 .

Caring for the Elderly

 2. …..generally begins at the age of 60People in this age group are called… …..Senior Citizens

 3. According to the World Health Organization…. ….there are almost 700 million people over the
age 60 living in the world today. …among those 13% are over 80 years old. …it is expected that by
2050 this number will be almost 2 billion and the number of elderly will be higher than the number
of children

 4. In the Philippines…. According to the National Statistics Office, the total number of Senior
Citizens (60 years old and above) is 4,565,560 as of 2009 ….this number comprises 5.97% of the total
Philippine population.

 5. More Statistics… At this time elderly population is growing by 800,0000 a monthDid you know
that…China has the most number of elderly in the world… …..about 88 million

 6. smellvisual and hearing problemsWhat are the Elderly Like?Physical susceptibility to

illnessesand taste losses Leading Cause of Death heart diseases pneumonia cancer

 7. decline in mental processes –What are the Elderly Like?Cognitive may experience memory
lapses or disorientation. Spotlight on: ALZHEIMER’s Disease…is a progressive irreversible brain
disorder that ischaracterized by gradual deterioration of memory,reasoning, language and physical
functioning...WHO reports as of 2009 that almost 35 million elderlysuffers from this kind of disease.

 8. What are the Elderly Like? Spotlight on: ALZHEIMER’s Disease … this disease has no cure and the
cause is unknown, as such people do not know how to prevent it although some doctors reported
that it could be alleviated with some form of diet and memory training games. Alzheimer’s is a sad
disease – the elderly cannot remember the people and place in their lives. They need consistent care
because they could walk away or get lost …

 9. because of their declining healthWhat are the Elderly Like?Social and limitedmobility, most
elderly have the tendency towithdraw from the society – spending most oftheir time looking back –
reflecting on what theyhave made out of their lives. Social Theories of Aging Disengagement
Theory Activity Theory Social breakdown Reconstruction Theory

 10. What are the Elderly Like? Social Theories of Aging Disengagement Theory – as older adults
slow down, they gradually withdraw from the society. Disengagement is a mutual activity in which
the elderly not only disengaged in the society, but the society disengages from the older adult. The
elderly develops greater self-preoccupation and decrease emotional ties with people and reduced
interest in social activities. Such social withdrawal and increased self-absorption was thought to
increase life satisfaction among them.

 11. What are the Elderly Like? Social Theories of Aging Activity Theory– as opposed to the
disengagement theory, this theory argues that the more active and involved the elderly are, the
more likely that they are satisfied with their lives. It is therefore important to find substitute
activities for them after their retirement.
 12. What are the Elderly Like? Social Theories of Aging Social Breakdown -Reconstruction Theory
This theory states that aging is promoted through negative psychological functioning brought
about by the negative views of the society about elderly and inadequate provision of services for
them. Social reconstruction can occur by changing the society’s view of the elderly and by
providing adequate social services for them.

 13. What are the Elderly Like? Society views elderly as Society develops label for the incompetent;
obsolete elderly: useless; ineffective; helpless Society provides inadequate support services, and
funds for the elderly. Elderly’s skills deteriorate Elderly labels self as incompetent

 14. What are the Elderly Like? Society develops positive label for Society views elderly as the
elderly: helpers; self-controlled; competent; important wise; competent Society provides support
systems for the elderly: family support; housing; health services; economics; nutrition and social
services. Elderly’s skills improve Elderly labels self as competent

Abuse

‘ ‘A single or repeated act or lack of appropriate A single or repeated act or lack of appropriate
action, occurring within any relationship action, occurring within any relationship where there is an
expectation of trust, which where there is an expectation of trust, which causes harm or distress to
an older person’ causes harm or distress to an older person’

There are five main types of abuse: There are five main types of abuse:

 Physical abuse: Physical abuse: (hitting, slapping, burning, (hitting, slapping, burning, pushing,
restraining or giving too much pushing, restraining or giving too much medication or the wrong
medication) medication or the wrong medication)

 Psychological abuse: Psychological abuse: (shouting, swearing, (shouting, swearing, frightening,

blaming, ignoring or humiliating a frightening, blaming, ignoring or humiliating a person) person)

 Financial abuse: Financial abuse: (the legal

il or unauthorized (the illegal or unauthorized use of a
person’s property, money, pension book use of a person’s property, money, pension book or other
valuables) or other valuables)

 Sexual abuse: Sexual abuse: (forcing a person to take part in (forcing a person to take part in any
sexual activity without his or her consent - any sexual activity without his or her consent - this can
occur in any relationship) this can occur in any relationship)

 Neglect : Neglect : ( where a person is deprived of ood,

f ( where a person is deprived of food, heat,
clothing or comfort or essential medication

 15. Issues Facing the Elderly ABUSE•It can happen in the family•It can happen in nursing homes•It
could be physical or psychological (like verbalabuse) – when they are named called or threatened,or
taken advantage because of their memoryproblems.•One form is NEGLECT! When people who
aresuppose to care for them ignore their needs andconcerns
 16. Issues Facing the Elderly ABUSE “Having someone else look after aging parents is a tough
decision to make, and is made even tougher by fact that one of four nursing homes has been blamed
for the death or serious injury to a resident each year, according to government figures.”

 17. Issues Facing the Elderly LONELINESS•Death of a husband or wife and many friends.••Children
are busy with work and may not even come to visit them. Grandchildren are busy with
school.•Physically weak elderly may feel that they areburden so they try to stay away even if people
arearound.•Loneliness leads to depression – they feel alone andunproductive.

 18. Issues Facing the Elderly POVERTY•They cannot earn anymore and they do not
havemoney.•May receive retirement pension but may not also beenough because of their
increasing medical needs.•As such many even try to continue working evenafter reaching the
retirement age.

 19. Issues Facing the Elderly HEALTH•diminished sensory and motor abilities•tendency to acquire
various illnesses such as heartdisease, Alzheimers, cancer, etc.

 20. Issues Facing the Elderly DISCRIMINATION•Job discrimination – employers prefer younger
applicants because….inexperienced workers have cheaper salaries…employers believe that the
elders could only stay inwork for a short time because of their decliningphysical condition….elderly
are thought of as slower and less capable.

 21. Issues Facing the Elderly DISCRIMINATION•Social discrimination – maybe excluded from
familyor community services because they are seen asincapable.Medical Discrimination - Some
doctors treat themwithout much care because they think they don’tdeserve such because they are
already old.

Statistical interpretation Statistical interpretation  Who is an elderly Who is an elderly  Concept of

Population aging Concept of Population aging  Geriatrics Geriatrics  Why need care Why need care
 What is Old age care What is Old age care 

Who are Elderly

 The person who has attained the age of 60 The person who has attained the age of 60 and above is
an old person/senior citizen and above is an old person/senior citizen  People may be considered
old when they People may be considered old when they become grandparents become
grandparents  When they begin to do less work or become When they begin to do less work or
become professionally inactive after retirement.

Young old age Young old age 60-70 years 60-70 years  Old old age Old old age 70-80 years 70-80
years  Oldest old age Oldest old age >80 years

What is old Age Care

 Positive interventions for strengthening family and social support systems for the family and social
support systems for the older persons is Old Age Care. older persons is Old Age Care. 

Components 
  Medical care
a) Preventive service
b) Curative service
  Social care

a)Care by family

b) rehabilitation

  Security

a)Law

b)Programmes

Earlier

 Traditionally elder care has been the Traditionally elder care has been the responsibility offamily
members responsibility of family members

 Joint family changes to extended family and Joint family changes to extended family and then
nuclear family system then nuclear family system

 In modern societies, elder care is now being provided increasingly by state or charitable provided
increasingly by state or charitable institutions institutions

elder care facilities - freestanding assisted - living facilities, nursing homes.

Where

 Depends on condition of individual.. Normal–home, old age home, daycare Normal –home, old
age home, daycare centers centers  Ill–hospice centers, hospitals ,home (home Ill –hospice
centers, hospitals ,home (home care nursing)

Management of old age care

Primary prevention  Preventive health care 

modification in habits ,Immunization (tetanus) 
Injury prevention  Osteoporosis prevention 
Secondary prevention  Screening  Tertiary
prevention -Rehabilitation

Curative

Medical Test Protocol  Physiotherapy  Occupational

ntervention
i

 Social and mental care

Involvement in the mainstream of society  Designating social roles and and responsibilities,
Utilizing their experience and wisdom  Combining old age homes and orphanages

Package of Services at different levels (SC/PHC/CHC/RGC)

Package of Services

 The range of services will include  Health promotion  Preventive services  Diagnosis and
management of geriatric medical problems (out and in-patient)  Day care services  Rehabilitative
services  Home based care  Districts will be linked to Regional Geriatric Centers for providing
tertiary level care.  Integration with existing primary health care delivery system and vertical at
district and above as more specialized health care are needed for the elderly.

Service at PHC

Weekly geriatric clinic by a trained Medical Officer  Conducting a routine health assessment (eye,
BP , blood sugar & record keeping).  Provision of medicines and proper advice on chronic ailments 
Public awareness on promotional, preventive and rehabilitative aspects of geriatrics during health
and village sanitation day/camps.  Referral services.

Service at SUBCENTRE

Health Education related to healthy ageing ◦ Domiciliary visits to home bound / bedridden elderly
persons . ◦ Arrange for suitable calipers and supportive devices. ◦ Linkage with other support groups
and day care centers

SERVICE AT SUBCENTRE

First Referral Unit (FRU) for the Elderly from PHCs and below.  Geriatric Clinic for the elderly
persons twice a week.  Rehabilitation Unit for physiotherapy and counselling  Domiciliary visits by
the rehabilitation worker for bed ridden elderly and counselling of the family members on their
home-based care.  Health promotion and Prevention  Referral of difficult cases to District
Hospital/higher health

SERVICE AT DISTRICT HOSPITAL

Geriatric Clinic for regular dedicated OPD services to

the Elderly with Lab facility & adequate medicine.

 Ten-bedded Geriatric Ward with existing specialties

 Provide services to referred by the CHCs/PHCs etc.

 Conducting camps for in PHCs/CHCs and other sites.

 Referral services to tertiary level hospitals

SERVICE AT REGIONAL CARE CENTRE

30-bedded Geriatric Ward for in-patient care and dedicated beds for the elderly patients in the
various specialties.  Laboratory investigation required for elderly with a special sample collection
centre in the OPD block.  Tertiary health care to the cases referred from medical colleges, district
hospitals and below.

Activities under NPHCE (National programme for health care of the elderly) at various levels
At Sub Centre level: Health Education related to healthy ageing, environmental modifications,
nutritional requirements, life styles and behavioural changes.  Special attention to home bound /
bedridden elderly persons and provide training to the family health care providers in looking after
the disabled elderly persons.  Arrange suitable callipers and supportive devices from the PHC. 
Linkage with other support groups and day care centres etc. operational in the area Following items
will be made available at the Subcentre level:  Walking Sticks  Calipers  Infrared Lamp  Shoulder
Wheel  Pulley  Walker (ordinary) No additional contractual

At PHC level:

The weekly geriatric clinic by trained medical officer.  Coordination with CHC, district hospital, sub
centers, other National Health Programmes/ Departments for medicines, ambulances

Training of manpower & Separate registration counter for elderly.

 Public awareness during health and village sanitation day/camps.  Provision of medicine to the
elderly for their medical ailments. Following items will be made available at the PHC:  Nebulizer 
Glucometer  Shoulder Wheel  Walker (ordinary)  Cervical traction (manual)  Exercise Bicycle 
Lumber Traction  Gait Training Apparatus  Infrared Lamp etc. Following items will be made
available at the PHC:  Nebulizer  Glucometer  Shoulder Wheel  Walker (ordinary)  Cervical
traction (manual)  Exercise Bicycle  Lumber Traction  Gait Training Apparatus  Infrared Lamp etc.

At RH/CHC level:

◦ First level medical referral centre for medical care and rehabilitation services ◦ Twice weekly health
clinics for the elderly persons ◦ Rehabilitation unit ◦ Domiciliary visits for care of disabled persons by
Multi rehabilitation worker ◦ Referral Services to DH ◦ Training of staff Following items will be made
available at the CHC:  Nebulizer  Gluc ometer  ECG Machine  Pulse Oximeter  Defibrillator 
Multi - Channel Monitor  Shortwave Diathermy

 Cervical traction

At District Hospital level

 Regular Geriatric OPD with Specialty Care for Elderly.  Geriatric Ward (10
-bedded) for in-patient
care to the Elderly.  Training to the Medical officers and paramedical staff of CHC’s and PHC’s 
Camps for Geriatric Services in PHCs/CHCs and other sites  Referral services for severe cases to
tertiary level hospitals/ Regional Geriatric Centers

Following items will be made available at the District Hospital:  Nebulizer  Glucometer  ECG
Machine  Defibrillator  Multi
-channel Monitor  Non invasive Ventilator  Shortwave Diathermy 
Ultrasound Therapy  Cervical traction (intermittent)  Pelvic traction (intermittent)  Tran electric
Nerve stimulator (TENS)  Adjustable Walker.
Regional Institutes States Linked

1 All India Institute of Medical Sciences, New Delhi

Delhi, Haryana, Uttarakhand, Punjab Himachal Pradesh, M.P.

2 Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh

Uttar Pradesh, Bihar, Jharkhand, West Bengal

3 Grant Medical College & JJ Hospital, Mumbai, Maharashtra,

Maharashtra, Goa, Northern Districts of Karnataka,Chattisgarh

4 Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir

Jammu & Kashmir

5 Govt. Medical College, Tiruvananthapuram, Kerala,

Kerala, Southern Districts of Karnataka & Tamil Nadu

6 Guwahati Medical College, Guwahati, Assam

Assam & NE States

7 Madras Medical College, Chennai, TN. Tamil Nadu, Andhra Pradesh, Orissa

At Regional Geriatric Centers level

Provide tertiary level services for complicated/serious Geriatric Cases.  Post graduate courses in
Geriatric Medicine.  Training to the trainers of identified District hospitalsand Medical Colleges. 
Developing evidence based treatment protocols for Geriatric diseases prevalent in the country. 
Developing/and updating Training modules & guidelines and IEC materials.  Research on specific
elderly diseases.

STATE LEVEL

State will monitor release of funds and expenditure incurred under various components of the
programme in the State.  Submit monthly statement of expenditure in the prescribed format to the
State Health Society.

ROLE OF NURSE

Healer

Nursing plays a significant role in helping individuals stay well, overcome or cope with disease
restore function and purpose in life and mobilize internal and external resources.  In this healer
role, gerontological nurse recognizes that most human beings value health, are responsible and
active participants in their health maintenance and illness management, and desires harmony and
wholeness with their environment.  Holoistic approach is essential viewed in context of their
biological, emotional, social, cultural and spiritual elements.
Caregiver

Conscientious application of Nursing process to care of elders.  Inherit in this role is the active
participation of older adults and their significant others and promotion of highest degree of self care
in elderly.  Providing care, efficiency and best interest that rob them of their existing independence

Educator

Formal and informal opportunities to share knowledge, skills related to care of older adults. 
Educating others including normal aging, pathophysiology, geriatric pharmacology and resources. 
Essential to this role is effective communication involving listening, interacting, clarifying, coaching,
validating and evaluating.

Advocacy

including aiding older adults in asserting their rights and obtaining required services, facilitating a
community or other group’s effort to affect change and achieve benefits for older adults.

Innovator

Assumes an inquisitive style, making conscious decisions and efforts to experiment for an end result
to improved gerontological practices.

PRINCIPLES FOR GERONOTOLOGICAL NURSING PRACTICE

Aging is a natural process common to all living organisms.  Various factors influence the aging
process.  Unique data and knowledge are used in applying the nursing process to the older
populations.  The elderly share similar self-care and human needs with all other human beings. 
Gerontological nursing strives to help older adults achieve optimum levels of physical, psychological,
social and spiritual and spiritual health so that the can achieve wholeness.