Introduction

Life expectancy risen all over the world

It is the concern of every nation to look after its
elderly population and educate them for a healthy
and active ageing
The world health assembly called for preventive
action to pay attention to the quality of life of the
elderly and to find effective alternatives to the rising
trends in institutional care
The goal for health for all is one of ensuring economic
and social equity
Ageing process
Ageing is a universal phenomenon
Old age is not, in itself, a disease, but is a
normal part of the human life span
Ageing is a normal, universal, progressive,
irreversible process
It is an inevitable physiological
phenomenon
The human –life span follows a recognized
pattern from birth to death
Contn…
A peak of human growth and development
is reached in the twenties
There is gradual deterioration in physical
and mental health after twenties
As the ageing process progresses mental
capabilities such as memory and physical
abilities further deteriorates
Aging is the manifestation of biological events

that occur over a period of time.

 Geriatrics is the branch of medicine concerned with medical
problems and care of older people.

Geriatrics pertains to all health care discipline, and

professions who care for these clients should be familiar
with the illnesses that affect them.
Geriatric nursing defined as the specialized
nursing care of older adults that occur in any
setting in which nurses use knowledge, expertise,
and caring abilities to promote optimal
functioning
It takes a broader perspective.

Gerontology is the comprehensive study of the process and

problems of ageing and focuses on the biological,
sociological, and psychological aspects of normal ageing.
A gerontological nurse is a nurse who works
predominantly with older people,
Providing nursing care,
Member of the multidisciplinary health and social care
team
Works in a variety of settings where older people are
cared for.
NORMAL AGING PROCESS:
NORMAL AGING PROCESS AND
CHANGES:PHYSICAL CHANGES:

DECREASE IN PHYSICAL STRENGTH,

ENDURANCE, AND FLEXIBILITY:
Muscle strength and flexibility decrease with age
muscle mass shrink from lack of use.
The capacity to assure strenuous effort gradually
declines.
They become less able to walk as far or lift- skeletal
muscles atrophy (shrink with age).
DECLINE IN EFFICIENCY OF BODY ORGANS:
The heart becomes a less efficient pump.
It requires more oxygen to do the same work it used
to do with less oxygen.
During the fifties, there also is an increased thickness
and hardening of the arteries causing blood pressure
to rise slightly and then level off.
Other problems associated with heart disease can
cause blood pressure to continue to rise to a point of
needing medication.
Taking medication as ordered is very important

when diagnosed with high blood pressure.

High blood pressure affects the organs inside

without giving any physical warning signs.

Not being treated and maintaining proper

medical care could result in a stroke and/or heart

attack.
Lungs become less elastic, and do not expand thus

less oxygen gets into them.

Smoking makes this problem worse

It takes longer for kidneys to get rid of waste

products.
These substances tend to remain in the body for a

longer period of time.

This is particularly the case with medications.
Urinary incontinence is not a normal change with

aging.
It is due to many other problems, such as

enlarged prostate, weak muscles, limited fluid

intake, or constipation.
Almost 60 percent of the time, this problem can

be improved easily and economically.

The reproductive system is affected in many ways.

In both men and women there is a slowing sexual

response
In men, there may be delayed penile erection,

infrequent orgasm, and decreased sperm motility,

causing decreased reproductive capacity.
Impotence is not a normal change - caused from

different medications
In women, after menopause there is decreased blood

flow to the vagina, delayed vaginal lubrication, and

diminished orgasm.
Estrogen therapy not only helps in minimizing these

occurrences in women, but also helps to keep the

heart and bones healthier.
Ovarian atrophy (shrinking) prevents women

from reproducing from the onset of menopause.

Alterations in skin become very obvious -

Wrinkling is the most common and most notable.

Increased wrinkling is due to a normal loss of

elastic tissue, excessive sun exposure, smoking, and

heredity.
Small skin hemorrhages are noted-a few of these

are normal.
The sweat glands also shrink, reducing sweating.

The result of changes in the functioning of critical

body organs tend to become more sensitive to

drugs.
LOSS OF BONE MASS

Thinning and shrinkage occurs in the bone, mostly in

the vertebrae (the back) and the long bones of the
arms and legs.
The compression of the spinal column makes many
people getting shorter as they age.
It also may account for the stooping posture of older
people.
Average height loss for most people is about two

inches by age 80.

The severe extreme change in bone is called

osteoporosis.
Mostly women are affected

Prevention is the best medicine.

Adequate intake of calcium (1500 mg./day)

Maintaining average body weight

Engaging in a regular weight bearing activity, such as

walking- best preventative measures to avoid the

dangers of osteoporosis as well as being prone to
fractures.
SLOWER REFLEXES
Joint movements slow with age because of changes

within the joints .

Reaction time is slower because of changes in the

central nervous system.

The time lapse between the brain receiving the signal

and the person responding to the signal increases

with age- may cause accidents and injury
TAKING LONGER TO RETURN TO
EQUILIBRIUM:
It takes longer for the body to return to balance
following a stress.
The older person’s body does not bounce back as
readily as a younger person’s body does from exercise,
illness, surgery, or situational stress.
Recovery/recuperation time usually is longer for older
adults than for younger adults.
Prevention, planning, and regular exercise are the
keys to feeling better.
DECLINE IN THE SENSES
All the senses are affected to some degree
The most impactful changes are hearing and vision,
Diminished efficiency in touch perception
loss in these senses can affect a person in several
ways.
Communication and interaction with others
Mobility and independence
Perception and response to the environment
Ease in accomplishing tasks
How they feel about themself?
Changes in endocrine system

The function of all the endocrine glands decreases,

leading to many endocrinal disorders among elderly

Changes in gastro-intestinal system

Due to ageing changes in teeth, mouth, stomach,
gallbladder, pancreas, liver resulting in various gastro
intestinal disorders
Nervous

and sensory system
Progressive loss of nervous and sensory system leads
to delayed reaction and response
Reduction in the efficiency of sensory perception due
to degenerative changes affects vision, hearing,
gastatory, tactile and olfactory senses
Atrophy of the brain, decreased blood flow and effect
on peripheral nerves like decrease in deep tender
reflexes, decrease in dopamine level, more in patient
with parkinson’s disease
Changes in respiratory system
Reduced Inspiratory and expiratory muscle
strength result in restricted ventilation and
decreased vital capacity
More use of Intercostal, accessory muscle and
diaphragm for expiration
Increased posterior thoracic curve resulting in
kyphosis, which restricts breathing
Psychological changes
Reactions to ageing and mental abilities vary from
person to person
Physical health and environmental factors have
an influence on the degree to which mental
faculties are maintained or impaired or changes in
personality
Social changes resulting from retirement, play an
important
Diminishes ability to remember new material
Long term memory is retained
Memories of early childhood will be recalled more
readily than those of recent events
Living in the past and reminiscing becomes a
common feature
Loss of contact with reality can occur when
memory for recent events become very poor
Intellectual abilities, intelligence declines in the later
years
Mental abilities declines as age advances
Learning abilities are dependent upon memory which
becomes less efficient in old age
Social changes
Society determines the role of the elderly person to even
at greater extent than the diminishing physical and
mental abilities associated with ageing
The major social changes are:
Retirement
Bereavement and loneliness
Reduced income
Deteriorating housing standards
Poor nutritional level
Problems arising out of lack of transport are likely to
reduce mobility and thus limit the opportunities for
interest and activities
 Ageing need not be a painful one or the one
that is associated with disease and disability
It should be a meaningful process and as WHO has
said the motto should be ‘Add Life to Years not
Years to Life’
COMMON HEALTH PROBLEMS:
Arthritis (49%)
Hypertension (37%)
Hearing Impairments (32%)
Heart Disease (30%)
Sinusitis (17%)
Cataracts (17%)
Orthopedic Impairments (16%)
Diabetes (9%)
Visual Impairments (9%)
Tinnitus (ringing in the ears) (8%)
Varicose Veins (8%)
FACTORS OF AGING:
FACTORS INFLUENCING AGING:
Hereditary factors-this is related to genetic factors.
This gene is not only the ageing gene, but could be
also a cancer gene
Environmental factors- 3 categories which can
influence the rate of ageing
i. Abiotic factors- are the physical and chemical
components of the environment such as:
 Climatic influence,
 Radiation,
 Pollution
ii. Biotic factors- result from the influences of the
thousands of living organisms which share man’s
environment.
Ageing processes are affected by such things as
pathogens, parasites and the quality and availability
of food products.
Socio-Economic Factors-
Adverse living and working conditions can increase
the ‘wear and tear’ tissues to which the individual is
exposed.
Stressful conditions of living are considered likely to
accelerated the process of ageing
 Modern industrialized society
 Income and poverty
 Chronic health problems
MYTHS AND FACTS OF AGING
Illness
Mental decline
Impotency
Ugliness
Mental illness
Uselessness
Isolation
Poverty
Depression
Political powers
 Myths

Elderly people are incompetent and incapable of

making decisions or handling their own affairs.

Most elderly live in nursing homes

All elderly people live in poverty

Older people are lonely and unhappy

Elderly do not want to work

“Old Age” begins at 65

Retirement ends active life

Most older people are pretty alike

They are sick, frail, and dependent on others

They are often cognitively impaired

They are depressed

They become more difficult and rigid with

advancing years
They barely cope with the inevitable declines

associated with ageing

 Facts
They are very diverse age group

For most older adults, if there is decline in some

intellectual abilities. It is not severe enough to cause

problems in daily living
Community dwelling older adults have lower rates

of diagnosable depression than younger adults

Most older adults maintain close contact with

family
Most older people live independently

Personality remains relatively consistent

throughout the life span

Most older people successfully adjust to the

challenges of ageing
PHYSIOLOGICAL CHANGE RESULTS

Decreased vascularity of dermis Increased pallor in white skin

Decreased amount of melanin Decreased hair colour (graying)

Decreased sebaceous and sweat Increased dry skin; decreased

gland function perspiration
Decreased subcutaneous fat Increased wrinkling

Decreased thickness of Increased susceptibility to

epidermis trauma
Increased localized Increased incidence of brown
pigmentation spots (senile lentigo)
PHYSIOLOGICAL CHANGE RESULTS

Increased capillary fragility Increased purple patches

(senile purpura)

Decreased density of hair Decreased amount and

growth thickness of hair on head and
body

Decreased rate of nail growth Increased brittleness of nails

Decreased peripheral Increased longitudinal ridges of
circulation nails; increased thickening and
Yellowing of nails

Increased androgen or estrogen Increased facial hair in women

ratio
PHYSIOLOGICAL RESULT
CHANGE

Decreased bone calcium Increased osteoporosis

Decreased fluid in Decreased height
intervertebral disks
Decreased blood supply to Decreased muscle strength
muscles
Decreased tissue elasticity Decreased mobility and
flexibility of ligaments and
tendons
Decreased muscle mass Decreased strength; increased
risk of falls
PHYSIOLOGICAL CHANGE RESULT

Decreased body fluids Decreased ability to humidify air

  result in drier mucous
membranes

Decreased number of cilia Decreased ability to trap debris

 

Decreased number of Increased risk for respiratory

macrophages infection

Decreased tissue elasticity in the Decreased gas exchange

alveoli and lower lung lobes
PHYSIOLOGICAL RESULT
CHANGE
Decreased muscle strength Decreased ability to breath
and endurance deeply; diminished strength
  of cough

Decreased number of Decreased gas exchange

capillaries
Increased calcification of Increased rigidity of rib cage;
cartilage decreased lung capacity
PHYSIOLOGICAL CHANGE RESULT
Decreased cardiac muscle tone Decreased tissue oxygenation
related to decreased cardiac
output and reserve
Increased heart size, left Compensation for decreased
ventricular muscle tone
Enlargement
 

Decreased cardiac output Increased chance of heart

  failure; decreased peripheral
  circulation
 
PHYSIOLOGICAL CHANGE RESULT

Decreased pacemaker cells Heart rate 40-100 BPM;

  increased incidence of ectopic
or premature beats;
increased risk for conduction
abnormalities
 
Decreased baroreceptor Decreased adaptation to
sensitivity changes in blood pressure

Increased incidence of valvular Increased risk for heart

sclerosis murmurs
 
Increased atherosclerosis Increased blood pressure,
weaker peripheral pulses
PHYSIOLOGICAL CHANGE RESULT

Increased plasma viscosity Increased risk for vascular

occlusion
Decreased red blood cell Increased incidence of
production anaemia

Decreased mobilization of Less effective phagocytosis

neutrophils

Increased immature T cells Decreased immune response

response
PHYSIOLOGICAL RESULT
CHANGE
Increased dental caries and Decreased ability to chew
tooth loss

Decreased thirst perception Increased risk for dehydration

Decreased gag reflex Increased incidence of

choking and aspiration

Decreased muscle tone at Increased incidence of

sphincters heartburn
PHYSIOLOGICAL RESULT
CHANGE

Decreased saliva and gastric Decreased digestion and

secretions absorption of nutrients

Decreased gastric motility and Increased flatulence and

peristalsis constipation

Decreased liver size and Decreased ability to metabolize

enzyme production drugs leading to increased risk
for toxicity
PHYSIOLOGICAL CHANGE RESULT
Decreased number of functional Decreased filtration rate with
nephrons decrease in drug clearance

Decreased blood supply Decreased removal of body wastes;

increased concentration of urine

Decreased muscle tone Increased volume of residual urine

Decreased tissue elasticity Decreased bladder capacity

Delayed or decreased perception of Increased incidence of incontinence

need to void
PHYSIOLOGICAL CHANGE RESULT

Decreased number of brain cells Slowed thought process

Decreased number of nerve Decreased reflex, coordination

fibres and perception

Decreased amounts of neuro Decreased perception of stimuli

receptors

Decreased peripheral nerve Decreased motor response

function
PHYSIOLOGICAL RESULT
CHANGE
Decreased number of eyelashes Increased risk for eye injury

Decreased tear production Increased risk for eye irritation

Increased discoloration of lens Decreased color perception

Decreased tissue elasticity Increased blurring

Decreased muscle tone

Decreased diameter of pupil
PHYSIOLOGICAL RESULT
CHANGE

Decreased tissue elasticity Decreased ability to distinguish

high-frequency sounds

Decreased joint mobility Decreased hearing ability

Decreased ceruminous cells in Increased risk for cerumen impaction

external ear canal causing conductive hearing loss
 

Atrophy of vestibular structures and Increased problems with balance

in the decreased number of hair cells
inner ear
COMMON DISORDERS SEEN
WITH AGING:
Otosclerosis

Tinnitus

Deafness
PHYSIOLOGICAL RESULT
CHANGE
Decreased number of papillae Decreased ability to taste
on tongue

Decreased number of nasal Decreased ability to receptors

sensory detect smell
receptors
PHYSIOLOGICAL CHANGE RESULT

Decreased pituitary secretions(growth Decreased muscle mass

hormone)

Decreased production of thyroid- Decreased metabolic rate

stimulating hormone
Decreased insulin production or Increased risk for type 2 diabetes
increased insulin resistance mellitus

Decreased production of parathyroid Increased blood calcium levels (seen

hormone with osteoporosis
PHYSIOLOGICAL CHANGE RESULT

Decreased estrogen levels Decreased vaginal secretions

Decreased tissue elasticity Decreased pubic hair; increased

  vaginal tissue fragility;
  increased tissue irritation,
decreased size of uterus;
decreased vaginal length and
width; decreased breast tissue

Increased vaginal alkalinity Increased risk for infection

PHYSIOLOGICAL RESULT
CHANGE

MALE

Decreased testosterone levels Decreased amount of facial

and pubic hair

Decreased circulation Decreased rate and force of

ejaculation; decreased speed
gaining an erection
MENTAL DISORDERS IN OLD
PEOPLE:
Depression 9 %
Subsyndromal depression 16 %
Panic disorder 2 %
Generalized anxiety disorder 12 %
Social phobia 5 %
Addiction 2 %
At least one mental disorder 34 %
ADJUSTMENT TO THE
STRESSORS OF LATE LIFE:
Psychologists work with older patients to deal with
the many life stressors
decline in health,
loss of loved ones, and
relocation to a new living situation.
ANXIETY DISORDERS:
Anxiety-related disorders include generalized anxiety
disorder, panic disorder, post-traumatic stress
disorder, and obsessive–compulsive disorder.
Psychologists use psychotherapy and supportive
counseling to treat anxiety disorders in older adults.
DEMENTIA:
RISK FACTORS OF DEMENTIA:
DEPRESSION:
DEPRESSION:
Depressive syndromes are frequent in old age and
especially frequent are minor forms of depression like
dysthymia, or subsyndromal depression.
Depression in older adults is a very treatable disorder.
Psychologists successfully identify and treat both
major depressive disorder and subclinical forms of
depression with psychotherapy.
END-OF-LIFE CARE:
Psychologists assist older adults and their families
with advanced care planning.
They counsel terminally ill patients and their families
on how to manage feelings, decrease distress, and
manage pain, and after the death, grief.
As depression and anxiety are often associated with a
terminal diagnosis and the progression of a disease,
psychologists assess and treat these mental health
conditions to minimize suffering and distress.
INCONTINENCE:
Psychologists use behavioral training methods, such
as biofeedback, bladder training, goal setting, and
self-monitoring, to reduce incontinence.
These treatments have proven to be more effective
than drug therapy.
Incontinence has significant implications for the
independence of older adults.
It is the second most common reason why families
admit an elder relative to a nursing home, which in
itself is associated with depression in older adults.
INSOMNIA:
Insomnia is prevalent among older adults, especially
medically ill elders.
Older adults are especially vulnerable to the adverse
effects of sleep medications, including memory
impairment and impaired daytime performance.
Psychologists have developed effective non
pharmacologic treatments for insomnia, including
cognitive–behavioral techniques, sleep restriction and
stimulus control, and sleep hygiene instruction.
FINANCIAL PROBLEMS OF
ELDERLY:
HEALTHCARE COSTS

FIXED INCOMES

FINANCIAL ABUSE
SUBSTANCE ABUSE:
SUICIDE:
INTELLIGENCE
LEARNING AND MEMORY
Vision problems

Hearing problems (Presbycusis, otosclerosis,

conductive sensory neural deafness)

Dementia

Disturbed cerebral perfusion

Drugs that affect the sensorium.

Disturbed neurologic function resulting in

decreased levels of consciousness.

Disturbed metabolic states.

ELDER ABUSE AND NEGLECT

SOCIAL ISOLATION
CAREGIVING:
Family caregivers provide care to most of the older adults
who have a disabling condition.
The role of caregiver can be rewarding, it can also be
quite stressful and taxing.
Caregivers may suffer from depression, anxiety, substance
abuse, anger, and stress-related health problems,
including cardiovascular disease.
Psychologists help family members to better deal with the
practical and emotional demands of caring for a physically
or cognitively impaired older relative.
CONCLUSION: