Lesson 12: Factors that affect normal functioning thickness, is also responsible for a decline in the

of the older persons body’s natural insulation, making

AGING older adults more sensitive to cold temperatures.B.
 Aging is a progressive deterioration of physiological Respiratory System
function, an intrinsic age-related  The changes to the respiratory system are
process of loss of viability and increase in vulnerability. apparent at the entrance to the system with
 Aging is the process of becoming older, a process changes to the nose.
that is genetically determined and  Connective tissue changes cause a relaxation of
environmentally modulated. the tissue at the lower edge of the
Characteristics of Aging septum; the reduced support causes the tip of the
• Biological ageing starts at 45 years of age in humans. nose to slightly rotate downward. Septal
• Ageing is inevitable, irreversible, progressive in deviations can occur, as well.
nature and is associated with physiological  Mouth breathing during sleep becomes more
and biological declines. common as a result, contributing to snoring
• Aging is a complex process composed of several and obstructive apnea.
features:  The submucosal glands have decreased
1. An exponential increase in mortality with age; secretions, reducing the ability to dilute mucus
2. Physiological changes that typically lead to a secretion; the thicker secretions are more difficult to
functional decline with age; remove and give the older person a
3. Increased susceptibility to certain diseases with age sensation of nasal stuffiness.
1. Social factors affecting old age  Various structural changes occur in the chest with
1. Old age is accompanied by role change and, often, age that reduce respiratory activity.
role loss expect transformations in  The calcification of costal cartilage makes the
occupational, family, and community roles. trachea and rib cage more rigid; the
1. Education, Work, and Financial Status anterior–posterior chest diameter increases, often
- Education: changes perception and thinking about life demonstrated by kyphosis; and
and health thoracic inspiratory and expiratory muscles are
- Work: lack of work, loss of income, continuous work weaker.
help physically as well as  There is a blunting of the cough and laryngeal
financially reflexes. In the lungs, cilia reduce in number
- Financial status: retirement, loss of income and there is hypertrophy of the bronchial mucous
- Source of income: pension plans, social security, gland, further complicating the ability to
personal earnings, asset incomes expel mucus and debris.
2. Marriage and Widowhood:  Alveoli reduce in number and stretch due to a
3. Retirement and Grandparenthood: progressive loss of elasticity—a process
4. Extended Families, Friends, and Group Involvement that begins by the sixth decade of life.
2. Physiologic Changes in Aging
 The lungs become smaller, less firm, lighter, and
1. Cells
more rigid and have less recoil.
 Organ and system changes can be traced to
 The sum of these changes causes less lung
changes at the basic cellular level. The
expansion, insufficient basilar inflation, and
number of cells is gradually reduced, leaving fewer
decreased ability to expel foreign or accumulated
functional cells in the body.
matter.
 Lean body mass is reduced, whereas fat tissue
 The lungs exhale less effectively, thereby
increases until the sixth decade of life.
increasing the residual volume.
Total body fat as a proportion of the body’s
 As the residual volume increases, the vital
composition increases (St-Onge &
capacity is reduced; maximum breathing
Gallagher, 2010; Woo, Leung, & Kwok, 2007).
capacity also decreases.
 Cellular solids and bone mass are decreased.
 Immobility can further reduce respiratory activity.
Extracellular fluid remains constant,
The decline in ventilatory capacity is
whereas intracellular fluid is decreased, resulting in
noticeable primarily when an extra breathing
less total body fluid. This decrease
demand is present, as the lower pulmonary
makes dehydration a significant risk to older adults.
reserve results in dyspnea more easily occurring.
A /Physical Appearance
 With less effective gas exchange and lack of
 Many physical changes of aging affect a person’s
basilar inflation, older adults are at high risk
appearance. Some of the more
for developing respiratory infections. Endurance
noticeable effects of the aging process begin to appear
training can produce a significant
after the fourth decade of life.
increase in lung capacity of older adults.
 It is then that men experience hair loss, and both
C. Cardiovascular System
sexes develop gray hair and wrinkles.
 Some cardiovascular changes commonly
 As body fat atrophies, the body’s contours gain a
attributed to age actually result from
bony appearance along with a
pathological conditions.
deepening of the hollows of the intercostal and
 Heart size does not change significantly due to
supraclavicular spaces, orbits, and
age; rather, enlarged hearts are associated
axillae.
with cardiac disease, and marked inactivity can
 Elongated ears, a double chin, and baggy eyelids are
cause cardiac atrophy.
among the more obvious
 There is a slight left ventricular hypertrophy with
manifestations of the loss of tissue elasticity throughout
age, and the aorta becomes dilated and
the body.
elongated.
 Skinfold thickness is significantly reduced in the
 Atrioventricular valves become thick and rigid as a
forearm and on the back of the hands.
result of sclerosis and fibrosis,
 The loss of subcutaneous fat content, responsible for
compounding the dysfunction associated with any
the decrease in skinfold
cardiac disease that may be present.
 There may be incomplete valve closure resulting in  After 30 years of age, periodontal disease is the
systolic and diastolic murmurs. major reason for tooth loss. More than
 Extra systolic sinus bradycardia and sinus arrhythmia half of all older adults must rely on partial or full
can occur in relation to irritability of dentures, which may not be worn regularly
the myocardium. because of discomfort or poor fit.
 Throughout the adult years, the heart muscle loses  If natural teeth are present, they often are in poor
its efficiency and contractile strength, condition; fracture easier; and have
resulting in reduced cardiac output under conditions of flatter surfaces, stains, and varying degrees of
physiologic stress. Pacemaker erosion and abrasion of the crown and root
cells become increasingly irregular and decrease in structure.
number, and the shell surrounding the  The tooth brittleness of some older people creates
sinus node thickens.  The isometric contraction phase the possibility of aspiration of tooth
and relaxation time of the left ventricle are prolonged; fragments.
the  Taste sensations become less acute with age
cycle of diastolic filling and systolic emptying requires because the tongue atrophies, affecting the
more time to be completed. taste buds; chronic irritation (as from pipe smoking)
 Usually, adults adjust to changes in the can reduce taste efficiency to a greater
cardiovascular system quite well; they learn that degree than that experienced through aging alone.
it is easier and more comfortable for them to take an  The sweet sensations on the tip of the tongue tend
elevator rather than the stairs, to to suffer a greater loss than the
drive instead of walking a long distance, and to pace sensations for sour, salt, and bitter flavors.
their activities.  Excessive seasoning of foods may be used to
 When unusual demands are placed on the heart compensate for taste alterations and could
(e.g., shoveling snow for the first time of lead to health problems for older individuals.  Loss
the season, receiving bad news, and running to catch a of papillae and sublingual varicosities on the tongue
bus), the person feels the effects. are common findings.
 The same holds true for older individuals who are not  Older adults produce approximately one third of
severely affected by less cardiac the amount of saliva they produced in
efficiency under non-stressful conditions. younger years.
 When older persons are faced with an added  Saliva often is diminished in quantity and is of
demand on their hearts, however, they note increased viscosity because of some of the
the difference. medications commonly used to treat geriatric
 Although the peak rate of the stressed heart may not conditions. Salivary ptyalin is decreased,
reach the levels experienced by interfering with the breakdown of starches.
younger persons, tachycardia in older people will last  Diminished muscle strength and tongue pressure
for a longer time. Stroke volume can interfere with mastication and
may increase to compensate for this situation, which swallowing.
results in elevated blood pressure,  Esophageal motility is affected by age.
although the blood pressure can remain stable as  Presbyesophagus is a condition characterized by
tachycardia progresses to heart failure a decreased intensity of propulsive
in older adults. waves and an increased frequency of non-propulsive
 The resting heart rate is unchanged. waves in the esophagus.
D. Gastrointestinal System  The esophagus tends to become slightly dilated,
 Although not as life threatening as respiratory or and esophageal emptying is slower,
cardiovascular problems, gastrointestinal which can cause discomfort because food remains in
symptoms may be of more bother and concern to older the esophagus for a longer time.
persons.  Relaxation of the lower esophageal sphincter may
 This system is altered by the aging process at all occur; when combined with the older
points. person’s weaker gag reflex and delayed esophageal
 Changes in the teeth and mouth and accessory emptying, aspiration becomes a risk.
structures such as the liver also affect  The stomach is believed to have reduced motility
gastrointestinal function. in old age, along with decreases in
 Tooth enamel becomes harder and more brittle with hunger contractions.
age. Dentin, the layer beneath the  Studies regarding changes in gastric emptying
enamel, becomes more fibrous and its production is time have been inconclusive, with some
decreased. claiming delayed gastric emptying to occur with
 The nerve chambers become narrower and shorter normal aging and others attributing it to
and teeth are less sensitive to stimuli. other factors.
 The root pulp experiences shrinkage and fibrosis, the  The gastric mucosa atrophies.
gingiva retracts, and bone density  Hydrochloric acid and pepsin decline with age; the
in the alveolar ridge is lost. higher pH of the stomach contributes
 Increasing numbers of root cavities and cavities to an increased incidence of gastric irritation in the
around existing dental work occur. older population.
 Flattening of the chewing cusps is common. The  Some atrophy occurs throughout the small and
bones that support the teeth decrease in large intestines, and fewer cells are
density and height, contributing to tooth loss. present on the absorbing surface of intestinal walls.
 Tooth loss is not a normal consequence of growing  There is a gradual reduction in the weight of the
old, but poor dental care, diet, and small intestine and shortening and
environmental influences have contributed to many of widening of the villi, leading to them developing the
today’s older population being shape of parallel ridges rather than
edentulous. the finger-like projections of earlier years.
 Functionally, there is no significant change in mean  The seminiferous tubules experience increased
small bowel transit time with age. fibrosis, thinning of the epithelium,
 Fat absorption is slower, and dextrose and xylose thickening of the basement membrane, and
are more difficult to absorb. Absorption narrowing of the lumen.
of vitamin B, vitamin B12, vitamin D, calcium, and iron  The structural changes can cause a reduction in
is faulty. sperm count in some men.
 The large intestine has reductions in mucous  Increases in follicle-stimulating and luteinizing
secretions and elasticity of the rectal wall. hormone levels occur, along with decreases
 Normal aging does not interfere with the motility of in both serum and bioavailable testosterone levels.
feces through the bowel, although other  Venous and arterial sclerosis and fibroelastosis of
factors that are highly prevalent in late life do contribute the corpus spongiosum can affect the
to constipation. penis with age.
 An age-related loss of tone of the internal sphincter  The older man does not lose the physical capacity
can affect bowel elimination. to achieve erections or ejaculations,
 Slower transmission of neural impulses to the lower although orgasm and ejaculation tend to be less
bowel reduces awareness of the need intense.
to evacuate the bowels.  There is some atrophy of the testes.
 With advancing age, the liver has reduced weight  Prostatic enlargement occurs in most older men.
and volume, but this seems to produce The rate and type vary among
no ill effects. individuals.
 The older liver is less able to regenerate damaged  Three fourths of men aged 65 years and older
cells. Liver function tests remain within have some degree of prostatism, which
a normal range. causes problems with urinary frequency. Although
 Less efficient cholesterol stabilization and absorption most prostatic enlargement is benign,
cause an increased incidence of it does pose a greater risk of malignancy and
gallstones. requires regular evaluation.
 The pancreatic ducts become dilated and distended,  The female genitalia demonstrate many changes
and often, the entire gland prolapses. with age, including atrophy of the vulva
E. Urinary System from hormonal changes, accompanied by the loss of
 The urinary system is affected by changes in the subcutaneous fat and hair and a
kidneys, ureters, and bladder. flattening of the labia.
 The renal mass becomes smaller with age, which is  The vagina of the older woman appears pink and
attributable to a cortical loss rather dry with a smooth, shiny canal because
than a loss of the renal medulla. of the loss of elastic tissue and rugae.
 Renal tissue growth declines and atherosclerosis  The vaginal epithelium becomes thin and
may promote atrophy of the kidney. These changes avascular. The vaginal environment is more
can have a profound effect on renal function, reducing alkaline in older women and is accompanied by a
renal blood flow change in the type of flora and a
and the glomerular filtration rate by approximately one reduction in secretions.
half between the ages of 20 and  The cervix atrophies and becomes smaller; the
90 years. endocervical epithelium also atrophies.
 Tubular function decreases. There is less efficient  The uterus shrinks and the endometrium
tubular exchange of substances, atrophies; however, the endometrium continues
conservation of water and sodium, and suppression of to respond to hormonal stimulation, which can be
antidiuretic hormone secretion in responsible for incidents of
the presence of hypo-osmolality. postmenopausal bleeding in older women on
 Older kidneys have less ability to conserve sodium in estrogen therapy.  The ligaments supporting the
response to sodium restriction. uterus weaken and can cause a backward tilting of
Although these changes can contribute to the
hyponatremia and nocturia, they do not affect uterus; this backward displacement along with the
specific gravity to any significant extent. reduced size of the uterus can make it
 The decrease in tubular function also causes difficult to palpate during an exam.
decreased reabsorption of glucose from the  The fallopian tubes atrophy and shorten with age,
filtrate, which can cause 1+ proteinuria and glycosuria and the ovaries atrophy and become
not to be of major diagnostic thicker and smaller.
significance.  The ovaries can shrink to such a small size that
 Urinary frequency, urgency, and nocturia accompany they are not palpable during an exam.
bladder changes with age. Bladder Despite these changes, the older woman does not
muscles weaken and bladder capacity decreases. lose the ability to engage in and enjoy
Emptying of the bladder is more intercourse or other forms of sexual pleasure.
difficult; retention of large volumes of urine may result.  Estrogen depletion also causes a weakening of
 The micturition reflex is delayed. Although urinary pelvic floor muscles, which can lead to an
incontinence is not a normal outcome involuntary release of urine when there is an
of aging, some stress incontinence may occur because increase in intra-abdominal pressure.
of a weakening of the pelvic G. Musculoskeletal System
diaphragm, particularly in multiparous women.  The kyphosis, enlarged joints, flabby muscles, and
F. Reproductive System decreased height of many older
 As men age, the seminal vesicles are affected by a persons result from the variety of musculoskeletal
smoothing of the mucosa, thinning of changes occurring with age.
the epithelium, replacement of muscle tissue with  Along with other body tissue, muscle fibers
connective tissue, and reduction of fluid atrophy and decrease in number, with fibrous
retaining capacity. tissue gradually replacing muscle tissue.
 Overall muscle mass, muscle strength, and muscle recognition and response to stimuli is associated
movements are decreased; the arm with a decrease in new axon growth and
and leg muscles, which become particularly flabby and nerve reinnervation of injured peripheral nerves.
weak, display these changes well.  The hypothalamus regulates temperature less
 Sarcopenia, the age-related loss of muscle mass, effectively.
strength, and function, is mostly seen  Brain cells slowly decline over the years, the
in inactive persons; thus, the importance of exercise to cerebral cortex undergoes some loss of
minimize the loss of muscle tone neurons, and there is some decrease in brain size
and strength cannot be emphasized enough. and weight, particularly after age 55
 Muscle tremors may be present and are believed to years.
be associated with degeneration of  Because the brain affects the sleep–wake cycle,
the extrapyramidal system. and circadian and homeostatic factors of
 The tendons shrink and harden, which causes a sleep regulation are altered with aging, changes in
decrease in tendon jerks. the sleep pattern occur, with stages III
 Reflexes are lessened in the arms, are nearly totally and IV of sleep becoming less prominent.
lost in the abdomen, but are  Frequent awakening during sleep is not unusual,
maintained in the knee. For various reasons, muscle although only a minimal amount of sleep
cramping frequently occurs. is actually lost.
 Bone mineral and bone mass are reduced, I. Sensory Organs
contributing to the brittleness of the bones of  Each of the five senses becomes less efficient with
older people, especially older women who experience advanced age, interfering in varying
an accelerated rate of bone loss degrees with safety, normal activities of daily living,
after menopause. and general well-being.
 Bone density decreases at a rate of 0.5% each year Vision
after the third decade of life.  Perhaps the sensory changes having the greatest
 There is diminished calcium absorption, a gradual impact are changes in vision.
resorption of the interior surface of the  Presbyopia, the inability to focus or accommodate
long bones, and a slower production of new bone on properly due to reduced elasticity of the
the outside surface. lens, is characteristic of older eyes and begins in the
 These changes make fractures a serious risk to the fourth decade of life.
older adults. Although long bones do  The stiffening of the muscle fibers of the lens that
not significantly shorten with age, thinning disks and occurs with presbyopia decreases the
shortening vertebrae reduce the eye’s ability to change the shape of the lens to focus
length of the spinal column, causing a reduction in on near objects and decreases the
height with age. ability to adapt to light. This vision problem causes
 Height may be further shortened because of varying most middle-aged and older adults to
degrees of kyphosis, a backward need corrective lenses to accommodate close and
tilting of the head, and some flexion at the hips and detailed work. The visual field narrows,
knees. making peripheral vision more difficult.
 A deterioration of the cartilage surface of joints and  There is difficulty maintaining convergence and
the formation of points and spurs may gazing upward. The pupil is less
limit joint activity and motion. responsive to light because the pupillary sphincter
H. Nervous System hardens, the pupil size decreases, and
 It is difficult to identify with accuracy the exact impact rhodopsin content in the rods decreases.
of aging on the nervous system  As a result, the light perception threshold
because of the dependence of this system’s function increases and vision in dim areas or at night is
on other body systems. For instance, difficult; older individuals require more light than
cardiovascular problems can reduce cerebral younger persons to see adequately.
circulation and be responsible for cerebral  Alterations in the blood supply of the retina and
dysfunction. retinal pigmented epithelium can cause
 There is a decline in brain weight and a reduction in macular degeneration, a condition in which there is a
blood flow to the brain; however, loss in central vision.
these structural changes do not appear to affect  Changes in the retina and retinal pathway interfere
thinking and behavior. with critical flicker fusion (the point at
 Declining nervous system function may be unnoticed which a flickering light is perceived as continuous
because changes are often rather than intermittent).
nonspecific and slowly progressing.  The density and size of the lens increase, causing
 A reduction in neurons, nerve fibers, cerebral blood the lens to become stiffer and more
flow, and metabolism is known to opaque.
occur. Reduced cerebral blood flow is accompanied  Opacification of the lens, which begins in the fifth
by a reduction in glucose utilization and decade, leads to the development of
metabolic rate of oxygen in the brain. cataracts, which increases sensitivity to glare, blurs
 Although β-amyloid and neurofibrillary tangles are vision, and interferes with night vision.
associated with Alzheimer’s disease,  Exposure to the ultraviolet rays of the sun
they can be present in older adults with normal contributes to cataract development. Yellowing
cognitive function. of the lens (possibly related to a chemical reaction
 The nerve conduction velocity is lower. These involving sunlight with amino acids)
changes are manifested by slower reflexes and alterations in the retina that affect color
and delayed response to multiple stimuli. Kinesthetic perception make older people less able to
sense lessens. differentiate the low-tone colors of the blues, greens,
 There is a slower response to changes in balance, a and violets.
factor contributing to falls. Slower
 Depth perception becomes distorted, causing  In addition to hearing problems, equilibrium can be
problems in correctly judging the height of altered because of degeneration of the
curbs and steps. This change results from a disparity vestibular structures and atrophy of the cochlea,
between the retinal images caused by the separation organ of Corti, and stria vascularis.
of the two eyes and is known as stereopsis. Taste and Smell
 Dark and light adaptation takes longer, as does the  Approximately half of all older persons experience
processing of visual information. Less some loss of their ability to smell. The
efficient reabsorption of intraocular fluid increases the sense of smell reduces with age because of a
older person’s risk of developing decrease in the number of sensory cells in
glaucoma. the nasal lining and fewer cells in the olfactory bulb
 The ciliary muscle gradually atrophies and is of the brain.
replaced with connective tissue.  By age 80 years, the detection of scent is almost
 The appearance of the eye may be altered; reduced half as sensitive as it was at its peak.
lacrimal secretions can cause the  Men tend to experience a greater loss in the ability
eyes to look dry and dull, and fat deposits can cause a to detect odors than women. As most of the taste
partial or complete glossy white acuity is dependent on smell, the reduction in the
circle to develop around the periphery of the cornea sense of smell alters
(arcus senilis). the sense of taste.
 Corneal sensitivity is diminished, which can increase  Atrophy of the tongue with age can diminish taste
the risk of injury to the cornea. sensations, although there is no
 The accumulation of lipid deposits in the cornea can conclusive evidence that the number or
cause a scattering of light rays, which responsiveness of taste buds decreases
blurs vision.  The ability to detect salt is affected more than
 In the posterior cavity, bits of debris and other taste sensations.
condensation become visible and may float  Reduced saliva production, poor oral hygiene,
across the visual field; these are commonly called medications, and conditions such as
floaters. sinusitis can also affect taste.
 Vitreous decreases and the proportion of liquid Touch
increases, causing the vitreous body to  A reduction in the number of and changes in the
pull away from the retina; blurred vision, distorted structural integrity of touch receptors
images, and floaters may result. occurs with age.
 Visual acuity progressively declines with age due to  Tactile sensation is reduced, as observed in the
decreased pupil size, scatter in the reduced ability of older persons to sense
cornea and lens, opacification of the lens and vitreous, pressure, and pain and differentiate temperatures.
and loss of photoreceptor cells in  These sensory changes can cause misperceptions
the retina. of the environment and, as a result,
Hearing profound safety risks.
 Presbycusis is progressive hearing loss that occurs J. Endocrine System
as a result of age-related changes to  The endocrine system has groups of cells and
the inner ear, including loss of hair cells, decreased glands that produce the chemical
blood supply, reduced flexibility of messengers known as hormones.
basilar membrane, degeneration of spiral ganglion  With age, the thyroid gland undergoes fibrosis,
cells, and reduced production of cellular infiltration, and increased
endolymph. nodularity.
 This degenerative hearing impairment is the most  The resulting decreased thyroid gland activity
serious problem affecting the inner ear causes a lower basal metabolic rate,
and retro cochlea. reduced radioactive iodine uptake, and less
 High-frequency sounds of 2,000 Hz and above are thyrotropin secretion and release.
the first to be lost; middle and low  Protein-bound iodine levels in the blood do not
frequencies also may be lost as the condition change, although total serum iodide is
progresses. reduced.
 A variety of factors, including continued exposure to  The release of thyroidal iodide decreases with
loud noise, may contribute to the age, and excretion of the 17-ketosteroids
occurrence of presbycusis. declines.
 This problem causes speech to sound distorted as  The thyroid gland progressively atrophies, and the
some of the high-pitched sounds (s, loss of adrenal function can further
sh, f, ph, and ch) are filtered from normal speech and decrease thyroid activity.
consonants are less able to be  Secretion of thyroid-stimulating hormone (TSH)
discerned. and the serum concentration of thyroxine
 This change is so gradual and subtle that affected (T4) do not change, although there is a significant
persons may not realize the extent of reduction in triiodothyronine (T3),
their hearing impairment. believed to be a result of the reduced conversion of
 Hearing can be further jeopardized by an T4 to T3.
accumulation of cerumen in the middle ear; the  Overall, the thyroid function remains adequate.
higher keratin content of cerumen as one ages  Much of the secretory activity of the adrenal cortex
contributes to this problem. is regulated by adrenocorticotropic
 The acoustic reflex, which protects the inner ear and hormone (ACTH), a pituitary hormone. As ACTH
filters auditory distractions from secretion decreases with age, secretory
sounds made by one’s own body and voice, is activity of the adrenal gland also decreases.
diminished due to a weakening and  Although the secretion of ACTH does not affect
stiffening of the middle ear muscles and ligaments. aldosterone secretion, it has been shown
that less aldosterone is produced and excreted in the in older women.
urine of older persons. The secretion  An increased growth of eyebrow, ear, and nostril
of glucocorticoids, 17- ketosteroids, progesterone, hair occurs in older men. Fingernails
androgen, and estrogen, also grow more slowly, are fragile and brittle, develop
influenced by the adrenal gland, is reduced as well. longitudinal striations, and experience a
 The pituitary gland decreases in volume by decrease in lunula size.
approximately 20% in older persons.  Perspiration is slightly reduced because the
Somatotropic growth hormone remains present in number and function of the sweat glands are
similar amounts, although the blood lessened.
level may be reduced with age. L. Immune System
 Decreases are seen in ACTH, TSH, follicle-  The aging of the immune system, known as
stimulating hormone, luteinizing hormone, and immunosenescence, includes a depressed
luteotropic hormone to varying degrees. immune response, which can cause infections to be
 Gonadal secretion declines with age, including a significant risk of older adults.
gradual decreases in testosterone,  After midlife, thymic mass decreases steadily, to
estrogen, and progesterone. the point that serum activity of thymic
 Except for alterations associated with changes in hormones is almost undetectable in the aged. T-cell
plasma calcium level or dysfunction of activity declines and more immature
other glands, the parathyroid glands maintain their T cells are present in the thymus.
function throughout life.  A significant decline in cell-mediated immunity
 There is a delayed and insufficient release of insulin occurs, and T lymphocytes are less able to
by the beta cells of the pancreas in proliferate in response to mitogens.
older people, and there is believed to be decreased  Changes in the T cells contribute to the
tissue sensitivity to circulating insulin. The older reactivation of varicella zoster and Mycobacterium
person’s ability to metabolize glucose is reduced, and tuberculosis, infections that are witnessed in many
sudden concentrations of older individuals. Serum
glucose cause higher and more prolonged immunoglobulin (Ig) concentration is not significantly
hyperglycemia levels; therefore, it is not altered; the concentration of IgM is
unusual to detect higher blood glucose levels in lower, whereas the concentrations of IgA and IgG
nondiabetic older persons. are higher.
K. Integumentary System  Responses to influenza, parainfluenza,
 Diet, general health, activity, exposure, and pneumococcus, and tetanus vaccines are less
hereditary factors influence the normal course effective (although vaccination is recommended
of aging of the skin. because of the serious potential
 This system’s changes are often the most consequences of infections for older adults). 
bothersome because they are obvious and Inflammatory defenses decline, and, often,
clearly reflect advancing years. inflammation presents atypically in older
 Flattening of the dermal–epidermal junction, reduced individuals (e.g., low-grade fever and minimal pain).
thickness and vascularity of the In addition, an increase in
dermis, slowing of epidermal proliferation, and an proinflammatory cytokines occurs with age, which is
increased quantity and degeneration of believed to be linked to
elastin fibers occur. atherosclerosis, diabetes, osteoporosis, and other
 Collagen fibers become coarser and more random, diseases that increase in prevalence
reducing skin elasticity. The dermis with age.
becomes more avascular and thinner.  In addition to maintaining a good nutritional state,
 As the skin becomes less elastic and drier and more older people can include foods in their
fragile, and as subcutaneous fat is diet that positively affect immunity, such as milk,
lost, lines, wrinkles, and sagging become evident. Skin yogurt, nonfat cottage cheese, eggs,
becomes irritated and breaks down fresh fruits and vegetables, nuts, garlic, onion,
more easily. sprouts, pure honey, and unsulfured
 There is a reduction in the number of melanocytes by molasses.
10% to 20% each decade beginning  A daily multivitamin and mineral supplement is
by the third decade of life, and the melanocytes cluster, also helpful.
causing skin pigmentation,  Regular physical activity can enhance immune
commonly referred to as age spots; these are more function, including exercises such as yoga
prevalent in areas of the body exposed and t’ai chi, which are low impact and have a
to the sun. positive effect on immunity.
 The reduction in melanocytes causes older adults to  Stress can affect the function of the immune
tan more slowly and less deeply. system because elevated cortisol levels can
 Skin immune response declines, causing older lead to a breakdown in lymphoid tissue, inhibition of
people to be more prone to skin infections. the production of natural killer cells,
 Benign and malignant skin neoplasms occur more increases in T-suppressor cells, and reductions in
with age. the levels of T-helper cells and virus
 Scalp, pubic, and axillary hair thins and grays due to fighting interferon.
a progressive loss of pigment cells Thermoregulation
and atrophy and fibrosis of hair bulbs; hair in the nose  Normal body temperatures are lower in later life
and ears becomes thicker. than in younger years. Mean body
 By age 50 years, most white men have some degree temperature ranges from 96.9°F to 98.3°F orally and
of baldness and about half of all 98°F to 99°F rectally.
people have evidence of gray hair.  Rectal and auditory canal temperatures are the
 Growth rate of scalp, pubic, and axillary hair most accurate and reliable indicators of
declines; the growth of facial hair may occur body temperature in older adults.
 There is a reduced ability to respond to cold with much caution because results may be biased
temperatures due to inefficient from the measurement tool or method
vasoconstriction, reduced peripheral circulation, of evaluation used.
decreased cardiac output, diminished  Early gerontological research on intelligence and
shivering, and reduced muscle mass and aging was guilty of such biases.
subcutaneous tissue.  Sick old people cannot be compared with healthy
 At the other extreme, differences in response to heat persons; people with different
are related to impaired sweating educational or cultural backgrounds cannot be
mechanisms and decreased cardiac output. compared; and one group of individuals
 These age-related changes cause older adults to be who are skilled and capable of taking an IQ test
more susceptible to heat stress. cannot be compared with those who have
Alterations in response to cold and hot environments sensory deficits and may not have ever taken this
increase the risks for accidental type of test.
hypothermia, heat exhaustion, and heat stroke.  Longitudinal studies that measure changes in a
3. Psychological Changes specific generation as it ages and that
 Psychological changes can be influenced by general compensate for sensory, health, and educational
health status, genetic factors, deficits are relatively recent, and they
educational achievement, activity, and physical and serve as the most accurate way of determining
social changes. intellectual changes with age.
 Sensory organ impairment can impede interaction  Basic intelligence is maintained; one does not
with the environment and other people, become intelligent with age. The abilities
thus influencing psychological status. for verbal comprehension and arithmetic operations
 Feeling depressed and socially isolated may obstruct are unchanged.
optimum psychological function.  Crystallized intelligence, which is the knowledge
4. Personality accumulated over a lifetime and arises
 Drastic changes in basic personality normally do not from the dominant hemisphere of the brain, is
occur as one ages. The kind and maintained through the adult years; this
gentle old person was most likely that way when form of intelligence enables the individual to use past
young; likewise, the cantankerous old learning and experiences for
person probably was not mild and meek in earlier problem solving.
years.  Fluid intelligence, involving new information and
 Excluding pathologic processes, the personality will emanating from the nondominant
be consistent with that of earlier years; hemisphere, controls emotions, retention of
possibly, it will be more openly and honestly nonintellectual information, creative
expressed. capacities, spatial perceptions, and aesthetic
 The alleged rigidity of older persons is more a result appreciation; this type of intelligence is
of physical and mental limitations believed to decline in later life.
than a personality change. For example, an older  Some decline in intellectual function occurs in the
person’s insistence that her furniture is moments preceding death. High levels
not rearranged may be interpreted as rigidity, but it of chronic psychological stress have been found to
may be a sound safety practice for be associated with an increased
someone coping with poor memory and visual deficits. incidence of mild cognitive impairment.
 Changes in personality traits may occur in response COMMUNICATION TIP
to events that alter self-attitude, such  Altered vision and hearing, the need for more time
as retirement, death of a spouse, loss of to process new information, and the
independence, income reduction, and disability. stress of an interaction with a health care
 No personality type describes all older adults; professional can prevent older adults from
personality in late life is a reflection of contributing valuable information during the
lifelong personality. assessment process and block them from
 Morale, attitude, and self-esteem tend to be stable hearing instructions.
throughout the life span.5. Memory  While respecting the individual’s level of function,
 The three types of memory are short term, lasting employ these strategies: Allow time for
from 30 seconds to 30 minutes; long questions to be answered, provide examples to
term, involving that learned long ago; and sensory, trigger memory, and reinforce instructions
which is obtained through the sensory through repetition and supplementing oral
organs and lasts only a few seconds. instructions with written ones.
 Retrieval of information from long-term memory can Learning
be slowed, particularly if the  Although learning ability is not seriously altered
information is not used or needed on a daily basis. with age, other factors can interfere with
 The ability to retain information in the consciousness the older person’s ability to learn, including
while manipulating other motivation, attention span, delayed
information—working memory function—is reduced. transmission of information to the brain, perceptual
 Older adults can improve some age-related deficits, and illness.  Older persons may display
forgetfulness by using memory aids less readiness to learn and depend on previous
(mnemonic devices) such as associating a name with experience for
an image, making notes or lists, and solutions to problems rather than experiment with
placing objects in consistent locations. new problem-solving techniques.
 Memory deficits can result from a variety of factors  Differences in the intensity and duration of the
other than normal aging. older person’s physiologic arousal may
Intelligence make it more difficult to extinguish previous
 In general, it is wise to interpret the findings related responses and acquire new material.
to intelligence and the older population
 The early phases of the learning process tend to be especially true for teams caring for older adults who
more difficult for older persons than often present with complex and
younger individuals; however, after a longer early interrelated conditions.
phase, they are then able to keep equal  As team size increases, teams have a more
pace. Learning occurs best when the new information difficult time creating a uniform culture and
is related to previously learned efficient meetings.
information.  Members of teams caring for older adults bring
 Although little difference is apparent between the old complementary skills and perspectives
and young in verbal or abstract that need to be woven together to develop a
ability, older persons do show some difficulty with comprehensive case formulation and to
perceptual motor tasks. Some evidence address what are often multiple biopsychosocial
indicates a tendency toward simple association rather needs of older patients.
than analysis.  For example, geriatric assessment is often shared
 Because it is generally a greater problem to learn among two or more providers who
new habits when old habits exist and administer measures and other components of an
must be unlearned, relearned, or modified, older assessment.
persons with many years of history may  Accordingly, geriatric health care teams are often
have difficulty in this area. interdisciplinary, rather than
Attention Span multidisciplinary, in nature.
 Older adults demonstrate a decrease in vigilance  On multidisciplinary teams, team members apply
performance (i.e., the ability to retain professional skills and expertise from
attention longer than 45 minutes). the perspective of their individual discipline. While
 They are more easily distracted by irrelevant multidisciplinary teams do allow for a
information and stimuli and are less able to broad range of knowledge and clinical expertise to
perform tasks that are complicated or require contribute to the care of the patient,
simultaneous performance. team members generally function in linear fashion
Emotions, Coping and Well-being and stay within their own “professional
 Emotions: Old age is an emotionally rich and lanes.”
complex phase of life.  On interdisciplinary teams, team members work in
 They have better control over emotions than do a more dynamic and interactive
younger adults. fashion.
Coping: Emotion focused  Members of interdisciplinary teams apply their
 Coping: older people tend to cope with stressful individual perspectives and question one
events in different ways. another to develop a richer and more holistic
 They rely more on emotion-focused forms of coping, understanding of the patient.
as opposed to active, problem  In addition, team members may contribute to the
solving approaches. assessment and care processes that
 Emotion-focused coping is more passive than involve other team members and disciplines. In
confrontational, individual than these ways, providers working on
interpersonal, and is oriented toward control of interdisciplinary teams often take one foot out of their
distressing feelings rather than toward professional lane, acting as an agent
alteration of stressful situations. of a larger collective, focused on the patient’s goals.
 Working on interdisciplinary teams can be
stimulating and rewarding for many providers.
Lesson 13: Geriatric Health Care Team  By virtue of its more inclusive and interactive
 Geriatric interprofessional team (IPT) care (also nature, the interdisciplinary team model can
referred to as interdisciplinary team care) result in more effective care.
is essential to providing effective care for complicated  At the same time, the interpersonal dynamics of an
older adults with multiple interdisciplinary team and the
comorbidities. requirement to operate outside of the comfort of
 Research has demonstrated that IPT care is one’s learned professional discipline can
associated with enhanced functional and be challenging for health care professionals,
cognitive status, reduced depression, and other particularly those with less experience
psychological symptoms, and improved working on teams.
subjective well-being.  A third type of health care team is the
 Geriatric IPT care has also been shown to reduce transdisciplinary team. Transdisciplinary teams
hospital readmissions and outpatient extend integration and flexibility even farther than
service use. their interdisciplinary counterpart. On
 Specialized IPTs focusing on specific diseases such transdisciplinary teams, professional boundaries are
as congestive heart failure, stroke, even more permeable, and providers
myocardial infarction, or dementia have also step farther outside of their traditional roles.
demonstrated improved patient outcomes.  The roles of team members on these teams are
 The current and projected health care workforce often characterized by greater “role
shortage, coupled with the aging of the release” (accepting that others outside one’s
population, dictate that care models be as efficient and professional discipline can engage in
effective as possible. activities traditionally performed by those within that
 Increasing numbers of frail, older adults with complex discipline) and “role expansion”
needs demand widespread adoption (engaging in activities traditionally beyond one’s
of geriatric IPTs. professional discipline).
 Successful teamwork is paramount to the delivery of  Transdisciplinary teams are less common than
high-quality clinical care. This is interdisciplinary teams, which have
become quite prominent and specifically recommended 10. Establish team norms, rules, and commitment
in many settings for the care of from team members. Create a mechanism
older adults. for enforcing governance rules.11. Promote ongoing
 Successful health care teams require effective evaluation of the effectiveness of the team.
communication, cohesiveness, role clarity, 12. Define acceptable behavior (willingness to work
trust, and respect among team members. This is effectively with other professionals to
especially true for interdisciplinary and develop a person-directed care plan; active
transdisciplinary teams. participation, and respect for others’ roles and
 Without these, IPTs may lose their interactive and opinions). Observe and value the participation of
complementary identity; even worse, each member equally.
dominating or retreating behavior may develop among 13. Identify and follow a decision process when roles
specific team members. overlap. Encourage and model open
 The principles and processes of effective teams and communication and collaboration.
key considerations for promoting 14. Resist setting rigid role boundaries.
successful engagement and functioning among team 15. Identify opportunities or requirements for team
members are discussed below. building meetings or retreats and team
Team members possess extensive professional training.
knowledge of their individual discipline SKILLS OF DIFFERENT PROFESSIONALS ON
but often have limited knowledge of other disciplines on TEAMS
the team.  IPTs are becoming increasingly more common in
 Beyond varied technical knowledge among team primary care, as practices organize
members, teams may be characterized “populations of patients” or “panels” shared by
by somewhat different values across professional multiple team members (physician, nurse
disciplines. social worker, or pharmacist).
 These differences are becoming less pronounced,  An added incentive for this approach includes
with the evolution of IPTs in most health evidence that team-based care makes
care settings and with many populations. practices more efficient.
 Professional disciplines vary significantly in how they  When the care plan is driven by the patient’s
characterize problems and their needs and values, care plan implementation
etiology. For instance, more medically oriented is more likely to be successful.
disciplines may focus on conducting  Consistent with other team models, primary care
diagnostic tests and explaining findings in biological teams emphasize goals that are
terms, whereas the social sciences determined by the patient, focused on the patient’s
(eg, psychology, social work) may emphasize own definitions of health, well-being,
psychosocial issues and consequences. and quality of life.
 In addition to differences in understanding and  Much like the development of individual
formulating plans of care team members competencies for specific health professions, key
of different disciplines vary substantially in the nature of competencies have also been identified for
treatments they typically prescribe interprofessional teams.
and, in the length, and frequency of patient visits.  The American Geriatric Society’s Partnership for
 These differences in perspectives and approaches Health in Aging (PHA), representing 10
may lead to tensions among team health care disciplines and 28 professional
members when roles and perspectives are unclear or organizations, developed a set of
poorly understood. multidisciplinary competencies for working with older
 However, on high-functioning and supportive teams, adults.
these different perspectives lead to  The six essential domains for entry-level
a much deeper understanding of the patient and a professionals working with older adults were
more comprehensive and effective identified as (1) health promotion and safety; (2)
treatment plan. comprehensive evaluation and
PRINCIPLES OF SUCCESSFUL appropriate assessment; (3) care planning and
TEAMWORKPRINCIPLES OF SUCCESSFUL coordination across the health care
TEAMWORK spectrum including end of life; (4) interdisciplinary
1. Establish overall purpose and function of the team. care and team care; (5) caregiver
2. Determine team composition: which professions are support; and (6) knowledge of health care systems
needed, number of members, and benefits.
professional identities.  Within the domain of interdisciplinary teams and
3. Allow the problem and the population to define the teamwork two competencies are spelled
composition of the team, not vice versa. out: (1) distinguish among, refer to, and/or consult
4. Determine the model of interprofessional teamwork with any of the multiple health care
(multidisciplinary vs interdisciplinary professionals who work with older adults, to achieve
vs transdisciplinary). positive outcomes; and (2)
5. Ensure clear understanding of the model by group communicate and collaborate with older adults, their
members. caregivers, health care professionals,
6. Learn about the norms and practices of other and direct-care workers to incorporate discipline-
professions and promote understanding and specific information into overall team care
respect for others’ expertise. planning and implementation.
7. Recognize the implications of specific language  An essential competency for teamwork is
(idioms) by the professionals involved. knowledge of other members’ skills and
8. Learn how to articulate information clearly to others. capabilities.
9. Ensure the patient’s health care goals will be shaped  While more health professionals have exposure to
first and foremost by the patient, and other disciplines during training than in
also by different perspectives from various disciplines. prior decades, few health care professionals learn
the skills of all the disciplines likely to
be part of an IPT. offices, hospitals, and nursing care facilities.
GERIATRIC HEALTH CARE TEAM Physical Therapist
1. Gerontologist/ Geriatrician  Physical therapists help injured, or ill people
 Geriatricians are physicians who work primarily with improve movement and manage pain.
the elderly. Although they address  They are often an important part of preventive
their patients' multiple medical problems and chronic care, rehabilitation, and treatment for
illnesses, geriatricians focus patients with chronic conditions, illnesses, or injuries.
primarily on quality of life and functional ability.  Provide services that improve or restore function
 Geriatricians also determine when it is no longer and mobility, relieve pain, and prevent
medically safe for seniors to live alone or limit permanent physical disabilities of patients
and counsel them on alternative living arrangements. suffering from injuries or disease. They
 They deal with diseases and conditions that often restore, maintain, and promote overall fitness and
accompany old age, such as health.
Alzheimer's disease, arthritis, memory loss, chronic  Practice in hospitals, clinics, skilled nursing
heart and lung disease, incontinence, osteoporosis, facilities, and private offices that have specially
Parkinson's disease, stroke, and vision and hearing equipped facilities. They also treat patients in
problems. In addition, hospital rooms, private homes, or schools.
geriatricians work with patients who take a variety of Physical Therapist Assistants and Aides
medications.  Physical therapist assistants (sometimes called
 They develop drug regimens that avoid negative PTAs) and physical therapist aides work
drug interactions. under the direction and supervision of physical
 They also counsel patients and families on end of life therapists.
care.  They help patients who are recovering from
Nurse Gerontologist injuries and illnesses regain movement and
 Geriatric nurses are specialized in providing health manage pain. Most physical therapist assistants
care to the elderly. and aides work in physical therapists' offices or in
 They develop and implement treatment plans for hospitals.
older adults, and help them deal with Speech Therapist
chronic illnesses like respiratory disorders, diabetes,  Speech-language pathologists (sometimes called
arteriosclerosis, hypertension, speech therapists) assess, diagnose,
genitourinary infections, and pressure injuries. treat, and help to prevent communication and
 Geriatric nurses promote health in aged individuals swallowing disorders in children and adults.
by addressing their physical, cultural,  Speech, language, and swallowing disorders result
psychosocial, and family issues. from a variety of causes, such as a
 Geriatric nurses involves educating and providing stroke, brain injury, hearing loss, developmental
support to the elderly and their families. delay, Parkinson’s disease, a cleft palate,
People suffering from recurring or unrelieved health or autism.
conditions need counseling, as do  Assess, diagnose, and treat speech, Ianguage, or
their families. swallowing difficulties, which may
 Geriatric nurses discuss the health concerns with the include inability to clearly produce speech, rhythm
patients and their relatives, explain and fluency problems like stuttering,
or recommend alterations in the medication regimen, voice disorders, problems understanding and
and provide instructions regarding producing language, cognitive
disease prevention and personal safety. communication impairments, such as attention,
Occupational Therapist memory, and problem-solving disorders,
 Occupational therapists treat injured, ill, or disabled swallowing difficulties.
patients through the therapeutic use  Practice independently, in school systems,
of everyday activities. hospitals, rehabilitation hospitals, and skilled
 They help these patients develop, recover, improve, nursing facilities, or through home health visits.
as well as maintain the skills needed Certified Nursing Assistant (CNA)
for daily living and working.  Certified nursing assistants provide basic skilled
 Help patients improve their ability to perform tasks in care for patients in hospitals and
living and working environments. residents of long-term care facilities, such as nursing
They work with individuals who suffer from a mentally, homes.
physically, developmentally, or  Nursing assistants who work in nursing homes
emotionally disabling condition. Improve upper body must be certified.
function and ability to perform ADLs.  They are frequently active providing personal care
 Practice in rehabilitation centers, home health care to frail or dependent individuals.
services, acute care settings, and  Understanding cognitive impairment is important,
skilled nursing facilities. as they often assist impaired patients
Occupational Therapy Assistants and Aides with activities of daily living (ADLs). They often need
 Occupational therapy assistants and aides help to help lift or move patients.
patients develop, recover, and improve Home Health Aide
the skills needed for daily living and working.  Home health aides help people who are disabled,
 Occupational therapy assistants are directly involved chronically ill, or cognitively impaired in
in providing therapy to patients, the community.
while occupational therapy aides typically perform  In some states, home health aides may be able to
support activities. Both assistants and give a client medication or check the
aides work under the direction of occupational client's vital signs under the direction of a nurse or
therapists. other health care practitioner. Home
 Occupational therapy assistants and aides work health aides held about 875,100 jobs in 2012.
primarily in occupational therapists'
 They generally work in the community visiting faith.
individual homes.  Mainly present within hospital setting, including
Personal Care bedside, emergency room, intensive care
 Personal care aides help clients with self-care and unit (ICU), and waiting areas.
everyday tasks and provide Psychiatric technicians and aides care
companionship.  Psychiatric technicians and aides care for people
 They work in a variety of settings, including patients' who have mental illness and
care communities. developmental disabilities. Technicians typically
Psychiatrist provide therapeutic care.
 Medical doctors who treat patients' mental,  Aides help patients in their daily activities and
emotional, and behavioral symptoms. ensure a safe, clean environment.
 Care for physically or men- tally ill, injured, disabled,  Psychiatric technicians and aides work in
or infirm individuals in hospitals, psychiatric hospitals, residential mental health
nursing care facilities, and mental health settings. facilities, and related health care settings.
Psychologist Pharmacist
 Study the human mind and human behavior.  Distribute prescription drugs to individuals. Advise
 Research psychologists investigate the physical, their patients, as well as physicians and
cognitive, emotional, or social aspects other health practitioners, on the selection, dosages,
of human behavior. interactions, and side effects of
 Psychologists in health ser- vice fields provide medications.
mental health care in hospitals, clinics,  Pharmacists monitor the health and progress of
schools, or private settings. patients to ensure the safe and effective
 Vary by subfield and place of employment. Some use of medication.
have private practices and others are  Most pharmacists work in a community setting,
employed in schools, hospitals, nursing homes, and such as a retail drugstore, or in a health
other health care facilities. care facility, such as a hospital, nursing home,
Geropsychologist mental health institution, or neighborhood
 Geropsychology is recognized as a specific specialty health clinic.
by the American Psychological Pharmacy Technicians
Association.  Geropsychology is now a formal  Pharmacy technicians help licensed pharmacists
specialty for which board certification is available dispense prescription medication to
through customers or health professionals.
the American Board of Professional Psychology  Pharmacy technicians work in pharmacies,
(ABPP). including those in grocery and drug stores
 Geropsychologists work across a variety of geriatric and in hospitals.
and related settings, including in Dietitian
home; outpatient geriatric clinics; primary care  Provides nutrition therapy to include planning,
practitioner (PCP) offices; inpatient implementing, and monitoring the nutrition
Social Worker (may also serve as care coordinator of patients. May work in office or health care
or case manager) settings.
 Assist patients with obtaining appropriate supportive Recreational Therapist
resources in community that will  A recreational therapist utilizes recreation
improve quality of life. Provide counseling to individuals involvement to improve the physical, cognitive,
and families. emotional, social, and leisure needs of clients.
 Serves as an advocate for families by actively  They assist clients to develop skills, knowledge,
seeking benefits and services needed. and behaviors for daily living and effective
Ensures appropriate referrals for suspected or actual community involvement.
abuse, neglect, or sexual assault  Employed by health care agencies and work in
psychiatric units; general hospital wards; assisted living hospitals or other health or residential
facilities; nursing homes. facilities and adult day care programs. Some may
 Social workers or case managers may spend their work in homes and in the community.
time in an office or residential facility, Respiratory Therapist
but they also may travel locally to visit clients, meet  Evaluate, recommend, and treat individuals with
with service providers, or attend respiratory or cardiopulmonary disorders.
meetings.  Perform diagnostic tests and administer
Medical Marriage and Family Therapist medications and interventions to improve
 Works with individuals and families with chronic or oxygenation and ventilation.
life-limiting illness.  Are skilled in bilevel positive airway pressure
 Using a biopsychosocial model, the therapist (BiPAP) and ventilator start-up,
emphasizes education, family systems, and management, and weaning.
collaboration between therapist and health  Insert and monitor arterial lines. Are skilled in
professionals to assist with complex problem attaining, maintaining, and managing the
solving. airway.
 Private practice, hospice agencies, hospitals,  Hospitals, home health agencies, skilled nursing
rehabilitation facilities, counseling centers, facilities, physician offices.
prison systems, and mental health organizations.  Practicing under the direction of a physician.
Chaplain GERONTOLOGICAL NURSING ROLES
 Provide pastoral visits with patients and family  In their activities with older adults, nurses’ function
members at bedside. Offer spiritual in a variety of roles, most of which fall
support, counseling, and prayer with patients/families. under the categories of healer, caregiver, educator,
 Provide crisis interventions, eg, emergency room, advocate, and innovator.
last rites, arrange for leader in own 1. Healer
 Early nursing practice was based on the Christian pathophysiology, geriatric pharmacology, health
concept of the intertwining of the flesh promotion, and available resources.
and spirit. In the mid-1800s, nursing’s role as a healing  With the diversity and complexities of health
art was recognized; this is apparent insurance plans, an important area for
through Florence Nightingale’s writings that nursing consumer education is teaching older adults how to
“puts the patient in the best condition interpret and compare various plans
for nature to act upon him” (Nightingale, 1860). to enable them to make informed decisions.
 As medical knowledge and technology grew more  Essential to the educator role is effective
sophisticated and the nursing communication involving listening, interacting,
profession became grounded more in science than in clarifying, coaching, validating, and evaluating.
healing arts, the early emphasis on  The nurse’s educator role also surfaces during
nurturance, comfort, empathy, and intuition was routine nurse–patient interactions.
replaced by detachment, objectivity, and  The nurse educates the patient to address
scientific approaches. knowledge deficits identified during the
 However, the revival of the holistic approach to assessment process.
health care has enabled nurses to again  New medications, treatments, and choices create
recognize the interdependency of body, mind, and the need for teaching to assure the
spirit in health and healing. patient has the knowledge and skill to competently
 Nursing plays a significant role in helping individuals make decisions and engage in care.
stay well, overcome or cope with  When teaching older adults:
disease, restore function, find meaning and purpose in 1. Assess knowledge deficits, readiness to learn,
life, and mobilize internal and and obstacles that could interfere with the
external resources. learning process
 In the healer role, the gerontological nurse 2. Organize the material prior to the teaching
recognizes that most human beings value experience
health, are responsible and active participants in their 3. Plan strategies to actively engage them in the
health maintenance and illness learning process
management, and desire harmony and wholeness with 4. Assure the environment is conducive to learning
their environment. (e.g., comfortable room temperature,
 A holistic approach is essential, recognizing that noise control, avoidance of glare, and lack of
older individuals must be viewed in the distractions and interruptions)
context of their biological, emotional, social, cultural, 5. Be sensitive to vision and hearing deficits that are
and spiritual elements. present
2. Caregiver 6. Speak on a level and in a language that is
 The major role played by nurses is that of a understandable
caregiver. In this role, gerontological nurses 7. Avoid medical jargon
use gerontological theory in the conscientious 8. Use several different teaching methods to
application of the nursing process to the supplement verbal presentation (e.g., videos,
care of older adults. demonstration, PowerPoint slides, pamphlets, and
 Inherent in this role is the active participation of older fact sheets)
adults and their significant others 9. Provide written material to complement verbal
and promotion of the highest degree of self-care. instruction; as blues and greens are difficult
 This is especially significant in that older adults who colors for older eyes, avoid using blueprint on green
are ill and disabled are at risk for paper
having decisions made and actions taken for them—in 10. Summarize what has been taught and recognize
the interest of “providing care,” knowledge gains
“efficiency,” and “best interest”—that rob them of their 11. Be aware of potential barriers to learning:
existing independence. Although the body of  Stress
knowledge of geriatrics and gerontological care has  Sensory deficits
grown  Limited educational or intellectual abilities
considerably, many practitioners lack this information.  Emotional state
 Gerontological nurses are challenged to ensure that  Pain, fatigue, and other symptoms
the care of older adults is based on  Unmet physiological needs
sound knowledge that reflects the unique  Attitudes or beliefs held about topic
characteristics, needs, and responses of older  Prior experience with issue
persons by disseminating gerontological principles and  Feelings of helplessness and hopelessness4.
practices. Advocate
 Nurses working in this specialty area are challenged  The gerontological nurse can function as an
to gain the knowledge and skills that advocate in several ways.
will enable them to meet the unique needs of older  First and foremost, advocacy for individual clients
adults and to assure evidence-based is essential and can include aiding older
practices are utilized. adults in asserting their rights and obtaining required
3. Educator services.
 Gerontological nurses must be prepared to take  In addition, nurses can advocate to facilitate a
advantage of formal and informal community’s or other group’s efforts to
opportunities to share knowledge and skills related to effect change and achieve benefits for older adults
the care of older adults. and to promote gerontological nursing,
 This education extends beyond professionals to the including new and expanded roles of nurses in this
general public. specialty.
 Areas in which gerontological nurses can educate 5. Innovator
others include normal aging,  Gerontological nursing continues to be an evolving
specialty; therefore, nurses have
opportunities to develop new technologies and different
modalities of care delivery.
 As an innovator, the gerontological nurse assumes
an inquisitive style, making conscious
decisions and efforts to experiment for a result of
improved gerontological practice.
 This requires the nurse to be willing to think “out of
the box” and take risks associated with
traveling down new roads, transforming visions into
reality.
ADVANCED PRACTICE NURSING ROLES
 To competently and effectively care for the clinical
complexities of older adults, nurses
need preparation in the unique principles and best
practices of geriatric care.
 This requires a broad knowledge base, capacity for
independent practice and leadership,
and complex clinical problem-solving ability that is
possible by nurses prepared for
advanced practice roles.
 Advance practice roles include geriatric nurse
practitioners, geriatric nurse clinical
specialists, and geropsychiatric nurse clinicians.
 Most of these roles require the completion of a
master’s degree at a minimum.
 There is strong evidence that nurses in advanced
practice roles make a significant
difference to the care of older adults.
 Gerontological nurse practitioners and clinical nurse
specialists have been shown to
improve the quality and reduce the cost of care for
older persons in a variety of settings,
including hospitals, nursing homes, and ambulatory
care.
 The clear positive impact on the health and well-
being of older adults should encourage