Understanding Geriatric Population

Consider the followings:  Some myths, misconceptions and

1. Physiologic and biological changes that negative stereotypes about older
normally occur during aging. people stem from our culture’s
2. Understand older adult’s special health values and beliefs.
requirements.  Many people perceived older adults
3. Help them learn to access community as senile, sick and incapable of
services, avoid falls, and deal with age- making worthwhile contributions to
related problems such as reduced visual society
acuity.
2. Fear of Aging
4. Understand the effects of prescription and
 Most people don’t know enough about the
over- the- counter drugs on older patients
realities of aging; they fear death and,
in long- term care.
therefore, fear of growing older.
5. Equally importantly, you need to examine
 GERONTOPHOBIA -refers to this fear &
your personal feelings about elderly people
the refusal to accept older people into the
to make sure that common misconceptions
mainstream of society.
about aging aren’t affecting the quality of
your care you provide.
2 extreme forms of Gerontophobia
6. You must consider end-of-life issues.

AGEISM- the negative stereotyping of

Important factors in understanding geriatric
aging and older persons, I a belief that
population
aging makes people unattractive,
1. Societal attitudes and beliefs unintelligent, and unproductive, it’s an
 As a group, older adults in our emotional prejudice.
society are stereotyped. AGE DISCRIMINATION – it goes
 Aging – is a natural process, but the beyond emotion; it’s the practice of treating
changes associated with it are rarely people differently simply because of their
viewed as natural or positive. age. (eg. Hiring, limited amount of health
 Health care professional commonly care provided.)
described it as a “LOSSES” such as
(loss of tissue elasticity or a decrease  What is aging?
 The word “aging and old age are highly
I blood flow.)
subjective.
 General, our society regards aging
 It is defined as having lived for a long time
as:
and is commonly synonymous with negative
 A series of inevitable,
terms, such as “ancient”, “antiquated”, and
negative events that a
“timeworn”.
person must tolerate
 Its process is complex: it can be described
 Health care professional
Chronologically
often mentioned age- related
Physiologically
changes and disease
And Functionally
conditions in the same
breath.
 CHRONOLOGICAL AGE
-refers to the number of years a person has lived. Strong chemical bonding between organic
- Age 65 became the maximum age of eligibility for molecules in the body causes increase
retirement benefits stiffness, chemical instability, and
-65 is the accepted age for status as a senior citizen insolubility of connective tissues
  deoxyribonucleic acid.
There are 3 chronological categories Sources;
Young- old (age 65 to 74)  Lipids, proteins, carbohydrates, and nucleic
Middle-old (age 75 to 84) acid.
Old-old (ages 85 and older) Retardants;
 Restricting calories and lathyrogens (anti-
PHYSIOLOGIC AGE link agents)
-refers to the determination of age by body
function. 2. Free radical-theory
Increased unstable free radical produced
FUNCTIONAL AGE harmful to biological system, such as
-refers to a person’s ability to contribute to chromosomal changes, payment to
society and benefit others and himself. accumulation.
- Those who require help are called – FRAIL
Sources;
ELDERLY
 Environmental pollutants, oxidation of
(Note: not all individuals of the same
dietary fat, protein, carbohydrates.
chronological age function at the same level.)
Retardants;
-age 75 is the fastest growing segment of the older
 Improving environmental monitoring;
population.
decreasing of free- radical stimulating
-age 75to 84 – about 25% need help with ADL
foods; increase intake of vitamin of A & C
-Age 85 and older – nearly ½ need help with ADL.
 Mecarplans and vitamin E
 
Characteristic common to the frail elderly
3. Immunologic theory
o Poor mental and physical health
o An aging immune system is less able to
o Low socioeconomic status
distinguish body cells from foreign cells; as
o Female gender (predominantly)
a result, it begins to attack and destroy
o Isolated living conditions (possibly)
body cells as if they were foreign.
o More & longer hospital stays with more
o This may explain the adult onset of such
money spent on health care & drugs
conditions as diabetes mellitus, rheumatic
o More frequent visit to the doctors
heart disease, and arthritis. Theorists have
o More use of nursing home beds than
speculated about several erratic cellular
hospital beds. mechanisms capable of precipitating attack
  on various tissues through auto aggression
Theories of aging or immunodeficiency’s.
Sources;
A. BIOLOGICAL THEORIES  Alteration of B and T cells of the humoral ad
1. Cross-link theory cellular system.
Retardants;
  Considering and immuno-engineering-
selective alteration replenishment or
rejuvenation of the immune system.
4. wear and tear theory
Body cells, structures, and functions wear
out or are overused through exposure to
internal and external stressors. Effects from
residual damage accumulate, the body can
longer resist stress and death occurs.
Sources;
 Repeat injury or overuse; internal and
external stressors (Physical, Psychological,
social, and environmental, including
trauma, chemicals, and buildup of naturally
occurring wastes.
Retardants;
 Reevaluating and possibly adjusting
lifestyle.
A. PSYCHOSOCIAL THEORIES
1. Activity theory
Successful aging and life satisfaction depend
on maintaining a high level of activity.
 Sources;
 Quality and meaningfulness over quantity
of activities; life satisfaction related to
involvement in life.
Retardants;
 Increasing activities in other areas when
activities in one area decrease.
2. Continuity theory
An individual remains essentially the same,
despite life changes. This theory focuses
more on personality and individual behavior
over time.
 Sources;
 Assumed stability of individual patterns or
orientation over time.
Retardants;
 Taking into account the impact major
societal changes, this can alter individual
expectations and behavior.
3. Disengagement theory
Progressive social disengagement occurs with
age.
 Sources;
 Decrease participation in society resulting
from age-related changes in health, energy,
income, and social roles.
Retardants;
 Taking into account diversity of individual
outlook and lifestyle and social structure
variables, such as economy and social
organizations.
4. Social exchange theory
 Social behavior involves doing what’s
valued and rewarded by society.
Sources;
 Diminished resources and increase
dependency leading to unequal
contribution to society and reduced power
and value; decreased number of roles
available in society.
Retardants;
 Assuming new roles and friendship with
other older adults to help socialize the
person and help the person adjust to age-
related norms.
Notes:
Aging is a normal part of human developmental.
Various theories have been proposed;
1. To explain the process of normal aging and
help dispel some of the myths.
2. Provide guidelines to determine how well a
patient is adjusting to aging.
 3. Identify areas that need to be assessed and
provide a basis for interventions and
rationales in nursing care.
4. (No single theory of aging is universally
accepted.)
Biological theories
Attempt to explain physical aging as an
involuntary process, which eventually leads to
cumulative changes in cells, tissues, and fluids.
Intrinsic biological theory maintains that aging
changes arise from internal, predetermined causes.
Extrinsic biological theory maintains that
environmental factors lead to structural alterations
which, in turn, cause degenerative changes.
Psychological theories
It attempts to explain age-related changes
in cognitive function, such as intelligence, memory,
learning, and problem solving.
Sociologic theories
It attempts to explain changes that affect
socialization and life satisfaction. It maintains that a
social expectation change, people assume new
roles, which leads to changes in identity.
Developmental theories
Describe specific life stages and tasks
associated with each stage.
Physiologic Changes of Aging
1. Aging is characterized by the loss of some
body cells and related metabolism in other
cells. This process results in a decline in
bodily function and changes in body
composition.
2. It’s important for you to recognize the
gradual changes in body function that
normally accompany aging so that you can
adjust your assessment techniques
accordingly.
3. It’s equally important for you to recognize
that even laboratory test values will change
to reflect the aging process.
4. Values considered abnormal in younger
adults may be normal in older adults.
Understanding the normal aging process
can help you understand why a person’s
risk of developing certain disease and
sustaining injuries increase over time
Nutrition
A person’s protein, vitamin, and mineral
requirements usually remain the same as he/she
ages, but caloric need decrease. Diminished activity
may lower energy requirements by about;
MEN & WOMEN- 200 Calories /day ages 51 to 75
Men - 500 Calories/day age over 75
Women - 400 calories/day age over 75
Other physiologic changes that can affect
nutrition in an older patient.
o Decrease renal function an, causing greater
susceptibility to dehydration and formation of
renal calculi
o Loss of calcium and nitrogen (patient isn’t
ambulatory)
o Diminished enzyme activity and gastric
secretions
o Reduced pepsin and hydrochloric acid
secretions, which tends to diminish the
absorption of calcium and vitamins B1 and B2.
o Decrease salivary flow and diminish sense of
taste which may reduce the person’s appetite
and increase his consumption of sweet, salty,
and spicy foods.
o Diminished intestinal motility and peristalsis of
the large intestine
o Thinning of tooth enamel, causing teeth to
become more brittle
o Decrease biting force
o Diminish gag reflex.
 Some common condition found in older people
can affect nutritional status:
1. Limiting patient’s mobility
2. Diminished intestinal motility -may cause GI
disorders like constipation & fecal
incontinence
3. Suffer constipation – cause by nutritionally
inadequate diet of soft, refined foods low in
dietary fiber, physical inactivity, emotional
stress or certain medications.
4. Laxative abuse -cause rapid transport of
food through GI tract, decreasing digestion
and absorption.
 
Socioeconomic & psychological factors that affect
nutritional status:
o Loneliness
o Decline of role & importance in the family
o Lack of money
o Transportation to buy nutritious foods.
 
ILLNESS AND INJURY: WHY THE RISK
INCREASE WITH AGE
o Decreased cerebral blood flow increases the
risk of stroke.
o An older person’s spinal cord is tightly encased
in vertebrae that may stud with bony spurs or
shrunken around the cord. Even minor fall can
cause sever cord damage.
o In older women, osteoporosis cause
compression fractures even without a history of
trauma
o Brittle bones make an older person especially
prone to fractures. Falling on an outstretched
arm or hand or experiencing a direct blow to
the arm or shoulder and is likely to fracture the
shoulder or humerus.
o Diminished heart rate and stroke volume place
an older person at risk for developing heart
failure, hypertensive crisis, arterial occlusion,
and myocardial infarction.
o Weakened chest musculature re person’s
reduces an older ability to clear lung secretions
and increase high risk of developing
pneumonia, tuberculosis, and other respiratory
diseases.
o In older men, prostatic hypertrophy is a
common cause of urinary tract obstruction and
acute urine retention.
o A weakened immune system increases an older
debilitated person’s risk of Acquiring almost
any infection to which he’s exposed.
DIFFERENT BODY SYSTEMS
INVOLVE IN THE PROCESS OF CHANGES
 
Age- related adjustment and transitions
The aging process is accompanied by role changes
and transitions:
Factors;
 Family role
 Age, sex, beliefs, attitudes, income, health, and
past experience
 Culture (illness, dependence/interdependence,
roles changes, losses an death in a context
that’s unique to their culture)
 ROLE CHANGES - depends on the situation
where in and varies.
 RETIREMENT
 MULTIPLE LOSSES
 LONELINESS
 DEPRESSION AND SUICIDE
 
Clinical Alert! :
 Suicidal rate in older adult men is seven
times that of women, an is rarely an
impulsive act, most suicide attempts aren’t
gestures or threats
Risk factors include;
 Alcoholism
 Bereavement
 Loss of health, loss of role
 Living alone
  And children who have married and moved
away.
 
DIFFERENT ORGAN/ BODY SYSTEMS
Respiratory system
Age-related anatomic changes in the upper airways
include:
o Nose enlargement from continued cartilage
growth
o General atrophy of the tonsils
o Tracheal deviations from changes in the aging
spine
o Thoracic changes – anteroposterior chest
diameter, as a result of altered calcium
metabolism and calcification of costal
cartilages, which reduces mobility of the chest
wall.
o KYPHOSIS advances with age because of such
factors as osteoporosis and vertebral collapse.
 diminishes ventilator capacity for the
following reasons:
1. lungs’ diffusing capacity declines
 decreases inspiratory and
expiratory muscle strength
diminishes vital capacity
2. Lung tissue degeneration causes a
decrease in the lung’s volume, thus
aging alone can cause EMPHYSEMA.
o Closing of some airways causing poor
ventilation of the basal areas, resulting I both a
decreased surface area for gas exchanges and
reduced partial pressure of oxygen (PO2)
o Normal partial pressure of a capacity, arterial
oxygen (PaO2) decrease to 70 to 85 mmHg.
o Oxygen saturation decrease by 5%. Lung
becomes more rigid, and the number and size
of alveoli decline with age.
o A 30% reduction in respiratory fluids heightens
the risk of pulmonary infection and mucus plug.
o Maximum breathing capacity, forced vital
capacity, and inspiratory reserve volume
diminished with age, leaving the patient with
lowered tolerance for oxygen debt.
Cardiovascular system
Heart usually becomes slightly smaller and
loses its contractile strength and efficiency.
(Exception occurs with people with hypertension or
heart disease.)
o By age 70, cardiac output at rest diminished by
about 30% to 35% in many people.
o Fibrotic and sclerotic changes thicken heart
valves and reduce flexibility, leading to rigidity
and incomplete closure of the heart valves,
which may result in systolic murmurs.
o Thickness of the left ventricular wall increase by
25% between age 30 and 80
o Develop obstructive coronary disease and
fibrosis of the cardiac skeleton.
o Hearts become irritable, extra systoles may
occur, along with sinus arrhythmias and sinus
bradycardias.
o Increase fibrous tissue infiltrates the sinoatrial
node and internodal atrial tracts, which may
cause atrial fibrillation and flutter.
o Vein dilates and stretch
o Coronary artery blood flow decreases by 35 %
between age 20 and 60.
o Aorta becomes more rigid, causing systolic
blood pressure to rise disproportionately higher
than the diastolic, resulting in a widened pulse
pressure.
o ECG (electrocardiogram)changes include
increase PR, QRS, and QT intervals
o Decrease amplitude of the QRS complex, and
shift of the QRS axis to the left.
o Decrease ability to respond to physical and
emotional stress.
o Heart rate takes longer to return to normal
after exercise.
o Arterial and venous insufficiency as the o Impaired renal clearance of drugs
strength and elasticity of blood vessel decrease. o Reduced bladder size and capacity
o   o Decreased renal ability to respond to
o This contributes older people increased variations in sodium intake
incidence of cardiovascular disease, particularly o By age 70, blood urea nitrogen levels rise by
coronary disease. 21%
o Residual urine, frequency and nocturia also
increase with age.
Gastrointestinal system
Aging are usually less debilitating to the GI system
Male reproductive system
than the other system. This includes the ff:
o Reduced testosterone production – which
o Diminished mucosal elasticity and reduced
in turn may cause the ff:
GI secretions, which in turn modify same
 decrease in libido, testes become atrophy,
process like digestion and absorption.
soften&
o Decrease in GI tract motility, bowel wall and
 Decreases sperm production by 48 % to
anal sphincter tone & abdominal muscle
67% between age 60 and 80.
strength- may cause complaints in ranging
o Prostate glands enlarge with age and its
from loss of appetite to constipation that
secretion diminishes.
may increase too as related to use of
o Decrease in seminal fluid, volume and less
multiple medications-common to older
viscous.
people.
 
o Decrease in liver weight, reduced
Female reproductive system
regenerative capacity
Declining estrogen and progesterone levels cause a
o Decreased blood flow to the liver- because
number of physical changes.
hepatic enzymes involved in oxidation and o It includes emotional & physical changes
reduction markedly decline with age.
o Transition from childbearing years to
o Liver metabolizes drugs and detoxifies
infertility.
substances becomes less efficient.
o As estrogen level decrease, menopausal
 
period approaches about age 50.
Renal system
 OVARIES
o Renal function diminishes after age 40. If
-Ovulation usually stops 1 to 2 years before
the person lives to age 90 it may have
menopause.
decreased by as much as 50% - this due to
-They become unresponsive to gonadotropic
the decline in the glomerular filtration rate.
simulation.
o Decrease renal blood flow by 53% from
-Ovaries become atrophy, thicker and smaller.
reduced cardiac output and age-related
atherosclerotic changes.
 VULVA
o Bladder muscles weaken- may results in
-The vulva atrophies with age.
incomplete bladder emptying -Pubic hair loss and flattening of labia majora
o Chronic urine retention- predisposing the -Vulva tissue shrinks- thus exposing the sensitive
bladder to infection. area around the urethra and Vagina to abrasions
o Diminished kidney size and irritation (e.g. Undergarments)
-introitus constricts
-tissues lose their elasticity and epidermis thin from
20 layers to about 5.
 VAGINA
-The vagina shortens and the mucous lining to
become thin, dry, less elastic and pale as a results
of decrease vascularity – due to atrophy.
-susceptible to abrasion
-The pH of vaginal secretions increases making the
vagina environment more alkaline.
-Flora changes causing increase in vaginal
infections.
 UTERUS
-After menopause, the uterus shrinks rapidly to
one-half its premenstrual weight to approximately
one-fourth its premenstrual size.
-Atrophy of the cervix and no longer produces
mucus for lubrication
-Endometrium and myometrium become thinner
 
 BREAST
-Atrophy of glandular, supporting, and fatty tissues
-Cooper’s ligament lose their elasticity
-Pendulous breast
-decrease in nipple size and becomes flat
-Fibrocystic disease present at menopause
diminishes
- Inframammary ridges become more pronounced.
 PELVIC SUPPORT STRUCTURES
(Relaxation of structures commonly occurs among
post reproductive women. Initially occurs during
labor & delivery, but clinical effects go unnoticed
until the process accelerates with menopausal
estrogen depletion and loss of connective elasticity
and tone.)
Signs and Symptoms:
 Pressure and pulling in the area above the
inguinal ligaments
 Low backache
 A feeling of pelvic heaviness
 Difficulty in rising from a chair
 Urinary stress incontinence occurs -if
urethrovesical ligaments weaken.
Neurologic system
o Neurons of the central and peripheral nervous
systems undergo degenerative changes.
o Nerve transmission slows down- causing the
older people to react more slowly to external
stimuli.
o After about age 50, the number of brain cells
decreases at a rate of about 1% per year.
o (note: Clinical effects usually aren’t noticeable
until aging is considerably more advanced)
o Hypothalamus becomes less effective at
regulating body temperature.
o Cerebral cortex undergoes 20% neuron loss
o Corneal reflex becomes slower, and the pain
threshold increases
o Experiences a decrease in stages III and IV
sleep- causing frequent awakening;
o Rapid eye-movement sleep decreases –
results in increased need for rest during the
day.
Musculoskeletal system
o Increase adipose tissue
o Diminish lean mass and bone mineral contents
o Height decrease – may results in exaggerated
spinal curvatures and narrowing intervertebral
spaces, which shorten the trunk and make the
arms, appear relatively long.
o Decrease bone and muscle mass causing
muscle weakness
o And collagen formation causing loss of
resilience and elasticity in joints and supporting
structures
o Synovial fluid more viscous and synovial
membranes become more fibrotic
o Difficulty in tandem walking
o Walks in shorter steps and wider leg stance to
achieve better balance and stable weight
distribution.