CARE OF OLDER ADULT

(LabaRN`27)
➢​ Old Age Categories:
○​ Young-old: 65–74 years old
SESSION 1: Introduction to
Gerontological Concepts ○​ Middle-old: 75–84 years old
○​ Old-old / Frail elderly: 85
——————————————————
years old and above
INTRODUCTION TO GERONTOLOGICAL
➢​ Gerontological Nursing – A
NURSING
nursing specialty focused on older
➢​ Gerontological nursing involves
adults’ health, involving prevention,
understanding the aging process
education, advocacy, and
and providing quality care to older
rehabilitation.
adults.
——————————————————
➢​ Nurses play a key role in
ROLES OF A GERONTOLOGICAL
promoting active and healthy
NURSE
aging.
1. Provider of Care
➢​ Florence Nightingale is recognized
➢​ Direct hands-on care to older adults
as the first geriatric nurse for her
in settings like hospitals,
early care of elderly workers.
communities, and homes.
➢​ Today, the field is based on research
➢​ Must be knowledgeable about
and collaboration, with many
common geriatric illnesses (e.g.,
resources and organizations
dementia, osteoporosis).
dedicated to elderly care
2. Teacher
——————————————————
➢​ Educates older adults and families
KEY TERMS
about modifiable risk factors,
➢​ Gerontology – Study of aging,
including:
covering biological, psychological,
○​ Healthy eating
and social aspects.
○​ Quitting smoking
Subfields:
○​ Managing stress
○​ Geriatrics – Medical care of
○​ Maintaining appropriate
older adults
weight
○​ Social Gerontology –
3. Manager / Leader
Focuses on social aspects of
➢​ Coordinates care with patients,
aging
families, and the healthcare team.
○​ Geropsychology – Mental
➢​ Ensures a balanced,
health and aging
patient-centered approach.
○​ Financial Gerontology –
4. Advocate
Financial planning for the
➢​ Supports older adults in making
elderly
informed decisions.
○​ Gerontological
➢​ Protects their rights and promotes
Rehabilitation Nursing –
autonomy.
Combines rehab and elderly
5. Research Consumer
care
➢​ Uses evidence-based practices.
➢​ Geriatrician – A physician trained in
➢​ Reads current research and applies
the medical care of the elderly.
it to clinical care.
➢​ Geropharmacology – Study of how
medications affect older adults.
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6.​ Collaboration – Work with patients,
SESSION 2: STANDARDS AND
GERONTOLOGIC NURSING PRACTICE families, and other health
PERSPECTIVE OF AGING professionals.
7.​ Research – Apply and evaluate
research findings.
ANA Standards of Gerontologic 8.​ Resource Utilization – Use
Nursing Practice resources wisely (safe, effective,
cost-efficient).
These are guidelines by the American
Nurses Association (ANA) that every
professional nurse must follow, ensuring Gerontologic Nursing
care is safe, ethical, and competent.
Competencies
A. Nursing Process Standards
➢​ Promote a positive attitude about
1.​ Assessment – Collect health data aging.
from the older adult. ➢​ Assess communication barriers in
2.​ Diagnosis – Analyze the data to elders.
make nursing diagnoses. ➢​ Use valid tools to assess older
3.​ Outcome Identification – Identify adults.
expected, age-appropriate ➢​ Check the home/living
outcomes. environment for safety.
4.​ Planning – Develop a care plan with ➢​ Support elders in achieving
specific interventions. personal goals.
5.​ Implementation – Carry out the ➢​ Identify and manage mistreatment
planned interventions. and geriatric syndromes.
6.​ Evaluation – Check progress ➢​ Understand the complexity of
toward goals. chronic and acute illnesses.
➢​ Compare models of care: PACE,
B. Quality Care Standards NICHE, Transitional Care, etc.
➢​ Promote ethical, restraint-free, and
1.​ Quality of Care – Evaluate EBP-based care.
effectiveness and improve practice. ➢​ Guide safe transitions (hospital →
2.​ Performance Appraisal – Reflect home/nursing facility).
on and assess your own ➢​ Consider the needs of caregivers,
performance. not just patients.
3.​ Education – Maintain updated ➢​ Advocate for hospice and palliative
knowledge and skills. care when appropriate.
4.​ Collegiality – Help peers and ➢​ Prevent risks and enhance patient
contribute to professional growth. safety and quality of life.
5.​ Ethics – Make decisions based on ➢​ Use programs that support wellness
what’s best and ethical for the older and independence.
adult. ➢​ Apply relevant theories and liberal
arts concepts in patient-centered
care.
 CARE OF OLDER ADULT
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SESSION 3: THEORIES OF AGING

Perspective of Aging

●​ Aging is natural and

BIOLOGICAL THEORIES OF AGING
developmental.
●​ Happens from birth, with gradual
body system changes.
Two Main Types
●​ Changes don’t occur uniformly in all
➢​ Stochastic (Statistical) – aging
people.
caused by random, external events.
●​ These changes may affect function,
➢​ Non-Stochastic – aging as a
participation, and life quality.
genetically programmed process.

Demographics of Aging Stochastic Theories

➢​ Global Trend: In the future, more
1.​ Free Radical Theory
people will be aged 65+ than kids
○​ Free radicals from oxygen
under 5.
metabolism damage cells
➢​ Philippines Data:
over time.
○​ In 2000: 4.6M senior
○​ Antioxidants (e.g., Vitamin C)
citizens (6% of population).
help reduce damage.
○​ After 20 years: 9.4M seniors
2.​ Orgel/Error Theory
(8.6% of population).
○​ Aging occurs due to
➢​ Implication: Nurses must be ready to
accumulated errors in
handle aging populations with
DNA/RNA synthesis.
appropriate care models and
○​ Mutations caused by external
knowledge.
factors like radiation.
3.​ Wear and Tear Theory
○​ Repeated use leads to
Impact of Aging on Family
cellular damage.
○​ Over-exercise may speed up
➢​ Alters family dynamics: caregiving
aging (more free radicals).
roles increase.
4.​ Connective Tissue/Cross-Link
➢​ May cause emotional, financial,
Theory
and physical stress on family.
○​ Abnormal bonds (cross-links)
➢​ Requires nursing support and
form in connective tissues,
education for caregivers.
reducing flexibility and
function.
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5.​ Subculture Theory
Non-Stochastic Theories ○​ Elderly form their own group
and interact mostly among
1.​ Programmed Theory themselves.
○​ Cells are pre-programmed to 6.​ Person-Environment-Fit Theory
die or stop dividing ○​ Functional ability must align
(apoptosis). with the environment for
2.​ Gene/Biological Clock Theory successful aging.
○​ Aging is controlled by genes. 7.​ Gerotranscendence Theory
○​ Biological rhythms (e.g., ○​ Aging brings a shift to
circadian rhythm) are spiritual maturity and cosmic
regulated by melatonin. perspective.
3.​ Neuroendocrine Theory
○​ Hormonal changes (↓
estrogen, GH, melatonin) Psychological Theories
influence aging.
4.​ Immunologic/Autoimmune Theory 1.​ Maslow’s Human Needs​
○​ Immune system weakens
with age, increasing ○​ Aging adults still pursue:
susceptibility to disease. ■​ Physiologic needs →
Safety → Belonging
→ Self-esteem →
PSYCHOSOCIAL THEORIES OF Self-actualization.
AGING 2.​ Jung’s Individualism Theory​

Sociological Theories ○​ Focus on inward reflection

and self-discovery in old age.
1.​ Disengagement Theory 3.​ Erikson’s Stages of Development​
○​ Older adults gradually
withdraw from society. ○​ Final stage: Integrity vs.
2.​ Activity Theory Despair (review life
○​ Staying active = satisfaction satisfaction vs. regrets).
and better aging. 4.​ Life Course Paradigm​
3.​ Continuity Theory
○​ Personality and behavior ○​ Aging follows a patterned
remain consistent with earlier sequence of life stages.
life stages. 5.​ Selective Optimization with
4.​ Age Stratification Theory Compensation​
○​ Aging influenced by social
cohort or generation. ○​ Older adults adapt to losses
by focusing on strengths and
compensating for
weaknesses.
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●​ Excretion: ↓ Kidney function →
NURSING THEORIES & drugs stay longer in the body.
IMPLICATIONS
Pharmacodynamics (What the drug does
✔️ Theory of Successful Aging to the body)

●​ ↑ Sensitivity to drugs.
●​ Defined as staying physically,
●​ ↓ Receptors and synapses →
mentally, and socially active.
altered responses.
●​ Flood’s Theory: guides nurses to
●​ Slower receptor signaling.
promote holistic well-being.

Adverse Drug Reactions (ADR)

SESSION 4: MEDICATION AND
POLYPHARMACY ●​ Common due to multiple
conditions + medications.
●​ Increased risk due to aging body
10 Rights of Drug Administration changes.

1.​ Right Patient

2.​ Right Medication Polypharmacy
3.​ Right Dosage
4.​ Right Route Definition: Use of more medications than
5.​ Right Time medically necessary.
6.​ Right Documentation
7.​ Right Client Education Causes of Polypharmacy
8.​ Right to Refuse
➢​ Poor communication among
9.​ Right Assessment
healthcare providers.
10.​Right Evaluation
➢​ Patient hides OTC/herbal use.
➢​ Fear of stopping meds.
➢​ Habitual med continuation.
Aging and Medication: Key
➢​ Financial issues or lifestyle changes.
Concepts ➢​ Cognitive decline → forgets meds.
Pharmacokinetics (What the body does Prevention Strategies
to the drug)
➢​ Review all meds regularly.
●​ Absorption: Slower due to ↓ GI ➢​ Know the indication and side
motility. effects of each drug.
●​ Distribution: Altered due to ↑ body ➢​ Stop meds with no clear benefit.
fat, ↓ body water, ↓ plasma proteins. ➢​ Avoid "prescribing cascade" (adding
●​ Metabolism: ↓ Liver function slows meds to treat side effects of other
drug breakdown. meds).
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SESSION 5 MEDICATION AND

Inappropriate Prescribing POLYPHARMACY

●​ Unnecessary or risky prescriptions

Nursing Scope and Standards of
for older adults.
●​ Happens when meds are prescribed Practice
without full review.
➢​ Standards = authoritative
statements that define nurses’
responsibilities.
Compliance Issues in Elderly
➢​ Reflect the values and priorities of
●​ May not follow prescriptions due to: the nursing profession.
○​ Side effect fear
○​ Cost
○​ Forgetfulness
Section 28 – Scope of Nursing
Ways to Improve Compliance
➢​ Nurses practice:
➔​ Educate patients clearly. ○​ Independently or in
➔​ Build trust and rapport. collaboration with other
➔​ Monitor medication-taking behavior. professionals.
○​ Provide care across the
lifespan (conception to old
Nurse’s Role in Medication age).
Management ➢​ Roles include:
○​ Health promotion
●​ Only team member who directly ○​ Prevention of illness
observes patient response to meds.
○​ Restoration of health
●​ Key in identifying adverse effects or
non-compliance. ○​ Alleviation of suffering
○​ Support for a peaceful death
Assessment Tools

➢​ Brown Bag Eval: Bring all meds to

check. Duties of a Nurse
➢​ Gait/Frailty Check: Watch for
med-related confusion, falls. A. Use the Nursing Process
➢​ Medication Adherence Tests:
Screen for physical/cognitive
●​ Includes care planning,
barriers.
➢​ Take-Home MAR: Patient logs interventions, evaluations.
missed doses and effects. ●​ Involves health teaching, comfort
➢​ Literacy Screen: Can they measures, medication
understand health instructions? administration, and personal care.
➢​ Swallowing Status: Especially if
tablet modifications are needed.
➢​ Collateral History: Ask caregivers
about patient’s med behavior.
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B. Link with Community Resources 1.​ Autonomy – Respect the patient's
right to decide.
●​ Collaborate and coordinate with the 2.​ Beneficence – Do good; act in
health team. patient’s best interest.
3.​ Nonmaleficence – Do no harm.
C. Provide Health Education 4.​ Justice – Fairness in care.
5.​ Fidelity – Keep promises, stay
●​ Educate individuals, families, and
faithful to duty.
communities.
6.​ Veracity – Tell the truth.
D. Teach and Supervise Nursing 7.​ Confidentiality – Respect privacy
Students and protect info.

●​ Involve in clinical teaching, guiding

care, and professional
decision-making. Patient Rights

E. Conduct Training and Research A. Advance Directives & Living Wills

●​ Advance nursing practice through ●​ Documents stating patient's care

continuing education. wishes when unable to decide.
●​ Required CPD for competency and ●​ Includes DNR, type of care, and
license renewal. end-of-life choices.

B. Durable Power of Attorney

●​ Legal person chosen to make

Senior Citizens' Rights (RA 7432,
decisions if patient becomes
RA 9257, RA 9994) incapacitated.
●​ Privileges include:
1.​ 20% discount on basic
Patient’s Bill of Rights (Key
services (healthcare, food,
transport). Rights)
2.​ Exemption from income tax
1.​ Right to appropriate care and
(if income is below poverty
treatment
line).
2.​ Right to informed consent
3.​ Free medical services in
3.​ Right to privacy and confidentiality
government facilities.
4.​ Right to choose provider and facility
4.​ Inclusion in socio-economic
5.​ Right to self-determination
programs.
6.​ Right to refuse treatment
7.​ Right to religious beliefs
8.​ Right to leave hospital
9.​ Right to medical records
Ethical Principles in Gerontologic
10.​Right to be informed and to
Nursing communicate freely
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SESSION 6 LEVELS OF CARE IN

Ethics in Practice OLDER ADULT

Handling Mistakes

➢​ Acknowledge mistake honestly and

LONG-TERM CARE
neutrally.
Definition: Ongoing care for older adults
➢​ Take action to correct and prevent
who are temporarily or permanently
recurrence.
disabled.
➢​ Apologize and report properly.
●​ Goal: Help them stay as
independent as possible while
Conflict of Interest reducing burden on hospitals or
families.
➢​ Occurs when personal or financial
interest conflicts with professional
duty. ASSISTED LIVING
➢​ Examples:
○​ Choosing profit over patient Definition: Residential facility for seniors
care. who need minimal help with daily activities.
○​ Biased decisions due to
relationships or incentives. ●​ Services:
○​ Pressure from insurance or ○​ Meals, personal care,
hospital policies. planned activities
○​ Safe environment with peers
○​ Encourages independence
and socialization
●​ Risk Factors:
○​ Age & Gender – Aging
increases dependency.
○​ Marital Status – Widows
may need more support.
○​ Lifestyle & History –
Chronic illness and habits
affect care needs.

INTERMEDIATE CARE

Definition: Short-term support to help older

adults recover after illness or
hospitalization.

➢​ Goal: Avoid hospital readmission

and help regain independence.
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➢​ Settings: Community hospital, ○​ Liver failure, cancer,
nursing home, or at home. neurological decline
●​ Goal: Improve quality of life, reduce
Types of Intermediate Care: suffering, support patient and family
emotionally and spiritually.
1.​ Bed-based services – Short-term
stays in rehab centers.
2.​ Community-based services – END-OF-LIFE CARE
Health support while living at home.
3.​ Crisis response – Immediate care Definition: Final stage care for dying
during urgent situations. patients.
4.​ Reablement services – Help older
adults relearn daily tasks. ●​ Focus:
○​ Dignity and peace
○​ Pain relief and symptom
SKILLED CARE management
○​ Emotional and spiritual
Definition: Medical or rehabilitative care by support
professionals (nurses, therapists).

●​ Used for: Post-surgery recovery, PROVIDING PHYSICAL COMFORT (for

wound care, IV therapy, physical Palliative & End-of-Life Care):
therapy.
➢​ Pain – Proper pain management is
essential.
ALZHEIMER’S CARE ➢​ Breathing issues – Use oxygen,
elevate head, or meds.
Definition: Specialized care for seniors with ➢​ Skin issues – Prevent bedsores,
dementia, especially Alzheimer’s disease. maintain hygiene.
➢​ Digestive problems – Manage
●​ Focus: nausea, constipation.
○​ Manage memory loss, ➢​ Temperature sensitivity – Adjust
confusion, behavior environment to avoid discomfort.
○​ Ensure safety and routine ➢​ Fatigue – Balance activity and rest.
○​ Support for caregivers

PALLIATIVE CARE

Definition: Comfort care for chronic or

terminal illness.

●​ Conditions:
○​ Progressive dementia
○​ Heart/respiratory diseases
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Spirituality & Suffering
SESSION 7 SPIRITUAL CARE
AMONG OLDER ADULT ➢​ Suffering: Inner distress from
illness/loss.
➢​ Goal: Be present with the patient,
A. Foundations of Spirituality in Older not just “fix” them.
Adults ➢​ Presence heals spiritual pain.

Spirituality
Prayer
➢​ Root: "Wind/breath" (Hebrew, Latin,
Greek) — gives life. ➢​ Boosts health: ↓ pain, anxiety,
➢​ Gives transcendent meaning & complications.
purpose, based on personal ➢​ Effects are strong when done
beliefs/values. personally or with others.

Religion Spirituality & Mental Health

➢​ Root: Latin “to bind together” — ●​ Depression & Heart Failure:​
organized system of beliefs.
➢​ Involves practices, rules, and ○​ Depression lowers spiritual
community belonging. well-being.
○​ Positive spirituality improves
Spirituality, Religion, & Culture recovery & outlook.
●​ Dementia & Spirituality:​
➢​ Culture shapes how spirituality &
religion are practiced. ○​ Patients retain spiritual
➢​ All three are interconnected in care. needs despite cognitive
decline.
○​ Higher spiritual practices →
Gerotranscendence (Erik Erikson’s 9th
slower Alzheimer’s
stage)
progression.
●​ Spiritual growth increases with age.
●​ Older adults shift focus:
End-of-Life Care & Spirituality
1.​ Cosmic dimension –
Accepting death/life cycle. ➢​ Helps with acceptance, peace,
2.​ Self-transcendence – Ego dignity.
is no longer the center. ➢​ Resiliency factors:
3.​ Social selectivity – Prioritize ○​ Spiritual beliefs
meaningful connections. ○​ Legacy & connection
○​ Being remembered, letting
go
○​ Acceptance of mortality
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Improving End-of-Life Care

Settings of Spiritual Support
●​ Let patients:
○​ Be heard, share Chaplains / Pastoral Care
fears/dreams
○​ Pray, reflect, or receive ➢​ Help patients & staff address
blessings spiritual concerns.
○​ Be surrounded by loved ones ➢​ Available in hospitals, homes, care
centers.

B. Spiritual Assessment & Intervention Community Clergy

Models
➢​ Can support patients at home.
Spiritual Assessment Tools ➢​ May not have degrees but provide
faith-based support.
1. FICA Model
Refer to Chaplain When:
F – Faith: Beliefs that support the patient?
➢​ Grief or isolation
I – Importance: Impact on health decisions?
➢​ Major change or stress
C – Community: Belong to a faith group? ➢​ Ethical issues
➢​ Desire for rituals or sacred
A – Address in care: Role of beliefs in connection
treatment?

Spiritual Interventions (Overlap with

2. HOPE Model
Psychosocial Care)
H – Hope/meaning
A. Creative Arts
O – Organized religion
➢​ Art, music, journaling to express
P – Personal spirituality emotions and heal.

E – Effects on care decisions B. Music

3. Kinney’s 3 Spiritual Questions ➢​ Personalized music improves mood,

reduces pain, and gives comfort.
1.​ What helped you get through tough
times? C. Story
2.​ Who do you turn to?
3.​ What meaning do you give to this? ➢​ Life stories give meaning, help
people feel heard and remembered.
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D. Spiritual Reminiscence

➢​ Reflecting on past experiences helps

find peace, purpose, and resolve
unfinished emotions.

E. Compassionate Presence

➢​ Be fully present and listen deeply —

builds trust and comfort.

F. Humor

➢​ Promotes connection and stress

relief.
➢​ Spiritual coping tool in difficult times.

Self-Care for Nurses

ANA Code of Ethics: Self-Care as

Spiritual Practice

➢​ Know what renews your spirit

(rituals, prayer, breaks).
➢​ Care for your own body-mind-spirit
daily.
➢​ Create a peaceful inner space.

Daily Self-Check Questions:

1.​ How do I enter my patient’s room?

2.​ Did I pause or center myself
beforehand?
3.​ How did I eat, rest, reflect?
4.​ How do I leave my patient’s room?