■ Developing nurses

NCM 114 ■ organizations/systems

1M: OVERVIEW OF GERONTOLOGY NURSING
Dr. Johanna de la Torre Aging
● Associated with changes in dynamic, biological,
*Texts inside a box* = additional info from the enhancement session physiological, envi’tal and etc processes

Ageism
DEFINITION OF TERMS ● Describes the negative stereotyping of older
adults and discrimination because of older age.
Gerontology ● Also found among HC prof.
● Is a multidisciplinary, concerned with physical, ○ Evident among people who are over 85
mental and social aspects and implications of years old
aging ■ Reasons: depression, cognitive
● Goal: understanding aging, maximizing impairment, substance abuse
functioning and achieve a high quality of life ● Often arrived in negative past experiences
● Broad term used to define the __ of aging ● Older people are (mostly in western places) less
● Subfields: valued and often considered a burned to society
○ Geriatrics, special gerontology, ● Factors to this point of view:
gerontological rehabilitation nursing ○ Loneliness, economically challenged
● Older adults are the focus of care
Senescence
Young old 64 - 74 ● occurs at the last stages of adulthood through
death
Middle old 75 - 84 ● the progressive deterioration of the body and its
process
Old old ≥ 85
Gerotranscendence
Geriatrics ● coping process of successful aging happens when
● The medical specialty focused on care and there is a major shift in the person's worldview
treatment of older persons ● Individual has a sense of acceptance of their
● Goal: understanding aging prognosis
● Decreased anxiety
Gerontologic Nursing
● Specialty of nursing profession that focus on the
care of older adults
● Requires an understanding associated with aging
● Focuses on preventive care as elderly clients are
often at risk of injuries.
● Nurses work in a long term facility with home
health care services
● Field is guided by the standards of nursing
practice
● GENERALIST
○ Basic entry-level program in nursing
completed
○ Licensed nurse for at least 2 years
● ADVANCED
○ Can be a Clinical specialist or
gerontological nurse practitioner
○ Focuses on three spheres:
■ Patient
 1. Incorporate professional attitudes, values, and
expectations about physical and mental aging in
the provision of patient-centered care for older
adults and their families.
Corresponding to Essential 8

2. Assess barriers for older adults in receiving,

understanding, and aging of information
Corresponding to Essential IV and IX

3. Use valid and reliable assessment tools to guide

nursing practice for older adults
Corresponding to Essential IX
4. Assess the living environments as it relates to
functional, physical, cognitive, psychological, and
social needs of older adults
Corresponding to Essential IX

5. Intervene to assist older adults and their support

19 GEROCOMPETENCIES AND 9 ESSENTIALS OF
network to achieve personal goals, based on the
BACCALAUREATE EDUCATION FOR
analysis of the living environment and availability
PROFESSIONAL NURSING PRACTICE
of community resources.
Corresponding to Essential VII

Essential Foundations for

6. Identify actual or potential mistreatment
Gerontological Nursing Practice
(physical, mental, or financial abuse, and/or
self-neglect in older adults and refer
Serves as a framework to help nurses integrate specific appropriately).
nursing content in our problem Corresponding to Essential V
● Essential I: Liberal Education for Baccalaureate
Nursing Practice 7. Implement strategies and use online guidelines to
● Essential II: Basic Organizational and Systems prevent and/or identify and manage geriatruc
Leadership for Quality Care and Patient Safety syndromes
● Essential III: Scholarship for Evidence-Based Corresponding to Essential IV and IX
Practice
● Essential IV: Information Management and 8. Recognize and respect the variations of care, the
Application of Patient Care Technology increased complexity, and the increased use of
● Essential V: Healthcare Policy, Finance, and healthcare resources inherent in caring for older
Regulatory Environments adults.
● Essential VI: Interprofessional Communication Corresponding to Essential IV and IV
and Collaboration for Improving Patient Health
Outcomes 9. Recognize the complex interaction of acute and
● Essential VII: Clinical Prevention and Population chronic comorbid physical and mental conditions
Health and associated treatments common to older
● Essential VIII: Professionalism and Professional adults.
Values Corresponding to Essential IX
● Essential IX: Baccalaureate Generalist Nursing
Practice 10. Compare models of care that promote safe,
quality physical and mental health care for older
adults
Gerocompetencies
Corresponding to Essential II
 19. Integrate relevant theories and concepts included
11. Facilitate ethical. Noncoercive decision making by in a liberal education into the delivery of patient-
older adults and/or families/caregivers for centered care for older adults.
maintaining everyday living, receiving treatment, Corresponding to Essential I
initiating advance directives, and implementing
and-of-life care.
WHY THE INCREASE OF THE NUMBER OF
Corresponding to Essential VIII
OLDER ADULTS

12. Promote adherence to the evidenced-based

practice of providing restraint-free care (both 1. Increase life expectancy of the seniors
physical and chemical restraints) 2. The fertility population at various points of
Corresponding to Essential II time changes in the life expectancy
throughout the 20th century due to better
13. Integrate leadership and communication health practices and preventive health
techniques that foster discussion and reflection services
on the extent to which diversity (among nurses,
nurse assistive personnel, therapists, physicians, Aging population
and patients) has the potential to impact the care ● Ha sprojected to increase to 55M in 2020
of older adults ● Out numbering children under 5 in the world for
Corresponding to Essential VI the first time in history.
● The life expectancy has almost doubled that for a
14. Facilitate safe and effective transitions across 65-year old, it will increase to 20-23 years more
levels of care, including acute, community-based, (Centers for Disease Control and Prevention,
and long-term care (e.g., home assisted living, 2009)
hospice, nursing homes) for older adults and their
families.
Corresponding to Essential IV and IX

15. Plant patient-centered care with consideration

for mental and physical health and well-being of
informal and formal caregivers of older adults.
Corresponding to Essential IX

16. Advocate for timely and appropriate palliative

and hospice care for older adults with physical
and cognitive impairments
Corresponding to Essential IX SO WHAT CHALLENGES THE OLDER ADULTS
ARE FACING NOW?
17. Implement and monitor strategies to prevent risk
and promote quality and safety (e.g. falls,
● Multiple chronic diseases
medication mismanagement, pressure ulcers) in
○ Prevalence of chronic disease increases
the nursing care of older adults with physical and
with age
cognitive needs.
○ An average 75 yo suffers from 3 chronic
Corresponding to Essential II and IV
diseases with 5 prescription drugs
● Affording health care services
18. Utilize resources/programs to promote
functional, physical, and mental wellness in older
adults
Corresponding to Essential VII
 THE DIFFERENT GENERATIONS

1. Traditionalist (trads) - value authority and a top

down management approach; hard working make
do or do without.
2. Baby boomers (boomers) - expect some degrees
of deference to their opinions; workaholics.
3. Generation X (gen x) - comfortable with
authority; will work as hard as is needed;
importance of work life balance.
4. Generation Y (gen y) - respect must be earned;
technology savvy; goal and achievement
oriented.
5. Generation Z (gen z) - many traits still do
emerge. Digital natives, fast decision makers,
highly connected.

More challenges are anticipated when modern treatments AGING IN PLACE

for disease and health care costs including medications ● Ability to live in one own’s home and community
have become a primary issue for many seniors safely, independently and comfortably regardless
of age, income or ability level
Republic Act 9994 ● Aging promotes:
Law supporting the elderly ○ independence
Amends and improves RA 9257 of 2003 ○ autonomy
Also relates to RA 9442 (Magna Carta for disabled ○ connection to social support/support
persons) system
● Expanded Senior Citizen Act of 2010 ● Remaining in one’s home and communities does
● Entitled to a 20% discount and exemption from not only avoid costly institutionalized care but
value added tax also builds relationship with the family
● To give full support to the improvement of the
total well-being of the elderly RA 9257
- This Act shall be known as the "Expanded
BABY BOOMERS
● Older adults of this time reaching the age of 65 Senior Citizens Act of 2003."
belong to the baby boomer generation - Republic Act. No. 7432 is hereby amended to
● This population will explode between 2010 and
read as follows
2013 although they have some difficulties using
technology, they are aware storytellers who are -
meant to be those who share secrets of wisdom
and knowledge life with the youth
 ENHANCEMENT SESSION

● Does not focus only in ill older adults

● Focus:
○ Disease prevention
○ Health promotion
● Patience
● Tolerance
● Understanding
● Basic nursing skills
 - In 2003, the collaborative efforts of John A.
GROUP REPORTS Hartford Institute for Geriatric Nursing, the
American Academy of Nursing, and the American
Association of Colleges of Nursing (AACN) led to
the development of the Hartford Geriatric
GERONTOLOGICAL NURSING TIMELINE
Nursing Initiative (HGNI).
2008
1880s - One of the newest journals to emerge in 2008
- Lowering the cost of caring and maintaining sick was the Journal of Gerontological Nursing
older adults had its beginnings with Florence Research.
Nightingale and Agnes Jones during the 1800s in
England.
PIONEERS IN GERONTOLOGICAL NURSING
1960s
- Gerontological nursing was formally recognized
when the ANA recommended a specialty group Virginia Stone (1912-1993)
for geriatric nurses and the formation of a ● Lead the development of the ANA’s standards of
geriatric nursing division. practice in gerontological nursing
- Convened the first national nursing meeting on Mary Opal Wolanin (1920 – 1997)
geriatric nursing practice. ● Interest in gerontological nursing while taking
1970s care of stroke patients
- In the early 1970s, the ANA Standards for ● Examined the benefits of rehabilitation
Geriatric Practice and the Journal of ● Supported the inclusion of gerontological nursing
Gerontological Nursing were first published (in ● Expert on long-term care nursing and
1970 and 1975, respectively). administration
- In the 1970s, the Veterans Administration funded ● Published book “Confusion: Prevention and Care”
a number of Geriatric Research Education and in 1981
Clinical Centers (GRECCs) at VA medical centers Irene Burnside (1924 – 2003)
across the United States. ● Started her career in psychiatric nursing and
1976 focused on the psychosocial needs for older
- In 1976, the ANA Geriatric Nursing Division adults.
changed its name to Gerontological Nursing ● Advocated an approach to care of the elderly
Division and published the Standards of focusing on what is left, not what is gone.
Gerontological Nursing (Ebersole & Touhy, 2006; ● Pioneered a therapeutic group work which
Meiner & Lueckenotte, 2006). recognizes the value of reminiscence and life
1980s review for older adults
- The National Gerontological Nursing Association Doris Schwartz (1917 – 1999)
was established, along with the ANA statement ● Wide career in nursing and public health
on the Scope and Standards of Gerontological education
Nursing Practice ● The first gerontological nurse who received
1990s funding from the National Institutes of Health
- In the 1990s, the John A. Hartford Foundation ● Fought for improved care for elderly
Institute for Geriatric Nursing was established at ● Author of “My 50 Years in Nursing: Give Us To Go
the NYU Division of Nursing. It provided Blithely” in 1995
unprecedented momentum to improve nursing
education and practice and increase nursing ● The development of gerontological nursing as a
research in the care of older adults. specialty is attributed to a host of nursing
st
21 Century pioneers. The majority of these nurses were from
- The 21st century has provided a resurgence in the United States; however, two key trailblazers
gerontological care, as older adults are gaining were from England. Florence Nightingale and
full status and recognition by society. Doreen Norton provided early insights into the
2003 “care of the aged.”
Florence Nightingale
 ● was truly the first gerontological nurse, because ■ There are many different levels of care that
she accepted the nurse superintendent position fall under the long-term care umbrella.
in an English institution comparable to our current These may include:
nursing homes.
● assisted living
● She cared for wealthy women’s maids and helpers
● intermediate care
in an institution called the Care of Sick
Gentlewomen in Distressed Circumstances ● skilled care
(Ebersole & Touhy, 2006). ● Alzheimer’s units.
■ Facilities that offer these services are
Doreen Norton generally called by one of several names:
● summarized her thoughts on geriatric nursing in a nursing homes, long-term care facilities
1956 speech at the annual conference of the
(LTCFs), skilled nursing facilities (SNFs),
Student Nurses Association in London.
● Focused her career on care of the aged and wrote retirement homes, assisted living facili-
about the unique and specific needs of elders ties, or rehabilitation and health care
and the nurses caring for them. She identified the villages.
advantages of including geriatric care in basic ■ Assisted Living: Assisted living provides
nursing education as: an alternative for those older adults who
○ (1) learning patience, tolerance,
do not feel safe living alone, who wish to
understanding, and basic nursing skills;
live in a community setting, or who need
○ (2) witnessing the terminal stages of
disease and the importance of skilled some additional help with activities of
nursing care at that time; daily living (ADLs).
○ (3) preparing for the future, because no Intermediate Care: This level of care
matter where one works in nursing, the provides 24-hour per day direct nursing
aged will be a great part of the care; contact and may be considered to be the
○ (4) recognizing the importance of
entry level into nursing home care.
appropriate rehabilitation, which calls
: Older persons are unable to live on their
upon all the skill that nurses possess; and
○ (5) being aware of the need to undertake own because of a number of factors,
research in geriatric nursing (Norton, including numerous medications to
1956). manage, mobility problems, or the
presence of chronic diseases that require
an amount of nursing supervision beyond
ELEMENTS OF GERONTOLOGICAL NURSING what a person could manage
PRACTICE independently (like diabetes, severe
arthritis, multiple medications, or
Recipients of Gerontological Nursing amputations complicated by mobility
➢ Acute Care Hospital changes).
■ is often the point of entry to the health care ■ Skilled Care: Skilled care units or skilled
system for older adults. nursing facilities (SNFs) are for those
■ Gerontological nurses focus on treatment older adults requiring more intensive
and nursing care of acute problems such as nursing care.
those occurring from trauma, accidents, :On this unit, one would expect to see
orthopedic injuries, respiratory ailments, or persons with tube feedings, IV fluids,
serious circulatory problems. multiple medica- tions, chronic wounds,
and even ventilators in some cases.
➢ Long- Term Care ■ Alzheimer’s Care: Offer units dedicated
to the major phases of Alzheimer’s
 disease (AD). During middle and late ■ Home Health Care: Older adults requiring
stage AD, the older patient cannot be left a longer period of observation or care from
alone and shows increasing signs of nurses may be candidates for home health
deterioration and inability to care for care services. Home care is designed for
themselves. those who are home- bound due to severity
■ Subacute or Transitional Care: of illness or immobility.
”Individuals seen in subacute care are ■ Foster Care or Group Homes: Are for
those needing assistance as a result of those older adults who can do most of their
non- healing wounds, chronic ventilator ADLs, but may have safety issues and
dependence, renal problems, intravenous require supervision with some activities such
therapy, and coma management and as dressing or taking medications.
those with complex medical and/or ■ Independent Living: Are for older adults
rehabilitative needs, including pediatrics, that is often in the community, but as
orthopedics, and neurological. These previously stated, may be available in many
units are designed to promote optimum LTCFs.
outcomes in the least expensive cost : In the community setting, independent
setting” (Easton, 1999, p. 15). living arrangements often take the form
■ Hospice: is the care for dying persons of senior housing, such as with apartment
and their families. Although many complexes that are exclusively devoted
patients in hospice are not elderly, the to the elderly.
majority of the dying are older. ■ Adult Day Care: : According to National
:The concept of hospice is centered Adult Day Services Association (2005),
around holistic, interdisciplinary care that Adult day services are community- based
helps the dying person “live until they group programs designed to meet the
die”. needs of functionally and/or cognitively
impaired adults through an individual plan
➢ Rehabilitation of care. These structured, comprehensive
■ Is done through the work of an pro- grams provide a variety of health,
interdisciplinary team that includes nurses, social, and other related support services
therapists, and physicians as well as other in a protective setting during any part of
professional staff as needed. a day, but less than 24-hour care.
■ The goals of rehabilitation are to:
● maximize independence
● promote maximal function ESSENTIAL FOUNDATIONS FOR THE PRACTICE
● prevent complications OF NURSING
● promote quality of life within each
person’s strengths and limitations.
Assumptions
➢ Community:
Knowledge, Skills, & Competencies
■ This is helpful for students of gerontological
Attitudes
nursing, because most older adults live in
Standards
the community, with only about 5% at any
Scope of Practice
given time residing in nursing homes. Within
Process
the community, one may find many different
areas for practice, only a few of which are:
BIOLOGICAL THEORIES OF AGING
 ■ DNA strand breaks and base
STOCHASTIC THEORIES modifications that cause gene
● Free Radical Theory modulation.
○ This theory emphasizes the significance of
how cells use oxygen (Hayflick, 1985). Also ● Orgel/Error Theory
known as superoxides, free radicals are ○ This theory suggests that cells accumulate
thought to react with proteins, lipids, errors in their DNA and RNA protein
deoxyribonucleic acid (DNA), and synthesis that cause the cells to die (Orgel,
ribonucleic acid (RNA), causing cellular 1970).
damage. ○ Environmental agents and randomly induced
○ The term free radical describes any events can cause error, with ultimate cellular
molecule that has a free electron, and this changes. It is well known that large amounts
property makes it react with healthy of X-ray radiation cause chromosomal
molecules in a destructive way. Free radical abnormali- ties.
molecule creates an extra negative charge. ○ It proposes that aging would not occur if
○ Exogenous sources of free radicals: Tobacco destructive factors such as radiation did not
smoke, Pesticides, Organic solvents, exist and cause “errors” such as mutations
Radiation, Ozone, and selected medications and regulatory disorders.
○ The free radical theory supports that as one ○ Hayflick (1996) does not support this theory,
ages, there is an accumulation of damage and explains that all aged cells do not have
that has been done to cells and, therefore, errant proteins, nor are all cells found with
the organism ages. errant proteins old.
○ The majority of the evidence to support this
theory is correlative in that oxidative ● Wear and Tear Theory
damage increases with age. ○ Explains that deterioration occurs with age,
○ The older adult is more vulnerable to free so that aging is thus a result of cells and
radical damage because free radicals are tissues in the body ‘wearing and tearing’
attracted to cells that have transient or with time, hence the theory’s name.
interrupted perfusion. ○ Speculations on its association with free
○ Free radicals are produced when the body radical production (see Free Radical Theory)
uses oxygen, such as with exercise. generated by excessive wear and tear due to
○ Free radicals are chemical species that arise strenuous activities exists, supporting the
from atoms as single unpaired electrons. idea that each theory of aging opens to
○ Because a free radical molecule is unpaired aging being a result of multiple factors.
it is able to enter reactions with other ○ This gradual deterioration is a result of
molecules, especially along membranes and degradation that occurs from an
with nucleic acids. Free radicals cause: accumulation of cellular damage, oxidative
■ Extensive cellular damage to DNA, stress, radiation exposure and a series of
which can cause malignancy and other deteriorative processes that occur
accelerated aging, due to oxidative with time in cells and tissues of the body.
modification of proteins that impact cell ○ According to Aigner et. al., aged cells lose
metabolism their ability to counteract biological
■ Lipid oxidation that damages responses (i.e. mechanical, inflammatory,
phospholipids in cell membranes, thus and other injuries) that the youth otherwise
affecting membrane permeability have due to their senescence.
 something called telomeres on the end of
● Connective tissue/Cross link theory chromosomes. As our cells divide, these
○ The connective tissue/ cross link theory is telomeres become shorter and shorter
also referred to as the glycosylation theory until eventually they've been entirely
of aging. stripped away. At which point the cell no
○ The theory represents an accumulation of longer divides.
cross-linked proteins that damages cells and ○ Why don't our cells endlessly regenerate
tissue, slowly leading to bodily changes that their telomeres? The replication limit
result in aging. prevents cancer, which is the
○ Cross-linking reactions are involved in the uncontrollable growth of cells.
age related changes in the studied proteins. ○ The point at which the cells stop
○ In the theory it is binding the simple sugar replicating is known as cellular
which is glucose to protein that causes senescence.
problems. After the binding has started the ○ Once the replication limit is reached the
protein becomes impaired and unable to cell gradually begins to lose its function
perform as efficiently. and die, causing age-related
○ Cross-linking can be seen in joints and skin characteristics.
that begin to stiffen.
● Gene/Biological Clock Theory
NONSTOCHASTIC THEORIES ○ This theory explains that each cell has a
- View aging as a series of predetermined events genetically programmed aging code that
happening to all organisms in a timed framework. is stored in the organism’s DNA.
○ This theory is described as comprising
● Programmed Theory genetic influences that predict physical
○ The hayflick phenomenon suggests that condition, occurrence of disease, cause
cells divide until they can no longer and age of death, and other factors that
divide. contribute to longevity (Slagboom,
○ Cells have a finite doubling potential Bastian, Beekman, Wendendorf, &
however it is unable to replicate after Meulenbelt, 2000).
they have done so a number of times. ○ A significant amount of research has
○ Cells divide until they are no longer able been done on circadian rhythms and their
to, and this triggers apoptosis or cell influence on sleep, melatonin, and aging
death. (Gonidakis & Longo, 2009; Sozou (Ahrendt, 2000; Moore, 1997; Richardson
& Kirkwood, 2001). & Tate, 2000).
○ Our body is made up of trillions of cells ○ These rhythms are defined as patterns of
which are constantly going through cell wakefulness and sleep that are integrated
division and every time they divide they into the 24-hour solar day (Porth, 2009).
make a copy of their DNA as well. This ○ Research has demonstrated that people
DNA is tightly packed into structures who do not have exposure to time cues
called chromosomes of which humans such as sunlight and clocks will
have 23 pairs. The problem is DNA automatically have sleep and wake cycles
replication isn't quite perfect and skips that include approximately 23.5 to 26.5
over the end of each chromosome. hours (Moore, Czeisler, & Richardson,
○ To protect against important DNA 1983). This clock seems to be controlled
information being cut out we have
 by an area in the hypothalamus called the feedback system cause disease;
suprachiasmatic nucleus (SCN). increased insulin growth factor
○ Melatonin is secreted by the pineal gland accelerates aging.
and is considered to be the hormone ○ This theory describes a change in
linked to sleep and wake cycles because hormone secretion, such as with the
there are large numbers of melatonin releasing hormones of the hypothalamus
receptors in the SCN. Researchers have and the stimulating hormones of the
studied the administration of melatonin pituitary gland, which manage the
to humans and found a shift in humans’ thyroid, parathyroid, and adrenal glands,
circadian rhythm similar to that caused by and how it influences the aging process.
light (Ahrendt, 2000). The sleep–wake The following major hormones are
cycle changes with aging, producing involved with aging:
more fragmented sleep, which is thought ■ Estrogen - decreases the thinning of
to be due to decreased levels of bones, and when women age, less
melatonin estrogen is produced by the ovaries.
○ This theory indicates that there may be As women grow older and experience
genes that trigger youth and general menopause, adipose tissue becomes
well-being as well as other genes that the major source of estrogen.
accelerate cell deterioration. ■ Growth hormone - is part of the
○ The knowledge being acquired from process that increases bone and
genome theory is greatly impacting the muscle strength. Growth hormone
possibility of being able to ward off aging stimulates the release of insulin-like
and disease. Studies of tumor suppressor growth factors produced by the liver.
gene replacement, prevention of ■ Melatonin - is produced by the pineal
angiogenesis with tumor growth, and gland and is thought to be
regulation of programmed cell death are responsible for coordinating seasonal
in process adaptations in the body.
○ Parr (1997) Biological Theories of Aging ○ When the stimulating and releasing
53 and Haq (2003) cited that caloric hormones of the pituitary and
restriction extends mammalian life. By hypothalamus are out of sync with the
restricting calories there is a decreased endocrine glands, an increase in disease
need for insulin exposure, which is expected in multiple organs and
consequently decreases growth factor systems.
exposure. ○ According to Rodenbeck, et.al. (2001)
with physiological aging and also with
certain psychiatric disorders, there is
● Neuroendocrine Theory increased activation of the
○ Developed by Vladimir Dilman, the hypothalamus-pituitary-adrenal axis,
neuroendocrine theory of aging states which causes increased plasma cortisol
that “The effectiveness of the body's levels. Thus the increase of cortisol levels
homeostatic adjustments declines with can be linked to multiple diseases.
aging—leading to the failure of adaptive ○ Holzenberger, et.al (2004) stated that
mechanisms, aging, and death.” inactivating insulin receptors in the
○ Problems with the adipose tissue of mice, the life span of
hypothalamus-pituitary endocrine gland the mice increases because less insulin
 exposure occurs. This further supports ● A hierarchy of five needs motivates human
the idea that the neuroendocrine system behavior: physiologic, safety and security, love
is connected to lifespan regulation. and belonging, self esteem and self actualization.
These needs are prioritized such that more basic
○ Thyagarajan, et.al. (2002) suggest that
needs like physiological functioning or safety take
as one ages, there is a loss of
precedence over personal growth needs.
neuroendocrine transmitter function that Individualism
is related to the cessation of reproductive ● Personality consists of an ego and personal and
cycles as well as the development of collective unconsciousness that views life from a
mammary and pituitary tumors. personal or external perspective. Older adults
search for life meaning and adapt to functional
and social losses. As an individuals age, they
● Immunological Theory
begin to reflect on their beliefs and life
○ In 1950-60s F. M. Burnet proposed the accomplishments.
first postulates of immunological theory. Stage of Personality
Then this theory was developed by R. ● According to Erik Erikson, we experience 8 stages
Walford and other scientists. The Immune of development over our lifespan. He believed
System has different important functions that personality developed in a series of stages.
● Personality develops in eight sequential stages
such as detecting and destroying a wide
with corresponding life development tasks.
variety of alien agents and distinguishing
● At each stage there is a crisis or task that we need
them from the organism’s own healthy to resolve.
cells and tissues which are preserved ○ Successful completion of each
from destruction. As we age, there will be developmental task results in a sense of
changes in essentially all physiologic competence and a healthy personality.
functions which include immunity, as the ○ Failure to master these tasks leads to
feelings of inadequacy
immune response decreases with aging
when the T-Cell function declines, it
increases the vulnerability to infectious
diseases thus causing ageing and death.
○ According to this theory, the normal
aging process of humans and animals is
related to faulty immunological function
(Effros, 2004).

PSYCHOLOGICAL THEORIES OF AGING

Psychological Theories
● Explain aging in terms of mental processes,
emotions, attitudes, motivation, and personality
development that is characterized by life stage
transitions. The eighth phase is characterized by evaluating life
● Psychological theories are concerned with accomplishments, struggles include letting go, accepting
personality or ego development and the care, detachment, and physical and mental decline.
challenges associated with various life stages.
● Societal norms affect how individuals envision ● Erikson’s task at this stage is called integrity vs.
their role and function in a society. despair. People in late adulthood or on this stage,
reflect on their lives and feel either a sense of
Human Needs satisfaction or a sense of failure. People who feel
 proud of their accomplishments feel a sense of contemplate death. Identifying with one’s age
integrity, and they can look back on their lives group, finding a residence compatible with one’s
with few regrets. However, people who are not limitations, and learning new roles postretirement
successful at this stage may feel as if their life has are major tasks.
been wasted. They focus on what “would have,”
“should have,” and “could have” been. They face Age stratification
the end of their lives with feelings of bitterness, ● Society is stratified by age groups that are the
depression, and despair. basis for acquiring resources, roles, status, and
deference from others. Age cohorts are
Life course/life span influenced by their historical context and share
● Life stages are predictable and structured by similar experiences, beliefs, attitudes, and
roles, relationships, values, development, and expectations of life-course transitions.
goals. Persons adapt to changing roles and
relationships. Age-group norms and Person-Environment-Fit
characteristics are an important part of the life ● Function is affected by ego strength, mobility,
course. health, cognition, sensory perception, and the
environment. Competency changes one’s ability
Selective Optimization to adapt to environmental demands.
● Individuals cope with aging losses through
activity/role selection, optimization, and Gerotranscendence
compensation. Critical life points are morbidity, ● The elderly transform from a materialistic/rational
mortality, and quality of life. Selective perspective toward oneness with the universe.
optimization with compensation facilitates Successful transformation includes an outward
successful aging focus, accepting impending death, substantive
relationships, intergenerational connectedness,
and unity with the universe.
Sociological Theories
● Changing roles, relationships, status, and
generational cohort impact the older adult’s NURSING THEORIES OF AGING
ability to adapt.

Activity Functional Consequence Theory

● Remaining occupied and involved is necessary to ● Functional Consequences Theory was developed
a satisfying late life. to provide a guiding framework for older adults
with physical impairment and disability.
Disengagement Environmental and biopsychosocial
● Gradual withdrawal from society and relationships consequences impact functioning. Nursing’s role
serves to maintain social equilibrium and promote is risk reduction to minimize age-associated
internal reflection. disability in order to enhance safety and quality of
living.
Subculture
● The elderly prefer to segregate from society in an Theory of Thriving
aging subculture sharing loss of status and ● The theory of thriving was developed to explain
societal negativity regarding the aged. Health the experience of nursing home residents. Failure
and mobility are key determinants of social to thrive first appeared in the aging literature as a
status. diagnosis for older adults with vague symptoms
such as fatigue, cachexia, and generalized
Continuity weakness. Other disciplines later added
● Personality influences roles and life satisfaction malnutrition, physical and cognitive dysfunction,
and remains consistent throughout life. Past and depression as major attributes. Newbern and
coping patterns recur as older adults adjust to Krowchuk suggested that difficulty with social
physical, financial and social decline and relationships and physical/cognitive dysfunction
 were related to a failure to thrive. Haight and Manager
colleagues proposed that the environment is an ● Gerontological nurses act as managers during
important contributor to how people age. They everyday care as they balance the concerns of
asserted that people thrive when they are in the patient, family, nursing, and the rest of the
harmony with their environment and personal interdisciplinary team. Nurse managers need to
relationships and fail to thrive when there is develop skills in staff coordination,
discord. This theory has helped bring together time-management, communication, and
elements of earlier aging theorists in ways that organization. Nursing care, patient, and family
make it accessible for nursing practice. satisfaction, staff retention, commitment, and
contentment all hold the key to success for the
staff involved and for the manager. The
gerontologic nurse manager uses management
skills when providing for patient care in a variety
of hospital and community settings. The
specialized skills and knowledge required for a
management position include maintaining
up-to-date information about federal and state
regulatory statutes as well as information related
ROLES OF THE GERONTOLOGICAL NURSE
to funding for elder care programs.

Provider Advocate
● Provider of care In the role of caregiver or ● As an advocate, the gerontological nurse acts on
provider of care, the gerontological nurse gives behalf of older adults to promote their best
direct, hands-on care to older adults in a variety interests and strengthen their autonomy and
of settings. Older adults often present with decision making. Advocacy may take many forms,
atypical symptoms that complicate diagnosis and including active involvement at the political level
treatment. Thus, the nurse as a care provider or helping to explain medical or nursing
should be educated about the common disease procedures to family members on a unit level.
processes seen in the older population. This Nurses may also advocate for patients through
includes knowledge of the backgrounds and other activities such as helping family members
statistics, risk factors, signs and symptoms, usual choose the best nursing home for their loved one
medical treatment, nursing care through or supporting family members who are in a
evidence-based practice, and rehabilitation if caregiving role. Whatever the situation,
applicable. gerontological nurses must remember that being
an advocate does not mean making decisions for
Teacher older adults, but empowering them to remain
● An essential part of all nursing is teaching. independent and retain dignity, even in difficult
Gerontological nurses focus their teaching on situations.
modifiable risk factors. Many diseases of aging
can be prevented through lifestyle modifications Research Consumer
such as a healthy diet, smoking cessation, ● It is significant that gerontological nurses as
appropriate weight maintenance, increased research consumers are well-aware and educated
physical activity, and stress management. Nurses on the current research literature and apply these
have a responsibility to educate the older adult learnings to clinical practice. When a
population about ways to decrease the risk of gerontological nurse is up to date and
certain disorders such as heart disease, cancer, knowledgeable enough about reliable, valid
and stroke, the leading causes of death for this sources and studies, it is easier to assess the
group. Nurses also may develop expertise in needs of their patients and evaluate the
specialized areas and teach skills to other nurses effectiveness of their care. Research helps nurses
in order to promote quality patient care among in terms of planning for patient care and overall
older adults. improving the patient’s quality of life.
Gerontological nurses can continue their
 education by participating in more seminars, regaining and maintaining the highest level of
organizations, or workshops and pursuing an functioning and independence possible.
additional formal education. ● Activity Theory suggests to remain engaged even
in old age as this will lead to higher life
satisfaction. This may include performing the
Life Expectancy activities of daily living, involving self in
https://ourworldindata.org/grapher/life-expectancy?tab= community service. This delays the negative
chart&time=1543..latest&region=Asia&country=~PHL effects of aging.
● Gerotranscendence Theory believes that the
individual develops his sense of spiritual unity
with the universe; A theory developed by
Tornstam, who believed that older adults undergo
cognitive transformation from being materialistic
toward oneness with the universe.

Self-Assessment Test / Review

● The gerontological nursing was formally
recognized as early as 1960's and produced more
gerontologic nurses with the help of these 4 ● Curative care - false
organizations. ● Mary Opal - true
○ American Nurses Association ● Jung’s theory - false??
■ ANA has revised the scope and ● RA 10654 - true
standards for gerontological ○ Republic Act No. 10645 was signed into
nursing practice law by His Excellency, President Benigno
○ John A. Hartford Foundation S. Aquino III, on November 5, 2014 which
■ Helped improve the nursing provides for the mandatory PhilHealth
education and practice through coverage of all senior citizens. ... All
research in the care of older senior citizens shall be covered by the
adults. national health insurance program if
○ National Gerontological Nursing Phi/Health.
Association ● DO NOT CAPITAL
○ Sigma Theta Tau International ● The theory of gerotranscendence, a
● Nightingale was the first superintendent developmental theory of positive aging was
gerontologist nurse. proposed by Lars Tornstam (from google)
● Doreen Norton particularly has emphasized the ● Senescence - cells irreversible stop
importance of geriatric nursing during her annual
dividing
conference of the Student Nurses Association in
● Gerotranscendence - materialistic to
London.
● The Functional Consequence Theory identifies
accepting
age-related biopsychosocial changes of aging
that require nursing attention to prevent
complications. An example of functional changes
include loss of muscle strength that may lead to
falls. Thus, the nurse has to include safety nursing
actions in her care plan.
● Gerontologic Rehabilitation Nursing refers to the
care given to older adults with chronic illnesses,
long term functional limitations. It focuses on
 4. Functional Assessment Scale
NCM 114
● Used to assess the older adults ability to
2M: GENERAL NURSING CARE
perform self care and fulfill important
CONSIDERATIONS FOR AN OLDER ADULT
Ms. Phoebe Kates T. Mangarin social roles
5. Therapeutic Communication with Older Adults
● Effective communication is important
Prerecorded Link:
● Ineffective communication = older
https://www.youtube.com/embed/xeEyYKJhsL8
*Texts inside a box* = additional info from the lecture people feel inadequate, disempowered
and helpless
● Ensure that older people think they are
Other materials:
Geriatric Examination Tool Kit being listened to, their concerns are
Comprehensive geriatric assessment being validated in a non judgemental
Cumulative Illness Rating Scale-Geriatric (CIRS-G)
way.
● Treat older people as individuals
CONTENTS
HISTORY TAKING AND INTERVIEW
1. History Taking and Interview
● How the nurse approaches the client ● Data gathered will help the nurse focus on
● Nurse should have respect, patience and particular areas of concern during the physical
be culturally aware examination
● Address the client with their last name ● To promote information exchange and enhance
● Approach: Adjust the environment, rapport: minimize distractions and speak clearly
shape the content and pace of visit, ● Put the patient at ease by explaining the reason
illicit the symptoms and address the for the interview and giving a brief overview of
cultural dimensions of aging how you’ll proceed
2. Physical Examinations ● Systematic collection of subjective data includes
● Foundation of medical treatment plan current and past health status
● Between the physiology of aging and ● Illicit the chief complaint on why the patient is
pathophysiologic conditions more seeking health care
common in the age complicates in these ● Find out when the present illness/symptom
diagnosis with appropriate intervention began
that leads to dangerous consequences ● Ask about past illnesses that require medical
3. Laboratory Assessment attention and hospital admission/other
● In aging, there is a decline in metabolic procedures
organ reserves: Cardiovascular, CNS, GI, ● Find out if the patient has history in CV, RR,
Hematopoietic & Endocrine systems Renal, Neurologic disorders, DM, Cancer, Injuries
● Most results of the elderly are similar to or falls
the results of the healthy young ● Document all prescription and non prescription
○ Caused by certain biological medications taken
reserves in those age over 75
● Linear passion: Its is important to know HISTORY TAKING CONSIDERATION
that most laboratory values in the ● Sensory Deficit
elderly are similar to those who are ○ If using assistive devices to hear or see
healthy and young (eyeglasses), encourage the lenient to
wear during the interview
 ○ Adequate lighting and minimization of
distractions ● Mental Status Examination (MSE)
● Underreporting of symptoms ○ Necessary early in the interview to
○ Older adults don’t report symptoms that determine the px reliability
are usually normal to aging like dyspnea, ○ Should be done tactly so the px does
vision/hearing deficits. Memory not become embarrassed, offended,
problems defensive
○ However, no symptoms should be ● Medical history
attributed to normal aging unless a ○ Nurses should ask questions designed
thorough evaluation is done and other to systematically review each body area
possible causes have been eliminated or system to check for other disorders or
● Unusual manifestations of disorder problems that px may have forgotten to
○ In older adults, typical manifestations of mention:
a disorder may be absent, older patient ■ Includes immunization and
present with nonspecific symptoms like surgical history
fatigue, confusion and weight loss ● Drug history
● Functional Decline as the only manifestation ○ Should be recorded and copy should be
○ Disorders may manifest as a functional given to the px and caregiver
decline (standard questions may not ○ Should contain drugs used including
apply) dietary supplements
● Difficulty recalling ○ Indicated drug allergies
○ Older clients may not accurately ● Alcohol, tobacco, and recreational drug use
remember past illness, hospitalizations, history
medical admissions/treatment in which ○ Px who smoke should be counseled to
data may be obtain elsewhere (family, stop
other healthcare professionals and ○ Check for alcohol disorders:
medical records) ■ Confusion
● Fear ■ Anger
○ They are reluctant to report systems in ■ Hostility
fear of hospitalization because they ■ Alcohol breath
associate it with dying ■ Impaired balance and gait
● Age-related disorders and problems ■ Tremors
○ Depression is common in older adults ■ Peripheral neuropathy
who are vulnerable and sick; make them ■ Nutritional deficiency
less likely to give health related ○ Short Michigan alcohol screening test
information ■ 10 question test
○ Clients with impaired cognition may ■ Designed for 65 and older
have difficulty describing problems in ● Nutritional history
evaluation ○ The type and frequency of food eaten is
determined
INTERVIEW CLIENT HISTORY ○ Px that eat less than 2 meals are at risk
- Asking patients to describe a typical day elicits for undernutrition
information about their quality of life as well as ○ Nurse should ask:
their mental and physical function ; this is useful ■ Special diets (low salt, etc)
in the 1st meeting with client ■ Intake of dietary fibers
- Client should be given time to speak about prescribed
personal things ■ Otc vitamins taken
 ■ Weight loss unavailable, appropriate decisions can
■ Change in fit of clothing be made
■ Amount of money spent on food
■ Access of food stores and 10 MINUTE GERIATRIC SCANNER
kitchen facilities ● Screening tool, for common problems in
■ Variety and freshness of food ambulatory eldery
● Mental health history ● Guides assessor in appropriate questions to ask
○ Mental health problems may not be during interview
detected easily in older adults ● Positive screen signifies older adults risk
○ Sadness, hopelessness, crying indicates ● Helpful in rapid and initial assessment
depression
○ Generalized anxiety is the most PHYSICAL EXAMINATION
common disorder in older patients often ● Key Topics:
accompanied by depression ○ Vital signs
○ Px should be asked about mental health ○ Skin and nails
care (use of psychoactive drugs, change ○ Head and neck
in circumstances, hearing loss, etc.) ○ Chest and back
○ Px spiritual preferences including ○ GI system
personal interpretation of aging, decline ○ Reproductive system
of health, death should be clarified ○ Musculoskeletal system
○ Feet
○ Neurological system
○ Mental status
● Function status of elderly ○ Nutritional status
○ Whether px can function independently ● If px becomes fatigue, test is stopped and
with ADL or IADL is determined as part postponed
of comprehensive geriatric assessment ● Px is given time to undress and prepare
○ Px may be asked open ended questions
about their ability to do activities or may
KEY POINTS IN PHYSICAL ASSESSMENT
be asked to fill out a standardized
assessment tools with questions about
● Observation of function
ADL or IADL (Katz ADL scale & Lotten
○ Valuable information of patient’s
IADL scale)
function may be gained through
● Social history
observation
○ Nurses should obtain info on px living
● Physical Assessment may require two sessions
condition particularly with where and
with inclusion of all systems
whom do they live with (alone, house,
○ physical exam should include all systems
etc)
particularly the mental status
○ What modes of transport are available
to them
GENERAL CONSIDERATIONS: PHYSICAL EXAM IN
● Advance directives
ELDERLY
○ Measures for prolonging life must be
● Limit the time the patient is in the supine
documented
position
○ Getting px accustomed to setting goal
○ this may cause back pain for persons
of care is important
with osteoarthritis or kyphoscoliosis and
○ When circumstances regarding medical
conditions and prior documentation is
 shortness of breath for those with “Approach the following areas with thoroughness and
cardiopulmonary disease sensitivity. Also keep in mind to assist their optimum level
○ having several pillows on hand for these of functioning”
patients will be greatly appreciated
● Multiple sessions may be required for a SOCIAL AREAS OF CONCERN WHEN ASSESSING
complete physical exam due to patient fatigue COMMON OR CONCERNING SYMPTOMS (Bickley,
○ While they are important, the rectal and 2016)
pelvic exams may be deferred to a later
session if not urgently required ● Activities of daily living (ADLs)
● Instrumental activities of daily living (IADLs)
FOUR GIANTS OF GERIATRIC (WHO, 2015) ● Medication
“Common problems encountered by the elderly” ● Nutrition
● Acute and chronic pain
1. FALLS OR IMMOBILITY ● Smoking and alcohol
2. COGNITIVE IMPAIRMENT URINARY ● Advance directives and palliative care
3. INCONTINENCE
4. DEPRESSION
ADLS AND IADLS (EUGERIA)
● Difficulties with ADLS and IADL corresponds
LABORATORY ASSESSMENT to how much supervision and hands-on care
Aging is associated with increases or decreases in the the older person needs
laboratory values. Understanding these changes improves ● This can determine the cost of care of the
diagnosis and diagnostic accuracy. There is also a decline facility whether someone is considered safe to
in metabolic research in most organ system as one of leave at home and whether a person is eligible
mention earlier it increased cardiovascular system the to enter their services
endocrine the neurological system

LAB VALUE CHANGES

● Normal laboratory values are derived from
analysis of what are considered to be disease
free populations (Huber et al., 2006)
● Changes and laboratory values that occur within
each which can be attributed to the normal
aging process and not to disease states. These
changes begin in the fourth decade of life and
continued in a linear fashion into old age
● Most laboratory values in the elderly are similar
to those of the healthy young (Coresh et al,
2003)
● Routine laboratory testing should be determined
by patients presentation, history, and current
use of medication as indicated

FUNCTIONAL ASSESSMENT SCALES

 ○ history and physical exam should include
problems common among the older
adults
● Cognition And Mental Health
○ where several validated screening test
for cognitive dysfunction is used such as
MSE and hamilton depression rating
scale
● Socio Environmental Situation
○ The patient social interaction network
including available social support
systems, special needs, and safety
environment are determined often by
the nurse or a social worker

CGA-A SUMMARY
FUNCTIONAL STATUS
● Core of geriatric assessment
6th Vital Sign In Geriatrics
COMPREHENSIVE GERIATRIC ASSESSMENT ○ Geriatric assessment must be guided by
(CGA) patient goals
○ The geriatric assessment can be used to
Requires evaluation of an older individuals: detect actionable problems not found
● functional status through routine history and physical
● medical status or comorbidities examination
● cognition ○ The CGA is an interdisciplinary
● nutritional status (typically, a geriatrician, nurse, social
● psychological state worker, and pharmacists) diagnostic and
● Support treatment protocol
● review of patients medications “I would highly suggest for you to find time on reading
about the geriatric assessment tools”
Rector and Arnold (2006)
● Geriatric assessment is a systematic CGA-A BENEFITS
multidimensional approach to improving ● Improves care and clinical outcomes
diagnostic accuracy in planning care for frail ● Greater diagnostic accuracy
elderly people ● Improve functional and mental status
● Controlled trials have documented many ● Reduced mortality
benefits from geriatric assessment, including ● Decreased use of nursing homes and acute care
improved functional status and survival and hospitals
reduced hospital and nursing home admissions ● Greater satisfaction with care

ASSESSMENT DOMAINS THERAPEUTIC COMMUNICATION WITH OLDER

ADULTS
● Functional Ability
○ Ability to do ADLs and IADLs
● By the time an older adult have the greatest
● Physical Health
need to communicate with his or her physician,
 life and physiologic changes involvement will be Links
the most difficult because unclear https://www.uptodate.com/contents/comprehensive-ger
communication can cause the whole medical iatric-assessment?fbclid=IwAR0jor0phdcL1L_c6kDJLA9
encounter to fall apart X4kH8wStf7o--2HybPSkqoRSlj-3l1gx-BYQ

FACTORS AFFECTING COMMUNICATION WITH https://geriatrictoolkit.missouri.edu/funct/index.html?fb

OLDER ADULTS clid=IwAR3yeHDoxOWmGWCF5IFILPhJf0F8VTriFAUT
● Sensory loss mSSdq55omNfcIr03te4trg8
● Decline in memory
● Slower processing of information https://www.iier.org.au/iier28/ulla.pdf
● Lessening of power and influence over their own
lives
● Retirement from work Information from the Supplemental Videos:
● Separation from family and friends Geriatric Examination Tool Kit
Functional Outcome Instruments
2O COMMUNICATION TIPS BY THE AAFP A. Basic Activities of Daily Living (BADL)
(Robinson, et al., 2006) a. Katz Index of ADLs
b. Barthel ADL Index
● Allow extra time for older patients
B. Instrumental Activities of Daily Living (IADL)
○ specially when they are going to express
(self-report / questionnaire)
about their thoughts and opinion about
a. LLFDI - Late Life Function and Disability
something Instrument
● Minimize distraction and auditory distractions b. SF-36 (proprietary; overview on website)
● Sit face to face with a patient c. FSQ - Functional Status Questionnaire
● Don't underestimate the power of eye contact d. Lawton-Brody IADL Scale
● Listen without interrupting the patient e. OASIS has both BADL & IADL portions,
○ because they tend to forget what you're (only used in Home Health)
C. Functional Mobility instruments
going to say when you're going to
a. Activity Measure for Post-Acute Care:
interrupt them
"AM-PAC, 6 Clicks" Inpatient, Acute short
● Speak slowly, clearly and loudly
form
● Use short simple words and sentences b. Functional Independence Measure (FIM)
● Stick to one topic at a time i. FIM is proprietary.
● Simplify and write down your instructions c. Physical Mobility Scale
● Use charts models and pictures to illustrate
message
● Frequently summer is the most important points
● Give the patient a chance to ask questions
● Schedule older patients earlier in the day
● Greet them as they arrive at the practice
● Sit them in a quite comfortable area
● Make signs and forms and brochures to read
● Be prepared to escort alternative patients from
room to room
● Check on them if they've been waiting in the
exam room
● Use touch to keep the patient relax and focused
● Say goodbye to end the visit on a positive note
 b. characterized by thinness and a reduction in
NCM 114 elasticity
3M: Normal Physiologic Changes c. Wrinkles caused by chronological aging are
and Their Implications to Care usually very fine and thus the skin appears
Dr. Johanna de la Torre relatively smooth.
B. Photoaging/Extrinsic aging
a. the result of chronic exposure to UV
Prerecorded Link:
radiation
b. characterized by deep wrinkles, sagging, and
a leathery appearance

Hi i used this format CHANGES ACCORDING TO SKIN LAYER: EPIDERMIS

SYSTEM
● generally thin on protected areas
● thicken on sun exposed areas
NORMAL CHANGES WITH AGING ● How is aging classified when assessing the skin?
○ intrinsic change – ↓ melanocyte
A. ○ extrinsic change – ↑melanocyte
GENERAL MEASURES TO MAINTAIN ● Keratinocyte – main cell type affected by photoaging
GASTROINTESTINAL HEALTH IN OLDER ADULTS ○ Decline with age
○ Proliferation of this cell cause brown spots or
1. senile lentigo
NURSING CARE FOR OLDER ADULTS WITH ● Decreased turnover rate of keratinocytes
AGE-RELATED CHANGES IN THE GASTROINTESTINAL ○ Prolonged exposure of the epidermal cells to
SYSTEM the environment
○ Increased risk of skin cancer; Slower wound
Nursing Assessment repair
● Objective Cues: ● Decreased number of active melanocytes
○ ○ Weakening of the protective barrier against
● Subjective Cues: UV radiation
○ ○ Increased risk of tumor formation and skin
Nursing Diagnosis cancer
● ● Reduction in pigment granules in melanocytes
Nursing Care Planning ○ Reduced ability to tan
● General Objectives: ● Grouping and increased size of melanocytes
● Specific Objectives: ○ Age spots
Nursing Interventions ● Reduction in number of Langerhans cells
Nursing Interventions Rationale ○ Dampened cell-mediated immune response
○ Increased susceptibility to infection and
tumor development
● Decline in vitamin D3 production
○ Increased risk of osteoporosis, osteomalacia,
and other diseases
● Pressure Injuries (Pressure ulcers)
○ can be prevented and influence by various
intrinsic and extrinsic factors
● Norton Risk Assessment Scale
● Braden Scale for Predicting Pressure Sore Risk
○ The lower the score the higher the risk

INTEGUMENTARY SYSTEM

NORMAL CHANGES WITH AGING

A. Chronological/Intrinsic aging:
a. refers to those changes considered to be
due only to the passage of time
 ● Changes in hair color, growth and distribution are
associated with aging
● Graying of hair
● Women tend to have some thinning of scalp hair and
frontal recession of hairline
● Men experience general thinning of their hair but their
hair of the eyebrows, ears and nose become longer
and coarser

CHANGES ACCORDING TO SKIN LAYER: NAIL

● With aging, nails become discolored, brittle hard and

thick
● Factors that contribute to the nail changes:
○ diminished blood supply to the nailbed
CHANGES ACCORDING TO SKIN LAYER: DERMIS
○ changes in the lipid composition of the nail
plate
● layer of the skin thins as much as 20% due to aging
○ nutritional disturbances, repeated trauma,
● The dermis contains
inflammation and local infection
○ Blood vessels
○ Nerves
GENERAL MEASURES TO MAINTAIN INTEGUMENT
○ Hair follicles
HEALTH IN OLDER ADULTS
○ Sebaceous glands
○ 79% collagen
● Skin, hair, and nails make up the integumentary
● Overall loss of collagen
system. With age, stem cell production slows, leading
○ Reduced ability to maintain skin suppleness
epidermal cells to reproduce more slowly and become
○ Increased likelihood of sagging and wrinkling
bigger and more irregular. This results in thinner, more
● Elastin loses resiliency and becomes more brittle
translucent skin, which means that skin injuries,
○ Reduced ability to return skin to normal
ripping, and infections are more common. When you
tension
combine this with a combination of hormone shifts
○ Sagging
and lifestyle changes, the structure and chemical
● Loss of vascularity
composition of many tissues will be affected
○ Decline in blood flow; impaired
● The usage of sun protection can help to decrease the
thermoregulation
effects of sun exposure on the skin and prevent
○ Decrease in skin temperature; dampened
disease from developing. It is now suggested that
ability to adapt to temperature change;
older persons be advised to apply sunscreen and
reduction in sweat and oil production
avoid excessive sun exposure.
● Decline in number of Pacini’s and Meissner’s
● Recommend that older people and their carers avoid
corpuscles
using soaps that dry out their skin even more, and
○ Reduced response to pressure and touch
instead use a moisturizer to replenish the moisture
○ Increased risk of injury; impaired ability to
lost during bathing.
perform fine maneuvers with hands
● Use of clothing and protection of high risk areas, such
● Sebaceous glands
as elbows and heels, with appropriate padding. may
○ Reduction of oil and wax production
be helpful in preventing skin tears
○ Increased roughness, dryness and itchiness
● To avoid hyperthermia or hypothermia, which are
of skin
dangerous side effects of typical aging changes when
exposed to severe heat or cold, proper environmental
CHANGES ACCORDING TO SKIN LAYER:
control and appropriate hydration are required.
SUBCUTANEOUS
● When normal and pathological aging changes make
independent nail care difficult, assist older persons
● Loss of thickness
with nail care and urge that they seek the treatment of
○ Impaired ability to insulate and protect
a podiatrist.
○ Increased risk of heat loss and hypothermia;
increased risk of injury and bruising
NURSING CARE FOR OLDER ADULTS WITH
● Decreased sweat gland function
AGE-RELATED CHANGES IN THE INTEGUMENTARY
○ This impairs the ability to maintain body
SYSTEM
temperature homeostasis

CHANGES ACCORDING TO SKIN LAYER: HAIR

 Provide optimum nutrition, This is to provide a positive
including vitamins (e.g., A, C, nitrogen balance to aid in
D, E) and protein. skin and tissue healing and
to maintain general good
health.

Apply appropriate dressing To promote wound healing

(e.g., adhesive or and to best meet needs of
nonadhesive film, hydrofiber client and care setting.
or gel, acrylics,
hydropolymers)
Nursing Assessment
● Objective Cues: Use pillow or foam wedges to These measures to reduce
○ Presence of redness on skin. keep bony prominences from sharing forces on the skin.
○ Pain score of 6/10. direct contact with each
○ Sacrum area is hot to touch. other.
● Subjective Cues:
The patient verbalized:
○ “I feel pain if I sit down a very long time.”
○ “I can also feel numbness on my heels when Musculo-skeletal System
standing or walking too long.”
○ “I can feel pain the prominence on the outer
side of the ankle.” NORMAL CHANGES WITH AGING
Nursing Diagnosis
● Impaired skin integrity as manifested by alteration in ● Muscles
skin integrity r/t pressure over bony prominence ○ Muscle loses size and strength
i. Muscle fibers reduce in number and
Nursing Care Planning shrink in size
● General Objectives: ii. Muscle tissue is replaced more
○ After 1 week of holistic student-nurse and slowly
client interaction, the client will have their iii. Changes in the nervous system
skin returned to its proper integrity cause muscles to have reduced
● Specific Objectives: tone and ability to contract.
○ After 8 hours of holistic student-nurse and ○ Changes in Muscle fiber
client interaction, the client will: ○ Loss of Motor Unit
■ Verbalize experiencing a pain with a ○ Protein Synthesis
score of less than 3 ○ Hormonal influences
■ No longer show redness on their skin ● Bones
■ Visually appear more comfortable ○ Loss of bone tissue
○ Low bone mass
Nursing Interventions ○ Becomes less dense
● Joints
Nursing Interventions Rationale ○ Joint movement becomes stiffer and less
flexible
Determine client’s level of To clarify the intervention ○ Ligaments tend to shorten and lose some
discomfort (e.g., can vary needs and priorities. flexibility
widely from minor itching or
aching, to deep pain with ALTERATIONS IN STRUCTURE & FUNCTION
burns, or excoriation
associated with drainage)

Maintain and instruct in good This helps to reduce risk of

skin hygiene (e.g., shower dermal trauma, improve
instead of bath, washing circulation, and promote
thoroughly, using mild comfort.
nondetergent soap, drying
gently and lubricating with
lotion or emollient, as
indicated)
 ○ Type 1 (slow-twitch, fatigue-resistant)
● SIGNIFICANT AMOUNTS OF LIPOFUSCIN & FAT
ARE DEPOSITED
● Density of motor unit diminishes
● Healthy muscle tissue constantly undergoes
remodeling
● Regeneration of muscle tissue slows with age
● Atrophied tissue replaced with fibrous tissue
○ Muscles of the hand – thin and bony
○ Arm and leg muscles – thin and flabby
● Slower movement
○ Decrease in the number of motor nerve units
○ Prolongation of the contraction time, latency
Skeleton
period and relaxation period
● Stature and Posture
○ Impairment of extrapyramidal nervous
○ Lengthening and broadening of the nose
system
and ears
● LESS EFFICIENT ABILITY TO STABILIZE THE BODY
○ Arms and legs may appear longer than torso
WITH POSTURAL CHANGES
○ Bony landmarks become more prominent
● MUSCLE FUNCTION - VOLUNTARY MOVEMENT
○ Height diminishes - 1.2 cm per 20 years
○ Vertebral column changes
○ Lean body mass decreases from sarcopenia
○ Ankylosis (stiffening)
■ Decreased muscle mass leading to
○ Shrinkage and sclerosis
loss of strength
○ Degenerative changes
○ Compression of spinal column
● MUSCLE FUNCTION - INVOLUNTARY MOVEMENT
○ Disc changes
○ Resting tremors
○ Vertebral changes
○ Muscular fasciculations
○ Shoulders narrow
○ Weakness in the legs or Paresthesia
○ Pelvis widens - “pear-shaped”
○ Restless legs
○ Decreased muscle strength, basal metabolic
○ Manifestations of impaired extrapyramidal
rate and activity levels
system
● Bone mass and metabolism
○ Drug side effects
○ At age 30, bone absorption > bone
○ Neurological disorders
formation
○ Caused by inactivity or relatively immobile
■ Genetic factors
○ Flickering of muscles of calves, eyelids,
■ Low body weight
hands and feet
■ Smoking
○ Fatigue and excessive loss of sodium
■ Excess Alcohol consumption
chloride
■ Hormonal Influences
○ Irresistible leg movements
○ Women experience accelerated loss during
○ Associated with neurological d/o, anemia,
the decade after menopause
renal failure and some drugs
○ At risk for sustaining
● MUSCLE FUNCTION - STRENGTH & ENDURANCE
■ vertebral body compression
○ Decrease in muscle strength
fractures
○ Disability
■ Colles’ fractures
○ Requires greater percentage of the
■ femoral neck fractures
remaining muscle mass and a higher
○ Cortical Bone Loss
percentage of the maximal capacity to
■ Women - 45 yrs. old
perform a task
■ Men - 50 yrs. Old
○ FACTORS THAT DECREASE ENDURANCE:
○ Factors that elevate osteoclast activity
■ Reduced blood flow
■ Decreased vitamin D intake
■ Impaired glucose transport
■ Reduced exposure to sunlight
■ Lower mitochondrial density
○ Factors that impede bone formation:
■ Decreased oxidative enzyme
■ Insufficient intake of dietary
■ Decreased phospho creatinine
calcium
repletion rate
■ Decreased absorption of calcium in
the intestines
GENERAL MEASURES TO MAINTAIN
■ Reduced physical activity
GASTROINTESTINAL HEALTH IN OLDER ADULTS
Musculature
● Have an active lifestyle
● Muscle wasting
a. Stretching
○ Great loss for Type II fibers (fast twitch)
 b. Muscle strengthening
○ Calcitonin
c. Pregressive resistance training
■ Inhibits calcium
● Healthy diet
○ Insulin
a. Fruits and vegetables
■ Helps in osteoblast proliferation
b. High protein
c. Drink vitamins
Osteoarthritis
i. Vitamin C
ii. Vitamin B6
iii. Vitamin D
iv. Vitamin K
v. Magnesium
vi. Omega-3 Fatty Acids
d. Drink milk
e. Drink water
f. Have regular checkups
g. Have home safety measures

NURSING CARE FOR OLDER ADULTS WITH

AGE-RELATED CHANGES IN THE MUSCULOSKELETAL
SYSTEM

Falls
● Most common cause of accidental death in older
adults
● 50-75% incidence in the nursing homes
● May cause cycle of disuse (Gray et al, 2019)
● Nursing problems:
○ Pain
○ Impaired mobility
○ Self-care deficit
○ Risk for falls

● Also known as degenerative joint disease

● Caused by progressive cartilage deterioration
causing pain during activity
● Nursing interventions:
○ Energy conservation
○ Gentle exercise program
○ Water therapy
○ Heat and cold therapy
○ NSAIDs as prescribed
● Nursing Diagnosis:Altered body image and self
concept

Nursing Assessment
● Objective Cues:
○ Decrease in ROM
○ Decrease in bone mass
○ Reluctant to attempt movement
○ Facial grimace when trying to move
● Subjective Cues:
○ The patient verbalized: “ It is very difficult to
Bone remodelling
stand up without assistance”
● Is influenced by the production of these hormones
○ Estrogen and testosterone (based on the
Nursing Diagnosis
book)
● Impaired physical mobility: decrease in ROM related
○ Growth hormone
to bone loss
■ Promote bone formation
specifically the cartilage
Nursing Care Planning
 ● General Objectives:
○ After 1 week of holistic student-nurse and
client interaction, the client will:
■ Perform physical activity
independently or within limits of
disease.
● Specific Objectives:
○ After 8 hours of holistic student-nurse and
client interaction, the client will:
■ Demonstrate measures to increase
mobility
■ Evaluate pain and quality of
management
Nursing Interventions
Nursing Interventions Rationale

Assess activity limitations, Influences choice of

noting presence and degree interventions
of restriction or ability.

Perform or assist with full ROM exercises enhance

range of motion (ROM) circulation, restore or
exercises on all extremities maintain muscle tone, and
using slow, smooth joint mobility, and prevent
movements. disuse contractures and
muscle atrophy.

Schedule activity or Activity and rest enhance

procedures with rest periods. healing and build muscle
Encourage participation in strength and endurance.
ADLs within individual Client participation
limitations promotes a sense of
independence and control.

Demonstrate use and assist Appropriate use of

with adjunctive devices such adjunctive devices provides
as walker or cane, as stability and support by
appropriate compensating for altered
muscle tone, strength,
balance and gait

Consult with physical and Collaboration helps in

occupational therapists and planning and implementing
rehabilitation team individualized programs.
GROUP 2 dizziness due to the less blood flow to the
brain
○ The main artery from the heart (aorta)
CARDIOVASCULAR SYSTEM
becomes thicker, stiffer, and less flexible.
This is probably related to changes in the
connective tissue of the blood vessel wall.
RECAP!
○ This makes the blood pressure higher and
● right ventricle pumps deoxygenated blood to the lungs
makes the heart work harder, which may lead
through the pulmonary valve.
● left ventricle pumps oxygen blood through the aortic to thickening of the heart muscle. The other
valve, distributing it out to the rest of the body. arteries also thicken and stiffen. This
conclude that most older adult have high
Causes of changes blood pressure
● Diet ● Blood
● Lifestyle ○ Blood volume is reduced owing to the drop in
● Tobacco use
plasma volume. Normal aging causes a
● comorbidities
reduction in total body water. Probably
Signs and Symptoms of changes
● Left ventricular wall thickens because the volume of the bone marrow is
● Decreased diastolic pressure less, and some of the hemopoietic tissues is
● S4 heart sound / murmur replaced by fat and connective tissues
Biological Theories of Aging ○ Blood coagulability also increases as we age.
● Free radicals and lipofuscin Because of increased platelet aggregation
● Apoptosis and decreased fibrinolytic activity.
● Inflammatory processes
○ The speed on how the red blood cells are
produced in older adults, response to stress
● Cardiomegaly - heart enlargement
○ Narrowing of blood vessels or illness is reduced. This creates a slower
● Thickening of heart walls - main pumping chamber response to blood loss and anemia.
● Decreased no. of myocardial cells ● Pumping Ability of the Heart
○ Due to a multitude of changes influencing
the structure and function of the heart
NORMAL CHANGES WITH AGING
muscle, the heart's pumping capacity
decreases with age. The heart normally
● Heart
continues to pump enough blood to supply
○ Normal changes in the heart include
all of the body's organs.
deposits of the "aging pigment," lipofuscin.
The heart muscle cells degenerate slightly.
The valves inside the heart, which control the GENERAL MEASURES TO MAINTAIN CARDIOVASCULAR
direction of blood flow, thicken and become HEALTH IN OLDER ADULTS
stiffer. The stiffness reduces diastolic
compliance, thereby limiting the amount of Cardiovascular diseases (CVDs) are the world’s leading killer,
blood that can fill the ventricles and the causing 1 in every 3 deaths. In the Philippines, cardiovascular
reduced contractility further limits the diseases are also the number one cause of death, with an
amount of blood ejected with each heartbeat. estimated 50,000 dying every year. The cause of heart attacks
○ The overall size of the heart does not and strokes are usually the presence of a combination of risk
increase with age, but the thickness of the factors, such as tobacco use, unhealthy diet and obesity,
left ventricular free wall and ventricular physical inactivity and use of alcohol, hypertension, diabetes
septum increases, as does the overall weight. and high level of cholesterol
○ In the myocardium, there are increases in fat,
collagen, elastin and a progressive loss of 1. Eat a heart healthy diet
myocytes. These factors contribute to the - A heart healthy diet consists of a combination of
stiffness and decreased myocardial different foods including fruits, vegetables, whole
contractility in the older adult’s heart. grains, legumes, and nuts. Cut down on salty meats
● Blood Vessels such as ham, bacon, tocino, sausage, hotdog, as well
○ Arteries thicken and become less distensible as salty food such as dried fish. Use calamansi juice
with age. and vinegar to season your food instead of
○ Baroreceptors become less sensitive when high-sodium condiments such as soy sauce, fish
aging which explains why older adults can sauce, bagoong, and ketchup. Avoid the consumption
experience orthostatic hypotension. a of processed, canned, and fast food. Replace
condition in which the blood pressure falls sweetened snacks such as doughnuts, cookies, and
when a person goes from lying or sitting to the like with fresh fruit and vegetables and if thirsty,
standing. This causes them to experiences substitute sweetened beverage sodas and sweetened
juices with water.
 Consider activities such as a stress management
2. If overweight, lose weight program, meditation, physical activity, and talking
- Balancing the calories you eat and drink with the things out with friends or family.
calories burned by being physically active helps to
maintain a healthy weight. Some ways you can NURSING CARE FOR OLDER ADULTS WITH
maintain a healthy weight include limiting portion size AGE-RELATED CHANGES IN THE CARDIOVASCULAR
and being physically active. SYSTEM

3. Increase regular physical activity to at least 2.5 hours Nursing Assessment

per week ○ Assess:
- Physical activity contributes to improved blood ■ based on the patient’s history and
pressure, improved levels of cholesterol and other symptoms.
blood lipids, and weight control. Some physical ■ Assess if older patients' usual activity level
activity is better than none. Inactive people can start has changed in the previous 5-10 years.
with small amounts of physical activity (even as a part ■ Assess if clients experience labored
of their normal daily activities) and gradually increase breathing and does it occurs with exertion or
duration, frequency and intensity. Adults are at rest and does it occur suddenly?
recommended to perform at least 150 minutes of ■ Obtain BP measurement
moderate physical activity (e.g. brisk walking, climbing Objective cues:
stairs, dancing, gardening or doing household chores ● Anxiety, restlessness
which can result in mild increase of heart rate) spread ● Dysrhythmias
throughout the week. ● Abnormal heart sounds (S3 and S4)
● chest pain or discomfort (Angina)
4. Don’t use tobacco ● Hypotension
- Tobacco use and exposure to second-hand smoke are ● Crackles, dyspnea, orthopnea
harmful to your heart. Smoking is the leading cause of
preventable death. Smoking adds to the damage to Subjective cues:
artery walls. It's never too late to get some benefit ● Client verbalizes that he feels tired and restless
from quitting smoking. Quitting tobacco use is the
biggest gift of health you can give your heart Nursing Diagnosis
● Decreased cardiac output as evidenced by
5. Avoid use of alcohol dysrhythmias related to alterations in rate, rhythm,
- Alcohol consumption has been linked to more than electrical conduction.
200 disease and injury conditions, including
cardiovascular diseases. While most Filipinos report Nursing Care Planning
their alcohol drinking occasionally, binge drinking is General Objectives:
common in the country. There is no safe level for After 8 hours of student nurse - client interaction, the client will
drinking alcohol, so it is better to avoid drinking verbalize that pain and discomfort is alleviated
alcohol altogether to protect your heart.
Specific Objectives:
6. Have your blood pressure and blood sugar checked After 8 hours of student nurse - client intervention, the client
regularly will be able to:
- An important way to maintain a healthy heart is for
your blood pressure and blood sugar to be checked 1. demonstrates adequate cardiac output as evidenced
regularly by a health worker. Some people do not by blood pressure and pulse rate and rhythm within
exhibit symptoms even if they already have high blood normal parameters for patient; strong peripheral
pressure – and it can hurt your heart. It is also pulses; and an ability to tolerate activity without
important to talk to your health worker if you have symptoms of dyspnea, syncope, or chest pain.
behavioural risks (unhealthy diet, physical inactivity,
use of tobacco and alcohol) so they can help you plan 2. exhibits warm, dry skin, eupnea with absence of
the lifestyle modifications you should take to get your pulmonary crackles.
heart health back on track. If you are diagnosed with 3. remains free of side effects from the medications
hypertension or diabetes, set targets with your health used to achieve adequate cardiac output.
worker and take your medicines regularly. Involve your
loved ones in your journey to a healthier heart. 4. explains actions and precautions to take for cardiac
disease.
7. Manage Stress

- Learn how to manage stress, relax, and cope with

problems to improve physical and emotional health.
 Interventions Rationale Dependent

Independent: 6. Administer - Digoxin is a cardiac glycoside

Digitalis (Lanoxin) that increases the myocardial
1. Give oxygen as - Supplemental oxygen increases as indicated contractile force (positive
indicated by the oxygen availability to the inotropic action). By increasing
patient’s myocardium and can help contractile force, digoxin can
symptoms, oxygen relieve symptoms of hypoxemia, increase cardiac output. It also
saturation, and ischemia, and subsequent slows the conduction of the
ABGs. activity intolerance The need is heart through the AV node.
based on the degree of Unfortunately, digitalis does not
pulmonary congestion and result in decreased mortality
resulting hypoxia. Ongoing rates in patients with HF though
pulse oximetry monitors the effective in preventing hospital
need for and effectiveness of readmission and decreasing
oxygen supplementation. symptoms of systolic HF
(Alkhawam et al., 2019; Qamer et
2. Provide a restful - Minimizing controllable al., 2019). Digitalis is considered
environment and stressors and unnecessary a second-line agent for heart
encourage periods disturbances reduces cardiac failure and was widely used in the
of rest and sleep; workload and oxygen demand past. Monitor the renal function
assist with (Rogers et al., 2015). Physical and serum potassium levels of
activities. and emotional rest allows the patients taking digitalis.
patient to conserve energy. The
degree of rest depends on the 7. Withhold digitalis - The incidence of toxicity is high
severity of HF. Patients with preparation as (20%) because of the narrow
severe HF may need to rest in indicated, notify margin between therapeutic and
bed, while those with mild to the physician if toxic ranges. Digoxin may have
moderate HF can be marked changes to be discontinued in the
ambulatory with limited activity. occur in cardiac presence of toxic drug levels, a
rate or rhythm or slow heart rate, or low potassium
3. Assist the patient - Allows for better chest signs of digitalis level.
in assuming a high expansion, thereby improving toxicity occur.
Fowler’s position. pulmonary capacity. In this
position, the venous return to 8. Prepare for - It may be necessary to correct
the heart is reduced, pulmonary insertion and bradydysrhythmias unresponsive
congestion is alleviated, and maintenance of to drug intervention. This can
pressure on the diaphragm is pacemaker, if aggravate congestive failure
minimized. Additionally, heart indicated. and/or produce pulmonary
failure with pulmonary edema.
congestion can cause a chronic
nonproductive cough worsening Interdependent
in the recumbent position (Platz
et al., 2017; Picano et al., 2010). 9. Collaborate with a - Can indicate the underlying
radiologic cause of HF. ST-segment
4. Check for calf - The risk for thrombophlebitis technologist for depression and T wave flattening
tenderness, increases with enforced bed monitoring of can develop because of
diminished pedal rest, reduced cardiac output, serial increased myocardial oxygen
pulses, swelling, and venous pooling. electrocardiogram demand, even if no coronary
local redness, or (ECG) and chest artery disease is present. A chest
pallor of extremity. x-ray changes. x-ray may show an enlarged
heart and pulmonary congestion.
5. Encourage active - For acute HF, bed rest may be
and passive temporarily indicated. 10. Collaborate with a - Helps in identifying patients at
exercises. Increase Otherwise, a total of 30 medical risk for excessive clot formation
activity as minutes of physical activity technologists for and measures changes in
tolerated. every day should be monitoring of coagulation processes or
encouraged (Yancy et al., 2017). Prothrombin time effectiveness of anticoagulant
(PT), activated therapy
 lesser extent, at the points where the ribs meet the
partial
vertebral column. As a result of these modifications,
thromboplastin
the chest wall becomes increasingly rigid.
time (aPTT)
● Under the weight of the body, the intervertebral discs
coagulation
become dry, less durable, and more compressed as we
studies.
age. Many older persons have the typical curvature of
the thoracic spine as a result of this. This curvature
can exceed 50 degrees (hyperkyphosis) in some
RESPIRATORY SYSTEM
people, particularly older ladies with osteoporosis or
muscle wastage. The gaps between the vertebrae
and between the ribs narrow as the thoracic spine
RESPI PATHOPHYSIO CLINICAL
curvature increases with age, reducing the volume of
FUNCTION CHANGES PRESENTATION
the rib cage.
● There is also a progressive loss of respiratory muscle
Mechanism, of Loss of elastic Increased reserve
strength as people get older, which is assumed to be
breathing recoil volume
due to a loss of muscle mass in the diaphragm and
intercostals. Muscle mass loss is more common
Decreased respi Decreased
among immobile individuals or people that live a
muscle mass & expiratory flow
sedentary lifestyle, as inactivity promotes muscle
strength rate
wastage and weakness.
Oxygenation Decreased Decreased partial ● As a result of these changes, breathing becomes
alveolar surface oxygen labored, and the coughing reflex becomes less
efficient, increasing the risk of respiratory tract
Lung defense Decreased Decreased ability infections.
mechanisms number of cells to clear secretions
Airways
Decreased cough Increased risk for ● The respiratory system contains an elaborate
reflex aspiration mechanism, known as the ciliary escalator, to
eliminate particulate debris, as each breath introduces
new infectious agents and irritants: mucus coats the
Dysphagia diet (pls research) inner surface of the bronchial tree and traps inhaled
particles such as dust and bacteria.
Signs of respiratory problem ● The frequency with which cilia beat decreases with
● Dyspnea age, slowing the ciliary escalator. In a study of people
○ Can be manifested by the general population aged 19 to 81, researchers discovered a clear
● Excessive coughing
age-related decline in inhaled particle clearance. This
○ Coughing and gag reflex is diminished so this is
could be linked to the airway's cilia and ciliated
not applicable
● Change in the mental status cells gradually decreasing in number. Smoking
○ early sign of respiratory problem reduces particle clearance much more because
○ Decreased oxygen transport to the brain cigarette smoke is harmful to ciliated cells.
affects the mental status
○ Respiratory and nervous system are interrelated
○ RATIONALE: Responses to hypoxemia / L INCREASE DECREASE
hypercapnia initially decreases cerebral
perfusion, which is manifested by forgetfulness U Diameter of alveolar ducts Size of airway
and irritability.
● Clubbing of fingers N Collagen of alveolar walls Elasticity of alveolar
○ Observed on the younger adults sacs

Common causes of aspiration among older adults

G Thickness of alveolar
● Stiffening of the esophageal wall
membranes
● Decreased sensitivity to discomfort
● Gag reflex is absent ● The conduction zone is the airway between the nose
and the bronchioles; it is an anatomical dead space in
NORMAL CHANGES WITH AGING which no gas exchange takes place. With age, the
cartilaginous rings that keep the upper airways open
ANATOMICAL CHANGES calcify, increasing the diameter of the larger
OTHER CHANGES: airways, particularly the trachea and bronchi, causing
● The chest wall is rather supple in early life. Rib this dead space to expand.
calcification however progresses with age, notably in ● Despite the fact that the amount of elastin and
the intercostal cartilages near the sternum, and, to a collagen fibres in lung tissue remains generally
 constant, the lungs lose elasticity and become Lung Health & Diseases Your lungs mature by the time you are
more dilated over time. This is assumed to be about 20-25 years old. After about the age of 35, it is
related to changes in the nature of collagen and normal for your lung function to decline gradually as you
elastin fibres, which become cross-linked or age. This can make breathing slightly more difficult as you get
degenerate with time, lowering the lung tissue's older.
elastic recoil.
The effects of tobacco smoke on the respiratory system include:
Alveolar changes
● The loss of elasticity in the lung tissue and ● irritation of the trachea (windpipe) and larynx (voice
airways as people age causes the diameter of the box)
respiratory bronchioles and alveolar ducts to gradually ● reduced lung function and breathlessness due to
expand (tiny tubes leading into the alveoli). The swelling and narrowing of the lung airways and excess
elastic fibres in the alveolar ducts begin to mucus in the lung passages
degenerate after the age of 50, resulting in alveolar ● impairment of the lungs’ clearance system, leading to
duct dilation. The structure of the alveoli is widened the build-up of poisonous substances, which results in
and the depth of the alveoli is reduced as a result. lung irritation and damage
The alveolar walls may dissolve and the air sacs ● increased risk of lung infection and symptoms such as
increase over time, giving the alveolar walls a coughing and wheezing
flattened look and lowering the total alveolar surface ● permanent damage to the air sacs of the lungs.
area.
● People in their 90s have typically lost around 25% of
The effects of immobility on the respiratory system include:
their alveolar surface area. These changes are
often exacerbated in smokers (and individuals who
Reductions in lung function, plasma volume and erythrocyte
inhale other particulate irritants), leading to the
number also lead to a drop in arterial oxygen saturation. At the
severe emphysema characteristic of chronic
same time, blood carbon dioxide concentrations increase
obstructive pulmonary disease.
(Trappe et al, 2006; Manning et al, 1999).
FUNCTIONAL CHANGES
The effects of surgery on lung function
The anatomical changes as previously mentioned can
subsequently lead to functional changes which we will now be
Impairment of respiratory muscle function after surgery may
discussing.
lead to postoperative complications.
● Decreases in peak airflow (how quickly someone can
exhale) and exchange of carbon dioxide and oxygen
GENERAL MEASURES TO MAINTAIN RESPIRATORY
● Decreases in measures of lung function such as vital
HEALTH IN OLDER ADULTS
capacity (the maximum amount of air that can be
breathed out following a maximum inhalation)
● Respiratory system is a critical organ system. And
● Weakening of the respiratory muscles
while changes in the respiratory system vary among
the older population, it is important to follow general
EXERCISE EFFECTS
measures to maintain respiratory health.
● Regular exercise improves lung capacity
● Obtain pneumonia immunization.
● Increases blood flow to the lungs
○ It helps protect against the 13 types of
● Helps reduce & strengthen respiratory muscles
pneumococcal bacteria and can also help
● Increase pulmonary arterial pressure during exercise
prevent ear infections and pneumonia
● Greater muscle oxidative capacity and expression
caused by those 13 types of pneumococcal
bacteria which is why it is significant to
obtain this vaccine.
● Obtain annual influenza immunization.
FACTORS THAT MAY FURTHER DECREASE LUNG
○ Flu vaccination is especially important for
FUNCTION
people 65 years and older because they are
at higher risk of developing serious flu
● Smoking
complications.
● Immobility
○ Also, immunity wanes over a year so annual
● Surgery
vaccination is needed to ensure the best
possible protection against flu.
Lungs are principal organs of respiration. The trachea
● Exercise regularly.
(windpipe) conducts inhaled air into the lungs through its
○ It is known that benefits of exercise are
tubular branches, called bronchi. The bronchi then divide into
numerous. Among older adults, regular
smaller and smaller branches (bronchioles), finally becoming
exercise programs help to increase vital
microscopic.
 capacity, prevent normal and pathological ○ Evaluate Vital Signs and respiratory rate with the use
changes of aging. of pulse oximeter. Having the normal range of a
○ Thus it is important for nurses to encourage respiratory rate for an adult is 12-20 breaths per
regular exercise participation. minute at rest, and the normal range for oxygen
● Get regular check-ups. saturation of the blood is 94–98% (SpO₂). Bradypnea
○ Regular check-ups help prevent diseases, indicates less than 12 breaths per minute, and
even when a person is feeling well. This is tachypnea is greater than 20 breaths per minute.
especially true for lung disease, which ○ Physical assessment that comprises the four
sometimes goes undetected until it is methods:
serious. ○ Inspection - this includes observing the level
● Avoid exposure to smoke and pollutants. of consciousness, breathing rate, pattern and
○ Environmental factors also influence effort, skin color, chest configuration, and
respiratory health where Indoor and outdoor symmetry of expansion.
air pollutants play a role in affecting this ○ Palpation - Palpation of the chest may be
aspect. Conscious choices in minimizing performed to investigate for areas of
exposure to air pollution in the places where abnormality related to injury or procedural
the older adults reside, work or stay can help complications. For example, if a patient has a
alleviate some of the stress to their chest tube or has recently had one removed,
respiratory systems. the nurse may palpate near the tube
● Avoid smoking. insertion site to assess for areas of air leak or
○ Cigarette smoking is one of the most critical crepitus.
negative predictors of longevity. It is well ■ Palpate for Crepitus feels like a
known as a risk factor for the development popping or crackling sensation
of multiple respiratory diseases. Smoking when the skin is palpated and is a
cessation is an important health measure for sign of air trapped under the
the respiratory system. It is also important to subcutaneous tissues. If palpating
avoid exposure to secondhand smoke and the chest, use light pressure with
people with respiratory illnesses because the fingertips to examine the
these can affect respiratory system anterior and posterior chest wall.
negatively. Chest palpation may be performed
● Seek prompt treatment of respiratory infections. to assess specifically for growths,
○ Older persons should be advised against masses, crepitus, pain, or
treating respiratory problems themselves. tenderness.
Many over-the counter cold and cough ■ Confirm symmetric chest expansion
remedies can have serious effects in older by placing your hands on the
adults and can interact with other anterior or posterior chest at the
medications being taken. same level, with thumbs over the
● Practice regular oral hygiene. sternum anteriorly or the spine
○ Having a healthy oral cavity is often posteriorly. As the patient inhales,
overlooked in preventing respiratory your thumbs should move apart
problems. Infections of the oral cavity can symmetrically. Unequal expansion
lead to respiratory infections or can decrease can occur with pneumonia, thoracic
appetite and facilitate a generally poor trauma, such as fractured ribs, or
health status. Teeth can break, leading to pneumothorax.
lung abscesses, infections or aspirated tooth ○ Auscultation - Using the diaphragm of the
fragments. stethoscope, listen to the movement of air
through the airways during inspiration and
NURSING CARE FOR OLDER ADULTS WITH expiration. Instruct the patient to take deep
AGE-RELATED CHANGES IN THE RESPIRATORY breaths through their mouth. Listen through
SYSTEM the entire respiratory cycle because different
sounds may be heard on inspiration and
Nursing Assessment expiration. As you move across the different
As the adult person ages, the cartilage and muscle support of lung fields, the sounds produced by airflow
the thorax becomes weakened and less flexible, resulting in a vary depending on the area you are
decrease in chest expansion. Older adults may also have auscultating because the size of the airways
weakened respiratory muscles, and breathing may become change.
more shallow. ○ Expected breath sounds:
■ Bronchial breath sounds
Objective assessment - are heard over the
 trachea and larynx and are ○ Can you describe your energy level? Is there
high-pitched and loud. any change from previous?
■ Bronchovesicular
sounds - are Nursing Diagnosis
medium-pitched and ● Ineffective Airway Clearance related to aspiration as
heard over the major evidenced by changes in rate and depth of
bronchi. respirations.
■ Vesicular breath sounds
- are heard over the lung
surfaces, are
lower-pitched, and often Plan of Care:
described as soft, rustling General objectives:
sounds. After 1 week of patient-nurse interaction, the client will be able
○ Adventitious breath sounds: to: maintain clear, open airways as evidenced by normal breath
■ Fine crackles, also called sounds, normal rate and depth of respirations, and ability to
rales, are popping or effectively cough up secretions after treatments and deep
crackling sounds heard on breaths.
inspiration that occur in Specific objectives:
association with conditions
that cause fluid to
accumulate within the
alveolar and interstitial - demonstrate increased air exchange.
spaces, such as heart - identify and avoid specific factors that inhibit
failure or pneumonia effective airway clearance.
■ Wheezes are - recognize the significance of changes in sputum to
whistling-type noises include color, character, amount, and odor.
produced during expiration
(and sometimes
inspiration) when air is
forced through airways
Interventions: Rationale:
narrowed by
bronchoconstriction or
Teach the patient the The most convenient way to
associated mucosal
proper ways of coughing remove most secretions is
edema. For example,
and breathing. (e.g., take a coughing. So it is necessary to
patients with asthma
deep breath, hold for 2 assist the patient during this
commonly have wheezing.
seconds, and cough two or activity. Deep breathing, on the
■ Stridor is heard only on
three times in succession). other hand, promotes
inspiration. It is associated
oxygenation before controlled
with mechanical
coughing.
obstruction at the level of
the trachea/upper airway.
Position the patient upright Upright position limits
if tolerated. Regularly check abdominal contents from
Subjective Assessment
the patient’s position to pushing upward and inhibiting
● Collect data using interview questions, paying
prevent sliding down in bed. lung expansion. This position
particular attention to what the patient is reporting.
promotes better lung expansion
● The interview should include questions regarding any
and improved air exchange.
current and past history of respiratory health
conditions or illnesses, medications, and reported
Encourage patient to Fluids help minimize mucosal
symptoms.
increase fluid intake to 3 drying and maximize ciliary
● Considering the patient’s age, gender, family history,
liters per day within the action to move secretions.
race, culture, environmental factors, and current
limits of cardiac reserve and
health practices when gathering subjective data. The
renal function.
information discovered during the interview process
guides the physical exam and subsequent patient Give medications as A variety of medications are
education. prescribed, such as prepared to manage specific
● Questions to ask may include: antibiotics, mucolytic problems. Most promote
○ Have you noticed a change in your agents, bronchodilators, clearance of airway secretions
breathing? expectorants, noting and may reduce airway
○ Do you get short of breath with activities effectiveness and side resistance.
that you did not before?
 effects.

Coordinate with a Chest physiotherapy includes

respiratory therapist for the techniques of postural
chest physiotherapy and drainage and chest percussion
nebulizer management as to mobilize secretions from
indicated. smaller airways that cannot be
eliminated by means of
coughing or suctioning.

Nursing Evaluation
● Patient maintains clear lung fields and remains free of
signs of respiratory distress.
 ○ This makes it easy for bacteria to
GROUP 3 build up and cause inflammation
and decay.
GASTROINTESTINAL SYSTEM
Jawbone and Joints
Changes in the gastrointestinal system can have multiple and ● Atrophy of muscles and bones of the jaw and
varied effects, including effects upon consumption and mouth.
absorption of nutrients and waste secretion. ● More difficult for older adults to chew their
food (Devlin & Ferguson, 1998; Digiovanna,
2000; Karlsson, Persson, & Carlsson, 1991;
Most of the GI structure including accessory glands remain its
function. Newton, Yemm, Abel, & Menhinick, 1993).
● Change in the ability of the nerves and
But due to decreasing sizes and insufficient blood flow to the muscle to coordinate functioning
organs, reduced secretions of antibodies, older adults are prone to (Digiovanna, 2000).
having GIT problems. Sense of Taste
● Taste sensation may diminish.
Atherosclerosis = decreases absorption and digestion in the small
● The number of taste buds decreases, and
intestines
the rest begin to shrink, losing mass vital to
● Leads to constipation
their operation.
Changes caused by: B. Esophagus
● Polypharmacy ● Decline in upper esophageal sphincter
○ Gastric upset pressure
● Stress ● Increased time for the upper esophageal
● Poor Nutrition sphincter to relax
○ Decrease in fiber diet
● Decreased intensity of esophageal
● Multiple Comorbidities
contractions potentially (Fulp, Dalton,
○ Hypertension
○ Diabetes Castell, & Castell, 1990; Hall & Wiley, 1999;
● Poor Hygiene Orr & Chen, 2002; Schroeder & Richter,
1994).
Common Manifestation ● Stiffening of the esophageal wall and less
● Edentolous sensitivity to discomfort and pain in the
○ Lack/absence of teeth common among older esophagus.
adults
● Decline on the ability to swallow.
○ Decreased nutrition
● The gag reflex also appears to be absent in
● Xerostomia
○ Loos of taste due to dry mouth around 40% of healthy older adults (Davies,
○ Cause: decrease in salivary production Kidd, Stone, & MacMahon, 1995).
○ Leads to tooth decay C. Stomach
● Anorexia ● Slower gastric emptying in premenopausal
○ Lack of appetite (in older adult) women as compared to postmenopausal
■ NOT an eating disorder in older adult women and men.
○ Manifested by low weight
○ Causally linked to increased
progesterone levels during the
Usually complain no taste
● Health teaching should be done menstrual cycle (Gryback et al.,
2000; Petring & Flachs, 1990).
D. Small and Large Intestine
NORMAL CHANGES WITH AGING Small Intestine
● Bacterial overgrowth
A. Oral Cavity: Dentition; Soft Oral Tissues; Jawbone ○ Causing malabsorption and
and Joints; Sense of Taste malnutrition
Dentition ● Changes in vitamin absorption are seen with
● Age-related changes in teeth cause them to particular vitamins but not others (Hall &
be less sensitive and more brittle (Devlin & Wiley, 1999).
Ferguson, 2008). Large Intestine
● Dental decay and tooth loss. ● Loss of enteric, or intestinal, neurons and a
● Bones become less dense and strong. loss of inhibitory nerve connection to the
Soft Oral Tissues smooth muscle in the colon.
● Tissues become thinner and less elastic ● Decreased colonic relaxation (Shaker et al.,
● Receding gums (gum recession) are 1998).
common in older adults. ● Longer colonic transit time (Madsen & Graff,
2004)
 ● The rectum shows an age-related increase in ○ “Mag sige og sakit ako tiyan”
fibrous tissue. Nursing Diagnosis
○ Reduce ability to stretch as feces ● Imbalanced Nutrition: Less than body requirements
pass through (Digiovanna, 2000). related to inability to intake enough food because of
● External anal sphincter thins with age and reflux as evidenced by inadequate food intake.
shows a decrease in motor neurons. Nursing Care Planning
○ Decline in contractile abilities ● General Objectives: After 1 week of holistic student
(Digiovanna, 2000; Nielson & nurse-client interaction, the patient will be able to
Pedersen, 1996; O’Mahony et al., ingest daily nutritional requirements in accordance to
2002; Rociu, Stoker, Eijkemans, & his activity level and metabolic needs.
Lameris, 2000). ● Specific Objectives: After 8 hours of student
○ Aging women experience a greater nurse-client interaction, the patient will be able to:
risk of anal sphincter changes (Hall, ○ Demonstrate behaviors, lifestyle changes
2002). such as food choices.
E. Pancreas ○ Achieve daily nutritional and metabolic
● Decreases in weight with age needs.
● Fibrosis and cell atrophy (Hall & Wiley, ○ Adjust ADLs in accordance with their
2003). condition.
F. Liver and Biliary Tract Nursing Interventions
● Decrease in size, as well as its blood flow and
Nursing Interventions Rationale
perfusion by 30% to 40%.
● Liver cells undergo structural alterations.
Instruct to remain in upright Helps control reflux and
● Decreased drug clearance due to the
position at least 2 hours after causes less irritation from
observed declines in liver size and blood flow
meals; avoiding eating 3 reflux action into the
(James, 1998; Le Couteur & McLean, 1998;
hours before bedtime. esophagus.
McLean & Le Couteur, 2004).
Instruct patients to eat slowly Helps prevent reflux.
GENERAL MEASURES TO MAINTAIN
and masticate foods well.
GASTROINTESTINAL HEALTH IN OLDER ADULTS
Encourage small frequent Small and frequent meals
1. Maintain a healthy diet. Add fiber to meals. Avoid meals of high calories and are easier to digest.
white foods and drink water. high protein foods.
2. Avoid foods that trigger heartburn or reflux. Such as
dairy or gluten. Obtain a nutritional history. Determining the feeding
3. Consider a probiotic since they contain helpful “good” habits of the client can
bacteria. Don’t take them for diarrhea unless it is after provide a basis for
specific types of infections. establishing a nutritional
4. Check your medications. Over-the-counter and plan.
prescription drugs can cause digestive problems. Talk
to your doctor about possible side effects and ask for Accurately measure the For baseline data.
a substitute patient’s weight and height.
5. Stay active. Exercise and physical activity offer lots of
health benefits, including preventing constipation. Administer pharmacological In order to achieve
Getting at least 150 minutes per week of physical management as prescribed optimum levels of care
activity is recommended. by physician

NURSING CARE FOR OLDER ADULTS WITH

AGE-RELATED CHANGES IN THE GASTROINTESTINAL
SYSTEM GENITOURINARY SYSTEM

Nursing Assessment
● Objective Cues: Urinary inconsistency cause:
○ Weight loss ● Loss of bladder control
○ Heartburn ● Weak pelvic floor contractions of muscles
○ Inadequate food intake ● Damage of the nerves
○ Leading to psychological problems
○ Epigastric pain after eating
■ Embarrassment
● Subjective Cues:
■ Distress
○ The patient verbalized “Kada homan nakog
kaon kay ako ma suka most of the time ako
gikaon”
Normal Changes with Aging men. With aging prostatic atrophy occurs
A. Kidney: Nephron; Tubules with focal areas of hyperplasia. Benign
● On the macrostructural level, kidney cortical nodular hyperplasia is present in 75% of
volume decreases, surface roughness males over 80 years.
increases, and the number and size of simple F. External Genitalia
renal cysts increase with age. ● For female vaginal walls become thinner,
● On the microstructural level, the histologic dryer, less elastic, and possibly irritated.
signs of nephrosclerosis Sometimes sex becomes painful due to
(arteriosclerosis/arteriolosclerosis, global these vaginal changes. Risk for vaginal yeast
glomerulosclerosis, interstitial fibrosis, and infections increases. The external genital
tubular atrophy) all increase with age. The tissue decreases and thins, and can become
decline of nephron number is accompanied irritated.
by a comparable reduction measured in ● For male, Together with the loss of skin
whole-kidney GFR. elasticity throughout the body and the
● Renal tubules undergo fatty degeneration effects of gravity, the scrotum and penis can
and irregular thickening of their basal both sag and look more wrinkled with age. A
membrane with increasing zones of tubular reduction in blood flow may also lighten the
atrophy and fibrosis color of the penis later in life.
● Renal tubular functions may also decrease G. Sexual Response
which deals with the regulation of water and ● A man's sexual response begins to slow down
sodium which can also decrease the after age 50. But a man's sexual drive is
reabsorption of glucose. more likely to be affected by his health and
B. Ureters his attitude about sex and intimacy than by
● The ureters do not change much with age. his age. It may take longer for a man to get
The maximum volume of urine that the an erection, and more time needs to pass
bladder can hold decreases. A person's between erections. Erections will be less
ability to delay urination after first sensing a firm.
need to urinate also declines. The rate of ● The most common sexual concerns of
urine flow out of the bladder and into the women of all ages include loss of sexual
urethra slows. desire, problems with arousal, inability to
C. Bladder: Micturition Cycle achieve orgasm, painful intercourse, negative
● The bladder wall changes. body image, and diminished sexual
● The elastic tissue becomes stiffer and the desirability and attractiveness.
bladder becomes less stretchy.
● The bladder cannot hold as much urine as GENERAL MEASURES TO MAINTAIN GENITOURINARY
before. The bladder muscles weaken. HEALTH IN OLDER ADULTS
● Increased dysfunction with aging includes
reduction in bladder capacity. Uninhibited 1. Stay hydrated. Older adults should drink at least 8
contractions and decreased urinary flow rate, glasses of water over the course of the day. This to
so the person experiences the need to avoid dehydration.
empty the bladder more frequently. 2. Limit salt intake. Too much salt in your diet keeps the
D. Urethra salt/mineral/water balance in your kidneys off-kilter.
● In women, the urethra shortens and its lining Paying attention to sodium labels on processed foods
becomes thinner. These changes in the and reducing intake of these may help lower the risk
urethra decrease the ability of the urinary for developing calcium-based kidney stones.
sphincter to close tightly, increasing the risk 3. Avoid constipation. Eating plenty of high fiber food
of urinary incontinence such as whole grains, vegetables and fruits.
● The urethra can become partially or totally 4. Exercise regularly. Physical activity can help prevent
blocked. In women, this can be due to bladder problems, as well as constipation. It can also
weakened muscles that cause the bladder or help older adults keep a healthy weight.
vagina to fall out of position (prolapse). In 5. Do pelvic floor muscle exercises. Pelvic floor exercises
men, the urethra can become blocked by an help hold urine in the bladder.
enlarged prostate gland. 6. Take enough time to fully empty the bladder when
E. Prostate urinating. Rushing when you urinate may not allow
● The prostate gland enlarges with age which older adults to fully empty the bladder. If the urine
can press against the bladder and the stays in the bladder too long, it can make a bladder
urethra. as some of the prostate tissue is infection increase.
replaced with a scar like tissue. This 7. Wipe from front to back if you’re a woman. The anus
condition, called benign prostatic and rectum have a lot of bacteria. Wiping from front
hyperplasia (BPH), affects about 50% of to back ensures that you don’t bring the bacteria into
 contact with the vagina, resulting in urinary tract
Intake. bacteria and toxins.
infections.
8. Be in a relaxed position while urinating. Relaxing the
muscles around the bladder will make it easier to
Emphasize the importance of Prevents the contamination
empty the bladder.
hygiene, especially the of urethra.
9. Use the bathroom often and when needed. Older
genital or perineal care.
adults should at least urinate 3 to 4 hours. Holding
urine in your bladder too long can weaken the bladder
Monitor urine output to To identify indications of
muscles.
changes in color, odor and progress or deviations from
10. Wear cotton underwear and loose-fitting clothes.
voiding patterns, input and the expected results
Wearing loose, cotton clothing will allow air to keep
output every 8 hours and
the area around the urethra dry.
monitor the results of
urinalysis repeated
NURSING CARE FOR OLDER ADULTS WITH
AGE-RELATED CHANGES IN THE GASTROINTESTINAL Administer antibiotics Reduces bacteria present
SYSTEM (ceftriaxone 1g IVf 10 drips) in urinary tract and those
as ordered. introduced by drainage
Nursing Assessment system
● Objective Cues:
○ LAB RESULTS: Initiate IV fluids as ordered Provides nourishment of
■ WBC 12.6 units (PLR 125ml/hr) the tissues and keep
■ Bacteriuria (8.6) patient hydrated
■ Blood in urine 3+
■ Protein +1 Collaborate with the MTs in Urine test can identify the
■ Segmenters: 0.87 monitoring urinalysis as presence of bacteria.
○ Temperature: 38.7 Celsius obtained
○ P: 82 beats per minute
○ R: 19 breaths per minute Collaborate with the MTs in Increased WBC determines
○ BP: 120/90 mm/Hg monitoring Complete Blood that there is a bacteria or
● Subjective Cues: count as obtained an infection.
○ ”Ga sakit kung mangihi ko” as verbalized by
the client
○ “gi hilanat sad ko og mam” as verbalized by
the client Nursing Evaluation
○ medyo Dark or cloudy akong urine” as After 8 hours of effective nursing care, there is an absence of
verbalized by the client acute pain as evidenced by:
Nursing Diagnosis ● Patient was able to have an efficient urination.
● Acute pain related to physiologic response to ● No tension in the bladder.
infection secondary to UTI ● calm appearance
Nursing Care Planning ● Normal vital signs
● General Objectives: After 1 week of holistic nursing ● The patient will remain free of infection as evidenced
care the pt. will have return of normal voiding pattern by orientation to person, place, and behavior within
and elimination the patient’s normal limits; respiratory rate and
● Specific Objectives: After 8 hours of effective nursing breathing pattern within the patient’s normal limits;
care, there will be an absence of acute pain as urine that is clear, has straw-yellow color and of
evidenced by: characteristic odor;
○ Reports no pain during urination. ● Client will report satisfactory pain control at a
○ There will be no tension in Bladder level less than 3 to 4 on a scale of 0 to 10
○ The patient will appear calm ● The pt. have returned of normal voiding pattern and
○ Temperature will be consistently normal elimination
Nursing Interventions
Nursing Interventions Rationale
IMMUNE SYSTEM
Assess pain, noting Provides information to aid
location,Intensity (scale of 0 in determining choice or Immunologic theory: normal aging process of humans is related
– 10), duration. effectiveness of to faulty immunological function. There is a decreased immune
interventions. function in the elderly. Slower immunologic response which
means there is an increased chance of getting sick or infected.
Encourage increased fluid Increased hydration flushes There is a reduced production of B and T cells in older adults.
 which produce antibodies to these
antigens.
“Administering vaccines against pneumonia and influenza to older
adults are as effective as giving these to younger population” ● Cytokine Dysregulation
● FALSE ○ Cytokines are crucial in controlling
● Older adults have impaired immune function the growth and activity of other
immune system cells and blood
cells. When released, they signal the
immune system to do its job.
NORMAL CHANGES WITH AGING Cytokines affect the growth of all
blood cells and other cells that help
A. Innate Immunity: Mucocutaneous Barriers; the body's immune and
Phagocytosis inflammation responses.
Definition ○ Dysregulation of cytokines may
● Type of immunity which a person is born cause prolonged and persistent
with. inflammation which lead to
● It is always present and is activated almost autoimmune disorders.
immediately upon exposure to an antigen. C. Cell Lysis
● It is the body’s initial attempt at ridding the ● As the cell ages, translational defects and
body of foreign substances. entropy increase the amount of cellular
● However, it does not have the ability to damage.
recognize a specific antigen. ● Clearance and quality control mechanisms
● Antigen-independent and results in no grow less effective.
immunologic memory of prior encounters ● Accumulated damage leads to a less healthy
with an antigen. cell due to build up of free radicals.
Types of Innate Immunity
● Physical or mucocutaneous barriers: skin, IMPACT OF CHANGES IN THE IMMUNE SYSTEM
mucosal membrane, mucosal secretions
● Phagocytosis: macrophages, natural killer A. Vaccination in Older Adults
cells, complement system, and inflammatory ● In comparison to younger adults, most
response currently used vaccines are less
B. Adaptive Immunity: Cell-Mediated Immunity; immunogenic and effective in the elderly.
Antibody Mediated Immunity; Cytokine Dysregulation This is due to a number of factors, including
Definition the fact that most vaccines are designed
● Also known as acquired immunity. specifically for children and young adults,
● Type of immunity that protects and heals the who have an immune system that differs
body when the innate immune system fails. from that of the elderly, who experience
● It provides the body with the ability to physiological immunosenescence alongside
recognize and remember specific pathogens a personal history of infections and
through their antigens. vaccinations.
● Involves the actions of two primary types of ● Vaccines stimulate the production of
leukocytes—B cells and T cells. antibody-producing B cells as well as
Types of Adaptive Immunity memory T cells against a foreign antigen by
● Cell mediated immunity: exposing the body to it. The T-cell response
○ Principal cellular agent is the T cell. of older people to a new antigen, such as
○ T cell responds to cancer cells, that introduced by vaccine, may be
virus-infected cells, single-cell particularly impaired due to a decrease in
fungi, parasites, and foreign cells in naive T cells with age. In fact, older adults' T
an organ transplant. cells have been shown to respond to
○ When activated, T cells differentiate vaccines more slowly. In general, age-related
into memory cells, cytotoxic cells, changes in vaccine response make vaccines
suppressor cells, and helper cells; less effective in older patients.
cytotoxic T cells attack the antigen B. Cancer & Immunosenescence
directly. ● Immune system alterations as people get
● Antibody mediated immunity (Humoral older contribute to an increase in the
immunity) incidence of most cancers as they get older.
○ Principal cellular agent is the B cell. This is due to the fact that cancers are
○ B cells respond to bacteria, immunogenic, which means that the immune
bacterial toxins, and some viruses. system may and does guard against
○ When activated, B cells form carcinogenesis. Immune competence, on the
memory cells and plasma cells, other hand, declines with age, a condition
 known colloquially as "immunosenescence," immune booster for seniors. Water helps your body
meaning that reduced immune surveillance absorb nutrients and minerals, and flush body waste.
against cancer could possibly contribute to 8. Minimize alcohol intake: Excessive alcohol
increasing disease in the elderly. consumption can weaken your immune system,
C. Infection & Immunosenescence making you more vulnerable to infections.
● Immunosenescence is associated with 9. Quit smoking: The chemicals in cigarettes are known
increased incidence of infectious diseases to damage lung tissue and increase the risk for cancer.
such as bronchitis and influenza.It has been But they can also cause respiratory illnesses such as
associated with a number of age-related the flu, bronchitis, and pneumonia.
autoimmune diseases and inflammatory 10. Avoid too much exposure from the sun: Avoid
reaction exposing your skin to too much sunlight. While vitamin
D. Patch Test Reactivity D from sunlight does help support healthy immune
● Many older patients complain of rhinitis, function, too much UV radiation can alter your DNA,
conjunctivitis, asthma, or itching, which they ultimately boosting your risk of cancer.
blame on allergies. Testing elderly individuals
for allergies can be difficult due to changes NURSING CARE FOR OLDER ADULTS WITH
in the skin, which can make it difficult to AGE-RELATED CHANGES IN THE IMMUNE SYSTEM
administer skin tests and assess the skin's
response. Nursing Diagnosis
● Avoidance tactics or particular allergen ● Risk for Infection r/t compromised immune system
immunization can be recommended after Nursing Care Planning
identifying specific allergens to which the ● General Objectives: After 1 week of nurse-client
elderly patient is sensitive, enhancing quality interaction, the patient will remain free from signs of
of life and reducing the need for drugs. any infection.
● Immunosenescence appears to have little ● Specific Objectives: After 8 hours of holistic nursing
effect on the immune response to care, the patient will be able to demonstrate
contactants. As a result, in this age group, techniques to prevent the spread of infection as
contact tests should be considered. evidenced by normal vital signs and absence of signs
and symptoms of infection.
GENERAL MEASURES TO MAINTAIN IMMUNE SYSTEM Nursing Interventions
HEALTH IN OLDER ADULTS Measures to prevent the spread of infection:
Nursing Interventions
1. Get vaccinated: The best way to prevent getting sick
with an infection or the flu is to get vaccinated. This is
Monitor baseline vital signs and signs of infection,including
needed because older adults have a weaker immune
the level of consciousness and orientation.
system.
2. Eat healthy and well-balanced meals: A healthy diet is
Assess the patient’s skin for tears, breaks, redness, or
essential to a strong immune system. Other than a
ulcers.
weaker immune system, poor nutrition or malnutrition
can affect overall health. Educate patient to maintain respiratory isolation: Always
3. Stay active: Regular physical activity can help older keep tissues at the bedside or with the patient; cover
adults stay strong, independent, and healthy. Not only mouth when coughing or sneezing.
does it boost their immune system, it also helps their
bones and joints stay flexible. Teach patient about the importance of handwashing.
4. Maintain a healthy weight: Carrying too much weight
has a negative impact on the immune system. It may Encourage nutritional intake rich in calories and protein,
lead to illnesses such as heart disorders or diabetes. vitamins and carbohydrates.
5. Reduce stress levels: Chronic stress can affect the
immune system by decreasing its effectiveness. Encourage adequate fluid intake of 2,000 to 3,000 mL of
Engaging in activities that are enjoyable and relaxing water per day, unless contraindicated.
reduces stress.
6. Get plenty of sleep: Sleep deprivation also reduces Encourage adequate rest to bolster the immune system.
the effectiveness of the immune system. Sleep
becomes more important with age because it also Administer anti-infective agents as ordered by the
helps improve brain function, concentration, and physician.
memory and sleep disorders are often linked to many
chronic diseases and conditions. Collect culture samples as ordered.
7. Stay hydrated: Dehydration in seniors often leads to
many health issues. Adequate hydration is a key
 ● Joints become more rigid and muscle strength
NERVOUS SYSTEM
declines
Gait
●OLDER MEN
Neurotransmitters
○ have wide-based, short stepped gait
● Acetylcholine
● OLDER WOMEN
● Serotonin
○ may develop a “waddling” narrow-based gait
● GABA Gamma aminobutyric acid
Thermoregulation
● Process that allows your body to maintain its core
NURSING CARE FOR OLDER ADULTS WITH internal temperature.
AGE-RELATED CHANGES IN THE NERVOUS SYSTEM ● A healthy internal body temperature falls within a
_____________________________________________________________ narrow window.
STRUCTURAL CHANGES IN THE AGING BRAIN ● Older adults are much more susceptible to
● Brain decreases in size and weight for both men and hypothermia and hyperthermia during temperature
women extremes.
● Brain weight declines after 55 years of age and can Sleep Changes
result in a 11% decrease ● The brain stores new information and gets rid of toxic
● Both men and women experience a volume loss waste. Nerve cells communicate and reorganize, which
● Men demonstrate a greater age-related volume loss supports healthy brain function.
in the brain as a whole as well as in the temporal and ● POOR SLEEP CAN BE A FACTOR IN DEVELOPING
frontal lobes compared to women OF CARDIOVASCULAR DISEASE
● The gyri shrinks and the sulci becomes wider
GENERAL MEASURES TO MAINTAIN
AGING PERIPHERAL NERVOUS SYSTEM ENDOCRINE/IMMUNE SYSTEM HEALTH IN OLDER
● Visual and Auditory ADULTS
● Sense of Taste _____________________________________________________________
● Sense of Touch
● Sense of Smell 1. Prioritize Physical Health
Without regular exercise, people over the age of 50
FUNCTIONAL ABILITIES
Cognition years can experience a range of health problems
● Older adults may experience temporary changes in including: Reduced muscle mass, strength and
cognitive function when hospitalized or admitted to physical endurance. Reduced coordination and
skilled nursing facilities, rehabilitation centres, or long balance. Reduced joint flexibility and mobility.
term care facilities 2. Manage High Blood Pressure
Reaction Time
High blood pressure is very common in older people.
● Neurons are lost which leads to decrease in the
As we age, our vascular system changes. Arteries get
number of synapses and neurotransmitters which
results in slowed nerve conduction and response time stiffer, so blood pressure goes up that is why the
Proprioception management is very important as this can help extend
● Loss of proprioception the life of an older adult.
● Changes in the biomechanics of joints and 3. Consume a Healthy Diet
neuromuscular control of the limbs A healthy diet is generally one that encompasses
Dizziness and Balance
staples like fruits and vegetables, whole grains, lean
Syncope
meats, fish and poultry, and low-fat or nonfat dairy
● Increased susceptibility to syncope with advancing
age attributed to age-related physiological products. It limits solid fats, sugar, and salt focuses on
impairments in heart rate and blood pressure, and portion control, and emphasizes hydration.
alterations in cerebral blood flow 4. Focus on Physical Activity
Orthostatic Hypotension Research has also shown a correlation between
● A form of low blood pressure caused by blood vessels physical activity and brain health.
failing to constrict when the body takes an upright
For seniors, walking is a popular option, as are
position.
● Increases with age. programs that instruct on how to move safely and
● 20/ 10 mm Hg after changing from a supine position prevent falls, which can further prevent brain injuries
to a standing position. that impact mental agility.
Motor Activity 5. Keep your mind active
● Especially posture, movement, and reflexes
In addition to enhancing a senior’s overall
● Reflexes are less brisk
well-being and quality of life, engaging in new
● Motor activity slows
 and old hobbies, particularly ones that are more
Give more time for the client This promotes the patient’s
cognitively demanding, can be beneficial for a
to focus on something. autonomy.
senior’s mental agility.
6. Stay Social and connected Provide access to familiar Familiarity reduces patient
Connecting with other people through social activities objects. confusion.
and community programs can keep your brain active
and help you feel less isolated. People who engage in
personally meaningful and productive activities with
others even tend to live longer, and studies show that ENDOCRINE SYSTEM
these activities may improve cognitive function.

NORMAL CHANGES WITH AGING

7. Manage stress
Over time, chronic stress can change the brain, affect
A. Pituitary and Thyroid Gland
memory and increase your risk for dementia.
○ The pituitary gland may gradually become
Therefore, it’s essential to manage stress and
smaller with age
strengthen your capacity to bounce back from ○ Alteration in responsiveness of target organs
stressful situations. or the hypothalamus itself
○ Decreased amplitude of hormones released
8. Mitigate cognitive health risks ○ Overall decrease in GH release and serum
concentrations
There’s a whole host of risk factors along with the ○ May appear lumpy (thyroid gland)
genetic, environmental, and lifestyle spectrum that ○ Less production of thyroid hormones
can affect cognitive health, any and all of which may
contribute to a decline in thinking skills and the ability B. Parathyroid and Adrenal Gland
to perform everyday tasks ○ Parathyroid hormones increase with age
○ Decreased levels of calcitonin
○ Decreased levels of estrogen in older adult
women
NURSING CARE FOR OLDER ADULTS WITH
○ Production of cortisol and aldosterone
AGE-RELATED CHANGES IN THE ENDOCRINE SYSTEM
decreases
_____________________________________________________________
○ Epinephrine and norepinephrine remain
normal
Nursing Diagnosis
● Disturb sensory perception related to neurologic
NORMAL CHANGES IN STRUCTURE AND FUNCTION
impairment
WITH AGING
Nursing Care Planning
● General Objectives: After 2 weeks of holistic nursing
A. Pancreas
care, the patient will show improvement in sensory
○ Changes in the size of the pancreas
perception.
○ Increased in fibrous material and some fatty
● Specific Objectives: After 8 hours of holistic nursing
deposition
care, the patient will sustain attention and
○ Localized arteriosclerotic changes
concentration to complete task or activities.
○ Decreased rate of pancreatic enzyme
Nursing Interventions
secretion
:
○ Decrease bicarbonate output
Nursing Interventions Nursing Rationale ○ Impairment of normal fat absorption
○ Decreased calcium absorption
Provide a daily routine and a Daily routines can help
consistent environment for reduce stress and increase B. Pineal Gland
the patient. feelings of security. ○ Increases with age
○ Deterioration in cardiac rhythm
Speak to the client in slow, This helps the client ○ Lack of melatonin with aging
calm manner with the comprehend speech easily.
appropriate volume. C. Breast
○ As people get older, their body naturally
Promote a calm, low Overstimulation may cause produces fewer reproductive hormones.
stimulation environment. stress. ○ Aging affects everyone differently
○ These changes in the breasts occur as a
 result of : ● The effect of physical activity in decreasing hot
i. low estrogen levels flushes
ii. changes in skin elasticity ● It is known that increase of hypothalamic β-endorphin
iii. Risk of developing growths production may stabilize thermoregulation
iv. Areolas may also change in ● Physical activity may help in controlling body weight,
appearance which is associated with more frequent vasomotor
○ Possible breast changes that may occur symptom reporting.
as a result of aging include:
i. stretch marks Menopause and Sexual Functioning
ii. breasts looking elongated and The loss of estrogen and testosterone following menopause
stretched can lead to changes in a woman's body and sexual drive.
iii. extra space between the breasts Also, lower levels of estrogen can cause a drop in blood supply
to the vagina. That can affect vaginal lubrication, causing the
FEMALE REPRODUCTIVE SYSTEM vagina to be too dry for comfortable sex.

Systemic Effects of Menopause:

Definition: Available Treatments of Vaginal Dryness
- during and after menopause, vaginal dryness can be
treated with water-soluble lubricants such as
- Is the permanent physiologic cessation of menses
Astroglide or K-Y Jelly
associated with declining ovarian function
- vaginal estrogen therapy
- Between 48 and 55 years of age

MALE REPRODUCTIVE SYSTEM

Systemic Effects:
- Increase in body fat and intra-abdominal deposition of Testosterone Therapy
body fat - Testosterone therapy is used primarily to treat symptoms of
- Level ofs of total and LDL cholesterol increase sexual dysfunction.
- Hot flashes
- The entire genitourinary system is affected
- Vaginal secretions decrease (dyspareunia)
- Vaginal pH increases

Systemic Effects: OSTEOPOROSIS

- 40 years old
- Slowly losing bone mass
- Declining production of estrogen in women
- Osteoclast: are the cells that degrade bone to initiate
normal bone remodeling and mediate bone loss in
pathologic conditions by increasing their resorptive
activity
- Estrogen: Estrogen is a sex hormone that is essential
to female bone health because it promotes the
activity of osteoblasts, which are cells that produce
bone. When estrogen levels drop during menopause,
the osteoblasts aren't able to effectively produce
bone.
- Bind with RANK-ligand, inhibiting the differentiation
and activation of osteoclast.

Quality of Life:
Menopause associated with deteriorating quality of life
● decreasing estrogen levels
● symptoms such as hot flushes, night sweats and
vaginal dryness.
● Physical activity enhance quality of life among
menopausal women
 sensitivity, especially in overweight and obese people
who are insulin resistant

2. Get Consistent, High-Quality Sleep

No matter how nutritious your diet is and how much
exercise you get, your health will suffer if you don’t
get enough restorative sleep. Poor sleep has been
linked to imbalances of many hormones, including
insulin, cortisol, leptin, ghrelin and growth hormone

3. Engage in Regular Exercise

Physical activity can strongly influence hormonal
health. A major benefit of exercise is its ability to
reduce insulin levels and increase insulin sensitivity.
For people who are unable to perform vigorous
exercise, even regular walking may increase these
hormone levels, potentially improving strength and
quality of life.

4. Avoid Sugar and Refined Carbs

Sugar and refined carbs have been linked to a number
of health problems. Indeed, avoiding or minimizing
these foods may be instrumental in optimizing
hormone function and avoiding obesity, diabetes and
other diseases.

5. Learn to Manage Stress

Stress can wreak havoc on your hormones. Two major
hormones affected by stress are cortisol and
adrenaline, which is also called epinephrine. However,
unlike hundreds of years ago when these hormones
were mainly triggered by threats from predators,
today they’re usually triggered by people’s busy, often
overwhelming lifestyles.

NURSING CARE FOR OLDER ADULTS WITH

AGE-RELATED CHANGES IN THE ENDOCRINE SYSTEM
_____________________________________________________________

Nursing Diagnosis
● Imbalanced Nutrition: Less Than Body Requirements
Erectile Dysfunction
related to decreased oral intake as evidenced by
Definition:
reported inadequate food intake, lack of interest in
- Is the inability to get and keep an erection firm
food.
enough for sex.
Cause:
Nursing Care Planning
- When blood flow in the penis is limited or nerves are
● General Objectives: After 2 weeks of holistic nursing
harmed.
care, the patient will display usual energy level and
Symptoms:
demonstrate stabilized weight or gain toward
- Trouble getting an erection
usual/desired range with normal laboratory values.
- Reduces sexual desire
● Specific Objectives: After 8 hours of holistic nursing
care, the patient will Ingest appropriate amounts of
GENERAL MEASURES TO MAINTAIN ENDOCRINE
calories/nutrients.
SYSTEM HEALTH IN OLDER ADULTS
Nursing Interventions
_____________________________________________________________
:

1. Avoid Overeating and Undertaking Nursing Interventions Nursing Rationale

Eating too much or too little may result in hormonal
shifts that lead to weight problems. Overeating is Determine older client’s This is to determine oral
shown to increase insulin levels and reduce insulin ability to chew, swallow, and health of client. Additionally,
 taste food and evaluate note denture fit as this may Refractive Loss of ● Reading
teeth and gums. be a factor that affects changes accommodative materials
ingestion and/or digestion
power in the lens must be
of nutrients.
held at
Explore lifestyle factors such This is to identify eating increasing
as specific eating habits, the practices that may need to distance in
meaning of food to client, be corrected and to provide order to
and individual food insight into dietary focus
preferences and interventions that may
● presbyopi
intolerances/aversions. appeal to client.
a
Investigate medications or Drug interactions, disease
maintenance the client is effects, allergies, and use of Cataract Opacities in the Interference
taking. laxatives or diuretics may normally crystalline with focus
affect appetite, food intake, lens of a sharp
or absorption.
image on
the retina
Collaborate with Formulating specific dietary
interdisciplinary team. needs and meal plan will
ensure that the client is
receiving recommended
nutrients and minerals
indicated for his/her age.

Posterior Liquefaction and May lead to

vitreous shrinkage of retinal
SPECIAL SENSES detachme vitreous tears and
nt
detachme
AGE-RELATED CHANGE IN THE SPECIAL SENSES: nt
STRUCTURAL AND FUNCTIONAL CHANGES
_____________________________________________________________

EYES
Eye Part Structural Functional
Change Change Age-relate ● Drusen appear ● Central vision is
d macular and coalesce in affected
Eyelids ● loss ● Lid margins degenerati the macula ● Distortion and
and elasticity turn in on (AMD)
● Formation of loss of central
lacrimal ● Loss of (entropion)
structures fibrotic disciform vision
orbital fat ● Lid margins
scars in the
● Decreased turn
macula
muscle (ectropion)
tone
● Wrinkles
develop

EARS/HEARING

Systemic Changes Functional Changes

OUTER EAR ● Presbycusis -

● cerumen tends to sensorineural
become harder and hearing loss
drier
 ● May develop problems walking because of reduced
ability to perceive where the body is in relation to the
MIDDLE EAR
floor
● Tympanic
membrane may ● Become more sensitive to light touches
atrophy or become
sclerotic
GENERAL MEASURES TO MAINTAIN SPECIAL SENSES’
INNER EAR HEALTH IN OLDER ADULTS
● Cells at the base of _____________________________________________________________
the cochlea
degenerate 1. Practicing a healthy lifestyle
a. Eating a balanced diet
b. Exercising
TASTE AND SMELL 2. Seek medical advice when any marked or sudden
changes in ability occur
Condition Definition SIGHT
1. Get enough sleep
Hypogeusia ● The number of 2. Exercise daily
taste buds 3. Consult with your eye doctor to keep the eyes moist
decreases enough
● Each remaining 4. Protect yourself against environmental irritants
taste bud begins to 5. Ask your doctor if you’re a candidate for refractive
shrink surgery
● Sensitivity to the 6. Eat healthy
five tastes often a. Omega-3 fatty acids
declines b. Lutein
● The mouth c. Zinc
produces less saliva d. Vitamins C and E
as we age which 7. Make sure your glasses or contacts prescription is up
causes the mouth to date
to dry 8. Ask your doctor if you’re a candidate for refractive
surgery
Hyposmia ● The sense of smell
can also diminish SOUND
● Decrease in the ● When around loud sounds, wear ear-protecting
number of olfactory headphones or foam earplugs
neurons and the ● Maintain a healthy weight and manage your blood
weakening of pressure and blood sugar levels
olfactory neural ● Manage stress levels
pathways to the
● Use hearing aids, if needed.
brain

SMELL
● Exercise regularly and avoid drinking excessive alcohol
AGE-RELATED CHANGE IN TOUCH, VIBRATION, AND
● Don’t use cleaning products and other chemicals with
PAIN SENSITIVITY
_____________________________________________________________ strong fumes
● Gently smell familiar aromas a few minutes everyday
● Sensations may be reduced or changed
○ Decreased blood flow to the nerve endings TOUCH
or to the spinal cord or brain ● Do whatever makes you happy
○ Lack of certain nutrients
○ Brain surgery, problems in the brain, TASTE
confusion, and nerve damage from injury or ● Manage conditions such as high blood pressure,
long-term (chronic) diseases inflammatory bowel disease and infections
○ Hard to tell the difference between cool and
● Switch to alcohol-based mouthwash and try a mouth
cold and hot and warm.
● Reduced ability to detect vibration, touch. moisturizer
● Reduced sensitivity to pain ● Add flavors to food
● May feel and recognize pain, but doesn’t bother
 NURSING CARE FOR OLDER ADULTS WITH yearly. Decreases in visual acuity
AGE-RELATED CHANGES IN THE SPECIAL SENSES can increase confusion in
the elderly patient.
Cataract
Provide sufficient lighting Elderly patients need twice
for the patient to carry out as much light as younger
activities people.

Provide lighting that avoids Elderly patient’s eyes are

glare on surfaces of walls, more sensitive to glare and
reading materials, and so cataracts diffuse and glare
forth. so that the patient has more
● Age related condition, that may occur as early as difficulty with vision.
40
● Secondary cataract may be caused by diabetes or
chronic use of steroids (NIH, 2015) Provide night light for the Patient’s eyes may require
● Signs and Symptoms patient’s room and ensure longer accommodation time
○ Dimmed/blurring vision lighting is adequate for the to changes in lighting levels.
○ Light sensitivity patient’s needs. Provision of adequate
○ Halo appears around lights lighting helps to prevent
○ Loss of color perception injury.
● Nursing diagnosis
○ Risk for injury
○ Anxiety resulting from uncertain surgical
outcome

Review terms:
● Presbyopia
● Presbycusis
● Glaucoma
● Different types of hearing loss

Need sufficient amount of light when reading

Nursing Diagnosis
● Disturbed sensory perception: Diminished visual
acuity related to changes in the eyes due to aging

Nursing Care Planning

● General Objectives: After 4 days of SN-client
interaction, the client will be able to obtain optimum
level of functioning
● Specific Objectives: After 8 hours of SN-client
interaction, the client will be able to: Maintain current
visual field and acuity without further loss

Nursing Interventions
Nursing Interventions Nursing Rationale

Assess the patient’s ability Provides a baseline for

to see and perform determination of changes
activities. affecting the patient’s visual
acuity.

Encourage patient to see an Can monitor progressive

ophthalmologist at least visual loss or complications.