patients.
 Nurses play a
significant role in
helping aging
person experience
health fulfillment and
sense of well being
73

Cont…
Nurses attitude towards aging can have an
enormous impact on patients.
It makes the nurse aware whether the
changes are related to aging or disease
condition.
It helps to differentiate normal aging from the
abnormal one.
74

Cont…
 It helps to provide specific care keeping in mind about the
various changes in their biological and psychological aspect.
 It can be tested, changed or used to guide research or to
provide base for evaluation.
 It guides the nurses in helping the old people adapt to various
changes.
 It helps the older people in rebalancing the relationship.
75

Forty is the old age of youth;
fifty the youth of old age….
76

It's sad to grow old, but nice
to ripen……
77

Major Theories of Aging:
Biological
 Somatic Mutation Theory (Changes associated with aging
are the result of decreased function and efficiency of cells
and organs)
 Programmed Aging Theory (Genetic clock determines
speed of aging)
 Cross-linkage, or Collagen, Theory (Loss of flexibility
results in diminished functional motility)
 Immunity Theory (Diminishing of thymus results in impaired
immunologic function)
 Stress Theory (Stress causes structural and chemical
changes that eventually result in irreversible tissue damage).
78

Major Theories of Aging:
Psychosocial
 Activity Theory (Life satisfaction depends on
maintaining an involvement with life by developing
new interests, hobbies, roles, and relationships).
 Disengagement Theory (Decreased interaction
between older person and others in the social
system is inevitable, mutual, and acceptable to both
the individual and society).
 Continuity Theory (Successful methods used
throughout life for adapting and adjusting to life
events are repeated.
Traits, habits, values, associations, and goals
remain stable, regardless of life changes). 79

Activity theory illustrated
80

Structural Damage Theories
Structural damage theories of aging are based on the
view that the molecular components of cells, over
time, begin to malfunction and break down:
1. Wear and Tear Theory:
2. Waste Accumulation Theory:
3. Faulty Reconstruction Theory:
4. Immuno-suppression Theory:
5. Errors and Repair Theory:
6. Molecular Cross-linkage Theory:
7. Mitochondrial Damage Theory:
81

Modern Theories of Aging
“Aging is a disease. The human lifespan
simply reflects the level of free radical
damage that accumulates in cells. When
enough damage accumulates, cells can‟t
survive properly anymore and they just
simply give up.”
— Earl Stadtman
National Institutes of Health
82

Myths about Aging
 Senility is a result of aging.
 Incontinence is a result of aging.
 Older adults are no longer interested in
sexuality.
 Most people spend their last years in
nursing homes.
 All elderly persons are financially
impoverished.
83

Realities of Aging
 Dementia is disease-related, not age-
related.
 Incontinence is not present among all
aged.
 Sexuality is a lifelong need.
 10% to 40% of elderly in the U.S. may
spend some time in extended care
facilities.
84

Normal Aging
 Despite stereotype most of the elderly
age well!
85

Physiologic Changes Associated
with Aging: Overview
 Respiratory System
 Cardiovascular
System
 Gastrointestinal
System
 Reproductive
System: Female
 Reproductive
System: Male
 Endocrine System
 Musculoskeletal
System
 Integumentary
System
 Nervous System
 Urinary System
 Sensory Changes
86

Physiological Changes
Process in Elderly
87

Respiratory System: Changes
 Muscles of respiration
become less flexible.
 Decrease in functional
capacity results in
dyspnea on exertion or
stress.
 Effectiveness of cough
mechanism lessens,
increasing risk of lung
infection.
 Alveoli thicken and
decrease in
number and size.
 Structural changes
in the skeleton can
decrease
diaphragmatic
expansion.
88

Respiratory
 Increased energy of
breathing
 Increased airways
resistance
 Increased in dead-space
89

Cardiovascular System:
Changes
 Cardiac output and
recovery time decline.
The heart requires more
time to return to normal
rate after a rate increase
in response to activity.
 Heart rate slows.
 Blood flow to all organs
decreases.
 Arterial elasticity
decreases,
causing increased
rise in blood
pressure.
 Veins dilate and
superficial vessels
become more
prominent.
90

Cardiovascular System: Changes…….
 The aorta and other arteries becomes thicker and
stiffer which may bring a moderate increase in
systolic blood pressure with aging.
 The valves between the chambers of the heart
thicken and become stiffer.
 The blood flow to the kidneys may decrease by 50
percent and to the brain by 15 to 20 percent.
 The pacemaker of the heart loses cells and
develops fibrous tissue and fat deposits.
91

Cardiovascular System: Changes…….
 The baroreceptors,
which monitor the blood
pressure and adjust our
blood pressure when we
change position become
less sensitive with aging.
 This can cause
orthostatic hypotension
92

Gastrointestinal System:
Changes
 Tooth enamel thins.
 Periodontal disease
rate increases.
 Taste buds decrease
in number, and saliva
production diminishes.
 Effectiveness of the
gag reflex lessens,
resulting in increased
risk of choking.
 Arterial elasticity
decreases, causing
increased rise in
blood pressure.
 Veins dilate and
superficial vessels
become more
prominent.
93

The Digestive System
• Stomach
motility
pH
• Sm. Intestine
absorption
• Large Intestine
motility
• Liver
•blood flow
94

 Liver:
 Reduced blood flow
 Altered clearance of
some drugs
 Decreased weight of
liver
 Reduced
regenerative
capacity of liver
 Liver metabolizes
less efficiently
95

 Intestines:
 As we age the small
intestines absorb less
calcium and vitamin D.
 Therefore, we need
more calcium to
prevent bone mineral
loss and osteoporosis
in later life.
96

 Some enzymes, such as lactase which
aids the digestion of lactose (a sugar
found in diary products) decline with age.
 Reduced peristalsis of the colon can
increase risk for constipation
97

 The ability to recognize sweet, sour, bitter,
or salty foods diminishes over time, altering
satisfaction with food.
 There is decreased salivation, so there is
difficulty in swallowing food.
 Reduced gastrointestinal motility results in
delayed emptying of stomach contents and
early satisfaction( feeling of fullness).
98

Reproductive System:
Female: Changes
 Estrogen production
decreases with onset of
menopause.
 Ovaries, uterus, and
cervix decrease in size.
 Vagina shortens,
narrows, becomes less
elastic; vaginal lining
thins.
 Supporting musculature
of the reproductive
organs
weakens, increasing risk
of uterine prolapse.
 Breast tissue diminishes.
 Libido and the need for
intimacy and
companionship in older
women remains
unchanged.
99

Reproductive System: Male:
Changes
 Testosterone production
decreases, resulting in
decreased size of testicles.
 Impotency may occur.
 Although more time is require
to obtain erection, the older
man often finds that he and
his partner can enjoy longer
periods of lovemaking prior to
ejaculation.
 Prostate gland may
enlarge.
 Libido and need for
intimacy and
companionship remain
unchanged in older
males.
 Sperm count and
viscosity of seminal fluid
decrease.
100

Reproductive system
COMPONENT CHANGES CLINICAL FINDINGS
1. Male
a. Penis
b. Testes
c. Prostate
d. Breasts
•Decreased subcutaneous fat.
•Decreased testosterone production
•Enlargement
•Increased subcutaneous fat
•Reduced size, easily
retractable foreskin.
•Urinary symptoms
•Gynecomastia
2. Female
a. Breasts
b. Vagina
c. Uterus
d. Ovaries
•Decreased subcutaneous fat
•Atrophy of tissue
•Decreased thickness of
myometrium
•Reduced function
•Decrease in size, more
pendulous
•Dry mucosa, narrower and
shorter vagina
•Decrease in size, uterine
prolapsed.
•Menopause
101

Endocrine System: Changes
 Alterations occur in both the reception and
the production of hormones.
 Release of insulin by the beta cells of the
pancreas slows, causing an increase in
blood sugar.
 Thyroid changes may lower the basal
metabolic rate.
102

Musculoskeletal System:
Changes
 Muscle mass and elasticity diminish, resulting
in decreased strength, coordination, and
increased reaction time.
 Bone demineralization occurs,
causing skeletal instability and
shrinking of intervertebral disks.
 Joints undergo degenerative changes,
resulting in stiffness, pain, and loss of range of
motion.
103

Musculoskeletal system
 By the time we
reach age 80,
most of us will
lose an average
of about 2 inches
of height.
104

 The primary factors
contributing to this
reduction in height
include
 compression of
vertebrae
 changes in posture,
 and increased
curvature of the hips
and knees.
105

 Weight increases until about age 60 and
then declines
 This pattern of weight change is more
likely the result of reductions in activity
and changes in eating rather than aging
itself.
 Bone mineral content diminished
106

 As we age, our muscles generally decrease
in strength, endurance, size and weight.
 Typically, we lose about 23 percent of our
muscle mass by age 80 as both the
number and size of muscle fibers decrease.
 Body fat mass can double, lean muscle
mass is lost
107

Integumentary System:
Changes (i)
 Subcutaneous tissue and elastin fibers
diminish, causing skin to become thinner and
less elastic.
 Hyperpigmentation or liver spots.
 Diminished secretions and moisturization.
 Body temperature regulation diminishes.
 Capillary blood flow decreases, resulting in
slower wound healing.
 Blood flow decreases, especially to lower
extremities. 108

Integumentary System:
Changes (ii)
 Vascular fragility causes senile purpura.
 Cutaneous sensitivity to pressure and
temperature diminishes.
 Melanin production decreases, causing gray-
white hair.
 Scalp, pubic, and axillary hair thin, and
women display increased facial hair.
 Nail growth slows, nails become more brittle,
and longitudinal nail ridges form.
109

Integumentary system
 One of the most
common physical
changes that
people associate
with aging is
 wrinkling
 Pigment alteration
 Thinning of the
skin.
110

 The most common changes in the skin
include:
 Thinning of the area between the
dermis and epidermis by about 20%
 Elastin and collagen decrease
 Reduction in size of cells
 Inability of skin to retain moisture
111

 The skin becomes less able to retain
fluids and is more easily dry and cracked.
 As a result, both the thickness and
elasticity of skin decrease.
 Therefore, sunscreens and moisturizing
creams play an important part in
protecting aging skin.
112

 In addition to changes in
the skin itself, the
subcutaneous layers of
fatty deposits decreases
with age.
 This gives some very
old people an emaciated
appearance.
113

Hair
 Hair becomes gray.
 Hair grays because of a
gradual decrease in the
production of melanin,
the pigment cells in the
hair bulbs.
 The graying of hair is
also influenced by
heredity and hormones.
115

 There are also fewer hair follicles on the
scalp and the growth rate of hair decreases
in the scalp, armpits, and pubic areas.
 However, hair growth actually accelerates
and thickens in places like nostrils, ear and
eyebrows, especially in men.
 Older women often have an increase in
facial hair as their estrogen levels decrease.
116

 Alopecia/
baldness: hair loss
is the norm
117

Genitourinary system
 After 40 renal function
decreases
 By 90 lose 50% of function
 Filtration and reabsorption
reduced
 Size and number of
nephrons decrease
119

 Bladder muscles weaken
 Kidney mass decreases by 25-30 percent
and the number of glomeruli decrease by
30 to 40 percent.
 These changes reduce the ability to filter
and concentrate urine and to clear drugs.
120

 With aging, there is a reduced hormonal
response (vasopressin) and an impaired
ability to conserve salt which may increase
risk for dehydration.
 Bladder capacity decreases and there is an
increase in residual urine and frequency.
 These changes increase the chances of
urinary infections, incontinence, and urinary
obstruction.
121

 In males, Benign
Prostatic Hyperplasia
(BPH) is more
common.
 In females, perineal
muscles relax, there
is urge incontinence
and stress urinary
incontinence.
122

Nervous system
 Neurons of central and
peripheral nervous
system degenerate
 Loss of brain mass
 Synthesis and
metabolism of the
major
neurotransmitters
reduced
123

 Nerve transmission slows so, older people
take longer to respond and react.
 Hypothalamus less effective in regulating
body temperature
 Reduced REM sleep, decreased deep
sleep
 After 50yrs lose 1% of neurons each year
 Waste products collect in brain, causing
plaques and tangles
124

Nervous System: Changes
 Neurons in the brain
decrease in number.
 Cerebral blood flow and
oxygen utilization
decrease.
 Time required to carry
out motor and sensory
tasks requiring
speed, coordination, bala
nce, and fine-motor hand
movements increases.
 Short-term memory may
somewhat diminish
without much change in
long-term memory.
 Night sleep disturbances
occur due to more
frequent and longer
wakeful periods.
 Deep-tendon reflexes
decrease, although
reflexes at the knees
remain fairly intact.
125

Dementia
 An organic brain pathology
characterized by losses in intellectual
functioning.
 The clinical manifestations associated
with dementia are never considered
normal aging changes.
126

Urinary System: Changes
 Nephrons in the kidneys
decrease in number and
function.
 Glomerular filtration
decreases.
 Blood urea nitrogen
increases.
 Sodium-conserving ability
diminishes.
 Bladder capacity decreases.
 Renal function increases
when the older client lies
down.
 Bladder and perineal
muscles weaken.
 Incidence of stress
incontinence increases in
older females.
 Prostate may enlarge in
older males, causing
urinary frequency and
dribbling.
127

Sensory Changes: Vision
 The lens becomes less
pliable and less able to
increase its curvature in
order to focus on near
objects.
 Accommodation of pupil
size decreases, resulting
in both decreased
adjustment to changes in
lighting and decreased
ability to tolerate glare.
 Vitreous humor
changes in
consistency, causing
blurred vision.
 Lacrimal glands
secrete less fluids,
causing dryness and
itching.
 Lens yellows,
causing distorted
color perception.
128

Sensory system
Vision:
 Visual impairment is
the most common
sensory problem of
older people.
 Not all older people
have impaired vision
 Loss of ability to see
items that are close
up begins in the 40‟s
129

 Size of pupil grows smaller
with age: focusing becomes
less accurate
 Lens of eye yellows making it
more difficult to see red and
green colors
 Sensitivity to glare increases
 Night and depth vision less
 Eyelids baggy and wrinkled
 Eyes deeper in sockets
 Conjunctiva thinner and
yellow
130

 Lens enlarges
 Lens becomes less
transparent
 Can actually
become clouded
 Results in cataracts.
131

 Quantity of tears
decreases
 About 95% of
individuals age 65
and older report
wearing glassing or
needing glasses to
improve their
vision.
132

Sensory
 Vision
 The lens tends to opacify,
which influences color
perception.
 There is a decrease in light
and dark adaptation.
 The lens tends to lose
elasticity, which increases the
distance of focusing.
 There is a decline in contrast
sensitivity and an increase in
sensitivity to glare.
133

Hearing
 Hearing loss is very
common with aging.
 Auditory changes
begin to noticed at
about 40 years of
age.
 30% people > 65
have significant
hearing impairment
134

 Membranes in the middle ear, including the
eardrum, become less flexible with age.
 In addition, the small bones in the middle
ear, the ossicles, become stiffer.
 Both these factors somewhat decrease
hearing sensitivity but are not thought to
cause significant impairment.
 Men more affected than women
135

 The vestibular apparatus begins to
degenerate with age in a similar way to
the hearing apparatus.
 Equilibrium becomes compromised and
older individuals may complain of
dizziness and lose their balance.
136

Sensory Changes: Hearing
 The pinna becomes less flexible, hair cells in
inner ear stiffen and atrophy, and cerumen
(earwax) increases.
 Number of neutrons in the cochlea decrease
and blood supply lessens, causing
degeneration.
 Presbycusis, the impairment of hearing in
older adults, is often accompanied by a loss
of tone discrimination.
137

Sensory
 Hearing
 Hair cells tend to be lost in the
organ of Corti.
 Cochlear neurons tend to be lost.
 Stiffening, thickening, and
calcification occur in multiple
components of the auditory
apparatus.
 Taste
 Older persons may have
decreased sensitivity to taste.
138

Taste
 Taste also
diminishes with age
 Some atrophy of the
tongue occurs with
age and this may
diminish sensitivity to
taste.
139

Smell
 The number of functioning
smell receptors decreases.
 After the age of 50 the sense
of smell decreases rapidly.
 By age 80, the sense of
smell is reduced by about
half.
140

Immune system
 Decline in
immune function
 Fatty marrow
replaced red
bone marrow
141

 As we grow older, our bodies are less
able to produce antibodies which are
important in fighting infections.
 As a result older adults are at greater risk
for infections and the mortality rate from
infection is much higher than in the young.
 Decreased production of thymic hormones
due to shrinkage of thymus gland leads to
infections.
142

Endocrine system
 Estrogen levels decrease in women.
 Other hormonal decreases include
testosterone, aldosterone, cortisol,
progesterone.
 The normal fasting glucose level rises 6-14
mg/dL every 10 years after age 50.
 Probably due to loss in number of insulin
receptor sites in cells.
143

Neuromuscular
 Reduced sensory input
 Delayed nerve conduction
 Reduced numbers of motor neurones
 Reduced muscle mass
Therefore vulnerability to falls!
144

Osteoporosis and Fractures
 Low dietary intake of Calcium
 Loss of endocrine protection
 Reduced endogenous production
of Vitamin D
 Disuse
 Disease – Chronic Renal
Disease, Rheumatoid Arthritis,
Thyroid Disease
 Medications – Steroids,
Thyroxine
145

Oral health is an important
component of „Active Ageing‟
and is included in policy
proposals related to health, one
of the three basic pillars.
147

Reduce risk factors associated with major
diseases and increase factors that protect
health throughout the life course
- Tobacco - Physical activity
- Nutrition - Healthy eating
- Oral Health - Psychological factors
- Alcohol and drugs - Medication
148

Oral Health Problem in Elderly
Tooth loss1
Denture related condition2
Coronal and root caries3
Periodontal disease4
Xerostomia5
Cancer and precancer6
149

Breaking the Chain of Infection
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
152

Signs and Symptoms of
Infection
 Confusion, dizziness, sudden onset of falls
 Fever
 Fast breathing or fast heart beat
 Pain or tenderness of the affected area or
all over
 Loss of energy
 Loss of appetite
 Nausea
 Vomiting
153

Signs and Symptoms of
Infection
 Diarrhea
 Rash
 Sores on mucus membranes
 Redness and swelling of a body part
 Discharge or drainage from the infected
area
 Cloudy and/or foul/thick urine
 Painful and/or difficult urination
 Foot blisters, cracks, change in color
154

Epidermis
Dermis
Subcutaneous fatty tissue
Sweat glands
Blood vessels
Nerves
Hair follicle
Skin Layers
156

Blood Flow
Normal blood flow through tiny
blood vessels called capillaries
Interrupted blood flow through
capillaries caused by pressure
157

Infection Bacteria
Ulcer deepens
Damage to underlying structures
Widening infection
Pressure Decreased blood flow
Lack of nutrients/O2Cell death
Shed cells Ulcer
Pressure Ulcer Snake
158

Locations for Pressure Ulcers
159

Braden Scale
 Nurses will use Braden Scale to assess for
pressure ulcer risk in the following six
areas:
 Sensory-perception (touch, hot, cold, pain)
 Moisture
 Activity
 Mobility
 Nutrition
 Friction and shear
161

Safe Use of Restraints
 Restraints require a doctor‟s order and must
be used only to treat a medical condition.
Never use restraints:
 As a permanent means of control
 As a form of punishment
 For the convenience of the staff
 As a substitute for activities or treatments
163

Seven Cs of Care of Terminally Ill patient
Concern : Compassion, worth, tender and involvement.
Competence: Skill and knowledge about illness
management eg pain, nausea, shortness of breath,
insomnia.
Communication: allowing patient to speak
Children: Allowing children to visit patient , brings
consolation.
Cohesion: Family cohesion
Cheerfulness: Gentle and appropriate sense of human.
 Humor can be palliative.
Consistency: Continuing, persistent attention and
involvement till the end.

Summary
 Aging of the population will result in 25% of the
population being over 65 by 2030
 The majority (?) of the elderly are well and enjoy a
reasonable socio-economic status (Nepal?)
 A small but significant subset of frail (delicate),
vulnerable elderly account for an excess of
adverse socio-economic and health care
outcomes. (Nepal: Common)
 More suffers: very old, female, living alone, with
multiple chronic diseases and taking multiple
medications.
165

Thank You
 Your geriatric
patients rely on
you to provide the
best care possible
and promoting
comfort in patient
care
166

Health promotion strategies
169

CVS
 Exercise regularly, pace activities
 Avoid smoking
 Eat low fat diet, low salt diet
 Participate in stress reduction activities
 Check blood pressure regularly
 Medication compliance
 Control weight.
170

Respiratory
 Exercise regularly
 Avoid smoking
 Take adequate fluids to liquefy secretions
 Avoid exposure to upper respiratory tract
infections.
171

GI
 Use mouthwash, brush, floss and receive
regular dental care.
 Sit up and avoid heavy activity after eating
 Limit antacids and laxatives.
 Eat a high fiber, low fat diet, drink adequate
fluids.
 Eat small, frequent meals.
 Toilet regularly.
172

SKIN
 Avoid solar exposure(clothing, sunscreen,
stay indoors).
 Dress appropriately for temperature.
 Maintain a safe indoor temperature
 Lubricate skin.
173

Genito-urinary
 Seek referral to urology specialist.
 Have ready access to toilet
 Wear easily manipulated clothing
 Drink adequate fluids
 Avoid bladder irritants (caffeinated
beverages, alcohol)
 Pelvic floor exercises.
174

Reproductive system
 Females may require estrogen
replacement therapy.
 To use a lubricant with intercourse.
175

Muskulo-Skeleton
 Exercise regularly.
 Eat a high calcium diet, limit phosphorus
intake.
 Take calcium and vitamin D supplements.
 Encourage use of assistive devices if
indicated
 Modify environment to reduce fall risk
 Encourage activity- take walks etc.
176

Nervous system
 Allow longer time to respond to stimulus
and move more deliberately.
 Encourage slow rising from a resting
position.
177

Sensory Eye
 Wear eyeglasses, use sunglasses outdoors.
 Avoid abrupt changes from dark to light.
 Use large print books.
 Use magnifier for reading.
 Avoid night driving.
 Use contrasting colors for color coding.
 Avoid glare of shiny surfaces and direct
sunlight.
178

Sensory Hearing
 Recommend a hearing examination.
 Reduce background noises.
 Encourage to face person and use non
verbal cues.
 Speak with a low pitched voice.
179

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