GERIA

Biologic Aging Theories

 Biologic of aging is the progressive loss of function. It can be viewed as a balance of
positive factors such as healthy diet, regular exercise, and coping resources and negative
factors such as obesity, unhealthy lifestyle (smoking), chronic illness, and stress that
exceeds the individual’s coping resources.
 Biologic aging is a multifactoral process involving genetics, oxidative stress, diet, and
environment.
 Research on biologic aging are attempts directed at increasing both the average life span
and the quality of life of adults including the older to persons. Efforts are directed towards
developing new anti aging therapies to slow down or reverse age- related changes that
result in chronic illness and disability.
 Based on numerous laboratory studies in rodents, caloric restriction (reducing dietary
intake extend by 25% to 50%) has been most consistently shown to significantly extend the
life span. Caloric restriction in rodents results in a decrease in metabolic activity, but
whether this accounts for the increase in longevity is not known. It may be that caloric
restriction results in changes in body composition, metabolism, and hormones that are
conductive to long life. However, whether this is also true for humans remains to be
determined. (Harper, Hughes, Robine).

 Stochastic Theories of Biologic Aging

1. Somatic Mutation Theory
2. Intrinsic Mutagenesis Theory
3. Free Radical Theory
4. Cross-Link Theory
• Nonstochastic Theories of Aging
1. Programmed Theory of Cell Death
2. Telomere -Telomerase Hypothesis
3. Neuroendocrine Theory
4. Immunologic Theory

A. Stochastic Theories of Biologic Aging

 Propose that aging is due to chance

1. Somatic Mutation Theory - Advocates that aging is a result of life long genetic damage:
There is faulty synthesis of DNA, RNA, or both.
 Alteration in RNA or DNA; protein or enzyme synthesis causes defective structure or
function.
 The lifespan is believed to be programmed before birth into the genes of DNA and the
changes in cells cause the changes in the organization and function associated with
aging.
2. Intrinsic Mutagenesis (Mutation) Theory - Postulates that the increase in mutational cells
occurs because of breakdown of genetic regulatory mechanisms.
  The basic premise is that the genetic regulatory mechanisms decrease throughout
life.
 Thus, more mutations occur with aging and these will ultimately result in functional
failure.
3. Free Radical Theory - Proposes that a free radical is a highly reactive atom or molecule that
carries an unpaired electron and thus seeks to combine with another molecule, causing an
oxidative process. This process, also called "oxidative stress", can ultimately disrupt cell
membranes and alter DNA and protein synthesis.
 Common diseases such as athero-sclerosis and cancer are associated with oxidative
stress. Cellular integrity, function, and regeneration mechanisms are inquired.
 Free radicals are natural byproducts of normal cellular processes and are also created
by such environmental factors as smog, tobacco, smoke, and radiation.
 There are numerous natural protective mechanisms to prevent oxidative damage.
Recent research has focused on the roles of various antioxidants, including vitamin C
and E, beta-carotene. and selenium, to slow down the oxidative process and
ultimately the aging process.
 However, the optimal doses of these substances have not been established. These
substances are currently being investigated for their usefulness in preventing diseases
related to aging such as oral, esophageal, and reproductive cancers; coronary artery
disease, and cataracts.

4. Cross Link Theory- Avers that over time and as a result of exposure to
chemicals and radiation in the environment, cross-links form between lipids,
proteins, and carbohydrates as well as nucleic acids.
 These cross-links result in decreased flexibility and elasticity and
this increases rigidity in tissues (e.g., blood vessels, skin, tendons,
etc.) Such changes in cell structure may explain the Observable
cosmetic changes associated with aging, such as wrinkles of the
skin and decreased distensibility of arterial blood vessels.

B. Nonstochastic Theories of Biologic Aging

 Hypothesizes that genes program age - related molecular and
cellular events.

1. Programmed Theory of Cell Death - Proposes that there is an impairment in the ability of
the cell to continue dividing.
 Biologic clock triggers specific cell behavior at specific time.
 The body has a specific number of cell divisions and specific lifespan. (The
faster one lives, the sooner one ages and dies).
2. Telomere - Telomerase Hypothesis - Proposes that telomeres are specialized repeadted
sequences that are present at the end DNA strands.
 Telomerase is the enzyme that synthesizes these repeated sequences.
 With aging there is loss of telomeres and a decrease in telomerase activity. Both of
which affect the number of cell can divide.
 It has also been hypothesized that shortening of the DNA is associated with cancer
development in older adults.
3. Neuroendocrine Theory - Proposes that aging occurs because functional decline in neurons
and associated hormones. It believes that neural and endocrine changes may trigger many
cellular and physiologic aspects of aging.
 It hypothesize that in aging there is organism’s loss of responsiveness of
neuroendocrine to various signals.
  The main focus of this theory is functional changes of hypothalamic – pituitary
system. These changes are accompanied by decline in functional capacity in other
endocrine organs, such as the adrenal and thyroid glands, ovaries and testes.

4. Immunologic Theory - Proposes declining functional capacity of the immune system as the
basis for aging.
• It believes that aging is not a passive weaving out of systems but an active self -
destruction mediated by the immune system.
• It is based on observing an age-associated decline in B and T call functioning,
accompanied by a decrease in resistance and an increase in autoimmune diseases
with aging.
Some studies have the findings that the immune system becomes more diversified
with age and demonstrates a progressive loss of self-regulatory patterns. The result
is an autoimmune response in which cells normal to the body are mistaken as
foreign and are attached by the person's own immune system.
Psychological Theories of Aging
• Describe the aging individual in terms of his or her social group/culture.
1. Disengagement Theory
The basis of this theory arises from the fact that human beings are mortal and must
eventually leave their place and role in society. Therefore, it is their responsibility to
look for suitable replacement.
2. Activity Theory
Assumes that the same norms exist for all mature individuals. The degree to which
the individual "acts like" or "looks like" a middle - aged is the determinant of the
aging process.
One must constantly struggle to remain functional and take on new activities to
replace lost one.
3. Continuity Theory
• Accounts for the continuous flow of phases in the life cycle and does not limit itself to
change.
• It assumes that persons will remain the same unless there are factors that stimulated
change or necessitate adaptation.

I. THE YOUNG ADULT

• The young adult is 20 to 40 years old.

• The developmental milestones of the young adult are as follows:

A. Physical Development
 The young adult has completed physical growth by the age of 20 years.
 The different systems of the body are functioning at their peak efficiency during
this period.
 Persons in their early 20’s are the peak of their physical attributes and intellectual
capacities.
 The musculoskeletal system is well- developed and coordinated.
Peak bones mass is between 30-35 years of age.
 These are the reproductive years for majority of persons.
 B. Psychosocial Development
 The young adult sets the direction for the remainder of his life.
 The roles of adulthood emerge: work, intimacy and parenting.
 The young adult has the capacity to develop intimate, lasting and committed
relationship with another person, cause, institution or creative effort
 The young adult develops a sense of responsibility. the maintenance of appropriate
impulse control, the ability to plan and implement realistic goals, and the develop of a
career.
 The developmental task of the young adult is INTIMACY vs. ISOLATION. (Erikson)

C. Cognitive Development
 Young adults are creative, have effective problem- solving abilities, are realistic, and
are less egocentric than they may have been as adolescents.
 Formal operation (generating hypotheses, rational tjinking deductive and futuristic
thinking) characterize thinking throughout adulthood.

D. Moral Development
 The young adult is capable of principled reasoning. Their choice of action is based on
principles. e.g conversation of the environment justifies protest action.
 Throughout adulthood, the person strives to develop an “Ethic of Care”. Women see
morality in the strive integrity of relationships and caring. For women, what is right is
taking responsibility for others as self- chosen decision. On the other hand, men
consider what is right to be what is just.

E. Spiritual Development
 The young adult develops "searching faith." Through a process of
questioning and doubting own faith, the young adult acquires a cognitive
as well as effective faith.

 Common Health Problems During Young Adulthood

 During young adulthood, lifestyle habits such as smoking, lack of exercise, and poor
personal hygiene increase the risk for future illness. Family history of cardiovascular and
other illnesses also increase the risk of illness.
 Those lifestyle habits that activate the stress response increase the risk of illness.
 Smoking is a well — documented risk factor for pulmonary, cardiac and vascular diseases
in smokers and individuals who received secondhand smoke.
 Persons who drink alcohol often also put their health in a risk.
 Prolonged stress increases wear and tear on the body's adaptive capacities. Stress —
related diseases such as ulcers, emotional disorders and infections could occur.
 Poor personal hygiene puts the young adult at risk for infection.
 Violence, is one of the most common cause of mortality and morbidity in the young adult
population
 Death and injury may occur from physical assaults, motor vehicle or other accidents, and
suicide attempts.
  Factors that may predispose to violence with subsequent injury or death, include
poverty, family breakdown, child abuse and neglect, repeated exposure to violence and
ready access to guns.
 Substance abuse is another factor that contributes to mortality and morbidity in young
adults.
 Unplanned pregnancies can have long-term physical and emotional effects in young
adult years. It is a continual source of stress.
 Sexually transmitted diseases (STD's) have immediate effects such as discharge,
discomfort and infection. These diseases may also lead to chronic disorders which can
result from genital herpes, infertility from to gonorrhea, sexually — or active even death
from AIDS. These those diseases can occur to sexually- active persons, especially those
with multiple partners
 Environmental or occupational factors like exposure to airborne particles, may cause
lung diseases and cancer.
 Occupational exposures may also involve the liver, brain, blood and skin.
 Job stress and family stress greatly affect the psychosocial health of young adults.
 Job stress can occur at any time in family life. Family life has peaks when everyone in
the family works together, and valleys when everyone in the family works together and
valleys when everyone appears to pull apart. Situational stressors occur during events
such as births, deaths, illness, marriages and job loses.
 Municipality of changing relationships and structures in the emerging young adult
family causes high levels of stress.

II. THE MIDDLE ADULT

 The middle adult is 40 to 65 years of age.
 The developmental milestones of the middle adult are as follows:
A. Physical Development
1. Appearance
 Hair begins to thin, gray hairs appear.
 Wrinkles occur due to poor skin turgor, decreased moisture, and loss of
subcutaneous fats
 Fats deposit in the abdominal area.
2. Musculoskeletal System
 Muscle atrophy at about age 60 years. This causes decrease in strength and
stamina.
 Shrinking vertebral discs. This causes loss of height by 1.5 to 3 inches.
 Calcium loss from the bones, especially among postmenopausal women. This
increase risk for fracture.
3. Cardiovascular System
 Decreased stress response, that leads to decreased cardiac output.
 Stiffer valves. This causes diastolic murmurs.
 Conductivity altered this causes ectopic beats; less ability to responds to changes
in blood pressure.
 Blood vessels lose elasticity and become thicker. This causes poorer perfusion to
vital organs with resulting hypoxia; varicosities; peripheral pulses not always
palpable.

4. Sensory Perception
  Loss of lid elasticity causes eyelids to droop or tum inward.
 Ocular changes in cornea, iris, pupil lens. This increases incidence of
astigmatism; need for more light; glare problem; need for eyeglasses; problems
with cataracts.
 Loss of accommodation causes decreased visual acuity for near vision
(presbyopia).
 Auditory canal narrows. This causes increased cerumen.
 Calcification of ossicles causes hearing loss.
 Changes in the organ of Corti. This results to impaired sound transmission,
tinnitus.
 Decreased auditory acuity for high — frequency sounds, particularly in men
(presbycussis).
 Olfactory bulb and cells decrease. This causes inability to discriminate odors.
 Diminished taste sensation. This causes decreased appetite to eat, or desire to add salt
to food.
5. Pulmonary System
 Enlargement and rigidity of the chest wall. This causes poor expansion with less
efficient exchange; shallower breathing; less effective cough.
 Increase in antero — posterior diameter of the chest. This causes Jess air exchange
in the lungs.
 Airway collapse, causes less efficient oxygen exchange, especially under stress.

6. Gastrointestinal System
 Increase in occurrence of hiatal hernia and decrease in intraabdominal strength.
This causes gastric reflux and peptic ulcers.
 Reduced gastric acid that leads to vitamin deficiency.
 Slower neural transmission, causes constipation and incontinence.
 Weakening of intestinal walls. This leads to diverticulosis (outpouchings of
mucous membrane of the intestine through its weakened muscle wall).
7. Renal System
 Decrease in blood flow, glomeruli, renin and filtration. This leads to decreased
creatinine clearance; loss of ability to concentrate urine and conserve water;
poor response to stress.
8. Neurologic System
 Diminished stages Ill and IV of sleep (deep sleep).
 Decreased proprioception. This leads to difficulty in changing position or
achieving balance.
 Altered pain sensation, causes decreased perception of pain.
 Tactile sense decreases. This causes loss of sensation in extremities.
 Sleep disorders, especially in different environments (e.g., hospital).

9. Endocrine System
 Slowed metabolism causes weight gain.
  Loss of sensitivity to insulin. Blood glucose does not return to normal as
quickly.
 Diminished sex hormones. This results to benign prostatic hyperplasia;
testicular firmness; vaginal dryness and atrophy; longer time to orgasm.
10. Sexuality
 Menopause (cessation of menstruation) occurs in women between ages 40 and
55, average 47 years.
 Climacterium (andropause) occurs in men due to decrease of androgen levels.
Occurs in men in their late 40's or early 50's. Throughout this period, a man is
still capable of producing fertile sperms and fathering a child. However, penile
erection is less firm, ejaculation is less frequent and the refractory period is
longer.

B. Psychosocial Development
 The middle adult becomes more altruistic, and concept of service others and
love and compassion gain prominence.
 The person becomes more engaged with civic and social works.
 The person may experience midlife crisis between the ages of 35 45 years, the
"deadline decade." This occurs when the individual recognizes the he/she has
reached the halfway mark of life.
 The developmental task of the middle — aged adult GENERATIVITY vs.
STAGNATION (Erikson). Generativity is concern for establishing and
guiding the next generation.
 Many middle adults find themselves in the "sandwich generation," caught
between the responsibilities of caring for dependent children and those of caring
for aging and ailing parents.
C. Cognitive Development
 Cognitive and intellectual ability change very little during adulthood. Cognitive
processes involve reaction time, memory, perception, learning, problem solving and
creativity.
 The middle — aged adult can reflect on the past and current experience and can
imagine, anticipate, plan and hope.
D. Moral Development
 The middle aged adult can move beyond the conventional level to the postconventional
level. (Kohlberg)
 In conventional level of moral development, action is taken to please another and gain
approval. At this stage, obeying laws and following rules is considered as the right
behavior.
 In postconventional level of moral development, standard of behavior is based on
adhering to laws that protect the welfare and
 Universal moral principles are internalized. The person respects other humans and
believes that relationships are based on mutual trust.
E. Spiritual Development
 The middle-aged person tends to be less dogmatic about religious beliefs. Religion may
offer more comfort than before.
 The person often relies on spiritual beliefs to help him deal with illness, death and tragedy.

 Common Health Problems During Middle Adulthood

  Stress-related illnesses are common among middle adults such as heart attacks (myocardial
infarction), hypertension. migraine headaches, ulcers and others.
 Psychosocial concerns like anxiety is common among middle adults. This is in response to
the physiologic and psychologic changes of middle age. Such anxiety can motivate the
middle adult to rethink life goals and can stimulate productivity. For some, this anxiety
precipitates psychosomatic illness and preoccupation with death.
 Depression is another psychosocial concern that is common among middle age adults. The
risk factors include disappointments or losses at work or school or in family relationships;
departure of child from home; physiologic changes of aging; menopause in females; family
history of depression. The incidence of depression in women is &/ice that of men.
Depression that occur at this stage is commonly characterized by moderate-to-high anxiety
and physical complaints.
 Chronic illnesses common among middle adults also include diabetes mellitus, rheumatoid
arthritis, multiple sclerosis, COPD.

III. THE OLDER ADULT (ELDERLY)

• This period extends above 65 years of age

A. Terminologies Related to the Care Of Elderly Clients

1. Gerontology. The science and study of the aging process.
2. Gerontologic Nursing. The care and attention to individuals undergoing the aging process with
emphasis on the developmental stages of aging.
3. Geriatrics. The science and study of the physiologic and pathologic problems Of individuals in
their later maturity
4. Geriatric Nursing. Care of the elderly individual regardless of whether they are diseased or
not
5. Senescence. The normal aging process
6. Senility. Aging process characterized by severe mental deterioration
7. Ageism, A negative attitude based and disparities in the care given the older
person.

 The Primary Changes of aging in Older Adults

1. Physiological Changes in Late Adulthood
a. Integumentary System
 Loss of subcutaneous supporting tissues. This cause the skin to wrinkle and sag,
and sensitive to pressure and trauma.
 Decreases sebaceous secretion. This cause alteration in body image.
 Thinning and graying hair. This causes alteration in body image.
 Atrophy of tiny arterioles near epidermis. This cause impaired vasomotor
homeostatic mechanism and poor temperature regulation. The elderly feels cold
even in warm climate.
b. Muskuloskeletal System
 Increased fat substitution for muscle.
 Muscle atrophy. This result to decreased muscular strength and function.
  Loss of calcium from bones especially in vertebral bodies. The elderly is prone to
fracture. Loss of calcium from vertebral bodies cause decrease in height.
 Deterioration of cartilage. This cause wear, friction and stiffness of joints.
c. Respiratory System
 Reduced chest wall compliance. This results from increased calcification of coastal
cartilage and decreased strength of Intercostal and accessory muscle and diaphragm.
 Reduced breathing capacity, reduced vital capacity, increased residual volume.
 Decreased cough reflex.
 Decreased ciliary activity,
 These changes in the respiratory system increase the risk for respiratory problems
(hypoxia. infections) among older adult
d. Cardiac System
 Endocardial thickening, thickened heart valves, decreased myocardial strength. These
lead to decreased cardiac output.
e. Vascular System
 Decreased elasticity of blood vessels. This leads to Increased blood pressure (BP).
 Atherosclerotic plaques develop. This may result to ischemia.
 Decreased efficiency of baroreceptors (receptors that are sensitive to changes in blood
pressure). This for postural hypotension.
f. Renal System
 Decreased blood flow to the kidneys. This causes reduction of glomerular filtration
rate (GFR),
 Reduced number of nephrons and creatinine clearance.
 These changes increase risk to drug toxicity and risk for fluid electrolyte
imbalances. Dehydration and occur even within short time of food and fluid
deprivation.
g. Nervous System
 Degeneration and atrophy neurons. This cause loss of memory, especially recent
memory. In addition, there is reduced concentration ability, decreased attention
span, decreased muscle coordination, decreased ability to perform fine motor
activities (activities done by the fingers).
 Decreased nerve acuity and sensation. This makes the elderly unaware of tissue
trauma like burns or pressure.
 Decision- making and judgment ability remain intact.
 Ability to learn is possible up to 200 years of life.
h. Gastrointestinal System
 Minimal loss of digestive enzymes. This leads to decreased absorption of nutrients.
 Decreased peristalsis. This leads to constipation.
i. Endocrine System
 Decreased utilization of insulin. This increases the risk to develop diabetes mellitus.
 Cessation of progesterone secretion and decreased plateau estrogen. These changes
lead to menopause.
 Gradual decline in testosterone and increase in level of estrogen in males. These
increase risk to develop BPH (Benign Prostatic Hyperplasia).
 Reduced basal metabolic rate (BMR) . This contributes to anorexia
j. Sensory System
 Vision
o Loss of accommodation (presbyopia)
o Loss of color sensitivity. The elderly experiences difficulty in perceiving
blues hues, especially purple
 o Decreased dark adaptation. Red light should be on during the night to
prevent falls when the client gets up and go to the bathroom.
o Decreased peripheral vision. This increases risk to accidents.
o Reduced sensitivity to glare,
 Hearing
o Degeneration of cochlea and auditory pathways. This results to loss of
hearing of high-pitched sound and difficulty in speech discrimination.
 Taste and Smell
 Decreased sense of taste and smell cause lack of appetite to eat. The elderly
prefers salty diet..
k. Dental
 Gums becomes less elastic and less vascular. The gums recede from remaining teeth,
exposing areas of teeth not covered with enamel.
l. Sexuality
 Minimal change in amount of sexual response.
 Increase in time for full sexual response.
 Reduced vaginal lubrication.
 Increased refractory period in males.
2. Psychosocial Changes in Late Adulthood.
a. Developmental task of the Older Adult (by Havighurst)
 Adjusting to decreased physical strength and health.
 Adjust to retirement and reduced income.
 Adjusting to the death of one’s spouse.
 Establishing an explicit affiliation with one’s age group.
 Meeting social and civic obligations.
 Establishing satisfactory living arrangements.
 Establishing satisfactory relationship with adult children.
 Finding meaning in life.
b. Developmental task of the Older Adult (by Erikson)
Ego integrity Despair

-Views life with sense of wholeness and derives -Believes they have made poor choices during
satisfaction from past accomplishment. life and wish they live life longer.

-Views death as an acceptable completion of -Inability to accept one’s fate.

life.
-Accepts one’s one and only life cycle.
-Bringing serenity and wisdom
-Gives rise to feeling with frustration,
discouragement, and a sense that one’s life has
been worthless.

 To achieve ego integrity, the older adult must have:

a. At least one companion in life.
b. Stable financial status.
c. Productive social, civic and religious activities.
NURSIND CARE OF THE OLDER ADULTS

1. Communication Considerations
 Demonstrate respect by remembering names and calling the client by the name he/she
prefers being address (instead of “ grandma”, or “grandpa”).
 Face the client when speaking.
 Speak distinctly, clearly, using normal tone of voice. DO NOT SHOUT. Increased
frequency of voice pitch makes hearing difficult.
 Provide written instruction. Memory and attention span have diminished.
2. Promoting Independence and Self-Esteem
 Place equipment conveniently and encourage the use of self- help device.
 Encourage the client to do as much as possible for himself/herself, provided that safety
is maintained.
 Assist the client with personal care as necessary.
 Acknowledge the client’s ability to think, reason and make decisions.
3. Promoting Hygiene and Skin Care
 Daily bath is not necessary for elderly client. The skin is dry and there is poor
temperature regulation. He/She feels cold most of the time. Sponge bath may be one
alternately with full bath.
 Use mild, superfatted soap ton promote moisture of skin. Dry skin can easily be
impaired.
 Use bath oils, lanolin, or body lotion to protect the skin. Avoid use of alcohol. Alcohol
dries the skin.
 Use protective device like sheepskin, flotation pads/ mattress to prevent pressure sores.
 Change position frequently. Loss of subcutaneous supporting tissues makes the skin
sensitive to pressure.
 Massage bony prominences and weight-bearing areas every two (2) hours. To promote
circulation and prevent pressure sores.
 Assist in ambulation as much as possible.
 Soak feet in warm water before cutting nails. The nails are usually hard.
4. Care of Visual Aid and Dentures
 Keep eyeglasses clean and always available.
 Keep night light on to prevent accidents.
 Clean dentures following each meal.
 Prevent damage and loss of visual aids and dentures.
5. Promotion of Exercise and Good Body Alignment
 Regular exercises of feet and legs to prevent peripheral vascular disorders (PVD’s)
 Encourage correct posture and deep breathing.
 Promote proper body alignment.
 Use footboard to keep bed sheet off the toes. This prevents foot drop.
 Active range-of-motion (ROM) exercises to increase and maintain muscle tone and
joint mobility.
 Practice gradual change of position to prevent orthostatic hypotension.
 Provide leather-soled or rubber-soled, well-fitting shoes to prevent accidents or falls.
 6. Regulation of Body Temperature
 Normal body temperature of the elderly client is below 98.6 F (37 C)
 Body temperature of 99F in the elderly indicates presence infection, usually
repiratory or bladder infection.
 Provide adequate warmth to client especially during cold climate, eg., several layers
of clothings, gloves, socks, bonnets.
7. Promotion of Sleep Patterns
 The elderly client sleeps lightly, intermittently, with frequents waking. Provide low
bed, night light, and adequate supervision when getting up to prevent falls.
 Limit fluid intake of the client before going to bed. This prevents sleep pattern
disturbance related to frequent urination (nocturia) during the night.
 Promote comfort and relaxation.
 Create restful environment.
 Attend to bedtime rituals.
 Promote regular sleeping and walking hours.
 Provide a glass of warm milk at bedtime.
 Avoid caffeine and alcohol in the evening.
 Go to bed only when sleepy.
 Avoid long naps in the afternoon.
8. Provision of Nutritional Needs
 Increase fiber (fruits, vegetables) in diet and fluids to prevent constipation.
 Provide vitamin and mineral supplements as prescribed. To promote health.
 Provide skim milk. This is rich in protein and calcium and low in fats and
cholesterol.
 Increase protein in diet but reduce calories. The metabolic rate of the elderly is
slowed.
 Nutritional Assessment of Older Adults:
 To assess the risk factors for poor nutritional status in older adults.
 The acronym SCALES can remind the nurse to assess important nutritional indicators:
S- sadness or mood changes
C- cholesterol, high
A-albumin, low
L- loss or gain weight
E- eating problems
S- shopping and food preparation problems
 There are also ways of improving eating habits that promotes proper nutrition. The
American College of Sport Medicine (2004) lists five ways to increase eating pleasure,
which aim to satisfy not only the appetite but also encourage good eating habits. These
include:
1. Adding texture and flavor to foods
 Texture: e.g. , cereals on yogurt
 Flavor: e.g. , garlic in meals
2. Stimulating sense of taste
 Eat hot and cold food in the same meals
 Rotate bits of food from the choices in your plate
 3. Eating with friend
 Arrange a regular date, e.g. ,every Wednesday evening.
 Have a potluck meal where friends bring a dish
4. Preparing food with care
 Buy and cook small quantities to avoid the same old left overs.
 Cook meals ahead and reheat or defrost when needed.
 Keep easy-to-fix items available in case you don’t feel like cooking.
5. Setting the table attractively
 Make mealtime more interesting ,fun, and enjoyable
 Eating adequate calories is critical so make it a focus of each day.
9. Promotion of Urinary Elimination
 Frequency of voiding is common. This due to decreased muscle tone of
bladderwith impairment of bladder emptying capacity. Increased residual urine
increases risk of urinary tract infection.
 Increase fluid intake to dilute urine and because its irritating properties.
 Reduced sensation, decreased awareness of the need to empty bladder, relaxation
of the sphincter. These cause urinary retention and incontinence.
 Relaxation of perineal muscles in elderly women interferes with complete
emptying of the bladder. This also causes urinary tract infection.
 Many elderly men have benign prostatic hypetrophy (BPH). The client should be
assessed for signs and symptoms of BPH.
 Changes in the lining of the vagina lead to decreased resistance to
microorganisms. Infection with discharge is common.
10. Sexuality
 The elderly is still capable of sexual arousal and orgasm.
11. Provision for Emotional Needs
 The elderly need someone to talk to. Plan time to visit; allow visits with
clergyman.
 The client is oftentimes comforted by touch. Touch conveys feelings of concern,
intent, and acceptance.
 Maintain family contact.
 Provide diversional activities, e.g. books or magazine with large prints, radio, TV.
 Allow the client verbalize feelings on death. Do not avoid the topic.

PHYSIOLOGIC CHANGES ASSOCIATED WITH AGING THAT INLFUENCE

MEDICATION ADMINISTRATION AND EFFECTIVENESS.

 Altered memory and less acute vision among elderly usually cause errors in taking
medications.
 Decrease in renal function, resulting in slower elimination of drugs and higher drug
concentrations in blood stream for longer periods.
 Less complete and slower absorption from the GI tract.
 Increased proportion of fat to learn body mass, which facilitates retention of fat soluble drugs
and increases potential toxicity.
 Decreased liver function which hinders biotransformation of drugs.
 Decreased organ sensitivity which means that the response to the same drug concentration in
the vicinity of the target organ is less in older people than in the young.
 Altered quality of organ responsiveness resulting in adverse effects becoming pronounced
before the therapeutic effects are achieved.
 Common causes of Medication Errors by Older Adults
 Poor eyesight (most common cause)
 Forgetting to take drugs,
 Use of non-prescription over-the-counter drugs.
 Use of medication prescribed for someone else.
 Lack of financial resources to obtain prescribed medication.
 Failure to understand instructions or the importance of the drug treatment.