GERIATRIC

NURSING
Definition of Terms
Geriatrics, the branch of medicine concerned
with the diagnosis, treatment and prevention of
disease in older people and the problems specific
to aging.
From the Greek “geron” meaning “old man” + “
iatreia” “ the treatment of disease”.

Geriatric nursing, is the field of nursing that

specializes in the care of the elderly

Gerontology, is the medical study of the aging

process
Is the scientific study of old age, emphasizing the
social and behavioral aspects of aging
Definition of Terms
Life Span, length of time that embraces all
the events of an organism's life, from
conception to death.
Is the maximum number of years an individual
can be expected to live in the absence of
disease or life-threatening trauma.

Life Expectancy, is the average number of

years that a person is expected to live.
 What is Aging?
A process that converts healthy adults into frail ones
with diminished reserves in most physiologic systems
and with an increasing vulnerability to most diseases.
A normal process of time-related change, begins with
birth and continues throughout life.
Theories of Aging
How AGING leads to the diseases of aging –
is still a mystery but there are theories?

The Endocrine System Theory, the organs

that secrete hormones regulating such
functions as metabolism, temperature, and
blood sugar levels, retain their ability to
function into advanced age.
these glands often become less sensitive to
the triggers that direct hormone secretion.
Theories of Aging
In the aging pancreas, for example, higher
blood sugar levels are required to stimulate
the release of insulin.
The ovaries and the testes, the endocrine
glands that regulate many aspects of sexual
reproduction.
 Theories of Aging
The Immune System Theory, A healthy immune
system protects the body against bacteria, viruses, and
other harmful agents by producing disease-fighting
proteins known as antibodies.
A healthy immune system also prevents the growth of
abnormal cells, which can become cancerous.
Theories of Aging
The immune theory believes that the entire
immune system loses its ability to distinguish
friend from foe within the body and attacks the
body's own tissues, producing what are called
autoimmune diseases.
The Wear and Tear Theory, suggests
that with use of the body, similar to a
machine, eventually wears out.
Theories of Aging
The Cross-Linkage Theory,
the noticeable changes in the
body’s collagen that leads to
wrinkles as person ages.
Theories of Aging
The Free Radical Theory, which
suggests that the body accumulates
cross-linking compounds or gathers
by-products (free radicals) that eventually
impede cell function
suggests that free radicals – highly reactive
by-products of oxidative metabolism react with
cellular constituents to generate dysfunctional
molecules that disrupt cellular function
The “Free Radical” Theory of Aging
Theories of Aging
The Senescent Factor (SF) Theory
One theory is based on the assumption that
aging, and diseases that occur more
frequently with advancing age, are caused by
structural damage to cells.
Theories of Aging
Erikson’sDevelopmental
Theory, Erikson theorized that a
person’s life consists of eight
stages, each representing a
crucial turning point in life
stretching from birth to death, with
its own developmental conflict to
be resolved.
The major developmental task of
old age is either to achieve ego
integrity or to suffer despair.
Developmental Tasks of
Older Adults
Maintenance of self-worth
Conflict resolution
Adjustment to the loss of dominant roles
Adjustment to the deaths of significant others
Environmental adaptation
Maintenance of optimal levels of wellness
Theories of Aging
The Activity Theory, which proposes that
life satisfaction in normal aging requires
maintaining the active lifestyle of middle age
The Continuity Theory, which proposes
that successful adjustment to old age requires
continuing life patterns across a lifetime.
Theories of aging
The Person-Environment Fit Theory,
considers the interrelationship between
people and their environment.
Theories of Aging
The Functional Consequences
Theory, normal age-related changes and
risk factors may negatively interfere with
patient outcomes and actually impair patient
activity and quality of life.
Psychosocial Aspects of
Aging
Successful psychological aging is reflected in
the ability of older people to adapt to physical,
mental, social, economic, and environmental
factors.
If the elderly are treated with dignity and
encouraged to maintain autonomy, the quality
of their lives will improve.
Stress and Coping in the
Older Adult
Coping patterns and the ability to adapt to stress develop
over the course of a lifetime and remain consistent later in
life.
Common stressors of old age include:
normal aging,
disabilities from chronic illness;
social and environmental losses
and deaths of significant others.
Many older adults rely strongly on their spiritual beliefs for
comfort during stressful times.
Living Arrangements
Older people often do best in their own
environment;
Many elderly people have
more-than-adequate financial resources and
good health even until very late in life;
 Living Arrangements

Recent retirees move to warmer climates and retirement

communities.
Older people may move in with a relative or to a nursing
home or an assisted living setting nearer a child’s home.
The Role of the Family
If dependency needs occur, the spouse often
assumes the responsibility of a caregiver.
In the absence of the surviving spouse, an
adult child usually assumes the responsibility.
 Psychosocial Stage 1 -
Trust vs. Mistrust
The first stage of Erikson’s theory of psychosocial
development occurs between birth and one year of age and
is the most fundamental stage in life.2
Because an infant is utterly dependent, the development of
trust is based on the dependability and quality of the child’s
caregivers.
If a child successfully develops trust, he or she will feel safe
and secure in the world. Caregivers who are inconsistent,
emotionally unavailable, or rejecting contribute to feelings of
mistrust in the children they care for. Failure to develop trust
will result in fear and a belief that the world is inconsistent
and unpredictable.
 Psychosocial Stage 2 -
Autonomy vs. Shame and
Doubt
The second stage of Erikson's theory of psychosocial
development takes place during early childhood and is focused
on children developing a greater sense of personal control.2

Like Freud, Erikson believed that toilet training was a vital part of
this process. However, Erikson's reasoning was quite different
then that of Freud's. Erikson believe that learning to control one’s
body functions leads to a feeling of control and a sense of
independence.

Other important events include gaining more control over food

choices, toy preferences, and clothing selection.

Children who successfully complete this stage feel secure and

confident, while those who do not are left with a sense of
inadequacy and self-doubt.
Psychosocial Stage 3 -
Initiative vs. Guilt

During the preschool years, children begin to

assert their power and control over the world
through directing play and other social
interaction.

Children who are successful at this stage feel

capable and able to lead others. Those who
fail to acquire these skills are left with a sense
of guilt, self-doubt and lack of initiative.3
 Psychosocial Stage 4 -
Industry vs. Inferiority
This stage covers the early school years from
approximately age 5 to 11.
Through social interactions, children begin to develop a
sense of pride in their accomplishments and abilities.
Children who are encouraged and commended by
parents and teachers develop a feeling of competence
and belief in their skills. Those who receive little or no
encouragement from parents, teachers, or peers will
doubt their ability to be successful.
 Psychosocial Stage 5 -
Identity vs. Confusion
During adolescence, children are exploring their
independence and developing a sense of self.
Those who receive proper encouragement and
reinforcement through personal exploration will emerge
from this stage with a strong sense of self and a feeling
of independence and control. Those who remain unsure
of their beliefs and desires will insecure and confused
about themselves and the future.
 Psychosocial Stage 6 -
Intimacy vs. Isolation
This stage covers the period of early adulthood when people
are exploring personal relationships.
Erikson believed it was vital that people develop close,
committed relationships with other people. Those who are
successful at this step will develop relationships that are
committed and secure.
Remember that each step builds on skills learned in previous
steps. Erikson believed that a strong sense of personal identity
was important to developing intimate relationships. Studies
have demonstrated that those with a poor sense of self tend to
have less committed relationships and are more likely to suffer
emotional isolation, loneliness, and depression.
Psychosocial Stage 7 -
Generativity vs. Stagnation

During adulthood, we continue to build our

lives, focusing on our career and family.
Those who are successful during this phase
will feel that they are contributing to the world
by being active in their home and community.
Those who fail to attain this skill will feel
unproductive and uninvolved in the world.
Psychosocial Stage 8 -
Integrity vs. Despair
This phase occurs during old age and is focused on reflecting
back on life.
Those who are unsuccessful during this phase will feel that
their life has been wasted and will experience many regrets.
The individual will be left with feelings of bitterness and
despair.
Those who feel proud of their accomplishments will feel a
sense of integrity. Successfully completing this phase means
looking back with few regrets and a general feeling of
satisfaction. These individuals will attain wisdom, even when
confronting death.
Age-Related
Decline
of Organ
Systems
or
Normal Changes
of Aging
Organ/ Change Physiologic effect Disease
System effect

Eyes Presbyopia ↓ accomodation Blindness

Cataracts ↑ susceptibility to glare
Need of good lighting
Organ/ Change Physiologic Disease
System effect effect
Ears ↓ high Impaired hearing Deafness
frequency with background
acuity noise
Organ/ Change Physiologic Disease
System effect effect

Skin Dry Easy bruising Ulcers

Friable
Organ/ Change Physiologic Disease
System effect effect

Musculo ↓muscle mass Sarcopenia Impaired

skeletal ↓ bone density Osteopenia functions
System Falls/ Fracture
Organ/ Change Physiologic Disease
System effect effect

Pulmo ↓ cough reflex Microaspiration Aspiration

↓ elasticity ↓ Resting PO2 pneumonia
↑ wall Dyspnea
stiffness
 Organ/ Change Physiologic Disease
System effect effect

Cardio ↓ arterial Hypotensive Syncope

compliance response to ↑ HR Heart failure
↓ ß-adrenergic ↓ CO and HR Heart block
response response to stress Orthostatic
↓ SA node Impaired BP on hypotension
automaticity standing, volume
depletion
Organ/ Change Physiologic effect Disease
System effect
GI ↓ hepatic ↓ drug metabolism Osteoporosis
function ↓ Ca absorption (empty B12
↓ gastric acidity stomach) deficiency
↓ colonic motility Constipation Fecal
↓ anorectal impaction
function Fecal
Stiffening of incontinence
↓ Stomach capacity
stomach fundus
Organ/ Change Physiologic Disease
System effect effect

Hema/ ↓ bone marrow

Immune reserve (?)
↓ T cell function
↑ autoantibodies Autoimmune
disease
Organ/ Change Physiologic Disease
System effect effect

Genito- Vaginal/ urethral Dyspareunia Symptomatic

mucosal atrophy Bacteriuria UTI;
Urinary
Urinary
Prostate ↑ residual urine incontinence
enlargement volume Urinary retention
Organ/ Change Physiologic Disease
System effect effect

Endo Impaired ↑ stress hypergly DM

glucose ↓ T4 dose in
homeostasis hypothy
↓ thyroxine
clearance
↓Na, ↑K
↑ ADH, ↓ renin,
↓ aldosterone
↓ testosterone
Impotence
↓ Vit D Osteopenia Fracture
absorption
Organ/ Change Physiologic Disease
System effect effect

Renal ↓ GFR Impaired Hyper/

↓ urine excretion of HypoNat
concentration/ some drugs
dilution Delayed
response to
salt or fluid
restriction or
overload
Organ/ Change Physiologic Disease
System effect effect
CNS Brain atrophy Benign Dementia,
↓ brain catechol senescent Delirium
synthesis forgetfulness Depression
↓ dopamine Stiff gait Parkinson’s
synthesis ↑ Body sway Falls
↓ righting reflexes Early Sleep apnea
↓ stage 4 sleep wakening,
Impaired thermal insomnia
Hypo/
regulation Lower resting
hyperthermia
temp
 Pharmacology and Aging
Age changes alter pharmacokinetics and
pharmacodynamics
Multiple disease states can also affect medication use
and response.
Pharmacokinetics is the medical description of the
absorption, distribution, biotransformation (metabolism),
and excretion of drugs and their metabolites.
 Pharmacology and Aging
Pharmacodynamics can be thought of as the effect of the
drug on the body.

With aging, there is a change in the number and affinity

of receptor sites on cell walls and a decline in the
availability of some neurotransmitters
Pharmacology and Aging
For example, both acetylcholine and
dopamine are thought to decline with the
aging process.
in some dementias, there is an additional loss
of acetylcholine
In Parkinson's disease, there is a loss of the
neurotransmitter dopamine.
Pharmacology and Aging
The older adult is at a higher risk for side
effects when given medications that further
block neurotransmitter systems.
Use of anticholinergics, which can cause dry
mouth, urinary retention, and confusion, can
further increase the risk of geriatric
syndromes such as impaired cognition and
urinary retention with overflow incontinence.
Pharmacology and Aging
Drugs with extrapyramidal effects can
produce parkinsonian-like symptoms of
rigidity, bradykinesia, and akathisia (motor
restlessness).

Xerostomia, the most common drug-induced

oral side effect
Xerostomia-dryness of the
mouth
Drugs that
produce
xerostomia
increase a
person’s risk of
developing
dental caries.
Xerostomia
The potential for
developing
rampant decay is
great in
individuals who
experience both
drug-induced
vomiting and
xerostomia.
Side-Effect Profiles and
Drug Classes of Concern in
Older Adults Drugs with
anticholinergics and
extrapyramidal effects
lead to the onset or
exacerbation of geriatric
syndromes.

Geriatric syndromes
include falls,
incontinence, confusion,
and mobility/functional
changes.
 Adverse Drug Reactions
The incidence of adverse drug reactions in older adults is
two to three times higher than in young adults.
Common gastrointestinal changes that lead to the
malabsorption of drugs include delayed gastric emptying,
reduced visceral blood flow, decreased intestinal motility
 Adverse Drug Reactions
. Changes in hepatic and renal function serve to reduce
drug metabolism and excretion.
Changes in body mass, such as increased adipose tissue
and loss of skeletal muscle, can affect the storage of
drugs.
Poor nutrition, common in older adults, also increases the
potential for adverse drug reactions.
 Adverse Drug Reactions
Drugs frequently associated with adverse reactions in
older adults include NSAIDs, digoxin, systemic
corticosteroids, diuretics, betablockers, methyldopa,
clonidine, benzodiazepines, and calcium channel
blockers.
The adverse conditions associated with these drugs are
delirium, falls, depression, urinary incontinence, and
constipation
 Medication Management
For Seniors
Dose Adjustments/ Dosing
In older adults, the general rule is to “start low and go
slow.”
For example, one-tenth of the usual dose of 5 to 10 mg of
haloperidol translates into a geriatric dose of 0.5 to 1 mg.
 Medication Management
For Seniors
Use of multiple agents becomes problematic when there
is no good rationale for their use,
Medication Management
For Seniors
Adherence
There is increased awareness that we need to
take into account the individuals' health goals,
lifestyle, and culture preferences in reviewing
medication use.
Strategies To Assist
Clients In Medication
Management
simplifying the regime (eg, use once daily
dosing versus multiple times when possible)
use of memory aids such as divided pillboxes
or bubble packing medication with days/times
for taking indicated or telephone reminder
services
and providing simple, clear-written instructions
in large font.
Strategies To Assist Clients In
Medication Management
assessing financial
barriers to optimum
medication use and
proposing alternatives,
such as generic brands,
should be addressed
Teamwork between the
client, nurse, physician,
and pharmacist is crucial
in optimal medication
management
Nutrition and Aging
Common Nutritional Concerns
Generally, older adults have
reduced caloric requirements
Gustatory and olfactory acuity
may be diminished,
There may be oral health
problems, such as a poor
dentition, ill-fitting dentures, or
periodontal disease that
makes chewing more difficult.
 Common Nutritional
Concerns
Impaired motor abilities
Medications and disease can affect appetite and
gastrointestinal motility.
Many times older adults are on fixed incomes and may
choose foods that cost less and are easy to prepare and
potentially less nutritious.
Older adults who live alone may not eat regularly or
healthfully.
 Common Nutritional
Concerns
Softer foods may be chosen when chewing function is
impaired
The older adult must have an adequate amount of fluids.
Many times dehydration causes confusion in the older
adult.
Common Nutritional Concerns
Many may not get sufficient exposure to sunlight, leading
to a reduced synthesis of vitamin D in their skin.
Calcium levels may fall
Deficiencies in vitamin B complex, vitamin C, and folic
acid are also common among older adults.
Pernicious anemia is most frequently seen in the older
population as a result of malabsorption of vitamin B12.
Barriers to Seeking Oral
Health Care
chronic health conditions and physical
impairments
Cost of dental services
Patients who are visually and/or hearing
impaired may find communication with office
personnel and practitioners too challenging.
Barriers to Seeking Oral
Health Care
Attitudes and beliefs also can influence
obtaining oral health care.
Oral health care professionals also may
exhibit ageism.
Interventions
Nutritional counseling

Dental hygienists to become familiar with a

patient’s way of life.

Nutritional intake is usually considered to be

synonymous with oral food and fluid intake.
Interventions

Upon proper consent, enteral nutrition may be

initiated if oral intake is not possible.

Mouth care
Sleep Changes in Older Adults

How much sleep do older

adults need?

Most adults need 7 or 8 hours

of sleep each night to feel fully
alert during the day.
What sleep changes are
common in older adults?
Older adults might get sleepy earlier in the
evening.
Insomnia.
They might wake up very early in the morning
and not be able to go back to sleep.
What causes sleep problems?
As we age, our body makes less of the chemicals and
hormones that help us sleep well (growth hormone and
melatonin).

Some lifestyle habits (such as smoking and drinking

alcohol or caffeinated drinks) can cause sleep problems.
Sleep problems may be caused by illness, by
pain, or by medicines.

However, people of all ages can have a sleep

disorder such as sleep apnea.
What is sleep apnea?
Sleep apnea is a disorder in which a person
stops breathing repeatedly while asleep.

This can happen hundreds of times in a night.

It can also cause high blood pressure and

increase the risk of heart attack.
What to do?
If you have sleep apnea
and are overweight, it
might help to lose weight.

It will also help to sleep

on your side, stop
If you smoke, you should quit. drinking alcohol or using
sleep medicines.
Many people who have sleep apnea need to
wear a nasal mask during the night to keep
their airways open.

Surgery is an option for people who have

severe cases of sleep apnea.
Medical Problems Affecting Sleep

Arthritis
Osteoporosis
Heartburn
Cancer
Parkinson's Disease
Dementia
Alzheimer's Disease
Medical Problems Affecting Sleep
Incontinence
Gastroesophageal Reflux
(GER)
Nocturnal Cardiac Ischemia
Chronic Obstructive
Pulmonary Disease
Congestive Heart Failure
Peripheral Vascular
Disease
How Sleep Changes?
Normal sleep consists of two major states: REM (Rapid
Eye Movement) sleep and NREM (nonREM) sleep.
NREM sleep is divided further into four sleep stages,
numbered stage 1, 2, 3 and 4.
Sleep deepens with each stage achieved; stages 3 and 4
(also called delta sleep) provide our bodies' deepest
sleep.
Our fifth stage is REM sleep, where dreaming occurs.
Are You Sleeping More, But Enjoying It Less?

a decrease in exposure to
natural light and a change in diet
may exacerbate sleep
difficulties.
daytime inactivity (lack of
exercise) and decreased mental
stimulation may also lead to the
"aging" of sleep.
The Impact of Sleep Problems?

Reduced energy,
greater difficulty concentrating,
diminished mood,
and greater risk for accidents, including fall-asleep
crashes.
Work performance and relationships can suffer too.
And pain may be intensified by the physical and mental
consequences of lack of sleep.
What can I do to sleep
better?
Go to bed and get up at the same time every
day, even on the weekends.
Do not take naps longer than about 20
minutes.
Don't read, snack or watch TV in bed. Use
your bedroom for sleep and other rooms for
other activities
Avoid caffeine about 8 hours before bedtime.
 What can I do to sleep
better?
Avoid nicotine and alcohol in the evening.
Don’t lie in bed for a long time trying to go to sleep.
What can I do to sleep
better?
Ask your doctor if any of your medicines could
be keeping you awake at night
(antidepressants, beta-blockers and
cardiovascular drugs)
Ask your doctor for help if pain or other health
problems keep you awake.
Try to exercise a little every day.