SEMINAR ON

GERIATRIC
CONSIDERATIONS
IN NURSING

SUBMITTED TO: SUBIMTTED

BY:
DR.NAVANEETHA, MS.NANDHINI.C,
PROFESSOR, M.SC(N)-I YEAR,
DEPT. OF CHN, CHN,
CON.PIMS. CON.PIMS.
SUBMITTED ON:

1
 30.12.2020

MASTER PLAN
Subject:Advance Nursing Practice Topic:Geriatric considerations in nursing

Unit:8 Date:30.12.2020

SL.NO TOPIC PG.NO

1 Objectives 3
 General objectives
 Specific objectives

2 Introduction 4

3 Demography 4

4 History of Geriatrics 4
5 Definition 4

6 Principles of gerontological nursing 5

7 Factors affecting ageing 5

8 Theories of ageing process 5-6

9 Age associated changes in the body 6-7

10 Diet for older adults 7

11 Specific concerns of the elderly population 7

12 Common problems in old age 7

13 Legal aspects of care 8

14 Prevention and nursing management 8-9

15 Steps taken by Government 10

16 Ageing:New nursing challenges 10

17 Responsibility of Gerontological nurse 11

18 Conclusion 11
19 Summary 11

20 Journal abstracts 12

21 Key words 12

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22 Bibilography 12

23 AV aids 12

OBJECTIVES

GENERAL OBJECTIVES:-

The students will acquire knowledge about geriatric considerations

in nursing and they can apply the gained knowledge in rendering nursing
service in a respective area with favourable attitude.

SPECIFIC OBJECTIVES:-

At the end of the class student will able to

1. Introduction of geriatric consideration in nursing

2. Define gerontology, geriatric care and gerontological nursing

3. List down the principles of gerontological nursing

4. Enlist the various factors that affecting ageing

5. Enumerate the theories of ageing process

6. Briefly discuss about the age associated changes in the body

7. Discuss about the dietary allowance for older adults

8. Enlist the specific concerns of the older population

9. List down the legal aspects of care

10.Briefly discuss about the prevention and nursing management in

geriatrics

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 11.Enumerate the steps taken by governments and non-governmental
organizations

12.Explain the new nursing challenges regards ageing

13.List dow0n the responsibility of geriotological nurseon

INTRODUCTION:

Aging, the normal process related change, begins with birth and
continues throughout life. Geriatric nursing is a nursing sub field involves
caring for older adults. Older adults have special needs which can become very
complex, employments prospects in the field of geriatric nursing very well.

A well being of an aged person depends on physical , mental ,social

and environmental factors. A total assessment includes an evaluation of all
major body system, social and mental status and the ability of the person to
function independently despite a chronic illness. Ageing is a difficult process
that can generate stress for the older person as well as for family members and
other people involves in long term often grow quickly frusted with the overall
lack of available resource.

DEMOGRAPHY:

 The no. of elderly increased more than 3 fold since 1950, from
approximately 130 million (4% of global population) to 419 million(6.9%)
in 2000.

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 The no. of elderly is now increasing by 8 million per year;by 2030,tis
increase will reach 24 million per year.

HISTORY OF GERIATRICS:

 Hippocrates & Aristrotle contributed to the theory of ageing.

 Nascher was the father of geriatrics and Majory warren was its mother.

MEANING:

The term Geriatrics came from the greek word “geron” meaning “old man”
and “iatros” meaning “healer. However, geriatrics is sometimes called medical
gerontology.

DEFINITION:

GERONTOLOGY

This is a science dealing with ageing process.

GERIATRIC CARE

This is related to the disease process of the old age and its aims at
keeping old persons at a state of self-dependence as far as possible
and to provides facilities to improve their quality of life.

GERONTOIOGICAL NURSE

A nurse who has specialization in geriatrics or in the care of old

people is called geriatric nurse or gerontological nurse.

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PRINCIPLES OF GERONTOLOGICAL NURSING:

-Aging is a natural process common to all living organisms.

-The elderly share similar self care and human needs with all other
human beings.

-Gerontological nursing strives to helps olders adults achieve

optimistic level of health physical, psychological, social and spiritual
health so that they can achieve wholeness.

-Various factors influence the aging process.

FACTORS AFFECTING AGEING:

 Hereditary factors

Hereditary diseases, the capacity for longevity and physical capacities

influence the ageing process.

 Environmental factors

Three types of environmental factors affects ageing:

a) Abiotic factors

Factors affecting ageing process like climate, radiation,

chemical and elements of pollution., etc

b) Biotic factors

In this, living organisms present in the environment like

pathogens, parasites, the availability and quality of food., etc
are included. They all influence the ageing of the person.

c) Socio-economic factors.

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 Several socio-economic factors creating adverse living or
working conditions increase ‘ the wear and tear” of life. Such
tensions make people grow old early.

THEORIES OF AGEING PROCESS:

a) Biological theories of ageing

Human ageing is a viewed as a total process that begins at

conception. Because individuals have unique genetic social,
psychological and economical factors inter twisted in their
lives, the course ageing varies from individual to individual.

I. Stochastic theories

This theory explains as ageing as an event that occurs

randomly and accumulate over time, whereas
non-stochastic theories view ageing as certain
predetermined, time phenomenon.

-Error theory

In 1963, Orgeel proposed the error theory, sometimes called

the error catastrophe theory. This theory’s hypothesis is
based on the idea that errors may occur in the transcription
in any step of the protein synthesis of DNA, and this
eventually leads to either ageing or the actual death of a cell.
In recent years, the theory has not been supported by
researcher.

-Free radical theory

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 Free radicals are by products of fundamental metabolic
activities within the body. Free radicals production may
increase as a result of environmental pollution such as ozone,
pesticides’ and radiation.

Normally they are neutralized by the enzymatic activity or

natural antioxidant, if they are not neutralized; they may
attach themselves to other molecules. These highly reactive
free radical react with the molecules in the cell membranes of
unsaturated lipid such as mitochondria, lysozomes and
nuclear membrane. Therefore the mitochondria for example,
can no longer function as efficiently, and their cell membranes
may be damaged.

-Cross link theory

The cross link theory of ageing hypothesizes that with age,

some protein become increasing cross linked or enmeshed and
may impede metabolic process by obstructing the passage of
nutrients and waste between the intracellular and
extracellular compartment.

According to this theory, normally separated molecular

structures are bound tighter through chemical reaction. This
primarily involves collagen, a new fibres’ are created, they
becomes unmeshed with old fibres and form an actual
chemical cross link. This results increase i the density of
collagen molecule but a decrease in it capacity to both
transport nutrients to cell and removes waste product from

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 the cell Ex, The skin of thee baby is soft and pliable whereas
ageing skin loses much of its elasticity.

-Wear and tear theory

This theory that cells proposed that cells wear out over time
because if continue use. This theory reflects a belief that
organs and tissues have a pre-programmed amount of
available energy and when the allotted energy is expanded.
Eventually, this leads to the death of entire organisms.

According to this theory, ageing is almost a pre-programmed

process thought to be vulnerable to stress or to an
accumulation of injuries or trauma, which may actually
accurate it.

According to Carnes, Staats, and Sonntag [ 2008], striated

muscle, heat muscles, muscles fibres, nerve cells and the brain
are irreplaceable when destroyed by wear and tear.

b) Non-stochastic theories

Non-stochastic theories view ageing as certain predetermined,

time phenomenon.

-Programmed theory

This study included an experimental on foetal fibroblastic cells and their

reproductive capabilities. The results of this landmark study changed the
way scientists viewed the biologic ageing process.

Hey-flick and Moorhead’s [1961] study shows the functional changes do

occurs within calls and are responsible for the ageing of the cells and the

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organism. This 1961 study founds that limited cell division did not occurs;
the immortality of individual cells was founds to be more an abnormal
occurrence than a normal one.

Life expectancy was generally seen as programmed, within a specific

species range; this biologic clock for human was estimated at 110-120
years. On the basis of the conclusions of their experiment, the Heyflick
limit theory is sometimes called the “biologic clock theory”, “cellular
ageing theory” or genetic theory.

-Immunity theory

The immune system is a network of specialized cells, tissues and organs

that provide protection against invading infections. The essential
component of the immune system are T lymphocytes, which are
responsible for cell mediated immunity, and B-lymphoctes, the antibodies
responsible for humoral immunity.

The changes that occur with ageing are most apparent in the
T-lymphocytes, although changes also occur in the functioning capacities
of B-lymphocytes. The changes in the immune system cannot be explained
by an exact cause and effect relationship, but they do seem to increase with
advancing age, it includes a decrease in human immune response , often
predisposing older adults to-

i. Decrease resistance to a tumour cell challenge and the development

of cancer.

ii. Decrease ability to initiate the immune process and mobilize the
body’s defence against aggressively attacking pathogens and

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 iii. Heightened production of auto antigens, often leading to an increase
in autoimmune-related diseases, such as systematic lupus
erythematous and rheumatoid arthritis.

2. Sociologic theories of ageing

Sociologic theories focus on changing roles and relationships. This theory

relate to various social adaptations in the lives of older adults.

a) Disengagement theory

In 1962, cuming and hennery published the first sociologic

theory of ageing in their book, growing old: the process of
disengagement.

According to this theory, a society and older people engage in

a mutually beneficial process of reciprocal withdrawal to
maintain social equilibrium, this process occurs
systematically and inevitably and its governed by society’s
needs, which override individual needs.

Moreover, older people desire this withdrawal and are happy

when it occurs. Individuals would change from being centred
on society and interacting in the community to being
self-centred process withdrawing from society by virtue of
becoming old.

b) Developmental task theory

This theory sees activity as necessary to maintain a persins

life satisfaction and positive self concept. In 1953, Havighurst
and Albrecht first proposed the idea that ageing successfully

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 is related to staying active, by remaining active the older
person stays young and lively does not withdrawn from
society because of an age parameter.

This theory is based on 3 assumptions:

 It is batter to be active than inactive.

 It is batter to be happy than unhappy.

 An older individual is the best judge of his or her own

success in achieving the first 2assumptions

Lemon and colleagues 1972 tested this theory and found a

significantly relationship between formal activity and life
satisfaction.

c) Continuity theory

The continuity theory dispels the premises of both the

disengagement and activity theories. According to this
theory, being active, trying to maintain a sense of being
middle-aged and willingly withdrawing from society doe not
necessary bring happiness, instead the community theory
proposes that how a person has been throughout life is how
that person will continue to be through the reminder of life.

According to this theory, the later part of life is a

continuation of earlier part and therefore the integral
component of the entire life cycle. The theory can be seen as a
developmental theory.

d) Age stratification theory

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 This theory ,firstly proposed by Riley and colleagues[1972],
address the interdependencies between age an element of the
social structure and the ageing of people and cohort as a
social process.

This theory attempts to explain the inter dependent between

older adults and society and how they constantly influence
each other in a variety of ways., it also emphasizes the flow
concepts

1) People pass through society in cohort that are ageing

socially, biologically and psychologically.

2) New cohorts are continually being born and

experiences a unique sense of history.

3) A society can be divided into various strata according

to age and roles.

4) Society itself is a continually changing, as are the

people and their roles in each age stratum.

5) A dynamic interplay exists between individual ageing

and social change.

e) Person environment fit theory

The person-environment fit theory considers the

interrelationships between personal competence and the
environment[Lawton 1982].

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 According to this theory, personal competence involves the
following factors which collectively contributes to a person’s
function ability: ego strength, motor skills, biologic health,
cognitive capacity, and sensory perceptual capacity.

Lawton asserts that for each person’s level of competence,

there is a level of demand or environmental press that is most
advantageous to that person’s function.

This is often used in planning appropriate environment for

older adults with disabilities.

3. Psychological theory

The basic assumptions of the psychological theories of ageing are

development her not end when a person reaches adulthood but remains a
dynamic process throughout her life span

a. Psychological ageing cannot readily be separated from

biologic and sociologic influence.

b. Psychological ageing, therefore influence not only

behavioural changes but also developmental aspects
related t the life of older adults.

c. There are psychological theories are given below

1. Maslow’s hierarchy of human needs

According to this theory, each individual has an innate

internal hierarchy of needs that motivate all human
behaviours.

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 When people achieve fulfilment of their elemental needs, they
strive to meet the needs of next level, continuing on until the
highest order of need is reached.

The human needs are often depicted as a pyramid, with the

most elemental needs at the base.

2. Jung’s theory of individualism

The Swiss psychologist carljung [196] proposed a theory of

personality development throughout life: childhood, youth
and young adulthood, middle age and old age.

According to this theory, a person’s personality visualised as

oriented either toward the external world[extroversion] or
toward subjective, inner experiences[introversion].Applying
this theory to individuals as they process through life’s
proposed that it is at onset of middle age that the person
begins to question values, beliefs and possible dreams left
unrealized.

During this period, the individual often searches for

answering about reaching goals questioning whether a part of
his or her personality or “ true self” has been neglected and
whether time is running out for completion of these quests.

As the person ages chronologically, the personality often

begins to change from being outwardly focused, concerned
about established oneself in society, to becoming more
inward, as the individual begins to search for answers from
within successful aging.

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3. Erickson’s 8 stages of life

In , Erickson [] proposed a theory of psychological

development , reflects cultural and social influences. The
major focus of development in the theory is an
individual’s ego structure, or sense of self, especially in
response to the way in which society shapes its
development.

The task of middle adulthood is resolving the

conflict between generatively and stagnation. During
older adulthood, the developmental task needing
resolution is balancing the search for integrity and
wholeness with a sense of despairs. [potter and Perry,]

4. Peck’s expansion of Erikson’s theory

Peck’s expanded the stage, ego integrity versus despair,

into three stage:

 Ego differentiation versus work role

preoccupation

 Body transcendence versus body

preoccupation and

 Ego transcendence versus ego

preoccupation.

During the first stage of this, the task for adults is to

achieve identity and feeling of worth from sources other
than the work role. The onset of retirement and

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 termination of the work role may reduce feelings of
self-worth.

The second stage, body transcendence versus body

preoccupation, refers to the older person’s view of the
physical changes that occur as a result of the aging
process. The task is to adjust to or transcend the declines
that may occur to maintain feelings of well-being.

The third and final stage involves acceptance of the

individual’s eventual death without dwelling on the
prospects of it. Remaining activity involved with a future
that extends beyond a person’s mortality is the
adjustment that must be made to achieve ego
transcendence.

5. Moral and spiritual development

Kohlberg has postulated a theory of moral development

that is based on interviews with young persons. He
recoganized distinct sequential stage of moral thinking.

Spirituality no longer merely denotes religious

affiliation, its synthesizes a person’s contemplative
experience. Illness, a life crises, or even the recognition
that one’s day on earth are limited may causes a person
to contemplate spiritually.

AGE ASSOCIATED CHANGES IHE BODY:

I. PHYSIOLOGICAL CHANGES:00

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  Integumentary system

 Cardiovascular system

 Respiratory system

 Genito-urinary system

 Gastro-intestinal system

 Musculoskeletal system

 Endocrine system

 Neurological system

 Sensory system

 Immune system

II. PSYCHOLOGICAL CHANGES:

 Personality functioning

 Memory functioning

 Intellectual functioning

 Learning abilities

 Adaptation to the tasks of ageing

 Psychiatric disorders in later life

III. SOCIO-CULTURAL ASPECTS OF AGEING

IV. SEXUAL ASPECTS OF AGEING

DIET FOR OLDER ADULTS:

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 -Recommended dietary allowance.

-Menu planning.

-Factors affecting nutritional status of the elderly.

SPECIFIC CONCERNS OF THE ELDRLY POPULATION:

1. Retirement

2. Elder abuse

-psychological abuse.

-physical abuse.

-Financial abuse.

-Sexual abuse.

3.Suicide.

COMMON PROBLEMS IN OLD AGE:

 Alzheimer’s disease.

 Strokes.

 Heart disease.

 Osteoarthritis.

 Rheumatoid arthritis.

 Diabetes.

 Urinary incontinence.

 Social isolation.

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LEGAL ASPECTS OF CARE:

 Negligence and malpractice

 Informed consent

 Medical directive to physician

 Patient self-determination ACT

PREVENTION AND NURSING MANAGEMENT OF ELDERLY:

i. Health assessment:-

COMPONENTS OF ASSESSMENT:-

 Physical

 Functional

 Psychological

 Socioeconomic

 Environmental

AIMS:-

-Cost effective

-Active elderly

-Provide quality care

EVALUATION OF NEWLY DISCOVERED RIK FACTORS

-Several functional disability

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 -Mild tomoderate dysfunction

MULTI-DISPLINARY GERIATRIC ASSESSMENT

ii. Preventive health care in elderly

 Primary prevention

-Health habits

--Immunization

-Injury prevention

 Secondary prevention

-Screening

 Tertiary prevention

-Rehabilitation

ADJUSTMENTS IN AGEING:

a) Family changes.

b) Retirement.

 Remote phase

 Near phase

 Honeymoon phase

 Disenchantment phase

 Stability phase

 Termination phase

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PRINCIPLES OF NURSING MANAGEMENT

CARE OG AGED:

a) Supporting cognitive function

b) Promoting physical safety

c) Reducing anxiety agitation

d) Improve communication

e) Promoting independence in self care activities

f) Providing for socialization and intimacy needs

g) Promoting adequate nutrition

h) Promoting balance activity and rest

i) Support home and community based care

STEPS TAKEN BY GOVERNMENTS AND NON –GOVERNMENTAL

ORGANIZATIONS:

GOVERMENTAL ORGANIZATIONS:-

a) LAWS:-

b) POLICIES:-

1. Minestry of social justice and empowernment

2. Minstery of rural development

3. Minestry of finance

4. Minestry of road transport and highways

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 5. Ministry of health and welfares

6. Miscellaneous

NON-GOVERNMENTAL ORGANIZATIONS:-

Helpage india

AGEING: NEW NURSING CHALLENGES:

-Gerontological psychiatric nurse specialist

-Care manager and family counsellor

-Pre admission assessor

-Nurse director

-Pre-retirement counsellor/educator

RSPONSIBILITY OF GERONTOLOGICAL NURSE:

-Guiding

-Eliminating

-Respecting

-Observing

-Noticing

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-Teaching

-Opening channels

-Listening

-Offering

-Generating

-Implementing

-Co-ordinating

-Assessing

-Linking nurse.

CONCLUSION:

The older adults are to be treated in a different way as their all bodily
systems are functioning in a diminished way.

SUMMARY:

JOURNAL ABSTRACT:Long term benefits of a lifestyle exercise program

for older people receiving a restorative home care service: A Pragmatic
randomized controlled trial

KEYWORDS:

Geriatrics, Gerontological nurse, ageing, elderly people, rehabilitation

BIBILOGRAPHY:

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Basheer shebeer.p and Khan s. Yaseen,” A concise textbook of advance

nursing practice”,1st edition, Emmess publishers, Bangalore

(2013),p.742-751.

Townsend mary. C, “Psychiatric mental health nursing”,7th edition, New

delhi(2012),p.824-851.

Basavanthapa B T,” Fundamental of nursing”, 2nd edition, Jaypee

publishers,New delhi(2009), p.635-637.

Kozier’s and erb’s,” Fundamental of nursing concepts process and

practice, 8th edition,Chennai(2009), p.406-423.

Potter and perry,” Fundamental of nursing”, 7th

edition,Elseiver,UP(2008), P.190-213.

WEBSITES:-

http://newoldage.blogs.nytimes.com/

http://www.britanniaca.com/

http://www.thefreedictionary.com/

http://slideshare.net/geriatric consideration in nursing/

AV AIDS: Powerpoint, blackboard,chart.

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