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The University of Hong Kong

The Bachelor (Full-time) of Nursing
Year IV
Course: NURS4201 Gerontological Nursing

Reflection: Age-related changes and life in old age

-Nursing roles on supporting elderly and caregivers
Cheung Hiu Fung 3035006601
Chong Lai Chung 2010287395
Chow Chi Hei 2010542331
Lee Wai Han 3035006857
Li Wing Mui 2012700092
Li Wing To 2012721840
Tam Wing Sze 2012710231
Tang Yuen Mei 2012709634
Word Count: 1977

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As the Chinese proverb goes An elderly at home is a treasure of your own,

people are expected to treat seniors with respect and compassion. This, however, may
not be the case in Hong Kong as there are a lot of cases that old people being
neglected or even abandoned by their family (Asia Pacific Institute of Ageing Studies,
2011). In order to build a harmonious city and thrive as a whole, it is of paramount
importance that we see the plight of our elders and repay them with care. To our honor,
we were invited to participate in the aging simulation activities held by the LinkAges
Centre to better comprehend the predicaments that the aged are facing and
contemplate what we, as nurses, can do to help them. In this journal, we will go
through the age-related challenges encountered by the older adults, our experience
with them, the general public response to elderly problems and what could nurses and
relatives do for them.
During the aging simulation, we are required to wear some old-age-simulation
devices like the glasses for Presbyopia and metallic restrainers on one side of our
limbs to represent sight loss and impaired mobility to get the physical limitation of the
elderly. We all had been given only plain congee which is low in nutrition, and wet
towels to sit on to feel the embarrassment and discomfort that brought by
incontinence. Furthermore, we were arranged to participate in activities that we
cannot enjoy with our old-age-simulation devices, for instances, we cannot enjoy
the TV shows and the chess games with glasses. Also, we are limited to walk as usual
with the restrainers. Out of our expectations, the staff in the Old Age Home treated
elderly very rudely, we felt disrespected and helplessness as our concerns, like
changing wet diaper, was not taken seriously. The experience gave us some hard times
for just more than an hour, but elderly who may have to face the worsening situations
for the rest of their life. It has inspired us, as nurses, to think more on our daily
experiences in practice and how we can improve our care to make the elderly to feel
better.
In fact, aging is an inevitable physiological change occurring in human over
time (Dong C.P. & Seung G.Y., 2013) and there are many physiological and
psychological changes in aging, which are based on different theories and evidences.
As supported by various theories, although no clear cause of aging is defined, theories
like gene theory wear-and-tear theory, free radical theory conclude that aging is
determined by genetics and environmental damage factors. These changes bring
elderly tremendous challenges in living, not only affects their health but quality of life
in many aspects, with some listed as below.

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First, elderly may experience difficulty in communication. Sensory abilities

decline as one ages with vison and hearing being the most impactful. The common
eye diseases in old age such as glaucoma, age-related macular degeneration, cataracts,
and diabetic retinopathy are superimposed upon aging changes in eyes, central
processing and diabetic history (Besdine, 2008). For hearing, about one-half of the
susceptibility to age-related hearing loss may be genetically determined (Eyken,
Camp & Laer, 2007). Elderly patients with visual impairment and hearing loss are
more prone to having depressive symptoms (Watkinson, S., 2011; Raffaella B.,Luca R
& Antonio C., 2012). These sensory losses hinder elderly communicate with others,
which further leads to social withdrawal and social isolation
Second, impaired mobility can be another great issue of aging as mobility for
elderly is importance for independence and socialization. As people age, cartilage
degenerates and inflammation, and osteoarthritis may happen, lead to pain and
limitation of joint mobility (Blagojevic, Jinks & Jeffery, et al., 2010). Also, other
declines in physiological attributes, such as muscle strength, can increase risk of falls
and subsequently greater risk of losing independence and individual's functional
ability.
Third, older people are prone to getting diseases that require more medical
treatment. For instances, healthcare associated infection and life-threatening
infections due to reduced immunity, increase invasive medical procedures, skin
changes and mucosal membrane changes (Weston, 2011) and increase risk of heart
disease (Young, 2002)
Fourth, mental health problems such as depression are also prevalent among the
elderly in Hong Kong (Ngan & Kwan, 2002). Alterations in the brain, such as
decreased availability of neurotransmitters and selective degeneration of neurons, are
known to increase the risk depression (Seshagiri, 2003), dementia and Parkinsons
diseases (Coates, 2011) in the elderly. Delirium, which is an acute confusion state
arising from medical condition, substance intoxication or substance withdrawal, is
found more susceptible in elderly than younger people. (Coates, 2011).
Also, older women tend to be dissatisfied with their body weight (Bedford & Johnson,
2005) and older people generally have lower body image and self-esteem than
younger people do (Baker & Gringart, 2009). Moreover, there are high prevalence
nursing home elderly having depressive symptoms, and the risk factors are difficulty
in swallowing, non-CSSA recipients and impairments in basic activities (Chow, Kong
& Wong, et al.2004). According to Coates & Davey (2011), older people who do seek

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help for urinary incontinence, which is not part of aging process, are stigmatized and
may be put off by negatives experiences with health professionals. Furthermore,
incontinence can lead to caregiver stress and institutionalization of the elder (DuBeau,
2007). In long term care facilities, Frail elderly ranks them having lower
quality-of-life, having long-term distress, poorer value of life and food-related
concerns, regardless of their frailty level (Chan & Pang, 2007). All in all, the mental
health and psychological changes of elderly are also key parts in assessing their
quality of life.
Unfortunately, older people are generally perceived as burden to general public
and caregivers. In economic aspect, Hong Kong citizens emphasize immediate
economic rewards that elders are perceived as economically unproductive (Phillipson,
1998). This coupled with our changing family structure and function from extended
family to nuclear family, there is less respect, care and engrossment towards the older
generation (Chow & Lum, 2008). Regrettably, most of Hong Kong people are not
living with their grandparents and only visit them occasionally (Kalyani & Leng,
2012). As a direct consequence, family ties with the elderly are weakened and ageism
gradually develops. More seriously, verbal abuse from caregivers is common in Hong
Kong Chinese family (Yan & Tang, 2004) which can be predicted by elderly poor
visual and memory abilities, dependence on family and family non-dependence on
elderly. All these result in higher burden , less satisfaction of social support, worse
health status of the elderly and poorer family functioning perceived by
caregivers(Wai-Tong, Chan & Morrissey, 2007). In institutional care, violence from
care providers are common and considered unavoidable by care providers (Sandvide,
strm, Norberg, Saveman, & RNT, 2004). Also, verbal and physical abuses were
reported highly prevalent among older Chinese with dementia, which may be due to
increase stress of caregivers and agitation from the care recipients (Yan & Kwok,
2011). Additionally, Hong Kong findings revealed that Chinese adults were not
actively preparing for their ageing because of busy life and too focusing on short-term
goals (Lee & Fan, 2008).
To reflect our nursing roles, nurses have always been providing the frontline
health care to older adults in various settings like hospital, community and assisted
living facilities. We, as future nurses, have the critical responsibility to heed to their
needs.
The nursing cares that can be provided to the elderly are multifold. First, we
should carry out comprehensive gerontological assessment to the elderly patients to

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assess their different perspectives of health, including their physical data,

psychological data and health history, etc. Applying assessment is essential to identify
the underlying stressors .Studies have shown that nurses can sometimes carry
misunderstanding to elderly patients. For example, hearing loss in older people may
be mistaken for cognitive impairment (NHS OIS, 2005). Nurses can also identify the
at-risk group of elderly in different aspects by using different standardized assessment
tools, like the IntraRAI Clinical Assessment Protocols (CAPs) for finding the elderly
with high tendency of troubling problems, designing or adjusting individual care plans
by considering individual strengths and weaknesses, constant review by setting up
baseline for periodic comparison and facilitate our available resources. . Drawing
back to our simulation, if nurses or old-age-home helpers could recognize our
impaired sight and switch some other more appropriate activities like listening radios,
we elderly would not feel so bored or angry. In consideration with the example
mentioned, nurses can characterize the specific nature of behaviors, i.e. an elderly
who often disruptive behavior may be due to the hearing loss instead of cognitive
problems, identify the underlying stressors or conditions contributing to the problems
such as a new medication or a specific routine which cause or worsen the behavior
problems. Shortly summarize, nurses can work out care plans and initiate nursing
actions based on individual assessment outcomes. Research also suggests that these
tools can also be accurately used in nursing home (Hartig, Engle & Graney, 1997).
Second, we can provide support and education for the relatives in caring elderly.
Nurses can encourage family to accompany elderly for daily activities to prevent
social isolation and promotes elderly mental health (Brody, 1995). Besides, (Wang,
2005) due to lack of geriatric training and different perceptions of health need and
health condition by nurses and caregivers contributing to caregivers psychological
abusive behavior towards elderly patients. (Hannum, Bowman & Kresevic, 2000),
nurses can assess relatives skills in taking care of elderly and offer bedside training to
form a comprehensive discharge planning such as ensuring relatives reminders of
elderlys adherence with medication. For relatives of elderly patients suffering chronic
illness, introducing them to caregivers connections or support system for continue
education is effective for strengthening their support (Madden & Fetterman, 2002). In
short conclusion, nurses can offer relatives knowledge about taking care of elderly
and refer them to support system.
Third, we should increase the self-image of elderly by recognizing aging
process while also encouraging them to continue their daily routines to maintain
physical, cognitive, and social function through physical activity, ambulation, reading

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the newspaper and socialization. This can lead to a better quality of life and adding a
sense of security and independence (Landefeld, Palmer, Kresevic, Fortinsky & Kowa,
1995)
Last but not least, although nurses are frontline caring elderly patients, we need
support from multidisciplinary team in both primary, community and hospital care
systems. For example, nurses can assist in community education training program.
Additionally, they can make recommendations on home designs adjusted for the aged,
such as introducing relatives to recruit home care services for frail elderly. Nurses can
also refer elderly and relatives to physical and occupational therapy services to
manage their functional decline .All these alleviate the pressure of the relatives while
respecting the family systems or dynamics and encouraging open dialogue and
emphasizing the elders strengths (Graf, 2006). In Hong Kong, nurses can cooperate
with District Elderly Community Centre (DECC) to provide community education,
support team, meal and laundry services and case management, etc. for supporting
elderly care and reducing family concern with help of trained professionals (Social
Welfare Department, 2005). Nurses can also communicate with the nurses in nursing
home or other community networks on topics of care for their elderly patients, such as
chronic pain management of elderly patients in nursing home (Higgins, Madjar, &
Walton, 2004).
To sum up, we appreciate this age simulation activity as it helps us understand
elderly feeling and explore the support they need. We think nurses should safeguard
our ethics to provide quality care for elderly. We should be flexible in our care to
preserve the values withheld in elderly. In addition, we should also enhance our
knowledge on geriatrics and geriatric care to bring positive impact for them and the
community on aging as elderly contributes their life to build our society and should be
considered as our society capitals rather than burdens.

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References:
Asia Pacific Institute of Ageing Studies, (2011) Report on elderly in poverty.
Retrieved on Oct 12, 2014 from
http://www.legco.gov.hk/yr06-07/english/hc/papers/hc0608cb2-2048-e.pdf
Baker, L., & Gringart, E. (2009). Body image and self-esteem in older adulthood.
Ageing and Society, 29(6), 977995.
Bedford, J.L., & Johnson, C.S. (2005). Societal influences on body image
dissatisfaction in younger and older women. Journal of Women and Aging,
18(1), 4155.
Blagojevic M, Jinks C, Jeffery A, et al. (2010) Risk factors for onset of osteoarthritis
of the knee in older adults: a systematic review and meta-analysis.
Osteoarthritis Cartilage. 2010
Brody, E.M. (1995). Prospects for family caregiving: response to change, continuity
and diversity. In Family caregiving in an aging society: Policy perspectives,
edited by R.A. Kane and J.D. Penrod. Thousand Oaks, CA: Sage Publications.
Carpenito, L.J. (2000). Nursing Diagnosis. Application to clinical practice. (8th ed.).
Philadelphia: Lippincott.
Census and Statistics Department (2012). Hong Kong population projections.
Retrieved on October 12, 2014 from
http://www.statistics.gov.hk/pub/B1120015052012XXXXB0100.pdf
Chan, C., & Chui, E. (2011). Association between cultural factors and the caregiving
burden for Chinese spousal caregivers of frail elderly in Hong Kong. Aging &
Mental Health, 15(4), 500-509.
Chan, H. L., & Pang, S. C. (2007). Quality of life concerns and end-of-life care
preferences of aged persons in long-term care facilities. Journal of Clinical
Nursing, 16(11), 2158-2166.
Chow and Lum (2008). Trends in family attitudes and values in Hong Kong.
Retrieved from Octorber 13, 2014, from
http://www.cpu.gov.hk/doc/tc/research_reports/20080822%20Trends%20in%2
0family%20attitudes%20and%20values%20in%20Hong%20Kong.pdf
Coates, A. (2011). Dementia, Mental Health, and the Older Adult. In Hindle A. &
Coates A., Nursing Care of Older People A Textbook for Students and
Nurses, 141-167, Oxford.
Covinsky, K. E., Palmer, R. M., Kresevic, D. M., Kahana, E., Counsell, S. R.,
Fortinsky, R. H., et al. (1998). Improving functional outcome in older patients.
Joint Commission Journal on Quality Improvement.

Page 8 of 10

Cruickshanks KJ, Nondahl DM, Tweed TS, et al. (2010) Education, occupation, noise
exposure history and the 10-yr cumulative incidence of hearing impairment in
older adults. Hear Res. 2010
Davey, A. C. (2011). Elimination and Continence and the Older Adult. In Hindle A. &
Coates A., Nursing Care of Older People A Textbook for Students and
Nurses, 185-199, Oxford.
Dong C.P. & Seung G.Y. (2013, August 20). Aging. Korean J Audiol, 39-44.
DuBeau C.E. (2007). Beyond the bladder: management of urinary incontinence in
older women. Clin Obstet Gynecol.
Graf, C. (2006). Functional decline in hospitalized older adults. American Journal of
Nursing.
Grazia O. Cunningham and Yvonne L. Michael. (2004). Concepts guiding the study of
the impact of the built environment on physical activity for older adults: A
review of the literature. American Journal of Health Promotion.
Gregory E Simon (2001). Treating depression in patients with chronic disease.
Retrieved October 13, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071593/
Hannum Rose, J., Bowman, K. F., & Kresevic, D. (2000). Nurse Versus Family
Caregiver Perspectives on Hospitalized Older Patients: An Exploratory Study
of Agreement at Admission and Discharge. Health Communication, 12(1), 63.
Hartig, M., Engle, V., & Graney, M. (1997). Accuracy of nurse aides' functional health
assessments of nursing home residents. The Journals of Gerontology. Series A,
Biological Sciences And Medical Sciences, 52(3), M142-M148.
Higgins, I., Madjar, I., & Walton, J. (2004). Chronic pain in elderly nursing home
residents: the need for nursing leadership. Journal of Nursing Management,
12(3), 167-173.
Kalyani K. MehtaLeng Leng Thang. (2012). Experiencing Grandparenthood: An
Asian Perspective. Springer
Landefeld, C. S., Palmer, R. M., Kresevic, D. M., Fortinsky, R. I., & Kowa, J. (1995).
A randomized trial of care in a hospital medical unit especially designed to
improve the functional outcomes of acutely ill older patients. New England
Journal of Medicine.
Lee, D. F., Chan, Tam, E. Y., & Yeung, W. K. (1999). Use of physical restraints on
elderly patients: an exploratory study of the perceptions of nurses in Hong
Kong. Journal of Advanced Nursing, 29(1), 153-159.
Lee, L., & Fan, R. (2008). An exploratory study on the perceptions of healthy ageing
among Chinese adults in Hong Kong. Journal of Clinical Nursing, 17(10),
1392-1394.

Page 9 of 10

Madden, C., & Fetterman, E. (2002). Caregiver Connections: A Caregiver Support

and Continuing Education System. Journal of Nutrition Education & Behavior,
34(2), S65.
Madoff RD, Williams JG, Caushaj PF, (1992). Fecal incontinence. N Engl J Med;
LAWRENCE H. YOUNG, (2002) HEART DISEASE IN THE ELDERLY,
Chapter 21, Yale University.
Merrill, D.M. 1997. Caring for elderly parents: juggling work, family, and caregiving
in middle and working class families. Westport, CT: Auburn House.
Michele Z., Tsoa W.L. and Hadijatou J.(2009). Neurological Problems in the Elderly,
Reichel's Care of the Elderly.
Ngan R, Kwan A. (2002). The mental health status and long term care needs of the
Chinese elderly in Hong Kong. Retrieved October 13, from
http://www.ncbi.nlm.nih.gov/pubmed/12365754
NHS Quality Improvement Scotland (2005). Best Practice Statement: Maximizing
Communication with Older People who have Hearing Disability, Edinburgh:
NHS QIS. Retrieved October 18, 2014, from
http://www.healthcareimprovementscotland.org/previous_resources/best_pract
ice_statement/older_people_and_hearing.aspx.
Phillipson (1998). Reconstructing Old Age: New Agendas in Social Theory and
Practice. Retrieved October 13, from
http://www.socresonline.org.uk/5/2/phillipson.html
Raffaella B.,Luca R, Antonio C.,Veronica C.Matteo R., Francesca D. A.,Michele R.,
Alida S.& Patrizio O. (2012, Jul). Hearing Loss and Depressive Symptoms in
Elderly Patients. Geriatrics & Gerontology International, 12, 440-445.
Resnick NM, Yalla SV, Laurino E, (1989): The pathophysiology of urinary
incontinence among institutionalized elderly person
Richard lv. Besdine (2008). Aging of the Human Nervous System: What Do We Know?
Retrieved October 13, from
http://med.brown.edu/neurology/articles/rb12908.pdf
Sandvide, ., strm, S., Norberg, A., Saveman, B., & RNT. (2004). Violence in
institutional care for elderly people from the perspective of involved care
providers. Scandinavian Journal of Caring Sciences, 18(4), 351-357.
Seshagiri R.D. (2003). Depression in older adults. In TS Dharmarajan and Robert A
Norman, (eds). Clinical geriatrics. New York, NY; London, UK: Parthenon
Pub. Group, c2003
Siu Lun Chow, E., Ming Hei Kong, B., Tak Po Wong, M., Draper, B., Ka Leung, L.,
Ho, S., & Chun Por, W. (2004). The prevalence of depressive symptoms
among elderly Chinese private nursing home residents in Hong Kong.

Page 10 of 10

International Journal of Geriatric Psychiatry, 19(8), 734-740.

Smee, D. J., Anson, J. M., Waddington, G. S., & Berry, H. L. (2012). Association
between Physical Functionality and Falls Risk in Community-Living Older
Adults. Current Gerontology & Geratrics Research, 1-6.
Social Welfare Department (2005). District Elderly Community Centre (DECC).
Retrieved October 18, 2014, from
http://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_csselderly/id_
districtel/
Van Eyken E, Van Camp G, Van Laer L. (2007). The complexity of age-related
hearing impairment: contributing environmental and genetic factors. Audiol
Neurootol.
Wai-Tong, C., Chan, S. C., & Morrissey, J. (2007). The perceived burden among
Chinese family caregivers of people with schizophrenia. Journal of Clinical
Nursing, 16(6), 1151-1161.
Wang, J. (2005). Psychological abuse behavior exhibited by caregivers in the care of
the elderly and correlated factors in long-term care facilities in Taiwan. The
Journal of Nursing Research: JNR, 13(4), 271-280.
Watkinson, S. (2011). Managing depression in older people with visual impairment.
Nursing Older People, 23(8), 23-28.
Weston, D. (2011). Hygiene, Infection Control, and the Older Adult. In Hindle A. &
Coates A., Nursing Care of Older People A Textbook for Students and
Nurses, 201-212, Oxford.
Yan, E., & Kwok, T. (2011). Abuse of older Chinese with dementia by family
caregivers: an inquiry into the role of caregiver burden. International Journal
Of Geriatric Psychiatry, 26(5), 527-535.
Yan, E., & Tang, C. (2004). Elder abuse by caregivers: a study of prevalence and risk
factors in Hong Kong Chinese families. Journal of Family Violence, 19(5),
269-277.
Yip P.S.F., Lee J., Chan B., Au J. (2001). A study of demographic changes under
sustained below-replacement fertility in Hong Kong SAR. Social Science &
Medicine, 53(8), 1003-1009.