NCMB314 Prelim Readings

BACHELOR OF SCIENCE IN NURSING:
NCMB 314 - CARE OF THE OLDER ADULTS

COURSE MODULE COURSE UNIT WEEK
1 1 1
Concepts, Principles, History and Theories in the Care of Older Adults
Read PEO (Program Educational Objectives)

✓ Understand required learning resources; refer to unit terminologies for jargons
✓ Proactively participate in online discussions
✓ Participate in weekly discussion board (Canvas)
✓ Complete and submit course unit tasks
At the end of this unit the students are expected to:
Cognitive:
1. Explain the different ways in which older adults have been viewed
throughout history.
2. Track historical landmarks and impact in the development of gerontological
nursing in practice of the nursing profession as a specialty.
a. Demographics Aging
b. Longevity and sex difference
c. Roles of the Gerontological Nurse
3. Identify the major theories of aging.
Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and
ideas
3. Accept comments and reactions of classmates on one’s opinions openly and
graciously.
4. Develop heightened interest in studying “Care of the Older adults”
Psychomotor:
1. Participate actively during class discussions and group activities
2. Express opinion and thoughts in front of the class
Textbooks:
Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones &
Bartlett Publishers.610.7365 G31 2010
Eliopoulos (2018). Gerontological Nursing 9th Edition.Wolters Kluwer
Meiner (2019). Gerontologic Nursing 6th Edition. ELS
PERSPECTIVE OF OLDER ADULTS THROUGH HISTORY
Historically, societies have viewed their elder members in a variety of ways. The
members of the current older population in the United States have offered the sacrifice,
strength, and spirit that made this country great. They were the proud GIs in world wars, the
brave immigrants who ventured into a new country, the bold entrepreneurs who took risks that
created wealth and opportunities for employment, and the unselfish parents who struggle to
give their children a better life. They have earned respect, admiration, and dignity. Today older
adults are viewed with positivism rather than prejudice, knowledge rather than myth, and
concern rather than neglect. This positive view was not always the norm.
In the time of Confucius, there was a direct correlation between a person’s age and the degree
of respect to which he or she was entitled. The early Egyptians dreaded growing old and
experimented with a variety of potions and schemes to maintain their youth. Opinions were
divided among the early Greeks. Plato promoted older adults as society’s best leaders,
whereas Aristotle denied older people any role in governmental matters. In the nations
conquered by the Roman Empire, the sick and aged were customarily the first to be killed.
And, woven throughout the Bible is God’s concern for the well-being of the family and desire
for people to respect elders
(Honor your father and your mother..Exodus 20:12).Yet the honor bestowed on older adults
was not sustained.
Medieval times gave rise to strong feelings regarding the superiority of youth; these
feelings were expressed in uprisings of sons against fathers. Although England developed
Poor Laws in the early 17th century that provided care for the destitute and enabled older
persons without family resources to have some modest safety net, many of the gains were lost
during the Industrial Revolution. No labor laws protected persons of advanced age; those
unable to meet the demands of industrial work settings were placed at the mercy of their
offspring of forced to beg on the streets for sustenance.
THE HISTORY OF GERONTOLOGICAL NURSING
The history and development of gerontological nursing is rich in diversity and

experiences, as is the population it serves. There has never been a more opportune time than
now to be a gerontological nurse. No matter where nurses practice, they will at some time in
their career care for older adults. The health care movement is constantly increasing life
expectancy; therefore, nurses must expect to care for relatively larger numbers of older people
over the next decades. With the increasing numbers of acute and chronic health conditions
experienced by elders, nurses are in key positions, and to promote positive aging.
The development of gerontological nursing as a specialty is attributed to a host of

nursing pioneers. The majority of these nurses were from the United States; however, two key
trailblazers were from England. Florence Nightingale and Doreen Norton provided early
insights into the “care of the aged”. Nightingale was truly the first geriatric nurse, Doreen
Norton focused her career on care of the aged and wrote often about the unique and specific
needs of elders.
Landmarks in the development of gerontological nursing as a specialty:
1902 American Journal of Nursing (AJN) publishes first geriatric article by an MD

1950 First geriatric nursing textbook, “Geriatric Nursing (Newton), published
First master’s thesis in geriatric nursing completed by Eleanor Pingrey
Geriatric becomes a specialization in nursing
1952 First geriatric nursing study published in Nursing Research
1961 ANA recommends specialty group for geriatric nurses
1962 ANA holds first National Nursing Meeting on Geriatric Nursing Practice
1966 ANA forms a geriatric nursing division, First Gerontological Clinical Nurse Specialist
master’s program begins at Duke University
1968 First RN (Laurie Gunter) presents at the International Congress of Gerontology
1969 Development of standards for geriatric nursing practice
1970 ANA creates the Standards of Practice for Geriatric Nursing
1973 ANA offers the first generalist certification in gerontological nursing
1975 First nursing journal for the care of older adults published : Journal of Gerontological
Nursing by Slack,Inc. First nursing conference held at the International Congress of
Gerontology.
1976 ANA Geriatric Nursing Division changes name to Gerontological Nursing Division
1981 ANA division of Gerontological Nursing publishes statement on scope of practice
1982 Development of Robert Wood Johnson Teaching Home Nursing Program
1983 First university chair in gerontological nursing in the United States (case western
reserve)
1987 ANA revises Standards and Scope of Gerontological Nursing Practice
1988 First Phd program in gerontological nursing established
1989 ANA certification established for Clinical Specialist in Gerontological nursing
1998 ANA certification available for geriatric advanced practice nurses as geriatric nurse
practitioners or gerontological clinical nurse specialist
• Gerontology – is the broad term used to define the study of aging and/or
the aged.
- “Gero” – old age “Ology”- study of
▪ Older Age Group:
▪ Young old – ages 65-74
▪ Middle Old – ages 75-84
▪ Old Old – 85 and up.
- Gerontophobia – fear of aging. Inability to accept aging adults in the
society.
- Age Discrimination – emotional prejudice among the older adult.
- Ageism – dislike of the aging and the older adult.
• Geriatrics – generic term relating to the aged, but specifica lly refers to
medical care for the aged.
• Gerontological Nursing – the aspect of gerontology that falls within the
discipline of nursing and the scope of nursing practice.
Demographics of Aging
▪ “Graying of America” - a phenomenon faced by all nations, not only the

U.S.
▪ Demographic Tidal Wave or A pig in a Python – a bulge in the population
moving slowly through times. (1946 -1964 : Baby Boomer)
• 1 out of 8 Americans age: 65 years old and up.
• 1997 – approximately 10% of the world’s population (Ag e 60 and
above)
• It is expected that by 2025, the number of persons 65 and older in
the United States will increase from 12% of the population (by 2000)
to 19%
In 2005, 13% of the U.S. population was over age 60

▪ 18.3 million aged 65–74
▪ 12.9 million aged 75–84
▪ 4.7% aged 85 or older
This number is estimated to increase:
▪ To 20 million in 2010 (6.8% of total),

▪ To 33 million in 2030 (9.2%), and
▪ To almost 50 million in 2050 (11.6%) (National Center for Health Statistics [NCHS],
2006).
By mid-21st century, old people will outnumber young for the first time in history. All Nations
have an aging population. The greatest increases will be in developing countries. Asian
countries have less time to prepare for aging -because aging is occurring more rapidly than
economic growth. Adequate healthcare services for the elderly may simply be beyond the
reach of many Asian countries. They may not be able to afford a large dependent elderly
population. They might not have the necessary institutions & financial systems in place (e.g.,
efficient and well-managed pension and healthcare programs)
(“The Future of Population in Asia: Asia's Aging Population”; Sidney B. Westley and Andrew
Mason; January 2005)
Why The Increase?
▪ Improved sanitation
▪ Advances in medical care
▪ Implementation of preventive health services
▪ In 1900s, deaths were due to infectious diseases and acute illnesses
▪ Older population now faced with new challenge
o Chronic disease
o Health care funding
▪ Average 75y/o has 3 chronic diseases & uses 5 types of medications
▪ 95% of health care expenditures for older Americans are for chronic diseases
▪ Changes in fertility rates
o Baby boom after WWII (1946 – 1964)
▪ 3.5 children per household
o Older population will explode between 2010 to 2030 when baby boomers reach age
65
IMPACT of the Baby Boomers
In anticipating needs and services for future generations of older adults, gerontological
nurses must consider the realities of the baby boomers, those born between 1946 and 1964,
which will be the next wave of senior citizens. Their impact on the growth of the older
population is such that it has been referred to as a demographic tidal wave. Baby boomers
began entering their senior years in 2011 and will continue to do until 2030.Although they are a
highly diverse group, representing people as different as Bill Clinton, Bill gates and Cher, they
do have some clearly defined characteristics that set them apart from other groups:
▪ Most have children, but this generation’s low birth rate means that they will have fewer
biologic children available to assist them in old age.
▪ They are better educated than preceding generations.
▪ Their household incomes tend to be higher than other groups, partly due to two incomes
(three out of four baby boomer women are in the labor force).
▪ They favour a more casual dress code than previous generations of older adults.
▪ They are enamored with “high-tech” products and are likely to own and use a home
computer.
▪ Their leisure time is scarcer than other adults, and they are morte likely to report feeling
stressed at the end of the day.
▪ As inventors of the fitness movement, they exercise more frequently than other adults.
Some assumption can be made concerning the baby boomer population as senior
adults. They are informed consumers of health care and desire a highly active role in
their care; their ability to access information often enables them to have as much
knowledge as their health care providers on some health issues. They are most likely
not going to be satisfied with the conditions of today’s nursing homes and will demand
that their long-term care facilities be equipped with bedside Internet access,
gymnasiums, juice bars, pools, and alternative therapies. Their blended families may
need special assistance because of the potential caregiving demands of several sets of
stepparents and step grandparents. Plans for services and architectural designs must
these factors into consideration.
LIFE EXPECTANCY:
▪ US : 75.7 years old
▪ Life Span : 115 years
▪ French women lived for 122 years (1994)
o Factors that affects life expectancy:
▪ Improved Sanitation
▪ Advances in Medical care
▪ Implementation of preventive health services.
▪ CENTENARIANS
o Predominant in lower educated more impoverished, widowed and
more disabled population.
o Weight less, take fewer medication, have fewer chronic disease.
Feminization of Later Life
▪ Women comprise 55% of the older population

▪ Women have a longer life expectancy
▪ The average life expectancy of women in the United States is 81 years
▪ The average life expectancy of men in the United States is 75.2 years
▪ Male exposure to risk factors may account for the differences
▪ Increases in female exposures to risk factors will reduce difference in life expectancy
Majority of older adults enjoy good health
But national surveys reveal that: 20% of adults 65y/o & above report a chronic disability.
Chronic Conditions in Seniors

▪ 80% have at least one chronic condition
▪ Two of the three leading causes of death declined by one third
o Heart disease and stroke
Majority of deaths (US) occur in people 65y/o & older
▪ 50% of deaths--caused by heart disease & cancer
▪ In the past 50 years --- a noted decline in overall deaths
 Due to the improvements in the prevention & early detection & treatment
of diseases
▪ Heart disease & cancer are two top causes of death, regardless of age, race, gender or
ethnicity
▪ Positive health reports declined with advancing age
▪ African American and Hispanic or Latinos - less likely to report good health than their
Caucasian or Asian counterparts.
Majority of people 75y/o & over
▪ remain functionally independent, and
▪ the proportion of older Americans with limitations in activities is declining (CDC, 2007a).
70% of Physical Decline Related to Modifiable Risk Factors
▪ Smoking
▪ Poor nutrition
▪ Physical inactivity
▪ Failure to use preventative and screening services
▪ Reason for the decline in limitations to activity of Older Adult :
Ageing population in the Philippines

According to Global Age Watch Index published by “Help Age”, the number of older people in
the Philippines is increasingly rapidly. In fact, it is growing faster that growth in the total
population. Consider that in 2000, there were an estimated 4.6 million senior citizens (defined
by law in the Philippines as an individual who is 60 years old or older). This represented about
6% of the total population. Percentage has been increasing to grow to 6.5 million older people
making up about 6.9% of the total population in ten years. The National Statistics Office (NSO)
projects that by 2030, older people will make up around 11.5% of the total population.
There will be increased demand for health services when there are increased in population.
The leading cause of morbidity is usually infection due to ageing of the body’s immune system.
Visual impairment, difficulty in walking, chewing, hearing, osteoporosis, arthritis and
incontinence are the common health related problems.
The average life expectancy was 66 years in males and 73 years in females. Older women
compromised 53.8% of population aged 60 plus. By 2050, we expect our elderly to rise to
23,633,000 (15.3% of total population).
THEORIES OF AGING
PSYCOSOCIAL THEORIES OF AGING

- Attempt to explain aging in terms of behaviour, personality and
attitude change.
1. SOCIOLOGICAL THEORIES
- changing roles, relationship, status and generational cohort impact
the older adult’s ability to adapt.
a. Activity theory
- Havighurst and Albrecht (1953)
- Remaining occupied and involved is necessary to satisfy late life.
- Activity engagement and positive adaptation.
b. Disengagement Theory
- Cumming and Henry (1961)
- Gradual withdrawal from society and relationships serves to
maintain social equilibrium and promote internal reflection.
c. Subculture Theory
- Rose (1965)
- The elderly prefer to segregate from society in an aging subculture
sharing loss of status and societal negati vity regarding the aged.
d. Continuity Theory
- Havighurst (1960)
- also known as Development Theory
- Personality influences role and life satisfaction and remains
consistent throughout life.
- 4 Personality types:
▪ Integrated
▪ Armored Defended
▪ Passive Dependent
▪ Unintegrated
e. Age Stratification Theory
- Riley (1960)
- Society is stratified by age groups that are the basis for acquiring
resources, roles, status and deference from others.
f. Person-Environment Fit Theory
- Lawton (1982)
- Function is affected by ego strength, mobility, health, cognition,
sensory perception and the environment.
II. Psychological theories

- Explain aging in terms of mental processes, emotions, attitudes,
motivation, and personality development that is characterized by life
stage transit ions.
a. Human needs
- Maslow’s (1954)
- Five basic needs motivate human behaviour in a lifelong process
toward need fulfilment.
- Self – Actualization
b. Individualism Theory
- Jung (1960)
- Personality consists of an ego and personal and collective
unconsciousness th at views life from a personal or external
perspective.
c. Stages of Personality Development
- Erikson (1963)
- Personality develops in eight sequential stages with corresponding
life tasks. The eighth phase, integrity versus despair, is
characterized by evaluating life accomplishments; struggles include
letting go, accepting care, detachment, and physical and ment al
decline.
d. Life-course/Lifespan Development
- Life stages are predictable and structured by roles, relationship,
values and goals.
BIOLOGICAL THEORIES OF AGING

- Explains that physiologic processes that change with aging.
I. STOCHASTIC THEORIES
- Based on random events that cause cellular damage that
accumulates as the organism ages.
a. Free Radical Theory
- Membranes, Nucleic acids and proteins are damaged by free
radicals which causes cellular injury,
- Exogenous Free radicals: Tobacco smoke, Pepticides, organic
solvents, Radiation, ozone and selected Medications.
- Health Teaching:
▪ Decrease calories in order to lower weight
▪ Maintain a diet high in nutrients using anti -oxidants
▪ Avoid inflammation
▪ Minimize accumulation of metals in the body that can trigger
free radicals reactions.
- Older adults are more vulnerable to free radicals.
b. Orgel/ Error Theory
- Errors in DNA and RNA synthesis occurs with aging.
c. Wear and Tear Theory
- Cells wears out and cannot function with aging.
- Like a machine which losses function when its parts wears off.
d. Connective Tissue Theory / Cross link theory
- With aging, proteins impede metabolic processes and cause trouble
with getting nutrients to cells and removing cellular waste products.
II. NON STOCHASTIC THEORIES OF AGING
- Based on the genetically programmed events that cause cellular
damage that accelerates aging of the organism.
a. Programmed Theory
- Cells divide until they are no longer able to and this triggers to
apoptosis or cell death.
- Shortening of the TELOMERES – the distal appendag es of the
chromosomes arm.
- TELOMERASE – an enzyme, “cellular fountain of youth”
b. Gene/ Biological Clock Theory
- Cells have a genetically programmed aging code.
c. Neuroendocrine theory
- Problems with the hypothalamus -pituitary-endocrine gland feedback
system causes disease.
- Increased insulin growth factor accelerates aging.
d. Immunologic/ Autoimmune Theory
- Aging is due to faulty immunological function, which is linked to
general well-being.
Age Discrimination – emotional prejudice among the older adult.

Ageism – a negative attitude toward aging or older person.
Apoptosis - a process of programmed cell death marked by cell shrinkage.
Baby boomers – alarge group of people born between 1946 and 1964, in the
time after the Second World War.
Centenarian- someone who is 100 years of age or older.
Elderly – usually described as those persons age 65 or over.
Free radicals- chemical species that arise from atoms as single unpaired
electrons
Geriatrics –medical care for the aged.
Gerontological Nursing – A specialty within nursing practice where the
clients/patients/residents are older persons.
Gerontology – is the broad term used to define the study of aging and/or the
aged.
Graying of America - similar to the aging of America, referring to the increase
in numbers of older Americans.
Nonstochastic theories of aging - theories stating that a series of genetically
programmed events occur to all organisms with aging
Stochastic theories of aging – theories stating that random events occurring in one’s life
cause damage that accumulates with aging
Telomerase- an enzyme that regulates chromosomal aging by its action on telomeres
Philippine Journal of Nursing
Journal of Gerontological Nursing
Websites:
Lecturio Video Aging Process
www.ebscohost.com
www.doh.gov.ph
http://www.pna-pjn.com
Study Questions:
I. Compare the similarities and differences between Global aging and Aging in the
Philippines.
Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones & Bartlett
Publishers.610.7365 G31 2010
Miller (2019).Nursing for Wellness in Older Adults 8th Edition . Wolters Kluwer
Touhy ( 2018). Ebersole and Hess Gerontological Nursing and Health Aging
Filit (2017). Brocklehurts Testbook of Geriatric Medicine and Gerontology
Patińo, Mary Jane. (2016). Caregiving volume 1. Manila: Rex Book Store. F 649.1 P27
2016,v.1, c1
Doenges, Marylinn E. (2002). Nursing care plans: guidelines for individualizing patient care,
6th ed. Philadelphia: F. A. Davis Company. R 610.73 D67 2002, c5
Meiner, S. E. (2007). Gerontological Nursing 3rd Edition. Quezon City. pp. 310-311, 371.
Wold, Gloria Hoffman. (2012). Basic geriatric nursing, 5th ed. MO: Elsevier.618.970231
W83 2012, c1
BACHELOR OF SCIENCE IN NURSING:
NCMB 314 - CARE OF THE OLDER ADULTS
1 2 2
Physiologic Changes in Aging and Changes in Mind
Read PEO (Program Educational Objectives)

✓ Read required learning resources; refer to unit terminologies for jargons
✓ Proactively participate in online discussions
✓ Participate in weekly discussion board (Canvas)
✓ Answer and submit course unit tasks
At the end of this unit the students are expected to:
Cognitive:
1. List common age-related changes at the cellular level; in physical appearance;
and to respiratory, cardiovascular, gastrointestinal, urinary, reproductive,
musculoskeletal, nervous, endocrine, integumentary, and sensory organs.
Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and
ideas
graciously.
4. Develop heightened interest in studying “Care of the Older adults”
Psychomotor:
2. Express opinion and thoughts in front of the class
Textbooks:
Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones &
Bartlett Publishers.610.7365 G31 2010
Lecturio: Video: Aging and memory dysfunction
III Physiologic Changes in Aging

Affecting various systems
1. Integumentary
Effects:
➢ Wrinkling
➢ Decrease of the skin’s immune responsiveness
➢ Dehydration and cracking of the skin
➢ Decreased sweat production
➢ Decreased numbers of functional melanocytes resulting in gray hair and atypical skin
pigmentation
➢ Loss of subcutaneous fat
➢ A general decrease in skin thickness
➢ An increased susceptibility to pathological conditions
➢ Growth of hair and nails decreases; nails become brittle with age
2. Muskulo-skeletal
▪ Decreased height
▪ Decreased ROM joints
▪ Increased postural sway/ difficulty balance
▪ Shrinking vertebral disc, slight kyposis
▪ Loss of bone mass, bones more brittle ( increased resorption )
▪ Muscle Atrophy/ decreased lean body mass
▪ Joint degeneration (Cartilage surface)
▪ Foot problems: bunions, coms, and calluses
3. Respiratory
▪ Decreased chest wall compliance
▪ Decreased maximal breathing capacity
▪ Decreased number of alveoli
▪ Decreased elasticity
▪ Decreased parenchyma
▪ Impaired cough reflex because of defective mucociliary function
▪ Increased vulnerability to hypoxia and emphysema
▪ Increased susceptibility to respiratory infections
4. Cardiovascular / Hematopoietic & Lymphatic

▪ Cardiac output decreases
▪ Aorta becomes dilated and elongated
▪ Resistance to peripheral blood flow increases by 1% per year
▪ Blood pressure increases
▪ Decrease cardiac output
▪ Less elasticity of the vessel
▪ More prominent arteries in head, neck, and extremities
▪ Stroke volume decreases by 1% per year
5. Hematopoietic & Lymphatic
6. Gastrointestinal
▪ Decrease esophageal motility
▪ Atrophy of gastric mucosa
▪ Decrease stomach motility, hunger contractions, and emptying time
▪ Less production of hydrochloric acid, lipase, and pancreatic enzymes
▪ Fewer cells on absorbing surface of intestine
▪ Slower peristalsis
▪ Decreased taste sensation
▪ Esophagus more dilated
▪ Reduced saliva and salivary ptyalin
7. Urinary
▪ Decrease in nephrons
▪ Between ages 20 and 90, renal blood flow decreases 53%, and glomerular filtration rate
decreases 50%
▪ Weaker bladder muscles
▪ Decreases size renal mass
▪ Decrease tubular function
▪ Decrease bladder capacity
8. Nervous
▪ Decrease brain weight
▪ Reduced blood flow in brain
▪ Changes in sleep pattern
▪ Decrease conduction velocity
▪ Slower response and reaction time
9. Special senses
▪ Hearing
o Atrophy of hair cells of organ of corti
o Tympanic membrane sclerosis and atrophy
o Increased cerumen and concentration of keratin
▪ Sight
o More opaque lens
o Decrease pupil size
o More spherical cornea
▪ Smell
o Impaired ability to identify and discriminate among odors
▪ Taste
o High prevalence of taste impairment, although most likely due to factors other than
normal aging
▪ Touch
o Reduction in tactile sensation
10. Endocrine
▪ Decrease thyroid activity
▪ ACTH secretion decreases
▪ Pituitary gland decreases in volume by approximately 205 in older person
▪ Gonadal secretion declines with age, including gradual decreases in testosterone,
estrogen, and progesterone
▪ TSH decreases
▪ Insufficient release of insulin by beta cells of the pancreas
11. Reproductive
▪ Male
o Fluid-retaining capacity of seminal vesicles reduces
o Possible reduction in sperm count
o Venous and arterial sclerosis of penis
o Prostate enlarges in most men
▪ Female
o Fallopian tubes atrophy and shorten
o Ovaries become thicker and smaller
o Cervix becomes smaller
o Drier, less elastic vaginal canal
o Flattening of labia
o Endocervical epithelium atropies
o Uterus becomes smaller in size
o Endometrium atropies
o More alkaline vaginal environment
o Loss of vulvar subcutaneous fat and hair
CHANGES TO THE MIND

Psychological changes can be influenced by general health status,
genetic factors, educational achievement, activity, and physical and social
changes. Sensory organ impairment can impede interaction with the
environment and other people, thus influencing psychological status. Feeling
depressed and socially isolated may obstruct psychological function.
Recognizing the variety of factors potentially affecting psychological status and
the range of individual responses to those factors, some generalizations can be
discussed.
A. PERSONALITY
➢ Drastic changes in basic personality normally do not occur as one
age. The kind and gentle old person was most likely that way when
young; likewise, the cantankerous old person probably was not mild
and meek in earlier years. Excluding pathologic processes, the
personality will be consistent with that of earlier years; possibly, it
will be more openly and honestly expressed. The alleged rigid ity of
older persons is more a result of physical and mental limitations
than a personality change. For example, an older person’s
insistence that her furniture not be rearranged may be interpreted as
rigidity, but it may be sound safety practice for someo ne coping with
poor memory and visual deficits. Changes in personality traits May
occur in response to events that alter self -attitude, such as
retirement, death of spouse, loss of independence, income
reduction, and disability. No personality type describ es all older
adults. Morale, attitude, and self -esteem tend to be stable
throughout the life span.
B. MEMORY
➢ The three type of memory are short term, lasting from 30 seconds to
30 minutes; long term, involving that learned long ago; and sensory,
which is obtained through the sensory organs and lasts only a few
seconds. Retrieval of information from long -term memory can be
slowed, particularly if the information in the consciousness while
manipulating other information -working memory function -is reduced.
Older adults can improve some age -related forgetfulness by using
memory aids (mnemonic devices) such as associating a name with
an image, making notes or lists, and placing objects in consistent
locations. Memory deficits can result form a variety o f factors other
than normal aging.
C. INTELLIGENCE
➢ In general, it is wise to interpret the findings related to intelligence
and the older population with much caution because results may be
biased from the measurement tool or method of evaluation used.
Early gerontological research on intelligence and aging was guilty of
such biases. Sick old people cannot be compared with healthy
persons; people with different educational or cultural backgrounds
cannot be compared; and one group of individuals who are ski lled
and capable of taking an IQ test cannot be compared with those who
have sensory deficits and may not have ever taken this type of test .
Longitudinal studies that measure changes in a specific generation
as it ages and that compensate for sensory, heal th, and educational
deficits are relatively recent, and they serve as the most accurate
way of determining intellectual changes with age.
Basic intelligence is maintained; one does not become more or
less intelligent with age. The ability for verbal compr ehension and
arithmetic operations are unchanged. Crystallized intelligence,
which is the knowledge accumulated over a lifetime and arises from
the dominant hemisphere of the brain, is maintained through the
adult years; this form of intelligence enables t he individual to use
past learning and experiences for problem solving. Fluid
intelligence, involving new information and emanating from the non -
dominant hemisphere, control emotions, retention of non -intellectual
information, creative capacities , special perceptions, and aesthetic
appreciation; this type of intelligence is believed to decline in later
life. Some decline in intellectual function occurs in the moments
preceding death. High levels of chronic psychological stress have
been found to be associat ed with an increased incidence of mild
cognitive impairment.
D.LEARNING
➢ Although learning ability is not seriously altered with age, other
factors can interfere with the older person’s ability to learn,
including motivation, attention span, delayed transmission of
information to the brain, perceptual deficits, and illness. Older
persons may display less readiness to learn and depend on previo us
experience for solutions to problems rather than experiment with
new problem-solving techniques. Differences in the intensity and
duration of the older person’s physiologic arousal may make it more
difficult to extinguish previous responses and acquire new material.
The early phases of the learning process tend to be more difficult for
older persons than younger individuals; however, after a longer
early phase, they are then able to keep equal pace. Learning occurs
best when the new information is relate d to previous learned
information. Although little difference is apparent between the old
and the young in verbal or abstract ability, older persons do show
some difficulty with perceptual motor tasks. Some evidence
indicates a tendency toward simply assoc iation rather than analysis,
Because generally a greater problem to learn new habits when old
habits exist and must be unlearned, relearned, or modified, older
persons with many years of history may have difficulty in this area.
E.ATTENTION SPAN
➢ Older adults demonstrate a decrease in vigilance performance (i.e.
the ability to retain attention longer than 45 minutes). They are more
easily distracted by irrelevant information and stimuli and are less to
perform tasks that are complicated or require simulrane ous
performance.
Philippine Journal of Nursing
Journal of Gerontological Nursing
Websites:
www.ebscohost.com
www.doh.gov.ph
http://www.pna-pjn.com
Study Questions:
1. What age-related changes can you identify in your parents/ grandparents?
2. Discuss risks and nursing considerations associated with age-related changes.
Publishers.610.7365 G31 2010
2016,v.1, c1
W83 2012, c1
BACHELOR OF SCIENCE IN NURSING
NCMB 314 CARE OF THE OLDER ADULT
1 3 3
Nursing Care of the Older Adult in Wellness (ASSESSMENT)
✔ Recite course and unit objectives

✔ Understand study guide prior to class attendance
✔ Use required learning resources; refer to unit
terminologies for jargons
✔ Proactively participate in online discussions
✔ Participate in weekly discussion board (Canvas)
✔ Answer and submit course unit tasks
At the end of the course unit (CU), learners will be able to:
Cognitive:
1. Understand 11 Basic functional Health Patterns of Older ADULT

2. Classify comprehensive geriatric assessment.
3. Describe the client’s functional level using Katz Index.
4. Explain mental status of the client using MMSE.
Affective:
1. Cooperate and listen attentively in class discussions
3. Respect comments and opinion of other and accepts criticism
Psychomotor:
1. Evaluate nutritional status of elderly using mini nutritional assessment.
2. Participate in interactive discussion concerning dose-response relationship of drugs.
Lecturio Video: Age Related Disorders: Assessing Cognitive disorders
ASSESSMENT (potential health hazard to identify risk factors for illness and injury)
Risk Factors
o Habits
o Lifestyle patterns
o Personal and family medical history
o Environmental conditions
Functional Status Assessment
Functional status is considered a significant component of an older adult’s quality of life.

Assessing functional status has long been viewed as an essential piece of the overall clinical
evaluation of an older person. Functional status assessment is a measurement of the older
adult’s ability to perform basic self-care tasks, or ADLs, and tasks that require more complex
activities for independent living, referred to as IADLs. Determination of the degree of functional
independence in these areas can identify a client’s abilities and limitations, leading to
appropriate interventions.
The client’s situation determines the location and time when any of the scales or tools
should be administered, as well as the number of times the client may need to be tested to
enjoy to ensure accurate results. Many tools are available, but the nurse should use only those
which are valid, reliable, and relevant to the practice setting.
The Katz Index is a useful tool to describe the client’s functional level
MiniMental State Examination

Approach the patient with respect and encouragement.
Ask: Do you have any trouble with your memory? Yes No
SCORE ITEM
5( ) TIME ORIENTATION
Ask:
What is the year ________________ (1), season __________________(1),
Month of the year_______________ (1), date ____________________, (1),
Day of the week ________________ (1)
5( ) PLACE ORIENTATION
Ask: Where are we now? What is the state __________________ (1), city ________________ (1),
part of the city _________________ (1), building _________________ (1)
floor of the building _____________ (1)
3( ) REGISTRATION OF THREE WORDS

Say : Listen carefully, I am going to say three words. You say them back after I stop. Ready..Here they are-
PONY (wait 1 second), QUARTER (wait 1 second), ORANGE (wait 1 second). What were those words?
_______________________ (1)
_______________________ (1)
_______________________ (1)
Give 1 point for each correct answer, then repeat them until the patient learns all three
5 ( ) SERIAL7s AS A TEST OF ATTENTION AND CALCULATION

Ask: Subtract 7 from 100 and continue to subtract 7 from each subsequent remainder until you stop.
What is 100 take away 7? _____________ (1)
Say:
Keep going. ________________________ (1), ____________________________ (1),
___________________________________ (1), ____________________________ (1)
3 ( ) RECALL OF THREE WORDS

Ask:
What were those three words I asked you to remember?
Give one point for each correct answer _______________________ (1),
_____________________________ (1), ________________________ (1)
2 ( ) NAMING
Ask:
What is this? (show pencil) _______________________ (1), What is this? (show watch) ____________________ (1),
1 ( ) REPETITION
Say: read the following
Now I am going to ask you to repeat what I say. Ready? No ifs, ands, or buts.
Now you say that ________________________________________ (1)
3 ( ) COMPREHENSION
Say:
Listen carefully because I am going to ask you to do something:
Take this paper in your left hand (1), fold it in half (1), and put it on the floor. (1)
1 ( ) WRITING
Say:
Please write a sentence. If patient does not respond, say: Write about weather (1)
1 ( ) READING
Say:
Please read the following and do what it says, but do not say it aloud. (1)
Close your eyes
1( ) DRAWING
Say: Please copy this design.
TOTAL SCORE ___________________________ Assess level of consciousness along a continuum

____________________________________________
Alert Drowsy Stupor Coma
YES NO YES NO FUNCTION BY PROXY

Cooperative: Deterioration from Please record date when patient was last able
Depressed: previous level of to perform the following task. Ask caregiver
Anxious: functioning: if patient independently handles:
Poor vision: Family history of Dementia: YES NO DATE
Poor hearing: Head trauma: Money/ Bills: _____________
Native Language: Stroke: Medication: _____________
_______________________ Alcohol Abuse: Transportation: _____________
Thyroid Disease: Telephone: _____________
PAR-Q AND YOU
Gordon’11 Basic functional Health Patterns of Older ADULT
1. Self-Perception/ Self-Concept Pattern

▪ This pattern encompasses a sense of personal identity;body language,
attitudes, and view of self in cognitive, physical, and affective realms; and
expressions of sense of worth and emotional state. Perceptions of self
should be explored with direct questions, asked with sensitivity. Emotional
patterns can be identified during this exploration of perceptual patterns.
o Subjective: Determine the client’s feelings about his or her
competencies and limitations, withdrawal from previous activities, self-
destructive actions, excessive grieving, and increased dependency on
others.
o Objective: Identify verbal and nonverbal cues related to the above
subjective data.
2. Roles/ Relationship Pattern

▪ This pattern encompasses the achievement of expected developmental
tasks. Basic needs for communication and interactions with other people,
as well as meaningful communications and satisfaction in relationship with
others are examined.
o Subjective: Determine family structure, history of relationships, and
social interactions with friends and acquaintances.
o Objective: Examine the family dynamics of interdependent,
dependent, and independent practices among members.
3. Health Perception/ Health Management Pattern

▪ This pattern encompasses the perceived level of health and current
management of any health problems.
o Subjective: Determine the level of understanding of any treatments
or therapy required for management of health deficits or activities;
include assessment of performance of activities of daily living
(ADLs) and /or instrumental activities of daily living (IADLs).
o Objective: Observe for cues that indicate effective management of
deficits, including the physical environment in which th client
resides.
4. Nutritional / Metabolic Pattern

▪ This pattern encompasses evaluation of dietary and other nutrition-related
indicators.
o Subjective: Determine the older adult’s description, patterns, and
perception of food and fluid intake and adequacy for maintaining a
healthy body mass index.
o Objective: Observe general appearance and various body system
indicators of nutritional status. Note height, weight, and fit of
clothes.
5. Coping/ Stress-Tolerance Pattern

▪ This pattern encompasses the client’s reserve and capacity to resist
challenges to self-integrity, and his or her ability to manage difficult
situations.
o Subjective: Assess ways to handle big and little problems that
occur in everyday life.
o Objective: Observe for the use of coping skills and stress-reducing
techniques, and note their effectiveness.
6. Cognitive/ Perceptual Pattern

▪ This pattern encompasses self-management of pain, presence of
communication difficulties, and deficits in sensory function.
o Subjective: Inquire about difficulties with sensory function and
communication, as well as the assessment of any cognitive
changes.
o Objective: Assess usual patterns of communication, and note the
client’s ability to comprehend.
7. Value/ Belief Pattern

▪ This pattern encompasses elements of spiritual well-being that the older
adult perceives as important for a satisfactory daily living experience and
the philosophic system that helps him or her function within society.
o Subjective: Identify the older adult’s values and beliefs about
spirituality, with a special emphasis on how this influences health
promotion behaviors.
o Objective: Determine what is important in the older adult’s life to
support coping strategies.
8. Activity/ Exercise Pattern

▪ This pattern encompasses information related to health promotion that
encourages the older adult to achieve the recommended 30 minutes daily
of physical activity on most days of the week.
o Subjective: Screen for safety related exercise and physical activity,
using screening measures such as the physical activity readiness
questionnaire (PAR-Q).
o Objective: Obtain vital signs and conduct cardiopulmonary and
musculoskeletal system assessments.
9. Rest and Sleep Pattern

▪ This pattern encompasses the sleep and rest patterns over a 24-hour
period and their effect on function.
o Subjective: Assess usual sleep patterns, including bedtime and
arousal time, quality of sleep, sleep environment, and distribution of
sleep hours within a 24 hour period.
o Objective: Have a client keep a sleep diary that includes naps and
rest periods.
10. Sexuality/ Reproductive Pattern

▪ This pattern encompasses the older adult’s behavioral expressions of
sexuality.
o Subjective: Assess client’s satisfaction or dissatisfaction with
current circumstances related to sexual function and intimacy,
including perceived satisfaction or dissatisfaction with sexuality or
sexual experiences.
o Objective: Discuss current sexual relationship. When none is
present, elicit the meaning this has for the client’s overall emotional
and physical well-being.
11. Elimination Pattern

▪ This pattern encompasses bowel and bladder excretory functions.
o Subjective: Assess lifelong elimination habits and excretory self-
care routines.
o Objective: Perform abdominal and rectal examination; external
genitalia and pelvic examination may be indicated.
PLANNING
➢ Exploring older adults’ personal ideas and beliefs concerning health needs
➢ Reading current literature regarding latest update for specific health promotion
➢ Current health policy information that will safeguard client rights
➢ Understanding and use of behavior change theories
Implementation
➢ Adopting a proactive stance toward an action plan for health promotion of the older
individual
➢ Activities, locations, and means of disseminating health promotion
➢ Annual health promotion screening
➢ Program that provide vaccinations for older adult
➢ Screening for cancer , diabetes, and other condition
➢ Monthly health talks provided in senior centers
➢ Housing sites
➢ Continuing retirement communities
➢ Advocate and educate about health promotion
➢ Safe medication use
EVALUATION
➢ Determining effectiveness of care plan
➢ Check established goals
➢ Establish appropriate and realistic revised goals and realistic steps to achieve them
● Mini-Mental State Exam (MMSE) is a widely used test of cognitive function among the
elderly; it includes tests of orientation, attention, memory, language and visual-spatial
skills.
• Katz Index of Independence in Activities of Daily Living, commonly referred to as the
Katz ADL, is the most appropriate instrument to assess functional status as a
measurement of the client's ability to perform activities of daily living independently .
• Physical Activity Readiness Questionnaire (PAR-Q) is a common method of
uncovering health and lifestyle issues prior to an exercise programmed starting. The
questionnaire is short and easy to administer and reveals any family history of illness.
Watch and Learn:
https://study.com/academy/lesson/nutrition-needs-for-older-adults.html
https://www.mdmag.com/peers-perspectives/nutrition-elderly/assessment-of-nutritional-status
https://www.youtube.com/watch?v=il76j5L4dns
Study Questions.
1. Get the physical activity, mental status and functional status of your grandparents using the “Par Q”,
“Katz Index” and MiniMental State Examination (MMSE).
(Upload your answer to canvas).
Textbooks:
Publishers.610.7365 G31 2010
2016,v.1, c1
W83 2012, c1
American Nurses Association. Nursing: Scope and Standards of Practice. 2nd ed. Silver
Spring, MD: American Nurses Association; 2010.
Websites:
www.ebscohost.com
http://mna-elderly.com
http://www.nutrition.tufts.edu/research/myplate-older-adults
NCMB 314 CARE OF THE OLDER ADULT
1 4 4
Health promotion, Health maintenance and home health considerations
✔ Read course and unit objectives

✔ Read study guide prior to class attendance
✔ Read required learning resources; refer to unit
Cognitive:
1. Distinguish the categories and types of home care organizations.

2. Explain benefits of home care.
3. Describe assisting living, special care units, and subacute care units as specialty care
settings of the nursing facility.
4. Describe factors that may disturb sleep in older adults.
Affective:
1. To differentiate the housing options for elderly.
2. Demonstrate tact and respect when challenging other people’s opinions and ideas.
3. Accept comments and reactions of classmates on one’s opinions openly and graciously.
Psychomotor:
1. Participate in interactive discussion concerning dose-response relationship of drugs.
https://nursekey.com/care-of-aging-skin-and-mucous-membranes/
https://nursekey.com/care-of-aging-skin-and-mucous-membranes/
https://thegreenfields.org/5-benefits-exercise-seniors-aging-adults/
PROMOTING HEALTHY AGING

HEALTHY PEOPLE INITIATIVE
1. An initiative of the US Department of Health and Human Services that
set forth health care objectives designed to increase the quality and
quantity of years of healthy life of Americans and to eliminate health
disparities.
2. FOCUS: minimize the loss of independence associated with illness and
functional decline.
COMPONENTS OF HEALTH PROMOTION FOR THE ELDERLY

1. Exercise
- Regular exercise and physical activity can improve health in a variety
of ways :
o Reduction in Heart Disease, Diabetes, High Blood pressure,
Colon CA, Depression, Anxiety, Excess weight, falling, bone
thinning, muscle wasting and joint pain.
o Nursing Implication:
▪ Motivate the elderly to have regular exercise and increase
their physical activity.
▪ Advise the elderly to have continuous exercise.
▪ Promote the physical activity and exercise as a habit for the
elderly.
2. Nutrition
- Eating and drinking habits have been implicated in 6:10 leading cause
of death in the elderly.
- Older adults are more prone to Obesity and Malnutrition.
o Nursing Implication:
▪ Proper Nutrition:
• Alcohol Consumption: Men twice a day, Women once
a day.
• Decrease Fats, Decrease Cholesterol Diet
• Balance Caloric Intake
• Daily Calcium, Vit. B12, Vit. D, Fruits and Vegetable.
3. Mental Health
- Decrease life satisfaction due to:
o Decrease Income (50%)
o Increase emotional losses
o Physical losses
o Caregiving responsibilities.
- Nursing Implication:
o Life Review – tool for preserving or enhancing the mental health
of the older adults.
▪ Life domains
▪ Autobiography, tape recording or videotape.
o Depression
▪ losses that accompanying aging such as widowhood,
chronic medical conditions and pain , and functional
dependence.
▪ Depression may lead to physical Decline.
▪ Plays a significant role in suicidal behaviors.
▪ Undetected in the elderly.
4. Model Health Promotion Programs for Older Adult

- Programs that have received federal funding and foundation supports
to evaluate their effectiveness and to encourage their replication.
- Focus: Older Adults.
a. Health wise – provides information and prevention tips on 190
common health problems.
b. Chronic Disease Self Management Program
▪ Founded by Nurse Researcher Kate Lorig.
Chronic Diseases: Self Management Program.
c. Project Enhance – Enhance Fitness and Enhance Wellness.
d. Ornish Program for Reversing Heart Disease
• Founded by Dr. Dean Ornish
• Enhancement of Elderly Nutrition
e. Benson’s Mind/Body Medical Institute
▪ Dr. Herbert Benson
▪ Combination of Relaxation: Nutrition, Exercise, and
Reframing from Negative thinking patterns.
f. Strong for life Model – exercised program for disabled and non -
disabled older adults.
5. Re-Engagement Instead of Retirement
- The likely alternative to retirement blessed with longevity, education,
health and positive attitude towards remaining engaged.
6. Green House
- Founded by Dr. William Thomas
- An Innovative and home -like alternative to nursing homes.
7. Safety
- Falls – leading cause of unintentional injury death in older adult.
- Elderly are vulnerable to falls as a result of:
o Postural Instability
o Decrease muscle Strength
o Gait Disturbances
o Decreased propioception
o visual/cognitive impairment
o polypharmacy
o Environmental conditions:
▪ Slippery surfaces, stairs, irregular surfaces, poor lightning,
incorrect foot ware, obstacles in the pathways.
o FALL-RISK ASSESSMENT: “I H ATE FALLING”

▪ I – nflammation of joints or joint deformity.
▪ H – ypotension (Orthostatic Blood pressure changes)

▪ A – uditory and Visual Impairments
▪ T – remors
▪ E – quilibrium problems.
▪ F – oot problems.
▪ A – rrythmias, heart block, valvular disease.
▪ L – eg Discrepancy
▪ L – ack of conditioning (General Weakness)
▪ I – llness
▪ N – utrition
▪ G – ait disturbance
DISEASE PREVENTION
- Helps prevent functional decline.
LEVELS OF DISEASE PREVENTION

1. Primary Prevention – designed to completely prevent a disease from
occurring.
2. Secondary Prevention – early detection and management of disease.
3. Tertiary Prevention – manage clinical disease in order to prevent them
from progressing or to avoid complications of the disease.
QUALITY OF LIFE
- How a person rates his or her life as satisfactory or not.
- Degree of Satisfaction and Dissatisfaction with life.
- WHO (1994)
o An individual’s perception of his or her position in life in the context
of their culture and value system where they live in and in relation to
their goals, expectations, standards and concerns.
QUALITY OF LIFE MODEL

- Physical Well being and Symptoms
- Psychological Well Being
- Social Well being
- Spiritual Well Being
Distinguishers:
• PHYSICAL WELL BEING
o Functional Ability, Strength/Fatigue, Sleep/Rest, Nausea, Appetite
and Constipation.
• PSYCHOLOGICAL WELL BEING
o Anxiety, Depression, enjoyment, leisure, pain distress, happiness,
fear, cognition/attention.
• SOCIAL WELL BEING
o Caregiver burden, roles and relationship, affection/sexual function,
appearance.
• SPIRITUAL WELL BEING
o Suffering, meaning of pain, religiosity, transcendence.
QUALITY OF LIFE PROGRAM
ACTIVE AGING
- Integrated health and quality of life program.
- Optimizing opportunities for health, participation in the community and
safe living in order to enhance quality of life.
- Center of Active Aging: Provide quality of life to the elderly.
- Enhance Autonomy, Independence, and Activity.
WHO’s DETERMINANTS OF HEALTH

- Affects aging and the qu ality of life of individuals, communities and
nations.
1. Behavioral Determinants
a. Physical Activity – contributes to muscle strength, flexibility, balance,
cardiovascular health and positive mood and improves cognition.
b. Nutrition – powerful and modifiable lif estyle factors.
- Increase in Vitamins and Minerals, increase in Vit. B6, B12, D, K and
folic acids, anti-oxidants Vitamins A,C, E, Beta -Carotene, Selenium,
Calcium and Iron. \\
c. Smoking – single most important preventable risk factors that cause
Premature Death.
- 5 A’s : Ask, Advise, Assess, Assist and Arrange.
d. Alcohol Abuse and Alcoholism – Elderly have the increase effects of
Alcohol because of pharmacologic changes associated with aging.
o Four Steps in Treating Alcoholism:
▪ Identify individuals requiring treat ment
▪ Determine individual’s readiness to discuss treatment.
▪ Assess individual’s requiring detoxification.
▪ Plan for post detoxification treatment in coordination with
other professional.
e. Medication Adherence
o Non-Adherence to medication.
o Invisible epidemic
o Risk Factors:
▪ Polypharmacy
▪ Physical Impairments
▪ Cognitive Limitations
▪ Limited Access to or affordability of health care services.
▪ Low-literacy patients.
o Strategy:
▪ Promote Self -efficiency.
▪ Empower patients to become informed medication consumers.
▪ Avoid strategies that could intimidate.
▪
Help the patient to develop a lists of short term goal and long
term goals.
▪ Plan for regular follow -up
▪ Implement a reward system.
2. Personal Determinants:
o Biological
o Genetic Impacts
3. Psychological Determinants:
- Intelligence
- Cognitive Capacity
4. Physical Determinants
- Safe Housing
5. Social Determinants
- Social Support
- Violence and Abuse
- Education and Literacy
6. Economic Determinants
7. Social Services Determinants
Guidelines for Primary and Secondary Health Promotion Activities for Older Adults
Health Promotion activity Recommendation Supportive Evidence
Mammogram Annually starting at age 40 and Based on randomized trials;
continue q 1 to 3 years until ages evidence for age to stop
70-85 screening not well established
Pelvic Examination/cervical smear Every 1-3 years after 2-3 negative Based on randomized trials;
annual examinations; can evidence for age stop screening
decrease or discontinue after ages not well established
65-70
Fecal occult blood test Annually after age of 50 Evidence from nonrandomized
or retrospective studies; fair
evidence to support
recommendation
Prostate examination Annually after age 50 if life Based on expert opinions or
expectancy is at least 10 years other considerations; limited
evidence to support
recommendation
Exercise Encourage aerobic and resistance Based on randomized trials
exercise as tolerated; ideally 30
minutes of moderate exercise daily
Low-cholesterol diet Keep daily fat intake at less than Guidelines not well established
35% of total calories, and
saturated fat and trans fatty acid
intake at less than 7% of calories
Alcohol intake Moderate alcohol use, defined as 1 Guidelines/safety not well
drink daily that does not exceed established
1.5 ounces (45ml) of liquor, 5
ounces (180 ml) of wine, or a
standard can of beer (National
Institute on Alcohol Abuse and
Alcoholism,2001)
II. HOME CARE AND HOSPICE

A. HOME HEALTH CARE – consists of multiple health and social services delivered to
recovering, chronically ill, or disabled individuals of all ages in their place of
residence.
Three main categories of home care providers

1. Home care organizations (National Association for Home Care)
2. Medicare-certified agencies include hospice and freestanding and
3. Facility-based home health agencies.
Benefits of HOME CARE services are individuals who:

1. Have a chronic medical conditions with exacerbations, such as congestive heart
Failure, COPD, unstable diabetes, kidney and liver disease with subsequent
transplantation, or recent strokes
2. Have chronic mental illnesses, such as depression, schizophrenia, and other
Psychoses
3. Need assistance with medical regimens to prevent readmission to an acute care
facility
4. Need continued treatment after discharge from a hospital facility (e.g. wound care,
intravenous therapy).
5. Require short-term assistance at home after same-day or outpatient surgery, are
terminally ill and want to die, or have families that want them to die with dignity in the
comfort of their homes.
Role of Home Care Agency

▪ Referrals are called in the home care agency (agency confirms home care
benefits)
▪ Schedules the admission visits
▪ Communicates the referral information to the nurse who will admitting the client
NURSE’S ROLE
▪ For initial evaluation
o Assess physical, functional, emotional, socioeconomic, and environmental
well-being
o Initiate plan of care
o Skills include:
 Health and self-care teaching
 Coordination and case management of complex care needs
 Medication administration and teaching about all medications
 Wound and decubitus care
 Urinary catheter care and teaching
 Ostomy care and teaching
 Postsurgical care
 Care of terminally ill client
 Case management
 Intravenous therapy, enteral and parenteral nutrition, and
chemotherapy
 Psychiatric nursing care
B. HOSPICE – Dying is the final phase in the trajectory of a chronic illness. Terminal
illnesses such as cancer and acquired immunodeficiency syndrome (AIDS) remain
incurable. However, because of pharmacologic and technologic advances in treatments,
cancer and AIDS are now considered chronic illnesses. Many chronically ill persons
choose to remain their homes during the last phase of their illness to prepare for death
in familiar surroundings, together with family and friends. Hospice provides care and
services to terminally ill persons and their families that enable individuals to die in
facilities or at home.
Hospice Services
▪ Comprehensive hospice program include Physician services, nursing care,
medical social work, counseling services and spiritual care, certified nursing
assistant services, additional therapies as needed (e.g., physical, occupational,
and speech therapy), in patient related to difficulty in managing symptoms,
medications, supplies, equipment, volunteers, respite services, continuous care
in times of crisis, and bereavement services.
III. Community based service providers are challenged to develop affordable and appropriate
programs to assist older adults to remain in the home while maintaining a good quality of life.
Community-services for older adults include:

o Respite care – short-term relief or time off for persons providing home care to ill,
disabled, or frail older adults. Adult day care services are a form of respite
provided outside the home. It provided at home or in institutional settings such as
specially designated hospital or nursing facility.
o Adult day care programs – provide a variety of health and social services to
older adults who live alone or with their families in the community.
o Senior citizen centers- senior centers are community facilities that provide a
broad range of services to older adults in the community. These services include
(1) health screening: (2) health promotion and wellness programs; (3) social,
educational, and recreational activities; (4) congregate meals; and (5) information
and referral services for older individuals and their families.
o Homemaker programs- Homemaker services include such things as
housecleaning, laundry, food shopping, meal preparation, and running errands.
o Home –delivered meals- Nutrition services provide older adults with
inexpensive, nutritious meals at home, or in group settings.
o Transportation- many communities provide transportation services for
disabledolder adulths through public or private agencies.
Factors affecting the Health Care needs of Noninstitutionaized older adult
➢ Functional status
o Term used to describe an individual’s ability to perform the normal, expected, or
required activities for self-care.
➢ Cognitive function
o Assess cognitive impairment which affects an individual’s functional status
HOUSING OPTIONS for OLDER ADULTS

TYPE OF HOUSING DESCRIPTION OF HOUSING
Accessory apartment This is a self- contained apartment unit within a house that allows an
individual to live independently without living alone. It generates
additional income for older homeowners and allows older renters to
live near relatives or friends and remain in a familiar community.
Assisted living facility (also This is a rental housing arrangement that provides room, meals,
called board and care home; utilities, and laundry and housekeeping services for a group of
personal care home; or residents. Such facilities offer a homelike atmosphere in which
sheltered care, residential care, residents share meals and have opportunities to interact. What
or domiciliary care facility) distinguishes these facilities from simple boarding homes is that they
provide protective oversight and regular contact with staff members.
Congregate housing Congregate housing was authorized in 1970 by the housing and
Urban Development Act . It is a group-living arrangement, usually an
apartment complex, that provides tenants with private living units
(including kitchen facilities), housekeeping services, and meals
served in a central dining room.
Elder Cottage Housing This is a small, self-contained portable unit that can be placed in the
Opportunity backyard or at the side of a single-family dwelling.
Foster home care Foster care for adults is similar in concept to foster care for children.
It is a social service administered by the state that places an older
person who needs some protective oversight or a assistance with
personal care in a family environment.
Home sharing Home sharing involves two or more unrelated people living together
in a house or apartment.
Life care or continuing care This is facility designed to support the concept of “ aging in place”. It
retirement community (CCRC) provides a continuum of living arrangements and care-from
assistance with household chores to nursing facility care- all within a
single retirement community.
(Philippines settings) A non-stock and non-profit organization, Kanlungan ni Maria is a home for
Kanlungan ni Maria Home for the the aged in the Philippines serving to provide true home to all abandoned,
Aged poor, sick and homeless elderly in the country.
Golden Reception and a 24-hour, 7-day-a-week assessment/diagnostic and residential care
Action Center for the facility that provides residential care to abandoned, neglected, unattached
Elderly and Other Special and homeless Filipino Senior Citizen who are 60 years old.
Cases
EMMAUS house of Emmaus House of Apostolate, Inc. (EHA) is a shelter for the homeless, old and
apostolate sickly people who have been given up by their families for a lot of reasons. One
common thing, though, they need other people to love and care for them. (Matt
22: 39 /1 John 3: 18)
COMMUNITY-BASED SERVICES
➢ Assessment of functional status aids in determining the type of services an older adult
needs to remain in his or her home. The type of services needed, the availability of the
services, the cost of the services, and the requirements to qualify for the services can
be determined by a home health agency.
2 Categories in Community Services

1. Formal- services that provides assessment, observation, teaching, certain technical
skills and personal care for short-period of time.
2. Informal services- include senior citizen centers, adult care services, nutrition
services, transportation services, and telephone monitoring services.
IV. ASSISSTED LIVING PROGRAMS –are an increasingly attractive long-term care setting,
placed between home care and the nursing facility in the continuum of long-term care.
Regulations are minimum, so there is great diversity in the types of service delivery models
used, the types of services offered, and the setting within which assisted living is provided.
Assisted living settings are homelike and offer an array of services, including meals,
assistance with bathing and dressing, social and recreational programs, personal laundry and
housekeeping services, transportation, 24-hour security, an emergency call system, health
checks, medication administration, and minor medical treatments. Many services are
purchased individually as needed by the resident.
V. SPECIAL CARE UNITS – Since the 1980s the popularity of specialized units for persons
with dementia has expanded. Special care unit (SCU) is the designation given to freestanding
facilities or units within nursing facilities that specialize in the care of people with Alzheimer’s
disease and other types of dementing illnesses. Behavioral manifestations of dementia are
managed in the environment without the use of chemical or physical restraints whenever
possible.
VI. GERIATRICS UNITS

VII. SUBACUTE CARE
Subacute care has become an increasingly popular level of care. The growth of
subacute care has been spurred by the belief that up to 40 % of clients in acute medical or
rehabilitation hospital units could be treated as effectively in less costly settings.
Persons in a subacute unit are stable and no longer acutely ill or requiring daily physician
visits. They may require services such as rehabilitation, intravenous medication therapy,
parenteral nutrition, complex respiratory care, and wound management.
C. Physical Care of Older Adults (Aging skin and mucous Membranes)
Complete assessment of skin, hair, and nails is best done when the person is undressed
so that all skin surfaces can be inspected. Skin assessment can be performed during a bath,
during daily personal hygiene, at bedtime, or at any other convenient time for the older person.
Independent older persons should be aware of what is normal for themselves, and they should
bring any changes to the attention of the physician. In a hospital or extended-care setting,
privacy must be maintained and modesty protected during the skin inspection. Assessment of
the skin and ancillary structures is an important responsibility of nurses. Nursing assistants and
attendant health care workers who assist with bathing or other care should be instructed to
report any unusual or questionable observations promptly to a nurse for further investigation.
Inspection should follow a logical order so that no pertinent observations are missed. Most
nurses find that a head-to-toe progression is the most helpful.
Dry Skin
Dry skin is one of the most common problems of aging. Various studies have shown that 75% to 85%
of people older than 65 years of age experience some degree of problem with dry skin. Physiologic
changes, excessive bathing, the use of harsh soaps, and a dry environment all contribute to
problems with dry skin.
Dry skin can result in itching (pruritus), burning, and cracking of the skin. Many older people
develop a habit of scratching or picking at dry or cracked skin, increasing their risk for further tissue
damage and infection. Skin irritation can be severe and can cause intense discomfort to older adults. In fact, it may be so
distracting that affected individuals cease to participate in social activities.
Dry, scaly skin commonly seen in older adults.
Rashes and Irritation

Rashes and skin irritation can be caused by factors other than dryness. Medications, communicable
diseases, and contact with chemical substances are common causes of skin rashes and pruritus.
Drug-induced skin reactions are seen more commonly among older patients than in younger
patients. Use of a potent topical corticosteroid has resulted in severe striae. The atrophy was so
severe that the skin tore, forming an ulcer.
Allergic response to medications can manifest as diffuse rashes over the body. Whenever a rash develops soon after
administration of new medication, an allergy should be suspected. It is appropriate to withhold that particular medication and
contact the physician to report the symptom.
One communicable source of skin irritation and severe pruritus is scabies. Scabies is a
superficial infection caused by a parasitic mite (Sarcoptes scabiei var. hominis) that burrows
under the skin. Older adults, especially individuals who suffer from chronic illness,
dementia, or a depressed immune system, are particularly vulnerable to scabies infections.
Signs of scabies include intense itching and fine, dark, wavy lines at the flexor surface of
the wrist or elbow, the webbed area of the fingers, the axilla, and the genitals. Recognition
of scabies may be difficult in older adults because it has an asymptomatic incubation period
of 4 to 6 weeks and because atypical presentations are common. When infestation is suspected, skin scrapings should be
examined to determine the presence of ova or mites.
Pigmentation
Changes in skin pigmentation are common with aging. Many of the changes are cosmetic and do not cause problems unless
they are located on the face or arms, where they may be distressing to the affected person. Common conditions such as acne
rosacea can be treated with topical medications, which help heal the skin and reduce redness, whereas others can be
concealed by appropriate use of cosmetics. Changes in the size or pigmentation of moles are of greater significance because
these changes may indicate the presence of a precancerous or cancerous condition that needs immediate medical attention.
Tissue Integrity
Breaks in tissue integrity increase the older person’s risk for infection and often result in the need for costly, time-consuming
treatments. These breaks can cause disfigurement and are frightening to older adults. Skin tears, abrasions, lacerations, and
ulcers most often result from friction, shearing force, moisture, and pressure. Even simple incidents such as contact with
furniture, sliding across bed linens, a grip during a transfer, or the removal of tape may result in significant skin trauma to the
older person.
Pressure Ulcers
Pressure ulcers are a particular risk to older adults who suffer from compromised circulation, restricted mobility, altered level of
consciousness, fecal or urinary incontinence, or nutritional problems. Studies estimating the occurrence of pressure ulcers
vary widely, but one consistent point is that they occur in all settings. Although most studies show that the incidence of
pressure ulcers has declined, there is still much work to be done. Pressure ulcers have negative effects on the overall health
of an elderly person. They can lead to infection, pain, loss of function, and even death. Furthermore, incidence of pressure
ulcers can leave care facilities and nurses vulnerable to lawsuits for negligence. They strain the health care system with
treatment costs estimated at $11 billion per year. New Medicare rules specify that a hospital will not be reimbursed for the care
of a patient who develops a pressure ulcer after being admitted to a hospital. This should be a great motivator for hospitals to
institute pressure ulcer prevention programs.
ELIMINATION
(Bowel)
Aging GI system
▪ Nutrition
➢ Good nutrition is
essential to older adult
Age related Changes
▪ Decrease saliva production
▪ Decrease gag reflex
▪ Altered intestinal enzymes
▪ Abdominal wall/muscles get weaker
▪ Decrease intestinal tone
▪ Decrease peristalsis
SELECTED GASTROINTESTINAL CONDITIONS

▪ Dry Mouth ( Xerostamia)-Saliva serves several important function, such as lubricating soft
tissues, assisting in remineralizing teeth, promoting taste sensations, and helping to control
bacteria and fungus in the oral cavity. Reduced saliva, therefore, can have significant
consequences.
▪ Dental Problems – Poor condition of teeth can restrict food intake, which can cause
constipation and malnourishment, it can also detract from appearance, which can affect
socialization, and this result in a poor appetite, which also can lead to malnourishment.
▪ Dysphagia – The incidence of swallowing difficulties increases with age. Dysphagia can be
oropharengeal, characterized by difficulty transferring food bolus or liquid from the mouth into
the pharynx and esophagus and more common in persons with neurologic damage, or
esophageal, involving difficulty with the transfer of food down the esophagus and more common
in persons with motility disorders, sphincter abnormalities, or mechanical obstructions caused
by strictures.
▪ Fecal Impaction – Prevention of constipation aids in avoiding fecal impaction. Observing the
frequency and character of bowel movements may aid in detecting the development of an
impaction; bowel elimination record is essential for older people in a hospital or nursing home
for identifying alterations in bowel elimination.
▪ Fecal Incontinence –Involuntary defecation, fecal incontinence, refers to inability to voluntary
control the passage of stool. It is most often associated with fecal impaction in older adults who
are institutionalized or physically or cognitively impaired.
COMMON PROBLEMS
Common problems Risk factors MANAGEMENT
CHRONIC CONSTIPATION ➢ Inactive lifestyle ➢ Diet high in fiber and fluid
➢ Low-fiber and low –fluid ➢ Regular activity
intake ➢ Foods ( prunes or chocolate pudding)
➢ Depression incorporated into diet
➢ Laxative abuse ➢ Yogurt or applesauce for individual
➢ Certain medications, chewing impairment
such as opiates,
sedatives, and
aluminum hydroxide
gels
➢ Dulled sensations that
cause the signal for
bowel elimination to be
missed
➢ Failure to allow
sufficient time for
complete emptying of
the bowel
GERD (ESOPHAGUS) S MOKING Avoid food & meds that

due to - LES TONE C AFFEINE Elevate HOB for sleeping
 Heartburn- PYROSIS, A LCOHOL Medications
 substernal burning pain- N CREASED INTRAGASTRIC 1.Antacids- neutralize stomach
Coughing PRESSURE
FATTY FOOD
acid- Maalox
2. H2 receptor blocker- gastric
acid ex.Ranitidine (Zantac)
3.Proton pump inhibitor(PPI)-
Nexium (Esomeprazole)
GASTRITIS (STOMACH) smoking, drinking alcohol, 1.Antacids- neutralize stomach acid-

Parietal cells HCL drinking coffee Maalox
IF- needed for absorption of Vit B12 in 2.Histamine H2 receptor antagonists-
small intestine Decreases gastric acid Ranitidine
(Zantac)
3.Proton pump inhibitors(PPI)-
Gastric ulcer Predisposing Factors: 1.Antacids- neutralize stomach acid-

Stress, smoking Maalox
Corticosteroids, 2.Histamine H2 receptor antagonists-
Alcohol, Aspirin Decreases gastric acid
NSAIDS
ex Ranitidine (Zantac)
3.Proton pump inhibitors(PPI)-
4. Mucosal protectant
Sucralfate
LIVER (Liver cirrhosis) Cause: portal HPN,

Complications
➢ Esophageal varices ➢ Associated w/
➢ Dilated & tortous veins in liver cirrhosis
submucosa of esophagus
Esophageal varices VS ,LOC, NPO, NGT

O2, Blood Transfusion
 Esophageal tamponade / balloon Vasopressin iv- lowers pressure Propranolol
tamponade
 Sengstaken- Blakemore or (Inderal)- reduces portal pressure
Minnesota tubes
Monitor - respiratory distress

ASCITES THERAPEUTICS
 Accumulation of plasma- rich fluid  Diuretics
w/n peritoneal cavity oncotic  Measure abdominal girth, weigh pt
pressure  Paracentesis
 Cirrhosis – most common cause
 Low salt diet
Colorectal Ca ▪ Cigarrete smoking, Primary tx :Surgery

alcohol
▪ Obesity, Hx of IBD
▪ Low fiber, High fat,
CHON (beef)
▪ Old (increased age)
▪ Ndometrial, ovarian
Ca
Most common s/s:
➢ Change in bowel
habits
➢ Unexplained
anemia
➢ Blood in stool
➢ Anorexia
ACTIVITY AND EXERCISE

5 Benefits of Exercise for Seniors and Aging Adults
You’ve heard it time and again: physical activity and exercise are good for you, and you should
aim to make them part of your routine. There are countless studies that prove the important
health benefits associated with exercise, and it becomes more important as we age. Regular
physical activity and exercise for seniors helps improve mental and physical health, both of
which will help you maintain your independence as you age. Below, we outline five benefits of
exercise for seniors and aging adults.
1. Prevent Disease
Studies have shown that maintaining regular physical activity can help prevent many common
diseases, such as heart disease and diabetes. Exercise improves overall immune function,
which is important for seniors as their immune systems are often compromised. Even light
exercise, such as walking, can be a powerful tool for preventable disease management.
2. Improved Mental Health

The mental health benefits of exercise are nearly endless. Exercise produces endorphins (the
“feel good” hormone), which act as a stress reliever and leaves you feeling happy and
satisfied. In addition, exercise has been linked to improving sleep, which is especially
important for older adults who often suffer from insomnia and disrupted sleep patterns.
3. Decreased Risks of Falls
Older adults are at a higher risk of falls, which can prove to be potentially disastrous for
maintaining independence. Exercise improves strength and flexibility, which also help improve
balance and coordination, reducing the risk of falls. Seniors take much longer to recover from
falls, so anything that helps avoid them in the first place is critical.
4. Social Engagement
Whether you join a walking group, go to group fitness classes or visit a gardening club,
exercise can be made into a fun social event. Maintaining strong social ties is important for
aging adults to feel a sense of purpose and avoid feelings of loneliness or depression. Above
all, the key is to find a form of exercise you love, and it will never feel like a chore again.
5. Improved Cognitive Function

Regular physical activity and fine-tuned motor skills benefit cognitive function. Countless
studies suggest a lower risk of dementia for physically active individuals, regardless of when
you begin a routine.
SLEEP AND THE OLDER ADULTS

Sleep is a natural, periodically recurring, physiologic state of rest for the body and mind; sleep
is a state of inactivity or response that is required to remain active.
Importance of Sleep
➢ Proper sleep
➢ architecture and adequate
➢ total sleep time are
➢ necessary for proper functioning.
Biologic Brain Functions Responsible for Sleep

➢ Regulation of sleep and wakefulness occurs primarily in the hypothalamus, which
contains both a sleep center and awakefulness center. The thalamus, limbic system, reticular
activating system is controlled by the hypothalamus and also influence sleep and wakefulness.
Age-Related Changes in Sleep

1. Increased Sleep Latency - a delay in the onset of sleep.
2. Reduced Sleep efficiency is the relative percentage of time in bed spent asleep.
3. Increased Nocturnal Awakenings
➢ Contribute to an overall decrease in the average number of hrs of sleep
4. Increased Daytime Sleepiness may be due to nocturnal awakening or other sleep
disturbances. It may also due to medication side effects.
5. Greater difficulty falling asleep
6. More frequent awakenings because of reduced slow wave sleep
7. Decreased amounts of nighttime sleep, especially deep sleep
8. More frequent daytime napping
9. Increased time spent trying to sleep as sleep becomes less efficient
 Age-related changes in the nervous system can affect sleep
◦ May be at the chemical, structural, and functional levels
◦ May result in a disorganization of sleep and disruption of circadian
rhythms
 Declines in the cerebral metabolic rate and cerebral blood flow
 Reductions of neuronal cell counts
 Structural changes, such as neuronal degeneration and atrophy
Sleep Requirements
 A common myth is that you require less sleep as you age
◦ Most older adults require 7 to 9 hours of sleep per night
◦ Less than 4 hours or greater than 9 hours of sleep is associated with higher
mortality
Potential causes of sleep disruption in older persons

Sleep Problems in Older Persons
 Sleep problems in older persons may result from
◦ Personal characteristics
 Advanced age
 Female gender
 Depression
◦ Environmental characteristics
◦ A combination of these factors
 Older women are more likely than older men to
◦ Take longer to fall asleep
◦ Wake more frequently after the onset of sleep
◦ Stay awake longer during these nighttime awakenings
 Older persons may take more daytime naps that disrupt normal sleep patterns.
STAGES TYPE OF SLEEP SELECTED CHARACTERISTICS
Stage 1 Light sleep Easily awakened

Stage 2 Medium deep sleep More relaxed then stage 1, slow eye movements,
fragmentary dreams, easily awakened
Stage 3 Medium deep sleep Relaxed muscles, slowed pulse, decrease body
temperature, awakened with moderate stimuli
Stage 4 Deep sleep Restorative sleep, body movement rare, awakened

with vigorous stimuli
REM Active sleep Rapid eye movement, increased or fluctuating pulse,

blood pressure, and respirations. Dreaming occurs.
◦ Wake more frequently after the onset of sleep

◦ Stay awake longer during these nighttime awakenings
.
Common causes of insomnia and sleep problems in older adults
Poor sleep habits and sleep environment. These include irregular sleep hours, consumption
of alcohol before bedtime, and falling asleep with the TV on. Make sure your room is
comfortable, dark and quiet, and your bedtime rituals conducive to sleep.
Pain or medical conditions. Health conditions such as a frequent need to urinate, pain,
arthritis, asthma, diabetes, osteoporosis, nighttime heartburn, and Alzheimer’s disease can
interfere with sleep. Talk to your doctor to address any medical issues.
Menopause and post menopause. During menopause, many women find that hot flashes
and night sweats can interrupt sleep. Even post menopause, sleep problems can continue.
Improving your daytime habits, especially diet and exercise, can help.
Medications. Older adults tend to take more medications than younger people and the
combination of drugs, as well as their side-effects, can impair sleep. Your doctor may be able
to make changes to your medications to improve sleep.
Lack of exercise. If you are too sedentary, you may never feel sleepy or feel sleepy all the
time. Regular aerobic exercise during the day can promote good sleep.
Stress. Significant life changes like retirement, the death of a loved one, or moving from a
family home can cause stress. Nothing improves your mood better than finding someone you
can talk to face-to-face.
[Read: Adjusting to Retirement: Handling the Stress and Anxiety]
Lack of social engagement. Social activities, family, and work can keep your activity level up
and prepare your body for a good night’s sleep. If you’re retired, try volunteering, joining a
seniors’ group, or taking an adult education class.
Sleep disorders. Restless Legs Syndrome (RLS) and sleep-disordered breathing—such as

snoring and sleep apnea—occur more frequently in older adults.
Lack of sunlight. Bright sunlight helps regulate melatonin and your sleep-wake cycles. Try to
get at least two hours of sunlight a day. Keep shades open during the day or use a light
therapy box.
II. Psychosocial care of Older Adults
COGNITIVE FUNCTION
Cognitive impairment, which often affects an individual’s functional status, is another
eligibility criterion used by various community programs. Cognitive status is assessed on
admission and again with every skilled nursing visit. Other disciplines are also responsible for
reporting a change in cognition to the nurse or case manager in home health. A change in
cognitive status frequently signals a change in another body system. The home health nurse
must establish a baseline assessment and be alert to deviations. Cognitive impairments can
be reversible or irreversible, and home health personnel are in a key position to detect any
changes.
Cognitive impairments are associated with functional limitations. For example,
individuals with deficits in memory, language, abstract thinking, and judgment have great
difficulty executing ADLs or IADLs (e.g. shopping, paying bills, preparing meals, and personal
care tasks)
SELF-CONCEPT – an organized pattern of

perceived characteristics, along with the values
attached to those attributes. (how a person
understand himself)
SELF-PERCEPTION – affect person’s personality

( wrong self-perception may lead to psychological
problems
COPING AND STRESS
The keys to healthy aging

As we grow older, we experience an increasing number of major life changes, including
career transitions and retirement, children leaving home, the loss of loved ones, physical and
health challenges—and even a loss of independence. How we handle and grow from these
changes is often the key to healthy aging.
Coping with change is difficult at any age and it’s natural to feel the losses you
experience. However, by balancing your sense of loss with positive factors, you can stay
healthy and continue to reinvent yourself as you pass through landmark ages of 60, 70, 80,
and beyond.
As well as learning to adapt to change, healthy aging also means finding new things you
enjoy, staying physically and socially active, and feeling connected to your community and
loved ones.
Tips help to maintain physical and emotional health
1: Learn to cope with change

2: Find meaning and joy
3: Stay connected
4: Get active and boost vitality
. 5: Keep your mind sharp
SEXUALITY AND AGING
For many years, sex was a major conversational taboo in the United States. Discussion
and education concerning this natural, normal process were discourage and avoided in most
circles. Literature on the subject was minimal and usually secured under lock and key. An
interest in sex was considered sinful and highly improper. Although people were aware that
sexual intercourse had more than a procactive function, the other benefits of this activity were
seldom openly shared; society viewed sexual expression outside of wedlock as disgraceful
and indecent. The reluctance to accept and intelligent confront human sexuality led to the
propagation of numerous myths, the persistence of ignorance and prejudice, and the
relegation of sex to a vulgar status.
Fortunately, attitudes have changed over the years, and sexuality has come to be
increasingly understood and appreciated. Education has helped erase the mysteries of sex for
adults and children, and magazines, books, television shows, and web sites on the topic
flourish.
AGE RELATED CHANGES AND SEXUAL RESPONSE

Despite the physical ability to remain sexually active in old age, various factors and age-
related changes do impact the older person’s sexual function. Although clinical data are
minimal and additional research is necessary, some general statements can be made about
sex and the older person:
▪ There is a decrease in sexual responsiveness and a reduction in the frequency of
orgasm
▪ Older men are slower to erect, mount and ejaculate
▪ Older women may experience dyspareunia (painful intercourse) as a result of less
lubrication, decreased distensibility, and thinning of the vaginal walls
▪ Many older women gain a new interest in sex, possibly because they no longer have to
fear an unwanted pregnancy or because they have more time and privacy with their
children grown and gone.
IDENTIFYING BARRIERS TO SEXUAL ACTIVITY

▪ Unavailability of a partner
▪ Psychological Barriers
▪ Medical conditions
▪ Erectile dysfunction
▪ Medication adverse effects
▪ Cognitive impairment
PROMOTING HEALTHY SEXUAL FUNCTION

▪ Basic education can help older adults and persons of all ages understand the effects of
the aging process on sexuality by providing a realistic framework for sexual functioning.
▪ Health assessment as part of health education cases, and during discharge planning
when reviewing capabilities and activity restrictions.
▪ Discuss sex openly with older people demonstrate recognition
▪ Identifies physical, emotional, and social threats to older adults’ sexuality and intimacy
and seeks solutions for problems.
▪ Promote practices that can enhance sexual function, including regular exercise, good
nutrition, limited alcohol intake, ample rest, stress management, good hygiene and
grooming practices, and enjoyable foreplay.
Insomia: inability to fall sleep, difficulty staying asleep, or premature waking

Holistic: pertains to whole persons; body, mind, and spirit.
Dyspareunia: painful intercourse sufficient to engage in sexual intercourse.
Erectile dysfunction: the inability to attain and maintain an erection of the penis
Watch and Learn:
https://www.youtube.com/watch?v=BwV2EMAdOic
https://www.youtube.com/watch?v=INQFlDsBtq0
https://www.youtube.com/watch?v=QfbCP-Y6v1M
https://www.resourcesforintegratedcare.com/GeriatricCompetentCare/2018_GCC_Webinar_Series/M
edications
Study Questions:
1. What preventive measures could you recommend to older adults to promote bowel
elimination?
2. What age-related changes affect bowel elimination?.
3. How will you promote rest and sleep in older adults?
Textbooks:
Publishers.610.7365 G31 2010
Patińo, Mary Jane. (2016). Caregiving volume 1. Manila: Rex Book Store. F 649.1 P27 2016,v.1, c1
Doenges, Marylinn E. (2002). Nursing care plans: guidelines for individualizing patient care, 6th ed.
Philadelphia: F. A. Davis Company. R 610.73 D67 2002, c5
Wold, Gloria Hoffman. (2012). Basic geriatric nursing, 5th ed. MO: Elsevier.618.970231 W83 2012,
c1
PHARMACOLOGY
1 5 5
Nursing Care of the Older Adult in Chronic Illness
Read course and unit objectives

✔ Use study guide prior to class attendance
✔ Upload required learning resources; refer to unit
Cognitive:
1. Explain the importance of sensory function and the impact of sensory deficits on older
adults.
2. Identify signs of and nursing interventions for older adults with cataracts, glaucoma,
macular degeneration, diabetes retinopathy, and hearing impairment.
3. Interpret the Physiologic, Psychologic, and Environmental causes of ACS.
4. Differentiate Dementia and ACS.
.
.
Affective:
1. Develop awareness on the potential causes of dementia.
2. Demonstrate tact and respect when challenging other people’s opinions and ideas
graciously.
Psychomotor:
1. Apply effective communication to clients with impaired verbal problem.
Publishers.610.7365 G31 2010
LECTURIO Aging Process (Nursing): Sensory /Perception Alteration
Good sensory function is an extremely valuable asset that is often taken for granted.
For instance, people are better able to protect themselves from harm when they can see, hear,
smell, touch, and communicate. The reduced ability to protect oneself from hazards because
of sensory deficits can result in serious falls from unseen obstacle, missed alarms and
warnings, ingestion of hazards because of sensory deficits can result to serious falls from
unseen obstacle, missed alarms and warnings, ingestion of hazardous substances form not
recognizing bad tastes, an inability to detect the odor of smoke or gas, and burns and skin
breakdown because of decrease cutaneous sensation of excessive temperature and pressure.
SENSORY IMPAIRMENT
1. Visual Impairment
 Personal cost for older person with visual impairment
◦ Loss of independence
◦ Social isolation
◦ Depression
◦ Decreased quality of life
 Signs of difficulty with vision
◦ Squinting or tilting head to see
◦ Changes in ability to drive, read, watch television, or write
◦ Holding objects closer to the face
◦ Difficulty with color discrimination and walking up or down stairs
◦ Hesitation in reaching for objects
◦ Not being able to find something (American Society on Aging, 2003)
Cataract
 Opacity of the crystalline lens or its capsule (partial or complete)
 Causes
- injury -- traumatic
- exposure to heat, UV light
- heredity / congenital
- aging (>55) – senile
- DM – secondary
- smoking & alcoholism
 Lens clouding → decreased light to retina → limited vision
 Development is slow and painless
 Leading cause of blindness in the world
 > 50% of adults > 65 years have cataracts → visual problems
 Cataract
❑ Risk factors
◦ Increased age
◦ Smoking and alcohol
◦ Diabetes, hyperlipidemia
◦ Trauma to the eye
◦ Exposure to the sun and UVB rays

◦ Corticosteroid medications
❑ Symptoms
◦ Blurred vision
◦ Glare
◦ Halos around objects
◦ Double vision
◦ Lack of color contrast or faded colors
◦ Poor night vision
Surgery
❑ Phacoemulsification
- “small incision cataract surgery”

- small incision done outside the cornea
- a tiny probe is inserted which emits ultrasound waves that soften & break up the lens
so that it can be removed by suction
❑ Extracapsular / Intracapsular cataract surgery
- incision is longer on the side of cornea & removes the cloudy core on the lens in
one piece
- the rest of the lens is removed by suction
Glaucoma
❑ Increase in intraocular pressure (IOP) → optic nerve damage → vision loss
❑ Open angle
◦ Slowed flow of aqueous humor through trabecular meshwork → build up→

increased IOP → damage to renal nerve fiber → loss of vision
◦ Painless vision loss
 Midperipheral visual field loss
Glaucoma
❑ Angle-closure
◦ Angle of the iris obstructs drainage of aqueous humor through trabecular

meshwork → increased IOP → visual changes
◦ Symptoms
 Unilateral headache
 Visual blurring
 Nausea and vomiting
 Photophobia
Risk Factors for Glaucoma

❑ Increased intraocular pressure
❑ Older than 60 years of age
❑ Family history of glaucoma
❑ Personal history of myopia, diabetes, hypertension, or migraines
❑ African American ancestry
Nursing Care
❑ Explain the importance of continued use of eye medications as ordered to prevent
further visual loss
❑ Explain the need for continued medical supervision for observation of IOP to ensure
control of the disorder
❑ Teach client to avoid exertion, stooping, straining for a bowel movement, coughing,
heavy lifting, or wearing constricting clothing, since these increase IOP
❑ Instruct the client to report severe eye or brow pain & nausea to the physician
Eye Examination
Visual Acuity
- always start with the right eye to ensure accurate recording
- cover the eye not being tested with an occluder
- 20/20 at 6 y/o
- Numerator (20 ft, the distance the person stands from the chart)
- Denominator (distance from which the normal eye can read the chart)
- CF, HP, LP, NLP
Age-Related Macular Degeneration (ARMD)
❑ Two types
▪ Dry (atrophic form)-involutional mac deg
 Breakdown or thinning of macular tissue related to the aging process
 Atrophy
 Retinal pigment degeneration
 Drusen accumulations
 Other symptoms
 Slow progression of visual loss
Age-Related Macular Degeneration (ARMD)

❑ Wet (Neovascular exudates)-exudative macular degeneration
▪ Blood or serum lead from newly formed blood vessels beneath retina→ scar
formation + visual problems
▪ Other symptoms
 More light required for reading
 Blurred vision
 Central scotomas
 Metamorphopsia
Other symptoms of Macular D

❑ Difficulty performing tasks – close central vision – reading and sewing
❑ Decreased color vision
❑ Dark or empty area in the center of vision
❑ Straight lines appearing wavy and crooked
❑ Words on a page looks blurred
Risk Factors for ARMD

❑ Age (above the age of 50)
❑ Cigarette smoking
❑ Family history of ARMD
❑ Increased exposure to ultraviolet light
❑ Caucasian race and light colored eyes
❑ Hypertension or cardiovascular disease
❑ Lack of dietary intake of antioxidants and zinc

Nursing Diagnoses for Vision- Impaired Older Patients
❑ Evaluate functional ability
▪ Perform activities of daily living, including the ability to read medication labels
▪ Drive or take public transportation
▪ Ambulate safely in familiar and strange environments
▪ Shop and pay for food and personal items
▪ Prepare food while maintaining a safe and hygienic environment
▪ Engage in recreational and leisure activities
Nursing Diagnoses for Vision- Impaired Older Patients

❑ Sensory/perceptual alterations: visual
▪ Encompasses a variety of nursing goals and interventions communication
 Safety
 Mobility
 Self-care activities
 Mood assessment
2. Hearing loss
❑ > 30% aged 65 to 76 years
❑ 50% >75 years
❑ Older men > older women
❑ Caucasian men and women > African American men and women
❑ Temporary threshold shift (TTS)
❑ Sounds < 75 dB(A) → temporary hearing loss
❑ Sounds > 85 dB(A) for 8hrs/day + many years → permanent loss
Risk Factors
▪ Long-term exposure to excessive noise
▪ Impacted cerumen (ear wax)
▪ Ototoxic medications
▪ Tumors
▪ Diseases that affect sensorineural hearing
▪ Smoking
▪ History of middle ear infection
▪ Chemical exposure (e.g., long duration of exposure to trichloroethylene)
A. Conductive Hearing Loss

Sound unable to be transmitted → poor reception + amplification
◦ Site of problem
 External or middle ear
❑ Cause
▪ Otitis externa
▪ Impacted cerumen
❑ Most common and reversible
▪ Otitis media
▪ Benign tumors
▪ Tympanic membrane perforation
▪ Foreign bodies
▪ Otosclerosis
 Conductive Hearing Loss
❑ Transmission hearing loss
❑ Damage external or middle ear
❑ Failure of sound waves to be transmitted through the external and/or middle ear
❑ Causes
- impacted earwax
- perforated eardrum
- otosclerosis (decreased mobility of the ossicles)
❑ Treatment
- hearing aids that amplify the sound, since the inner ear and organs of sound
perception are not damaged
B.Sensorineural Hearing Loss

❑ Problems with cochlea + auditory nerve → sound distortion
❑ Causes
▪ Presbycusis
▪ (bilateral progressive hearing loss especially at high frequencies in

elderly people)
▪ High-frequency hearing loss from excessive noise (industrial noise, gunfire,
“rock & roll” deafness)
 Impaired ability to hear high pitches
 Rare, severe hearing loss or deafness
▪ Damage as a result of excessive noise exposure
▪ Meniere’s disease
▪ Tumors
▪ Infection
❑ Perceptive / “Nerve” hearing loss
❑ Pathologic changes in the inner ear, VIII cranial nerve, and/or auditory centers of the
brain
❑ Causes
- Presbycusis (bilateral progressive hearing loss especially at high frequencies in

elderly people)
- High-frequency hearing loss from excessive noise (industrial noise, gunfire,
“rock & roll” deafness)
Hearing Loss Assessment

◦ History
◦ Physical examination
 Inspection
 Examination of ear canal

 Childhood ear infections → ruptured eardrum → jagged white scars
on tympanic membrane in elderly
◦ Hearing Handicap Inventory for the Elderly (HHIE-S)
o Talk with family members
Common Hearing Problems in Older Persons

❑ Tinnitus
▪ Objective—pulsatile sounds with turbulent blood flow through the ear
 Hypertension
 Anemia
 Hyperthyroidism
▪ Subjective—perception of sound without sound stimulus
 Medications
 Infections
 Neurological conditions
 Disorders related to hearing loss
Nursing Diagnoses Associated with Hearing Impairment

❑ Assessment
▪ Ability to perform activities of daily living
 Communication
 Driving or taking public transportation
 Safety awareness including the ability to hear alarms, doorbells
 Engaging in leisure and recreational activities
Nursing Diagnoses Associated with Hearing Impairment

❑ Diagnosis
▪ Sensory/perceptual alterations: hearing with a variety of nursing goals and

interventions
 Communication
 Safety
 Self-care activities
 Mood
 Recreation and leisure activities
Protocol in cerumen removal

❑ Clip and remove ear hairs
❑ Instill softening agent, mineral oil, carbamide peroxide or glycerin solution
❑ Irrigate the ear using bulb syringe
❑ Use a solution of 3oz 3% hydrogen peroxide in 1 qt water warmed to 98 to 100 F., or

plain normal saline solution
❑ Place a towel around the client’s neck and tip head to the side being drained-have an
emesis basin
❑ Tip the head to side that is being irrigated
❑ Place the tip of the irrigating device just inside the external meatus –tip visible
❑ Straighten auditory meatus draw pinna up and down
❑ Flow of irrigating fluid should be steady, lavage continues until the cerumen is removed
❑ Drain excess fluid by tilting the head toward the affected side
❑ Impacted cerumen must be manuallt extracted by a physician or apn with an otoscope

and a curette
3. Taste
❑ Contributing factors to taste alterations
▪ Oral condition
▪ Olfactory function
▪ Medications
▪ Diseases
▪ Surgical interventions
▪ Environmental exposure
▪ Medical conditions
Taste
❑ Oral status can affect gustatory function
▪ Poor dentition → improper chewing → less flavor release
▪ Improperly fitting dentures → obstruction of palate → decreased taste perception
▪ Oral infections → release of acidic substances → altered taste + impaired

salivary stimulations → decreased ability for food to dissolve → diminished flavor
❑ Focused assessment for taste disturbances
▪ Head and neck
▪ Mucous membranes
▪ Interview with focus on past dietary habits
❑ Education
▪ Implications of inability to distinguished between salt and sugar
▪ Decreased taste → lack of motivation to prepare + eat → malnutrition
Xerostomia
❑ Cause
◦ Systemic diseases
◦ Radiation
◦ Medications
◦ Sjogren’s syndrome
❑ Implications
◦ Altered taste
◦ Difficulty swallowing → Risk for aspiration pneumonia
◦ Periodontal disease
◦ Speech difficulties → embarrassment → social isolation
◦ Dry lips + dry mucosa → increased infection + dental caries

◦ Halitosis
◦ Sleeping problems
Nursing Diagnoses Associated with Taste Impairment

❑ Sensory/perceptual alterations: gustatory
❑ Intake less than necessary for caloric requirements
4. Olfactory Dysfunction
❑ Statistics
◦ Males > females
❑ Causes
◦ Nasal and sinus disease
◦ Upper respiratory infection
◦ Head trauma
◦ Secondary
 Chemotherapy or other medications
 Radiation
 Current or past use of cocaine or tobacco
 Poor dentition
Olfactory Dysfunction
❑ Special concerns
◦ Safety related to smoke and fire
◦ Malnourishment
❑ Sense of smell fails to be detected because it is not adequately tested
◦ Use three familiar smells
◦ Repeat with both nostrils, in different orders
❑ Nursing diagnoses associated with hyposmia

◦ Sensory/perceptual alterations: olfactory
Nursing Diagnoses
❑ Nursing diagnosis associated with hyposmia
◦ Sensory/perceptual alterations: olfactory
❑ Nursing diagnosis for changes in physical sensations
◦ Sensory/perceptual alterations: tactile
Nursing Assessment
❑ Assess safety and preventive measures
❑ Additional assessment
▪ Nutrition
▪ Patient safety
 Date and label all foods
 Place natural gas detectors in the home (for gas heat)
 Place smoke detectors in strategic locations
 Establish schedules for personal hygiene and house cleaning
 Remove kitchen waste every evening
Learning Objective :Recognize nursing interventions that can be implemented to assist the
aging patient with sensory changes.
Eye Examinations
❑ Healthy older adults
▪ Complete eye examination every 1 to 2 years
 Visual acuity
 Retina
 Intraocular pressure
❑ Diabetics
▪ Complete eye examination annually
Assessment of Vision
❑ Observe appearance
▪ Clothing cleanliness
▪ Self-care
▪ Indications of bumps and bruises
Interview
❑ Adequacy of vision
❑ Recent changes in vision
❑ Visual problems
◦ Red eye
◦ Excessive tearing or discharge
◦ Headache or feeling of eyestrain when reading or doing close work
◦ Foreign body sensation in the eye
◦ New onset of double vision or rapid deterioration of visual acuity
◦ New onset of haziness, flashing lights, or moving spots
◦ Loss of central or peripheral vision
◦ Trauma or eye injury
◦ Date of last exam
◦ Inspection
◦ Movement of eyelids
◦ Abnormally colored sclera
◦ Abnormal or absent papillary response
Vision
❑ Snellen chart or reading from print
❑ Visual field testing
❑ Extraocular movements
Visual Aids
❑ Helpful aids for visually impaired
◦ Low-vision clinics for suggestions
◦ Telescopic lenses
◦ Books in Braille
◦ Computer scanners and readers
◦ Tinted glasses to reduce glare, large print books and magazines
◦ Seeing eye dogs
◦ Canes
❑ Often rejected because of the stigma attached
❑ Very expensive and not covered by Medicare
❑ Register with Commission for the Blind
◦ Books on tape and tape player
◦ Telephones with large numbers
◦ High-intensity lights
Visual Difficulties May Limit Independence

❑ Interference with ability to drive
❑ Trouble reading and writing
Identification of Safety Problems at Home

❑ Provide adequate lighting in high-traffic areas
❑ Recommend motion sensors to turn on lights when an older person walks into a room
❑ Look for areas where lighting is inconsistent; use proper lampshades to prevent glare
❑ Use contrast when painting so that walls, floors, and other structural elements of the
environment can be discriminated easily
❑ Avoid reflective floors
Identification of Safety Problems at Home

❑ Use “hot” colors, such as red, orange, and yellow for signage
❑ Urge the use of supplementary lamps near work and reading areas
❑ Use red colored tape or paint on the edges of stairs and in entryways to provide warning
and signal the need to step up or down
❑ Avoid complicated rug patterns that may overwhelm the eye and obscure steps and
ledges
❑ Teach the importance of walking slowly when entering a room
ARMD Preventive Measures

❑ Nurses should encourage
▪ Wearing ultraviolet protective lenses in sun
▪ Smoking cessation
▪ Exercising routinely
▪ Eating a healthy diet consisting of fruits and vegetables
▪ Taking vitamins in divided doses twice a day to delay progression
 Zinc oxide 80 mgm
PHYSIOLOGIC, PSYCHOLOGIC, AND ENVIRONMENTAL CAUSES OF ACUTE

CONFUSIONAL STATES IN HOSPITALIZED OLDER ADULTS
I. PHYSIOLOGIC
A. Primary Cerebral Disease
1. Nonstructural factors
a. Vascular Insufficiency –transient ischemic attacks, cerebrovascular accidents,
thrombosis
b. Central nervous system infection- acute and chronic meningitis, neurosyphillis,
brain abscess
2. Structural Factors
a. Trauma-subdural hematoma, concussion, contusion, intracranial hemorrhage
b. Tumors- primary and metastatic
c. Normal pressure hydrocephalus
B. Extracranial Disease
1. Cardiovascular abnormalities
a. Decrease cardiac output state-myocardial infarction, arrhythmias, congestive
heart failure, cardiogenic shock
b. Alterations in peripheral vascular resistance-increased and decrease states
c. Vascular occlusion-disseminated intravascular coagulopathy, emboli
2. Pulmonary abnormalities
a. Inadequate gas exchange states-pulmonary disease, alveolar hypoventilation
b. Infection-pneumonia
3. Systemic infective processes-acute and chronic
a. Viral
b. Bacterial- endocarditis, pyelonephritis, cystitis, mycosis
4. Metabolic disturbances
a. Electrolytes abnormalities-hypercalcemia, hyponatremia and hypernatrimia,
hypokalemia and hyperkalemia, hypochloremia and hyperchloremia,
hyperphosphatemia
b. Acidosis and alkalosis
c. Hypoglycemia and hyperglycemia
d. Acute and chronic renal failure
e. Volume depletion-hemorrhage, inadequate fluid intake, diuretics
f. Hepatic failure
g. Porphyria
5. Drug intoxifications- therapeutic and substance abuse
a. Misuse of prescribed medications
b. Side effects of therapeutic medications
c. Drug-drug interaction
d. Improper use of over-the –counter medications
e. Ingestion of heavy metals and industrial poisons
6. Endocrine disturbance
a. Hypothyroidism and hyperthyroidism
b. Diabetes mellitus
c. Hypopituitarism
d. Hypoparathyroidism and hyperparathyroidism
7. Nutritional deficiencies
a. B Vitamins
b. Vitamin C
c. Protein
8. Physiologic stress-pain, surgery
9. Alterations in temperature regulation-hypothermia and hyperthermia
10. Unknown physiologic abnormality-sometimes defined as pseudodelirium
II. PSYCHOLOGIC
1. Severe emotional stress-postoperative states, relocation, hospitalization
2. Depression
3. Anxiety
4. Pain- acute and chronic
5. Fatigue
6. Grief
7. Sensory/perceptual deficits-noise, alteration in function of senses
8. Mania
9. Paranoia
10. Situational disturbances

III. ENVIRONMENTAL
1. Unfamiliar environment creating a lack of meaning in the environment
2. Sensory deprivation or environmental monotony creating a lack of meaning in the
Environment
3. Sensory overload
4. Immobilization-therapeutic, physical, pharmacologic
5. Sleep deprivation
6. Lack of temporospacial reference points
Differentiating Dementia and ACS
CLINICAL FEATURE ACUTE CONFUSIONAL STATE DEMENTIA
Onset Acute/subacute; depends on cause; Chronic, generally insidious;depend on

often occurs at twilight cause
Course Short; diural fluctuations in symptoms; Long; no diural effects; symptoms

worse at night, dark, and on awakening progressive, yet relatively stable over time
Duration Hours to less than 1 month Months to years
Awareness Fluctuates, generally reduced Generally clear
Alertness Fluctuates-reduced or increased Generally normal
Attention Impaired, often fluctuates Generally normal
Orientation Fluctuates in severity, generally impaired May be impaired
Memory Recent and immediate memory Recent and remote memory impaired;
impaired; unable to register new loss of recent memory is first sign; some
information or recall recent events loss of common knowledge
Thinking Disorganized, distorted, fragmented, Difficulty with abstraction and word finding
slow, or accelerated
Perception Distorted, illusions, delusions, or Misperceptions often absent

hallucinations
Sleep-wake cycle Disturbed, cycle reversed Fragmented

How do you communicate effectively with the elderly with impaired verbal
communication?
➢ Use proper form of address. Establish respect right away by using formal language. ...
➢ Make older patients comfortable. ...
➢ Take a few moments to establish rapport. ...
➢ Try not to rush. ...
➢ Avoid interrupting. ...
➢ Use active listening skills. ...
➢ Demonstrate empathy. ...
➢ Avoid medical jargon.
● Cataract – clouding of crystalline lens of eye

● Glaucoma – eye disease involving increased intraocular pressure
● Macular degeneration – loss of central vision due to the development of drusen deposits in the
retinal pigmented epithelium
● Presbyusis – age-related high – frequency sensorineural hearing loss
● Presbyopia – age-related decrease in eye’s ability to change the shape of lens to focus on near
objects
● Xerostomia - refers to a condition in which the salivary glands in your mouth don't make enough saliva
to keep your mouth wet
Watch and Learn:
https://www.youtube.com/watch?v=BwV2EMAdOic
https://www.youtube.com/watch?v=INQFlDsBtq0
Study Questions:
1. What are the effects of aging on sensory function?
2. What can be done to prevent sensory dysfunction vision and hearing losses with aging?
3. Explain language barrier that lead to impaired verbal communication?
Textbooks:
Publishers.610.7365 G31 2010
2016,v.1, c1
W83 2012, c1
Websites:
http://thepoint.lww.com/Eliopoulos8e
http:www.sleepfoundation.org
LECTURIO Aging Process (Nursing): Sensory /Perception Alteration

NCMB314 Prelim Readings

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BACHELOR OF SCIENCE IN NURSING:

NCMB 314 - CARE OF THE OLDER ADULTS

Read PEO (Program Educational Objectives)

At the end of this unit the students are expected to:

The history and development of gerontological nursing is rich in diversity and

The development of gerontological nursing as a specialty is attributed to a host of

Landmarks in the development of gerontological nursing as a specialty:

1902 American Journal of Nursing (AJN) publishes first geriatric article by an MD

▪ “Graying of America” - a phenomenon faced by all nations, not only the

In 2005, 13% of the U.S. population was over age 60

This number is estimated to increase:

▪ To 20 million in 2010 (6.8% of total),

Why The Increase?

IMPACT of the Baby Boomers

▪ They are better educated than preceding generations.

Feminization of Later Life

▪ Women comprise 55% of the older population

Chronic Conditions in Seniors

Ageing population in the Philippines

PSYCOSOCIAL THEORIES OF AGING

II. Psychological theories

BIOLOGICAL THEORIES OF AGING

Age Discrimination – emotional prejudice among the older adult.

Philippine Journal of Nursing

Journal of Gerontological Nursing

Read PEO (Program Educational Objectives)

At the end of this unit the students are expected to:

III Physiologic Changes in Aging

4. Cardiovascular / Hematopoietic & Lymphatic

CHANGES TO THE MIND

Philippine Journal of Nursing

Journal of Gerontological Nursing

Nursing Care of the Older Adult in Wellness (ASSESSMENT)

✔ Recite course and unit objectives

1. Understand 11 Basic functional Health Patterns of Older ADULT

Lecturio Video: Age Related Disorders: Assessing Cognitive disorders

Functional Status Assessment

Functional status is considered a significant component of an older adult’s quality of life.

MiniMental State Examination

3( ) REGISTRATION OF THREE WORDS

5 ( ) SERIAL7s AS A TEST OF ATTENTION AND CALCULATION

3 ( ) RECALL OF THREE WORDS

TOTAL SCORE ___________________________ Assess level of consciousness along a continuum

YES NO YES NO FUNCTION BY PROXY

Gordon’11 Basic functional Health Patterns of Older ADULT

1. Self-Perception/ Self-Concept Pattern

2. Roles/ Relationship Pattern

3. Health Perception/ Health Management Pattern

4. Nutritional / Metabolic Pattern

5. Coping/ Stress-Tolerance Pattern

6. Cognitive/ Perceptual Pattern

7. Value/ Belief Pattern

8. Activity/ Exercise Pattern

9. Rest and Sleep Pattern

10. Sexuality/ Reproductive Pattern

11. Elimination Pattern

✔ Read course and unit objectives

1. Distinguish the categories and types of home care organizations.

PROMOTING HEALTHY AGING

COMPONENTS OF HEALTH PROMOTION FOR THE ELDERLY