Geriatric nursing
take his choices and decisions
Aging is a continuous, complex, and dynamic process
that begin with birth and ends with death. It is a
continuous and non-repairable process of human life and
body decays gradually and slowly with time; not only a
physical body but the mind too. The thought and
adaptation also change as we grow older our
haemostatic mechanism become less sensitive, slower,
less accurate and less well sustainable. As a result of the
process to aging changes in human tissues cells occur
which bring about alterations in the appearance and
abilities of the individual. The risk death is also increases
in the age advances.
Definition
Elder- all individuals over the age of 65-74 were
considered older or elder. It can be categorized in to 3
types.
 Young old: 65-75 years old
 Middle old: 75-84 years old
 Old: 85-100 years old
Aging process
 Heredity
 Nutrition
 Health status
 Life experiences
 Environment
 Activity
 Stress produce unique
Geriatrics – this word Is taken greek word “gears” (old
age) and iarik (medicine) is the branch of medicine
concerned with medical problems and care of older
people.
Gerontology – this is the scientific study of the process
and problem of aging and focuses on the biological
aspects of normal aging.
Geriatric nursing – it defined as the specialized nursing
care of the older adults that occur in any setting in which
nurses use knowledge, expertise and caring abilities to
perform optimal functioning.
General principles of geriatric
 Consider individually, consult his preferences
 Be patient, kind and sympathetic, communicate
effectively demonstrate respect
 Encourage independence and encourage him to
 Assists elderly to achieve emotionally stability
 Stimulate mental acuity and sensory input and
physical to uplift their self-esteem, self-concept,
and confidence.
 Make elderly stay at home interesting and lively
 Provide diversion/occupational therapy
 Maintain privacy
 handle them gently
 make them comfortable by providing comfortable
bed, bed linen etc.
 encourage them to maintain body hygiene thus
regulate body temperature
 assist them to take care of visual, auditory, and
dental aid
geriatric health team
 geriatrics, nurses, physiotherapist, health worker,
social worker
changes with the aging process
a. changes in posture and appearance-at aging
process lean body mass in muscle tissue is lost,
whereas the proportion of fats increase. Change
in body composition is due to the result of ther
diet and lifestyle, the skin becomes wrinkled,
dried and tougher skin surface due to the
ultraviolet from the sun which damage the elastic
fiber and this is known as photo aging
b. changes in Musculo-skeletal system – older
people suffer from arthritis, paralytic, stroke in
addition to osteoporosis problems. This produces
stiffness of joint making them difficult for easy
movement such as getting up from a chair, to
turn their neck and to keep an erect posture.
c. Changes in CNS- because of changes in CNS
older people develop decrease ability to orient
their bodies in space to detect externally induced
changes in body portion. Atrophy of the brain
decrease blood flow and affection of peripheral
nerves like deep tendon reflexes
d. Changes in respiratory system- w/ aging the
respiratory muscle strength is reduced, the lungs
loose elasticity so that efficiency in breathing is
reduced.
e. Changes in immune system- this aging affect
immune system of the body making it defective
and attacking not just foreign proteins, bacteria,
 viruses, but also producing antibodies against
itself (i.e. diabetes and rheumatoid arthritis
f. Changes in cardiovascular system – a loss of
elastic tissue and increase in collagen and the
muscle fibres are deposited with an age, pigment
of fats and proteins called LIPOFUSICIN which is
the cause of loss of elasticity in the arteries
g. Changes in urinary system- the kidney also
lose their capacity to absorb glucose as well as
their concentrating and diluting ability
contributing to increased problems w/
dehydration and loss of salts in the blood
h. Changes in gastrointestinal system- the main
changes are the decrease in contraction of the
muscle and more time for the cardiac sphincter
to open, thus taking more time for the transmitted
to the stomach before having a full meal. This will
produce loss of appetite and cause deficiency in
nutrients, this is the reason older people eat
small amount of salt.
i. Changes in endocrine system - this estrogen
protects women from hard disease and bone
demineralizing. The other hormone are
testerone, thyroid, growth hormone and insulin
production are decreased. Changes in insulin
level causes high blood sugar level and diabetic.
j. Changes in reproductive system- in men the
sperm count decrease erection process
decrease urge for sexual intercourse gradually
decrease. In women the production of the eggs
in the ovary decrease and menopause sets in
along with less estrogen. Vaginal secretion
decrease causing dry vagina. Laxity in pelvic
floor causes prolapsed of the uterus and bladder.
Incontinence of urine, cancer breast ovary and
cervix are common in old age.
k. Changes in sensory function- sensation is the
process of taking information through sense
organs.
- Changes in touch, deteriorate w/ age especially
in finger-tips and palms and in the lower
extremities, this is my also cause less level of
painful stimuli, but they may complain of pain due
to thedepression.
- Changes in vision, loss of vision in older people
prevents the form their daily activities. The
important problems is the changes in the visual
pathways of the brain and in the visual cortex
which block the transmission stimuli from the
sensory organ.
- Changes in hearing, an older person who is
having a hearing loss learns to adapt and make
changes in behaviour and social interaction, so
as to reduce the bad social impact of hearing
loss.
- Changes in taste and smell, in older people
their taste also changes due to the loss in taste
buds as the age or their ability to appreciate
taste. So they may require more salt, more spicy
food so in order to avoid giving more salty and
spicy food.
The common old age health problems
Cardiovascular disease – hypertension,
atherosclerosis, congestive heart failure, cardiomyopathy
strokes
Locomotor disorder- osteoarthritis, rheumatoid arthritis,
gout, fibrositis, myositis
Cancer- prostrate and breast cancer
Diabetes and urinary incontinence
Role of nurse in elderly care
 Promotion of self respect and dignity- the aim
in the geriatric ward should be to reduced to a
minimum amount of control, restriction and
supervision imposed upon patients and to
encourage the maximum of personal choice,
decision making and emotions should be shown
 Approach towards the elderly- elderly may
have difficulty in understanding what is said to
them because of loss of sensory function and
reduced comprehension. They should be spoken
to clearly and face to face.
 Promotion of comfort- physical and mental
comfort and relaxation has to be achieved. Care
of the skin, care of the body structure, maintain
nutritional status, maintain fluid balance, maintain
body temp.
 Safety- correct height of bed and chairs, extra
comforts w/ cushion, the provision of walking
aids like walker or sticks or wheel chairs, grab
nails to hold and walk and also hand rails, which
are environment features that contribute to the
safety of the pt.
 Promotion of independence- Pt. is encouraged
to be out of bed as much as possible according
to the capabilities and needs. Movement and
mobility should continue throughout the pt. care.
  Promotion of mental activity and interest- the
disease and disabilities and social problems of
the elderly are such that the time spent in
hospital may be an extended one.
 Use of medications in elderly- drug interaction
increases with age and the number of the drugs
taken. Many elderly report adverse reaction to
the medication therefore the nurses should know
the various drugs, their actions, side effects, and
must cautiously for the elderly.
 Rehabilitation- rehabilitation for elderly includes
all those activities which aim at restoring the pt.
to the highest possible degree of independent
living of which he is capable which also include
physiotherapy and speech therapy
 Role of community and family- the ultimate
aim of treatment and rehabilitation is to achieve
for the person a normal social setting
 Assess elderly for elderly abuse- many of the
elderly are abused in their own home in relatives
homes and even facilities responsible for their
care. Elderly person can be harmed physically or
emotionally neglectful or overwhelmed caregiver
or being preyed upon financially
 Teach the self care- the aim of the geriatric
nursing is along with to provide the
preventive,promotive and curative care the
rehabilative care is also provided by the nurse.
Needs of elderly
 Physical needs – it is important part of total
health programme the elderly. It is vital to keep
moving and exercise; maintain circulation,
muscle tone and general health and to prevent
disuse deformity. The need for the physical
safety is upmost important.
 Mental needs- disease associated w/ aging-
such as Alzheimer and Parkinson become more
commonplace as well. All of this takes a toll on
their mental health, too. Knowing their health is
declining can be disappointment hard to cope
with. Losing loved ones as the age brings on
seemingly never ending parade of grief. And the
isolation of being place in an assisted living
facilities or nursing home can make some people
feel like there’s little left to live.
 Social needs- one thing that should keep on
mind is to shwer all your love and care on your
elderly relative or family member. Just because
they have become old and slow, doest not mean
that you should ignore them or let them be
confined themselves. Spend time with them, chat
w/ them, and make them feel wanted, cared for
and loved. Pay special attention to their room.
Your could consider installing a few senior citizen
firneldy appliances which they would be use.
 Psychological need of the elderly- elderly can
be easoly overwhelmed by a disaster and may
experience difficulty in coping w/ the situation
and their feelings. We can help them by talking
openly about what has happened and how they
feel about it. Encourage them to also speak
freely about whatever is on their minds. Be
careful not to argue with them or to tell them how
they should feel. There feeling are real to them
and nurse need to validate those feeling, express
confidence in your ability to help them
 Emotional needs - elderly not only physical
obstacles as their bodies age but they
experience emotional challenges as well. Seniors
are faced w/ stress that may include living on a
reduced retirement income or being unable to
care for theselves independently. Caretakers
need to know what to expect regarding the
emotional of seniors and be prepared to help w/
them
 Spiritual needs- many elders take their faith and
religious practice very seriously and display a
high level of spirituality. Involvement in religion
often helps the adult to resolve issue related to
the meaning of life, to adversity or to good
fortune. Religion may also be an important
coping resource, leading to enhanced well being.
Abuse of early
- Abuse involves physical emotional or sexual
abuse and also can neglect or economic
exploration
- Mistreatment of older people referred to as elder
abuse- was first described in british scientific
journal in1975 under the term granny battering
- Old people may have to undergo a lot of neglect
- The abuse may be a physical nature may it be
psychological (involving emotional or verbal
aggression) or it may involve financial or other
material maltreatment and the neglect may be
intentional or unintentional
- Elder abuse refers to ill treatment of an elderly
person.
- It is a very sensitive issue and require a high
index of suspicion
Victims guarantee aging in place that is the resident can move
from one level of care to the next as needs change. For
- A female of very advanced age residents the transition to a nursing home is easier,
- Role less family because they are able to remain in familiar surroundings.
- Functionally impaired They may require buy in or an up front annuity purchase
- Lonely followed by monthly payments which cover services,
- Some are men amenities, and needed medical care

Legal and Ethical issue Nursing home (skilled nursing facility)- offer 24 hrs a
day car for those who can no longer live independent. In
- Informed consent nursing homes trained medical professionals provide
- Autonomy specialized care to seniors with severe illness or injuries.
- Euthanasia Specially in short term or acute nursing
- Assisted suicide care ,intermediate care
- Pallation

Types of facilities – the range of housing options and

varying levels of care offered within senior communities
helps ensure that every senior will find a perfact match
for their housing needs and for their lifestyle

Independent living facilities- are ideal for senior who

does not need personal or medical care but who like live
with other seniors who share similar interest. Im ILF
seniors can take advanatage of planned comm. Events,
field trips, shopping, excursions and co-premise project.
The apartment are not licensed and regulated.

Adult homes- are licensed and regulated for temporary

or longterm residence by adults unable to live
independently. They usually include supervision,
personal care, housekeeping, and 3x meals a day

Family types home- offer a long term residential care,

house keeping and supervision for four or fewer adults
unrelated to operator. The department of social service
overseas their operation

Enriched house- is similar to adult homes with the

exception that seniors live in independent living units.
They offer a minimum of one meal per day and are
licensed by state department of health

Assisted living facilities- an excellent alternative to

nursing homes for senior who need help with their ability
but who do not need 24 hrs care. Room board, case
management and skilled nursing service come from
outside agency. This program accept medical,
supplemental security income (SSI) and home relief
recipients

Contuining care retirement communities (lifecare

comm.)- offer a variety of facilities from assisted living
facilities to nursing home all on one campus. They