Objectives for

Module 1:
After 4 week of teacher – learner interaction through online, the students
will:
a. identify gerontology nursing and the demographics of aging
b. illustrate briefly aging as a developmental process;,
c. Apply the role of the nurse utilizing the different theories in aging
 Review on the Stages of Growth and
Development

Piaget's Theory of Cognitive Development: Proposed by Jean Piaget, this theoryNursing

focuses on
how children's thinking processes evolve as they mature. Piaget identified four stages of
cognitive development: sensorimotor, preoperational, concrete operational, and formal
operational. Each stage is characterized by distinct cognitive abilities and ways of
understanding the world.
Review on the Stages of Growth ad
Development

Erikson’s Eight Stages of Psychosocial Development

Infancy= Trust versus Mistrust
Toddler= Autonomy versus Shame and Doubt
Preschool= Initiative versus Guilt
School Age= Industry versus Inferiority
Adolescent= Identity versus Role Confusion
Young Adult= Intimacy versus Isolation
Middle Adult= Generativity versus Stagnation
Older Adult- Self Actualization/ Integrity versus Despair
Psychologist have divided the old
into 4 groups;
1. young old = 65 to 74
2. middle old = 75 to 84
3. old-old = 85and above
4. centenarian = 100 and older
Gerontology =means a study of the growing process of
aging of normal, healthy and functioning
individuals.
Gerone= is term given to people who are old but
gracefully able to function as a useful citizen in the
home and in the community.
Geriatrics= is a term given to people who are old
or who behave old.
= signify care given to old sick people.
• Aging = is a slow process of growth towards
maturity of mind, body and spirit
= comprises of a series of changes
that occur in all living organism.
Myth about aging

• 1. Drinking magic portion from

the fountain of youth restore youthfulness.
• 2. Eating young sprout of ginger, garlic, and onions will
restore aging.
• 3. Washing one’s face with the first drops of a mother’s
milk fades away wrinkles.
• 4. Drinking raw eggs every first seven days of the month
will keep younger looks.
 HISTORY OF
GERONTOLOGICAL
NURSING
 Aging in Us

Introduction to Gerontology of Nursing:

1600= in early American puritan community the

process of aging considered a sacred
pilgrimage to God.

1800=devaluated/ became a symbol growth and

expansion

1935= with the establishment of societal security the

time when one became old was set at 65
1966= established within the American Nurses
Association the Division of Geriatric Nursing
Practice
1965= Act passed by the government which is “ The
Older American Act”

> brought major changes in the way health care

is financed, older people over 65 avail health
care and start the growth of nursing home
industry.
GERONTOLOGICAL NURSING:

• GERONTOLOGY: a specialty in nursing pertaining to the

care of older adults in their normal development process.
 Geriatrcis, from greek word “ geras “ ( old age ) iatrics
( medicine )
 Is the brance of medicine that is concerned with medical
problems and care of older persons
• = scientific study of the aging process
• = studies all aspects of aging
• = a multidisciplinary field that draws biological,
psychological and social sicence
Demographics of Aging:

• Share of aging population the Philippines 2015-2100

In 2015, the share of population older than 65 amounted to
about 4.6 percent. In 2100, the percentage of the population
above the age of 65 was forecasted to reach 25.6 percent. The
share of the aging population was forecasted to increase
throughout the years.Jan 22, 2020
• • Philippines: aging population 2015-2100 | Sta
Percent Increase in Population65+ 1990-
2030
350
300
250
200
150
100
50
0
African American Asian Pacific Hepanics White
American Indian islanders
Key trends in population ageing

the number of older persons is expected to double again by 2050 ( 2.1

bil )
> Globally, the number of persons aged 80 years or over is projected
to increase more than
threefold between 2017 and 2050, rising from 137 million to 425
million.
between 2017 and 2050.
 in Europe and in Northern America, there is one in every five aged 60
or over in 2017,
> 2050, older persons are expected to account for 35 per cent of the
population in Europe, 28 percent in Northern America, 25 per cent in
Latin
> Data for 67 countries indicate that older persons have become more
likely in recent decades to live independently (around 37 per cent )
DEVELOPMENTAL PROCESS of AGING

• What is aging
> Aging is a continuous process from birth to death, which
encompasses physical, social, psychological, and spiritual
changes.
AGING as a DEVELOPMENTAL PROCESS

• As grows older, the body size, height, weight, limbs and

musculature change in measurable ways
• Together with development is maturation, it is a change
due to biological in nature/ genetic endownment
• Genes we possess contain blue prints for changes as
determined by the genes inherit
• Biological system move as predetermined biological table
preparing us for developmental changes
• Maturation and experience in the environment bring
about development changes
 Theories of Aging
• Theory = a cluster of conclusions in search of a
premise.
= is an explanation that makes sense to us
of some phenomenon

Biological/ Physical Theory

1. Stochastic theory
2. Non- stochastic theory ( pre- determine theory)
1. Error theory = aging as a result of an accumulation of
errors in the synthesis of cellular DNA and
RNA. Ex. Visible sign is the gray hair

2. Wear and tear = cell errors are the result of

“wearing out” over time because of continued use
and trauma; one of the earliest theory of aging
Ex. Shoulder pain of pitcher and knee of a run
3. Cross- link theory = explains aging in terms
of the accumulation of errors by cross – linking
or stiffening of protein in the cell.
> proteins link with glucose and other sugars in
the presence of oxygen and become stiff and thick.
 2. Psychological Theory
Description Explains aging in terms of mental processes, emotions, attitudes and motivations
characterized by life stage transition

Human needs Five basic needs motivate behaviour in a life long process
Individualism Personality consist of an ego, collective unconscious that views life from a personal and
external perspective. Older adults search for meaning and adapt to functional and social
issues
Stages of Personality Personality develops in eight sequential stages with corresponding life developmental
task. The eight task, Integrity versus despair characterized by evaluating life’s
accomplishments, struggles includes letting go, accepting care, detachment and
physical and mental decline
Life course/ Life Span Life Stages are predictable and structured by roles, relationship, values, development
and goals. Persons adapt to changing roles and relationship. Age group norms and
characterisics are an important part of the life course.
Selective Indivudals cope with aging lossess through activity/ role selection, optimization and
optimization compensation. Critical life points are morbidity, mortality, and quality of life.
Selective optimization with compensation facilitates successful agin
 3. Sociological
Description Theories
Refers to the changing roles, relationship, status and generational
cohort impact the older adult’s ability to adapt
Activity Remaining occupied and involved is necessary to a satisfying late life
Disengagement Gradual withdrawal from society and relationships serves to maintain
social equilibrium and promote internal reflection
Subculture The elderly prefer to segregate from society in aging subculture sharing
loss of status and societal negativity regarding the aged. Health and
mobility are key determinants of social status.
Personality influence roles and life’ satisfaction and remains consistent
Continuity throughout life. Past coping patterns recur as older adults adjust to
physical , financial and social decline and contemplate death.
Identifying with one’s age group finding a residence compatible with
ones limitations
Age Society is stratified by age group which is the basis for acquiring
stratification resources, roles, status and deference from others
Person Function is affected by egostrength, mobility, health and cognition
Environment sensory perception and the environment. Competency changes once
Fit ability to adapt ot new environment demands
Gerontransecendenc Elderly transform from a materialistic/ rational perspective towar oneness with the universe.
e
 3. Programmed theory (non stochastic
theory )

• > changes of aging to a process that is thought to be

predetermined or ‘ programmed ‘ at the cellular level.
• > this means that each cell has a natural life expectancy.
• > as more cells stop or cease to replicate the signs of aging
appear and ultimately the person “dies” at a predetermined
age.
• Free Radical theory = among the most understood and accepted
theory
• > it is believed that cellular errors are the result of random damage
from molecules in the cells, called free radicals.

free radicals – are natural by product of cellular activity

> with aging the damage cause by free radicals occur faster than the
cells repair as a result there will be cell death.
• The free radical theory of the aging process is
based on the hypothesis that with increasing age,
mutations of the mitochondrial DNA will
accumulate and will at least lead to a loss of
function with subsequent acceleration of cell
death. Even if this theory is widely accepted, the
reactive-oxygen-species-induced mutations of
mitochondrial DNA, the accumulation of
mitochondrial DNA and the role of antioxidants
are not fully understood
• Neuroendocrine cells are chemical messengers of the endocrine system,
passing signals from one neuron to the next, and from a neuron to a target
cell across a synapse. The endocrine system, in which these messengers
operate, regulates body composition, fat deposition, skeletal mass, muscle
strength, metabolism, body weight, and physical well-being. Multiple
endocrine changes evolve with aging in all species and, not surprisingly,
some of the physiologic manifestations of aging that we see clinically are
related to the effects of declining neuroendocrine levels.
• 1. Neuroendocrine –Immunologic theory = changes in the
integrated neuroendocrine and immune system.

• > programmed deaths of the immune cells from damage

caused by the increase of free radicals as aging
progresses.
• Nutrition theory = is the most logical theory to
qualify long life
• >one essential factor that promotes longevity is
good nutrition.
• > good nutrition is also the body’s defense against
disease.
• > tissue cells, nerves, muscles and bones that are
appropriately nourished with the proper nutrition
all throughout the developmental stages maintain
the structure and function of the body and its
optimum activity.
• Poor nutrition and inadequate nutrition on other hand
stunt growth of the brain, muscles, bones, and the whole
body system.
• 2. Wear and Tear theory = states that a person gets
eventually old as he wears off the cells, nerves, muscles
and his physical component through the years

> it emphasizes the dying –off cells and aging comes as a

consequence of this.
4. Tension theory = person grows old because of the tension
that he experience in his life.

• > when one is tensed, he uses up his energy reserve burn

his calories and fatigues his body.
• > the body and mind age faster than when the person is
not tense.

• 4. Stress theory = person grows old because of the stress

that he experience in his life.
• 5. Transition theory = shows the role of shifting or change
of one situation to another on the aging process.

• > there are too many transition in one’s life and there is no
adequate preparation that accompany that shifting of role
or situation become a threat to the security of the
individual and this will hasten aging.
Theories of Aging according to Letty Kuan
Roles in Gerontological Nursing

1. Generalist = provide care according to

various models
> nursing experiences with elders across the
continuum of care
> nursing care in acute care setting or nursing
care in
a. retirement home
b. nutrition center
 c. home care agency
d. adult day health program
e. senior housing
f. rehabilitation center
2. Specialist = expertise in planning and
evaluating care
> advanced preparation of masters level
3. advanced clinical expertise
Acute care
a. Comprises 60 percent of medical – surgical patients
b. Chronic illness and injury

Community and home base care

a. Adult day health program
b. primary health clinic
c. retirement communities
d. independent senior housing
> long term care = comprises variety of
health, social and personal
care that is provided in
caring for chronic
illness, functional and
cognitive deficits
 Objectives for Module 2:

After 4 week of teacher – learner interaction through online, the students

will:
a. Discuss the physiologic changes in aging;,
b. Apply the core elements and the standards in the practice of
gerontology nursing in the practice of care of older adults
c. Identify the different advocacy programs in the care of older adults
 CORE ELEMENTS of GERONTOLOGICAL
NURSING

1. Evidenced based Practice -- nursing follows a systematic

approach that uses existing research for clinical
decision making.
-> best practice are evidenced based and are built on the
expertise of the nurse.

2. Standard – reflect the level and expectations of care that

are desired and serve as a model against which practice
can be judged
> these serve to both guide and evaluate nursing plans.
Holistic gerontological care is concerned with;
a. Facilitating growth towards wholeness
b. Promoting recovery and learning from an illness
c. Maximizing quality of life when one possesses an
incurable illness or disability
d. Providing peace, comfort and dignity as death is
approached
3. Principles – are those given facts or widely accepted theories
that guide nursing action.
as professional nurses are responsible for using these
principles as the foundation of nursing practice.

Holistic Gerontological Care --- incorporates knowledge and

skills from a variety of disciplines to address the physical,
mental, social, and spiritual health of an individuals.
PHYSICAL CHANGES ( AGING)

• INTEGUMENTARY SYSTEM
• > the largest most visible organ in the body
• 5 major function of the skin
• 1. it protects underlying tissues from injury by preventing
the passage of microorganisms.
• 2. it regulates the body temperature.
• 3. it secretes sebum an oily substance that softens and
lubricates the hair and skin, protect the hair from
becoming brittle
• 4. it transmits sensations through nerve impulses
• 5. it produces and absorbs vitamin D
• 3 layers of the skin
• 1. epidermis
• 2. dermis
• 3. hypodermis
• Epidermis = the outer layer of the skin and is composed of
keratinocytes and squamous cells..
• 1. epidermis thins , making blood vessels and bruises much
more visible
• 2. melanocytes decrease, lightening of the skin
• 3. melanin increase , frenckles and nevi appear
• 4. age spots or liver spots found on the back of the hand,
wrist and on the face because of increase melanin
• 5. thick brown lesion ( seborrheic keratoses ) common
among men
• 6. wound healing will take 48 to 72 hrs, decease epithelial
cell replacement (50 yrs)
• DERMIS = composed of a matrix of yellow elastic fibers
that provides stretch and recoil and white fibrous collagen
fibers.
• > supports hair follicles, sweat and sebaceous glands and
blood vessels that provides nourishment to the epidermis
• 1. older skin looks more transparent and fragile because
dermis loses about 20% of its thickness
2
• 2. skin pallor and cooler skin temperature because dermal
blood vessels are reduced
• 3. collagen synthesis decrease causing the skin to “give”
less under stress and tear more easily
• 4. sagging appearance of the skin and loss of stretch and
resilience because elastic fibers thickens and fragments
• 5. breast begin to sag and become pendulous
• HYPODERMIS= inner most layer of the skin contains
connective tissue, blood vessels, and nerves
• > major component are subcutaneous tissue or adipose
tissue which store calories and provides thermal
regulation, shape and form the body and acts as a shock
absorber against trauma.
• 1. hypodermis atrophy , fats deceases ,person becomes
more sensitive to cold
• 2. hyperthermia as a result of the reduced efficiency of
eccrine (sweat gland)
• > the usual response to heat is to produce moisture or
sweat from these glands thus cool the skin by
evaporation , with aging the glands become fibrotic and
become avascular leading to a decline in the efficiency of
the body to cool down.
Hair

• 1. men and women in all racial groups have less

hair as they grow old
• 2. hair in the head thins
• 3. hair in the ears, nose, and eyebrows of older
men increase and become thick/ stiff
• 4. hair becomes dry and coarser
• 5. older women develop chin and facial hai
• 6. leg, axilla, and pubic hair lessens and in some
instances disappear in post menopausal women
Nails
• 1. harder and thickens, more brittle and opaque
• 2. shape change, flat or concave instead of convex
• 3. vertical ridges appear, because of decreasing water, calcium
and lipid
• 4. nail growth decrease , because of decrease blood supply
• 5. half moon ( lanule ) of the fingernail may entirely disappear
• 6. color of the nail change from yellow to gray
• Onycochomycosis = fungal infection of the nail
• Promoting healthy skin

• 1. avoid excessive exposure to ultraviolet light

• 2. keep skin moisturize
• 5. half moon ( lanule ) of the fingernail may entirely
disappear
• 6. color of the nail change from yellow to gray
• Onycochomycosis = fungal infection of the nail
• Promoting healthy skin
• 1. avoid excessive exposure to ultraviolet light
• 2. keep skin moisturize
Promoting Healthy Skin

• 1. avoid excessive exposure to ultraviolet light

• 2. keep skin moisturize
• 3. avoid use of dry soap
• 4. always use sunscreen
• 5. keep well hydrated
Musculoskeletal System

Comprises of bones, joints, tendons, ligaments and

muscles
Function
1. body movement in space for gross response to
environment forces
2. maintenance of posture factors that influence changes
in musculoskeletal system (age, sex, race, environment )
> ligaments, tendons and joints become hardened, more
rigid and less flexible
> muscle tissue decrease or atrophies
> adipose tissue increase in men on waist line,
• 4 vertical disk become thin causing shortness of the trunk due
to water loss and dehydration
• Kyphosis = a curvature of the cervical vertebrae because of
reduce bone mineral density, stooped appearance
• 5. bones of the arms and legs appear disproportionate in
sizeOsteoporosis because of mineral density is low
Promoting healthy bones and muscles
• A. ensure regular intake of vitamin D and calcium
• B. engage in regular weight bearing exercise ex. Tai chi
• C. engage in regular flexibility and balance ex. Yoga
Cardiovascuar System

• > responsible for the transport of oxygen and nutrient rich

blood to the organ
• > transport metabolism waste products to the kidneys and
the bowels
• 1. the size of the heart remains unchanged in healthy
adults but the left ventricle wall thickens by as much as
50% by the 80 yrs
• 2. left atrium increase in size slightly due to adaptation
that enhances ventricular filling
• 3. coronary artery blood flow decrease
• 4 stoke volume and cardiac output decrease
Blood Vessels

1. decrease elasticity and recoil result to decrease blood

supply to various organs
2. flow to the coronary arteries and in the brain is minimal
3. decrease perfusion of the other organs especially liver
and kidney
4. less changes are found in the veins but sometimes they
stretched and the valves become less efficient
5. lower edema develop more quickly and deep vein
thrombosis due to sluggish venous return
Promoting HEALTHY HEART

1. engage in regular exercise

2. eat a low- fat , low- cholesterol, balanced diet
3. maintain tight control of diabetes
• 4. do not smoke and avoid exposure to smoke
• 5. avoid environmental pollutants
• 6. practice stress management
• 7. minimize sodium intake
• 8. maintain ideal body weight
• RESPIRATORY SYSTEM
• > vehicle for ventilation an gas exchange

• 1. loss of elastic recoil

• 2. stiffening of the chest
• 3. efficiency in gas exchange
• 4. increase resistance to air flow
• > respiratory problems are common
• 5. change in anatomical structure of the chest and altered
muscle strength this can affect ones ability to cough
forcefully
• 6. respiratory cilia are less effective
• 7. decrease effectiveness of the cough response and
cough reflex
• Promoting healthy lungs
• 1. obtain pneumonia immunization
• 2. obtain annual influenza immunization
• 3. avoid exposure to smoke and pollutants
• 4. do not smoke
• 5. avoid person with respiratory illness
• 6. seek prompt treatment of respiratory infections
• 7. wash hands frequently
• 8. practice thorough regular oral hygiene
• RENAL SYSTEM
• > responsible for regulating water and salts in the body
• > maintaining acid base balance
• KIDNEY
• 1. changes in blood flow and the ability to regulate body
fluids ( 10 % per decade ) this is the result of vascular
changes and fixed anatomical and structural changes
• 2. kidneys lose as many as 50% nephrons with a change in
the body to regulate body fluids and maintain adequate
day to day fluids homeostasis
• 3. decrease in size and function occurs in the kidney
cortex, begin at the age of 30 and becomes significant at
70.
• 4. renal reserve is lost and the ability to response to either
salt or water load is compromised
• 5. urine creatinine shows decline even in healthy aging
because of reduce lean muscle
urine creatinine clearance = is an important indication for
appropriate drug therapy, reflecting the ability to handle
medication passing through and metabolized by the body.
Decrease to 100 ml/ min by the age 80
Plasma creatinine remain constant throughout life.
• ENDOCRINE
• > working together with the neurologic system, provides
regulation and control of the integration of the body
activities through the secretion of the hormones from
glands throughout the body.
• PANCREAS = secretes insulin, glucagon, somatostatin,
and pancreatic polypeptides these substances will
decrease to any level
• THYROID GLAND
• 1. slight changes, the gland will atrophy
• 2. diminished secretion of the TSH ( thyroid stimulating
hormone ) T4 ( thyroxine ) and decreased plasma
triiodothyronine (T3 )
• REPRODUCTIVE SYSTEM
> Serve as physiologic purpose of human procreation
• Women lose the ability to procreate after the menopause
whereas men remain fertile during their entire life.
• FEMALE REPRODUCTIVE
• 1. breast are smaller, pendulous and less firm
• 2. labia majora and labia minora become less prominent
• 3. pubic hair thins
• 4. ovaries, cervix, and uterus slowly atrophy
• 5. vagina shortens, narrow and loss some of its elasticity
• 6. vaginal wall lose their ability to lubricate quickly
especially if the woman is not sexually active, more
stimulation needed to achieve orgasm
• 7. vaginal epithelium changes, ph rises from 4.0 to 6.0
before menopause 6.5 to 8.0
• Vaginal changes resulting to
• 1. dyspareunia painful intercourse
• 2. trauma during intercourse
• 3. more susceptible to infection
• MALE
• 1. the testes atrophy and softens
• 2. seminiferous tubules thickens
• 3. sperm count does not decrease but fertility reduce
because of higher number of sperm lacking motility
• 4. erectile changes are also seen, more stimulation
needed to achieve full erection
• 5. ejaculation is slower and less forceful
• 6. hormone , testosterone level is reduced
• 7. by the age 80 yrs 80% of men have some degree of
prostatic enlargement which result to (BPH ) benign
prostatic hypertrophy
• BPH causes;
• compression of urethra
↓
urinary retention
↓
repeated urinary infection
and overflow incontinence
• GASTROINTESTINAL
• Digestive system includes GI tract and the accessory
organs that aids digestion.
• Mouth and teeth
• Wear and tear of years and use
• 1. teeth loose enamel and dentin, vulnerable to decay
( caries )
• 2. roots of teeth become more brittle and break more
easily
• Edentulous = all teeth removed
• 3. gums become susceptible to periodontal disease
• 4. taste buds decline in number
• 5. salivary secretions lessens
• 6. dry mouth ( xerostomia )
• ESOPHAGUS
• 1. contraction increase in frequency but are more
disorganize
• 2. sluggish emptying of esophagus
↓
forces lower end to dilate
↓
greater stress on the area
↓
digestive discomfort
• Pathology GERD result gastro esophageal reflux disease
• STOMACH
• 1. decrease gastric motility
• 2. reduction in the secretion of bicarbonate and gastric
mucus
• Hypochlorhydria = insufficient hydrochloric acid
• Pernicious anemia = stomach is not able to utilize ingested
B12 vitamins
• 3. stomach ph increase , protective alkaline viscous mucus
of the stomach is lost ( peptic ulcer disease )

• 4. loss smooth muscle in the stomach delays emptying

time, which may lead to anorexia or weight loss as a result
of distention, meal induced fullness and the feeling of
satiety
Intestine
• 1. the villi become broader and shorter and less functional,
nutrients absorption is affected , vitamins, minerals,
carbohydrates, fats absorb more slowly
• 2. changes in motility
• 3. peristalsis is slowed , constipation result
• PROMOTING HEALTHY DIGESTION
• 1. practice good oral hygiene
• 2. wear properly fitting dentures
• 3. seek prompt treatment of dental caries and periodontal
disease
• 4. maintain adequate intake of fluids
• 5. respond promptly to urge to defecate
• 6. eat a balance diet rich with fibers
• 7. avoid prolonged periods of immobility
• Accessory organs ( liver and gallbladder)
• 1. liver decrease in volume and weight
• 2. decrease liver blood flow of 30 % to 40 %
• 3. gallbladder stone increases
• 4. decrease in bile acid synthesis
• Neurological ( CNS )
• 1. dendrites appear to be “ wearing out “
• 2. decrease in number of neurons
• 3. decrease brain weight and size
• 4. sleep disturbances may also be a normal part of aging
as a result of changes in reticular formation, loss of deep
sleep stage 3 and 4
• 5. mild memory impairment and difficulties with balance
• 6. performance of task may take longer which is an
indication of central processing is slow
• 7. decrease level of neurotransmitter, serotonin,
catecholamine
• PERIPHERAL NERVOUS SYSTEM
• 1. vibrating sense in the lower extremities may be
nonexistent, cause risk of injury
• 2. tactile sensitivity decrease in connection with the loss of
nerve endings in the skin
• > if someone less aware of the body position and has less
tactile awareness , risk for falling will increase
• 3. kinesthetic sense or one’s position in space is altered
because of changes in both peripheral and central
nervous system
• > it takes time or longer to realize the surface is uneven
and without notice changed in position, risk for fall
• SENSORY CHANGES
• > changes occur in sensory organs as a result of a
combination of intrinsic and extrinsic factors
• EYE AND VISION
• 1. presbyopia decrease in near vision , begins at midlife 45
to 55 yrs of age
• 95 % of older adults age 65 wear glasses for close vision
• 18 % also use a magnifying glasses for reading and close
work
• EXTRAOCULAR
• 1. eyelids lose elasticity and drooping ( senile ptosis )
result
• 2. the lids sag far enough to block vision
• 3. spasm of the orbicular muscle may cause lower lid to
turn inward (entropion )
• 4. lower lashes that curl inward irritate the cornea ,
surgery is needed to prevent permanent injury
• 5. decrease in the orbicular muscle strength may result in
ectropion or an out –turning of the lower lid
• 6. inability to close completely lead to excessively dry eyes
• Dry eye syndrome = severe deficiency of lubrication
• OCULAR
• cornea = is the a vascular transparent outer surface of the
eye that retracts light rays entering the eye through the
pupil
• 1. cornea becomes flatter, less smooth and thicker, dull in
appearance which result to increase farsightedness
( hyperopia )
• . Myopia =nearsighted
• 2. increase in intraocular pressure leads to glaucoma
because of decrease re absorption of the intraocular fluid
becomes less efficient
• 3. thickening of the lens
• 4. decrease response of the pupils and changes in the lens,
there is inability to adjust to changes in light and the need
for greater levels of lighting
• 5. light scattering increases and the color perception
decreases
• > reflection of lights, outdoor sunlight
• People require 3 times as much light to see things
• INTRAOCULAR
• Retina = which line the inside of the eye
• 1. color clarity diminishes by 25 % for 60 yrs
• 59 % for 80 yrs especially blue, violets and green colors
• > light colors such as red, orange and yellow are more
easily seen
• 2. yellowing of the lens and impaired transmission of light
to the retina
• EAR AND HEARING
1. hearing loss affects 1/3 of all adults between 65 to 74 yrs,
½ between 75 to 79 yrs
Presbycusis bacause of vestibular sensitivity as a result
degeneration of the organ of cochlea and otic nerve loss,
transmission of waves to the brain is therefore impaired
• > sounds with high frequency like consonants, the
chirping of the birds and rustling of leaves
• 2. the auricle loses flexibility and becomes longer and
wider
• 3. lobe sags, elongates and wrinkles
• 4. stiff, wiry and rough hairs grow at the periphery of the
auricle
• 5. tympanic membrane appears dull and gray
PROMOTING HEALTHY EYES
1. Protect eyes from ultraviolet light
2. avoid eye strain, use a bright light when needed
3. visit health care provider promptly if there are changes
in vision
4. Have yearly dilated eye examination
• Promoting healthy ears
• 1. avoid exposure to excessively loud noises
• 2. avoid injury with cotton –tipped applicators and other
cleaning materials
• 3. use appropriate assistive devices like hearing aids
• 4. see or visit health care provider promptly if there are
sudden changes in hearing
• IMMUNE SYSTEM
• > protect the host from invasions of foreign substances
and organisms
• 1. decrease immunity at the cellular level, resulting to
increase risk of infection
SOCIAL, PSYCHOLOGICAL,SPIRITUAL AND COGNITIVE
ASPECTS OF AGING

• Each individual has unique life experiences and because of

this must be seen holistically through the lens of time.
• The relationship between biological, social, and
psychological development exist from childhood and
adolescence varies more in adulthood because of greater
variations in life experiences and demands as one
matures.
• LIFE SPAN DEVELOPMENT APPROACH (Papalia)
• >refers to an individual progress through time and
expected pattern of changes.
• 1. Development is life long. Each part of the life span
influenced by the past and will affect the future.
• 2. development depends on history and context . This
means that person develops within a certain set of time
and place. Human are influence by historical, social and
cultural context.
•
• 3.Development is multidimensional and multidirectional
and involves a balance of growth and decline.
• Types of aging
• 1. chronological age – measured by the
• number of years lived
• 2. biological age – a person physical condition and how
well vital organs are functioning,
• 3. psychological age- expressed through the persons
ability and control of memory, learning capacity, emotions
and judgment
• 4. social age – measured by age related behavior that
conform to an expected status and role within a
particular culture or society.
• SOCIOLOGICAL THEORIES OF AGING
• 1. Disengagement theory ( Cummimg and Henry ) >aging is
inevitable mutual withdrawal or disengagement resulting in
decrease interaction between the person and others in the
social system he or she belong.
• 2. Activity theory ( MADDOX ) –
• > emphasizes the importance of ongoing social activity
• > persons self concept is related to the roles held by that
person
• 3. Continuity theory ( Havighurst ) = life satisfaction with
engagement or disengagement depends on the personality
traits
• 3 personality traits
• 1. normal progression of aging, personality
traits remain the same.
• 2. influence role activity and ones level of
interest
• 3. personality influences life satisfaction
regardless of social participation.
• 4. Social exchange theory ( Dowd ) – this
theory is based in the consideration of the cost
benefit model of social participation.
• 5. Modernization theory ( Achenbaum ) - social
changes that have resulted in the devaluing of
both the contributions of elders and the elders
themselves.
• > the status and therefore the value of elders is
lost when their labors re no longer considered
useful.
• 6. Symbolic interaction theory (Hooyman and
Kiyak ) – explains that the kind of aging
process people experience is a result of
interaction between the environment , the
individual, and the meaning the person
attributed to his or her activity.
• Implications for gerontological nurses
• 1. provide useful information / background for
enhancing healthy aging
• 2. applied to different approaches to aging in
many ways ( senior centers , nursing homes)
• Psychological theory
• 1. Jung's theories of personality ( Carl Jung )
• > theory of the development of a personality
throughout life from childhood to old age.
First half of life = having purpose of its own
Last half of life = time of inner discovery, inner
growth, self awareness and reflective activity.
• 2. Developmental task ( Eric Erikson 8 task
model) = developmental stages and task of life
from early childhood to later elder hood
• > he propose that all person return again and
again to a task that been poorly resolved in the
past.
• Middle age generativity if successful in this
task one established oneself and contributes
meaningful ways for the future and future
generation.
• FAILURE result to stagnation
HAVIGHURST’S DEVELOPMENTAL TASK
MIDDLE AGE
1. Assisting teenage children to become
responsible and happy adults.
2. Achieving adult social and civic responsibility
3. Reaching and maintaining satisfactory
performance in ones occupational career.
4. developing adult leisure time activities
• 5. relating to ones spouse as a person
• 6. adjusting to aging parents
• LATER MATURITY
• 1. adjusting to decreasing physical strength
and health
• 2. adjusting to retirement and reduced income.
• 3. Adjusting to death of the spouse
• 5. establishing an explicit affiliation with ones age
group.
• 6. adapting social roles in flexible way.
• 7. establishing satisfactory living arrangement
3. Theory of Gerotranscendence ( Tornstam)
A shift in perspective from the material world to the
cosmic and concurrent with an increasing life
satisfaction.
 is thought to be gradual and on going shift that
generated by normal personal disruption.
• Characteristics of Gerotranscendence theory
• 1. a high degree of life satisfaction
• 2. complex and active coping pattern
• 3. less concern of body image and material
possession
• 4. decrease fear of death
• 5. affinity with past and future generation
• 6 decrease self centeredness
• SPIRITUALITY AND AGING
• > quality of life derived from social and cultural
environment that involves faith, a search of
meaning and connection with others and a
transcendence of self and well being .
• > spiritual aspects transcends the physical and
psychosocial to reach the deepest individual
capacity of love, hope and meaning
• > as people age / or grow old and move closer
to death , spirituality may become more
important.
• > declining physical health , loss of loved ones
and realization that life's end may be near
often challenge older people to reflect on the
meaning of their lives .
• Implication to Nurses
• 1. knowledgeable and respectful of the rites,
rituals of varying religion , cultural beliefs and
values
• 2. religious and spiritual resources should be
available in all setting where older people
reside.
• 3. assist elders in reflecting on the meaning
and purpose of life and achieving spiritual well
being.
• Spiritual nursing responses
• 1. relief of physical discomfort
• 2. comforting touch which foster patient nurse
connection
• 3. authentic presence
• 4. attentive listening
• 5. knowing the patient as a person
• 6. listening to life stories
• 7. sharing fears and listening to self doubts or guilt
• 8. fostering forgiveness and reconciliation
• 9. sharing caring words and love
10. referring a person to a spiritual councilor.
• Identifying elders at risk for spiritual distress
• 1. evidence of depression
• 2. cognitive impairment
• 3. diagnosis and treatment of a life threatening
, chronic or terminal illness
• 4. verbalized questioning or loss of faith
• 5. expression of interpersonal or emotional
suffering, loss of hope, lack of meaning, need
to find meaning of suffering.
• COGNITION AND AGING
• Cognition – is the process of acquiring , sharing
and using information.
• > cognitive function decline in old age because
of decrease number of neurons , decrease
brain size and decrease brain weight.
Cognitive function includes the following
categories
1. attention span
• 2. concentration 10. problem solving
• 3. intelligence 11. social intactness
• 4. judgment 12. psychomotor
• 5. learning ability
• 6. ability
• 7. memory
• 8. orientation
• 9. perception
• Myth About Aging and the Brain
• Myth: Memory decline is inevitable as we age.
• Fact: Many people reach old age and have no
memory problems. Participation in physical
exercise, stimulating mental activity,
socialization, healthy diet and stress
management helps maintain brain health.
• Myth: You cannot change your brain.
• Fact: The brain is constantly changing in
response to experience and learning and
retains this “ plasticity “well into aging.
• Myth: There is no point in trying to teach older
adults anything since “ you can’t teach an old
dog new tricks”
• Fact: Basic intelligence remains unchanged
with age, and older adults should be provided
with the opportunities for continued learning.

•
• Fluid Intelligence ( native intelligence )
• > consist of the skills that are biologically
determined, independent of experience or
learning.
• Crystallized intelligence is comprised of
knowledge and abilities that a person acquires
through education.
SEMI-FINAL
Comprehensive Geriatric Assessment

• Geriatric assessment is a multidimensional,

multidisciplinary diagnostic instrument
designed to collect data on the medical,
psychosocial and functional capabilities and
limitations of elderly patients.
• Importance of geriatric assessment
1. practitioners/ nurses use the information
generated to develop treatment and long
term follow up plans.
• 2. arrange primary care and rehabilitative
services
• 3. organize and facilitate process of case
management
• 4. determine long term care
• 5. make the best use of health care resources
Geriatric assessment differs from a standard
medical evaluation in 3 ways;
1. it focuses on elderly individuals with complex
problems
2. it emphasizes functional status and quality of
life.
3. it frequently takes advantage of an
interdisciplinary team providers
• Prevalent problems faced by the elder patient
this is referred to as the “ FIVE I’s of Geriatrics”
• 1. intellectual impairment
• 2. immobility
• 3. instability
• 4. incontinence
• 5. iatrogenic disorders
Assessment tools are following;
1. physical health
2. motor capacity
3. manual ability
4. self care ability
5. instrumental abilities
6. cognitive functioning
7. social function
• 3 approaches used for collecting assessment data;
.
• 1. self report format – questions are either ask
• directly or the person is
• expected to respond to
• written questions about his
• or her health status.
• 2. report by proxy - obtained indirectly, that is
• the nurse asks another person,
• such as a staff nurse, aide, spouse, or
• child to report their observation
• 3. observation – the nurse collects and records
the data, she or he has measured
and observed the persons health status using
objective parameter.
• HISTORY TAKING
Parts of the history that should be given
emphasis;
A. Medication history
1. nurses should take particular care in
identifying all drugs the patient is currently
taking
2. the record should contain a list of all
currently prescribed medications
• Including indication, dosage, schedule, and duration, all
over the counter preparations,
previously prescribed medications with the duration of
use, date of discontinuation and reasons of withdrawal
3. Specific notes regarding drug allergies and reactions
• B. Medical history
• a. immunization history ( tetanus, influenza,
pneumococcal vaccine )
b listing of previous illnesses and diagnosis
c. any previous operations or hospitalization
d. any blood transfusion
e. complete obstetric and gynecologic history for female
patients
• C. Personal and social history
a. detailed description of alcohol use, tobacco
use and caffeine intake.
b. patients sleep pattern and use of medication
c. questions about frequency and ease of falling asleep ,
quality of sleep, snoring, napping and degree of daytime
somnolence should be ask.
• Dietary assessment
The US National Screening Initiative develop a public
awareness checklist that allows patients and caregivers to
rate their nutritional health.
Recommendations for interventions are based on the score.
NUTRITION CHECKLIST
( National Council of Aging )
• 1. I have an illness or condition that made me change the
kind or amount of food I eat.
• 2. I eat fewer than 2 meals/ day
• 3. I eat few fruits or vegetables or milk
• 4. I have 3 or more drinks of beer, liquor almost everyday.
• 5. I have tooth or mouth problems that make it hard for
me to eat
6. I don’t always have enough money to buy food to eat.
7. I eat alone most of the time
8. I take 3 or more different prescribed OTC drugs a day
9. Without wanting to , I lost or gained 10 lbs. in the last 6
months
10. I am not always physically able to shop, cook and feed
myself
Scoring 0 -2 --- good
3 -5 ---moderate nutritional risk
6 or more --- high nutritional risk
For frail elders Mini Nutritional assessment
D. Emotional History
1. Patients should be asked about any previous emotional
difficulty or difficult adjustments such as job changes
• 2. previous patterns of coping with stress
• 3. episodes of depression or patients history of depression
E. Occupational / retirement status
1. retirement was voluntary or forced
2. retirement posed additional problem s with spouse or
family
3. occupational factors that may have affect physical or
mental condition such as exposure to toxic materials
F. Social Supports
1. list of all living relatives, their current places of residence
2. frequency of contact with the patient
3. willingness and ability to care for the elders
G. Family history
1. information regarding the patients parents, children and
spouse
H. Functional assessment
1. patients capacity for independent living.
Screening can be accomplished through variety of
instruments. These instruments can assess basic activities
of daily living ADL using acronym DEATH
D- dressing
E- Eating
A- Ambulating
T – Toileting
H – Hygiene
Instrumental activities of daily living acronym SHAFT
S – Shopping
H– housekeeping
A– Accounting
F –Food preparation
T-- transportation
• Activities of daily living scale
• Bathing - either sponge bath, tub bath or shower
Receives no assistance ___
Receives assistance in bathing only one part of the body___
Receives assistance in bathing more than one part of the
body ___
DRESSING – gets clothes from closets and drawer
• Get clothes and gets completely dressed without
assistance ____
• Get clothes and gets dressed without assistance, except
for assistance in tying shoes
• Receives assistance in getting clothes or in getting
dressed or stays partly or completely undressed ____
• TOILETING – going to the toilet room for bowel and urine
elimination, cleaning self after elimination and arranging
clothes.
• Goes to the toilet room , cleans self and arranges clothes
without assistance ____
• Receives assistance in going to toilet room or in cleaning
self or in arranging clothes or in use of night bedpan or
commode _____
• Doesn't go to toilet room for the elimination process
TRANSFER
Moves in and out of bed as well as in and out of chair without
assistance _____
Moves in and out of bed or chair with assistance___
Doesn’t get out of bed ______
• Continence
• Controls urination and bowel movement completely by
self _____
• Has occasional accidents______
• Supervision helps keep urine or bowel control catheter is
used or person is incontinent____
• FEEDING
• Feeds self without assistance _____
• Feeds self except in getting assistance in cutting meat or
bread______
• Receives assistance in feeding or is fed partly or
completely through tubes or injections ___
• I. Environmental history
1. understanding of the living arrangement
2. safety measures
3. home evaluation which includes lighting, flooring,
furniture location, and air conditioning
4. kitchen, bathroom and stairway should be evaluated for
safety, common sites for falls and injuries.
J. Assessment for depression
a. patients should be asked about signs and symptoms
related to their emotional condition
GERIATRIC DEPRESSION SCALE
Choose the best answer for how you felt over the past
week;
1. Are you basically satisfied with your life? Yes/ no
2. Have you drooped many of your activities and interest?
Yes/ no
3. Do you feel that that your life is empty? Yes/ no
4. Do you often get bored? yes / no
5. Are you in good spirit most of the time? Yes/ no
6. Do you often feel helpless? Yes / no
7. Are you afraid that something bad is going happen? Yes /
no
8. Do you feel happy most of the time ? Yes / no
9 . Do you prefer to stay home rather than go out and do
new things? Yes/ no
10. Do you feel you have more problems with memory?
Yes /no
11. Do you think it is more wonderful to be alive now? Yes/
no
12. Do you feel pretty worthless the way you are now? Yes /
no
13. Do you feel that your situation is hopeless? Yes/ no
14. Do you feel full of energy? Yes/ no
15. Do you think that most people are better off than you
are? Yes /no
Scoring scale, one point for each of these answers. Cut –off
score (0-5) normal above 5 suggest depression
1. no 7. no 13. no
2. yes 8. yes 14. yes
3. yes 9. yes 15. yes
4. yes 10. yes
5. no 11. no
6. yes 12. yes
SEXUAL HISTORY
> sexuality may be an important aspect of many geriatric
patients including the oldest old.
> sexual history helps health practitioners evaluate medical,
psychological, and educational needs of the elder patient
PHYSICAL EXAMINATION
A. vital sign – carefully and completely
1. body temperature- oral, axillary
2. pulse- pulse rhythms, pulse pressure
3. blood pressure
4. respiratory rate
5. pain
2. general appearance
a. height
b. weight
c. skin inspection
3. HEENT Examination
1. Eyes – test visual acuity
2. Ears – use of an otoscope to detect cerumen
3. Hearing – simple test of hearing acuity such as rubbing
two fingers or placing a ticking watch near the ear can be
useful.
4 mouth and throat – examined with notation regarding the
condition of the tongue, buccal surfaces and dentition.
4. other systems
1. neck
2. chest
3. abdomen
4. lymphatics
5. breast
6 . Genital
7. rectal
Comprehensive Assessment for the
Frail and Medically Complex Elder
F A N C A P E S = is a model for a comprehensive yet
prioritized assessment that is especially useful for the frail
elders
= it emphasizes the determination of a very basic needs
and the individual’s functional ability to meet these needs
independently, needs that form the most basic level of
Maslow’s Hierarchy.
F = fluids
A = aeration
N = nutrition
C = communication
A = activity
P = pain
E = elimination
S = socialization and social skills
Frailty = a stage of age related physiologic vulnerability,
resulting from impaired homeostatic reserved and a
reduced capacity of the organism to withstand stress.
= both physical and mental decline and leads
to an increased risk for morbidity and
mortality.
FLUIDS
a. What is the current state of hydration?
b. Does the person have the functional capacity to
consume adequate fluids to maintain optimal health?
c. ability to sense thirst
d. mechanically obtain the needed fluids swallow them
and excrete them
AERATION
1. Is the person’s oxygen exchange adequate for full
respiratory functioning?
2. Is supplemental oxygen required, is it possible for the
person to obtain it?
3. What is the respiratory rate and depth at rest and
during activity , talking ,walking and exercise and while
performing activities of daily living?
4. What sounds are auscultated , palpated, and percussed
and what do they suggest ?
5. Assess apical and lung field

NUTRITION
1. What is the type and amount of food consumed?
2. Does the person have the ability to bite, chew, and
swallow?
3. Oral health status or periodontal disease.
4. For edentulous persons, do their dentures fit properly
and are they worn?
5. Does the person understand the need for special diets?
6. Is the person risk for aspiration , including those who
are tube fed?
7. Assessment using nutritional checklist.
COMMUNICATION
1. Is the person able to communicate his or her needs
adequately?
2. do the person who provide care understand the
patients form of communication?
3. what is the person’s ability to hear in various
environments?
4. are there any environmental situations in which
understanding of the spoken word is inadequate?
5. Is the person depends on lip reading?
6. Is the person vision adequate?
7. Is the person able to clearly articulate words that are
understandable to others?
8. Does the person have either expressive or receptive
aphasia, and if so has a speech therapist?
9. What is the person’s reading and comprehension level.
ACTIVITY
1. Is the persons able to participate in the activities
necessary to meet basic needs such as toileting,
grooming and meal preparation?
2. How much assistance is needed, if any and is someone
available to provide this if needed?
3. Is the person’s able to participate in activities that meet
higher levels of needs such as belonging or finding
meaning in life?
4. What is the person’s ability to feed, toilet, dress, and
groom, to prepare meals, dial the telephone and to
voluntarily move about with or without assistive devices?
5. Does the person have coordination , balance,
ambulatory skills, grip strength and other capabilities
necessary to participate fully in day to day life?
PAIN
1. Is the person experiencing physical, psychological or
spiritual pain?
2. Is the person able to express pain and the desire for
relief?
3. How does the person customarily attain pain relief?
ELIMINATION
1. Is the person having difficulty with bladder or bowel
elimination?
2. Does the environment interfere with mechanical
elimination and related personal hygiene? Ex are
toileting facilities adequate and accessible ?
3. re any assistive devices used, are they available and
functioning?
SOCIALIZATION AND SOCIAL SKILLS
1. Is the person able to negotiate relationships in society to
give and receive love and friendship and to feel self worth?
FUNCTIONAL ASSESSMENT
A thorough functional assessment will help the
gerontological nurse promote healthy aging by doing the
following;
1. Identifying the specific areas in which help is needed or
not needed.
2. Assisting in the determination of the need for special
specific service.
3. Providing information that may be useful in the
determining the safety of the particular living situation
Major tools used in functional assessment are the following;
1. Self care are known as ADLs ( activities of daily living )
identified as eating, toileting, ambulation, bathing,
dressing and grooming.
2. Instrumental activities of daily living or IADLs such as
cleaning, yard work, shopping, and money
management are the tasks needed for independent
living.
Instrumental activities of daily living
1. TELEPHONE
I: able to work up numbers, dial, and receive and make calls
without help
A: able to answer phone or dial operator in an emergency
but needs special phone or help in getting number or
dialing
D: unable to use telephone
2. TRAVELING
I: able to drive own car or travel alone on bus or taxi
A: able to travel but not alone
D: unable to travel
3. SHOPPING
I: able to take care of all shopping with transportation
provided
A: able to shop but not alone
D: unable to shop
4. PREPARING MEALS
I: able to plan and cook full meals
A: able to prepare light foods but unable to cook full meals
alone
D: unable to prepare any meals
5. HOUSEWORK
I: able to do heavy work
A: able to do light housework but needs help with heavy
tasks
D: unable to do any housework
6. MEDICATION
I: able to take medication in the right dose at the right time
A: able to take mediation but needs reminding or someone
to prepare them
D: unable to take medication
MONEY
I: able to manage buying needs , write checks and pay bills
D: able to manage daily buying needs but needs help
managing check book and paying bills.
D: unable to manage money

MENTAL STATUS ASSESSMENT

As persons enter their 80’s and 90’s their risk for impaired
cognitive abilities increases, increase rate of illnesses such
as Alzcheirmers’s .
The gerontological nurse must be aware of the basic tools
that are used in the assessment of mental status
especially cognitive abilities and mood.
Cognitive Measures

1. Mini- mental state examination = the tool that is most

used, a 30 item instrument that is used to screen for
cognitive deficiencies and is one of the factors in the
determination of a diagnosis of dementia or delirium.
> it tests orientation, short term memory, attention,
calculation ability, language and construction.
> written test, administered to persons who are able to
see and write.
Scoring
30 points no impairment
24-26 mild cognitive impairment
21-23 mild Alzheimer's’ disease
10- 20 moderate Alzheimer's
10 below severe Alzheimer’s
2. Clock drawing test = which has been used since 1992, is a
screening tool that helps identify those with cognitive
impairment and that is used as a measure of severity.
INSTRUCTION
On the blank piece of paper ;
Ask the elders to draw a circle
Ask the elder to place the numbers 1- 12 inside the circle as
for a clock
Ask the elder to place the hands at 3:45
Scoring
Draws closed circle score 1 point
Places the number in correct score 1 point
Position
Includes all 12 numbers score 1 point
Places hands in correct position score 1 point
Interpretations;
Errors such as grossly distorted contour or extraneous
markings are rarely produced by cognitively intact
persons.
Clinical judgment must be applied, but a low score
indicates the need for further evaluation.
3. Mini – cog = it is used as a tool that could establish
cognitive status more quickly without equipment needed.
Components
3 item recall , give 3 items, ask to repeat , divert and recall
MOOD MEASURES
Geriatric depression scale is used as mood measurement
the same with geriatric assessment.
Functional Assessment
Functional Performance Test
a. Standing balance
Instructions: semi tandem stand. The nurse
a. First demonstrates the task
( the heel of one foot is placed to the side of the first toe of
the other foot)
b. Supports one arm of the elder adult while he or she
positions the feet as demonstrated above. The elder
can choose which foot to place forward
c. Asks if the person is ready then release the support and
begins timing.
d. Stop timing when the elder moves the feet or grasps the
nurse or when 10 seconds have elapsed.
Scoring
0 10 seconds unable
1 -2 3 seconds unable
3 4 -9 seconds unable
4 10 seconds able
2. Walking Speed
Instructions: The nurse
a. Sets up an 8 foot walking course with an additional 2
feet at both ends free of any obstacles.
b. place an 8 foot rigid carpenter’s ruler to the side of the
course.
c. instruct the older adult “ to walk to the other end of the
course at your normal speed, just like walking down the
street to go to the store
d. times 2 walks. The fastest of the 2 is used as the score
Scoring
0 unable
1 5-6 seconds
2 4.1 to 5.6 seconds
3 3.2 to 4 seconds
4 below 3.2 seconds
CHAIR STANDS
Instructions : The nurse
a. Places a straight- backed chair next to a wall.
b. asks the older adult to fold the arms across the chest
and stand up from the chair 1 time.
c. Asks the older adult to stand and sit 5 times as quickly
as possible .
d. Count the time from initial sitting position to the final
standing position at the end of the fifth time.
Scoring
0 unable
1 16. 6 seconds
2 13. 7 to 16.5 seconds
3 11. 2 to 13.6 seconds
4 below 11.2 seconds
Assessment for social supports
Surrounding network of intimates, friends and family and
their ability to provide companionship and assistance in
times of need.
Family Apgar addresses five specific family functions
a. Adaptation
b. partnership
3. Growth
4. Affection
5. Resolution
Apgar tool is useful in the following situations
1. Interviewing a new patient
2. Interviewing a person who will be caring for a
chronically ill family member
3. Following adverse events like death, diagnosis of
cancer
4. When the family history suggest family dysfunction .
Chronic Illness

Chronic illness = are conditions that last a year or more and

require ongoing medical attention or limit activities of
daily living.
From nursing perspective “ chronic illness “ is irreversible
presence, accumulation or latency or disease state or
impairments that involve the total human environment
for;
a. Supportive care
b. Self care
c. Maintenance of function
d. Prevention of further disability
Chronic illness can be categorized as follows;
1. Nonfatal = conditions such osteoarthritis, vision problem,
these contribute to disability and increased health cost
but most individual can live with them for many years.
2. Serious eventually fatal chronic illness = can lead to death
ex cancer, organ failure, heart failure, stroke
3. Frailty = a condition in which the body has little reserve
left and any disturbance can cause multiple health
conditions and cost
Clinical problems in the Elderly
Cardiovascular systems
a. hypertension
b. coronary artery disease
Gastrointestinal systems
a. Constipation
b. peptic ulcer disease
Genitourinary system
c. Urinary incontinence
d. benign prostatic hypertrophy
3. Nephrotic syndrome
4. Acute renal failure
5. Chronic renal failure
Endocrine system
a. Diabetes mellitus
b. Thyroid disorder
Respiratory systems
a. COPD
b. Pulmonary tuberculosis
c. Lung cancer
d. Pneumonia
Musculoskeletal system
a. Osteoporosis
b. Osteoarthritis
c. Rheumatoid arthritis
d. Gout
Nervous system
a. Dementia
b. Alzheimer’s
c. stroke
d. Parkinson’s disease
Gynecological problem
e. Atrophic vaginitis
f. Prolapsed of the uterus
Integumentary
a. Melanoma
b. xeroxis
c. photoaging
Senses
d. Glaucoma
e. Cataract
f. hearing loss
HEALTH MAINTENANCE
Main goal in caring for the elderly are;
1. Prevention of disease
2. maintenance of function
3. independence and life satisfaction
Prevention of disease and illness and disability has been
categorized in 3 levels
1. Primary = prevention refers to interventions that are
designed to reduced the risk of getting a disease or illness
2. Secondary = prevention refers to interventions to
improved outcomes in people who are already have a
given disease
3. Tertiary = interventions to prevent the progression of
disability through systematic identification, treatment and
rehabilitation.
Methods of interventions primary level;
a. Counseling to encourage a change in behavior
( regarding diet, exercise, alcohol or nicotine use)
b. immunization
Secondary prevention;
1. Routine screening during medical check up
Tertiary prevention;
1 . Identifications of elders problems treatment and
rehabilitation based on the patient's problem
Community Resources In the
Care Of Older Person/ Elderly
New Models of Community Care
1. Adult day services = community based group program
designed to provide social and some health services to
adults who need supervised care in a safe setting during
day.
2. Senior retirement communities = communities
designed for elders .
3. Adult foster care = provide assistive care in a homelike
setting that will enhance function and quality of life
that allows elders to remain
In a community based setting.
4. Residential care facilities = nonmedical community based
residential setting , two or more unrelated adults and
provide services such as meals, medication,
transportation, and assistance with ADL.
5. Assisted living = residential care with assisted living
facilities
> long term care , skilled nurses and with facilities
6. Continuing care retirement community = with facilities,
skilled nurses, access the 3 levels of care
7. Population specific communities = this provides older
adults more options / that they fine more comfortable /
welcome ( tennis, golf )
8. Nursing homes = are setting for the delivery of round the
clock care for those who need specialized care that
cannot be provided elsewhere.
a. 2 levels of care
b. Nursing care facility
c. licensed skilled professionals
HOSPICE CARE = neither prolong life nor hasten death but
attempts to improve the quality of a patients last days
of life by offering comfort and dignity in the form of
palliative care, physical, emotional and spiritual support
for the people with terminal illness and their families.
Palliative care= comfort rather than cure on the treatment
of symptoms rather than disease.
Hospice care;
1. Embraces death as a natural part of life
2. People dying require practical help and caring presence
during the painful procedure.
3. contributes human peace, comfort and dignity.
Hospice philosophy of care;
1. Affirms support and care for people in the last phases of
incurable disease so they may live as fully and
comfortably as possible.
2. Recognizes dying as part of the normal process of living
and focuses on maintaining the quality of remaining of
life.
3. It exist in the hope and belief that through appropriate
care patients, families may be free to attain a degree of
mental and spiritual preparations for death that is
satisfactory to them.
Hospice team;
1. Physician
2. nurse
3. Home health aids
4. Social worker
5. Chaplain/ priest
6. Non- professional volunteers
Nurses role in hospice care;
1. Knowledge in anatomy and physiology with
pathophysiological causes of numerous disease.
2. well- grounded skill in physical assessment and in
various nursing procedure ( colostomy, tracheostomy,
catheterization )
3. above average knowledge of pharmacology especially
in analgesic, emetics, tranquilizers, steroids,
cardiotonics, chemotherapy.
4. Sensitivity in human relationship
5. Personal characteristics such as emotional stability,
flexibility and life philosophy of faith.
6. Skill in using psychological principles in individual and
group situation
7. Measures to comfort the dying in the last hours.
Home care = is the provision of comprehensive health
services to individuals and families in their own residence
for the purpose of promoting, maintaining or restoring ,
minimizing the effects of illness and disability.
For nurses home care is;
> more than doing home visits
> being prepared to become a member of the team caring
for chronically ill or terminally ill patient at home
Patients managed in the home;
1. Patients with chronic illness
2. acute episodes illness
3. patients discharged from the hospital who still require
medical supervision or rehabilitation or terminally ill
patients.
Home care services includes the following;
1. Medical
2. rehabilitation
3. counseling and health education
4. wellness program
5. diagnostic procedure
6. nursing care
7. spiritual care
8. support care
9. transportation services
10. bereavement care
11. environmental assessment
Ethical aspects in the care of the
elderly/ older person
Ethics = provides intellectual framework that deals with
systematic approaches to questions of morality.
Nurses have the obligations to help patients
(BENEFICENCE )
Not to harm patients ( NON MALEFISENCE )
Guard what patients tell them of strict confidence
( CONFIDENTIALITY )
Treat all patients justly ( JUSTICE )
Other ethical principles that must be applied in the clinical
practice;
1. Competence = this is the decisional capacity of the nurse
2. Fidelity = this is the emotional obligation between the
nurse and patient to respect integrity and person hood.
> to treat person with respect requires that they are not
treated as things but treated as human and that their
interest must be considered in any interaction.
3. Utilitarianism = this consider human well- being to be a
primary value. It will seek the greatest possible good for
the greatest number of people.
 4. Autonomy = the individual is free to choose and
implement ones own decisions free from deceit ,
constraints, coercion.
5. Veracity = this binds both nurses and the patient in an
association with the truth.
.> the patient must tell the truth in order that an
appropriate care can be provided.
Ethical consideration in elderly
care
1. Confidentiality = bioethical principle which respects the
right of privacy.
> provides the patient the right to keep medical
information solely within the nurse patient , doctor
patient relationship.
Information should not be provided to anyone else
without the patient consent.
Not providing information to family members of
competent patients , unless the patients want the
information shared.
2. Informed consent = is the process whereby patients after
sufficiently being conformed, make rational decisions to
consent or not consent to a procedure , diagnosis or
treatment thereby respecting persons basis right to self
determination.
3. Justice = fair and equal services in rendering care.
Aspects of home care

1. Preventive = includes health promotion and

maintenance for each family member
2. diagnostic = includes various laboratory and ancillary
procedures in the management of the patient and their
family members.
3. therapeutic = includes the pharmacologic and non-
pharmacologic management of the patients illness as
well as that of their family.
4. rehabilitative = various exercises and rehabilitation
measures
5. Long term maintenance = sustaining the care of the
chronically or terminally ill patients
6. Psychosocial care = addressing the psychological ,
emotional and social needs of the patients and their
families.