Learning Module in NCM 114 Final

LET’S BEGIN!
UNIT 16 ( WEEK 16 ) VERBAL AND NON VERBAL COMMUNICATIONS IN

ELDERLY
Intended Learning Outcomes ( Wee 16 -ILO )
At the end of the unit, you are expected to:

1. Differentiate verbal and nonverbal communication
2. Discuss the different tips to use in verbal and non-verbal communication
Introduction
Effective communication with older people is an important aspect of

nursing practice. Ineffective communication can lead to older people
feeling inadequate, disempowered and helpless. Nurses have a duty to
ensure that older people think they are being listened to and that their
concerns are being validated in a non-judgemental way. Central to effective
communication is the ability of nurses to be self-aware, and monitor their
thoughts and feelings about, for example, negative stereotypes associated
with the ageing process. Effective communication can sometimes be
difficult to achieve due to the effects of ageing, but nurses can overcome
some barriers through thoughtful interventions. It is important to treat
older people as individuals, and to monitor and adapt communication
accordingly. By doing so, nurses can ensure older people feel empowered,
respected and able to maintain their independence.
This unit will focus on the definitions of interest and any other terms
related. It also deals with the basic concept of simple interest and discount.
Please proceed immediately to the “Unlocking of Difficulties” part since
the first lesson is also definition of essential terms.
Unlocking of Difficulties
To attend the following intended learning outcomes for the first

lesson of the course, you need to fully understand the following essential
knowledge that will be laid down in the succeeding pages. Please note that
you are not limited to exclusively refer to these resources. Thus, you are
expected to utilize other books, research articles and other resources that
are available in the library e.g. ebrary, search.proquest.com etc.
Key Terms
Communication is the act of conveying meanings from one entity or group
to another through the use of mutually understood signs, symbols, and
semiotic rules.
Malpractice- improper, illegal, or negligent professional activity or
treatment, especially by a medical practitioner, lawyer, or public official.
Rapport is a close and harmonious relationship in which the people or
groups concerned are with each other, understand each other’s feelings or
ideas, and communicates smoothly.
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Lecture Notes
UNIT 16- VERBAL AND NON VERBAL COMMUNICATIONS IN ELDERLY
https://www.google.com/search?q=verbal+communication+with+elderly+patients&sxsrf= Retrieved on November 11, 2020
 Verbal communication refers to the production of spoken language

to send an intentional message to a listener.
 With typical aging, communication skills change subtly at least in part
because of changes in physical health, depression, and cognitive
decline.
 Aging is responsible for physiologic changes in hearing, voice, and
speech processes.
 Good communication is an important part of the healing process
 Patients are more likely to adhere to treatment and have better
outcomes, they express greater satisfaction with their treatment,
and they are less likely to file malpractice suits.
 Studies show that good communication is a teachable skill.
 Medical students who receive communication training improve
dramatically in talking with, assessing, and building relationships
with patients. Time management skills also improve.
 Interpersonal communication skills are considered so important that
they are a core competency identified by the Accreditation Council
on Graduate Medical Education and the American Board of Medical
Specialties.
 Learning—and using—effective communication techniques may help
you build more satisfying relationships with older patients and
become even more skilled at managing their care.
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EFFECTIVE COMMUNICATION HAS PRACTICAL BENEFITS IT CAN:
 Help prevent medical errors
 Lead to improved health outcomes
 Strengthen the patient-provider relationship
 Make the most of limited interaction time
TIPS FOR IMPROVING COMMUNICATION WITH OLDER PATIENTS
1. USE PROPER FORM OF ADDRESS
https://www.google.com/search?q=verbal+communication+with+elderly Retrieved on November 11, 2020
 Establish respect right away by using formal language. As one patient

said, "Don't call me Edna, and I won't call you Sonny." Use Mr., Mrs.,
Ms., and so on. Or, you might ask your patient about preferred forms
of address and how she or he would like to address you. Avoid using
familiar terms, like "dear" and "hon," which tend to sound
patronizing.
 Be sure to talk to your staff about the importance of being respectful
to all your patients, especially those who are older and might be
used to more formal terms of address.
2. MAKE OLDER PATIENTS COMFORTABLE
https://www.google.com/search?q=verbal+communication+with+elderly+patients&hl= Retrieved on November 11, 2020
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 Introduce yourself clearly and do not speak too quickly. Show
from the start that you accept the patient and want to hear his
or her concerns. If you are in a hospital setting, remember to
explain your role or refresh the patient’s memory of it.
 In the exam room, greet everyone and apologize for any
delays. With new patients, try a few comments to promote
rapport: "Are you from this area?" or "Do you have family
nearby?" With returning patients, friendly questions about
their families or activities can relieve stress.
3. TRY NOT TO RUSH
https://www.google.com/search?q=verbal+communication+with+elderly+patients&hl Retrieved on November 11, 2020
 Older people may have trouble following rapid-fire questioning or

torrents of information. By speaking more slowly, you will give them
time to process what is being asked or said.
 If you tend to speak quickly, especially if your accent is different from
what your patients are used to hearing, try to slow down. This gives
them time to take in and better understand what you are saying.
 Avoid hurrying older patients. Time spent discussing concerns will
allow you to gather important information and may lead to improved
cooperation and treatment adherence.
 Feeling rushed leads people to believe they are not being heard or
understood. Be aware of the patient's own tendency to minimize
complaints or to worry that he or she is taking too much of your
time.
 If time is an issue, you might suggest that your patients prepare a list
of their health concerns in advance of their appointments.
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4.AVOID INTERRUPTING
https://www.google.com/search?q=verbal+communication+with+elderly+patients&sxsrf= Retrieved on November 12, 2020
 One study found that doctors, on average, interrupt patients within

the first 18 seconds of the initial interview. Once interrupted, a
patient is less likely to reveal all of his or her concerns. This means
finding out what you need to know may require another visit or
some follow-up phone calls.
5.USE ACTIVE LISTENING SKILLS
 Face the patient, maintain eye contact, and when he or she is talking,
use frequent, brief responses, such as "okay," "I see," and "uh-
huh." Active listening keeps the discussion focused and lets patients
know you understand their concerns.
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6.DEMONSTRATE EMPATHY
 Watch for opportunities to respond to patients' emotions, using

phrases such as "That sounds difficult," or "I'm sorry you're facing
this problem; I think we can work on it together."
 Studies show that clinical empathy can be learned and practiced and
that it adds less than a minute to the patient interview. It also has
rewards in terms of patient satisfaction, understanding, and
adherence to treatment.
7.AVOID MEDICAL JARGON
 Try not to assume that patients know medical terminology or a lot

about their disease. Introduce necessary information by first asking
patients what they know about their condition and building on that
 Although some terms seem commonplace—MRIs, CT scans, stress
tests, and so on—some older patients may be unfamiliar with what
each test really is.
 Check often to be sure that your patient understands what you are
saying. You might ask the patient to repeat back the diagnosis or care
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plan in his or her own words—this can help with recall, as well.
 You may want to spell or write down diagnoses or important terms
to remember.
8.BE CAREFUL ABOUT LANGUAGE
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ttps://www.google.com/search?q=verbal+communication+with+elderly+patients&hl=en&sx Retrieved on November 12, 2020
 Some words may have different meanings to older patients than to

you or your peers.
 Words may also have different connotations based on cultural or
ethnic background. For example, the word "dementia" may connote
insanity, and the word "cancer" may be considered a death sentence.
 Although you cannot anticipate every generational and
cultural/ethnic difference in language use, being aware of the
possibility may help you to communicate more clearly.
 Use simple, common language, and ask if clarification is needed.
 Offer to repeat or reword the information: "I know this is complex.
I'll do my best to explain, but let me know if you have any questions
or just want me to go over it again."
9.WRITE DOWN TAKE-AWAY POINTS
 It can often be difficult for patients to remember everything

discussed during an appointment about their condition and care.
 Older adults can especially benefit from having written notes to refer
back to that summarize major points from the visit.
 Try to make these notes simple and clear, avoiding ambiguous and
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complicated language.
 For example, you might write, "Drink at least one 6-oz glass of water
every 2 hours" instead of "Increase fluids."
htt
ps://www.google.com/search?q=verbal+communication+with+elderly+Retrieved on November 12, 2020
10.ENSURE AN UNDERSTANDING OF THE HEALTH INFORMATION

Conclude the visit by making sure the patient understands:
 What is the main health issue
 What he or she needs to do
 Why it is important to act
 One way to do this is the "teach-back method"—ask patients to say
what they understand from the visit.
 Also, ask about any potential issues that might keep the patient from
carrying out the treatment plan.
https://www.google.com/search?q=verbal+communication+with+elderly+patients&Retrieved on November 12, 2020
11.COMPENSATING FOR VISUAL DEFICITS

 Visual disorders become more common as people age. Here are
some things you can do to help manage the difficulties caused by
visual deficits:
 Make sure there is adequate lighting, including sufficient light on
your face. Try to minimize glare.
 Check that your patient has brought and is wearing eyeglasses, if
needed.
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 Make sure that handwritten instructions are clear.
 If your patient has trouble reading, consider alternatives such as
recording instructions, providing large pictures or diagrams, or using
aids such as specially configured pillboxes.
 When using printed materials, make sure the type is large enough
and the typeface is easy to read. The following print size (14 pt)
works well: This size is readable.
https://www.google.com/search?q=verbal+communication+with+elderly+patients&h Retrieved on November 12, 2020
NON VERBAL COMMUNICATION
https://www.google.com/search?q=non+verbal+communication+with+elderly+patient Retrieved on November 12, 2020
 One useful way to categorize nonverbal communication is to

distinguish between nonverbal and paraverbal behavior.
 Nonverbal behavior consists of communicative actions distinct from
speech such as facial expressions, gesturing, body posture and
positioning
THE IMPORTANCE OF NONVERBAL COMMUNICATION
 Your nonverbal communication cues—the way you listen, look,
move, and react—tell the person you’re communicating with
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whether or not you care, if you’re being truthful, and how well
you’re listening.
 When your nonverbal signals match up with the words you’re saying,
they increase trust, clarity, and rapport. When they don’t, they can
generate tension, mistrust, and confusion.
 If you want to become a better communicator, it’s important to
become more sensitive not only to the body language and nonverbal
cues of others, but also to your own.
How to Use Non-Verbal Communication in Seniors with Alzheimer’s
 If you’re a caregiver for someone with Alzheimer’s1, you know how
challenging this condition can be.
 Problems with memory loss, personality changes, and a host of
behavioral symptoms can make every day a battle.
 Often, these issues are compounded by the fact that former
communication methods may no longer work with the patient,
especially in the later stages of the disease. This is why it’s crucial to
learn about non-verbal communication when looking after seniors
with Alzheimer’s.
TIPS FOR WORDLESS COMMUNICATION

Here a few silent ways you can make yourself understood to your loved
one:
Make eye contact. This shows the person you are engaged and paying
attention.
Re-introduce yourself with a handshake. If the Alzheimer’s has progressed
to the point where your loved one no longer recognizes you, you may have
to “introduce” yourself every time you meet.
Give them space. We don’t often think of “space” as a way of
communicating. However, giving a person too little space can be an
aggressive act, even if it’s unintentional.
Level with them. If your loved one is constantly seated, or in a wheelchair,
you may appear intimidating if you stand over them. Try to sit next to
them, or crouch down when you have something important to say.
Don’t be cross. Avoid crossing your arms if you can. It often indicates anger
and defensiveness (and can be interpreted this way, even if you’re not
feeling those emotions).
No sudden movements. No, your loved one isn’t an animal in the wild. But
in a way, the same rules apply. Sudden or rushed gestures can be seen as
frightening or threatening to many individuals.
Make a gesture. Visual cues are often much more effective in
communicating with Alzheimer’s patients than words. Pointing or handing
a person an object allows them to easily see what you mean.
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Use good touches. Although suddenly touching an Alzheimer’s patient can
startle them, a gradual approach can convey warmth and support. For
instance, placing your hand on their upper arm, or gently taking their hand,
can make them feel more relaxed and at ease.
Smile. This may seem like an obvious suggestion, but it’s not easy to
remember in between all your caretaking responsibilities! Still, a genuine
smile is one of the simplest ways to express love and a sense of well-being.
Laugh. Similar to a smile, laughing increases “feel good” endorphins, and
lets your loved one experience a brief burst of joy. Watching funny videos
(that rely on slapstick or non-verbal humor) are a great way to loosen you
both up and have a happy afternoon – no talking required!
There are several ways nonverbal communication can support your ability
to communicate effectively in the workplace, including:
Supports your message. When having a conversation, participating in a

meeting or engaging in conversation, nonverbal cues can emphasize and
underscore the content of your message. For example, using hand gestures
to indicate the importance of an idea may tell your listeners to pay
attention to and remember a key point.
Communicates messages. You may also use nonverbal communication

completely to communicate with others. For example, if someone is
explaining a sentiment you admire and agree with, you might nod your
head up and down to express solidarity.
Communicates intention. Your body language may also intentionally or

unintentionally express your current condition. For example, people may
pick up nonverbal cues that you are being dishonest, unengaged, excited or
aggressive.
Conveys feelings. You can also use nonverbal communication to show your
feelings, such as disappointment, relief, happiness, contentment and more.
Offers support. Nonverbal cues are also a great way to show support.
Whether it's a simple smile or pat on the back, action may speak louder
than words in many cases.
Showcases your personality. Nonverbal communication is a great way to

show who you are. For example, a kind and optimistic person might
frequently smile with open body language and offer friendly touches.
Indicates a desired action. This might include inching toward a door to

indicate your desire to leave the room, raising your hand to offer an idea or
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putting your hand out to meet someone new.
Deescalates tension. Using a calm tone of voice, open body language, and
directive gestures may help to resolve a difficult situation.
Types of nonverbal communication
There are several types of nonverbal communications you should be aware
of, including:
1. Body language
Body language is the way someone situates their body naturally depending
on the situation, the environment and how they are feeling.
Example: Someone might cross their arms if they are feeling angry or
nervous.
2. Movement
The way you move your arms and legs such as walking quickly or slowly,
standing, sitting or fidgeting, can all convey different messages to
onlookers.
Example: Sitting still and paying attention in a meeting conveys respect and
attention.
3. Posture
The way you sit or stand can also communicate your comfort level,
professionalism and general disposition towards a person or conversation.
Example: Someone might slouch their shoulders if they feel tired,
frustrated or disappointed.
4. Gestures
While gestures vary widely across communities, they are generally used
both intentionally and unintentionally to convey information to others.
Example: Someone in the United States might display a “thumbs up” to
communicate confirmation or that they feel positively about something.
5. Space
Creating or closing distance between yourself and the people around you
can also convey messages about your comfort level, the importance of the
conversation, your desire to support or connect with others and more.
Example: You might stand two to three feet away from a new contact to
respect their boundaries.
6. Paralanguage:
Paralanguage includes the non-language elements of speech, such as your
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talking speed, pitch, intonation, volume and more.
Example: You might speak quickly if you are excited about something.
7. Facial expressions
One of the most common forms of nonverbal communication is facial
expressions. Using the eyebrows, mouth, eyes and facial muscles to convey
can be very effective when communicating both emotion and information.
Example: Someone might raise their eyebrows and open their eyes widely
if they feel surprised.
8. Eye contact
Strategically using eye content (or lack of eye contact) is an extremely
effective way to communicate your attention and interest.
Example: Looking away from someone and at the ground or your phone
may convey disinterest or disrespect.
9. Touch
Some people also use touch as a form of communication. Most commonly,
it is used to communicate support or comfort. This form of communication
should be used sparingly and only when you know the receiving party is
okay with it. It should never be used to convey anger, frustration or any
other negative emotions.
Example: Placing your hand on a friend’s shoulder may convey support or
empathy.
Focus Questions
Instructions: Answer the following questions in complete sentence with

rubrics provided via messenger.
1. What is verbal and nonverbal communications?

2. What are the types of nonverbal communication?
3. Why establishment of respect and rapport are important in dealing with
elderly clients?
Related Readings For Supplemental readings on the Care of Older Adults,
please refer to these sources provided.
https://www.indeed.com/career-advice/career-development/nonverbal-
communication-skills
https://blog.ioaging.org/home-care/how-to-use-nonverbalcommunication-
with-seniors-with-alzheimers/
https://www.nia.nih.gov/health/tips-improving-communication-older-
patients
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Assessment Activities
Directions: Answer the following essay questions with rubrics provided via
Google Classroom
1. Differentiate verbal and nonverbal communication
2. Discuss the different tips to use in verbal and non-verbal communication
REFERENCES
patients
LET’S BEGIN!
UNIT 17 ( WEEK 17 ) NURSING INTERVENTION WITH ELDERLY OR FAMILY/

CLASSIFICATION OF INTERVENTION AND
GENERAL GUIDELINES TO CARE IN ELDERLY
Intended Learning Outcomes ( Wee 17 -ILO )

1. Explain the different interventions with elderly and family
2. Discuss the classification of interventions
3. Expound the general guidelines to care for the elderly.
Introduction
The Nursing Interventions Classification is a care classification system which

describes the activities that nurses perform as a part of the planning phase
of the nursing process associated with the creation of a nursing care plan
The more you look into nursing careers, the more you realize that a day in
the life of a nurse is rarely boring. You recently came across the
term nursing intervention, which sounds like even more drama than the TV
shows “Grey’s Anatomy” and “Intervention” combined!
Nurses can certainly experience their share of excitement during work, but
nursing interventions aren’t quite as dramatic as they might sound. Unlike
what you might be thinking, a nursing intervention isn’t just for patients
struggling with addiction, and they definitely don’t always end in gut-
wrenching emotional confrontations.
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If it’s not a tension-filled scene in which a nurse confronts a patient,
what is a nursing intervention? Join us as we learn more about how nursing
interventions work in the real world, including everything aspiring nurses
need to know about this facet of patient care.
Please proceed immediately to the “Unlocking of Difficulties” part since the

first lesson is also definition of essential terms.

Key Terms
Rehabilitation: The process of helping a person who has suffered an illness

or injury restore lost skills and so regain maximum self-sufficiency.
Emotional support is a vital component of a healthy relationship and
indicates that a relationship is deeper and more meaningful than a casual
acquaintance.
Counseling is advice which a therapist or other expert gives to someone
about a particular problem.
Structural interventions refer to public health interventions that promote
health by altering the structural context within which health is produced
and reproduced.
Active listening is a technique that is used in counseling, training, and
solving disputes or conflicts.
Reminiscence therapy is used to counsel and support older people, and is

an intervention technique with brain-injured patients and those who
appear to have "Alzheimer's and other forms of cognitive disease."
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Lecture Notes
UNIT 17-NURSING INTERVENTION WITH ELDERLY OR FAMILY/

CLASSIFICATION OF INTERVENTION AND GENERAL GUIDELINES TO CARE
IN ELDERLY
NURSING INTERVENTION WITH ELDERLY OR FAMILY
.
https://www.google.com/search?q=nursing+intervention+among+elderl Retrieved on November 12, 2020
1. Giving sickness care including intensive care or elderly care such as

feeding, bathing, range of motion and turning.
2. Enabling the senior to perform his or her own hygiene and grooming.
3. Implementing medical procedures and treatments as ordered by the
physician.
4. Encouraging the senior to use energy saving device.
5. Adapting procedure or techniques to the home situation.
6. Encouraging regimen of activity or rehabilitation to reduce
disengagement
7. Maintaining communication with the senior for example by listening
to him reminisce
8. Reduce sensory and emotional immobility.
9. Meeting spiritual needs by calling the minister, read passage from
the Bible, say a prayer at their request.
10.Maintaining communication with the family or significant others.
11.Teaching and counseling the person or family to help them become
more adaptive or independent.
12.Reducing anxiety by being supportive and available to the person
and family experiencing death.
13.Referring the elderly person of family to health, social and welfare
agencies as indicated.
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https://www.google.com/search?q=reminiscence+therapy&hl=en&sxsrf=ALeKk03 Retrieved on November 13, 2020
OTHER INTERVENTIONS INCLUDES:

1. Coordinating care given by other health team members
2. Collaborating with others to provide continuity of care
3. Directing others, including the family, to give care to elderly person.
https://www.google.com/search?q=reminiscence+therapy&hl=en&sxsrf=ALeKk Retrieved on November 13, 2020
CLASSIFICATION OF INTERVENTIONS
1.SUPPORTIVE INTERVENTIONS
 Supportive care involves the provision of emotional support
informally or through structured interventions.
 Support interventions include activities such as general counseling
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https://www.google.com/search?q=the+general+guidelines+to+care Retrieved on November 13, 2020
 related to emotional and other issues, active listening, and presence.

 Supportive interventions may be provided by healthcare
professionals or may be structured as peer group support.
 Interventions can be one-on-one individualized sessions, support
group sessions, or specific interventions with caregivers, families,
etc.
https://www.google.com/search?q=THE+GENERAL+GUIDELINES+TO+CA Retrieved on November 13, 2020
 Support interventions may be provided via telephone, physical

presence, or online groups that may be either referred by a
professional or unrefereed.
 Expressive writing for emotional disclosure can be seen as a specific
type of supportive intervention; however, it is not grouped in the
intervention of supportive care.
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https://www.google.com/search?q=THE+GENERAL+GUIDELINES+TO+CARE+FOR+THE+ELDERLY& Retrieved on November 13, 2020
 Expressive writing, as a very specific approach, is evaluated in ONS

PEP resources as its own type of intervention.
 Supportive care/support interventions have been evaluated in
patients with cancer for anxiety, caregiver strain and burden,
chemotherapy-induced nausea and vomiting, and depression.
https://www.google.com/search?q=THE+GENERAL+GUIDELINES+TO+CARE+FOR+TH Retrieved on November 12, 202
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2.GENERATIVE INTERVENTIONS
h
ttps://www.google.com/search?q=nursing+interventions+classification&hl=en&sxsr Retrieved on November 13, 2020
 Generative nursing actions are innovative and rehabilitative.

 They help the person or family develop different approaches to
coping with stress or crisis and are especially used when assisting
another with struggles involved in roll changes or identity crisis.
http
s://www.google.com/search?q=THE+GENERAL+GUIDELINES+TO+CAR Retrieved on November 13, 2020
 Rehabilitative are special healthcare services that help a person

regain physical, mental, and/or cognitive (thinking and learning)
abilities that have been lost or impaired as a result of disease, injury,
or treatment.
 Rehabilitation services help people return to daily life and live in a
normal or near-normal way. These services may include physical
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therapy, occupational therapy, speech and language therapy,
cognitive therapy, and mental health rehabilitation services.
h
ttps://www.google.com/search?q=examples+of+rehabilitative+health+care& Retrieved on November 13, 2020
 The primary purpose of innovative care is to benefit a patient(s), not

to collect data to support a hypothesis or theory. It is a non-standard
procedure or treatment that is employed solely to enhance the
wellbeing of a patient, but for which there is limited prospective
evidence of safety and efficacy.
https:/
/www.google.com/search?q=protective+nursing+intervention&tbm= Retrieved on November 13, 2020
3. Protective nursing actions are measures that promote health and

prevent disease.
 They improve or correct situations. Examples are immunizations,

health teaching or anticipatory guidance; or preventing
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complications and disease sequel (Bower 1972).
https://www.google.com/search?q=protective+nursing+intervention&tbm = Retrieved on November 13, 2020
 They improve or correct situations. Examples are immunizations,

health teaching or anticipatory guidance; or preventing
complications and disease sequel (Bower 1972).
https://www.google.com/search?q=immunization&tbm=isch&ved=2ahUKEwi Retrieved on November 13, 2020
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GENERAL GUIDELINES TO CARE FOR THE ELDERLY
https://www.google.com/search?q=THE+GENERAL+GUIDELINES+TO+CARE+FOR+THE Retrieved on November 13, 2020
1. Consider individuality of the elderly patients.

2. Handle them gently and maintain privacy while providing care.
3. Communicate effectively. Make sure they can hear.
4. Encourage independence as possible
5. Assist to achieve emotional stability
6. Protect from injury, falls, and accidents with proper instructions or
arrangements
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https://www.google.com/search?q=THE+GENERAL+GUIDELINES+TO+CARE+FOR Retrieved on November 13, 2020
7. The elderly are highly prone to develop bedsores.

8. Help them to establish good sleeping pattern. Try to engage them in
a certain activities during day / time so that they can sleep well
during night time.
https://www.google.com/search?q=THE+GENERAL+GUIDELINES+TO+CARE+FOR + Retrieved on November 13, 2020
9. Caution them about self- use of drugs especially analgesics and

narcotics.
Focus Questions

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1. What is the meaning of intervention?
2. What is the main purpose innovative and rehabilitative care?
3. What are the examples of protective nursing interventions?
4. How to apply continuity of care among elderly?
Related Readings For Supplemental readings on the Care of Older Adults,
please refer to these sources provided.
https://www.ons.org/node/4181?
display=pepnavigator&sort_by=created&items_per_page=5
https://online.husson.edu/nursing-interventions-nic-system/
Jennifer Kim and Sally Miller ( 2017 ). Geriatric Syndrome Geriatric Society
Maree, Bernoth ( 2016 ). Healthy Ageing and Aged Care
Google Classroom
1. Explain the different interventions with elderly and family

2. Discuss the classification of interventions
3. Expound the general guidelines to care for the elderly
REFERENCES
patients
https://www.ons.org/node/4181?
display=pepnavigator&sort_by=created&items_per_page=5
https://online.husson.edu/nursing-interventions-nic-system/
https://www.rasmussen.edu/degrees/nursing/blog/nursing-intervention-
beginners-guide/
25
Jennifer Kim and Sally Miller (2017). Geriatric Syndrome Geriatric Society
Maree, Bernoth ( 2016 ). Healthy Ageing and Aged Care
26
https://www.google.com/search?q=priority+of+goals+in+elderly& Retrieved on October 7,2020
1.NURSING DIAGNOSES IDENTIFIED

A. RISK FOR FALLS
Common Risk Factors for the Nursing Diagnosis Risk for Falls
 Age (especially ≥ 65 years)
 Impaired physical mobility
 Loss of muscle strength
 Altered sensory perception
 Presence of illness (Alzheimer’s disease, dementia, osteoporosis)
 Urinary incontinence
 Use of medications
 Disorientation
 Dizziness
 Lack of knowledge of environmental hazards secondary to confusion
 Improper use of aids (e.g., canes, walkers, wheelchair, crutches)
NURSING INTERVENTIONS
1.Identify factors that increase the level of fall risk
RATIONALE:
These factors will help in determining interventions necessary for the
patient. Risk factors include age, presence of an illness, sensory and motor
deficits, medication use, and inappropriate use of mobility aids.
2. Assess the patient’s environment for factors associated with an

increased risk for fall.
RATIONALE:
A patient who is not familiar with the placement of furniture in an area or
who has inadequate lighting in the house increases the risk for falls.
3. Secure a wristband identification to warn healthcare providers to
implement fall precaution on the patient.
RATIONALE:
Healthcare providers need to recognize patients at high risk for falls to
implement measures to promote patient safety and prevent falls.
4. Place assistive devices and commonly use items within reach.
RATIONALE:
Provides easy access to assistive devices and personal care items. Items
such as call bell, telephone, and water should be kept close to avoid
27
frequent reaching.
5. Review hospital protocols regarding transferring a patient.

RATIONALE:
Hospital facility should have clear policies and procedures during transfers
that will ensure the patient’s safety.
6. Keep the patient’s bed in the lowest position at all times.

RATIONALE:
Keeping the bed closer to the floor prevents injury and risk of falls.
7. Answer call light as soon as possible.
RATIONALE:
This is to prevent an unstable patient from ambulating without any
assistance.
8. Use side rails on bed as needed

RATIONALE:
Raising the side rails reduces the risk of patients falling out of bed during
transport.
9. Advise the patient to wear shoes or slippers with non-slip soles when
walking.
RATIONALE:
Wearing non-slip footwear help prevents slips and falls.
10. Orient the patient to the surroundings. Avoid re-arranging the furniture
in the room.
RATIONALE:
The patient should be familiarized with the bed, location of the bathroom,
furniture, and other environmental hazards that can cause older patients to
trip or fall.
B. IMPAIRED GAS EXCHANGE

Related Factor
 Reduced oxygenation with decreased functional lung tissue
1. Monitor and record the following during admission and routinely
thereafter: respiratory rate, depth, and pattern; breath sounds, cough,
sputum, and mental status.
RATIONALE
Provides baseline data for subsequent assessments of the
patient’s respiratory system.
2. Assess subtle changes in patient’s behavior or mental status e.g., anxiety,
disorientation, hostility, and restlessness. Check oxygen levels using pulse
oximetry (higher than 92%) or reviewing ABG values (optimally Pao 2 80%-
95% or higher).
RATIONALE:
28
These changes in the sensorium can indicate decreasing oxygen levels. To
comprehensively monitor pulse oximetry, the hemoglobin (Hgb) must be
determined.
3. Auscultate the lungs for adventitious sounds.

RATIONALE:
When people get older, lungs elasticity decreases. The lower portion of the
lung is not sufficiently aerated resulting in the occurrence of crackles
(usually heard in individuals 75 years of age and above). This sign alone
does not imply the presence of a disease condition.
4. Encourage breathing and coughing exercises. Instruct patient in use of

incentive spirometry if applicable.
RATIONALE:
These measures provide alveolar expansion and remove the secretions
from the bronchial tree, resulting to optimal gas exchange.
5. Encourage increased fluid intake (greater than 2.5 liters daily) unless
contraindicated by a renal or cardiac condition.
RATIONALE:
Adequate hydration promotes mobilization of secretions.
6. Treat hyperthermia immediately, reduce pain, lessen pacing activity, and

decrease anxiety.
RATIONALE:
These measures decrease the demand for increased oxygen consumption.
7. Teach the patient in the use of support devices such as nasal cannulas or
oxygen masks.
RATIONALE:
Knowledge about this equipment promotes adherence to the treatment.
C.HYPERTHERMIA
RELATED FACTOR
 Age-related changes in thermoregulation and environmental
exposure
1. Monitor temperature through the use of a low-range thermometer if
available.
RATIONALE:
This assessment will indicate the presence of hypothermia. The normal
temperature of an older adult is 35.5°C (96°F).
2. Monitor oral temperature by placing the tip of the thermometer far back
in the patient’s mouth.
RATIONALE:
29
Oral temperature provides the most accurate reading of a patient’s core
temperature.
3. Assess and record the mental status of the patient.

RATIONALE:
Increasing disorientation, altered sensorium, or atypical behaviour may
indicate hypothermia.
4. Watch out with the use of sedatives, muscle relaxants,

and hypnotics (including anesthetics).
RATIONALE:
These pharmacologic therapies can decrease shivering, hence put patients
at risk for environmental hypothermia. Furthermore, elderly people are at
risk for environmental hypothermia at ambient temperatures of 22.22°-
23.89°C (72°-75° F)
5. Make sure to give blankets to patients undergoing testing or x-ray

examination.
RATIONALE:
This measure will keep the patient warm thus it will help avoid
hypothermia.
6. Warm the patient internally by providing warm oral or IV fluids if the
patient’s temperature drops below 35°C (95°F).
RATIONALE:
This method is done to reverse moderate to severe hypothermia. Other
methods include warmed saline gastric or rectal irrigations or introduction
of warmed humidified air into the airway.
7. Watch out for signs of excessive rapid rewarming.

RATIONALE:
Irregular HR, dysrhythmias, and very warm extremities caused by
vasodilation in the periphery, which causes heat loss from the core are
some of the signs of excessive rapid rewarming.
8. Once the patient’s temperature fails to increase by 1°F/hr using these

methods, anticipate laboratory request for WBC count for
possible sepsis, glucose level for hypoglycemia, and thyroid test
for hypothyroidism.
RATIONALE:
Causes aside from environmental factors may be responsible for the
hypothermia.
9. Administer antibiotics as prescribed for sepsis, glucose for hypoglycemia,
or thyroid therapy.
30
RATIONALE:
Treating the underlying condition will help the patient’s temperature to
return to normal.
D.DISTURBED SLEEP PATTERN

RELATED FACTORS
 Unfamiliar surroundings and hospital routines/interruptions
1. Assess and record the patient’s sleeping pattern, gathering information
from the patient’s significant others or caregiver.
RATIONALE:
Elderly people usually sleep less than they did when they were younger and
often awaken more frequently during at night.
2. Gather inquiries regarding activity level and nap.

RATIONALE:
Persons with a low level of activity and who take naps frequently sleep only
4 to 5 hours per night.
3. Monitor the patient’s activity level.

RATIONALE:
If the patient complains of being tired after activities or displays behaviors
such as irritability, yelling, or shouting, encourage napping after lunch or
early in the afternoon. Otherwise, discourage daytime napping, especially
in the later afternoon, because it can interfere with night time sleep.
4. Identify the patient’s typical night time routine and try to follow it.
RATIONALE:
Emulating the typical night time rituals may promote sleep.
5. Try to arrange activities together such as doing vital signs, taking

medication, and toileting.
RATIONALE:
This lessens the frequency of interruptions and promotes rest and sleep.
6.Refrain the patient from drinking caffeinated coffee, cola, and tea after 6
pm.
RATIONALE:
The effect of stimulants includes increase alertness, insomnia and frequent
nighttime awakenings to urinate
7. Provide a calm and quiet environment and lessen interruptions during

sleep hours.
RATIONALE:
Exposure to bright lights, unnecessary noises, snoring roommates, and loud
talking can result in sleep deprivation. Use of white noise sound generators
31
may facilitate sleep.
8. Administer pain medications as ordered; provide back rub, and pleasant

conversation at sleep time.
RATIONALE:
These interventions promote comfort thus enhance the sleep.
E.CONSTIPATION
RELATED FACTOR
 Changes in diet, decreased activity, and psychosocial factors
1. During admission, assess and record the patient’s normal bowel
elimination pattern (frequency, time of day, associated habits, and previous
measures to manage constipation). Discuss with the patient’s significant
others or caregiver if the patient cannot provide this information.
RATIONALE:
This assessment sets a baseline and identifies the normal bowel elimination
pattern of the patient.
2. Quantify the amount of roughage to the severity of constipation.

RATIONALE:
Excessive roughage taken too rapidly can cause gas, bloating and diarrhea.
3. Assess hydration status for signs of dehydration. Maintain diet, fluid,
activity, and continuation of routines. If there is an absence of bowel
movement within 3 days, start with mild laxatives to attempt to reattain
the normal bowel pattern.
RATIONALE:
The use of osmotic medications can result in dehydration. Fluid volume
deficit can result in hard stools, which are more difficult to pass.
4. Inform the patient that changes happening during hospitalization may

increase the risk of constipation.
RATIONALE:
Constipation is not difficult to handle preventively than it is when present
or prolonged.
5. Educate the patient about the connection between fluid intake and
constipation. Encourage fluid intake (2500 ml/day) unless contraindicated.
Assess and record bowel movements (amount, date, time, consistency).
RATIONALE:
Increase consumption of fluids can make the stool soft and lessens the risk
of constipation. Patients with renal, cardiac, or hepatic diseases may have a
fluid restriction.
32
6. Instruct the patient to include roughage in every meal when possible. For
patients with low tolerance to raw foods, encourage intake of bran via
cereals, bread, and muffin.
RATIONALE:
Having roughage (raw fruits and vegetables, whole grains, legumes, nuts,
fruits with skin) in the diet adds bulk in the stool, therefore, minimizes
episodes of constipation.
7. Educate the patient about the connection between activity level and
constipation.
RATIONALE:
Regular exercise stimulates peristaltic movement thus it can reduce or
prevent constipation.
8. Encourage the patient to use his or her gastrocolic or duodenocolic reflex

to promote colonic emptying, if the usual bowel movement happens in the
early morning
RATIONALE:
Scheduling interventions that correspond with the bowel habits of the
patient are more likely to increase bowel movements.
9. Try to use the patient’s previously effective measures. Follow the maxim
“start low, go slow” (i.e., apply the lowest level of non-natural intervention
and progress gently to a more powerful intervention).
RATIONALE:
Aggressive measures done may lead to rebound constipation and can
hinder with subsequent bowel movements.
10. Administer laxatives as ordered after diagnostic imaging of the

gastrointestinal tract with the aid of barium.
RATIONALE:
Laxatives are administered to facilitate barium removal. This will prevent
rebound constipation due to severe disruption of bowel habit during the
preparation.
2.POTENTIAL FOR RECOVERY
33
https://www.google.com/search?q=POTENTIAL+FOR+RECOVERY+FOR+ADULTS Retrieved on October 7, 2020
Recovery is a process of change through which people improve their health

and wellness, live self-directed lives, and strive to reach their full potential.
There are four major dimensions that support recovery:
 Health—overcoming or managing one’s disease(s) or symptoms and
making informed, healthy choices that support physical and
emotional well-being.
 Home—having a stable and safe place to live.
 Purpose—conducting meaningful daily activities and having the
independence, income, and resources to participate in society.
 Community—having relationships and social networks that provide
support, friendship, love, and hope.
3.AMOUNT OF TIME NEEDED BY THE SENIOR
https://www.google.com/search?q=amount+of+time+needed+for+older+adult Retrieved on October 7,2020
 One of the most difficult tasks we face as humans living in a society is

how we take care of our beloved elders.
 There may come a point in time when a senior can no longer live on
their own, though, so as members of their families, we must make
difficult decisions regarding how we handle this situation.
 It’s emotionally taxing to see someone you love not be able to take
care of themselves when they used to be the one taking care of you.
34
 But on the other hand, there’s only so much you can do to take care
of a senior in your family until it becomes overbearing and inhibits
your ability to live a normal life.
 There’s a middle ground that can often be found when it’s necessary.
That’s particularly true at a certain point where it makes sense for
both the senior and the caregiver to develop a plan for senior care.
But this is an expansive industry, so it’s important to determine
which type of care you or a loved one may need.
Focus Questions

1. How time management is important in the care of elderly?

2. Prioritizations of nursing diagnoses are essential to nursing care. Explain
why?
3.How does health care provider plays an important role in patient’s
recovery?
Related Readings
For Supplemental readings on the Care of Older Adults, please refer to

these sources provided.
https://www.google.com/search?
q=nursing+diagnosis+identified+in+elderly&o
https://www.samhsa.gov/find-help/recovery
https://aging.com/knowing-when-it-may-be-time-for-assisted-living/
Google Classroom
1. Enumerate and discuss the identified nursing diagnoses among elderly.
2. Explain the recovery process as this related to older adult.
3. Describe how often should nurses render time with older adult in
providing care?
REFERENCES
q=nursing+diagnosis+identified+in+elderly&o
35
https://www.samhsa.gov/find-help/recovery
https://aging.com/knowing-when-it-may-be-time-for-assisted-living/
UNIT 12-14 ( WEEK 12-14 ) PHYSICAL STATUS OF ADULT

Intended Learning Outcomes ( Week 12-14 ILO )
1. What is meant by noncompliance of treatment?

2. What is the effect of insomnia to the health of older adults?
3. How does health care provider assess the physical status of the elderly?
Introduction
As individuals age, they are at risk for diseases and disabling conditions, use
more medical care services, and incur medical expenses. While there is no
doubt that age is a predictor of morbidity and mortality, its predictive value
is limited. The health status of the elderly is better than generally assumed,
varies remarkably among individuals, and is changing as successive cohorts
progressively challenge the definition of old age.

KET TERMS
Anxiety- is your body's natural response to stress. It's a feeling of fear or
apprehension about what's to come.
Custodial care is non-medical care that helps individuals with their daily
basic care, such as eating and bathing.
Grief is the response to loss, particularly to the loss of someone or
something that has died, to which a bond or affection was formed.
36
Cognitive impairment is when a person has trouble remembering, learning
new things, concentrating, or making decisions that affect their everyday
life.
Social anxiety disorder (also called social phobia) is a mental health
condition. It is an intense, persistent fear of being watched and judged by
others. This fear can affect work, school, and your other day-to-day
activities.
Disengagement is a process by which people gradually stop being involved
in a conflict, activity, or organization.
Lecture Notes
UNIT 12-14- PHYSICAL STATUS OF ADULT
1.ANXIETY
https://www.google.com/search?q=anxiety&sxsrf=ALeKk03_Qt Retrieved on October 9, 2020
 Excessive anxiety that causes distress or that interferes with daily

activities is not a normal part of aging, and can lead to a variety of
health problems and decreased functioning in everyday life.
 Between 3% and 14% of older adults meet the criteria for a
diagnosable anxiety disorder.
 International Journal of Geriatric Psychiatry found that more than
27% of older adults under the care of an aging service provider have
symptoms of anxiety that may not amount to diagnosis of a disorder,
but significantly impact their functioning.
 The most common anxiety disorders include specific phobias and
generalized anxiety disorder. Social phobia, obsessive-compulsive
disorder, panic disorder, and post- traumatic stress disorder (PTSD)
37
are less common.
2.CONFUSION
https://www.google.com/search?q=confusion+in+elderly&tbm=isch&veRetrieved on October 9, 2020
 Confusion is a common problem in persons over 65 years of age.

 The decline in normal cognitive ability may be acute, or it may be
chronic and progressive.
 In older persons, confusion is usually a symptom of delirium or
dementia, although it may be due to major depression or psychosis.
3.EMOTIONAL OR SOCIAL DEPRIVATION
https://www.google.com/search?q=Emotional+or+Social++Deprivation Retrieved on October 9, 2020
 The elderly need to stay emotionally connected to family and friends.

As time progresses and life evolves, the emotional needs of people
change. The elderly go through a gamut of emotions as they age.
 Loneliness is one of the major feelings that an elderly
person experiences
 Social deprivation is the reduction or prevention of culturally normal
interaction between an individual and the rest of society.
 Social exclusion of older persons is a complex process that involves

the lack or denial of resources, rights, goods and services as people
age, and the inability to participate in the normal relationships and
38
activities, available to the majority of people across the varied and
multiple domains of society.
4.DISENGAGEMENT
https://www.google.com/search?q=Disengagement+in+elderlyRetrieved on October 9, 2020
 A person is ready to disengage when they are aware of the short

time remaining in their life and they no longer wish to fulfill their
current social roles; and society allows for disengagement in order to
provide jobs for those coming of age, to satisfy the social needs of a
nuclear family, and because people die
5.MOURNING
https://www.google.com/search?q=Mourning+in+elderly&tbm=isch&v Retrieved on October 9, 2020
 Loss is inevitable for the elderly, and with loss comes grief.
 Losses are not just the deaths of loved ones, friends, and
acquaintances. The elderly also experience loss and grief as they
39
begin to have a diminished ability in activities of daily living.
 This then can cause the elderly to lose a sense of purpose.
 Many elderly also have difficulty when they can no longer live
independently. They struggle with the loss of their homes, their
possessions, their health, body parts, their vocations, not to mention
their independence.
6.IMPAIRED ADJUSTMENT TO CRISIS
https://www.google.com/search?q=Impaired+adjustment+to+crisis+in+elderly Retrieved on October 9, 2020
 Elderly care differs greatly between countries and there are

tremendous cultural and political variations in the way in which
ageing is viewed.
 A more age-friendly approach is needed to ensure healthy ageing
with dignity. To meet this goal, more investment—financial and
human resources—is, without doubt an urgent necessity.
 In a climate of austerity, efforts can also be exerted in other areas,
especially disease prevention and health promotion for older people,
together with interventions to reduce smoking, alcohol consumption,
and obesity.
 Additionally, better coordination is needed between health care,
long-term care, and social services to enhance capacities and ensure
sustainable services.
 Elderly care is in crisis, and it is likely to be so for a long time. But
ageing is not an inevitable drain on social and health-care resources.
 Within the crisis there are opportunities to rethink and reform health
care and social systems for the benefit of all.
7. NON- COMPLIANCE OF TREATMENT
40
https://www.google.com/search?q=non+compliance+of+treatment+in+elderly Retrieved on October 9, 2020
 Geriatric population is more prone for various chronic and recurrent

illnesses like diabetes mellitus, hypertension, IHD, arthritis,
neurodegenerative, gastrointestinal, ocular, genitourinary,
respiratory disorders etc., which may require chronic medication
with multiple drugs.
 Poor compliance in this age group accounts for medication wastage
with increased cost of healthcare and substantial worsening of the
disease with disability or death.
 Most of the human and economic costs associated with non-
adherence can be avoided by improving medication adherence.
8. PAIN
https://www.google.com/search?q=pain+elderly&tbm=isch&ved Retrieved on October 9, 2020
 Is a common complaint of the elderly. As the number of individuals

older than 65 years continues to rise, frailty and chronic diseases
associated with pain will likely increase.
41
 Therefore, primary care physicians will face a significant challenge in
pain management in older adults. The elderly are more likely to have
arthritis, bone and joint disorders, cancer, and other chronic
disorders associated with pain. Between 25% and 50% of
community-dwelling elderly have important pain problems.
 Geriatric nursing home residents have an even higher prevalence of
pain, which is estimated to be between 45% and 80%.3
 The elderly are often either untreated or undertreated for pain and
consequences of under treatment for pain can have a negative
impact on the health and quality of life of the elderly, resulting in
depression, anxiety, social isolation, cognitive impairment,
immobility, and sleep disturbances.
 Reasons that physicians often cite for inadequate pain control
include lack of training, inappropriate pain assessment, and
reluctance to prescribe opioids.
9. ALTERED ABILITY TO PERFORM ACTIVITIES OF DAILY LIVING
https://www.google.com/search?q=Altered+Ability+to+Perform+Activities+of+Daily+Living+in+eld Retrieved on October 10,2020
 Functional status and the ability to care for oneself have a significant
impact on a senior’s quality of life.
 Changes in ADLs can be caused by underlying medical conditions,
failing to recognize these growing needs can also contribute to a
cycle of physical and mental health problems.
 Unmet needs for help with activities of daily living can lead to
malnutrition, poor personal hygiene, isolation, illnesses like urinary
42
tract infections (UTIs), and falls.
 Studies have shown that ADL disabilities are associated with an
increased risk for mortality.
 Ensuring a senior has the daily care they need can help prevent new
and worsening health issues, keep overall costs down, and delay or
eliminate the need for institutional care. Therefore, a senior’s
functional abilities are often factored into important care decisions
along with their medical needs.
 The ability to perform ADLs is often used to determine what types of
care and senior living settings are suitable for an elder. For example,
independent living facilities do not provide any assistance with ADLs.
 This type of unskilled care is usually referred to as personal care or
custodial care.
 If a resident requires help, he or she will have to get it from a family
caregiver, hire in-home care or move to a higher level of care where
ADL support is provided (e.g. an assisted living facility, a memory
care unit, a nursing home).
10.IMPAIRED MOBILITY
https://www.g
oogle.com/search?q=impaired+mobility+in+elderly&tbm=Retrieved on October 9, 2020
 Decline in functional ability among the elderly is of clinical relevance

as a marker of potentially treatable clinical disease.
 It is possible to screen older people for mobility issues and apply

early interventions to prevent mobility problems and rehabilitate
existing mobility impairments
43
 Problems associated with aging can affect a person’s ability to move
around, or mobility.
 Mobility problems may include unsteadiness while walking, difficulty
getting in and out of a chair, or falls. Muscle weakness, joint
problems, pain, disease, and neurological difficulties can all
contribute to mobility problems.
 Sometimes several mild problems combine and occur
simultaneously, affecting mobility. It can also make the difference
between living at home or in a facility.
 The primary mobility problem that older people experience is falling.
Falls are a major cause of injury and death, so prevention is
important.
 Older bones break more easily, heal less quickly, and may not heal
completely. If a hip is fractured, canes, walkers, or wheelchairs might
be permanently needed. If the senior is afraid of falling, address it, or
he or she may become afraid to move around.
11.IMPAIRED NUTRITION- HYDRATION STATUS
https://www.google.c
om/search?q=impaired+nutrition-+hydration+status+in+elderly Retrieved on October 9, 2020
 Poor nutritional status is not a normal part of aging and may result in
adverse outcomes such as increased risk and delayed healing of
pressure injuries, decline in function, dehydration, and increased risk
of death. Causes of low food intake and impaired nutritional status
include depression, inability to eat independently, chewing and
swallowing difficulties, pain, medications that inhibit appetite, and
cognitive or functional impairments.
 Organizations that do not take steps to ensure residents' adequate
nutrition and hydration put their residents at severe risk of adverse
outcomes and leave themselves prone to liability and citations for
44
regulatory noncompliance.
 Aging services organizations can improve residents' nutritional status
by conducting nutritional assessments, by developing individualized
care plans that focus on improving nutrition and hydration, by
implementing appropriate interventions, and by monitoring
interventions for effectiveness
12.IMPAIRED SKIN INTEGRITY
https://www.google.com/search?q=Impaired+Skin+Integrity+in+elderly&tbm=isc Retrieved on October 10,2020
 The skin is the largest organ of our body, covering 18 square feet and
weighing approximately 12 pounds.
 Despite positive characteristics, the skin is always susceptible to and
at risk of injury and breakdown.
 Maintaining skin integrity equals maintaining skin health, and this
includes people of any age.
 Older adults are at a higher risk because of the skin aging process. As
skin ages, the junction between the epidermis and dermis thins and
flattens, reducing circulation.
 Moisturizing factors in older adults also reduce, thus causing dry,
flaky skin and increased risk of skin breakdown.
13.IMPAIRED SENSORY PROCESS
45
https://www.google.com/search?q=Impaired+Sensory+Process+in+elderly&tbm Retrieved on October 10,2020
 Out of the five physical senses, impairment in vision and hearing,

especially simultaneously, may have the greatest impact on the
health of older adults.
 These impairments are associated with poor health outcomes, such
as limitations in physical function and activities of daily living (ADLs),
social isolation, cognitive decline, depression, poor self-rated health
(SRH), communication difficulties, and even mortality.
 Studying the effect of vision and hearing impairment on life
expectancy and health expectancy -- the duration of remaining life
expected to be spent with (or without) health problems -- in older
adults is relevant because these impairments affect both the quality
and the quantity of life.
 This would allow care providers, policy makers and older adults and
their families to thoroughly understand the impact of these
common, yet often treatable, impairments.
14.Impaired Verbal Communication
https://www.google.com/search?q=Impaired+Verbal+Communication+in+elderly&tbm Retrieved on October 10,202
 Communication is an essential aspect of life, yet it can be taken for

granted. Its centrality to being in the world and in professional
practice often becomes evident when nurses and older adults
46
encounter communication difficulties.
 The factors that can affect nurses' communication with older adults
relate to the older adult, the nurse, sociocultural considerations and
the environment, and the interactions between these factors.
 In adopting a person-centred approach to communicating with older
adults, it is necessary to get to know the person as an individual and
ensure communication meets their needs and abilities.
 Effective communication is essential in nursing practice and requires
professional competence and engagement.
15. INSOMIA
https://www.google.com/search?q=insomnia+in+elderly&tbm=isch&ved=2a Retrieved on October 10,2020
 Insomnia is commonly seen in elderly populations and is associated

with numerous individual and socioeconomic consequences.
 Elderly patients are more likely to suffer from chronic insomnia
characterized by difficulty maintaining sleep than difficulty initiating
sleep.
 Management of insomnia in these patients requires very careful
evaluation and exclusion of an underlying medical or psychiatric
condition.
 Non-pharmacologic interventions in elderly patients, especially use

of behavioral therapy, have demonstrated some success.
 Commonly prescribed medications have also been effective, though
47
they have limitations.
 Newer agents currently under investigation for insomnia hold
promise for good efficacy and safety in the elderly population.
Focus Questions

1. What is meant by noncompliance of treatment?

2. What is the effect of insomnia to the health of older adults?
3. How does health care provider assess the physical status of the elderly?
Related Readings
https://www.mhanational.org/anxiety-older-adults#:~:text=Like%20depr
https://www.aafp.org/afp/1998/0315/p1358.html#:~:text=Confusion%20in
%20the%20elderly%
q=emotional+deprivation+in+elderly&sxsrf=ALeKk
https://www.thoughtco.com/disengagement-theory-3026258
https://www.caringfortheages.com/article/S1526-4114(06)60298-9/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296451/
https://www.google.com/search?biw=1280&bih=578&sxsrf=ALeKk025-
ckAC
https://www.agingcare.com/articles/activities-of-daily-living-why-this-
measure-matter
https://www.prestige-nursing.co.uk/mobility/mobility-in-the-
elderly/https://www.ecri.org/components/CCRM/pages/rescare5.aspx#:~:t
ext=Nutrition%20and%20Hydration%
https://www.woundsource.com/blog/maintaining-skin-integrity
biw=1280&bih=578&sxsrf=ALeKk032wgfw3F4O
https://www.google.com/search?biw=1280&bih=578&sxsrf=AL
https://www.google.com/search?biw=1280&bih=578&sxsrf=ALe
48
Google Classroom
1. Enumerate and describe the physical status as these related to older

adults.
REFERENCES
https://www.mhanational.org/anxiety-older-adults#:~:text=Like%20depr
https://www.aafp.org/afp/1998/0315/p1358.html#:~:text=Confusion%20in
%20the%20elderly%
q=emotional+deprivation+in+elderly&sxsrf=ALeKk
https://www.thoughtco.com/disengagement-theory-3026258
https://www.caringfortheages.com/article/S1526-4114(06)60298-9/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296451/
https://www.google.com/search?biw=1280&bih=578&sxsrf=ALeKk025-
ckAC
https://www.agingcare.com/articles/activities-of-daily-living-why-this-
measure-matter
https://www.prestige-nursing.co.uk/mobility/mobility-in-the-
elderly/https://www.ecri.org/components/CCRM/pages/rescare5.aspx#:~:t
ext=Nutrition%20and%20Hydration%
https://www.woundsource.com/blog/maintaining-skin-integrity
biw=1280&bih=578&sxsrf=ALeKk032wgfw3F4O
https://www.google.com/search?biw=1280&bih=578&sxsrf=AL
https://www.google.com/search?biw=1280&bih=578&sxsrf=ALe
49
4.MAINTAINING CONTINENCE
https://www.google.com/search?q=maintaining+continence+for+elderly Retrieved on September 6, 2020
 Continence care relates to helping an individual achieve and

maintain this control of their bladder or bowel functions, through
tips on how to keep the bladder healthy, continence assessment,
identifying a suitable course of treatment if necessary and emotional
support and advice.
 Good toilet habits help prevent incontinence:
50
 Go to the toilet to urinate only when your bladder is full. ...
 Take your time on the toilet. ...
 Go to the toilet when you feel the urge to pass a bowel motion. ...
 Give yourself plenty of time to pass a bowel motion.
 Don't strain to open your bowels.
 Encourage the older person to get out of bed and use a commode
next to the bed or walk to the toilet if possible. Show the older
person and their family how to use the call bell if they need
assistance to use the toilet. Encourage the patient to completely
empty their bladder with each void.
5.GROOMING
https://www.google.com/search?q=grooming+for+elderly&hl=en&sxsr Retrieved on September 6, 2020

 Being unable to take care of one's hygiene and grooming without
help begins to make most seniors feel as though they are simply no
longer self-sufficient. When helping a senior or elderly person with
their hygiene and grooming tasks, take care to treat them as you
would any adult- with respect and dignity.
6.FEEDING
https://www.google.com/search?q=feeding++for+elderly&hl=en&sxs Retrieved on September 6, 2020
51
 To maintain a healthy diet and balanced nutrition. To prevent
complications such as aspiration pneumonia induced by choking. To
encourage and assist elders with eating problems so as to maximize
their independence and self-care ability. To make eating an
enjoyable experience to improve their quality of life.
 Elders with chronic illness and impaired mobility may suffer from
various degrees of feeding problems. It is therefore important for
carers of these elders to provide appropriate assistance according to
the elders' individual needs.
7.TRANSFERRING
https://www.google.com/search?q=transferring+++for+elderly+purpose Retrieved on September 6, 2020

 Every day, countless family caregivers struggle to reposition and
transfer seniors with limited mobility.
 Many are performing these tasks without any help from additional
people or assistive equipment, risking their own health and safety
and that of their loved ones.
 Falls, back injuries and chronic pain are common results of manually
lifting mobility challenged seniors.
 A patient lift can help make transfers much safer and easier for
everyone involved in a senior’s daily care.
8.SHOPPING FOR GROCERY
52
https://www.google.com/search?q=shopping+for+grocer Retrieved on September 6, 2020
 Groceries are a necessity for everyone, but shopping for groceries
can be one of the most difficult types of shopping for the elderly. It
requires a drive to and from the store, bending to reach items on low
shelves, pushing a heavy shopping cart, and lugging heavy bags into
the house upon returning home
9.USING PUBLIC TRANSPORTATION
https://www.google.com/search?q=using+public+transportation++in+ol Retrieved on September 6, 2020

 Transportation is necessary for access to healthcare, community
participation, and overall quality of life. This is no different for older
adult populations.
 Older adults are more likely to restrict their driving in bad weather,
at night, or on high speed roads than their younger counterparts.

 Many older adults also give up driving completely because of
concerns over their ability to drive safely.
 Older adults often experience mobility impairment that limits their
ability to utilize modes of “active transportation” such as bicycling or
walking. These barriers to transportation can potentially lead to
lower access to healthcare, missed or delayed medical
appointments, and increased costs.
53
10.USING THE TELEPHONE
https://www.google.com/search?q=easy+to+use+telephone+for+eld Retrieved on September 6, 2020
 If you’re a senior living at home, chances are you’ve thought about

owning cell phone to help you stay safe and connected.
 Or maybe you already own one and are hoping to optimize its
settings to meet your unique needs. Either way, when choosing a cell
phone for yourself or your baby boomer relative, it’s important to do
your research.
11.PERFORMING HOUSEWORK
https://www.google.com/search?q=Performing+Housework+for+elderly Retrieved on September 6, 2020
54
 While it may be hard to accept, most of us will require some type of
care assistance after the age of 65. You may be used to handling
everything yourself, dividing up duties with your spouse, or relying
on family members for minor help around the home. But as you get
older and your circumstances change, getting around and taking care
of yourself can become more and more difficult. If the idea of moving
to a retirement community, assisted living facility, or nursing home
doesn’t appeal, home care services may be able to help keep you
living in your own home for longer.
12.DOING HOME REPAIR
https://www.google.com/search?q=Doing+Home+Repair+for+elderly Retrieved on September 6, 2020
 Home repairs and modifications help seniors live in their homes for
as long as possible.
 Making your older adult’s home safer and more accessible reduces
fall risk, prevents accidents, and increases independence.
 In addition, home updates can reduce energy usage, which lowers
utility bills.
13.PREPARING FOR MEALS
55
https://www.google.com/search?q=preparing+meals+for Retrieved on September 6, 2020
 If you care for a senior loved one, your days are probably very busy.
It isn’t uncommon for caregivers to work outside the home while
also raising a family of their own. When time is short, eating a well-
balanced diet becomes more difficult to do. Convenience foods and
fast food restaurants are a quick solution, but they are not usually
very healthy.
 Caregivers are often also responsible for creating menus and making
meals for their older family member. One solution that makes it
easier on you and your senior loved one is to make and freeze
healthy entrees that you can pull out of the freezer and serve as
needed.
14.DOING LAUNDRY
https://www.google.com/search?q=doing+laundry+for+eld Retrieved on September 6, 2020

 Emotionally, clean laundry can make an elderly person feel good
about how they look and smell. When they have on clean clothes,
56
they know they look their best and their self-confidence grows.
 Most people take clean laundry for granted, but when an elderly
person is limited in ability; it can seem like an impossible goal.
 Clean laundry is important for everyone, but many family caregivers
don’t take into consideration what it takes for an aging adult to
gather, sort, wash, dry, fold and put away clothes, bedding, and
towels. Family caregivers can pitch in and help, but the best way to
ensure their aging relatives have clean laundry is to hire a home care
provider.
15.TAKING MEDICATION
ttps://www.google.com/search?q=Medication+safety+for- Retrieved on September 6, 2020
 Take your medicine regularly and according to your health care

provider's instructions. Don't take prescription medications that your
health care provider has not prescribed for you.
 And don't skip doses or stop taking medication without first
consulting with your provider.
MEDICATION SAFETY TIPS FOR OLDER ADULTS

 Keep a medication list
 Take medicine as prescribed:
 Talk to a doctor about side-effects
 Be aware of potential drug interactions:
Focus Questions
57
1. What is the role of Health Care Provider in patients’ ADL?
2. How important activities of daily living among elderly?
Related Readings
q=medication+safety+for+older+adults&oq=&aqs=
https://www.google.com/search?q=taking+medicatio
https://www.google.com/search?q=doing+laundry+for+elderly&
https://www.google.com/search?q=elderly+meal+plan+samples&
https://www.google.com/search?q=functional+status&oq
Google Classroom
1. Categorize the different activities of daily living of adult persons.
2. Enumerate and discuss the most chronic illness affecting elderly.
References
q=medication+safety+for+older+adults&oq=&aqs=
https://www.google.com/search?q=taking+medicatio
https://www.google.com/search?q=doing+laundry+for+elderly&
https://www.google.com/search?q=elderly+meal+plan+samples&
https://www.google.com/search?q=bathing+for+elderly+purpose
https://www.google.com/search?sxsrf=ALeKk02tCLhu9Xi7dmI8k-Xnh7
https://www.google.com/search?sxsrf=ALeKk00DWTaqnAzYHgJgfCj71w
https://www.google.com/search?sxsrf=ALeKk02arscr-DoDTYFM
https://www.google.com/search?sxsrf=ALeKk03L28Cps6
UNIT 8-9 WEEK (8-9)- COMMON CHRONIC DISEASES AFFLICTING ELDERLY
58
Intended Learning Outcomes ( Week 8-9-ILO )

1. Discuss the causes of the most common diseases afflicting elderly
Introduction
Chronic disease: A disease that persists for a long time. A chronic disease is
one lasting 3 months or more, by the definition of the U.S. National Center
for Health Statistics. Chronic diseases generally cannot be prevented by
vaccines or cured by medication, nor do they just disappear. Eighty-eight
percent of Americans over 65 years of age have at least one chronic health
condition (as of 1998). Health damages behaviours - particularly tobacco
use, lack of physical activity, and poor eating habits - are major contributors
to the leading chronic diseases.
Key Terms
Antirheumatic drug- refers to agents used in the therapy of inflammatory
arthritis, predominantly rheumatoid arthritis.
Major Depression-is a mood disorder that causes a persistent feeling of
sadness and loss of interest and can interfere with your daily functioning.
Insulin -is a hormone made in your pancreas, a gland located behind your
stomach
Benign prostatic hyperplasia (BPH)-also called prostate enlargement, is a
noncancerous increase in size of the prostate gland.
Bradykinesia -means slowness of movement and is one of the cardinal
manifestations of Parkinson's disease.
Limb rigidity- refers to abnormal stiffness in the limbs or other body parts,
which prevents muscles from stretching and relaxing.
UV Rays-radiation that is in the region of the ultraviolet spectrum which
59
extends from about 280 to 320 nm in wavelength and that is primarily
responsible for sunburn, aging of the skin, and the development of skin
cancer.
Muscle wasting -is a loss of muscle mass due to the muscles weakening

and shrinking.
Diversional Activities- activities are quite diverse and may vary from:
Spiritual, cultural and social activities. Sensory enrichment, activities such
as pet therapy, aromatherapy and massage.
Kegel exercise-is like pretending you have to urinate and then holding it.
Gait -means the way a person walks.
Lecture Notes
UNIT 8-9- COMMON CHRONIC DISEASES AFFLICTING ELDERLY

1.ADULT ONSET DIABETES
https://www.google.com/search?q=diabetes&biw=1280&bih=578&sxsrf Retrieved on September 8, 2020
 Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a

form of diabetes that is characterized by high blood sugar, insulin
resistance, and relative lack of insulin. Common symptoms include
increased thirst, frequent urination, and unexplained weight loss.
NURSING IMPLICATIONS
 Diet control helps regulate weight, which is extremely important in
Type 2 diabetes.
 Eating healthy foods and following a diet program if overweight, is
essential and should be stressed in diabetic teaching
 Exercise burns calories, which helps control weight.
2.ARTHRITIS
60
https://www.google.com/search?q=arthritis+causes&tbm=isch&ved Retrieved on September 8, 2020
 Is the swelling and tenderness of one or more of your joints

 Symptoms of arthritis
 joint pain, tenderness and stiffness.
 inflammation in and around the joints.
 restricted movement of the joints.
 warm red skin over the affected joint.
 weakness and muscle wasting.
 Provide a variety of comfort measures (eg, application of heat or
cold; massage, position changes, rest; foam mattress, supportive
pillow, splints; relaxation techniques, diversional activities).
 Administer anti-inflammatory, analgesic, and slow-acting
antirheumatic medications as prescribed.
3.KIDNEY AND BLADDER PROBLEM
https://www.google.com/search?q=3.%09KIDNEY+AND+BLADDER+PROBL Retrieved on September 8, 2020
Kidney infection, also called pyelonephritis, is when bacteria or viruses
61
cause problems in one or both of your kidneys. It’s a type of urinary
tract infection (UTI).
 Your kidneys’ main job is to remove waste and take extra water from
your blood. They’re part of your urinary tract, which makes liquid
waste (urine) and removes it from your body. Like the exhaust
system on your car, you want everything to work like it should so
waste moves in one direction only: out.
 Your urinary tract is made up of your: Kidneys. These clean waste
from your blood and make urine (your pee).
SYMPTOMS OF A KIDNEY INFECTION INCLUDE:
 Blood or pus in your pee

 Fever and chills
 Loss of appetite
 Pain in your lower back, side, or groin
 Upset stomach or vomiting
 Weakness or fatigue
 You may also have some of the symptoms of a bladder infection, such
as:
 Burning or pain when you pee
 A constant urge to pee, even soon after you empty your bladder
 Cloudy or bad-smelling urine
 Pain in your lower belly
 Peeing much more often than usual
 Drink enough fluids, especially water. Most healthy people should

try to drink six to eight, 8-ounce glasses of fluid each day. Water is
the best fluid for bladder health. At least half of fluid intake should
be water. Some people need to drink less water because of certain
conditions, such as kidney failure or heart disease. Ask your
healthcare provider how much fluid is healthy for you.
 Limit alcohol and caffeine. Cutting down on alcohol and caffeinated
foods and drinks—such as coffee, tea, chocolate, and most sodas—
may help.
 Quit smoking. If you smoke, take steps to quit . If you don’t smoke,
don’t start.
 Avoid constipation. Eating plenty of high-fiber foods (like whole
grains, vegetables, and fruits), drinking enough water, and being
62
physically active can help prevent constipation.
 Keep a healthy weight. Making healthy food choices and being
physically active can help you keep a healthy weight.
 Exercise regularly. Physical activity can help prevent bladder
problems, as well as constipation. It can also help you keep a
healthy weight.
 Do pelvic floor muscle exercises. Pelvic floor exercises, also known
as Kegel exercises, help hold urine in the bladder. Daily exercises
can strengthen these muscles, which can help keep urine from
leaking when you sneeze, cough, lift, laugh, or have a sudden urge
to urinate.
 Use the bathroom often and when needed. Try to urinate at least
every 3 to 4 hours. Holding urine in your bladder for too long can
weaken your bladder muscles and make a bladder infection more
likely.
 Take enough time to fully empty the bladder when
urinating. Rushing when you urinate may not allow you to fully
empty the bladder. If urine stays in the bladder too long, it can
make a bladder infection more likely.
 Be in a relaxed position while urinating. Relaxing the muscles
around the bladder will make it easier to empty the bladder. For
women, hovering over the toilet seat may make it hard to relax, so
it is best to sit on the toilet seat.
 Wipe from front to back after using the toilet. Women should wipe
from front to back to keep bacteria from getting into the urethra.
This step is most important after a bowel movement.
 Urinate after sex. Both women and men should urinate shortly after
sex to flush away bacteria that may have entered the urethra during
sex.
 Wear cotton underwear and loose-fitting clothes. Wearing loose,
cotton clothing will allow air to keep the area around the urethra
dry. Tight-fitting jeans and nylon underwear can trap moisture and
help bacteria grow.
4.DEMENTIA
63
https://www.google.com/search?q=4.%09Dementia&tbm=isch&v Retrieved on September 8, 2020
 Dementia is a collective term used to describe various symptoms of

cognitive decline, such as forgetfulness.
 It is a symptom of several underlying diseases and brain disorders.
 Dementia is not a single disease in itself, but a general term to
describe symptoms of impairment in memory, communication, and
thinking.
NURSING INTERVENTION
 Orient client. Frequently orient client to reality and surroundings.

 Encourage caregivers about patient reorientation.
 Enforce with positive feedback.
 Explain simply.
 Discourage suspiciousness of others
 Avoid cultivation of false ideas
 Observe client closely
5.PARKINSON’S DISEASE
https://www.google.com/search?q=parkinson%27s+disease&sxsrf= Retrieved on September 9, 2020
64
 Parkinson's disease (PD) is a neurodegenerative disorder that affects
predominately dopamine-producing (“dopaminergic”) neurons in a
specific area of the brain called substantia nigra.
 Symptoms generally develop slowly over years.
 The progression of symptoms is often a bit different from one person
to another due to the diversity of the disease. People with PD may
experience:
 Tremor, mainly at rest and described as pill rolling tremor in hands.
Other forms of tremor are possible
 Bradykinesia
 Limb rigidity
 Gait and balance problems
 Assess neurological status.
 Assess ability to swallow and chew.
 Provide high-calorie, high-protein, high-fiber soft diet with small,
frequent feedings.
 Increase fluid intake to 2000 mL/day.
 Monitor for constipation.
 Promote independence along with safety measures.
 Avoid rushing the client with activities.
 Assist with ambulation and provide assistive devices.
 Instruct client to rock back and forth to initiate movement.
 Instruct the client to wear low-heeled shoes.
 Encourage the client to lift feet when walking and avoid prolonged
sitting.
 Provide a firm mattress, and position the client prone, without a pillow,
to facilitate proper posture.
 Instruct in proper posture by teaching the client to hold the hands
behind the back to keep the spine and neck erect.
 Promote physical therapy and rehabilitation.
 Administer anticholinergic medications as prescribed to treat tremors
and rigidity and to inhibit the action of acetylcholine.
 Administer antiparkinsonian medications to increase the level of
dopamine in the CNS.
 Instruct the client to avoid foods high in vitamin B6 because they block
the effects of antiparkinsonian medications.
 Instruct the client to avoid monoamine oxidase inhibitors because they
will precipitate hypertensive crisis.
6.GLAUCOMA
65
https://www.google.com/search?q=6.%09GLAUCOMA&tbm=isch&v Retrieved on September 8,2020
 Is a group of eye conditions that damage the optic nerve, the health
of which is vital for good vision.
 This damage is often caused by an abnormally high pressure in your
eye.
 Glaucoma is one of the leading causes of blindness for people over
the age of 60.
SIGN AND SYMPTOMS
 Blurred vision that happens suddenly

 Severe eye pain, often described as an intense, throbbing pain, along
with reddening of the eye
 Headache around the eyes or the forehead
 Nausea and vomiting accompanied by severe eye pain
 Seeing halos around lights, such as rainbow-colored circles around
lights or unusual sensitivity to lights
7.LUNG DISEASE
https://www.google.com/search?q=lung+disease&tbm=isch&ved Retrieved on September 9, 2020
66
 Lung diseases are some of the most common medical conditions in the
world. Tens of millions of people have lung disease in the U.S. alone.
Smoking, infections, and genes cause most lung diseases.
 Your lungs are part of a complex system, expanding and relaxing
thousands of times each day to bring in oxygen and send out carbon
dioxide. Lung disease can happen when there are problems in any part
of this system.
Your windpipe (trachea) branches into tubes called bronchi, which in

turn become smaller tubes throughout your lungs. Diseases that can
affect these airways include:
1. Asthma. Your airways are constantly inflamed and may spasm,
causing wheezing and shortness of breath. Allergies, infections, or
pollution can trigger asthma symptoms.
2. Chronic obstructive pulmonary disease (COPD). With this lung

condition, you can’t exhale the way you usually would, which causes
trouble breathing.
3. Chronic bronchitis. This form of COPD brings a long-term wet cough.
4. Emphysema. Lung damage allows air to be trapped in your lungs in
this form of COPD. Trouble blowing air out is its hallmark.
5. Acute bronchitis. This sudden infection of your airways is usually
caused by a virus.
6. Cystic fibrosis. With this condition, you have trouble clearing mucus
out of your bronchi. This leads to repeated lung infections.
Your airways branch into tiny tubes (bronchioles) that end in clusters of
air sacs called alveoli. These air sacs make up most of your lung tissue.
Lung diseases affecting your alveoli include:
7. Pneumonia. An infection of your alveoli, usually by bacteria or
viruses, including the coronavirus that causes COVID-19.
Tuberculosis Pneumonia that slowly gets worse, caused by the bacteria
Mycobacterium tuberculosis.
8. Emphysema. This happens when the fragile links between alveoli are
damaged. Smoking is the usual cause. (Emphysema also limits airflow,
affecting your airways.)
Pulmonary edema. Fluid leaks out of the small blood vessels of your
lung into the air sacs and the area around them. One form is caused by
heart failure and back pressure in your lungs' blood vessels. In another
form, injury to your lung causes the leak of fluid.
Lung cancer. It has many forms and may start in any part of your lungs.
It most often happens in the main part of your lung, in or near the air
sacs.
Acute respiratory distress syndrome (ARDS). This is a severe, sudden
injury to the lungs from a serious illness. COVID-19 is one example.
Many people who have ARDS need help breathing from a machine
called a ventilator until their lungs recover.
67
Pneumoconiosis. This is a category of conditions caused by inhaling
something that injures your lungs. Examples include black lung disease
from coal dust and asbestosis from asbestos dust.
Patient and family teaching is an important nursing intervention to

enhance self-management in patients with any chronic pulmonary
disorder.
To achieve airway clearance: The nurse must appropriately administer

bronchodilators and corticosteroids and become alert for potential side
effects.
1. Direct or controlled coughing. The nurse instructs the patient in direct

or controlled coughing, which is more effective and reduces fatigue
associated with undirected forceful coughing.
2. Inspiratory muscle training. This may help improve the breathing

pattern.
3. Diaphragmatic breathing. Diaphragmatic breathing reduces
respiratory rate, increases alveolar ventilation, and sometimes helps
expel as much air as possible during expiration.
3. Pursed lip breathing. Pursed lip breathing helps slow expiration,
prevents collapse of small airways, and control the rate and depth of
respiration.
To improve activity intolerance:
4. Manage daily activities. Daily activities must be paced throughout the
day and support devices can be also used to decrease energy
expenditure.
5. Exercise training. Exercise training can help strengthen muscles of the
upper and lower extremities and improve exercise tolerance and
endurance.
6. Walking aids. Use of walking aids may be recommended to improve
activity levels and ambulation.
TO MONITOR AND MANAGE POTENTIAL COMPLICATIONS:
1. Monitor cognitive changes. The nurse should monitor for cognitive
changes such as personality and behaviour changes and memory
impairment.
2. Monitor pulse oximetry values. Pulse oximetry values are used to
assess the patient’s need for oxygen and administer supplemental
oxygen as prescribed.
3. Prevent infection. The nurse should encourage the patient to be
68
immunized against influenza and S. pneumonia because the patient
is prone to respiratory infection
8.CATARACT
https://www.google.com/search?q=cataract+disease&tbm=isch&ved Retrieved on September 9, 2020
 A cataract is a dense, cloudy area that forms in the lens of the eye. A
cataract begins when proteins in the eye form clumps that prevent
the lens from sending clear images to the retina. The retina works by
converting the light that comes through the lens into signals.
SIGNS AND SYMPTOMS OF CATARACTS INCLUDE:
 Clouded, blurred or dim vision.

 Increasing difficulty with vision at night
 Sensitivity to light and glare
 Need for brighter light for reading and other activities
 Seeing "halos" around lights
 Frequent changes in eyeglass or contact lens prescription
 Fading or yellowing of colors
PREVENTION OF CATARACTS
 To reduce your risk of developing cataracts:

 protect your eyes from UVB rays by wearing sunglasses outside
 have regular eye exams
 stop smoking
 eat fruits and vegetables that contain antioxidants
 maintain a healthy weight
 keep diabetes and other medical conditions in check
9.OSTEOPOROSIS
69
https://www.google.com/search?q=osteoporosis&tbm=isch&ve Retrieved on September 9, 2020
 Is a bone disease that occurs when the body loses too much bone,
makes too little bone, or both. As a result, bones become weak and
may break from a fall or, in serious cases, from sneezing or minor
bumps. Osteoporosis means “porous bone.” Viewed under a
microscope, healthy bone looks like a honeycomb.
Signs and Symptoms

 Back pain, caused by a fractured or collapsed vertebra.
 Loss of height over time.
 A stooped posture.
 A bone that breaks much more easily than expected.
NURSING INTERVENTIONS APPROPRIATE FOR A PATIENT WITH
OSTEOPOROSIS ARE:
 Promoting understanding of osteoporosis and the treatment

regimen. Patient teaching focuses on factors influencing the
development of osteoporosis, interventions to arrest or slow the
process, and measures to relieve symptoms.
 Relieving pain. Advise the patient to rest in bed in a supine or side-
lying position several times a day; the mattress should be firm and
non-sagging; knee flexion increases comfort; intermittent
local heat and back rubs promote muscle relaxation, and
the nurse should encourage good posture and teach body
mechanics.
 Improving bowel movement. Early institution of high fiber
diet, increased fluids, and the use of prescribed stool softeners help
prevent or minimize constipation.
 Preventing injury. The nurse encourages walking, good body
mechanics, and good posture plus daily weight-bearing activity
outdoors to enhance production of vitamin D.
10.ENLARGED PROSTATE
70
 An enlarged prostate means the gland has grown bigger. Prostate
enlargement happens to almost all men as they get older.
An enlarged prostate is often called benign prostatic hyperplasia
(BPH). It is not cancer, and it does not raise your risk
for prostate cancer.
https://www.google.com/search?q=enlarged+prostate&tbm=isch&ved Retrieved on September 9, 2020
SYMPTOMS MAY INCLUDE:
 Dribbling at the end of urinating.

 Inability to urinate (urinary retention)
 Incomplete emptying of your bladder.
 Incontinence.
 Needing to urinate 2 or more times per night.
 Pain with urination or bloody urine (these may indicate infection)
 Slowed or delayed start of the urinary stream
 Provide and encourage meticulous catheter and perineal care.

 Reduces risk of ascending infection.
 Recommend sitz bath as indicated
 Promotes muscle relaxation, decreases edema, and may enhance
voiding effort.
11.ALZHEIMER’S DISEASE
71
https://www.google.com/search?q=alzheimer%27s+disease&tb Retrieved on September 9, 202
 Alzheimer's disease is a progressive disorder that causes brain cells

to waste away (degenerate) and dies.
 Alzheimer's disease is the most common cause of dementia — a
continuous decline in thinking, behavioral and social skills that
disrupts a person's ability to function independently
 Assess patient’s ability for thought processing every shift. Observe

patient for cognitive functioning, memory changes, disorientation,
difficulty with communication, or changes in thinking patterns.
 Assess the level of cognitive disorders such as change to orientation
to people, places and times, range, attention, thinking skills.
 Assess level of confusion and disorientation.
 Assess patient’s ability to cope with events, interests in surroundings
and activity, motivation, and changes in memory pattern.
 Orient patient to environment as needed, if patient’s short term
memory is intact. Using of calendars, radio, newspapers, television
and so forth, are also appropriate.
 Assess patient for sensory deprivation, concurrent use of CNS drugs,
poor nutrition, dehydration, infection, or other concomitant disease
processes.
 Maintain a regular daily schedule routine to prevent problems that
may result from thirst, hunger, lack of sleep, or inadequate exercise.
 Allow patient the freedom to sit in a chair near the window, utilize
books and magazines as desired.
72
 Label drawers, use written reminders notes, pictures, or color-coding
articles to assist patients.
 Allow hoarding and wandering in a controlled environment, as
appropriate or within acceptable limitations.
 Provide positive reinforcement and feedback for positive behaviors.
12.DEPRESSION
https://www.google.com/search?q=depression&tbm=isch&ved=2 Retrieved on September 9, 2020
 Is a mood disorder that causes a persistent feeling of sadness and

loss of interest.
 Also called major depressive disorder or clinical depression, it affects
how you feel, think and behave and can lead to a variety of
emotional and physical problems.
THE MOST COMMON CAUSE OF DEPRESSION IN OLDER ADULTS
 These include a fear of death or dying as well as anxiety over

financial problems or health issues.
 Recent bereavements. The death of friends, family members, and
pets, or the loss of a spouse or partner is common causes of
depression in older adults.
SIGNS AND SYMPTOMS OF DEPRESSION IN OLDER ADULTS
 Sadness or feelings of despair

 Unexplained or aggravated aches and pains
 Loss of interest in socializing or hobbies
 Weight loss or loss of appetite
 Feelings of hopelessness or helplessness
73
 Lack of motivation and energy
 Sleep disturbances (difficulty falling asleep or staying asleep,
oversleeping, or daytime sleepiness)
 Loss of self-worth (worries about being a burden, feelings of
worthlessness or self-loathing)
 Slowed movement or speech
 Increased use of alcohol or other drugs
 Fixation on death; thoughts of suicide
 Memory problems
 Neglecting personal care (skipping meals, forgetting meds, neglecting
personal hygiene)
 Assist with self-care and personal hygiene.

 Encourage patient to eat.
 Give warm milk or back rubs at bedtime to improve sleep.
 Plan activities for times when the patient's energy level peaks.
Focus Question
Instruction: Answer the following questions in complete sentence with

rubrics provided thru Google Classroom.
1. What is depression and its effects the patient and family?
2. How lung disease fatal among elderly?
3. What is the use of pulse oximeter in monitoring lung problem?
4. How chronic illness does affect the activity of daily living among
elderly?
5. How to combat depression in adult?
Related Readings
For supplemental readings on the Care of Adults please refer to the sources
provided
74
Maree, Bernoth (2016). Healthy Ageing and Aged Care.
Robnette, H.R., Brossoie. N., & Walter,C. ( 2020) Gerontology for the Health
Care Professional ( 4th ed )
Jennifer Kim and Sally Miller (2017). Geriatric Syndrome. Journal American
Geriatric Society
Directions: Answer the following essay questions with rubrics thru Google
Classroom.
1. Categorize the different activities of daily living of adult persons.
References
https://www.google.com/search?ei=vydXX5j9FY290PEP8oabkAQ&
ei=li5XX8qvH4PAoATegpiYCw&q=adult+diabetes+nursing
https://www.google.com/search?ei=ki9XXOLISu0PEPmyV-
Ag&q=arthritis&oq
ei=3i9XXWLAqK70PEPzvmFqAk&q=arthritis+nursing+intervention
https://www.webmd.com/a-to-z-guides/kidney-infections-symptoms-and-
treatments#1
ei=ezFXX7LYEcPGmAWCzqqgDA&q=dementia&oq=dementia
https://www.google.com/search?ei=_TFXX7-
hM6OwmAXI4YPQBQ&q=dementia+nursing+interventions&o
https://www.parkinson.org/understanding-parkinsons/what-is-parkinsons
https://www.parkinson.org/understanding-parkinsons/what-is-parkinsons
https://www.google.com/search?ei=mjtXX9TXMtG-0PEPpYymmA0&q=
https://www.webmd.com/lung/lung-diseases-overview
75
https://www.healthline.com/health/cataract#:~:text=A%20cataract%20is
%20a%20dense
https://www.nof.org/patients/what-is-osteoporosis/#:
https://medlineplus.gov/ency/article/000381.htm#:~:text=An%20enlarged
https://www.mayoclinic.org/diseases-conditions/alzheimers-
disease/symptoms-causes/syc-20350447
https://www.mayoclinic.org/diseases-conditions/depression/symptoms-
causes/syc-20356007
https://www.helpguide.org/articles/depression/depression-in-older-
adults.htm
76
https://www.google.com/search?q=
image+on+gastrointestinal+older+adults Retrieved on August 8,2020
1. Reduced GI secretions, reduced GI motility, decreased weight of

liver,reduced regenerative capacity of liver,liver metabolizes less
efficiently.
2. In old age, the rate of gastric secretion decreases and incidence of
peptic ulcer and gastritis increases. These gastric problems in adult
may be a result of Helicobacter pylori, drug ingestion or genetically
programmed changes that may occur in old age.
F. Excretory System
https://www.google.com/search?q=image+on+genitourinary+older+adult Retrieved on August 8,2020
3. The kidneys of older adults have more difficult time responding to

any added metabolic stressor on the body when nephron becomes
less efficient and fewer in numbers. Like other the other organs,
older kidneys work well under normal conditions but have reduced
tolerance for disease, whether originating from the kidneys
themselves or from other organs. This is why older adults are more
likely to experience acute or chronic renal failure than younger
individual.
G. Musculoskeletal System
77
https://www.google.com/search?q=image+on+musculoskeletal+older+adult Retrieved on August 8,2020
4. Musculoskeletal dysfunction is a major cause of disability in older

adults altering mobility, fine motor control, and the mechanics of
respiration. It occurs as a result of a decline in muscle mass
( sarcopenia ), which causes overall strength to deteriorate. Other
changes that take place within musculoskeletal system include
decreased reflexes, loss of cartilage and thinning of the vertebrae,
decrease calcium absorption, joint cartilage deterioration and
deterioration of extrapyramidal system.
5. As people age, their joints are affected by changes in cartilage and in

connective tissue. The cartilage inside a joint becomes thinner, and
components of the cartilage (the proteoglycans—substances that
help provide the cartilage's resilience) become altered, which may
make the joint less resilient and more susceptible to damage. Thus,
in some people, the surfaces of the joint do not slide as well over
each other as they used to. This process may lead to osteoarthritis.
Additionally, joints become stiffer because the connective tissue
within ligaments and tendons becomes more rigid and brittle. This
change also limits the range of motion of joints.
H. Nervous System
https://www.google.com/search?q=image+on+nervous+system+older+adults Retrieved on August 8,2020
6. The nervous system in older adult loses nerve cell mass and shows
78
some brain atrophy. Nerve cells and dendrites decline in number,
which allows transformation, shortens reaction times and weakens
reflexes. Brain weight is said to decrease with age, but this does not
seem to interfere with individual thought process.
7. As one ages there is a loss of up to 10,000 nerve cells a day. While

there is a loss of all cell types in the body as part of the aging
process, nerve cells do not reproduce so the lost cells are not
replaced. The loss of nerve cells results in a decreases in the function
of the nervous system. The exact function lost is depended on the
individual and the exact cells lost. As there are many more nerve
cells than are necessary for the proper functioning of the nervous
system, it is unlikely that routine loss of nerve cells causes any
apparent problems until advanced old age.
I.ENDOCRINE SYSTEM
https://www.google.com/search?q=image+on+endocrine+system+in+older+adults Retrieved on August 8,2020
8. As the body ages, changes occur that affect the endocrine system,
sometimes altering the production, secretion, and catabolism of
hormones. For example, the structure of the anterior pituitary gland
changes as vascularization decreases and the connective tissue
content increases with increasing age.
9. This restructuring affects the gland’s hormone production. For
example, the amount of human growth hormone that is produced
declines with age, resulting in the reduced muscle mass commonly
observed in the elderly.
10.The adrenal glands also undergo changes as the body ages; as fibrous
tissue increases, the production of cortisol and aldosterone
decreases.
11.Interestingly, the production and secretion of epinephrine and
norepinephrine remain normal throughout the aging process.
J.IMMUNE SYSTEM
79
https://www.google.com/search?q=image+on+immune+system+in+older+adult Retrieved on August 8,2020
12.The age related decline of immune system functioning gives arises to

three general categories of illness that preferentially afflict older
adults:
13.Infection
14.Cancer
15.Autoimmune disease
16.The overall incidence of infectious disease rises in late adulthood.

Infection diseases, particularly prevalent among older adults are
17.Influenza
18.Pneumonia
19.Tuberculosis
20.Meningitis
21.Urinary tract infection.
22.Cancer increases in prevalence with age such as:

23.Leukemia
24.Lung
25.Prostate
26.Breast
27.Stomach
28.Pancreatic cancer
29.With aging, the outer skin layer (epidermis) thins, even though the
number of cell layers remains unchanged.
30.The number of pigment-containing cells (melanocytes) decreases.
The remaining melanocytes increase in size.
31.Aging skin looks thinner, paler, and clear (translucent).
32. Large pigmented spots, including age spots, liver spots, or lentigos,
may appear in sun-exposed areas.
33.Changes in the connective tissue reduce the skin's strength and
elasticity known as elastosis and more noticeable in sun-exposed
areas (solar elastosis).
34.Elastosis produces the leathery, weather-beaten appearance

common to farmers, sailors, and others who spend a large amount of
80
time outdoors.
35.The blood vessels of the dermis become more fragile that leads to:
36.Bruising
37.Bleeding under the skin (often called senile purpura)
38. Cherry angiomas
39.Sebaceous glands produce less oil as you age.
40.Men experience a minimal decrease, most often after the age of 80.
41. Women gradually produce less oil beginning after menopause.
42.This can make it harder to keep the skin moist, resulting in dryness
and itchiness.
43.The subcutaneous fat layer thins so it has less insulation and
padding.
44. This increases your risk of skin injury and reduces your ability to
maintain body temperature because you have less natural insulation,
you can get hypothermia in cold weather.
45.The sweat glands produce less sweat that makes it harder to keep
cool.
46. Your risk for overheating or developing heat stroke increases.
47.Growths such as:
48. skin tags
49. warts
50.rough patches (keratoses)
EFFECT OF CHANGES
51.As you age, you are at increased risk for skin injury.
52. Your skin is:
53.thinner
54.more fragile
55. lose protective fat layer
56.You also may be less able to sense:
57.touch
58.pressure
59.vibration
60.heat
61.and cold
62.Rubbing or pulling on the skin can cause skin tears.
63. Fragile blood vessels can break easily.
64. Bruises, flat collections of blood (purpura), and raised collections of
blood (hematomas) may form after even a minor injury.
65.Pressure ulcers can be caused by:
66.skin changes
67.loss of the fat layer
68.reduced activity
69.poor nutrition
70.and illnesses
81
71.Sores are most easily seen on the outside surface of the forearms,
but they can occur anywhere on the body.
72.Aging skin repairs itself more slowly than younger skin. Wound
healing may be up to 4 times slower.
73. This contributes to pressure ulcers and infections.
Factors Affects Healing:
74.diabetes
75.blood vessel changes
76.lowered immunity
COMMON PROBLEMS
Skin disorders are so common among older people that it is often hard to
tell normal changes from those related to a disorder. More than 90% of all
older people have some type of skin disorder.
77.Skin disorders can be caused by many conditions including:

Blood vessel diseases, such as
78. arteriosclerosis
79.diabetes
80. heart disease
81. liver disease
82.nutritional deficiencies
83.obesity
84.reactions to medicines
85.stress
86.Other causes of skin changes:
87.allergies to plants and other substances
88.climate
89.clothing
90.exposures to industrial and household chemicals
91.indoor heating
92.Sunlight can cause:
93.Loss of elasticity (elastosis)
94.Noncancerous skin growths (keratoacanthomas)
95.Pigment changes such as liver spots
96.Thickening of the skin
97.Sun exposure has also been directly linked to skin cancers including:
98.basal cell cancer
99.squamous cell carcinoma
100. melanoma
A .Major Components
1.FUNCTIONAL CAPACITY OF AN ADULT
82
101. Refers to the ability to perform activities necessary or
desirable in daily life.
102. Functional status is directly influenced by health conditions,
particularly in the context of an elder's environment and social
support network.
103. Changes in functional status (eg, not being able to bathe
independently) should prompt further diagnostic evaluation and
intervention.
104. Measurement of functional status can be valuable in
monitoring response to treatment and can provide prognostic
information that assists in long-term care planning.
2. FALL RISK
105. The injury rate for older adults falls in the midrange for all age
group, with 196 per 196 per 1000 persons injured among those aged
65 years old and older (Department of Commerce, 2010 ).
106. Older women have a higher rate of injuries than any adult
female age group whereas the rate among men declines through the
years.
107. Accidents rank as the six-leading cause of death for older
adults, with falls leading cause of injury related deaths.
108. Approximately one-third of community-dwelling persons age
65 years and one-half of those over 80 years of age fall each year.
109. Patients who have fallen or have a gait or balance problem are
at higher risk of having a subsequent fall and losing independence.
110. An assessment of fall risk should be integrated into the history
and physical examination of all geriatric patients (algorithm 1). (See
"Falls in older persons: Risk factors and patient evaluation", section
on 'Falls risk assessment' and "Causes and evaluation of neurologic
gait disorders in older adults".)
3.COGNITION
111. It decreases with age due to cumulative nature of lifestyle
choices (e.g., in the realm of nutrition, self- neglect, or substance use
or abuse).
112. The incidence of dementia increases with age, particularly
among those over 85 years, yet many patients with cognitive
impairment remain undiagnosed. The value of making an early
diagnosis includes the possibility of uncovering treatable conditions.
The evaluation of cognitive function can include a thorough history
and brief cognition screens.
113. If these raise suspicion for cognitive impairment, additional
evaluation is indicated, which may include detailed mental status
examination, neuropsychologic testing, tests to evaluate medical
conditions that may contribute to cognitive impairment (eg, B12,
thyroid-stimulating hormone [TSH]), depression assessment, and/or
83
radiographic imaging (computed tomography [CT] or magnetic
resonance imaging [MRI]).
4.MOOD
114. Psychological changes can be influenced by general health
status, genetic factors, educational achievements, activity and
physical and social changes.
115. Depressive illness in the elder population is a serious health
concern leading to unnecessary suffering, impaired functional status,
increased mortality, and excessive use of health care resources.
(See "Diagnosis and management of late-life unipolar depression".)
5.POLYPHARMACY
116. Older persons are often prescribed multiple medications by
different health care providers, putting them at increased risk for
drug-drug interactions and adverse drug events. The clinician should
review the patient's medications at each visit.
117. The best method of detecting potential problems with
polypharmacy is to have patients bring in all of his/her medications
(prescription and nonprescription) in their bottles.
118. Discrepancies between what is documented in the medical
record and what the patient is actually taking must be reconciled.
119. As health systems have moved towards electronic health
records and e-prescribing, the potential to detect potential
medication errors and interactions has increased substantially.
120. Although this can improve safety, record-generated messages
about unimportant or rare interactions may lead to "reminder
fatigue."
121. The high prevalence of health condition in the older
population causes this group to use a large member and variety of
medication. Drug use by older adults has been steadily increasing
every year, most older people use at least one drug regularly.
122. Researchers have found that the number of drugs used by
older persons increase with age.
The most used drugs by the older population include:
123. cardiovascular agents

124. antihypertensive
125. analgesics
126. antiarrhritic agents
127. sedatives
128. tranquilizers
129. laxatives
130. antacid
6.SOCIAL SUPPORT
84
https://www.google.com/search?q=image+on+social+support+in+older+adult Retrieved on August 8,2020
131. Social support is characterized by the functional and

qualitative dimension of the network of social relations and may
be offered by means of help, care or instrumental, economic
social, physical and emotional accompaniment, exercised
reciprocally or unilaterally.
132. Having a positive social lifestyle can increase
an elderly person's psychological and physical well-being, lowering
their amount of stress, and helping treat issues such as anxiety or
depression.
133. The existence of a strong social support network in an elder's
life can frequently be the determining factor of whether the patient
can remain at home or needs placement in an institution.
134. A brief screen of social support includes taking a social history
and determining who would be available to the elder to help if he or
she becomes ill.
135. Early identification of problems with social support can help
planning and timely development of resource referrals.
136. For patients with functional impairment, the clinician should
ascertain who the person has available to help with activities of daily
living.
7.FINANCIAL CONCERN
https://www.google.com/search?q=image+on+financial+concer+in+older+adult Retrieved on August 8,2020
137. Older adults’ financial situations are a function of their income,

wealth, costs, and debts, with housing costs a major piece of the
household budget.
138. The financial situation of a functionally impaired older adult is
85
important to assess. Elders may qualify for state or local benefits,
depending upon their income.
139. Older patients occasionally have other benefits such as long-
term care insurance or veteran's benefits that can help in paying for
caregivers or prevent the need for institutionalization.
8.GOALS OF CARE
140. Older adult patients who are appropriate for CGA have limited
potential to return to fully healthy and independent lives. Hence,
choices must be made about what outcomes are most important for
them and their families.
141. Goals of care often differ from advance care preferences that
focus on future states of health that would be acceptable,
determination of surrogates to make decisions, and medical
treatments.
142. Generally, advance directives are framed in the context of
future deterioration of health status.
143. By contrast, a patient’s goals of care are often positive (eg,
regaining a previous health status, attending a future family event).
Frequently, social (eg, living at home, maintaining social activities)
and functional (eg, completing ADLs without help) goals assume
priority over health-related goals (eg, survival).
144. They are also patient-centric and individualized. For example,
regaining independent ambulation after a hip fracture may be a goal
for one patient whereas another might be content with use of a
walker.
145. Both short-term and longer-range goals should be considered
and progress towards meeting these goals should be monitored,
including reassessment if goals are not met within a specified time
period. One approach that has been used in CGA is Goal Attainment
Scaling .
9.ADVANCE CARE PREFERENCES

146. Clinicians should begin discussions with all patients about
preferences for specific treatments while the patient still has the
cognitive capacity to make these decisions.
147. These discussions should include preparation for in-the-
moment decision-making which includes :
148. choosing an appropriate decision-maker
149. clarifying and articulating patients’ values over time
150. thinking about factors other than the patient's stated
preferences in surrogate decision-making.
151. As an example, patients who want to extend their life as long

as possible might be asked about what should be done if the
86
patient’s health status changes and doctors recommend against
further treatment, or if it becomes too hard for loved ones to keep
them at home.
152. Advance directives help guide therapy if a patient is unable to
speak for him or herself and are vital to caring optimally for the
geriatric population:
153. Advance care planning is one key element to achieving patient
autonomy by allowing patients to participate in decisions about their
medical care.
154. Advance care planning is based on the premise that on-going
discussions about end-of-life issues accompanied by written advance
directives are valuable to help loved ones, physicians, and other
providers better understand and make treatment decisions
consistent with patients' wishes, if the patient becomes
incapacitated.
ADDITIONAL COMPONENTS
1.NUTRITION/ WEIGHT
https://www.google.com/search?q=nutritional+stutus++in+older+adult Retrieved on August 8,2020
155. Older persons are particularly vulnerable to malnutrition.

Moreover, attempts to provide them with adequate nutrition
encounter many practical problems.
156. First, their nutritional requirements are not well defined.
157. Since both lean body mass and basal metabolic rate decline
with age, an older person’s energy requirement per kilogram of body
weight is also reduced.
2.URINARY CONTINENCE
158. Urinary frequency, urgency, and nocturia accompany bladder

changes with age. Bladder muscles weaken and bladder capacity
decreases.
87
159. Emptying of the bladder more difficult; retention of large
volumes of urine may result.
3.SEXUAL FUNCTION
160. Many people want and need to be close to others as they grow
older.
161. It includes the desire to continue an active, satisfying sex life.
162. With aging, that may mean adapting sexual activity to
accommodate physical, health, and other changes.
4.VISION/ HEARING
https://www.google.com/search?q=image+on+hearing+impairment+in+older Retrieved on August 8,2020
163. Change in vision is due to alteration to structural components

of the visual system.
164. The sharpness of your vision (visual acuity) gradually declines.
165. The most common problem is difficulty focusing the eyes on
close-up objects. This condition is called presbyopia. Reading glasses,
bifocal glasses, or contact lenses can help correct presbyopia.
166. Common eye disorders that cause vision changes that are NOT
normal includes:
167. Cataracts- clouding of the lens of the eye

168. Glaucoma-rise in fluid pressure in the eye
169. Macular degeneration- disease in the macula (responsible for
central vision) that causes vision loss
170. Retinopathy -- disease in the retina often caused by diabetes
or high blood pressure
171. Hearing occurs after sound vibrations cross the eardrum to

the inner ear.
172. The vibrations are changed into nerve signals in the inner ear
and are carried to the brain by the auditory nerve.
88
173. Structures inside the ear start to change and their functions
decline. Your ability to pick up sounds decreases.
174. You may also have problems maintaining your balance as you
sit, stand, and walk.
5.Dentition
https://www.google.com/search?q=dentition+in+older+adult . Retrieved on August 8,2020
175. Only in the last decade has the possible effect of oral health on
the general health and mortality of elderly people attracted much
attention.
176. An association between number of teeth and mortality has
been reported in several studies. As people age, many lose teeth.
177. Tooth loss reduces masticatory capacity, which can influence
food selection, nutritional status, and general health.
178. Evidence is also increasing that oral infections play a role in the
pathogenesis of some systemic diseases.
6.Living condition
179. The World Health Organization defined quality of life as an

“individual perception of his or her living situation, understood in a
cultural context, value system and in relation to the objectives,
expectations and standards of a given society”.
180. From this perspective, health-related quality of life includes
areas such as physical health, psychological state, level of
independence of the person, personal relationships, beliefs in a
particular context or the natural environment, social support, and
perceived social support.
7.Spirituality
181. Is the essence of our being that transcends and connect us to
the Divine and other living organisms. It involves relationships and
feelings (Eliopoulos, 2014).
89
182. Spiritual Needs
183. Love
184. Meaning and purpose
185. Hope
186. Dignity
187. Forgiveness
188. Gratitude
B. Best Indication for CGA
1. Age
189. Older people admitted for acute inpatient hospital care are at
high risk of adverse events, long stays, readmission and long term
care use.
190. There is considerable evidence on assessment and co-
ordination of care for older patients with complex needs using
Comprehensive Geriatric Assessment.
2.Medical Comorbidity
191. Older adults generally have multiple medical problems as well

as subclinical changes in several physiologic systems.
3.Psychological Disorders
192. Mental health indicates a capacity to cope effectively with and

manage life’s stresses in an effort to achieve a state of emotional
homeostasis.
Selected Mental Health Conditions:
193. Depression
194. Anxiety
195. Alcohol abuse
196. Hypochondriasis
197.
Specific geriatric condition:
198. Dementia
199. Fall
Focus Question
Instruction: Answer the following questions in complete sentence with

200. Explain the importance of conducting comprehensive
90
assessment among older adult.
201. Discuss the effect of medication use among older client.
202. Describe the physiological and psychological changes among

older person.
Related Readings
For supplemental readings on Comprehensive Assessment please refer to

the sources provided.
messenger.
203. Discuss Comprehensive Geriatric Assessment
204. Describe the different physical, psychological and spiritual

changes among elderly clients.
References
Books
Eliopolous. C.,( 2014 ) Gerontogical Nursing ( 8th ed. )
Geriatric Society
Electronic.
1.https://courses.lumenlearning.com/atd-herkimer-
biologyofaging/chapter/development-and-aging-of-the-endocrine-system/.
2. https://www.hindawi.com/journals/jar/2011/156061/
91
5.https://academic.oup.com/ageing/article/47/1/149/4682984
6.https://academic.oup.com/biomedgerontology/article
UNIT 2 – WEEK (2 )- CONDUCTING ASSESSMENT
Intended Learning Outcomes ( Week 2- ILO )

205. Explain the purpose of conducting the assessment.
206. Discuss the method of conducting the assessment.
Introduction
The ability to assess patients in a holistic manner is a skill integral to

nursing regardless of the practice setting. Eliciting a complete health
history, using appropriate physical assessment skills, while respecting,
spiritual and cultural consideration Cheever,et al,2020).

Key Terms
Syndrome- a group of symptoms which consistently occur together, or a

condition characterized by a set of associated symptoms.
Delirium- is an abrupt change in the brain that causes mental confusion and
emotional disruption.
Dietician- is a medically trained professional that alters an individual's diet

based on medical conditions ...
92
Multifactorial-caused or marked by a polygenic mode of inheritance
dependent on a number of genes at different loci.
Podiatrists- a person who treats the feet and their ailments.
Lecture Notes
UNIT 2-CONDUCTING THE ASSESSMENT
https://www.google.com/search?q=image+on+conducting+assessment+on+elder Retrieved on August 10,2020
207. Geriatric conditions such as functional impairment and

dementia are common and frequently unrecognized or inadequately
addressed in older adults.
208. Identifying geriatric conditions by performing a geriatric
assessment can help clinicians manage these conditions and prevent
or delay their complications.
209. Geriatric syndrome is a term that is often used to refer to
common health conditions in older adults that do not fit into distinct
organ-based disease categories and often have multifactorial causes.
210. The lists includes conditions such as:
211. cognitive impairment
212. delirium
213. incontinence
214. malnutrition
215. falls
216. gait disorders
217. pressure ulcers
218. sleep disorders
219. sensory deficits
220. fatigue
221. dizziness
222. These conditions are common in older adults, and they may
have a major impact on quality of life and disability.
93
223. Geriatric syndromes can best be identified by a geriatric
assessment.
224. Although the geriatric assessment is a diagnostic process, the
term is often used to include both evaluation and management.
225. Geriatric assessment is sometimes used to refer to evaluation
by the individual clinician (usually a primary care clinician or a
geriatrician) and at other times is used to refer to a more intensive
multidisciplinary program, also known as a comprehensive geriatric
assessment (CGA).
226. The range of health care professionals working in the
assessment team varies based on the services provided by individual
comprehensive geriatric assessment (CGA) programs.
227. In many settings, the CGA process relies on a core team

consisting the following:
228. clinician
229. nurse
230. social worker
231. physical and
232. occupational therapists
233. dieticians
234. pharmacists
235. psychiatrists
236. psychologists
237. dentists
238. audiologists
239. podiatrists
240. opticians
241. These professionals are usually on-staff in the hospital setting
and are also available in the community, access to and
reimbursement for these services have limited the availability of CGA
programs.
242. Traditionally, the various components of the evaluation are
completed by different members of the team, with considerable
variability in the assessments.
243. The medical assessment of older persons may be conducted by
a physician (usually a geriatrician), nurse practitioner, or physician
assistant.
244. The core team (geriatrician, nurse, social worker) may conduct
only brief initial assessments or screens for some dimensions.
Focus Questions

94
245. What is the impact of health care professionals to geriatric
clients in conducting accurate assessment?
246. How does a geriatric condition affect their lives?
Related Readings
For supplemental readings on the conducting assessment, please see these

link
q=journal+of+comprehensive+assessment+on+elderly
https://www.youtube.com/watch?v=9ZoJZwE4If8
Learning/ Assessment Activities
Direction: Send your answer thru messenger to be submitted next week.

Rubrics will be given via messenger for the basis of your grade.
247. Explain the purpose of conducting the assessment.
248. Discuss the method of conducting the assessment.
Reference:
Geriatric Society
Unit 3- Week ( 3 )- INFORMATION TO BE COLLECTED
Intended Learning Outcome (Week 3-ILO )
249. Discuss the significance of data collection.
250. Contrast Urinary and Fecal Incontinence.
95
Introduction
Collecting healthcare data generated across a variety of sources

encourages efficient communication between doctors and patients, and
increases the overall quality of patient care providing deeper insights into
specific conditions.


knowledge that will be laid down in the succeeding pages.
Key Terms
Therapeutic Interventions- is an effort made by individuals or groups to

improve the well-being of someone else who either is in need of help but
refusing it or is otherwise unable to initiate or accept help.
Dementia- is a general term for loss of memory, language, problem-solving

and other thinking abilities that are severe enough to interfere with daily
life.
Comorbidities- the simultaneous presence of two chronic diseases or

conditions in a patient.
Epidemiological studies measure the risk of illness or death in an exposed

population compared to that risk in an identical, unexposed population.
Degenerative Disease- is the result of a continuous process based

on degenerative cell changes, affecting tissues or organs, which will
increasingly deteriorate over time.
Lecture Notes
UNIT 3- INFORMATION TO BE COLLECTED
1.Ability to perform functional task and need for assistance
96
251. The assessment of functional abilities in older adults refers to a
comprehensive assessment to determine the level of
independence that older adults have when performing activities of
daily living.
252. This assessment enables the planning of therapeutic
interventions, social care and clinical support, and also supports
clinical reasoning in detecting early signs of dementia.
2.Fall History
253. Falls are defined as an unintentional lowering to rest from a
higher to a lower position, not due to loss of consciousness or violent
impact (Kellogg International Work Group on the Prevention of Falls
by the Elderly, 1987).
254. Falls often go unrecognized by health care professionals
because they are not routinely evaluated while taking a patient’s
history or during a physical exam (unless there is frank injury).
255. Many patients do not admit to falling for fear of losing their
independence.
256. Many factors that contribute to fall risk in older adults. The
World Health Organization Europe (2004) has characterized risks into
two broad categories, intrinsic and extrinsic risk factors for falls.
257. Intrinsic risk factors include a history of falls, age, gender,
medical conditions, impaired mobility and gait, sedentary behavior,
psychological status, nutritional deficiencies, impaired cognition,
visual impairments and foot problems.
258. Many older adults have multiple comorbidities including
neurological, cardiovascular, metabolic, urinary, musculoskeletal,
and psychological disorders that may increase their risk of falls.
3.Urinary and Fecal Incontinence

259. Urinary incontinence the ability of the kidneys to regulate the
concentration of the bodily substances according to need diminishes
with age.
260. Pain in older adults is common and has a tremendous impact
on quality of life in this age group.
261. There is great variability in the reported prevalence, likely due

to differences in the reporting period for pain, the intensity of pain
reported, and composition of the older population studies.
262. Crook et al 5 reported age-specific rates 29% for those aged
between 71 and 80 years when asked “how often are you troubled
by pain during the past 2 weeks…” Brattburg et al6 reported a 12-
month prevalence of mild to severe pain in 75% in those over 75
years of age.
263. Epidemiologic studies commonly show that pain affecting
97
joints, feet, and legs is increased with age; that pain in the head,
abdomen, and chest is reduced; but back pain frequency varies
widely.7, 8, and 9.
264. The high prevalence of degenerative joint disease overwhelms
any contribution from other causes in all surveys.
Focused Questions
Instructions: Explain each question, before you start answering, read the
related readings for your reference. Please organize your essay with rubrics
provided via messenger.
265. How does data collection important?
Related Readings
https://link.springer.com/referenceworkentry
https://www.uth.tmc.edu/hgec/GemsAndPearls/geriatricSyndromes
https://www.sciencedirect.com/topics/medicine-and-dentistry/pain-in-
older-adult
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.6.114

Rubrics will be given via messenger for the basis of your grade
266. Discuss the importance of data collection.
267. Contrast urinary and faecal incontinence.
References
Books
Geriatric Society
Electronic
https://www.uth.tmc.edu/hgec/GemsAndPearls/geriatricSyndromes_Fall
98
Unit 4- Week( 4) : ELDERLY CLIENTELE DESIRE
Intended Learning Outcome ( ILO-week 4 )
1. Discuss the elderly clientele desires.
2. Elaborate the elderly clientele desires.
Introduction
Older persons receiving care and services at home may have difficulty
articulating their preferences, especially those regarding abstract matters
phrased as safety versus freedom. When that query was put to home care
clients, about one-third preferred to come and go as they pleased and be less
safe; about one-third preferred to be safe and protected even with restricted
freedom; and one-third were ambivalent, undecided, or wanted both safety
and autonomy.
This unit will focus on the definitions of interest and any other terms related.
It also deals with the basic concept of simple interest and discount.
To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential knowledge
that will be laid down in the succeeding pages. Please note that you are not
limited to exclusively refer to these resources. Thus, you are expected to
utilize other books, research articles and other resources that are available in
the library e.g. ebrary, search.proquest.com etc.
Key Terms
Distress- is a general term used to describe unpleasant feelings or emotions

that impact your level of functioning.
Treatment- medical care given to a patient for an illness or injury.
Self- determination- the process by which a person controls their own life
99
Lecture Notes
Unit 4- Unit 4- Elderly Clientele Desire
 Be recognized as a person and not regarded as a room number, a

disease,
 Be comforted ,to have distress recognized, perceived that health
workers are making efforts to make him physically and emotionally
comfortable, the aged person can tolerate pain if he or she is not being
neglected.
 Learn what is causing health problems or distress in terminology that
he or she can understand.
 Know what treatment and care is planned, length of treatment and
what can be expected as an end result.
 Have some self- determination what about activities he or she will take
part in so long as he or she does not injure self or others.
Focused Questions
Instructions: Explain the following questions in complete sentence. Rubrics

will be provided via messenger individually.
1. What are the common health problems in elderly clients?
Related Readings
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.6.114

Rubrics will be given via messenger for the basis of your grade.
1. Discuss the elderly clientele desires.
2. Elaborate the elderly clientele desires
100
References
Geriatric Society.
101

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LET’S BEGIN!

UNIT 16 ( WEEK 16 ) VERBAL AND NON VERBAL COMMUNICATIONS IN

At the end of the unit, you are expected to:

Effective communication with older people is an important aspect of

To attend the following intended learning outcomes for the first

UNIT 16- VERBAL AND NON VERBAL COMMUNICATIONS IN ELDERLY

https://www.google.com/search?q=verbal+communication+with+elderly+patients&sxsrf= Retrieved on November 11, 2020

 Verbal communication refers to the production of spoken language

1. USE PROPER FORM OF ADDRESS

https://www.google.com/search?q=verbal+communication+with+elderly Retrieved on November 11, 2020

 Establish respect right away by using formal language. As one patient

2. MAKE OLDER PATIENTS COMFORTABLE

https://www.google.com/search?q=verbal+communication+with+elderly+patients&hl= Retrieved on November 11, 2020

https://www.google.com/search?q=verbal+communication+with+elderly+patients&hl Retrieved on November 11, 2020

 Older people may have trouble following rapid-fire questioning or

https://www.google.com/search?q=verbal+communication+with+elderly+patients&sxsrf= Retrieved on November 12, 2020

 One study found that doctors, on average, interrupt patients within

5.USE ACTIVE LISTENING SKILLS

https://www.google.com/search?q=verbal+communication+with+elderly+patients&hl= Retrieved on November 12, 2020

 Watch for opportunities to respond to patients' emotions, using

7.AVOID MEDICAL JARGON

https://www.google.com/search?q=verbal+communication+with+elderly+patients&hl= Retrieved on November 12, 2020

 Try not to assume that patients know medical terminology or a lot

8.BE CAREFUL ABOUT LANGUAGE

 Some words may have different meanings to older patients than to

9.WRITE DOWN TAKE-AWAY POINTS

 It can often be difficult for patients to remember everything

10.ENSURE AN UNDERSTANDING OF THE HEALTH INFORMATION

https://www.google.com/search?q=verbal+communication+with+elderly+patients&Retrieved on November 12, 2020

11.COMPENSATING FOR VISUAL DEFICITS

https://www.google.com/search?q=verbal+communication+with+elderly+patients&h Retrieved on November 12, 2020

NON VERBAL COMMUNICATION

https://www.google.com/search?q=non+verbal+communication+with+elderly+patient Retrieved on November 12, 2020

 One useful way to categorize nonverbal communication is to

TIPS FOR WORDLESS COMMUNICATION

Supports your message. When having a conversation, participating in a

Communicates messages. You may also use nonverbal communication

Communicates intention. Your body language may also intentionally or

Showcases your personality. Nonverbal communication is a great way to

Indicates a desired action. This might include inching toward a door to

Instructions: Answer the following questions in complete sentence with

1. What is verbal and non- verbal communications?

UNIT 17 ( WEEK 17 ) NURSING INTERVENTION WITH ELDERLY OR FAMILY/

Intended Learning Outcomes ( Wee 17 -ILO )

At the end of the unit, you are expected to:

The Nursing Interventions Classification is a care classification system which

Please proceed immediately to the “Unlocking of Difficulties” part since the

To attend the following intended learning outcomes for the first

Rehabilitation: The process of helping a person who has suffered an illness

Reminiscence therapy is used to counsel and support older people, and is

UNIT 17-NURSING INTERVENTION WITH ELDERLY OR FAMILY/

https://www.google.com/search?q=nursing+intervention+among+elderl Retrieved on November 12, 2020

1. Giving sickness care including intensive care or elderly care such as

OTHER INTERVENTIONS INCLUDES:

https://www.google.com/search?q=reminiscence+therapy&hl=en&sxsrf=ALeKk Retrieved on November 13, 2020

 related to emotional and other issues, active listening, and presence.

https://www.google.com/search?q=THE+GENERAL+GUIDELINES+TO+CA Retrieved on November 13, 2020

 Support interventions may be provided via telephone, physical

 Expressive writing, as a very specific approach, is evaluated in ONS