Geriatric nursing ppt

Mr.Vikas Anil Ghadge
RJS College of Nursing

 A man life is normally divided into five main
stages namely infancy childhood adolescence
adulthood and old age. In each of these stages
an individual has to find himself in different
situations and face different problems. The old
age is not without problems, in old age
physical strength deteriorates, mental stability
diminishes, and money power become bleak
coupled with negligence from the younger
generation.

 Ageing is not merely the passage of time .it is the
manifestation of biological events that occur over
a span of time. It is important to recognize that
people age differently .the ageing body does
change. Some system slow down, while others
lose there “fine tuning “As a general rule, slight,
gradual changes are common, and most of these
are not problems to the person who experiences
them .sudden and dramatic changes might
indicate serious health problems.

 Biological aspect of ageing
 Psychological aspects of ageing
 Socio-cultural aspects of ageing
 Sexual aspects of ageing

 Individual are unique in there psychological
and physical and ageing processes. As the
individual ages, there is a quantitative loss of
cells and changes in many of enzymatic
activities within cells. Age related a change
occur at different rate in different people.

 Decreased the number of brain cells.
 Decrease in cell of the nerve fibres.
 Decreased neurotransmitter.
 Risk of injury due to diminished hearing, vision touch,
 Decreased pain sensation,
 Decreased balance,
 Decreased appetite leading to malnutrition due to
diminished sense of smell and taste.
 Incontinence of urine and stool due to decreased
sphincter tone.
 Forgetfulness due to diminished short term memory.
 Lowered self esteem due to kyphosis.

 Sensory losses with old age affect all sensory
organs and can be devastating to the person
who cannot see to read or watch television
hear conversation well enough to
communicate, or discriminate taste well
enough to enjoy food.

 Sensory losses can often be helped by assistive
devices such as glasses and hearing aids. In
contrast, sensory deprivation is the absence of
stimuli in the environment or the ability to
interpret existing stimuli (perhaps as a result of a
sensory loss). This deprivation can lead to
boredom, confusion, irritability, disorientation,
and anxiety. Meaningful sensory stimulation
offered to the older person is often helpful in
correcting this problem.

 As new cells form on the outside surface of
the lens of the eye, the older central cells
accumulate and become yellow, rigid, dense,
and cloudy, leaving only the outer portion of
the lens elastic enough to change shape
(accommodate) and focus at near and far
distances. As the lens becomes less flexible,
the near point of focus gets farther away. This
condition,“PRESBYOPIA”.

 Cataracts,
 Glaucoma,
 Diabetic retinopathy,
 And age –related macular degeneration in its most severe
forms, is the most common cause of blindness.
 In adults older than 55 years of age in the United States,
and it is estimated to affect more than 10 million
Americans.
 RISK factors include sunlight exposure, cigarette smoking,
heredity, and people with fair skin and blue eyes are much
more prone to the diseases.
 Sunglasses and hats with visors provide some protection.
Yearly eye checkups ensure early detection, which makes
surgical much more successful.

 PRESBYCUSIS, is a loss of the ability to hear high-
frequency tones attributed to irreversible inner ear
changes, occurs in midlife. Older peoples are unable
to follow conversation B/O tones of high – frequency
consonants (letters like F, S, TH, CH, SH, B T P) all
sound alike. Hearing loss may cause the older person to
respond inappropriately. Misunderstand conversation
and to avoid social interaction. This behaviour may be
erroneously interpreted as confusion. Wax builds up or
other correctable problems may be responsible for
major hearing difficulties. A properly prescribed and
fitted hearing aid may be useful in reducing hearing
deficits.

 There are 4 basic tastes: -sweet, sour salty, and
bitter sweet tastes are particularly dulled in
older people. Blunted taste may contribute to
the preference for salty, highly seasoned
foods, but herbs, onions, garlic and lemon
should be encouraged as substitutes for salt to
flavour food.

 Decreased elasticity
 Decreased Secretions of natural oil and
perspiration
 Thinning of skin
 Decreased heat regulation
 Protection against trauma and solar expose
 The number of pressure and light touch sensors
decrease with age
 Immune vascular and thermoregulatory response
of the skin decreased with age.
 Loss of hair colour and thinning of pubic, axillary
and scalp hair

 Hypertension
 Isolated systolic hypertension
 Primary hypertension
 Secondary hypertension
 congestive heart failure
 coronary artery disease
 arteriosclerosis,
 Hypertension intermittent claudication(leg pain
caused by walking)
 peripheral vascular disease,
 orthostatic hypotension

 Decreased gas exchange
 Decreased physical ability
 Increased potential for infection or aspiration
 Decreased elasticity of alveolar sacs
 Skeletal changes of chest
 Slower mucus transport
 Decreased cough strength
 Dysphasia

 Decreased physical activity due to decreased
muscle size and tone.
 Decreased mobility due to decreased range of
motion in joints affecting gait, posture,
balance and flexibility
 Increased risk of fall due to joint instability
osteoarthritis, joint pain, reduced ability for
activities of daily living of fracture due to
osteoporosis.

 GENITOURINARY SYSTEM
 Nocturnal
 Polyurea
 Decreased number of nephrons
 Impairing ability to concentrate urine and
 Eliminate medications which are excreted out
by the kidney.

 Difficulty in chewing
 Dry mouth
 Difficulty in digesting starches and fatty food
 Decreased appetite
 Malnutrition
 Feeling of fullness heart burn after meals
 Constipation pernicious anaemia

 Changes in women
 Decreased breast tissue
 Sexual dysfunctions
 Decreased sexual desire
 Vaginal narrowing and decreased elasticity
 Decreased vaginal secretions

 Changes in men
 In male decreased size of penis and testes
 Erectile ability undergoes changes. Takes
longer time for erection, amount of semen is
reduced and the intensity of ejaculation is
lessened.
 It is not clear that whether the increase in
importance is age related.

 Intellectual functioning
 Fluid abilities or abilities involved in solving
novel problems tend to decline from adult period
to old age.
 High degree of regularity in intellectual functions
presents on most of the old age people.
 Intellectual abilities of older people do not
decline, but do become absolute.
 There formal educational experience is reflected
in their intelligence performance.

 Learning ability
 The ability to learn is not decline by age
 The slowing of reaction time with age and over
arousal of central nervous system are noted in old
age. May leads to lower level of performance in
tasks which requires high efficiency.
 Ability to learn continues throughout the life,
although strongly influenced by personal interests
and preferences.
 Accuracy of performance diminishes.

 By the time individuals reach 60-70 years of
age they have experienced numerous losses,
and morning has become a lifelong process.
 It is impossible for some of the older age
people to complete the grief process in
response to one loss before the other loss
occurs.
 Because the grief is cumulative, this can result
in bereavement over load.

 The need for attachment is consistent
throughout the life span.
 Well being of senior citizens can be
contributed through socialization and
companionship.

 Death anxiety among the elderly is more of a
myth than reality
 The feeling of abandment, pain and loss may
leads to fear or anxiety in elderly

 The later life constitute a time of especially
high risk for emotional distress
 Dementia depressive disorder, delirium, sleeps
disorder etc at the most common psychiatric
illness seen among elderly

 Old age brings many important socially
induced changes, some of those change have
the potential for negative effect on both the
physical and mental well being of older
persons. They want protections from hazards
and wariness of everyday tasks. They want to
be treated with respect and dignity and also
want to die with respect and dignity.

 In developing countries and Asian countries the aged
are awarded a position of honor that place emphasis on
family cohesiveness. In industrialized countries many
negative stereotyped perspectives on aging still
persisting, aged are always tries or sick, slow and
forgetful, isolated and lonely, unproductive etc.
Emplacement is one of the area where the aged faces
discrimination .although compulsory retirements has
been eliminated, discrimination still persist in hiring
and promoting the aged employees. The status of
elderly may improve with time as the number of elder
person increases worldwide.

 Menopause may begin anytime during the 4os
or early 50s
 Gradual decline in the functioning of the
ovaries and subsequent reduction in the
production of estrogen
 The walls of the vagina become thin and
inelastic and vaginal lubrication decreases.
 Orgasmic uterine contractions become septic.

 All these changes result in vaginal burning,
pelvic aching, irritability etc.
 In some women these changes result in vaginal
burning in avoidance of sexual intercourse
 These symptoms are more likely to occur
infrequent intercourse of only one time a month
or less
 Regular and more frequent sexual activity result
in a greater capacity for sexual performance.

 Testosterone production decline gradually as
they increase
 As a result of these hormonal changes the
erection takes place slowly and requires more
genital stimulation to achieve.
 The volume of ejaculate decreases and the
force of ejaculation lessen
 The testis become smaller, but most men
continue to produce viable sperm well in to
old age.

 Three types of factor that mainly affect aging
 Genetic and environmental factor
 Life style
 Disease

 The ageing processes depends on a combination
of both genetic and environmental factors
recognizing that every individual has his or her
own unique genetic make and environment,
which interact with each other ,that is why the
ageing processes can occur at such different rates
in different people.
 Environmental stress associated with exposure to
excessive heat and light trigger the activity of
aging genes.

 However many environmental conditions,
such as the quality of health care that you
receive, have substantial effect on aging. A
healthy lifestyle is an especially important
factor in healthy ageing and longevity.

 Not smoking
 Drinking alcohol in moderation
 Exercising
 Getting adequate rest
 Eating a diet high in fruits and vegetables
 Coping with stress
 Having a positive outlook

 Ageing processes in men is mainly brought
about by over consumption of alcohol and
heavy smoking. Lack of exercise, inadequate
rest or sleep, mental stress show symptoms of
early aging. Other factors like regular
consumption of excessive spicy food and
caffeine renders an old look. Sloth and
sluggish lifestyle makes one feel old.

 Ageing and disease related in subtle and
complex ways. Several conditions that were
once thought to be part of normal ageing have
now shown to be due to disease processes that
can be influenced by lifestyle.

 Biological theories
 Non-biological theories
 Disengagement Theory
 Activity Theory
 Selectivity Theory
 Continuity Theory

 At present, the biological basis of ageing is
unknown. Most scientists agree that substantial
variability exists in the rates of ageing across
different species, and that this to a large extent is
genetically based. In model organisms and
laboratory settings, researchers have been able to
demonstrate that selected alterations in specific
genes can extend lifespan (quite substantially in
nematodes, less so in fruit flies, and less again in
mice) Even in the relatively simple and short-
lived organisms, the mechanism of ageing remain
to be elucidated.

 a)Disengagement Theory
 This is the idea that separation of older people
from active roles in society is normal and
appropriate, and benefits both society and
older individuals. There are research data
suggesting that the elderly who do become
detached from society as those were initially
reclusive individuals, and such disengagement
is not purely a response to ageing.

 In contrast to disengagement theory, this theory implies
that the more active elderly people are, the more likely
they are to be satisfied with life. The view that elderly
adults should maintain well- being by keeping active
has had a considerable history • However, this theory
may be just as inappropriate as disengagement for
some people as the current paradigm on the psychology
of ageing is that both disengagement theory and
activity theory may be optimal for certain people in old
age, depending on both circumstances and personality
traits of the individual concerned.

 Mediates between Activity and
Disengagement Theory, which suggests that it
may benefit older people to become more
active in some aspects of their lives, more
disengaged in others.

 The view that in ageing people are inclined to
maintain, as much as they can, the same habits,
personalities, and styles of life that they have
developed in earlier years. Continuity theory is
Atchley's theory that individuals, in later life,
make adaptations to enable them to gain a sense
of continuity between the past and the present,
and the theory implies that this sense of
continuity helps to contribute to well-being in
later life.

 Mental health problems among older adults
 Multiple social, psychological, and biological factors
determine the level of mental health of a person at any
point of time. As well as the typical life stressors common
to all people, many older adults lose their ability to live
independently because of limited mobility, chronic pain,
frailty or other mental or physical problems, and require
some form of long-term care. In addition, older people are
more likely to experience events such as bereavement, a
drop in socioeconomic status with retirement, or a
disability. All of these factors can result in isolation, loss of
independence, loneliness and psychological distress in
older people.

 Dementia is a syndrome in which there is
deterioration in memory, thinking, behaviour and
the ability to perform everyday activities. It
mainly affects older people, although it is not a
normal part of ageing. It is estimated that 47.5
million people worldwide are living with
dementia. The total number of people with
dementia is projected to increase to 75.6 million
in 2030 and 135.5 million in 2050, with majority
of sufferers living in low- and middle-income
countries.

 Depression can cause great suffering and leads to
impaired functioning in daily life. Unipolar
depression occurs in 7% of the general elderly
population and it accounts for 5.7% of YLDs
among over 60 year olds. Depression is both
under diagnosed and undertreated in primary care
settings. Symptoms of depression in older adults
are often overlooked and untreated because they
coincide with other problems encountered by
older adults.

 Elder abuse is a general term used to describe
certain types of harm to older adults. Other
terms commonly used include: "elder
mistreatment", "senior abuse", "abuse in later
life", "abuse of
 older adults", "abuse of older women", and
"abuse of older men".

 1. Physical abuse
 2. Psychological abuse
 3. Financial abuse
 4. Sexual abuse
 5. Neglect

 1. Physical abuse: (hitting, slapping, burning,
pushing, restraining or giving too much
medication or the wrong medication)
 2. Psychological abuse: (shouting, swearing,
frightening, blaming, ignoring or humiliating a
person)

 Financial abuse: (the illegal or unauthorized
use of a person’s property, money, pension
book or other valuables)
 4. Sexual abuse: (forcing a person to take part
in any sexual activity without his or her
consent - this can occur in any relationship)

 Neglect: (where a person is deprived of food,
heat, clothing or comfort or essential
medication) an older person may either suffer
from only one form of abuse, or different
types of abuses at the same time.

 Some numbers of facilities are provided to the
older persons by government and NGOs
 Some scheme facilities and agencies working
in the field of old age solutions are mentioned
 Social assistance programs
 National policy for older person (NPOP)
 National council for older person (NCOP)

 National old age pension scheme
 National family benefits scheme
 Pension for freedom fighters
 Old age homes
 60 + 60 declared as senior citizen

 Rebate on income tax
 More intrest in saving in bank
 Concession in fair
 Telephone connection under n-oyt category
 Separate ramps and queues, booking
reservation window, counters for elderly
 Insurance and pension scheme
 Employment scheme after retirement

 Geriatric clinics
 Special camps fix day service foe aged
 Separate registration and medicine counter
 Free supply of medicine to BPL elderly
 Free diagnosis/x-ray ECG
 Medical insurance
 Ambulance service
 Training to medical nursing paramedical for
care of elderly

 Legal protection for older person through
maintenance and welfare of parents and senior
citizen bill 2007
 Free legal aid/cells
 NGOs and voluntary agencies
 Help age India. Delhi (regional centers across
India)
 Rajasthan voluntary health association Jaipur

 Voluntary health association TTT institution
Chennai
 Healthy service societies Hyderabad
 Ramakrishna math and mission, belurmath,
Howrah west Bengal
 Sambandh, Bhubaneswar, Orissa
 Missionary of charity (mother Tarrasa centre)
Kolkata


 G [Guiding] : giving guidance to people of all ages
regarding ageing process.
 E [Eliminating] : eliminating the ageism or notion of old
age as disease.
 R [Respecting] : respecting the right of old people.
 O [Observing] : observing the facilities provided to old
people and improving them.
 N [Noticing] : noticing health hazards that may happen in
old age and try to reduce them.
 T [Teaching] : teaching how to take care of old people, for
those who are caring for them (family member, friends,
community health workers, voluntary organization)
 O [Opening Channels] : opening the channels of
development activities for the care of the aged.

 L [Listening] : listening attentively to the problem of old people and
giving importance to them.
 O [Offering] : offering positivism, presenting different possibilities to life.
 G [Generating] : generating energy for the participation in the care of
aged and researches for new supporting techniques.
 I [Implementing] : implementing activities for rehabilitation and re
adjustment.
 C [Coordinating] : co-ordinating different services related to care of the
aged.
 A [Assessing] : assessing the needs and the health of the old people.
 L [Linking] : linking contacting services according to need.

 N[Nurturing] : prepare future nurses for the care
of the aged.
 U [Understanding] : understanding every old
person as an invaluable asset of the society.
 R [Recognizing] : recognizing the moral and
religious aspect of old age.
 S [Supporting] : supporting the old people in
accepting realities.
 E [Education And Encouraging] : educating
and encouraging old people for selfcare.

 Shebeer.P .Basheer S. YaseenKhan; A concise Text Book of
ADVANCED Nursing Practice:Ist edition Bangalore:emeses
medical publisher; 2012. Page no 742-51.
 2. Krishnakumari; Community health nursing –Principles
and Practices: Ist edition Jabalpur; Kumar Publishing house
, publishers of medical and nursing book,2008. Page no
479-90.
 3. Park k. Textbook of preventive and social medicine:
21st edition New Delhi banarsidas bhanot publishers: 2012.
 4. Potter perry Fundamental of Nursing: 6thedition:
published by Elsevier,A division Reed Elsevier India
Private Limited. Page no 237-57
 5. Long Phipps Cassmeyer, Medical-Surgical Nursing:
3rdEdition: Publisher A lison Miller. Page no 47-69.

Geriatric nursing ppt

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