CARE OF THE

OLDER
PERSONS

Prepared by:

Datinguinoo, Justine D.

Delmo, Ma. Victoria P.

Fernando, Mark John T.

Foster, Ferdinand K.

Garcia, Julyn V.

Hermano, Ancelle C.

Laranga, Aubrey P.
DEMOGRAPHICS OF AGING
The number of older people is growing
In the Philippines, the number of older people is increasing rapidly, faster than growth in the
total population. In 2000, there were 4.6 million senior citizens (60 years or older), representing
about 6% of the total population. In one decade, this grew to 6.5 million older people or about
6.9% of the total population. The National Statistics Office projects that by 2030, older people
will make up around 11.5 % of the total population.

Older people need care and support

An ageing population increases the demand for health services.Older people suffer from both
degenerative and communicable diseases due to the ageing of the body’s immune system. The
leading causes of morbidity are infections, while visual impairment, difficulty in walking,
chewing, hearing, osteoporosis, arthritis and incontinence are other common health-related
problems.

Older people struggle with poverty

According to the Department of Social Welfare and Development (DSWD), a nearly a third
(31.4%) of older people were living in poverty in 2000.Currently, this number is estimated to be
1.3 million older people.

More than half of all older people (57.1%) were employed in 2000. More males were employed
(63.6%) than women (37.4%). The majority of those employed (41%) were involved in primary
economic activities such as farming, forestry work and fishing.

THEORIES OF AGING

By understanding and describing how we age, researchers have developed several different
theories of aging. The two categories are programmed theories and error theories.

 Programmed Theories assert that the human body is designed to age and there is a
certain biological timeline that our bodies follow.
 Programmed Longevity: Aging is caused by certain genes switching on and off
over time.
 Endocrine Theory: Changes in hormones control aging.
 Immunological Theory: The immune system is programmed to decline over
time, leaving people more susceptible to diseases.
 Error Theories assert that aging is caused by environmental damage to our body's
systems, which accumulates over time.
 Wear and Tear: Cells and tissues simply wear out.
 Rates of Living: The faster an organism uses oxygen, the shorter it lives.
 Cross-Linking: Cross-linked proteins accumulate and slow down body
processes.
 Free Radicals: Free radicals cause damage to cells that eventually impairs
function.
 Somatic DNA Damage: Genetic mutations cause cells to malfunction.

Genetics and Aging

Studies have demonstrated that genetics can play a major role in aging. When researchers adjust
the genes in certain mice, yeast cells, and other organisms, they can almost double the lifespan of
these creatures. The meaning of these experiments for people is not known, but researchers think
that genetics account for up to 35 percent of the variation in aging among people. Some key
concepts in genetics and aging include:
  Longevity Genes: There are specific genes which help a person live longer.
 Cell Senescence: The process by which cells deteriorate over time.
 Telomeres: Structures on the end of DNA that eventually are depleted, resulting in cells
ceasing to replicate.
 Stem Cells: These cells can become any type of cell in the body and hold promise to
repair damage caused by aging.

Biochemistry

No matter what genes you have inherited, your body is continually undergoing complex
biochemical reactions. Some of these reactions cause damage and, ultimately, aging in the body.
Studying these complex reactions is helping researchers understand how the body changes as it
ages. Important concepts in the biochemistry of aging include:

 Free Radicals: Unstable oxygen molecules which can damage cells.

 Protein Cross-Linking: Excess sugars in the bloodstream can cause protein molecules to
literally stick together.
 DNA Repair: For unknown reasons, the systems in the body to repair DNA seem to
become less effective in older people.
 Heat Shock Proteins: These proteins help cells survive stress and are present in fewer
numbers in older people.
 Hormones: The body's hormones change as we age, causing many shifts in organ
systems and other functions.

Body Systems

As we age, our body's organs and other systems make changes. These changes alter our
susceptibility to various diseases. Researchers are just beginning to understand the processes that
cause changes over time in our body systems. Understanding these processes is important
because many of the effects of aging are first noticed in our body systems. Here is a brief
overview of how body systems age:

 Heart Aging: The heart muscle thickens with age as a response to the thickening of the
arteries. This thicker heart has a lower maximum pumping rate.
 Immune System Aging: T cells take longer to replenish in older people and their ability
to function declines.
 Arteries and Aging: Arteries usually to stiffen with age, making it more difficult for the
heart to pump blood through them.
 Lung Aging: The maximum capacity of the lungs may decrease as much as 40 percent
between ages 20 and 70.
 Brain Aging: As the brain ages, some of the connections between neurons seem to be
reduced or less efficient. This is not yet well understood.
 Kidney Aging: The kidneys become less efficient at cleaning waste from the body.
 Bladder Aging: The total capacity of the bladder declines and tissues may atrophy,
causing incontinence.
 Body Fat and Aging: Body fat increases until middle age and then weight typically
begins to decrease. The body fat also moves deeper in the body as we age.
 Muscle Aging: Muscle tone declines about 22 percent by age 70, though exercise can
slow this decline.

 Bone Aging: Starting at age 35, our bones begin to lose density. Walking, running and
resistance training can slow this process.
 Sight and Aging: Starting in the 40s, difficulty seeing close detail may begin.
 Hearing and Aging: As people age, the ability to hear high frequencies declines.
Behavioral Factors

The good news is that many of these causes of aging can be modified through your behaviors:

 By eating foods loaded with antioxidants, you can minimize damage caused by free
radicals.
 By exercising, you can limit bone and muscle loss.
 By keeping your cholesterol low, you can slow the hardening of your arteries and protect
your heart.
 By practicing mental fitness, you can keep your brain sharp.

Lifestyle factors have also been shown to extend life. Rats and mice on a calorie restricted diet
(30 percent fewer daily calories) live up to 40 percent longer. Positive thinking has also been
shown to extend life in people by up to 7.5 years.

The Aging Family the Well Older Person Changes in the Older person and their
Implication to Care
Aging families need to learn how to manage transitions together. However, aging
families are not by definition “teams.” Often family members need to address unarticulated
assumptions about their own multiple roles in the family.

Physical Changes
Wrinkles are a classic sign of aging, although people actually develop wrinkles all
throughout life. Older skin is less elastic and thinner and is therefore more prone to developing
wrinkles. Reaction time slows further, muscle strength and mobility diminishes

Physiological Changes
Physiological changes occur with aging in all organ systems. The cardiac output
decreases, blood pressure increases and arteriosclerosis develops. The lungs show impaired gas
exchange, a decrease in vital capacity and slower expiratory flow rates. The creatinine clearance
decreases with age although the serum creatinine level remains relatively constant due to a
proportionate age-related decrease in creatinine production.

Biological Changes
Biological changes that occur with age in the human body affect mood, attitude to the
environment, physical condition and social activity, and designate the place of seniors in the
family and society

Social and Psychological Emotions

Sensory systems become less sensitive and acute, lifelong sleep patterns undergo change,
and there is decline in certain aspect of memory.
CULTURAL FACTORS AND ETHNICITY SUCH AS REGARD FOR ELDERS
Many believe it is our culture's negative depiction of aging. In many other cultures, however, old
age is revered. The elderly are highly valued, and the process of aging is embraced.

Other possibly contributory lifestyle factors include alcohol consumption, stress, diet, exercise,
disease, and medication. In summary, the genetic influences on aging may be highly overrated,
with lifestyle choices exerting far more important effects on physical aging.

Socio-cultural factors are customs, lifestyles and values that characterize a society. More
specifically, cultural aspects include aesthetics, education, language, law and politics,
religion, social organizations, technology and material culture, values and attitudes.

Personal and cultural values of each individual were directly measured, and their congruence
were calculated and compared across age and cultures. These age differences, and their
associations with subjective well-being, were generally not influenced by cultural values.

One of the primary reasons seniority is important to unions and union workers is that it can
determine the pay, benefits and job responsibilities of workers. Seniority also may affect benefits
such as vacation time.
Perception of health for elderly
The perception of health in what way objective health-related variables interfere with psychic
health and personality factors in explaining self-perception of health in the elderly. Two hundred
and sixty-one patients aged 60 and older of an internal medicine hospital previously examined
between 1994 and 1997 were once more contacted five years later. One hundred and sixty-four
patients could not be included in the present investigation because of death, dementia, or severe
physical illness. Of the 97 patients eligible for this second investigation, 74 agreed to participate.
They were investigated extensively by means of psychometric scales and diagnostic interviews.
A positive selection effect could be found for the sample of the present investigation with regard
to age and health-related variables. Subjective evaluation of health correlated highly with the
self-evaluation scales that recorded subjective well-being (life satisfaction, anxiety, and
depression), and with the sense of coherence, but not substantially with objective health-related
variables. A backward regression resulted in an adjusted R2 = 0.33 for the three retained
variables "subjective physical complaints", "sense of coherence" and "self-evaluated depression"
which rendered the same variance clarification of subjective health as did the model including all
variables. Since the elderly represent the majority of patients treated in general hospitals and as
subjective health and subjective physical complaints influence frequency of medical
consultations and health care utilization, this is an important issue for consultation of psychiatry
and health policy.

RISK FACTORS ASSOCIATED WITH CHRONIC ILLNESS

A diverse range of factors influence the health and wellbeing of the Australian population. These
factors are attributes, characteristics or exposures that increase the likelihood of a person
developing a disease or health disorder5. They can be categorised as follows:
 Behavioural risk factors – these are the most common risk factors for many chronic
conditions. As such, they are often a major focus for prevention strategies and
interventions.
– Examples include smoking, poor diet and nutrition, harmful consumption of alcohol,
physical inactivity and/or cognitive inactivity.
  Biomedical risk factors – these relate to the condition, state or function of the body that
contributes to the development of chronic conditions. The effects of a single biomedical
risk factor can be intensified when additional biomedical risk factors or behavioural risk
factors are present.
– Examples include high blood pressure, high blood cholesterol, overweight or obesity,
impaired glucose tolerance, stress, mental illness, trauma, or illness (communicable
disease).
 Non-modifiable risk factors – these comprise individual physical and psychological
components.
– Examples include age, sex, genetics or intergenerational influences.
 Physical environment determinates – these comprise both the natural and built
environment, can impact health in a subtle or obvious manner and can occur over the
short or long-term.
– Examples include UV exposure, air pollution, urban environment, or geographical
location.
 Social and economic determinants – these can be difficult for individuals to control,
however they influence the way in which people live their lives6.
– Examples include beliefs, customs and culture, education and employment status.
According to the Centers for Disease Control (CDC) a lot of the sickness, disability, and even
death associated with chronic disease can be avoided through preventive measures. The CDC
suggests lessening the possibility of the onset of chronic disease in later years by:
 Practicing a healthy lifestyle that includes healthy eating, regular exercise and avoiding
tobacco use
 Regular use of early detection and testing such as breast, prostate and cervical cancer
screenings, diabetes and cholesterol screenings, bone density scans, etc.

HEALTH PROBLEMS IN CHRONIC ILLNESS

All too often, because there are so many chronic conditions that seem to afflict older persons,
there is the mistaken perception that diabetes, arthritis and the like, are just "part of growing old"
and nothing can be done about them. The truth is most of these diseases and conditions are
treatable and should be addressed by a physician. According to the American Society of
Consultant Pharmacists, the most common chronic diseases afflicting the elderly are:
 Adult onset diabetes
 Arthritis
 Kidney and bladder problems
 Dementia
 Parkinson's disease
 Glaucoma
 Lung disease
 Cataracts
 Osteoporosis
 Enlarged prostate
  Alzheimer's disease
 Macular degeneration
 Depression
 Cardiovascular disease

Geriatric Assessment

 Is a multidimensional, multidisciplinary assessmentdesigned to evaluate an older

person's functional ability, physical health, cognition and mental health, and
socioenvironmental circumstances.
 usually initiated when the physician identifies a potential problem.

Purpose of a geriatric assessment

 Comprehensive geriatric assessment (CGA) is defined as a multidisciplinary diagnostic
and treatment process that identifies medical, psychosocial, and functional capabilities of
an older adult in order to develop a coordinated plan to maximize overall health with
aging.

Functional Ability
Functional status refers to a person's ability to perform tasks that are required for living. The
geriatric assessment begins with a review of the two key divisions of functional ability: activities
of daily living (ADL) and instrumental activities of daily living (IADL). ADL are self-care
activities that a person performs daily (e.g., eating, dressing, bathing, transferring between the
bed and a chair, using the toilet, controlling bladder and bowel functions). IADL are activities
that are needed to live independently (e.g., doing housework, preparing meals, taking
medications properly, managing finances, using a telephone).

Table 1

Katz Index of Independence in Activities of Daily Living

ACTIVITIES (1 OR DEPENDENCE (0
0 POINTS) INDEPENDENCE (1 POINT)* POINTS) †

Bathing Bathes self completely or Needs help with bathing

needs help in bathing only a more than one part of the
single part of the body, such body, getting in or out of
Points:______ as the back, genital area, or the bathtub or shower;
disabled extremity requires total bathing

Dressing Gets clothes from closets and
drawers, and puts on clothes
and outer garments complete
Points:______ with fasteners; may need
help tying shoes
Needs help with dressing
self or needs to be
completely dressed

Toileting Goes to toilet, gets on and Needs help transferring to

ACTIVITIES (1 OR DEPENDENCE (0
0 POINTS) INDEPENDENCE (1 POINT)* POINTS) †

off, arranges clothes, cleans the toilet and cleaning

Points:______
genital area without help self, or uses bedpan or
commode

Transferring Moves in and out of bed or Needs help in moving

chair unassisted; mechanical from bed to chair or
transfer aids are acceptable requires a complete
Points:______ transfer

Fecal and urinary Exercises complete self- Is partially or totally

continence control over urination and incontinent of bowel or
defecation bladder

Points:______

Feeding Gets food from plate into Needs partial or total help
mouth without help; with feeding or requires
preparation of food may be parenteral feeding
Points:______ done by another person

Total points‡: _________

*—No supervision, direction, or personal assistance.

†—With supervision, direction, personal assistance, or total care.
‡—Score of 6 = high (patient is independent); score of 0 = low (patient is very dependent).

Table 2

Lawton Instrumental Activities of Daily Living Scale (Self-Rated Version)

For each question, circle the points for the answer that best applies to your situation.

1. Can you use the telephone?

Without help 3

With some help 2

Completely unable to use the telephone 1

2. Can you get to places that are out of walking distance?

Without help 3

With some help 2

Completely unable to travel unless special arrangements are made 1

3. Can you go shopping for groceries?

Without help 3

With some help 2

Completely unable to do any shopping 1

4. Can you prepare your own meals?

Without help 3

With some help 2

Completely unable to prepare any meals 1

5. Can you do your own housework?

Without help 3

With some help 2

Completely unable to do any housework 1

6. Can you do your own handyman work?

Without help 3

With some help 2

 Completely unable to do any handyman work 1

7. Can you do your own laundry?

Without help 3

With some help 2

Completely unable to do any laundry 1

8a. Do you use any medications?

Yes (If “yes,” answer question 8b) 1

No (If “no,” answer question 8c) 2

8b. Do you take your own medication?

Without help (in the right doses at the right time) 3

With some help (take medication if someone prepares it for you or 2

reminds you to take it)

Completely unable to take own medication 1

8c. If you had to take medication, could you do it?

Without help (in the right doses at the right time) 3

With some help (take medication if someone prepares it for you or 2

reminds you to take it)

Completely unable to take own medication 1

9. Can you manage your own money?

Without help 3

With some help 2

Completely unable to handle money 1

NOTE: Scores have meaning only for a particular patient (e.g., declining scores over time
reveal deterioration). Some questions may be sex-specific and can be modified by the
interviewer.

Physical Health
The geriatric assessment incorporates all facets of a conventional medical history, including
main problem, current illness, past and current medical problems, family and social history,
demographic data, and a review of systems. The approach to the history and physical
examination, however, should be specific to older persons. In particular, topics such as nutrition,
vision, hearing, fecal and urinary continence, balance and fall prevention, osteoporosis, and
polypharmacy should be included in the evaluation. Table 3 is an example of a focused geriatric
physical examination.

Table 3

Sample Focused Geriatric Physical Examination

PHYSICAL SIGN OR
SIGNS SYMPTOM DIFFERENTIAL DIAGNOSES

Vital signs

Blood pressure Hypertension Adverse effects from

medication, autonomic
dysfunction

Orthostatic Adverse effects from

hypotension medication, atherosclerosis,
coronary artery disease

Heart rate Bradycardia Adverse effects from

medication, heart block

Irregularly irregular Atrial fibrillation

heart rate

Respiratory rate Increased respiratory Chronic obstructive pulmonary

rate greater than 24 disease, congestive heart failure,
breaths per minute pneumonia

Temperature Hyperthermia, Hyper- and hypothyroidism,

hypothermia infection

General Unintentional weight Cancer, depression

loss
 PHYSICAL SIGN OR
SIGNS SYMPTOM DIFFERENTIAL DIAGNOSES

Weight gain Adverse effects from congestive

heart failure medication

Head Asymmetric facial or Bell palsy, stroke, transient

extraocular muscle ischemic attack
weakness or paralysis

Frontal bossing Paget disease

Temporal artery Temporal arteritis

tenderness

Eyes Eye pain Glaucoma, temporal arteritis

Impaired visual Presbyopia

acuity

Loss of central vision Age-related macular

degeneration

Loss of peripheral Glaucoma, stroke

vision

Ocular lens Cataracts

opacification

Ears Hearing loss Acoustic neuroma, adverse

effects from medication,
cerumen impaction, faulty or ill-
fitting hearing aids, Paget
disease

Mouth, throat Gum or mouth sores Dental or periodontal disease,

ill-fitting dentures

Leukoplakia Cancerous and precancerous

lesions

Xerostomia Age-related, Sjögren syndrome

Neck Carotid bruits Aortic stenosis, cerebrovascular

disease
 PHYSICAL SIGN OR
SIGNS SYMPTOM DIFFERENTIAL DIAGNOSES

Thyroid enlargement Hyper- and hypothyroidism

and nodularity

Cardiac Fourth heart sound Left ventricular thickening

(S4)

Systolic ejection, Valvular arteriosclerosis

regurgitant murmurs

Pulmonary Barrel chest Emphysema

Shortness of breath Asthma, cardiomyopathy,

chronic obstructive pulmonary
disease, congestive heart failure

Breasts Masses Cancer, fibroadenoma

Abdomen Pulsatile mass Aortic aneurysm

Gastrointestinal, Atrophy of the Estrogen deficiency

genital/rectal vaginal mucosa

Constipation Adverse effects from

medication, colorectal cancer,
dehydration, hypothyroidism,
inactivity, inadequate fiber
intake

Fecal incontinence Fecal impaction, rectal cancer,

rectal prolapse

Prostate enlargement Benign prostatic hypertrophy

Prostate nodules Prostate cancer

Rectal mass, occult Colorectal cancer

blood

Urinary incontinence Bladder or uterine prolapse,

detrusor instability, estrogen
deficiency
 PHYSICAL SIGN OR
SIGNS SYMPTOM DIFFERENTIAL DIAGNOSES

Extremities Abnormalities of the Bunions, onychomycosis

feet

Diminished or absent Peripheral vascular disease,

lower extremity venous insufficiency
pulses

Heberden nodes Osteoarthritis

Pedal edema Adverse effects from

medication, congestive heart
failure

Muscular/skeletal Diminished range of Arthritis, fracture

motion, pain

Dorsal kyphosis, Cancer, compression fracture,

vertebral tenderness, osteoporosis
back pain

Gait disturbances Adverse effects from

medication, arthritis,
deconditioning, foot
abnormalities, Parkinson
disease, stroke

Leg pain Intermittent claudication,

neuropathy, osteoarthritis,
radiculopathy, venous
insufficiency

Muscle wasting Atrophy, malnutrition

Proximal muscle pain Polymyalgia rheumatica

and weakness

Skin Erythema, ulceration Anticoagulant use, elder abuse,

over pressure points, idiopathic thrombocytopenic
unexplained bruises purpura

Premalignant or Actinic keratoses, basal cell

malignant lesions carcinoma, malignant
melanoma, pressure ulcer,
squamous cell carcinoma
 PHYSICAL SIGN OR
SIGNS SYMPTOM DIFFERENTIAL DIAGNOSES

Neurologic Tremor with rigidity Parkinson disease

NOTE: When performing a geriatric physical examination, physicians should be alert for some
of these signs and symptoms.

Cognition and Mental Health

DEPRESSION
The USPSTF recommends screening adults for depression if systems of care are in place. Of the
several validated screening instruments for depression, the Geriatric Depression Scale and the
Hamilton Depression Scale are the easiest to use and most widely accepted. However, a simple
two-question screening tool (“During the past month, have you been bothered by feelings of
sadness, depression, or hopelessness?” and “Have you often been bothered by a lack of interest
or pleasure in doing things?”) is as effective as these longer scales. Responding in the affirmative
to one or both of these questions is a positive screening test for depression that requires further
evaluation.

DEMENTIA
Early diagnosis of dementia allows patients timely access to medications and helps families to
make preparations for the future. It can also help in the management of other symptoms that
often accompany the early stages of dementia, such as depression and irritability.

Mini-Cognitive Assessment Instrument

Step 1. Ask the patient to repeat three unrelated words, such as “ball,” “dog,” and
“window.”

Step 2. Ask the patient to draw a simple clock set to 10 minutes after eleven o'clock
(11:10). A correct response is drawing of a circle with the numbers placed in
approximately the correct positions, with the hands pointing to the 11 and 2.

Step 3. Ask the patient to recall the three words from Step 1. One point is given for
each item that is recalled correctly.

Interpretation

NUMBER OF ITEMS CLOCK DRAWING INTERPRETATION OF

CORRECTLY RECALLED TEST RESULT SCREEN FOR DEMENTIA

0 Normal Positive

0 Abnormal Positive
NUMBER OF ITEMS CLOCK DRAWING INTERPRETATION OF
CORRECTLY RECALLED TEST RESULT SCREEN FOR DEMENTIA

1 Normal Negative

1 Abnormal Positive

2 Normal Negative

2 Abnormal Positive

3 Normal Negative

3 Abnormal Negative

Adapted with permission from Ebell MH. Brief screening instruments for dementia in primary
care. Am Fam Physician. 2009;79(6):500, with additional information from reference 47.

Socioenvironmental Circumstances
According to the U.S. Census Bureau, approximately 70 percent of noninstitutionalized adults 65
years and older live with their spouses or extended family, and 30 percent live
alone. Determining the most suitable living arrangements for older patients is an important
function of the geriatric assessment. Although options for housing for older persons vary widely,
there are three basic types: private homes in the community, assisted living residences, and
skilled nursing facilities (e.g., rehabilitation hospitals, nursing homes). Factors affecting the
patient's socioenvironmental circumstances include their social interaction network, available
support resources, special needs, and environmental safety.

NURSING DIAGNOSIS RELATED TO WELLNESS & CHRONIC ILLNESS

Curtin and Lubkin (1995) offered the following definition of chronic illness from a nursing
perspective : “ Chronic Illness is the irreversible presence, accumulation, or latency of disease
states or impairments that involve the total human environment for supportive care and self-care,
maintenance of function and prevention of further disability.”
A nursing diagnosis is a standardized statement about the health of an individual, community or
family. Based on the nursing diagnosis, a nurse selects a method of intervention to provide
necessary care to patients. Nurses are responsible for choosing the correct diagnosis and are
accountable for a patient’s outcome after receiving care. Nurses use several types of nursing
diagnosis statements.
Actual
An actual nursing diagnosis is a clinical judgment about a current patient health problem, which
is present at the time of the nursing assessment, verified by presence of the major defining
symptoms, signs and characteristics, and would benefit from nursing care. Examples of an actual
nursing diagnosis statement are anxiety characterized by fear, panic, apprehension and sleep
disturbances, or an ineffective airway clearance characterized by an ineffective cough, abnormal
breathing or a fever.

Risk
A risk nursing diagnosis is clinical judgment about a health problem which does not yet exist,
but with respect to which the individual, family or community has risk factors. These risk factors
lead to the conclusion that the patient is at a higher risk for developing the health problem in the
near future than others. Examples of a risk nursing diagnosis statement are risk for injury related
to disorientation and altered mobility and a risk for infection related to a compromised immune
system or diabetes.

Wellness
A wellness nursing diagnosis statement is a clinical judgment that an individual, family or
community is able to transition to a level of higher wellness. Before giving a diagnosis of
wellness, two factors must be present. An individual, family or community must possess
effective present function or status and show a desire for increased wellness. Examples of a
wellness nursing diagnosis statement are readiness for enhanced family coping or readiness for
enhanced spiritual well-being.

Syndrome
A syndrome nursing diagnosis statement is a clinical judgment, which is associated with a cluster
of predicted high-risk or actual nursing diagnosis, related to a certain situation or event. There
are five types of syndrome diagnosis: post-trauma syndrome, rape trauma syndrome, relocation
stress syndrome, impaired environmental interpretation syndrome and disuse syndrome. An
example of a syndrome nursing diagnosis statement is rape trauma syndrome manifested by
sleep pattern disturbance, anger and genitourinary discomfort and related to feeling anxious
about possible resulting health problems.

PROBLEMS RELATED TO THE OLDER PERSONS

PHYSIOLOGIC FUNCTIOING
In the early years of this period of life, physical functions are usually still effective.
As time passes, gradual internal and external physiologic changes occur.
These are not pathologic changes but normal changes that result from aging
Normal aging affects all physiological processes. Subtle irreversible changes in the function of
most organs can be shown to occur by the third and fourth decades of life, with progressive
deterioration with age.
Integumentary System

 Wrinkling and sagging of skin occur with decreased skin elasticity; dryness and scaling are
common.
 Balding becomes common in men, and women also experience thinning of hair; hair loses
pigmentation.
 Skin pigmentation and moles are common, although the skin may become pale because of loss
of melanocytes. Melanin production decreases
 Nails typically thicken, becoming brittle and yellowed

Musculoskeletal System

 Decreases in subcutaneous tissue and weight commonly are found in the old-old.
 Muscle mass and strength decrease.
 Bone demineralization occurs, and bones become porous and brittle. Fracture is more
common
 Joints tend to stiffen and lose flexibility, and range of motion may decrease.
 Overall mobility commonly slows, and posture tends to stoop.
 Height decreases slightly.
 Joints develop degenerative changes

Cardiopulmonary

 Blood vessels become less elastic and often rigid and tortuous. Venous return becomes less
efficient. Fatty plaque deposits continue to occur in the linings of the blood vessels. Lower-
extremity edema and cooling may occur, particularly with decreased mobility. Peripheral
pulses are not always palpable.
 The body is less able to increase heart rate and cardiac output with activity.
 Pulmonary elasticity and ciliary action decrease, so that clearing of the lungs becomes less
efficient. Respiratory rate may increase, accompanied by diminished depth.
 Effectiveness of the cough mechanism lessens increasing risk of lung infection
 Brain and coronary arteries receiving more blood than other organs.

Gastrointestinal

 Digestive juices continue to diminish, and nutrient absorption decreases.

 Malnutrition and anemia become more common.
 With reduced muscle tone and decreased peristalsis, constipation and indigestion are
common complaints.
 Gag reflex is less effective.

Neurologic

 The central nervous system responds more slowly to multiple stimuli. Hence, the cognitive
and behavioral response of the older adult may be delayed.
 Rate of reflex response decreases.
 Temperature regulation and pain/pressure perception become less efficient.
 There may be a loss of sensation in the extremities.
 The older adult may also experience difficulty with balance, coordination, fine movements,
and spatial (space) orientation, resulting in an increased risk for falls.
 Sleep at night typically shortens, and the older adult may awaken more easily. Cat-naps
become common.
 Short term memory diminished without changes in long term memory.
Special Senses

 Diminished visual acuity (presbyopia) occurs, with increased sensitivity to glare, decreased
ability to adjust to darkness, decreased accommodation, decreased depth perception, and
decreased color discrimination.
 Cataracts may further obscure vision. Difficulty reading small print might result. Daytime or
night driving might be compromised.

 The senses of taste and smell are decreased. Sensitivity to odors might be reduced. Problems
with nutrition may result.

Endocrine System
Hormonal Changes
 The hormonal changes that take place in midlife affect men and women differently. Women
undergo menopause, a gradual decrease in ovarian function, with subsequent depletion of
estrogen and progesterone. This change usually occurs between 40 and 55 years of age.
 With the cessation of ovulation, menstrual periods stop either gradually or abruptly, and
many women experience hot flashes, mood swings, and fatigue.
 The loss of estrogen also increases the risk for osteoporosis and heart disease. The process
can last for several years, and afterward the woman can no longer become pregnant.
 Men do not experience physical symptoms from the decreased levels of hormones, called
andropause.
 Androgen levels diminish slowly; the man may have some loss of sexual potency but is still
capable of reproduction.
Glucose Homeostasis
 Type 2 DM, Increasing age results in a progressive deterioration in the number and the
function of insulin producing beta cells. The capacity of these cells to recognize and respond
to changes in glucose concentration is impaired.

Genitourinary
 Blood flow to the kidneys decreases with diminished cardiac output.
 The number of functioning nephron units decreases by 50%; waste products may be filtered
and excreted more slowly.
 Fluids and electrolytes remain within normal ranges, but the balance is fragile.
 Bladder capacity decreases by 50%. Voiding becomes more frequent; two or three times a
night is usual. A decrease in bladder and sphincter muscle control may result in stress
incontinence or incomplete bladder emptying.
 About 75% of men over 65 years of age experience hypertrophy of the prostate gland;
surgery may be required if urinary retention occurs.
 There is atrophy, decrease of secretions, and thinning of the older woman's genital tract.
 Major clinical manifestation for UTI – signs of acute confusion
 For frequent urination - make no changes in the client’s dietary intake and keep the
clientfrom self-limiting fluids.

BEHAVIORAL
Elderly Rage, Anger and Yelling
Age and illness can intensify longstanding personality traits in some unpleasant ways. For
example, an irritable person may frequently become enraged, or an impatient person may
become demanding and impossible to please. Unfortunately, the primary caregiver is often an
angry elder’s main target.
Caring for those with Abusive Behaviors
Occasionally, seniors will lash out at the person who is making the biggest effort to take care of
them. Left unchecked, the anger and frustration described above can become so severe that it
results in abuse of the caregiver. In some cases, abuse may stem from a mental illness, such as
narcissistic and borderline personality disorders.
Elders who Refuse to Shower
The issue of elders refusing to take showers, change their clothes and take care of personal
hygiene is far more common than most people think. Sometimes depression is the cause, and
another factor could be control. As people age, they lose more and more control over their lives,
but one thing they generally can control is dressing and showers. The more you nag them to take
a bath and put on fresh clothes, the more they resist.

Paranoia and Hallucinations in the Elderly

Paranoia and hallucinations in the elderly can take many forms. Seniors may accuse family
members of stealing, see people and things that aren’t there, or believe someone is trying to harm
them.
Elders who Demand Undivided Attention
Once a family member becomes a caregiver, the care recipient might construe this commitment
as a 24-hour full-time job. However, family caregivers have other obligations and priorities like
work, family, and their own physical and mental health. Seniors who are still capable of doing
things for themselves can easily become completely dependent on a caregiver for all of their
physical and emotional needs. It is one thing when they truly need extensive assistance, but when
this dependency is elective, it can make their demands even more frustrating.

SAFETY
Fall Prevention Safety
The older adult is at increased risk for accidental injury because of changes in vision and
hearing, loss of mass and strength of muscles, slower reflexes and reaction time, and decreased
sensory ability. Remove obstacles in the house that could cause tripping. Make sure that the bed
rails used for transitioning or support and the I.V. poles used for support while ambulating are
sturdy.
Taking Medications safely
Keep all medications in their original containers so you don't mix up medicines.
Make a list of all the medicines, including over-the-counter products and dietary supplements.
The list should include the name of each medicine, healthcare provider who prescribed it, reason
it was prescribed, amount you take, and time (s) you take it. Read and save in one place all
written information that comes with the medicine.

Fire and Kitchen Safety

Replace appliances that have fraying or damaged electrical cords.Use a microwave rather than
the stove. Point pot handles away from the front edge of the stove. This ensures that you won’t
bump into them or catch your sleeve on them. Never leave cooking food unattended. Never
smoke in bed or leave candles burning, even for a short time, in an empty room.

Home Safety
Make sure all hallways, stairs, and paths are well lit and clear of objects such as books or shoes.
Use rails and banisters when going up and down the stairs. Never place scatter rugs at the bottom
or top of stairs Tape all area rugs to the floor so they do not move when you walk on them.
NEEDS FOR SELF-CARE, LIFE SUPPORT, HEALTH MAINTENANCE
Self-Care
Grooming
One of the things that can negatively impact how you feel about yourself is when you are
unhappy with your appearance. Other people’s opinions aside, just knowing that you are well
groomed and clean is an excellent way to promote happiness and satisfaction within yourself.

Bathing & Hygiene

Maintaining a good level of personal hygiene is important for the health and wellbeing of
seniors. Bathing assistance is included in personal care—spanning from sponge baths for seniors
who are less mobile, to supervision in the shower or bathtub to ensure their safety.

Eating/Feeding
When necessary, an in-home care professional can prepare meals and feed seniors who are
otherwise unable to feed themselves in a manner that promotes the dignity and respect that each
individual is entitled to.

Toileting/Continence Care
Attending to daily toileting needs or providing continence care is critical. Toileting needs may
range from supervision to helping seniors during the entire toileting process.

Dressing
Dressing is a basic part of daily life, but dressing and undressing can present significant
difficulties and safety hazards for some seniors.

Life Support

Life support replaces or supports a failing bodily function. When patients have curable or
treatable conditions, life support is used temporarily until the illness or disease can be stabilized
and the body can resume normal functioning. At times, the body never regains the ability to
function without life support.

A treatment may be beneficial if it relieves suffering, restores functioning, or enhances the

quality of life. The same treatment can be considered burdensome if it causes pain, prolongs the
dying process without offering benefit, or adds to the perception of a diminished quality of life.

Artificial nutrition and hydration

Artificial nutrition and hydration (or tube feeding) adds to or replaces ordinary eating and
drinking by giving a chemically balanced mix of nutrients and fluids through a tube placed
directly into the stomach, the upper intestine, or a vein. Artificial nutrition and hydration can
save lives when used until the body heals.

Cardiopulmonary resuscitation
Cardiopulmonary resuscitation (CPR) is a group of treatments used when someone's heart and/or
breathing stops. CPR is used in an attempt to restart the heart and breathing. Electric shock and
drugs also are used frequently to stimulate the heart.

Mechanical ventilation
Mechanical ventilation is used to support or replace the function of the lungs. A machine called a
ventilator (or respirator) forces air into the lungs. The ventilator is attached to a tube inserted in
the nose or mouth and down into the windpipe (or trachea).
Kidney dialysis
Kidney dialysis is a life-support treatment that uses a special machine to filter harmful wastes,
salt and excess fluid from your blood. This restores the blood to a normal, healthy balance.
Dialysis replaces many of the kidneys’ important functions for people whose kidneys have
stopped working properly.

Health Maintenance
Your mental and physical health plays a crucial role in the latter years of your life.
Prevention and early detection are the best defense against illness and disease.

Diet
Older adults should consume a well-balanced diet based on the food pyramid and recommended
daily allowances of nutrients. Some changes in caloric intake and protein and vitamin needs
appear to be desirable with aging.

Exercise
Regular exercise should be a part of any daily plan for older adults (Figure 4-1). Exercise can
help keep the joints flexible, maintain muscle mass, control blood glucose levels and weight, and
promote a sense of well-being. Exercise does not need to be aerobic to benefit older adults.
Walking, swimming, golfing, housekeeping, and active lawn work or gardening are all
considered exercise.

Tobacco and Alcohol

It is never too late to stop smoking. Even the body of an older person can repair damage once
smoking is discontinued. Cessation may be difficult when smoking has been a long-standing
habit, but various aids are now available to help smokers quit. Before using any of these aids,
older adults should seek guidance from their physicians because they may need to follow some
special precautions related to existing health problems.

Physical Examinations and Preventive Overall Care

Older adults should be examined at least once a year by their physicians—more often if known
health problems exist. Some older adults resist this because of the cost or fear about what the
physician may find. Cost is a real concern to many older adults, but inadequate health
maintenance should be of more concern. A delay in the recognition of problems may make them
more difficult and more costly to treat. Physical examinations provide an opportunity for the
physician to detect problems before they become more serious, to monitor and treat chronic
conditions, and to prevent some health problems.

Dental Examinations and Preventive Oral Care

Dental examinations should be obtained and an inspection of the oral cavity performed on a
regular basis (at least once a year). Today’s older adults are keeping their natural teeth longer
than previous generations were able to, probably because of better nutrition and improved
prophylactic dental care. Gum disease and tooth decay are major causes of tooth loss. To prevent
or slow the progress of these dental problems, older adults should brush their natural teeth at
least daily using fluoride toothpaste and should floss carefully between the teeth. Mouthwash
may help refresh the breath, but it cannot replace regular brushing.

Maintaining Healthy Attitudes

Strong connections exist between the mind and body. Older adults who maintain a positive
outlook on life tend to follow good health practices and remain healthier longer.
Regular interaction with other people of all age groups helps maintain a positive attitude toward
life. It is recommended that older adults get out of the house as often as possible, even if only for
shopping or dinner. Keeping in touch with family and friends is important.