NURSING CARE OF ELDERLY

INTRODUCTION:

The lifespan for both male (>65 years) and female (75
years) has raised significantly and it is estimated that by
the turn of this century, numerically the highest number
of old people will be in India. Nurses and health
professionals therefore have to be aware of the
complexity of the care of elder people.

A man's life is normally divided into five main stages

namely infancy, childhood, adolescence, adulthood and old age. In each of these stages an
individual has to find himself in different situations and face different problems. The old age
is not without problems. In old age physical strength deteriorates, mental stability diminishes;
money power becomes bleak coupled with negligence from the younger generation.

ELDERLY CARE

1. Elderly care, or simply eldercare is the fulfillment of the special needs and
requirements that are unique to senior citizens. This broad term encompasses
such services as assisted living, adult day care, long term care, nursing
homes (often referred to as residential care), hospice care, and home care.
2. Elderly care emphasizes the social and personal requirements of senior citizens
who need some assistance with daily activities and health care, but who desire to
age with dignity. It is an important distinction, in that the design of housing,
services, activities, employee training and such should be truly customer-
centered. It is also noteworthy that a large amount of global elderly care falls
under the unpaid market sector.

AGING

1. Ageing is the process of becoming older. Aging is not merely the passage of time. It is
the manifestation of biological events that occur over a span of time.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
 2. Aging is a lifelong process of growing up and growing old. It begins at conception and
ends with death. So, in this sense, we are all aging from the time of birth. In our
younger years, aging is called by other names. For example, in our infant years, we call
aging “growth and development.” In our teenage and young adult years, we refer to
aging as “maturation.” After age 30, our physical body begins to wear out and our
functioning declines.

AGING INCLUDES THREE PARTS:

 Growth and development: In our infant years

 Maturation: In our teenage and young adult years and
 Senescence: After age 30. So, aging should be explained based on these three parts.

DIFFERENT TYPES OF AGING

Aging can be viewed in different way. We need broader eyes, views to understand the aging
related issues. In this context aging is classified as biological aging, psychological aging, social
aging,

Chronological Aging

Chronological Aging is the number of years a person has lived so far. An 85-year-old lady is
chronologically older than a man who is 75 years old. However, chronological age may not
match a person’s biological, psychological, or social age. For example, the 85-year- old woman
may be an active volunteer, while the 75-year-old man could be homebound. Sometimes we
say, “he looks younger than his age,” or “she does not act her age.” In these cases, the
biological, psychological, and social age do not match the chronological age.

Biological Aging

Biological Aging involves the loss of cells over time. With biological aging, tissues and organs
are less likely to function efficiently, the body’s ability to repair itself slows down, and the
immune functions decline, making the body more prone to infection. Biological aging is
sometimes referred to as Physical Aging. A person who keeps fit and gets regular check-ups
can appear biologically younger than someone who is the same age but does not keep fit.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
Psychological Aging

Psychological Aging involves changes in memory, learning, intelligence, personality, and

coping. An older person who is mentally active and is able to deal with new situations can be
said to be psychologically young.

Social Aging

Social Aging refers to changes in roles and relationships as we age. For example, it is not
unusual for older people to gain new roles, like becoming grandparents. Or they may change
roles, from an employee to a retiree. With role changes in later years, society may expect
people to behave in certain ways. So, for some people, it may not be proper for “grandma”
to go roller skating or bungee jumping because “these are things that young people do.” The
social age of a person in a given context can be very important because it shapes the meaning
of aging for the person, and this can make aging a positive or negative experience.

Functional aging

It is related to how people compare psychologically to others to similar age.

CATEGORY OF OLDER PERSONS

With increasing life expectancy and number people increasing day by day in the 60+ category,
age 60 years and above is also further classified for the demographic data collection and for
other purposes also. In the western and developed countries chronologically 65 years is
considered as beginning of aging and accordingly the aging can be classified as:

a) Young old: Year (65 to 74)

b) Middle Old: Year (75 to 84)
c) Old-Old: Years (85+)
d) Centenarians (100+)

NORMAL BIOLOGICAL AGEING PROCESS

The ageing process is the gradual, decreased ability of the body to functions and to heal itself.
As our body age, they naturally deteriorate in the late years, many essential functions begin
operating at a suboptimal level.
There are three main factors that influence the body’s ageing process.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  First as we grow older, the number of mistake incurred by daily Cellular reproduction
increases. The body actually create non-functional cells, leading to more rapid
deteriorate of the body’s functions with advantage age. A large percentage of our cells
even though they were present are useless. These non-functional cells sometime
interfere with normal cellular process.
 The second part of the ageing process related to Cellular damage that cause the
shortening of DNA. As time passes increased damage to healthy DNA leads to
accelerated cell death and our old bodies simply cannot generate cells fast enough to
compensate for the loss. This process is most visible and obvious in our skin the older
we get the thinner our skin becomes.
 The third part of the ageing process involves the Cellular deconregulation of our
national oxidative enzymes such as superoxide dismutase and catalase and
glutathione perxoidase, making our antioxidant defence less efficient with age.

MECHANISM OF AGEING

 The genes determine the lifespan, genes may have a role to play in the ageing process.
 Wear and Tear of important organs by continues functioning.
 Accumulation of toxic materials (E.g. cholesterol) in the vital organ like heart, brain
eye and thereby damaging them.

 Loss of important genetic material during DNA repair.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  Accumulate of stress over lifetime with its resultant effects.
 Exertion of production and deficiency of important hormones e.g. growth hormone
and androgen, oestrogen and thyroid hormones.

 Evaluation of ageing helps to explain why survival, reproductive success, and

functioning of almost all living organism decline at old age.
FACTOR AFFECTING AGING:

Three types of factor that mainly affect aging Genetic and environmental factor, Life style and
Disease

1. Genetic and Environmental Factors

The aging process depends on a combination of both genetic and environmental factors.
Recognizing that every individual has his or her own unique genetic makeup and environment,
which interact with each other, that is why the aging process can occur at such different rates
in different people. Environmental stress associated with exposure to excessive heat and light
trigger the activity of aging genes. However, many environmental conditions, such as the
quality of health care that people receive, have a substantial effect on aging.

2. Life style

A healthy lifestyle is an especially important factor in healthy aging and longevity. Behaviours
of a Healthy Lifestyle:

 Not smoking
 Drinking alcohol in moderation
 Exercising
 Getting adequate rest
 Eating a diet high in fruits and vegetables
 Coping with stress
 Having a positive outlook

Aging process in men is mainly brought about by over consumption of alcohol and
heavy smoking. Lack of exercise, inadequate rest or sleep, mental stress show symptoms of

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
early aging. Other factors like regular consumption of excessive spicy food and caffeine
renders an old look. Sloth and sluggish lifestyle makes one feel old.

3. Disease

Aging and disease are related in subtle and complex ways. Several conditions that were once
thought to be part of normal aging have now been shown to be due to disease processes that
can be influenced by lifestyle. For example:

 Heart and blood vessel diseases are more common in people who eat a lot of meat
and fat. Similarly, cataract formation in the eye largely depends on the amount of
exposure to direct sunlight.
 Osteoporosis and arthritis are the main factors governing aging process in women.
 The toxins produced in Parkinson's disease degenerate the neurons that hinders the
memory of brain.
 In Alzheimer’s disease, a substance known as amyloid is produced that destroys the
brain cells. All these interferes with the normal aging process.

AGE RELATED BODY SYSTEM CHANGES IN ELDERLY / ASPECTS OF AGING:

Normal aging has four aspects:

1. Biological aspect of aging

2. Psychological aspects of aging
3. Sociocultural aspects of aging
4. Sexual aspects of ageing

1. Biological aspect of aging

Individuals are unique in their psychological and physical aging process. As the individual ages,
there is a quantitative loss of cells and changes in many of enzymatic activities within cells.
Age related a change occurs at different rate in different people.

Nervous system

 Decreased speed of neural conduction

 Decreased number of brain cells
 Decrease in cell of the nerve fibres

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  Decreased neurotransmitters
 Decline in memory for recent events
 Decreased rapid eye movement sleep
 Decreased cerebral circulation

Sensory changes

Eye:

 Diminished ability to focus on close objects

 Decreased visual acuity
 The eye's external changes give evidence of advancing age. These changes result from
loss of orbital fat, loss of elastic tissue and decreased muscle tone.
 The cornea flattens which reduces the refractory power
 The retina of older individual becomes thinner because of fewer neural cells and
receives only 1/3rd of the amount of light that of a younger person. Due to this
problem in reading, not able to see in dim light and also have difficulty in colour
perception.
 The lens of the eye loses its elasticity and increases in density

Ear:

 Hearing problem
 Cerumen gland are reduced in number dry and hard ear wax, along with itching.
 Degenerative changes occur in ossicles contributing to hearing loss
 Presbycusis is the term used to describe hearing loss associated with normal aging.

Taste and smell:

 Decreased ability to taste and smell

 Very rarely the capacity to smell diminishes;
 Taste perception and taste discrimination decreases as the age advances

Integumentary system

 Decreased elasticity
 Decreased secretion of natural oil and perspiration

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  Thinning of skin
 Decreased heat regulation
 Decreased protection against trauma and solar exposure
 The number of pressure and light touch sensors decreases with age
 Immune, vascular and thermoregulatory responses of the skin decrease with age.
 Loss of hair colour and thinning of pubic, axillary and scalp hair.

Cardiovascular system

 Decreased physical demands and activity of heart.

 Slower heart rate and reduce cardiac output
 Decreased contractility
 Impaired coronary artery blood flow
 Less oxygen and blood supply to organ, so that it affects the function of organ
 Decreased altered preload and after load
 Increased atherosclerotic plaques and blood pressure
 Diminished ability to respond to stress.

Respiratory system

 Respiratory muscles are atrophied and weaken so reduced the ability of chest enlarge
 Short of breath
 Increased rigidity of thoracic cage, residual lung volume
 Decreased gas exchange and diffusing capacity
 Decreased elasticity and vital capacity
 Decreased cough efficiency.

Musculoskeletal system

 Decreased bone density

 Decreased muscle size and strength
 Decreased joint cartilage
 In aging, the increased parathyroid hormone, decreased vitamin D and calcitonin also
play role in calcium loss in older people.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  In women, estrogen deficiency, calcium malabsorption, lifestyle factors (calcium
intake and exercise) can result in bone loss.
 Aging brings decline in numbers of muscles resulting in reduced muscle mass.
 The muscle strength also reduces especially due to lack of exercise.

Urinary system

 Decreased blood supply and loss of nephrons

 Less blood can filtered by the kidney
 Decreased bladder capacity, and concentrating
 Decreased diluting ability
 Increased prostate size
 Delayed sensation to void
 In female relaxed perineal muscles
 In men, BPH is associated with aging leads to urinary incontinence (dribbling).
 Increasing age is also associated with an increase in involuntary bladder contractions,
a reduction in bladder capacity and an increase in residual volume. These contribute
to development of incontinence in older adults.
 Weak pelvic muscles causes stress incontinence.

Gastrointestinal system

 Decreased salivary secretions, loss of teeth

 Lose of sense of smell and taste so decrease the appetite and desire food
 Slowing of peristaltic action
 Altered nutrition, digestion and bowel function
 Weakening of lower oesophageal sphincter
 Difficult to chew food because of loose teeth.
 Liver weight and size decreases with age
 There is decrease in number of hepatic cells and as a result, a diminished capacity for
metabolism of drugs and hormones.

Reproductive system

Changes in women:

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  Decreased breast tissue
 Sexual dysfunction
 Decreased sexual desire
 Vaginal narrowing and decreased elasticity
 Decreased vaginal secretions

Changes in men:

 In male decreased size of penis and testes

 Erectile ability undergoes changes. Takes longer time for erection, amount of semen
is reduced and the intensity of ejaculation is lessened.
 It is not clear that whether the increase in impotence is age related

2. Psychological aspects of aging

Memory functioning

 Short term memory deteriorate with age, long term memory does not show similar
changes.
 A well-educated and mentally active person does not exhibit such changes in faster
rate.
 The time required for memory scanning is longer for both recent and remote recall
among older people.
 This can be attributed to social or health factors (stress, fatigue, illness), but it can also
occur with certain physiological changes due to aging. (decreased blood flow to the
brain)

Intellectual functioning

 Fluid abilities or abilities involved in solving novel problems, tend to decline from adult
period to old age.
 High degree of regularity in intellectual function present on most of the old age people
 Intellectual abilities of older people do not decline, but do become obsolete.
 Their formal educational experience is reflected in their intelligence performance

Learning ability

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  The ability to learn is not decline by age.
 The slowing of reaction time with age and over arousal of central nervous system are
noted in old age. It may lead to lower level of performance in tasks which requires
high efficiency.
 Ability to learn continue throughout the life, although strongly influenced by personal
interests and preferences.
 Accuracy of performances diminishes.

Loss and grief

 By the time individuals reach 60-70 yrs. of age, they have experienced numerous
losses, and mourning has become a lifelong process.
 It is impossible for some of the older age people to complete the grief process in
response to one loss before the other loss occurs.
 Because the Grief is cumulative, this can result in bereavement over load.
 This can further predispose to depression. Attachment to others
 The need for attachment is consistent throughout the life span
 Wellbeing of senior citizens can be contributed through socialization and
companionship.

Dealing with death

 Death anxiety among the elderly is more of a myth than reality

 The feeling of abandment, pain and loss may leads to fear or anxiety in elderly
Psychiatric disorders
 The later life constitute a time of especially high risk for emotional distress
 Dementia, depressive disorders, delirium, sleep disorders etc. are the most common
psychiatric illness seen among elderly.

3. Sociocultural aspects of aging

 Old age brings many important socially induced changes, some of those changes have
the potential for negative effect on both the physical and mental wellbeing of older
persons
 They want protection from hazards and weariness of everyday tasks

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  They want to be treated with respect and dignity and also want to die with respect
and dignity
 In developing countries and Asian countries the aged are awarded a position of
honour, that place emphasize on family cohesiveness.
 In industrialized countries many negative stereotyped perspectives on aging still
persisting, aged are always tires or sick, slow and forgetful, isolated and lonely,
unproductive etc.
 Emplacement is one of the area where the aged faces discrimination. Although
compulsory retirements has been eliminated, discrimination still persist in hiring and
promoting the aged employees.
 The status of elderly may improve with time as the number of elder person increases
world wide

4. Sexual aspects of ageing

Changes in female:

 Menopause may begin anytime during the 40s or early 50s

 Gradual decline in the functioning of the ovaries and subsequent reduction in the
production of oestrogen.
 The walls of the vagina become thin and inelastic and vaginal lubrication decreases.
 Orgasmic uterine contractions become spastic.
 All these changes result in vaginal burning, pelvic aching, irritability etc
 In some women these changes result in avoidance of sexual intercourse
 These symptoms are more likely to occur with infrequent intercourse of only one time
a month or less
 Regular and more frequent sexual activity result in a greater capacity for sexual
performance

Changes in male:

 Testosterone production decline gradually as the age increases

 As a result of these hormonal changes the erection takes place slowly and requires
more genital stimulation to achieve.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  The volume of ejaculate decreases and the force of ejaculation lessens
 The testis become smaller, but most men continue to produce viable sperm well in to
old age.

THEORIES OF AGEING / EVOLUATIONARY BASIS OF AGEING

Ageing theories which mainly has been categorise into two main categories:
I. Error Theory
Ageing is a result of internal or external assaults that damage cells or organs so they can no
longer function properly.
II. Programmed Theory
Ageing has a biological time table or internal biological clock.

1. Error Theory
 Waste accumulation theory
 Mitochondrial damage theory
a) Waste Accumulation Theory
The human lifespan simply reflects the level of free radical damage that accumulates in cells
when enough damage accumulates, cells cannot survive properly anymore and they just
simply give up.
Genetic mutations occur and accumulate with increasing age, causing cells to deteriorate and
malfunction RNA molecule is highly susceptible to oxidative stress
b) Mitochondrial Damage Theory
It is well known that mitochondrial DNA is much more oxidized with age than nuclear DNA
reactive oxygen species are continuously generated in the mitochondrial electron transport
chain.

2. Programmed Theory
a. Immunological Theory
The immune system is programmed to decline over time which leads to an increased
vulnerability to infections, disease and thus aging and death. It is well documented that the
effectiveness of the immune system peaks at puberty and gradually declines thereafter with
advance in age. e.g. as one grows older antibodies lose their effectiveness.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
Biological Aging Theories

a) Evolutionary

 Once an organism has produced viable offspring its body is no longer needed. It then
ages and dies.

 Certain genes may be useful in early life but detrimental in later life.
 Late acting genes have not been removed because they act after reproduction.

b) Physiological

 Programmed theories maintain that ageing occurs due to intrinsic timing mechanisms
and signals. e.g. Genetic timers.

 Stochastic theories maintain that ageing occurs as the result of chance or accidental
events. e.g. free radical damage.
HEALTH PROBLEMS IN OLD AGE / COMMON HEALTH PROBLEMS IN ELDERLY:

I. Physical health problems among older adults:

1. Cardiovascular system:

 Hypertension
 Ischemic heart disease
 Heart failure
 Peripheral vascular disease

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  Varicose veins
 Stroke attack

Nursing intervention:

 Exercise regularly, pace activities

 Avoid smoking
 Eat a low fat, low salt diet
 Weight control
 Check blood pressure regularly
 Participate in stress reduction activities
 Regular medication

Respiratory system:

 Chronic pneumonia
 Obstructive pulmonary disease
 Dyspnoea
 Breathlessness

Nursing intervention

 Deep breathing exercise regularly

 Avoid smoking
 Take adequate fluids
 Prevent pulmonary infections
 Avoid crowds during cold and flu season
 Wash hands frequently

Neurologic behavioural:

 Parkinsonism-characterized by tremor, rigidity, slowness of movement

 Alzheimer disease- loss of short term memory, deterioration in behavior and slowness
of thought
 Dementia- it is a chronic or persistent disorder of behavior and higher intellectual
function due to organic brain disease.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  Depression, anxiety
 Sleep disturbance

Nursing intervention:

 Advice for hospitalization and encourage visitors

 Teach fall prevention technique
 Environmental safety like sufficient light, proper chairs for seating, elevated toilet
seats
 Encourage slow rising from a resting position
 Reduce the risk of falls

Gastrointestinal system:

 Problem with speech, chewing and swallowing

 Constipation
 Lose of teeths
 Colon gas and faecal impaction
 Diarrhoea
 Gastro oesophageal reflux or hernia
 Faecal incontinence, prolapsed rectum
 Dysphagia, anorexia

Nursing intervention:

 Use ice chips

 Mouth wash, brush, massage gums daily
 Eat small quantity, frequent meals
 Eat high fibre, low fat diet, limit laxatives
 Toilet regularly
 Drink adequate fluid
 For appetite serve food attractively and different types of foods

Urinary system:

 Renal insufficiency

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  Urinary incontinence
 Urinary tract infection
 Enlarged prostate in males
 Sexual dysfunction

Nursing intervention:

 Regular supervision is necessary

 Ready access to toilet
 Drink adequate fluids
 Avoid bladder irritants e.g. alcohol, caffeine
 Practice pelvic floor muscle exercise
 Maintain perineal hygiene
 Skin should be clean and dry. Apply cream
 Clean underclothes

Reproductive system:

 Female- breast cancer, cervical cancer

 Painful intercourse
 Vaginal bleeding, vaginal itching and irritation
 Male- prostate cancer
 Delayed erection

Nursing intervention:

 Health and sexual counselling

 Advice about personal hygiene

Musculoskeletal system:

 Paget’s disease
 Osteoporosis
 Osteomalacia
 Rheumatoid arthritis
 Spondilosis

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  Complaints of back pain and joint pain
 Stiffness of joints
 Fractures
 Foot pathology gait disturbance

Nursing intervention:

 Exercise regularly
 Eat high calcium diet
 Limit phosphorus intake
 Hormones and calcium supplements may be prescribed

Dermatologic:

 Pressure sores
 Herpes zoster
 Dermatitis
 Pruritus

Nursing Intervention:

 Avoid solar exposure

 Cloth dress appropriately for temperature
 Maintain a safe indoor temperature
 Bath only 1-2 times weekly
 Excessive use of soap should be avoided
 Apply cream for lubricate skin

II. Mental health problems among older adults:

MENTAL HEALTH
Changes in cognitive ability, excessive forget fullness and mood swings are not a part of
normal aging. Changes in mental status may be related to many factors such alteration in diet
and fluid and electrolyte balance. Therefore health professionals must recognize, assess,
refer, collaborate, treat and support older adults exhibit noticeable changes in intellect of
affect.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
Some of the Common Problems
 Depression
 Acute confusional state (Delirium)
 Anxiety disorders
 Cognitive impairment and dementia
 Late life delusional disorder
 Alcoholism
 Personality disorder
 Obsessive compulsive disorder
 Drug and substance abuse.
 Sleep and rest pattern
 Coping abilities

Dementia
Dementia and acute confusional state usually
are the result of organic diseases characterised
by impairment of intellectual functions. E.g.
Aphasia, aphaxia.

Clinical Manifestations

 Language impairment
 Apraxia (difficulty in performing skilled
tasks)

 Agnosia (inability to recognise objects)

 Impaired executive function (poor performance, poor judgement and planning)

Diagnosis

 History collection

 Clinical examination including mental

 function

 CSF examination

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  CT scan

Treatment
 Home health aid to assist in personal hygiene home cares to assist in house work
transportation
 Support groups such as the alzhemeirs associations are often of value to the family
 Legal council should be recommended to help the patient and family

Depression

Depression occurs in 5 to 10% of community - dwelling elderly

due to lack of social supports.

Clinical Manifestations

 Sleep disturbance
 Lack of interest
 Feeling of guilty
 Suicidal ideation

Treatment

 Medical and pharmacological Management Methylphenidate 5 to 10 mg at 8 a.m. and

noon is often very effective.

 Treatment should be continued for up to a year because relapse rates are higher in the
elderly.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
Acute Confusional State (Delirium)

 Delirium called acute confusional state

and progressive to disorientation.

 Delirium due to hyponatraemia,

hyperosmolality, hypercapria

Clinical Manifestations

 Disturbance in memory,
 Thought disorder
 Emotional changes
 Disturbance of perception.

TREATMENT

 Supportive treatment ECT (Electroconvulsive Therapy)

 Anopsychotics

SENSORY SYSTEM
People interact with the world through the sense, sensory losses associated with old age
affect all sensory organs. Nearly half of older man and one third of older women report
difficulty hearing without aHearing Aid 16% of old men and 19% of older women report
difficulty seeing even with the corrective lenses.

Sensory Problems

 Decreased visual perception

 Decreased elasticity of the ear drum

 Decreased sense of smell

 Decreased taste perception

 Decreased touch sensation

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
Vision

 Decrease peripheral vision.

 Decrease night vision.

 Decrease capacity to distinguish colour.

 Reduced lubrication resulting in dry, itchy eyes.

Management

 Approach people directly not from the side.

 Proper lighting can make a big difference.

 Assist with choosing clothes if needed

 Use of natural tear products.

Hearing

 Auditory changes begin to be noticed at about 40

years of age.

 Environmental factors such as exposure to noise,

medications and infections as well as genetics may
contribute to hearing loss.

 Hearing loss may cause older people to respond

inappropriately.

 Older people often cannot following conversation because tones of high frequency
consonants (F, S, TH, CH, SH, B, T, P) all sound alike.

Management

 Reduce extra noise when trying to have a conversation.

 Place yourself so the person can see you and fairly close – increased volume not
always helpful.

 Make sure you have the person’s attention before speaking.

 Have doctor check for and remove wax if needed.

 Arrange for hearing assessment and provide support to use a hearing aid if needed.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
Taste and Sweet

 Four basic taste (Sweet, Sour, Salty and Bitter) are particularly dulled in older people.

 Changes in the sense of smell are related to cell loss in the nasal passage and in the
olfactory bulb in the brain.

 Environmental factors such as long term exposure to toxins (Dust, Pollen and Smoke)
contribute to the cellular damage.

Management

 May enjoy smaller attractive meals help to smell food preparation.

 Serve the food in attractive ways.

Skin

 Age related changes the thickness of

epidermis decreases along with loss of
moisture making the skin dry and rough.

 The melanocyte number decline which

reduces protection against Sun rays and leads
to appearance of small hypopigmentedspots.

 In the dermis the fibroblast number and the

production of extracellular matrix decreases causing wrinkling of the skin.

 Scalp are turns grey due to loss of melanin.

 Growth of nails slows down.

Management

 Use of moisturizers are bath oils can make bath tub slippery.

 As a care provider keep nails short

 Pat gently when helping to dry after bathing.

 Bottom of feet may be core pay attention to foot dear.

 May feel cooler than others but be more at risk of sun stroke.

 Use sun screen hats long sleeves.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
  Be careful with such things as hot water bottles.
HEALTH PROMOTION IN ELDERLY:

Health maintenance and health promotion is very important. In health care of elderly
following points are included:

1. Exercise and activity

2. Nutrition and diet
3. Stress management
4. Self-care and responsibility
5. Community services

Exercise and activity:

Balance between exercise and activity is most important for elder person as it decrease risk
of many health issues. Exercise also improve nutrition and reduce stress. In addition it
decrease risk of hypertension or maintain blood pressure in hypertensive elder person. It
increase oxygen saturation and increase lungs capacity. Elder person should do exercise on
regular basis as tolerated. They should do light exercise like walking and slow running.

Nutrition and diet:

Maintenance of nutritional status in elder persons are also important because with increase
in age digestive capacity diminish. The nutrition should be well balance that has higher
amount of calcium, iron and other essential nutrients. Following things should be considered
by elder person regarding diet:

 Meal time should be kept simple and calm.

 Food is cut in to small pieces to prevent choking.
 Liquids food may be easier to swallow.
 Temperature of the food should be checked to prevent burns.
 Encourage for good mouth care.
 Avoid alcohol.
 Review all prescription and over the counter medication with patient and evaluate
nutritional status.

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
Stress management:

By the time individuals reach 60-70 yrs of age, they have experienced numerous losses, and
stress has become a lifelong process. In addition hormonal changes also cause stress among
elderly. So stress management is essential for them. Long term stress cause hypertension,
stroke and heart disease. Explain older person about stress management techniques like
yoga, exercise meditation etc.

Self care and responsibility:

Older person also need to learn about self care and responsibility. So following instruction
can be given to them about self care:

 Monitor blood pressure and blood sugar regularly.

 Diet control and balance diet.
 Stop alcohol consumption and smoking
 Get vision and hearing checked periodically.
 Advice to take proper rest and sleep.
 Exercise regularly.

Community services:

Many community supports exist that help the older person maintain independence. Informal
sources of help, such as family, friends, the mail carrier, church members, and neighbors, can
all keep an informal watch. Area Agencies on Aging perform many community services,
including telephone reassurance, friendly visitors, home repair services, and home- delivered
meals. Homemaker and chore services can be obtained at an hourly rate through these
agencies or through local community nursing services.

Most commonly used services are as follow:

 Group counseling centre

 Adult day centre
 Rehabilitation centre
 Hospice care
 Ambulatory care centre

Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)
Prepared by: Mr. Deepak Patel, M.Sc. Nursing, BTNC, Sagar (M.P.)