Geriatric Considerations in Nursing

2. MISS SUJATA MOHAPATRA

4. TERMINOLOGY
AGEING
GERENTOLOGY
GERIATRICS
GERIATRIC CARE
GERIATRIC NURSING
GERENTOLOGICAL NURSE

5. hIsTORY
• Hippocrates &Aristotle contributed to the
theory of ageing.
• Nascher was the father of geriatrics and
Majory Warren was its Mother.
• The 1st Geriatric service was started in U.K
in 1947.
• Geriatric department at GH, Chennai was
established in 1978.

6. KEY facTs
• The number of people above 60 years is
assessed to be over 49 crores in world & by the
year 2040 their number will be 140 crores.
• 70 million population in India-2001
• 177 million population -2025
• Cataract &Visual impairment- 88%
• Arthritis &locomotion disorder-40%
• CVD &HT – 18%

8. cLassIfIcaTION

9. PhYsIOLOGIcaL
asPEcTs Of aGEING

10. INTEGUMENTARY CHANGES
Pr oduct i on of new ski n
cel l s decr eases,
Sebaceous and
Sudor i f er ous gl ands
become l ess act i ve.
I ncr eased sensi t i vi t y t o
–Temper at ur e.
Nai l s become t hi ck,
t ough, and br i t t l e,
Seni l e l ent i gi nes

11. INTEGUMENTARY SYSTEM CARE
Good ski n, nai l , and hai r
car e ar e essent i al ;
Shampooi ng done l ess
f r equent l y
Car e f or sor e or i nj ur i es
i mmedi at el y
Dai l y shower s avoi ded
Lanol i n l ot i ons used
Use mi l d soaps

12. CARIOVASCULAR CHANGES
Heart muscle becomes less efficient,
and cardiac output decreases with
aging.
Blood vessels narrow and become less
elastic.
Blood flow to the vital organs may
decrease.
Blood pressure may increase or
decrease.
The atrial chambers increase in size
with ageing.

14. Contd…
Elderly only aware of
circulatory changes
when:
• Exercising
• Stressed
• Excited
• Sick
• Anything that
increases their need
in the body’s need for
oxygen and nutrients.
During this change they may
experience periods of:
• Numbness in the hands
and/or feet
• Rapid heart rate
• Weakness
• Dizziness

15. CARDIOVASCULAR SYSTEM CARE
With circulatory changes:
– Periods of rest
– Avoid strenuous exercise or over-exertion
– Moderate exercise, according to individual’s
tolerance
To prevent Thrombus:
– Support stockings
– Anti-embolism hose
– Not using tight bands around the legs
– Confined to bed- do ROM exercises

16. RESPIRATORY CHANGES
 Increased antero-posterior chest diameter.
 The alveoli become thinner and less elastic.
 Changes in the larynx lead to a higher-pitched and weaker
voice.
 Increase residual lung volume & decreased vital capacity.
 Changes may cause the elderly to experience:
– Dyspnea, Tachypnea
– Difficulty coughing up secretions
– Increases susceptibility to infections
such as a cold or pneumonia.

17. RESPIRATORY CARE
• Alternate activity with periods of rest.
• Proper body alignment & positioning.
• Sleep in semi-fowlers position.
• Avoid polluted air.
• Breath deeply & cough frequently.
• Smoking cessation & frequent hand
hygiene.
• Yearly influenza vaccination.

18. GASTROINTESTINAL CHANGES
• Fewer digestive juices and
enzymes produced
• Gastric motility & peristalsis
decreases.
• Periodontal diseases.
• Liver function decreases
• Dysphagia & decrease of taste
receptors.

19. GASTROINTESTINAL CARE
• Repair or replacement of damaged teeth.
• Relaxed eating atmosphere.
• Careful use of seasoning to improve taste of food.
• Recommend high-fiber, high-protein & low fat foods.
• Regular dental care & eating small , frequent meals.
• Healthy version of “Empty Calorie Foods”
• Increase fluid intake.

20. NEUROLOGIC CHANGES
• Blood flow to the brain
decreases, loss of brain cells
• Interferes with
– Thinking - Reacting
– Interpreting -
Remembering
– Sense of taste, smell, vision,
and hearing diminish.

21. NEUROLOGIC CARE
 May take longer to react, but given enough time, they
can think and react appropriately.
• Familiarity with the mini-mental status examination is
essential to be able to evaluate mental status!
• Geriatric Counseling for mental changes.
• Use of spectacles, Hearing aid can help
resolve some problems.
• Add sugar, salt, or pepper to improve
appetite.

22. MUSCULOSKELETAL CHANGES
Muscles loose tone, volume, and
strength
Changes causes the elderly
individual to experience:
Gradual loss in height
Decreased mobility
Weakness
Movement is slower
Balance is less sure
Difficulty with fine motor skills

23. MUSCULOSKELETAL CARE
• Encourage exercise as much as their physical
condition permits.
• Diet rich in protein, calcium, and vitamins.
• Well-fitting shoes with non-slip soles and flat heels.
• Grab bars in the bathroom.
• Hand rails in halls and on stairs.
• Walkers, Quad cane

24. GENITOURINARY CHANGES
Decrease of estrogen /
progesterone in female &
Testosterone in male.
Kidneys decrease in size &
become less efficient.
Bladder becomes less efficient.
In Females
• Vaginal infection or inflammation.
• Prolapsed uterus & Breast sag.

25. GENITOURINARY CARE
• Increase fluid intake to improve
kidney function.
• Regular trips to bathroom
• Wear easy to remove clothing
• Use absorbent pads
• Bladder training programs.
• Understand physical and
psychological sexual needs of the
elderly.

26. PSYCHOLOGICAL ASPECTS OF AGING
MEMORY FUNCTIONING
INTELLECTUAL FUNCTIONING
LEARNING ABILITY
PSYCHIATRIC DISORDERS IN LATER LIFE
ADAPTATION TO THE TASKS OF AGING
Loss and grief
Attachment to others
Maintenance of self identity
Dealing with death

27. PSYCHOLOGICAL SUPPORT FOR
AGING
• Effective communication
• Prevent loneliness
• Recreational activities
• Maintenance of Self esteem

28. RISK OF AGEING

29. GERIATRIC
PRINCIPLES

30. PREVENTION FROM
COMMON GERIATRIC
HEALTH PROBLEMS

31. GERIATRIC HEALTH CARE
TEAM MEMBERS

32. SPECIAL NuRSING
CONSIDERATION
• Risk for loneliness
• Altered dentition
• Knowledge deficit
• Risk for fall
• Confusion
• Sexual dysfunction
• Neuropsychological changes

33. ROLE OF GERO-NuRSE

34. OLD AGE ORGANISATIONS
Help age International
Geriatric society of India
Govt initiatives
• National policy on older persons
• The academic organisations of
geriatrics in India.
Non-govt initiative
• Old age Home
• Day care Centre

35. RESEARCH STUDIES
1. Long-term Benefits of a Lifestyle Exercise
Program for Older People Receiving a Restorative
Home Care Service: A Pragmatic Randomized
Controlled Trial.
 Restorative home care services are short term, individualized
programs aimed at maximizing an older person’s ability to live
-independently and maintain their function.
 The aim of this study was to examine over the longer term, the
effectiveness and maintenance of a (modified) lifestyle
functional exercise program (LiFE) compared to the current,
structured exercise program used in a restorative home care
service

36.  A pragmatic randomized controlled trial was employed with two
study arms: LiFE (intervention) and a structured exercise
program (control).
 Data were collected at baseline, post-intervention (eight weeks)
and six months.
 No difference between the groups for exercise adherence was
found. The LiFE group showed significantly better progress for
25% of the outcomes compared to the structured exercise
group over the six months.
CONCLUSION
Community and health care organizations delivering
restorative home care services should consider this lifestyle
exercise program for their clients. It is particularly appropriate
for those older people who are not interested in structured
types of exercise, those who will not keep using weights to offer
resistance, or those who suggest they have limited time.

37. 2. Timing, Duration and Quality of Sleep, and Level of
Daytime Sleepiness in 1166 Retired Seniors
 A telephone survey of 1166 community resident seniors (658
male, 508 female, age between 65 and 97 years, mean 74.8
years) was undertaken.
 The median PSQI score was 5 and the median ESS score 6,
suggesting that neither sleep problems, nor daytime sleepiness
problems, were particularly prevalent in this sample of seniors.
 The STQ indicated that the habitual timing of the sleep episode
appeared to be within the usual 11 pm to 7:30 am range, with
about 7.5 hours of actual sleep within that interval being
reported
 There was, however, a sizable minority who broke this pattern,
with 25% of the sample reporting less than 6.7 hours of sleep,
and problems with nocturnal sleep and daytime sleepiness

39. SUMMERIZATION

40. Listen to the aged………
For they will tell you about living and dying.
For they will enlighten you about problem-solving,
sexuality, grief, sensory deprivation, and
survival.
For they will teach you how to be courageous,
loving and generous.
Irene Burnside, 1975

42. BIBLIOGRAPHY
Basheer shebeer p. and khan s. yaseen. A concise
textbook of advance nursing practice. 1st ed. Emmess
edical publishers.bangalore;2013. p 742-751.
Townsend Mary C. Psychiatric Mental Health Nursing. 7th
ed. Jaypee.New Delhi;2012. p 824-851.
Basavanthapa B T. Fundamental of Nursing. 2nd ed.
Jaypee.New Delhi;2009. p 635-637.
Kozier’s and erb’s. Fundamental of Nursing concepts
process and practice. 8th ed. Dorling Kindersley.
Cheenai;2009. p 406-423.
Potter Patricia A. and Perry Anne Griffin. Fundamental of
Nursing. 7th ed. Elsevier.UP;2009. p 190-213.
http://newoldage.blogs.nytimes.com/
http://www.britannica.com/
http://www.thefreedicitionary.com/