1. Gerontological Nursing
INTRODUCTION TO
GERONTOLOGIC NURSiNG
Jose Karlo M. Pañgan,RN, MAN
`
Week
One

2. GERONTOLOGY
NURSING
WEEK ONE

3. GERONTOLOGY
 Fromthe Greek word
Geron, “old man
 The scientific study of
the process of aging
and the problems of
aged persons; includes
biologic, sociologic,
physiologic,
psychologic, and
economic aspects

4. “Gero” – old age;
“Ology” - study of
Older Age Group:
Young Old – ages 65-74
Middle Old – ages 75-84
Old Old – 85 and up.

5. TERMINOLOGIES
Gerontophobia – fear
of aging. Inability to
accept aging adults in
the society.
Age Discrimination –
emo-prejudice among
the older adult.
Ageism – dislike of the
aging and the older
adult.

6.  Geriatrics– generic term relating to the
aged, but specifically refers to medical
care for the aged.
 SocialGerontology – concerned mainly
with the social aspects of aging versus
the biological or psychological
 Geropsychology – refers to the
specialists in psychiatry whose
knowledge, expertise and practice are
with the older population.

7.  Geropharmaceutics – also called
Geropharmacology is a unique branch in
which pharmacists obtain special training
in geriatrics.
 Financial Gerontology – combines
knowledge of financial planning and
services with a special expertise in the
needs of older adults.

8. Gerontological Rehabilitation Nursing –
combines expertise in Gerontologic nursing
with rehabilitation concepts and practice.
Gerontological Nursing – the aspect of
gerontology that falls within the discipline of
nursing and the scope of nursing practice.

9. ROLES OF THE GERONTOLOGIC
NURSE
 Provider of care
 Teacher
 Manager
 Advocate
 Research Consumer

10. DEMOGRAPHICS OF OLD
PEOPLE
 “Graying of America” -
a phenomenon faced
by all nations, not only
the U.S.
 Demographic Tidal
Wave or A pig in a
Python – a bulge in the
population moving
slowly through times.
(1946-1964 : Baby
Boomer)

11. DEMOGRAPHICS OF OLD
PEOPLE
 By year 2010, the number of persons 65
and older in the United States is at 39
million: 13% of the population. By 2010-
2030, it is expected that 65 year olds will
be more than 79 million.
 Women comprise the majority of the
older population in all nations (55%), and
the majority of these women (58%) live in
developing countries.

12. Marital Status
 An important determinant of health and
well- being, it influences income,
mobility, housing, intimacy, and social
interaction.

13. Gender
 Women live longer than men due to
reduced maternal mortality, decreased
death rate from infectious diseases, and
increase death rate in men from chronic
diseases.
 Women are likely to poor, alone, and
greater degree of functional impairment
and chronic diseases.

14. Living Arrangement and
Housing
A person’s overall degree of health and
well-being greatly influences the
selection of housing in old age. Ideal
housing promotes functional
independence while emphasizing safety
and social interaction needs.

15. Geographic Distribution
 Older adults are less likely to change
residence than other age-groups.
“Aging-in-place”.

16. Education
 The educational level of older adult
clients affects the nurse-client health
teaching process and an important
consideration in health promotion
and disease prevention.

17. Income and Poverty
 Major source of income is SSS, and
other supplemental income like
assets, public and private
pensions, earnings and public
assistance.
 Income affects health and lifestyle –
people are unable to meet basic
needs and typically reduced the
amount of spending in health-related
matters.

18. Employment
Two-thirds of older, self-
employed workers were men.
The labor force participation
of older men has remained
fairly constant

19. Functional Status
 Functionalability is of
greater concern to
older adults and the
nurses than the
incidence and
prevalence of chronic
diseases.

20.  Functional ability – the capacity to
carry out the basic self-care activities
that ensure overall health and well-
being.
 ADLs: Bathing, Dressing, eating,
transferring and toileting;
 InstrumantalADLs: shopping,
cooking, housekeeping, laundry and
handling money.

21.  Nurseshould determine the plan of
action on impact of chronic diseases.
Improvement and Prevention are the
keys.

22. Implications to Health Care
Delivery
 Create roles that meet the needs of the
older people, across the continuum of
care
 Develop models of care directed at all
levels of prevention with emphasis on
primary prevention and health
promotion services in the Community-
Based Setting.
 Assume leadership, in health care and in
political arena.

23. SETTINGS OF CARE
Acute Care Setting
 Only few hospitals can adequately
manage acute conditions by
preventing functional decline:
 IMPLICATION persons.: hospital setting
continues to be one of the most
dangerous for older

25.  The point of entry to the health care
systems for older adults.
 Inthis setting, Gerontologic Nurses focus
on treatment and nursing care of acute
problems such as those occurring from
trauma, accidents, orthopaedic
injuries, respiratory ailments or serious
circulatory problems.

26. Long Term Care/Nursing Facilities
 Include Assisted Living,
Intermediate care, subacute or
transitional care skilled care and
Alzheimer’s unit.

28. Assisted Living / Home Care
 Provides an alternative for those
older adults who do not feel safe
living alone, who wish to live in a
community setting or who need
some additional help with the
activities of daily living.

29. Intermediate Care
 Level of care provides 24 hour per
day direct nursing contact and
may be considered to be the
entry level into the nursing home
care.

30. Subacute or Transitional Care
 generally for patients who require
more intensive nursing care than the
traditional nursing home can
provide but less than the acute
care hospital.

31. Nurses Requirement
 Understanding of the normal and
abnormal aging
 Strong assessment skills to detect subtle
changes that may indicate impending,
serious problems
 Excellent communication skills especially
with DDD patients.
 Keen understanding of rehabilitation
principles
 Sensitivity and patience.

32. LEADING CAUSE OF MORTALITY
 Heart Diseases
 Malignancies
 Cerebrovascular disease
 Chronic lower respiratory diseases
 Influenza and Pneumonia
 Diabetes Mellitus

33. LEADING CAUSE OF MORBIDITY
 Arthritis
 Hypertension
 Heart Diseases
 Hearing Impairments
 Cataracts
 Orthopedic impairments
 Sinusitis
 Diabetes

34. Theories of Aging
 Biological
 Stochastic and Non-stochastic
 Sociological
 Psychological

35. THEORIES OF AGING:
 I.
STOCHASTIC THEORIES
 Based on random events that cause
cellular damage that accumulates as the
organism ages.
 II.
NON STOCHASTIC THEORIES OF AGING
 Based on the genetically programmed
events that cause cellular damage that
accelerates aging of the organism.

36. I. STOCHASTIC THEORIES
Free Radical Theory
 Membranes, Nucleic acids
and proteins are damaged by
free radicals which causes
cellular injury,
 Exogenous Free radicals:
Tobacco smoke, Pepticides,
organic solvents, Radiation,
ozone and selected
Medications.

38. Health Teaching
Decrease calories in order to lower
weight
Maintain a diet high in nutrients using
anti-oxidants
Avoid inflammation
Minimize accumulation of metals in
the body that can trigger free
radicals reactions.
 Older adults are more vulnerable to
free radicals.

39. Orgel/ Error Theory
 Errors
in DNA and
RNA synthesis
occurs with
aging.

40. Wear and Tear Theory
 Cells wears out and cannot function
with aging.
 Like a machine which losses function
when its parts wears off.

43. Connective Tissue Theory /
Cross-linkage theory
 With aging, proteins impede metabolic
processes and cause trouble with
getting nutrients to cells and removing
cellular waste products.

44. II. NON STOCHASTIC THEORIES
OF AGING
Programmed Theory/ Haylick
Limit Theory
 Cells divide until they are no longer
able to and this triggers to apoptosis or
cell death.
 Shortening of the TELOMERES – the
distal appendages of the
chromosomes arm.
 TELOMERASE – an enzyme, “cellular
fountain of youth”

45. Gene/ Biological Clock Theory
 Cells have a genetically
programmed aging code.

46. Neuroendocrine control or
pacemaker theory
 Problems with the hypothalamus-
pituitary-endocrine gland feedback
system causes disease.
 Increased insulin growth factor
accelerates aging.

47. Immunologic/ Autoimmune
Theory
 Aging is due to faulty immunological
function, which is linked to general
well-being.

48. SOCIOLOGIC THEORIES OF
AGING
 Attemptto explain aging in terms of
behaviour, personality and attitude
change.

49. SOCIOLOGICAL THEORIES
 changing roles, relationship, status
and generational cohort impact
the older adult’s ability to adapt.

50. Activity theory
 Havighurst and Albrecht
(1953)
 Remaining occupied
and involved is
necessary to satisfy late
life.
 Activity engagement
and positive adaptation.

51. Disengagement Theory
 Cumming and Henry (1961)
 Gradual withdrawal from society and
relationships serves to maintain social
equilibrium and promote internal
reflection.

52. Continuity Theory
 Havighurst(1960)
 also known as Development
Theory
 Personality influences role and life
satisfaction and remains
consistent throughout life.

53. Age Stratification Theory
 Riley (1960)
 Society is stratified by age
groups that are the basis
for acquiring resources,
roles, status and
deference from others.

54.  Lawton (1982)
 Function is affected by ego strength, mobility,
health, cognition, sensory perception and the
environment.
Person-Environment Fit Theory

55. PSYCHOLOGICAL THEORIES OF AGING
 Explain aging in terms of mental
processes, emotions, attitudes,
motivation, and personality
development that is characterized
by life stage transitions.

56. Human needs
 Maslow’s (1954)
 Five basic needs motivate human
behaviour in a lifelong process
toward need fulfilment.
 Self – Actualization

58. Individualism Theory
 Jung (1960)
 Personality consists
of an ego and
personal and
collective
unconsciousness
that views life from a
personal or external
perspective.

59. Stages of Personality
Development
 Erikson(1963)
 Personality develops in eight
sequential stages with corresponding
life tasks. The eighth phase, integrity
versus despair, is characterized by
evaluating life accomplishments;
struggles include letting
go, accepting
care, detachment, and physical and
mental decline.

61. Selective optimization with
compensation
 individuals
cope with aging losses
through activity /role
selection, optimization and
compensation.

62. GERONTOLOGIC ASSESSMENT
 Learning Objective: Explain the relationship
between physical and psychosocial aspects of
aging as it affects the assessment process.
 Special Considerations affecting assessment
 Interrelationship between Physical and
Psychosocial aspects of aging.
 Nature of Disease and disability and their effects
on functional status
 Tailoring the nursing assessment to the older
person
 The health history
 Additional assessment measures

63. PRINCIPLES OF ASSESSMENT
 Use of an individual, person-centered
approach
 View of clients as participants in health
monitoring and treatment
 An emphasis on clients’ functional
ability
 Note: Nursing-Focused Assessment should be
scientifically based-knowledge and always practice to
acquire the art of assessment.

64. Environmental
factors
Health
Status

65. Effects of Selected Variables
on Functional Status

66. Variable Effect
Apathy
Confusion
Visual and Auditory Loss Disorientation
Dependency
Loss of Control
Confusion
Agitation
Multiple strange and Dependency
unfamiliar environments Loss of control
Sleep disturbance
Relocation Stress
Mobility impairment
Dependency
Loss of Control
Acute medical Illness
Sleep Disturbance
Pressure Ulcer
Inadequate food intake
Persistent confusion
Drug Toxicity
Potential for further mobility impairment
Loss of function
Altered pharmacokinetics Altered patterns of bowel and bladder elimination
and pharmacodynamics Loss of Appetite: affects healing, Bowel function,
energy level; dehydration
Sleep disturbance

67. Problem Classic Presentation Elderly patients
Urinary Tract Dysuria, frequency, Dysuria often absent,
Infections
urgency, nocturia frequency, urgency, nocturia
sometimes present.
Incontinence, delirium, falls,
and anorexia are other signs
Myocardial Severe substernal Sometimes no chest pain,or
Infections
chest pain, atypical pain location: jaw,
diaphoresis, nauseam neck, shoulder, epigastric
dyspnea area. Dyspnea, may or may
or may not be present.
Tachypnea, arrtyhmia,
hypotension, restlessness,
syncope, and
fatigue/weakness. Fall
Bacterial Productive cough and Cough: productive, dry or
Pneumonia
purulent sputum, chills absent; chills and fever and or
and fever, pleuritic chest ↑ WBC may be absent.
pain, ↑WBC Tachypnea, slight cyanosis,
delirium, anorexia, NV,
tachycardia.

68. CHF ↑ dyspnea,fatigue, ALL and/or anorexia, restlessness,
weight gain, pedal delirium cyanosis, and falls.Cough.
edema, nocturia,
bibasilar crackles
Hyperthyroidis Heat intolerance, fast slowing down (apathetic hypo), lethargy,
m pace, exophthalmos, weakness, depression, atrial defibrillation,
↑ pulse, hyperreflexia, and CHF
tremor
Hypothyroidism Weakness, fatigue, Often w/o over symptoms. Majority of
cold intolerance, Cases Subclinical. Delirium, dementia,
lethargy, skin dryness, depression/lethargy, constipation, weight
and scaling, loss, muscle weakness/unsteady gait are
constipation common.
Depression Dysphoric Mood and Classic symptoms may or may not be
thoughts, withdrawal, present.
crying, weight loss, Memory and concentration problems,
constipation, cognitive and behavioural changes,
insomnia increased dependency, anxiety and
sleep.
Be alert for CHF, CA, DM, infectious
diseases, and anemia. Cardiovascular
agents. Anxiolytics, amphetamines,
narcotics and hormones can also play a
role.

69. 2.2 NATURE OF DISEASE AND
DISABILITY AND THEIR EFFECTS
ON THE FUNCTIONAL STATUS

70.  Aging does not necessarily result in
diseases and disability
 Chronic diseases increases older
adults’ vulnerability to functional
decline
 Common Mistake: Nurses and adults
attribute vague signs and symptoms as
normal signs of “growing old”.

71. A comprehensive assessment of
physical and psychosocial
function is important because it
can provide valuable clues to a
diseases’ effect on functional
status.

72.  NursingAction: Identify NORMAL
VS. ABNORMAL: dependable
benchmarks of health are
previous laboratory findings
 Watch out for vague signs and
symptoms: do not ignore and
look for non-specific signs.

73. 2.2.1 Decreased Efficiency of
homeostatic Mechanisms
 The older persons’ adaptive reserves are
reduced- results in decreased ability to
respond to physical and emotional stress.
 Immunocompetence is affected by
multiple factors.

74. Adults repeatedly encounters
losses: needs time to recover
between losses and recuperation.
The shorter time interval between
losses, the lesser ability to respond
and return to baseline stage of
health compared to younger
people.

75. Nursing Action
Assess older adults for presence of
physical and psychological
stressors and their physical and
emotional manifestations.

76. Lack of Standards of Health
and illness
 Difficultyarises on identifying the health
status of older adults due to:
 Norms or standards are always redefined
 Polypharmacy and state of illness and
disease may affect laboratory data.
 No aging norms for many pathologic
conditions
 There are few landmarks for stages of
development for the older adulthood
compared to other age groups.

77. Nursing Action:
 Assume heterogeneity rather
homogeneity: uniqueness of personal
health standards.
 Look for previous health history and
related matters: previous
work, residence, lifestyle etc.
 Compare presenting signs and
symptoms with the older adults’ normal
baseline.

78. COGNITIVE IMPAIRMENT
 Delirium – one of the most
common, atypical presentations of
illness in older adults.

79. Confusion, mental status changes,
cognitive changes and delirium –
used to describe one of the most
common manifestations of illness in old
age.

80. Acute Confusional State (ACS)-
 an organic brain syndrome
characterized by transient, global
cognitive impairment of abrupt onset
and relatively brief duration,
accompanied by diurnal fluctuation of
simultaneous disturbances of the sleep-
wake cycle, psychomotor behavior,
attention, and affect”( Foreman, 1986)

81. Dementia – a global, sustained
deterioration of cognitive function in
an alert client.
Other manifestations: memory
impairment, aphasia, apraxia,
agnosia, or disturbance in executive
functioning; planning, organizing,
sequencing and abstracting.

82. Primary dementia
Senile dementia of Alzheimer’s
type, Lewy body disease, Pick’s
Disease, Creutzfeldt-Jakob
Disease and multi-infarct
dementia

83. Secondary Dementia
Normal pressure Hydrocephalus,
intracranial masses or lesions,
pseudodementia, and Parkinson’s
dementia.

84. Differentiating Dementia and
ACS
FEATURE ACS DEMENTIA
Acute/subacute; depends Chronic, generally insidious;
on cause; often occurs at depends on cause
ONSET twilight
Short, diurnal fluctuations, Long, no diurnal effects,
worse at night, dark and symptoms progressive, stable
COURSE awakening
Hours to less than 1 month Months to years
DURATION
Fluctuates, generally Generally Clear
AWARENESS reduced

85. Fluctuates, reduced or Generally normal
ALERTNESS increased
Impaired, often fluctuates Generally normal
ATTENTION
Fluctuates, in severity, May be impaired
ORIENTATION impaired
Recent and immediate Recent and remote
memory impaired; unable to memory impaired; loss of
register new information or recent memory is 1 st sign;
MEMORY recall recent events some loss of common
knowledge
Disorganized, distorted, Difficulty with abstract and
THINKING fragment, slow, or word finding
accelerated
Distorted, illusions, delusions, Misperceptions often
PERCEPTION or hallucinations absent
Disturbed, cycle reversed Fragmented
SLEEP-WAKE
CYCLE

86. TAILORING THE NURSING
ASSESSMENT TO THE OLDER
PERSONS
 Environmental suggestions during assessment of
the older adults
 Provide adequate space, especially if client uses
mobility aids
 Minimize noise and distractions
 Set a comfortable, warm temperature with no
drafts.
 Use diffuse lighting.
 Avoid glossy or highly polished surfaces.

87.  Place client in a comfortable
position
 Maintain proximity to the bathroom
 Keep water and other preferred
fluids available
 Provide a place to hang or store
garments and belongings
 Maintain absolute privacy

88.  Plan the assessment: consider client
status
 Be patient, relaxed and unhurried.
 Allow client plenty of time to respond
to questions and directions. Maximize
use of silence.
 Be alert to signs of increasing fatigue.
 Conduct assessment during client’s
peak energy time.

89. THE HEALTH HISTORY
 The first phase of a
comprehensive, nursing-focused health
assessment, provides a subjective
account of the older adults’ current and
past health.
 The nursing history should include
assessment of
functional, cognitive, affective, and
social well-being.
 The interviewer should adapt the styles
and techniques of interview in the

90. THE INTERVIEWER
Factors to consider during nurse-client
communication during assessment
 Attitudeof nurse
 Myths and Stereotypes about older
people
 Nurse’s own anxiety and fear of
personal aging

91. Guide to an effective interview
State reason for the interview
Let client accomplish a pre
interview form
A goal-directed interview
process
Setting of time limit

92. Secure permission to take down
notes
Observe most effective and
comfortable distance and
position, and personal space for
the session
Appropriate use of touch
Take advantage of
opportunities such as meal time,
game, hobby, and other social
activity.

93. THE CLIENT
 There are factors the nurse should consider
while interviewing an older adult such as:
 Sensory-perceptual deficits
 Anxiety
 Reduced energy level
 Pain
 Multiple and interrelated health problems
 The tendency to reminisce

94. THE HEALTH HISTORY FORMAT
 Client Profile/ Biographic data
 Family Profile
 Occupational Profile
 Living Environment profile
 Recreation/Leisure Profile
 Resources/Support systems used

95. THE HEALTH HISTORY FORMAT
 Description of typical day
 Present health status
 Medications
 Immunization and health Screening Status
 Allergies
 Nutrition
 Past Health Status
 Family History
 Review of Systems

96. SYMPTOM ANALYSIS FACTORS
 Dimensions of a Symptom
Location
Quality
Quantity
Timing
Setting
Aggravating or Alleviating factors
Associated symptoms

97. THE PHYSICAL EXAMINATION
APPROACH AND SEQUENCE
 Should be systematic and deliberate
 Determine client strengths and
capabilities; disabilities and limitations
 Verify and gain objective support
 Gather objective data not previously
known

98. GENERAL GUIDELINES
Recognition of no previous experience
with the nurse conducting physical
examination by the adult
Be alert on the clients energy level
Respect the client’s modesty
Keep the client comfortably draped
Sequence examination to keep position
changes to a minimum

99. Develop an efficient sequence for
examination that minimizes nurse and
client movement
Ensure comfort for the client
Warn of any discomfort that may occur. Be
gentle
Probe painful areas last
Share findings with the client when possible
Take advantage of teachable moments
Develop a standard format on which to
note selected findings.

100. EQUIPMENT AND SKILLS
Check proper function and
readiness of all equipment
Place equipment within reach
Use of Inspection, Auscultation,
Palpation, and Percussion.

101. ADDITIONAL ASSESSMENT
MEASURES
 Functional Status Assessment – refers to
the measurement of the older adults’
ability to perform basic self-care tasks, or
ADLs, and task that require more
complex activities for independent living
referred to as IADLs.

102.  KATZ Index of ADLs –
Determines results of treatments
and the prognosis in older and
chronically ill people.

104.  Barthel Index – tool for measuring
functional status, rates self-care
abilities in the areas of
feeding, moving
toileting, bathing, walking, propelling
a wheelchair, using stairs, dressing
and bowel and bladder control

105.  Lawtonand Brody’s IADLs – a range
of activities more complex than
KATZ and Barthel. Usage of
telephone, shopping, preparing
food, housekeeping, laundry, meds,
transporting and finances.

107. Cognitive/Affective
Assessment
 assesses
level of cognitive function
and the effect of the assessed
degree of impairment on functional
ability

108. Short Portable Mental Status
Questionnaire (SPMSQ) –
used to detect the presence and
degree of intellectual impairment to
assess orientation, memory in relation to
self-care ability, remote memory and
mathability.

110.  MiniMental State Examination – tests
the cognitive aspects of mental
function: orientation, registration,
attention, and calculation, recall and
language

112.  Mini-Cog - an instrument that
combines a simple test of memory
with a clock drawing test.
 Geriatric
Depression Scale - a score
of five (5) or more may indicate
depression

113. Social Assessment –
(1) Social function is correlated with
physical and mental function, (2) an
individual’s social well-being can
positively affect his or her ability to
cope with the physical impairments
and ability to remain independent, and
(3) a satisfactory level of social function
is a significant outcome in and of itself.

114.  Family APGAR – Stands for:
Adaptation, Partnership, Growth,
Affection and Resolve.
 Older Adult Resources and Services
(OARS) Multidimensional Functional
Assessment Questionnaire - a social
resource scale, one of the better-
known measures of general social
function for older adults

115. Thank you!!