Geriatric Nursing

Geriatrics
 Study of old age; physiology,
pathology, diagnosis &
management of diseases of older
adults.
 Gerontologic/Gerontic Nursing

 Fieldof nursing that specializes in

the care of the elderly
 Emphasis of care is focused

promoting, maintaining, &

restoring health & independence
 Life Span
 Maximum number of years a person
can live under the best conditions in
the absence of disease

Life Expectancy – average number of

years that a person can be expected
to live.
Age Related Body System Changes:

 Cardiovascular

Heart valves become thicker &

stiffer; arteries lose elasticity; Ca
& fat deposits in arterial walls;
veins become tortuous
 Health Promotion

 Regularexercise, proper diet,

weight control, regular blood
pressure check ups, avoidance of
smoking & stress management
 Respiratory Changes
 Increase A-P diameter, kyphosis,
calcification of costal cartilages,
diminished efficiency of respiratory
muscles, decreased alveolar
surface area, decreased cough
efficiency, reduced ciliary activity
 Health Promotion

 Regular exercise, Increase fluid

intake, annual influenza
vaccination, avoidance of smoking
Health Promotion
 Integumentary Changes

 Lossof resiliency wrinkling &

sagging of the skin, hair
pigmentation decreases, skin
becomes drier, subcutaneous fat
decreases
 Health Promotion

 Wear appropriate skin protection

from the sun, maintaining a
suitable temperature indoors, use
lubricating skin cream
 Reproductive Changes
 Thinning of the vaginal wall, loss of
elasticity, decrease vaginal
secretions, atrophy of the uterus &
ovaries, decreased pubococcygeal
muscle tone
In men penis & testes decrease in
size, decrease levels of androgen
 Health Promotion

 Sexual activity should not be

discouraged, referral to sex
counselor if necessary, vaginal
lubricant & estrogen replacement
therapy
 Genitourinary Changes

 Changes in kidney function,

bladder capacity decreases, urine
retention & incontinence; Benign
prostatic hyperplasia in older men
 Health Promotion

 Adequate fluid hydration, pelvic

floor exercises
 Gastrointestinal Changes

 Decrease salivary flow, decrease

gastric motility, constipation
 Health Promotion
 Regular dental care, eating small
frequent meals, eating high fiber
low fat diet, ingesting adequate
amount of fluids, regular bowel
habits
 Musculoskeletal Changes

 Decrease in bone mass & density,

osteoporosis in postmenopausal
women, decrease muscle mass &
strength, backpain, deterioration
of cartilage & joints
 Health Promotion
 High calcium intake (dairy products &
dark green leafy vegetables), low
phosphorous diet, exercise, Ca
supplements, Vitamin D & Fluoride
are given
 Encourage a regular exercise

program
 Nervous System Changes

 Decrease in brain mass due to

loss of nerve cells, reduction in
the synthesis of neurotransmitter
substances, slow nerve impulse
conduction, reduction in cerebral
blood flow
 Health Promotion

 Allowa longer time to respond to

a stimulus & to move deliberately,
avoid injury
 Sensory Changes

 Presbyopia –when the near point

of focus become farther away due
to decrease flexibility of the lens –
corrective glasses
 Presbycusis – loss of the ability to
hear high frequency tones due to
irreversible inner ear changes –
hearing aids to reduce hearing
deficits
 Mental Health Disorders:

 Depression – most common

affective or mood disorder of old
age
- disrupts quality of life, increases
the risk of suicide
 Signs & Symptoms

 Feeling of sadness & fatigue

 Diminished memory &

concentration
 Feelings of guilt & worthlessness
 Sleep/appetite disturbances,
restlessness
 Decrease attention span

 Suicidal ideation
 Nursing Management
 Psychotherapeutic approach
(Cognitive & behavioral) & anti
depressant medications
Fluoxetine (Prozac), Paroxetine (Paxil)
 Dementia

 Senile dementia (Chronic brain

syndrome)
 Characterized by a general

decline in intellectual functioning

 Loss of memory, abstract
reasoning ability, judgment &
language
 Personality changes

 Decrease ability to perform ADL’s

 Alzheimer’s Disease
 Primary degenerative dementia
 Senile dementia of the Alzheimer's type

 Progressive, irreversible, degenerative

neurologic disease that begins

insidiously with gradual losses of
cognitive function & disturbances in
behavior & affect
 Pathophysiology
 Neurofibrillary tangles (mass of
non functioning neurons)
 Senile or neuritic plaques (deposits

of beta amyloid proteins)

 Happen in cerebral cortex =

decreased brain size

 Decrease acetylcholine, important
in memory processing
 Risk factors – age & family history

 Dx Evaluation – history, clinical

symptoms, EEG, CT Scan, MRI,

blood & CSF studies
 Clinical Manifestations:
 Forgetfulness, subtle memory loss,
inability to recognize familiar faces,
places & objects, repeat the same
stories, difficulty in everyday
activities, voracious appetite, wander
at night for several hours
needs help in doing ADL’s
Progressive memory loss: retrograde
amnesia
(loss of memory of events before the
disease) followed by anterograde
amnesia (inability to learn new
things).
Sometimes the client who formerly was
well mannered in the table becomes
sloppy. Or sometimes the client
suddenly undresses in front of the
family members.
 Clients usually use Confabulation –
fabrication of events or experiences
to fill in memory gaps, so as to save
their own self esteem
 Nursing Interventions
 Help maintain optimal cognitive
functioning
 Promoting patient’s safety

 Promoting independence in self-

care activities
 Maintaining adequate nutrition
 Managing sleep pattern

disturbances
 Supporting & educating family

caregivers
 Abuse to the Older Adult
 Abuse involves, physical, emotional or
sexual abuse and also can involve
neglect or economic exploitation
 Individuals that are most at risk are

children or older adults, because of their

dependency, immobility or altered mental
status
 Victims may attempt to dismiss
injuries as accidental and abusers
prevent victims from receiving proper
medical care to avoid discovery
 Victims are often isolated socially by

their abusers
A typical victim of abuse is usually
an old woman with few social
contacts with at least one physical
or mental impairment that limits
the ability to perform ADLs. The
client usually lives alone or lives
with the abuser and is usually
dependent on the abuser’s
care.