CONCEPTS, PRINCIPLES and THEORIES 1950: The first textbook on gerontology education

was published.
in the CARE of OLDER ADULTS
1968: The ANA published geriatric standards of
INTRODUCTION
practice, and a geriatric certificate was offered.
• Aging is determined by society and culture
1984: The specialty of Geriatric Nurse Practitioner is
• In 1935 with the establishment of Social
formed.
Security, “old” was set at 65 years of age.
• In the 2000s, “old” was established closer 2010: The first edition of Scope and Standards of
to 70 years of age. Gerontological Nursing Practice is published.
• Traditional categories of aging are:
o Young-old: 65 to 74 years
o Middle-old: 75 to 84 years
• Aging is not merely the passage of time.
o Old-old: Older than 85 years
• As a general rule, slight, gradual changes
are common, and most of these are not
ELDERCARE problems to the person who experiences
them.
• Eldercare is the fastest growing
employment sector.
• Older adults are the core consumers of
GERONTOLOGY VS. GERIATRICS
health care.
• Older adults have the highest rates of Scientific and medical disciplines, respectively,
outpatient visits. concerned with all aspects of health and disease in
• The interest of nurses to care for older the elderly and with the normal aging process
adults is low.
• Concerned primarily with the changes that
occur between maturity and death and with
the factors that influence these changes. It
Aging Depends On:
addresses the social and economic effects
• Decade during which one was born or his of an aging population and the physiological
or her history and psychological aspects of aging to learn
• Gender about the aging process and possibly
• Ethnic group minimize disabilities
• Health • Hence, both deal with aging but geriatrics
focuses on the care of aging people while
gerontology is the actual study of the aging
EARLY HISTORY OF THE GERONTOLOGICAL process. A geriatrician or geriatric physician
NURSE
and gerontology nurse, works to promote
1906: Lavinia Dock addressed the needs of older health in the older adults while preventing
adults in Early History of the Gerontological Nurse and treating diseases prone to them.

1906: Lavinia Dock addressed the needs of older • Therefore, Gerontology is the study of aging
adults in almshouses(charitable). and/or the aged, this includes the
biopsychosocial of aging
1912: The American Nurses Association (ANA)
appointed an almshouse committee to oversee • While, Geriatrics relates to the medical care
nursing for older adults. of the aged.

1935: With the passage of the Social Security Act,

monies were set aside for old-age insurance and Gerontology is the study of aging and the aged
public assistance. 1940s: Centers for the excellence
for geriatric care were established. • Geriatrics - medical care of the aged

• Social Gerontology - focuses on social

aspects of aging

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• Geropsychology - seeks to address the 1. AGING IS A DEVELOPMENTAL PROCESS:
concerns of older adults
• Aging is a developmental process that starts
• Geropharmacology - study of at birth
pharmacology in relation to older adults • Gradual changes process in body structures
and systems
• Financial Gerontology - combines • Changes in physical, psychological, cultural
knowledge of financial planning and services and social levels
with special expertise in the needs of the • Multidimensional that can impact function,
older adults participation, and quality of life
• Dimensions of ageing are increasing and
• Gerotological Rehabilitation Nursing
expanding over time, while others are
-combines expertise in the gerontological
declining. Reaction time may slow down with
nursing with rehabilitation concepts and
age
practice
Despite the normality and naturalness of this
• Gerontological Nursing - nurses
experience , many people approach aging as though
advocating for the health of older persons at it were a pathologic experience, witnessed by
all levels of prevention.
comments that associate aging with:

• “looking gray and wrinkled”

Gerontological nursing • ”losing one’s mind”
• Discipline of nursing and scope of nursing • “becoming sick and frail”
practice
• ”obtaining little satisfaction from life”
• It involves nurses advocating for the health
of older adults at all levels of prevention • “returning to childlike behavior”

• A nurse who has specialization in geriatrics • “being useless”

or in the care of old people is called
GERIATRIC NURSE or GERONTOLOGICAL Ageism- negative attitude towards aging and older
NURSE adults

Classification of aging:

Gerontological nurse: • Ageing or Normal Aging

• Work with health elderly persons in their • Probabilistic Ageing

communities, acutely ill elders requiring
• Chronological Ageing
hospitalization and treatment, and
chronically ill or disabled elders in long term • Social Ageing
facilities, skilled care, home care, and
hospice • Biological Ageing (Senescence)

• Scope: from the time of “old age” until death • Proximal Ageing

• Distal Ageing

Gerontological Care: • Psychological ageing

✓ This is related to the disease process of

old age and it aims at keeping old persons
at a state of self- dependence as far as
possible and to provide facilities to improve
their quality of life

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B. Demography of Aging and 1. Ensuring fulfillment of physical needs

Implications for Health and 2. Providing emotional support and comfort

Nursing Care 3. Maintaining connections with family and
1. GLOBAL AGING community

• Worlwide by 2050 – population of 60 yrs old 4. Instilling a sense of meaning to life

will outnumber 15 yrs old (developing or 5. Managing crises
low-income countries).

• Europe & America by 2040 as projected 60

yrs old will exceed the no. of children in Asia, While interviewing older adults, it is important to
Latin America and Caribbean. explore all persons who are “significant others” to an
individual and fulfill a family role
• UN estimated that by 2050- world
population of 270,000 centenarians would Asking older adults, the ff questions can facilitate the
grow to 2,3 million identification of significant persons who perform family
functions for them:
• At 2016 - 103 million – 5%
population is age 60 yrs old 1. Who checks on you regurlaly?

• At 2017 – increased over 35% 2. Who shops with or for you?

• Life expectancy (57.4 yrs male / 63.2 yrs 3. Who escorts you to the clinic or physician
female)
Asking older adults, the ff questions can facilitate the
• Females are projected to expect an increase identification of significant persons who perform
of 4.0 years on life expectancy and males an family functions for them:
increase of 4.7 years in life expectancy by
4. Who assists with or manages your
2030
problems?

5. Who takes care of you when you are ill?

C. IMPACT OF AGING MEMBERS IN THE 6. Who helps you to make decisions?
FAMILY:
7. Who do you seek for emotional effort?
Older Adults and their Family Family Compositions:

• Couples (married, unmarried, heterosexual

or homosexual) Family Roles - family members assume certain roles
as result of their socialization process and family
• Couples with children needs and expectations.

• Parent and child (or children) 1. Decision maker - the person granted or
assumes responsibility for making important
• Siblings decisions or is called in times of crises
• Groups of unrelated individuals
2. Caregiver - the person who provides direct
• Multigenerations services, looks after and assist with personal
care and home management

3. Deviant - the “problem child” who has

Identification of Family Members strayed from family norms. May be used to
fulfill family need for scapegoat or provide
One can identify family members by looking for those
sense of purpose for the family members
individuals who fulfill family functions
who compensate for the individual
In aging families, family functions are somewhat
4. Dependent - a person who depends on
modified to address the special needs of the elderly
other family members for economic or
and focus on the following:
caregiving assistance

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5. Victim - a person who forfeits his or her 2. The manner of communication. Do they share daily
legitimate rights and may be physically, events or have contacts only on holidays Is their style
emotionally, socially or economically abused of interaction parent-child or adult-adult
by the family
3. Their attitudes, values and beliefs. Do they feel the
Nurses must be sensitive to the fact that certain young should take care of the old or that children owe
“negative” roles may not have the adverse effect on their parents nothing? What are their expectations of
the family unit that would be anticipated; likewise, a family members, friends and society?
“positive” roles may not welcomed be by the family.
4. Links with organization and the community. How
The impact of these roles should be explored when involved are they with the persons external to the
assessing a family unit. family unit?

Nurses must be sensitive to the fact that certain • Elderly individuals experience loss of health;
“negative” roles may not have the adverse effect on loss of independence ; dependence on a
the family unit that would be anticipated; likewise, a fixed income – strain other members of the
“positive” roles may not welcomed be by the family. family.

The impact of these roles should be explored when • Younger people - watch family members
assessing a family unit. grow older - reminded of their own
aging process.

• Elderly person would live in one of her

FAMILY CAREGIVING - primarily provided by the children.
adult children of the older person. Often, the varying
levels of participation among siblings may cause • Older adults face the guilt of having to leave
stress within the family. their parents- busy on active and productive
lives.
It is important for the nurse to recognize the types and
levels of family caregiving: • Roles and relationships between the family
members may change.
1. Routine care - regular assistance that is
incorporated into the daily routine of the caregiver

2. Back-up-care assistance with routine activities Benefits of having an older adult in the family:
that is provided only at the request of the main
caregiver 1. Help in family’s finances
2. Help in raising/taking care of children
3. Circumscribed care - participation that is 3. Give family a sense of companionship &
provided on a regular basis within boundaries set by security
the caregiver 4. Give its members sense of the past and
identity
4. Sporadic care - irregular participation at the
caregivers

5. Dissociation - potential caregiver does not Challenges that may experience by an Older
participate at all in Adult:

1. Abuse occurs because of added caregivers

2. Caregivers make adjustment to
FAMILY DYNAMICS - dynamics among family accommodate the need of older adults
members can have positive or negative effects on the 3. Younger generation may placed with greater
elderly responsibility for eldercare
In assessing the family unit, it is useful to explore the 4. Older adult will presume to be head of the
following issues: household which cause friction

1. How family members feel about each other. Do

they love but not like, admire, respect, or enjoy each
other? How do they express affection?

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D. THEORIES OF AGING AND IT’S NURSING understanding of the difference between age-related
changes and those that may actually be pathologic
IMPLICATION
2. SOCIOLOGIC THEORIES - focus on roles and
1. BIOLOGIC THEORIES- concerned with relationships within which individuals engage later in
answering basic questions regarding physiologic life
process that occur in all living organism in time
a. Disengagement Theory - as individuals
2. STOCHASTIC THEORIES - explain aging as age, they withdraw from society, and society
events that occur randomly and accumulate over time encourages this withdrawal
a. Error theory- the theory is based on the
idea that errors can occur in the transcription b. Activity/development Task Theory -
of the synthesis of deoxyribonucleic acid individual need to remain active to age
(DNA). These errors are perpetuated and successfully. Activity is necessary to maintain
eventually lead to systems that do not life satisfaction and a positive self concept
function at the optimal level.
c. Continuity Theory - Individuals will
b. Free Radical Theory -free radicals are respond to aging in the same way they have
byproducts of metabolism. When these responded to previous life events. The same
byproducts accumulate, they damage the habits, commitments, preferences, and other
cell membrane, which decreases its personality characteristics developed during
efficiency. The body produces antioxidants adulthood are maintained in older adult.
that scavenge the free radicals.
d. Age stratification Theory - society
c. Cross-Linkage Theory - with age, consist of groups of cohorts that age
according to this theory, some proteins in collectively. The people and roles in these
the body become cross-linked. This does not cohorts change and influence each other, as
allow for normal metabolic activities, and does society at large. Therefore, a high
waste products accumulate in the cells.. The degree of interdependence exists between
result is that tissues do not function at older adults and society.
optimal efficiency.
e. Person-Environment Theory - an
d. Wear and Tear Theory - equates humans individual has personal competencies that
with machines. It hypothesizes that aging is assist the person in dealing with the
the result of continuous use of the body environment. These competencies may
overtime. change with aging, thus affecting the older
person's ability to interrelate with the
environment.
Nonstochastic Theories – view as certain
predetermined, timed phenomenon
Nursing Implication:
a. Programmed Theory - normal cells divide
a limited number of times and that life a. Nurses need to know that whatever
expectancy is preprogrammed. similarities exists among the individuals of a
cohort group, they are still individuals. Other
b. Immunity Theory - changes occur in the adults are not homogenous sociologic
immune system, specifically in T group, and care needs to be taken not to
Lymphocytes. These changes leave the treat them as if they were.
individual more vulnerable to the disease.

3. PSYCHOLOGICAL THEORIES - influenced by

Nursing Implication: both biology and sociology, address how a person
responds to the tasks of his or her age
a. Aging and disease do not go hand in hand, and the
nurse caring for older adults needs to have a clear

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a. Maslow's Hierarchy of Human needs - E. PHYSIOLOGIC CHANGES IN AGING
human motivation is viewed as a hierarchy of needs
AFFECTING VARIOUS SYSTEMS
that are critical to the growth and development of all
people. Individuals are viewed as active participants in
life, striving for delf actualization.
1. INTEGUMENTARY:
b. Jung's Theory of Individualism - development
Skin:
is viewed as occurring throughout adulthood, with
self-realization as the goal of personality development. • Wrinkling, pigment alteration, and thinning of
As an individual age, he or she can transform into a the skin.
more spiritual being. • Elastin and collagen decrease.
• Reduction in size of cells.
c. Erikson's Eight Stages of Life - all people
• Loss of subcutaneous layer of fatty deposits.
experience eight psychosocial stages during a lifetime.
• The inability of the skin to retain moisture
Each stage represents a crisis, where the goal is to
integrate physical maturation and psychosocial Hair:
demands. At each stage, the person could resolve the
crisis. Successful mastery prepares individual for • More than half of all hair is 50% gray by age
continued development. Individuals always have 50 due to a decrease in the production of
within themselves an opportunity to rework a previous melanin ( can be hormonal and hereditary).
psychosocial stage into a more successful outcome.

d. Peck's Expansion of Erikson's Theory seven

developmental are identified as occurring during
Erikson's final tuo stages. The final three
developmental task identified for old age are:

1. ego differentiation vs. work role

preoccupation
2. body transcendence vs. body
preoccupation, and
3. ego transcendence vs. ego
preoccupation

e. Selective Optimization Theory with

Compensation - physical capacity diminishes with
age. An individual who ages successfully compensates
for these deficits through selection, optimization and
compensation

Nursing Implication:

a. The nurse must understand that in each stage of 2. MUSCULO-SKELETAL

life, specific developmental task need to be achieved.
• Structural changes in the musculoskeletal
Instead of hampering their achievement, nurses
system may place aging patients at
should facilitate them.
increased risk for weakness, immobility, falls,
musculoskeletal injuries, and pain
syndromes. Selected aging changes include:
• Cartilage degeneration and loss of tissue
elasticity in the joints
• Decreased muscle mass and contractility
• Increased muscular fat, causing reduced
muscle quality
• Loss of bone mass

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• Muscles generally decrease in strength, ADLs an older person no longer participates
endurance, size, and weight. in and WHY )
• Loss of about 23% of muscle mass by age • Recommend cough suppressants with
80 as both the no. and the size of muscle caution
fibers decreases. • Encourage fluid intake to prevent secretions
• Loss of an average of about 2 inches of from becoming thickened
height. • Positioning & increased abdominal pressure
• Compression of vertebrae, etc. greatly impact breathing patterns
▪ Decreased bone calcium • Position can be critical to distribution of
▪ Decreased fluid in intervertebral disk ventilation, as older adults have increased
▪ Decreased blood supply to muscles vulnerability to shallow breathing
▪ Decreased tissue elasticity • Assessment findings include diminished
▪ Decreased muscle mass breath sounds, particularly at lung bases
▪ Decreased body fluids
▪ Decreased number of cilia
▪ Decreased number of macrophages
▪ Decreased tissue elasticity in the alveoli and
lower lung lobes
▪ Decreased muscle strength and endurance
▪ Decreased number of capillaries- decreased
gas exchange
▪ Decreased calcification of cartilage

Nursing assessment and care strategies:

3. RESPIRATORY: • Assess breathing depth and effort
Changes in the respiratory system include: • Assess cough and sputum production
• Assess for signs and symptoms of
• Loss of elasticity in airways and bony thorax respiratory infection
• Loss of muscle and weakening of respiratory
musculature, contributing to poor lung
expansion 4. CARDIOVASCULAR
• Ventilation-perfusion mismatch
• Reduced arterial oxygen tension ▪ The cardiovascular system changes center
• Blunted ventilator response to hypoxia or around decreased system flexibility. In
hypercapnia addition to genetics and lifestyle, older
• Lungs become stiffer, muscle strength individuals are at increased risk for elevated
diminishes, and the chest wall becomes blood pressure, heart attack, stroke, and
more rigid. other cardiovascular diseases as a result of
• Total lung capacity remains constant, but the following changes:
vital capacity decreases, and residual volume ▪ Decreased mechanical and contractile
increases. efficiency
• Alveolar surface area decreases by up to ▪ Arterial wall thickening and stiffening of the
20%. Alveoli tend to collapse sooner on veins
expiration. ▪ Increased elastolytic and collagenolytic
• There is an increase in mucus production and activity
a decrease in the activity and number of cilia. ▪ Increased smooth muscle tone
• The body becomes less efficient in ▪ Elevated systolic arterial pressures due to
monitoring and controlling breathing. stiffening of vessels
▪ Increased preload and afterload
▪ Left ventricular hypertrophy
▪ Decreased plasma renin and aldosterone
Nursing Considerations:
activity including decreased reactivity to
• Complaints of dyspnea may not occur until upright posture or response to sodium
interference with ADLs (determine which restriction

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▪ Cardiac hypertrophy, which may lead to To treat heart disease:
diastolic dysfunction
▪ Conduction defects and rhythm disturbances, • Lower high blood pressure and high
such as increased risk of atrial fibrillation cholesterol levels
▪ Fall in stroke volume and then cardiac • Keep diabetes under control
output, so cardiac output may not be as • Take medication to treat angina (chest pain)
efficient with exercise (Navaratnarajah &
7 Steps to Heart Disease Prevention:
Jackson, 2013)
o Heart rate decreases. 1. Get enough exercise
o Respiration decreases. 2. Quit smoking
o Systolic BP increases (aorta & 3. Eat a heart-healthy diet
other arteries thickened/stiffened). 4. Watch your numbers
o Valves between the chambers of 5. Reduce your alcohol intake
heart thickened /stiffened. 6. Minimize stress in life
o Baro-receptors which monitor BP 7. Watch your weight
become less sensitive.
o Quick changes in position may
cause dizziness from orthostatic 5. HEMATOPOIETIC AND LYMPHATIC
hypotension
Hematopoietic system suffers the consequences of
aging, manifested by the emergence of chronic
anemia, immune dysfunction, increased incidence of
myeloproliferative syndromes, and overt chronic and
acute myeloid malignancies.

▪ Increased plasma viscosity

▪ Decreased RBC production
▪ Decrease mobilization of neutrophils
▪ Increase immature T-cells response
▪ Lower serum albumin levels

Nursing assessment and care strategies:

• Monitor lab test, including Hgb, Hct, WBC,

and differential- report abnormal findings
promptly to the primary care provider
• Assess nutritional intake for adequacy of
protein, iron and vitamins; assess for
▪ Decreased cardiac muscle tone
peripheral edema- administer nutritional
▪ Increased heart size, left ventricular
supplements as ordered.
enlargement
▪ Decreased cardiac output
▪ Decreased elasticity of heart muscles and
blood vessels 6. GASTROINTESTINAL
▪ Decrease pacemaker cells • As individuals age, the smooth muscle
▪ Decrease barreceptor sensitivity activity and absorption may change in the
▪ Increased incidence of valvular sclerosis gastrointestinal system. This may result in
▪ Increased atherosclerosis more issues with constipation, appetite, and
nutritional imbalances. Other changes with
aging include:
Nursing assessment and care strategies: • Decreased saliva production
• Desynchronization of contraction and
• Assess apical and peripheral
relaxation of smooth muscle and sphincter
• Assess blood pressure lying, sitting and control, making deglutition less effective
standing
• Altered protein metabolism and nutrient
• Assess ability to tolerate activity absorption
• Prolonged transit time

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• Atrophy of gastrointestinal mucosa Decrease muscle tone at Increased incidence of
• Decreased strength of colonic muscle sphicters heartburn (esophageal reflux)
• Decrease in liver and pancreas size Decreased saliva and gastric Decreased digestion and
(Navaratnarajah & Jackson, 2013; secretions; Increased gastric pH absorption of nutrients; altered
Rughwani, 2011) absorption of some medications
▪ A decrease in strength of muscles of that are pH-dependent
mastication, taste, and thirst perception. Decreased gastric motility and Increased flatulence,
peristalsis constipation, and bowel
▪ Decreased gastric motility with delayed
impaction
emptying.
Decreased liver size and Decreased ability to metabolize
▪ Atrophy of protective mucosa. enzyme production drugs, leading to increased risk
▪ Malabsorption of CHO, Vit B12, Vit D, folic for toxicity
acid, and calcium.
▪ Impaired sensation to defecate.
▪ Reduced hepatic reserve. – Decreased Nursing Assessment and Care Strategies to
metabolism of drugs. Gastrointestinal Changes

Stomach:

• Atrophic gastritis. 7. URINARY

• Achlorhydria (insufficient production of
• Overall, kidney function and bladder capacity
stomach acid).
decrease with age.
• Gastric ulcers (after the age of 60 years, and
• The bladder and sphincters lose elasticity
can be benign or malignant).
and are less responsive to stimulus to
Liver: urinate.
• Men commonly experience enlargement of
• Reduced blood flow. the prostate.
• Altered clearance of some drugs. ▪ Decreased number of functional nephrons
• Diminishing the capacity to regenerate ▪ Decreased blood supply
damaged liver cells. ▪ Decreased muscle tone
▪ Decreased tissue elasticity
Intestine: ▪ Delayed or decreased perception of need to
• Prevalence of diverticulitis increases with void
age. ▪ Increased nocturnal urine production
• Reduced peristalsis (intestinal muscle ▪ Increased size of prostate (male)
contractions) of the large intestine. Nursing assessment and care strategies:
• Increased vulnerability to infections, tumors,
and immune disease. • Monitor for signs of drug toxicity-promptly
• Less production of antibodies. notify primary care of relevant observance
• The mortality rate from infection is much • Assess for urinary frequency- palpate
higher than in young. (example: pneumonia bladder after voiding or use Doppler to
or sepsis, UTI.) determine whether bladder is emptying
completely
• Assess for signs and symptoms of urinary
Gastrointestinal changes associated with tract infections- obtain a urine specimen for
aging urinalysis
• Assess frequency and timing of episodes of
PHYSIOLOGIC RESULTS incontinence- establish a toileting schedule
CHANGE based on assessment data
Increased dental Decreased ability to chew normally;
caries and tooth loss decreased nutritional status
Decreased thirst Increased risk for dehydration and
perception constipation
Decreased gag reflex Increased incidence of choking and
aspiration

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8. NERVOUS • Assess visual acquity- encourage or schedule
regular professional eye examinations.
Changes to the nervous system:
Educate importance of adequate light with
• The part of the brain that controls breathing minimum glare. Explain importance of using
may lose some of its function. When this eyeglasses appropriately for reading or
happens, lungs are not able to get enough distance, particularly when driving
oxygen. Not enough carbon dioxide may • Assess ability to detect objects within the
leave the lungs. Breathing may get more environment- provide adequate lighting and
difficult. contrast in colors to highlight important
• Nerves in your airways that trigger coughing structures such as the edge of stairs, light
become less sensitive. Large amounts of fixtures, faucets, etc.
particles like smoke or germs may collect in
the lungs and may be hard to cough up.
• Neurologic changes associated with aging: AUDITORY:
▪ Decreased number of brain cells
▪ Decreased number of nerve fibers ▪ Decreased tissue elasticity
▪ Decreased amounts of neuroreceptors ▪ Decreased joint mobility
▪ Decreased peripheral nerve function ▪ Decreased ceruminous cells in external ear
canal
Nursing assessment and care strategies: ▪ Atrophy of the vestibular structures and in
the inner ear
• Assess alertness level, cognition, and
functional abilities Nursing assessment and care strategies:
• Assess balance and reflexes
• Assess hearing and balance
• Inspect ear canal for cerumen impaction
9. SPECIAL SENSES • Assess functioning of hearing aid if used
• Assess for social isolation or behavioral
• Hearing-structures inside the ear start to background noise
change and their functions decline, ability to
pick up sounds decreases,(presbycusis),
may also have problems maintaining OLFACTORY:
balance as in sitting, standing, and walking
• Decreased number of papillae on
• Vision- (visual acuity) gradually tongue
declines,presbyopia. Reading glasses, bifocal
• Decreased number of nasal sensory
glasses, or contact lenses can help correct
presbyopia, less able to tolerate glare. Nursing assessment and care strategies:
• Taste and smell- decreased
• Touch, Vibration and Pain- sensations • Assess ability to smell and taste
reduced or changed

VISION: 10. ENDOCRINE

• Decreased number of eyelashes Pancreas: – Muscle cells become less sensitive to
• Decrease tear production the effects of insulin produced in the body.
• Increased discoloration of lens
• Decreased tissue elasticity • The normal fasting glucose level rises 6-14
• Decreased muscle tone mg/dl every 10 years.
• Type 2 Diabetes mellitus occurs when the
Nursing assessment and care strategies: body develops resistance to insulin.
(Vision)
Adrenal glands: – Aldosterone levels are 30%
• Assess for signs of irritation, inflammation, lower in adults aged 70 to 80 years than in younger
and dryness- encourage regular use of adults. Lower aldosterone levels may cause
synthetic tear prepartions to help reduce orthostatic hypotension. – The secretion of cortisol
irritation caused by inadequate tear diminishes by 25% with age.
production

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▪ Decreased pituitary secretions (Growth Nursing assessment and care strategies:
Hormone )- Decreased muscle mass
▪ Decreased production of TSH- Decreased • Assess for signs and symptoms of infection
metabolic rate or inflammation
▪ Decreased insulin production or increased • Assess factors that may interfere with sexual
insulin resistance- increased risk for TYPE 2 activity
DIABETES
▪ Decreased production of parathyroid
hormone- increased blood calcium levels II. NURSING CARE OF THE OLDER ADULT IN
(seen with osteoporosis) WELLNESS

Nursing assessment and care strategies: 1.SUBJECTIVE DATA -information that is reported
by the patient, can't be verified or perceived by the
✓ Monitor laboratory values, paying special examiner. The examiner should document subjective
attention to minerals, such as calcium and complaints.. (“feeling hot,” “pain,” “numbness,”
sodium levels, and blood glucose-educate “tingling” or “nausea.”) VERBALIZED
patient regarding dietary needs and self-
testing of blood glucose Nursing/Health History:

✓ Assess for body temperature, weight, hair • collection in a face-to-face approach with the
distribution or behavioral changes, which client or a review of the client’s written
may indicate endocrine imbalance- notify history. Includes medical history, review of
primary care provider of assessment systems, medication history, nutritional
findings history, and factors that influence the
person’s quality of life, including:
o Living arrangements - co-
11. REPRODUCTIVE reside with children
o Financial resources - need to
Females extend their role as provider – less
income of children
As hormone levels fall, other changes occur in the o Support - Support
reproductive system, including: available? Family and friends
• Vaginal walls become thinner, dryer, less nearby? How involved are they?
elastic, and possibly irritated. Provide you the support you need?
• Sometimes sex becomes painful due to Guidelines for an Assessment of Older Adults
these vaginal changes.
• risk for vaginal yeast infections increases. • Conduct the assessment at a time when the
client is at his or her best.
Males • Avoid biasing the response ( record what
• Occur primarily in the testes. was observe)
• Testicular tissue mass decreases. • Explore more information, but only if needed
• The level of the male sex hormone, (confidentiality)
testosterone decreases gradually. • Approach sensitive information in a matter-
• There may be problems getting an erection. of-fact manner (with basis)
• Record the client’s words for
Female: accuracy.(legality; proper management)

• Decreased estrogen levels Functional Health

• Decreased tissue elasticity
• Increased vaginal alkanility • FUNCTIONAL ASSESSMENT
Determine the functional status of the client
Male: including:
o Identifying areas where help is
• Decreased testosterone levels needed
• Decreased circulation o Determining whether a change in
abilities has occurred

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o Assisting in the determination of a further health problems. One of the best ways to
need evaluate the health status of older adults is through
o Determining the safety of the functional assessment which provides objective data
client’s living situation/condition that may indicate future decline or improvement in
• If the client is healthy and active, record a health status, allowing the nurse to intervene
simple statement such as, “The client is appropriately.
active and independent and denies
functional difficulties.” BEST TOOL: The Katz Index of Independence in
Activities of Daily Living, commonly referred to as the
Functional Abilities: Katz ADL, is the most appropriate instrument to
assess functional status as a measurement of the
• Activities of daily living (ADLs) client’s ability to perform activities of daily living
o Eating – loss of teeth, mastication independently.
problem
o Toileting – incontinence, TARGET POPULATION: The instrument is most
constipation effectively used among older adults in a variety of care
o Ambulation – slow to move settings, when baseline measurements, taken when
o Bathing – watch closely – fall, the client is well, are compared to periodic or
injury, slipping subsequent measures.
o Dressing – slow to move and
dressing up problem
o Grooming – assisted in combing,
lotion & etc. application
• Instrumental activities of daily living (IADLs)
o House cleaning – choose chores to
be done
o Shopping – if still able but with
assistance/accompanied
o Managing money – guide in
allocation of budget

FUNCTIONAL ASSESSMENT TOOLS:

• Tools to assess activities of daily living

(ADLs)
o Katz Index -Independence in
Activities of Daily Living (ADL),
measures and assess functional
status.
o Barthel Index - SCALE that
measures disability or dependence
in activities of daily living(ADL) in
stroke patients.
o Functional Index Measure- 18 item
measurement that assess level
of disability and change in status in
response to rehabilitation or
medical intervention.
A. ASSESSMENT:

Katz Index of Independence in Activities of Daily Living

(ADL)

WHY: Normal aging changes and health problems

frequently show themselves as declines in the
functional status of older adults. Decline may place
the older adult on a spiral of iatrogenesis leading to

NCM114 4067
• Was created to be more sensitive, detailed
and comprehensive when compared to the
Barthel Index.
• uses ordinal scale from 0-7 to describe the
level of dependence one has in performing a
certain task.
• Normative scores for various conditions
available for comparison
• 18 Test items (13 motor, 5 cognitive)
• Good test-retest reliability (~0.85)
• Inter-rater reliability widely ranges between
studies, and inconclusive. (~0.4-~0.95)
• Tools to assess instrumental activities of daily
living (IADLs)
• Other Tools:
o Blessed Dementia Score(BDS) -
brief behavioral scale based on the
interview of a close informant.
o Clinical Dementia Rating
Scale(CDS) - 5-point scale
that characterize six domains of
cognitive and functional
performance applicable to
Alzheimer disease (Memory,
Orientation, Judgment & Problem
Solving, Community Affairs, Home
& Hobbies, and Personal Care)
o Global Deterioration Scale(GDS) -
overview of the 7 stages of
cognitive function for those
suffering from a primary
degenerative dementia such as
Alzheimer's disease.
o Fulmer SPICES (Sleep disturbance,
Problems with eating and feeding,
Incontinence, Confusion, Evidence
of falls, and
o Skin breakdown) – framework for
assessing 6 "marker conditions“
o ; provide a snapshot of a patient's
overall health and the quality of
care.

NCM114 4067
2. OBJECTIVE DATA Elimination: Difficulty with bladder or bowel
elimination
Psychological Assessment
Socialization: Ability to give and receive love and
• MENTAL ASSESSMENT friendship
o Assess if an increase in age (years,
Planning for successful aging
months, days) has resulted in an
increased rate of dementing illness. 1.) Avoidance of physical illness and disability
o Assess cognition and mood.
2.) Maintenance of high physical and cognitive
function
Cognition and mood assessment 3.) Continuing engagement in social and productive
activities –
Tools for cognition assessment

• Mini-Mental State Examination- test of

cognitive function; it includes tests of Home care and Hospice
orientation, attention, memory, language
and visual-spatial skills. 1. Alert Level: Community-Based Services - builds strengths of
scoring below education adjusted cut-off the child, family and community where that family
scores - cognitively impaired. lives ( A nurse visits an elderly person at home to help
• Clock Drawing Test- medical expert assesses with medication)
the sketches to discover any deficiencies in
Assisted Living - a system of housing and limited
the cognitive processes
care that is designed for senior citizens who need
• The Mini-Cog- is a 3-minute instrument that
some assistance with daily activities
can increase detection of cognitive
impairment Special Care Units - SCU for dementia; SCU
Tools for mood assessment for Alzheimer’s and ICU’s

• Geriatric Depression Scale - identify Geriatric Units - Geriatric intensive care unit is a
symptoms of depression special intensive care unit to management of critically
ill elderly; world population is aging.
Physical assessment

• Is time consuming.
• Begins the moment the nurse sees the Steps to Successful Aging.
person. 1. Adopt and maintain healthy habits and positive
• Perform a problem assessment first- takes lifestyles:
length of time to conduct assessment.
• When the focus is a well-check assessment, • Avoid cigarette smoking
the emphasis is placed on health problems • Have no more than one alcoholic beverage
in later life. in a 24 hour period
• Assessment of the Frail and Medically • Exercise regularly, maintaining the triad of
Complex (chronic illness) weight bearing,aerobic, and
• balance activities
Model for assessment is FANCAPES: • Maintain a comfortable weight
Fluids : State of hydration Get regular medical checkups
Aeration: Respiratory functioning
Nutrition: Food intake consumption (Type and 2.Maintain intellectual stimulation and socialization:
amount) • Pursue hobbies and interests with passion,
Communication: Ability of the older adult to particularly those such as dancing that are
adequately communicate needs social
Activity: Ability to meet basic needs of toileting, • Strengthen family relationships
grooming, and meal preparation • Resolve intergenerational conflicts
Pain: Physical, psychological, or spiritual pain • Engage in adult educational activities to
challenge your mind

NCM114 4067
3. Be wise in financial planning: • It is for people who need help with daily care,
but not as much help as a nursing home
• Plan in advance for retirement provides.
• Carefully manage investments and assets • The living facilities range in size from as few
• Assure adequate insurance coverage as 25 residents to 120 or more.
• Decide on your future living arrangements • Typically, a few "levels of care" are offered,
4. Work to maintain dignity and good health in old age: with residents paying more for higher levels
of care.
• Choose a physician knowledgeable in the
medical care of older adults.
• Choose a health care system that facilitates 5. Special Care Units
appointments and care for elders.
• Communicate your goals of care to your • the most common types of living
family and physician. environments for clients with dementia who
• Express your advance directives in writing. cannot live on their own anymore
• especially designed for clients with dementia,
implying resident security and safety
2. Home care and Hospice Older adult- through locking systems, signposts and
communal living areas
friendly communities will:
• The staff is specially trained to deal with
• Address basic needs. behavioral and psychological symptoms of
• Optimize health and wellness. dementia (BPSD), a heterogeneous
• Maximize independence for the frail and collection of behaviors and noncognitive
disabled. symptoms occurring in the course of
• Provide social and civic engagement. dementia.
• A special care unit (SCU) is an in client unit
Interventions for the older adult to remain in the home within a healthcare facility that is custom-
include: designed, staffed, and equipped to care for
people with specific health conditions. They
• Adequate transportation
are usually in a physically separate space
• Home modification
from other client populations.
• Barrier-free housing
• Wider doors and hallways (36") Bathroom 6. Geriatric Units
on the first floor Outlets at wheelchair level
• Reinforced walls for support bars
IMPLEMENTATION

• Aging Skin and Mucous – dry skin; pressure

3. Community-Based Services
sores ( moisture ,positioning)
• Community-based care settings include: • Elimination - bowel elimination : CR near; less
o Adult day care services caffeine intake ; high fiber and fluid intake ;
o Residential care facilities exercise ; Provide appropriate supplies and
o Assisted living facilities emotional support.
o Continuing care retirement • Activity and Exercises – brisk walking ;
communities physical activity prevents heart disease and
• Program for All Inclusive Care for the Elderly diabetes
(PACE) an alternative to nursing home care • Sleep and Rest – use low wattage bulb ;
confusion occur due lack of rest and sleep
• Engagement with Life – visit friends ; eat
4. Assisted Living Residence outside ; watch movie ; read news
• Self-Perception and Self-Concept - "The
• Also known as Assisted living Facility (ALF) individual's belief about himself or herself,
similar to that of a retirement home person's attributes and who and what the
• It is usually a housing facility for people with self is".
disabilities or for adults who cannot • Coping and Stress - exercising regularly ;
• or who choose not to live independently. eating a well-balanced diet ; involved in

NCM114 4067
community events.; volunteer for a cause
you care about; relaxation techniques and
mediation.
• Values and Beliefs - help with ADL such as
housework and personal - washing,
dressing, or eating. Friend or transportation
to an appointment.
• Sexuality and Aging - slower sexual arousal;
increase feelings of stress, change your
interest in sex (women) ; sexually inactive by
age 70(men)

2. Psychosocial care of Older Adults

• Cognition and Perception - reasoning,

memory, and processing speed, decline
gradually over time.

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