Understanding Geriatric Population

Consider the followings:  Some myths, misconceptions and

1. Physiologic and biological changes that negative stereotypes about older
normally occur during aging. people stem from our culture’s
2. Understand older adult’s special health values and beliefs.
requirements.  Many people perceived older adults
3. Help them learn to access community as senile, sick and incapable of
services, avoid falls, and deal with age- making worthwhile contributions to
related problems such as reduced visual society
acuity.
2. Fear of Aging
4. Understand the effects of prescription and
 Most people don’t know enough about the
over- the- counter drugs on older patients
realities of aging; they fear death and,
in long- term care.
therefore, fear of growing older.
5. Equally importantly, you need to examine
 GERONTOPHOBIA -refers to this fear &
your personal feelings about elderly people
the refusal to accept older people into the
to make sure that common misconceptions
mainstream of society.
about aging aren’t affecting the quality of
your care you provide.
2 extreme forms of Gerontophobia
6. You must consider end-of-life issues.

AGEISM- the negative stereotyping of

Important factors in understanding geriatric
aging and older persons, I a belief that
population
aging makes people unattractive,
1. Societal attitudes and beliefs unintelligent, and unproductive, it’s an
 As a group, older adults in our emotional prejudice.
society are stereotyped. AGE DISCRIMINATION – it goes
 Aging – is a natural process, but the beyond emotion; it’s the practice of treating
changes associated with it are rarely people differently simply because of their
viewed as natural or positive. age. (eg. Hiring, limited amount of health
 Health care professional commonly care provided.)
described it as a “LOSSES” such as
(loss of tissue elasticity or a decrease  What is aging?
 The word “aging and old age are highly
I blood flow.)
subjective.
 General, our society regards aging
 It is defined as having lived for a long time
as:
and is commonly synonymous with negative
 A series of inevitable,
terms, such as “ancient”, “antiquated”, and
negative events that a
“timeworn”.
person must tolerate
 Its process is complex: it can be described
 Health care professional
Chronologically
often mentioned age- related
Physiologically
changes and disease
And Functionally
conditions in the same
breath.
 CHRONOLOGICAL AGE
-refers to the number of years a person has lived. Strong chemical bonding between organic
- Age 65 became the maximum age of eligibility for molecules in the body causes increase
retirement benefits stiffness, chemical instability, and
-65 is the accepted age for status as a senior citizen insolubility of connective tissues
  deoxyribonucleic acid.
There are 3 chronological categories Sources;
Young- old (age 65 to 74)  Lipids, proteins, carbohydrates, and nucleic
Middle-old (age 75 to 84) acid.
Old-old (ages 85 and older) Retardants;
 Restricting calories and lathyrogens (anti-
PHYSIOLOGIC AGE link agents)
-refers to the determination of age by body
function. 2. Free radical-theory
Increased unstable free radical produced
FUNCTIONAL AGE harmful to biological system, such as
-refers to a person’s ability to contribute to chromosomal changes, payment to
society and benefit others and himself. accumulation.
- Those who require help are called – FRAIL
Sources;
ELDERLY
 Environmental pollutants, oxidation of
(Note: not all individuals of the same
dietary fat, protein, carbohydrates.
chronological age function at the same level.)
Retardants;
-age 75 is the fastest growing segment of the older
 Improving environmental monitoring;
population.
decreasing of free- radical stimulating
-age 75to 84 – about 25% need help with ADL
foods; increase intake of vitamin of A & C
-Age 85 and older – nearly ½ need help with ADL.
 Mecarplans and vitamin E
 
Characteristic common to the frail elderly
3. Immunologic theory
o Poor mental and physical health
o An aging immune system is less able to
o Low socioeconomic status
distinguish body cells from foreign cells; as
o Female gender (predominantly)
a result, it begins to attack and destroy
o Isolated living conditions (possibly)
body cells as if they were foreign.
o More & longer hospital stays with more
o This may explain the adult onset of such
money spent on health care & drugs
conditions as diabetes mellitus, rheumatic
o More frequent visit to the doctors
heart disease, and arthritis. Theorists have
o More use of nursing home beds than
speculated about several erratic cellular
hospital beds. mechanisms capable of precipitating attack
  on various tissues through auto aggression
Theories of aging or immunodeficiency’s.
Sources;
A. BIOLOGICAL THEORIES  Alteration of B and T cells of the humoral ad
1. Cross-link theory cellular system.
Retardants;
  Considering and immuno-engineering-  Taking into account the impact major
selective alteration replenishment or societal changes, this can alter individual
rejuvenation of the immune system. expectations and behavior.

4. wear and tear theory 3. Disengagement theory

Body cells, structures, and functions wear Progressive social disengagement occurs with
out or are overused through exposure to age.
internal and external stressors. Effects from  Sources;
residual damage accumulate, the body can  Decrease participation in society resulting
longer resist stress and death occurs. from age-related changes in health, energy,
Sources; income, and social roles.
 Repeat injury or overuse; internal and Retardants;
external stressors (Physical, Psychological,  Taking into account diversity of individual
social, and environmental, including outlook and lifestyle and social structure
trauma, chemicals, and buildup of naturally variables, such as economy and social
occurring wastes. organizations.
Retardants;
 Reevaluating and possibly adjusting
4. Social exchange theory
lifestyle.
 Social behavior involves doing what’s
A. PSYCHOSOCIAL THEORIES valued and rewarded by society.
 
1. Activity theory
Successful aging and life satisfaction depend Sources;
on maintaining a high level of activity.  Diminished resources and increase
 Sources; dependency leading to unequal
 Quality and meaningfulness over quantity contribution to society and reduced power
of activities; life satisfaction related to and value; decreased number of roles
involvement in life. available in society.
Retardants; Retardants;
 Increasing activities in other areas when  Assuming new roles and friendship with
activities in one area decrease. other older adults to help socialize the
person and help the person adjust to age-
2. Continuity theory related norms.
An individual remains essentially the same,
despite life changes. This theory focuses Notes:
more on personality and individual behavior Aging is a normal part of human developmental.
over time. Various theories have been proposed;
1. To explain the process of normal aging and
 Sources; help dispel some of the myths.
 Assumed stability of individual patterns or 2. Provide guidelines to determine how well a
orientation over time. patient is adjusting to aging.
Retardants;
 3. Identify areas that need to be assessed and 3. It’s equally important for you to recognize
provide a basis for interventions and that even laboratory test values will change
rationales in nursing care. to reflect the aging process.
4. (No single theory of aging is universally 4. Values considered abnormal in younger
accepted.) adults may be normal in older adults.
Understanding the normal aging process
Biological theories can help you understand why a person’s
Attempt to explain physical aging as an risk of developing certain disease and
involuntary process, which eventually leads to sustaining injuries increase over time
cumulative changes in cells, tissues, and fluids.
Intrinsic biological theory maintains that aging Nutrition
changes arise from internal, predetermined causes. A person’s protein, vitamin, and mineral
Extrinsic biological theory maintains that requirements usually remain the same as he/she
environmental factors lead to structural alterations ages, but caloric need decrease. Diminished activity
which, in turn, cause degenerative changes. may lower energy requirements by about;
MEN & WOMEN- 200 Calories /day ages 51 to 75
Psychological theories Men - 500 Calories/day age over 75
It attempts to explain age-related changes Women - 400 calories/day age over 75
in cognitive function, such as intelligence, memory,
learning, and problem solving. Other physiologic changes that can affect
nutrition in an older patient.
Sociologic theories o Decrease renal function an, causing greater
It attempts to explain changes that affect susceptibility to dehydration and formation of
socialization and life satisfaction. It maintains that a renal calculi
social expectation change, people assume new o Loss of calcium and nitrogen (patient isn’t
roles, which leads to changes in identity. ambulatory)
o Diminished enzyme activity and gastric
Developmental theories
secretions
Describe specific life stages and tasks
o Reduced pepsin and hydrochloric acid
associated with each stage.
secretions, which tends to diminish the
 
absorption of calcium and vitamins B1 and B2.
Physiologic Changes of Aging
o Decrease salivary flow and diminish sense of
1. Aging is characterized by the loss of some
taste which may reduce the person’s appetite
body cells and related metabolism in other
and increase his consumption of sweet, salty,
cells. This process results in a decline in
and spicy foods.
bodily function and changes in body
o Diminished intestinal motility and peristalsis of
composition.
the large intestine
2. It’s important for you to recognize the
o Thinning of tooth enamel, causing teeth to
gradual changes in body function that
become more brittle
normally accompany aging so that you can
o Decrease biting force
adjust your assessment techniques
o Diminish gag reflex.
accordingly.
 
 Some common condition found in older people o Weakened chest musculature re person’s
can affect nutritional status: reduces an older ability to clear lung secretions
1. Limiting patient’s mobility and increase high risk of developing
2. Diminished intestinal motility -may cause GI pneumonia, tuberculosis, and other respiratory
disorders like constipation & fecal diseases.
incontinence o In older men, prostatic hypertrophy is a
3. Suffer constipation – cause by nutritionally common cause of urinary tract obstruction and
inadequate diet of soft, refined foods low in acute urine retention.
dietary fiber, physical inactivity, emotional o A weakened immune system increases an older
stress or certain medications. debilitated person’s risk of Acquiring almost
4. Laxative abuse -cause rapid transport of any infection to which he’s exposed.
food through GI tract, decreasing digestion
and absorption. DIFFERENT BODY SYSTEMS
  INVOLVE IN THE PROCESS OF CHANGES
Socioeconomic & psychological factors that affect  
nutritional status: Age- related adjustment and transitions
o Loneliness The aging process is accompanied by role changes
o Decline of role & importance in the family and transitions:
o Lack of money Factors;
o Transportation to buy nutritious foods.  Family role
   Age, sex, beliefs, attitudes, income, health, and
ILLNESS AND INJURY: WHY THE RISK past experience
INCREASE WITH AGE  Culture (illness, dependence/interdependence,
o Decreased cerebral blood flow increases the roles changes, losses an death in a context
risk of stroke. that’s unique to their culture)
o An older person’s spinal cord is tightly encased  ROLE CHANGES - depends on the situation
in vertebrae that may stud with bony spurs or where in and varies.
shrunken around the cord. Even minor fall can  RETIREMENT
cause sever cord damage.  MULTIPLE LOSSES
o In older women, osteoporosis cause  LONELINESS
compression fractures even without a history of  DEPRESSION AND SUICIDE
trauma  
o Brittle bones make an older person especially Clinical Alert! :
prone to fractures. Falling on an outstretched  Suicidal rate in older adult men is seven
arm or hand or experiencing a direct blow to times that of women, an is rarely an
the arm or shoulder and is likely to fracture the impulsive act, most suicide attempts aren’t
shoulder or humerus. gestures or threats
o Diminished heart rate and stroke volume place Risk factors include;
an older person at risk for developing heart  Alcoholism
failure, hypertensive crisis, arterial occlusion,  Bereavement
and myocardial infarction.  Loss of health, loss of role
 Living alone
  And children who have married and moved o Maximum breathing capacity, forced vital
away. capacity, and inspiratory reserve volume
  diminished with age, leaving the patient with
lowered tolerance for oxygen debt.
DIFFERENT ORGAN/ BODY SYSTEMS
Cardiovascular system
Respiratory system Heart usually becomes slightly smaller and
Age-related anatomic changes in the upper airways loses its contractile strength and efficiency.
include: (Exception occurs with people with hypertension or
o Nose enlargement from continued cartilage heart disease.)
growth o By age 70, cardiac output at rest diminished by
o General atrophy of the tonsils about 30% to 35% in many people.
o Tracheal deviations from changes in the aging o Fibrotic and sclerotic changes thicken heart
spine valves and reduce flexibility, leading to rigidity
o Thoracic changes – anteroposterior chest and incomplete closure of the heart valves,
diameter, as a result of altered calcium which may result in systolic murmurs.
metabolism and calcification of costal o Thickness of the left ventricular wall increase by
cartilages, which reduces mobility of the chest 25% between age 30 and 80
wall. o Develop obstructive coronary disease and
o KYPHOSIS advances with age because of such fibrosis of the cardiac skeleton.
factors as osteoporosis and vertebral collapse. o Hearts become irritable, extra systoles may
 diminishes ventilator capacity for the occur, along with sinus arrhythmias and sinus
following reasons: bradycardias.
1. lungs’ diffusing capacity declines o Increase fibrous tissue infiltrates the sinoatrial
 decreases inspiratory and node and internodal atrial tracts, which may
expiratory muscle strength cause atrial fibrillation and flutter.
diminishes vital capacity o Vein dilates and stretch
2. Lung tissue degeneration causes a o Coronary artery blood flow decreases by 35 %
decrease in the lung’s volume, thus
between age 20 and 60.
aging alone can cause EMPHYSEMA.
o Aorta becomes more rigid, causing systolic
o Closing of some airways causing poor
blood pressure to rise disproportionately higher
ventilation of the basal areas, resulting I both a
than the diastolic, resulting in a widened pulse
decreased surface area for gas exchanges and
pressure.
reduced partial pressure of oxygen (PO2)
o ECG (electrocardiogram)changes include
o Normal partial pressure of a capacity, arterial
increase PR, QRS, and QT intervals
oxygen (PaO2) decrease to 70 to 85 mmHg.
o Decrease amplitude of the QRS complex, and
o Oxygen saturation decrease by 5%. Lung
shift of the QRS axis to the left.
becomes more rigid, and the number and size
o Decrease ability to respond to physical and
of alveoli decline with age.
emotional stress.
o A 30% reduction in respiratory fluids heightens
o Heart rate takes longer to return to normal
the risk of pulmonary infection and mucus plug.
after exercise.
o Arterial and venous insufficiency as the o Impaired renal clearance of drugs
strength and elasticity of blood vessel decrease. o Reduced bladder size and capacity
o   o Decreased renal ability to respond to
o This contributes older people increased variations in sodium intake
incidence of cardiovascular disease, particularly o By age 70, blood urea nitrogen levels rise by
coronary disease. 21%
o Residual urine, frequency and nocturia also
increase with age.
Gastrointestinal system
Aging are usually less debilitating to the GI system
Male reproductive system
than the other system. This includes the ff:
o Reduced testosterone production – which
o Diminished mucosal elasticity and reduced
in turn may cause the ff:
GI secretions, which in turn modify same
 decrease in libido, testes become atrophy,
process like digestion and absorption.
soften&
o Decrease in GI tract motility, bowel wall and
 Decreases sperm production by 48 % to
anal sphincter tone & abdominal muscle
67% between age 60 and 80.
strength- may cause complaints in ranging
o Prostate glands enlarge with age and its
from loss of appetite to constipation that
secretion diminishes.
may increase too as related to use of
o Decrease in seminal fluid, volume and less
multiple medications-common to older
viscous.
people.
 
o Decrease in liver weight, reduced
Female reproductive system
regenerative capacity
Declining estrogen and progesterone levels cause a
o Decreased blood flow to the liver- because
number of physical changes.
hepatic enzymes involved in oxidation and o It includes emotional & physical changes
reduction markedly decline with age.
o Transition from childbearing years to
o Liver metabolizes drugs and detoxifies
infertility.
substances becomes less efficient.
o As estrogen level decrease, menopausal
 
period approaches about age 50.
Renal system
 OVARIES
o Renal function diminishes after age 40. If
-Ovulation usually stops 1 to 2 years before
the person lives to age 90 it may have
menopause.
decreased by as much as 50% - this due to
-They become unresponsive to gonadotropic
the decline in the glomerular filtration rate.
simulation.
o Decrease renal blood flow by 53% from
-Ovaries become atrophy, thicker and smaller.
reduced cardiac output and age-related
atherosclerotic changes.
 VULVA
o Bladder muscles weaken- may results in
-The vulva atrophies with age.
incomplete bladder emptying -Pubic hair loss and flattening of labia majora
o Chronic urine retention- predisposing the -Vulva tissue shrinks- thus exposing the sensitive
bladder to infection. area around the urethra and Vagina to abrasions
o Diminished kidney size and irritation (e.g. Undergarments)
-introitus constricts  Difficulty in rising from a chair
-tissues lose their elasticity and epidermis thin from  Urinary stress incontinence occurs -if
20 layers to about 5. urethrovesical ligaments weaken.
 
 VAGINA Neurologic system
-The vagina shortens and the mucous lining to o Neurons of the central and peripheral nervous
become thin, dry, less elastic and pale as a results systems undergo degenerative changes.
of decrease vascularity – due to atrophy. o Nerve transmission slows down- causing the
-susceptible to abrasion older people to react more slowly to external
-The pH of vaginal secretions increases making the stimuli.
vagina environment more alkaline. o After about age 50, the number of brain cells
-Flora changes causing increase in vaginal decreases at a rate of about 1% per year.
infections. o (note: Clinical effects usually aren’t noticeable
until aging is considerably more advanced)
 UTERUS o Hypothalamus becomes less effective at
-After menopause, the uterus shrinks rapidly to regulating body temperature.
one-half its premenstrual weight to approximately o Cerebral cortex undergoes 20% neuron loss
one-fourth its premenstrual size. o Corneal reflex becomes slower, and the pain
-Atrophy of the cervix and no longer produces threshold increases
mucus for lubrication o Experiences a decrease in stages III and IV
-Endometrium and myometrium become thinner sleep- causing frequent awakening;
  o Rapid eye-movement sleep decreases –
 BREAST results in increased need for rest during the
-Atrophy of glandular, supporting, and fatty tissues day.
-Cooper’s ligament lose their elasticity
-Pendulous breast Musculoskeletal system
-decrease in nipple size and becomes flat o Increase adipose tissue
-Fibrocystic disease present at menopause o Diminish lean mass and bone mineral contents
diminishes o Height decrease – may results in exaggerated
- Inframammary ridges become more pronounced.
spinal curvatures and narrowing intervertebral
 PELVIC SUPPORT STRUCTURES
spaces, which shorten the trunk and make the
(Relaxation of structures commonly occurs among
arms, appear relatively long.
post reproductive women. Initially occurs during
o Decrease bone and muscle mass causing
labor & delivery, but clinical effects go unnoticed
muscle weakness
until the process accelerates with menopausal
o And collagen formation causing loss of
estrogen depletion and loss of connective elasticity
resilience and elasticity in joints and supporting
and tone.)
structures
Signs and Symptoms:
o Synovial fluid more viscous and synovial
 Pressure and pulling in the area above the
membranes become more fibrotic
inguinal ligaments
o Difficulty in tandem walking
 Low backache
 A feeling of pelvic heaviness
o Walks in shorter steps and wider leg stance to
achieve better balance and stable weight
distribution.