GERONTOLOGICAL NURSING
and the old old, very old, or frail elderly (ages 85 and
Key Terms:
Ageism – negative approach toward aging or older
person
Attitudes – values, thoughts and belief held by a person
Certification – type of credential earned through
meeting specific requirements that validate expertise
and knowledge in a specialty area
Core competencies – essential skills and knowledge
needed to provide high quality care to older adults
Geriatrics – medical care of the aged
Gero competencies – set of standards or competencies
to meet in order to provide high quality care to older
adults
Gerontological Nursing – specialty within nursing
practice in which the clients, patients and residents are
older person
Gerontological rehabilitation nursing – gerontological
nursing care of older person in which rehabilitation is
emphasize; care for those with rehabilitation problems
such as stroke, brain injury, neurological disorder or
orthopedic surgeries.
Gerontology – study of aging process
Landmarks in gerontological nursing – key events in the
development of the specialty of gerontological nursing
HISTORY of GERONTOLOGICAL NURSING
1960s – ANA forms gerontological nursing specialty
1970s – ANA creates the SOP for geriatric nursing
1990s – Hartford Foundation Institute for geriatric
nursing established at NYU
21st century – “baby boomers” begin turning 65;
growing interest in gerontological care
Today, the older age group is often divided into the
young old (ages 65–74), the middle old (ages 75–84),
THIRD YEAR – FIRST SEMESTER
up).
GERONTOLOGY SUBFIELDS
1. social gerontology
- concerned mainly with the social aspects of aging
versus the biological or psychological. “Social
gerontologists not only draw on research from all the
social sciences—sociology, psychology, economics, and
political science—they also seek to understand how the
biological processes of aging in- influence the social
aspects of aging”.
2. Geropsychology
- is a branch of psychology concerned with helping older
persons and their families maintain well-being,
overcome problems, and achieve maximum potential
during later life.
3. Geropharmacology
- is the study of pharmacology as it relates to older
adults
ROLES OF GERONTOLOGICAL NURSE
1. Direct-care provider
- hands-on care to older adults in a variety of settings.
2. Teacher
- Gerontological nurses focus their teaching on
modifiable risk factors and health promotion
3. Leader
- Gerontological nurses act as leaders during everyday
practice as they balance the concerns of the patient,
family, nursing, and the rest of the interprofessional
team.
4. advocate
- As an advocate, the gerontological nurse acts on
behalf of older adults to promote their best interests
and strengthen their autonomy and decision making.
GERONTOLOGICAL NURSING
Why the increase in the number of older adults?

5. Evidence-based clinician The e trend of increasing numbers of older adults in the

United States can be attributed to two main causes:’
- e appropriate level of involvement for nurses at the
baccalaureate level is implementation of evidence- 1. e increased life expectancy of our seniors
based practice (EBP) principles. Gerontological nurses
2. fertility of the U.S. population at various points in
must remain abreast of current research literature,
time.
reading and translating into practice the results of
reliable and valid studies. the life expectancy for someone who was 65 years old
was 12 additional years for males (or 77 years total) and
Scope and Standards of Practice
13 additional years for females (or 78 years total).
- the scope of nursing practice is defined by state
Chronic diseases – is the most common disease in older
regulation, but is also in- influenced by the
adults such as cancer, heart disease, diabetes,
unique needs of the population being served.
neurodegenerative disease)
the needs of older adults are complex and
multifaceted, and the focus of nursing care when the baby boomer generation reaches age 65. - is
depends on the setting in which the nurse extremely large segment of the U.S. population, who
practices. were born between 1946 and 1964, started turning 65
in 2011. - is anticipated increase has been called both a
demographic tidal wave (MIAH et al., 2004) and a pig in
a python (meaning a bulge in population moving slowly
through time)
CHAPTER 2:
Changes in life expectancy throughout the 20th century
Aging in place
were mainly due to improved sanitation, advances in
- is defined as the ability to live in one’s own
medical care, and the implementation of preventive
home and community safely, independently,
health services
and comfortably, regardless of age, income,
or ability level - Older adult consumes primary care services,
Baby boomers hospital services, nursing home services and
Centenarian - home care services.
Chronic disease - - Health professionals, particularly those with
Cohorts long education (e.g., medicine), are also ageing
Genetics - hereditary and are at greater risk for depletion as the
Genomics - is the identication of gene sequences in population ages.
the DNA
Health disparities Health care services and population ageing
Independent living
Older adult - Ageing of population = decreased in mobility,
Oldest adult increase in dependence, injury, disability,
Senior citizen chronic disease, medication consumption.
Elders - - Ageing and depletion of health workforce
- Health care provision focus shift towards
prevention & long-term care
- Health care accessibility
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GERONTOLOGICAL NURSING
- Health care financing prolonging the lives of those with disabilities
such as mental retardation.

Chronic Diseases:
AGING POPULATION
 Heart disease
Health disparities – defined as “preventable differences
 Arthritis
in the burden of disease, injury, violence or in
 Stroke
opportunities to achieve optimal health experienced by
 Cancer
socially disadvantaged racial, ethnic and other
 Diabetes
population groups and communities”
 Obesity
- Not all older adults in the United States have  Glaucoma
beneted from recent advances in health care  Macular degeneration
because of factors such as age, gender, race,  Cataracts
and economic circumstances.  Eduntulism
Older foreign-born population  Mild cognitive impairment (Alzheimer)

- Those people who are living in a country other LEADING CAUSE OF DEATH FOR OLDER ADULTS WAS
than where they are born DISEASE OF THE HEART

U.S. Veterans MORTALITY AND MORBIDITY

- There are currently three cohorts of aging veterans: CAUSES OF DEATH

1. those who served in World War II
2. those who served in the Korean War
3. those who served in Vietnam
- - e leading cause of death for older adults in
2006 was diseases of the heart, followed by
malignant neoplasms, cerebrovascular diseases,
chronic lower respiratory diseases, Alzheimer’s
disease, diabetes

GENETICS AND GENOMICS

The Aging Disabled Population
GENOMICS - identication of gene sequences in the DNA
- Advances in health care have increased the life
span of persons with disabilities. - ese include GENETICS - study of heredity and the transmission of
those traumatically injured as well as those certain genes through generations.
born with or who acquired a disability.

Disabled older population GOOD HEALTH IN AGING

- Advances in health care have increased the life
span of person with disabilities including
individuals with acquired or congenital
disabilities
- Developmentally disabled individuals are
another special aging group. Technological
advances and improvements in health care are
-
Active aging – means growing old in good health and as
a full member of society, feeling more fulfilled in our
jobs, more independent in our daily lives and more
involved as citizen
10 steps to healthy aging:

 Exercise
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 Eat a healthy diet STOCHASTIC THEORIES OF AGING
 Don’t smoke
TELOMERASE
 Engage socially with others
 Have a positive attitude about aging TELOMERE
 Get regular health check-ups
 Protect your eyes
 Avoid excessive sun exposure Psychosocial Theories
 Get sufficient good quality sleep
Sociological Theories
 Pay attention to your pension and get expert
financial advice  Changing roles, relationships, status and
generational cohort impact the older adult’s
Vaccinations prevent diseases
ability to adapt
 Influenza
Activity
 Pneumococcal disease
 Tetanus-diphtheria-pertussis  Remaining occupied and involved is necessary
 Chicken pox and shingles to a satisfying late life
 Meningococcal disease
Disengagement
 Measles-Mumps-Rubella
 Human papillomavirus  Gradual withdrawal from society and
 Hepatitis A and B relationships serves to maintain social
 Polio equilibrium and promote internal reflection

Centenarians Subculture

-  The elderly prefer to segregate from society in

an aging subculture sharing loss of status and
societal negativity regarding the aged. Health
THEORIES OF AGING and mobility are key determinants of social
status

Continuity
KEY TERMS
 Personality influences role and life satisfaction
APOPTOSIS and remains consistent throughout life. Past
FREE RADICALS coping patterns recur as older adults adjust to
physical, financial and social decline and
IMMUNOMODULATION contemplate death
LIPOFUSCIN Age stratification
MELATONIN  Society is stratified by age groups that are the
MITOCHONDRIA basis for acquiring resources, roles, status and
deference from others. Age cohorts are
NONSTOCHASTIC THEORIES OF AGING influences by their historical context and share
REACTIVE OXYGEN SPECIES (ROS) similar experiences, beliefs, attitudes and
expectation in life
SENESCENCE
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GERONTOLOGICAL NURSING
Person environment-fit
 Function is affected by ego strength, mobility,
health, cognition, sensory perception and the
environment. Competency changes once ability
to adapt to environment demands
Gerotranscendence
 The elderly transform from a
materialistic/rational perspective toward
oneness with the universe. It includes an
outward focus, accepting impending death,
substantive relationships, intergenerational
connectedness and unity with the universe
Psychological Theories
- Explain aging in terms of mental processes,
emotions, attitudes, motivation, and personality
development that is characterized by life stage
transitions.
Human needs
 Five basic needs motivate human behavior in a
lifelong process toward need fulfillment
 Physiological needs
 Safety and security
 Love and belongingness
 Esteem
 Self-actualization
Individualism
 Personality consist of an ego and personal and
collective unconsciousness that views life from
a personal or external perspective. Search for
life meaning and adapt to functional and social
losses
Stages of Personality
 Personality 8 sequential development task. The
8th integrity vs despair is characterized by
evaluating life accomplishments, struggles
include letting go, accepting care, detachment
and physical & mental decline
THIRD YEAR – FIRST SEMESTER
Life – Course/Life span
 Life stages are predictable and structured by
roles, relationships, values, development and
goals. Person adapts to changing roles and
relationships. Age group norms and
characteristics are important part of life course
Selective optimization
 Individuals cope with aging losses through
activity/role selection, optimization and
comprehension. Critical points are morbidity,
mortality and quality of life. Selective
optimization with compensation facilities
successful aging
Biological Theories
A. Stochastic Theories
- Based on random events that cause cellular
damage that accumulates as the organism ages.
Free radical theory
 Membranes, nucleic acids, and proteins are
damaged by free radicals, which causes cellular
injury and aging.
 It is the end product of oxidative metabolism.
Produce when the body uses oxygen such as
with exercise. Free radicals cause excessive
cellular damage. Membranes, nucleic acids and
proteins are damaged
 Also known as superoxides, free radicals are
thought to react with proteins, lipids,
deoxyribonucleic acid (DNA), and ribonucleic
acid (RNA), causing cellular damage. - is damage
accumulating over time and is thought to
accelerate aging.
Orgel/Error theory
 Errors in DNA and RNA synthesis occur with
aging.
 Environmental agents and events can cause
error and ultimate cellular changes. (i.e. x-rays)
GERONTOLOGICAL NURSING
 - is theory suggests that, over time, cells
accumulate errors in their DNA and RNA protein
synthesis that cause the cells to die
Wear & Tear theory

 Cells wear out and cannot function with aging.
 Cells in the heart muscle, neurons, striated
muscle and the brain cannot replace
themselves after they are destroyed. Cells wear
out and cannot function with aging
Connective tissue theory
 With aging, proteins impede metabolic
processes and cause trouble with getting
nutrients to cells and removing cellular waste
products.
 Also a cross link theory. Elastin dries up and
cracks with age, skin tends to be drier and
wrinkled because of decreased extracellular
fluid, deposits of calcium, chloride and sodium
build up in cardiovascular system. Proteins
impede metabolic processes cause trouble in
getting nutrients
B. Nonstochastic Theory
- Based on genetically programmed events that
cause cellular damage that accelerates aging of
the organism
Programmed theory
 Cells divide until they are no longer able to, and
this triggers apoptosis or cell death.
 As people age, cells stops dividing
 Apoptosis – death of cell
 Telomeres enzyme
 Telomerase enzyme – the enzyme that
stimulates the addition of telomeric portions to
the end of chromosomes, thereby maintaining
the self-renewal capacity of cells.
THIRD YEAR – FIRST SEMESTER
 also called a “cellular fountain of youth,” allows
human cells grown in the laboratory to continue
to replicate long past the time they normally
stop dividing. Normal human cells do not have
telomerase.
Gene/Biological clock theory
 Cells have a genetically programmed aging
code.
 Comprising genetic influences that predict
physical condition, occurrence of diseases,
cause and age of death and other factors that
contribute to longevity
 Sleep and wake cycles
 Hypothalamus (supraschiamatic nucleus)
neuronal firing
 Cells have aging code genetically
 Melatonin – secreted by pineal gland/hormone
for sleep and wake, fragmented sleep (old)
Neuroendocrine theory
 Problems with the hypothalamus-
pituitaryendocrine gland feedback system cause
disease; increased insulin growth factor
accelerates aging.
 Change in hormone secretion
 Less estrogen (thinning of bones) adipose tissue
becomes the source
 Growth hormone – muscle strength, stimulates
the release of insulin like growth factor
produced by the liver
 Melatonin – pineal gland; responsible for
coordinating seasonal adaptations in the body
 Increase insulin accelerates aging
Immunologic/Autoimmune theory
 Decrease immune function due to thymus gland
shrinking of its capacity, altered lymphocyte
function, cell mediated and humoral immune
response. Immunological function, linked to
general well being
GERONTOLOGICAL NURSING
 Aging is due to faulty immunological function, AGING OF PHYSIOLOGICAL SYSTEMS
which is linked to general well-being.
Aging process

 Occur in one physiological system can directly

Nursing Theories of Aging or indirectly influence other physiological
systems
Functional consequences theory
 Physiological aging is an extremely individual
 Environmental and biopsychosocial process and that how the body ages is greatly
consequences impact functioning affected by a person’s genetic makeup, health
 Nursing role is risk reduction to minimize age – behaviors and availability of resources
associated disability in order to enhance safety
and quality living
 Miller asserts that aging adults experience CARDIOVASCULAR SYSTEM
environmental and biopsychosocial
 Heart and vasculature deliver the blood to
consequences that impact their functioning. - e
every organ system in the body, maintaining
nurse’s role is to assess for age-related changes
oxygen level, supplying nutrients and carrying
and accompanying risk factors, and to design
toxins away to be filtered by the Spleen and
interventions directed toward risk reduction
Liver
and minimizing age-associated disability.
 Main function: maintain homeostasis by
Nursing’s goal is to maximize functioning and
transferring oxygen, nutrients and hormones to
minimize dependency to improve the safety
other organs systems
and quality of living
Aging Changes:

 Enlargement of heart chamber and coronary

Theory of Thriving
cells
 Failure to thrive is caused by discord between  Aged arteries become extended and twisted
individual and environment or relationships  All four cardiac valves increase in circumference
 Nurses identify and modify factors that  SA node demonstrates some fibrosis
contribute to disharmony among these  Loss of pacemaker cells
elements.
Cardiovascular aging mechanism
Theory of Successful aging
 Finding the mechanism responsible for the
 According to this theory, aging successfully aging of the cardiovascular system could lead to
means remaining physically, psychologically and interventions and therapies aimed at reducing
socially engaged in meaningful ways that are the age-associated physiological factors that
individually defined alter cardiovascular structure and functioning.
 Progressive process adaptation
Cardiovascular structural and functional changes that
 Maybe successful or unsuccessful depending
occurs with age
upon person’s ability to cope
 Influence by person’s choices  Structural changes
 Aging people experience changes, according to  Functional changes
their beliefs and perspectives  No change with relation to age
 Cardiac aging
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GERONTOLOGICAL NURSING
 Vascular aging - Ovaries
- Uterus
Autonomic Nervous System Aging effects:
- Vagina
 Orthostatic hypotension  Menopause
 Norepinephrine concentrations increase
MALE REPRODUCTIVE SYSTEM
 Impaired sympathetic nerve response and
resistance in peripheral vessels Aging changes:

RESPIRATORY SYSTEM  Neuroendocrine change

 Male system changes
 Composed of mouth, nose, pharynx, trachea
- Testes
and lungs, as well as the diaphragm and rib
- Glands
muscles.
- Penis
Aging Changes:  Andropause – decline and eventual deficiency
in testosterone levels significant enough to
 Alveoli
cause clinical symptoms
 Lung elasticity
 Chest wall NERVOUS SYSTEM
 Changes in respiratory measures
 2 components: CNS and PNS
Age related pathologies of Respiratory System:
Aging brain:
 Chronic Obstructive Pulmonary Disease (COPD)
 Overall structural changes
 Pneumonia
 Neuron changes
GENITOURINARY SYSTEM  Neurotransmitter change
- Cholinergic
 Contains the kidney and associated renal
- Dopaminergic
arteries and veins, the ureters, bladder and
- Monoaminergic
urethra running through the genital
- Amino acid transmitters
Urinary Structural changes with Age: - Neuroendocrine changes
 Vascular changes
 Kidneys
 Plaques and tangles
 Bladder
 Free radicals
 Ureters and Urethra
Aging Spinal Cord:
Urinary Functional changes with Age:
 Cells
 Urination
 Nerve conduction
 Glomerular filtration rate
 Homeostasis changes Aging Peripheral Nervous System:
 Hormone changes
 The peripheral nervous system contains
FEMALE REPRODUCTIVE SYSTEM approximately 100 billion nerve cells
 Somatic motor neurons
Aging changes:
 Autonomic motor neurons
 Neuroendocrine function  Injury responsiveness
 Female system changes
ENDOCRINE SYSTEM
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GERONTOLOGICAL NURSING
The endocrine system consists of various glands, groups  Loss of motor units
of cells that produce and secrete chemical messengers  Hormonal influences
known as hormones.  Protein synthesis
 Nutritional factors
 Consists of various glands, groups of cells that
- Muscle strength and quality
produce and secrete chemical messengers
known as hormones THE SKELETAL SYSTEM
 Hypothalamus and Pituitary gland: growth
- the skeletal system is composed of the 206
hormone and Vasopressin
bones of the body as well as the joints that
 Adrenal cortex: glucocorticoids,
connect them
mineralocorticoids
- bone
 Pancreas: blood glucose level, age related
 bone type
glucose intolerance, insulin resistance, insulin
- aging of bone
secretion
 type
MUSCLE  strength

Aging changes: AGE-RELATED DISEASE AND INJURY OF THE BONE

 Sarcopenia  osteoporosis
 Changes in muscle fibers  bone fractures
 Loss of motor units  joint types and problems
 Protein synthesis  Immovable joints
 Nutritional factors  Cartilaginous joints
 Synovial joints
SKELETAL SYSTEM
 Disease of joints
Aging changes:  Osteoarthritis

 Osteoporosis SENSORY SYSTEM

 Bone fractures
 Provides constant stimulation to the body and
 Joint types and problems
relays important messages to the mind and
- Immovable joints
body
- Cartilaginous joints
- Synovial joints Aging changes:

THE MUSCLE  Touch

- The ability to touch and distinguish texture and
- The body’s muscular system is composed of
sensation tends to decline with age due to a
three types of muscle – skeletal muscle, smooth
decrease in the number and alteration in the
muscle, and cardiac muscle
structural integrity of touch receptors.
THE SKELETAL MUSCLE
 Smell
- Skeletal muscles are composed of several thin
- The chemical sense of smell and taste work
muscle’s bundles
together and influence each other as a
- Aging of the skeletal muscle
functional entity
 Sarcopenia
 Taste
 Changes in muscle fibers
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GERONTOLOGICAL NURSING
- Taste, or gustation, and the chemoreceptors for  Network of cells and biochemical responsible
taste are located in approximately 10,000 taste for defending the body against pathogens such
buds found mostly on the tongue. as bacteria, viruses, fungi, and parasites.
- Age related gustation changes - Innate immunity
 Vision - Acquired immunity
- The eyes monitor objects and conditions around - Humoral immunity
the body, continually sending sensory messages - Cell-mediated immunity
to the brain such that the body can elicit - autoimmunity
appropriate responses to the outside
HEMATOPOIETIC SYSTEM
environment.
- Age-related changes in visual function  Responsible for production, differentiation and
- Age-related eye disease proliferation of mature blood cells from stem
 Hearing cells.
 Anatomy of the ear  Hematopoiesis
 Middle ear  The blood cells
 Inner ear - Erythrocytes
 Vestibular system - Leukocytes
 Hearing mechanism - thrombocytes
 Hearing loss
STEM CELLS AND AGING
INTEGUMENTARY SYSTEM
- proliferative capacity of stem cells
 Skin, hair, nails, sweat and sebaceous (oil) - CD34+ progenitor stem cells
glands - Age-related changes in the cytokine network
 Skin
- Epidermis
- Dermis ANEMIA AND AGING
- Subcutaneous
- Anemia is a condition in which a deficiency in
Aging changes: the number of erythrocytes or the amount of
hemoglobin they contain limits the exchange of
 Greatest changes in aging skin are seen in the
oxygen and carbon dioxide between the blood
dermis
and tissues
 There is a general thinning of the dermal layer,
- If anemia is diagnosed in older adults there is
with loss of thickness averaging 20% in older
almost always another comorbid medical
persons
condition present and underlying the anemia.
 Estrogen and aging skin
GENETIC ANEMIA
Aging of skin accessory structures
- How a person ages id often attributed to
 Hair,
intrinsic factors, such as genetics and hereditary
 nails
factors, as well as extrinsic factors, such as diet
 glands
and exercise.
IMMUNE SYSTEM - Centenarians, older adult who lived to 100
years or longer, are studied to research genetic
components, disease states, dietary habits,
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exercise regimens, and other factors REPRODUCTIVE SYSTEM
throughout the life span.
- Sexuality is important and maintained in many
COMMON AGEING CHANGES older persons
- Dyspareunia common in postmenopausal
Cardiovascular system
women
- Atherosclerosis increases in older persons
TEACHING AND COMMUNICATING OLDER ADULTS
- Coronary artery disease (CAD) most common
cause of death in Americans Communication Basics:
 Treatable by risk factors modifications – even
- How we provide and receive information from
older old benefit
others
 Exertional chest pain or severe dyspnea –
- Coveys a message between a sender and
cardinal symptom.
receiver
- Congestive heart failure
- Dynamic: ongoing exchange of information with
 Common cause of hospitalization
feedback
 Responds well to aggressive treatment
- Verbal: relies on knowledge of common
- Arterial fibrillation
language
 15% over 65 years old, increased frequency
- Nonverbal: includes tone of voice and physical
with age
behaviors
 Anticoagulation avoids embolic
complications Framework to Understanding Normal and Abnormal
Aging:
Physical changes related to aging pulmonary
a. Normal language and speech
Respiratory system
 The longer one lives, the more that person is
- Generally, no non-disease related pulmonary exposed to a variety of words and meanings
changes are expected in elders. There is an and thus their vocabulary continues to extend
increased incidence of COPD related to b. Developmental maturational paths
exposures, mostly cigarette smoking.  Super-normal or successful aging
- Elders have a higher risk of pneumonia  Normal aging
 Pneumonia vaccination indicated at age  Dementia group
65 for all, for high-risk patients earlier,  Mild cognitive impairment or unsuccessful aging
with a booster at 65
 Influenza carriers’ greater risk,
vaccination helpful COMPREHENSIVE ASSESSMENT

Urinary system changes  Basis of individualized plan of care for an older

adult
- There is an age-related decline in renal function
 Necessary to recognize changes that occur in
- While many older persons are going around
relation to these complex factors
with only 25% of the renal function, they had at
twenty, they have plenty of reserve. Functional Assessment:
- The problem – many drugs are removed by the
 Identify an older adult’s ability to perform
kidney and thus dosing reduction is necessary in
 ADL
older persons.
 Instrumental ADL
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 Advanced ADL  Spiritual assessment
 Physical performance measures  Obesity
 BMI
Physical Assessment:
 History of weight change
 Based on technical competence in physical  Emphasis on weight management
assessment, knowledge of the normal changes  Consultation with nutritionist or dietician
and diseases associated with aging and good
communication skills
 System approach TEACHING & COMMUNICATING WITH OLDER ADULTS

System Approach: COMMUNICATION BASICS

 Circulatory function - How we provide and receive information from

 Respiratory function others
 GI function - Conveys a message between a sender and a
 GU function receiver
 Sexual function - Dynamic: ongoing exchange of information with
 Neurological function feedback.
 Musculoskeletal function - Relies on intact senses, physical and cognitive
 Sensory function processes needed to send and receive
 Integumentary function messages, and a conducive environment. , such
 Endocrine and Metabolic function as hearing and vision, and physical and
 Hematologic and Immune function cognitive processes, all of which are required to
send and receive messages.
Cognitive Assessment: - In addition, the environment must be conducive
 Usually understood in relation to the qualities to permitting message transmission between
of attention, memory, language, visuospatial the sender and receiver.
skills and executive capacity - Verbal: relies on knowledge of a common
 Age related changes vary among older adults language as well as the ability to produce
 Mini Mental State Examination (MMSE) words.
 Assessing the needs of adults with dementia - Nonverbal: include tone of voice and physical
 Declines associated with Alzheimer disease behaviors such as body language and eye
contact.
Psychological Assessment: - patient-centered communication as key
characteristics of quality health care.
 Quality of life
Dimensions of patient centeredness include
Social Assessment: respect for patient values, preferences, and
expressed needs, along with a focus on
 Those with low quantity and quality of social
information, communication, and education of
relationships have a higher morbidity and
patients in clear terms.
mortality risk
 Lubben Social Network Scale Communication and Older Adults
 Seeman and Berkman
- Successful aging is a concept to which both
Other Assessment: young and old aspire. Successful aging includes
not only maintaining physical, cognitive, and
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GERONTOLOGICAL NURSING
functional abilities, but also maintaining
engagement with others, through
communication.
- Environmental and situational factors in uence
nursing communication with older adults. - ese
include the institutional context of
communication, the focus on care tasks,
lessened opportunities for communication, and
intergenerational communication issues.
Additional situations that a ect communication
include the normal and pathological conditions
of aging.
PERSON-CENTERED COMMUNICATION
- Person-centered communication is an integral
part of person-centered care and re ects a focus
on the patient and their unique perceptions and
experiences with health and illness. Nursing
interventions include providing information to
promote health and healing and to engage
patients in self-care. - us, person-centered care
conrms the uniqueness of the patient and
allows the patient to participate in his or her
own care.
Communication Obstacles Faced by Older Adults
Lack of Opportunities
- Older adults experience an increased lack of
opportunities for communication. As age
advances, social networks decline as children
leave home and spouses and signi cant others
die.
Intergenerational Communication
- elderspeak and is widespread in community
and elder-care settings. Elderspeak is similar to
babytalk. adding repetitions and stressing and
altering the pitch of one’s speech, resulting in
speech that is overly caring and controlling and
less respectful than normal adult-to-adult
speech.
- Communication Predicament of Aging Model
describes how these speech modications occur
THIRD YEAR – FIRST SEMESTER
and lead to negative outcomes for older adults.
Aging individuals who receive elderspeak
messages may recognize they are being talked
down to and respond by withdrawing from
engagement in patronizing conversations, or
they may su er increased depression or
decreased self-esteem. Older adults may also
respond by enacting behaviors consistent with
their own negative stereotypes of a frail elder
and may avoid self-care activities.
- Communication Enhancement Model provides
direction for e ective healthcare-provider
communication. - is model directs that the
younger adult healthcare provider make an
individualized assessment of the
communication abilities of each older adult and
only modify speech as needed to support e
ective communication with that individual. For
example, many younger adults assume that all
older adults have hearing loss and speak loudly
and slowly to all elders. For older adults with
intact hearing, excessively loud and high-
pitched speech can be distorted, making it
harder for them to understand.
Cultural Competence and Health Literacy
- A good practice is the teach-back method. A er
providing health information, nurses should
have patients repeat back to them what
information they have received. - is is an easy
and e ective method to assess comprehension
of health teaching.
- Communication in end-of-life care is of critical
importance and may be complicated by
emotional distress and prior relationships with
family and signi cant others. Providing
information may be especially dicult for
healthcare workers when the news is bad or
when listening skills of patients and families are
poor.
Vision Normal-Aging Changes in Vision
- Age-related changes can start occurring in one’s
30s. Over time, the cornea become less
GERONTOLOGICAL NURSING
sensitive and the pupils decrease to about one-
third of their size during young adulthood
- In the normal aging process, presbyopia (aging-
eye) Presbyopia is the decreased ability of the
eye lens to focus on nearby objects due to
normal aging.
Pathological Changes That Affect Vision
Visual impairments in the aging population may be
related to pathological issues such as age-related
1. macular degeneration - is a progressive degeneration
of eye tissue and the e ects are irreversible.
2. cataracts - or opaqueness of the lens, is the most
common age-related eye disease and is reversed
through surgical tre
3. Glaucoma is the slow and progressive deterioration
of optic nerve bers; peripheral vision is impaired rst,
followed by central vision.
4. Diabetic retinopathy, or changes in the eye as a
result of diabetes, can also cause blindness. Early
detection and treatment help to prevent blindness
Vision and Communication
- However, for most people, reading becomes
more di cult. - e person may hold the text
further away in order for it to be clearer, ask
someone else to read it aloud to him/her, or
may simply refuse to read it. Vision issues a ect
the ability to read for enjoyment as well as for
necessary activities such as reading and paying
a bill, being able to see what to order o a menu,
reading a calendar of appointments, or nding a
phone number in the phonebook.
FRAMEWORK FOR UNDERSTANDING NORMAL AND
ABNORMAL AGING
 Normal language and speech
THIRD YEAR – FIRST SEMESTER
- The longer one lives, the more that person is
exposed to a variety of words and meanings,
and thus their vocabulary continues to expand.
 DEVELOPMENTAL MATURATIONAL PATHS
- Supernormal or successful aging
- Normal aging
- Mild cognitive impairment or unsuccessful aging
- Dementia group
AGING TRAJECTORIES
- Super normal or successful aging – able to be
very successful. Engage and socially advantaged
and hit a peak of their mental abilities in late
middle life. they are usually doing what they
enjoy right up to their death.
- Normal aging – does well and hit their social
and cognitive peaks in early midlife, but can
have a couple divergent endings, independent
or needs support.
- Mild cognitive impairments – earlier cognitive
losses and struggles with normal functioning as
they progress past their midlife years.
- Dementia group – needs constant attention,
considered to progress and age very different
from the other three groups.
CATEGORIES OF NORMAL AND ABNORMAL BARRIERS
TO COMMUNICATION
1. INTERNAL
2. EXTERNAL
3. LANGUAGE
Internal barriers and interventions
- Maturational variations in cognition
- Brain function and cognition
- Normal aging changes in cognition with
compensatory strategies
- Pathological changes that affect cognition and
communication
- The effects of cognitive issues on
communication
GERONTOLOGICAL NURSING
BRAIN FUNCTION & COGNITION
Cognitive changes
- As people age, there is a gradual decrease in
brain mass and neuronal function that results in
cognitive changes. Long-term and short-term
memory declines as people age.
a. short term memory
- is limited in capacity and information remains for only
a few seconds. Older adults can hold approximately 5–9
pieces of information in short-term memory, such as a
phone number. Some information in the short-term
memory is then encoded to be stored in
STAC – scaffolding theory of aging and cognition – a
process in which the individuals brain recruits additional
neuron connections for maintain memory and decoding
what has been observed.
Interventions for those with cognitive and language
barriers
- NORMAL AND ABNORMAL CHANGES IN VISION
 CARE PARTNER STRATEGIES FOR
VISIONS BARRIERS
- NORMAL AGING CHANGES IN HEARING
 CARE PARTNER INTERVENTIONS FOR
HEARING IMPAIREMENTS
- PHYSICAL LIMITATIONS
- DUAL SENSORY IMPAIREMENT

EXTERNAL BARRIERS AND INTERVENTIONS

b. long term memory
- ENVIRONMENT NOISE
- is much more expansive than short-term memory and
- POWER OF CHOICE
there is no limit as to how long information can be
- PHYSICAL ENVIRONMENT
stored here.
- CULTURAL SHIFTS IN LIVING ENVIRONMENT

LANGUAGE FOR IMPROVING COMMUNICATION WITH

1. declarative OLDER ADULTS

- factual information that can be declared and is divided - BUILDING TRUST AND RESPECT
into three types:  AVOID ELDERSPEAK
 COMMUNICATION PREDICAMENT OF AGING
A. episodic (event)
MODEL
b. sematic (concepts)  PAY ATTENTION TO THE NONVERAL
 PARTNERING COMMUNICATION
c. lexical (word memory)
 USE PERSON-FIRST LANGUAGE
 INLCUDE THE PATIENT
 SPEAK SLOWER AND PAUSE BETWEEN PHRASES
2. non declarative  PROVIDE ADDITIONAL TIME FOR THE PERSON
A. MOTOR SKILLS TO RESPOND
 SIMPLIFY VOCABULARY AND AVOID JARGON
B. COGNITIVE SKILLS  USE SHORT, DIRECT, CLEAR PHRASES
C. REFLEX RESPONSE  USE APPROPRIATE TOUCH TO COMMUNICATE
 SPEAK IN THE DIRECTION OF THE PERSON
D. PRIMING  SPEAK INTO THE EAR WITH LESS OR NO
E. CONDITIONED RESPONSES HEARING LOSS
 WRITE OUT INFORMATION
COMPENSATORY SCAFFOLDING  PROVIDE WRITTEN INFORMATION IN LARGE,
EASY-TO-READ PRINT
THIRD YEAR – FIRST SEMESTER
GERONTOLOGICAL NURSING
 ENCOURAGE USE OF CAUSE
 ELIMINATE OR MINIMIZE BACKGROUND NOISE
 LIMIT THE NUMBER OF SPEAKER
 POSITION YOURSELF IN THE PERSON’S DIRECT
LINE OF VISION
 USE GESTURES TO AID IN COMMUNICATION
 MAKE SURE ANY ASSISTIVE DEVICES ARE ON
AND WORKING
USING THE COMMUNICATION ENHANCEMENT MODEL
 THIS MODEL DIRECTS THE YOUNGER ADULT
HEALTHCARE PROVIDER TO MAKE AN
INDIVIDUALIZE ASSESSMENT OF THE
COMMUNICATION ABILITIES OF EACH OLDER
ADULT AND MODIFY SPEECH ONLY AS NEEDED
TO SUPPORT EFEFCTIVE COMMUNICATION
WITH THE INDIVIDUAL.
- COMPENSATORY STRATEGIES
- RESTORATIVE STRATEGIES
REGULATORY COMMUNICATION GOALS FOR OLDER
ADULTS
- COMMUNICATING WITH FAMILIES AND
SIGNIFANT OTHERS
- DEVELOPING STRATEGIES FOR EFFECTIVE
COMMUNICATION WITH PERSONS WITH
VISION, HEARING, COGNITIVE, AND/OR SPEECH-
LANGUAGE IMPAIRMENTS.
TEACHING OLDER ADULTS AND THEIR FAMILIES
- OLDER ADULTS MAY HAVE UNIQUE PHYSICAL,
PSYCHOLOGICAL, OR COGNITIVE LIMITATIONS
THAT AFFECT LEARNING ABILITY SIMILAR TO
HOW THESE SAME LIMITATIONS AFFECT
SPEECH AND COMMUNICATION
- UNDERSTANDING PHYSICAL, PSYCHOLOGICAL,
AND COGNITION CHANGES IMPACTING
LEARNING
THEORY OF ADULT LEARNING
- ADULTS NEED TO KNOW WHY THEY NEED TO
LEARN SOMETHING BEFORE LEARNING IT.
THIRD YEAR – FIRST SEMESTER
- THE SELF-CONCEPT OF ADULTS IS HEAVILY
DEPENDENT ON A MOVE TOWARD SELF-
DIRECTION.
- PRIOR EXPERIENCES OF THE LEARNER PROVIDES
A RICH RESOURCE FOR LEARNING
- ADULT TYPICALLY BECOME READY TO LEARN
WHEN THEY EXPERIENCE A NEED TO COPE
WITH A LIFE SITUATION OR PERFORM A TASK
- ADULTS ORIENTATION TO LEARNING IS LIFE-
CENTERED; EDUCATION IS A PROCESS OF
DEVELOPING INCREASED COMPETENCY LEVELS
TO ACHIEVE THEIR FULL POTENTIAL
- THE MOTIVATION FOR ADULT LEARNERS IS
INTERNAL RATHER THAN EXTERNAL.
STRATEGIES FOR TEACHING OLDER ADULTS
- USE THE PRINCIPAL OF ADULT LEARNING
THEORY
- USE MULTIPLE TEACHING MODALITIES TO KEEP
THE MATERIAL INTERESTING AND MAINTAIN
ATTENTION.
- REMEMBER TO ACCOMMODATE ANY USUAL
PHYSICAL NEEDS
- MAKE PRESENTATIONS ELDER-FRIENDLY
TECHNOLOGY FOR OLDER ADULTS’ LIFELONG
LEARNING
- DEVELOP A STRUCTURED AND SIMPLE
INTERFACE PROCESS.
- MAINTAIN FEEDBACK PROCESSES OFFERING
WAYS TO MAKE ADJUSTMENT.
- BE READY TO ASSIST THE USER IN HOW HE OR
SHE THINKS THROUGH AN ISSUE AND GIVE
GUIDANCE FOR DECISION MAKING.
- INTEGRATE LEARNING PRINCIPLES ALLOWING
FOR DIVERSE WAYS OF GAINING INFORMATION
STRATEGIES FOR EFFECTIVE COMMUNICATION
(VISION, HEARING, COGNITIVE, SPEECH-LANGUAGE
IMPAIRMENT)
VISION
- USE PERSON – FIRST LANGUAGE
- INCLUDE THE PATIENT
GERONTOLOGICAL NURSING
- PROVIDE INFORMATION IN LARGE EASY TO
READ PRINT
- POSITION YOURSELF IN THE PERSON’S DIRECT
LINE OF VISION
- MAKE SURE GLASSES ARE WORN
- USE RELATIONAL CONNECTIONS AND PARTNER
WITH THE PATIENT

HEARING

- USE PERSON – 1ST LANGUAGE

- USE SLOWER SPEAKING RATE AND PAUSE
BETWEEN PHRASES
- INCLUDE THE PATIENT AND ASK IF YOU ARE
SPEAKING LOUD ENOUGH
- PROVIDE ADDITIONAL TIME FOR THE PERSON
TO RESPOND
- SUMMARIZE
- SPEAK INTO THE EAR WITH LESS HEARING LOSS
- WRITE OUT INFORMATION
- ELIMINATE OR MINIMIZE BACKGROUND NOISE
- LIMIT THE NUMBER OF SPEAKERS IN THE ROOM
- POSITION YOURSELF IN THE LINE OF DIRECT
VISION
 MAKE SURE THE HEARING AIDS OR ASSISTIVE
LISTENING DEVICES ARE WORKING
- SAY THE PERSONS NAME
- USE TOUCH TO GAIN ATTENTION
- USE RELATIONAL CONNECTIONS AND PARTNER
WITH THE PATIENT

THIRD YEAR – FIRST SEMESTER