GERIATRIC

NURSING
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INTRODUCTION
Ageing the normal process of time related change,
begins with birth and continues throughout life. The
older segment of the population is growing more
rapidly than the rest of the population: the U.S
Census Bureau projects that by the year 2030,
there will be more than 65 years of age than
people younger than 18 years of age. As the older
population increases, the number of people who
live to be very old will also increase.
Health professionals will be challenged to design strategies that
address the higher prevalence of illness within this aging population.
Many chronic conditions commonly found among older people can be
managed, limited, and even prevented. Older people are more likely to
maintain good health and functional independence if appropriate
community based support services are available.

HISTORY OF GEDIATRIC NURSING

The development of gerontological

nursing came through the combined
efforts of the American Journal of
Nursing, John A. Hartford Foundation
Institute for Geriatric Nursing and the
American Nurses Association. However,
it was the American Nursing Association
(ANA) that formed a specialized group
for geriatric nurses in the 1960s and
recognized it over the next three
decades.
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Programs were established to solidify the geriatric nursing
specialization and nurses were given substantial educational
opportunities through the development of Geriatric Research Education
and Clinical Centre’s (GRECCs), allowing them to provide quality care
for older veterans. Later, certificate programs, baccalaureate degrees,
and master’s degrees were created to allow applicants to become
geriatric nurses in their respective states.
Caring for the aged is not a new concept in nursing; Florence
Nightingale pioneered this specialized field. She was renowned as the
first geriatric nurse because of her nurse superintendent position in an
English institution, where she cared for helpers and maids of wealthy
women. Nowadays, gerontological care is recognized by society
through the collaboration of several organizations and hardworking
individuals in the field of nursing. In time, geriatric nurses trained for the
job and an evidence-based geriatric nursing practice was developed,
which allowed the production of books, journals, websites and even
organizations dedicated to caring for older adults.

DEFINITION

AGEING

The process of growing old, is

defined as the gradual
biological impairment of normal
function, probably as a result of
changes made to cells (mitotic
cells, such as fibroblasts and
post-mitotic cells, such as
neurons) and structural
component.
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GERONTOLOGY

Gerontology it is a science that deals with study of ageing process.

GERIATRIC CARE

Geriatric care This is related to the disease process of old age and its
aims at keeping old person at the state of self-dependent as far as
possible & to provide facilities to improve the life.

GERIATRIC NURSING

Geriatric nursing Geriatric nursing is the specialty that concerns itself

with the provision of nursing services to geriatric or aged individuals.

GERIATRIC NURSING

Geriatric nursing Geriatric nursing is the specialty that concerns itself

with the provision of nursing services to geriatric or aged individuals.

AGEING

ATTITUDES TOWARDS AGING

The way we care for aged individuals is

influenced by our experiences with family,
friends, neighbourhood, school and even work.
Aging is a normal process, and it is common to
see older people around in our community.
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However, derogatory attitudes toward older adults often exist because
of negative past experiences. Some of us may not have solid beliefs
about older adults, but separating myth from reality is a good way of
appreciating older adults and caring for them in the correct manner.

DEMOGRAPHICS OF AGING

In the latest census by the US Census

Bureau, a whopping 39.6 million older
adults reside in America, which makes up
12.9% of the population of the country. By
2035, it is expected that 1 out of 5
individuals will be 65 years or older. These
seniors will be different from those of past
decades. They will enjoy better health,
longer lives, and more active lifestyles
because of technology and new
advancements in medical care.
However, the increased life expectancy has also caused the creation of
three elderly subpopulations, namely the young old (people aged 65 to
74), the old (people aged 74 to 84) and the oldest-old (people aged
85+). The new retirees will require medical and Social Security
assistance to meet their needs. They will also need long-term care to
maintain their health and well-being throughout the remainder of their
lives.

ECONOMICS OF AGING

As more and more people are born, a growing number are also
becoming elderly. The growing population of the elderly is due to
declining fertility rates and increased longevity. According to the
Centre’s older Disease Control and Prevention,
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the life expectancy of a new-born
today is nearly 78 years, which is
more than twice as long as those born
a thousand years ago. In 1930,
people were expected to live for
59.7 years; and in 1960, life
expectancy increased to 69.7 years.
This dramatic increase in life
expectancy is not an accident.
It is the result of public health initiatives, infectious disease control and
new surgical and rehabilitation techniques. In fact, there is a significant
decrease in mortality rates, accounted for in 2007, which showed a
declining percentage of deaths from the 15 leading diseases like
stroke, diabetes, accidents, homicide, influenza, pneumonia and many
others. Also, medical breakthroughs are solving our problems with birth,
early infancy disorders as well as contagious diseases, thereby
improving longevity and allowing people to live longer than in past
decades.

HOUSING ARRANGEMENTS

Housing arrangements are one of the

many things we have to consider when
we get older. Senior individuals have
specific needs, and most have fragile
bones and lifestyle diseases that need
long-term care.
They may require specialized nursing services, but they also need better
housing conditions. Nowadays, there are a lot of accommodation
options for elderly individuals, including nursing homes, retirement
communities and apartments designed for older people. Some of these
options may be suitable for a particular person, while others are not.
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HEALTHCARE PROVISIONS
The elderly population is vulnerable to a variety of health problems.
Prevention and control requires a multifaceted approach with
collaboration of the social welfare, health, legal and rural/urban
development sectors. A geriatric healthcare program should contain a
comprehensive policy at the start. Any healthcare provision be
supported by a strong political will and social action to make the
policies efficient and sustainable. Nevertheless, other measures like
improving healthcare knowledge, health insurance and promotion of a
healthy lifestyle are also the keys to better elderly care.
The provision of quality healthcare
services to the elderly population
imposes several challenges. It is
important to address the factors
that hinder these services to
develop a better way of life for
our seniors. Families with the
elderly should take a significant,
role in ensuring that their needs are adequately met. Failure to address
their healthcare needs early on can result in costly issues later. In fact, it
can aggravate an existing condition that causes a major meltdown
within the family.

IMPACT OF AGING MEMBERS IN THE FAMILY

Many of our older individuals experience a decline in their physical and
cognitive functioning. This has made them lose the ability to live
independently, forcing them to seek long-term care services from
institutions like long-stay hospitals, nursing homes, residential care and
assisted living facilities. Families with older people often carry the
burden of caring for these individuals,
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accumulating significant costs when they do. In less developed
countries where affordable long-term care facilities are not available,
families with elderly adults withdraw from their employment or school
commitments just to care for these family members and make ends
meet. They may end up with significant debt due to their
hospitalization, medication maintenance, and home care adjustment
costs.
The impact of having an aging family member often varies on how well
they handle the changes and demands of day- to-day living. Most
families with a solid economic background and strong financial support
from the government seek long-term nursing services to care for the
elderly. Unfortunately, this may not apply to families with fewer
resources and unemployed family members. The demands of an elderly
individual are often unpredictable and changing. Thus, families should
be prepared for this day to balance the situation and ensure the
provision of a safe retirement for their loved ones.

THEORIES OF AGING
There are several theories about the
process of aging, yet they are mutually
exclusive and often contradict one
another. Nowadays, the biological
theories of aging have two main
categories:
1. The programmed theory; ageing has a biological timetable or
internal biological clock
2. The damage or error theory. ; Ageing is a result of internal or
external assaults that damage cells or organs so they can no longer
function properly.

PROGRAMMED THEORIES OR NON-STOCHASTIC

THEORIES
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Programmed senescence theory
Endocrine theory
Imunology theory

ERROR THEORIES

Wear and tear theory

Cross linking theory
Free radical theory
Error catastroph theory
Somatic mutation theory

PROGRAMMED THEORIES OR NON-

STOCHASTIC THEORIES
The programmed theory implies that aging has a biological timetable
and is regulated by the changes in gene expression affecting the
systems responsible for our repair, maintenance and defence responses.

PROGRAMMED SENESCENCE
THEORY/HAYFLICK LIMIT THEORY
1950’s hayflick ina series of classic experiments demonstrated that
culture skin fibroblasts would reproduce or divide a finite number of
times. From these observations rose the programmed theory of cell
death. In this theory, it is proposed that there is an impairment in the
ability of the cell to continue dividing.
The hay flicks limit theory indicates that there is a need to slow down
the rate of cell division if we want to live long lives. Cell division can be
slowed, down by diet and lifestyle, etc., but it is also surmised that cell
division can be improved with many of the protocols of the other.
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ageing theories described herein. The use of ribonucleic acids improve
cell repair process, enhance cellular capacities and increase the
maximum number of cell division in animals and vitro tests.

ENDOCRINE THEORY OR
NEUROENDOCRINE THEORY
First proposed by Professor Vladimir
Dilman and Ward Dean MD, this theory
elaborates on wear and tear by focusing
on the neuroendocrine system. This system
is a complicated network of biochemical
that govern the release of hormones
which are altered by the walnut sized
gland called the hypothalamus located in
the brain.
This theory proposes that aging occurs because of functional
decrements in neurons and associated hormones.
It suggests that neural and endocrine changes may be pacemaker for
many cellular and physiologic aspects of aging. This approach relates
aging to the organism’s loss of responsiveness of neuroendocrine tissues
to various signals. In some cases, this is a result of a loss of receptors,
but in others, it is caused by changes in neurotransmission beyond the
receptors. An important focus of this theory is the functional changes of
hypothalamicpituitary system. These changes are accompanied by a
decline functional capacity in other endocrine organs such as the
adrenal and thyroid glands, ovaries and testes. The hypothalamus
controls various chain-reactions to, instruct other organs and glands to
release their hormones, etc. The hypothalamus also responds to the
body hormone levels as a guide to the overall hormonal activity. But as
we grow older, the hypothalamus loses it precision regulatory ability
and the receptors which uptake individual hormones become less
sensitive to them.
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IMMUNOLOGIC THEORY
It proposes declining functional capacity of immune system as the basic
for the ageing process. It suggests that ageing is not passive wearing
out of systems but an active selfdestruction mediated by immune system.
This theory is based observing an age associated decline in T-cell
functioning accompanied by a decrease in resistance and increase in
autoimmune disease with ageing. Some studies of cell division suggest
that cells of the immune system become more diversified with age and
demonstrate a progressive loss of self -regulatory patterns. The result is
an autoimmune phenomena in which cells normal to the body are
mistaken as foreign and are attacked by the persons own immune
system.

ERROR THEORIES
Error theories emphasize the environmental
impact that induces cumulative damage,
instigating the aging process. These two
theories are based on evolutionary concepts
wherein aging is considered the result of an
individual’s inability to combat the natural
deterioration processes and is a result of a
biological program that allows decay and
death to attain a direct evolutionary benefit.

WEAR AND TEAR THEORY

Early theory on ageing proposed that there is fixed store of energy

available to the body as time passes, the energy is depleted and
because it cannot be restored, the person dies.
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CROSS LINKED THEORY

It postulates that over time and as a result of exposure to chemicals

and radiation in the environment. Cross-links have formed between
lipids, proteins, and carbohydrates as well as nucleic acid
These cross-links result in decreased flexibility and elasticity and this
increases rigidity in tissues.
Such changes in cell structure may explain the observable cosmetic
changes associated with ageing, such as wrinkles of skin and
decreased dispensability of arterial blood vessels.
The cross-linking theory of aging is also referred to as the
glycosylation theory of aging. In this theory, it is the binding of
glucose to protein, that causes various problems
once this binding has occurred, the protein becomes impaired and
is unable to perform as efficiently. Living a longer life is going to
lead to the increased possibility of oxygen meeting glucose and
protein and known cross- linking disorders include senile cataract
and the appearance of tough, leathery, and yellow skin.
Indeed, you can see cross-linked in action now. Simply cut an apple
in half and watch the oxygen in the air react with the glucose in the
apple as it turns yellow and brown as eventually becomes tough.

FREE RADICAL THEORY

It was proposed in 1956 by Harman
A free radical is highly reactive atom or molecule that carries an
unpaired electron and thus seeks to combine with another molecule,
causing an oxidative process
This process, also called oxidative stress, can ultimately disrupt cell
membrane and alter DNA and protein synthesis
Common diseases such as atherosclerosis and cancer are
associated with oxidative stress.
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Cellular integrity, function and
regeneration mechanisms are injured
Free radicals are natural by products
of many normal cellular processes and
are also created by such
environmental factors as smog,
tobacco smoke and radiation.
There are numerous natural protective
mechanisms in place to prevent
oxidative damage.
Recent researches focused on roles of various antioxidants,
including vitamin-c and E, beta-carotene and selenium, to slow
down the oxidative process and ultimately aging processes.
The term free radical describes any molecule that has a free
electron, and this property makes it react with healthy molecules in
a destructive way
Because the free radical molecule has an extra electron, it creates
an extra negative charge. This unbalanced energy makes the free
radical bind itself to another balanced molecule as it tries to steal
electrons. In so doing, the balanced molecule becomes unbalanced
and thus a free radical itself. Perhaps a bit like bumper-cars
crashing into each other at the fair.
It is known that diet, lifestyle, drugs and radiation etc , are
accelerators of free radicals production within the body
However there is also natural production of free radicals within the
body. This is the result of the production of energy. Particularly from
the mitochondria. The simple process of eating, drinking and
breathing form free radicals from the energy production cycles, as
the body produces the universal energy molecule ATP.
Free radicles are known to attack the structure of cell membranes,
which then create metabolic waste products. Such toxic
accumulation interfere with cell communication, disturb DNA,RNA
and protein synthesis,
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lower energy levels and generally impede vital chemical processes.
Free radicals can however be transformed by free radical
scavengers(antioxidants) particular antioxidants will bind to
particular free radicals and help to stabilize them
Free radicals come in a hierarchy with the hydroxyl radical and the
superoxide radical at the top of the list. It is therefore necessary to
take a cross section of anti-oxidants in order for the process of
elimination of the free radicals to occur, otherwise higher damaged
free radicals may be converted into a greater number of lower
damaged free radicals.
Such a broad cross section of anti-oxidants includes substances such
as beta-carotene, vitamin C, grape seed extract, vitamin E and
possibly also stronger substances such as hydergine, melatonin and
vinpocetine.

ERROR AND FIDELITY THEORY

An error is a mistake and fidelity refers

to being faithful, so knowing that we
can discuss this theory. Also remember
that this occurs over a lifetime.
Normally, we constantly or faithfully
produce cells throughout our bodies
using our same correct DNA map to
do so time & time again.
This theory is saying that over time an error or mistake occurs in our
DNA map (protein)and it begins to produce cells that are not
correct-it’s like going from producing a high quality product to
producing a lesser quality product. This deterioration results in aging
and eventually over a lifetime, death.
The somatic mutation and intrinsic mutagenesis theories postulate
that aging is a result of lifelong genetic damage which may include,
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the progressive accumulation of faulty copying in dividing cells or
accumulation of errors in information containing molecules

SOMATIC THEORY OR GENE MUTATION

THEORY
Scientists investigated the role of mutations
in aging, radiation not only increased
animal mutation but it also accelerated
their aging process as well.

FUNCTIONS OF GERONTOLOGICAL
NURSING
The functions of geronotological nurse are mentioned on the basis of
spelling of the word:
G (guiding): Giving guidance to people of all ages regarding ageing
process.
E (elimination): eliminating ageism, or considering old age as disease.
R (respecting): respecting the rights of older people,
O (observing): observing the facilities provided to old people &
improving them.
N (noticing): noticing health hazards that may happen in old age & try
to reduce them.
T (teaching): teaching how to take care of old people, for those who
are caring for them
O (opening channels): opening the channels of development activities
for the care of the aged.
L (listening): listening attentively to the problems of old people & giving
due importance to them.
O (offering): offering positivism presenting different possibilities of life.
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G (generating): generating energy for participation in the care of
aged & researches for new supporting techniques.
I (implementing): implementing activities for rehabilitation &
readjustment.
C (coordinating): coordinating different services related to the care of
the aged.
A (assessing): Assessing the needs & health of the old people. L (linking):
linking, contacting services according to need.
N (nurturing): prepare future nurses for the care of the aged.
U (understanding): understanding every old person as an invaluable
asset of the society.
R (recognizing): recognizing the moral & religious aspects of old age &
giving them recognition.
S (supporting): supporting the old people in accepting realities &
preparing them mentally for impending death.
E (education & encouraging): educating & encouraging old people for
self-care.

PHYSIOLOGICAL CHANGES DUE TO

AGING

PHYSIOLOGIC CHANGES IN THE

INTEGUMENTARY SYSTEM
Skin changes are the most visible signs of aging.
As we age, our skin becomes wrinkled and prone
to injury. This is due to the fact that pigment-
containing cells decrease, and connective tissues
as well as the blood vessel function deteriorates.
An elderly individual usually experiences a
change in their skin’s elasticity and strength.
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The sebaceous glands will generate a lower production of oil and the
dermis becomes fragile. As a result, most elderly men and women have
problems with insulation or a reduced ability to maintain body
temperature. The subcutaneous fat layer thins and it loses its protective
layer. The skin is less able to feel touch, vibration, pressure, heat and
cold.
Aging skin has a reduced ability to repair itself. Elderly individuals often
experience a delayed wound healing, thereby making pressure ulcers
and infections worse. Skin disorders among older people are often
related to conditions like arteriosclerosis, liver disease, heart disease,
nutritional deficiencies, diabetes, obesity, stress and allergies. These
skin changes can be alleviated through adequate nutrition and proper
hydration. Older people are prone to injuries and nutritional
deficiencies. This is why they have to be mindful of what they eat and
the lifestyle they choose.

PHYSIOLOGIC CHANGES IN THE

MUSCULOSKELETAL SYSTEM
Physiologic changes in the
musculoskeletal system of men and
women usually start at the age of 30.
The density of bones starts to diminish at
this age, especially for women nearing
the menopausal stage. As a result, bones
are becoming fragile and are likely to
break.
We often do not notice these
musculoskeletal changes of our body as
we grow older,
but time and time again, the joints are affected by the changes in our
connective tissue and cartilage. The cartilage becomes thinner and its
components altered,
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making it less resilient and therefore
susceptible to damage. Some people find
their joints a bit different than they used
to be, and experience a condition called
osteoarthritis. In osteoarthritis, joints
become stiffer and the tendons brittle
and rigid. Individuals with this condition
often have a limited range of motion.
They often cannot perform their daily
routine because of the pain and
inflammation experienced in the joints.
Furthermore, muscle mass also deteriorates in aging. The size of muscle
fibers and the amount of muscle tissue gradually decreases throughout
life. This will result in a loss of muscle strength which stresses the joints
and predisposes them to be arthritic as well. Fortunately, muscle mass
and muscle strength can be preserved through regular exercise. This will
significantly delay the changes in our musculoskeletal system and allow
us to maximize the functioning of our muscles.

PHYSIOLOGIC CHANGES IN THE

RESPIRATORY SYSTEM
The effects of aging on the respiratory
system are similar to other organs. Through
time, the maximum function of our lungs
will gradually decline. It will decrease its
gas exchange, peak flow and vital
capacity. Respiratory muscles will also
weaken as well as their effectiveness in
creating a barrier against bacteria,
viruses, and other harmful organisms.
However, the agerelated changes in the respiratory system do not
often lead to symptoms in healthy individuals.
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This will only reduce the ability to perform intense aerobic exercises like
biking, running and mountain climbing. Thus, older people have limited
capacity to perform certain activities.
Individuals who have existing medical problems such as heart disease
and obesity may have a limited lung function as well. They are at a
higher risk of viral and bacterial infections like pneumonia and lung
cancer. Hence, older people often acquire diseases faster than young
adults.

PHYSIOLOGIC CHANGES IN THE

CARDIOVASCULAR SYSTEM
Physiologic changes in the cardiovascular
system typically occur as we age. The heart is a
natural pacemaker that regulates the
heartbeat, but through time, some of its
pathways will develop fat deposits and fibrous
tissue. This may result in a slower heart rate and
a slight increase in its size, especially the left
ventricle. Older people often experience an
abnormal rhythm like atrial fibrillation and a
heart murmur, caused by stiffness of the valves.
Receptors in the cardiovascular system often monitor the blood
pressure whenever a person performs certain activities and changes
positions. But as we age, these receptors become less sensitive, which is
why many older people experience orthostatic hypotension. The
capillary walls of the heart will also thicken and the main aorta artery
becomes stiffer, thicker and less flexible. Normal aging can cause a
reduction of total body water (TBW). Blood volume decreases and
there is less fluid in the bloodstream. Red blood cells, which respond to
stress and any kind of illness, are fewer in number while the white blood
cells remain at the same levels, though their ability to ward off bacteria
and other sorts of infection.
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PHYSIOLOGIC CHANGES IN THE
HEMATOPOIETIC AND LYMPHATIC SYSTEM
The main role of the hematopoietic and lymphatic system is to protect
the body against infection and illness. With advancing age, this system
becomes less effective. The T and B cells, the primary cells involved in
attacking specific invaders, become less responsive. The T cells are
responsible for cellular immunity, and they often respond to infection
and invasion of a pathogen. The B cells, on the other hand, are
responsible for producing antibodies. However, they become less
responsive over time, making the body more susceptible to bacterial
and viral infections.
Vaccinations for viruses are strongly
recommended for older people because
their lymphatic system is not working as
well as when they were younger.
Moreover, the increased occurrence of
cancer in older individuals is due to the
declining ability of the lymphatic system
to eliminate tumor cells efficiently. This is
also caused by nutritional deficiency,
common in older adults.

PHYSIOLOGIC CHANGES IN
GASTROINTESTINAL SYSTEM
Aging is often a factor in different gastrointestinal disorders. With age,
the strength of the esophageal contractions, as well as the tension of
the upper esophageal sphincter, will decrease; but this does not affect
or impair the movement of food. A peptic ulcer is common in older
people,
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because of the decreasing capacity of the stomach lining to resist any
damage, particularly in those using aspirin and NSAID’s as maintenance.
Aging can even affect the ability of the stomach to accommodate
more food because of its decreasing elasticity and capacity to empty
food into the small intestines. This is why most older adults have a
decreased appetite for food.
Other parts of the gastrointestinal system are also affected by aging.
For instance, the small intestines will have a decreasing lactase level,
which leads to the intolerance of milk and dairy products. There will be
an excessive growth of bacteria which can lead to bloating, pain and
weight loss. The pancreas, gallbladder, and liver usually decrease in
weight as we age. Some of the tissues are replaced by scaring and a
number of structural as well as microscopic changes occur, making
these organs prone to injury and illness.

PHYSIOLOGIC CHANGES IN THE URINARY

SYSTEM
There is a slow and steady decline in
kidneys weight as we age. At the age of
30 to 40, twothirds of the kidneys’
function of filtering blood undergoes a
gradual decline. The arteries that supply
the kidneys become narrower, which
makes even healthy kidneys decrease in
size. Also, the small arteries that flow to
the glomeruli thicken over time, reducing
their capacity to function.
This declining ability will have an impact on the nephrons that excrete
waste products. That is why several drugs are not filtered and removed
properly as we age. However, sufficient kidney function can be
preserved to the meet the body’s needs. The changes that occur in our
kidneys may or may not cause disease,
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but this can reduce the degree of
reserve kidney function. This means that
both kidneys have to work to their full
capacity to perform the normal kidney
function. Ureters do not undergo a lot
of changes compared to the bladder
and urethra. The volume of urine that a
bladder holds decreases with time, as
well as the ability to delay urination
after feeling the need to urinate.
There is also a decreasing rate of urine outflow to the urethra and the
sporadic contractions of the bladder wall muscles are not blocked by
the brain, resulting in urinary incontinence. In women, there is a
shortening of the urethra and a thinning of its lining. These changes will
decrease the urinary sphincter’s ability to close tightly, placing a person
at risk for urinary incontinence. In men, the prostate gland tends to
enlarge and blocks the flow of urine. This blockage can cause urinary
retention and kidney damage if left untreated.

PHYSIOLOGIC CHANGES IN THE NERVOUS

SYSTEM
The brain is the primary organ of the nervous system. During childhood,
its ability to think and function steadily increases, allowing a child to
acquire complex skills. Its abilities is relatively stable in early adulthood
and will decline after a certain age. Although brain functioning as we
age varies from person to person, it usually affects short-term memory,
verbal abilities and intellectual performance. Older people often have
a slower reaction time and brain performance compared to young
people. The effects of aging on brain functioning have an influence on
certain disorders like stroke, an underactive thyroid gland and
degenerative brain disorders like Alzheimer’s disease. However, this
varies from person to person.
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The spinal cord and the peripheral nerves will also change as people
age. The disks located in the backbones become brittle and hard,
losing its capacity to cushion it and start to place pressure on the spinal
cord and the nerves emerging from it. Peripheral nerves, on the
contrary, may conduct impulses slowly, resulting in a decrease of
sensation, clumsiness and slower reflexes. Degeneration is common
among older people. The blood flow decreases and the ability of the
nervous system to self-repair becomes slower and incomplete. This
makes them vulnerable to injuries and various diseases.

PHYSIOLOGIC CHANGES IN THE ENDOCRINE

SYSTEM
Despite the changes caused by aging,
the endocrine system functions well in
older people. The changes that occur
are due to the external factors and
genetically programmed changes of
the cells. They may affect hormonal
production and secretion, hormonal
metabolism, rhythms in the body, and
target cell’s response to hormones
and hormone levels that circulate in
the blood.
For instance, the development of Type II Diabetes is thought to be
related to increasing age, especially in those individuals at greater risk
of the disorder. This affects the size of the pituitary gland that regulates
the production of hormones. Decreased levels of hormones can also
affect heart function and cause lean muscles and osteoporosis.

PHYSIOLOGIC CHANGES IN THE REPRODUCTIVE

AND GENITOURINARY SYSTEM
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Aging affects woman’s ovaries,
resulting in menopause. This usually
happens between the age of 45 and
65 at which time the ovaries stop
producing estrogen and progesterone
and cease storing egg cells. When this
happens, the menstrual period stops
and a woman cannot bear children
anymore. But before menopause takes
place, there are perimenopause signs
that every woman experiences.
These symptoms include more frequent periods at first and occasional
missed periods in the following months. This accompanies a change in
the menstrual flow and periods that are either shorter or longer.
Menopause is a normal part of a woman’s aging process. It declines
hormone levels, affecting other parts of the genitourinary system.
Vaginal walls become drier, thinner and less elastic, making sex more
painful and placing a woman at greater risk for vaginal yeast
infections. Meanwhile, men do not have a major or rapid change in
fertility as they grow older. Aging can only affect the testicular tissue,
erectile function, and sperm production. Although it varies from person
to person, most men experience an enlargement of the prostate gland,
which causes a condition called benign prostatic hypertrophy. Erectile
dysfunction and infertility occur when there is a gradual decrease in the
production of testosterone, a male hormone found in the testes.

FACTORS AFFECTING HEALTH

PROMOTION IN ELDERLY
Health promotion in the elderly is sometimes challenging. Several
factors can affect the planning and preparation of meals, for example,
as some people are not able to obtain the necessary nutrients,
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for optimum physical and psychological well-being. The good news is
that a lot of these factors can be controlled and their negative impact
can be minimized.

DECREASED TASTE AND SMELL

Older adults have fewer taste buds

compared to younger people. According
to Medline Plus, the number of taste buds
starts to decrease at the age of 40 to 50
in women and 50 to 60 in men. Some of
them atrophy, leading to a reduced taste
sensation and loss of appetite.
Elderly adults often do not eat well and have a lesser food consumption
than younger adults. This is also due to their diminished sense of smell
caused by a loss of the nerve endings in the nose.

LOSS OF APPETITE

A lot of people have a lesser

appetite as they age. According to
the Academy of Nutrition and
Dietetics, around 5 to 10% of adults
over 45 years old experience iron
deficiency anemia caused by
difficulty in chewing and loss of
appetite.
The inability to obtain the right nutrients can affect the overall nutrition
of an elderly; thus, it is recommended to supplement with vitamins and
eat small and frequent meals. Food can be made more appetizing by
adding or using spices and preparing different kinds of meals every
day.
 Geriatric Nursing
LACK OF MOBILITY AND FINANCIAL ISSUES

Seniors with a disability often have

problems buying nutritious foods and meals.
These individuals have limited access to the
supermarket because of their physical
condition, but programs such as delivery
meal services are now offered to make
nutritious foods accessible. Nevertheless,
financial issues like a small fixed income
among the elderly population impose a
great problem for health promotion.
This limits food selection in older people, especially those with special
dietary needs.

NUTRIENT ABSORPTION

Most older adults may not be able to absorb the essential nutrients from
food and other sources of nutrition because of age-related changes in
metabolism. They often experience a Vitamin B12 deficiency because
their digestive tract is unable to absorb the vitamin well, making them
at risk for depression and dementia. A blood test can assess this
deficiency and vitamin B12 shots may be necessary to supplement the
loss.

REPRODUCTIVE SYSTEM PROBLEMS

Women lose 3 to 5 percent of their bone mass as their estrogen

production declines. This menopausal stage can lead to a greater risk
for osteoporosis, as calcium production decreases over time.
 Geriatric Nursing
Men on the other hand, experience prostate problems which can block
the urinary system and cause difficulty with urination and bowel
movement. Unfortunately, these reproductive system problems can limit
an elderly person’s compliance with health promotion.

RELIGION

Older adults have different views on life.

Bound by faith, these seniors believe
that aging is a normal process and
compliance with health promotion is an
added cost. Therefore, they tend to
isolate themselves and wait for their
time of death.

RISK FOR HEART DISEASE

The risk for heart disease increases after we reach

50. For older adults, developing heart disease is
common. They cannot easily perform certain tasks
because of unstable blood pressure. Some elderly
even limit their food selection because of the
possibility of aggravating the disease.

DEPRESSION AND ISOLATION

Older adults who live alone are vulnerable to social isolation. They are
prone to depression which can lead to poor nutrition and disease
complications. Nowadays, a lot of senior centers and elderly care
programs are reaching out to these individuals to minimize depression
and promote optimum health and well-being.
 Geriatric Nursing
TYPES OF NON VERBAL
COMMUNICATION
Good communication is the core foundation of a successful relationship.
In caring for the elderly, it is essential to recognize and be familiar with
non-verbal communication – like facial expressions, eye contact,
gestures, tone of voice and posture. These signals have a huge impact,
because it is often the starting point of conversation, especially when it
comes to providing quality healthcare. Most older adults have varying
special needs. Their interaction with others is quite limited compared to
young people because of their age and disability. If we do not
recognize the nonverbal cues displayed in an older adult, we cannot
become an effective healthcare provider

FACIAL EXPRESSIONS

There are several types of

nonverbal communication signs,
and facial expressions are some
of them. The human face is
expressive, and it can convey
many emotions without ever
saying a word.
Unlike other forms of non-verbal communication, facial expressions are
universal. We can express happiness, anger, sadness, fear, and disgust
similarly regardless of one’s culture. However, subtle cues alter the
balance. Thus, it is important to get to know the particuilar older adult
you are caring for to know what they are trying to communicate, even
without words.

BODY MOVEMENT AND POSTURE

 Geriatric Nursing
Our perception towards other people is affected by how they stand, sit,
walk and hold their head. The way we carry ourselves says a lot about
us. Nonverbal communication includes posture, stance, bearing and
subtle movements.

GESTURES

Gestures are part of our daily lives. We use

our hands when we speak or argue and
express ourselves by waving, pointing or
beckoning. However, it is important to
take note that gestures have a different
meaning in different cultures.
Even simple things like nodding, patting someone on the head or
showing your feet can have an entirely different meaning, depending
on where you come from. They might be easily misinterpreted if not
done properly.

EYE CONTACT

Eye contact is an important type of

nonverbal communication tool. For the
elderly, this may not be applicable at all
times, but for someone who has clear
vision and perception, it can imply
various emotions. It can mean interest,
affection, attraction or even hostility.

TOUCH

Touch is also a form of interpersonal communication. A handshake, a

warm hug, a reassuring tap on the back,
 Geriatric Nursing
a patronizing pat on the head or a controlling grip on the arm are all
forms of communicating a message, but they provide different
meanings. If you are unsure about the other person’s reaction, it is best
to use touch and body contact moderately so as not to offend anyone.

SPACE

Some elderly require a lot of space to

feel comfortable. This type of nonverbal
communication should be observed
because personal space needs vary
widely. It usually depends on the culture,
situation, and closeness of the
relationship. If the older adult sits close
to you, it may indicate feelings of
comfort, closeness or affection.
But, it can also mean that they come from a culture where less personal
space is the norm, and they have no other alternate feelings attached
to it.

VOICE

The tone of the voice and how you say something can convey a very
different meaning. Communicating with an elderly person requires a
particular tone and pace of voice. When communicating with someone
who is older, try not to speak too fast or use unnecessary slang. Talk at
a clear and slow pace, without sounding condescending or patronizing.
It is important to understand this kind of nonverbal communication to
promote understanding and convey the right message.

MORBIDITY IN OLD AGE

 Geriatric Nursing
Nearly half of the older people have one or more chronic diseases.
Further nearly 40% of them have one or more disability. Common are
Hypertension
Cataract
Osteoarthritis
COPD
Ischemic heart disease
Diabetes
Dyspepsia
Constipation
Depression

MORTALITY IN OLD AGE

Mortality on old age the common causes of death in rural india are the
following
Ischemic heart disease
Stroke
Lung cancer
Tuberculosis

NUTRITION AND AGEING

Healthy eating should be part of every
elder’s diet plan. Food intake provides
energy and sufficient nutrients when done
properly. However, without proper
nutrition, the aging process can affect
several organs and cause various health
complications,
which in some extreme cases may lead to an irreversible disability.
 Geriatric Nursing
Proper nutrition should be followed to promote quality of life among
elderly adults the ingestion of essential nutrients should be taken into
consideration.

VITAMIN D AND CALCIUM

Elderly individuals require more vitamin

and calcium to keep their bones strong
and healthy. Foods rich in calcium include
fat free or low fat milk and dairy products,
yogurt, fortified cereals, dark green leafy
vegetables,
fruit juices and canned fish with soft bones. Elderly adults need at least
three servings of vitamin d and calcium every day. If calcium
supplements or multivitamins are taken as a replacement, make sure to
choose one containing vitamin D.

FIBER

Fiber is essential in every elderly dirt to

keep the bowel functions normal and
promote a healthy heart. It gives one a
feeling of fullness which in return minimizes
a feeling of hunger.
Older men and women should consume at least 30 grams of fiber each
day from healthy food sources like vegetables, fruit, and whole grains.
There are also other grocery products with fiber content, but choose
those with at least three grams of dietary fiber per serving.

POTASSIUM
 Geriatric Nursing
Like any other nutrient potassium is also important to maintain and
promote healthy living among older adults increasing potassium intake
and decreasing sodium consumption may lower the risk of high blood
pressure and cardiovascular diseases. Foods rich in potassium intake
green leafy vegetables, fruit, yogurt, and low fat milk. Try to avoid foods
with a high sodium content. Rather then using salt in dishes, replace it
with herbs and spices to lessen the sodium intake.

HEALTHY FATS

For overall health and weight control, fat

caloric consumption should be at least 20
to 35 percent of the diet. Most of the fat
intake should comes from heart friendly
unsaturated fat sources like extra virgin
olive oil, walnuts, canola oil, and almonds.
Healthy older adults without heart disease should limit the consumption
of saturated fats to 10 percentile, while those with a high cholesterol
history should limit it to 7 percent of their daily food intake. Red meat,
fried foods and even full fat diary products should be used minimally or
in some cases even avoided.

MAKING CALORIE COUNT

Older individuals cannot eat the way they

did in the 20s if they want to maintain their
weight. It is sad fact that as we age, tend
to less active, lose muscle mass and gain
fact. These changes cause the metabolism
to slow down and require an individual to
keep it up his or her entire lifespan.
 Geriatric Nursing
The number of calories needed to consume everyday on the persons
age, gender, and level of activity. For older adults with a sedentary
lifestyle , atleast 2000 calorie should be consumed daily while for those
with a moderately active lifestyle, calorie consumption should be
atleast 2200 to 2400 per day. Moreover an active older adult should
consume at least 2400 to 2800 calories per day. This should be
balanced with physical activity to keep up the metabolism, build muscle
and increase energy.

FACTORS AFFECTING NUTRITIONAL

STATUS OF ELDERLY
Changes in normal physiology
Dental problems
Changes in taste and smell
Ability to digest and absorb nutrients can affect both the quality
and quantity of food consumed and overall suboptimal nutritional
status.

INCREASED PREVALENCE OF CHRONIC

DISEASES
Obesity
Accidents and trauma
Heart disease
Cancer
Arthritis
Osteoporosis
Diabetes
Senile dementia
The use of prescription drugs can result
Physician ordered changes in the diet
Decrease in strength and ability to shop or cook
Disturbances in the ability of the body to utilize nutrients normally
 Geriatric Nursing
SOCIOECONOMIC, PSYCHOLOGICAL AND
CULTURAL FACTORS
Low income.
Beliefs and superstitions regarding food
and dietary habits.
Social isolation.
Depression and loneliness from loss of
spouse.
Family members and friends can decrease
the quantity and quality of the diet.
Alcoholism and use of therapeutic drugs, when alcohol is substituted
for nutritious foods, it may interfere with absorption of some
nutrients, notably folic acid. Longterm use of certain therapeutic
drugs that interfere with absorption and metabolism of nutrients is
an important cause of malnutrition in the elderly.

OTHER FACTORS
Loss of taste
Loss of interest in food
Depression due to loss of independence or
bereavement, or simply eating alone can
reduce appetite.
Poor appetite
Difficulty in chewing
Constipation

DRUGS NUTRIENT INTERACTION

Drugs nutrient interaction it has been estimated that 76% - 92% of
elderly use at least one prescription or non-prescription drug daily.
 Geriatric Nursing
With increasing age, the body’s ability to metabolize medications
decreases, therefore making it difficult for older adults to excrete
multiple medications. Older people take various medications for: heart
disease, and to treat respiratory problems, gastrointestinal disorders
and arthritis.

DRUGS THAT ALTER NUTRIENT INTAKE

Drugs that alter nutrient intake, Drugs either

prescribed or over the counter may contribute
undesirable side effects that can cause a
reduction in food intake and thus nutrients
entering the body.

DRUGS THAT CAN ALTER NUTRIENT

EXCRETION
Drugs have been found to alter re-absorption in
the kidneys or displace nutrients from their
plasma protein carriers. Diuretics such as
Frusemide increase renal loss of potassium,
calcium, sodium, Magnesium and thiamine,
Gentamicin, ithramycin and Actinomycin D
increase the excretion of calcium. Corticosteroids
may cause sodium retention. Increased
magnesium urinary loss is due to mediations such
as, Thiazides and Frusemide, alcohol,
Cyclosporine, and gentamycin.

NATIONAL POLICY FOR OLD AGE

The National policy old age was announced govt of India in Jan 1999.
 Geriatric Nursing
The principle area of intervention and
action strategies were suggested in the
policy sector include the following:
Financial security for older persons
working in the formal sector as well
as working in the informal sector.
Health care & nutrition to enable
older person to cope with the health
associated with ageing with
particular emphasis on prevention.
Shelter/ housing keeping in view the lifestyle of older person.
Emphasis upon education, training & information needs for older
adults.
Priority attention to vulnerable groups such as the destitute, widows,
& disable older person Protection of life & property of older person.
Concessions rebate & discounts to older person. Participation of
NGOs in the care of aged. Strengthening the family & reinforcing
inter-generational relationship between children & older person.
Formation of self-support group of older person.
Development of the manpower for the caring of aged.
Development of self support group of older person
Creative use of media in the sector care of old person
Establishment of a specific bureau for older person in the ministry
reviewing the policy every three years. Establishment of a national
association of older person.
Establishment of a national council for older person.
Use of social justice committee & experts of public administration to
coordinate & monitor the implementation of the policy.

RESPONSIBILITEIS OF
GERONTOLOGICAL NURSE
 Geriatric Nursing
The main objective of gerontological
nursing is to improve the quality of
life of old people. The nurse has the
following role in gerontological
nursing:
Care giver & Health educator
Coordinator of health services.
Counsellor & guardian
Health assessment: In health assessment of old person,
Daily activities of living.
Activities related to use of equipment or procedure (telephone,
bank account, food preparation)
Health screening
Promoting good nutrition Promoting activity & exercise.
Preventive care of elderly: In case of elderly, their physical & mental
safety is very important.
Gerontological nurse & care giver should pay special attention to
the following safety measures:
Protection from unhealthy environment.
Protection from mental tensions.
Special care of personal health.
Protection from physical & mental injuries, threats & fatigue.
Providing rehabilitation services.
Providing psychological support.

SPIRITUALITY & AGEING

Spirituality is the power of the mind, it is the ability to look up to life, it is

the attitude that we adopt to make our lives better. Spirituality teaches
us to follow morals, rights and obligations thus making our lives fruitful
and successful. Spirituality and old age go in tandem because this is the
time people get free to relax and enjoy the fruits of their hard work.
 Geriatric Nursing
Spirituality is the cord that binds the mind, body and soul together.
spirituality and religious participation are highly correlated with
positive successful ageing. As much as diet, exercise, self-efficacy &
social connectedness stimulating an interest in understanding of why
spirituality has such a positive effect on the quality of life & end of life.
Older adults who are more religious tend to demonstrate greater
wellbeing than those who are not. Spirituality tends to an important &
adaptive role in ageing that seems to lead to a better quality of life &
life satisfaction as well as longevity.
Importance of spirituality: It has 3 major areas of importance: Mortality,
Coping , and Recovery .
Geriatric care may be delivered in the following settings:

PHYSICIAN'S OFFICE

The most common reasons for visits are routine

diagnosis and management of acute and chronic
problems, health promotion and disease
prevention, and pre surgical or postsurgical
evaluation.

PATIENT’S HOME
home care is most commonly used after hospital
discharge, but hospitalization is not a prerequisite.
Also, a small but growing number of health care
practitioners deliver care for acute and chronic
problems and sometimes end of life care in a
patient's home.

LONG TERM CARE FACILITIES

Include assisted living facilities, board and care facilities,
 Geriatric Nursing
nursing homes, and life care communities. Whether patients require
care in a long term we facility depends partly on the patient‘s wishes
and needs and on the family‘s ability to meet the patient‘s needs.

DAY CARE FACILITY

These facilities provide medical, rehabilitative, cognitive, and social
services several hours a day for several days a week.

HOSPITALS
Only seriously ill elderly patients should be
hospitalized. Hospitalization itself poses risks to
elderly patients because of confinement,
immobility, diagnostic testing, and treatments.

HOSPICES
provide care for the dying. The goal is to alleviate symptoms and keep
people comfortable rather than to cure a disorder. Hospice care can
be provided in the home, a nursing home, or an inpatient facility.

SENIOR COMMUNITIES

Senior housing is designed for high functioning elders, defined as those

not requiring assistance with ADLs. Senior communities are usually
neighbourhoods or towns

ROLE OF NURSE IN GERIATRIC CARE

Nursing interventions are aimed at maintaining the patient‘, physical
safety.
 Geriatric Nursing
reducing anxiety and agitation, improving communication, promoting
independence in self-care activities.. providing for the patient‘s needs
for socialization. self esteem, and intimacy. maintaining adequate
nutrition. managing sleep mm disturbances" and supporting and
educating family care givers. Research has demonstrated that w the
nurse can provide such support. older adults are able to maintain
higher levels of perceived and actual health.

SUPPORTING COGNITIVE FUNCTION

As the patient‘s cognitive ability declines, the nurse
provides a calm predictable environment that helps
the person interpret his or her surroundings and
activities. Environmental stimuli are limited and a
regular routine is followed. A quite. Pleasant manner of
speaking, clear and simple explanations and use of
memory aids will help to minimize confusion and
disorientation and give the patient a sense of security.

PROMINENTLY DISPLAYED CLOCKS AND

CALENDAR
May enhance orientation to time. Colour coding the door may help the
patient who has difficulty locating his or her room. Active participation
may help the patient to maintain cognitive, functional and social
interaction abilities for a longer period. Physical activity and
communication have also been demonstrated to slow some of the
cognitive decline.

PROMOTING PHYSICAL SAFETY

A safe environment allows the patient to move about as freely as
possible and relieves the family of constant worry about safety. To
prevent falls and other injuries. All obvious hazards are removed.
 Geriatric Nursing
Nightlights are helpful. The patient‘s intake of medication and food is
monitored .smoking is allowed only with supervision. A hazard free
environment allows the patient maximum independence and a Sense of
autonomy. Because of a short attention span and forgetfulness,
wondering Behaviour can often be reduced by gentle persuading or
distracting the patient. Restraints are avoided because they may
increase agitation. Doors leading from the house must be secured.
Outside the home, all activities must be supervised to protect and the
patient should wear an Identification bracelet or neck chain in case he
or she becomes separated from the Care giver.

REDUCING ANXIETY AND AGITATION

Despite profound cognitive losses, the
patient will, at times, be aware of his or her
rapidly diminishing abilities. The patient still
need constant emotional support that
reinforce a positive self-image. When losses
of skills occur, goals are adjusted to fit the
patient‘s declining ability. The environment
should be kept uncluttered, familiar, and
noise free.
Excitement and confusion can be upsetting and may Precipitate and
combative, agitated state known as a catastrophic reaction (over
reaction to excessive stimulation). During such a reaction the patient
responds. by screaming, crying or becoming abusive (physically or
verbally). This may the patient‘s only way of expressing an inability to
cope with the environment. When this occurs it is to remain and
unhurried. Measures such as listening to music, stroking, rocking may
quite patient. Frequently the patient forgets what triggered the
reaction. Structuring of activities is also helpful. Becoming familiar with
the patient‘s predicted responses to certain stressors helps care givers,
 Geriatric Nursing
to avoid similar situations the time older persons with dementia have
progressed to the late stage of the disease, they typically in nursing
homes and are predominantly cared for by nurse‘s aids.

IMPROVING COMMUNICATION

To promote the patient‘s interpretation of

messages, the nurse should remain unhurried
and reduce noises and distractions. Use of
clear, easy to understand sentences to convey
messages is essential patients frequently
forget the meaning of words or have difficulty
in organizing and expressing thoughts.
In the early stage, lists and simple written instructions may be helpful. In
the later stage, the patient may be able to point out at objects or use
non-verbal language to communicate. Tactile stimuli such as hugs and
hand pats are usually interpreted as signs of affection, concern and
security.

PROVIDING FOR SOCIALIZATION AND

INTIMACY NEEDS
Because socialization with friends and family can be comforting, Idlers
and phone mils are encouraged. Visits should be brief and non-stressful;
limiting visitors to one or two at a time helps reduce overstimulation.
Recreation is important, and people are encouraged to participate in
simple. Realistic goals for activities that provide satisfaction are
appropriate. Hobbies and activities such as walking, exercising and
socializing can improve quality of life. The non-Judgemental friendliness
of a pet can stimulate comfort and provide contentment Care of plants
and pets can be satisfying and an outlet for energy. Simple expressions
of love as holding, touching are often meaningful..
 Geriatric Nursing
PROVIDING ADEQUATE NUTRITION
mealtime can be pleasant social occasion or a
time of upset and distress, and it should be kept
simple, calm without confrontations. People
prefer foods that are appetizing and tastes
good. To avoid playing with food, one dish at a
time. Food is cut into small pieces to avoid
choking. Liquids may be easier to swallow if they
converted to to gelatine. Hot foods and
beverages are served warm to prevent bums.

PROMOTING BALANCED ACTIVITY AND REST

Many people complain with sleep disturbances and wandering
behaviours that inappropriate. These behaviours are most likely to
occur when there are unmet physical or psychological needs.
Caregivers must identify the needs of the patient who are exhibiting
these behaviours because further health decline may occur if they are
not corrected. During the day time physical activity can be encouraged
and long durations of sleep during the day time are discouraged.

SUPPORTING HOME AND COMMUNITY

BASED CARE
The emotional burden on the families of
elderly are enormous. The physical health is
often stable and mental degeneration is
gradual. Family members may be faced with
difficult decisions. Anger and agitation
exhibited by the older adults are often
misunderstood by the family members.
 Geriatric Nursing
Abuse and neglect of the older adults must be avoided and they have
to be constantly supervised on the minor and major ailments for
immediate medical help is mandatory.

SUMMARY
The older adults being vulnerable to
many health issues constitute the
higher vulnerable group. They must be
constantly supervised and taken care
of the minor ailments and approach
immediately for medical help in cases
of emergency.
The nurses must coordinate with the older health team members to
provide comprehensive and holistic care considering all the needs and
domains of a human being. Assisting in their daily activities and
encourage them to perform minimum physical activity as tolerated
which improves self esteem and enhances self image of the older adult.

BIBLIOGRAPHY
1. Shabeer.k.basheer ,text book of advance nursing practice
2. Brunner& suddarths,text book of medical surgical nursing\
3. www.geriatric nursing.org
4. www.scribd.com/geriatric nursing
5. www.slideshare.com/geriatric nursing