PRESENTATION ON

Epidemiological Statistics
Biological Theories
Biological Aspects of Aging
Psychological Aspects of Aging & Memory Functioning

Subject: Mental health Nursing

Unit XVIII : The Aging Individual

Submitted to,

Submitted by,

Dr. K Lalitha
Professor
Dept. of Nursing
NIMHANS

Thejaswini Padua A. Kallan

II Year MSc Nursing
Dept. of Nursing
NIMHANS

INTRODUCTION2
The number of individuals over the age of 65 years (referred to as late adulthood) is rapidly
expanding. The public has become increasingly sophisticated in its knowledge and expectations
of older-adult health care. As a result, the health care profession has been required to pay greater
attention to specialization, thereby responding to the increasing consumer demand. The nurse
who works with older adults with mental illness is challenged to integrate psychiatric nursing
skills with knowledge of physiological disorders, the normal aging process, and socio-cultural
influences on elderly people and their families. Many nurses who work with these patients
welcome the opportunity to integrate nurse practitioner and psychiatric nursing skills.

EPIDEMIOLOGICAL STATISTICS1
India is in a phase of demographic transition. As per the 1991 census, the population of the
elderly in India was 57 million as compared with 20 million in 1951. There has been a sharp
increase in the number of elderly persons between 1991 and 2001 and it has been projected that
by the year 2050, the number of elderly people would rise to about 324 million. India has thus
acquired the label of an ageing nation with 7.7% of its population being more than 60 years
old.
In India, the elderly people suffer from dual medical problems, i.e., both communicable as well
as noncommunicable diseases. This is further compounded by impairment of special sensory
functions like vision and hearing. A decline in immunity as well as age-related physiologic
changes leads to an increased burden of communicable diseases in the elderly. The prevalence of
tuberculosis is higher among the elderly than younger individuals. A study of 100 elderly people
in Himachal Pradesh found that most of the patients came from a rural background. They were
also smokers and alcoholics. It is shown that among the population over 60 years of age, 10%
suffer from impaired physical mobility and 10% are hospitalized at any given time, both
proportions rising with increasing age. In the population over 70 years of age, more than 50%
suffer from one or more chronic conditions. The chronic illnesses usually include hypertension,
coronary heart disease, and cancer. According to Government of India statistics, cardiovascular
disorders account for one-third of elderly mortality. Respiratory disorders account for 10%
mortality while infections including tuberculosis account for another 10%. Neoplasm accounts
for 6% and accidents, poisoning, and violence constitute less than 4% of elderly mortality with
more or less similar rates for nutritional, metabolic, gastrointestinal, and genito-urinary
infections.

THEORIES OF AGING1
A number of theories related to the aging process have been described. These theories are
grouped into two broad categories: biological and psychosocial.

 Biological Theories
Biological theories attempt to explain the physical process of aging, including molecular and
cellular changes in the major organ systems and the bodys ability to function adequately and
resist disease. They also attempt to explain why people age differently and what factors affect
longevity and the bodys ability to resist disease.
1. Genetic Theory : According to genetic theory, aging is an involuntarily
inherited process that operates over time to alter cellular or tissue structures. This theory suggests
that life span and longevity changes are predetermined. Stanley, Blair, and Beare (2005) state:
Genetic theories posit that the replication process at the cellular level becomes deranged by
inappropriate information provided from the cell nucleus. The DNA molecule becomes crosslinked with another substance that alters the genetic information. This cross-linking results in
errors at the cellular level that eventually cause the bodys organs and systems to fail. The
development of free radicals, collagen, and lipofuscin in the aging body, and of an increased
frequency in the occurrence of cancer and autoimmune disorders, provide some evidence for this
theory and the proposition that error or mutation occurs at the molecular and cellular level.
2. Wear-and-Tear Theory: According to this theory believe that the body
wears out on a scheduled basis. Free radicals, which are the waste products of metabolism,
accumulate and cause damage to important biological structures. Free radicals are molecules
with unpaired electrons that exist normally in the body; they also are produced by ionizing
radiation, ozone, and chemical toxins. According to this theory, these free radicals cause DNA
damage, cross-linkage of collagen, and the accumulation of age pigments. Environmental Theory
According to this theory, factors in the environment (e.g., industrial carcinogens, sunlight,
trauma, and infection) bring about changes in the aging process. Although these factors are
known to accelerate aging, the impact of the environment is a secondary rather than a primary
factor in aging. Science is only beginning to uncover the many environmental factors that affect
aging.
3. Immunity Theory: The immunity theory describes an age-related decline in
the immune system. As people ages, their ability to defend against foreign organisms decreases,
resulting in susceptibility to diseases such as cancer and infection. Along with the diminished
immune function, a rise in the bodys autoimmune response occurs, leading to the development
of autoimmune diseases such as rheumatoid arthritis and allergies to food and environmental
agents.
4. Neuroendocrine Theory: This theory proposes that aging occurs because of a slowing
of the secretion of certain hormones that have an impact on reactions regulated by the nervous
system. This is most clearly demonstrated in the pituitary gland, thyroid, adrenals, and the glands
of reproduction. Although research has given some credence to a predictable biological clock
that controls fertility, there is much more to be learned from the study of the neuroendocrine
system in relation to a systemic aging process that is controlled by a clock.

 Psychosocial Theories:
Psychosocial theories focus on social and psychological changes that accompany advancing age,
as opposed to the biological implications of anatomic deterioration. Several theories have
attempted to describe how attitudes and behavior in the early phases of life affect peoples
reactions during the late phase. This work is called the process of successful aging.
1. Personality Theory: Personality theories address aspects of psychological
growth without delineating specific tasks or expectations of older adults. Some evidence
suggests that personality characteristics in old age are highly correlated with early life
characteristics. Murray and associates (2009) state: No specific personality changes occur as a
result of aging. The older person becomes more of what he or she was. The older person
continues to develop emotionally and in personality and adds on characteristics instead of
making drastic changes. In extreme old age, however, people show greater similarity in certain
characteristics, probably because of similar declines in biological functioning and societal
opportunities. In a classic study by Reichard, Livson, and Peterson (1962), the personalities of
older men were classified into the following five major categories according to their patterns of
adjustment to aging.
1. Mature men are considered well-balanced persons who
maintain close personal relationships. They accept both the strengths and weaknesses of their
age, finding little to regret about retirement and approaching most problems in a relaxed or
convivial manner without continually having to assess blame.
2. Rocking chair personalities are found in passive
dependent individuals who are content to lean on others for support, to disengage, and to let most
of lifes activities pass them by.
3. Armored men have well-integrated defence
mechanisms, which serve as adequate protection. Rigid and stable, they present a strong silent
front and often rely on activity as an expression of their continuing independence.
4. Angry men are bitter about life,
themselves, and other people. Aggressiveness is common, as is suspicion of others, especially of
minorities or women. With little tolerance for ambiguity or frustration, they have always shown
some instability in work and their personal lives, and now feel extremely threatened by old age.
5. Self-haters are similar to angry men,
except that most of their animosity is turned inward on themselves. Seeing themselves as dismal
failures, being old only depresses them allhe more.
The investigators identified the mature, rocking chair, and armored categories as characteristic
of healthy, adjusted individuals and the angry and selfhater categories as less successful at aging.
In all cases, the evidence suggested that the personalities of the subjects, although distinguished
by age-specific criteria, had not changed appreciably throughout most of adulthood.
2. Developmental Task Theory: Developmental tasks are the activities and
challenges that one must accomplish at specific stages in life to achieve successful aging.
Erikson (1963) described the primary task of old age as being able to see ones life as having
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been lived with integrity. In the absence of achieving that sense of having lived well, the older
adult is at risk for becoming preoccupied with feelings of regret or despair.
3. Disengagement Theory: Disengagement theory describes the
process of withdrawal by older adults from societal roles and responsibilities. According to the
theory, this withdrawal process is predictable, systematic, inevitable, and necessary for the
proper functioning of a growing society. Older adults were said to be happy when social contacts
diminished and responsibilities were assumed by a younger generation. The benefit to the older
adult is thought to be in providing time for reflecting on lifes accomplishments and for coming
to terms with unfulfilled expectations. The benefit to society is thought to be an orderly transfer
of power from old to young. There have been many critics of this theory, and the postulates have
been challenged. For many healthy and productive older individuals, the prospect of a slower
pace and fewer responsibilities is undesirable.
4. Activity Theory: In direct opposition to the disengagement theory is the
activity theory of aging, which holds that the way to age successfully is to stay active. Multiple
studies have validated the positive relationship between maintaining meaningful interaction with
others and physical and mental well-being. Sadock and Sadock (2007) suggested that social
integration is the prime factor in determining psychosocial adaptation in later life. Social
integration refers to how the aging individual is included and takes part in the life and activities
of his or her society. This theory holds that the maintenance of activities is important to most
people as a basis for deriving and sustaining satisfaction, self-esteem, and health.
5. Continuity Theory: This theory, also known as the developmental
theory, is a follow-up to the disengagement and activity theories. It emphasizes the individuals
previously established coping abilities and personal character traits as a basis for predicting how
the person will adjust to the changes of aging. Basic lifestyle characteristics are likely to remain
stable in old age, barring physical or other types of complications that necessitate change. A
person who has enjoyed the company of others and an active social life will continue to enjoy
this lifestyle into old age. One who has preferred solitude and a limited number of activities will
probably find satisfaction in a continuation of this lifestyle. Maintenance of internal continuity is
motivated by the need for preservation of self-esteem, ego integrity, cognitive function, and
social support. As they age, individuals maintain their self-concept by reinterpreting their current
experiences so that old values can take on new meanings in keeping with present circumstances.
Internal self-concepts and beliefs are not readily vulnerable to environmental change, and
external continuity in skills, activities, roles, and relationships can remain remarkably stable into
the 70s. Physical illness or death of friends and loved ones may preclude continued social
interaction .

BIOLOGICAL ASPECTS OF AGING2

Individuals are unique in their physical and psychological aging processes, as influenced by
their predisposition or resistance to illness; the effects of their external environment and
behaviors; their exposure to trauma, infections, and past diseases; and the health and illness
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practices they have adopted during their life span. As the individual ages, there is a quantitative
loss of cells and changes in many of the enzymatic activities within cells, resulting in a
diminished responsiveness to biological demands made on the body. Age-related changes occur
at different rates for different individuals, although in actuality, when growth stops, aging begins.
This section presents a brief overview of the normal biological changes that occur with the aging
process.
Skin: One of the most dramatic changes that occurs in aging is the loss of elastin in the
skin. This effect, as well as changes in collagen, causes aged skin to wrinkle and sag. Excessive
exposure to sunlight compounds these changes and increases the risk of developing skin cancer.
Fat redistribution results in a loss of the subcutaneous cushion of adipose tissue. Thus, older
people lose insulation and are more sensitive to extremes of ambient temperature than are
younger people (Stanley, Blair, & Beare, 2005). A diminished supply of blood vessels to the skin
results in a slower rate of healing.
Cardiovascular System :The age-related decline in the cardiovascular system is thought
to be the major determinant of decreased tolerance for exercise and loss of conditioning and the
overall decline in energy reserve. The aging heart is characterized by modest hypertrophy and
loss of pacemaker cells, resulting in a decrease in maximal heart rate and diminished cardiac
output (Blair, 2012). This results in a decrease in response to work demands and some
diminishment of blood flow to the brain, kidneys, liver, and muscles. Heart rate also slows with
time. If arteriosclerosis is present, cardiac function is further compromised.
Respiratory System: Thoracic expansion is diminished by an increase in fibrous
tissue and loss of elastin. Pulmonary vital capacity decreases, and the amount of residual air
increases. Scattered areas of fibrosis in the alveolar septa interfere with exchange of oxygen and
carbon dioxide. These changes are accelerated by the use of cigarettes or other inhaled
substances. Cough and laryngeal reflexes are reduced, causing decreased ability to defend the
airway. Decreased pulmonary blood flow and diffusion ability result in reduced efficiency in
responding to sudden respiratory demands.
Musculoskeletal System: Skeletal aging involving the bones, muscles, ligaments, and
tendons probably generates the most frequent limitations on activities of daily living experienced
by aging individuals. Loss of muscle mass is significant, although this occurs more slowly in
men than in women. Demineralization of the bones occurs at a rate of about 1 percent per year
throughout the life span in both men and women. However, this increases to approximately 10
percent in women around menopause, making them particularly vulnerable to osteoporosis.
Individual muscle fibers become thinner and less elastic with age. Muscles become less flexible
following disuse. There is diminished storage of muscle glycogen, resulting in loss of energy
reserve for increased activity. These changes are accelerated by nutritional deficiencies and
inactivity.
Gastrointestinal System: In the oral cavity, the teeth show a reduction in dentine
production, shrinkage and fibrosis of root pulp, gingival retraction, and loss of bone density in
the alveolar ridges. There is some loss of peristalsis in the stomach and intestines, and gastric
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acid production decreases. Levels of intrinsic factor may also decrease, resulting in vitamin B12
malabsorption in some aging individuals. A significant decrease in absorptive surface area of the
small intestine may be associated with some decline in nutrient absorption. Motility slowdown of
the large intestine, combined with poor dietary habits, dehydration, lack of exercise, and some
medications, may give rise to problems with constipation. There is a modest decrease in size and
weight of the liver resulting in losses in enzyme activity required to deactivate certain
medications by the liver. These age related changes can influence the metabolism and excretion
of these medications. These changes, along with the pharmacokinetics of the drug, must be
considered when giving medications to aging individuals.
Endocrine System: A decreased level of thyroid hormones causes a lowered basal
metabolic rate. Decreased amounts of adrenocorticotropic hormone may result in less efficient
stress response. Impairments in glucose tolerance are evident in aging individuals. Studies of
glucose challenges show that insulin levels are equivalent to or slightly higher than those from
younger challenged individuals, although peripheral insulin resistance appears to play a
significant role in carbohydrate intolerance. The observed glucose clearance abnormalities and
insulin resistance in older people may be related to many factors other than biological aging
(e.g., obesity, family history of diabetes) and may be influenced substantially by diet or exercise.
Genitourinary System: Age-related declines in renal function occur because of a
steady attrition of nephrons and sclerosis within the glomeruli over time. Vascular changes affect
blood flow to the kidneys, which results in reduced glomerular filtration and tubular function.
Elderly people are prone to develop the syndrome of inappropriate antidiuretic hormone
secretion, and levels of blood urea nitrogen and creatinine may be elevated slightly. The overall
decline in renal functioning has serious implications for physicians who prescribe medications
for elderly individuals. In men, enlargement of the prostate gland is common as aging occurs.
Prostatic hypertrophy is associated with an increased risk for urinary retention and may also be a
cause of urinary incontinence (Johnston, Harper, & Landefeld, 2013). Loss of muscle and
sphincter control, as well as the use of some medications, may cause urinary incontinence in
women. Not only is this problem a cause of social stigma, but also, if left untreated, it increases
the risk of urinary tract infection and local skin irritation. Normal changes in the genitalia are
discussed in the section Sexual Aspects of Aging.
Immune System: Aging results in changes in both cell-mediated and antibodymediated immune responses. The size of the thymus gland declines continuously from just
beyond puberty to about 15 percent of its original size at age 50. The consequences of these
changes include a greater susceptibility to infections and a diminished inflammatory response
that results in delayed healing. There is also evidence of an increase in various autoantibodies as
a person ages, increasing the risk of autoimmune disorders, such as rheumatoid arthritis
(National Institutes of Health [NIH], 2012). Because of the overall decrease in efficiency of the
immune system, the proliferation of abnormal cells is facilitated in the elderly individual. Cancer
is the best example of aberrant cells allowed to proliferate due to the ineffectiveness of the
immune system.
Nervous System: With aging, there is an absolute loss of neurons,
which correlates with decreases in brain weight of about 10 percent by age 90 (Murray et al.,
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2009). Gross morphological examination reveals gyral atrophy in the frontal, temporal, and
parietal lobes; widening of the sulci; and ventricular enlargement. However, it must be
remembered that these changes have been identified in careful study of adults with normal
intellectual function. The brain has enormous reserve, and little cerebral function is lost over
time, although greater functional decline is noted in the periphery (Stanley et al., 2005). There
appears to be a disproportionately greater loss of cells in the cerebellum, the locus coeruleus, the
substantia nigra, and olfactory bulbs, accounting for some of the more characteristic aging
behaviors such as mild gait disturbances, sleep disruptions, and decreased smell and taste
perception. Some of the age-related changes within the nervous system may be due to alterations
in neurotransmitter release, uptake, turnover, catabolism, or receptor functions (Beers & Jones,
2004; Blair, 2012). A great deal of attention is being given to brain biochemistry and in particular
to the neurotransmitters acetylcholine, dopamine, norepinephrine, and epinephrine. These
biochemical changes may be responsible for the altered responses of many older persons to
stressful events and some biological treatments.
Sensory Systems: 1.Vision : Visual acuity begins to decrease in midlife.
Presbyopia (blurred near vision) is the standard marker of aging of the eye. It is caused by a loss
of elasticity of the crystalline lens, and results in compromised accommodation. Cataract
development is inevitable if the individual lives long enough for the changes to occur. Cataracts
occur when the lens of the eye becomes less resilient (due to compression of fibers) and
increasingly opaque (as proteins lump together), ultimately resulting in a loss of visual acuity.
The color in the iris may fade, and the pupil may become irregular in shape. A decrease in
production of secretions by the lacrimal glands may cause dryness and result in increased
irritation and infection. The pupil may become constricted, requiring an increase in the amount
of light needed for reading.
2. Hearing: Hearing changes significantly with the
aging process. Gradually over time, the ear loses its sensitivity to discriminate sounds because of
damage to the hair cells of the cochlea. The most dramatic decline appears to be in perception of
high-frequency sounds. Age-related hearing loss, called presbycusis, is common and affects more
than half of all adults by age 75 years (Blevins, 2013). It is more common in men than it is in
women, a fact that may be related to differences in levels of lifetime noise exposure.
3. Taste and Smell: Taste sensitivity decreases over the life
span. Taste discrimination decreases, and bitter taste sensations predominate. Sensitivity to sweet
and salty tastes is diminished. The deterioration of the olfactory bulbs is accompanied by loss of
smell acuity. The aromatic component of taste perception diminishes.
4. Touch and Pain: Organized sensory nerve receptors on the skin
continue to decrease throughout the life span; thus, the touch threshold increases with age. The
ability to feel pain also decreases in response to these changes, and the ability to perceive and
interpret painful stimuli changes. These changes have critical implications for the elderly in their
potential inability to use sensory warnings to escape serious injury.

PSYCHOLOGICAL ASPECTS OF AGING2,3

Adaptation to the Tasks of Aging
Loss and Grief : Individuals experience losses from the very beginning of life. By the time
individuals reach their 60s and 70s, they have experienced numerous losses, and mourning has
become a lifelong process. Unfortunately, with the aging process comes a convergence of losses,
the timing of which makes it impossible for the aging individual to complete the grief process in
response to one loss before another occurs. Because grief is cumulative, this can result in
bereavement overload, which has been implicated in the predisposition to depression in the
elderly.
Attachment to Others: Many studies have confirmed the importance of interpersonal
relationships at all stages in the life cycle. Murray and associates (2009) state: Social networks
contribute to well-being of the elder by (a) promoting socialization and companionship, (b)
elevating morale and life satisfaction, (c) buffering the effects of stressful events, (d) providing a
confidant, and (e) facilitating coping skills and mastery. This need for attachment is consistent
with the activity theory of aging that correlates the importance of social integration with
successful adaptation in later life.
Maintenance of Self-Identity :Self-concept and self-image appear to remain stable over
time. Factors that have been shown to favour good psychosocial adjustment in later life are
sustained family relationships, maturity of ego defences, absence of alcoholism, and absence of
depressive disorder. Studies show that the elderly have a strong need for and remarkable
capability of retaining a persistent self-concept in the face of the many changes that contribute to
instability in later life.
Dealing With Death : anxiety among the aging is apparently more of a myth than a reality.
Studies have not supported the negative view of death as an overriding psychological factor in
the aging process. Various investigators who have worked with dying persons report that it is not
death itself, but abandonment, pain, and confusion that are feared. What many desire most is
someone to talk with, to show them their lifes meaning is not shattered merely because they are
about to die.
Retirement : An individuals view of retirement is a product of many factors, including overall
life attitude, support of significant others, and personal expectations. For individuals who, during
their adult years, defined themselves and their success according to their work contributions,
retirement is likely to produce feelings of uneasiness and anxiety. An individual who views
retirement as the end of the productive years will dread the change in life pattern and social
status and may fear being a burden to others, both socially and financially. Many adults, though,
look forward to retirement as their reward for years of hard work and contributions and fill their
newly freed days with activities, travel, new skills or hobbies, and interests that time constraints
had prohibited them from pursuing during their earlier years. These individuals typically led
more balanced lives during their working years, viewing their value as a combination of many
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factors including work, family, and community involvement; they adjust more easily to the loss
of employment status by balancing this change with other positive aspects of their lives. Also,
individuals who have planned for retirement and made arrangements (financial, housing, social)
ahead of time tend to adjust more readily to this change in work status.

MEMORY FUNCTIONING2
Age-related memory deficiencies have been extensively reported in the literature. Although
short-term memory seems to deteriorate with age, perhaps because of poorer sorting strategies,
long-term memory does not show similar changes. However, in nearly every instance, welleducated, mentally active people do not exhibit the same decline in memory functioning as their
age peers who lack similar opportunities to flex their minds. Nevertheless, with few exceptions,
the time required for memory scanning is longer for both recent and remote recall among older
people. This can sometimes be attributed to social or health factors (e.g., stress, fatigue, illness),
but it can also occur because of certain normal physical changes associated with aging (e.g.,
decreased blood flow to the brain).
Intellectual Functioning
There appears to be a high degree of regularity in intellectual functioning across the adult age
span. Crystallized abilities, or knowledge acquired in the course of the socialization process, tend
to remain stable over the adult life span. Fluid abilities, or abilities involved in solving novel
problems, tend to decline gradually from young to old adulthood. In other words, intellectual
abilities of older people do not decline but do become obsolete. The age of their formal
educational experiences is reflected in their intelligence scoring.
Learning Ability
The ability to learn is not diminished by age. Studies, however, have shown that some aspects of
learning do change with age. The ordinary slowing of reaction time with age for nearly all tasks
or the over-arousal of the central nervous system may account for lower performance levels on
tests requiring rapid responses. Under conditions that allow for self-pacing by the participant,
differences in accuracy of performance diminish. Ability to learn continues throughout life,
although strongly influenced by interests, activity, motivation, health, and experience.
Adjustments do need to be made in teaching methodology and time allowed for learning.

NURSING MANAGEMENT3
1. Diagnosis: Risk for Injury related to confused mental status.
Expected Outcome: Client will be free from injury to self or others.
Interventions/Rationales

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1. Approach in a calm, nonthreatening manner. (Decreases anxiety level, which further impairs
mental status.)
2. Determine the presence of personal or environmental risk factors. (Identification of
safety hazards is the first step in minimizing such hazards).
3. Orient client regularly to his environment. (To decrease clients frustration level and
better understand client needs.)
4. Closely supervise client at night to assess safety. (To determine which risk
factors are present and what safety measures should be implemented.)
5. Set limits on self-destructive behavior. (To promote safety of
client and others.)
6. Monitor judgment, decision-making ability, and impulse
control. (Impaired judgment and impulsivity increase the likelihood of unsafe behaviors.)
7. Minimize specific hazards in the home (e.g., remove
stove knobs, store cleaning products and medications in a locked area, clear floor and hallway of
obstacles). (To make the home environment safer.)
8. Provide an ID bracelet for client to wear at home, and
participate in local police registry if available. (To increase possibility of clients quick return to
home if he wanders away.)
9. Keep nightlights on at night. (Decreases the potential for
falls.)
10. Instruct family to install an alarm system on all exit
doors. (To minimize the possibility of wandering.)
2. Diagnosis: Disturbed Sleep Pattern related to altered mental status
Expected Outcome: Client will experience at least 4 hours of uninterrupted sleep at night.
Interventions/Rationales
1. Monitor and keep a record of sleep patterns. (To determine a baseline for future evaluation of
progress or lack of progress.)
2. Minimize daytime napping. (Older adults need less sleep, so daytime napping only
subtracts from amount of sleep required at night.)
3. Schedule exercise 2 hours prior to scheduled bedtime. (To provide relaxation.)
4. Teach client and family simple relaxation techniques. (Keeping
instructions simple helps the client who is confused to better absorb the information. Relaxation
techniques can be used to promote sleep.)
5. Limit caffeine intake. (Caffeine can interfere with sleep.)
6. Ensure quiet environment with a soft nightlight.(
Promotes relaxation and a sense of comfort.) 7. Provide comfort measures and teach such
measures to family. (The use of back rubs and rearranging linens can promote comfort and
relaxation.)
3. Diagnosis: Self-Care Deficit related to cognitive impairment

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Expected Outcome: client will perform activities of daily living (ADL) with optimal
independence.
Interventions/Rationales
1. Monitor ability to perform ADLs. (To determine the clients level of functional ability and the
amount of assistance that is needed.)
2. Encourage client to perform the skills that are present. (To prevent functional disuse
and to promote self-esteem.)
3. If necessary, give step-by-step directions in clear simple terms with only one
step at a time. (Breaking a task down into small segments increases the likelihood of successful
completion.) 4. Instruct family to purchase clothing (or modify existing wardrobe) with Velcro
fasteners instead of buttons and zippers.( Decreases amount of effort client must expend to dress
self appropriately without assistance.)

REFERENCE
1. Gopal K Ingle, Anita Nath. Geriatric Health in India: Concerns and Solutions.
Indian J Community Med. 2008 Oct; 33(4): 214218.
2. Townsend C Mary. Psychiatric mental health nursing. 8th ed. Philadelphia: FA
Davis company. 2015.
3. Sue C. DeLaune, Patricia K. Ladner. Fundamentals of nursing standards
&practice. 2nd edition.

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