Seminar

on
Geriatric Consideration

Presented By
Ajay Kumar Patel
M.Sc. Nursing 2nd Sem.
INTRODUCTION:

• Ageing is the ultimate end

result of life and is an
essential part of it but the
duration of ageing and it is
intensity can be decreases.

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• Meaning of Geriatric:
The word “GERIATRICS
“is derived from Greek word
‘geras‘ means old age and
‘atrics’ means cure of illness.
Dr.Nascher is the father of
geriatrics.

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Definition:
Ageing is a natural process. Old age
is an incurable disease.
Acc. to Seneca
Ageing is the progressive and
generalized impairment of functions
resulting in the loss of adaptive
response to stress and in increasing
the risk of age related diseases.
Acc. To Dr.A.B.Dey
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GERENTOLOGY
• It is the study of ageing and older adults .
It is a specialized area within various
disciplines such as nursing, psychology, and
social work.
GERIATRICS
• “The branch of medicine dealing with the
age physiological & psychological aspects
of aging & with diagnosis, treatment of
disease affecting older adults.”

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GERONTOLOGICAL NURSING :

“It is concerned with assessment

of the health & functional status
of older adults, diagnosis, planning
& implementing health care &
services to meet the indentified
needs.”

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Purposes of Geriatric Study:
Larger people requiring care.
Considerable period of life after 60
or 70 requiring care.
No decline in the number or proportion
of other people requiring care.
Competition among groups due to
scarcity of resources in developing
countries.

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CATAGORIES OF AGED
POPULATION
• Young: 65-75yrs
• Old: 75-85yrs
• Old-old: 85-100yrs
• Elite old: Over 100yrs
Women have a longer life expectancy
than men.

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THEORIES OF AGEING:
1.Wear and tear theories -
Proposes that like automobiles vital
parts that run down with time ,
leading to ageing and death, faster
an organism live faster it dies .
It states that cells wear out through
exposure to internal and external
stressors, including trauma chemicals
and build up of natural waste.

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2. Endocrine theory:

Events occurring in the

hypothalamus and pituitary are
responsible for changes in
hormone production and response
that result in the organism’
decline.

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3. Free radical theory:
Unstable free radicals result
from the oxidation of organic
materials. These radicals cause
biochemical changes in the cells
and cells cannot regenerate
themselves

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4. Genetic theory:
• Organism is genetically programmed
for a predetermined number of cell
divisions after which the organism
dies.It also states that damage to
the protein synthesis occur, faulty
proteins will be synthesized and will
gradually accumulate, causing a
progressive decline.

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5. Cross linking theory:

Irreversible ageing of proteins such

as collagen is responsible for the
ultimate failure of tissues and
organs. As cells age chemical
reactions create strong bonds b/n
proteins. These bonds cause loss of
elasticity, stiffness, and eventual
loss of functions.

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6. Immunological theory:
Proposes that the immune system
becomes less effective with age,
becomes less resistance to
diseases.As immune function
decreases an increase in
autoimmune response occur,
causing the body to produce
antibodies that attack it.

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 CONCEPTS IN THE PRACTICE OF
GERIATRICS:
 Some cases such as anemia, confusion,
and recent onset of incontinence
warrant immediate attention as they
may be associated with several life
threatening conditions.
 All clinical abnormalities complained or
detected cannot be given equal
importance and need to be prioritized.

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Conti..
 A single diagnosis for many coexisting
symptoms is not possible in old age.
Many diseases coexist and needs a
multiple management strategy.
 Multiple small deficits often produce
major disability and multiple small
interventions produce dramatic results
 Older people often require rapid access to
health care and may need specialized care.

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Conti….
 Apart from medicines and surgeries,
physiotherapy and counseling play a
major role in care of older patients
 Contrary to popular belief, all kinds
of prevention are effective in old age.
Nurses and health care workers;
therefore provide preventive
interventions in all situations.

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CARE SETTINGS FOR ELDERS:
Acute care facilities:
Long term care facilities:
Hospice
Community

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Acute care Facilities:
• Preventing nosocomial infections.
• Preventing therapy related problems
(eg. confusion, sleeplessness,
dehydration and decreased nutrition).
• Assessing for potential undiagnosed
health problems(eg.depression ,drug or
alcohol abuse)
• Preventing complications (e.g. decubitis
ulcer).

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Long term care:
• Assisted living -provides meals, weekly activities,
and a pleasant environment to socialize.
• Intermediate living - provides additional
assistance, no longer able to live independently,
24hrs direct nursing contact.
• Skilled care units- care for clients on tube feeds,
IVs chronic wounds, and ventilators.
• Alzheimer’s units- involves patients with
progressive dementia, memory loss, inability to
care for themselves

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Hospice:
• Requires a great deal of patience,
expertise, understanding,
interdisciplinary communication, and
compassion skills on the part of
gerontology nurses.
• Rehabilitation : Goal is to maintain
physical independence
(eg. After orthopaedic surgery, stroke,
or amputation).

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Community:
• Home health care—prevents hospital
readmissions.
• Nurse run clinics-helps to manage chronic
illness.
• Adult day care---focus is on social
activities where the level of nursing varies
from giving bath, administering medication
to wound dressing .Family members who
care for their elders and are working
during the day often use these settings.
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PROBLEMS OF OLD AGE:
PHYSIOLOGICAL CHANGES
Cardiovascular:
Reduced cardiac output and stroke volume.
shortness of breath.
Reduced elasticity & increased rigidity of arteries.
progressive loss of myocardial muscle cells.
hypertension,
ischemic heart disease,
congestive cardiac failure, (syncope)

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• Nursing management:
• nutrition ,
• Activity
• Prevent drug side effects
• salt restriction,
• follow up.

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Respiratory:
increased risk of infection.
declines Muscles strength.
thoracic cage becomes stiff and rigid.
Decrease in cough reflex causes
obstruction.

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Problems:
 pneumonia,
tuberculosis,
bronchial asthma,
chronic obstructive pulmonary
disease,
lung cancer.

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Nursing management:
Proper positioning of the patient.
Administration of oxygen and
nebulized drugs.
Proper dietary management.
Training in relaxation techniques.
Assistance in medication.
Psychological support.
Assistance in mechanical ventilation.

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G I System:
Delayed swallowing.
Delayed emptying of liquids.
Gastric secretions may decrease or increase
cause infection.
Malnutrition
Decreased peristalsis.
Liver volume blood perfusion decline with age
detoxification of toxins, hormones, etc.

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Problems :
hiatus hernia,
gastro-oesophageal reflux,
peptic ulcer, cancer of
gastrointestinal tract,
constipation. Constipation is not a
part of normal age related changes.
Hepatobiliary disease is often due
to drugs.

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• Nursing management:-
Wt. loss if person is obese.
Small, frequent, bland food.
Avoid tea coffee, tea and colas.
Sleeping in semi upright position.
Taking antacids .

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Endocrine System:
Circadian rhythm of various
hormones declines,
circulating growth hormone
level declines ,
insulin secretion decreases.

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Problems :-
• Diabetes mellitus,
• hypothyroidism,
• hyperthyroidism.

Nursing management :-
»Health education.
»Planned diet.
»Care of feet.
»Regular followup.
»Blood pressure monitoring.
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Musculoseletal System :
• Loss of muscle strength,
• loss of motor cells & their
replacement by connective tissue.
• Bone loss starts between 35 to 45
yrs in both sexes,
• bones becomes porous &prone to
fractures

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• Problems :-
• Osteoarthritis,
• rheumatoid arthritis,
• osteoporosis, fractures,
• hip displacements etc

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Nursing management :-
• Prevent fractures.
• Ca. & vit. Rich diet
• Avoid tea, coffee,& alcohol.
• Brisk physical exercise.
• Hormonal therapy to women.

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Genito-urinary System:
• Menopause between 40-50 years of age.
• ovaries reduce the production.
• Several physical changes occur in woman.
• Loss of bladder control specially in female.
• Older men don't experiences hormonal changes
• enlargement of the prostate over 65 yr
• The kidney size & no. of nephrons decline with
age.
• The bladder capacity decreases.
• Enlarged prostate can block the urine flow.
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Problems:
• UTI,
• BPH,
• Malignancy of prostate,
• urinary in continence.

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Nursing Management:
• Regular voiding.
• Limiting of fluid intake to day time
• Preventing leakage
• Avoiding sternous exercise
• Limiting the use of dietary irritants.
• Practicing relaxation techniques
• Maintaining good skin & personal hygiene
• Monitoring for UTI

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Sensory System:
Skin
 fragility.
 Progressive wrinkling & sagging,
 brown age spots
 Increased dryness & pallor,
 decreased perspiration & thinning & greying of hair etc.
Due to decrease in sebaceous gland activity,
 loss of subcutaneous fat.
 loss of skin elasticity,
 reduced no. of sweat glands & clustering of
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 Eye: -
Eye becomes lax.
lens becomes rigid,
loss of accommodation,
degeneration of retina,
inability to see small objects,
extra sensitivity to glare etc.

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 Ears
 presbycusis,
 can interfere with socialization,
 make them mentally impaired .
 The following behaviour indicate hearing loss;
 Tend to shout or speak loudly.
 Ask to repeat things, talks little ,
 Becomes suspicious.

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 Taste and smell
• taste buds diminish and interfere with
the enjoyment of food .Receptors for
smell decreases.

Problems: -
reduced food intake, excess use of salt &
sugar, inability to smell may lead to fire
hazard.

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 PSYCHOLOGICAL CHANGES
Stresses of old age:
Widow hood or death of significant other ,
caring for an aged & diseased spouse , fear of
death , financial problems social isolation &
loneliness , ageism & age discrimination
Depression:
Commonest mental health problem in old age
Usual complaints are somatic , sleep disturbance
& agitation

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Delirium:
It is an acute confusional state & is a potentially reversible
cognitive impairment due to physiological causes, may also be
due to environmental factors.
The usual causes are as follows:
• Side effects of drugs.
• Electrolyte imbalance & dehydration
• Nutritional deficiencies
• Hypoxic states as anemia & hyotension
• Hypoglycemia & hyper glycemia
• Hearing & vision deficiencies
• Relocation to unfamiliar places & people

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Dementia:
It is a progressive loss of cognitive
function. Deterioration leads to a decline
in the ability to perform basic &
instrumental activities of daily living. The
most common form of dementia is
Alzheimer’s disease.
Dementia is themost common health
problem of old age.

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Approaches in reducing violent
behavior:
• Make a routine for daily care,
• determine the ideal time of day to
do needed things,
• Do not surprise the person,
• Avoid the arguments, divert the
attention,
• Reorient to time, person & place

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Stroke:
(Interms of frequency, urgency & hospital
admissions stroke is the most common problems,
one of the top three causes of death & disability in
later life).
• It can be occlusive, thrombotic, embolic or
hemorrhagic strokes.
• Risk factor can be hypertension, increasing age,
family history, obesity, lack of exercise, heart
failure, Atrial fibrillation, diabetes mellitus, and
anticoagulant therapy.

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Mgt. to minimize impairment
Prevention & treatment of complication Intervention include –
• Nutrition, skin care, positioning to avoid aspiration,
bladder & bowel care.
• Rehabilitation to minimize disability
• Adaptation to minimize handicaps
• Hypertension is the single most imp. risk factor for
stroke. Primary prevention of stroke is one of the
imp. goal of healthy ageing & achievement of this
goal demands early detection & control of
hypertension.
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PSYCHOSOCIAL CHANGES
A number of theories have attempted to explain
psychosocial changes.
1. Disengagement Theory :
Proposes that mutual withdrawl between
older people and his environmental occur.
2. Activity Theory :
Proposes that best way to age is to stay
active physically and mentally.

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3. Continuity Theory :
People maintain their values, habits of and
behavior in old age.
3. According to Erikson :
Development task is (ego integrity vs.
despair) the people who attain integrity have
sense of wholeness and accept death as an
accomplishment.
By contrast, the people who ‘despair’ often
feel bad on choices they made in their life.

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 COGNITIVE CHANGES
Perception:-
It is the ability to interpret the environment.
• The ability to perceive the environment
& react appropriately in diminished.
• The brain loses mass with ageing,
• blood flow to the brain decreases,
• The meninges thicken & brain
metabolism slows.

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Cognitive ability:-
• In elders, it is more often a difference in speed
than in ability.
• Overall older adults maintain intelligence,
problem solving, judgment, creativity & other
well practiced cognitive skills.
• Memory impairment is more prevalent in persons
over age 85.
• Cognitive impairment that interferes with normal
life is not considered part of normal ageing.

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Memory -
• Sensory memory – It is the momentary
perception of stimuli from the
environment
• Short term memory - Information held
in the brain for immediate use, also
referred recent memory.
• Long term memory - Information stored
for periods longer than 72 hrs & usually
weeks & years.

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Learning :-

Needs additional time for learning ,

largely because of the problem of
retrieving information . Have more
difficulty than younger ones in learning
information they do not consider useful.

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Adverse Drug reactions :
• Older person require multiple drugs due to the
presence of multiple diseases. As a result
adverse drug reactions are quite common . The
effect and absorption of drugs get changed due
physiological changes of old age.
• Common adverse drug reactions are confusion,
delirium, postural hypotension falls, anxiety,
depression, sleep disturbance, constipation,
diarrhea, urinary incontinence and urinary
retention.

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To avoid drug reactions:
– Frequent review of medication.
– Instructions about possible side
effects.
– Minimize the number of drugs.
– Use of specific drugs for specific
illness.
– Use of drugs and minimal side
effects.
– Limited use of over the counter drugs.

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 Development tasks of elders:
65-75 years ->Adjusting to:
• Decreased physical strength and health.
• Retirement and lower income.
• Death of parents, spouses and friends.
• Leisure time.
• Slower cognitive and physical response.
• Active and involved.
• Satisfying living arrangements as ageing
progresses.
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75 years and Older:
• Adapting to living alone.
• Safeguarding physical and mental health.
• Possibility of moving into a nursing home.
• Remaining in touch with other family
members.
• Finding meaning in life.
• Adjusting to one’s own death.

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ELDER MISTREATMENT
Elder abuse refers to the ill treatment of an older person.
Home is usual place of abuse. It can be physical abuse,
psychological, financial.
• Physical abuse: Intentional use of force leading
to pain and injury.eg. slapping, hitting., pushing,
burning and sprains, cuts etc.
• Psychological abuse:Repeated and consultant
use of threats, humiliation, scolding.
• Financial abuse: Includes unauthorized and
improper use of resources of the older person.

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Neglect:
Includes repeated deprivation of
the assistance that the older
person needs for activities of daily
living,
eg. Failure to provide food, shelter,
clothing, medical fee, hygiene,
bedsores, over sedation,
depression, confusion etc.

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Identification of older abuse:
Usually difficult to recognize.
• Skin injuries, bruises, bedsores with inadequate
explanation.
• Evidence of sever malnutrition.
• Poor personal hygiene
• Bleeding from genitor urinary tract and afraid
/hesitant to talk about.
• Left alone without much to do for enjoyment.
• Most commonly victim are widows, economically
dependent,
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Prevention:
• Assessment of older physical, mental
capacity.
• Assessment of general quality of care.
• Assessment of relation with the abuser
at home or in the institution and his
problem.
• Counseling of abuser.
• Information to appropriate agencies

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HEALTH EDUCATION FOR ELDERS
Human Biology:
Family Health:
Nutrition:
Hygiene:
Control of Disease:
Mental Health:.
Prevention of Accidents:
Use of Health services:

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FACILITIES PROVIDED BY GOVT.
In most of the society family members provide
the bulk of support and care to older adults.
In India the social programs are minimal as follow:
National old pension scheme.
Widow pension scheme.
Pension and family pension scheme for
govt. employees.
Govt. run old age homes.

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Conti…….
Income tax benefits.
Medical insurance for accident and hospital
treatment.
Supply of grains under “Annapurna Scheme”
Priority telephone connections.
Special counters for railways reservation,
filling of income tax returns.
Training of informal career by National Open
School and National Institute of Social defense.

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 POLICY FOR RAILWAY
CONCSSION
 The persons aged 60 years above
shall be granted 30% concession and
the concessions will be admissible in
all classes and trains including
Rajdhani & Satabdi.
Separate reservation counters shall
be earmarked for the senior
citizens.

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• References:-
1. Berman A, Snyder S.J, Kozier , Erb G; Promoting health
in elders , Fundamentals of nursing.8thed.2008; Pearson
education .406-427.
2. Potter P. A., Perry A.G; Older Adults, Fundamentals of
nursing. 5th ed.2001;Harcourt (India) pvt.ltd. 244-272.
3. Dey A.B; A Manual for trainers for nurses, Health care of
older people; 2003.
4. Molony S. L; Why assess older adults for inappropriate
medication use ; A J N. Jan-2009; 109 ( 1) : 69-78.

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5. Titler M , Dochterman J. ,et.al. Nursing interventions and
other factors associated with discharge , disposition in
older patients after hip fracture . Nursing research July-
Aug 2006;55 ( 4 ): 231-242.
6. P.Princy Yesudian and D.P.Singh.Profile of elderly
women in India.HelpAge India Research & Development
Journal .May2009;15 (2).
7. Tae Wha Lee,Sue Kin ,Seun Young Joe.Changing health
care issues and context for elderly women in
Asia;Implications for a research agenda for
nursing.Nursing Outlook2008;56:308-313.
8. Paul Y.Takahashi.Pressure ulcers and prognosis:Candid
conversations about healing and death.Geriatrics
Nov.2008;63(11):6-9
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