GERIATRIC

CONSIDERATIONS IN
NURSING
 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.
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 ).
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.
Indian Scenario:

• Current population of India is more than

1.33 billion
• The total population of nation is growing at
the rate of 1.13%.
In India , elderly population is over 103
million and it is expected to reach the mark
of 177 million almost double by the year
2025
GERIATRICS DEFINITON:
• The term Geriatrics Came from the Greek
word “geron” meaning “old man” and “iatros”
meaning “healer”.
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.
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.
B) Psychological Theories
1) Personality Theory.
2) Developmental Task Theory.
3) Disengagement Theory.
4) Activity Theory.
5) Continuity Theory.
 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..
 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.
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.
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.
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
crosslinked proteins damages cells and
tissues, slowing down bodily processes
resulting in aging.
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.
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.
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.
(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.
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.
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.
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.
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.
Psychosocial challenges of the
elderly population:
WIDOWHOOD
• Widowhood affects more women than men, as
women tend to live longer.
• Adjusting to the loss of someone you have
shared life which is often difficult.
• Many older women have lived family-oriented
lives and have been dependent on their
husbands. They find themselves in new
roles—such as financial manager—that they
need to learn.
Common additional consequences include the
following:
• Loss of companionship and intimacy
• Loss of one’s sexual partner
• Feelings of grief, loneliness, and emptiness
• Increased responsibilities
• Increased dependence on others
• Loss of income and less efficient financial
management
• Changes in relationships with children, married
friends, and other family members.
• The impact of the loss can be tremendous, and the
feelings of grief, loneliness, and emptiness may be
overwhelming.
AGEIST ATTITUDES
• Because of the ageist attitudes common in modern
industrialized societies, many older adults deny that they
are old.
• Ageism can lead to prejudices, fear of aging, and feelings
of devaluation and degradation.
• Consequences of negative age-based stereotypes
include :
 Impaired memory
 Decreased cognitive performance
 Declining will to live
 Diminished positive affect
 Negative effects on physical health
 Behavioral changes such as decreased walking speed
and shaky handwriting
Retirement:
– Viewed as a milestone that marks the passage into older
adulthood. The age of 60 years is the traditional retirement age;
-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.
However, there is a growing trend toward “bridge employment”
involving a transition from full-time to part-time employment
before retirement.

– Retirement has both social and economic implications for

elderly individuals
• Studies have found that bridge employment facilitates:
 Adjustment to retirement by helping older adults structure
their time
 Offering opportunities for supplemental income
 Developing new routines and interests before full
retirement
The following factors commonly influence the decision to
retire:
 Health
 Financial assets
 Job conditions
 Pension availability
 Family circumstances
 Opportunities for continued employment
 Continued ability to perform job responsibilities
CHRONIC ILLNESS AND FUNCTIONAL
IMPAIRMENTS
• Most functional limitations necessitate only minor adjustments
in daily living, but some, such as considerable cognitive,
mobility, or visual impairments, significantly increase one’s
dependence on others.
• Other consequences of chronic illnesses include the following :
 Threats to self-esteem and altered self-concept
 Changes in lifestyle
 Unpredictability about one’s ability to do what one wants
 Expenditures for assistance, medications, and medical care
 Frequent trips to health care providers
 Adverse medication effects, which sometimes cause further
functional impairments
 Increased vulnerability to personal crimes and fear of crime
RELOCATION
• Another common psychosocial adjustment for older
adults is the decision to move from the family home
because of factors :
Loss of spouse
Lack of available assistive services
Lack of a kinship network or caregiver
Chronic conditions and declining functional abilities
 Cognitive impairment or psychiatric illness.
• Increased dependence on others because of health
problems
• Older adults whose adult children have moved to
another location may relocate to be closer to them.
• Or older adults may choose to move to a
desirable geographic location after they retire.
• Problems also arise for older homeowners who
find it more difficult to physically and financially
maintain their home and pay for utilities.
• Relocation to a nursing home is a significant
life event for some older adults.
• Nurses can ensure that older adults are
involved as much as possible in decisions.
DEATH OF FRIENDS AND FAMILY
• The loss of friends and family becomes inevitable with each
year. Because meaningful social relationships are an important
predictor of well-being for older adults.
• Loss of family and friends is likely to have a negative impact
on psychosocial wellness.
• Those who are able to adjust their expectations and do not feel
a sense of social isolation may fare better than those who
perceive themselves as socially isolated and disconnected .
• Nurses have many opportunities to promote healthy
psychosocial function during the usual course of caring for
older adults.
 Incorporate communication techniques
 To enhance self-esteem
 Promote a sense of control
 Fostering social support
Nursing interventions to promote healthy psychosocial
function
ENHANCING SELF-ESTEEM
• Essential component of nursing care for older adults because
self-esteem is an important coping resource and a factor that
influences well-being.
• Ensuring easy access to their usual assistive devices
• Providing as much privacy as possible
• Asking about food preferences and ensuring as much choice
as possible
• Asking open-ended questions, such as, “Is there anything that
we can do to help you manage better while you’re here?”
• Asking, “Is there anything you’re worried about that I can help
you with?”
• Ensuring that staff members address persons by their
preferred names
• Involving as much as possible in decisions that affect them
PROMOTING A SENSE OF CONTROL
• Nurses address psychosocial needs of older adults with
interventions
• Nursing interventions to promote a sense of control for
older adults include involving them as much as possible in
organizing their schedule and providing information about
their plan of care.
• Nursing interventions also address factors that can
threaten perceived control, such as :
Lack of privacy
 Loss of individuality, which commonly occur in
institutional settings.
FOSTERING SOCIAL SUPPORTS
Social isolation is likely to occur because of any of the
following factors that commonly occur in older adulthood:
Hearing impairments and other communication barriers
Chronic illnesses that limit activity or energy
Lack of social opportunities because of caregiving
responsibilities
Mobility limitations, including the inability to drive a
vehicle
Mental or psychosocial impairments that interfere with
relationships
• Foster positive social interactions in group settings, such
as dining and activity rooms.
• Sometimes, a very simple intervention, such as
positioning chairs (including wheelchairs)
• In home settings, nurses can identify
community resources, such as volunteer
friendly visitor and meal programs, to decrease
social isolation.
• Support and education groups that primarily
focus on coping with a chronic illness
 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 .
Causes of Elder Abuse
• Ageism
• Retaliation
• Caregiver stress
• Caregiver unemployment
• Environmental condition
• Increased life expectancy
• Resentment of dependence
• Lack of community resources
• Lack of financial resources
• Lack of close family ties violence as a way of life
• A history of personal and mental problems and
• A history of alcohol and drug abuse
Prevention
• Avoid isolating elders : Depression, sadness and loneliness
• Stay in touch with your elders.
• Keep elders active.
• Encourage to attend religious services and community
activities.
• Don’t allow elders to live with someone who is known to be
abusive or violent.
• Be wary of caregivers or friends needing financial help, or
those who have issues with illicit drugs.
• Elders should be aware of their own financial affairs.
• Don’t allow a caretaker or family member to impulsively alter
an elder’s will, or add their names to financial accounts or land
titles.
• Inform elders to be wary of solicitations from the telephone,
internet or mail.
 CHANGES ASSOCIATED WITH AGING
(NORMAL AGING PROCESS)
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.
Parameters of Cardiovascular Assessment
• Cardiac assessment: ECG; heart rate, rhythm, murmurs, heart
sounds
• Assess BP (lying, sitting, standing) and pulse for symmetry.
• Palpate carotid artery and peripheral pulses for symmetry.

Nursing care Strategies for cardiovascular problems

• Safety precautions for orthostatic hypotension
• Encourage lifestyle practices to attain a healthy body weight
(BMI 18.5-24.9 kg/m2). And maintain normal blood pressure.
• Healthy diet
• Physical activity
• Smoking cessation
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.
Parameters of Pulmonary Assessment
• Assess respiration rate, rhythm, regularity, volume,
depth, exercise capacity.
• Inspect thorax, symmetry of chest expansion. Obtain
smoking history.
• Monitor secretions, breathing rate during sedation,
positioning, arterial blood gases, pulse oximetry.
• Assess cough, need for suctioning.
Nursing care strategies
• Maintain patent airways through upright
positioning/ repositioning, suctioning, and
bronchodilators
• Provide oxygen as needed
• Incentive spirometry as indicated,
• particularly if immobile or
• declining in function
• Education on cough
• enhancement, and smoking
• cessation
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.
• Bladder capacity decreases and increase in residual
urine and frequency.
• These changes increase the chances of urinary
infections, incontinence, and urinary obstruction.
Parameters of Renal and genitourinary assessment
• Assess the renal function (creatinine clearance)
• Assess need/dose of nephrotoxic drugs
• Assess for fluid/ electrolyte and acid/ base
imbalances
• Evaluate nocturnal polyuria, urinary incontinence,
BPH. Assess UTI symptoms.
Nursing-care Strategies
• Monitor nephrotoxic and renal cleared drug levels
• Maintain fluid/electrolyte balance. Minimum 1500-
2500mL/day from fluids and foods for 50 to 80 kg
adults to prevent dehydration
• For nocturnal polyuria: limit fluids in evening, avoid
caffeine, use prompted voiding schedule.
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.
 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.
 Intestine:
• – Prevalence of diverticulitis increases with
age.
• – Reduced peristalsis (intestinal muscle
contractions) of large intestine.
• – 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.)
Parameters of Gastrointestinal Assessment
• Assess oral cavity; chewing and swallowing capacity,
dysphagia
• Monitor weight, calculate BMI.
• Determine dietary intake, compare to nutritional
guidelines.
• Assess for GERD, constipation and fecal incontinence;
fecal impaction by digital examination of rectum or
palpation abdomen.
Nursing-care Strategies
• Monitor drug levels and LFT if on medications
metabolized by liver
• Assess nutritional indicators
• Educate on lifestyle modifications
• Educate on normal bowel frequency, diet,
exercise, recommended laxatives
• Encourage mobility; provide laxatives if on
constipating medications.
• Encourage participation in community-based
nutrition programs; educate on healthful diets
Changes in Immune system:

– 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:
• Muscles generally decrease in strength, endurance,
size and weight
• The number and size of muscle fibers decrease
• Lose of an average of about
2 inches of height
• Compression of vertebrae,
changes in posture, and
increased curvature of the
hips and knees.
Bones
• Bone mass begins to gradually decline as aging
disrupts the balance between the cells that produce
bone.
• Bones become thin and become more porous.
• Women have a more rapid rate of bone loss than
men, with 1 most rapid losses occurring in the 5
years following menopause.
Parameters of Musculoskeletal system
Assessment
• General observation of posture, stance, and walking.
• The Timed Up-and-Go Test provides a quick
assessment of an older adult’s overall mobility and
function.
• For patients with existing disabilities, an inquiry is
made to assure the patient has been evaluated in
physical therapy
• Osteoporosis can be assessed by additional
questioning of the patient regarding any back pain,
joint pain, and loss of height.
• Bone mineral density (BMD) testing can also be
completed.
Nursing-care Strategies
• Regular exercise such as walking and resistance
training as well as doing household chores help
preserve flexibility and strength and delay or prevent
musculoskeletal deterioration.
• Exercise has well-documented musculoskeletal
benefits, as well as decreasing the risk of falls for
older adults.
• Studies have shown that older individuals may be
able to achieve significant strength gains through
properly designed resistive strength-training
regimens.
CHANGES IN INTEGUMENTARY SYSTEM
Skin
• Wrinkling, pigment alteration and thinning of the skin
• A thinning of the area between the dermis and
epidermis by about 20%
• Elastin and collagen decrease
• Reduction in size of cells
• Loss of subcutaneous layers of fatty deposits
• Inability of skin to retain moisture
• 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 ).
Parameters of Integumentary System Assessment
Identifying Opportunities for Health Promotion
• Assessment questions are aimed at identifying the
person’s perception of any problems, any risk factors
• Nurses obtain information about medications and
other risk factors, and they incorporate this
information into the skin assessment.
• Comprehensive assessment, such as information
about:
 Fluid intake
Nutritional status
Mobility and safety, is applicable to the assessment
of the skin.
Observing Skin, Hair, and Nails
• Close inspection of the skin in a warm, private, and
well-lit environment
• Older adults may focus on benign conditions, such
as xerosis, but not notice more serious conditions
such as skin cancer.
• Nurses observe skin color, turgor, dryness, overall
condition, and any growths or pathologic conditions.
• Assess for erythema or pressure areas
• Assessment includes inspecting the skin for brown
actinic keratosis precancerous lesions.
• Untreated, these lesions may progress to squamous
cell carcinomas, which are reddish dome-shaped
lesions.
Nursing-care Strategies
Promoting healthy skin
• It depends on the overall health of the person, the
maintenance of optimal nutrition and hydration is an
important intervention
• Other factors, including :
Smoking
Dehydration
Sun exposure
 Low environmental humidity
The use of harsh cleansing products,
are likely to contribute to xerosis in older adults.
Preventing Skin Wrinkles
• Avoiding too much exposure to sunlight and using a
sunscreen with a sun protection factor (SPF) of 15 or
higher
• Topical products containing alpha- or beta-hydroxy
acids may be beneficial
• Be alert : older adults might develop an allergic or
sensitivity reaction to some of the ingredients in
topical products.
• Information about the harmful effects of sunlight
should be included in health education
Use the following guide to identify for themselves any
skin changes that require further evaluation:
“ABCDE” SIGNS FOR SKIN LESIONS”
• Asymmetric shape: irregular or different-looking sides
• Border that is irregular: ragged, notched, blurred,
irregular
• Color change: different shades, uneven distribution
• Diameter: larger than a quarter of an inch (6 mm),
increasing
• Evolving: any change in size, shape, color, or texture,
or any new symptoms such as itching, bleeding, or
crusting
CHANGES IN THE SENSORY SYSTEM
Vision
• Visual impairment is the most common.
About 95% of individuals aged 65 and older report
wearing glasses or need glasses to improve their
vision
• The pupil decreases in size, by age 60, it is about 1/3
the size it was at 20
• The lens of the eye becomes yellowed, more rigid,
and slightly cloudy
• The iris becomes more rigid overtime.
Parameters of Vision Assessment
• Interviewing About Vision Changes
• Identifying Opportunities for Health Promotion
• Observing Cues to Visual Function
• Using Standard Vision Tests
Nursing-care Strategies
• Some activity tips to promote productive aging with
older adults with low vision may include:
Color contrasting various areas
for easier identification of transitions
or hazards in the home
• Maintaining good lighting in pathways and stairways
• Using labels and various other organizational
methods to identify small items
• Keeping commonly used items in easy-to-access
locations
• Avoiding moving quickly into a dark room or lighted
area; giving the eyes time to adjust to changing light
levels
• Using large-print books, checkbooks, or magnifying
glasses for reading
Hearing
• It contributes significantly to social isolation
• Membranes in the middle ear, including the eardrum, become
less flexible with age
• Small bones in the middle ear, the ossicles, become stiffer.
• The vestibular apparatus begins to degenerate with age
• Equilibrium becomes compromised and may complain of
dizziness
• Presbycusis : It is characterized by a decrease in perception of
higher frequency tones and a decrease in speech
discrimination
Parameters of Hearing Assessment
• Interviewing About Hearing Changes
• Observing Behavioral Cues
• Using Hearing Assessment Tools
Nursing- Strategies
• Promoting Hearing Wellness for All Older Adults
• Preventing and Alleviating Impacted Cerumen
• Compensating for Hearing Deficits
• Assistive Listening Devices
• Hearing Aids
• Speak slowly and clearly
Smell
• The number of functioning smell
receptors decreases
• There is increase in the
threshold for smell.
Taste
• Taste also diminishes with age
• Atrophy of the tongue occurs with age and this may
diminish sensitivity to taste
CHANGES IN THE NERVOUS SYSTEM
• Older nerve cells may have fewer dendrites and some
may become demyelinated which can slow the speed of
message transmission
• Impairment in cognitive capacity and the ability to manage
daily activities
• The incidence of cognitive impairment increases with age
Memory
• Poor recall of verbal words
• Perform less well on tasks
• Conceptualization, mental flexibility and the capacity for
abstraction decline with age.
General intelligence
• Performance scores which measure problem solving
ability tend to decline
Parameters of Nervous system assessment
• Collect health history of past and present
• Assess deep tendon reflexes
• Assessment Cranial nerves : sensory and motor to
rule out any abnormality
• Mini Mental Status Examination
Nursing-Strategies
• Assist in performing activity of daily living.
• Keep all their needed things in their reach.
• Teach fall prevention technique.
COGNITIVE CHANGES
• Cognitive function, deterioration leads to a decline in
the ability to perform activities of daily living.
• There is problem of cognition in old age giving rise to:

Delirium: It is a potentially reversible cognitive

impairment that is due to physiological cause.
Dementia : Dementia is generalized impairment of
intellectual functioning that interferes with social and
occupational functioning
It presents following symptoms:
• Deficits of memory
• Deficits of language
• Disturbed perception
• Impaired learning and problem-solving
• Impaired judgement

• Depression : 20% older adults may experience late

life depression. Depression reduces happiness and
well –being.
Causes
• Electrolyte imbalance
• Cerebral anoxia
• Hypoglycemia
• Medications, Drug effect
• Cerebral vascular infarction or hemorrhage.
Parameters of cognitive assessment
• Perform Mini–Mental State Examination (MMSE)
• The highest possible score is 30 points.
• Score less than 25 need further evaluation for
possible AD or other dementias, depression, delirium,
or schizophrenia.
• Score 20 or less generally have one of these
disorders
 MINI–MENTAL STATE EXAMINATION

Points Questions
Category
 The patient is asked to provide information on
1. Orientation 10 the time (e.g., year, season, month, date, and
day of week). (1 point each)
to time and  The patient is asked to provide information on
the present location (e.g., state, county, city,
place hospital, and floor). (1 point each)

 The patient is asked to repeat three named

2. 3 prompts (apple, table, penny). (1 point each)
Registration

 The patient is asked to

3. Attention 5 spell WORLD backwards.
(Points given up to first misplaced letter, e.g., 2
and points for “DLORW”)
calculation
  The patient is asked to recall the
4. Recall 3 three objects memorized in
“registration” above. (1 point each)

 The patient is asked to name two

5. 2 objects when they are displayed
(pencil and watch). (1 point each)
Language

 The patient is asked to speak back a

6. 1 phrase (“No ifs, ands, or buts”). (1
point)
Repetition
CHANGES IN THE ENDOCRINE SYSTEM
• Age-related changes in the thyroid
gland affect almost all body functions and
include the following:
Decreased secretion and plasma levels of
triiodothyronine (T3), especially in men
Increasingly common hypothyroidism
Decreased secretion of thyroid-stimulating
hormone (TSH)
Decreased responsiveness of plasma TSH
concentration to thyrotropin-releasing
hormone (TRH), especially in men
• Androgen and estrogen secretions diminish
with aging.
Declining estrogen levels result in atrophy of
the ovaries, uterus, and vaginal tissue in older
women, which may make sexual intercourse
painful.
Older men may develop firmer testes and
hypertrophy of the prostate gland.
These changes, together with other physical
and psychosocial changes, may decrease
sexual capacity.
• Pancreas : Insulin response.
Insulin continues to be produced in sufficient
quantities in older adults but their muscle cells
may become less sensitive to the effects of
insulin.
The “normal” fasting glucose level rises 6-14
mg/dl every 10 years.
• 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
Parameters of endocrine assessment
• Physical examination, patient history, blood tests and
assessment of symptoms.
• Sexual function may be assessed with a physical
exam & S/S
• Libido may be affected by nonphysiologic causes
including depression, stress, and other emotional
concerns.
Nursing-strategies
• Endocrine conditions, such as hypothyroidism, may
be treated with medications to replace the hormones
that are deficient in the body.
• Replacement should be initiated slowly, particularly in
those with coronary artery disease, to prevent angina
Diet In Elderly
• The energy requirements of a person decrease with
increase in age. This is because of a lowered BMR
and lessened physical activity.

Composition of diet:
• Proteins : It should be up to 12-14% of the total
calories should be from proteins. But, due to
decreased appetite and poor digestion, the elderly
tend to consume less protein.
• Fat : A diet with high content of saturated fatty acids
tends to increase the level of cholesterol in the
blood.
• Carbohydrates : It should be not less than 100
IMPORTANT CONSIDERATIONS IN THE
CARE OF GERIATRIC CLIENTS
Assessing the Needs of Older Adults
• The inter-relationship between physical and
psychological aspects of life
• The effects of disease and disability
• The decreased efficiency of homeostatic
mechanisms
• The lack of standards for health and illness
norms
• Altered presentation and response to specific
diseases.
Physiological Concern
Promotion of healthy lifestyle
• This includes exercise, sleep and stress
management. It will prevent the occurrence of certain
medical illnesses common in this age.

Preventive: Measures that nurse can recommend

• Regular exercise.
• Weight reduction, if overweight.
• Management of HTN
• Smoking cessation
• Immunization for influenza, pneumococcol
pneumonia and tetanus.
Diet In Elderly
• The energy requirements of a person decrease with
increase in age. This is because of a lowered BMR
and lessened physical activity.

Composition of diet:
• Proteins : It should be up to 12-14% of the total
calories should be from proteins. But, due to
decreased appetite and poor digestion, the elderly
tend to consume less protein.
• Fat : A diet with high content of saturated fatty acids
tends to increase the level of cholesterol in the blood.
• Carbohydrates : It should be not less than 100
grams per day.
Certain important minerals need to be included in diet
which are as follows:

• Calcium : As people become older, the bones

become demineralized. So calcium intake should be
not less than 400 mg per day.
• Iron : Deficiency leads to anemia. So the diet should
contain sufficient amount of iron. The recommended
daily allowance is 30 mg/day.
• Water : The fluid intake should be at least 1.5-2 liters
per day in a normal elderly person.
• Roughage or dietary fiber : Rough fiber is not well-
tolerated by the intestine in old people. But, the tender
fiber of vegetables, fruits and whole-grain cereals will
encourage normal bowel movements
Foods to avoid
• High fat foods : Saturated fats, eat products,
full fat dairy products.
• High sodium foods : Canned, processed foods,
salted nuts, sauce and salted snacks like nuts.
• Refined sugar: Cakes, cookies or candy.
PRESSURE INJURIES
• The older people have an aged skin and the
skin appears thin and fragile.
• The age-related changes may lead to
ulceration.
• All clinicians working with older people at risk
for, or suffering from pressure ulcers .
• Implement individualized and comprehensive
care.
MEDICATION IN GERIATRIC CLIENTS
• The elderly are at increased risk of adverse effects
with certain drugs.
• Risk of an adverse effect increases exponentially with
the number of drugs used.

Causes of increased risk are:

• Decreased body mass
• Decreased hepatic mass
• Decreased clearance
• Decreased GFR.
Nurse's Role
• Ensure safe and appropriate use of all
medications
• Older adults should be taught the names of all
drugs being taken
• When and how to take them, desirable and
undesirable effects of drugs
• Examine for potential interaction with food or
other drugs.
COMMUNICATION
• One important aspect of elderly nursing is
communicating effectively with the patient or
with family members.
Therapeutic touch
• Gentle touch conveys affection and friendliness
• It helps comfort the older adult
• Provide sensory stimulation
• Induce relaxation
• Provide physical and emotional comfort
• Convey warmth
• Communicate interest.
Communication technique for visual
impairment
• Sit or stand in front of the client in full view
• Face the older adult while speaking, do not
cover your face
• Provide diffuse, bright, non-glare lighting
• Encourage the older adult to use his or her
familiar assistive devices such as glasses.
Communication technique for hearing impaired
• Speak directly to the client, do not cover your mouth
• Speak in clear, low-pitched tones
• Reduce background noises
• Ask if there is a good ear and speak toward that ear
• Encourage to use assistive devices.
• Check the ear canal for cerumen impaction.
Reality Orientation
• It is a communication technique used to make an
older adult more aware of time, place and person.
Purposes
• Restoring sense of reality .
• Promoting socialization .
• Improving the level of awareness
• Elevating independent functioning.

Nurse's Role
• Frequent reminders of person, time and place
• Use of environmental aids such as clocks, calendars,
personal belongings
• Therapeutic communication
• Answer questions simply and honestly with sensitivity
and a caring attitude.
HOUSING AND ENVIRONMENT
• Changes in social roles, family responsibilities and
health status influence older adult's living
arrangements. Some choose to live with family
members, other prefer their own homes or
apartments near their families.
Management
• Color contrast should be good
• Furniture should be comfortable
• Furniture should provide back support
• Bed should be comfortable and getting out of bed
should be easier and safer.
Nurse's Role
• Assess environment, to promote
independence and functional ability
• Assess safety, find risks in the environment
and older adult ability to recognize and
respond to the risks
• Risk includes factors leading to injury, within
house, such as water heaters set at
excessively hot temperature, throw rugs that
could cause a fall.
Suicide:

– People older than 65 years (12 % of

population) represent disproportionately high
percentage of individuals who commit
suicide.
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.
Rheumatoid Arthritis
• Caused by inflammation of the joint lining in
synovial joints.
• Affect any joint, but is more common in peripheral
joints
• RA can cause functional disability, significant pain
and joint destruction, leading to deformity and
premature mortality.
Osteoarthritis
• Most common form of arthritis.
• Chronic, irreversible and degenerative condition
• Characterized by the breakdown of cartilage in
joints, which causes affected bones to rub against
each other leading to permanent damage.
 Heart Diseases
• Called as "silent killer" because it usually
produces no symptoms..
• Hypertension can cause certain organs (called
target organs), including the kidney, heart and
eyes deteriorate overtime
Diabetes
• Diabetes in old age is a serious sickness
• Yet another difficulty is reduction in weight of
the elderly, since they cannot be made to
undergo hard strenuous exercises.
Stroke
• There are 15 million people who have a stroke each
year.
• Stroke is the second leading cause of death for
people above the age of 60, and the fifth leading
cause in people aged 15 to 59 years.

Urinary Incontinence
• About one-third of women and 10% of all men above
60 years have incontinence.
• Incontinence is the loss of control over urine and fecal
elimination.. There are four principal types of
incontinence: urge, stress, overflow, and functional .
• Urge incontinence is generally caused by
uninhibited bladder contractions (detrusor
overactivity) that lead to leakage of urine.
In men, this condition often is accompanied by
urethral obstruction from BPH.
Urethral obstruction is common in older men but rare
in older women.
Cystoscopic examination and urinalysis may be
necessary to determine the cause.

• Stress incontinence is urinary loss related to

laughing, standing, coughing, or lifting heavy objects.
• Overflow incontinence (urinary frequency, nocturia,
and frequent dribbling) is related to detrusor
underactivity, which may be caused by sacral lower
motor nerve dysfunction (“neurogenic bladder”).

• Functional incontinence occurs when the patient

has either physical or psychological factors that
impair the ability to get to the toilet (e.g., a patient
who is wheelchair-bound or has dementia)
Social Isolation
• Isolation may be a choice, the result of a desire not to
interact with others
• May also be a response to conditions that inhibit the
ability or the opportunity to interact with others.
Causes of Isolation
• Loss of work role
- Health problems, i.e. impaired hearing, diminished
vision and
reduced mobility
- Feeling of rejection
- Feeling of unattractiveness.
RESOURCES FOR THE CARE OF OLDER ADULTS
Association of Gerontology, Banaras Hindu University,
Varanasi, India
• Founded in 1982.
Objectives
• To promote advancement of knowledge both by research
and training
• To organize scientific meetings, either under its own
auspices or jointly with other organizations, and
• To publish journals, reviews, abstracts, newsletter, etc. on
gerontology.
Activities
• It works to insure high standards of research and practice
in gerontology, and to maximize Conducts research in
biological, clinical and psychosocial aspects of
gerontology.
Indian Gerontological Association
• Professor KL Sharma, founded the Indian Gerontological Association
in 1968. In 1971, the association became affiliated with International
Association of Gerontology.
• Now the association runs a day-care center and counseling center for
senior citizens.

All India Senior Citizens Confederation

• It was formed in 2001, a national organization to bring together and
represent senior citizens across India. Today it has,
federations/associations covers following 14 states:
• Maharashtra, Karnataka, Andhra Pradesh, Gujarat, Chhattisgarh, Uttar
Pradesh, Madhya Pradesh, Bihar, Jammu & Kashmir Assam, Haryana,
Goa, Kerala and Rajasthan.
STEPS TAKEN BY GOVERNMENT
National Policy for Older Persons (NPOP)
• It was announced in 1999 by the Ministry of Social Justice &
Empowerment.
Objectives
• To enable and support voluntary organizations and NGOs to
supplement the care provided by the family
• To provide care and protection to the vulnerable group
• To provide healthcare facility to elderly and to promote research and
training facilities to the care givers
• To create awareness amongst elderly persons to develop themselves in
to fully independent citizen.
STEPS TAKEN BY GOVERNMENT
National Policy for Older Persons (NPOP)
• It was announced in 1999 by the Ministry of Social Justice &
Empowerment.
Objectives
• To enable and support voluntary organizations and NGOs to
supplement the care provided by the family
• To provide care and protection to the vulnerable group
• To provide healthcare facility to elderly and to promote research and
training facilities to the care givers
• To create awareness amongst elderly persons to develop themselves in
to fully independent citizen.
Features
Financial Security
• The old age pension scheme to eventually cover all eligible older
persons
• Pension scheme to be broadened to include both public and private
sectors
• The public distribution system to reach out to cover all 60+ living
below the poverty line.
Healthcare and Nutrition
• Providing public health services and health insurance
• Tax reliefs, grants, land grant at concessional rates to NGOs
• Private hospitals to provide economical and specialized care for the
older persons
• Setting up geriatrics wards and running of training and orientation
program for geriatric care
• Expansion of mental health services, counseling facilities for the
elderly having mental health problems.
Shelter
• Earmarking 10% of the houses in private and government housing
schemes and easy access to loans
• Layout of housing colonies to be sensitive to the needs of the older
persons
• Quick disposal of cases of property-transfer, mutation, property-tax,
etc.

Welfare
• Identify the more vulnerable among the older persons such as poor,
infirm and those without family support
• Assistance to voluntary organizations by way of grants in aid for
construction/maintenance of old-age home, day care centers, supply of
disability-related aids and appliances, etc.
Basic facilities
Providing identity cards
 Fare concession
Preference in reservation of seats
Earmarking of seats in local public transport
Modifications in designs of public transport
Priority in allotting gas and telephone connections, etc.

NGOs (Non governmental Organizations)

• Supporting NGOs and ensuring transparency, accountability,
simplification of procedures and timely release of grants to working
for the older persons.