2. LEARNING OBJECTIVES
Introduction of Geriatric Consideration in Nursing.
Definition of Geriatrics.
Theories of Aging.
Changes associated with Aging.
Common problems in old age.
Important considerations in care of geriatric clients.
Resources for care of older adults.
Steps taken by government.
3. INTRODUCTION
• Declining fertility rates combined with steady
improvement in life expectancy over the 20th century
produced dramatic growth in the world’s elderly
population.
• People aged 65 and over now comprise a greater
share of the world’s population than ever before.
• Population aging refers to an increase in the
percentage of elderly people ( > 65 ).
4. Demography:
• The no. of elderly increased more than 3 fold since
1950, from approximately 130 million (4% of global
population) to 419 million (6.9%) in 2000.
• The no. of elderly is now increasing by 8 million per
year ; by 2030, this increase will reach 24 million per
year.
5. Indian Scenario:
• Current population of India is more than 1.21 billion
( acc. to Census of India 2011 ).
• The total population of nation is growing at the rate
of 1.41%.
• In India , elderly population is over 82 million and it is
expected to reach the mark of 177 million almost
double by the year 2025.
6. GERIATRICS
DEFINITON:
• It is a sub-speciality of internal medicine that focuses
on health care of elderly people.
• It aims to promote health by preventing and treating
disease and disabilities in older adults.
7. Meaning:
• The term Geriatrics Came from the Greek word
“geron” meaning “old man” and “iatros” meaning
“healer”.
• However , geriatrics is sometimes called medical
gerontolgy.
10. 1) Programmed Theories:
Programmed Senescence Theory / Hayflick
Limit Theory:
– In 1950’s Hayflick Suggested that the human cell is
limited in no. of times it can divide, he theorized
that it can divide 50 times, after which they simply
stop dividing ( and hence die). He showed that
nutrition has an effect on cells, with overfed cells
dividing much faster than underfed cells, as cells
divide to help repair and regenerate themselves.
– The Hayflick Limit indicates that there is a need to
slow down the rate of cell division if we want to
live long lives. Cell division can be slowed down by
diet and lifestyles etc..
11. Endocrine / Neuro-endocrine Theory:
– First proposed by Prof. Vladimir Dilman & Ward
Dean MD.
– The Endocrine theory states that , as we age , the
endocrine system becomes less efficient and
eventually leads to the effects of aging.
– Hormones level are affected by factors such as
stress and infection.
12. Immunologic Theory:
– According to this theory , the rate of aging is
controlled by the immune system .
– This theory states that , as we age the no. of cells
start to decrease becoming less functional.
13. 2) Error Theories:
Wear & Tear Theory:
– Early Theory on aging proposed that there is a fixed
storage of energy available to the body . As time
passes , the energy is depleted and because it can not
be restored , the person dies.
– Later, other theories emerged. The wear & tear theory
stated that the body is like a machine that wears out
its parts with repeated use. The effects of aging are
caused by progressive damage to cells and body
systems over time. This was not widely accepted.
14. Crossed linked theory:
– It also referred to as the glycosylation theory of
aging , was proposed by Johan Bjorksten in 1942.
– Acc. To this theory , an accumulation of cross-
linked proteins damages cells and tissues, slowing
down bodily processes resulting in aging.
15. Free radical Theory:
– Proposed by Denham Harman in 1956.
– It states that organisms age because cells
accumulate free radical damage over time .
– A free radical is any atom or molecule that has a
single unpaired electron in an outer shell.
– Free radical are unstable, short lived and highly
reactive, as they attack nearby molecules in order
to steal their electrons and gain stability, causing
radical chain reactions to occur.
16. Error catastrophe theory:
– Proposed by Leslie Orgel in 1963.
– It states that aging is the result of the
accumulation of errors in cellular molecules that
are essential for cellular function and
reproduction that eventually reaches a
catastrophic level that is incompatible with
cellular survival.
– Catastrophe means a sudden event causing
damage or suffering.
17. Somatic theory or Gene mutation theory:
– It states that an important part of aging is
determined by what happens to our genes after
we inherit them. From the time of conception, our
body’s cells are continually reproducing.
Additionally , exposures to toxins, radiation or UV
light can cause mutations in the body’s genes .
– The body can correct or destroy most of the
mutations, but not all of them. Eventually , the
mutated cells accumulate, copy themselves and
cause problems in the body’s functioning related
to aging.
18. (B) Psychological Theories:
1) Personality Theory:
– These theories address aspects of psychological
growth without delineating specific tasks or
expectations of older adults.
– Some evidence suggests that personality
characteristics in old age are highly correlated
with early life characteristics.
19. 2) Development task Theory:
– The developmental tasks are activities and
challenges that one must accomplish at specific
stages in life to achieve successful aging.
– Erikson (1963) described the primary task of old
age as being able to see one’s life as having been
lived with integrity .
– In the absence of achieving that sense of having
lived well, the older adult is at risk for becoming
preoccupied with feelings of regret or dispair.
20. 3) Disengagement Theory:
– It describes the process of withdrawal by older
adults from societal roles and responsibilities.
– Acc. to this theory , this withdrawal process is
predictable , systemic , inevitable, and necessary
for proper functioning of a growing society.
– The benefit to society is thought to be an orderly
transfer of power from old to young.
21. 4) Activity Theory.
– This theory occurs when individuals engage in a
full day of activities and maintain a level of
productivity to age successfully .
– It says , the more you do , the better you will age .
– People who remain active and engaged tend to be
happier , healthier , and more in touch with what
is going on around them.
22. 5) Continuity Theory.
– Also called developmental theory.
– This theory is the follow up to the disengagement
and activity theories .
– It emphasizes the individual previously established
coping abilities and personal character traits as a
basis for predicting how the person will adjust to
changes of aging.
23. CHANGES ASSOCIATED WITH AGING
(NORMAL AGING PROCESS)
• A no. of physiological changes occur as we grow
older. It is important to be able to recognize the
changes of normal aging versus the effects of
disease.
• Untreated disease can result in “excess disability”
and reduce the quality of life of individuals.
24. a) Biological aspects of aging:
Cardiovascular Changes:
– Heart rate decreases.
– Respiration decreases.
– Systolic BP increases (aorta & other arteries
thickened/stiffened).
– Valves b/w the chambers of heart thickened
/stiffened.
– Baro-receptors which monitor BP become less
sensitive . Quick changes in position may cause
dizziness from orthostatic hypotension.
25. Changes in Pulmonary system:
– Lungs become stiffer , muscle strength diminishes,
and chest wall become more rigid.
– Total lung capacity remains constant but vital
capacity decreases and residual volume increases.
– Alveolar surface area decreases by up to 20%.
Alveoli tend to collapse sooner on expiration.
– There is an increase in mucus production and a
decrease in the activity and no. of cilia.
– Body becomes less efficient In monitoring and
controlling breathing.
26. Changes in genito-urinary system:
– Kidney mass decreases by 25-30% and the no. of
glomeruli decrease by 30-40%. These changes
reduce the ability to filter and concentrate urine
and to clear drugs.
– With aging there is a reduced hormonal response
(vasopressin) and an impaired ability to conserve
salt which may increase risk for dehydration.
27. Changes in gastro- intestinal system:
– Decrease in strength of muscles of mastication,
taste and thirst perception.
– Decreased gatric motility with delayed emptying .
– Atrophy of protective mucosa.
– Malabsorption of CHO, vit B12 , vit D, folic acid and
calcium.
– Impaired sensation to defecate.
– Reduced hepatic reserve.
– Decreased metabolism of drugs.
28. • Stomach :
– Atrophic gastritis.
– Achlorhydria (insufficient production of stomach
acid).
– Gastric ulcers (after the age of 60 years, and can
be benign of malignant).
• Liver:
– Reduced blood flow.
– Altered clearance of some drugs.
– Diminishing the capacity to regenerate damaged
liver cells.
29. • Intestine:
– Prevalence of diverticulitis increases with age.
– Reduced peristalsis (intestinal muscle
contractions) of large intestine.
30. – Increased vulnerability to infections, tumors and
immune disease.
– Less production of antibodies.
– Mortality rate from infection is much higher than
in young. (example: pneumonia or sepsis, UTI.)
Changes in Immune system:
31. – Muscles generally decrease in strength ,
endurance, size and weight.
– Loss of about 23% of muscle mass by age 80 as
both the no. and size of muscle fibers decrease.
– Loss of an average of about 2 inches of height.
– Compression of vertebrae, etc.
Changes in musculo-skeletal system:
32. Skin:
– Wrinkling , pigment alteration and thinning of
skin.
– Elastin and collagen decrease.
– Reduction in size of cells.
– Loss of subcutaneous layer of fatty deposits.
– Inability of skin to retain moisture.
Changes in Integumentary system :
33. Hair:
– by age 50 years, the hair of more than half of all is
50% gray. It is due to decrease in the production
of melanin. ( can be hormonal and hereditary ).
34. Vision:
– Most common, about 95% of people aged 65
years or more report wearing glasses or need
glasses to improve their vision.
– Lens of eye become yellowed, cloudy.
Hearing:
– Membrane in middle ear including the eardrum
become less flexible with age.
– Vestibular begins to degenerate with age leading
hearing loss.
Changes in sensory system:
35. Smell:
– No. of functioning smell receptors decreases.
– There is an increase in the threshold for smell.
Taste:
– Taste also diminishes with age.
– Atrophy of tongue occurs with age and this may
diminishes sensitivity to taste.
Touch:
– Sense of touch and response to painful stimuli
decreases.
– Actual no. of touch receptors decreases which
results in a higher threshold for touch.
36. Pancreas:
– Muscle cells become less sensitive to the effects
of insulin produced in body.
– The normal fasting glucose level rises 6-14 mg/dl
every 10 years.
– Type 2 Diabetes mellitus occurs when the body
develops resistance to insulin.
Changes in Endocrine system:
37. Adrenal glands:
– Aldosterone levels are 30% lower in adults aged
70 to 80 years than in younger adults. Lower
aldosterone levels may cause orthostatic
hypotension.
– Secretion of cortisol diminishes by 25% with age.
38. b) Psychological aspects of aging:
Memory functioning:
– Age related memory deficiencies have been
reported in literature.
– Short term memory and long term memory does
not show similar changes.
39. – These abilities of older people do not decline but
do become obsolete (out of date).
– The age of their formal educational experiences is
reflected in their intelligence scoring.
Intellectual functioning:
40. Learning abilities:
– The ability to learn is not diminished by age.
– Studies however, have shown that some aspects
of learning do change with age.
41. Adaptation to the tasks of aging:
– Loss of grief.
– Attachments to others.
– Maintenance of self identity.
– Dealing with death.
43. c) Socio-cultural aspect of aging:
Old age brings many important socially induced
changes, some of which have the potential for
negative effect on both the physical & mental
wellbeing of older persons.
44. d) Sexual aspects of aging:
Sexuality and the sexual needs of elderly people are
frequently misunderstood, repressed and ignored.
45. Special concerns of the elderly
population:
Retirement:
– Sadock & Sadock (2007) reported that, of those
people who voluntarily retire, most re-center the
work force with 2 years.
– The reasons they give for doing this include
negative reactions to being retired , feelings of
being unproductive , economic hardship , and
loneliness.
– Retirement has both social and economic
implications for elderly individuals
46. Elder abuse :
– Abuse of elderly individuals may be psychological ,
physical or financial . And the Neglect may be
intentional or unintentional.
– Psychological abuse includes yelling, insulting,
harsh commands, threats, silence and social
isolation.
– Physical abuse is described as striking. Shoving,
beating or restraints.
– Financial abuse refers to misuse or theft of
finances, property to fulfill the physical needs of
an individual who can not do so independently.
– In addition, elderly individuals may be the victims
of sexual abuse .
47. • Factors that contribute to abuse:
– Longer life (>75 of age).
– Dependency.
– Stress.
– Learned violence.
48. Suicide:
– People older than 65 years (12 % of population)
represent disproportionately high percentage of
individuals who commit suicide.
– Of all the suicides, 16% are committed by this age
group . The group especially at risk appears to be
white men. Predisposing factors may include
loneliness, financial problems, physical illness, loss,
depression, widowed, divorced .
– Components of intervention with suicidal elderly
person should include demonstration of genuine
concern, interest , and caring , solving their issues,
prevent isolation.
49. COMMON PROBLEMS IN OLD AGE
• Alzheimer’s Disease:
– It is a slow and gradual disease that begins in part
of brain that controls memory.
– It affects a greater no. of intellectual and
emotional and behavioral abilities , it has no
known cause for this disease.
– As person grows older, he is at greater risk of
developing Alzheimer’s . After 60, the risk is one
in 20, but after 80 it is one in 5.
50. • Strokes:
– About 15 million people have stroke , each year it is a
2nd leading cause of death for older than 60yrs of age .
• Heart disease:
– Hypertension (silent killer).
• Osteoarthritis :
– It is most common form of arthritis .
• Rheumatoid Arthritis:
– Inflammation of joint lining in the synovial (free
moving ) joints.
51. • Diabetes:
– Due to lack of movement or work in old aged
people.
• Urinary incontinence:
– About 1/3rd of women and 10% of all men above
age of 60 have incontinence.
– In this people loose control over their bladder and
bowel movements.
• Social isolation.
54. STEPS TAKEN BY GOVT.
o National Policy for Older Persons:
It was announced in 1999 by the. Ministry of Social
Justice & Empowerment
Objectives are:
– To enable and support voluntary organizations and
NGO ’s to supplement the care provided by family.
– To provide care and protection to vulnerable
groups.
55. – To provide health care facility to elderly and to
promote research & training facilities to care
givers.
– To create awareness among elderly persons to
develop themselves in to fully independent
citizen.
56. o Revision of national policy on older persons:
It was created in March 14, 2010.
Age of senior citizen is different for different
benefits , such as:
– 60 years for concession in railways.
– 60 years by banks for extra 0.5% interest to senior
citizen.
– 63 years for concession in air journey by Indian
airlines.
– 65 years for benefit to senior citizens under
income tax.
57. CONCLUSION
To overcome the geriatric problem and to
ensure a good , healthy and quality life , the
elderly members of society can move a long
way with support of the family members.
58. SUMMARY
Introduction of Geriatric Consideration in Nursing.
Definition of Geriatrics.
Theories of Aging.
Changes associated with Aging.
Common problems in old age.
Important considerations in care of geriatric clients.
Resources for care of older adults.
Steps taken by government.
59. RESEARCH INPUT
Nursing considerations in the geriatric surgical
patient: the perioperative continuum of care.
Author- Mamaril ME, et al. 2006.
Although aging is a natural process, caring for an
older person is not the same as caring for a
middle - aged adult person. The peri-operative
and peri-anesthesia nurses need to be competent
in geriatric nursing care and posses specialized
knowledge and skills related a myriad of geriatric
issues. This article focuses on the special needs of
elderly population and how the peri-operative
nursing team may address their care best.
60. REFERENCES
Brar KN, Rawat CH, A Textbook of Advanced Nursing
Practice, 1st Ed. , 2015, Published by Jaypee Brothers
Medical Publishers (P) Ltd., Page -1058-71.
Kaur L, Kaur M, A Textbook of Nursing Foundation , 2nd
Ed. , Published by S. Vikas & Company , Page- 69.
Townsend MC, A Textbook of Psychiatric Mental
Health Nursing, 7th Ed. ,2012, Published by Jaypee
Brothers, Page- 826-849.
https://www.ncbi.nlm.nih.gov/m/pubmed/16698344/
