GERONTOLOGICAL

NURSING
Prepared by:
Andrew Isiah P. Bonifacio, RN
Overview of Topics

◦ Definition of Terms
◦ Health Promotion Among Geriatric Patients
◦ Assessment & Management of Common Medical, Surgical,
& Psychiatric Problems at Old Age
THE AGING PROCESS
Aging

◦inevitable and steadily progressive process

◦follows a chronological pattern
◦begins at the moment of conception and
continues throughout the remainder of life.
Phases of Old Age

Young –Old • 65-74 years

Middle-Old • 75-84 years

Old-Old • 85-99 years

Centenarian • 100+
NCLEX STYLE QUESTION
◦ Which of the following is/are common myths about
aging/older people in the US? (Select all that apply)

1. Being old means being sick.

2. Most older people are set in their ways and cannot learn new things or
take up new activities.
3. Health promotion is wasted on older people.
4. Older adults do not pull their own weight and are a drain on societal
resources.
5. Older people are isolated and lonely.
6. Older people have no interest in sex.
“OLD” STATISTICS
“Old” Statistics in the US

◦The number of Americans ages 65 and older

is projected to nearly double from 56 million
in 2018 to 98.2 million by 2060, and the 65-
and-older age group’s share of the total
population will rise from 16 percent to 23
percent.
Long-term Care Facilities
 LEADING GERIATRIC CONDITIONS
Heart disease: 647,457

Cancer: 599,108

Chronic lower respiratory diseases: 160,201

Stroke (cerebrovascular diseases): 146,383

Alzheimer’s disease: 121,404

Diabetes: 83,564

Influenza and Pneumonia: 55,672

Nephritis, nephrotic syndrome and nephrosis: 50,633

Intentional self-harm (suicide): 47,173

NCLEX STYLE QUESTION
◦ A nurse overhears a young person say: “I’m having a senior moment
because I forgot....” How should the nurse interpret this statement?

1. A comical statement without age bias

2. A stereotypical reference to older adults that can be termed ageism
3. Reflects age-related knowledge since memory decreases with age
4. A derogatory remark, but one that reflects a truism
AGEISM

comprises the prejudices and

stereotypes that are applied to
older people, and perpetuate
negativism against them.
GERONTOLOGICAL
CHANGES
INTEGUMENTARY SYSTEM
◦ Thinner, drier, and less elastic skin
◦ Slower wound healing
◦ Hair loss occurs
◦ Varicosities with brown/blue discolorations
◦ Increased appearance of “age spots”
and/or “liver spots and raised lesions
(seborrheic keratosis).
◦ Nails become brittle and thick.
NCLEX STYLE QUESTION
◦ A health-care provider documents, in the
medical record of an 87-year-old
hospitalized client, normal elder skin
changes of senile purpura. The elder has
no other skin changes. When assessing
the client, which skin change, illustrated
below, should the nurse expect to find?
MUSCULOSKELETAL SYSTEM
◦ Loss of bone calcium, atrophic
cartilage, and muscle occurs.
◦ Bone mineral density (BMD) decreases.
◦ Range of motion (ROM) of joints
decreases.
◦ Muscle cells are lost and not replaced.
◦ Lean body mass decreases with
increased body fat.
CARDIOVASCULAR SYSTEM
◦ Cardiac output decreases
◦ Diastolic murmurs are present
◦ Dysrhythmias (bradycardia,
tachycardia, atrial fibrillation, and
heart block) become more common
◦ Significant increases in systolic BP
occur
◦ Arteriosclerosis increases with age
NCLEX STYLE QUESTION
◦ When assessing the cardiovascular system of a 75-year-old male, a nurse
auscultates a systolic heart murmur. This is the only abnormality noted.
Which analysis by the nurse is correct?

1. Usually representative of some kind of underlying heart disease

2. Indication for valve replacement
3. Indication that the client has congestive heart failure (CHF)
4. Common due to age-related calcification and stiffening of the heart valves
RESPIRATORY SYSTEM
◦ Lungs lose elasticity
◦ Increased dead space in the lungs
◦ Decrease of alveolar surface area
◦ Decreased reaction of peripheral and
central chemoreceptors to hypoxia
and hypercapnia
◦ Decrease of cilia
◦ Decrease of strength and muscle
mass in the body
GASTROINTESTINAL SYSTEM
◦ Decreased saliva and dry mouth are
common.
◦ Dental caries (tooth decay) and loss of teeth
increase,
◦ Hunger sensations decrease due to
diminishing taste buds.
◦ Relaxation of the lower esophageal sphincter
◦ Decreased peristalsis
◦ Decreased stomach and intestinal enzymes
GENITOURINARY SYSTEM

◦ Size and weight of the

kidney decrease due to
reduced renal tissue growth.
◦ Glomerular filtration rate
decreases.
◦ Increased risk for reflux of
urine into the ureters
REPRODUCTIVE SYSTEM
WOMEN
• Women’s ovarian function
decreases
• Breast tissue involutes.
• Ovaries and the uterus slowly
atrophy
• Perineal muscle weakness and
atrophy of the vulva occur with
age.
• Vaginal mucous membrane
becomes dry
• Libido may or may not decline.
MEN
• Testes atrophy, lose weight,
and soften.
• Erection changes are seen.
• Prostate enlargement due to
changes in testosterone levels
• Testosterone production
decreases and libido can
decline.
ENDOCRINE SYSTEM
◦ Estrogen production ceases with
menopause; ovaries, uterus, and
vaginal tissue atrophy.
◦ Gonadal secretion of
progesterone and testosterone
decreases.
◦ Insulin production decreases or
insulin resistance increases.
◦ Thyroid activity decreases
 NEUROLOGICAL & SENSORY SYSTEM
◦ There is a decrease of neurons and
neurotransmitters in the brain, which do not
regenerate.
◦ Central processing decreases; performance
of tasks is slower.
◦ Significantly lower or nonexistent vibratory
senses in the lower extremities
◦ Decrease of tactile sensitivity
◦ Loss of connection in nerve endings in the
skin
◦ Loss of proprioception, affecting balance
 COMPREHENSIVE
GERIATRIC ASSESSMENT
& MANAGEMENT
HEALTH HISTORY TAKING

Disease prevention
Review of acute
and health
and chronic Medications Functional status
maintenance
medical problems
review

Driving status and Geriatric review of

Social supports Finances
safety record symptoms
ACUTE &
CHRONIC
CONDITIONS
COMMON TO
GERIATRIC
PATIENTS
PRESSURE ULCERS

◦localized injury to the skin

and/or underlying tissue,
usually over a bony
prominence, as a result of
pressure, or pressure in
combination with shear/or
friction (NPUAP, 2010)
ETIOLOGY
Intensity and
duration of
pressure on the
skin

Tolerance of the
skin and its
structures to
pressure
MECHANISMS OF PATHOLOGY

Aggravating factors

Increased pressure

Blood vessel occlusion

Poor cell perfusion

Tissue necrosis
PRESSURE ULCER CATEGORIES

Stage I • Nonblanchable erythema of intact skin

Stage II • Partial-thickness skin loss

Stage III • Full-thickness skin loss

Stage IV • Full-thickness skin loss with extensive damage

PRESSURE
ULCER
CATEGORIES
Stage 1
PRESSURE
ULCER
CATEGORIES
Stage 2
PRESSURE
ULCER
CATEGORIES
Stage 3
PRESSURE
ULCER
CATEGORIES
Stage 4
PRESSURE ULCER INCIDENCE

◦majority of pressure ulcers occur on people over 70

years of age.
◦SINCE 2008, the Centers for Medicare and Medicaid
Services (CMS) announced that hospitals will no
longer be reimbursed for treatment of pressure
ulcers that developed during the hospital stays of
Medicare patients.
RISK ASSESSMENT FOR PRESSURE
ULCERS
◦ Braden Scale
◦ used for risk assessment in the following categories of older
patients:

1.All bed- or chair-bound patients, or those whose ability to

reposition is impaired
2.All at-risk patients on admission to healthcare facilities and
regularly thereafter
3.All older patients with decreased mental status, incontinence,
and nutritional deficits
PREVENTION OF PRESSURE ULCERS

◦ Reposition q2h (1 ½ hour schedule if redness occurs)

◦ Ensure proper positioning.
◦ Avoid sitting (except if feeding).
◦ ROM q8h.
◦ Use support surfaces when possible.
◦ Encourage adequate skin care and nutrition.
MANAGEMENT OF PRESSURE ULCERS

Stage I • Transparent film; adherent hydrocolloid

Stage II • Normal saline or approved cleaner

• Transparent film, hydrogel, hydrocolloid

Stage III • Normal saline or approved cleaner

• Calcium alginate, hydrocolloids or foam

Stage IV • Debridement
• Calcium alginate, hydrocolloids or foam
 TYPES OF DEBRIDEMENT

SHARP • Use of a scalpel/surgical instrument

MECHANICAL • Use of topical force or wound irrigation

CHEMICAL • Use of enzymatic agents like collagenase

• use of a moisture-retentive dressing to cover the

AUTOLYTIC wound
PROPHYLACTIC ANTIBIOTICS

Silver sulfadiazine

Mafenide acetate
NCLEX STYLE QUESTION
◦ The nurse is using home telehealth monitoring to manage care for an 80-
year-old who is home bound. The client spends most of the day in bed. Two
months ago, the nurse detected sacral redness from friction and shearing
force of being in bed. Last month, the client had increased sacral redness
and the area was classified as a Stage I pressure ulcer. On this visit, the nurse
is assessing the sacral area using a video camera. The nurse compares the
site from a visit made 1 month ago (see figure part A) to the assessment
made at this visit (see figure part B). Upon comparing the change of the
pressure ulcer from this visit to the previous visit, the nurse should do which
of the following first?

1.Instruct the home health aide to reposition the client every 2 hours while the
client is awake.
2.Ask the client's daughter to purchase a foam mattress.
3.Contact the physician to request a hydrocolloid dressing.
4.Suggest that the client ask a neighbor to purchase antibiotic cream at the
drugstore.
CELLULITIS

◦acute bacterial infection of the skin and

subcutaneous tissue
◦occurs most frequently on the lower legs and face
◦may appear in a localized area as a complication of
a wound infection, or it may involve an entire limb.
CELLULITIS: SIGNS & SYMPTOMS

◦intense pain, heat, redness, and swelling

◦blistering may occur
◦fever may be present or not
◦increase in white blood cells (WBCs)
◦tender lymph nodes (lymphadenopathy)
CELLULITIS: COMPLICATIONS

Sepsis

Necrotizing fasciitis
CELLULITIS: DIAGNOSIS

◦Wound culture
via wound
biopsy
CELLULITIS: MANAGEMENT

◦Determine causative agent and give appropriate

antimicrobial therapy (ex: aminoglycosides)
◦Hydrocortisone 1% or 2.5% can be applied for
short-term treatment of inflamed dry skin.
CELLULITIS: NURSING CONSIDERATIONS

◦Cover wound adequately and change

dressing regularly.
◦Keep affected area clean and elevated.
◦Apply cool compress but NOT ICE
PACKS.
OSTEOPOROSIS

◦“porous bones” or fragile bone disease

◦most common metabolic disease, affecting 50% of
older women during their lifetime
◦usual onset of 5 to 6 years after menopause (LOW
ESTROGEN LEVELS IS THE LEADING CAUSE
AMONG WOMEN)
OSTEOPOROSIS: RISK FACTORS
RACE
FEMALE
AGING (WHITES & LOW BMI
GENDER
ASIANS)

POOR
EXCESS
CALCIUM SMOKING ALCOHOLISM
CAFFEINE
INTAKE

LONG TERM
DIABETES
STEROID LACTATION
MELLITUS
THERAPY
OSTEOPOROSIS: PATHOPHYSIOLOGY
LOWER
ESTROGEN
LEVELS

INCREASED DECREASED
OSTEOCLAST OSTEOBLAST

INCREASED DECREASED
BONE BONE
RESORPTION FORMATION
OSTEOPOROSIS: MANIFESTATIONS

◦ decrease in height (initial sign)

◦ low back pain
◦ Dowager’s hump
◦ femoral neck and distal radius
fractures
OSTEOPOROSIS: DIAGNOSIS
◦ DEXA Scan
◦ Dual Energy X-Ray Absorptiometry
Scan
◦ test for bone mineral density
◦ compares patient’s bone density
to a normal adult (T Score)
◦ if patient’s T score < -2.5, patient
has osteoporosis
OSTEOPOROSIS: COMPLICATION

Pathologic fracture
•Vertebral
•Hip
•Long bone
OSTEOPOROSIS: MANAGEMENT

Drug Therapy
• Biphosphonates
• Thiazide diuretics
• Calcitonin
• Selective estrogen receptor modulator
• Calcium carbonate
OSTEOPOROSIS: MANAGEMENT

Nutritional Therapy
• Dairy products
• Green, leafy vegetables (spinach, broccoli)
• Almonds
• Salmon & oysters
OSTEOPOROSIS: MANAGEMENT

Surgical
Therapy
•Vertebroplasty
•Kyphoplasty
OSTEOPOROSIS: MANAGEMENT

Lifestyle Modification
•Increase exercise to at least 30 minutes
a day (best type: weight-bearing)
•Quit/cut down on alcohol and
smoking.
OSTEOPOROSIS: HEALTH PROMOTION

Annual bone mineral density testing starting at the age

of 65

Adequate intake of calcium and Vitamin D in the diet

Regular physical activity

PAGET’S DISEASE
◦ osteitis deformans
◦ chronic skeletal bone disorder in which
excessive bone resorption is followed by
replacement of normal marrow by vascular,
fibrous connective tissue BUT new bone is
larger, disorganized, and structurally weaker.
◦ commonly affected are pelvis, long bones,
spine, ribs, sternum, and cranium
PAGET’S DISEASE: RISK FACTORS

RACE
MALE
AGING (BRITISH
GENDER
DESCENT)

HISTORY
GENETICS HEREDITY OF VIRAL
INFECTION
PAGET’S DISEASE: PATHOLOGIC
CHANGES
PAGET’S DISEASE: MANIFESTATIONS

Enlarged head Headache Deafness

High systolic Bone pain on

Bowing of legs
pressure area of deformity

Increased
warmth and
Kyphosis
tenderness over
deformed area
PAGET’S DISEASE: COMPLICATION

Pathologic fracture

Facial deformity

Osteosarcoma
PAGET’S DISEASE: DIAGNOSIS
◦ Elevated serum alkaline
phosphatase
◦ X-rays may demonstrate affected
bone is curved and the bone
cortex is thickened and irregular
PAGET’S DISEASE: MANAGEMENT

Drug Therapy
•Biphosphonates
•Calcitonin
•NSAIDs for pain
PAGET’S DISEASE: MANAGEMENT
Supportive & Collaborative Therapy
• Firm mattress to provide back support
• Wearing of corset or light brace to support when
upright
• Use of assistive devices for ambulation
• No heavy lifting and twisting
• Referral to physical therapist
BRONCHIECTASIS
◦ lung condition that
causes coughing up
mucus due to scarred
tissue in the bronchi
◦ fairly common among
people aged 75 years
and older, but it can also
happen to younger
people.
BRONCHIECTASIS: RISK FACTORS

Chronic and Chronic or

Cystic fibrosis inflammatory severe lung
lung disease infections

Repeated
Deficits in the aspiration of
immune system things other
than air
BRONCHIECTASIS: MANIFESTATIONS

Chest pain
Productive
Hemoptysis (respiratory Wheezing
coughing
origin)

Clubbing Weight loss Flare-ups

BRONCHIECTASIS: DIFFERENTIAL
DIAGNOSIS
BRONCHITIS BRONCHIOLITIS BRONCHIECTASIS

• Secondary to • Secondary to • Secondary to CF

smoking RSV infection or aging
• Non-infectious • Infectious • Non-infectious
• Common among • Common among • Common among
adults and older very young older adults
adults children • Irreversible
• Irreversible • Reversible
BRONCHIECTASIS: DIAGNOSIS

◦ Chest CT scan or X-ray

◦ Blood tests and sputum
cultures
◦ Lung function tests
◦ Bronchoscopy
BRONCHIECTASIS: MANAGEMENT

Supportive & Preventive

Management
• Prophylactic antibiotics
• Chest Physiotherapy
• Positive Expiratory Pressure
Devices
HIATAL HERNIA
◦ also referred to as
diaphragmatic hernia and
esophageal hernia
◦ herniation of a portion of the
stomach into the esophagus
through an opening, or hiatus, in
the diaphragm
◦ common in older adults and
occur more often in women than
in men
HIATAL HERNIA: RISK FACTORS
Weakness of diaphragmatic muscles
due to
• Old age (50 and above)
• Pregnancy
• Obesity
• Smoking

Increased pressure in the abdominal

cavity by
• Heavylifting
• Straining
• Excessive coughing
• Excessive vomiting
HIATAL HERNIA: TYPES
SLIDING (A)
• Most common
• Affected by position (happens when
patient is supine; disappears when
patient stands up)

ROLLING (B)
• Medical emergency
• “Pocket” is formed beside the
esophagus cutting blood supply to
stomach
HIATAL HERNIA: MANIFESTATIONS

Signs and symptoms of GERD

• Heartburn
• Dyspepsia
• Dysphagia
• Water brash
• Globus sensation
HIATAL HERNIA: DIAGNOSIS

ESOPHAGRAM

EGD
HIATAL HERNIA: MANAGEMENT

Lifestyle Modifications
•Quit/cut down on smoking
•Decrease pressure on abdomen
•No heavylifting and straining
DEMENTIA
◦ permanent, progressive
impairment in cognitive
functioning manifested by
memory loss (both long-term
and short-term) and
accompanied by impairment
in judgment, abstract
thinking, and social behavior.
DEMENTIA: ETIOLOGY

◦Causes vary, although the clinical picture is

similar for most dementias.
◦Often, no definitive diagnosis can be made
until completion of a postmortem
examination.
DEMENTIA: CHARACTERISTICS

Personality changes

Confusion

Disorientation

Deterioration of intellectual functioning, loss of memory

Decline of appropriate judgment and ADLs

DEMENTIA: TYPES
Alzheimer’s disease
• the brains of individuals with Alzheimer’s have
an abundance of beta amyloid plaques,
neurofibrillary tangles, and atrophic brain cells
and tissue.
• the most common brain disorder and is one of
the leading causes of death in the older adult.
DEMENTIA: TYPES

Dementia with Lewy

bodies
•Microscopic deposits develop in
the brain that damage nerve cells.
DEMENTIA: TYPES

Vascular or multifocal dementia

•Ischemic brain lesions develop as a
result of a history of hyperlipidemia,
hypertension, smoking, or obesity.
DEMENTIA: TYPES

Frontotemporal dementia
(Pick’s disease)
•The frontal and temporal lobes
of the brain degenerate.
DEMENTIA: THREE STAGE MODEL

•Lasts 2 to 4 years
•Minor memory loss and
MILD difficulty learning
•Long-term memory and
reasoning remain intact
DEMENTIA: THREE STAGE MODEL

• Lasts 2 to 10 years
• Withdrawal, confusion, increasing
difficulty in self-care and daily
MODERATE tasks, difficulty in communicating
• Behavioral changes include
anger, anxiety and frustration
DEMENTIA: THREE STAGE MODEL

• Lasts 1 to 3 years
• Complete incapacitation; will not eat
unless fed
SEVERE • Patient does not recognize people
• Loss of bodily functions (ex: swallowing)
• Violent episodes and aggression are
common
DEMENTIA: SEVEN STAGE MODEL

Stage 4:
Stage 2: Very Stage 3: Mild
Stage 1: No Moderate
Mild Cognitive Cognitive
Impairment Cognitive
Decline Decline
Decline

Stage 5:
Stage 7: Very Stage 6: Severe
Moderately
Severe Cognitive Cognitive
Severe Cognitive
Decline Decline
Decline
 FOUR As OF DEMENTIA

agnosia amnesia apraxia

aphasia
DEMENTIA: DRUG THERAPY
 DEMENTIA: MANAGEMENT
◦ Make brief, frequent contacts, because attention span is
short.
◦ Allow clients time to talk and to complete projects.
◦ Stimulate associative patterns to improve recall (by
repeating, summarizing, and focusing).
◦ Reinforce reality-oriented comments.
◦ Keep environment structured the same as much as
possible (e.g., same room and placement of furniture);
routine is important to diminish stress.
◦ Recognize the importance of compensatory mechanisms
(e.g., confabulation) to increase self-esteem; build
psychological reserve.
NCLEX STYLE QUESTION
◦ While waiting to be seen in an emergency department (ED) for
possible CHF, an elderly client with moderate dementia jumps up and
says, “I have to go feed my chickens now.” A triage nurse’s most
appropriate response is:
1. “All right, you may leave.”
2. “Please tell us about your chickens.”
3. “That noise was the TV, not chickens.”
4. “You are not on the farm anymore.”
NCLEX STYLE QUESTION
The nurse finds that an 87-year-old woman with Alzheimer’s disease is continually
rubbing, flexing, and kicking out her legs throughout the day. The night shift reports
that this same behavior escalates at night, preventing her from obtaining her required
sleep. The next step the nurse should take is to

a. ask the physician for a daytime sedative for the patient.

b. request soft restraints to prevent her from falling out of her bed.
c. ask the physician for a nighttime sleep medication for the patient.
d. assess the patient more closely, suspecting a disorder such as restless legs
syndrome.
AGE-RELATED MACULAR
DEGENERATION (AMD)
◦ most common cause of irreversible central vision loss in
people over age 60 in the United States.
◦ happens when the small central portion of the retina, called
the macula, deteriorates.
AMD: RISK FACTORS
Increasing age Smoking history Hypertension Obesity

Use of thyroid
Hyperopia Familial incidence Caucasians hormones and
hydrochlorothiazides

Excessive aspirin use Arthritis

AMD: TYPES

DRY
• Non-exudative type
• Few, small yellow deposits called drusen
accumulate in the macula

• Exudative type

WET • Blood vessels under the macula leak blood

and fluid into the retina causing blind spots
and loss of central vision
AMD: MANIFESTATIONS
Worse or less clear visions

Scotomas

Metamorphosia

Dark, blurry areas in the center of vision

Rarely, worse or different color perception

AMD: DIAGNOSIS

Ophthalmoscopy
• Look for presence of drusen

The Amsler grid test

• help define the involved area, and it provides a baseline for future
comparison.
Fundus photography and IV angiography
• may help to further determine the extent and type of AMD.
AMD: TREATMENT
Anti-angiogenesis drugs
• aflibercept (Eylea), bevacizumab (Avastin), pegaptanib (Macugen), and ranibizumab
(Lucentis)
• block the creation of blood vessels and leaking from the vessels in the eye that cause wet
macular degeneration.
Laser therapy
• High-energy laser light can destroy abnormal blood vessels growing

Photodynamic laser therapy

• Injection of a light-sensitive drug -- verteporfin (Visudyne) -- into the bloodstream, and
absorbed by the abnormal blood vessels. Your doctor then shines a laser into your eye to
trigger the medication to damage those blood vessels
Submacular surgery
AMD: PREVENTION
◦A large study found that some people with dry
AMD could slow the disease by taking
supplements of vitamins C and E, lutein,
zeaxanthin, zinc, and copper.
HEALTH PROMOTION
OF THE ELDERLY
Objectives of health promotion
Increase quality and years of healthy life

Maintain function

Eliminate health disparities and independency

Improve (enhance) quality of life

Extend life expectancy → ↓ premature mortality caused by chronic& acute

diseases
Components of health promotion

Periodic
Exercise Nutrition Rest & sleep medical
check up

High risk
Spiritual Psychosocial
behavior
well-being well-being
prevention
EXERCISE
EXERCISE

Exercise (health-enhancing
physical activity) is purposeful,
bodily exertion to produce health-
enhancing benefits (fitness).
TYPES OF EXERCISE
ISOMETRIC

ISOTONIC

ISOKINETIC

AEROBIC
BENEFITS OF REGULAR PHYSICAL ACTIVITY

better heart
lower risk for promotes muscular
and lung
early death weight loss fitness
function

improved
fall mood
memory and self-esteem
prevention stability
mental clarity
SOCIAL BENEFITS OF EXERCISE
◦Improve
social
interaction &
relation with
other
ROLE OF THE NURSE DURING EXERCISE
I- Assessment done at the beginning of exercise program
include:
1. History & physical examination (CVS, resp, musculoskeletal &
neurological system)
2. Renal & liver function tests
3. ECG,& exercise stress test
4. Assess range of motion & use of assistive devices.
5. Assess environmental hazards

II-Set a regular time to exercise each day

III- Before starting exercise the nurse should advice the
elderly about:
1. Document baseline resting function status (ht &resp rate, bl.sugar)
2. 10 minutes warms up stretching exercise
3. Drink water before and after exercise is important as water will be
lost during exercise
4. Clothes worn during exercise should allow for easy movement
and perspiration.
5. Athletic shoes provide both support and protection
6. Outdoor exercise should be avoided in extremely hot or cold
weather.
During exercise
◦Monitor heart & resp. rate
◦Stop exercise if elderly has fatigue , chest pain or
↑heart & resp. rate
After exercise:
◦10 minutes cooling up at end of exercise
◦Monitor pulse rate during cooling for returning to
resting ht. rate
NUTRITION
It is neglected especially those
living alone or with low
income.
Factors affecting nutritional
status:
1) Age related changes
2) Psychosocial factors
3) Economic factors
4) Cultural factors
NUTRITIONAL REQUIREMENT OF
ELDERLY

Calories
◦Caloric requirement diminished by 10% in
age 51-75 years and by 20-25% in age
more than 75 years.
NUTRITIONAL REQUIREMENT OF ELDERLY

Protein
◦ 0.8 g/kg body wt
◦ A balanced diet of a healthy elderly should contain 12-14%
of total caloric intake.
◦ During infection, stress, trauma protein ↑ to 1.6 or 1.5 g/kg
body wt
NUTRITIONAL REQUIREMENT OF ELDERLY

Fat
◦ Fat either saturated or unsaturated
◦ Total fat intake limited to 30 % or less of total energy
intake
◦ Saturated fat limited to 10-15% of total energy intake
◦ Dietary cholesterol intake limited to 300mg/ day or less
NUTRITIONAL REQUIREMENT OF ELDERLY

Carbohydrates
◦ CHO is essential for maintaining normal bl. glucose level & preventing protein
break down.
◦ 50% of total calories---- CHO
◦ Simple CHO as sugar, honey ( avoided)
◦ Complex CHO as vegetables, grains, fruits
◦ Complex CHO has vit, minerals, fibers which help in bowel elimination& ↓ bl.
cholesterol level.
NUTRITIONAL REQUIREMENT OF
ELDERLY
Vitamins and Minerals
◦ Calcium:---for mineralization of bone &has a role in blood & cardiac
function.
◦ Daily requirement 1200 mg./day if there is no contraindications

◦ Vitamin D :------ needed for calcium absorption& metabolism.

◦ Exposure 15 minutes/day to sun is enough
REST & SLEEP
IMPORTANCE OF REST & SLEEP

Conserve energy

Provide organ respite (rest)

Restore the mental alertness& neurological efficiency

Relieve tension

Emerge feeling of well being

Nursing measures adopted to promote sleep
1. Engage in exercise program
2. Avoid exercise within 3-4 hr. of bedtime.
3. Spend time out door in the sunlight each day but avoid period
between 12 noon to 3 PM.
4. Engage in relaxing activities near bedtime.
5. Avoid tobacco at bedtime
6. Avoid drinking any caffeinated beverages before mid afternoon.
7. Limit fluid intake after dinner hour if nocturia is a problem.
8. Limit daytime naps to 30 minutes or less.
9. Avoid using the bed for watching TV, writing bills, and reading.
PERIODIC MEDICAL
EXAMINATION
 Health screening Period
BP Each visit or 3-6 months
Ht & wt Periodically as part of
comprehensive physical examination

Dental check up Once / year( annually)

Fecal occult blood, colonoscopy & ( annually)
sigmoidoscopy

Vision including glaucoma test Every 2 years

 Health screening Period

Hearing Evaluate periodically

Cholesterol level Every 5 years

Cancer screening Annually

Mammography for women under 1-2 years
70 y
Digital rectal examination Annually
IMMUNIZATIONS
 Vaccination Period

Influenza (over 65y) Annually (mid October to mid

November)
Tetanus & diphtheria Every 10 years

Pneumococcal vaccination Once at age 65y, revaccination for

high risk fatal pneumonia/6 y
 6- Spiritual Well- being
◦Spiritual well-being is the practice and
philosophy of the integral aspects of
mental, emotional and overall wellbeing.

◦Spiritual well-being is a state in which the

positive aspects of spirituality are
experienced, incorporated and lived by the
individual and reflected into ones
environment.
Signs of spiritual distress:
◦ Doubt
◦ Despair
◦ Guilt
◦ Boredom
◦ Expression of anger toward god
Benefits

◦ The practice and incorporation of Spiritual Wellbeing into one’s life influences and includes benefits for ones;
Emotional Wellbeing, Physical Wellbeing, and Mental Wellbeing.
Some of the measurable benefits that people experience
from spiritual wellbeing counseling and groups
include:
◦ A feeling of being more contented with their life’s
situation
◦ Greater enjoyment of self time, finding an inner peace
◦ Greater ability to take control of and resolve their life’s
issues
◦ A greater sense of satisfaction in their activities and
life situations
◦ Ability to take a more active part in life rather than
standing still and watching it pass by
◦ Ability to build more intimate, loving and lasting
relationships
◦ A greater feeling of purpose and meaning in their life
 Measures to increase Spiritual well being
◦ Identify ways that believes give meaning to life
◦ Use problem solving to solve any conflict related to spirituality
◦ Meeting with religious man at regular intervals
◦ Presence of religious literatures in the immediate environment such as Quran on beside table
◦ Reading in religious books & praying
◦ Discuss role of spirituality in one’s life
 7- Psychosocial Well- being
Psychosocial changes may alter an individual relationship with others.
Physical wellbeing depend on:
◦ Psychosocial wellbeing
◦ Social structure
◦ Personal relationships
In Later years many adjustment are necessary
Role of the nurse in health promotion
◦ Assessment to his physical health, Psychosocial Well- being, lifestyle pattern, hobbies, high risk
behaviors, knowledge, believes& attitudes that affect health & wellbeing.
◦ Assess health needs
◦ Assess social , environmental & cultural influences on health behaviors
◦ Lifestyle modifications is a comprehensive approach for effective change in heath promotion
behaviors
◦ Nurse role should directed toward helping elderly to cope with his function level ------delay
disabilities & impairments.
◦ Nurse identify environmental hazards & make necessary modifications
◦ Identify social needs & encourage participation & social support groups.
◦ Nurse should inform elderly & caregivers about aging process, common disorders & disabilities ,
different services available
◦ Encourage elderly to take better care to them, avoid high risk behaviors,& hazards
affecting their health.
◦ Regular and continuous evaluation is important aspect of nurse’s role.
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