NCM 114 Midterm Module Content

LET’S BEGIN!
UNIT 6-7 WEEK (6-7)- FUNCTIONAL STATUS
Intended Learning Outcomes ( Week 6-7-ILO )
At the end of the unit, you are expected to:

1. Categorize the different activities of daily living of adult persons.
2. Explain the importance of activities of daily living among elderly

clients.
Introduction
Preservation of function and independence is one of the goals of successful

aging. Functional status is measured by the ability of people to perform
basic and instrumental activities of daily living (ADLs). Basic activities of
daily living (BADLs) consist of self-care tasks and include feeding, bathing,
dressing, using the toilet, personal hygiene, ability to transfer from bed to
chair and back again, and walking .Instrumental activities of daily living
(IADLs) allow a person to live independently in a community. They include
the ability to use the telephone, perform housework and laundry, shop,
prepare meals, manage finances, take medications, and arrange
appropriate transportation. More advanced ADLs include hobbies and
leisure activities. https://www.google.com/search?q=functional+status&oq
This unit will focus on the definitions of interest and any other terms
related. It also deals with the basic concept of simple interest and discount.
Please proceed immediately to the “Unlocking of Difficulties” part since
the first lesson is also definition of essential terms.
Unlocking of Difficulties
To attend the following intended learning outcomes for the first

lesson of the course, you need to fully understand the following essential
knowledge that will be laid down in the succeeding pages. Please note that
you are not limited to exclusively refer to these resources. Thus, you are
expected to utilize other books, research articles and other resources that
are available in the library e.g. ebrary, search.proquest.com etc.
Key Terms
Activity of Daily Living-is a term used in healthcare to refer to people's
daily self-care activities.
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Grooming-refers to the things that people do to keep themselves clean and
make their face, hair, and skin look nice.
Gait- a manner of walking or moving on foot. 2 : a sequence of foot
movements (as a walk, trot, pace, or canter) by which a horse or a dog
moves forward.
Degeneration-a process by which a tissue deteriorates, loses functional

activity, and may become converted into or replaced by other kinds of
tissue.
Parkinson’s disease-a progressive disease of the nervous system marked by
tremor, muscular rigidity, and slow, imprecise movement, chiefly affecting
middle-aged and elderly people.
Lecture Notes
UNIT 1- FUNCTIONAL STATUS
ACTIVITIES OF DAILY LIVING
https://www.google.com/search?q=activities+of+daily+living&sxsr Retrieved on September 6, 2020
1.BATHING
https://www.google.com/search?q=Bathing+for+elderly&tbm=isch&ved = Retrieved on September 6, 2020
 Bathing once or twice a week is acceptable for older adults, as the

purpose is to prevent the skin from breaking down and lower the risk
of skin infections.
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 Seniors also tend to be less active than younger adults, so they can
get away with fewer baths. However, you don't want your loved one
to develop body odor.
2.Dressing
https://www.google.com/search?q=Dressing+for+elderly+purposes Retrieved on September 6, 2020
 Many older adults prefer to be dressed in daytime clothes each day.

 Being dressed often helps them feel more confident and be more
comfortable interacting with others. But for many caregivers, helping
someone dress and undress twice a day can be mentally and
physically exhausting
3.TOILETING
https://www.google.com/search?q=Toileting+for+elderly+purp Retrieved on September 6, 2020
 One of the most common aging in place challenges elderly people

and their caregivers will encounter is the daily activity of toileting.
 Toileting is a naturally private matter and when older people need
help with it, it can be a source of embarrassment both for them and
their caregivers.
 For many elderly who strive to age in place for as long as possible,
dealing with needing help with this embarrassing daily activity is
unavoidable.
 For many caregivers, it is one they manage the best they can, often
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needing to overcome that barrier of awkwardness, particularly with
aging parents.
4.MAINTAINING CONTINENCE
https://www.google.com/search?q=maintaining+continence+for+elderly Retrieved on September 6, 2020
 Continence care relates to helping an individual achieve and

maintain this control of their bladder or bowel functions, through
tips on how to keep the bladder healthy, continence assessment,
identifying a suitable course of treatment if necessary and emotional
support and advice.
 Good toilet habits help prevent incontinence:
 Go to the toilet to urinate only when your bladder is full. ...
 Take your time on the toilet. ...
 Go to the toilet when you feel the urge to pass a bowel motion. ...
 Give yourself plenty of time to pass a bowel motion.
 Don't strain to open your bowels.
 Encourage the older person to get out of bed and use a commode
next to the bed or walk to the toilet if possible. Show the older
person and their family how to use the call bell if they need
assistance to use the toilet. Encourage the patient to completely
empty their bladder with each void.
5.GROOMING
https://www.google.com/search?q=grooming+for+elderly&hl=en&sxsr Retrieved on September 6, 2020
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 Being unable to take care of one's hygiene and grooming without
help begins to make most seniors feel as though they are simply no
longer self-sufficient. When helping a senior or elderly person with
their hygiene and grooming tasks, take care to treat them as you
would any adult- with respect and dignity.
6.FEEDING
https://www.google.com/search?q=feeding++for+elderly&hl=en&sxs Retrieved on September 6, 2020
 To maintain a healthy diet and balanced nutrition. To prevent

complications such as aspiration pneumonia induced by choking. To
encourage and assist elders with eating problems so as to maximize
their independence and self-care ability. To make eating an
enjoyable experience to improve their quality of life.
 Elders with chronic illness and impaired mobility may suffer from
various degrees of feeding problems. It is therefore important for
carers of these elders to provide appropriate assistance according to
the elders' individual needs.
7.TRANSFERRING
https://www.google.com/search?q=transferring+++for+elderly+purpose Retrieved on September 6, 2020
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 Every day, countless family caregivers struggle to reposition and
transfer seniors with limited mobility.
 Many are performing these tasks without any help from additional
people or assistive equipment, risking their own health and safety
and that of their loved ones.
 Falls, back injuries and chronic pain are common results of manually
lifting mobility challenged seniors.
 A patient lift can help make transfers much safer and easier for
everyone involved in a senior’s daily care.
8.SHOPPING FOR GROCERY
https://www.google.com/search?q=shopping+for+grocer Retrieved on September 6, 2020

 Groceries are a necessity for everyone, but shopping for groceries
can be one of the most difficult types of shopping for the elderly. It
requires a drive to and from the store, bending to reach items on low
shelves, pushing a heavy shopping cart, and lugging heavy bags into
the house upon returning home
9.USING PUBLIC TRANSPORTATION
https://www.google.com/search?q=using+public+transportation++in+ol Retrieved on September 6, 2020

 Transportation is necessary for access to healthcare, community
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participation, and overall quality of life. This is no different for older
adult populations.
 Older adults are more likely to restrict their driving in bad weather,
at night, or on high speed roads than their younger counterparts.
 Many older adults also give up driving completely because of
concerns over their ability to drive safely.
 Older adults often experience mobility impairment that limits their
ability to utilize modes of “active transportation” such as bicycling or
walking. These barriers to transportation can potentially lead to
lower access to healthcare, missed or delayed medical
appointments, and increased costs.
10.USING THE TELEPHONE
https://www.google.com/search?q=easy+to+use+telephone+for+eld Retrieved on September 6, 2020
 If you’re a senior living at home, chances are you’ve thought about

owning cell phone to help you stay safe and connected.
 Or maybe you already own one and are hoping to optimize its
settings to meet your unique needs. Either way, when choosing a cell
phone for yourself or your baby boomer relative, it’s important to do
your research.
11.PERFORMING HOUSEWORK
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https://www.google.com/search?q=Performing+Housework+for+elderly Retrieved on September 6, 2020
 While it may be hard to accept, most of us will require some type of

care assistance after the age of 65. You may be used to handling
everything yourself, dividing up duties with your spouse, or relying
on family members for minor help around the home. But as you get
older and your circumstances change, getting around and taking care
of yourself can become more and more difficult. If the idea of moving
to a retirement community, assisted living facility, or nursing home
doesn’t appeal, home care services may be able to help keep you
living in your own home for longer.
12.DOING HOME REPAIR
https://www.google.com/search?q=Doing+Home+Repair+for+elderly Retrieved on September 6, 2020
 Home repairs and modifications help seniors live in their homes for
as long as possible.
 Making your older adult’s home safer and more accessible reduces
fall risk, prevents accidents, and increases independence.
 In addition, home updates can reduce energy usage, which lowers
utility bills.
13.PREPARING FOR MEALS
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https://www.google.com/search?q=preparing+meals+for Retrieved on September 6, 2020
 If you care for a senior loved one, your days are probably very busy.
It isn’t uncommon for caregivers to work outside the home while
also raising a family of their own. When time is short, eating a well-
balanced diet becomes more difficult to do. Convenience foods and
fast food restaurants are a quick solution, but they are not usually
very healthy.
 Caregivers are often also responsible for creating menus and making
meals for their older family member. One solution that makes it
easier on you and your senior loved one is to make and freeze
healthy entrees that you can pull out of the freezer and serve as
needed.
14.DOING LAUNDRY
https://www.google.com/search?q=doing+laundry+for+eld Retrieved on September 6, 2020

 Emotionally, clean laundry can make an elderly person feel good
about how they look and smell. When they have on clean clothes,
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they know they look their best and their self-confidence grows.
 Most people take clean laundry for granted, but when an elderly
person is limited in ability; it can seem like an impossible goal.
 Clean laundry is important for everyone, but many family caregivers
don’t take into consideration what it takes for an aging adult to
gather, sort, wash, dry, fold and put away clothes, bedding, and
towels. Family caregivers can pitch in and help, but the best way to
ensure their aging relatives have clean laundry is to hire a home care
provider.
15.TAKING MEDICATION
ttps://www.google.com/search?q=Medication+safety+for- Retrieved on September 6, 2020
 Take your medicine regularly and according to your health care

provider's instructions. Don't take prescription medications that your
health care provider has not prescribed for you.
 And don't skip doses or stop taking medication without first
consulting with your provider.
MEDICATION SAFETY TIPS FOR OLDER ADULTS

 Keep a medication list
 Take medicine as prescribed:
 Talk to a doctor about side-effects
 Be aware of potential drug interactions:
Focus Questions
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Instructions: Answer the following questions in complete sentence with
rubrics provided via messenger.
1. What is the role of Health Care Provider in patients’ ADL?
2. How important activities of daily living among elderly?
Related Readings
For Supplemental readings on the Care of Older Adults, please refer to
these sources provided.
https://www.google.com/search?
q=medication+safety+for+older+adults&oq=&aqs=
https://www.google.com/search?q=taking+medicatio
https://www.google.com/search?q=doing+laundry+for+elderly&
https://www.google.com/search?q=elderly+meal+plan+samples&
https://www.google.com/search?q=functional+status&oq
Assessment Activities
Directions: Answer the following essay questions with rubrics provided via
Google Classroom
2. Enumerate and discuss the most chronic illness affecting elderly.
References
q=medication+safety+for+older+adults&oq=&aqs=
https://www.google.com/search?q=taking+medicatio
https://www.google.com/search?q=doing+laundry+for+elderly&
https://www.google.com/search?q=elderly+meal+plan+samples&
https://www.google.com/search?q=bathing+for+elderly+purpose
https://www.google.com/search?sxsrf=ALeKk02tCLhu9Xi7dmI8k-Xnh7
https://www.google.com/search?sxsrf=ALeKk00DWTaqnAzYHgJgfCj71w
https://www.google.com/search?sxsrf=ALeKk02arscr-DoDTYFM
https://www.google.com/search?sxsrf=ALeKk03L28Cps6
UNIT 8-9 WEEK (8-9)- COMMON CHRONIC DISEASES AFFLICTING ELDERLY
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Intended Learning Outcomes ( Week 8-9-ILO )

1. Discuss the causes of the most common diseases afflicting elderly
Introduction
Chronic disease: A disease that persists for a long time. A chronic disease is
one lasting 3 months or more, by the definition of the U.S. National Center
for Health Statistics. Chronic diseases generally cannot be prevented by
vaccines or cured by medication, nor do they just disappear. Eighty-eight
percent of Americans over 65 years of age have at least one chronic health
condition (as of 1998). Health damages behaviours - particularly tobacco
use, lack of physical activity, and poor eating habits - are major contributors
to the leading chronic diseases.
Key Terms
Antirheumatic drug- refers to agents used in the therapy of inflammatory
arthritis, predominantly rheumatoid arthritis.
Major Depression-is a mood disorder that causes a persistent feeling of
sadness and loss of interest and can interfere with your daily functioning.
Insulin -is a hormone made in your pancreas, a gland located behind your
stomach
Benign prostatic hyperplasia (BPH)-also called prostate enlargement, is a
noncancerous increase in size of the prostate gland.
Bradykinesia -means slowness of movement and is one of the cardinal
manifestations of Parkinson's disease.
Limb rigidity- refers to abnormal stiffness in the limbs or other body parts,
which prevents muscles from stretching and relaxing.
UV Rays-radiation that is in the region of the ultraviolet spectrum which
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extends from about 280 to 320 nm in wavelength and that is primarily
responsible for sunburn, aging of the skin, and the development of skin
cancer.
Muscle wasting -is a loss of muscle mass due to the muscles weakening

and shrinking.
Diversional Activities- activities are quite diverse and may vary from:
Spiritual, cultural and social activities. Sensory enrichment, activities such
as pet therapy, aromatherapy and massage.
Kegel exercise-is like pretending you have to urinate and then holding it.
Gait -means the way a person walks.
Lecture Notes
UNIT 8-9- COMMON CHRONIC DISEASES AFFLICTING ELDERLY

1.ADULT ONSET DIABETES
https://www.google.com/search?q=diabetes&biw=1280&bih=578&sxsrf Retrieved on September 8, 2020
 Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a

form of diabetes that is characterized by high blood sugar, insulin
resistance, and relative lack of insulin. Common symptoms include
increased thirst, frequent urination, and unexplained weight loss.
NURSING IMPLICATIONS
 Diet control helps regulate weight, which is extremely important in
Type 2 diabetes.
 Eating healthy foods and following a diet program if overweight, is
essential and should be stressed in diabetic teaching
 Exercise burns calories, which helps control weight.
2.ARTHRITIS
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https://www.google.com/search?q=arthritis+causes&tbm=isch&ved Retrieved on September 8, 2020
 Is the swelling and tenderness of one or more of your joints

 Symptoms of arthritis
 joint pain, tenderness and stiffness.
 inflammation in and around the joints.
 restricted movement of the joints.
 warm red skin over the affected joint.
 weakness and muscle wasting.
NURSING INTERVENTIONS
 Provide a variety of comfort measures (eg, application of heat or
cold; massage, position changes, rest; foam mattress, supportive
pillow, splints; relaxation techniques, diversional activities).
 Administer anti-inflammatory, analgesic, and slow-acting anti
rheumatic medications as prescribed.
3.KIDNEY AND BLADDER PROBLEM
https://www.google.com/search?q=3.%09KIDNEY+AND+BLADDER+PROBL Retrieved on September 8, 2020
Kidney infection, also called pyelonephritis, is when bacteria or viruses
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cause problems in one or both of your kidneys. It’s a type of urinary
tract infection (UTI).
 Your kidneys’ main job is to remove waste and take extra water from
your blood. They’re part of your urinary tract, which makes liquid
waste (urine) and removes it from your body. Like the exhaust
system on your car, you want everything to work like it should so
waste moves in one direction only: out.
 Your urinary tract is made up of your: Kidneys. These clean waste
from your blood and make urine (your pee).
SYMPTOMS OF A KIDNEY INFECTION INCLUDE:
 Blood or pus in your pee

 Fever and chills
 Loss of appetite
 Pain in your lower back, side, or groin
 Upset stomach or vomiting
 Weakness or fatigue
 You may also have some of the symptoms of a bladder infection, such
as:
 Burning or pain when you pee
 A constant urge to pee, even soon after you empty your bladder
 Cloudy or bad-smelling urine
 Pain in your lower belly
 Peeing much more often than usual
 Drink enough fluids, especially water. Most healthy people should

try to drink six to eight, 8-ounce glasses of fluid each day. Water is
the best fluid for bladder health. At least half of fluid intake should
be water. Some people need to drink less water because of certain
conditions, such as kidney failure or heart disease. Ask your
healthcare provider how much fluid is healthy for you.
 Limit alcohol and caffeine. Cutting down on alcohol and caffeinated
foods and drinks—such as coffee, tea, chocolate, and most sodas—
may help.
 Quit smoking. If you smoke, take steps to quit . If you don’t smoke,
don’t start.
 Avoid constipation. Eating plenty of high-fiber foods (like whole
grains, vegetables, and fruits), drinking enough water, and being
physically active can help prevent constipation.
 Keep a healthy weight. Making healthy food choices and being
physically active can help you keep a healthy weight.
 Exercise regularly. Physical activity can help prevent bladder
problems, as well as constipation. It can also help you keep a
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healthy weight.
 Do pelvic floor muscle exercises. Pelvic floor exercises, also known
as Kegel exercises, help hold urine in the bladder. Daily exercises
can strengthen these muscles, which can help keep urine from
leaking when you sneeze, cough, lift, laugh, or have a sudden urge
to urinate.
 Use the bathroom often and when needed. Try to urinate at least
every 3 to 4 hours. Holding urine in your bladder for too long can
weaken your bladder muscles and make a bladder infection more
likely.
 Take enough time to fully empty the bladder when
urinating. Rushing when you urinate may not allow you to fully
empty the bladder. If urine stays in the bladder too long, it can
make a bladder infection more likely.
 Be in a relaxed position while urinating. Relaxing the muscles
around the bladder will make it easier to empty the bladder. For
women, hovering over the toilet seat may make it hard to relax, so
it is best to sit on the toilet seat.
 Wipe from front to back after using the toilet. Women should wipe
from front to back to keep bacteria from getting into the urethra.
This step is most important after a bowel movement.
 Urinate after sex. Both women and men should urinate shortly after
sex to flush away bacteria that may have entered the urethra during
sex.
 Wear cotton underwear and loose-fitting clothes. Wearing loose,
cotton clothing will allow air to keep the area around the urethra
dry. Tight-fitting jeans and nylon underwear can trap moisture and
help bacteria grow.
4.DEMENTIA
https://www.google.com/search?q=4.%09Dementia&tbm=isch&v Retrieved on September 8, 2020
 Dementia is a collective term used to describe various symptoms of

cognitive decline, such as forgetfulness.
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 It is a symptom of several underlying diseases and brain disorders.
 Dementia is not a single disease in itself, but a general term to
describe symptoms of impairment in memory, communication, and
thinking.
NURSING INTERVENTION
 Orient client. Frequently orient client to reality and surroundings.

 Encourage caregivers about patient reorientation.
 Enforce with positive feedback.
 Explain simply.
 Discourage suspiciousness of others
 Avoid cultivation of false ideas
 Observe client closely
5.PARKINSON’S DISEASE
https://www.google.com/search?q=parkinson%27s+disease&sxsrf= Retrieved on September 9, 2020
 Parkinson's disease (PD) is a neurodegenerative disorder that affects

predominately dopamine-producing (“dopaminergic”) neurons in a
specific area of the brain called substantia nigra.
 Symptoms generally develop slowly over years.
 The progression of symptoms is often a bit different from one person
to another due to the diversity of the disease. People with PD may
experience:
 Tremor, mainly at rest and described as pill rolling tremor in hands.
Other forms of tremor are possible
 Bradykinesia
 Limb rigidity
 Gait and balance problems
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 Assess neurological status.
 Assess ability to swallow and chew.
 Provide high-calorie, high-protein, high-fiber soft diet with small,
frequent feedings.
 Increase fluid intake to 2000 mL/day.
 Monitor for constipation.
 Promote independence along with safety measures.
 Avoid rushing the client with activities.
 Assist with ambulation and provide assistive devices.
 Instruct client to rock back and forth to initiate movement.
 Instruct the client to wear low-heeled shoes.
 Encourage the client to lift feet when walking and avoid prolonged
sitting.
 Provide a firm mattress, and position the client prone, without a pillow,
to facilitate proper posture.
 Instruct in proper posture by teaching the client to hold the hands
behind the back to keep the spine and neck erect.
 Promote physical therapy and rehabilitation.
 Administer anticholinergic medications as prescribed to treat tremors
and rigidity and to inhibit the action of acetylcholine.
 Administer antiparkinsonian medications to increase the level of
dopamine in the CNS.
 Instruct the client to avoid foods high in vitamin B6 because they block
the effects of antiparkinsonian medications.
 Instruct the client to avoid monoamine oxidase inhibitors because they
will precipitate hypertensive crisis.
6.GLAUCOMA
https://www.google.com/search?q=6.%09GLAUCOMA&tbm=isch&v Retrieved on September 8,2020
 Is a group of eye conditions that damage the optic nerve, the health
of which is vital for good vision.
 This damage is often caused by an abnormally high pressure in your
eye.
 Glaucoma is one of the leading causes of blindness for people over
the age of 60.
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SIGN AND SYMPTOMS
 Blurred vision that happens suddenly

 Severe eye pain, often described as an intense, throbbing pain, along
with reddening of the eye
 Headache around the eyes or the forehead
 Nausea and vomiting accompanied by severe eye pain
 Seeing halos around lights, such as rainbow-colored circles around
lights or unusual sensitivity to lights
7.LUNG DISEASE
https://www.google.com/search?q=lung+disease&tbm=isch&ved Retrieved on September 9, 2020
 Lung diseases are some of the most common medical conditions in the
world. Tens of millions of people have lung disease in the U.S. alone.
Smoking, infections, and genes cause most lung diseases.
 Your lungs are part of a complex system, expanding and relaxing
thousands of times each day to bring in oxygen and send out carbon
dioxide. Lung disease can happen when there are problems in any part
of this system.
Your windpipe (trachea) branches into tubes called bronchi, which in

turn become smaller tubes throughout your lungs. Diseases that can
affect these airways include:
1. Asthma. Your airways are constantly inflamed and may spasm,
causing wheezing and shortness of breath. Allergies, infections, or
pollution can trigger asthma symptoms.
2. Chronic obstructive pulmonary disease (COPD). With this lung

condition, you can’t exhale the way you usually would, which causes
trouble breathing.
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3. Chronic bronchitis. This form of COPD brings a long-term wet cough.
4. Emphysema. Lung damage allows air to be trapped in your lungs in
this form of COPD. Trouble blowing air out is its hallmark.
5. Acute bronchitis. This sudden infection of your airways is usually
caused by a virus.
6. Cystic fibrosis. With this condition, you have trouble clearing mucus
out of your bronchi. This leads to repeated lung infections.
Your airways branch into tiny tubes (bronchioles) that end in clusters of
air sacs called alveoli. These air sacs make up most of your lung tissue.
Lung diseases affecting your alveoli include:
7. Pneumonia. An infection of your alveoli, usually by bacteria or
viruses, including the coronavirus that causes COVID-19.
Tuberculosis Pneumonia that slowly gets worse, caused by the bacteria
Mycobacterium tuberculosis.
8. Emphysema. This happens when the fragile links between alveoli are
damaged. Smoking is the usual cause. (Emphysema also limits airflow,
affecting your airways.)
Pulmonary edema. Fluid leaks out of the small blood vessels of your
lung into the air sacs and the area around them. One form is caused by
heart failure and back pressure in your lungs' blood vessels. In another
form, injury to your lung causes the leak of fluid.
Lung cancer. It has many forms and may start in any part of your lungs.
It most often happens in the main part of your lung, in or near the air
sacs.
Acute respiratory distress syndrome (ARDS). This is a severe, sudden
injury to the lungs from a serious illness. COVID-19 is one example.
Many people who have ARDS need help breathing from a machine
called a ventilator until their lungs recover.
Pneumoconiosis. This is a category of conditions caused by inhaling
something that injures your lungs. Examples include black lung disease
from coal dust and asbestosis from asbestos dust.
Patient and family teaching is an important nursing intervention to

enhance self-management in patients with any chronic pulmonary
disorder.
To achieve airway clearance: The nurse must appropriately administer

bronchodilators and corticosteroids and become alert for potential side
effects.
1. Direct or controlled coughing. The nurse instructs the patient in direct
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or controlled coughing, which is more effective and reduces fatigue
associated with undirected forceful coughing.
2. Inspiratory muscle training. This may help improve the breathing

pattern.
3. Diaphragmatic breathing. Diaphragmatic breathing reduces
respiratory rate, increases alveolar ventilation, and sometimes helps
expel as much air as possible during expiration.
3. Pursed lip breathing. Pursed lip breathing helps slow expiration,
prevents collapse of small airways, and control the rate and depth of
respiration.
To improve activity intolerance:
4. Manage daily activities. Daily activities must be paced throughout the
day and support devices can be also used to decrease energy
expenditure.
5. Exercise training. Exercise training can help strengthen muscles of the
upper and lower extremities and improve exercise tolerance and
endurance.
6. Walking aids. Use of walking aids may be recommended to improve
activity levels and ambulation.
TO MONITOR AND MANAGE POTENTIAL COMPLICATIONS:
1. Monitor cognitive changes. The nurse should monitor for cognitive
changes such as personality and behaviour changes and memory
impairment.
2. Monitor pulse oximetry values. Pulse oximetry values are used to
assess the patient’s need for oxygen and administer supplemental
oxygen as prescribed.
3. Prevent infection. The nurse should encourage the patient to be
immunized against influenza and S. pneumonia because the patient
is prone to respiratory infection
8.CATARACT
https://www.google.com/search?q=cataract+disease&tbm=isch&ved Retrieved on September 9, 2020
 A cataract is a dense, cloudy area that forms in the lens of the eye. A
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cataract begins when proteins in the eye form clumps that prevent
the lens from sending clear images to the retina. The retina works by
converting the light that comes through the lens into signals.
SIGNS AND SYMPTOMS OF CATARACTS INCLUDE:
 Clouded, blurred or dim vision.

 Increasing difficulty with vision at night
 Sensitivity to light and glare
 Need for brighter light for reading and other activities
 Seeing "halos" around lights
 Frequent changes in eyeglass or contact lens prescription
 Fading or yellowing of colors
PREVENTION OF CATARACTS
 To reduce your risk of developing cataracts:

 protect your eyes from UVB rays by wearing sunglasses outside
 have regular eye exams
 stop smoking
 eat fruits and vegetables that contain antioxidants
 maintain a healthy weight
 keep diabetes and other medical conditions in check
9.OSTEOPOROSIS
https://www.google.com/search?q=osteoporosis&tbm=isch&ve Retrieved on September 9, 2020
 Is a bone disease that occurs when the body loses too much bone,
makes too little bone, or both. As a result, bones become weak and
may break from a fall or, in serious cases, from sneezing or minor
bumps. Osteoporosis means “porous bone.” Viewed under a
microscope, healthy bone looks like a honeycomb.
Signs and Symptoms

22
 Back pain, caused by a fractured or collapsed vertebra.
 Loss of height over time.
 A stooped posture.
 A bone that breaks much more easily than expected.
NURSING INTERVENTIONS APPROPRIATE FOR A PATIENT WITH
OSTEOPOROSIS ARE:
 Promoting understanding of osteoporosis and the treatment

regimen. Patient teaching focuses on factors influencing the
development of osteoporosis, interventions to arrest or slow the
process, and measures to relieve symptoms.
 Relieving pain. Advise the patient to rest in bed in a supine or side-
lying position several times a day; the mattress should be firm and
non-sagging; knee flexion increases comfort; intermittent
local heat and back rubs promote muscle relaxation, and
the nurse should encourage good posture and teach body
mechanics.
 Improving bowel movement. Early institution of high fiber
diet, increased fluids, and the use of prescribed stool softeners help
prevent or minimize constipation.
 Preventing injury. The nurse encourages walking, good body
mechanics, and good posture plus daily weight-bearing activity
outdoors to enhance production of vitamin D.
10.ENLARGED PROSTATE
 An enlarged prostate means the gland has grown bigger. Prostate
enlargement happens to almost all men as they get older.
An enlarged prostate is often called benign prostatic hyperplasia
(BPH). It is not cancer, and it does not raise your risk
for prostate cancer.
https://www.google.com/search?q=enlarged+prostate&tbm=isch&ved Retrieved on September 9, 2020
SYMPTOMS MAY INCLUDE:
23
 Dribbling at the end of urinating.
 Inability to urinate (urinary retention)
 Incomplete emptying of your bladder.
 Incontinence.
 Needing to urinate 2 or more times per night.
 Pain with urination or bloody urine (these may indicate infection)
 Slowed or delayed start of the urinary stream
 Provide and encourage meticulous catheter and perineal care.

 Reduces risk of ascending infection.
 Recommend sitz bath as indicated
 Promotes muscle relaxation, decreases edema, and may enhance
voiding effort.
11.ALZHEIMER’S DISEASE
https://www.google.com/search?q=alzheimer%27s+disease&tb Retrieved on September 9, 202
 Alzheimer's disease is a progressive disorder that causes brain cells

to waste away (degenerate) and dies.
 Alzheimer's disease is the most common cause of dementia — a
continuous decline in thinking, behavioral and social skills that
disrupts a person's ability to function independently
24
 Assess patient’s ability for thought processing every shift. Observe
patient for cognitive functioning, memory changes, disorientation,
difficulty with communication, or changes in thinking patterns.
 Assess the level of cognitive disorders such as change to orientation
to people, places and times, range, attention, thinking skills.
 Assess level of confusion and disorientation.
 Assess patient’s ability to cope with events, interests in surroundings
and activity, motivation, and changes in memory pattern.
 Orient patient to environment as needed, if patient’s short term
memory is intact. Using of calendars, radio, newspapers, television
and so forth, are also appropriate.
 Assess patient for sensory deprivation, concurrent use of CNS drugs,
poor nutrition, dehydration, infection, or other concomitant disease
processes.
 Maintain a regular daily schedule routine to prevent problems that
may result from thirst, hunger, lack of sleep, or inadequate exercise.
 Allow patient the freedom to sit in a chair near the window, utilize
books and magazines as desired.
 Label drawers, use written reminders notes, pictures, or color-coding
articles to assist patients.
 Allow hoarding and wandering in a controlled environment, as
appropriate or within acceptable limitations.
 Provide positive reinforcement and feedback for positive behaviors.
12.DEPRESSION
https://www.google.com/search?q=depression&tbm=isch&ved=2 Retrieved on September 9, 2020
 Is a mood disorder that causes a persistent feeling of sadness and

loss of interest.
25
 Also called major depressive disorder or clinical depression, it affects
how you feel, think and behave and can lead to a variety of
emotional and physical problems.
THE MOST COMMON CAUSE OF DEPRESSION IN OLDER ADULTS
 These include a fear of death or dying as well as anxiety over

financial problems or health issues.
 Recent bereavements. The death of friends, family members, and
pets, or the loss of a spouse or partner is common causes of
depression in older adults.
SIGNS AND SYMPTOMS OF DEPRESSION IN OLDER ADULTS
 Sadness or feelings of despair

 Unexplained or aggravated aches and pains
 Loss of interest in socializing or hobbies
 Weight loss or loss of appetite
 Feelings of hopelessness or helplessness
 Lack of motivation and energy
 Sleep disturbances (difficulty falling asleep or staying asleep,
oversleeping, or daytime sleepiness)
 Loss of self-worth (worries about being a burden, feelings of
worthlessness or self-loathing)
 Slowed movement or speech
 Increased use of alcohol or other drugs
 Fixation on death; thoughts of suicide
 Memory problems
 Neglecting personal care (skipping meals, forgetting meds, neglecting
personal hygiene)
 Assist with self-care and personal hygiene.

 Encourage patient to eat.
 Give warm milk or back rubs at bedtime to improve sleep.
 Plan activities for times when the patient's energy level peaks.
Focus Question
26
Instruction: Answer the following questions in complete sentence with
rubrics provided thru Google Classroom.
1. What is depression and its effects the patient and family?
2. How lung disease fatal among elderly?
3. What is the use of pulse oximeter in monitoring lung problem?
4. How chronic illness does affect the activity of daily living among
elderly?
5. How to combat depression in adult?
Related Readings
For supplemental readings on the Care of Adults please refer to the sources
provided
Maree, Bernoth (2016). Healthy Ageing and Aged Care.
Robnette, H.R., Brossoie. N., & Walter,C. ( 2020) Gerontology for the Health
Care Professional ( 4th ed )
Jennifer Kim and Sally Miller (2017). Geriatric Syndrome. Journal American
Geriatric Society
Directions: Answer the following essay questions with rubrics thru Google
Classroom.
References
https://www.google.com/search?ei=vydXX5j9FY290PEP8oabkAQ&
ei=li5XX8qvH4PAoATegpiYCw&q=adult+diabetes+nursing
https://www.google.com/search?ei=ki9XXOLISu0PEPmyV-
27
Ag&q=arthritis&oq
ei=3i9XXWLAqK70PEPzvmFqAk&q=arthritis+nursing+intervention
https://www.webmd.com/a-to-z-guides/kidney-infections-symptoms-and-
treatments#1
ei=ezFXX7LYEcPGmAWCzqqgDA&q=dementia&oq=dementia
https://www.google.com/search?ei=_TFXX7-
hM6OwmAXI4YPQBQ&q=dementia+nursing+interventions&o
https://www.parkinson.org/understanding-parkinsons/what-is-parkinsons
https://www.parkinson.org/understanding-parkinsons/what-is-parkinsons
https://www.google.com/search?ei=mjtXX9TXMtG-0PEPpYymmA0&q=
https://www.webmd.com/lung/lung-diseases-overview
https://www.healthline.com/health/cataract#:~:text=A%20cataract%20is
%20a%20dense
https://www.nof.org/patients/what-is-osteoporosis/#:
https://medlineplus.gov/ency/article/000381.htm#:~:text=An%20enlarged
https://www.mayoclinic.org/diseases-conditions/alzheimers-
disease/symptoms-causes/syc-20350447
https://www.mayoclinic.org/diseases-conditions/depression/symptoms-
causes/syc-20356007
https://www.helpguide.org/articles/depression/depression-in-older-
adults.htm
28
https://www.google.com/search?q=
image+on+gastrointestinal+older+adults Retrieved on August 8,2020
1. Reduced GI secretions, reduced GI motility, decreased weight of

liver,reduced regenerative capacity of liver,liver metabolizes less
efficiently.
2. In old age, the rate of gastric secretion decreases and incidence of
peptic ulcer and gastritis increases. These gastric problems in adult
may be a result of Helicobacter pylori, drug ingestion or genetically
programmed changes that may occur in old age.
F. Excretory System
29
https://www.google.com/search?q=image+on+genitourinary+older+adult Retrieved on August 8,2020
3. The kidneys of older adults have more difficult time responding to

any added metabolic stressor on the body when nephron becomes
less efficient and fewer in numbers. Like other the other organs,
older kidneys work well under normal conditions but have reduced
tolerance for disease, whether originating from the kidneys
themselves or from other organs. This is why older adults are more
likely to experience acute or chronic renal failure than younger
individual.
G. Musculoskeletal System
https://www.google.com/search?q=image+on+musculoskeletal+older+adult Retrieved on August 8,2020
4. Musculoskeletal dysfunction is a major cause of disability in older

adults altering mobility, fine motor control, and the mechanics of
respiration. It occurs as a result of a decline in muscle mass
( sarcopenia ), which causes overall strength to deteriorate. Other
changes that take place within musculoskeletal system include
decreased reflexes, loss of cartilage and thinning of the vertebrae,
decrease calcium absorption, joint cartilage deterioration and
deterioration of extrapyramidal system.
5. As people age, their joints are affected by changes in cartilage and in

30
connective tissue. The cartilage inside a joint becomes thinner, and
components of the cartilage (the proteoglycans—substances that
help provide the cartilage's resilience) become altered, which may
make the joint less resilient and more susceptible to damage. Thus,
in some people, the surfaces of the joint do not slide as well over
each other as they used to. This process may lead to osteoarthritis.
Additionally, joints become stiffer because the connective tissue
within ligaments and tendons becomes more rigid and brittle. This
change also limits the range of motion of joints.
H. Nervous System
https://www.google.com/search?q=image+on+nervous+system+older+adults Retrieved on August 8,2020
6. The nervous system in older adult loses nerve cell mass and shows
some brain atrophy. Nerve cells and dendrites decline in number,
which allows transformation, shortens reaction times and weakens
reflexes. Brain weight is said to decrease with age, but this does not
seem to interfere with individual thought process.
7. As one ages there is a loss of up to 10,000 nerve cells a day. While

there is a loss of all cell types in the body as part of the aging
process, nerve cells do not reproduce so the lost cells are not
replaced. The loss of nerve cells results in a decreases in the function
of the nervous system. The exact function lost is depended on the
individual and the exact cells lost. As there are many more nerve
cells than are necessary for the proper functioning of the nervous
system, it is unlikely that routine loss of nerve cells causes any
apparent problems until advanced old age.
I.ENDOCRINE SYSTEM
31
https://www.google.com/search?q=image+on+endocrine+system+in+older+adults Retrieved on August 8,2020
8. As the body ages, changes occur that affect the endocrine system,
sometimes altering the production, secretion, and catabolism of
hormones. For example, the structure of the anterior pituitary gland
changes as vascularization decreases and the connective tissue
content increases with increasing age.
9. This restructuring affects the gland’s hormone production. For
example, the amount of human growth hormone that is produced
declines with age, resulting in the reduced muscle mass commonly
observed in the elderly.
10.The adrenal glands also undergo changes as the body ages; as fibrous
tissue increases, the production of cortisol and aldosterone
decreases.
11.Interestingly, the production and secretion of epinephrine and
norepinephrine remain normal throughout the aging process.
J.IMMUNE SYSTEM
https://www.google.com/search?q=image+on+immune+system+in+older+adult Retrieved on August 8,2020
12.The age related decline of immune system functioning gives arises to

three general categories of illness that preferentially afflict older
adults:
13.Infection
14.Cancer
15.Autoimmune disease
32
16.The overall incidence of infectious disease rises in late adulthood.
Infection diseases, particularly prevalent among older adults are
17.Influenza
18.Pneumonia
19.Tuberculosis
20.Meningitis
21.Urinary tract infection.
22.Cancer increases in prevalence with age such as:

23.Leukemia
24.Lung
25.Prostate
26.Breast
27.Stomach
28.Pancreatic cancer
29.With aging, the outer skin layer (epidermis) thins, even though the
number of cell layers remains unchanged.
30.The number of pigment-containing cells (melanocytes) decreases.
The remaining melanocytes increase in size.
31.Aging skin looks thinner, paler, and clear (translucent).
32. Large pigmented spots, including age spots, liver spots, or lentigos,
may appear in sun-exposed areas.
33.Changes in the connective tissue reduce the skin's strength and
elasticity known as elastosis and more noticeable in sun-exposed
areas (solar elastosis).
34.Elastosis produces the leathery, weather-beaten appearance

common to farmers, sailors, and others who spend a large amount of
time outdoors.
35.The blood vessels of the dermis become more fragile that leads to:
36.Bruising
37.Bleeding under the skin (often called senile purpura)
38. Cherry angiomas
39.Sebaceous glands produce less oil as you age.
40.Men experience a minimal decrease, most often after the age of 80.
41. Women gradually produce less oil beginning after menopause.
42.This can make it harder to keep the skin moist, resulting in dryness
and itchiness.
43.The subcutaneous fat layer thins so it has less insulation and
padding.
44. This increases your risk of skin injury and reduces your ability to
maintain body temperature because you have less natural insulation,
you can get hypothermia in cold weather.
45.The sweat glands produce less sweat that makes it harder to keep
cool.
46. Your risk for overheating or developing heat stroke increases.
33
47.Growths such as:
48. skin tags
49. warts
50.rough patches (keratoses)
EFFECT OF CHANGES
51.As you age, you are at increased risk for skin injury.
52. Your skin is:
53.thinner
54.more fragile
55. lose protective fat layer
56.You also may be less able to sense:
57.touch
58.pressure
59.vibration
60.heat
61.and cold
62.Rubbing or pulling on the skin can cause skin tears.
63. Fragile blood vessels can break easily.
64. Bruises, flat collections of blood (purpura), and raised collections of
blood (hematomas) may form after even a minor injury.
65.Pressure ulcers can be caused by:
66.skin changes
67.loss of the fat layer
68.reduced activity
69.poor nutrition
70.and illnesses
71.Sores are most easily seen on the outside surface of the forearms,
but they can occur anywhere on the body.
72.Aging skin repairs itself more slowly than younger skin. Wound
healing may be up to 4 times slower.
73. This contributes to pressure ulcers and infections.
Factors Affects Healing:
74.diabetes
75.blood vessel changes
76.lowered immunity
COMMON PROBLEMS
Skin disorders are so common among older people that it is often hard to
tell normal changes from those related to a disorder. More than 90% of all
older people have some type of skin disorder.
77.Skin disorders can be caused by many conditions including:

Blood vessel diseases, such as
78. arteriosclerosis
34
79.diabetes
80. heart disease
81. liver disease
82.nutritional deficiencies
83.obesity
84.reactions to medicines
85.stress
86.Other causes of skin changes:
87.allergies to plants and other substances
88.climate
89.clothing
90.exposures to industrial and household chemicals
91.indoor heating
92.Sunlight can cause:
93.Loss of elasticity (elastosis)
94.Noncancerous skin growths (keratoacanthomas)
95.Pigment changes such as liver spots
96.Thickening of the skin
97.Sun exposure has also been directly linked to skin cancers including:
98.basal cell cancer
99.squamous cell carcinoma
100. melanoma
A .Major Components
1.FUNCTIONAL CAPACITY OF AN ADULT

101. Refers to the ability to perform activities necessary or
desirable in daily life.
102. Functional status is directly influenced by health conditions,
particularly in the context of an elder's environment and social
support network.
103. Changes in functional status (eg, not being able to bathe
independently) should prompt further diagnostic evaluation and
intervention.
104. Measurement of functional status can be valuable in
monitoring response to treatment and can provide prognostic
information that assists in long-term care planning.
2. FALL RISK
105. The injury rate for older adults falls in the midrange for all age
group, with 196 per 196 per 1000 persons injured among those aged
65 years old and older (Department of Commerce, 2010 ).
106. Older women have a higher rate of injuries than any adult
female age group whereas the rate among men declines through the
35
years.
107. Accidents rank as the six-leading cause of death for older
adults, with falls leading cause of injury related deaths.
108. Approximately one-third of community-dwelling persons age
65 years and one-half of those over 80 years of age fall each year.
109. Patients who have fallen or have a gait or balance problem are
at higher risk of having a subsequent fall and losing independence.
110. An assessment of fall risk should be integrated into the history
and physical examination of all geriatric patients (algorithm 1). (See
"Falls in older persons: Risk factors and patient evaluation", section
on 'Falls risk assessment' and "Causes and evaluation of neurologic
gait disorders in older adults".)
3.COGNITION
111. It decreases with age due to cumulative nature of lifestyle
choices (e.g., in the realm of nutrition, self- neglect, or substance use
or abuse).
112. The incidence of dementia increases with age, particularly
among those over 85 years, yet many patients with cognitive
impairment remain undiagnosed. The value of making an early
diagnosis includes the possibility of uncovering treatable conditions.
The evaluation of cognitive function can include a thorough history
and brief cognition screens.
113. If these raise suspicion for cognitive impairment, additional
evaluation is indicated, which may include detailed mental status
examination, neuropsychologic testing, tests to evaluate medical
conditions that may contribute to cognitive impairment (eg, B12,
thyroid-stimulating hormone [TSH]), depression assessment, and/or
radiographic imaging (computed tomography [CT] or magnetic
resonance imaging [MRI]).
4.MOOD
114. Psychological changes can be influenced by general health
status, genetic factors, educational achievements, activity and
physical and social changes.
115. Depressive illness in the elder population is a serious health
concern leading to unnecessary suffering, impaired functional status,
increased mortality, and excessive use of health care resources.
(See "Diagnosis and management of late-life unipolar depression".)
5.POLYPHARMACY
116. Older persons are often prescribed multiple medications by
different health care providers, putting them at increased risk for
drug-drug interactions and adverse drug events. The clinician should
review the patient's medications at each visit.
117. The best method of detecting potential problems with
36
polypharmacy is to have patients bring in all of his/her medications
(prescription and nonprescription) in their bottles.
118. Discrepancies between what is documented in the medical
record and what the patient is actually taking must be reconciled.
119. As health systems have moved towards electronic health
records and e-prescribing, the potential to detect potential
medication errors and interactions has increased substantially.
120. Although this can improve safety, record-generated messages
about unimportant or rare interactions may lead to "reminder
fatigue."
121. The high prevalence of health condition in the older
population causes this group to use a large member and variety of
medication. Drug use by older adults has been steadily increasing
every year, most older people use at least one drug regularly.
122. Researchers have found that the number of drugs used by
older persons increase with age.
The most used drugs by the older population include:
123. cardiovascular agents

124. antihypertensive
125. analgesics
126. antiarrhritic agents
127. sedatives
128. tranquilizers
129. laxatives
130. antacid
6.SOCIAL SUPPORT
https://www.google.com/search?q=image+on+social+support+in+older+adult Retrieved on August 8,2020
131. Social support is characterized by the functional and

qualitative dimension of the network of social relations and may
be offered by means of help, care or instrumental, economic
social, physical and emotional accompaniment, exercised
reciprocally or unilaterally.
132. Having a positive social lifestyle can increase
an elderly person's psychological and physical well-being, lowering
their amount of stress, and helping treat issues such as anxiety or
37
depression.
133. The existence of a strong social support network in an elder's
life can frequently be the determining factor of whether the patient
can remain at home or needs placement in an institution.
134. A brief screen of social support includes taking a social history
and determining who would be available to the elder to help if he or
she becomes ill.
135. Early identification of problems with social support can help
planning and timely development of resource referrals.
136. For patients with functional impairment, the clinician should
ascertain who the person has available to help with activities of daily
living.
7.FINANCIAL CONCERN
https://www.google.com/search?q=image+on+financial+concer+in+older+adult Retrieved on August 8,2020
137. Older adults’ financial situations are a function of their income,

wealth, costs, and debts, with housing costs a major piece of the
household budget.
138. The financial situation of a functionally impaired older adult is
important to assess. Elders may qualify for state or local benefits,
depending upon their income.
139. Older patients occasionally have other benefits such as long-
term care insurance or veteran's benefits that can help in paying for
caregivers or prevent the need for institutionalization.
8.GOALS OF CARE
140. Older adult patients who are appropriate for CGA have limited
potential to return to fully healthy and independent lives. Hence,
choices must be made about what outcomes are most important for
them and their families.
141. Goals of care often differ from advance care preferences that
focus on future states of health that would be acceptable,
determination of surrogates to make decisions, and medical
treatments.
142. Generally, advance directives are framed in the context of
future deterioration of health status.
38
143. By contrast, a patient’s goals of care are often positive (eg,
regaining a previous health status, attending a future family event).
Frequently, social (eg, living at home, maintaining social activities)
and functional (eg, completing ADLs without help) goals assume
priority over health-related goals (eg, survival).
144. They are also patient-centric and individualized. For example,
regaining independent ambulation after a hip fracture may be a goal
for one patient whereas another might be content with use of a
walker.
145. Both short-term and longer-range goals should be considered
and progress towards meeting these goals should be monitored,
including reassessment if goals are not met within a specified time
period. One approach that has been used in CGA is Goal Attainment
Scaling .
9.ADVANCE CARE PREFERENCES

146. Clinicians should begin discussions with all patients about
preferences for specific treatments while the patient still has the
cognitive capacity to make these decisions.
147. These discussions should include preparation for in-the-
moment decision-making which includes :
148. choosing an appropriate decision-maker
149. clarifying and articulating patients’ values over time
150. thinking about factors other than the patient's stated
preferences in surrogate decision-making.
151. As an example, patients who want to extend their life as long

as possible might be asked about what should be done if the
patient’s health status changes and doctors recommend against
further treatment, or if it becomes too hard for loved ones to keep
them at home.
152. Advance directives help guide therapy if a patient is unable to
speak for him or herself and are vital to caring optimally for the
geriatric population:
153. Advance care planning is one key element to achieving patient
autonomy by allowing patients to participate in decisions about their
medical care.
154. Advance care planning is based on the premise that on-going
discussions about end-of-life issues accompanied by written advance
directives are valuable to help loved ones, physicians, and other
providers better understand and make treatment decisions
consistent with patients' wishes, if the patient becomes
incapacitated.
ADDITIONAL COMPONENTS
39
1.NUTRITION/ WEIGHT
https://www.google.com/search?q=nutritional+stutus++in+older+adult Retrieved on August 8,2020
155. Older persons are particularly vulnerable to malnutrition.

Moreover, attempts to provide them with adequate nutrition
encounter many practical problems.
156. First, their nutritional requirements are not well defined.
157. Since both lean body mass and basal metabolic rate decline
with age, an older person’s energy requirement per kilogram of body
weight is also reduced.
2.URINARY CONTINENCE
158. Urinary frequency, urgency, and nocturia accompany bladder

changes with age. Bladder muscles weaken and bladder capacity
decreases.
159. Emptying of the bladder more difficult; retention of large

volumes of urine may result.
3.SEXUAL FUNCTION
160. Many people want and need to be close to others as they grow
older.
161. It includes the desire to continue an active, satisfying sex life.
162. With aging, that may mean adapting sexual activity to
accommodate physical, health, and other changes.
4.VISION/ HEARING
40
https://www.google.com/search?q=image+on+hearing+impairment+in+older Retrieved on August 8,2020
163. Change in vision is due to alteration to structural components

of the visual system.
164. The sharpness of your vision (visual acuity) gradually declines.
165. The most common problem is difficulty focusing the eyes on
close-up objects. This condition is called presbyopia. Reading glasses,
bifocal glasses, or contact lenses can help correct presbyopia.
166. Common eye disorders that cause vision changes that are NOT
normal includes:
167. Cataracts- clouding of the lens of the eye

168. Glaucoma-rise in fluid pressure in the eye
169. Macular degeneration- disease in the macula (responsible for
central vision) that causes vision loss
170. Retinopathy -- disease in the retina often caused by diabetes
or high blood pressure
171. Hearing occurs after sound vibrations cross the eardrum to

the inner ear.
172. The vibrations are changed into nerve signals in the inner ear
and are carried to the brain by the auditory nerve.
173. Structures inside the ear start to change and their functions
decline. Your ability to pick up sounds decreases.
174. You may also have problems maintaining your balance as you
sit, stand, and walk.
5.Dentition
41
https://www.google.com/search?q=dentition+in+older+adult . Retrieved on August 8,2020
175. Only in the last decade has the possible effect of oral health on
the general health and mortality of elderly people attracted much
attention.
176. An association between number of teeth and mortality has
been reported in several studies. As people age, many lose teeth.
177. Tooth loss reduces masticatory capacity, which can influence
food selection, nutritional status, and general health.
178. Evidence is also increasing that oral infections play a role in the
pathogenesis of some systemic diseases.
6.Living condition
179. The World Health Organization defined quality of life as an

“individual perception of his or her living situation, understood in a
cultural context, value system and in relation to the objectives,
expectations and standards of a given society”.
180. From this perspective, health-related quality of life includes
areas such as physical health, psychological state, level of
independence of the person, personal relationships, beliefs in a
particular context or the natural environment, social support, and
perceived social support.
7.Spirituality
181. Is the essence of our being that transcends and connect us to
the Divine and other living organisms. It involves relationships and
feelings (Eliopoulos, 2014).
182. Spiritual Needs
183. Love
184. Meaning and purpose
185. Hope
186. Dignity
187. Forgiveness
188. Gratitude
42
B. Best Indication for CGA
1. Age
189. Older people admitted for acute inpatient hospital care are at
high risk of adverse events, long stays, readmission and long term
care use.
190. There is considerable evidence on assessment and co-
ordination of care for older patients with complex needs using
Comprehensive Geriatric Assessment.
2.Medical Comorbidity
191. Older adults generally have multiple medical problems as well

as subclinical changes in several physiologic systems.
3.Psychological Disorders
192. Mental health indicates a capacity to cope effectively with and

manage life’s stresses in an effort to achieve a state of emotional
homeostasis.
Selected Mental Health Conditions:
193. Depression
194. Anxiety
195. Alcohol abuse
196. Hypochondriasis
197.
Specific geriatric condition:
198. Dementia
199. Fall
Focus Question
Instruction: Answer the following questions in complete sentence with

200. Explain the importance of conducting comprehensive

assessment among older adult.
201. Discuss the effect of medication use among older client.
202. Describe the physiological and psychological changes among

older person.
43
Related Readings
For supplemental readings on Comprehensive Assessment please refer to

the sources provided.
Directions: Answer the following essay questions with rubrics provided via
messenger.
203. Discuss Comprehensive Geriatric Assessment
204. Describe the different physical, psychological and spiritual

changes among elderly clients.
References
Books
Eliopolous. C.,( 2014 ) Gerontogical Nursing ( 8th ed. )
Geriatric Society
Electronic.
1.https://courses.lumenlearning.com/atd-herkimer-
biologyofaging/chapter/development-and-aging-of-the-endocrine-system/.
2. https://www.hindawi.com/journals/jar/2011/156061/
5.https://academic.oup.com/ageing/article/47/1/149/4682984
6.https://academic.oup.com/biomedgerontology/article
UNIT 2 – WEEK (2 )- CONDUCTING ASSESSMENT
44
Intended Learning Outcomes ( Week 2- ILO )

205. Explain the purpose of conducting the assessment.
206. Discuss the method of conducting the assessment.
Introduction
The ability to assess patients in a holistic manner is a skill integral to

nursing regardless of the practice setting. Eliciting a complete health
history, using appropriate physical assessment skills, while respecting,
spiritual and cultural consideration Cheever,et al,2020).

knowledge that will be laid down in the succeeding pages. Please note that
you are not limited to exclusively refer to these resources. Thus, you are
expected to utilize other books, research articles and other resources that
are available in the library e.g. ebrary, search.proquest.com etc.
Key Terms
Syndrome- a group of symptoms which consistently occur together, or a

condition characterized by a set of associated symptoms.
Delirium- is an abrupt change in the brain that causes mental confusion and
emotional disruption.
Dietician- is a medically trained professional that alters an individual's diet

based on medical conditions ...
Multifactorial-caused or marked by a polygenic mode of inheritance

dependent on a number of genes at different loci.
Podiatrists- a person who treats the feet and their ailments.
Lecture Notes
45
UNIT 2-CONDUCTING THE ASSESSMENT
https://www.google.com/search?q=image+on+conducting+assessment+on+elder Retrieved on August 10,2020
207. Geriatric conditions such as functional impairment and

dementia are common and frequently unrecognized or inadequately
addressed in older adults.
208. Identifying geriatric conditions by performing a geriatric
assessment can help clinicians manage these conditions and prevent
or delay their complications.
209. Geriatric syndrome is a term that is often used to refer to
common health conditions in older adults that do not fit into distinct
organ-based disease categories and often have multifactorial causes.
210. The lists includes conditions such as:
211. cognitive impairment
212. delirium
213. incontinence
214. malnutrition
215. falls
216. gait disorders
217. pressure ulcers
218. sleep disorders
219. sensory deficits
220. fatigue
221. dizziness
222. These conditions are common in older adults, and they may
have a major impact on quality of life and disability.
223. Geriatric syndromes can best be identified by a geriatric
assessment.
224. Although the geriatric assessment is a diagnostic process, the
term is often used to include both evaluation and management.
225. Geriatric assessment is sometimes used to refer to evaluation
by the individual clinician (usually a primary care clinician or a
geriatrician) and at other times is used to refer to a more intensive
46
multidisciplinary program, also known as a comprehensive geriatric
assessment (CGA).
226. The range of health care professionals working in the
assessment team varies based on the services provided by individual
comprehensive geriatric assessment (CGA) programs.
227. In many settings, the CGA process relies on a core team

consisting the following:
228. clinician
229. nurse
230. social worker
231. physical and
232. occupational therapists
233. dieticians
234. pharmacists
235. psychiatrists
236. psychologists
237. dentists
238. audiologists
239. podiatrists
240. opticians
241. These professionals are usually on-staff in the hospital setting
and are also available in the community, access to and
reimbursement for these services have limited the availability of CGA
programs.
242. Traditionally, the various components of the evaluation are
completed by different members of the team, with considerable
variability in the assessments.
243. The medical assessment of older persons may be conducted by
a physician (usually a geriatrician), nurse practitioner, or physician
assistant.
244. The core team (geriatrician, nurse, social worker) may conduct
only brief initial assessments or screens for some dimensions.
Focus Questions
Instructions: Answer the following questions in complete sentence with

245. What is the impact of health care professionals to geriatric

clients in conducting accurate assessment?
246. How does a geriatric condition affect their lives?
Related Readings
47
For supplemental readings on the conducting assessment, please see these
link
q=journal+of+comprehensive+assessment+on+elderly
https://www.youtube.com/watch?v=9ZoJZwE4If8
Learning/ Assessment Activities
Direction: Send your answer thru messenger to be submitted next week.

Rubrics will be given via messenger for the basis of your grade.
247. Explain the purpose of conducting the assessment.
248. Discuss the method of conducting the assessment.
Reference:
Geriatric Society
Unit 3- Week ( 3 )- INFORMATION TO BE COLLECTED
Intended Learning Outcome (Week 3-ILO )
249. Discuss the significance of data collection.
250. Contrast Urinary and Fecal Incontinence.
Introduction
Collecting healthcare data generated across a variety of sources

encourages efficient communication between doctors and patients, and
increases the overall quality of patient care providing deeper insights into
specific conditions.
48


knowledge that will be laid down in the succeeding pages.
Key Terms
Therapeutic Interventions- is an effort made by individuals or groups to

improve the well-being of someone else who either is in need of help but
refusing it or is otherwise unable to initiate or accept help.
Dementia- is a general term for loss of memory, language, problem-solving

and other thinking abilities that are severe enough to interfere with daily
life.
Comorbidities- the simultaneous presence of two chronic diseases or

conditions in a patient.
Epidemiological studies measure the risk of illness or death in an exposed

population compared to that risk in an identical, unexposed population.
Degenerative Disease- is the result of a continuous process based

on degenerative cell changes, affecting tissues or organs, which will
increasingly deteriorate over time.
Lecture Notes
UNIT 3- INFORMATION TO BE COLLECTED
1.Ability to perform functional task and need for assistance
251. The assessment of functional abilities in older adults refers to a

comprehensive assessment to determine the level of
independence that older adults have when performing activities of
daily living.
252. This assessment enables the planning of therapeutic
interventions, social care and clinical support, and also supports
clinical reasoning in detecting early signs of dementia.
49
2.Fall History
253. Falls are defined as an unintentional lowering to rest from a
higher to a lower position, not due to loss of consciousness or violent
impact (Kellogg International Work Group on the Prevention of Falls
by the Elderly, 1987).
254. Falls often go unrecognized by health care professionals
because they are not routinely evaluated while taking a patient’s
history or during a physical exam (unless there is frank injury).
255. Many patients do not admit to falling for fear of losing their
independence.
256. Many factors that contribute to fall risk in older adults. The
World Health Organization Europe (2004) has characterized risks into
two broad categories, intrinsic and extrinsic risk factors for falls.
257. Intrinsic risk factors include a history of falls, age, gender,
medical conditions, impaired mobility and gait, sedentary behavior,
psychological status, nutritional deficiencies, impaired cognition,
visual impairments and foot problems.
258. Many older adults have multiple comorbidities including
neurological, cardiovascular, metabolic, urinary, musculoskeletal,
and psychological disorders that may increase their risk of falls.
3.Urinary and Fecal Incontinence

259. Urinary incontinence the ability of the kidneys to regulate the
concentration of the bodily substances according to need diminishes
with age.
260. Pain in older adults is common and has a tremendous impact
on quality of life in this age group.
261. There is great variability in the reported prevalence, likely due

to differences in the reporting period for pain, the intensity of pain
reported, and composition of the older population studies.
262. Crook et al 5 reported age-specific rates 29% for those aged
between 71 and 80 years when asked “how often are you troubled
by pain during the past 2 weeks…” Brattburg et al6 reported a 12-
month prevalence of mild to severe pain in 75% in those over 75
years of age.
263. Epidemiologic studies commonly show that pain affecting
joints, feet, and legs is increased with age; that pain in the head,
abdomen, and chest is reduced; but back pain frequency varies
widely.7, 8, and 9.
264. The high prevalence of degenerative joint disease overwhelms
any contribution from other causes in all surveys.
Focused Questions
50
Instructions: Explain each question, before you start answering, read the
related readings for your reference. Please organize your essay with rubrics
provided via messenger.
265. How does data collection important?
Related Readings
https://link.springer.com/referenceworkentry
https://www.uth.tmc.edu/hgec/GemsAndPearls/geriatricSyndromes
https://www.sciencedirect.com/topics/medicine-and-dentistry/pain-in-
older-adult
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.6.114

Rubrics will be given via messenger for the basis of your grade
266. Discuss the importance of data collection.
267. Contrast urinary and faecal incontinence.
References
Books
Geriatric Society
Electronic
https://www.uth.tmc.edu/hgec/GemsAndPearls/geriatricSyndromes_Fall
Unit 4- Week( 4) : ELDERLY CLIENTELE DESIRE
Intended Learning Outcome ( ILO-week 4 )
51
1. Discuss the elderly clientele desires.
2. Elaborate the elderly clientele desires.
Introduction
Older persons receiving care and services at home may have difficulty
articulating their preferences, especially those regarding abstract matters
phrased as safety versus freedom. When that query was put to home care
clients, about one-third preferred to come and go as they pleased and be less
safe; about one-third preferred to be safe and protected even with restricted
freedom; and one-third were ambivalent, undecided, or wanted both safety
and autonomy.
This unit will focus on the definitions of interest and any other terms related.
It also deals with the basic concept of simple interest and discount.
To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential knowledge
that will be laid down in the succeeding pages. Please note that you are not
limited to exclusively refer to these resources. Thus, you are expected to
utilize other books, research articles and other resources that are available in
the library e.g. ebrary, search.proquest.com etc.
Key Terms
Distress- is a general term used to describe unpleasant feelings or emotions

that impact your level of functioning.
Treatment- medical care given to a patient for an illness or injury.
Self- determination- the process by which a person controls their own life
Lecture Notes
Unit 4- Unit 4- Elderly Clientele Desire
52
 Be recognized as a person and not regarded as a room number, a
disease,
 Be comforted ,to have distress recognized, perceived that health
workers are making efforts to make him physically and emotionally
comfortable, the aged person can tolerate pain if he or she is not being
neglected.
 Learn what is causing health problems or distress in terminology that
he or she can understand.
 Know what treatment and care is planned, length of treatment and
what can be expected as an end result.
 Have some self- determination what about activities he or she will take
part in so long as he or she does not injure self or others.
Focused Questions
Instructions: Explain the following questions in complete sentence. Rubrics

will be provided via messenger individually.
1. What are the common health problems in elderly clients?
Related Readings
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.6.114

Rubrics will be given via messenger for the basis of your grade.
1. Discuss the elderly clientele desires.
2. Elaborate the elderly clientele desires
References
53
Geriatric Society.
54

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LET’S BEGIN!

UNIT 6-7 WEEK (6-7)- FUNCTIONAL STATUS

Intended Learning Outcomes ( Week 6-7-ILO )

At the end of the unit, you are expected to:

2. Explain the importance of activities of daily living among elderly

Preservation of function and independence is one of the goals of successful

To attend the following intended learning outcomes for the first

Degeneration-a process by which a tissue deteriorates, loses functional

UNIT 1- FUNCTIONAL STATUS

ACTIVITIES OF DAILY LIVING

https://www.google.com/search?q=activities+of+daily+living&sxsr Retrieved on September 6, 2020

https://www.google.com/search?q=Bathing+for+elderly&tbm=isch&ved = Retrieved on September 6, 2020

 Bathing once or twice a week is acceptable for older adults, as the

https://www.google.com/search?q=Dressing+for+elderly+purposes Retrieved on September 6, 2020

 Many older adults prefer to be dressed in daytime clothes each day.

https://www.google.com/search?q=Toileting+for+elderly+purp Retrieved on September 6, 2020

 One of the most common aging in place challenges elderly people

https://www.google.com/search?q=maintaining+continence+for+elderly Retrieved on September 6, 2020

 Continence care relates to helping an individual achieve and

https://www.google.com/search?q=grooming+for+elderly&hl=en&sxsr Retrieved on September 6, 2020

https://www.google.com/search?q=feeding++for+elderly&hl=en&sxs Retrieved on September 6, 2020

 To maintain a healthy diet and balanced nutrition. To prevent

https://www.google.com/search?q=transferring+++for+elderly+purpose Retrieved on September 6, 2020

8.SHOPPING FOR GROCERY

https://www.google.com/search?q=shopping+for+grocer Retrieved on September 6, 2020

9.USING PUBLIC TRANSPORTATION

https://www.google.com/search?q=using+public+transportation++in+ol Retrieved on September 6, 2020

https://www.google.com/search?q=easy+to+use+telephone+for+eld Retrieved on September 6, 2020

 If you’re a senior living at home, chances are you’ve thought about

 While it may be hard to accept, most of us will require some type of

12.DOING HOME REPAIR

https://www.google.com/search?q=Doing+Home+Repair+for+elderly Retrieved on September 6, 2020

13.PREPARING FOR MEALS

https://www.google.com/search?q=doing+laundry+for+eld Retrieved on September 6, 2020

ttps://www.google.com/search?q=Medication+safety+for- Retrieved on September 6, 2020

 Take your medicine regularly and according to your health care

MEDICATION SAFETY TIPS FOR OLDER ADULTS

2. How important activities of daily living among elderly?

UNIT 8-9 WEEK (8-9)- COMMON CHRONIC DISEASES AFFLICTING ELDERLY

At the end of the unit, you are expected to:

UV Rays-radiation that is in the region of the ultraviolet spectrum which

Muscle wasting -is a loss of muscle mass due to the muscles weakening

UNIT 8-9- COMMON CHRONIC DISEASES AFFLICTING ELDERLY

https://www.google.com/search?q=diabetes&biw=1280&bih=578&sxsrf Retrieved on September 8, 2020

 Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a

 Is the swelling and tenderness of one or more of your joints

3.KIDNEY AND BLADDER PROBLEM

https://www.google.com/search?q=3.%09KIDNEY+AND+BLADDER+PROBL Retrieved on September 8, 2020

Kidney infection, also called pyelonephritis, is when bacteria or viruses

 Blood or pus in your pee

 Drink enough fluids, especially water. Most healthy people should

https://www.google.com/search?q=4.%09Dementia&tbm=isch&v Retrieved on September 8, 2020

 Dementia is a collective term used to describe various symptoms of

 Orient client. Frequently orient client to reality and surroundings.

https://www.google.com/search?q=parkinson%27s+disease&sxsrf= Retrieved on September 9, 2020

 Parkinson's disease (PD) is a neurodegenerative disorder that affects

https://www.google.com/search?q=6.%09GLAUCOMA&tbm=isch&v Retrieved on September 8,2020

 Blurred vision that happens suddenly

https://www.google.com/search?q=lung+disease&tbm=isch&ved Retrieved on September 9, 2020

Your windpipe (trachea) branches into tubes called bronchi, which in

2. Chronic obstructive pulmonary disease (COPD). With this lung

Patient and family teaching is an important nursing intervention to

To achieve airway clearance: The nurse must appropriately administer