Professional Documents
Culture Documents
“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
• Described the aging individual in terms of his / her social group / culture.
1. DISENGAGEMENT -the basis of this theory arises from the fact that human beings
THEORY 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
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-one must constantly struggle to remain functional & take on new
activities to replace lost one
3. CONTINUITY -accounts for the continuous flow of phases in the life cycle &
THEORY does not limit itself to change
-it assumes that persons will remain the same unless there are
factors that stimulate change or necessitate adaptation
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 -loss of skin elasticity, increased dryness, & ↓
skin subcutaneous fat
-clustering of melanocytes
Brown “age spots” (lentigo senilus) on
-reduced number of sweat glands
exposed body parts (face, arms, hands)
-progressive loss of pigment cells from hair
Decreased perspiration
bulbs; decrease melanin production
Thinning & graying of scalp, pubic & -↑ calcium deposits
axillary hair
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-diminished delivery & diffusion of oxygen to
difficult, short, heavy, rapid breathing the tissues to repay the normal oxygen debt
(dyspnea) following intense exercise because of exertion or changes in both
respiratory & vascular tissues
CARDIOVASCULAR
reduced cardiac output & stroke volume, -↑ rigidity & thickness of the heart valves
particularly during increased activity or (hence ↓filling/emptying abilities); ↓
unusual demands; may result in shortness contractile strength
of breath in exertion & pooling of blood in
the extremities
reduced elasticity & increased rigidity of -↑ calcium deposits in the muscular layer
the arteries
GASTROINTESTINAL
delayed swallowing time -alteration in swallowing mechanism
increased tendency for ingestion -gradual decrease in digestive enzyme,
reduction in gastric pH & slower absorption
increased tendency for constipation rate
-↓ muscle tone of the intestines; ↓ peristalsis
URINARY
reduced filtering ability of the kidney & -↓ number of functioning nephrons &
impaired renal function arteriosclerotic changes in blood flow
less effective concentration of urine -↓ tubular function
urinary urgency & urinary frequency -enlarged prostate gland in men; weakened
muscle supporting the bladder or weakness of
the urinary sphincter in women
tendency for a nocturnal frequency & -↓ bladder capacity & tone
retention of residual urine
GENITALS
prostate enlargement (benign) in men -exact mechanism is unclear; possible
multiple changes in women (shrinkage & endocrine changes
atrophy of the vulva, cervix, uterus, -diminished secretion of female hormones &
fallopian tubes & ovaries; reduction in more alkaline vaginal pH
secretions; & changes in vagina flora)
reduced vaginal lubrication
increase in time for full sexual response
Peck (1968): proposed the 3 developmental task for older adults (contrast-Erikson’s)
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Ego transcendence vs. ego preoccupation
• 65 TO 75 YEARS
. Economic change
= Assisted living – a facility that meets the needs of the older person (e.g.
wide
= 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
. Maintaining independence and self-esteem – aging people need to recognized for the unique
Individual characteristics
. Facing death and grieving – great bonds of affection and closeness can develop during this
period of
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-When a mate dies, the remaining partner inevitably experiences
feelings of loss, emptiness, and loneliness.
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
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
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.
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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.
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
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.
1. Weight
2. Height
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3. Vital signs
a. Symptoms of depression
. Accidents
. Fall
. Hypothermia
. Chronic disabling illness – arthritis, osteoporosis, heart disease, COPD, hearing & visual
. Drug use and misuse – consider the variations in absorption, distribution, metabolism, and
excretion
. Alcoholism
. Dementia – is a slow, insidious process that results in progressive loss of cognitive function
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Nursing intervention:
c. Financial abuse – taking their money or forcing them to sign over their
assets
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
avoid hot showers or baths, may cause venous dilatation thereby venous
pooling.
10. Hypertension
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Nursing intervention
No weightlifting
11. Osteoporosis
Nursing intervention
- fish
- beans
- orange juice
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
Communication considerations
- demonstrate respect by remembering names and calling the person by the name
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- face the person when speaking
- 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
foot care – soak feet in warm water before cutting nails (usually hard and scaly)
regular exercises of feet and legs to prevent PVD (peripheral vascular disorders)
Temperature
Nutritional needs
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
Emotional needs
allow to verbalize about feelings on death (do not avoid the topic)
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
Safety
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-home safety measures to prevent falls, fire, burns, scalds and
electrocution
bone calcification
Elimination
Social Interaction
fears
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