PREPARED BY: CLEENSEA CAMILLE R.

ERREA
CARE OF OLDER ADULTS NCM114j lower BP, less depression, fewer heart
attacks and lower incidence of CA.
MODULE 1 • Proper nutrition also has the same affect
Meanings: on the aging process, it delays the
progression of debilitating illness or
Elderly: means old aging disability.
Aging • Recent research even suggest that
weight loss and exercise can reverse
• part of life changes that occurs as one the severity of diabetes.
grows older or maturation process.
• Inevitable and steadily progressive that
begins at the moment of conception and
continuous throughout the remainder of
life.
Geriatric
• come from a Greek word GERON
means “old man” and IATROS meaning
“healer or medicine”
• Related to caring for old people
Gerontology
• Study of all aspects the aging process
and its consequences in human
• Scientific holistic study of aging process
and problems of aging
Gerontology Nursing: branch of nursing /
specialty of nursing pertaining to older adults
Older Adults
• Young Old: 65-74 years
• Middle Old: 75-84 years
• Old Older: 85 and older
Presently: 12.8% of population
2030: will increase to 20% of population

Attitudes Toward Aging

• Many elderlies buy into the notion that
they themselves are no longer useful
and are a burden to others.
• Aging makes little attempt to keep
themselves healthy and active after all,
they are getting closer to the end of their
lives.
• No desire to try new things or to
challenge themselves or to eat or
exercise properly.
• There is a great deal of research that
demonstrate aging individuals can learn,
retain memory and be actively involved
in business and their community.
• Lack of physical exercise, social
involvement and mental stimulation in
older adults that leads to deterioration of
minds and bodies.
• Older person’s negative attitude towards
aging become self-filling.
• Studies show older people who are
physically active have less joint pain,
Gerontophobia: fear of aging, of getting old;
of the elderly
Ageism
• stereotyping and descripting against an
individual or groups on the basis of their
age; this maybe systematic or casual
• coined din 1969 by Robert Niel Butler to
describe discrimination against seniors
and patterned on racism and sexism.
• Butler defined it as combination of three
connected elements
1. Prejudicial attitude towards older people
and the aging process
2. Discriminatory practices against older
people

3. Institutional policies and practices that
perpetuates stereotypes about elderly
people.
Negative discriminatory practices among
people of old age or “Age related Bias”
Cultural Factors/Ethnicity Respect and
Health Perception for Older Person
Where we have been:
• each culture of elderly brings a unique
history that has shaped and formed who
they are and how they view around them;
• there are common influences that cut
across racial lines however looking at
cultural and racial concerns one must
identify the cultural meaning and the
dynamics of the aging process with in
specific minority groups.
Where we are now:
• Current generation of the elderly as the
"Quiet Revolution" defining them as a
revolution of older individuals
representing the broadest range of
ethnic, cultural, regional, religions,
political and socioeconomic diversity
ever witness in a certain society.
• "Kanlungan ni Maria Home for the
Aged" in NCR
• "DSWD"- Home for the elderly" Talon-
Talon Zamboanga City
• As a result of poor adequate resources
among the poor, life expectancy is six
years less than other populated group.
Twice the total population for elderly in
the Philippines in favor of living with
relatives this is based on the idea of
familia « family is forever"
• Social factors among the family include:
1. High percentage that live below
poverty level
2. Inadequate health care brought about
by poverty cultural factors
3. High illiteracy rate
4. Low occupational levels resulting from
few benefits and retirement plans
• Traditional Asian culture often observe a
form of “filial piety" which demands
family members usually the eldest son to
respect, care for and assume
responsibility for elder parents.
Unfortunately, this traditional attitude of
respect
PREPARED BY: CLEENSEA CAMILLE R. ERREA
often clash now with dominant American
values. This cultural cash results to 75%%
living with their children dropped to 66%
lately.
Where we are going:
For the general population the implication for the
aging population will require competent
individuals train to respect and work with such
diverse group.
Factors include:
1. Income
2. Health Care
3. Poverty
4. Religious and spiritual beliefs
Respect Cultural Diversity
• LISTEN to concerns
• SHARE knowledge and build MUTUAL
UNDERSTANDING
• SEEK collaborative solution
• RESPECT cultural diversity
• Identify and build upon STRENGHTS
• Set children up for SUCCESS in learning
• SHARE and CELEBRATE successes
PREPARING FOR OLD AGE
“Preparing for the Golden Years"
Four Essential Preparations for Our Rusty
Years:
1. 1.Planning for The Stages of Decline
2. Initiating Family Planning Conversation
3. Making End-of-Life Arrangements
4. Getting our Financial Ducks in a Row
Theories of Aging
2 types of theory:
1. Biological Theory
2. Psychosocial Theory
Biological Theory:
• Attempts to explain physical aging as an
involuntary process, eventually leads to
cumulative changes in cells, tissues and
fluids.

2 Sub Type:
Intrinsic biological Theory
• Maintains that aging changes arise from
internal predetermined causes.
Extrinsic biological Theory
• Maintains that environmental factors
lead to structural alterations, causes
degenerative changes.
A. Free-radical Theory:
• Very famous theory of aging was
developed by Denham Harmen MD in
1956
• Free radicals are molecules with extra
cellular changes, which alters the
structure and function of the cell
membrane.
• Increased unstable free-radicals
produces harmful effects to biological
systems, such as chromosomal & DNA
changes.
• Oxidation of fat, protein and
carbohydrates within the body produces
the free radical.
B. Cross-link theory / Connective Tissue
Theory:
• This theory asserts that the molecules of
collagen and elastin, connective tissues
components, from bonds increase the
cell rigidity.
• Chemical reaction occurs as a chemical
bond between cells it will separate
normally bonded cells.
• Attributes aging to chemical changes
that happen in the body.
C. Immunological Theory:
• Theories suggest that the immune
system is responsible for aging.
• An aging immune system is less able to
attack and destroy body cells as if they
are foreign cells (antigen).
PREPARED BY: CLEENSEA CAMILLE R. ERREA
• It results in destroying own body cells
through auto aggression or
immunodeficiency.
D. Error Theory
• Focus on decreased bonding of
protein cells in response to stressors
such as radiation.
• Lead error in synthesis of RNA and
DNA that produces cells with
impaired function.
E. Wear and Tear Theory:
• Body cells, structures and function
wear through exposure to internal
and external stressors.
• The more you abuse your body, the
faster it will wear out.
Example: More stressors (taking more weight)
in younger age ultimately leads to tearing like
spinal cord or joint problems.
F. Genetic Theory or Gene Theory:
• Genetic inclination
• Lifespan is largely determined by the
genes we inherit.
• Longevity is primarily determined at
the amount of conception and is
largely reliant on our parents and
their genes.
G. Neuroendocrine Control /
“Pacemaker Theory” Aging Clock;
Hormone Theory:
• Results from the functional
perturbations both in neutral control
and endocrine output of the
hypothalamic-pituitary-adrenal axis.
• Dysfunction in the activity of various
endocrine glands and their target
organs.
Psychosocial Theories
A. Disengagement Theory
• Formulated by Cummings and
Henry in 1961
• States that aging people are
withdraw from customary role
and engage in more
introspective, self-focused
activities.
• Decrease participation in society
resulting from age related
changes in health, energy,
income and social roles.

This theory includes 4 basic concepts:
• Aging person withdraws from society.
• Disengagement is biologically and
psychologically intrinsic and inevitable.
• Disengagement is considered
necessary for successful aging.
• Disengagement is beneficial for older
adult and society.
B. Continuity Theory /
Developmental Theory:
• States personality remain same and
behavior become more predictable as
people age.
• Mainly focus on personality and
individual behavior over time.
C. Activity Theory:
• The maintenance if optimal physical,
mental and social activity is necessary
for successful aging.
D. Adjustment Theory:
• This defines as a serious of adjustment
to retirement, to grand parenthood, to
changes in income, to changes in social
life, marital status and to potential
deterioration of health and wellbeing.
E. Gerotranscedence Theory:
• Meaning of life is clear
• Aware of God purpose; prayer; training
younger people; more on what you can
give to others.
F. Age stratification Theory:
• Group together as on (bingo social,
prayer meeting)
G. Selective optimization with
compensation Theory:
• Strategy for improving health and well
being in older adults and a model for
successful aging thing’s you can’t do
before, you compensate doing similar.
H. Functional Consequences Theory:
• Focuses on the needs that are unique to
older individuals.
• Proposes the ability of older adults to
maintain maximal care is affected by the
interaction of normal age-related
changes and additional risk factors the
individual encounters.
PREPARED BY: CLEENSEA CAMILLE R. ERREA
I. Theory of Thriving:
• A good gerontological theory that
integrates knowledge, tells how and why
phenomena are related to prediction
and provide process and understanding.
• Author created this theory with a holistic
lifespan perspective for studying people
in their environments as they age.
Normal Aging Process
Factors which influence aging:
• Hereditary Factors
• Environmental factors
➢ Abiotic Factors (Pollutants,
radiation,etc)
➢ Biotic Factors (Living Organism)
• Socioeconomic factors (Stressors)
Advance Directive
• Living will regarding health matters
• Durable power of attorney for health
matters
MODULE 2
Care for the Older Persons:
• Normal developmental process
• Occurring throughout the human
lifespan
• Causes a mild progressive decline in
body system functioning
Chronological Age:
• Refers to the number of years the
person has lived
• Most commonly used objective method
• Serves a s a criterion in society for
certain activities, such as driving,
employment and the collection of
retirement benefits.
Physiological Age:
• Refers to the determination of age by
body function
Functional Age
• Refers to a person’s ability to contribute
to society and benefit others and
himself.
➢ Fastest growing population – Age 75
➢ Those who require help – frail elderly
➢ Non-institutionalized adults 75-84 ---
25% need help with daily activities
➢ Aged 85 and older – one half need
help with daily activities.

Psychological Theories
Explain aging in terms of mental processes,
emotions attitudes, motivation, and personality
development that is characterized by life stage
transitions.
A. Human Needs
• Five basic needs motivate human
behavior in a lifelong process toward
need fulfillment.
• Maslow surmised that a hierarchy of five
needs motivates human behavior:
physiologic, safety and security, love and
belonging, self-esteem, and self-
actualization.
B. Individualism
• Personality consists of an ego and a
personal and collective unconsciousness
that views life from a personal or external
perspective.
• Older adults search for life meaning and
adapt to functional and social losses.
C. Stages of Personality Development
• Personality develops in eight sequential
stages with corresponding life tasks.
• The eighth phase, integrity versus
despair, is characterized by evaluating
life accomplishments; struggles include
letting go, accepting care, detachment,
and physical and mental decline.
D. Life Course / Lifespan Development
• life stages are predictable and
structured by roles, relationships,
values, and goals.
• Persons adapt to changing roles and
relationships.
• Age group norms and characteristics
are an important part of the life course.
1. Age Cohorts
• Persons who share the experience of a
particular event or time in history are
grouped together in what is called a
cohort.
• a) AGES 55 TO 64
persons in this age group are generally
healthy and have resources to maintain
housing.
• b) AGES 65-74
Retirement ordinarily causes income to
decrease by about 35% or more. This
reduction in income often offset by
reduced expenditures associated with
PREPARED BY: CLEENSEA CAMILLE R. ERREA
working, such as transportation, clothing
and meals (away from home).
• c) AGES 75-84
Many persons in this age group live
alone, which affects their average
household income.
• d) AGES 85 AND OLDER
This age cohort is at risk for an increase
in chronic disease, resulting in
decreased ability to perform daily
activities of daily living(ADL) and
increased expenses for assistance,
assistive devices, and medication.
• Has the lowest average annual income
level of all older Americans.
2. Poverty
• Inadequate income may affect the
quality of life for older adults.
• Delay seeking medical help.
• May not follow through with the
prescribed treatment or medications.
3. Education
• Has been shown to have a strong
relationship to health risk factors.
• The level of education influence, earning
ability, information absorption, problem-
solving ability, value systems, and
lifestyle behaviors
4. Health Status
• The health status of older adults
influences their socioeconomic status.
Persons over 65 have an average of 2
chronic conditions (Lorig, 1993)
➢ The most common chronic problems in
1994 were arthritis(50%), followed by
hypertension (36%), heart disease
(32%), hearing impairments (29),
cataracts (17%), orthopedic impairments
(16%)16%%, sinusitis (15%) and
diabetes.
➢ Functional Ability - measured by the
individual's ability to perform ADLs and
instrumental activities of daily living
(IADLS).
➢ ADLs include six personal care
activities: eating, toileting, bathing,
transferring, dressing, and continence.
➢ IADLs -refers to the following home-
management activities: preparing meals,
shopping, managing money, using the
telephone, doing light housework, doing

laundry, using transportation and taking
medications appropriately.
➢ Nurses can work with older adults -
prolong independence by encouraging
self-management of chronic conditions.
➢ Self-management is defined as learning
and practicing the skills necessary to
carry on an active and emotionally
satisfying life.
5. Insurance Coverage
• Health insurance is a necessity for older
adults because of medical problems
therefore medical expenses- increase
with age.
• As persons age, they visit the doctor
more often (US Census Bureau, 2004).
6. Support Systems
• throughout lite, people make new
acquaintances, develop friendships, and
form family circles. People identify with
schools, churches or synagogues,
clubs, neighborhoods, and towns.
• These are the places and people they
turn to when they need advice or help,
want to celebrate, or are grieving.
The Aging Family
• A basic social unit consisting of parents
and their children, considered as a
group whether dwelling together or not:
the traditional family.
• A social unit consisting of one or more
adults together with the children they
care for: a single-parent family, any
group of persons closely related by
blood, as parents, children, uncles,
aunts, and cousins: to marry into a
socially prominent family.
Family Members:
• form the nucleus of relationships for the
majority of the older adults and the
support system it they become
dependent.
• Intergenerational web: sons, daughters,
stepchildren, in-laws, nieces, nephews,
grandchildren and great grandchildren.
• All these people may play an important
part in maintaining satisfaction in later
life.
Roles And Relationship:
• Roles of members CHANGE.
PREPARED BY: CLEENSEA CAMILLE R. ERREA
• Grandparents may assume parental
roles to their grandchildren.
• Adult children may provide limited or
extensive caring to their own parents.
• This caregiving may be TEMPORARY
or LONG-TERM.
Important Issues and Future Directions:
• The family -most precious naturally
occurring and cost-effective resources.
Its role in protecting our elders must be
supported and augmented.
• The health of our older citizens can best
be protected and improved by both
supporting and educating the family as
the primary vehicle for maintaining the
health and well-being of all members of
our aging society.
Aging Changes in Cardiovascular
Structure:
Cardiac Aging
• Enlargement of heart chambers and
coronary cells occurs with age, as does
increased thickening of the heart walls.,
especially in the left ventricle.
• Ventricles in the heart also begin to
thicken and stiffen in correlation with
continued steady production of collagen.
Vascular Aging
• Aged arteries become extended and
twisted. With age, large arteries begin to
dilate and stiffen, leading to
hypertension.
Aging of the Respiratory System:
Alveoli
• The volume of blood distributed to
pulmonary circulation declines with age
due to a decreasing number of
capillaries per alveolus -impairs efficient
passage of oxygen from the alveoli to
the blood.
Lung Elasticity
• With age, there is a decrease in the
lungs' elasticity, which in turn causes a
change in the elastic recoil properties of
the lungs. Loss of elastic recoil causes
the lung s to close prematurely, trapping
air inside and preventing the lungs from
emptying completely.
The Chest Wall

• The Chest Wall becomes stiffer with
advancing age, decreasing the ease
with which the thoracic cavity can
expand. The stiffness of the chest
reduces its ability to expand during
inhalation and contract during
exhalation.
Aging of the Gastrointestinal System:
Pharynx and esophagus
• Overall, the gastrointestinal system
appears to be relatively preserved in
aging with only minor changes.
• The two gastrointestinal areas most
affected by age are the upper tract
(pharynx and esophagus) and the colon.
Stiffening of the esophageal wall affect
the older patient's ability to swallow.
Dysphagia, reflux, heartburn and chest
pain are common complaints.
The Large Intestine
• The rectum, a colonic structure that is
located before the anus, shows age-
related increase in fibrous tissue. This
increase reduces the rectum's ability to
stretch as feces pass through.
Urinary Structural Changes with Age:
Kidneys
• With age, the kidneys shrink in length
and width. Changes in renal blood flow
and glomerular filtration rate (GFR)
account for a majority of functional
disability in the kidneys with age.
Bladder
• With age, the bladder decreases in size
and develops fibrous matter in the
bladder wall, changing its overall
stretching capacity ad contractibility
(Diogiovanna, 2000).
Urination
• The amount of urine expelled from the
body decreases with age.
Reproductive System:
Ovaries
• With age, the ovaries atrophy to such a
small size that they can become
impalpable during an exam. (Smith,
1998).
Uterus
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• Age-related decreases in uterine
endometrial thickening during menstrual
cycles occur as the result of decreased
estrogen and progesterone levels. -
decline in menstrual flow.
Vagina
• With age, the vagina becomes shorter
and narrower and the vaginal walls tend
to thin and weaken. As a result, the
vagina can become very dry, causing
intercourse to be very painful.
Menopause
• The menopause transition is defined by
declines in estradiol along with the onset
of variable menstrual cycles. Periods of
amenorrhea trigger the move into the
late stages.
Testes
• In aging, the testes decrease in both
size and weight, but with high variability
among men. Although a decline in
sperm production occurs in aging males,
the production never ceases, as a
result, the older male remains fertile.
Glands
• The biggest concern in older males is
changes in the prostate gland. The
lining and muscle layer of the prostate
gland become thinner with age,
probably dueto the reduced blood flow
to the area.
• Benign Prostatic Hypertrophy (BPH)--
remains very common among aging
males.
Penis
• The penis begins to show fibrous
changes in erectile tissue around the
urethra starting in the 30's and 40's.
This fibrosis in erectile tissue – increase
in the amount of time it takes to achieve
an erection l older male.
Andropause
• a decline in testosterone levels and
eventually deficiency significant enough
to cause clinical symptoms (American
Society for Reproductive Medicine).
• Unlike menopause, andropause Occurs
gradually over time and does not occur
in all aging males.

• Symptoms include: low libido;
decreased energy, strength and
stamina; increased irritability; and
cognitive changes.
Nervous System:
The Aging Brain
• Memory changes can be observed by
the fifth decade, but changes remain
variable among individuals. The brain
decreases in size and weight as men
and women age.
The Aging Spinal Cord
Nerve Conduction
• According to Abrams and colleagues
(1995), the aging spine may narrow due
to pressure on the spinal cord resulting
from bone overgrowth. Due to this
narrowing, changes in sensation can
occur.
The Muscle:
• A reduction in muscle mass occurs to at
least some degree in all elderly persons
as compared to young healthy,
physically active young adults ---
sarcopenia.
• Sarcopenia -associated with
tremendous increases in functional
disability and frailty.
The Skeletal System:
Estrogen deficiency
• key contributor to bone loss and bone
loss accelerates in women after
menopause due to a decline in estrogen
levels.
Estrogen deficiency
• plays a role in bone loss among men--
due to a decline in levels of estrogen,
not testosterone.
Osteoporosis
• Results from reductions in bone quantity
and strength that are greater than the
usual age-related reduction. Bones of
those with osteoporosis are very
porous--containing numerous holes or
empty pockets--prone to fracture.
Sensory System:
Touch
• The ability to touch and distinguish
texture and sensation tends to decline
PREPARED BY: CLEENSEA CAMILLE R. ERREA
with age due to a decrease in the
number and alteration in the structural
integrity of touch receptors or
Meissener's corpuscles and pressure
receptors or Pacinian corpuscles.
• Receptors that are related to the sense
of touch are also known as
mechanoreceptors.
Smell
• A decrease in the number of olfactory
neurons and weakening of olfactory
neural pathways to the brain lead to a
reduction in the ability to identify and
distinguish aromas. A decrease in the
sense of smell is referred to as
hyposmia.
Taste
• Aging causes a deerease in taste, also
known as bypogensia, usually more
noticeable around the age of 60 with more
severe declines occurring after the
age of 70.
Vision
• most common visual concerns in aging -
- presbyopia or the inability to focus on
nearby objects, such as newsprint. This
is also called farsigbtedness.
Hearing
• Age-related hearing loss occurs as a
result of changes in the inner ear.
• Aging changes that cause hearing loss
include the alteration and decline in the
ability to hear high frequency sounds,
and the ability to discern. Age-related
hearing loss, also known as
presbycusis--most common sensory
deficit in the older population.
The Integumentary System:
• The greatest changes in aging skin -
dermis. There is a general thinning of
the dermal layer, with loss of thickness
averaging 20% in older persons.
• This thinning of the dermis is due in
large part to a general loss of collagen-
approximately 1% loss per year in
adulthood.
The Immune System:
Immunosenescence
• refers to the aging of the immune
system.

• Associated with increased incidence of
infectious disease such as bronchitis
and influenza.
• It is also implicated in the increased
incidence of tumors and cancer that
occurs with age.
Cultural Factors / Ethnicity
Ethnicity
• Refers to what some have called race.
Ex, African, European, Asian
Nationality
• Refers to the geographic location of the
person's birth (or the country with which
he or she identifies)
Diversity of Elders
• Wide range of life experiences
• Lifestyles
• Health status
• Socioeconomic status
• Religion
PREPARED BY: CLEENSEA CAMILLE R. ERREA
Geriatric Assessment
• "A multidisciplinary diagnostic
process intended to determine a frail
older person's medical, functional,
and psychosocial status and
limitations in order to develop a plan
for treatment and long-term follow-
up"
• Diagnose and develop an overall plan
of care for treatment and long term
follow up
• Optimizes independence and prevent
future disabilities.
Functional Assessment:
Identify an older adult's ability to:
• perform self-care, self-maintenance, and
physical activities.
Disability
• impact that health problems have on an
individual's ability to perform tasks,
roles, and activities

Patterns of Health & Disease in the Older Physical Assessment:

Adult • Physical assessment with a "systems"
A. Diseases that occur to varying degrees approach, reviews each body system
in most older adults first by taking a history-then physical
1. Cataracts examination.
2. Arteriosclerosis
3. Benign prostatic hypertrophy [males] 1. Circulatory Function
• Family history, current problems with
B. Diseases with increased incidence with chest pain/discomfort (exertion); current
advancing age diagnoses and associated medications;
1. Neoplastic disease over-the- counter and herbal medicines;
2. Diabetes mellitus sources of stress; adherence to current
3. Dementia disorders medical regimens.
• Physical examination, blood pressure,
C. Diseases that have more serious chest sounds, pulse rate.
consequences in the • Exercise stress test, blood and serum
elderly tests, electrocardiograms and other
1. pneumonia tests for imaging and assessing the
2. influenza condition of the heart and blood vessels.
3. trauma
2. Respiratory Function
D. Very common chronic diseases • Current medications /history of smoking
1. arthritis behavior and exposure to environmental
2. hypertension pollutants.
3. heart disease • Assess: current difficulties and anxieties
associated with breathing, decreased
E. Functional disability energy to complete everyday tasks,
1. 32% of persons Over 65 years have some frequent coughing, and production of
limitation of functions excess sputum.
2. 25% of persons over 65 years require help • Observation of posture and
with at least one ADL or IADL. breathlessness, and listening to chest
sounds.

• Pulmonary function test, chest x-ray,
and sputum analysis.
3. Gastrointestinal function
• Usual diet; appetite and changes in
appetite; nausea, vomiting, indigestion,
stomach discomforts; problems with
bowel function (constipation and
diarrhea)
• Barium enemas and x-rays, stool
analysis examination of the colon.
• Oral health assessment -overlooked
with older adults-
"Oral health practices including brushing,
flossing, and regular contact with a dentist.”
4. Genitourinary Function (sometimes
neglected)
• Abnormal bleeding, vaginal discharge,
urinary symptoms. Pelvic examinations
and Pap smears.
• Older men- enlarged prostate
• Chronic Renal Failure -complication of
age-related diseases (diabetes and
hypertension).
• Incontinence - not a normal part ot aging
• Health history -previous or current
difficulties related to the frequency and
voluntary flow of urine during either the
day or night; medication use.
• Urine analysis tests for blood, bacteria,
and other components.
5. Neurological Function
• Medications, medical diagnosis related
to the neurological system (history or
family history of stroke)
• Previous and current impairments in
speech, expression, swallowing,
memory, orientation, energy level,
balance, sensation, and motor function.
• Sleep disturbance, tremors, and
seizures.
6. Musculoskeletal Function
• The most commonly reported illness
among older adults is osteoarthritis
(weight-bearing joints-hips/ knees).
• Observation of posture and walking can
assist in asking the appropriate
questions:
✓ Does the older adult favor one
side of the body while walking?
✓ Are assistive devices such as
canes and walkers being used?
PREPARED BY: CLEENSEA CAMILLE R. ERREA
*Canes and walkers should be at the
appropriate height in relation to body height.
7. Sensory Function
• Diminished vision and hearing- greatest
impact on older adults. -- negative
effects on social interaction -- Social and
psychological health.
• *The following two Screening
procedures are simple tests for
functional vision:
✓ Ask the older adult to read a
newspaper headline and story
✓ Ask the older adult to read the
prescription bottle
• Hearing loss is a major concern for
many older adults.
• *The following question is useful in
assessing ear and hearing problems:
✓ Are you experiencing a hearing
problem or any ear pain, ringing
in the ears, or ear discharge?
• older adults wearing hearing aids--
regularly assessed and monitored.
8. Integumentary Function
• Skin problems and concerns and
inspecting the skin.
• Skin injury =close monitoring and
treatment
• Rashes, itching, dryness, frequent
bruising, and any open sores.
• Color, hydration, circulation, and
intactness.
9. Cognitive Assessment
• Attention, memory, language.
• *The most extensively used cognitive
assessment tool is the Mini Mental State
Examination (MMSE) --measures
change in cognitive impairment.
Psychological Assessment:
• Weighted toward assessment of mental
disorders.
• Clinical Depression -most common
mental health problem among older
adults
Social Assessment:
• social network and on the interaction
between the older adult and family,
friends, neighbors, and community.

Spiritual Support:
• Religiosity -believing in God, organized
rituals
• Spirituality -ideas of belief that
encompasses personal philosophy and
an understanding of meaning and
purpose in life.
Problems Related to the Older Persons
1. Physiologic Functioning
➢ Urinary Incontinence
- common problem of the elderly and has
tremendous impact on both the
morbidity and quality of life of elderly
people.
a) Stress Incontinence- involuntary loss of
urine during activities that increase intra-
abdominal pressure lifting, coughing,
sneezing and laughing).
b) Urge Incontinence - associated with a
strong, abrupt desire to void and the
inability to inhibit leakage in time to
reach the toilet.
c) Reflex Incontinence - results from
uninhibited bladder contractions with no
sensation of needing to void or urgency.
d) Overflow Incontinence - overdistention
of the bladder due to abnormal emptying
e) Functional Incontinence - refers to
problems from factors external to the
lower urinary tract (cognitive
impairments, physical disabilities)
Management of Incontinence:
• Managing Hydration
• Prompted Voiding
• Bladder Training
• Pharmacological management
Sleep Disorder
• more prevalent with age. Individuals
with multiple illnesses rate their sleep as
being of poorer quality
➢ Management of Sleep Disorder:
✓ Sleep Hygiene
✓ Environmental Restructuring
✓ Medications- Zolpidem (Ambien),
Zaleplon (Sonata)
2. Behavioral
• Anxiety
➢ tachycardia and palpitations,
gastrointestinal disorders, insomnia, and
tachypnea
PREPARED BY: CLEENSEA CAMILLE R. ERREA
❖ Nursing Care;
✓ Decrease environmental
stimuli
✓ Stay with the patient
✓ Make no demands and do not
ask patient to make decisions
✓ Support current coping
mechanism (crying, talking,
etc.)
✓ Don't confront or argue with
the patient
✓ Speak slowly in a soft, calm
voice
• Depression
➢ Although depression is the most
common mental health disorder in older
adults, it is not a normal consequence of aging.
❖ Interventions:
✓ Pharmacological therapy- tricyclic
anti-depressants
✓ Exercise
✓ Counseling
• Polypharmacy
➢ the act of taking many medications
concurrently
➢ The consequences of polypharmacy in
the older adult range from mild annoying
to life threatening
➢ adverse drug reactions/drug-drug
interaction medication errors
➢ non-adherence not willing to follow the
instructions given for prescribed
treatments.
3. Safety
• Falls an event which results in a person
unintentionally coming to rest on
• the ground or another lower level.
❖ Interventions:
✓ Modify the environment
✓ Evaluate Gait and balance-
assess muscle strength and
ability frequently and institute
appropriate measures for safe
mobility and transfer
techniques
✓ Review Medications
 PREPARED BY: CLEENSEA CAMILLE R. ERREA
MODULE 3
LEVELS OF CARE • Skilled Nursing Care - refers to a
patient's need to care or treatment that
Primary: can only be performed by licensed
• Prevention of both illness and disease nurse. A nursing home is a facility for
promotion of wellness, when both illness the residential care of elderly or disabled
and disease are absent. people. Nursing home can also be
referred to as skilled nursing facility, rest
Secondary: homes, convalescent homes or care.
• Hospitalization or institutionalization to • Home Care - services (as nursing or
avoid chronicity. personal care) provided to a
homebound individual ( as one who is
Tertiary Rehabilitation convalescing, disabled or terminally ill)
• With such health deviations to regain home care as an alternative to
and maintain the highest level of institutionalization
function and independence • Adult Day Care Center - typically a non-
residential facility that supports the
Quaternary Prevention health, nutritional, social and daily living
• Experiencing illness but there is no needs of adults in professionally staffed
identified disease to protect elderly from group setting. These facilities provide
new medical invasion and suggest adults the transitional care short-term
intervention which are ethically rehabilitation following hospital
acceptable. discharge.

Care Setting:
Gordon's Functional Health Pattern In
• Acute Care - branch of secondary care
Elderly
where a patient receives active but
• Level I - able to perform full self-care
short-term treatment for a severe injury
• Level II - requires assistance or
or episodes of illness, an urgent medical
supervision of another person
condition or during recovery from
• Level III- requires assistance or
surgery.
supervision of another person and
• Long-term care - involves a variety of
equipment or device
services designed to meet a person's
• Level IV - completely dependent and
health or personal care needs during a
does not participate in activities
short or long period of time these
services help people to live as
independently and safety possible when
they can no longer perform the day
activities on their own; provide a safe
environment for chronically ill and
functionally dependent
• Short term care- type of treatment that
has a defined outcome e.g., treatment
for an injury.
• Intermediate Care - an emerging
concept in health care which may offer
attractive alternatives to hospital care for
elderly no longer as six weeks but can
be as little as one or two weeks if the
staff believe that is what you need to
reach your goals.
• Basic services - in-patient care to
patients who have need to for skilled
nursing supervision and need supportive
care, but who do not require continuing
nursing care.