Geriatrics: Greek word “geras” meaning old age,
and “iatro”, meaning relating to medical treatment.
- Medical specialty that deals with the
physiology of aging and with diagnosis and
treatment of disease affecting older adults.
Gerontology: study of all aspects of the aging
process, including the clinical, psychological,
economic, and sociologic problems of older adults.
- Study of understanding of process of aging
Gerontics: coined by Gunter and Estes in 1979 to
define the nursing care and the services provided
to older adults.
- Care and service provided to older people.
GerintoPHOBIA: Fear of aging and the refusal to
accept older adults into the mainstream of society.
Ageism: extreme forms of gerontophobia are
ageism and age discrimination; disliking aging and
older adults based on the belief that aging makes
people unattractive, unintelligent, and
unproductive.
- Occurs because of myths and stereotypes.
Myths
- Older adults are pretty much alike; No
different adults have different needs.
- Generally, are alone and lonely.
- Tend to be sick, frail, and dependent on
others.
- Often cognitively impaired; they can
exercise their ability.
- Suffer from depression.
- Become more difficult and rigid with
advancing years.
OLD: having lived or existed for a long time
AGING: a complex process that can be described
chronologically, physiologically, and functionally.
- Process of gerontology.
OLDER: 55 to 64
ELDERLY: 65 to 74
AGED: 75 to 84
Bacca Levy, (Yale University) professor, found that
young people who hold positive feelings toward
older adults live 7.5 years longer that those with
negative perceptions of aging.
DEMOGRAPHICS OF OLDER ADULTS
- Data that would be necessary to understand
human population group.
- Provide information about the present that
allows projection into the future.
Demo Facts
Life expectancy: is the number of years an average
person can expect to live.
- Projected from the time of birth to the ages
of all people who die in a given year.
- Life expectancy in the ph is increasing
before but now it is decreasing (cause of
pandemic)
Global Aging
- Population aging is much faster than in the
past.
- In 2020 there are more older people than
younger people.
- Between 2015 and 2020 the population of
older adult nearly double from 12% to 22%.
 - It started in high-income countries like
Japan. (Now low- and middle-income
countries that are experiencing it).
Data Say
- Long life is a worldwide phenomenon (u
can’t control it)
- 8% of the population is age 65 or older.
- Developing countries lead the world in
longevity statistics.
Composition of Olde Adults in the Philippines as of
2020
- 60 years old and over are regarded as senior
citizen.
- There were more females than male among
the senior citizen in 2020.
Aging Index of the Philippines
- The proportion of 60 years and over per 100
persons under the age of 15 years was
computed at 27.6% in 2020.
Implications
- There are needs of healthcare to older
adults.
- More people will have chronic conditions.
- Widows may be unprepared to provide for
their own needs and will need assistance.
(As the role of women is changing)
Theories of Aging: this are concepts, principles that
put together and tested.
- These theories have been looked and
studied.
- It helps explain and give some logical order
to our observation.
- Observations including physical and
behavioral data, are collected and studied
to scientifically prove or disprove their
effects on aging.
Biologic Theories: Physical changes that happens in
ageing.
- Describe the process of aging thru cell
function, genetics.
Classifications includes:
A. Genetic: Programmed Theory (“BIOLOGICAL
CLOCK”):
- When we are born the time starts; each of
has a genetic gene “that is PROGRAM.”
- In cancer all of has an oncogene to be it
stimulates are the factors/lifestyle.
- All of has a genetic program for how long
our cells will live. It means that we are able
to predict change (grey/white hair)
B. Molecular: aging in context of cellular
deuteriation.
C. Cellular
Run out of Program Theory
- Proposes that every person has a limited
amount of genetic material that will run out
eventually.
Rate of Living Theory
- Propose that individual have a finite number
of breaths or heartbeats that are used up
over time.
- We are program to have a certain number.
Gene Theory
- Existence of one or more harmful genes
that activate over time.
Molecular Theories of Aging
- Aging is controlled by genetic material that
are encoded to predetermine growth and
decline.
Error Theory (RNA)
- Errors in ribonucleic acid (RNA) is necessary
for protein synthesis cause errors, resulting
in a progressive decline in biological
function.
Somatic Mutation Theory
- Aging results from deoxyribonucleic acid
(DNA) damage caused by exposure to
chemical or radiation this damage can cause
chromosomal abnormalities that lead to
disease or loss of function later on.
Cellular Theories
 - Aging is a process that occurs because of
CELL DAMAGE.
Free Radical Theory (Common CT): As a exposure to
pollution, radiation this cause release free radical
which can damage the cells eventually the DNA and
immune system can cause deterioration in function.
- Conditions that are common to older adults
when they are expose to FR such as
arthritis.
- Lipofuscin a free radical that commonly
building up of fatty pigment granules that
cause age spots in older adults.
- Free radicals can be reduced by use of
antioxidants such as vitamins A, C, and E,
carotenoids, zinc, selenium.
Cellular: Cell as direct tiger of aging
Cross link or Connective Tissue Theory: there are
cell molecules from Free radical, DNA and
connective tissue that link or bonds that decrease
the ability of the tissue to replace itself.
- This results in skin changes typically
attributes to aging such as dryness,
wrinkles, and loss of elasticity.
Clinker Theory: combines somatic mutation, free
radical, and crosslink theories to suggest that
chemical produced by metabolism accumulate in
normal cells and cause damage to body organs,
such as the muscles, heart, nerves, and the brain.
Wear and Tear Theory: loose of function just like
machine where its parts wear out.
- Cells, tissues, and organs are damaged by
internal or external stressors.; there is
maintenance where good practices like
eating healthy etc.
Reliability and Longevity Theory: Changes in the
body as result of degradation (disease) and failure
(death).
- Complex electronic equipment: there is only
a certain time or longevity it functions.
- If you have a failing heart also the rest of
the body fails.
Neuroendocrine Theory: focuses on complicated
chemical interaction set off by the hypothalamus of
the brain.
- Hypothalamus initiates the release of
various hormones that product bodily
function.
- With age, the hypothalamus appears to be
less precise in regulating endocrine
function, leading to age-relates changes
such as decreased muscle mass.
- It proposed that hormone supplement may
designed to delay or control age-related
changes.
Immunologic Theory: aging is a function of changes
in the immune system.
- Defensive mechanism of the body as a
culprit to aging.
- Weaking overtime makes the person
susceptible to the disease.
- Increase in autoimmune disease and
allergies seen with aging caused by
immunologic theory. Ex: rheumatoid
arthritis.
- Because of deficiency in immune system.
Caloric Theory: correlates aging to calorie intake.
- As we grow old our metabolic efficiency
becomes less efficient. Consume low calorie
diet so that metabolic activity will not
compromise.
- Metabolic efficiency can be achieved by
consuming a high nutrient but low-calorie
diet.
- Metabolic slow efficiency can translate to
disease.
Psychosocial Theories: It attempts to explain why
older adults have different responses to the aging
process.
- Aging is always associated why psychosocial
responses.
Under Psychosocial Theory
Disengagement Theory: it explains why aging
persons separate from the mainstream of society.
 - Cause they perceived to be not benefitted
to society.
- Withdraw from society cause by a thinking
of unusefulness.
- Prevent by participation.
Activity Theory: relates to active participation.
- The more active they (mental activities) are
the higher the chance they have longer life.
- This activity can promote self-esteem them
improve quality of life.
Trace Theories: It traces personality and personal
adjustment throughout a person’s life.
Eric Erickson Theory: All of all goes thru 8 stages of
developmental tasks.
- Trust vs mistrust
- Autonomy vs shame and doubt
- Initiative vs guilt
- Industry vs inferiority
- Identity vs ide confusion
- Intimacy vs isolation
- Generative vs stagnation
- Integrity vs despair
Havighurst’s Theory defines specific tasks for late
life.
- Specific tasks have to achieve adjusting to
decreased physical strength and health,
adjustment to retirement and decreased
income, establishing a relationship with
one’s age group, adapting to social roles in a
flexible way, establishing satisfactory living
arrangements.
- Task that has to go thru aging and have the
ability to accept or achieve it.
Newman’s Theory: identifies the tasks of aging as
coping with physical changes of aging.
- Accepting one life as it is
Carl Jung’s Theory: developmental in terms of
knowing the meaning of life.
- People always in the process of searching.
- Life becomes an ongoing search for the
“true self.”
- He proposes that individual is likely to shift
from an outward focus (success and social
position) to a more inward focus.
- Successful aging includes acceptance and
valuing of the self without regard to the
view of others.
Implications for Nurses
- Help individual achieve the longest,
healthiest loves possible by promoting good
health maintenance practices and a healthy
environment.
- Recognize problems and provide
interventions.
Realities of Aging in a Family
- 80% of older adults who need care will
receive assistance from their families.
- Children are expected to take care.
- Problem who will be taking care
- Sandwich generations “middle age” working
and taking care of children.
- Loss independence the most significant
issue: they don’t want to ask help.
- Distress of not be able to do things.
Types of Abuse
Emotional Abuse: most subtle and difficult to
recognize.
- Includes behaviors such as isolating,
ignoring, or depersonalizing older adults.
- Negative communication/verbalization
- Insidious that it can damage the older
adult’s sense of self-esteem.
Forbid, Isolate, Verbal.
Signs of EA
- Lack of eye contact
- Trembling
- Agitation
- Evasiveness
- Hypervigilance
Financial Abuse: resources of an older person are
stolen or misused by a person whom the older
adult trust.

Neglect: passive form of abuse in which caregivers
fail to provide for the needs.
Abandonment: deserted responsibility
Abusive Behaviors in Health Care
- Use of sedative or hypnotic that are not
necessary.
- Use of retrains when they are not medically
indicated.
- Withholding of privileges
- Ethnic slurs: using of own dialect as an
aggressive.
Physiologic Changes in Aging Affecting Various
Systems
- Changes seen with aging are specific and
unique to each person.
- Nurse must avoid falling into the trap of
stereotyping older adults.
Integumentary System Changes
- Always happen is epidermis that outer layer
of skin becomes fragile.
- Skin repairs more slowly in older individuals,
increasing the risk of infection.
Melanocyte activity declines with age.
- Melanocyte clusters can form areas of
deepened pigmentation, a condition called
SENILE LENTIGO refers to as age spots or
liver spots most often see in body areas that
are most exposed.
- - Poor nutrition (calcium and vitamin D)
Seborrheic Keratosis: slightly raised, wartlike
macules may cause discomfort and itching.
Seborrheic Dermatitis: hairline is the site excessive
production of the sebum.
Skin Tags: Cutaneous Papilloma, small brown, or
flesh-colored projections of skin that are most
often observed on the necks of older adults.
Common Disorders in Integ
- Basal Cell Carcinoma (common on older
men) and Melanoma, who as 5x sunburn on
any age
- Pressure Ulcer
- Contact and allergic dermatitis: appear as
rashes or inflammation that is either
localized to certain areas of the body or
generalized.
- Herpes Zoster: fungal, yeast, and bacterial
infection, and infestation with scabies.
(Target one zone of the body)
Common Disorders related to Musculoskeletal
System
Osteoporosis: Excessive loss of calcium from bone.
“Sponge Like”
- Gradual loss of bone density and an
increased risk of bone fractures.
- The rate of bone resorption (rebuilding) is
greater than the rate of bone formation
which cause porous (sponge like), brittle,
and fragile and fracture easily
- Multiple compression fractures of the
vertebrae result in skeletal deformity
(kyphosis) *kuba it is associated with weight
loss
- Spontaneous hip fractures may lead to a
fall.
Risk Factor
- Malabsorption disorders such as celiac
disease
- Post – menopausal
- Genetics: Caucasian and Asian
Osteoarthritis – most common and most
frequently disabling joint disorder ;
 Deterioration of cartilage (specifically:
ARTICULAR CARTILAGE) “HYALIN”
 “wear and tear” arthritis
  when the cartilage and other tissues within
the joint break down or have a change in Risk factors
their structure.  Women
Noninflammatory – cause of too much use it can be  Age: 35 – 45
Chronic, non – systemic disorder of joints (WEIGHT  Genetic and autoimmune
– BEARNING JOINT AFFECTED)  Fatigue most common complain because it
is systemic (AUTOIMMUNE)
Clinical Manifestation  Small joints are first affected
 Pain, stiffness is most common in the  Pannus formation: inflammatory cells and
morning after awakening. It usually last less death tissues
than 30 minutes  Symmetrical and systemic
 OA occurs most often in weight bearing  Stiffness greater than 30 minutes worse in
joints (hips, knees, cervical and lumbar the morning
spine)
 Bony nodes may be present (painless) Clinical Manifestation
 Heberden’s node: distal (abnormal  Palpation of joint reveals spongy or boggy
deformity) tissue
 Bouchard’s node: proximal  Symmetric bilateral: both knees are
 Osteophytes (spurs) – extra bones affected
 Inside of the bone experience “SCLEROSIS”
(scar).

Diagnostic Procedure
 X-ray: narrowing of joint space

Medical Management
 Acetaminophen (paracetamol) NSAIDs do
not cause ulcer  Small joints are first affected hands and feet
 CoX-2 enzyme blocker: Celebrex (celecoxib) misalign or deviation
cannot cause ulcer Swan -neck deformity: distal joints
 Opioids and intra-articular corticosteroids Ulnar deviation: carpal area
 Glucosamine: address ability of joints Boutonniere deformity: on the thumb
 Raynaud’s phenomenon – decreased blood
Nursing Management flow in the fingers (digital blanching or
 Application of heart modalities or warm cyanosis)
compress if pain subside  Stages: (synovitis, pannus, anclyosis)
 Low impact exercise, walking, aerobics.
STRENGTH RAINING lifting weights, ROM Anti-CCP: indicates RA
 Avoid high impact: running/jogging, Decrease hydration because of inflammatory
humping rope. process
 Ice packs acute inflammation if the pain is
onset Medications
 Plan daily activities when pain is less severe; - NSAID, such as aspirin, acetaminophen,
pain meds before exercising ibuprofen, and naproxen.
 Weight reduction - Disease modifying antirheumatic drugs
(DMARDs), such as cyclosporine,
Rheumatoid Arthritis: autoimmune; inflammatory azathioprine, sulfasalazine, and
disorder “SYNOLVIUN” (synovitis); Joint lining is methotrexate.
called synovium
Nursing Management
 Use splints to immobilize
 Cold packs onset pain
 Warm when pain subside
 Schedule activity when pain is less severe
 Promote enough amount of sleep
 Supplements vitamins, iron and protein one
factor of this disease is anemia
 Flat on firm mattress
 Lie prone several times to prevent hip
flexion
 No pillow under the joints
 Use one pillow under the head because of
the risk of kyphosis
Respiratory System Changes: decreasing recoil in in
the lungs result diminish air exchange.
- Mucous membranes in the nose become
dry as the fluid content of body tissues;
thus, incoming air is not humidified as
effectively.
- Cilia decrease, diminishing ability to trap
and remove debris.
- Decreased vocal cord elasticity changes in
voice pitch and quality, where the voice
develops a more tremulous character;
difficulty to understand older adult as a
prob.
Decreased body fluids: decreased ability to
humidify air.
Decreased tissue elasticity in the alveoli: dec gas
exchange increased pooling of secretions.
Increased calcification of cartilage: increased
rigidity of rib cage; decreased lung capacity.
Nursing Consideration
- Assess breathing depth and effort: position
to facilitates of respirations.
- Assess cough and sputum production:
encourage adequate fluid intake.
Common Disorders RS
Pneumonia: acute inflammation of the lungs
caused by bacterial, viral fungal, chemical, or
mechanical agents.
- Alveoli and bronchioles becomes clogged
with a thick fibrous substance that
decreased the ability of the lung to
exchange gases.
- Breath sounds
Tuberculosis: infections disease caused by bacillus
mycobacterium tuberculosis, which spreads by
means of airborne DROPLETS.
Treatment:
- Antimicrobial agents such as isoniazid,
rifampin, ethambutol, and streptomycin.
- Administered for a period of months.
Cardiovascular System Changes
Decreased cardiac muscle tone: decreased tissue
oxygenation related to decreased cardiac output
and reserve.
- Output increased heart size, left ventricle
enlargement.
Decreased cardiac output: increased chance of
heart failure; decreased peripheral circulation.
Increased atherosclerosis: Increased blood
pressure, weaker peripheral pulses.
Decreased baroreceptors sensitivity: decreased
adaptation of changes in blood pressure.
Nursing Consideration
- Assess apical and peripheral pulses: observe
closely for abnormal sounds and irregularity
of rhythm.
- Assess ability to tolerate activity: instruct
patient to rest if short of breath or fatigued.
Myocardial Infarction: occlusion of the coronary
arteries decrease the nutrient and oxygen flow to
the myocardium.
 - Total oxygen deprivation result in
myocardial tissue necrosis.
S&S
- Sudden onset of dyspnea or chest
discomfort, confusion and syncope.
Coronary Valve Disease: elasticity of the valves;
there is deposition of calcium which prevent valves
to seal cause regurgitation of blood from one
chamber to another and ultimately heart failure.
- Heart cannot control spillages of blood
result in mitral calve prolapse including
chest pain, fatigue, dyspnea.
Cardiac Arrhythmia: abnormality of ventricular
rhythm.
Cardiomegaly: enlargement of heart; chronic heart
failure.
- As we age, the muscular wall of the left
ventricle thickness, Because arteries and
vein lose elasticity with age, the heart must
pump harder to move blood through the
vessels.
- Defense is to improve the output of blood
from the heart to meet the body’s tissue
demands for oxygenated blood.
Arteriosclerosis: is caused by plaques forming in the
lumen, further restricting blood flow.
- Factors including obesity, high. Cholesterol
intake, cigarette smoking, and diabetes
mellitus.
- Decreased blood flow deprives the tissue of
oxygen and nutrients and cause ischemia. If
complete obstruction may result to tissue
death.
Aneurysm: ballooning/out pouching of the arteries
is common in older adults who suffer from
arteriosclerotic blood vessel changes.
- Raptures can acquire can caused
cardiogenic shock.
- SILENT KILLER
Hypertension
- 60% of person older than 65 years old have
hypertension, increasing to more than 70%
at age 75.
Essential Hypertension: caused by diet, smoking,
stress, increased serum cholesterol levels.
Treatment:
- Rest
- Exercise
- Dietary sodium restriction
- Thiazide diuretic
- Calcium channel blocker
Hematopoietic and Lymphatic System Changes
- Increased plasma viscosity (thick): increased
risk for vascular occlusion.
- Decreased mobilization of neutrophils: less
effective phagocytosis (ability of cell to
engulf foreign substance)
- T-cell responsible for the immune response;
increased immature t-cells response =
decreased immune response.
- Lower serum albumin levels = edema;
increased level of medications that are
highly protein bounds.
Anemia: low level of RBCs or insufficient
hemoglobin.
- Iron deficiency anemia result from
inadequate nutritional intake, blood loss.
Pernicious Anemia: is associated with decreased
intake or absorption of vitamin B12. Folic acid
deficiency anemia is usually caused by poor
nutrition, chronic alcohol abuse, or malabsorption
syndromes.
Leukemia: excessive production of IMMATURE
WBCs.
- Abnormal cells present.
 - Both acute and chronic varieties.
- Chronic lymphocytic leukemia is the form
most often seen in older adults; immature
lymphocyte.
Gastrointestinal System Changes
- Decreased thirst perception: they do not
feel thirst; dehydration occur also this can
be seen on constipation.
- Decreased gag reflex; choking and
aspiration.
- Decreased muscle tone at sphincters:
increased incident of heartburn (esophageal
reflux)
- Decreased saliva and gastric secretions;
increased gastric pH: decreased digestion
and absorption of nutrients; altered
absorption of some medication that are pH-
dependent.
- Decreased gastric motility and peristalsis:
increased flatulence, constipation.
- Decreased liver size and enzyme
production: decreased ability to metabolize
drugs, leading to increased risk for toxicity.
Nursing Assessment and Care
- Assess oral cavity for dentition, condition of
mucous membranes and hygiene.
- Assess swallow and gag reflexes.
- Monitor weight changes (esp.: fluid cause
the are at risk of dehydration)
- Assess bowel sounds and bowel elimination
patterns.
- Assess effectiveness of medication: observe
for therapeutic effects.
Common Disorder related to Gastrointestinal
System
Hiatal Hernia: protrusion of the stomach into the
thoracic cavity through the esophageal opening in
the diaphragm.
- Complaints may include heartburn, acid
reflux, or generalized epigastric distress.
Gastroesophageal reflux disease (GERD)
- Is a major problem that can occur with
hiatal hernia.
- Gastric contents move backward into the
esophagus, where they increase the risk of
aspiration.
Treatment involves the use of antacids, histamine
antagonist, protein pump inhibitors, and dietary
modification.
- Avoid/ reduce fatty foods, carbonated
beverages, alcohol and foods that contain
caffeine.
- Small frequent feeding can prevent the
bulging of the
Meeting 3 (1:14:04)
Endocrine System Changes
- Decreased pituitary secretions (growth
hormone); decreased muscle mass.
- Decreased production of thyroid-stimulating
hormone; decreased metabolic rate.
- Decreased insulin production; increased risk
for type 2 diabetes mellites.
- Decreased production of parathyroid
hormone; increased blood calcium levels
(seen with osteoporosis)
Nursing Assessments
- Monitor laboratory values, paying special
attention to minerals, such as calcium and
sodium levels, and blood glucose.
- Assess foe body temperature, weight, hair
distribution or behavioral changes, which
may indicate endocrine imbalance
Common Disorders
Diabetes Mellitus: abnormal metabolism of
carbohydrates, protein, and fats, resulting in
elevated plasma glucose levels.
- Hypoglycemia is a potentially serious
problem for people receiving insulin or oral
hypoglycemia agents.; Classic signs include
 headache, nausea, weakness, tremors or
trembling sensation, pallor, anxiety,
irritability, tachycardia, sweating, and
hunger.
Treatment is based on the specific plasma glucose
level.
- Level of 40 to 60 mg/dl respond best to
foods such as milk and crackers
- 20 to 40 mg/dl ; refined carbohydrate such
as honey, juice, or sugar.
- If unconscious, the patient is treated with
intramuscular injection of glucagon or
intravenous infusion of 50% glucose
(D5050).
Hypothyroidism: cold intolerance, dry skin, dry and
thin body hair, constipation, depression, and lack of
energy.
Reproductive System Changes
Uterine Prolapse: uterus is protruding out.
- Prolapse of the uterus is commonly
observes in women.
Vaginal Infection
- Change in vagina pH may lead to increased
incidence of vaginal infection, particularly
infections
- Increased alkaline level and reduce acidity
- Increased vaginal discharge, irritation.
Breast Cancer (most common in women)
- Regular breast examination (including
mammography)
Prostate Cancer ( common in male)
HEALTH ASSESSMENT OF OLDER ADULTS
Health Screening: identify apparently healthy
people who are at risk for predispose/ develop an
illness.
Purpose of Screening
- Referral to the most appropriate health
service provider
- Early screenings reduce frustration in older
adults
- Reduce wasteful use of time and resources
Cardiovascular Risk
- Screening for dyslipidemia
- Risk factor is lipid disorders
- High levels of cholesterol and LDL-C and low
level
- Lipid-lowering drug therapy cause 30.0%
relative risk reduction in total CAD and
26.0% relative risk reduction in CAD
mortality in people with abnormal lipid
levels
Screening for tobacco use
- Culprit to cardiovascular disease , COPD,
respiratory, and malignant
Screening for high blood pressure
- Comprehensive cardiovascular risk
assessment and education session is
reduced the risk by .87%
- Benefits of treating hypertension regardless
of its severity; lowering the systolic blood
pressure by 10 mmHg using
antihypertensive agents in people aged 60 -
69 years could prevent 41.0% of stroke and
22.0% of CAD events.
Screening for Diabetic Risk
- The prevalence of type 2 diabetes in
European and Asian people aged 60-79
years range between 10 and 20%.
Screening for cancers
- 60% of the new cancer cases and 65.0% of
the cancer mortality occur in less developed
nations.
- Colorectal cancer, lung cancer, and breast
cancer in women.