INTRODUCTION The broader field of gerontology is the study of ageing process includes the biologic, psychological and sociological

sciences .Gerent logical nursing is the field of nursing that specializes in care of the elderly. Standards and scope of gerent logical nursing practice were originally developed in 1969. and revised in 1976 and 1987 by the American nurses Association. The nurse gerontologist can be either a specialist or a generalist offering compressive nursing care to the older person. Gerontology nursing can be provided in acute, chronic and community settings. The nurse helps the older person to maintain dignity and maximum autonomy despite physical, social psychological losses. Because older age is normal occurrence that encompasses all experiences of life, care and concern for the elderly cannot be limited to one discipline. Optimal care of the elderly cannot be limited through a co-operative effort. Nurse collaborates with the interdisciplinary team to obtain non- nursing services and provide a holistic approach to care. DEFINITION [ACC. TO BRUNNER AND SUDDARTHS: 2001] GERIATRICS:-It is the study of old age includes the physiology, pathology, diagnosis and management of the disease of older adults. GERENTOLOGICAL NURSING:-It is the field of nursing that specializes in the care of elderly. PSYCHOSOCIAL ASPECTS OF AGEING Successful psychological ageing is reflected in the older persons ability to adapt to physical, social and emotional losses and to achieve contentment, serenity and life satisfactions. Because changes in life patterns are inevitable over a life time, the older person needs residency and coping skills when confronting stresses and change. Positive self image enhances risk taking and participation in new, untested roles. Although attitudes towards old people differ in ethnic subcultures, a subtitle theme of ageism- prejudice or discrimination against older people predominates our society. Fear of ageing and inability for many to confront their own ageing process may trigger against beliefs. Retirement and perceived non productivity are also responsible for negative feelings. If the elderly are treated with dignity and encouraged to maintain autonomy, the quality of their lives will improved. STRESS AND COPING IN OLDER ADULT Knowledge of success in younger adulthood helps a person develop a positive self- image that remains solid even with adversities of age. A persons ability to adapt to changes, to make decisions and responds predictably is all

determined by past experiences. A flexible, well- functioning person will probably, continue such common stressors of older age include normal ageing changes that impair physical function , activities and appearance; disabilities of chronic illness; social and environmental losses of income ,roles and activities and the death of significant others. DEVELOPMENTAL THEORIES OF AGEING [ Erickson-1963] He delineated the major developmental task old age as ego integrity versus despair. Ego integrity suggests an acceptance of ones lifestyle and a belief that choices made were the best that could be made at a particular time. Despair the opposite of ego integrity, implies that older person feels dissatisfied and disappointed with his or her life. SOCIOLOGICAL THEORIES OF AGEING It attempts to predict and explain the social interactions and roles that contribute to the older adults successful adjustment to the old age ACTIVITY THEORY [ Havighurst-1972]:-It popes that life satisfaction in normal ageing involves maintaining the active lifestyle of middle age. CONTINUITY THEORY [Atchley-1989, Neugarten-1961]:-It proposes that successful adjustment to old age rests with the ability of person to continue across a life time. COGNITIVE ASPECTS OF AGEING Intelligence:-When intelligence test scores from people of all ages are compared, test scores for older adults show a progressive decline beginning in midlife; however if has been demonstrated that environment and health have a considerable influence on a score and their decline, where as other types donot[ problem-solving ability based on experiences, verbal comphrensive] Learning and memory:- The ability to learn and acquire new skills and information decreases in the older adult. Many older people continue to learn and participate in varied educational experiences. Components of memory that include short memory [5-3sec], recent memory [1 hr-several day] and long term memory etc

DEMOGRAPHICS OF OLDER PEOPLE The older population numbered 35.9 million in 2003.At closer look at the demographics of the generation revealed in 2003 a sex ratio of 140 women for every 100 men. Minority populations of this generation represents today about 17.6 % of all older adults, with projections that the minority composition will double by 2030.Most older adults live in a noninstitutional community setting and a majority [67%] of them live with someone else significantly as one ages. In 2004 37.4 % of noninstitutionalized older persons assessed their health as excellent to very good. IMPORTANCE OF GERENTOLOGIC CONSIDERATION IN NURSING Nurses are key providers of health and social care and as such their work has come under increasing scrutiny by policy makers as well as service purchasers and providers in terms of cost effectiveness and quality of service. It seems important therefore to establish the thoughts and views of the older people who are in recipient of continuing care services. Nurses who work with older people have produced the value and skills and continuing care. Patient regarded easy exchange of thoughts and ideas as essential part of therapy. Older people appearly to feel especially strongly about professional attitudes and have indicated a strong need to be treated as individuals and with respect. The older people valued hospitality, social interaction, reciprocity and expected their doctor to be more paternalistic than the younger informants did. To ascertain the value which the older people who are residents in continuing care settings, place on nursing. COMMUNITY BASED MODEL FOR GERENTOLOGICAL NURSING Communities are where older people live, work and socialize. Often older people can remain in the setting of their choice by modifying their environment and obtaining support services. Community health settings include public health departments, nurse managed health centers, ambulatory care clinics and home health agencies. Legislation that affects the health care system is a product of that culture. In 2000 the organization that administers Medicare and Medicaid changed in name from health care financing administration to center for medicine and Medicaid services Most of the individuals to wish to stay in their own homes and communities and will be frequent consumers of health services. Nurses are involved in direct care, providing self care information, contributing the supervision of paraprofessionals, or collaborating with other disciplines to provide the most appropriate , high quality, cost effective care at the most appropriate level and location.

Knowledge of resources is a fundamental part of caring for the older adult in any community. The nurse assees the need for health and helps develop the sources CHANGES OF BODY SYSTEM Cardiovascular: - Decreased cardiac output and increased blood pressure. Respiratory:-Increase in residual lung volume, decrease in vital capacity and decreased gas exchange. Integument:-Decreased protection against trauma and sun exposure, decreased protection against temperature. Reproductive [Male]:-Decreased size of penis and tests, slower sexual response. [Female] Vaginal narrowing, decreased elasticity vaginal secretions and slower sexual response Musculosketal:-Loss of bone density, muscle strength and size. Genitourinary[Male]:-Benign prostate hyperplasia [Female]Relaxed perineal muscles, urgue incontinence, stress urinary incontinence Gastrointestinal:-Decreased salivation, dysphagia, reduced gastrointestinal mobility, delayed esophageal and gastric emptying. Nervous system:-Reduced speed in nerve conduction, increased confusion with physical illness loss of environmental cues and reduced cerebral circulation. Special senses [Hearing]:- Decreased ability to hear high frequency sounds. [Taste and Smell]Decreased ability to taste and smell . [Vision]:-Inability to tolerate glare, difficulty adjusting to changes of light intensity; decreases ability to distinguish colours. Mental health:-Cognitive impairment, organic mental disorder and Alzheimers disease HEALTH ASSESSMENT Nurse in community health emphasize wellness with the goal of maintaining optimal function, physically, mentally, socially and spiritually as to be as independent as possible for as long as possible.

Functional assessment:As a measure of physical and mental abilities to ADLs functional assessment is an important parameter for determining an elders ability for self care at home. In addition to self reports by the elder and family members , the ability to perform the ADLs also need to be observed by the nurse by having the elder perform as many of these activities as possible. Physical assessment Emphasis is placed on areas the most impact functional ability [eg:vision hearing and strength]The health history for older adult must include frequent enquiries about exercise, nutrition, medication use, substance use, incontinence, memory, depression, social activities and isolation. In addition to the usual height, weight, blood pressure needs to be checked sitting, lying and standing for orthostatic hypotension, a common problem in elders. Along with usual adult physical examination, vision and hearing, mouth, skin, breast [for woman], and men [prostate] and feet need to be assessed. Complete blood count, urine analysis, thyroid screen are done periodically depending on the situation. Mental assessment It is focused on memory and mood. Cognitive functioning; orientation, registration, attention and calculation, recall and language and praxis. Elders with significant mental or emotional impairments are referred their primary care provider for the evaluation and treatment. Socienvironmental assessment These factors are asses to identify family and living situations, social support systems, financial status and environment hazards.A homesafely checklist may be administerd on the initial visit and periodicvally thereafter to monitor for the hazards contributing to accidents, falls and injuiries in elders. In analyzing the findings of geriatric assessment, nurse must remember that effects of normal ageing are being redefined continuously. NEEDS & PROBLEMS OF THE ELDERLY PEOPLE IMPAIRED MOBILITY The common cause include parkinsons osteoarthritis, sensory deficits etc. disease, diabetic neuropathy,

o Elderly patients should be encouraged to stay as active as possible to avoid the the downward spiral of immobility o Treat the existing problem o Bed rest should be provided o The patient should perform active range of motion exercise o Frequent position changes hlp offset the hazards of immobility DIZINESS Older people frequently seeks help for dizziness. It presents a particular challenge because there are so many possible internal & external causes. The causes for these sensations range in severity from minor, as in build up of ear wax, to significant, as in dysfunction of the cerebral cortex, cerebellum , brain stem etc. o o o o o Provide treatment for internal or external causes Bed rest should be provided Give plenty of water Check the vitals in between Be with the patient

FALLS & FALLING Its a common & preventable source of mortality & morbidity in older adults. A result of multiple possible physiologic & iatrogenic disorders ,falls causes further negative sequels. o Treat the underlying cause o Restraints in the form of physical modalities(lap belts, geriatric chairs etc) o Chemical modalities (medications) URINARY INCONTINENCE It can be acute & develop during an illness, or it can develop chronically. Over a period of years it may be due to neurological or structural abnormalities. The pelvic floor serves as the supporting mechanism or Hammock for the bladder, uterus & rectum It may have become weakened as a result of pregnancy, labor & delivery, prior pelvic surgeries. o o o o Treat the underling cause Encourage the patient to do kegal exercise Keep urinal with the patient Behavioral therapy

ALTERD RESPONSE TO ILLNESS o The interdisciplinary team & the nursing staff can help avert negative outcomes of being acknowledgeable about the physiologic & psychological responses of older adult to acute illness by planning & implementing measures. o Careful & frequent assessment of vitals, mental status, Fluid balance, skin integrity o Promotion of independent & self care & mobility o Assistance with frequent positioning & deep breathing exercises & toileting ALTERD EMOTIONAL IMPACT The emotional component of illness in older people may differ from that in younger people. Many elderly people equate good heath with the absence of old age. o The nurse must recognize the implication of fear, anxiety & dependency in elderly patients o Autonomy & independent decision making are encouraged o A positive & confident demeanor in the nurse & the family promote a positive mental outlook in the elderly patients OLDER ADULT IN A PROTECTED ENVIRONMENT o Many housing communities for older people provide opportunities for socialization & recreation o Life care communities offers all the features of refinement communities plus health care & skilled nursing care units. o Nursing homes offer a variety of health & personal services that include skilled nursing care & rehabilitation. o The nurse & social worker can function as advocates, emphasizing this point & encouraging a family decision that includes the patient. NEEDS IN FAMILY o Planning for care & understanding the psychosocial issues confronting the older person must be accomplished within the context of the family o In the absence spouse, an adult child is usually assume caregiver responsibilities & eventually may need help in providing care & support o Regardless of the amount of responsibility & love the adult child exhibits towards the dependent elderly patients, strains develop if care continues over a long period of time.

NEEDS IN THE HOME ENVIRONMENT 1. SAFETY & COMFORT o Injuries rank 7th as a cause of death for older people. The nurse can encourages lifestyle & environmental changes that the older adult & his or her family can adopt o Adequate lighting with minimal glare & shadow can be achieved through the use of small area lamps, indirect lighting shear curtains to diffuse direct sunlight, dull rather than shiny surfaces & night lights. o Loose clothing, improperly fitting shoes, scatter rugs, small objects & pets create hazards & increase the risk of accidents 2. PERSONAL SPACE o Older people needs a place of his or her own, a special location that can offer security, comfort & privacy. The nurse can help the older person to maintain his or her space. MEDICATIONS & ELDERLY Medications have improved the health & wellbeing of older people by alleviating symptoms of discomfort, treating chronic illness & curing infectious process. The nurse administering medications to older people must be aware of following:o Dosage often must be reduced o Overdoses & medications toxicity at usual therapeutic dosages are common o Review the medication schedule periodically o Encourage him or her, take the medications regularly COMMUNITY PROGRAMMES & HEALTH SERVICE Hospital & health services are used by the elderly more than by other age groups in the population. Disabilities resulting from chronic illness create the need in elders for help with basic activities of daily living. Community programmes provide help beyond the capabilities of informal supports. Such valuable services as health care at home or in an adult day care centre, opportunities for socialization, transportation & home delivered meals often keep the older person in the community & need for nursing home 1. HOME CARE

o The older adults usually prefers to live independently, even if he or she has difficulty getting around the home. This may be against the wishes of the persons adult children o The home care include supports from family, friends, the mail carrier church members & neighbors, telephone reassurance 2. HOSPICE SUPPORTS OR SERVICES o Hospice has been described as a programme of supportive & palliative services for dying patients & their families include physical, psychological, social & spiritual dimensions of care o The family must agree to assist in the care of the patients & services are brought into the home as needed. MENTAL ILLNESS o o o o o o . Supporting cognitive functions Promoting physical safety Reducing anxiety & agitation Improving communication skills Promoting independence in self care activities Providing for socialization & intimacy needs NURSES ROLE IN COMMUNITY CARE SETTINGS

SENIOR CENTERS:-Senior centers were developed in the early 1940s to provide social and recreational activities. Now many centers are multipurpose, offering recreation, education, counseling, therapies, hot meals and case management, as well as health screening and education. Nurses have a unique opportunity to provide services to a group of older persons who wish to remain independent in the community. ADULT DAY HEALTH:-This for individuals whose mental or physical function requires them to obtain more health care and supervision. It serves as more of medical model than the senior centre, and often individuals return home to their caregivers at night. Some settings offer respite care for short term overnight relief for caregivers. Support groups for care givers are offered by nurses. HOME HEALTH:-It can be provided by multidisciplinary teams. Nurses provide individual and environmental assessments, direct skilled care treatment and short term guidance and instruction. Nurses often function independently in the home and must rely on their own resources and knowledge to improve and adapt care to meet the clients unique physical and social circumstances. They work closely with the family and other caregivers to provide necessary communication and continuity of care.

HOSPICE:-It represents a philosophy of caring for and supporting life to its fullest until death occurs. The team encourages the client and family to jointly make decisions to meet physical, emotional, spiritual and comfort needs. ASSISTED LIVING:-It covers a wide variety of choices, from a single shared room to opulent independent living accommodations in a full service, life care community. The differences are related to the type and extend of the amenities provided and the contract signed for them. The role of nurse varies depending on the philosophy and leadership of the management of the facility. The nurse generally provides assessments and interventions, medication review, education and advocacy. LONG TERM CARE:-Nursing home provides a safe environment, special diets and activities, routine personal care and the treatment and management of health care needs for those needing rehabilitation, as well as those needing a permananent supportive residence. REHABILITATION:- It is a combination of physical, occupational, psychological and speech therapy to maintain or recover their physical capacities. Rehabilitation is typically needed for older adults after a hip fracture, stroke or prolonged illness that results in serious reconditioning. ROLE OF NURSE IN HEALTH PROMOTION, PREVENTION AND WELLNESS Nurses in the community focuses on the prevention of disease and the promotion and maintenance of health. To achieve these goals nurses are involved in client and community education, counseling, advocacy and case management. The goal is improving the health of the individual and the community through collaborative practice with other members of the health care team. Achieving this goal involves the nurse in all 3 levels of prevention. Nurses should be familiar with the guidelines for preventive services and screening activities for individuals 65 yrs of age and older. The term wellness was coined by Travis [2004] to help bring to mind the idea of health as holistic rather than merely the absence of disease or illness. It includes physical, emotional, mental and spiritual components. Travis [2004] outlined five dimensions of wellness. Self responsibility:-The core of wellness, encouraging self strategies, taking control of health and life choices and partnering with health care providers rather than abdicating control. Nutritional awareness:- Learning about the selection and preparation of food and developing eating habits that lead to more balanced, nutritionally appropriate diet.

Physical fitness:-Involving aerobic capacity, body structure, body composition, balance muscle flexibility and muscle strength. Stress management:-Developing attitudes and ways to cope with events in life that seem beyond control and that cause negative physical and mental problems. Environmental sensitivity:-Influencing ones personal room or home space; physical earth, issues of conservation and pollution and social components of government, economics and culture. NURSES ROLE IN ETHICAL AND LEGAL ISSUES AFFECTING OLDER ADULT Loss of rights, victimization and other grave problems face the person who has made no plans for personal and property management in th e event of disability or death. The nurse as an advocate encourage the older person to prepare advance directives for future decision making in the event of incapacitation. Power of attorney is a legal agreement that authorizes a person who is designated by the older people to act in specific, outlined purpose on behalf of the signer. A trust is another option that competent older person can consider. If incompetent older person can consider. If incompetence or disability occurs, management of the property is undertaken according to the persons wish. [PSDA] Patient self- determination act, a federally mandated law, was enacted to require patient education about advance directives at the time of hospital admission documentation of education is also required. PSDA is also mandated in nursing homes with the primary goal of enhancing resident autonomy by increasing involvement in health care decision making. TRAINING AND SUPERVISION FOR ELDRELY PEOPLE IN THE HOME: Home safety assessment and equipment Meals on wheels Home maker and core services Telephone reassurance and friendly visitor Personal emergency response system Pharmacies or grocers that develop Area agencies on ageing services State health, legal , social, service departments Adult protective services- city social services Home health aide Home health nurses and therapists Hospice

IN THE COMMUNITY: o Specialized transportation for disabled o Multipurpose senior centers o Health screenings, health fairs o Congregate meal services o Community mental health clubs o Adult day health care o Respite care o Community nursing clinics o Comphrensive geriatric medical services o Medicare and Medicaid health maintenance organizations o Care giver or disease focused support groups o Case or disease management o Health promotion or self care classes IN SPECIAL HOUSING: Elder cottage housing opportunity Home sharing Accessory apartments Foster home Group home Assisted living facility Life care community Retirement village Intermediate care facility Skilled nursing facility Rehabilitation hospital Sub acute unit or hospital Acute care hospital State mental hospital AGENCIES AND WELFARE PROGRAMME FOR ELDERLY PEOPLE HEALTHY PEOPLE 2010 FOR OLDER ADULTS : The goals are to maintain their health and functional independence and compress morbidity and dependence into the shortest possible time objectives related to improvements in nutrition, tobacco use reductions, weight control, physical activity, immunizations and health care visits are focused on all age groups. Community health nurses can healp address the need for more health education and programmes for older adults. FEDERAL PROGRAMMES Social security act of older peoples, 1935 Department of health and human services administration on ageing State and area agencies on ageing

Multipurpose senior centers Senior employment Volunteer programmes Foster grand parents Senior nutrition programme Health education and prevention activities Administer Medicare and Medicaid insurance programmes Offer food and nutrition programme Offer low-cost public housing for elders

NATIONAL PRIVATE AND VOLUNTARY NON PROFIT PROGRAMME National council on ageing,1980 as a national resources for information, consultation, sponsors publication, special programmes, advocacy activities, research and training Health promotion institute National elder care institute of health promotion Enhance knowledge and skills of those working with older adults and their families. Multidisciplinary professional and scientific organization for those working in the field of gerontology. Chelating therapy: It is used to treat atherosclerosis and other chronic TYPES OF ALTERNATIVE MEDICINES COMMONLY USED IN ELDERLY Chelating therapy: It is used to treat atherosclerosis and other chronic degenerative disease through intravenous infusions of ethylene diamenetetraacetic acid. Chiropractic medicine: It focuses on the spine as integrally involved in maintaining health and balance. It is primarily used to treat lower back neck pain. Naturopathy: It is philosophy and a way of life that emphasizes the bodys ability to heal itself by the use of remedies such as nutritional counseling, homeopathy, herbs, massage, yoga, hydrotherapy and fresh air and general avoidance of drugs and surgery. Acupunture:It is the practice of inserting needles into specific points along the body meridian system to treat disease, relieve pain and the balance flow of energy in the body. REHABILITATION FOR OLDER PEOPLE It is a combination of physical, occupational, psychological and speech therapy to maintain or recover their physical capacities. Rehabilitation is typically needed for older adults after a hip fracture, stroke or prolonged illness that results in serious reconditioning.

The nursing reflects a minor participative approach to care which implies involvement of the client in establishing goals which reflect to some degree their needs and wants. Rehabilitation with older people is about being positive. It doesnt just take place in special units, but continues in the persons own home, in hospital, or in care homes. Older people have the potential to improve or maintain their health status, even if remaining highly dependent on others. All members of the team should participate in the process of enabling and facilitating older people to ensure they are able to achieve the maximum movement and mobility. The nurses care plan should facilitate choice ion a range of activities that encourages physical activity. The nurse role, working with in the multidisciplinary team in any care home setting, should aim to prevent any further loss of mobility, maintain and improve current ability, even on a very small scale, should always be striving to enhance quality of life. In order to achieve these goals the nurse should have working knowledge of the roles of the occupational therapists and chiropodist, on order to understand how their specialist skills can be used affectively to encourage good nursing. SUMMARY The geriatric consideration in nursing deals with health assessment, systemic changes, various models & theories, training & supervision for elderly, agencies & welfare programmes for elderly & role of nurses in various levels. CONCLUSION Gerentologic nursing is the field of nursing that specializes in care of elderly. Emphases of care is placed on promoting & maintaining functional status, thus promoting independence. The nurse helps the older persons to maintain dignity & maximum autonomy despite physical, social & psychological losses. Optimal care of the elderly people can best be provided through a cooperative effort. An interdisciplinary team, through comphrensive geriatric assessment, can combine expertise & resources to provide insight to all aspects of the ageing process. l BIBLIOGRAPHY Brunner & suddarths (2003), Text book of medical surgical nursing, 9 th edition, Library of congress cataloging publication, Pp no:148-171 Potter & perry(2000), Fundamentals of nursing,mosbys publication,ist edition

Ppno:243-269 Marcia Stanhope(2007), Public health nursing, mosbys publication,7 th edition Pp no:664-682 Phipps(2002), Medical surgical nursing,mosbys publication, 7 th edition,Ppno: 52-70