GERIATRICS

By Mr. Macharia
RN BScN
 Objectives
• Definition of terms
• Describe aging process
• Systemic changes associated with aging
• Describe conditions associated with aging
 Definition of terms
1. Aging
• is a gradual process, characterized by continued
development and maturation.
2. Geriatrics:
• the study of old age that includes the physiology,
pathology, diagnosis, and management of the
disorders and diseases of older adults
3. Gerontology:
• the combined biologic, psychological, and
sociologic study of older adults within their
environment
4. Gerontologic/geriatric nursing:
• the field of nursing that specializes in the
nursing process as it relates to the
assessment, nursing diagnosis, planning,
implementation, and evaluation of older
adults in all environments including acute,
intermediate, and skilled care as well as within
the community
 Cont….
• Comorbidity: Having more than one illness at
the same time (e.g diabetes and congestive
failure)
 THEORIES OF AGING
1. Genetic Theory of Aging
• It holds that life span depends to a great extent on
genetic factors.
• Genes within the organism control “genetic clocks,”
which determine the occurrence and rate of metabolic
processes, including cell division.
• Wear-and-tear Theory
• organisms wear out from increased metabolic
functioning, and cells become exhausted from
continual energy depletion from adapting to stressors.
 2. Immunity Theory of Aging
• It focuses on the functions of the immune system.
• This system, composed primarily of the bone
marrow, thymus, spleen, and lymph nodes, seeks out
and destroys foreign agents (viruses, bacteria, and
cells undergoing neoplastic changes).
• The immune response declines steadily after younger
adulthood as the thymus loses size and function.
• The change in the immune system associated with
age, also known as immunosenescence, are thought
to be responsible for the increase in infections such
as pneumonia and septicemia, immune disorders,
and cancer as adults age.
 3. Cross-Linkage Theory
• Cross-linkage is a chemical reaction that
produces damage to the DNA and cell death.
• As one ages, cross-links accumulate, leading to
essential molecules in the cell binding
together and interfering with normal cell
function.
 4. Free Radical Theory
• Free radicals, formed during cellular
metabolism, are molecules with separated
high-energy electrons, which can have adverse
effects on adjacent molecules.
• Lipids, found in cell membranes, as well as
proteins and cell organelles, are affected.
• Over time, irreversible damage results from
the accumulated effects of this damage.
 Age- related change
• The wellbeing of older adults depends on
physical , psychological, mental, social,
economic, and environmental factors.
• A total assessment includes an evaluation of
all major body systems, social and mental
status.
 Normal age related changes
PHYSICAL ASPECTS OF AGING
1. Cardiovascular System
• Heart disease is the leading cause of death in the aged.
• The heart valves become thicker and stiffer
• Heart muscle and arteries lose their elasticity.
• Calcium and fat deposits accumulate within arterial
walls, and veins become increasingly tortuous.
• Although function is maintained under normal
circumstances, the cardiovascular system has less
reserve and responds less efficiently to stress.
• The maximum cardiac output decreases by
about 25% from age 20 to age 80.
• Under conditions of stress, both the maximum
cardiac output and the maximum HR diminish
gradually.
• All these changes contributes to hypertension
 Health promotion strategies
• Exercise regularly;
• pace activities;
• Avoid smoking;
• eat a low-fat, low-salt diet;
• participate in stress-reduction activities;
• check blood pressure regularly;
• Medication compliance;
• weight control
 2. Respiratory System
• Increased anteroposterior chest diameter
• osteoporotic collapse of vertebrae resulting in
kyphosis (increased convex curvature of the spine)
• calcification of the costal cartilages and reduced
mobility of the ribs
• diminished efficiency of the respiratory muscles as
a results of calcification and weakening of the
muscle of chest wall
• Increased lung rigidity, and decreased alveolar
surface area. Increased rigidity or loss of elastic
recoil in the lung results in increased residual lung
volume and decreased vital capacity.
 Cont…
• Gas exchange and diffusing capacity are also
diminished.
• Decreased cough efficiency, reduced ciliary
activity, and increased respiratory dead space
make the older person more vulnerable to
respiratory infections.
 Health promotion strategies
• Exercise regularly;
• avoid smoking;
• Take adequate fluids to liquefy secretions;
• receive yearly influenza immunization;
• avoid exposure to upper respiratory tract
infections
• pneumococcal vaccination
• Frequent hand hygiene
 3. Integumentary System
• The epidermis and dermis become thinner
due to decreased proliferation
• Elastic fibers are reduced in number, and
collagen becomes stiffer.
• Subcutaneous fat diminishes, particularly in
the extremities leads to temperature change.
• Decreased numbers of capillaries in the skin
result in diminished blood supply.
• These changes cause a loss of resiliency and
wrinkling and sagging of the skin and dryness.
 Cont…
• Hair pigmentation decreases, resulting in
gradual graying.
• The skin becomes drier and susceptible to
irritations because of decreased activity of the
sebaceous and sweat glands.
• These changes in the integument reduce
tolerance to extremes of temperature and to
exposure to the sun.
 Health promotion strategies
• Avoiding exposure to the sun
• use a lubricating skin cream
• maintaining adequate intake of water (8 to 10
eight-ounce glasses per day).
 4. Reproductive System
• Ovarian production of estrogen and
progesterone ceases with menopause.
• thinning of the vaginal wall, along with a
narrowing in size and a loss of elasticity
• decreased vaginal secretions, resulting in
vaginal dryness, itching, and decreased acidity
• Involution (atrophy) of the uterus and ovaries
• decreased pubococcygeal muscle tone,
resulting in a relaxed vagina and perineum.
• These changes contribute to vaginal bleeding
and painful intercourse.
• In older men, the penis and testes decrease in
size, and levels of androgens diminish. Erectile
dysfunction may develop with concomitant
cardiovascular disease, neurologic disorders,
diabetes, or even respiratory disease, which
limits exercise tolerance.
• Sexual desire and activity decline but do not
disappear.
 5. Genitourinary System
• The genitourinary system continues to function adequately in
older people, although there is a decrease in kidney mass,
primarily because of a loss of nephrons.
• Decreased filtration rate
• diminished tubular function with less efficiency in resorbing
and concentrating the urine
• a slower restoration of acid–base balance in response to
stress.
• In most cases change of renal function may be attributed to a
combination of aging and pathologic conditions such as HTN
 Cont...
• Older women often suffer from stress or urge
incontinence, or both.
• Benign prostatic hyperplasia (enlarged prostate
gland), causes a gradual increase in urine
retention and overflow incontinence.
• Prostate cancer, a slow-growing cancer, is most
often seen in men older than 70 years of age.
• Kidney and bladder cancers are most frequently
seen after the age of 50 years.
• Adequate consumption of fluids to reduce the risk
of bladder infections and urinary incontinence.
• voiding every 2 to 3 hours while awake.
• Avoidance of bladder irritating substances—such
as caffeinated, carbonated, and acidic beverages
• Avoid alcohol to reduce urinary urgency and
frequency.
• Water intake should be increased to avoid
concentrated urine, which causes urinary urgency.
• Pelvic floor exercises (Kegel) to reduce the
symptoms of stress and urge incontinence.
 6. Gastrointestinal System
• The older adult is at increased risk for impaired
nutrition due to difficulty purchasing.
• Periodontal disease leading to tooth decay and loss of
teeth is common.
• Salivary flow diminishes, causing a dry mouth.
• A preference for sweet and salty foods results from a
decrease of taste receptors.
• feelings of fullness, heartburn, and indigestion. Gastric
motility may decrease, resulting in delayed emptying
of stomach contents.
• Diminished secretion of acid and pepsin reduces
the absorption of iron, calcium, and vitamin B12.
• Absorption of nutrients in the small intestine also
appears to diminish with age.
• The function of the liver, gallbladder, and
pancreas is generally maintained, although
absorption and tolerance to fat may decrease.
• The incidence of gallstones and common bile
duct stones increases progressively with
advancing years.
• Constipation
 Health promotion practices
• regular dental care;
• eating small, frequent meals;
• avoiding heavy activity after eating;
• eating a high-fiber, low-fat diet;
• ingesting an adequate amount of fluids;
• establishing regular bowel habits;
• avoiding the use of laxatives and antacids.
• Understanding that there is a direct correlation
between loss of smell and taste perception and food
intake.
 7. Nutritional Health
• Decreased physical activity and a slower metabolic
rate reduce the number of calories needed by the
older adult to maintain an ideal weight.
• Apathy, immobility, depression, loneliness,
poverty, inadequate knowledge, lack of oral
health, and lack of taste discrimination also
contribute to suboptimal nutrient intake.
• Budgetary constraints and physical limitations may
impair food shopping and meal preparation.
• Education regarding healthy versus “empty-
calorie” foods is helpful.
 Health promotion practices
• Encouraging a diet that is low in sodium and saturated
fats and high in vegetables, fruits, and fish.
• No more than 20% to 25% of dietary calories should
be consumed as fat.
• Simple sugars should be avoided and complex
carbohydrates encouraged.
• Potatoes, whole grains, brown rice, and fruit provide
the person with minerals, vitamins, and fiber and
should be encouraged.
• Drinking 8 to 10 eight-ounce glasses of water per day
 8. Musculoskeletal System
• A gradual, progressive decrease in bone mass
begins before the age of 40 years.
• Excessive loss of bone density results in
osteoporosis
• A loss of height occurs in later life as a result
of osteoporotic changes of the spine, kyphosis
(excessive convex curvature of the spine), and
flexion of the hips and knees. These changes
negatively affect mobility, balance, and
internal organ function
• The muscles diminish in size and lose strength,
flexibility, and endurance with decreased
activity and advanced age.
• Back pain is common.
• Beginning in middle age, the cartilage of joints
progressively deteriorates.
• Degenerative joint disease is found in
everyone past the age of 70 years.
• Calcium supplements, vitamin D, fluoride,
estrogens, and
• weight-bearing exercises
• Reduction of caffeine and alcohol
 9. Nervous System
• reduction in cerebral blood flow
• The loss of nerve cells contributes to a progressive loss
of brain mass, and the synthesis and metabolism of the
major neurotransmitters are also reduced.
• Because nerve impulses are conducted more slowly,
older people take longer to respond and react.
• The autonomic nervous system performs less
efficiently, and postural hypotension, which causes the
person to lose consciousness or feel lightheaded on
standing up quickly, may occur.
• Cerebral ischemia with related lightheadedness may
interfere with mobility and safety.
• Mental function is threatened by physical or
emotional stresses.
• A sudden onset of confusion may be the first
symptom of an infection or change in physical
condition (pneumonia, urinary tract infection,
medication interactions, dehydration, and
others).
• A slowed reaction time places the older
person at risk for falls and injuries, including
driving errors.
 10. Sensory system
SENSORY LOSSES VERSUS SENSORY DEPRIVATION
• Sensory losses can often be helped by assistive
devices such as glasses and hearing aids.
• Sensory deprivation is the absence of stimuli in
the environment or the inability to interpret
existing stimuli (perhaps as a result of a sensory
loss).
• This deprivation can lead to boredom, confusion,
irritability, disorientation, and anxiety.
• One sense can substitute for another in observing
and interpreting stimuli.
• The nurse can enhance sensory stimulation in
the environment with colors, pictures,
textures, tastes, smells, and sounds.
• The stimuli are most meaningful if they are
interpreted to the older person and if they are
changed often.
• Cognitively impaired persons respond well to
touch and to familiar music.
 VISION
• As new cells form on the outside surface of
the lens of the eye,
• the older central cells accumulate and become
yellow, rigid, dense, and cloudy, leaving only
the outer portion of the lens elastic enough to
change shape (accommodate) and focus at
near and far distances.
• As the lens becomes less flexible, the near
point of focus gets farther away (presbyopia).
• The ability to discern blue from green decreases.
• The pupil dilates slowly and less completely
because of increased stiffness of the muscles of
the iris, so the older person takes longer to adjust
when going to and from light and dark
environments or settings and needs brighter light
for close vision.
• Although pathologic visual conditions are not part
of normal aging, the incidence of eye disease
(most commonly cataracts, glaucoma, diabetic
retinopathy, and age-related macular
degeneration) increases in older people.
 HEARING
• Presbycusis, a loss of the ability to hear high-
frequency tones attributed to irreversible inner ear
changes, occurs in midlife.
• Older people are often unable to follow
conversation because tones of high-frequency
consonants (letters f, s, th, ch, sh, b, t, p) all sound
alike.
• Hearing loss may cause the older person to respond
inappropriately, misunderstand conversation, and
avoid social interaction.
• Wax buildup or other correctable problems may
also be responsible for major hearing difficulties.
 TASTE AND SMELL
• Of the four basic tastes (sweet, sour, salty, and
bitter), sweet tastes are particularly dulled in
older people.
• Blunted taste may contribute to the
preference for salty, highly seasoned foods,
but
• herbs, onions, garlic, and lemon should be
encouraged as substitutes for salt to flavor
food.
 PSYCHOSOCIAL ASPECTS OF AGING
• Successful psychological aging is reflected in
the older person’s ability to adapt to physical,
social, and emotional losses and to achieve
contentment, serenity, and life satisfactions.
• A positive self-image enhances risk taking and
participation in new, untested roles.
• Fear of aging and the inability of many to
confront their own aging process may trigger
ageist beliefs.
• Retirement and perceived non-productivity
are responsible for negative feelings.
• Nurses are expected to facilitate successful
aging g by recommending health promotion
strategies such as anticipatory planning for
retirement, including ensuring adequate
income , developing routine rest associated
with work, and relying on other people and
groups to feel leisure time
 Stress and Coping in the Older Adult
• Coping patterns and the ability to adapt to
stress are developed over the course of a
lifetime and remain consistent later in life.
• Experiencing success in younger adulthood
helps a person develop a positive self-image
that remains solid through even the
adversities of old age.
• Common stressors of old age include normal
aging changes that impair physical function,
activities, and appearance; disabilities from
chronic illness; social and environmental losses
related to loss of income and decreased ability
to perform previous roles and activities; and the
deaths of significant others.
• Many older adults rely strongly on their spiritual
beliefs for comfort during stressful times.
 COGNITIVE ASPECTS OF AGING
Intelligence
• Certain types of intelligence (eg, spatial perceptions
and retention of nonintellectual information)
decline, whereas other types do not (problem-
solving ability based on past experiences, verbal
comprehension, mathematical ability).
• Cardiovascular health, a stimulating environment,
high levels of education, occupational status, and
income all appear to have a positive effect on
intelligence scores in later life.
 Learning and Memory
• The ability to learn and acquire new skills and information
decreases in the older adult, particularly after the seventh
decade of life.
• Despite this, many older people continue to learn and
participate in varied educational experiences.
• Motivation, speed of performance, and physical status all are
important influences on learning.
• The components of memory, an integral part of learning,
include short-term memory (5 to 30 seconds), recent memory
(1 hour to several days), and long-term memory (lifetime).
• Acquisition of information, registration (recording),
retention (storing), and recall (retrieval) are
essential components of the memory process.
• Sensory losses, distractions, and disinterest
interfere with acquiring and recording information.
• Age-related loss occurs more frequently with
short-term and recent memory; in the absence of
a pathologic process, this is called benign
senescent forgetfulness.
 ENVIRONMENTAL ASPECTS OF AGING
• About 95% of the elderly live in the
community, and 75% own their homes.
• Ideally, older persons do best in their own,
familiar environment.
• Planning for care and understanding the
psychosocial issues confronting the older
person must be accomplished within the
context of the family.
• Social attitudes and cultural values often
dictate that adult children should provide
services and financial support and assume the
burden of care if their aged parents are unable
to care for themselves.
• Illness creates special problems for people
who live alone.
• If community agencies or adult children are
unable to provide care, elders are at high risk
for institutionalization.
PHARMACOLOGIC ASPECTS OF AGING
• Older people use more medications than does any
other age group
• Medications improve the health and well-being of
older people by alleviating symptoms of
discomfort, treating chronic illnesses, and curing
infectious processes.
• Problems commonly occur, however, because of
medication interactions, multiple medication
effects, multiple medication use (polypharmacy),
and noncompliance.
 Impaired Mobility
• Common causes are Parkinson’s disease, diabetic
neuropathy, cardiovascular compromise, osteoarthritis,
osteoporosis, and sensory deficits.
• Environmental barriers and iatrogenic factors are also
significant.
• Elderly patients should be encouraged to stay as active as
possible.
• During illness, bed rest should be kept to a minimum.
• When bed rest cannot be avoided, the patient should
perform active range-of-motion and strengthening
exercises with the unaffected extremities, and the nurse
should perform passive range-of-motion exercises on the
affected extremities.
 Dizziness
• Older people frequently seek help for dizziness.
• It is further complicated because of an inability
to differentiate between the true dizziness (a
sensation of disorientation in relation to
position) and vertigo (a spinning sensation).
• The causes for these sensations range in
severity from minor, as in a buildup of ear wax,
to severe, as in dysfunction of the cerebral
cortex, cerebellum, brain stem, proprioceptive
receptors, or the vestibular system.
 Falls and Falling
• Falling is a common and preventable source of mortality and morbidity in
older adults.
• As the major cause of trauma in the elderly, falls are not often fatal but
do threaten health and the quality of life.
• Normal and pathologic consequences of aging that contribute to
increased falls are:
 visual changes such as loss of depth perception, susceptibility to glare,
loss of visual acuity, and difficulty in light accommodation.
 Neurologic changes include loss of balance, dizziness, loss of position
sense, and delayed reaction time.
 Cardiovascular changes may result in cerebral hypoxia and postural
hypotension.
 Cognitive changes include confusion, loss of judgment, and impulsive
behavior.
 Musculoskeletal changes include altered posture and decreased muscle
strength.
 Urinary Incontinence
• Urinary incontinence can be acute, developing
during an illness, or it can develop chronically
over a period of years.
• The older patient often does not report this
very common problem unless specifically
asked.
• Transient causes may be attributed to delirium
and dehydration; restricted mobility and
restraints; inflammation, infection, and
impaction; and pharmaceuticals and polyuria
(use the acronym DRIP to remember them).
• Detrusor hyperactivity with impaired
contractility.
• The patient has absolutely no warning that he
or she is about to lose urine. When toileted,
the patient often voids only a small volume of
urine or none at all, then experiences a large
volume of incontinence after leaving the
bathroom.
 Depression
• is the most common affective or mood disorder of old age and is
often responsive to treatment.
• Depression disrupts quality of life, increases the risk of suicide,
and becomes self-perpetuating.
• It may also be an early sign of a chronic illness or the result of
physical illness.
• Signs of depression include feelings of sadness, fatigue,
diminished memory and concentration, feelings of guilt or
worthlessness, sleep disturbances, appetite disturbances with
excessive weight loss or gain, restlessness, impaired attention
span, and suicidal ideation.
• Although depression among the elderly is widespread, it is often
undiagnosed and untreated.
• Geriatric depression and symptoms of dementia often overlap,