Geriatric Nursing

Geriatrics 
Study

of old age; physiology, pathology, diagnosis & management of diseases of older adults.

Gerontologic/Gerontic Nursing 
Field

of nursing that specializes in the care of the elderly  Emphasis of care is focused promoting, maintaining, & restoring health & independence

Life Span 

Maximum number of years a person can live under the best conditions in the absence of disease Life Expectancy average number of years that a person can be expected to live.

Age Related Body System Changes: 
Cardiovascular

Heart valves become thicker & stiffer; arteries lose elasticity; Ca & fat deposits in arterial walls; veins become tortuous

Health Promotion 
Regular

exercise, proper diet, weight control, regular blood pressure check ups, avoidance of smoking & stress management

Respiratory Changes 
Increase

AA-P diameter, kyphosis, calcification of costal cartilages, diminished efficiency of respiratory muscles, decreased alveolar surface area, decreased cough efficiency, reduced ciliary activity

Health Promotion 
Regular

exercise, Increase fluid intake, annual influenza vaccination, avoidance of smoking

Health Promotion

Integumentary Changes 
Loss

of resiliency wrinkling & sagging of the skin, hair pigmentation decreases, skin becomes drier, subcutaneous fat decreases

Health Promotion 
Wear

appropriate skin protection from the sun, maintaining a suitable temperature indoors, use lubricating skin cream

Reproductive Changes 
Thinning

of the vaginal wall, loss of elasticity, decrease vaginal secretions, atrophy of the uterus & ovaries, decreased pubococcygeal muscle tone In men penis & testes decrease in size, decrease levels of androgen

Health Promotion 
Sexual

activity should not be discouraged, referral to sex counselor if necessary, vaginal lubricant & estrogen replacement therapy

Genitourinary Changes 
Changes

in kidney function, bladder capacity decreases, urine retention & incontinence; Benign prostatic hyperplasia in older men

Health Promotion 
Adequate

fluid hydration, pelvic floor exercises

Gastrointestinal Changes 
Decrease

salivary flow, decrease gastric motility, constipation

Health Promotion 
Regular

dental care, eating small frequent meals, eating high fiber low fat diet, ingesting adequate amount of fluids, regular bowel habits

Musculoskeletal Changes 
Decrease

in bone mass & density, osteoporosis in postmenopausal women, decrease muscle mass & strength, backpain, deterioration of cartilage & joints

Health Promotion 
High

calcium intake (dairy products & dark green leafy vegetables), low phosphorous diet, exercise, Ca supplements, Vitamin D & Fluoride are given  Encourage a regular exercise program

Nervous System Changes 
Decrease

in brain mass due to loss of nerve cells, reduction in the synthesis of neurotransmitter substances, slow nerve impulse conduction, reduction in cerebral blood flow

Health Promotion 
Allow

a longer time to respond to a stimulus & to move deliberately, avoid injury

Sensory Changes 
Presbyopia

when the near point of focus become farther away due to decrease flexibility of the lens corrective glasses 

Presbycusis

loss of the ability to hear high frequency tones due to irreversible inner ear changes hearing aids to reduce hearing deficits

Mental Health Disorders:
most common affective or mood disorder of old age - disrupts quality of life, increases the risk of suicide 
Depression

Signs & Symptoms 
Feeling

of sadness & fatigue  Diminished memory & concentration  Feelings of guilt & worthlessness 

Sleep/appetite

disturbances,

restlessness  Decrease attention span  Suicidal ideation

Nursing Management
Psychotherapeutic approach (Cognitive & behavioral) & anti depressant medications Fluoxetine (Prozac), Paroxetine (Paxil) 

Dementia 
Senile

dementia (Chronic brain syndrome)  Characterized by a general decline in intellectual functioning

of memory, abstract reasoning ability, judgment & language  Personality changes  Decrease ability to perform ADL s 
Loss

Alzheimer s Disease
Primary degenerative dementia  Senile dementia of the Alzheimer's type  Progressive, irreversible, degenerative neurologic disease that begins insidiously with gradual losses of cognitive function & disturbances in behavior & affect 

Pathophysiology 
Neurofibrillary

tangles (mass of non functioning neurons)  Senile or neuritic plaques (deposits of beta amyloid proteins)  Happen in cerebral cortex = decreased brain size 

Decrease

acetylcholine, important in memory processing  Risk factors age & family history  Dx Evaluation history, clinical symptoms, EEG, CT Scan, MRI, blood & CSF studies

Clinical Manifestations: 

Forgetfulness, subtle memory loss, inability to recognize familiar faces, places & objects, repeat the same stories, difficulty in everyday activities, voracious appetite, wander at night for several hours needs help in doing ADL s 

Progressive memory loss: retrograde amnesia (loss of memory of events before the disease) followed by anterograde amnesia (inability to learn new things).

Sometimes the client who formerly was well mannered in the table becomes sloppy. Or sometimes the client suddenly undresses in front of the family members. 

Clients usually use Confabulation fabrication of events or experiences to fill in memory gaps, so as to save their own self esteem

Nursing Interventions 
Help

maintain optimal cognitive functioning  Promoting patient s safety  Promoting independence in selfselfcare activities 

Maintaining

adequate nutrition  Managing sleep pattern disturbances  Supporting & educating family caregivers

Abuse to the Older Adult
Abuse involves, physical, emotional or sexual abuse and also can involve neglect or economic exploitation  Individuals that are most at risk are children or older adults, because of their dependency, immobility or altered mental status 

Victims may attempt to dismiss injuries as accidental and abusers prevent victims from receiving proper medical care to avoid discovery  Victims are often isolated socially by their abusers 

A typical victim of abuse is usually an old woman with few social contacts with at least one physical or mental impairment that limits the ability to perform ADLs. The client usually lives alone or lives with the abuser and is usually dependent on the abuser s care.

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