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A. Theoritical Review
The aging process is a physiological, which will be experienced by everyone. Elderly or
elderly is someone who reaches the age of 60 and above (Act No. 13 / year 1998)
CHAPTER I Article 1, paragraph 2). Age is not a disease but is a process of decreased
endurance in the face of stimuli from within and outside the body. Decrease in body
function in each individual is different and there is no firm limit on what age the
appearance of a person begins to decline (Nugroho, 2000).
1. The Theories of The Aging Process
Theories that explain how and why the aging process occurs are usually grouped into
two major groups, namely biological (physiological) and psychological (Stanley,
1.1 Theory Biological
1.1.1 Theory Genetic
According to this theory aging occurs as a result of biochemical changes
that are digested by molecules / DNA and each cell in time will have a
1.1.2 Theory Wear and Tear
The theory of wear and tear (worn and damaged) suggests that the
accumulation of metabolic waste or nutrients can damage DNA synthesis,
thus promoting organ malfunction. Free radicals are examples of
metabolic waste products that cause damage when accumulation occurs.
1.1.3 Theory Imunity
Immune theory describes a setback in the immune system associated with
aging. As people get older, the body's metabolic processes undergo
changes and secrete certain substances that are unacceptable to other body
tissues. This is what causes their defenses against foreign organisms to
1.1.4 Theory Neuroendocrine
Experts point out that aging occurs because of a slowdown in secretion of
certain hormones that have an impact on the reactions set by the nervous
1.1.5 Theory Environment
According to this theory, factors in the environment such as carcinogens,
sunlight, trauma and infection can bring changes in the aging process.
Although environmental impacts are known to accelerate aging, they are
secondary and are not a major factor in aging.

1.2 Theory Psychological

1.2.1 Theory Personality
Personality theory mentions aspects of psychological growth without
describing the expectations or specific tasks of the elderly. This theory
states that the changes that occur in the elderly is strongly influenced by
the type of personality it has.
1.2.2 Theory Developmental task

Erickson's research results show that developmental tasks are the activities
and challenges that a person must meet at the specific stages of his life to
achieve successful aging. Erickson outlines the main task of the elderly is
being able to see one's life as a life lived with integrity.
1.2.3 Theory Disengagement
Disengagement theory (termination theory) describes the process of
withdrawal by the elderly from the roles of society and responsibility.
1.2.4 Theory Activity
This theory argues that the path to successful aging is to remain active.
The importance of staying socially active as a tool for healthy adjustment
for the elderly.
1.2.5 Theory Continuty
This theory is also known as developmental theory. This theory
emphasizes the ability of prior individual coping and personality as the
basis for predicting how one will be able to adapt to changes caused by

2. Decreased Physiological Function in Elderly

The decline in physiological function of the elderly includes changes from cellular
level to all organ systems of the body, including:
2.1 Decreased Respiratory Function
Decreased respiratory function that often occurs in elderly occurs due to structural
and multiple functional changes in the lungs. Decrease of functions include:
2.1.1 Pulmonary elasticity decreases, chest wall stiffness increases, chest muscle
strength decreases so that breathing fast and shallow (normal: 12-20 times
/ minute).
2.1.2 A decrease in ciliary motion in the respiratory system wall results in
decreased cough reflexes resulting in a buildup of secretions and causing
2.1.3 Decreased pulmonary activity (expanding and deflating) so that the
amount of respiratory air entering the lungs decreases.
2.1.4 Alveoli is widened and the number decreases (normal surface area (50m²)
causes diffusion of diffusion process.
2.1.5 The decrease in oxygen (O2) of the arteries to 75 mmHg interferes with
the oxygenation process of hemoglobin, so that O2 is not transported all to
the tissues and causes shortness of breath
2.1.6 CO2 in the artery does not change so that the composition of O2 in the
arteries also decreases that gradually becomes toxic in the body itself.
2.2 Decreased Cardiovascular Function
With increasing age, the heart and blood vessels undergo both structural and
functional changes. Decreased cardiovascular function:
2.2.1 Heart valve thickens and becomes stiff.
2.2.2 The ability of the heart to pump blood decreases causing decreased
contraction and volume.
2.2.3 Loss of elasticity of blood vessels causes chest pain.

2.2.4 Lack of effectiveness of peripheral blood vessels for oxygenation causes
odeme in the legs, changes in position from sleep to sitting (sitting to
standing) can lead to sudden dizziness.
2.2.5 Blood pressure is increased due to increased peripheral vascular resistance
(normal ± 170/90 mmHg).
2.2.6 Heart rate decreased (normal 60-90 times / min)
2.3 Decreased Digestive Function
This decrease in digestive function starts from the teeth to the anus. The decrease
2.3.1 Atrophic changes in the jaw, making teeth easier to date.
2.3.2 Pale gums are a result of decreased blood supply.
2.3.3 The elderly sometimes experience a sensation of taste and decreased
ability to recognize a sense that is not sharp because danya chronic
irritation of the mucous membrane.
2.3.4 The esophagus widened.
2.3.5 The hunger decreases, the stomach acid decreases.
2.3.6 Difficulty in digesting food is the result of gastric mucosal atrophy and
decreased gastric motility.
2.3.7 Peristaltic weak and absorption function weakened (normal 5-25 times /
minute) causing constipation.
2.4 Decreased Urogenital Function
In the elderly will experience decreased kidney and sexual function, among
2.4.1 The kidneys shrink and the nephrons become atrophy, the blood flow to
the kidneys decreases until the filtration in the glomerolus decreases.
2.4.2 The reduced tubular function resulted; type of urine decreased; proteinuria
(usually +1); BUN increased up to 21mg%; the value of the renal
threshold to glucose increased.
2.4.3 Muscle muscle vesika urinaria (bladder) becomes weak which causes
Urination frequency increases.
2.4.4 Vesica urinaria is difficult to be emptied in elderly men resulting in
increased urinary retention (> 600mL per day).
2.4.5 Increased blood pressure (especially systolic pressure) although diastolic
pressure also often increases as peripheral blood vessels increase.
2.4.6 Enlarged prostate ± 75% started by men aged over 65 years.
2.4.7 Vulvar atrophy.
2.4.8 The vaginal membrane becomes dry, the elasticity of the tissue decreases
as well as the surface becomes smooth, the secretion becomes reduced, the
reaction is more alkaline to the color change.
2.4.9 The frequency of sexsual intercouse tends to decrease.
2.5 Decreased Metabolic/Endocrine Function
Decreased Metabolic / Endocrine function that may be experienced by the elderly
2.5.1 Production of almost all hormones decreases.
2.5.2 The function of parathyroid and its secretion is unchanged.

2.5.3 Pituitary: hormone growth exists but is lower and exists only in blood
vessels and decreases in production of ACTH, TSH, FSH and LH.
2.5.4 Decrease in activity of tiriod BMR (Basal Metabolic Rate) decreases and
decreases the power of substance exchange.
2.5.5 Decreased secretion of hormones aldesterone, progesterone, estrogen,
2.5.6 Physical changes that can occur due to decreased endocrine function in the
elderly include fatigue, frequent urination at night, polyphagia, polydipsia
and dizziness.
2.6 Decreased Function of the Joints and Bones
Bones and joints are aging that affect the decline in physiological function.
Decrease of this function include:
2.6.1 Bones lose density (fluid) and brittle so that the elderly have a greater risk
of fracture.
2.6.2 Kyphosis
2.6.3 The joints become enlarged and become stiff causing pain.
2.6.4 Waist, knee and wrist finger limited.
2.6.5 On intervertebral discs thinning and becoming short (reduced height).
2.6.6 Tendons constrict and have sclerosis
2.6.7 The muscle fibers shrink so that a person moves into a sluggish, muscular
cramp and tremor.
2.7 Decreased Function of Innocece
The central and peripheral components of the nervous system integrate all the
functions of the body. The function of the neural system is to receive, store,
process and transmit information. In elderly the aging of the nervous system,
among others:
2.7.1 The brain weight will decrease about 10-20% in aging between the ages of
30-70 years.
2.7.2 The rapid decrease of the nervous system.
2.7.3 Slow in responding and time to think.
2.7.4 Minimizing the sensory nerves.
2.7.5 Reduced vision, hearing loss, decreased olfactory nerve and taste, are
more sensitive to temperature changes with low resistance to cold.
2.7.6 Less sensitive to touch
2.8 Decreased Vision Function
Decreases that occur in elderly vision function, among others:
2.8.1 The cornea is more spherical (sphere).
2.8.2 Pupillary sphincter arises sclerosis and loss of response to light.
2.8.3 Lenses are more bleak (turbidity on the lens).
2.8.4 Increased threshold, light observation, adaptation power to darkness
slower, hard to see in dark light.
2.8.5 Loss of accommodation power.
2.8.6 Reduced field of view and reduced viewing area.
2.8.7 Decreased power distinguishes blue or green on scale.
2.9 Decreased Hearing Function
Decreases that occur in elderly hearing function, among others:

2.9.1 Loss of hearing ability in the inner ear especially to sounds or high notes,
unclear sounds, difficult to understand words.
2.9.2 Vertigo.
2.9.3 Tympanic membrane to atrophy causes otosclerosis.
2.9.4 The occurrence of collecting serumen, can harden because of increased
B. Problems that occur in the elderly
1. Dementia
Dementia is an intellectual / memory disorder that is generally progressive and
irreversible. Usually this is common in people aged> 65 years. In Indonesia often
assume that this dementia is a normal symptom in every parent. But the fact that a
misperception or perception that every parent experiencing impairment or decreased
memory is a normal process only. This assumption must be removed from our wrong
view of society.
Risk factors that often cause elderly to develop dementia are: age, family history,
female gender. Dementia is a primary degenerative disease in the central nervous
system and is a vascular disease.
Main symptoms:
1.1 Affression depression
1.2 Loss of interest
1.3 Reduced energy (easy)
2. Depression
Disturbance is the most important thing in the elderly problem. Age is not a factor to
be a precursor to a syndrome of non-synchronic disorders and the problems facing an
elderly person who are depressed. Symptoms of depression in elderly with young
adults are different where in elderly there are somatic complaints.
3. Schizophrenia
Schizophrenia does not start in the end of youth / young adult and lasts a lifetime.
Women more often suffer from schizophrenia than men. The difference of late onset
is precisely the case of paranoid nasopharyngealysis of late onset.
4. DisturbanceDelivery
The onset of the usage is disrupted for 40-55 years, but it is still possible. In the
disorder of delusions there are the most common understandings are: the pursuit of
pursuit and somatic understanding.
The deletion of disturbing parties is:
4.1 The death of the couple
4.2 Isolation social
4.3 Financial is not good
4.4 Illness
4.5 Disability
4.6 Impaired hearing / sight
5. Disturbance Anxiety
Disturbance is anxiety disorders, phobias, disordered disorders, disorders, general
anxiety, intracranic disorders, extraspascatraumatic disorders. Early onset of disorders
of breastmilk is rare, but it remains. Signs and symptoms are inadmissible in the
agony of consciousness, but the co-operation, but not more, leads to reparation to the

human patient. Theoryexistential explains the lack of any identifiable stimulus on the
basis of the specificity of the quasi-cherished nature.
The most common anxiety is about her death. One may come to the thought of death
with a sense of despair and anxiety, a book with a sense of joy and a sense of integrity
("Erik Erikson"). The fragility of the neuromuscemic system that fosters the
development of anxiety after a severe stressor. The more common disorders of the
principal types of the rhythm of the racial pythonic acid in the fidal stage are easily
formed by physical devices.
6. Somatiform Disorder
The disorder is dominated by a commonly occurring symptom of patients> 60 years.
The disturbance of the hormone and the prognosis is careful. For example, the patient
should also perform a physical examination so that he / she believes that it does not
involve a lethal disease. The invadation of this disorder is a psychological and
pharmacological approach.
7. Disturbance of use of alcohol and other substances
The history of alcohol / alcohol dependence does provide a history of excess
resources that commences on a mature / adult basis. Their brands have the
disposition. A large proportion of patients with chronic alcohol use may have chronic
cortical diseases such as wernicke encephalopathy and korsakoff syndrome.
8. Sleep Disorders
Old age is the single most frequent factor associated with increased prevalence of
sleep. The phenomenon that is often ignored from your consciousness is:
8.1 Distraction.
8.2 Daytime sleepiness.
8.3 Sleep for a day.

C. Pathway

D. Assessment
1. Physiological / physical
1.1 Stratus nutrition
1.2 BMI = Kg Normal female BB = 18 -25
1.3 (TB) 2 women = 17 – 23
1.4 Intake fluid in 24 hours
1.5 Skin condition
1.6 Conditions of lips, oral mucosa, teeth
1.7 Medical history, alcohol, other addictive substances
1.8 Evaluation of vision, hearing and mobility
1.9 Nutritional-related complaints: digestive system disorders, appetite, preferred and
disliked foods, flavor and aroma
1.10 Habit of eating time (2 -3 X a day, snak dlll)
2. Psychosocial / affective
2.1 The habit of eating (eating alone, while watching TV, etc.)
2.2 Environmental situation (capacity of food supply, processing and storage of food)
2.3 Sociocultural effect that affects the pattern of nutrition and elimination
2.4 Depression conditions that can interfere with the fulfillment of nutrients
2.5 Extra examination / laboratory
2.5.1 Blood analysis
2.5.2 Creatinine: indekz muscle mass
2.5.3 Serum proteins especially for synthesis of antibodies and lymphocytes, in cellular
immunity, enzymes, hormones, broad cell structure, tissue structure.

E. Nursing Diagnose
1. Changes in nutrients is less than the need for related to inadequate nutrition due to
2. High risk of infection related to decreased intake of calories and protein.
3. Damage to physical mobility related to skleletal deformity,, pain, activity intolerance.
4. Acute Pain related to inflammatory process, joint destruction.

F. Intervention
1. Changes in nutrients is less than the need for related to inadequate nutrition due to
Goals : Adequate nutritional needs are met
 Increase oral input
 Show increase in BB

Intervention Rational
1) Create ideal BB goals and 1) Adequate nutrition avoids
adequate daily nutritional needs malnutrition
2) Weigh daily, monitor the results 2) Early detection of BB
of laboratory tests changes and nutritional
3) Explain the importance of input
adequate nutrition 3) With the correct

4) Teach individuals to use understanding will motivate
flavorings (such as spices) the client for his nutritional
5) Encourage individuals to eat with input
others 4) The delicious aroma will
6) Maintain good oral hygiene arouse the appetite
(toothbrush) before and after 5) By eating together
chewing food psychologically increases
7) Suggest eating with small your appetite
portions but often 6) A clean mouth situation
8) Instruct individuals who have improves comfort
decreased appetite for: 7) Reduce feelings of tension
 Eat dry when waking up in the stomach
 Avoid foods that are too sweet, 8) Increase food intake
 Drink a little through a straw
 Eat whenever tolerance is
 Eat small portions low in fat and
eat frequently
2. High risk of infection related to decreased intake of calories and protein.
Goals : The client will show the ability to avoid signs of infection
Criteria : signs of inflammation not found: heat, swelling, pain, red, malfunction

Intervention Rational
1) Assess regular signs of inflammation 1) Early detection to prevent
regularly inflammation
2) Teach about the need to maintain 2) Prevent the occurrence of
personal hygiene and environment infection due to the environment
3) Increase the ability of TKTP nutris and less healthy hygiene
intake 3) Increase protein levels in the
4) Note the long-term use of drugs that body so as to enhance the ability
can cause immunosuppression of immunity in the body
4) Reduce the risk of infection
3. Damage to physical mobility related to skleletal deformity,, pain, activity intolerance.
Goals : Clients can mobilize adequately
Criteria: Demonstrate techniques / behaviors that enable activities

Intervention Rational
1) Evaluate monitoring of inflammation 1) The level of activity depends on
/ pain levels the development / resolution of
2) Help with active / passive range of the inflammatory process
motion 2) Maintaining joint function,
3) Change positions often with personal muscle strength
enough 3) Eliminates pressure on the

4) Provide a comfortable environment tissues and improves circulation
such as auxiliary tools 4) Avoid injury
4. Acute Pain related to inflammatory process, joint destruction.
Goals: Indicates pain is reduced / lost
Criteria: looks relaxed, able to sleep and participate in activities

Intervention Rational
1) Assess the pain complaint, note the 1) Helps in determining pain
location of pain and intensity. Record management
factors that accelerate the signs of 2) In severe disease bed rest is
pain necessary to limit the pain
2) Let the client take a comfortable 3) Heat increases muscle relaxation
position at rest or sleep and mobility, decreasing pain
3) Instruct the client to warm bath, and joint stiffness.
provide a washcloth to compress the 4) Increases relaxation / reduces
joints muscle tension
4) Give gentle massage 5) As an anti-inflammatory and
5) Collaborative drug delivery such as: mild analgesic effect in reducing
aspirin, ibuprofen, naproksin, stiffness.
piroxikam, phenoprofen

Anonym, 2009.panduan gerontology. EGC. Jakarta

Czeresna. H,dkk. 2000. PedomanPengelolaanKesehatanPasienGeriatri. EdisiPertama FKUI.


Martono, hadi&krispranarka. 2009. Buku Ajar Geriatri (ilmukesehatanusialanjut). Jakarta :FK