GERIATRIC CONSIDERATIONS IN NURSING

Introduction
Aging ,the normal process of time –related change ,begins with birth and continues throughout
life.Geriatric nursing is a nursing sub field involves caring for older adults. Older adults have
special needs which can become very complex, making employments prospects in the field of
geriatric nursing very well. Aging, the normal process of time related change, begins with birth
and continues throughout life. Gerontologic nursing is provided in acute care, skilled and assisted
living, community and home setting. The nurse helps the older person to maintain dignity and
maximum autonomy despite physical, social and psychological losses.

A well being of an aged person depends on physical, mental,

social and environmental factors. A totaltotal assessment includes an evaluation of all major body
system, social and mental status and the ability of the person to function independently despite a
chronic illness.Aging is a difficult process that can generate stress for the older person as well
as for family members & others people involved in long term care often grow quickly frusted
with the overall lack of available resource.

Meaning.
Geriatrics-the study of old age that includes the physiology ,pathology,diagnosisAnd
management of the disorders and diseases of older adult.

Definition
“The branch of medicine concern with the diagnosis, treatment and prevention of disease in older
people and the problem specific to aging.”

Gerontology:-gerontology is the study of the social, cultural, psychological, cognitive and

biological aspect of aging.

Geriatric nursing:- “ nursing care of the aged patient given in the home, in hospital, or special
institutions such as nursing homes, psychiatric institute etc.”

The field of nursing that relates to the assessment,nursing

diagnosis,planning,implementation,and evaluation of older adults in all environments
including acute ,intermediate and skilled care as well as within the community .
Principles of Gerontological nursing
• Aging is a natural process common to all living organisms.
• The elderly share similarself-care and human needs with all other human beings.
• Gerontological nursing strives to help older adults achieve optimum level of physical,
psychological and social and spiritual health so that they can achieve wholeness.
• Various factors influence the aging process.

CHARACTERISTICS OF ELDERS

The major characteristics of the elder population includes

demographic,socioeconomic,ethnicity and health characteristic.

1. DEMOGRAPHIC.
At onetime, all individual over the age of 65 were consideredold. Withadvancements indisease
control, living conditions and healthtechnology. People are living longer. A 65 yr old American
women may expect to live another 19yrs and a 65yr old-American man may expect to reach the
age of 81yr. the elderly are as heterogeneous as any other age group that spans 40 yrs or
more.as a result ,the categories of elders have expanded from one to four with each one
having a distinct set of interests and heath care need.

CATEGORIZING THE AGING POPULATION.

1. YOUNG –OLD- 65 TO 75YRS.

2 OLD- 75 TO 85 YRS.

3. OLD-OLD 85 TO 100YRS.

4. ELITE-OLD OVER 100YRS

2. SOCIOECONOMIC-

Socioeconomic characteristics such as gender, marital status ,education, income and living
arrangements vary among the young –old and old-old groups. Womenoutnumber men foreg.
The young –old and old-old groups have nearly 2 million more women than men, women have
a longer life expectancy than man, in addition women are more likely than men to be
widowed and there are higher remarriage rates for older men. Education can affect the
socioeconomic status of the elder higher education is usually associated with higherincome.
Educational levels for older adults are gradually increasing as indicated by the increasing
percentage rates of people 65yrs and older.

3. ETHNICITY.

The growing population of elders consists of increasing numbers of minority elders.when

projecting to 2050,the higher proportion of the elder white population will continue,how
ever.the non-white elder population is expected to increase with elder hispanies being the
fastest growing subpopulation group. These numbers emphasize the importance of nurses
being culturally sensitive and competent.

4. HEALTH-

Chronic health problems and disabilities increase as age increases however,disease is not a
normal outcome of aging.the vast majority (73./.) of older Americans related their health as
good, very good or excellent, even though most have chronic health conditions and 20./.
report a disability,nurses need to be aware that promoting health and wellness and assessing
and promoting functional abilities for activities of daily living continue to be valid and
important for 65 yrs old clients who have 16 to 90 more yrs. to enjoy life.

Theories of aging process

Human aging is viewed as a total process that begins at conception. Because individual have
unique genetic social, psychologic and economical factorsintertwined in their lives, the course of
aging varies from individual to individual.

The recognition of universal truth is what we attempt to discover through the theories of aging—
1. Biological theories of aging-

Biological theories are concerned with answering basic questions regarding the
physiologic process that occur in all living organisms as they age chronologically.
- This theories include explanation of the following:

• Deleterious effects leading to decreasing function of the organism.

• Gradually occurring age-related changes that progress over time and
• Intrinsic changes that may affect all members of a species because of the chronological
age.
- The biologic theories can be subdivided into two maim divisions-
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A) Stochastic theory:- this theory explain as aging as an event that occurs randomly and
accumulate over time, whereas nonstochastic theories view aging as certain
predetermined, time phenomenon.

- In 1963, orgel proposed the error theory,sometimes called the error catastrophe theory.
- This theory’s hypothesis is based on the idea that errors may occure in the transcription
in any step of the protein synthesis of DNA, and this eventually leads to either the
aging or the actual death of a cell.
- In recent years, the theory has not been supported by researcher.

ii.) Free- radical theory-

- Free radicals are by products of fundamental metabolic activities within the body.
- Free radicle production may increase as a result of environmental pollution such as
ozone, pesticides, and radiation.
- Normally they are neutralized by the enzymatic activity or natural antioxidant, if they
are not neutralized; they may attach themselves to other molecules.
- These highly reactive free radical react with the molecules in cell membranes, in
particular, cell membranes of unsaturated lipid such as mitochondria, lysozymes and
nuclear membrane
- Therefore, the mitochondria, for example, can no longer function as efficiently, and
their cell membranes may become damaged.

Cross link theory-

- The cross link theory of aging hypothesizes that with age, some protein become
increasing cross linked or enmeshed and may impede metabolic processes by
 obstructing the passage of nutrients and waste between the intracellular and
extracellular compartment.
- According to this theory, normally separated molecular structures are bound together
through chemical reaction. This primarily involves collagen, a new fibres are created,
they become unmeshed with old fibres and form an actual chemical cross link.
- This results increase in the density of collagen molecule but a decrease in its capacity
to both transport nutrients to cell and remove waste products from the cells.
Ex. The skin of the baby is soft and pliable whereas aging skin losses much of its
elasticity.

iv.) Wear & tear theory:-

- This theory proposed that cells wear out over time because of continue use.
- This theory reflects a belief that organs and tissues have a preprogramed amount of
available energy and wear out when the allotted energy is expended. Eventually, this
leads to the death of the entire organism.
- According to this theory, aging is almost a preprogramed process- a process thought
to be vulnerable to stress or to an accumulation of injuries or trauma, which may
actually accelerate it.
- According to Carnes, Staats, and Sonntag (2008), striated muscle, heart muscles,
muscles fibres, nerve cells and the brain are irreplaceable when destroyed by wear and
tear.

B) Nonstochastic theories:-
Nonstochastic theories view aging as certain predetermined, time phenomenon.

I) Programmed theory or Heyflick limit theory:-

- This study included an experiment on fetal fibroblastic cells and their reproductive
capabilities. The results of this landmark study changed the way scientistsviewd the
biologic aging process.
- Hey-flick and Mooreheads (1961) study shows that functional changes do occur within
calls and are responsible for the aging of the cells and the organism.
- This 1961 study found that unlimited cell division did not occurs; the immortality of
individual cells was found to be more an abnormal occurrence than a normal one.
- Life expectancy was generally seen as programmed, within a specific species range;
this biologic clock for human was estimated at 110-120 years.
- On the basis of the conclusions of this experiment, the Heyflick limit theory is
sometimes called the “biologic clock theory.”, “cellular aging theory” .or genetic
theory.

II) Immunity theory: - the immune system is a network of specialized cells,

tissues, and organs that provide protection against invading infections.
- The essential component of the immune system are T lymphocytes, which are
responsible for cell mediated immunity, and B- lymphocytes, the antibodies
responsible for humoral immunity.
 - The changes that occure with aging are most apperent in the T- lymphocytes, although
changes also occue in the functioning capabilities of B- lymphocytes.
- The changes in the immune system cannot be explained by an exact cause and effect
relationship, but they do seem to increase with advancing age.
- These changes includes a decrease in human immune response, often predisposing
older adult to—
- * decrease resistance to a tumour cell challenge and the development of cancer.
- * decrease ability to initiate the immune process and mobilize the bodys defence
against aggressively attacking pathogens, and
- * heightened production of auto antigens, often leading to an increase in autoimmune –
related diseases, such as systematic lupus erythematous and rheumatoid arthritis.

2.) Sociologic theories of aging :-

Sociologic theories focus on changing roles and relationships. This theory relate to various
social adaptations in the lives of older adults.

i. Disengagement theory:-
- In 1962, cuming and hennery published the first sociologic theory of aging in their
book, growing old: the process of disengagement.
 - According to disengagement theory, a society and older people engage in a mutually
beneficial process of reciprocal withdrawal to maintain social equilibrium.
- This process occurs systematically and inevitably ans is governed by society’s needs,
which override individual needs.
- Moreover, older people desire this withdrawal and are happy when it occurs.
- Individuals would change from being centered on society and intracting I n the
community to being self-centered process withdrawingfrom society by virtue of
becoming old.

ii. Activity theory or developmental task theory:- this theory sees activity as necessary to
maintain a persins life satisfaction and positive self concept.
- In 1953, Havighurst and Albracht first proposed the idea that aging successfully is
related to staying active.
- By remaining active, the older person stays young and lively does not withdrawn from
society because of an age parameter.
- This theory is based on 3 assumptions:
• It is batter to be active than inactive.
• It is batter to be happy than unhappy.
• An older individual is the best judge of his or her own successs in achieving the first 2
assumptions
- Lemon and colleagues 1972 tested this theory and found a significantly relationship
between formal activity and life satisfaction.

iii. Continuity theory:-

- The continuity theory dispels the permises of both the disengagement and activity
theoties.
- According to this theory, being active, trying to maintain a sense of being middle –
aged and willingly withdrawing from society does not necessarily bring happiness.
- Instead, the continuity theory proposes that how a person has been throughout life is
hoe that person will continue to be through the reminder of life.
- According to this theory, the later part of life is a continuation of earlier part and
therefore the integral component of the entire life cycle. The theory can be seen as a
developmental theory.

iv. Age stratification theory:-

- The Age stratification theory, firstly proposed by Riley and colleagues (1972), address
the interdependencies between age as an element of the social structure and the aging
of people and cohort as a social process.
- The theory attempts to explain the inter dependent between older adults and society
and how they constantly influence each other in a variety of ways.
- This theory emphasizes the following concepts
 • People pass through society in cohort that are aging socially, biologically and
psychologically.
• New cohorts are continually being born and each experiences a unique sense of history.
• A society can be divided into various strata according to age and roles.
• Society itself is continually changing, as are the people and their roles in each age
stratum.
• A dynamic interplay exists between individual aging and social change.

- Two additional components of age integration are the absence of age barriers and the
presence of cross age interactions.
- Age integration is seen as an important factors in combating ageism and improving
quality of life, not only for older adults, but for younger generations.

v. Person- environment fit theory:-

- The Person- environment fit theory considers the interrelationships between personal
competence and the environment (Lawton 1982).
- According to this theory , personal competence involves the following factors which
collectively contribute to a person’s functional ability : ego strength, motor skills,
biologic health, cognitive capacity, and sensory perceptual capacity.
- Lawton asserts that for each person’s level of competence, there is a level of demand
or environmental press that is most advantageous to that person’s function.
- This theory is often used in planning appropriate environment for older adults with
disabilities.

3.) Psychological theory:-

The basic assumptions of the psychological theories of aging are that development does
not end when a person reaches adulthood but remains a dynamic process throughout her
life span.

- Psychological aging cannot readily be separated from biologic and sociologic

influence.
- Psychological aging , therefore influence not only behavioural changes but also
developmental aspects related to the life of older adults.
- There are psychological theories are given below-

Psychological
theories of aging
a) Maslow's hierarchy of human needs:-

- According to this theory , each individual has an innate internal hierarchy of

needs that motivate all human behaviours.
- When people achieve fulfilment of their elemental needs, they strive to meet the
needs of next level , continuing on until the highest order of need is reached.
- The human needs are often depicted as a pyramid, with the most elemental needs
at the base.

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b) Jung's theory of individualism:-

- The swiss psychologist carljung (1960) proposed a theory of personality development
throughout life: childhood, youth and young adulthood, middle age and old age.
- According to this theory, a person’s personality visualized as oriented either toward the
external world(extroversion) or toward subjective, inner experiences (introversion).
 - Applying this theory to individuals as they progress through life, Jung’s proposed that
it is at the onset of middle age that the person begins to question values, beliefs and
possible dreams left unrealized.
- During this period, the individual often searches for answering about reaching goals
questioning whether a part of his or her personality or “true self” has been neglected
and whether time is running out for completion of these quests.
- This may be the first time the individual becomes aware the effects of the aging
process and the fact that the first part of adult life is over.
- As the person ages chronologically, the personality often begins to change from being
outwardly focused, concerned about establishing oneself in society, to becoming more
inward, as the individual begins to search for answers from within successful aging.

c) Erikson's 8 stages of life:-

- In 1959, Erickson (1993) proposed a theory of psychological development that reflects

cultural and social influences
- The major focus of development in this theory is an individual’s ego structure, or sense
of self, especially in response to the way in which society shapes its development.

- The task of middle adulthood is resolving the conflict between generativity and
stagnation. During older adulthood, the developmental task needing resolution is
balancing the search for integrity and wholeness with a sense of dispairs. (potter &
perry,2004)

d) Peck's expansion ofErikson’s theory:-

- Peck’s (1968) expanded the 8 stage, ego integrity versus despair, into three stages:
• Ego differentiation versus work role preoccupation
• Body transcendence versus body preoccupation and
• Ego transcendence versus ego preoccupation.

- During the first stage of this, the task for older adults is to achieve identity and feelings
of worth from sources other than the work role. The onset of retirement and
termination of the work role may reduce feelings of self-worth

- The second stage, bodytranscendence versus body preoccupation, refers to the older
person’s view of the physical changes that occur as a result of the aging process. The
task is to adjust to or transcend the declines that may occur to maintain feelings of
well-being.

- The third and final stage involves acceptance of the individual’s eventual death
without dwelling on the prospect of it. Remaining activity involved with a future that
extends beyond a person’s mortality is the adjustment that must be made to achieve
ego transcendence.
 e) Selective optimization with compensation:-
- This theory’s central focus is that individuals develops certain strategies to manage the
losses of function that occur over time.
- This general process of adaptation consist of 3 interacting elements
• Selection, which refers to an increasing restriction or one’s life to fewer domains of
functioning because of an age- related loss.
• Optimization, which reflects the view the people engage in behaviours to enrich their lives.
• Compensation, which results from restrictions caused by aging, requiring older adults to
compensate for any losses by developing suitable, alternative adaptations.
- The lifelong process of selective optimization with compensation allow people to aged
successfully

4.) Moral and spiritual development:-

- Kohlberg has postulated a theory of moral development that is based on interviews with
young persons. He recognized distinct sequential stage of moral thinking.

- spirituality no longer merely denotes religious affiliation, it synthesizes a person’s

contemplative experience. Illness, a life crisis , or even the recognition that one’s day on
earth are limited may cause a person to contemplate spirituality.

Age related physiological changes

Age related changes, physiological changes occur in all organ systems. The cardiac output
decreases, blood pressure increases and arteriosclerosis develops.

The rate of aging is the same a 45 year old man as it is for an 85 year old man; the difference is
that by 85 years of age more age related changes in have accumulated.

 Age related changes in the skin

- The skin, hair and nails all changes with age. Two types of skin aging are intrinsic
aging, based on genetic makeup and normal aging, and extrinsic factors such as
smoking exposure to sun UV light and environmental pollutants.
- Epidermal thickness decreases, but the number of the cell layer remains about the
same.
- Cells of the epidermis have decreased moisture contributing to a dry and rough
appearance in old age.
- Melanocytes decrease about 10%- 20% each decades, reducing skin protection from
UV rays, their regeneration rate varies, resulting dark pigmented areas called
Lentigosenilis (age spots).
- Langerhans cells in the skin decrease by nearly50%, reducing the skins immune
response and increasing the incidence in skin tumours,allergic reactions and infections.
- The dermis losses about 20% of its thickness in older age, causing the skin to appear
paper thin or transparent. Collagen decreases and assumes disorderly arrangement, and
 elastin fibres thicken and fragment. These changes influence skin quality and elasticity
with resultant skin wrinkling and sagging specially in sun exposed skin.
- The loss of subcutaneous fat predisposes older individuals to wrinkles as do our facial
expression.
- The size of sebaceous glands increases, whereas their sebum tends to decrease. The
sweat glands decrease in numbers and function, reducing perspiration and predisposing
older individual to hypothermia.
- The sweating response is reduced and a lower metabolic rate caused by a decline in
learn body mass lessen heat production. The layer of fat cells in the hypodermis
becomes thinner with age, reducing both protection from and the insulation the
prevents loss of body heat. Especially noticeable in the face, legs and hands.
- The most visible sign of greying of the hair, hair loss and baldness, caused by sex-
linked, genetic and radial factor. Men having increase hair growth in the ear, nose and
eyebrows and women have more hair growth on the chin and around the lips.
- Nails grow more slowly, often becoming lacklustre hard thick and brittle and develop a
grey or yellowish appearance.

 Age related changes in the skeletal system

- The primary and probably most significant age related change in the skeletal system is
a gradual loss of calcium from bone and bone mass & density.
- Aging affects the cartilage in the body’s joint. Cartilage surface become rougher in
joint areas receiving the greatest stress. This reduces flexibility and the cushioning
effect of cartilage allowing bones to rub against bones, resulting in pain and restriction
of joint movement.
- Cartilage of the intervertebral discs changes with age by losing fluid and becoming
stiffer and less compressible, restricting body flexibility and resulting lower back pain.
And compression of spinal disc resulting in decreased height.
- The strength of tendons and ligaments are decreased with age and shows some
decrease in water content these changes also contribute to decrease strength and
mobility in the skeletal system.
- Age related changes in vitamin D synthesis results in decrease calcium decrease
absorptionia through to be responsible for oeteoporosis, and fracture.

 muscles
- Muscles strength tends to decline with age, partially as a result of loss of motor units
and muscle fibres.
- There is some muscle atrophy with age, although how much is caused by the aging
process and how much is not clear.
- The decrease in the muscle mass and in contractile force or weakness often noted in
older adults is called sarcopenia. Sarcopenia increasesfatigue, frailty and disabilities
have a ,major risk of falling.

 Nervous system
- There are some losses of neurons with age, although the amount and the location of the
loss vary and neuronal loss varies substantially among different region of the brain.
 - Some neurons may shrink with age rather than being completely lost. Accompanying
the loss of neuron is a decrease in brain weight and size.
- Lipofusion accumulates in the nerve cells, cardiac muscles, skeletal muscles, smooth
muscle, thymus gland, pancreas, adrenals, liver, spleen, and parts of sperm ducts.Some
believe Lipofusion is related to cell activity and the more active or normal cell, the less
accumulation of Lipofusion.
- Decrease number of functional nerve cells may reduce the strength of the message
being transmitted.
- Sleeping time or patter is change with increasing age.

 Cardiovascular r system
- The heart valve become thicker and stiffer and heart muscles and arteries loss their
elasticity.
- The cardiac output decrease about 25% from age 20 to age 80, because of several
factors. Hypertension occurs due to thickening of the wall of hyperplasia of the intima,
collagenisation of the media and accumulation of calcium and phosphate in elastic
fibres progressively occur with age.
- With aging there is an associated increase in diastolic and systolic myocardial stiffness,
perhaps due to increased interstitial fibrosis in the myocardium. There is progressive
stiffness of arteries with age, particularly of the thoracic aorta, leading to an increased
after load of the heart.

 Respiratory system
- Aging affects lung capacity and function and including increased anterioposterior chest
diameter, osteoporotic collapse of vertebrae result in kyphosis
- The total capacity of lung remainsconstant, however and thus the residual volume
increases with the age. The elastic recoil of the lungs decreases with the age and thus
there is a greater tendency for airway to collapse.
- Gas exchange and diffusing and capacity are also diminished.
- Decrease cough efficiency reduced cilliary activity and increased respiratory dead
space make the older person more vulnerable to respiratory infections.
- Low oxygen levels have been linked to a reduced to fight off infections.

 Gastrointestinal system
- In elderly people’ssalivary flow probably decrease with aging and cause dry mouth.
- Chewing power is diminished, because of the decreased bulk of the muscle of
mastication.
- Gustatory and olfactory sensation tends to decrease with aging. The ability to detect
and discriminate between sweet, salt, bitter, and sour testes. Thresholds for salt and
bitter taste show age related elevations, whereas that for sweet taste appears stable.
- A recent study has shown age related changes of increased stiffness and reduced
primary and secondary peristalsis in the esophagus that is associated with a
deterioration of esophageal function beginning after the age of 40.
- Aging resulting in overall decline in gastric acid output.
 - Small bowel or colon becomes hypotonic, which leads to increase storage capacity,
longer stool transit time and greater stool dehydration causing constipation In elderly.
- Absorption of fat soluble vit A is increased in the elderly while vot-d absorption may
be impaired. Absorption of gink and calcium declines with age.
- Hepatic drug metabolism becomes more slowly in the elderly because of decrease in
the appearance, amount or distribution of the endoplasmic reticulum.

 Genitourinary system
- There is a decrease in kidney mass, primarily because of a loss of nephrons.
- Decrease filtration rate, diminished tubular function with less efficiency in reabsorbing
and concentrating the urine.
- Older women often suffer from stress or urge incontinence or both. Enlarged prostate
gland which is a common finding in older men causes a gradual increase in urine
retention.
- In older women there is greater chance of UTI due to decreased oestrogen level, which
shortens the urethral length, allowing easier passage of bacteria into the bladder, less
fluid consumption which causes concentrated urine in which bacteria can be
proliferate.
- GFR of 60 ml/ min/1.73 m2 is within the normal reference range for male >60 years
and women >50 yrs.

 Reproductive system
- In females: ovarian production of oestrogen and progesterone ceases with menopause.
- Thinning of the vaginal wall, along with a narrowing in size and a loss of elasticity,
decreases acidity, vaginal dryness and itching, atrophy of the uterus and ovaries and
decreased pubococcygeal muscle tone resulting in relaxed vagina and perineum. These
changes contribute to vaginal bleeding and painful intercourse.
- In older males: the panis and testes decrease in size and level of androgen diminished.
- Erectile dysfunction may develop.
- Sexual desire and activity decline but do not disappear.

 Endocrine system
- With aging there is reduced growth hormone secretion. This decrease in growth
hormone secretion is known to cause a reduction in protein synthesis, a decrease in
lean body mass and a decline od immune function.
- A progressive deterioration on the number of and function of insulin producing beta
cells.
- Menopause occurs because of the disappearance of oocytes from the ovary.

 Sensory system
- The pupil dilates slowly because of increased stiffness of the muscles of the eye.
- Lens become less flexible, the near point of focus gets further away.
- Presbycusis, a loss of the ability to hear high frequency tones attributed to irreversible
inner ear changes occurs in midlife.
 - The four basic tastes sweet, sour, salty & bitter, sweet testes are particularly dulled in
older people.

Psychological changes in aging

• Because of changes in life patterns are inevitable over a life time, the older person needs
resiliency and coping skills when confronting stresses and change.
• Retirement and perceived nonproductivity are responsible for negative felling.
• Many older peoples rely strongly on their spiritual beliefs for comport during stressful times.
• Older adults nay experience temporary changes in cognitive functions when hospitalized or
admitted to a skilled nursing facilities, rehabilitation centres or long- term care facilities.
• The ability to learn and acquire new skills and information decreases in the older adults
particularly 7th decades of life.
• Sensory losses, distractions and disinterest interfere with acquiring and recording information.
• Age related loss occurs more frequently with short term and recent memory.

Diet for older adults

• Since good nutrition is of immense significance during old age, care should be taken that
the diet of elderly are nutritionally adequate and well balanced.
• With the advancement of age, the energy needs are reduced as a result the total quantum of
food intake is lowered while the requirement of most of the other nutrients remains
unaltered.
• According to DRI
“energy for adult (18 yrs. ) male = 12830 Kj/day (3067 kcal/ day)
Female = 10060 kj / day (2403k,cal/ day )”
“for 80 years male = 10268 Kj/day (2452 k,cal/ day)
Female = 8233 Kj/day (1967 k,cal/ day)”

• Few factors to be kept in mind while planning balanced diet for the elderly:
- Limiting the intake of sodium
- Limit the intake of solid fats.
- Intake of energy rich food like sweets, fried foods, cereals and starch needs to be
reduced.
- Select fat free or low fat milk and milk products (cheese, yoghurt) to boost the intake
to maintain healthy bones.
- Eat seafood, poultry and eggs, to boost the intake of high quality, protein, vitaminB12,
iron and trace minerals to prevent anaemia, and thyroid problems.
 - Protein requirement according to Mahan et al (2011) recommend upto 1.2 gm
protein/kg body weight for older adult over the age of 65 years.

Recommended dietary allowance

1 Energy 1976 kcal.

2 Protein 60 gm
3 calcium 400 gm

Diet menu planning

meal Food stuff Quantity

Early morning break Tea, 1 cup
fast Poached egg, toast 2
with butter, apple 1

Mid morning Coffee + biscuit 1 cup, 2 slice

Lunch Chapatti 2 slice
Palaksaag, daal 1 serving
Salad
Fruit custard. 1 serving

Evening Vegetable upma 1 serving

Tea 1 cup

Dinner Laukikofta curry 1 serving

Potato & cauliflower 1 serving
Chapatti / rice 2 slice/ 1 serving
Daal / boondiraita 1 serving

At bed time milk 1 glass

Factors affecting nutritional status of the elderly

1. Changes in normal physiology:- dental problems, changes in taste and smell and disability
to digest and absorb nutrients can be affect both quality and quantity of food consumed
and overall suboptimal nutritional status.
2. Increased prevalence of chronic disease:- obesity, accidents, trauma, heart disease,
cancer, arthritis, osteoporosis, DM, senile dementia and the use of prescription drugs can
result in physician- oriented changes in the diet.
3. Socio- economic, psychological, and cultural factors:- low income, beliefs and
superstitions regarding food and dietary habits, social isolation, depression and loneliness
from spouse, family and friends can decrease the quality and quantity of the diet.
4. Alcoholism and use of therapeutic drugs:- when alcohol is substituted for nutrition, it
may interfere with absorption of some nutrients notably folic acid.
5. Other factors: loss of taste, loss of interest in food, poor appetite, constipation, difficulty
-in chewing.

LEGAL ASPECTS OF CARE.

Nursing is also guided by legal parameters .the practice of nursing is regulated in each
state through the individual state governments.

 Negligence and malpractice.

Negligence is a legal term for performing an action that causes harm to another
person or neglecting to perform an act that would have prevented harm malpractice is
a form of negligence that implies failure to act as a ‘’reasonably prudent nurse’’ the
standard of care of any nurse must be comparable to that of a nurse who is
reasonable and prudent.

 Informed consent.

Before any care is given.the person must agree to the treatment or

procedure.the person receives a full explanation of all facts need to make an
intelligent and informed decision .include in this explanation are the risks and
benefits involved.

 Medical directive to physician.

In some states ,the natural death act allows a person to request the withholding
or withdrawal of artificial measures to prolong life.in the event of terminal
illness.this document is called a medical directive to physician or living will.

 Patient self –determination ACT.

In 1990.federal law established the patient self determination ACT(PSD) under the
omnibus budget reconciliation act (OBRA) of 1987, this federal law mandates the right
of all individuals to be involved in making decisions concerning their medical care the
PSD
Act is intended to assist people in making decisions about their
Health care before they are faced with the trauma of life .threatening situations
under his law the patient has the right to refuse or accept the treatment and to
formulate advance directives .this allows individuals to make treatment desires carried.
Responsibilities of Gerontological nurse

The main objective of Gerontological nursing is to improve the quality of life of older people. The
nurse has fulfil the following role in Gerontological nursing.

 As a care giver
 Health educator
 Coordination of health services.
 Promoting good nutrition and activity & exercise.
 Protection from unhealthy environment
 Protect from physical and mental injuries, threats.
 Provide rehabilitation services
 Provide psychological support

CONCLUSION-
Gerontological nursing has taken several centuries to become
acknowledged as a separate nursing speciality.it rise should be understood within the
context of the emergence and development of nursing profession generally additionally
the growth care of elderly persons around the world, must be considered.it is
important to note that the preparation of the Gerontological nurses in dictatedsome
what which will influence the status of this speciality in different countries.
BIBILIOGRAPHY:-

1. Elipolous charlotte. Gerontological nursing,6th edition 2005;Lippincott Williams

&wilikans publications. Page no. 14, 18, 43, 80
2. Miller A. carol. Nursing for wellness in older adults 5th edition 2009
3. Park . textbook of preventive and social medicine, banarasidasbhanotpublisher.page no-
812-814
4. Basher shabeer P and khan S. yaseen , Aconcise textbook of advance nursing practice.1st
edition Emmess medical publisher Page no 742-751
5. Basavanthapa BT fundamental of nursing 2nd edition 2009, Jaypee publisher new Delhi
Page no- 824-851
6. Potter Patrica A. and perryanne griffin, fundamental of nursing 7th edition2009, elesiver
UP page no. 190-213

Website

1. http://www.slideshare.net/mobile/amrytharnair/geriatric27615199
2. http://www.slideshare.net/mobile/sujatamohapatra/geriatricconsiderationinnursing.
3. http://www.scribed.com/mobile/doc/78523048/geriatricconsiderationsinnursing#
4.
 GOVT. COLLEGE OF NURSING
JAGDALPUR

SUBJECT- NURSINGRESEARCH

TOPIC PRESENTATION ON
“RESEARCH PROCESS”

SUBMITTED TO
MRS. SMITA JHA
READER (OBG) SUBMITTED BY
GCON JAGDALPUR MS. SAVITA
 MSC. NSG PREVIOUS
GCON JAGDALPUR

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HANDOUTdate- 11/6/2018

SUBJECT- ADVANCE NURSING PRACTICE

TOPIC- GERIATRIC CONSIDERATIONS IN NURSING

PRESENTED BY- MS. SAVITA GUIDED BY- MRS. SMITA JHA

Introduction :-Geriatric nursing is a nursing sub field involves caring for older adults. Older adults have
special needs which can become very complex, making employments prospects in the field of geriatric
nursing very well.

Definition Geriatrics:- the study of old age, includes the physiology, pathology, diagnosis and
management of the diseases of older adults.

Geriatric nursing:- “ nursing care of the aged patient given in the home, in hospital, or special institutions
such as nursing homes, psychiatric institute etc.”
Principles of Gerontological nursing:-
Characteristics of elders:-
Theories of aging process:

Age related changes in the body—

 Physical changes
 Psychological changes

Diet for older adults-

RDA
Menu planning

Legal aspects of geriatric care:-

 Responsibility of Gerontological nurse
Conclusion
TABLE - 1 Normal Changes of Aging and Nursing Interventions
System Age related changes
Cardiovascula • Heart becomes larger and
r system occupies agreater amount of
space within the chest.
• Reduction in the amount of
functional muscle mass of heart.
• Decreased amount of blood that
is pumped throughoutthe
circulatory system.
• More adventitious S4 heart
sounds.
• Premature contractions and
arrhythmias.
• Blood flow is slower
• (wounds heal slower and
impacts medication metabolism
• and distribution).
• Low diastolic pressure.
• Increased pulse pressure.
Respiratory • Decreased vital respiratory capacity.
system • Lungs lose elasticity.
• Loss of water and calcium in bones
causes the thoracic cage to stiffen.
• Decreased amount of cilia lining
system.
• Decreased cough reflex.
Nursing intervention
•Can be cardiomyopathy, so refer for
diagnostic tests.
• Inform patient that exercise can ultimately
reduce the strain on the heart.
• Heart murmurs require further tests to
determine its effect.
• Fatigue, SOB, DOE, dizziness, chest pain,
headache, sudden weight gain, or changes in
cognitive function or cognition requires full
assessment.
• Know that the time of effectiveness may
take longer when giving meds.
• Inform patient that low diastolic pressure is
a risk for cerebrovascular accidents or strokes.
• Inform patient that exercise lowers
blood pressure.
• Note that auscultating sounds is difficult
so it must be done on all lung fields in a
quiet environment.
• Inform that pollution and smoking
worsens the cilia (try to help stop smok-
ing by recommending behavioral man-
agement classes, support groups/nicotine
replacement therapies, antidepression
medications).
• Tell patients that they are at risk for
choking.
• Make sure patient’s respiratory function is
frequently assessed.
• Encourage regular exercise
 Integumentary • Skin becomes thinner and more • Promote the use of sun block and tell
system fragile. patient to avoid overexposure.
• Skin is dry and loses elasticity • Avoid the use of soaps that dry skin and
(wrinkles). Use a lotion after baths.
• Sweat glands lessen, which leads to • Protect high-risk areas such as elbows
less perspiration. and heels with padding.
• Subcutaneous fat and muscular • Refer to a podiatrist.
layers begin to diminish; less • Help older adult maintain personal
padding, more easily bruised. appearance.
• Dryness.
• Skin tears.
• Fingernails and toenails become
thick and brittle.
• Hair becomes gray, fine, and thin.
• Facial hair on women.
• Decreased body hair on men and
women.
Gastro- • Inflamed gums. Assess older adult’s ability to chew.
intestinal • Periodontal disease. • Refer older adult for further oral evaluation
system • Sensitive teeth. if necessary.
• Tooth loss. • Assist older adults in making changes
• Decreased peristalsis of esophagus. with their eating habits.
• Decreased gut motility, gastric acid • Assess nutritional health frequently.
production, and absorption of • Encourage older adult to drink water (1.5 L).
nutrients. • Add bulk and fibre to diet.
• Difficulty evaluating wastes • Promote exercise.
(constipation). • Enemas and laxative medications may
• Involuntary leakage of liquid stool be given in severe situations.
(fecal incontinence). • Diets high in fibre and bulk, adequate fluids,
and exercise.
• Bowel habit training (for cognitively
impaired).
• In severe cases, surgery may be appropriate.

Urinary • Kidneys experience a loss of • Assess urinary incontinence.

system nephrons and glomeruli. • Kegel exercises.
• Bladder tone and volume capacity • Voiding schedules (for cognitively
decreases. impaired).
• Incontinence (not a normal change,
but occurs in response).

• Decrease in total muscle and bone • Encourage older adult to exercise

mass. Regularly.
• Muscle units that combine to form
muscle groups diminish.
.

Reproductive • Decrease in testosterone in men, • Help older adult feel comfortable when
system and estrogen, progesterone, and discussing sexuality.
androgen in women. • Give vaginal lubricants to females.
Women: • Inform men to increase the time between
• Follicular depletion in the ovaries. erections.
• Natural breast tissue is replaced by •Discuss use of oral erective agents.
fatty tissue.
• Labia shrinks.
 • Decrease in vaginal lubrications and
shortening and narrowing of the
vagina.
• Strength of orgasmic contraction
diminishes, and orgasmic phase is
decreased.

Men:
• Increased length of time needed for
erections and
ejaculation.

Sensory Eyes • Make sure older adult has a baseline eye

system • Visual acuity declines. assessment early in older adulthood and
• Ability of pupil to constrict in follow up eye exams yearly.
response to stimuli decreases. • Help older adult remove cerumen.
• Peripheral vision declines.
• Lens of the eye often becomes
yellow. • Obtain a thorough history of taste and
• Arcussenilus. smell sensations and a physical examina-
tion of the nose and mouth.
Ears • Obtain a thorough diet history.
• Increased amount of hard cerumen.
Taste and smell
• 30% of taste buds diminish
Neurological • Total brain weight decreases. • Help older adult maintain an active
system • Shift in the proportion of gray body and mind.
matter to white matter. • Encourage older adults to participate in
• Loss of neurons. cognitive activities
• Increase in the number of senile
plaques.
• Blood flow to the cerebrum
decreases.
System
Normal Aging Changes
Cardiovascular System
• Heart becomes larger and occupies a
greater amount of space within the chest.
• Reduction in the amount of functional muscle mass of
heart.
• Decreased amount of blood that is pumped throughoutthe circulatory system.

• More adventitious S4 heart sounds.

• Premature contractions and arrhythmias.
• Blood flow is slower
(wounds heal slower and impacts medication metabolism
and distribution).
• Low diastolic pressure.
• Increased pulse pressure.
•Can be cardiomyopathy, so refer for
diagnostic tests.
•
Inform patient that exercise canulti-
mately reduce the strain on the heart.
•
Heart murmurs require further tests to
determine its effect.
•
Fatigue, SOB, DOE, dizziness, chest
pain, headache, sudden weight gain, or
changes in cognitive function or cogni-
tion requires full assessment.
•
Know that the time of effectiveness may
take longer when giving meds.
•
Inform patient that low diastolic pres-
sure is a risk for cerebrovascular ac-
cidents or strokes.
•
Inform patient that exercise lowers
blood pressure.
78
Peripheral Vascular
System
•
Increase in the peripheral vascular resistance (blood has a
hard time returning to the heart and lungs).
•
Valves in the veins don’t functioneffi
ciently and form (non-
pathological) edema.
•
Inform patient that age, diet, genetics,
and lack of exercise can transform non-
pathological to pathological (atheroscle-
rosis and arteriosclerosis), which can
result in CVD.
•
Monitor older adults’ cholesterol levels
with lowering agents to prevent athero-
sclerosis and arteriosclerosis.
•
Inform patient that exercise results in
lower cholesterol levels.
•
Discuss the right medication, exercise
program, and diet for the patient as a
means to slow the progression of cardiac
changes.
Respiratory System
•
Decreased vital respiratory capacity.
•
Lungs lose elasticity.
•
Loss of water and calcium in bones causes the thoracic cage
to stiffen.
•
Decreased amount of cilia lining system.
•
Decreased cough refl
ex.
•
Note that auscultating sounds is diffi
cult
so it must be done on all lung fi
elds in a
quiet environment.
•
Inform that pollution and smoking
worsens the cilia (try to help stop smok-
ing by recommending behavioral man-
agement classes, support groups/nicotine
replacement therapies, antidepression
medications).
•
Tell patients that they are at risk for
choking.
•
Make sure patient’s respiratory function
is frequently assessed.
•
Encourage regular exercise.
(continued)
79
Integumentary System
•
Skin becomes thinner and more fragile.
•
Skin is dry and loses elasticity (wrinkles).
•
Sweat glands lessen, which leads to less perspiration.
•
Subcutaneous fat and muscular layers begin to diminish;
less padding, more easily bruised.
•
Dryness.
•
Skin tears.
•
Fingernails and toenails become thick and brittle.
•
Hair becomes gray, fi
ne, and thin.
•
Facial hair on women.
•
Decreased body hair on men and women.
•
Promote the use of sun block and tell
patient to avoid overexposure.
•
Avoid the use of soaps that dry skin and
use a lotion after baths.
•
Protect high-risk areas such as elbows
and heels with padding.
•
Refer to a podiatrist.
•
Help older adult maintain personal
appearance.
Gastrointestinal
System
• Infl
amed gums.
• Periodontal disease.
• Sensitive teeth.
• Tooth loss.
• Decreased peristalsis of esophagus.
•
Decreased gut motility, gastric acid production, and absorp-
tion of nutrients.
•
Diffi
culty evaluating wastes (constipation).
•
Involuntary leakage of liquid stool (fecal incontinence).
• Assess older adult’s ability to chew.
•
Refer older adult for further oral evalua-
tion if necessary.
•
Assist older adults in making changes
with their eating habits.
•
Assess nutritional health frequently.
•
Encourage older adult to drink water
(1.5 L).
• Add bulk and fi
ber to diet.
• Promote exercise.
•
Enemas and laxative medications may
be given in severe situations.
•
Diets high in fi
ber and bulk, adequate
fl
uids, and exercise.
•
Bowel habit training (for cognitively
impaired).
•
In severe cases, surgery may be appropriate.
TABLE 3.1 Normal Changes of Aging and Nursing Interventions
(Continued)
System
Normal Aging Changes
Nursing Interventions
80
Urinary System
•
Kidneys experience a loss of nephrons and glomeruli.
•
Bladder tone and volume capacity decreases.
•
Incontinence (not a normal change, but occurs in response).
• Assess urinary incontinence.
• Kegel exercises.
•
Voiding schedules (for cognitively
impaired).
Musculoskeletal
System
•
Decrease in total muscle and bone mass.
•
Muscle units that combine to form muscle groups diminish.
•
Encourage older adult to exercise
regularly.
Sexual/Reproductive
System
•
Decrease in testosterone in men, and estrogen, progester-
one, and androgen in women.
Women:
• Follicular depletion in the ovaries.
•
Natural breast tissue is replaced by fatty tissue.
• Labia shrinks.
•
Decrease in vaginal lubrications and shortening and nar-
rowing of the vagina.
•
Strength of orgasmic contraction diminishes, and orgasmic
phase is decreased.
Men:
•
Increased length of time needed for erections and
ejaculation.
•
Help older adult feel comfortable when
discussing sexuality.
•
Give vaginal lubricants to females.
•
Inform men to increase the time between
erections.
• Discuss use of oral erective agents.
(continued)
81
Senses
Eyes
• Visual acuity declines.
•
Ability of pupil to constrict in response to stimuli decreases.
• Peripheral vision declines.
• Lens of the eye often becomes yellow.
• Arcussenilus.
Ears
•
Increased amount of hard cerumen.
Taste and smell
• 30% of taste buds diminish.
•
Make sure older adult has a baseline eye
assessment early in older adulthood and
follow up eye exams yearly.
• Help older adult remove cerumen.
•
Obtain a thorough history of taste and
smell sensations and a physical examina-
tion of the nose and mouth.
• Obtain a thorough diet history.
Neurological System
• Total brain weight decreases.
•
Shift in the proportion of gray matter to white matter.
• Loss of neurons.
• Increase in the number of senile plaques.
• Blood flow to the cerebrum decreases.
Help older adult maintain an active
body and mind.
•
Encourage older adults to participate in
cognitive activities.
T