1

SEMINAR
ON

CARE OF
ELDERLY
PATIENTS

SUBMITTED TO SUBMITTED BY
SUMI.G
1st MSc (N)

SUBMITTED ON
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Sl. No. CONTENTS PAGE NO.

1 INTRODUCTION 4
2 TERMINOLGIES 4
3 LIFE SPAN 4
4 FACTORS RELATED TO AGEING 5
5 SUCCESSFUL AGEING 9
6 THEORIES OF AGEING 10
7 ATTITUDES TOWARDS AGEING 12
8 CHANGE IN BODY SYSTEM 12
9 STRESS AND COPING IN OLDER ADULT 13
10 PHYSICAL ASPECTS OF AGING 14
11 COGNITIVE ASPECTS OF AGING 14
12 PHARMACOLOGICAL ASPECTS OF AGING 16
13 AGE RELATED PHYSIOLOGICAL CHANGES 17
14 ELDER ABUSE AND NEGLECT 21
15 SPECIAL CONSIDERATION IN CARE OF 25
ELDERLY
16 LEGAL AND ETHICAL ISSUES 25
17 COMMUNITY AND INSTITUTIONAL HEALTH 28
CARE
18 NURSING MANAGEMENT 30
19 CONCLUSION 34
20 BIBLIOGRAPHY 35
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GENERAL OBJECTIVES

At the end of the class, the students are able to gain adequate knowledge
regarding the care of elderly patients and apply their skills while giving care to
patients.

SPECIFIC OBJECTIVES

At the end of the of the class, the students will be able to

define gerontology, geriatrics

explain the lifespan

list down the factors related to ageing

explain successful ageing

narrate theories of ageing

explain psychological aspects of ageing

explain physical aspects of ageing

narrate the cognitive aspects of ageing

narrate pharmacologic aspects of ageing

explain age related physiological changes

enumerate the elder abuse and neglect

list down the special consideration of elderly

explain the ethical and legal issues of elderly

list down the community and institutional health care

explain the nursing management

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INTRODUCTION
Ageing is a natural phenomenon which is exhibited by all biological species.
With the advancement of time all of them get exposed to environmental – internal
and external challenges as they age. Ageing refers to a multidimensional process of
physical, psychological and social change.

Care of older adults presents challenges to nurses that require skilled

assessment and creative adaptations of nursing interventions. The nurse approaches
the older adult patient with a whole-person. Nurses must understand the normal
aging process and be prepared to care for clients who have chronic disorders and
complex acute conditions.

Nurses who care for older clients must be aware of the unique physical,
psychosocial, legal, ethical, economic issues surrounding the aging process. Normal
aging changes the structure and function of various organ systems.

Geriatrics comes from the Greek word ‘GERAS’ means ‘old age’ and ‘IATRIKOS’
which means ‘branch of medicine’.

TERMINOLOGIES
Gerontology is the branch of medical science concerned with the diagnosis and
treatment of diseases affecting older people.

Ageing is the process of growing old or developing the appearance and

characteristics of old age.

Geriatrics the branch of medical science concerned with the diagnosis and treatment
of diseases affecting elderly people.

Gerontologic nursing is the care of older adults based on the speciality body of
knowledge of gerontology.

Gerodontics is a dental specialty concerned with the care and treatment of the
dental problems of the aged.

LIFESPAN
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An animal's life is often divided into various age ranges. However, because biological
changes are slow-moving and can vary within one's own species, arbitrary dates are
usually set to mark periods of life. The human divisions given below are not valid in
all cultures:

 Juvenile [via infancy, childhood, preadolescence, adolescence (teenager)]: 0–

19
 Early adulthood: 20–39
 Middle adulthood: 40–59
 Late adulthood: 60+

Ages can also be divided into numerical units:

Term Age (years, inclusive)

Denarian 10 to 19
Vicenarian 20 to 29
Tricenarian 30 to 39
Quadragenarian 40 to 49
Quinquagenarian 50 to 59
Sexagenarian 60 to 69
Septuagenarian 70 to 79
Octogenarian 80 to 89
Nonagenarian 90 to 99
Centenarian 100 to 109
Supercentenarian 110 and older

People from 13 to 19 years of age are also known as teens or teenagers. The casual
terms "twentysomething", "thirtysomething", etc. are also in use to describe people
by decades of age.

FACTORS RELATED TO AGEING

Cultural variations

In some cultures there are other ways to express age by counting years with or
without including current year. For example, it could be said about the same person
that he is twenty years old or that he is in the twenty-first year of his life. In Russian
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the former expression is generally used, the latter one has restricted usage: it is used
for age of a deceased person in obituaries and for the age of an adult when it is
desired to show him/her older than he/she is. Depending on cultural and personal
philosophy, ageing can be seen as an undesirable phenomenon, reducing beauty and
bringing one closer to death; or as an accumulation of wisdom, mark of survival, and
a status worthy of respect. In some cases numerical age is important (whether good
or bad), whereas others find the stage in life that one has reached (adulthood,
independence, marriage, retirement, career success) to be more important.

Legal

There are variations in many countries as to what age a person legally becomes an
adult.

Most legal systems define a specific ages for when an individual is allowed or obliged
to do particular activities. These ages include voting age, drinking age, age of
consent, age of majority, age of criminal responsibility, marriageable age, age of
candidacy, and mandatory retirement age. Admission to a movie for instance, may
depend on age according to a motion picture rating system. A bus fare might be
discounted for the young or old.

Similarly in many countries in jurisprudence, the defence of infancy is a form of

defence by which a defendant argues that, at the time a law was broken, they were
not liable for their actions, and thus should not be held liable for a crime. Many
courts recognise that defendants who are considered to be juveniles may avoid
criminal prosecution on account of their age, and in borderline cases the age of the
offender is often held to be a mitigating circumstance

Economics

As life expectancy rises and birth rates decline in developed countries, the median
age itself rises. According to the United Nations, this process is taking place in nearly
every country in the world. A rising median age can have significant social and
economic implications, as the workforce gets progressively older and the number of
old workers and retirees grows relative to the number of young workers. Older
people generally incur more health-related costs than do younger people, and in the
workplace can also cost more in worker's compensation and pension liabilities. In
most developed countries an older workforce is somewhat inevitable. In the United
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States, for instance, the Bureau of Labor Statistics estimates that one in four
American workers will be 55 or older by 2020.

Health care demand

Many societies in Western Europe and Japan have ageing populations. While the
effects on society are complex, there is a concern about the impact on health care
demand. The large number of suggestions in the literature for specific interventions
to cope with the expected increase in demand for long-term care in ageing societies
can be organised under four headings: improve system performance; redesign
service delivery; support informal caregivers; and shift demographic parameters.

However, the annual growth in national health spending is not mainly due to
increasing demand from ageing populations, but rather has been driven by rising
incomes, costly new medical technology, a shortage of health care workers and
informational asymmetries between providers and patients. A number of health
problems become more prevalent as people get older. These include mental health
problems as well as physical health problems, especially dementia.

Even so, it has been estimated that population ageing only explains 0.2 percentage
points of the annual growth rate in medical spending of 4.3 percent since 1970. In
addition, certain reforms to Medicare decreased elderly spending on home health
care by 12.5 percent per year between 1996 and 2000. This would suggest that the
impact of ageing populations on health care costs is not inevitable.

Impact on prisons

As of July 2007, medical costs for a typical inmate in the United States might run an
agency around $33 per day, while costs for an ageing inmate could run upwards of
$100. Most State DOCs report spending more than 10 percent of the annual budget
on elderly care. That is expected to rise over the next 10–20 years. Some states have
talked about releasing ageing inmates early.[26]

Cognitive effects

Steady decline in many cognitive processes is seen across the lifespan, accelerating
from the twenties or thirties. Research has focused in particular on memory and
ageing, and has found decline in many types of memory with ageing, but not in
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semantic memory or general knowledge such as vocabulary definitions, which

typically increases or remains steady until the late adulthood. Early studies on
changes in cognition with age generally found declines in intelligence in the elderly,
but studies were cross-sectional rather than longitudinal and thus results may be an
artefact of cohort rather than a true example of decline. However, longitudinal
studies could be confounded due to prior test experience. Intelligence may decline
with age, though the rate may vary depending on the type, and may in fact remain
steady throughout most of the lifespan, dropping suddenly only as people near the
end of their lives. Individual variations in rate of cognitive decline may therefore be
explained in terms of people having different lengths of life. There are changes to the
brain: though neuron loss is minor after 20 years of age there is a 10% reduction
each decade in the total length of the brain's myelinated axons. Coping and well-
being

Psychologists have examined coping skills in the elderly. Various factors, such as
social support, religion and spirituality, active engagement with life and having an
internal locus of control have been proposed as being beneficial in helping people to
cope with stressful life events in later life. Social support and personal control are
possibly the two most important factors that predict well-being, morbidity and
mortality in adults. Other factors that may link to well-being and quality of life in the
elderly include social relationships (possibly relationships with pets as well as
humans), and health.

Individuals in different wings in the same retirement home have demonstrated a

lower risk of mortality and higher alertness and self-rated health in the wing where
residents had greater control over their environment, though personal control may
have less impact on specific measures of health. Social control, perceptions of how
much influence one has over one's social relationships, shows support as a
moderator variable for the relationship between social support and perceived health
in the elderly, and may positively influence coping in the elderly.

Religion

Religion has been an important factor used by the elderly in coping with the
demands of later life, and appears more often than other forms of coping later in life.
Religiosity is a multidimensional variable; while participation in religious activities in
the sense of participation in formal and organised rituals may decline, it may become
a more informal, but still important aspect of life such as through personal or private
prayer.
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Self-rated health

Self-ratings of health, the beliefs in one's own health as excellent, fair or poor, has
been correlated with well-being and mortality in the elderly; positive ratings are
linked to high well-being and reduced mortality. Various reasons have been
proposed for this association; people who are objectively healthy may naturally rate
their health better than that of their ill counterparts, though this link has been
observed even in studies which have controlled for socioeconomic status,
psychological functioning and health status. This finding is generally stronger for men
than women, though the pattern between genders is not universal across all studies,
and some results suggest sex-based differences only appear in certain age groups, for
certain causes of mortality and within a specific sub-set of self-ratings of health.

Retirement

Retirement, a common transition faced by the elderly, may have both positive and
negative consequences.

SUCCESSFUL AGEING

The concept of successful ageing can be traced back to the 1950s, and was
popularised in the 1980s. Previous research into ageing exaggerated the extent to
which health disabilities, such as diabetes or osteoporosis, could be attributed
exclusively to age, and research in gerontology exaggerated the homogeneity of
samples of elderly people. Successful ageing consists of three components: Low
probability of disease or disability.

1. High cognitive and physical function capacity;

2. Active engagement with life.

A greater number of people self-report successful ageing than those that strictly
meet these criteria.

Successful ageing may be viewed an interdisciplinary concept, spanning both

psychology and sociology, where it is seen as the transaction between society and
individuals across the life span with specific focus on the later years of life. The terms
"healthy ageing" and "optimal ageing" have been proposed as alternatives to
successful ageing, partly because the term "successful ageing" has been criticised for
making healthy ageing sound too competitive.
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Six suggested dimensions of successful ageing include

1. No physical disability over the age of 75 as rated by a physician;

2. Good subjective health assessment (i.e. good self-ratings of one's health);
3. Length of disabled life;
4. Good mental health;
5. Objective social support;
6. Self-rated life satisfaction in eight domains, namely marriage, income-related
work, children, friendship and social contacts, hobbies, community service
activities, religion and recreation/sports.

THEORIES OF AGEING
Various theories have been proposed to explain the process of normal ageing and
help dispel some of the myths. Theories have tried to explain the biopsychological
process of ageing. These theories also identify areas that need to be assessed and
provide a basis for interventions and nursing care

Biological theories

Biological theories attempt to explain physical aging as an involuntary process, which

eventually leads to cumulative changes in cells, tissues and fluids.

At present, the biological basis of ageing is unknown. Most scientists agree that
substantial variability exists in the rates of ageing across different species, and that
this to a large extent is genetically based. In model organisms and laboratory
settings, researchers have been able to demonstrate that selected alterations in
specific genes can extend lifespan (quite substantially in nematodes, less so in fruit
flies, and less again in mice. Life span extension can occur as the result of genetic
alterations that increase DNA repair, reduce oxidative damage or reduce cell suicide
(apoptosis) due to DNA damage. Even in the relatively simple and short-lived
organisms, the mechanism of ageing remains to be elucidated. Less is known about
mammalian ageing, in part due to the much longer lives in even small mammals such
as the mouse.

Evolutionary Theories: Enquiry into the evolution of ageing aims to explain why
almost all living things weaken and die with age.

Some theories suggest that ageing is a disease. Two examples are

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DNA damage theory of aging: Known causes of cancer (radiation, chemical and viral)
account for about 30% of the total cancer burden and for about 30% of the total DNA
damage. DNA damage causes the cells to stop dividing or induce apoptosis, often
affecting stem cell pools and hence hindering regeneration. DNA damage is thought
to be the common pathway causing both cancer and ageing. It seems unlikely that
the estimates of the DNA damage due to radiation and chemical causes have been
significantly underestimated. Viral infection would appear to be the most likely cause
of the other 70% of DNA damage especially in cells that are not exposed to smoking
and sun light. It has been argued, too, that intrinsic causes of DNA damage are more
important drivers of ageing.

 Intrinsic biological theory: maintains that ageing changes arising from internal
predetermined causes.
 Extrinsic biological theory: maintains environmental factors lead to structural
alterations which, inturn cause degenerative changes.

Genetic theories

Many theories suggest that ageing results from the accumulation of damage to DNA
in the cell, or organ. Since DNA is the formative basis of cell structure and function,
damage to the DNA molecule, or genes, can lead to its loss of integrity and early cell
death.

Examples include:

 Accumulative-Waste Theory: The biological theory of ageing those points to a

buildup of cells of waste products that presumably interferes with
metabolism.
 Wear-and-Tear Theory: The very general idea that changes associated with
ageing are the result of chance damage that accumulates over time.
 Somatic Mutation Theory: The biological theory that ageing results from
damage to the genetic integrity of the body’s cells.
 Error Accumulation Theory: The idea that ageing results from chance events
that escape proof reading mechanisms, which gradually damages the genetic
code.

Non-biological theories

Disengagement Theory
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This is the idea that separation of older people from active roles in society is
normal and appropriate, and benefits both society and older individuals.
Disengagement theory, first proposed by Cumming and Henry, has received
considerable attention in gerontology, but has been much criticised. The
original data on which Cumming and Henry based the theory were from a
rather small sample of older adults in Kansas City, and from this select sample
Cumming and Henry then took disengagement to be a universal theory. There
are research data suggesting that the elderly who do become detached from
society are those who were initially reclusive individuals, and such
disengagement is not purely a response to ageing.

Activity theory

In contrast to disengagement theory, this theory implies that the more active
elderly people are, the more likely they are to be satisfied with life. The view
that elderly adults should maintain well-being by keeping active has had a
considerable history, and since 1972, this has come to be known as activity
theory.]However, this theory may be just as inappropriate as disengagement
for some people as the current paradigm on the psychology of ageing is that
both disengagement theory and activity theory may be optimal for certain
people in old age, depending on both circumstances and personality traits of
the individual concerned. There are also data which query whether, as activity
theory implies, greater social activity is linked with well-being in adulthood.

ATTITUDES TOWARDS AGEING

It is important that ht e nurse maintains the position that aging is normal and is not
related to disease. Age is a date in time and is influenced by many factors, including
emotional and physical health, developmental stage, and socio economic status.

As people age, they are exposed to more and different life experiences. The
accumulation of these differences makes older adults more diverse than any other
age group. As the nurse assess the older adult, it is important to consider this
diversity. The nurse should assess the patient for perception of age.

Myths and stereotypes about aging, found throughout society, are often supported
by media reports of problematic older adults. Myths and stereotypes regarding aging
provide the basis of commonly held misconceptions that may lead to errors in
assessments and unnecessary limitations to interventions.
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CHANGES IN BODY SYSTEM

AGE RELATED CHANGES

The well being of older people depends on physical, mental, social, economic and
environmental factors. A total assessment includes an evaluation of all major body
systems, social and mental status, and the ability of a person to function
independently despite having a chronic illness or disability.

PSYCHOLOGICAL ASPECTS OF AGING

Successful psychological aging is reflected in the ability of older people to adapt to

physical, social and emotional losses and to achieve contentment, serenity and life
satisfaction.

Although attitudes towards older people differ in ethnic subcultures, a subtle theme
of ageism – prejudice or discrimination against older people- predominates in our
society, and many myths surround ageing. Ageism is based on stereotypes, simplified
and often untrue beliefs that reinforce society’s negative image of older people.
Although older people make up an extremely heterogeneous and increasingly a
racially and ethnically diverse group, negative stereotypes are attributed to all of
them.

Fear of aging and the inability of many to confront their own aging process may
trigger ageist beliefs. Retirement and perceived non productivity are also responsible
for negative feelings, because a younger working person may see an older person as
someone who is not contributing to society and who is draining economic resources.

Many negative images are so common in society that the elderly themselves often
believe and perpetuate them. Only through an understanding of the aging process
and respect for each person as an individual can be myths of aging be dispelled. If
the elderly are treated with dignity and encouraged to maintain autonomy, the
quality of their lives will improve.

STRESS AND COPING IN OLDER ADULT

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Coping patterns and the ability to adapt to stress develop over a course of life
time and remain consistent later in life. Experiencing success in younger adult hood
helps a person develop a positive self image that remains solid through the
adversities of old age. A person’s ability to adapt to changes, make decisions and
respond predictably is also determined by past experiences. A flexible, well
functioning person will probably continue as such. However losses may accumulate
within a short period of time and may become overwhelming. The older person will
often have fewer choices and diminished resources to deal with stressful events.
common stressors of old age include normal aging changes that impair physical
function , activities and appearance, disabilities from chronic illness , social and
environmental loses related to loss of income and decreased ability to perform
previous roles and activities; and the deaths of the significant others. Many older
adults rely strongly on their spiritual beliefs for comfort during stressful times.

LIVING ARRANGEMENTS

More than 95% of the elderly live in the community, and more than 78% own their
homes. In 203, 58.5% of elderly people were living alone. Of the elderly people were
living alone. Of the elderly people who live alone in the community, widowed women
predominate. In 2003, 71% of men ages 65 to 74 were married compared to 41% of
women in the same age group. Among those aged 85 or older, about 50% of men
were married compared to only 13% of the women. This difference in marital status
is a result of several factors: women have a longer life expectancy than men do;
women tend to remain widowed, whereas women often remarry.

Older people often do best in their own environment and can successfully remain in
home for many years. Furthermore the family, home and familiar community may
have strong emotional significance for them, and this should not be ignored. With
advanced age and increasing disability, adjustment to the environment may be
required to allow older adults to remain in their own homes or apartments.
Additional family support such as meals on wheels or transportation services may be
necessary to compensate for declining function and mobility.

PHYSICAL ASPECTS OF AGEING

As previously mentioned, intrinsic aging (from within the person) refers to those
changes caused by the normal aging process that are genetically programmed and
essentially universal within a species. Universality is the major criterion used to
distinguish normal aging from pathologic changes associated with illness. However,
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people age quite differently and at different rates, so chronologic age is often less
predictive of obvious aging characteristics than other factors, such as genetics and
lifestyle. For example, extrinsic aging results from influences outside the person. Air
pollution and excessive exposure to sunlight are examples of extrinsic factors that
may hasten the aging process and that can be eliminated or reduced.

Cellular and extracellular changes of old age cause a change in physical appearance
and a decline in function. Measurable changes in shape and body makeup occur. The
body’s ability to maintain homeostasis becomes increasingly diminished with cellular
aging, and organ systems cannot function at full efficiency because of cellular and
tissue deficits. Cells become less able to replace themselves, and they accumulate a
pigment known as lipofuscin. A degradation of elastin and collagen causes
connective tissue to become stiffer and less elastic. All of these results in diminished
capacity for organ function and increased vulnerability to disease and stress.

COGNITIVE ASPECTS OF AGEING

Cognition can be affected by many variables, including sensory impairment,

physiologic health, environment, and psychosocial influences. Older adults may
experience temporary changes in cognitive function when hospitalized or admitted
to skilled nursing facilities, rehabilitation centers, or long –term care facilities. These
changes are related to differences in the environment or in medical therapy, or to
alternation in role performance. In 2002, the proportion of people with moderate to
severe memory impairment ranged from approximately 5% among people ages 65 to
69 years to 32% among people 85 years and older.

Intelligence

When intelligence test scores from people of all ages are compared, test scores for
older adults show a progressive decline beginning in midlife. However research has
shown that environment and health have a considerable influence on scores and that
certain types of intelligence (e.g., spatial perceptions and retention of nonintellectual
information) decline, whereas others (e.g., problem–solving ability based on past
experiences, verbal comprehension, mathematical ability) do not. Cardiovascular
health, a stimulating environment, high levels of education, occupational status, and
income all appear to have a positive effect on intelligence scores in later life.

Learning and Memory

According to Hooyman and Kiyak “significant age-related declines in intelligence,

learning, and memory appear not to be inevitable.” These authors summarized the
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major studies on cognitive function in later years and provided the following
overview.

Many factors affect the ability of older people to learn and remember and to
perform well in testing situations. Older adults who have higher levels of education,
good sensory function, good nutrition, and jobs that require complex problem-
solving skills continue to demonstrate intelligence, memory, and the capacity for
learning. Part of the problem in testing older adults is determining what is
determining what is actually being tested (e.g., speed of response) and whether the
test results are indicative of a normal age-related change, a sensory deficit, or poor
health. However, age differences continue to emerge even with untimed tests and
when the tests are controlled for variations in motor and sensory function. In
general, there is a decline in fluid intelligence, the biologically determined
intelligence used for flexibility in thinking and problem solving. Crystallized
intelligence that gained through education and lifelong experiences (e.g., verbal
skills), remains intact. This is termed the classic aging pattern of intelligence. Despite
these slight declines, many older people continue to learn and participate in varied
educational experiences.

Good health and motivation are important influences on learning. Nurses can
support the process by which older adults learn by using the following strategies:

 Supplying mnemonics to enhance recall of related data

 Encouraging ongoing learning
 Linking new information with familiar information
 Using visual, auditory, and other sensory cues
 Encouraging learners to wear prescription glasses and hearing aids
 Providing glare-free lightning
 Providing a quiet, non distracting environment
 Setting short-term goals with input from the learner
 Keeping teaching periods short
 Pacing learning tasks according to the endurance of the learner
 Encouraging verbal participation by learners
 Reinforcing successful learning in a positive manner

PHARMACOLOGIC ASPECTS OF AGEING

Older people use more medications than any other age group. Although they
represent only 12.6% of the total population, they use 30% of all prescribed
medications and 40% of all over-the-counter medications. Medications improve the
 17

health and well-being of older people by relieving pain and discomfort, treating
chronic illnesses, and curing infectious processes. However, adverse drug reactions
are common because of medication interactions, multiple medication effects,
incorrect dosages, and the use of multiple medications. The potential for drug-drug
interactions increases with increased drug use; such interactions are responsible for
numerous emergency department and physician visits, which cost billions of dollars
annually.

Certain types of medications that carry high risks for older patients are often
inappropriately prescribed. A study matching explicit criteria for appropriate
prescription against a comprehensive drug benefit plan for elderly patients found
that significant percentages of patients could be considered to be taking certain
medications inappropriately (38% of patients taking antidepressants, 19% taking oral
hypoglycemic agents, 18% taking sedative-hypnotics, and 13% taking Non Steroidal
Anti-Inflammatory Drugs [NSAIDs].

AGE RELATED PHYSIOLOGIC CHANGES

Age related physiologic changes affect every body system. These changes are normal
and occur as people age. However, the age at which specific changes become evident
differs from person to person and within the same person.

CARDIOVASCULAR SYSTEM

Endocardial changes include increase in thickness and opacity, more in left

atrium and least in right ventricle. There is a collagen deposition along with increased
stratification and elastic tissue fragmentation in the endocardium. The overall heart
weight increases as a result of hypertrophy of the left ventricle. Amyloid deposition
along with fibrosis may cause arrhythmias in the elderly.

RESPIRATORY SYSTEM

The coughing and laryngeal reflexes may be reduced in the elderly. Chest wall
compliance decrease s due to kyphoscoliosis. There is a decrease in diaphragmatic
strength. The expiratory and inspiratory intercostal muscles undergo atrophy after
the 5th decade. There is a progressive decline in the elastic recoil of the lungs
resulting in an increased compliance. There is a decline in the vital capacity and an
increase in the residual volume due to loss of elastic recoil of the lungs, increased
stiffness of chest wall and decreased force generated by respiratory muscle.

KIDNEYS
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There is a decline in the total number of functional glomeruli to about one half
to two- thirds by the 7 th decade of life. There is a fatty degeneration and the basal
membranes become irregularly thickened. The weakening of tubular basal
membranes may give rise to diverticular from the distal and convoluted tubules. The
GFR declines with age in most elderly at the rate of 1 ml/min/year between 40-80
years of age.

There is a tendency to develop hyperkalemia due to decreased rennin and

aldosterone levels especially in patients on potassium suppliments and potassium
spring drugs. They are also more prone to develop hypokalemia when diuretics are
administered.

GASTROINTESTINAL TRACT

Most elderly over the age of 65 years have tooth loss and those present are
often diseased or decayed. Dental caries or periodontal disease is primarily
responsible for tooth loss. Oesophagus declines its motility leading to deglutition
problem. The term “presbyesophagus” coined by Soergel refers to a combination of
reduced peristalsis and efficiency in the elderly. An increased tendency towards
dysphagia and GERD is seen in elderly.

Gastric mucosal defences are impaired in the elderly possibly due to

decreased prostaglandin as well as bicarbonate and mucosal secretions. There is an
atrophy of intestinal mucosa due to a reduction in the villus height. Incidence of gall
stones with advancing age, possibly because of increased cholesterol synthesis by
the liver coupled with reduced bile acid synthesis.

ENDOCRINE SYSTEM

Endocrine problems in the elderly may present with both specific and non
specific or a typical signs and symptoms. Growth hormone secretion declines
progressively with aging possibly due to decreased hypothalamic secretion of GHRH.
Capsular fibrosis and nodular hyperplasia occurs in adrenals and glucose tolerance
also declines.

INTEGUMENTARY SYSTEM

SKIN

There is a decrease adherence of epidermis to dermis because of loss of epidermal

rete edges and dermal papillae. This may lead to blister formation and bullous
disorders which is more severe in elderly. There is a generalised dermal atrophy. The
 19

fine wrinkling noted in ageing skin and a reduced number of eccrine glands along
with a decrease in size and number of hair follicles. Cutaneous sensation is impaired
leading to increased predisposition to thermal burns.

HAIR AND NAILS

Senescent baldness is a feature in all individuals to a variable extent. Hair

diameter, hair length and percentage of hair are decreased along with graying of
hair.

Nail plate is thinner and longitudinal ridging is evident. Nails are lustreless and
the growth rate is decreased by at least 50 percent.

CHANGES SUBJECTIVE AND HEALTH PROMOTION AND

OBJECTIVE SYMPTOMS STATEGIES

Cardiovascular System Complaints of fatigue with Exercise regularly; pace

Decreased cardiac output; increased heart rate activities; avoid smoking;
diminished ability to respond recovery time Normal eat a low-fat, low-salt diet;
to stress; heart rate and stroke BP<14/90 mm Hg. participate in stress-
volume do not increase with reduction activities; check
maximum demand; slower blood pressure regularly;
heart recovery rate; increased medication compliance;
blood pressure weight control

Respiratory System
Increase in residual lung Fatigue and breathlessness Exercise regularly; avoid
volume; decrease in vital with sustained activity; smoking; take adequate
capacity; decreased cough impaired healing of tissues fluids to liquefy secretions;
efficiency as a result of decreased receive yearly influenza
oxygenation; difficulty immunization; avoid
coughing up secretions exposure to upper
respiratory tract infections

Skin appears thin and Avoid solar exposure

Integumentary System
Decreased protection against
trauma and sun exposure;
decreased protection against
temperature extremes;
diminished secretion of natural
oils and perspiration
wrinkled; complaints of
injuries, bruises, and
sunburn; complaints of
intolerance to heart; bone
structure is prominent; dry
skin
(clothing, sunscreen, stay
indoors); dress
appropriately for
temperature; maintain a
safe indoor temperature;
shower preferable to tub
bath; lubricate skin

Reproductive System May require vaginal

 20

Female: Vaginal narrowing and Female: Painful estrogen replacement;

decreased elasticity; decreased intercourse; vaginal itching gynecology/urology follow-
vaginal secretions and irritation; delayed up; use a lubricant with
Male: Decreased size of penis orgasm intercourse
and testes Male and Female: Male: Delayed erection
Slower sexual response and achievement of
orgasm

Musculoskeletal System weight loss; prone to

Loss of bone density; loss of fractures; kyphosis; back Exercise regularly; eat a
muscle strength and size; pain; loss of strength, high-calcium diet; limit
degenerated joint cartilage flexibility, and endurance; phosphorus intake; take
joint pain calcium and vitamin D
supplements as prescribed
Genitourinary System
Male: Benign prostatic Urinary retention; Seek referral to urology
hyperplasia irritative voiding specialist; have ready
Female: Relaxed perineal symptoms including access to toilet; wear easily
muscles, destrusor instability frequency, feeling of manipulated clothing; drink
(urge incontinence), urethral incomplete bladder adequate fluids; avoid
dysfunction (stress urinary emptying, multiple night bladder irritants (eg,
incontinence) time voiding caffeinated beverages,
Urgency/frequency alcohol, artificial
syndrome, decreased sweeteners); pelvic floor
“warning time,” bathroom muscle exercises,
mapping; drops of urine preferably learned via
lost with cough, laugh, biofeed-back; consider
position change urologic workup
Wear easily manipulated
clothing; drink adequate
fluids; avoid bladder
irritants (e.g. caffeinated
beverages, alcohol, artificial
sweeteners); pelvic floor
muscle exercises;
preferably learned via bio
feed-back; consider urology
workup
Complaints of dry mouth;
Gastrointestinal system complaints of fullness, Use ice chips, mouthwash;
Decreased salivation; difficulty heartburn, and brush, floss, and massage
swallowing food; delayed indigestion; constipation, gums daily; receive regular
esophageal and gastric flatulence, and dental care; eat small,
 21

emptying; reduced indigestion; constipation, frequent meals; sit up and

gastrointestinal motility flatulence, and abdominal avoid heavy activity after
discomfort eating; limit antacids; eat a
high-fiber, low-fat diet;
limit laxatives; toilet
regularly; drink adequate
fluids
Slower to respond and
react; learning takes Pace teaching; with
Nervous System longer; becomes confused hospitalization, encourage
Reduced speed in nerve with hospital admission; visitors; enhance sensory
conduction; increased faintness; frequent falls stimulation; with sudden
confusion with physical illness confusion, look for cause;
and loss of environment cues; encourage slow rising from
reduced cerebral circulation a resting position
(becomes faint, loses balance)
Holds objects far away
Special Senses from face; complaints of Wear eyeglasses, use
 Vision: Diminished glare; poor night vision; sunglasses outdoors; avoid
ability to focus on close confuses colors abrupt changes from dark
objects; inability to Gives inappropriate to light; use adequate
tolerate glare; difficulty responses; asks people to indoor lighting with area
adjusting to changes of repeat words; strains lights and nightlights; use
light intensity; forward to hear large-print books; use
decreased ability to Uses excessive sugar and magnifier for reading; avoid
distinguish colors salt night driving; use
 Hearing: Decreased contrasting colors for color
ability to hear high- coding; avoid glare of shiny
frequency sounds surfaces and direct sunlight
 Taste and smell: Recommend a hearing
Decreased ability to examination; reduce
taste and smell background noise; face
person; enunciate clearly;
speak with a low-pitched
voice; use nonverbal cues
Encourage use of lemon,
spices, and herbs.
 22

ELDER ABUSE AND NEGLECT

Many elderly adults are abused in their own homes, in relatives’ homes, and even in
facilities responsible for their care. If any suspect that an elderly person is at risk
from a neglectful or overwhelmed caregiver, or being preyed upon financially, it’s
important to report it.

As elders become more physically frail, they’re less able to stand up to bullying and
or fight back if attacked. They may not see or hear as well or think as clearly as they
used to, leaving openings for unscrupulous people to take advantage of them.
Mental or physical ailments may make them more trying companions for the people
who live with them.

Physical abuse

Physical elder abuse is non-accidental use of force against an elderly person that
results in physical pain, injury, or impairment. Such abuse includes not only physical
assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or
confinement.

Emotional abuse

In emotional or psychological senior abuse, people speak to or treat elderly persons

in ways that cause emotional pain or distress.

Verbal forms of emotional elder abuse include

 Intimidation through yelling or threats

 Humiliation and ridicule
 Habitual blaming

Nonverbal psychological elder abuse can take the form of

 Ignoring the elderly person

 Isolating an elder from friends or activities
 Terrorizing or menacing the elderly person

Sexual abuse

Sexual elder abuse is contact with an elderly person without the elder’s consent.
Such contact can involve physical sex acts, but activities such as showing an elderly
person pornographic material, forcing the person to watch sex acts, or forcing the
elder to undress are also considered sexual elder abuse.

Neglect or abandonment by caregivers

 23

Elder neglect, failure to fulfil a caretaking obligation, constitutes more than half of all
reported cases of elder abuse. It can be active (intentional) or passive (unintentional,
based on factors such as ignorance or denial that an elderly charge needs as much
care as he or she does).

Financial exploitation

This involves unauthorized use of an elderly person’s funds or property, either by a

caregiver or an outside scam artist.

An unscrupulous caregiver might

 Misuse an elder’s personal checks, credit cards, or accounts

 Steal cash, income checks, or household goods
 Forge the elder’s signature
 Engage in identity theft

Typical rackets that target elders include

 Announcements of a “prize” that the elderly person has won but must pay
money to claim
 Phony charities
 Investment fraud

Healthcare fraud and abuse

Carried out by unethical doctors, nurses, hospital personnel, and other professional
care providers, examples of healthcare fraud and abuse regarding elders include

 Not providing healthcare, but charging for it

 Overcharging or double-billing for medical care or services
 Getting kickbacks for referrals to other providers or for prescribing certain
drugs
 Overmedication or under medication

General signs of abuse

The following are warning signs of some kind of elder abuse:

 Frequent arguments or tension between the caregiver and the elderly person
 Changes in personality or behaviour in the elder

If you suspect elderly abuse, but aren't sure, look for clusters of the following
physical and behavioural signs.
 24

Physical abuse

 Unexplained signs of injury such as bruises, welts, or scars, especially if they

appear symmetrically on two side of the body
 Broken bones, sprains, or dislocations
 Report of drug overdose or apparent failure to take medication regularly (a
prescription has more remaining than it should)
 Broken eyeglasses or frames
 Signs of being restrained, such as rope marks on wrists
 Caregiver’s refusal to allow you to see the elder alone

Emotional abuse

In addition to the general signs above, indications of emotional elder abuse include:

 Threatening, belittling, or controlling caregiver behavior that you witness

 Behaviour from the elder that mimics dementia, such as rocking, sucking, or
mumbling to oneself

Sexual abuse

 Bruises around breasts or genitals

 Unexplained venereal disease or genital infections
 Unexplained vaginal or anal bleeding
 Torn, stained, or bloody underclothing

Neglect by caregivers or self-neglect

 Unusual weight loss, malnutrition, dehydration

 Untreated physical problems, such as bed sores
 Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
 Being left dirty or un bathed
 Unsuitable clothing or covering for the weather
 Unsafe living conditions (no heat or running water; faulty electrical wiring,
other fire hazards)
 Desertion of the elder at a public place

Financial exploitation

 Significant withdrawals from the elder’s accounts

 Sudden changes in the elder’s financial condition
 Items or cash missing from the senior’s household
 Suspicious changes in wills, power of attorney, titles, and policies
 Addition of names to the senior’s signature card
 25

 Unpaid bills or lack of medical care, although the elder has enough money to
pay for them
 Financial activity the senior couldn’t have done, such as an ATM withdrawal
when the account holder is bedridden
 Unnecessary services, goods, or subscriptions

Healthcare fraud and abuse

 Duplicate billings for the same medical service or device

 Evidence of overmedication or under medication
 Evidence of inadequate care when bills are paid in full
 Problems with the care facility: poorly trained, poorly paid, or insufficient
staff; crowding; inadequate responses to questions about care.

SPECIAL CONSIDERATIONS IN CARE OF ELDERLYS

1) Promotion of Self Respect and Dignity: Life in any institutional setting or

group living usually involves some restrictions to personal choice and liberty.
Respect for the elderly person’s feelings & emotions should be shown. When
staff makes positive efforts to develop good relationships with patients & gain
their individual respect and friendship, group control becomes easier &
difficult situations of personal relationship or resistance to treatment are
greatly reduced.
2) Promotion of Comfort: Physical & mental comfort & relaxation has to be
achieved. There are many factors that contribute to comfort of the elderly;
care of skin, care of bony structures, maintain temperature and fluid balance.
3) Safety : Unpolished floors, good lighting, the absence of impediments to easy
movement and mobility, correct height of beds, chairs and the provision of
walking aids, grab-rails & hand-rails are environmental features which
contribute to the safety of patients.
4) Daily Living Activities: The patient is encouraged to be out of bed as much as
possible so as to promote mobility, to reduce the risk of complications such as
pressure sores, contractures, dehydration, thrombosis & dependency,
independence encourage self-respect.
5) Promotion of Independence: The patient is encouraged to the maximum
possible level of self-care and decision-making. Staff should give guidance,
encouragement and support rather than try to control the whole life of the
patient.
6) Promotion of Movement and Mobility: The patient is encouraged to be out of
bed as much as possible, according to capabilities and needs. Movement and
 26

mobility should continue throughout the patient’s care for the prevention of
further deterioration.
7) Use of Medications in Elderly: Drug interaction increases with age & numbers
of drugs taken. Therefore, nurses needs to have the knowledge of various
drugs their actions, side effects & must use drugs cautiously for the elderly.
8) Rehabilitation: Rehabilitation for the elderly includes all those activities
which aim at restoring the patient to the highest degree of independent living
of which he or she is capable which shared also included physiotherapist.

AIDS AND PROSTHESIS

Prosthesis is an artificial device used to replace a missing body part, such as a
limb, tooth, eye or heart valve.

In medicine, prosthesis is an artificial extension that replaces a missing body part. It

is part of the field of biomechatronics, the science of fusing mechanical devices with
human muscle, skeleton and nervous systems to assist or enhance motor control lost
by trauma, disease or defect. These are typically used to replace parts lost by injury
or missing from birth or to supplement defective body parts. Medical devices that
can be considered prosthetics include artificial eyes, palatal obturator, gastric bands
and dentures.

Dental prosthesis

It is an artificial appliance which is used as a substitution for the replacement of

teeth. There are two main categories of dentures, depending on whether they are
used replace missing teeth on the mandibular arch or the maxillary arch.

Types of dental prosthesis

COMPLETE DENTURES

When a person has had all of their teeth removed we must make complete dentures
for the person to wear. When the teeth are removed we are left with a ridge of bone
on the upper and lower parts of our mouth, which we can use to put false teeth on.

REMOVABLE FALSE DENTURES

An important step in maintaining a healthy smile is to replace teeth. When teeth are
missing, the remaining ones can change position, drifting into the surrounding space.
Teeth that are out of position can damage tissues in the mouth. Also it may be
difficult to clean thoroughly between crooked teeth.
 27

Removable partial dentures usually consist of replacement teeth attached to pink or

gum colored plastic bases, which are connected by metal framework.

HEARING AIDS

A hearing aid is an electro acoustic body worn apparatus which typically fits in
or behind the wearer’s ear, and is designed to amplify and modulate sound for the
wearer.

These are incapable of truly correcting a hearing loss; they are an aid to make sounds
more accessible

TYPES

Hearing aids vary in size, power and circuitry. It includes

POCKET MODEL

It can be worn in a pocket or harness at chest wall. It consists of the body of the
hearing aid containing microphone, amplifier and controls. A cord transmits the
electric output to a receiver, which converts this signal to sound. The receiver is
attached to a mould, which holds it in place.

BEHIND THE EAR (BTE)

BTE aids have a small plastic case that fits behind the pinna and provides sound to
the ear via air conduction of sound through a small length of tubing, or electrically
with a wire and miniature speaker placed speaker placed in the ear canal. The
delivery of sound to the ear is usually through an ear mould that is custom made, or
other pliable fixture that contours to the individual’s ear.

IN THE EAR (ITE)

The hearing aid is housed in a hard plastic shell which is often custom made by taking
an ear impression. These devices fit in the outer ear bowl (concha); they are
sometimes visible when standing face to face with someone.

IN THE CANAL (ITC), MINI CANAL (MIC) AND COMPLETELY IN THE CANAL AIDS (CIC)

ITC aids are smaller, filling only the bottom half of the external ear. MIC and CIC aids
are often not visible unless we look into the wearer’s ear. These aids are intended for
mild to moderately severe losses.

SPECTACLE TYPE
 28

The hearing aid components are incorporated within a spectacle frame. It is useful
for persons who require glasses along with hearing aids.

REMOTE MICROPHONE (RM)

It is a new category developed by ReSound that combines the advantages of the

behind-the- ear and custom models. The microphone is moved to the outer ear and
is connected to the main body of the hearing aid by a thin transparent tube.

BONE CONDUCTION (BC)

This is used when the ear canal is blocked or in cases where conventional
amplification cannot be given. A bone conduction vibrator is placed on the mastoid
bone behind the ear.

LEGAL AND ETHICAL ISSUES

The most common legal and ethical issues in geriatric care involve assessment of
decisional capacity and competence, identification of decision makers, resolution of
conflicts about care, disclosure of information, termination of treatment at the end
of life, and decisions about long-term care. Although the approach to resolution of
these issues is similar for all age groups, the physiologic, psychologic, and social
reserves of the elderly place them at greater risk of adverse outcomes. The fact that
the elderly often lack the support of family and friends makes them especially
vulnerable to the automatic and sometimes unthoughtful process of the health care
system.

Although aging may pose some many pose some special challenges, it is unfair to
make assumptions about a person’s abilities or needs based on age alone. Rather,
physicians should assess each elderly patient individually and delineate treatment
options accordingly. Physicians must also advocate for their patients’ ethical interests
and legal rights, especially in the medical context, about which patients are often ill-
informed or misled.

Elderly patients are often targets of unscrupulous schemes to defraud them of

property or money. Health care practitioners may be the first to recognize such
schemes and should offer help and referral for legal assistance.
 29

INFORMED CONSENT

A decisionally capable patient’s legally binding treatment decision reached

voluntarily and based on information about risks, benefits, and alternative
treatments gained from discussion with a health care practitioner.

Several legal principles form the basis for informed consent. The right of
knowledgeable self-determination and choice obligates the health care practitioner
to inform patients of the risks and benefits of alternative treatments. The
constitutional right to privacy, as well as the concept of personal liberty and
restraints on state interference with independent action and choice, allows
capacitated persons to choose individually appropriate medical care from among
available treatment options.

Self-determination (the concept that “every adults of sound mind has the right to
decide what shall be done with his own body”), or autonomy, is the foundation of
the legal and ethical doctrine of informed consent. When decision making is
preceded by discussion with a health care practitioner who provides the patient with
the information necessary for choosing among options, the patient’s consent or
refusal is said to be informed and is ethically valid and legally binding. All states
require that informed consent of the capacitated patient precede medical
intervention. The patient has the legal and ethical right to make an informed choice,
i.e.; to consent to or refuse care, even if the likely outcome of the refusal is death.
The physician is legally and ethically obligated to promote this right to all patients,
even to those who are unsophisticated or difficult to info

AUTONOMY

Autonomy is the personal freedom and independence to direct one’s own life &
make choices for and about one self. Autonomous people are capable of rational
thought and problem solving. Loss of autonomy and independence is a real fear
among older people. A nurse has the responsibility to encourage the older person’s
autonomy in any way possible. This can be done by supervision and education of
staff to listen & allow the person time to make choices and discussions with family
members about what is occurring and how they can enhance the older person’s
autonomy.

CONFIDENTALITY AND DISCLOSURE

Ethical oaths and specific statues protect the confidentiality of physician patient
communication, ethical and legal bedrock of the therapeutic relationship. Even well-
 30

being family involvement without the patient’s consent violates the patient’s right of
confidentiality. Protection of private patient information is essential to encouraging
patient candor in revealing symptoms and behaviours relevant to diagnosis and
treatment. Protection of a patient’s secrets, private thoughts and feelings is also
required for decency.

EUTHANESIA, ASSISTED SUICIDE AND PALLIATION

Euthanasia, an action taken by health care practitioner intended to result in a

patient’s death, is illegal in USA. Some patients whose life expectancy is reduced and
who are suffering severely request euthanesia.

Assisted suicide, an action intended to cause his own death with drugs supplied by a
physician, is illegal in all states except Oregon. Physicians can intend to minimize
physical and emotional suffering, even if a secondary result is the shortening of life,
but they cannot specifically intend to hasten death.

The issue of palliation, or pain relief, is inextricable from that of assisted

suicide for 2 reasons:
1. Many dying patients have unrelieved pain or other intolerable
symptoms
2. Most patients requested assisted suicide, do not want to die; they just
want the suffering to stop.

DISCHARGE AND PLACEMENT

Physicians and family members routinely make decisions about discharge and
placement without consulting the patient and often over the patient’s objectives.
Just as capacitated patients have the right to consent to or refuse treatment; they
also have the right to choose their living arrangements and outpatient care.

Despite the family members’ best efforts, they may be unable to meet the safety or
health care needs of the elderly person. Whereas the patient’s decision to consent to
or refuse care is determined by patient autonomy, the decision to accept or refuse
care is governed by the notion of accommodation.

Even if residing with family or residing alone poses a greater risk than living in a long
term care facility, the patient has the right to choose either. Many elderly persons
choose to return home even when health care practitioners believe that residential
treatment is medically and socially preferable. Some patients choose to return home
when the possible result is death. If the patient is decisionally capacitated and
appreciates and accepts the consequences, this choice can be legally and ethically
 31

supportable. A decisionally capacitated patient cannot be placed in a residential

facility over his objection without a court order.

COMMUNITY AND INSTITUITONAL HEALTH CARE

Whether there are official programs or volunteer efforts, community services provide
a wealth of support for the community. These services may be social, economic
health related, legal and advocacy or spiritually focused in nature.

HOME CARE

Home care is range of health and supportive services provided in the home for
people who require assistance in meeting their health care needs. These agencies
may be governmental, private or voluntary.

Care is provided by professional nurses or non- professional staff, such as home

maker aids. Home health care is covered by medicine and health insurance. Services
include skilled nursing, physical therapy, occupational therapy, speech therapy, social
work, nutritional counseling and provision of some medical supplies and equipment.

HOSPICE CARE

A hospice is a resource for the terminally ill. A hospice can be an independent unit
within the community that provides support to the client and family in the home or it
may be contained within an institution. The program focused on meeting the needs
of the dying patient and family.

The goal of the hospice care is to keep the individual as comfortable and pain- free as
possible. Physical, psychological, social and spiritual care is given to the dying person
and the family by a team of doctors, nurses, social workers, clergy and volunteers.

RESPITE CARE

It provides care giver relief for a brief, time limited period. It can be offered in home,
through a day care program or within an institution. An advantage of home care is
that the patient is familiar with physical environment.

The continual demand for care of a seriously ill or dependent family member can
create emotional and physical stress. Studies indicate that respite services reduce
caregiver stress.

DAY CARE
 32

Day care provides an alternative to institutionalization. Offering health and

rehabilitative services. Day care center clients are usually not seriously ill, although
they may have chronic conditions or disabilities that limit independence. These
individuals cannot be left alone during the when family members are at work or are
unavailable. They come to day care programs and return home in the evening. Day
care offers a variety of services ranging from health care to social programs.

SENIOR CENTERS

They offer a variety of social, health and nutritional, educational and recreational
services. They give older people the opportunity to gather for social activity. Besides
being meeting places, senior centers offer counseling, special trips, legal services and
advice on financial matters.

CHECK - IN SERVICES

Some senior centers, churches and other community agencies offer telephone check
in services , in which a volunteer phone a client at a certain time each day to
ascertain his status and to provide social contact.

LONG TERM CARE

Declining health, decreased physical and human resources and increased

dependence may require an older adult to stay in a long term acre facility. Long term
care refers to a continuum of services, including medical care, nursing acre and
personal or psychological services. Long term care services provide care for people at
varying levels of dependence who will require care for an extended period.

EMERGENCY RESPONSE SYSTEM (ERS)

It provides a link between the elder living alone and emergency services. The ESR
when activated can dispatch police, an ambulance or other appropriate services to
the individual’s home. ESR alarms may be worn as jewellary, may be attached to the
telephone or may be placed next to the bed or in the bathroom.

NURSING MANAGEMENT
In order to understand the aged patient, nurses must have a thorough
knowledge of growth and development. Ageing should be viewed as a
developmental process in the life span. Theodore Lidz describes 3 phases in the
ageing process. The first is the retirement; the second is the senescent phase when
 33

failing powers make the person increasingly dependent and third is the senile or
dotage phase when the person is almost completely dependent on others.

Several nursing research studies have been conducted to analyse the health
needs and problems of elderly clients. Findings of the studies revealed that elderly
clients primarily have the problems of loneliness, worthlessness, depression stress,
dependency, incapability, disease condition, impaired motility and functional,
structural and perceptual problems.

OBJECTIVES

The main objectives of providing nursing care to the elderly are:

 Promote and maintain optimum level of health and function

 Detect health problems at an early stage
 Prevent deterioration of an existing disease condition
 Prevent further complication

GENERAL CARE

1. Consider individuality. Do not attempt to alter lifelong character and

behaviour. Give time to learn, to listen and to adapt.
2. Be patient, kind and sympathetic. Communicate effectively. Demonstrate
respect.
3. Encourage independence and encourage him to make his own choices and
decisions in taking care of himself.
4. Assist the elderly to achieve emotional stability. Support him during his
periods of anxiety. Give the person time to express his feelings.
5. Make the elderly’s stay at home interesting and lively.
6. Provide divertional/occupational therapy to enable them to pass time.
7. Maintain privacy while caring for them.
8. Handle them gently.
9. Make them comfortable by providing a comfortable bed, bed linen etc. Keep
bed dry, smooth and unwrinkled.
10. Encourage them to maintain body hygiene, regulate body temperature and
protect themselves in changing weather by wearing proper clothing.
11. Assist them to take care of visual, auditory and dental aids.
12. Protect them from injuries, falls and accidents, etc. make arrangements for
night lights or bed lights to avoid confusion and accidents among the elderly.
13. Ensure adequate nutrition. Assist in taking food and fluids; encourage eating
and drinking adequately.
 34

14. Facilitate elimination. Encourage them to maintain external genital hygiene.

15. Help elderly to establish good sleep patterns
16. Caution elderly about the use of drugs, especially analgesics, narcotics, etc.

SPECIAL NURSING CARE

Problems of the elderly pertain to various body systems functioning and psych
social aspects. Diseases of special senses and the musculo skeletal, circulatory,
respiratory, nervous and GI systems and skin and mucus membranes occur
frequently.

Nursing care must be individualised, taking into consideration the clients past
experiences, needs and individual goals. The patient should be an active participant
in his own care plan. He should be supported for his strengths and helped to
recognise his weaknesses and overcome them.

Elderly patients must be guided to understand and accept the ageing process
and ensuing psycho physiological and social changes. Nurses have major role in
promoting quality of life for the elderly through health promotion and health
protection. She can help the elderly to distinguish the effects of ageing from those of
the disease.

NURSING ASSESSMENT

As with all age groups, assessment of the older adult provides the data base for the
rest of the nursing process. Before beginning the assessment, the nurse must meet
the primary needs first. All assistive needs such as glasses and hearing aids must be
in place.

The focus of a comprehensive geriatric assessment is to determine appropriate

interventions to maintain and enhance the functional abilities of the client. It is
conducted at a geriatric evaluation unit by an interdisciplinary geriatric team.

NURSING DIAGNOSIS

 Activity intolerance
 Fatigue
 Impaired gas exchange
 Risk for aspiration
 Risk for infection
 Impaired urinary elimination
 Insomnia
 35

 Sexual dysfunction

PLANNING

When setting goals with the older adult, it is helpful to identify the strengths and
abilities that the patient demonstrates. Care givers should be included in goal
development. Priority goals for the older adult might include gaining a sense of
control, feeling safe and reducing stress.

NURSING IMPLEMENTATION

When carrying out a plan of action, the nurse may need to modify the approach and
techniques used on the basis of the physical and mental status of the elderly patient.

 HEALTH PROMOTION

Health promotion and prevention of health problems in the older adult are
focussed on 3 areas: reduction in disease and problems increased targeted
services that reduces health hazards and increased participation in health
promotion activities.

 HOSPITAL DISCHARGE

The nurse can use screening tools to identify high-risk patients. The post
discharge assistance needed by high risk patients include bathing, taking
medications, housekeeping, shopping, preparing meals and making a
satisfactory transportation arrangement.

 ASSISTIVE DEVICES

The use of assistive devices should be considered as an intervention for the

older client. Using appropriative assistive devices such as dentures, glasses,
hearing aids, walkers, and wheel chairs can diminish disability. These tools and
devices should be used in patient care plan when appropriate.

 SAFETY

Environmental safety is crucial in the health maintenance of the older person.

With normal sensory changes, slowed reaction time, decreased thermal and
pain sensitivity, changes in gait and balance and medication effects, the older
adult is prone to accidents. Most accidents occur in or around the home. Falls,
motor vehicle accidents and fire are the common causes of accidental death in
older adults.
 36

The nurse can provide valuable counsel regarding environmental changes,

which may improve safety for the older adult. Measures such as stronger
lighting, coloured step strips, tub and toilet grab bars and stairway hand rails
can be effective in safety- proofing. The nurse can also advocate for home fire
and security alarms. The nurse should also do a fall risk assessment of all older
people and ask about number of falls in the past year.

 SLEEP

Adequacy of sleep is also a concern of the older adult because of altered sleep
patterns. Older adults experience a marked decrease in sleep and are easily
aroused. Older adults have difficulty in maintaining prolonged sleep. Often
assurance from the will reduce the anxiety concerning sleep.

EVALUATION

The evaluation phase is similar for all nursing process. The nurse should evaluate the
effectiveness of nursing care by evaluating the changes in self care activities; health
status etc. when evaluating the nursing care, the nurse should focus on functional
improvement rather than cure.

CONCLUSION
When caring of older adults, use the same technique that is used to care for any
other adult but with modifications. In the field of geriatrics, nurses must undoubtfully
continue to assume multidisciplinary roles to give proper care.

BIBLIOGRAPHY
BOOK REFERENCE
 37

 O. P. Sharma (2008) Textbook of Geriatrics and Gerontology (3 rd edition) Viva

books private limited, New Delhi. Page No. 24-31, 751-763
 Chinthamani (2011) Lewis’s Medical Surgical Nursing (2 nd edition) Elsevier
Publications, Haryana. Page No.55-71
 Joyce M Black, Jane Hawkanson Hawks (2008) Medical Surgical Nursing (7 th
edition) Elsevier Publications, New Delhi. Page No.47-63
 Javed Ansari, Farukh Khan (2010) A Textbook of Medical Surgical Nursing 11
(1st edition) S.Vikas and Company Medical Publishers, Jalandar. Page No. 1105-
1161
 Suzanne C. Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H.
Cheever[2009] Text Book of Medical Surgical Nursing[2 nd edition]
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NET REFERENCE

 en.wikipedia.org/wiki/Ageing
 batheticrecords.com/theories_of_ageing/