GERIATRICS

“Grow old with me/ the best is yet to be. /The last of life, for which the first was made.”
By: Robert Browning
Late Adulthood can be divided into 4 subgroups:
 65 to 74 yrs. Of age – Young old
 75 to 84 yrs. Of age – Middle age
 85 to 99 yrs. Of age – Old old
 100 yrs. Or more – Elite old
DEFINITION OF TERMS:
 GERONTOLOGY – the science & study of aging process
 GERONTOLOGIC NURSING – the care & attention to individuals undergoing the aging process with the emphasis
on the developmental stages of aging
 GERIATRICS – the science & study of the physiologic & pathologic problems of individuals in their later maturity;
a medical specialty that addresses the diagnosis and treatment of physical problems of the elderly
 GERIATRIC NURSING – care of the elderly individual regardless of whether they are diseased or not
 SENESCENCE – the normal aging process
 SENILITY – aging process characterized by severe mental deterioration
 AGING – physiologic, behavioral & social changes that occur with increasing chronological age

I. A.COMMON BIOLOGIC THEORIES OF AGING

THEORY TYPE HYPOTHESIS

1. WEAR & TEAR THEORY -Proposes that humans like automobiles have different parts that run down with
time, leading to aging & death
-proposes that the faster an organism lives, the quicker it dies
-proposes that cell wear out through exposure to internal & external stressors
(trauma, chemicals, build up of natural wastes)
2. ENDOCRINE THEORY -proposes that events that occurring in the hypothalamus & pituitary are
responsible for changes in hormone production & response that result in the
organism’s decline
3. FREE – RADICAL THEORY -proposes that unstable free-radicals (groups of atoms) result from the oxidation
of organic materials such carbohydrates, & proteins. These radicals cause
biochemical changes in the cells & the cells cannot regenerate themselves.
4. GENETIC THEORY / -proposes that organism is genetically programmed for a predetermined number
MUTATION THEORY of cell divisions, after which the cells/organism dies
-proposes that when damage to the protein synthesis occurs, faulty proteins will
be synthesized & will gradually accumulates, causing a progressive decline in the
organism
5. CROSS – LINKING THEORY / -proposes that the irreversible aging of proteins such as collagen is responsible for
COLLAGEN THEORY the ultimate failures of tissues & organs
-proposes that cells age, chemical reactions create strong bonds, or cross-
linkages between proteins. These bonds cause loss of elasticity, stiffness, &
eventual loss of function
6. AUTOIMMUNE THEORY / -proposes that the immune system becomes less effective with age, & viruses that
IMMUNOLOGIC THEORY have incubated in the body become able to damage body organs
-proposes that a decrease in immune function may result in an increase in an
autoimmune responses causing the body to produce antibodies that itself
I. B. PSYCHOSOCIAL THEORIES
 Described the aging individual in terms of his / her social group / culture.
1. DISENGAGEMENT THEORY -the basis of this theory arises from the fact that human beings are mortal & must
eventually leave their place & role in society. Therefore, it is their responsibility to
look for suitable replacement
2. ACTIVITY THEORY -assumes that the same norms exists for all mature individuals. The degree to
which the individual “acts like” or “looks like” a middle – aged is the determinant
of the aging process
-one must constantly struggle to remain functional & take on new activities to
replace lost one
3. CONTINUITY THEORY -accounts for the continuous flow of phases in the life cycle & does not limit itself
to change
-it assumes that persons will remain the same unless there are factors that
stimulate change or necessitate adaptation
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II. NORMAL PHYSICAL CHANGES ASSOCIATED WITH AGING
PHYSICAL CHANGES RATIONALE
INTEGUMENTARY
 Increased skin dryness -↓in sebaceous glands activity & tissue fluid
 Increased skin pallor -↓vascularity of the dermis
 Increased skin fragility -reduced thickness & vascularity of the dermis; loss of
subcutaneous fats
 Progressive wrinkling & sagging of the skin -loss of skin elasticity, increased dryness, & ↓
subcutaneous fat
 Brown “age spots” (lentigo senilus) on exposed body -clustering of melanocytes
parts (face, arms, hands)
 Decreased perspiration -reduced number of sweat glands
 Thinning & graying of scalp, pubic & axillary hair -progressive loss of pigment cells from hair bulbs;
decrease melanin production
 Slower nail growth & increased thickening with -↑ calcium deposits
ridges
NEUROMUSCULAR
 Decreased speed & power of skeletal muscle -↓ in muscle fiber
contractions
 Slower reaction time -diminished conduction speed of nerve fibers & ↓
muscle tone
 Loss of height (stature) -atrophy of intervertebral disk
 Osteoporosis -bone demineralization, loss of calcium from the bones=
increase propensity to Fracture
 Joint stiffness -deterioration of joint cartridge
 Impaired balance -↓muscle reaction time & coordination
SENSORY / PERCEPTION
VISION
 loss of visual acuity -Degeneration leading to lens opacity (cataract),
thickening & inelasticity (presbyopia)
 increased sensitivity to glare & decreased ability to -changes in the ciliary muscle; rigid pupil sphincter;
adjust to darkness decrease in pupil size
 partial or complete glossy white circle around the -fatty deposits
periphery of the cornea (arcus senilis)
 loss of color sensitivity (esp. color PURPLE)
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 progressive loss of hearing -changes in the structures & nerve tissues in the inner
ear (presbycusis); thickening of the ear drum
 decreased sense of taste, especially sweet -↓ in number of taste buds in the tongue because of
sensations @ the tip of the tongue(prefers SALTY tongue atrophy
DIET)
 decreased sense of smell -atrophy of the olfactory bulb at the base of the brain
(responsible to smell perception)
 increase threshold for sensations of pain, touch, & -possible nerve conduction & neuron changes
temperature
PULMONARY
 decreased ability to expel foreign object or -↓ elasticity & ciliary activity
accumulated matter
 decreased lung expansion, less effective exhalation, -weakened thoracic muscles; calcification of costal
reduced vital capacity & increased residual volume cartilage- making the rib more rigid; dilatation from
inelasticity of alveoli
 difficult, short, heavy, rapid breathing (dyspnea) -diminished delivery & diffusion of oxygen to the tissues
following intense exercise to repay the normal oxygen debt because of exertion or
changes in both respiratory & vascular tissues
CARDIOVASCULAR
 reduced cardiac output & stroke volume, particularly -↑ rigidity & thickness of the heart valves (hence
during increased activity or unusual demands; may ↓filling/emptying abilities); ↓ contractile strength
result in shortness of breath in exertion & pooling of
blood in the extremities
 reduced elasticity & increased rigidity of the arteries -↑ calcium deposits in the muscular layer

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  increased in diastolic & systolic pressure -inelasticity of systemic arteries & ↑ peripheral
resistance
 orthostatic hypertension -Reduce sensitivity of the blood pressure – regulating
baroreceptors

GASTROINTESTINAL
 delayed swallowing time
 increased tendency for ingestion
 increased tendency for constipation
URINARY
 reduced filtering ability of the kidney & impaired
renal function
 less effective concentration of urine
 urinary urgency & urinary frequency
 tendency for a nocturnal frequency & retention of
residual urine
GENITALS
 prostate enlargement (benign) in men
 multiple changes in women (shrinkage & atrophy of
the vulva, cervix, uterus, fallopian tubes & ovaries;
reduction in secretions; & changes in vagina flora)
 reduced vaginal lubrication
 increase in time for full sexual response
-alteration in swallowing mechanism
-gradual decrease in digestive enzyme, reduction in
gastric pH & slower absorption rate
-↓ muscle tone of the intestines; ↓ peristalsis
-↓ number of functioning nephrons & arteriosclerotic
changes in blood flow
-↓ tubular function
-enlarged prostate gland in men; weakened muscle
supporting the bladder or weakness of the urinary
sphincter in women
-↓ bladder capacity & tone
-exact mechanism is unclear; possible endocrine changes
-diminished secretion of female hormones & more
alkaline vaginal pH

Erikson (1963) - developmental task = “ego integrity vs. despair”

EGO INTEGRITY
 views life with a sense of wholeness & derives 
satisfaction from past accomplishments
 views death as an acceptable completion of life
 accepts one’s one and only life cycle
 bringing serenity & wisdom
DESPAIR
believes they have made poor choices during life &
wish they live life longer
 inability to accept one’s fate
 gives rise to feeling with frustration, discouragement,
& a sense that one’s life has been worthless

Peck (1968): proposed the 3 developmental task for older adults (contrast-Erikson’s)
1. Ego Differentiation vs. work – role preoccupation
2. Body transcendence vs. body preoccupation
3. Ego transcendence vs. ego preoccupation

 DEVELOPMENTAL TASK OF OLDER ADULTS (HAVIGHURST – 1972 ; believes these occur lifetime)
 65 TO 75 YEARS
- Adjusting to decreasing physical strength and health
- Adjusting to retirement and lower and fixed income
- Adjusting to the death of parents, spouses and friends
- Adjusting to new relationships with adult children
- Adjusting to leisure time
- Adjusting to slower physical and cognitive responses
- Keeping active and involved
- Making satisfying living arrangements as aging progresses
 75 YEARS AND OLDER
- Adapting to living alone
- Safeguarding to physical and mental health
- Adjusting to the possibility of moving into a nursing home
- Remaining in touch with other family members
- Finding meaning in life
- Adjusting for one’s own death

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  FACTORS AFFECTING THE HEALTH OF OLDER PERSON
1. Economic change
2. Relocation – relocation stress syndrome
= Assisted living – a facility that meets the needs of the older person (e.g. wide
doorways, grab bars in the bathroom, a call light )
= Adult day care – a center that provides health and social services to older person
= Adult foster care and group home – offers services to individuals who can care for
themselves but require some form of supervision for safety purposes

3. Maintaining independence and self-esteem – aging people need to recognized for the unique
Individual characteristics
4. Facing death and grieving – great bonds of affection and closeness can develop during this period of
aging together and nurturing each other
-When a mate dies, the remaining partner inevitably experiences feelings of loss,
emptiness, and loneliness.
-More women than men face bereavement and solitude because women
usually live longer

 COGNITIVE DEVELOPMENT
 Older people need additional time for learning, largely because of the problem retrieving
information. Motivation is important.
 Lifelong mental activity, particularly verbal activity, helps the older person retain a high level of
cognitive function and may help maintain long-term memory.
 A decline in intellectual abilities that interferes with social or occupational functions should
always be regarded as abnormal.

 MORAL DEVELOPMENT
+ Kohlberg’s Moral Development (relationships are based on MUTUAL TRUST)
- Pre-conventional level – an older person at this level obeys rules to avoid pain and the
displeasure of others
- Conventional level – where most older people stay, they follow society’s rules of conduct in
response to the expectation of others

PRINCIPLES IN THE CAREOF OLDER PERSON

o Independence:
1. Older persons should have access to adequate food, water, shelter, clothing and health care through the
provision of income, family and community support and self-help.
2. Older persons should have the opportunity to work or to have access to other income-generating opportunities.
3. Older persons should be able to participate in determining when and at what pace withdrawal from the labour
force takes place.
4. Older persons should have access to appropriate educational and training programmes.
5. Older persons should be able to live in environments that are safe and adaptable to personal preferences and
changing capacities.
6. Older persons should be able to reside at home for as long as possible.

o Participation:
7. Older persons should remain integrated in society, participate actively in the formulation and implementation of
policies that directly affect their well-being and share their knowledge and skills with younger generations.
8. Older persons should be able to seek and develop opportunities for service to the community and to serve as
volunteers in positions appropriate to their interests and capabilities.
9. Older persons should be able to form movements or associations of older persons.

o Care:
10. Older persons should benefit from family and community care and protection in accordance with each society's
system of cultural values.
11. Older persons should have access to health care to help them to maintain or regain the optimum level of
physical, mental and emotional well- being and to prevent or delay the onset of illness.
12. Older persons should have access to social and legal services to enhance their autonomy, protection and care.
13. Older persons should be able to utilize appropriate levels of institutional care providing protection,
rehabilitation and social and mental stimulation in a humane and secure environment.

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 14. Older persons should be able to enjoy human rights and fundamental freedoms when residing in any shelter,
care or treatment facility, including full respect for their dignity, beliefs, needs and privacy and for the right to
make decisions about their care and the quality of their lives.

o Self-fulfillment
15. Older persons should be able to pursue opportunities for the full development of their potential.
16. Older persons should have access to the educational, cultural, spiritual and recreational resources of society.
Dignity
17. Older persons should be able to live in dignity and security and be free of exploitation and physical or mental
abuse.
18. Older persons should be treated fairly regardless of age, gender, racial or ethnic background, disability or other
status, and be valued independently of their economic contribution.

 HEALTH ASSESSMENT
GERIATRIC ASSESSMENT – is a comprehensive evaluation designed to optimize an older person’s ability to
enjoy god health, improve their overall quality of life, reduce the need for hospitalization and or
institutionalization, and enable them to live independently for as long as possible.

Assessment consists of the following steps:

1. An examination of the older person’s current status in terms of:
- physical, mental and psychosocial health
- ability to function well and to independently perform the basic activities of daily living such
as dressing, bathing, meal preparation, medication management.
- Living arrangements, their social network and their access to support services
2. An identification of current problems or anticipated future problems in any of these areas.
3. The development of a comprehensive care plan which addresses all problems identified, suggests
specific interventions or actions required and makes specific recommendation regarding resources
needed to provide the necessary support services.
4. The management of a successful linkage between resources and the older person and that person’s
family, so that provision of necessary services is assured.
5. An ongoing monitoring of the extent to which this linkage has or has not addressed the problems
identified, and the modification of the care plan as needed.

Assessment activities include the measurement of:

1. Weight
2. Height
3. Vital signs
4. Observation of the skin for dehydration status or presence of lesion
5. Examination of visual acuity using the Snellen’s chart
6. Examination of hearing acuity using the Weber and Rinne tests
7. Ask the following:
a. Usual dietary pattern
b. Any problem with bowel / urinary elimination
c. Activity / exercise and sleep / rest pattern
d. Family and social activities and interest
e. Any problems with reading, writing, or problem solving
f. Adjustment to retirement or loss of partner
Health care Professionals should also be alert for the following:
a. Symptoms of depression
b. Risk factors for suicide
c. Signs of abnormal bereavement
d. Changes in cognitive function
e. Medications that increase risk of falls
f. Signs of physical abuse or neglect
g. Skin lesions (malignant and peripheral)
h. Tooth decay, gingivitis, loose teeth
i. Peripheral arterial disease

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 COMMON HEALTH PROBLEMS AMONG ELDERLY
1. Accidents
2. Fall
3. Hypothermia
4. Chronic disabling illness – arthritis, osteoporosis, heart disease, COPD, hearing & visual
5. Drug use and misuse – consider the variations in absorption, distribution, metabolism, and excretion
of drugs in relation to physiologic changes associated with aging
6. Alcoholism
7. Dementia – is a slow, insidious process that results in progressive loss of cognitive function
Alzheimer’s disease – most common type of dementia
Characteristics: changes in memory, judgment, language, mathematic calculation, abstract reasoning,
problem solving ability and impulsive behavior, stupor, confusion, disorientation
Nursing intervention:
 Spend time with the patient
 Use touch to convey concern
 Provide frequent reiteration of orientation data (e.g time, place)
 Have clocks or calendars in the environment
 Explain all actions, procedures, and routines to the patient
 Address the patient by his name
 Keep a routine of activities
8. Elder abuse – passive or active
 TYPES OF ELDER ABUSE:
a. Psychological abuse – instilling fear, threatening or making the elderly perform demanding task
b. Physical abuse – hitting, slapping or burning
c. Financial abuse – taking their money or forcing them to sign over their assets
d. Neglect – withholding food, medication or basic care
e. Infringement of personal rights – restraining for long periods of time against their will or
isolating them from normal social interactions
f. Sexual abuse
 The perpetrator of abuse is usually the spouse or the child of the victim. Caregivers who abuse their
elderly family members are often middle age or older or have emotional problems such as
alcoholism or substance abuse.

9. Postural hypotension
Nursing intervention
 get out of bed slowly
 sleep with head of bed slightly elevated
 have a daily fluid intake of 2 to 3 liters per day
 avoid hot showers or baths, may cause venous dilatation thereby venous pooling.
 Rest for 1 hour after meals
 Avoid hyperventilation – lowers BP
 Exercise regimen is recommended
 Use thigh – length elastic stockings to reduce venous pooling
 Avoid prolong standing
 Pharmacotherapy – Fludrocortisone (a mineralocorticoid that promotes retention of water and
sodium)

10. Hypertension
Nursing intervention
 Encourage stress education and relaxation
 Encourage exercise such as swimming and walking
 Encourage healthy diet (fresh fruit, rice vegetables)
 No weightlifting
 Quit smoking & alcohol
 Reduce intake of saturated fats
 Reduce salt intake to 1 to 6 gms per day
 Take prescribed medications at regular basis

11. Osteoporosis
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 Nursing intervention
 Have adequate calcium in the diet
- milk or dairy products
- fish
- beans
- orange juice
- cereal or bread that have added calcium
- take calcium supplements
 get regular exercise
 Avoid alcohol, quit smoking. Alcohol and smoking reduce bone mass.
 Avoid large amount of proteins – rich or salty and caffeinated foods. It cause loss of calcium from
the body
 Make the home safe to avoid accidents
 Practice good posture
 Use body mechanics when lifting objects
 Do back exercises to improve posture
 Wear rubber soled, low heeled shoes that grip well

CHANGES IN THE OLDER PERSON & THEIR IMPLICATION TO CARE

 Communication considerations
- demonstrate respect by remembering names and calling the person by the name
- he/she prefers being addressed (instead of “grandma or grandpa”)
- face the person when speaking
- speak distinctly and clearly
- do not shout, increased frequency of voice pitch makes hearing difficult
- increase frequency consonants (f, s, th, ch, sh, b, t, p)
- provide written instruction/repetition of instructions – memory & attention span have diminished

 Promoting independence and self- esteem

- place equipment conveniently and encourage the use of self – help device
- encourage them to do as much as possible for themselves, provided that safety is maintained
- acknowledge the elderly client’s ability to think, reason and make decisions
- assist with personal care as necessary

 Hygienic practices and skin care

- daily bath is not necessary = dry skin
- use mild, super fatted soap
- use bath oils, lanolin or body lotion (no alcohol content)
- use pressure mattresses, floatation pads/mattresses alternately
- change position frequently
- massage bony prominences and weight bearing areas every 2 hours
- assist in ambulation as much as possible
- foot care – soak feet in warm water before cutting nails (usually hard and scaly)

 Visual aids and dental care

- keep eyeglasses clean and always available
- keep night lights to prevent accidents
- clean dentures following each meal
- prevent loss of dentures

 Exercise and body alignment

- regular exercises of feet and legs to prevent PVD (peripheral vascular disorders)
- encourage correct posture and deep breathing
- use supportive pillows and firm mattress
 Temperature
- less than 37.0 ⁰C
- temperature of 99 ⁰F indicates infection (bladder/respiratory)
 Sleep patterns and mental status
- usually sleep lightly, intermittently with frequent walking (low bed/night light/adequate supervision when
getting up)
 Nutritional needs
- increase fiber and fluid intake to prevent constipation
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 - vitamin & mineral supplements
- dry skim milk (rich in protein and calcium)
- decrease in calories, increase in CHON diet

 Urinary elimination
- frequency voiding is common (decreased muscle tone of the bladder emptying capacity, increased residual
urine infection)
- increase fluid intake to dilute urine and decreases its irritating properties (limit fluids during night to prevent
nocturia)
 Sexuality
- still capable of sexual arousal and orgasm

 Emotional needs
- needs someone to talk(plan time to visit; allow visit to clergyman)
- comforted by touch (conveys feelings of concern, interest and acceptance)
- maintain family contact
- provide diversional activities (books/magazine with large prints, radio or tv)
- allow to verbalize about feelings on death (do not avoid the topic)

THE AGING FAMILY

- planning for care & understanding the older person must be accomplished within the context of the family
- FAMILY – important source of support for older people
- SPOUSE – assumes the role of primary caregiver if dependency needs occur
- ADULT CHILD – usually assumes the caregiver responsibility & help in providing care & support in the
absence of surviving spouse
- in times of sickness, if community resources or older children are unable to provide care, the elderly are at
high risk for institutionalization

 HEALTH PROMOTION
Health test and screening
-as for middle age adults

Safety
-home safety measures to prevent falls, fire, burns, scalds and electrocution
-motor vehicle safety reinforcement, especially when driving at night
-precautions to prevent pedestrian accidents

Nutrition and Exercise

-importance of well balance diet with fewer calories to accommodate lower metabolic
rate and decrease physical activity
-importance of sufficient amounts of vitamin D and Calcium to prevent osteoporosis
-nutritional and exercise factors may lead to cardiovascular disease (obesity,
cholesterol, lack of exercise)
-a regular program of moderate exercise to maintain joint mobility, muscle tone and
bone calcification

Elimination
-importance of adequate roughage in the diet, adequate exercises and at least 8 ounce
glasses of fluid daily to prevent constipation

Social Interaction
-encouraging intellectual and educational pursuit
-encouraging personal relationships that promote discussion of feelings, concerns and
fears
-availability of social community centers and programs for seniors