Geriatrics NCM 114j

Elderly: means old aging MYTHS FACTS

Aging: is part of life changes that occurs as one grows older Impaired • Most people • Although short
or maturation process; inevitable and steadily progressive memory age 65 and term-memory
process that beings at the moment of conception and older believed declines, long
continuous throughout the remainder of life that they have term memory
Geriatric: come from the Greek meaning GERON means moderate and remains fairly
“old man” and IATROS meaning “healer or medicine = severe memory intact
related to caring for old people impairment • A majority are not
Gerontology: study of all aspects the aging process and its • Moderate disabled
consequences in man, the scientific holistic study of aging severe disability
process and problems of aging Learning • You can’t teach • Older people can
Gerontology Nursing: branch of nursing/ specialty of new tricks and oldie new learn if given a bit
nursing pertaining to older adults tricks more time. They
Gerontophobia: fear of aging; of getting old; of the elderly are more detail ad
Ageism: stereotyping and descripting against an individual careful
or groups on the basis of their age; this maybe systematic Sexuality • Older people • Although sexual
or casual; coined in 1969 by Robert Niel Butler to describe gave no interest capacity declines
or capacity for with age, it does
discrimination against seniors and patterned on racism
sex not disappear.
and sexism. Butler defined ageism as three connected Intimacy remains
elements; prejudicial attitude towards older people and the important
aging process; discriminatory practices against older throughout our life
people; and institutional policies and practices that Physical • Too old to take • Physical activity at
perpetuates stereotype about elderly people. Negative activity part in exercise any age can
discriminatory practices among people of old age or Age- or weight lifting strengthen your
Related Bias program and it heart, lungs,
could actually muscles; can also
OLDER ADULTS hurt them lower your BP and
YOUNG OLD 65 – 74 helps slow bone
MIDDLE OLD 75 – 84 loss
OLD OLDER 85 AND OLDER On smoking • Too late to stop • Never too late to
PRESENTLY: 12.8% if population smoking quit smoking
2030: will increase to 20% of population

Attitudes Toward Aging Sleep • The older the • Still good asleep
• Many elderlies buy into notion that they themselves re person gets the hygiene
no longer useful and are a burden to others less sleeping
• The aging makes little attempt to keep themselves they need
healthy and active after all, they are getting closer to Driving • Older drivers • Older drivers have
the end of their lives have most of fewer accidents
• They have no desire to try new things or to change the driving per miles driven
themselves or to eat or exercise properly accidents and to avoid
speeding and
• There is a great deal of research that demonstrated driving at night.
aging individuals can learn, retain memory and However, people
actively involved in business and their community over 70 are more
• A lack of physical exercise, social involvement, and likely to die from
mental stimulation in older adults often leads to crash injuries and
deterioration of minds and their bodies should have their
• The older person’s negative attitude towards aging vision and hearing
become self-fulfilling checked regularly
• Many studies show older people who are physically AIDS • Older people • Older people need
active have less joint pain, lower BP, les depression, don’t need to to take the same
fewer heart attacks and lower incidence of CA worry about precaution as
getting AIDS younger people
• Proper nutrition also has the same affect in the aging
do. AIDS can
process; it delays the progression of debilitating
happen to
illness or disability somebody more
• Recent research even suggest that weight loss and than 50 years old
exercise can reverse the severity of diabetes Personality • Tend to become • Personality is one
low, grumpy of the consonants
Lack of Social Stimulation = Poor Mental Health (bad tempered of life; as people
• Having interest in something not only stimulates an and miserable) age they likely to
older person’s mind but also creates a better mental and set in their behave much as
attitude which results often in better health ways they did as they
• There is empirical evidence that using one’s brain were becoming
may prevent dementia in older age adults. Age related
changes don’t
affect the ability to
enjoy life.
Personality seems
to be changing
significantly might

PREPARED BY: JAVIER, A.A.

 be due to sensory Respecting Cultural Diversity
changes, • LISTEN to concerns
depression and • SHARE knowledge and build MUTUAL
reactions to UNDERSTANDING
medications or
• SEEK collaborative solution
might be diet, lack
of exercise, lack of • RESPECT cultural diversity
sleep or boring • Identify and build upon STRENGHTS
about getting old • Set children up for SUCCESS in learning
or boring about • SHARE and CELEBRATE successes
money
Physical • Exercise is Preparing for Old Age: Preparing for the Golden Years
Activity imperative; Four essential preparations for our rusty years:
exercise can 1. Planning for the stages of Decline
reverse the 2. Initiating Family Planning Conversation
severity of 3. Making End-of-life Arrangements
diabetes 4. Getting our Financial Ducks in a Row
Falls • Common in
seniors; fear of Probable Stage of Elder Decline
falling may lead to Independent
falls Living
Supportive
Isolation • Isolation may lead Living
to depression Assisted
Living
Dependent
Living
Cultural Factors/ Ethnicity Respect and Health Perception Palliative
for older person Care
Where we have been each culture of elderly brings a unique
history that has shaped and formed who they are and how 1. Intrinsic Biological Theory
they view around them; there are common influences that • It maintains that aging changes arise from
cut across racial lines however looking at cultural and racial internal predetermined causes
concerns one must identify the cultural meaning and the
dynamics of the aging process with in specific minority 2. Extrinsic Biological Theory
groups. • It maintains that environmental factors lead to
structural alterations which in turn cause
Where are we now degenerative changes
• Current generation of elderly as the Quiet Revolution
a. Free – radical theory
defining them as a revolution off older individuals
o It is very famous theory of aging was
representing the broadest range of ethnic, cultural,
developed by Denham Harman MD on
regional, religions, political, and socioeconomic
1956
diversity ever witness in a certain society.
o (free electron) are molecules with an extra
o Kanlungan ni Maria Home for the Aged in NCR
cellular charge, which alters the structure
o DSWD – home for the elderly in Talon-Talon
and function of the cell membrane
Z.C.
o Increased unstable free-radicals produces
• As a result of poor adequate resources among the harmful effects to biological systems, such
poor, life expectancy is six years less than other as chromosomal and DNA changes
populated group. Twice the total population for elderly o Oxidation of fat, protein and carbohydrates
in the Philippines in favor of living with relatives this is within the body produces the free-radicals
based on the idea of familia “family is forever”
• Social factors among family include:
1. High percentage that live below poverty level
2. Inadequate health care brought about by
poverty cultural factors
3. High literacy rate
4. Low occupational levels resulting from few
benefits and retirement plans
• Traditional Asian culture often observe a form of filial
piety which demands family members usually the
eldest son to respect, care for and assume
responsibility for elder parents. Unfortunately, this
traditional attitude of respect often clash now with
dominant American values, this culture clash results
to 75% living with their children dropped to 66% lately
Where are we going
For the general population, the implication for the aging b. Cross – link theory/ connective tissue theory
population will require competent individuals train to o The molecules of collagen and elastin,
respect and work with such diverse group. Factors include: connective tissue components, from bonds
1. Income that increase the cell rigidity
2. Health care o Chemical reaction occurs as a chemical
3. Poverty bond between cells it will separate
4. Religious and spiritual beliefs normally bonded cells

PREPARED BY: JAVIER, A.A.

 3. Psychosocial Theory
Aging attempts to explain age related changes in
cognitive function such as intelligence, memory,
learning and problem solving

a. Immunological theory
o Formulated by Cummings and Henry
(1961) states that aging people are
withdraw from customary role and engage
in more introspective, self-focused
activities
o Decrease participation in society resulting
from age related changed in health,
energy, income and social roles
o This theory includes 4 basic concepts:
▪ Aging person withdraws from society
▪ disengagement is biologically and
psychologically intrinsic and
inevitable
▪ disengagement is considered
necessary for successful aging
▪ disengagement is beneficial for older
adults and society
c. Immunological theory
o Some theorist suggest that the immune b. Continuity/ Developmental theory
system is responsible for aging o Personality remain same and behavior
o An aging immune system is less able to become more predictable as people age
attack and destroy body cells as if they are o Mainly focus on personality and individual
foreign cells (antigen) behavior over time
o It results in destroying own body cells
through auto aggression or c. Activity theory
immunodeficiency o The maintenance of optimal physical,
mental and social activity is necessary for
d. Error theory successful aging
o Decreased bonding of protein cells in
response to stressors such as radiation d. Adjustment theory
o Leads errors in synthesis of RNA and DNA o A serious of adjustment to retirement, to
that produces cells with impaired function grand parenthood, to changes in income,
to changes in social life and marital status
e. Wear and tear theory and to potential deterioration of health and
o Body cells, structures and function wear well-being
out through exposure to internal and
external stressors e. Gerotranscendence theory
o Inherent in this theory is the idea that the o Meaning of life is clear
more you abuse your body, the faster it will o Aware of God purpose; prayerful; training
wear out younger people; more on what you can give
o Ex: more stressors (taking more weight) in to others
younger age ultimately leads to tearing like
spinal cord or joint problems f. Age stratification theory
o Group together as one (bingo socials,
f. Genetic/ Gene theory prayer meeting)
o Genetic inclination; lifespan is largely
determined by the genes we inherit g. Selective optimization with compensation theory
o Our longevity is primarily determined at o Strategy for improving health and well-
the amount of conception and is largely being in older adults and a model for
reliant on our parents and their genes successful aging thing’s you can’t do
before, you compensate doing similar
g. Neuroendocrine Control/ Pacemaker theory/
Aging Clock Hormone Theory h. Functional consequences theory
o Results from the functional perturbations o Focuses on the needs that are unique to
both in neuronal control and endocrine older individuals
output of the hypothalamic-pituitary- o Proposes the ability of older adults to
adrenal axis maintain maximal care is affected by the
o Result in dysfunction in the activity of interaction of normal age-related changes
various endocrine glands and their target and additional risk factors the individual
organs encounters

i. Adjustment theory
o A serious of adjustment to retirement, to
grand parenthood, to changes in income,
to changes in social life and marital status

PREPARED BY: JAVIER, A.A.

 and to potential deterioration of health and
well-being

j. Theory of Thriving
o Integrates knowledge, tells how and why
phenomena are related leads to prediction
and provide process and understanding
o Based on these criteria, the authors
created with a holistic lifespan perspective
for studying people in their environments
as they age

Normal Aging Process

1. Hereditary factors
2. Environmental factors: abiotic (pollutants, radiations)
and biotic (living organisms)
3. Socio economic factors (stressors)

Advance Directive
• Living will be regarding health matters
• Durable power of attorney for health matters

CARE OF THE OLDER

PERSONS
o Older adults search for life meaning and adapt
Demographic of Aging to functional and social losses
• a normal developmental process o
• occurring throughout the human life span
• causes a mild progressive decline in body system
functioning

a. Chronological Age
• refers to the number of years the person has
lived
• most commonly used objective method
• serves as a criterion in society for certain
activities, such as driving, employment and the
collection of retirement benefits. Three
categories:
o young old (ages 65 – 74)
o middle old (ages 75 – 84)
o old-old (ages 85 and older)

b. Physiologic age
• Determination of age by body function
c. Functional age
• Person’s ability to contribute to society and
benefit others and himself
• Fastest growing segment of the older
population: age 75
• Those who require help: frail elderly
• Non-institutionalized adults ages 75 – 84 →
25% need help with daily activity
• Aged 85 and older – ½ need help with ADLs

A. HUMAN NEEDS
o Five basic needs motivate human behavior in a
lifelong process toward need fulfillment
o Maslow surmised that a hierarchy of five needs
motivates human behavior: physiologic, safety
and security, love and belonging, self-esteem,
and self-actualization

B. INDIVIDUALISM
o Personality consist of an ego and a personal and
collective unconsciousness that views life from
a personal or external perspective

PREPARED BY: JAVIER, A.A.

 SOCIOECONOMIC ASPECTS
OF AGING
5. Insurance Coverage
1. Age Cohorts • Necessity for older adults because of medical
• persons who share the experience of a particular problems – therefore medical expenses increase with
event or time in history are grouped together in what age
is called a cohort • As person age, they visit the doctor more often (US
o AGES 55 – 64: persons in this age group are Census Bureau, 2004): establishing rapport
generally healthy and have resources to
maintain housing 6. Support Systems
o AGES 65 – 74: retirement ordinarily causes • Throughout life, people make new acquaintances,
income to decrease by about 35% or more. This develop friendships and form family circles. People
reduction in income often offset by reduced identify with schools, churches or synagogues, clubs,
expenditures associated with working, such as neighborhoods and towns. These are places and
transportation, clothing and meals (away from people they turn to when they need advice or help,
home). want to celebrate or are grieving.
▪ Government at 65 GSIS (x3)
▪ Private at 65 SSS
o AGES 75 – 84: many persons in this age group AGING FAMILY
live alone, with affects their average household FAMILY: a basic social unit consisting of parents and their
income children, considered as a group, whether dwelling together
o AGES 85 AND OLDER: at risk for an increase in or not: the traditional family
chronic dse, resulting in decreased ability to COMMUNITY: next unit of the society
perform ADL and increased expenses for • A social unit consisting of one or more adults together
assistance, assistive devices and medication. with children they care for: a single-parent family
Has the lowest average annual income level of • Any group of persons closely related by blood, as
all older people parents, children, uncles, aunts and cousins: to marry
into a socially prominent family
2. Poverty
• Inadequate income may affect the quality of life for FAMILY MEMBERS: form the nucleus of relationships for
older adults the majority of the older adults and the support system if
• Delay seeking medical help they become dependent
• May not follow through with the prescribed treatment • Intergenerational web (extended family): sons,
or medications daughters, stepchildren, in-laws, nieces, nephews,
grandchildren and great grand children
3. Education • All these people may play an important part in
• Has been shown to have a strong relationship to maintaining satisfaction in later life
health risk factors. The level of education influences • Everyone comes from a family
earning ability information absorption, problem-
solving ability, value systems and lifestyle behaviors Roles and Relationships
Role of members CHANGE
4. Health Status • Grandparents assume parental roles to their
• Persons over 65 an average of 2 chronic conditions grandchildren
(Lorig, 1993) • Adult children may provide limited or extensive
• The most common chronic problems in 1994 were caring to their own parents
arthritis (50%), followed by hypertension (36%), heart • This caregiving may be TEMPORARY or LONG-
dse (32%), heart impairments (29%), cataracts (17%), TERM
orthopedic impairments (16%), sinusitis (15%) and
diabetes. Families as a Resource or Risk Factor
• Functional ability: measure by the individual’s ability Families are generally considered to be a vital resource and
to perform ADLs and instrumental activities of daily integral part of an individual’s social network across the
living (IADLs) lifespan. Family relationships, like all relationships, vary in
o ADLS: include size personal care activities: positive and negative qualities as they make an individual
eating, toileting, bathing, transferring, dressing feel loved and cared for as well as irritated and frustrated.
and continence
o IADLS: home-management activities: preparing Important Issues and Future Directions
meals, shopping, managing money, using the • The family – most precious naturally occurring and
telephone, doing light housework, laundry, using cost effect resources. Its role in protecting our elders
transportation and taking medications must be supporter and augmented
appropriately.
• The health of our older citizens can best be protected
• Nurses can work with older adults – prolong and improved by both supporting and educating the
independence by encouraging self-management of family as the primary vehicle for maintaining the
chronic conditions health well-being of all members of our aging society
• Self-management: learning and practicing the skills
necessary to carry on an active and emotionally
satisfying life.
o Repeated demonstration to promote the
patient’s retention and involvement to task

PREPARED BY: JAVIER, A.A.

 Changes in the Older Person & their Implications to Care REPRODUCTIVE SYSTEM
CARDIOVASCULAR STRUCTURE Ovaries
Cardiac Aging o With age, the ovaries atrophy to such a small size
o Enlargement of heart chambers and coronary that they can become impalpable during the exam
cells occurs with age, as does increased Uterus
thickening of the heart walls, especially in the o Age-related decreases in uterine endometrial
left ventricle thickening during menstrual cycles occur as the
o Ventricles in the heart also begin to thicken and result of decreased estrogen and progesterone
stiffen in correlation with continued steady levels → decline in menstrual flow
production of collagen Vagina
Vascular Aging o With age, the vagina becomes shorter and
o Aged arteries become extended and twisted. With narrower and the vaginal walls tens to thin and
age, large arteries begin to dilate and stiffen, weaken. As a result, the vagina can become very
leading to hypertension dry, causing intercourse to be very painful
Menopause
RESPIRATORY SYSTEM o Declines in estradiol along with the onset of
Alveoli variable menstrual cycles. Periods of amenorrhea
o The volume of blood distributed to pulmonary trigger the move into the late stages
circulation declines with age due to a decreasing
number of capillaries per alveolus → impairs Testes
efficient passage of oxygen from the alveoli to the o Decrease in both size and weight, but with high
blood variability among men. Although a decline in sperm
Lung Elasticity production occurs in aging males. The production
o With age, these is a decrease in the lungs’ never ceases, as a result, the older male remains
elasticity, which in turn causes a change in the fertile
elastic recoil properties of the lungs Glands
o Loss of elastic recoil = lunges closes prematurely, o Changes in prostate gland. The lining and muscle
trapping air inside and preventing the lungs from layer of the prostate gland become thinner with
emptying completely age, probably due to the reduced blood flow to the
Chest Wall area. Benign Prostatic Hypertrophy (BPH) –
o Becomes stiffer with advancing age, decreasing remains very common among aging males
the case with which the thoracic cavity can Penis
expand o Show fibrous changes in erectile tissue around the
o The stiffness of the chest reduces its ability to urethra starting in the 30s and 40s.
expand during inhalation and contract during o The fibrosis in erectile tissue → increase in the
exhalation amount of time it takes to achieve an erection in
older males
GASTROINTESTINAL SYSTEM
Pharynx and esophagus Andropause: a decline in testosterone levels and eventually
o Overall the, GI system appears to be relatively deficiency significant enough to cause clinical symptoms.
preserved in aging with only minor changes. The Unlike menopause, andropause occurs gradually over time
two GI are most affected by age are the upper and does not occur in all aging males. Symptoms include:
tract (pharynx and esophagus) and the colon low libido, decreased energy, strength and stamina,
▪ Lukewarm water; soft diet increased irritability and cognitive changes.
o Stiffening of the esophageal wall affect the older
patient’s ability to swallow NERVOUS SYSTEM
o Dysphagia, reflux, heartburn and chest pain are Aging Brain
common complaints o Memory changes can be observed by the fifth
Large Intestine decade, but changes remain variable among
o Rectum, a colonic structure that is located individuals
before the anus, shows age-related increase in o Decreases in size and weight as men and women
fibrous tissue age
o This increase reduces the rectum’s ability to Aging Spinal Cord
stretch as feces pass through o Nerve Conduction
▪ May narrow due to pressure on the spinal
URINARY STRUCTURE cord resulting from bone overgrowth. Due
Kidneys to this narrowing, changes in sensation can
o Shrink in length and width occur
o Change sin renal blood flow and glomerular
filtration rate (GFR) account for a majority of MUSCLE
functional disability in the kidneys with age • A reduction in muscle mass occurs to at least
Bladder some degree in all elderly persons as compared
o Decrease in size and develops fibrous matter in the to young healthy, physically active young adults
bladder wall, changing its overall stretching → Sacropenia
capacity and contractibility o Associated with tremendous increases in
Urination functional disability and frailty
o Amount of urine expelled from the body decrease
with age SKELETAL SYSTEM
Estrogen Deficiency
o Key contributor to bone loss, accelerates in
women after menopause due to a decline in
estrogen levels

PREPARED BY: JAVIER, A.A.

 o Plays a role in bone loss among men – due to a Cultural Factors/ Ethnicity
decline in levels of estrogen, not testosterone Ethnicity: race like African, European, Asian
Osteoporosis Nationality: geographic location of the person’s birth (or the
o Reduction in bone quantity and strength that are country with which he or she identifies)
greater than the usual age-related reduction
o Bones with osteoporosis are very porous – Diversity of Elders
containing numerous holes or empty pockets – ✓ Wide range of life ✓ Health status
prone to fracture experiences ✓ Socioeconomic status
✓ Lifestyles ✓ Religion
SENSORY SYSTEM
Touch Patterns of Health and Disease in the Older Adult
o Ability to touch and distinguish texture and A. Disease that occur to varying degrees in most older
sensation tends to decline adults: cataracts, arteriosclerosis, benign prostatic
o Decrease in the number and alteration in the hypertrophy (males)
structural integrity of touch receptors or B. Disease with increased incidence with advancing age:
Meissener’s corpuscles and pressure receptors neoplastic dse, diabetes mellitus, dementia disorders
or Pacinian corpuscles C. Disease that have more serious consequence in the
o Receptors that are elated to the sense of touch elderly: pneumonia, influenza, trauma
are also known as mechanoreceptors D. Very common chronic disease: arthritis, hypertension.
o Prone to burns heart disease
E. Functional disability
Smell a. 32% of persons over 65 years have some
o Decrease in the number of olfactory neurons limitation of functions
and weakening of olfactory neutral pathways to b. 25% of persons over 65 yeas require help with
the brain lead to a reduction in the ability to at least one ADL or IADL
identify and distinguish aromas
o Decrease in the sense of smell – hyposmia GERIATRIC ASSESSMENT
Taste − A multidisciplinary diagnostic process intended to
o Decrease in taste – hypogensia, usually more determine a frail older person’s medical, functional,
noticeable around the age of 60 with more and psychosocial status and limitations in order to
severe declines occurring after the age of 70 develop a plan for treatment and long-term follow-up
Vision − Diagnose and develop an overall plan of care for
o Most common visual concerns in aging – treatment and long term follow up
prebyopia or the inability to focus on nearby − Optimizes independence and prevent future
objects, such as newsprint → farsightedness disabilities
(normal signs of aging) FUNCTIONAL ASSESSMENT
Hearing − Identify an older adult’s ability to perform self-care,
o Changes in the inner ear self-maintenance, and physical activities
o Hearing loss include the alteration and decline − Disability impact that health problems have on an
in the ability to hear high frequency sounds, and individual’s ability to perform tasks, roles and
the ability to discern activities
o Age related hearing loss – prebycusis – most PHYSICAL ASSESSMENT
common sensory deficit in the older population
− Physical assessment with a “systems” approach,
▪ Talk slightly & slowly repeat in lower voice
reviews each body system first by taking a history –
then physical examination
INTEGUMENTARY SYSTEM
The greatest changes in aging skin – dermis. There is a
1. Circulatory Function
general thinning of the dermal layer, with loss of thickness
• Family history, current problems with chest
averaging 20% in older persons. This thinning of the dermis
pain/ discomfort (exertion); current diagnoses
is due in large part to a general loss of collagen –
and associated medications’ over-the-counter
approximately 1% loss per year in adulthood
and herbal medicines; sources of stress;
adherence to current medical regimens
IMMUNE SYSTEM
Immunosenescence • Physical examination, blood pressure, chest
o Aging immune system sounds, pulse rate
o Associated with increased incidence of • Exercise stress test, blood and serum tests,
infectious disease such as bronchitis influenza electrocardiograms and other tests for imaging
o It is also implicated in the increased incidence of and assessing the condition of the heart and
tumors and cancer that occurs with age blood vessels

2. Respiratory Function
• Current medications/ history of smoking
behavior and exposure to environmental
pollutants
• Assess: current difficulties and anxieties
associated with breathing, decreased energy to
complete everyday tasks, frequent coughing and
production of excess sputum
• Observation of posture and breathlessness, and
listening to chest sounds
• Pulmonary function test, chest x-ray and sputum
analysis

PREPARED BY: JAVIER, A.A.

3. Gastrointestinal Function • Rashes, itching, dryness, frequent bruising and
• Usual diet; appetite and changes in appetite; any open sores
nausea, vomiting, indigestion, stomach • Color, hydration, circulation and intactness
discomforts, problems with bowel function
(constipation and diarrhea) COGNITIVE ASSESSMENT
• Barium enemas and x-rays, stool analysis • Attention, memory, language
examination of the colon o The most extensively used cognitive assessment
• Oral health assessment – overlooked with older tools is the Mini Mental State Examination
adults (MMSE) – measures change in cognitive
o Oral health practices including impairment
brushing, flossing and regular contact
with a dentist
4. Genitourinary Function (sometimes neglected)
• Abnormal bleeding, vaginal discharge, urinary
symptoms. Pelvic examinations and PAP smears
• Older men – enlarged prostate
• Chronic renal failure – complication of age-
related dses (diabetes and hypertension)
• Incontinence – not a normal part of aging
• Health history – previous or current difficulties
related to the frequency and voluntary flow of
urine during either the day or night; medication
use
• Urine analysis tests for blood, bacteria, and
other components
5. Neurological Function
• Medications, medical diagnosis related to the PSYCHOLOGICAL ASSESSMENT
neurological system (history or family history od • Weighted toward assessment of mental disorders
stroke)
• Clinical depression – most common mental health
• Previous and current impairment in speech, problem among older adults
expression, swallowing, memory, orientation,
energy level, balance, sensation and motor SOCIAL ASSESSMENT
function
• Social network and on the interaction between the
• Sleep disturbance, tremors, and seizures older adult and family, friends, neighbors and
6. Musculoskeletal Function community
• The most commonly reported illness among • Spiritual support: religiosity – believing in God,
older adults is osteoarthritis (Weight-bearing organized rituals
joints-hips/knees)
o Spirituality – ideas of belief that encompasses
• Observation of purpose and walking can assist personal philosophy and an understanding of
in asking the appropriate questions meaning and purpose in life
o Does the older adult favor one side of the
body while walking? 1. Physiologic Functioning
o Are assistive devices such as canes and • Urinary Incontinence: common problem of the elderly
walkers being used? and has tremendous impact on both the morbidity
▪ Canes and walkers should be at the and quality of life of elderly peoples
appropriate height in relation to
a. Stress incontinence: involuntary loss of
body height urine during activities that increase intra-
7. Sensory Function abdominal pressure (lifting, coughing,
• Diminished vision and hearing – greatest impact sneezing and laughing)
on older adults --- negative effects on social b. Urge incontinence: associated with a
interactions – social and psychological health strong, abrupt desire to void and the
o The following two screening procedures inability to inhibit leakage in time to reach
are simple tests for functional vision: the toilet
▪ Ask the older adult to read a c. Reflex incontinence: results from inhibited
newspaper headline and story bladder contractions with no sensation of
▪ Ask the older adult to read the needing to void or urgency
prescription bottle d. Overflow incontinence: over distention of
• Hearing loss is a major concern for many older the bladder due to abnormal emptying
adults e. Functional incontinence: refers to
o The following question is useful in problems from factors external to the lower
assessing ear and hearing problems: urinary tract (cognitive impairments,
▪ Are you experiencing a hearing physical disabilities)
problem or any ear pain, ringing in
the ears or ear discharge? Management of Incontinence: Managing
• Older adults wearing aids – regularly assessed hydration, prompted voiding, bladder training,
and monitored pharmacological management
8. Integumentary Function
• Skin problems and concerns and inspecting the • Sleep disorder: more prevalent with age. Individuals
skin with multiple illnesses rate their sleep as being of
• Skin injury = close monitoring and treatment poorer quality

PREPARED BY: JAVIER, A.A.

 Management of Sleep Disorder: sleep hygiene,
environmental restricting, medications – LEVELS OF CARE
Zolpidem (Ambien), Zaleplon (Sonata) • Primary: prevention of both illness and disease
promotion of wellness
2. Behavioral o Prevention there is vulnerability; promotion no
• Anxiety: tachycardia and palpitations, gastrointestinal vulnerability
disorders, insomnia and tachypnea o Disease causes illness: one can have a disease
without illness
Nursing Care: decrease environmental stimuli, stay • Secondary: hospitalization or institutionalization to
with the patient, make no demands and do not ask avoid chronicity
patient to make decisions, support current coping o Case finding
mechanism (crying, talking, etc.), don’t confront or • Tertiary Rehabilitation: with such health deviations to
argue with the patient, speak slowly in a soft, calm regain and maintain the highest level of function and
voice independence
• Quaternary Prevention: experiencing illness buy there
• Depression: although depression is the most common is no identified disease; to protect him from new
mental health disorder in older adults, it is not a medical invasion and suggest intervention which are
normal consequence of aging ethically acceptable
Interventions: pharmacological therapy – Care Setting
tricyclic anti-depressants, exercise, counseling Actual Care: branch of 20 care where a px receives active
but short-term tx for a severe injury or episodes of illness,
an urgent medical condition or during recovery from surgery
• Polypharmacy
o The act of taking many medications concurrently Long-term Care: involves a variety services designed to
o The consequences of polypharmacy in the older meet a person’s health or personal care needs during a
adult range from mild annoying to life short or long period of time these services help people to
threatening live as independently and safety possible when they can no
o Adverse drug reactions/ drug-drug interaction longer perform the day activities on their own, long term
medication errors provide a safe environment for chronically ill and
o Non-adherence - not willing to follow the functionally dependent
instructions given for prescribes treatments
Short-term Care: type of tx that has a desired outcome; e.g.
3. Safety tx for an injury
• Falls – an event which results in a person
unintentionally coming to rest on the ground or Intermediate Care: an emerging concept in health care
another lower level which may offer attractive alternatives to hospital care for
elderly no longer as six weeks but can be as little as one or
Interventions: modify the environment, evaluate two weeks if the staff believe that is what you need to reach
Gait and balance – assess muscle strength and your goals
ability frequently and institute appropriate
measures for safe mobility and transfer Basic Services: In px care to pxs who have need to for
techniques, Review medications skilled nursing supervision and need supportive care, but
who do not require continue nursing care

Skilled Nursing Care: refers to a px’s need to care or tx that

can only be performed by licensed nurse. A nursing home
is facility for the residential care of elderly or disables
people. Nursing home can also be referred to as skilled nsg.
Facility, rest homes, convalescent homes or care

Home Care: services (as nsg or personal care) provided to

a homebound individual (as one who is convalescing,
disabled or terminally ill) home care as an alternative to
institutionalization

Adult Day Care Center: typically, a non-residential facility

that supports the health, nutritional, social and daily living
needs of adults in professionally staffed group setting.
These facilities provide adults the transitional care short-
term rehab following hospital discharge

PREPARED BY: JAVIER, A.A.

 Gordon’s Functional Health Pattern in Elderly
LEVEL I – able to perform full self-care
LEVEL II – requires assistance or supervision of another
person
LEVEL III – requires assistance or supervision of another
person and equipment or device
LEVEL IV – completely dependent and does not participate
in activities

PREPARED BY: JAVIER, A.A.

Geriatrics NCM 114j

PREPARED BY: JAVIER, A.A.