INTRODUCTION TO GERONTOLOGY - Elite- old.

chronologically gifted: 95 years old

and older
Gerontology: study of aging and of the aged.
The Number
Subfields:
- 1990: 2.7% of total world population (5.38)
Geriatrics: medical care of the aged
- 1996: 3.6% of total world population (5.78)
- 2025: est 7.7% of total world population
Social gerontology- social aspects of aging vs
(est.88)
biological and psychological
- 2030: est 20% of total world population

Geropsychology- specialists in psychiatry whose

Features of population aging
knowledge, expertise and practice are with the older
- The most rapid growth occurs in the oldest
population.
age groups-the oldest old (80+or 85+ years)
and centenarians (100+ years) n particular.
Geropharmaceutics
- Population aging is particularly rapid among
Geropharmacology
women, resulting in “feminization” of
- Pharmacists obtain special training in
population aging (because of lower mortality
geriatrics
rates among women)
- Another consequence of lower female
Financial gerontology- combines knowledge of
mortality is the fact that almost half of older
financial planning and services with special expertise
women (45%) in 2000 were windows, thus
in the needs of the older adults
living without spousal support.

Gerontological rehabilitation nursing- combines

Key Issues for Older People
expertise in gerontological nursing with rehabilitation
- Traditional support systems being eroded
concepts and practice
- Government resources to devote to growing
older population are limited
Gerontological nursing- aspect of gerontology that
- Many older people unable to accumulate
falls within the discipline of nursing and scope of
sufficient resources during their working lives
nursing practice
Scope
Impacts of Family Change
- Nurses advocating for the health of older
-Less residential extension of households
persons at all levels of prevention from the
-More physical separation due to migration
time of old age until death
-Less children available to support older persons
-Reversal of net intergenerational wealth flows from
DEMOGRAPHICS OF AGING
older relatives to children

-according to healthy people 2010, individuals aged

65 years can be expected to live an average of 18
more years than they did 100 years ago, for a total of
Ageism Myths and Facts
83 years.
-Those aged 75 years can be expected to live an
Myth 1: Older adults are of little benefit to society
average of 11 more years, for a total of 86 years
Fact: Older adult disabilities are declining; older adults
-Older adults are expected to represent
are part of a family where they give and receive love,
approximately 20% of the population by the year
support and care; function in professional role
2030.
Myth 2: Older adults are a drain on society’s
resources
Division of the older age group
Fact: older adults had already paid the system from
- Young old: 65-74 years old
which they are now drawing; many older adults do
- Middle old: 75-84 years old
not retire; many retired older adults are engaged in
- Old-old: very old and frail elderly: 85-94 years
unpaid volunteer (custodial care and others) work
old
thus saving employer’s cost
Myth 3: Older adults are cranky and disagreeable
Fact: equal number of cranky and disagreeable young
adults; continuity theory
- Maintain similar and the same personality and
coping strategies; older adults are sick thus
become cranky; negative interaction with
nurses is symptom of the illness rather than of
aging
Myth 4: You can’t teach old dogs new tricks
Fact: Older adults may still benefit from health
education activities
Myth 5: Older adults are all senile
Fact: Senility refers to cognitive impairment
(dementia); dementia is not a normal process of aging
but a pathological disease process
Myth 6: Depression is a normal response to the many
losses older adults experience with aging
Fact: depression is an abnormal response to the many
physiological changes of aging, they are more
susceptible to pathophysiology thus predisposing
them to depression
Myth 7: Older adults are no longer interested in sex
Fact: sexuality continues throughout the life of older
adults
Myth 8: Older adults smell
Fact: Sweat glands decrease with age: urinary and
bowel incontinence are pathologic and are highly
treatable
Myth 9: The secret to successful aging is to choose
your parent wisely
Fact: there is a lot that individuals can do to age
gracefully
Myth 10: Because older adults are close to death and
are ready to die, they do not require special
consideration at end of life
Fact: older adults require equal and specialized
attention to physical, social, psychological and
spiritual task at the end of life. End of life seems to
complete an important developmental task of aging
thus nurses play a role to help older adults complete
this task.
“With old age comes skill. It’s called “Multi Tasking!
You can Laugh, cough, sneeze, fart and pee all at the
same time”
THE AGING SCENARIO
-The country consists of approximately 103 million
inhabitants, with less than 5% of the population 65
years and older
-The age structure of the Philippines resembles many
other developing countries because there is a greater
proportion of younger Filipinos in comparison to older
Filipinos
-The 60 years and older population of the Philippines
is expected to increase by 4.2% whereas the 80 years
and older population is expected to increase by 0.4%
from 2010 to 2030.
-Life expectancy of Filipinos is 57.4 years for males
and 63.2 years for females.
-Females are projected to expect an increase of 4.0
years in life expectancy and males an increase of 4.7
years in life expectancy by 2030,
-The improvement in life expectancy can be attributed
to advances in public health in the Philippines, which
have eradicated many of the diseases that once
caused earlier mortality of Filipinos.
THE CULTURE OF CARING
-Filipinos value filial piety and caring for older family
members later in life.
-It is an obligation to care for family members
-Families would opt to provide care themselves rather
than resort to any health or social services for
assistance in providing care
-Catholicism reinforces the concept that caregiving is
expected of family members
CULTURAL CONCERS
-Older Filipinos may have to sacrifice their financial
assets to care for younger family members
-Almost a quarter of Filipinos living in poverty are
older adults who do not have the financial means
necessary to sustain an adequate quality of life
-Working-age Filipinos must often remain in the
workforce longer to financially support younger
dependents and other family members.
-A lack of institutional care in the Philippines means
that older Filipinos are often cared for by Family
members at home.
WHAT ARE BEING DONE?
Republic Act No. 344 or the Accessibility Law of 1982
provides for the minimum requirements and
standards to make buildings, facilities, and utilities for
public use accessible to persons with disability,
including older persons who are confined to
wheelchairs and those who have difficulty in walking
or climbing stairs, among others.
Republic Act No. 7876 entitled “An Act Establishing a
Senior Citizens Center in all Cities and Municipalities
of the Philippines, and Appropriating Funds.
Therefore” provides for the establishment of Senior
Citizens Centers to cater to older persons’
socialization and interaction needs as well as to serve
as a venue for the conduct of other meaningful
activities.
Republic Act No. 8425 provides for the
institutionalization and enhancement of the social
reform agenda by creating the National Anti-Poverty
Commission (NAPC). Through its multi-dimensional
and cross-sectoral approach, NAPC provides a
mechanism for older persons to participate in policy
formulation and decision-making on matters
concerning poverty alleviation.
Republic Act No. 10155, known as “The General
Appropriations Act of 2012”, under Section 28
mandates that all government agencies and
instrumentalities should allocate one percent of their
total agency budget to programs and projects for
older persons and persons with disabilities.
Republic Act No. 9994, known as “Expanded Seniors
Citizen Act of 2010′′, an act granting additional
benefits and privileges to senior citizens, further
amending Republic Act No. 7432 and otherwise
known as “an act to maximize the contribution of
senior citizens to nation building, grant benefits and
special
Presidential Proclamation No. 470, Series of 1994,
declaring the first week of October of every year as
“Elderly Filipino Week.” privileges and for other
purposes”
Executive Order No. 105, Series of 2003, approved
and directed the implementation of the program
providing for group homes and foster
The Philippine Plan of Action for Senior Citizens
(2011-2016) aims to ensure active aging for senior
citizens where preventive and promotive aspects of
health are emphasized in communities and where
health services are accessible, affordable and
available at all times. Envisioning a population of
senior citizens who are self-sufficient and self-reliant,
this plan aims to promote financial security and
financial independence of senior citizens by
developing community-based local delivery systems
to address their needs.
The Department of Social Welfare Development
(DSWD) has issued Administrative Order No. 4 series
of 2010, “Guidelines on the Home Care Support
Services for Senior Citizens”, establishing community
based health care services for older persons.
The RA 9994 provides health care services for poor
older persons such as free medical services on
government hospitals, discounted services on private
hospitals and clinics, free vaccines, discounted
medicines, and mandatory PhilHealth coverage.
The Philippine Constitution supports the formation of
community based organizations. The DSWD have
facilitated the formation of older people’s
associations in every city and municipality. They are
also tasked to provide technical assistance to support
and strengthen OPAs.
Under the RA 9994, the Philippine Government
provides a social pension of 12USD (Php500) per
month to poor older persons aged 77 and over who
are not yet receiving any government or private
pension. The Department of Social Welfare and
Development is the lead agency tasked with
identifying and reviewing social pension beneficiaries.
CMO 15 s 2017 Policies, Standards and Guidelines for
the BSN Program provided for the inclusion of NCM
114 Care of the Older Person in the Professional
Courses with 2 units lecture and 1 unit laboratory
WHAT NEEDS TO BE DONE?
-Family caregiver training
-Training on care of the older person across health
allied professions
-Establishment of accessible programs and services
for older people
-Health services for older people in geographically
isolated areas
-Preservation of cultural practices in the care of the
older person
-Awareness campaign and information dissemination
on the existing laws and policies for the welfare of the
older person
LESSON 2:
WHY THE POPULATION IS AGING?
•Population dynamics
-Variations in birth and death role
•Declining fertility rates
-Declining share of young people in society, increases
the older population automatically
•Longevity increase
- Increase in life expectancy
- Advances in the field of medicine, medical
technology and biotechnology
THEORIES OF AGING
•A good gerontological theory integrates knowledge,
tells how and why phenomena are related, leads to
prediction and provides process and understanding
•In addition, a good theory must be holistic and take
into account all that impacts on a person throughout
a lifetime of aging
BIOLOGICAL THEORIES
-explain information regarding the physiologic
processes that change with aging
•Stochastic or statistical perspective
- Identifies episodic events that happen
throughout one’s life that cause random cell
damage and accumulate over time, thus
causing aging
•Nonstochastic theories
- Series of predetermined events happening to
all organisms in a timed framework
•Defect theory
PSYCHOLOGICAL THEORIES
- Explain aging in terms of mental processes,
emotions, attitudes, motivation and
personality development that is characterized
by life stage transitions.
MORAL/SPIRITUAL THEORIES
- Support the idea that once an older individual
finds spiritual wholeness, this transcends the
need to inhabit a body, and they die.
SOCIOLOGICAL THEORIES
- Changing roles, relationships, status, and
generational cohort impact the older adult’s
ability to adapt.
NURSING THEORIES OF AGING
- Developed to guide nursing care of the elderly
FREE RADICAL THEORY OF AGING
Theoretical propositions
- Aging is due to oxidative metabolism and the
effects of free radicals, which are the end
products of oxidative metabolism
What are free radicals?
- Free radicals are like robbers which are
deficient in energy
- Free radicals attack and snatch energy from
the other cells to satisfy themselves
ORGER OR ERROR THEORY OF AGING
Theoretical proposition
- Aging would not occur if destructive factors
did not exist and cause “errors” such as
mutations and regulatory disorders.
WEAR AND TEAR THEORY
Theoretical proposition
- Aged cells have lost the ability to counteract
mechanical, inflammatory, and other injuries
due to their senescence
CONNECTIVE TISSUE OR CROSS-LINK THEORY
Theoretical propositions
- Over time, biochemical processes create
connections between structures not normally
connected
PROGRAM OR FEATURE THEORY
Theoretical propositions
- Cells divide until they can no longer divide,
whereupon the cell’s infrastructure
recognizes this inability to further divide and
triggers the apoptosis sequence or death of
the cell
GENE OR BIOLOGICAL CLOCK THEORY
Theoretical propositions
- Each cell or perhaps the entire organism has a
genetically programmed aging code that is
stored in the organism’s DNA
NEUROENDOCRINE THEORY
Theoretical propositions
- A change in hormone secretion have an
influence in the aging process
IMMUNOLOGIC OR AUTOIMMUNE THEORY
Theoretical proposition
- Normal aging process of human and animals is
related to faulty immunological function
DEFECT THEORY
Theoretical propositions
- Breakdown and losses that occur with aging
are accidents or mistakes
HUMAN NEEDS THEORY
Theoretical proposition
- Hierarchy of five needs motivates human
behavior: physiologic, safety and security,
love and belonging, self-esteem and self-
actualization
STAGES OF HUMAN DEVELOPMENT
Theoretical propositions
- Older adults experience the developmental
stage known as “ego integrity versus despair,
characterized by evaluating one’s life and
accomplishment for meaning
- Theoretical proposition
INDIVIDUALISM THEORY
Theoretical propositions
- Individual personalities tend to view life
primarily either through the self or through
others
LIFE-COURSE OR LIFE SPAN DEVELOPMENT
PARADIGM
Theoretical propositions
- Life occurs in stages that are structured
according to one’s roles, relationships,
internal values and goals
SELECTIVE OPTIMIZATION WITH COMPENSATION
THEORY
- Emerged from the life-course perspective
Theoretical proposition
- Individuals learn to cope with the functional
losses of aging through processes of selection,
optimization and compensation.
KOHLBERG’S STAGES OF MORAL DEVELOPMENT
Theoretical proposition
- An individual goes through a series of moral
reasoning activities that become progressively
more sophisticated throughout life
TORNSTAM’S THEORY OF GEROTRANSCEDENCE
Theoretical proposition
- Aging individuals undergo a cognitive
transformation from a materialistic, rational
perspective toward oneness with the
universe.
DISENGAGEMENT THEORY
Theoretical proposition
- Aging is characterized by gradual
disengagement from society and relationships
ACTIVITY THEORY
Theoretical proposition
- Remaining occupied and involved is a
necessary ingredient to satisfying late-life
CONTINUITY THEORY OR DEVELOPMENT THEORY
Theoretical proposition
- Personality is well-developed by the time one
reaches old age and tends to remain
consistent across the lifespan
SUBCULTURE THEORY
- Older adults is a unique subculture within the
society that is formed as a defensive response
to society’s negative attitudes and the loss of
status that accompanies aging. Older adults
prefer to interact among themselves.
AGE STRATIFICATION THEORY
Theoretical proposition
- Aging and society are interrelated and cause
reciprocal changes to individuals, age group
cohorts and society.
PERSON-ENVIRONMENT FIT THEORY
Theoretical proposition
- Functional competence in relations to the
environment
FUNCTIONAL CONSEQUENCES THEORY
Theoretical proposition
- Aging adults experience environmental and
biopsychosocial consequences that impact
their functioning
THEORY OF THRIVING
Theoretical proposition
- Thriving is achieved when there is harmony
between a person and his or her physical
environment and personal relationships
SOCIOECONOMIC ASPECTS OF AGING
• Workers 55 and older account for 18.8 percent of
the labor force today- up from 17.6 percent at the
start of the current economic recession and higher
than any time since 1948
•Their share of the workforce has increased by 7.1
percent over the last 21 months.
•The lack of access to retirement savings, coupled
with a massive financial market crisis leaves older
workers scrambling for other sources of income.
• Benefits for those retiring today are less than they
were for previous generations due to benefit cut—a
higher normal retirement age—enacted in 1983. This
Leaves wage earnings as the primary pressure valve
for cash-strapped retirees.
SOCIAL CHANGES WITH AGING
• Gradual isolation
- Geographical sense: moving away from
friends
- Physical sense: difficulty with traveling,
difficulty in seeing and hearing
•Senior adult role
- Loss of prestige, status and self-esteem
PSYCHOLOGICAL CHANGES WITH AGING
•Information processing
- Reaction time: increase with age
- Intelligence: the same until late into the aging
process
- Learning: constant, given enough time to
learn
- Memory: difficulty with short term recall, long
term recall remains intact
- Problem-solving: less use of trial and error;
prior to giving solutions most older people
“think through”
•Personality
- Remains constant as one ages; becomes more
and more pronounced than when the person
who was once young; individual differences
become more pronounced
•Myth of senility
- Ageism: discrimination based on age,
employment, attitude towards the aged
- Gerontophobia: fear of old age; product of
high value contemporary places on youth
•Retirement
- Represents reward for participation in labor
force
- Ensure turnover of the labor force
- Decreased income
- Leaves older adults a “Roleless role”
EMOTIONAL CHANGES IN AGING
- Aging is associated with gains in emotional life
- Older adults increased ability to regulate
emotion aids in the enhancement of positive
emotions and down-regulation of negative
ones
- Frequency and duration of positive emotions
increase, those of negative emotions decrease
with aging
- Older adults prefer emotionally satisfying
relationships over ones that are related to
knowledge-acquisition (limited time)
- Aging increases emotional control= positive
emotion
- Older adults are especially unlikely to conform
to others judgments when the judgment is
related to emotion, such as identifying an
emotional facial expression
PRINCIPLES OF GERIATRIC ASSESSMENT
 Geriatric assessment is a broad term used to
describe the health evaluation of older patients,
which emphasizes components and outcomes
different from that of the standard medical
evaluation
 This approach recognizes that the health status of
older person is dependent on influences beyond
the manifestations of their medical conditions.
 Among these are social, psychological and mental
health, and environmental factors
 Geriatric assessment also places high value on
functional status, both as a dimension to be
evaluation and as an outcome to be improved or
maintained,
 Although in the strictest sense geriatric
assessment is a diagnostic process, many use the
term to include both evaluation and
management.

 Geriatric assessment differs according to the
setting where the patient is being evaluated
 In the hospital setting, the initial assessment is
usually directed at the acute medical problem
that precipitated the hospitalization.
 As the patient, begins to recover and plans
are initiated for discharge, other components
(eg, social support, environment) assume
increasing importance in the assessment
 The inpatient setting can be problematic for
geriatric assessment because of the rapidly
changing status of several key dimensions.
 Nursing home geriatric assessment requires
that attention be directed to selected aspects
of assessment such as nutritional status and
self-care activities.
 Geriatric assessment conducted in the
patient’s home provides an opportunity for an
entirely different type of assessment;
environmental factors (eg, home safety) and
insights into functional status (eg cleanliness
of the home) can be directly assessed.
COMPONENTS OF THE GERIATRIC ASSESSMENT
 In addition to the standard medical history
and physical examination, the clinician should
systematically search for specific conditions
that are common among older persons and
that might have considerable impact on
function.
 In the course of the traditional medical
evaluation, these problems may go unnoticed
because older patients fail to report them
spontaneously.
 For example, they may not recognize that
falling is a treatable medical problem.
 They may also be embarrassed to mention
problems with maintaining urinary continence
or with sexual function.
 Finally, they may believe that these symptoms
such as hearing loss, are normal aspects of
aging that cannot be helped.
VISUAL IMPAIREMENT
 Visual impairement is a common and
often underreported problem in the older
population
 The standard method of screening for
problems with visual acuity is the Snellen eye
chart
HEARING IMPAIREMENT
 Hearing impairement is among the most
common medical conditions reported by
older persons, affecting approximately
one third of those 65 years or older
 Hearing impairement is associated with
reduced cognitive, emotional, social and
physical function, as well as increased
hospitalizations, and the use of
amplification devices has led to improved
functional status and quality of life of
older persons.
 Screening for hearing loss can be
accomplished by several methods
 The most accurate of these is the Welch
Allyn AudioScope 3 a handheld otoscope
with a built-in audiometer
 A simple alternative is to rely on patient’s
own subjective report of hearing loss. A
self-reported hearing loss question
involves asking patients whether they feel
they have hearing impairement.
 Another alternative is the whispered
voice test
Malnutrition/Weight Loss
 Malnutrition is a global term that
encompasses many different nutritional
problems that are associated with diverse
health consequences.
 Both extremes of body weight place older
people at risk for subsequent functional
impairment, morbidity and mortality.
 Among community-dwelling older persons,
the most common nutritional disorder is
obesity.
 In addition, a small percentage of community
dwelling older persons have energy or protein
energy under nutrition, which places them at
higher risk for death and functional decline.
Urinary Incontinence
 Urinary incontinence (UI) is common,
estimated to affect 11% to 34% of older men
and 17% to 55% of older women, and is
underrecognized.
  Patients may be embarrassed to raise the
issue; they may also regard it as a normal
aspect of aging.
 Urinary incontinence has been associated
with depressive symptoms in older adults and
is a major factor in nursing home placement.
 Asking two questions can screen for
incontinence:
o “In the last year, have you ever lost
your urine and gotten wet?” and if so
o Have you lost urine on at least six
separate days?
BALANCE AND GAIT IMPAIRMENTS AND FALLING
 Over one third of community dwelling
persons over age 65 fall every year.
 Falls are independently associated with
functional and mobility decline.
 Patients who have fallen or have a gait or
balance problem are at higher risk of another
fall.
 The risk of falling can be assessed by asking all
older patients if they have fallen in the last
year, and then performing a multifactorial
falls assessment by testing balance, gait and
lower extremity strength
 Observing patients walking and performing
balance maneuvers best assesses balance and
gait disorders
POLYPHARMACY
 Polypharmacy in older patients is associated
with adverse drug reactions, reduced
adherence and inappropriate medication
usage.
 Older persons often receive care from
multiple providers and may fill prescriptions
at several pharmacies.
 Patients should be instructed, therefore to
bring in all current medications- both
prescription and nonprescription medications-
to each visit, for a through medication
reconciliation and to check for a potential
drug-drug interactions.
COGNITIVE ASSESSMENT
 Because the prevalence of Alzheimer disease,
other dementias and cognitive impairement
rises considerably with advancing age, the
yield of screening for cognitive impairement
increases with age.
 There is insufficient evidence on the balance
of benefits and harms of screening for
cognitive impairment, but clinicians should
assess cognition when there is suspicion of
impairement.
 Several screens are available for clinical use
and some can be performed in 5 minutes or
less.
 Among hospitalized patients, mental status
should be assessed at the time of hospital
admission and then periodically because older
persons are especially prone to develop
delirium during the hospital stay.
AFFECTIVE ASSESSMETNT
 Major depression and other affective
disorders are common among older adults
and are likely under diagnosed, as symptoms
may be underreported, present atypically or
be masked by cognitive impairment or other
neurologic diseases such as Parkinson disease.
 Given their association with increased
disability, health care utilization, morbidity
and mortality and decreased quality of life,
clinical detection and treatment of affective
disorders is paramount.
 A brief two-item screening inquiry asks about
the frequency of depressed mood and
anhedonia over the past 2 weeks.
ASSESSMENT OF FUNCTION
 Measurement of functional status is an
essential component of the assessment of
older person
 The patient’s ability to function can be viewed
as a summary measure of the overall impact
of health condition in the context of his or her
environment and social support system.
 Moreover, in older persons, the ability to
function consistent with their personal
lifestyle desires should be an important
consideration in all-care planning.
 Measurement of functional status is also
valuable in monitoring response to treatment
and may provide prognostic information that
will help plan for long-term care.
 Functional status can be assessed at three
levels: basic activities of daily living (BADLs),
IADLs, and advanced activities of daily living
(AADLs)
  BADLs refers to self-care tasks such as
bathing, dressing, toileting, continence,
grooming, feeding and transferring
 IADLs refers to the ability to maintain an
independent household such as shopping for
groceries, driving, or using public
transportation using the telephone, meal
preparation, housework, home repair,
laundry, taking medications and handling
finances whereas AADLs refer to the ability to
fulfill societal, community and family roles as
well as participate in recreational or
occupational tasks.
 These advanced activities vary considerably
from individual to individual but may be
valuable in monitoring functional status prior
to the development of disability
ASSESSMENT OF SOCIAL SUPPORT
 The composition of the older patient’s social
support structure can be assessed by asking a
few questions about relationship such as
family, friends, neighbors and caregivers
when obtaining the social history.
 The quality of these relationships should also
be determined.
 For very frail older persons, the availability of
assistance from family and friends is
frequently the determining factor of whether
a functionally dependent older person
remains at home or is institutionalized.
 If dependency is noted during functional
assessment, then the clinician should inquire
as to who provides help for specific BADL and
IADL functions and whether these persons are
paid or voluntary help.
 Even in healthier older persons, it is often
valuable to raise the question of who would
be available to help if the patient becomes ill.
 Early identification of problems with social
support may prompt planning to develop
resources should the necessity arise.
 For vulnerable older adults, clinicians should
be mindful of signs of elder abuse, neglect, or
exploitation and if suspected are mandated to
report cases.
ECONOMIC ASSESSMENT
 Although some clinicians feel uncomfortable
assessing the economic status of their
patients, inquiring about financial stress may
prompt referral to social work or other
agencies and help prevent the associated
poor health outcomes.
 Furthermore, insurance status is routinely
collected by office staff and a patient’s income
can be assessed and eligibility determined for
state or local benefits.
 For the frail and functionally impaired older
adult, clinicians should partner with patients
and families to provide anticipatory guidance
regarding the resources that may be required
to pay for care at home or in a residential
facility.
ENVIRONMENTAL ASSESSMENT
 Environmental assessment encompasses two
dimensions, the safety of the home
environment and the adequacy of the
patient’s access to needed personal and
medical services.
 Particularly among frail individuals and those
with mobility and balance problems, the
home environment should be assessed for
safety.
 For those receiving home health services, in-
home safety inspections can be performed,
including recommendations for installations
of adaptive devices such as shower bars and
raised toilet seats.
 Older persons who begin to develop IADL
dependencies should be evaluatied for the
geographic proximity of necessary services
such as grocery shopping and banking, their
need for use of such services and their ability
to use these services in their current living
situations,
 Increasingly some of these services are
available online through many older persons,
particularly those who are frail do not feel
comfortable using the internet to purchase
services.
 Older drivers are at increased risk for motor
vehicle accidents secondary to functional
impairments, medications and medical
conditions
SPIRITUALITY
 Spirituality whether affiliated with a formal
religious denomination or nonreligious
intangible elements, has increasingly been
 recognized as an important influence on
health and quality of life.
 Frequent attendance of religious services has
been associated with lower health care
utilization and mortality rates
 Formal instruments for assessing spirituality
have been developed such as the FICA tool for
spiritual assessment, but these are not widely
used in clinical practice.
 Simply asking older persons whether religion
or spirituality is important to them may
provide insights that may facilitate their care
 Especially in hospital settings, involvement of
pastoral care may be valuable in supporting
the patient and in framing medical decisions
in the context of the patients personal belief
system
ADVANCE DIRECTIVES
 An advance health care directive enables
patients to make sure that their health care
wishes are known in advance and considered
it for any reason they are unable to speak for
themselves. It allows a patient to appoint a
durable power of attorney, or health care
proxy who will have legal authority to make
health care decisions in the event that patient
is incapacitated or whereupon the patient
grants such authority.
 Discussions of advance directives are
especially important for older patients and
should be initiated early on, to discuss the
patients goals and preferences for care should
they experience progressive cognitive
impairment of acute illness.
 Physicians can assist patients by focusing on
patients overall goals of care, rather than
specific detailed interventions and
incorporating these goals into the patients
current clinical situation
 A particularly important time to discuss such
preferences is prior to surgery because of the
possivility of surgical complications of
postoperative delirium which may preclude
discussions following the procedure.
 Such discussions should be revisited any time
there are significant changes in a patients
medical condition and a better understanding
about prognosis becomes available as
patients often revise their thoughts about the
burdens
 Cultural differences regarding preferences for
advance directives and end of life care should
be recognized and respected
 Overall patients are receptive and grateful for
discussion of their goals and preferences for
care and increasingly advanced directive
counseling discussions have been incentivized
and recognized in quality of care measures,
with various tools being developed to support
advanced care planning in practice.
CHANGES IN THE OLDER PERSON AND
IMPLICATIONS FOR HEALTH CARE
CARDIOVASCULAR SYSTEM
Normal Aging Changes:
• Heart becomes larger and occupies
a greater amount of space within the
chest.
• Reduction in the amount of functional muscle mass
of heart.
• Decreased amount of blood that is
pumped throughout the circulatory
system.
• More adventitious S4 heart sounds.
• Premature contractions and
arrhythmias.
• Blood flow is slower (wounds heal
slower and impacts medication
metabolism and distribution).
• Low diastolic pressure.
• Increased pulse pressure
Nursing Intervention
• Can be cardiomyopathy, so refer for diagnostic
tests.
• Inform patient that exercise can ultimately reduce
the strain on the heart.
• Heart murmurs require further tests to determine
its
effect.
• Fatigue, SOB, DOE, dizziness, chest pain, headache,
sudden weight gain, or changes in cognitive
function or cognition requires full assessment.
• Know that the time of effectiveness may take
longer when giving meds.
 • Inform patient that low diastolic pressure is a risk be done on all lung fields in a quiet environment.
for • Inform that pollution and smoking worsens the
cerebrovascular accidents or strokes. cilia (try to help stop smoking by recommending
• Inform patient that exercise lowers behavioral management classes, support
groups/nicotine replacement therapies,
PERIPHERAL VASCULAR SYSTEM antidepression medications).
• Tell patients that they are at risk for choking.
Normal Aging Changes: • Make sure patient’s respiratory function is
• Increase in the frequently assessed.
peripheral vascular • Encourage regular exercise.
resistance (blood has a
hard time returning to INTEGUMENTARY SYSTEM
the heart and lungs).
• Valves in the veins Normal Aging Changes:
don’t function • Skin becomes thinner and more fragile.
efficiently and form nonpathological • Skin is dry and loses elasticity (wrinkles).
edema. • Sweat glands lessen, which leads to less
perspiration.
Nursing Intervention: • Subcutaneous fat and muscular layers begin
• Inform patient that age, diet, genetics, and lack of to diminish; less padding, more easily bruised.
exercise can transform nonpathological to • Dryness.
pathological (atherosclerosis and arteriosclerosis), • Skin tears.
which can result in CVD. • Fingernails and toenails become thick and
• Monitor older adults’ cholesterol levels with brittle.
lowering • Hair becomes gray, fine, and thin.
agents to prevent atherosclerosis and • Facial hair on women.
arteriosclerosis. • Decreased body hair on men and women.
• Inform patient that exercise results in lower
cholesterol levels. Nursing Intervention
• Discuss the right medication, exercise program, and • Promote the use of sun block
diet for the patient as a means to slow the and tell patient to avoid
progression of cardiac changes. overexposure.
• Avoid the use of soaps that
RESPIRATORY SYSTEM dry skin and use a lotion
after baths.
Normal Aging Changes: • Protect high-risk areas such as elbows and heels
• Decreased vital with
respiratory capacity. padding.
• Lungs lose elasticity. • Refer to a podiatrist.
• Loss of water and • Help older adult maintain
calcium in bones personal appearance.
causes the thoracic
cage to stiffen. GASTROINTESTINAL SYSTEM
• Decreased amount of
cilia lining system. Normal Aging Changes:
• Decreased cough reflex. • Inflamed gums.
• Periodontal disease.
NURSING INTERVENTION • Sensitive teeth.
• Note that auscultating sounds is difficult so it must • Tooth loss.
• Decreased peristalsis of MUSCULOSKELETAL SYSTEM
esophagus.
• Decreased gut motility, Normal Aging Changes
gastric acid production, • Decrease in total muscle and bone
and absorption of mass.
nutrients. • Muscle units that combine to form
• Difficulty evaluating wastes muscle groups diminish.
(constipation).
• Involuntary leakage of Nursing Intervention
liquid stool (fecal • Encourage older adult to
incontinence). exercise regularly.

Nursing Intervention SEXUAL REPRODUCTIVE SYSTEM

• Assess older adult’s ability to chew.
• Refer older adult for further oral evaluation if Normal Aging Changes:
necessary. • Decrease in testosterone in men, and
• Assist older adults in making changes with their estrogen, progesterone, and androgen in
eating women. Women:
habits. • Follicular depletion in the ovaries.
• Assess nutritional health frequently. • Natural breast tissue is replaced by fatty
• Encourage older adult to drink water (1.5 L). tissue.
• Add bulk and fiber to diet. • Labia shrinks.
• Promote exercise. • Decrease in vaginal lubrications and
• Enemas and laxative medications may be given in shortening and narrowing of the vagina.
severe • Strength of orgasmic contraction diminishes,
situations. and orgasmic phase is decreased.
• Diets high in fiber and bulk, adequate fluids, and Men:
exercise. • Increased length of time needed for
• Bowel habit training (for cognitively impaired). erections and ejaculation.
• In severe cases, surgery may be appropriate.
Nursing Intervention
URINARY SYSTEM • Help older adult feel
comfortable when
Normal Aging Changes discussing sexuality.
• Kidneys experience a loss of nephrons • Give vaginal lubricants
and glomeruli. to females.
• Bladder tone and volume capacity • Inform men to increase
decreases. the time between
• Incontinence (not a normal change, but erections.
occurs in response). • Discuss use of oral
erective agents.
Nursing Intervention
• Assess urinary incontinence. SENSES
• Kegel exercises.
• Voiding schedules (for Normal Aging Changes:
cognitively impaired). Eyes
• Visual acuity declines.
• Ability of pupil to constrict in response to stimuli
decreases.
• Peripheral vision declines.
• Lens of the eye often becomes yellow.
• Arcus senilus. Ears
• Increased amount of hard cerumen.
Taste and smell
• 30% of taste buds diminish.
Nursing Intervention
• Make sure older adult has a
baseline eye assessment early in
older adulthood and follow up
eye exams yearly.
• Help older adult remove
cerumen.
• Obtain a thorough history of taste and smell
sensations and a
physical examination of the nose
and mouth.
• Obtain a thorough diet history.
• Poor diet
• Physical inactivity
• Mobility problems
• Limited access to healthcare
SOCIAL ISOLATION CAN OCCUR AS A RESULT OF
• Lack of information about programs and services
• Lack of home care and home supports
• Lack of support services, weak family, social and
community networks
• Lack of participation in recreational, social and
community activities
SPIRITUAL ISOLATION CAN OCCUR AS A RESULT OF:
• Inability to observe religious and spiritual practices
as a result of lack of access and opportunity
• Loss of meaning and purpose in life
• Loss of sense of connectedness and belonging to
something larger than oneself

NEUROLOGICAL SYSTEM MENTAL-EMOTIONAL ISOLATION CAN OCCUR AS A

RESULT OF:
Normal Aging Changes: • Mental disabilities
• Total brain weight decreases. • Low self-esteem
• Shift in the proportion of gray • The impact of cultural change on the status of elders
matter to white matter. • Difficulties accepting ageing
• Loss of neurons. • Communication problems with family or community
• Increase in the number of health workers as a result of language and cultural
senile plaques. barriers
• Blood flow to the cerebrum • Ageist, sexist, racist attitudes
decreases. • Stress

Nursing Intervention
• Help older adult maintain
an active body and
mind.
• Encourage older adults to
participate in cognitive
activities.

CULTURAL FACTORS ASSOCIATED WITH AGING

Barriers to Ageing Well: The Problem of
Unwanted Isolation

Physical isolation can occur as a result of:

• Geographic isolation
• Lack of transportation
• Poor physical health
• Inadequate housing