CARE FOR ELDERLY PERSON

Introduction:
Aging is a continuous, complex, and dynamic process that begins with birth and ends with death. It
is a continuous and non reparable process of human life the body decays gradually and slowly with
time; not only physical body but the mind too. The thought and adaptation also change. As we grow
older our haemostatic mechanism become less sensitive, slower, less accurate and less well
sustainable. As a result of the process to aging, changes in human tissues and cells occur which
bring about alterations in the appearance and abilities of the individual. The risk of death also
increases as the age advances. Mortality rates rises continuously as age advances. With
improvement in the socioeconomic conditions and medical care, mortality rate is decreasing and
number of people in elderly category is increasing. There are 70-75 million people beyond 60 years
in India at present constituting 7-8% of total population. Aging is interplay between genetic factors,
environment and life style. Intrinsic or genetic factors reflect the change in ability to repair the cell
damage brought about by free radicals and radiation.

DEFINITION
Elder: All individuals over the age of 60-65 were considered old or elder. It can be categorized in
to 4 types:

 Young old: 65 to 75years.

 Old: 75 to 85 years.
 Old-old: 85 to 100 years.
 Elite old: Over 100 years

Geriatrics: This word is taken greek word ‘gears’(old age) and ‘iarike’ (medicine) is the branch of
medicine concerned with medical problems and care of older people.

Gerontology: This is the scientific study of the process and problem of ageing and focuses on the
biological aspects of normal ageing.

Geriatric Nursing: It is defined as the specialized nursing care of the older adults that occur in any
setting in which nurses’ use, knowledge, expertise and caring abilities to perform optimal
functioning.

OBJECTIVES OF GERIATRIC NURSING CARE

1. Describe the ageing process.
2. Explained the theories of ageing to factors influencing ageing.
3. Identified age related physiological changes in various systems, such as cardiovascular
system, central nervous systems and musculoskeletal system of elderly.
4. Describe patho-physiological changes that lead to the disorders of various systems.
5. Statethe role and function of nurses in geriatric care.
6. State the role of the family and governmental organizations in the care of elderly.
7. Recognize the need for research in care of elderly.
CHANGES WITH THE AGING PROCESS

a).Changes in the posture and appearance: as aging process lean body mass in muscle tissue is
lost, whereas the proportion of fat increases. There is loss of elasticity and flexibility of the muscle
tissue due to increase in fibre, decrease in muscle mass after the age of 50. Change in the body
composition is due to the result of their diet and lifestyle. The skin becomes wrinkled, dried and
tougher skin surfaces due to the ultraviolet from the sun which damage the elastic fiber and this is
known as photo ageing. Thus their posture becomes stooped forward with flexed knees, hips and
elbows and head is tilted back.

b).Changes in musculo-skeletal system: Older people suffer from arthritis, paralytic stroke in
addition to osteoporosis problems. This produces stiffness of joint making them difficult for easy
movement such as getting up from a chair, to turn their neck and to keep an erect posture. The same
way the collapsing of vertebrae causes a hunched back or kyphosis in addition to spondlytis.

c).Changes in the central nervous system: Because of changes in central nervous system older
people develop decreased ability to orient their bodies in space to detect externally induced changes
in body position. Atrophy of the brain, decreased blood flow and affection of peripheral nerves like
deep tendon reflexes.

d).Changes in the respiratory system: With ageing the inspiratory and expiratory muscle strength
is reduced, the lungs loose elasticity so that efficiency in breathing is reduced.

e).Changes in immune system: This ageing ,affect the immune system of the body making it
defective, and attacking not just foreign proteins, bacteria and viruses, but also producing antibodies
against itself, e.g. cancer, diabetes and rheumatoid arthritis.

f).Changes in cardiovascular system: A loss of elastic tissue and an increase in collagen and the
muscle fibres are deposited with an age, pigment of fats and proteins called LIPOFUSCIN which is
the cause of loss of elasticity in the arteries. Also deposit of fat on the walls of arteries causing
artherosclerosis, or weakening of the walls, later causing aneurysms.

g).Changes in the urinary system: With age, the kidney decrease in volume and weight and the
total number of filters are reduced affecting the functions of the kidney by 50%. The kidneys also
lose their capacity to absorb glucose, as well as their concentrating and diluting ability, contributing
to increased problems with dehydration and loss of salts in the blood.

h).Changes in the gastrointestinal system: The main changes are the decrease in contraction of
the muscles and more time for the cardiac sphincter to open, thus taking more time for the
transmitted to the stomach, even before having a full meal. This will produce loss of appetite and
cause deficiency in nutrients. This is the reasons older people eat small quantities of food.

i).Changes in the endocrine system:. The main is oestrogen in woman and progesterone in men
which is responsible for the menopause in women. This oestrogen protects women from hard
disease and bone demineralising. The other hormones are testosterone, thyroid, growth hormones
and insulin, whose productions are decreased. Changes in insulin level causes high blood sugar
level and diabetic.
 j).Changes in reproductory system: In men, the sperm count decreases, the erection process
decreases, urge for sexual intercourse gradually decreases. Enlarged prostate is another problem. In
women, the production of eggs in ovary decreases and menopause sets in along with less oestrogen.
Vaginal secretion decreases causing dry vagina. Laxity in pelvic floor causes prolapsed of the uterus
and bladder. Incontinence of urine. Cancer breast ovary and cervix are common in old age.

k).Changes in sensory functions: Sensation is the process of taking information through the sense
organs. There is a reduction in the efficiency of sensory perception as a result of degeneration
changes. The ability to respond to the information provided by the series may also be reduced.

 Sense of touch: Sense of touch deteriorate with age especially in finger-tips and palms and in the
lower extremities. This also causes less levels of painful stimuli. But they may complain of pain and
it is due to depression.
 Changes in vision: The loss of vision in older people prevents them from their daily activities.
The important problem is the changes in the visual pathways of the brain and in the visual cortex
which block the transmission of stimuli from the sensory organ. The surface of the cornea thickens
causing the rounded surface of the cornea to become less smooth and flatter and irregular in shape
and also the blood vessels become prominent.
 Changes in hearing: An older person, who is having some hearing loss, learns to adapt and
make changes in behavior and in social interactions, so as to reduce the bad social impact of hearing
loss.
 Changes in taste and smell: We can see that as with the age their taste also changes due to the
loss in taste buds as they aged, or their ability to appreciate taste. So they may require, more salt and
more spicy food so in order to avoid giving more salty and spicy food, see that their food is
enhanced with good food odors to increase their appetite.

NEEDS OF ELDERLY

 Physical Needs: Physical activity is an important part of a total health programe for the
elderly. It is vital to keep moving and exercise; to maintain circulation, muscle tone and general
health and to prevent disuse deformity. The need for the physical safety is of upmost important.

 Mental Needs: Diseases associated with aging — such as Alzheimer’s and Parkinson’s —
become more commonplace as well. All of this takes a toll on their mental health, too. Knowing
their health is declining can be a disappointment hard to cope with. Losing loved ones as the age
brings on a seemingly never-ending parade of grief. And the isolation of being placed in an
assisted living facility or nursing home can make some people feel like there’s little left to live
for.

 Social Needs: One thing that should keep in mind is, to shower all your love and care on your
elderly relative or family member. Just because they have become old and slow, does not mean
that you should ignore them or let them be confined to themselves. Spend time with them, chat
with them and make them feel wanted, cared for and loved. Pay special attention to their room.
You could consider installing a few senior citizen friendly appliances which they would be
 comfortable using. Also, you should consider installing certain medical alarms that are specially
made keeping in mind elderly citizens

 Psychological Needs of the Elderly: The elderly can be easily overwhelmed by a disaster
and may experience difficulty in coping with the situation and their feelings. We can help them
by talking openly about what has happened and how they feel about it. Encourage them to also
speak freely about whatever is on their minds. Be careful not to argue with them, or to tell them
how they SHOULD feel. Their feelings are real to them and nurse need to validate those
feelings. Express confidence in your ability to help them.

 Emotional Needs: The elderly not only face physical obstacles as their bodies' age but they
experience emotional challenges as well. Seniors are faced with stresses that may include living
on a reduced retirement income or being unable to care for themselves independently. They may
be facing the loss of a spouse, siblings or close friends. Caretakers need to know what to expect
regarding the emotions of seniors and be prepared to help with them.

 Spiritual Needs: Many elders take their faith and religious practice very seriously and display
a high level of spirituality. Involvement in religion often helps the adult to resolve issues related
to the meaning of life, to adversity or to good fortune. Religion may also be an important coping
resource, leading to enhanced well-being.

ROLE OF NURSE IN ELDERLY CARE

1. Promotion of self-respect and dignity: The aim in the geriatric ward should be toreduced to
a minimum amount of control, restriction and supervision imposed upon patients and to
encourage the maximum of personal choice, decision making and participation in their own
care on the part of the patients. Respect for the elderly patient’s feelings and emotions should
be shown. A limitation of physical and mental abilities does not imply that the individual
should be patronized or treated as being incapable of normal human feelings and responses.
Depression is common amongst elderly people and this can be aggravated to illness or social
deterioration necessating admission to hospital. When staff make positive efforts to develop
good relationships with patient’s and gain their individual respect and friendship, group control
becomes easier and difficult situations of personal relationship or resistance to treatment are
greatly reduced.

2. Approach towards the elderly: Elderly may have difficulty in understanding what is said to
them because of loss of sensory functions and reduced comprehension. They should be spoken
to clearly and face to face. If they are sitting it is helpful for the nurse to kneel rather than to
speak above the patient. She should sit with the patients while feeding him. Elderly will regress
and start behaving in a childish manner if they are treated with indifference towards their
feelings and pride.So the nurse who care for him, should have inspiration instead of ignorance,
she should have understanding instead of prejudice. She should give them faith in the
 treatment they are getting. She should show them love in place of their dear and near ones and
give them joy.
Daily living activities of the elderly: The patient is encouraged to be out of bed as much as
possible so as to promote mobility to reduce the the risk of complications. Cleanliness and
personal tidiness are important to health and safety, but should not become a dominating issues.
Life long habits of elderly patients should be accepted.

3. Promotion of comfort: Physical and mental comfort and relaxation has to be achieved.
There are many factors that contribute to the comfort of the elderly patient which apply the
patient in any age group and the nurse will apply skills and knowledge obtained in general
training when dealing with the elderly also. Additional points to consider are:
 Care of the skin.
 Care of bony structure.
 Maintain nutritional status.
 Maintain fluid balance.
 Maintain body temperature.

4. Safety : Correct height of bed and chairs, extra comforts with cushions, the provision of
walking aids like walker or walking sticks or wheel chairs, grabrails to hold and walk and also
hand rails, which are environmental features that contribute to the safety of the patients.
Constant personal observations and support has to be provided for those with some degree of
confusion and for the restless bed ridden patients.

5. Promotion of independence: Patient is encouraged to the maximum possible level of self

care and decision making. Dressing and undressing, toileting, bathing, making their way to day
rooms or other places, selecting from a menu, buying clothing or foot wear. Planning their
daily activities or their future living pattern are an activity in which pattern should be involved
themselves as much as possible, rather than having done for them with little or no participants.

6. Promotion of movement and mobility: The patient is encouraged to be out of bed as much
as possible according to the capabilities and needs. Movement and mobility should continue
throughout the patient’s care. The prevention of further deterioration is an important aspect of
geriatric care and movement and activity is continued even where it is considered unlikely that
the patient will be able to achieve full mobility.

7. Promotion of mental activity and interests: The diseases and disabilities and social
problems of the elderly are such that the time spent in hospital may be an extended one.
Considerations must be given to meeting the intellectual and recreational needs of all patients
as well as providing means for ensuring that the mental stimulus.

8. Use of medications in elderly: Drug interactions increases with age and the number of drugs
taken. Many elderly report adverse reaction to the medication. Therefore nurses needs to have
 the knowledge of various drugs, their actions, side effects and must use drugs cautiously for the
elderly.

9. Rehabilitation: Rehabilitation for the elderly includes all those activities which aim at
restoring the patient to the highest possible degree of independent living of which he is capable
which should also include physiotherapy and speech therapy.

10. Role of community and family: The ultimate aim of treatment and rehabilitation is to
achieve for the person a normal social setting.

11. Assess elderly for elderly abuse: many of the elderly are abused in their own homes, in
relatives’ homes, and even in  facilities responsible for their care. Any of the elderly person can
be being harmed physically or emotionally by a neglectful or overwhelmed caregiver or being
preyed upon financially. As elders become more physically frail, they’re less able to stand up to
bullying and or fight back if attacked. They may not see or hear as well or think as clearly as
they used to. Mental or physical ailments may make them more trying companions for the
people who live with them. Abuse of elders takes many different forms, some involving
intimidation or threats against the elderly, some involving neglect, and others involving
financial chicanery. The most common is the physical abuse, emotional abuse, sexual abuse,
Neglect or abandonment by caregivers and Financial exploitation etc. In every state, physical,
sexual, and financial abuses targeting elders that violate laws against assault, rape, theft, and
other offenses are punishable as crimes. With some variation among states, certain types of
emotional elder abuse and elder neglect are subject to criminal prosecution, depending on the
perpetrators' conduct and intent and the consequences for the victim.

12. Teach the self- care: The aim of the geriatric nursing is along with to provide the preventive,
promotive and curative care, the rehabilitative care is also provided by the nurse. Nurse should
teach the patient about the self care. The care of the elderly outside the hospital forms an
important role of geriatric care. The time spent in hospital is a small portion of a time during
which care and support from health personnel and social service personal are required by the
patient.

References:

1. Panda.U.N.an introduction of geriatrics.1sted.NewDelhi:CBSpublishers;Pp 8-10, 181-83.

2. RosdahlBunker.textbook of basic nursing.6th ed. lippincottpublishers;Pp 1332-40.
3. www.wikipedia.com
SUBMITTED BY:
AMARJEET KAUR
MSc. NSG 1ST YEAR
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