GERIATRIC

NURSING
 Goals of Geriatric Nursing
• Functional status and use strengths to achieve
optimal independence
• Facilitating the highest level of function or
quality of life
• Increased safety and quality of life
• Maintain and improve the health of the elderly
 DEFINITION OF TERMS
• GERIATRICS- the study of old age that includes the
physiology, pathology, diagnosis, and management
of the disorders and diseases of older adults
• GERENTOLOGY- the scientific study of the aging
process, a multidisciplinary field that draws from the
biologic, psychological, sociologic sciences to provide
insight into all aspects of aging process
 DEFINITION OF TERMS
• GERONTOLOGIC/GERIATRIC
NURSING- field of nursing that relates to
the assessment , nursing diagnosis,
planning, implementation, and evaluation
of older adults in all environments
• SENESCENCE – normal aging process
• SENILITY – aging process characterized
by severe mental deterioration
 DEFINITION OF TERMS
• AGEISM- bias against older people w/o
considering their functional status
• INTRINSIC AGING- refers to those
changes caused by normal aging
process
• EXTRINSIC AGING- refers to aging that
results from influences outside the
person
HEALTH CARE OF THE ELDERLY
 DEMOGRAPHICS OF AGING
• Life expectancy - 47 years in 1900 to 77.2 years
in 2001.
• As the older population increases the number
of people who live to a very old age also
increases.
• By 2030, it is estimated that 20% of population
will be 65 years of age or older
• 20% of this will report a chronic disability
• The leading causes of death in people 65 years
of age and older:
CAUSE OF DEATHS IN 65 YRS
AND ABOVE
• Heart diseases
• Neoplasms
• Cerebrovascular diseases
• COPD
• Pneumonia and influenza
• DM
• Accidents
• Alzheimer’s diseases
• Renal problems
 HEALTH STATUS OF THE OLDER
ADULT
• Improvements in the prevention and early
detection and treatment of diseases
• In the past 50 years there has been a decline in
overall deaths (30%) and disability
• More likely to maintain good health, functional
independence, positive lifelong health
behaviours or at least limit or prevent chronic
conditions  if encouraged to do so and
appropriate community-based support services
are available
 BIOLOGIC
THEORIES OF
AGING
 BIOLOGIC THEORIES OF
AGING
1. Immune system theory
2. Cross-linking theory
3. Free radical theory
4. Stress theory (wear and tear)
5. Genetics theory
6. Neuroendocrine theories
1. IMMUNE SYSTEM THEORY
• The thymus and bone marrow, are
affected by the aging process
• Contributes to a decline in T-cell
production and stem cell efficiency
• Increase of infections, autoimmune
disease, and cancer with aging
 2. CROSS-LINKING THEORY
• A chemical reaction that binds glucose to
protein, which causes abnormal division of
DNA
• Interfering with normal cell functioning and
intracellular transport over a lifetime
• Eventually causes tissue and organ failure
 3. FREE RADICAL THEORY
• Molecules that are highly reactive as a
result of oxygen metabolism in the body
• Over time, cause physical decline by
damaging proteins, enzymes and DNA
 4. STRESS THEORY (wear and
tear)
• The body, like any machine, will eventually
“wear out” secondary to repetitive usage,
damage and stress
• Individuals react differently to stress
(positive and negative), causing controversy
over the concept
 5. GENETICS THEORY
• Pre-programmed life expectancy. Cells
can only divide a specific number of times
• Life expectancies among family members
is similar, eg. If the parents died over the
age of 80, the children are more likely to
live to that age
6. NEUROENDOCRINE THEORIES

• Anterior pituitary hormones are thought

to contribute to the aging process
• An imbalance of certain chemicals in
the brain may contribute to altered cell
division within the body
CHARACTERISTICS
OF ELDERLY / AGE
RELATED CHANGES
 NORMAL AGE –
RELATED CHANGES
1. Homeostasis become increasingly
diminished with cellular and organ system
aging
2. Cells become less able to replace and
accumulate a pigment called lipofuscin
3. Degradation of elastin and collagen
causes connective tissue to become stiffer
and less elastic
 DIFFERENT ASPECTS OF
AGING :

• Physical aspect of aging

• Psychosocial aspect of aging
• Cognitive aspect of aging
• Environmental aspect
• Pharmacological aspect
 PHYSICAL
CHANGES OF
AGING
CHANGES SUBJECTIVE/OBJECTIVE HEALTH PROMOTION
FINDINGS STRATEGIES

CVS- Heart valves Complaint of fatigue with Lifestyle modification, Exercise

becomes thicker, Heart increase activity ;increase regularly; weight control; avoid
muscle and arteries lose heart rate recovery time; smoking; eat low fat low salt food;
their elasticity, normal BP < or = to BP control; medication compliance;
Accumulation of Ca and fat 140/90mmhg stress management
deposits, Veins become
tortuous, Less reserve and
less response to stress
RESPI- Increase in lung Fatigue & breathlessness with Exercise regularly; avoid smoking;
rigidity and elastic recoil, sustained activity; impaired take adequate fluids to liquefy
increase in residual lung healing of tissue as a result secretion; receive yearly influenza
volume; decrease in vital of decrease oxygenation ; immunization :avoid exposure to
capacity; decrease cough difficulty coughing up secretion URTI
efficiency
Integumentary system: Skin appears thin and Avoid solar exposure; dress
Decreased protection wrinkled; complaint of injuries appropriately for temperature;
against trauma and sun and bruises; complain of lubricate skin; maintain safe indoor
exposure; decreased intolerance to heat; bone temperature
protection against extreme structure is prominent; dry skin
temperature; diminished
secretion of natural oils
and perspiration
Reproductive system: Female: painful May require vaginal
Female: vaginal narrowing intercourse; vaginal estrogen replacement ;
and decrease elasticity; bleeding ff intercourse, gynecology /urology ff-up;
decrease vaginal secretion, delayed orgasm, vaginal use lubricant when
slower sexual response itchiness and irritation intercourse, pelvic floor
Male: decrease size of Male: delayed erection and execise
penis and testes ; slower achievement of orgasm,
sexual response BPH

Musculoskeletal system: Height loss; prone to Exercise regularly, eat high

Loss of bone density ; loss fracture; kyphosis; back calcium diet; limit
of muscles strength and pain; loss of strength, phosphorus intake; take
size; degenerative joint flexibility and endurance ; calcium and vit D
cartilage joint pain supplement

Genito-urinary system: Urinary retention, irritative Seek referral to urology;

Male: benign prostatic voiding symptoms including ready access to toilet; drink
hyperplasia frequency, feeling of adequate fluids
incomplete bladder
emptying,
Female: relaxed perineal Wear easily manipulated
urgency/frequency
muscles; urethral clothing; drink adequate
syndrome, drop of urine
dysfunction fluids
when cough
Gastrointestinal Complaint of dry Use ice chips,
system: mouth; complaint mouthwash, eat high
Decrease salivation, of fullness, fiber, low fat diet,
difficulty swallowing heartburn and limit laxatives; toilet
food; delayed indigestion; regularly; adequate
esophageal and gastric constipation, fluids
emptying; reduced flatulence and
abdominal
gastrointestinal motility
discomfort
Nervous system: Slower to Pace teaching;
Reduced speed in respond and enhance sensory
nerve conduction; react; learning stimulation;
increase confusion with takes longer; encourage slow
physical illness and faintness, rising from resting
loss of environment frequent falls position
cues; reduced cerebral
circulation
SPECIAL SENSES : Holds object far Wear eyeglasses;
Vision: diminished away from face ; use sunglasses
ability to focus on complain of glare; outdoor; use large
close object, inability poor night vision; print book; use
to tolerate glare; confuses color magnifiers for
difficulty adjusting to reading
change of light
intensity; decrease
ability to H: Recommended
distinguished colors H: Give
inappropriate hearing examination;
Hearing: decrease response; ask enunciate clearly;
ability to hear high- people to repeat speak with low pitch
frequency sounds words; strain forward voice; use nonverbal
Taste and smell: to hear cues
decrease ability to T: Encourage use of
T: Uses excessive
taste and smell lemon, spices and
sugar and salts
herbs
PHYSICAL ASPECTS OF AGING
A. SPECIAL SENSES
I. VISION
Changes:
• Presbyopia
• Decrease lacrimal secretions
• Pupils: smaller-decreased peripheral
vision
• Inability to adapt to the dark; increased
sensitivity to glare
• Lens: larger, more rigid, and discoloured
(yellow opacity)- decreased depth
perception and ability to focus
• Colors distorted
 PHYSICAL CHANGES OF
AGING
Nursing Interventions:
• 1. Increased illumination without glare
• 2. Safe environment by orienting client to
surroundings and removing potential
hazards
• 3. Use sunglasses outdoors
• 4. Use large-print books
• 5. Avoid night driving
 PHYSICAL CHANGES OF
AGING
III. TASTE/SMELL
Changes:
• Olfactory fibers atrophy-decreased sense of
smell, decreased appetite and ability to enjoy
foods
Nursing Interventions:
• Attractive meals in comfortable social setting
• Vary taste, textures, and colors of foods
• Be alert for difficulty chewing or swallowing
when selecting foods
 PHYSICAL CHANGES OF
AGING
IV. TOUCH
Changes:
• Sensory nerve receptors less acute- requires
stronger stimuli, increased pain tolerance, skin tears,
more difficult to distinguish hot, cold, or pressure
• Fine discrimination abilities impaired, especially
hands and feet
Nursing Interventions:
• Protect skin from injury
• Lower bath water temperature to 100-105F
• Provide for safety around hot liquids at mealtimes
 PHYSICAL CHANGES OF
AGING
B. NERVOUS SYSTEM
Changes:
• Overall intellect remains the same
• Short-term memory loss and learning
ability slowed
• Myelin sheath degenerates- decreased
reaction time, reduced deep tendon
reflexes, and decreased time to respond to
stimuli
• Sleep hours decreases
 PHYSICAL CHANGES OF
AGING

Nursing Interventions:
1. Independence in daily activities
2.Allow ample time for completion of tasks
3.Recreational and diversional
activitiesMaintain environmental stability,
minimize frequency of transfers
 PHYSICAL CHANGES OF
AGING
C. INTEGUMENTARY
Changes:
• Sweat glands diminish- decreased
thermoregulation
• Collagen and subcutaneous fat decreases –
wrinkles, poor skin turgor (poor estimate of
hydration)
• Hair follicles decrease/produce less melanin-
baldness/gray hair
• Vascular supply to nailbeds reduced- dull,
brittle nails- hard to cut
• Delayed wound healing
 PHYSICAL CHANGES OF
AGING
Nursing Interventions:
• Maintain adequate hydration
• Avoid overexposure to the sun
• Dress appropriately for temperature
• Keep skin clean, dry, lubricated, and pressure
free
• Provide adequate heat and humidity in
environment
• Provide adequate warmth
• Decrease frequency of baths
 PHYSICAL CHANGES OF
AGING
D. MUSCULOSKELETAL
Changes:
• Muscle fibers decrease and muscles atrophy-
decreased strength and endurance
• Bone density decreases – osteoporosis,
increased fractures
• Ligaments and tendons lose elasticity-
decreased ROM in joints
• Intervertebral disks narrow- increased spine
curves, balance diminishes (center of gravity)
 PHYSICAL CHANGES OF
AGING
Nursing Interventions:
• Exercise program
• Optimum physical activity within level of ability
• Optimum nutrition, especially intake of protein,
calcium, and vitamins
• Appropriate adaptive or assistive devices to
enhance mobility
 PHYSICAL CHANGES OF
AGING
E. CARDIOVASCULAR
Changes:
• Increased blood pressure, especially systolic
• Baroreceptors less sensitive (orthostatic
hypotension)
• Decreased venous valve competency
• Mitral/ aortic valves thicker and more rigid
• Decreased stroke volume and cardiac output
• Decreased pacemaker cells
 PHYSICAL CHANGES OF
AGING
Nursing Interventions:
• Assess symptoms and make appropriate
modification in care
• Teach client to change positions slowly to
avoid falls
• Minimize edema and fatigue with rest periods
and elevation of legs
• Teach energy conservation methods in daily
activities
 PHYSICAL CHANGES OF
AGING
F. RESPIRATORY
Changes:
• Muscles weaken and atrophy, rib cage
calcifies, barrel-shaped chest-increased energy
to expand lungs, harder to cough and deep
breathe
• Less tidal volume and increased residual
volume secondary to cell fibrosis
• Alveoli decrease and thicken – less sensitive to
hypoxia and hypercapnia
• Atrophy of cilia- slowed cough reflex,
increased risk of infection
 PHYSICAL CHANGES OF
AGING
Nursing Interventions:
• Manipulate environment to enhance
ventilation
• Position client to promote optimum
ventilation
• Encourage exercises and prescribed
pulmonary exercises
• Encourage annual influenza vaccines and one-
time pneumococcal vaccine
 PHYSICAL CHANGES OF AGING

G. GASTROINTESTINAL
Changes:
• Decreased smooth muscle tone
• Decreased in digestive enzymes
• Decreased saliva, loss of teeth
• Decreased sphincter tone
 PHYSICAL CHANGES OF
AGING
Nursing Interventions:
• Assess condition of teeth and mouth, fit and
comfort of dentures, and ability to chew
• Fluids and foods higher in fiber
• Optimal activity and encourage the client to
exercise daily.
• Promote independence and privacy in use of
bathroom
• Keep stool record and observe for constipation
 PHYSICAL CHANGES OF
AGING
H. RENAL
Changes:
• Decreased GFR secondary to decreased
kidney size and number of nephrons and
decreased renal blood flow
• Decreased bladder capacity and weakened
bladder and pelvic muscles
- Prostate enlargement/obstruction
 PHYSICAL CHANGES OF
AGING
Nursing Interventions:
• Assess voiding patterns
• Provide adequate fluids
• Establish a bladder program to promote
continence (assist to bathroom or offer bedpan
every 2-3 hours)
• Avoid catheterization unless comatose, skin
breakdown, or bladder outlet obstruction
 PHYSICAL CHANGES OF
AGING
I. REPRODUCTIVE
Changes in Female:
• Diminished vaginal secretions secondary
to decreased estrogen- painful
intercourse, infections
Changes in Male:
• Slower erections and ejaculations
secondary to sclerosis of penile veins and
arteries- decrease in sexual activity
 PHYSICAL CHANGES OF
AGING
Nursing Interventions:
• Promote good perineal care, treat with
prescribed creams (eg. Estrogen)
• Use vaginal lubricant as needed
• Provide encouragement and discuss
modifications of sexual expression as necessary;
rest before and after sexual activity
 PHYSICAL CHANGES OF AGING

J. NUTRITIONAL HEALTH
• - Elderly require fewer calories and a more
nutrient-rich, healthy diet
• - Reducing fat intake while getting enough
protein, vitamins, minerals, and dietary fiber
• - Encouraging a diet that is low in sodium and
saturated fats and high in vegetables, fruits, and
fish.
• - Variety of foods to maintain healthy nutrition
PHYSICAL CHANGES OF AGING
K. SLEEP
• Elderly tend to take longer to fall asleep,
awaken more easily and frequently, and spend
less time in deep sleep due to noise, pain or
nocturia
• Recommendations: prudent sleep hygiene
behaviours, consistent bedtime routine,
avoiding or limiting daytime napping,
decrease/avoid fluid intake before bedtime,
and avoiding caffeine and nicotine after noon
PSYCHOSOCIAL
CHANGES OF
AGING
 PSYCHOLOGICAL ASPECT OF
AGING
• Ageism – prejudice or discrimination against older people
• Comprises of the ff:
• 1. Stress and coping in the older adult
- positive self-image
- determined by past experiences
2. Developmental theory of aging
- Erickson – ego integrity vs despair
- Havighurst - death
3. Sociologic theories of aging
 COMMON STRESSORS
1. Normal aging changes that impair physical
function, activities and appearance
2. Disabilities from chronic illness
3. Social environmental losses related to loss
of income and decrease abilities to perform
previous roles and activities
4. Lack of social engagement
5. Death of significant others
 ERICKSON
DEVELOPMENTAL THEORY
OF AGING
Ego integrity vs Despair
• Achieving ego integrity:
1. Accepting one’s lifestyle
2. Believing that one’s choice were the
best at particular time
3. Being in control of one’s life
 ERICKSON DEVELOPMENTAL
THEORY OF AGING : “EGO INTEGRITY VS
DESPAIR”
• EGO INTEGRITY • DESPAIR
• View life with sense of • Believes they have
wholeness & satisfaction made poor choices
from past accomplishment during life and wish
• View death as an they live life longer
acceptable completion of • Inability to accept one’s
life fate
• Accepts one’s one and • Give rise to feeling with
only life cycle frustration,
• Bringing serenity & discouragement and a
wisdom sense that one’s life has
been worthless
 HAVIGHURST
DEVELOPMENTAL THEORY
OF AGING
Task of older people are the ff:
1. Adjusting to retirement after a lifetime of
employment with possible reduction of income
2. Decreases in physical strength and health
3. Death of spouse
4. Establishing affiliation with one’s age group
5. Adapting to new social roles in a flexible way
6. Establishing satisfactory physical living
arrangement
 COMBINING THE CONCEPT:
ERICKSON AND
HAVIGHURST

• 1. Maintenance of self-worth
• 2. Conflict resolution
• 3. Adjustment to the loss of dominant roles
• 4. Adjustment to the death of significant others
• 5. Environmental adaptation
• 6. Maintenance of optimal level of wellness
A. PSYCHOSOCIAL ASPECTS OF
AGING
• Successful psychological aging is reflected in
the ability of older people to adapt to physical,
social, and emotional losses and to achieve
contentment, serenity and life satisfaction
• Resiliency and coping skills when confronting
stresses and changes with positive self-image
• Ageism- Through an understanding of the
aging process and respect for elders can
ageism be dispelled
SOCIOLOGIC
CHANGES OF
AGING
 SOCIOLOGIC THEORIES
OF AGING
• Sociologic theories - attempt and predict
social interaction and roles that
contribute to the older adult successful
adjustment to old age
• A. ACTIVITY THEORY
• B. CONTINUITY THEORY
• C. PERSON-ENVIRONMENT FIT
THEORY
 PSYCHOLGIC / SOCIAL
THEORIES OF AGING
1. Activity Theory
• Maintaining a level of active involvement
in life helps the older adult stay
psychologically and socially healthy
• As life roles or physical capacity are lost,
the older adult will substitute new roles or
intellectual activities
 PSYCHOLGIC / SOCIAL
THEORIES OF AGING
2. Continuity or Developmental
theory
• Adjustment to old age is impacted by
individual personality, and the older adult
will exhibit similar choices and decisions
to younger years
 PSYCHOLGIC / SOCIAL
THEORIES OF AGING

3. Disengagement theory
• Gradual mutual withdrawal between
the individual and society as the aging
process continues
 COGNITIVE
CHANGES OF
AGING
 COGNITIVE ASPECT OF
AGING
• Affected by the ff:
• 1. sensory impairment
• 2. physiologic health
• 3. environment and psychosocial
influences
• Comprises by the ff:
1. Intelligence
2. Learning
3. Memory
 COGNITIVE ASPECT OF
AGING
1. Intelligence – only spatial perception
and non intellectual information decline
beginning in midlife
2. Learning – decline especially after the
7th decade of life
Influences by the ff:
1. motivation
2. speed of performance
3. physical status
 COGNITIVE ASPECT OF
AGING
FACTORS THAT INFLUENCE COGNITION:
- cardiovascular health
- a stimulating environment
- good sensory function
- high levels of education
- occupational status and income
- good nutrition
- jobs that require complex problem-solving skills have a
positive effect on intelligence and learning scores in later
life
 COGNITIVE ASPECT OF
AGING
3. Memory-integral part of learning
1. short-term memory- 5 to 30 secs.
2. recent memory - 1hour to several days
3. long term memory- lifetime
Benign Senescent Forgetfulness – age-related
loss that affect the short term and recent memory
 COGNITIVE ASPECT OF AGING

• Classic Aging Pattern of Intelligence – is

a decline in fluid intelligence (the
biologically determined intelligence used
for flexibility in thinking and problem
solving)
• And an intact Crystallized intelligence
( gained through education and lifelong
experiences eg. Verbal skills ).
 ROLE OF A NURSE
1. Supplies mnemonics to enhance recall of related data
2. Encourage ongoing learning
3. Links new information with familiar information
4. Uses visual, auditory and other sensory cues
5. Encourage learners to wear prescribed glasses and hearing aids
6. Provides glare – free lighting
7. Provide quiet non distracting environment
8. Sets short term goals with input from the learners
9. Keep teaching periods short
10. Pace learning tasks according to the endurance of the learner
11. Encourage verbal participation of learners
12. Reinforce successful learning in a positive manner
ENVIRONMENTAL
ASPECTS OF
AGING
ENVIRONMENTAL ASPECT OF AGING

1. Living arrangement option

2. Life care plans
3. Role of the family
4. Community support services
5. Home health care
6. Safety comfort in the home environment
7. Hospice services
 ENVIRONMENTAL ASPECTS OF
AGING
LIVING ARRANGEMENTS:
1. CONTINUING CARE RETIREMENT
COMMUNITIES
•  Independent single-dwelling houses
or apartments - for people who can
manage all of their day-to-day needs
ENVIRONMENTAL ASPECTS OF
AGING
2. ASSISTED LIVING FACILITIES
• - Allows for a degree of independence while
providing minimal nursing assistance
(administration of meds, assistance with ADLs,
laundry, cleaning, and meals)
3. NURSING HOMES
• - Offer continues nursing care. This area of
facility offers subacute care with high level of
nursing care for residents who need to be
hospitalized or to be transferred from an acute
care setting
 ENVIRONMENTAL
ASPECTS OF AGING
• Life care plans - a document that
assess and evaluates a client’s present,
future, health care and living needs
• Role of family- planning for care and
understanding psychosocial issues in
adults must be accomplished w/in the
context of the family
 ENVIRONMENTAL
ASPECTS OF AGING
• Community support services – helps the
older person to maintain independence
• Home health care – means to prevent
hospitalization
• Safety and comfort in the home -adequate
lighting, sharply contrasting colors, grab
bars, anti-slip mat, loose clothing and
well-fitted shoes, familiar settings
PHARMACOLOGIC
ASPECTS OF
AGING
PHARMACOLOGIC ASPECTS OF
AGING
• Older people use more medications than any
other age group.
• Adverse drug reactions are common because of
multiple medication affects, incorrect dosages,
and the use of multiple medications which
causes drug interactions.
• Certain types of medications that carry high
risks for older patients are often inappropriately
prescribed.
PHARMACOLOGIC ASPECTS OF
AGING

• Any medication is capable of altering

nutritional status
• These medications may alter electrolyte
balance, as well as carbohydrate and
fat metabolism
 PHARMACOLOGIC ASPECT
OF AGING
• Altered pharmacokinetics - reduce
capacity of the liver and kidney to
metabolize and excrete the medications
• Lowered efficiency of the circulatory
and nervous system in coping w/ effects
of medications
PHARMACOLOGIC ASPECT OF
AGING
Altered Pharmacokinetics
• Rate of drug absorption possibly delayed
• Serious alterations in drug binding to plasma
proteins (fewer binding sites)
• Proportion of body fat increases with age
• Decreased metabolism and elimination
resulting in prolonged duration of action
NURSING IMPLICATIONS
1. Dosages should be reduced and over
dosage and toxicity monitored for
increased plasma and tissue levels
2. Meds w/ a narrow safety margin
(digitalis) must be administered
cautiously
3. Improve CO to increase the delivery rate
to the target organ or storage tissue
NURSING IMPLICATIONS
4. Monitor circulatory and CNS - less able
to cope w/ effects of certain medications
5. Watch out for idiosyncratic or unusual
responses to meds
6. Check for drug-drug interactions
7. High fiber diet and use of psyllium
(metamucil) or other laxatives may
accelerate GIT transport and reduce
absorption of meds
NURSING IMPLICATIONS
8. Check that patient’s are dependable
and religiously taking medications
9. Teach self-administration of
medications and request return demo
 NURSES ROLE TO IMPROVE
COMPLIANCE
1. Explain the reaction, side effects and dosage of each
medication
2. Write out the medication schedule
3. Review the medication schedule periodically
4. Use of standard containers without safety lids
5. Destroy all unused medication
6. Discourage the use of the OTC medication and herbal
medicine without consulting health professionals
7. Encourage the patient to bring all the medication,
including OTC medication regularly when visiting the
primary health care provider
 NURSING CARE
1. Conduct a “brown bag” evaluation to
assess all prescription, over-the-counter,
and herbal medications the client may be
taking
2. Assess the client’s understanding of the
reasons for the drug’s therapy
3. Assess the client’s vision, memory,
judgement, reading level, and motivation
to determine ability to self-medicate
 NURSING CARE
4. Provide instructions in large-print,
premeasured syringes, memory aids,
and daily drug dose containers to
enhance self-medicating abilities
5. Check with the pharmacist for any
drug-drug interactions if unsure
6. Before beginning a medication, obtain
baseline vital signs, mental status,
vision, and bowel / bladder function
 NURSING CARE
7. Drug-induced side effects may present as
confusion, incontinence, falls or immobility
8. Assess the client’s ability to pay for the
prescriptions
9. If the client requires assistance in taking
medications, teach family members.
10. Proper techniques for administering oral
medications include: position head forward
with neck slightly flexed to facilitate
swallowing and avoid risk of aspiration
 NURSING CARE
11. If client has swallowing difficulties,
obtain liquid forms of oral medications
wherever possible
12. Assess client for effectiveness of
medications and any adverse reactions
COMMON HEALTH
PROBLEMS OF
AGING
 GERIATRIC SYNDROME
• “ frail syndrome”
• frail person are those who are more
vulnerable to significant problem and
meeting 1 or more of the ff: condition :
1. being 85 years of age older
2. being unable to perform ADL
3. suffering from multiple chronic dses
 Geriatrics Syndrome :
Manifestations:
1. Impaired mobility
2. Dizziness
3. Falls and falling
4. Urinary incontinence
 IMPAIRED MOBILITY
Common Causes:
• 1. Osteoporosis
• 2. Osteoarthritis
• 3. CVS
• 4. Parkinson dses.
• 5. DM neuropathy
Management: encourage them to stay as
active as possible
 DIZZINESS
• True dizziness – sensation of
disorientation in relation to position
• Vertigo – spinning sensation
 FALL
• Common and most preventable source
of morbidity and mortality
• Major cause of trauma in elderly
URINARY INCONTINENCE
Common Causes:
1. Delirium and dehydration
2. Restricted mobility and restraint
3. Inflammation and infection
4. Pharmaceutical and polyuria
 PATTERNS OF HEALTH AND
DISEASE IN THE OLDER ADULT
1. Diseases that occur to varying degrees
in most older adults
• Cataracts
• Arteriosclerosis
• Benign prostatic hypertrophy (males)

2. Diseases with increased incidence

with advancing age
• Neoplastic disease
• Diabetes mellitus
• Dementia disorders
 PATTERNS OF HEALTH AND
DISEASE IN THE OLDER ADULT
3. Diseases that have more serious
consequences in the elderly and make
homeostasis more difficult to maintain
• Pneumonia
• Influenza
• Trauma

4. Chronic disease very common

• Seventy-nine percent of
noninstitutionalized persons over age 70
have at least one chronic disease
• Most hospital visits for persons over 65 are
for chronic diseases
 PATTERNS OF HEALTH AND
DISEASE IN THE OLDER ADULT
5. Functional disability (inability to
perform activities of daily living (ADL))
• Thirty-two percent of persons over 65
have some limitations of functions
• Twenty-five percent of persons over 65
require help with at least one ADL or
IADL (instrumental activities of daily
living)

6. Chronic vs acute disease

Charact Chronic diseases Acute diseases
eristic
Cause Multiple Causes; often related Specific etiologies
to lifestyle
Onset Slow, insidious Rapid
Duration Intermediate; remissions and Short
exacerbations
Understan Often difficult because of Simpler because
ding of intermediate course, symptoms more overt
disease remissions and exacerbations

Outcomes -Somewhat predictable but often -Symptoms resolve with

debilitating and associated with cure of disease
long periods of illness -Outcome usually
-Management of conditions favorable; cures
-Lifestyle changes required -Health care provider
-Individual with disease must directs care and cure
 COMMON MENTAL
PROBLEMS
• Depression
• Delirium
• Dementia
• Alzheimer’s
• Parkinson’s
 MENTAL HANDICAP

A. DEPRESSION- the most common

affective or mood disorder of old age
• - signs of depression includes feeling of
sadness, fatigue, diminished memory and
concentration, feelings of guilt or
worthlessness, sleep disturbances, appetite
disturbances, restlessness, impaired
attention span, and suicidal ideation.
 MENTAL HANDICAP
A. DEPRESSION-
Management:
• Evaluation of the patient’s medication regimen and
eliminating or changing any medications that contribute
to depression.
• Antidepressants and short-term psychotherapy in
combination are affective in treating late-life depression
• It may take 4 to 6 weeks for symptoms to diminish,
and during this period, nurses should offer explanations
and encouragement
B. DELIRIUM-
• Called acute confusional state, begins
with confusion and progresses to
disorientation
• Thinking is disorganized and the
attention span is short.
• Hallucinations, illusions, delusions,
fear, anxiety, and paronoia may be also
be evident
B. DELIRIUM-
• If unrecognized and left untreated, permanent,
irreversible brain damage or death can follow.
• Treatment of the underlying cause is the most
important, and therapeutic interventions vary
depending on the cause
• Nursing Interventions: The environment
should be quite and calm, nutritional and fluid
intake should be supervised and monitored,
provide familiar environmental cues and
encourages family members to touch and talk to
the patient
C. DEMENTIA- Slow progression in
alteration in function of both memory and
either language, perception, visiospatial
function, calculation, judgement,
abstraction, and problem-solving
- the characteristic changes fall into
three general categories- cognitive,
functional and behavioural-and they
eventually destroy a person’s ability to
function
 DEMENTIA
To diagnose at least 2 domain of altered
function must exist: memory and at least
1 of the ff:
• 1. language
• 2. perception
• 3. visiospatial function
• 4. calculation
• 5. judgement
• 6. abstraction
• 7. problem solving
 COGNITIVE DISORDERS (formerly Organic Mental Disorders)
Delirium (acute confusion) Dementia
Consciousne Clouded; reduced clarity Not clouded
ss
Memory Recent, immediate Recent, immediate, remote
Orientation Disoriented May be disoriented
Etiology - Physiologic - Unknown
- Infection - Genetic component
- Drug related intoxication - Decrease metabolic activity of the brain
Course - abrupt (short period of time, - Insidious
within hours to days); - slow and
- fluctuates during the course - progressive;
of the day, - does not fluctuate
- brief course;
- often reversible and
temporary
Cognition Change in cognition Change in cognition
- memory deficit, - Aphasia – language disturbance
- disorientation, - Apraxia – impaired ability to carry out motor
- language disturbance activities despite intact motor function
- illusion - Agnosia – failure to recognize, identify
- misinterpretation object
- Disturbances in executive functioning
Management R-outine – aside from safe and therapeutic environment, provide consistent
physical environment, familiar caregiver (one nurse), in a well lit less stimulating
room, limit frustrating and confusing decision making, avoid changes, speak in
clear, low pitched voice (don’t shout), daily routine
R-epeat – provide information, orient to time, place and person, give direction
one at a time then repeat exactly as necessary;
R-einforce – use of environmental cues to stimulate memory (calendar, clock,
signs)
D. ALZHEIMER’S-
• A progressive, irreversible, degenerative,
neurologic disease that begins insidiously, and
gradual losses of cognitive function and
disturbances in behaviour and affect
- Factors: genes, neurotransmitter changes,
vascular abnormalities, stress hormones,
circadian changes, head trauma and seizures
Pathophysiology: Neurofibrillary tangles, senile or
neuritic plaques (deposits of amyloid protein),
neuronal damage in the cerebral cortex resulting
in decreased brain size.
Nursing Management: Focuses on the
Following Aspects:
1. Supporting cognitive function
2. Promoting physical safety
3. Promoting independence in Self-care activities
4. Reducing anxiety and agitation
5. Improving communication
6. Providing for socialization and intimacy needs
7. Promoting adequate nutrition
8. Promoting balanced activity and Rest
9. Supporting Home and Community-based care
E. PARKINSON’S -
• A progressive disorder with
degeneration of the nerve cells in the
basal ganglia resulting in generalized
decline in muscular function, causing
disorder of the extrapyramidal system.
Pathophysiology: Disorder causes
degeneration of the dopamine-
producing neurons in the substantia
nigra in the midbrain.
 Parkinson’s Disease
Degeneration of the substantia nigra
Pathophysiology of Parkinson’s
Disease
Pathophysiology of Parkinson’s
Disease
E. PARKINSON’S -

Assessment Findings: Tremor, rigidity,

bradykinesia, fatigue, stooped posture,
difficulty rising from sitting position, masklike
face with decreased blinking of eyes, quiet
monotone speech, emotional lability,
depression, increased salivation, drooling,
cramped small handwriting, excessive
sweating, seborrhoea, lacrimation,
constipation and decreased sexual capacity
Nursing Management:
1. Administer medications as ordered (Levodopa, Carbidopa,
Amantadine, Anticholinergic, Antihistamines, Bromocriptine, MAO
inhibitor and Tricyclic antidepressants)
2. Provide a safe environment
3. Provide measures to increase mobility
4. Encourage independence in self-care activities
5. Improve communication abilitiy
6. Refer for speech therapy when indicated
7. Maintain adequate nutrition
8. Avoid constipation and maintain adequate bowel elimination
9. Provide psychologic support to client and significant others
10. Provide client teaching and discharge planning
 NURSING
PROCESS IN THE
CARE OF THE
ELDERLY
 ASSESSMENT
I. HEALTH HISTORY AND
GERENTOLOGIC FOCUS
A . ASSESSMENT OF THE OLDER
ADULT CLIENT IS COMPLEX
1. Allow sufficient time to conduct a
thorough healthy history interview
2. Depending on the client’s stability, the
interview may take more than one
session
B. PRESENTING PROBLEM
1. Assess client systematically
depending upon the presenting
problem
2. Typical presentations of disease may
change with age
3. The problem is likely to have multiple
contributing factors and affect the
client’s functional abilities
 C. MENTAL STATUS AND
MENTAL HEALTH
1. It is important to maintain a baseline for
orientation, memory, level of alertness,
and decision-making capabilities

2. Assess the client for quality of life

issues, mood, affect, and anxiety
D. LIFESTYLE AND FUNCTION
1. Often, there is little correlation between
diseases and functional abilities
2. The functional assessment provides a
clearer picture of physical, psychological,
and social health
3. Use the client’s own baseline from previous
assessments to determine any changes in
function
4. Have the client demonstrate function
wherever possible
 E. MEDICATION USAGE
1. Ask for information about all types of
medications that the client is taking,
2. Be sure the client understands the purpose,
dosage, side effects, and any special
considerations or interactions for all
medications
3. Discuss the client’s abilities to obtain
medications (eg. Renewing prescriptions,
paying for medications)
4. Polypharmacy is often present. Average
older adult takes 11 prescription medications
per day
F. NUTRITION AND HYDRATION
1. Obtain food/ fluid intake profile (either 24
hours or 3 days)
2. Determine any difficulties ingesting food/ fluids
(chewing, salivation, swallowing, manual
dexterity, tremors)
3. Any foods the client is unable to eat (dairy
products, sodium, sugar) or foods the client
should eat (potassium- or calcium-rich
foods/fluids)
4. Taking in adequate amounts of water daily to
stay hydrated
5. Ability to afford/purchase/prepare food
 G. PAST MEDICAL HISTORY
1. Inquire about all chronic diseases and
conditions.
- Be aware that the client may not even
consider certain conditions treatable and
therefore does not mention them, eg.
Urinary incontinence or pain from arthritis
2. Obtain information about previous
illnesses, hospitalizations, and
surgeries
 DIAGNOSIS
II. Physical Examination
• Assess body systems as indicated
• Note physical changes in the older adult
III. Laboratory/Diagnostic Tests
• Laboratory tests as indicated according to
symptoms of individual client
• Interpret lab test results with aging
changes in mind
ANALYSIS/ NURSING DIANOSES
FOR OLDER ADULT CLIENTS
A. Activity intolerance
B. Bowel incontinence, constipation, diarrhea
C. Acute or chronic pain
D. Anxiety or death anxiety
E. Deficient fluid volume
F. Risk for infection
G. Impaired memory
H. Impaired physical mobility
I. Impaired oral mucous membrane
J. Imbalanced nutrition: less or more than body
requirements
ANALYSIS/ NURSING DIANOSES
FOR OLDER ADULT CLIENTS
K. Ineffective airway clearance or breathing pattern, or
impaired gas exchange
L. Self-care deficits: feeding, bathing/hygiene,
dressing, grooming, toileting
M. Disturbed body image or ineffective role
performance
N. Disturbed sensory perception
O. Sexual dysfunction
P. Impaired skin integrity
Q. Disturbed sleep pattern
R. Disturbed thought process
ANALYSIS/ NURSING DIANOSES
FOR OLDER ADULT CLIENTS
S. Ineffective tissue perfusion
T. Impaired urinary elimination
U. Deficient diversional activity
V. Wandering
W. Impaired social interaction
X. Risk for other-directed violence
Y. Risk for falls or injury
Z. Relocation stress syndrome
AA. Impaired home maintenance
 PLANNING AND
IMPLEMENTATION
GOALS : CLIENT WILL MAINTAIN
A. Maximum functional independence
B. Normal bowel and bladder elimination patterns
C. Sufficient communication skills
D. Positive self-concept
E. Freedom from injury and infection
F. Optimal cognitive functioning
G. Adequate nutritional status and fluid balance
H. A restful sleep pattern
I. Social contacts and interpersonal needs
J. Treatment regimens are prescribed
 EVALUATION
A. Client performs self-care activities or
caregiver provides assistance as needed
B. Client is continent of bowel and bladder;
voids in adequate amounts and has
regular bowel movements
C. Client is able to successfully
communicate needs and concerns
D. Client makes positive statements about
self
E. Client/ caregiver modifies environment to
support safety
 EVALUATION
F. Client is alert, calm, and oriented if
possible
G. Skin is intact without pressure ulcers
H. Client eats a nutritionally balanced diet
and maintains a stable weight
I. Client maintains friends, social
interactions, and sexual function
J. Client describes and adheres to
treatment plan
DEATH AND DYING
 OVERVIEW OF DEATH AND
DYING
• One of the most difficult issues in nursing
practice
• Often difficult for nurses to maintain
objectivity because of identification and
response to death based on own value
system and personal experiences
• Nurses need to take time to analyze their
own feelings about death before they can
effectively help others with terminal illness
 ASSESSMENT
A. Physical discomfort
B. Emotional reaction (withdrawal, anger,
acceptance) and stage of dying
C. Desire to discuss impending death,
value of own life
D. Level of consciousness
E. Family needs
F. Stages of dying (Kuber-Ross)
 STAGES OF GRIEVING
(Kubbler-Ross)
1. Denial – refuses to believe that the loss has
occurred
2. Anger – the individual resists the loss and may
“act out” feelings.
3. Bargaining – the individual attempts to make a
deal in an attempt to postpone the reality of
loss.
4. Depression – feeling of loneliness and
withdrawal from others
5. Acceptance – the individual comes to terms
with loss, or impending loss, psychological
reactions to the loss cease, and the interaction
to other people resumed
 Stages of Grieving
Stages Behaviors
DENIAL Refuses to believe that loss is
happening
ANGER Retaliation/Hostility

BARGAINING Feelings of guilt, fear of

punishment for sins
Laments over what has
DEPRESSION happened , withdrawn
behavior

ACCEPTANCE Begins to plan like wills,

prosthesis, comes to terms
with loss
 Stages of beliefs in death
AGE BELIEFS
Infancy to 5 years NO clear concept of Death
old It is Reversible. Temporary sleep
Immobility and Inactivity
5 to 9 years Understands DEATH is FINAL but can be AVOIDED
9-12 years Death is INEVITABLE
Understands own mortality
Fears death
12-18 years Fears a lingering Death
Fantasizes avoidance of death
18-45 Attitude is influenced by religion
Increased attitude and awareness
45-65 years Experiences peak of death anxiety
Accepts mortality
65 and above Death as multiple meanings, encounters and fears
 END OF LIFE CARE
• Goal setting in palliative care
• Discussing end of life care
1. Initiate discussion
2. Clarify understanding of medical
treatment plan & prognosis
3. Identify end of life priorities
4. Contribute for the interdisciplinary care
plan
 END OF LIFE CARE
Assessment of end of life care beliefs,
preferences & practices
1. Disclosure or truth telling
2. Decision making style
3. Symptom management
4. Life sustaining treatment expectations
5. Desired location of dying
 END OF LIFE CARE
Assessment of end of life care beliefs,
preferences & practices
6. Spiritual or religious practices
7. Care of the body after death
8. Expression of grief
9. Funeral & burial practices
10. Mourning practices
 SIGNS OF APPROACHING
DEATH
• Anorexia, Decreased intake; lack of swallowing
• Decrease urine output
• Patient sleeps more & begins to detach from
environment, drowsiness, sleeping, agitation
• Mental confusion, Disorientation, delirium
• Audio-visual impairment & incomprehensible
speech
• Secretions may accumulate at the back of
throat
 SIGNS OF APPROACHING
DEATH
• Irregular breathing with apnea
• Restlessness
• Initially px feels hot then cold after
• Loss of bladder control/incontinence
• Weakness and fatigue
• Surges of energy
• Fever
• Bowel changes
NURSING DIAGNOSES FOR THE
DYING CLIENT MAY INCLUDE:
• A. Anxiety F. Impaired mobility
• B. Pain G. Powerlessness
• C. Ineffective coping H. Self-care
• D. Fear I. Social isolation
• E. Anticipatory grieving J. Hopelessness
 PLANNING
GOALS:
1. Optimum physical comfort
2. Sense of security
3. Discuss what death means and to
progress through stages of dying
4. Help client accept losses
5. Provide relief from loneliness, fear and
depression
 INTERVENTION
1. Recognize clients/families have own way of
dealing with death and dying
2. Support clients/families as they work through
dying process
3. Accept negative responses from clients/
families
4. Encourage clients/families to discuss feelings
related to death and dying
5. Support staff and seek support for self when
dealing with dying client and grieving family
 EVALUATION
A. Client has
1. Discuss feelings about impending death
and acknowledges inevitable outcome
2. Been comfortable and participated in self-
care for as long as possible
B. Family discussed feelings about loss
of loved one
GRIEF AND LOSS
 GRIEF AND LOSS
• GRIEF= total response to
emotional experience related to loss
• MOURNING= behavioral response
• BEREAVEMENT= Subjective
includes grief ad mourning
• LOSS= something valuable is gone
 GRIEF AND LOSS
• Responses to loss are strongly
influenced by one’s cultural background
• The grief process involves a sequence
of affective, cognitive and psychological
states as a person responds to and
finally accepts a loss.
 ASSESSMENT
A. Weight loss
B. Sleep disturbances
C. Thoughts centered on loss
D. Dependency, withdrawal, anger, guilt
E. Suicide potential
 NURSING DIAGNOSIS
A. Ineffective coping
B. Hopelessness
C. Sleep pattern disturbances
D. Disturbed thought process
E. Risk for violence, self-directed
 PLANNING
Goals: Client/Family will:
1. Discuss responses to loss
2. Resume normal sleeping/eating
patterns
3. Resume ADL as they accept loss
 NURSING INTERVENTIONS
FOR GRIEF AND MOURNING
1. Assess emotional affect
2. Assess for guilt and regrets
3. Assess for presence of social support
4. Assess for coping skills
5. Assess for signs of complicated grief
& offer referral
 NURSING INTERVENTIONS
FOR GRIEF AND MOURNING
A. Support expression of feelings
B. Employ emphatic listening
C. Encourage telling of stories in open ended
statements
D. Encourage client/family to express feelings
E. Accept negative feelings/ defenses
F. Assist mourner to find an outlet
G. Explain mourning process and relate to
client/ family responses
H. Refer client/ family to support groups
 EVALUATION
Client/ Family Has:
1. Expressed feelings
2. Progressed through mourning process
3. Seeked necessary support groups
 Care Following Death
• Preparing the family
•Care after death
- Removal of tubes, equipment
- Bathing and dressing the body
- Positioning the body
- Respect cultural preferences
•Evaluate circumstances
•Organ donor procedures
 POSTMORTEM CHANGES
• PALLOR MORTIS - 15–120 MINUTES after the
death
• ALGOR PORTIS - 10 TO 32 HOURS
• RIGOR MORTIS - 2 TO 4 HOURS and PEAK
AT 12 HOURS
• LIVOR MORTIS - 20 MINUTES TO 3 HOURS,
MAXIMUM 6-12 HOURS
• DECOMPOSITION - FEW HOURS TO 3
WEEKS
• SKELETONIZATION - THREE WEEKS TO
SEVERAL YEARS
• 1. PALLOR MORTIS – postmortem
paleness 15 – 120 minutes after the
death because of lack of capillary
circulation
• 2. ALGOR PORTIS – reduction in body
temperature by 2 degrees Celsius in the
first hour & 1 degree Celsius until
room temperature by 10 to 32 hours
• 3. RIGOR MORTIS – chemical change
in the muscles; limbs become stiff 2-4
hours and peaks at 12 hours
• 4. LIVOR MORTIS – post mortem
lividity or hypostasis; settling of the
blood in the dependent portion of the
body; purplish red discoloration of the
body by heavy red blood cells sinking
through serum by gravity in 20 minutes
to 3 hours, maximum 6 to 12 hours.
• 5. DECOMPOSITION – rotting; tissues
of a dead organism break down into
simpler forms of matter in a few hours
to 3 weeks.
• 6. SKELETONIZATION – complete
decomposition of the non-bony parts of
a corpse; leading to a bare skeleton in 3
weeks to several years
Care Following Death (cont.)

•Removal of the body from bed

•Rigor mortis 2-4 hrs after death
•Embalming
•Dispositions
THE END

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