NCM 214 – CARE OF OLDER ADULTS

WHEN YOU HEAR THE WORD GERIATRICS, WHAT COMES FIRST TO YOUR MIND?

DEFINITION

GERIATRICS

• Generic term for “aged”

• Refers to medical care for older adults

• The branch of medicine that deals wirth

the diseases and problems of old age

• Viewed by many nurses as having limited

application to nursing due to its medical and
disease orientation

• relating to old people especially with

regard to their healthcare

GERIATRIC NURSING

• The nursing care of older people with health problems, or those requiring tertiary (kailangan ng

hospitalization) care

• The branch of nursing concerned with the care of the older population, including promotion of

healthy aging, as well as prevention, assessment and management of psychological, economic and

sociological problems

CORE ELEMENTS OF GERONTOLOGICAL NURSING PRACTICE

1. EVIDENCE BASED PRACTICE

- there was a time when nursing care was guided more by trial and error than sound

research and knowledge

- now nursing follows a systematic approach that uses existing research for clinical

decision making process known as evidence- based practice

EVIDENCE BASED PRACTICE- perform/ apply in practice skills that has been proven to be effective

daken solution- for diabetic patients, mixture of sodium hypochlorite (0.4% to 0.5%)

and boric acid (4%) (zonrox) diluted in water.

2. STANDARDS

- reflects the level and expectations of care that are desired and serve as a model against

which practice can be judged

- Standard serve to both guide and evaluate nursing practice

3. COMPETENCIES

-nurses who work with older adults need to have competencies specific to gerontological nursing

to promote the highest possible quality of care to older adults

BASIC COMPETENCIES OF A GERONTOLOGICAL NURSE

1. differentiate normal from abnormal findings in the older adults

2. assess the older adult’s physical, emotional, mental, and social satus and function

3. engage the older adult in all aspects of care to the maximum extent possible

4. Provide information and education on a level and in a language appropriate for the individual

5. individualized care planning and implementation of the plans

6. Identify and reduce risks

7. empower the older adult to exercise maximum decision making

8. Identify and respect preferences arising from the older adult’s culture , language, race, gender,

sexual preference, lifestyle, experience, and roles

9. assist the older adult in evaluating, deciding, locating, and transitioning to environments that fulfill

living and care needs

10. Advocate for and protect the rights of the older person

11. facilitate discussion of and honor advance directives

 Demographics of Aging

• Number of persons aged 60 years or over by development group from 1980 to 2050

less developed countries often have overpopulation leading to increasing population of the elderlies as well

TRADITIONALIST BABY BOOMER GENERATION X MILLENNIALS

S
BIRTH YEARS 1900-1945 1946-1964 1965-1980 1980-2000
NUMBER 80 MIL 51 MIL 75 MIL
OTHER NAMES Veterans, Silent, "Me" Genertion, Gen X, Xers, The Generation Y, Gen
Moral Authority, Moral Authority Doer, Post Y, Generation
Radio Babies, The Boomers, 13th Next, Echo
Forgotten Generation Boomers, Chief
Generation Friendship
Officers, 24/7's
FAMOUS PEOPLE Bob Dole, Bill Clinton, Meryl Barack Obama, Ashton Kutcher,
Elizabeth Taylor Streep Jennifer Lopez Serena Williams
Percentage of population over age 65, 1950-2050

Ten countries or areas with the largest share of persons aged 60 years or over in 1980, 2017 and 2050

Older adults are expected to represent 20% of population bring many concerns and issues

a. Available resources for older adults to live happy and healthy lives, geriatric nurses.
b. Need for facilities to take care of older persons
c. Need for competent geriatric nurses.

By 2040, about 10.1% of the total population would be 65+ years. By then, the Philippines will be an aging
population (Siegel and Swanson, 2004).
 REASONS FOR LIVING LONGER

1. Advances in medications to treat different illnesses

2. Immunizations to prevent diseases which lead to improved economic conditions
3. Improved nutrition -
4. New diagnostic techniques to assist in the early treatment and management of a disease.

HISTORY OF GERONTOLOGICAL NURSING

1900 – the need for gerontological nursing specialty was identified

1904 – first article on the nursing of the aged was published

1966 – the division of geriatric nursing practice was established, giving nursing of the aged specialty status

TERMINOLOGIES

Gerontology

• Form the Greek Geron, meaning "old man"

• Scientific study of the process of aging and the problems of aged persons
• Including biologic, sociologic, psychologic, and economic aspects

Gerontological nursing

• This specialty of nursing involves assessing the health and functional status of older adults
• The term most often used by nurses specializing in this field
• Planning and implementing health care and services to meet the identified needs and evaluating the
effectiveness of such care (Nursing process but specialized in the care of older people)

AGEISM

-Ageism is a prejudice or discrimination against people based on their age

-It typically applies to people who are older but can also affect young people

- Ageism has a negative impact on physical and mental health and reports link it

with earlier death.-

WAYS TO CATEGORIZE AGEISM:

● INSTITUTIONAL AGEISM (MACRO LEVEL)

- Occurs when an institution perpetuates ageism through its

action and ….

● INTERPERSONAL AGEISM (MESO LEVEL)

 - occurs in social interactions

● Internalized ageism (Micro Level)

- When a person internalizes ageist beliefs and applies them to

themselves

AGEISM CAN ALSO VARY ACCDG TO A SITUATION

- openly aggressive beliefs about age

Ex. teenagers are violent or dangerous

Benevolent ageism involves someone having patronizing beliefs towards

EX. older adults are childlike and require guidance w/ basic tasks

AGE DISCRIMI\NATION is when someone

● age is a number,not a use-by date. Everyone should feel like they are

treated equally and fairly regardless of their age.

● age discrimination can happen at any point in a person’s life but it is

most likely happen to older people and youth.

● It is against the law for someone to treat you unfairly because of your

age or how old they think you are.

Definition:

● Age discrimination is when someone treats you unfairly because of

your age or the age they think you are.

EXAMPLES OF AGE DISCRIMINATION

1. A manager making choices around redundancy, or forcing someone to retire, because of their age.

2. A restaurant manager refusing service to a couple with their 2 young

children, saying the restaurant does not serve children under the age of

12 as they might disrupt other diners.

3. A candidate being asked their age at a job interview and then not being

given the job because the employer wants a younger person for the

role.
ELDERLY- 60 YRS OLD ABOVE

MANIFESTATIONS OF DEMENTIA

-echolalia- repeating words

-peeing and pooping their pants

-memory loss- very first symptom

Gerontologic - Nursing Overview:

https://www.youtube.com/watch?v=135uCWSG3N0
 CARE OF THE CHRONICALLY ILL AND THE OLDER PERSON
THEORIES OF AGING

FUNCTIONS

1. Attempt to explain the phenomenon of aging

2. Provide a perspective from which to view aging
3. Provide a springboard research

CLASSIFICATIONS

BIOLOGICAL SOCIOLOGICAL PSYCHOLOGICAL

• Free Radical • Activity • Theory of Individualism
• Orgel/Error • Dis-engagement • Human Needs
• Wear and Tear • Subculture • Stage of
• Connective Tissue • Continuity Personality
• Programmed • Age Satisfaction Development
• Gene/Biological Clock • Person Environment Fit
• Neuroendocrine • Gerotranscendence
• Immunologic
NURSING THEORY OF AGING

• Functional Consequences Theory

• Theory of Thriving

BIOLOGICAL Theories

View aging as occurring at molecular and cellular level 2

Categories

• Stochastic theories - random assault

• Nonstochastic - predetermine process

STOCHASTIC THEORY

1. Free Radicals and Lipofuscin theories

• Aging is due to the effects of free radicals
o Damages protein, enzymes, and DNA
o the cells cannot regenerate themselves
• Lipofuscin a lipoprotein by product of oxidation
o Interferes with the diffusion and transport of essential metabolites
2. Orgel/Error Theory
• As cells ages, various changes occurs naturally in its DNA and RNA
• Proposes that error can occur in the transcription of the synthesis of DNA
• May lead to aging or death of a cell
3. Wear and Tear Theories
 • Attribute aging to the repeated use and injury of the body over time
• Proposes that cells wear out through exposure to internal and external stressors, including trauma,
chemicals, and buildup of natural wastes.
4. Cross Linking Theory/Connective Tissue Theory
• Proposes that as cells age, chemical reactions create strong bonds, or cross linkages, between proteins.
• Primarily involves collagen loss of elasticity, stiffness
- responsible for the ultimate failure of tissues and organs.

NONSTOCHASTIC THEORY

1. Programmed theory of Aging

• Proposes that animals and humans are born with a genetic program or a biological clock
• Hayflick phenomenon/human fibroblast replicative senescence model
2. Gene/Biological Clock Theory
• cell has a genetically programmed aging code that is stored in the organism s DNA
• organism is genetically programmed for a predetermined number of cell divisions, after which the
cells/organism dies.
3. Neuroendocrine & Neurochemicals Theory
• aging is the result of changes in the brain and endocrine glands
• specific AP hormones and imbalance of chemicals in the brain impairs healthy cell division
4. Immunologic/Autoimmune Theory
• Describes an age-related decline in the immune system.
• focus on the role of thymus gland, the weight and size of the thymus gland decrease with age as
thus the body’s capability for T-cell differentiation.

OTHER BIOLOGICAL THEORIES

1. Genetic/Mutation Theory - changes in replication of DNA-RNA

2. Rate of Living Theory - body has a fixed rate of potential for living, the faster one lives, the sooner
ones ages and dies.
3. Waste Theory - chemical wastes produce deterioration by interfering with cellular functioning
4. Collagen Theory - collagen stiffens with age causes stiffness that affects function

PSYCHOLOGICAL Theories

• Focus on behavior and attitude changes that accompany advancing age as opposed to the
biological implication of the anatomic deterioration
1. PERSONALITY THEORY/THEORY OF INDIVIDUALISM
• Theory of Adult Personality Development (Carl Jung)
• last stage of life is a time of looking backward rather than forward.
• the older adult must come to terms with the reality of his life retrospectively.
• “Healthy aging depended not on the amount of social activity a person has, but how satisfied a
person is with that social activity.”
2. PSYCHOSOCIAL DEVELOPMENTAL TASK (Erik Erikson)
 • primary task of old age is being able to see one's life as having been lived with integrity
• In the absence of achieving the sense of having lived well, the older adult is at risk for having
preoccupied with feelings of regret or despair
3. HUMAN NEEDS THEORY (Abraham Maslow)
• needs are prioritized such that more basic needs like physiological functioning or safety take
precedence over personal growth

SOCIOLOGICAL Theories

1. DISENGAGEMENT THEORY
• views aging a process in which society and the individual gradually withdraw from each other to the mutual
satisfaction and benefits of both
• Individual - freed from societal roles & focus on themselves
• Society - orderly means of transferring of power/role from old to young
• “aging is an inevitable, mutual withdrawal or disengagement, resulting in decreased interaction between
the aging person and others in the social system he/she belongs to.” -Cummings & Henry
2. ACTIVITY THEORY
• The direct opposition to the disengagement theory
• People need to be active if they are to age successfully
• By remaining active, the older people stays young and lively and does not withdraw from society because of
age parameters
3. CONTINUITY THEORY
• Dispels both disengagement and activity theory
• Propose how a person has been throughout life is how that person will continue to be through the
remainder of life
• As people age they try to maintain or continue previous habits, preferences, values, belief
• “basic personality, attitudes, and behaviors remain constant throughout the life span” - Havighurst
4. SUBCULTURE THEORY
• views older adults as unique subculture within society
• formed as a defensive response to society’s negative attitudes and the loss of status that
accompanies aging
5. AGE SATISFACTION THEORY
• society is stratified into different age categories that are the basis for acquiring sources, roles, status,
and deference from others in society
• age cohorts are influenced by the historical context in which they live
6. PERSON ENVIRONMENT FIT THEORY
• Functional competence is affected by multiple intrapersonal conditions such as ego strength, motor
skills, biologic health, cognitive capacity, and sensori-perceptual capacity
7. GEROTRANSCENDENCE THEORY
• aging individuals undergo a cognitive transformation from a materialistic, rational perspective toward
oneness with the universe
NURSING THEORIES OF AGING

1. Functional Consequences Theory

• Environmental and biopsychosocial consequences impact functioning
MANAGEMENT:
• Nursing roles is risk reduction to minimize age associated disability in order to enhance safety and
quality of living
2. Theory of Thriving
• Failure to thrive results from a discord between the individual and his or her environment or
relationships.
MANAGEMENT:
• Nurses identify and modify factors that contribute to disharmony among these elements.
TERMINOLOGIES:

GERONTOLOGY

- From the Greek geron, meaning "old man"

- Scientific study of the process of aging and the problems of the aged persons - includes biologic,
sociologic, psychologic, and economic aspects

GERIATRICS

- From the Greek geras, meaning "old age"

- The branch of medicine that deals with the diseases and problems of old age
- Viewed by many nurses as having limited application to nursing due to its medical and disease
orientation

GERONTOLOGICAL NURSING

- This specialty of nursing involves assessing the health and functional status of older adults
- Planning and implementing health care and services to meet the identified needs and evaluating the
effectiveness of such care

GERIATRICS NURSING

- The nursing care of older people with health problems, or those requiring tertiary care
- Used to define the study of aging and/or the aged

FINANCIAL GERONTOLOGY

- A subfield that combines knowledge of financial planning and services with a special expertise in the needs
of older adults;

SOCIAL GERONTOLOGY

- Seek to understand how the biological processes of aging influence the social aspect

GERONTOLOGICAL REHABILITATION NURSING

- Combines expertise in gerontological nursing with rehabilitation concepts and practice

GERONTHOPHOBIA

- Fear and refusal to accept older people into the mainstream of society

Age Discrimination

- The practice of treating people differently simply because of their age

Ageism

- The negative stereotyping of aging and older persons

- A belief that aging makes people unattractive, unintelligent, and unproductive; it's an emotional prejudice
- Can be seen as a process of discrimination against people because they are old
 Chronological Categories of old age:

• Young-old (65-74 years old)

• Middle-old (75-84 years old)
• Old-old (85 years old and above)

PHYSIOLOGIC AGE

- The determination of age by function

- “Biological age” – relative to your calendar age

FUNCTIONAL AGE

- person's ability to contribute to society and benefit others and himself

GERONTOLOGIC NURSING

Roles of a Gerontologic Nurse

1. Provider of care
- gives directs hands on care to older adults in a variety of settings
2. Manager
- Plans and coordinate the care of the elderly
- Balances the concerns of the elder, family, nursing staff and the rest of the health team
- Develop skills in staff coordination, time management, assertiveness, communication and
organization
3. Teacher
- Organize and provides instructions on healthy aging, disease detection, treatment and
rehabilitation to older patients and families
- Focus on teaching in modifiable risk factors and health promotion
- Thru lifestyle modifications like healthy diet, smoking cessation, appropriate weight
maintenance, increase physical activity, and stress management
4. Advocate
- Acts on behalf of the older adults to promote their best interest and strengthen their autonomy and decision
making
- does not mean making decisions for older adults, but empowering them to remain independent and retain
dignity
- including active involvement at the political level or helping to explain medical or nursing
procedures to family members on a unit level.
5. Research Consumer/Researcher
- Read & put into practice the results of reliable & valid studies
- Assists with data collection & identification of appropriate research sites
- Uses evidenced-based results
 CARE OF THE ELDERLY

Acute Care of the Elderly (ACE)

- Is a specialized program that addresses the needs of hospitalized older adults in a

multidisciplinary team approach to prevent functional and cognitive decline to improve outcomes
and satisfaction

Four (4) key concepts:

1. A safe environment
- Uncluttered halls
- Carpeted floors
- Raised toilet seats
- A common lounge area
2. Patient-centered interdisciplinary care
- To address key nursing issues such as mobility, skin care, nutrition and continence
3. Discharge planning
- Goal: returning the older adult to his or her former living status
4. Careful medical and nursing interventions
- To prevent adverse outcomes and avoid iatrogenic problem
- Iatrogenic – dse caused by medical tx chuchu like chemotherapy, radiation therapy – commonly produces
iatrogenic effect like hair loss, thinning of hair, hemolytic anemia, nv, infertility

SETTING OF CARE

ACUTE CARE HOSPITAL

- Focuses on management of acute problems (often involving exacerbation of magiging severe yung
condition like cardiopulmonary condition, cancer treatment or orthopedic problems)
 - Trauma, accidents
- Orthopedic injuries
- Serious circulatory or respiratory problems
- Also a branch of secondary health care where a patient receives active but short-term treatment for a
severe injury or episode of illness or any urgent medical condition
- Opposite of long-term care or chronic care
- Pwede na idischarge once ma treat na ang patient

INTERMEDIATE CARE

- Level of care – to provides 24-hour per day direct nursing contact

- Considered to be the entry level into nursing home care
- A long-term facility that provides nursing and supportive care to residents

ASSISTED LIVING

- Who wish to live in a community setting, and need some additional help with activities of daily living
(ADLs)
- ALF
- A burgeoning option for older adults provides an alternative for those older adults who do not feel safe
living alone
- A housing facility for people with disabilities for adults who cannot or who choose not to live
independently

LONG TERM CARE FACILITY

- Traditionally referred to as nursing homes, long-term care facilities provide support to persons of any age
who have lost some or all of their capacity
- Registered nurses who work provide planning and overside of numerous residents; directing and
coordinating the care

SKILLED CARE

- "Skilled care units" or "skilled nursing facilities" (SNFs)

- For older adults chronically ill
- An inpatient rehabilitation and medical treatment center staffed with medical professionals
a. Subacute/transitional care
- Patients who require more intensive nursing care than the traditional nursing home can provide, but less
intensive than the acute care hospital
- Frequent patient assessments are needed for a limited time period for stabilization or completion of a
treatment regimen
- Snf patients are often transferred from the hospital to continue their recovery
- From an acute episode and often required continual therapy
b. Alzheimer's unit
- Units detected to the major phases of Alzheimer's disease (AD)
- Bc of the high rate of Alzheimer's disease and other dementing illnesses or dementia with
advanced age
 - Goal is to preserve the functional status via supportive care that foster self-worth and
socialization even in context of diminishing cognitive capacity
- Some long term care facilities or nursing homes may separate part of the bldg intended for these pts.

HOME HEALTH CARE

- For older adults requiring a longer period of observation or care from nurses
- Designed for those who are home bound due to severity of illness or immobility
- Includes skilled nursing care and therapists
- Services provided by one or a group of agencies
- Ang nurses muadto sa bahay ng client; magrender ng care

HOSPICE CARE

- Caring for dying persons and their families

- Number of team members specialized in palliative care
- Manyo of the patients in hospice is not elderly the majority of the dying ar the older

REHABILITATION

- May be found in various degrees in several settings, including the acute care hospital, subacute or
transitional care, and LCTFs

COMMUNITY SETTING

- Most older adults live in the community, with only about 5% at any given time are residing in nursing
homes
- Continuing care retirement community (CCRC) – other term

INDEPENDENT LIVING

- Independent living arrangements take the form of senior housing, such as apartment complexes exclusively
devoted to the elderly
- Offer amenities, activities

FOSTER CARE HOME/GROUP HOMES

- For elderly who can do most of their ADLs but may have safety issues and require supervision with
some activities such as dressing or taking medications
- More personalized supervision in a smaller, more family-like environment, should be licensed to provide
services

ADULT DAY CARE

- For older adults who are unable to remain at home during the day without supervision.
- Used by family members who may work during the day and wish to have their relative safely cared for
in their absence.

GREEN HOUSE CONCEPT

 - To replace more than 100 nursing homes nationwide with clusters of small, cozy houses, each housing 8
to 10 residents in private rooms, with private bathrooms and an open kitchen.
- Primary purpose: to serve as a place where elders can receive assistance and support with activities
of daily living and clinical care without that assistance becoming the focus of their existence.

COMPLEMENTARY AND ALTERNATIVE CARE

- Traditional medicine are used such as acupuncture, massage therapy or herbal medicines.
- Acupuncture originated sa China; alleviate pain; treat various conditions

LEVELS OF CARE AND ITS GOAL

1. Aggressive – Goal: Extension of life

• Interventions: aggressive chemotherapy, invasive testing, radical surgery
2. Modified – Goal: Extension of life with consideration of the burden of treatment
• Interventions: management of illness with medications, minimally invasive surgery, non-invasive testing.
3. Palliative Care
• Goal: patient comfort with life extension as secondary goal
• Interventions: pain management, symptom control, gentle rehabilitation, holistic care
4. Hospice Care – Goal: Comfortable death
• Interventions: pain management, symptom control, holistic care.
 FUNCTIONAL ASSESSMENT
- older patients are more likely than younger patients to have unrecognized comorbidities and impairments that
increase their risk of medical morbidity, functional decline, and mortality
- -functional impairments and cognitive and affective problems are particularly prevalent among older patients,
and can be improved with early detection

DETERMINING THE RISK AND/OR PRESENCE OF FUNCTIONAL IMPAIRMENTS

- functional impairments and cognitive and affective problems are particularly prevalent among older patients,
and can be improved with recognition and treatment
- completing brief assessment of older patients requires effective use of a broad range medical interviewing
skills

OUR GOAL
1. accurately assessing the functional, cognitive, and affective status of older patients, and
2. effectively communicating with older adults

INTENDED LEARNING OUTCOMES

By the end of the exercise the learner should be able to:
1. Ask a brief series of questions to identify impairments in Basic Activities of Daily Living and Instrumental
Activities of Daily Living (including medication use)
2. Ask about the presence or absence of falls
3. Screen patients for gain impairment and fall risk using the timed up and go test
4. Screen patients for cognitive impairment by administering and interpreting the MINICOG EXAMINATION
5. Screen patients for major depressive illness using a two-question screener.
6. Use appropriate interviewing techniques to facilitate communication with older patients.
7. Demonstrate respect for older patients

PROCESS

Interview
- begin the interview with an introduction of yourself and statement like
“Hello, Mr/Ms. Gerhard. I understand you’re…. I need to review some things with you..”

- Your next questions should be directed to assessing physical function and the patient’s capacities at home just
prior to hospital admission/nursing home

ASSESSING PATIENT’S FUNCTIONAL STATUS

Definition of Terms
1. Functional Impairment - difficulty performing, or requiring the assistance of another person to perform, one or
more of the activities of daily living (ADL)
2. ADLs - activities of daily living; are the essential elements of self-care; the tasks of everylife
3. IADLs - +INSTRUMENTAL ; associated with independent living in the community and provide a basis for
considering the type of services necessary in maintaining independence

ACTIVITIES OF DAILY LIVING (ADLs) INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADLs)

 bathing administering own medication

dressing grocery shopping

toileting preparing meals

transfers using the telephone

Grooming driving and transportation

Feeding handling own finances

housekeeping

laundry

SCREENING FOR COGNITIVE IMPAIRMENT

Prevalence:
65 years of age or older-3%
90 years of age or older doubles in prevalence every 5 years reaching 40-50%

CLINICAL IMPLICATIONS:
unrecognized cognitive impairment is a risk factor for:
● medication non-adherence
● poor compliance with behavioral recommendations
● difficulty navigating the health care system
● caregiver stress

ASSESSMENT:
- Patients with suspected cognitive impairment should be screened for delirium and depression
- Delirium is a disorder of attention and should be considered in patients with waxing and waning attention or
level of consciousness
- Delirium is commonly a side effect of medications and often unrecognized by clinicians

DELIRIUM AND DEMENTIA

Delirium

- Acute confusion, usually reversible

Dementia

- irreversible, progressive impairment in cognitive function

Mild Cognitive Impairment

- Transitional stage between normal cognitive aging and dementia in which the person has short term memory
impairment and challenges with complex cognitive function

- sometimes d mapansin, bc short term lang, mukha lang nakalimutan, and na confuse

- malisdan sab mag kwenta

Sundowner Syndrome

- nocturnal confusion (occurs during afternoon/night)

 DELIRIUM VS. DEMENTIA
DELIRIUM
CAUSE Disruption of brain function due to
medication side effect,
circulatory disturbance, low or high
blood pressure, low or high blood
glucose, etc.
ONSET Rapid change within days
MENTAL STATUS -short term memory impaired more
than long term memory
- disoriented
- confused
- distorted thinking
- incoherent speech
- maybe suspicious
CONSCIOUSNESS can be highly agitated or dull
(Alertness)
BEHAVIOR - can be hyperactive
- can be less active than normal
- or fluctuate between both
RECOVERY Disease can be reversed and normal
mental status restored if cause is
treated promptly.
TOOLS FOR FUNCTIONAL ASSESSMENT
1. BIOLOGICAL ASSESSMENT
DEMENTIA
Damage to brain tissue due to Alzheimer’s or
other degenerative disease, circulatory
problems, lack of O2, infection, trauma, etc.
slow, months to years before symptoms are
evident.
- Poor short long term memory
- disoriented
- confused
- difficulty finding proper word to use
- impaired judgment
- problem with arithmetic and problem solving
Normal
- inappropriate
- maybe unsteady on feet
- difficulty with coordinated movements
- Progression of disease may be
slowed, but disease cannot be
reversed
- Usually continues to worsen
 a. Assessment of Physical Health
b. Functional Status
2. PSYCHOLOGICAL ASSESSMENT
a. Cognitive Assessment
b. Affective Assessment
3. SOCIOLOGICAL ASSESSMENT
a. Social Network Assessment

BIOLOGICAL ASSESSMENT

A. Assessment of Physical (General) Health

1. Sickness Impact Profile

2. Pain Assessment

SICKNESS IMPACT

PROFILE

- Was developed to assess health status as a measure of health care outcomes

PAIN ASSESSMENT

- Pain is common among older patients as a result of chronic conditions, as well as acute illness, and is
often called the sixth vital sign.

VISUAL SCALE FOR DOCUMENTING PAIN INTENSITY

A. Faces Pain Scale (FPS)

• Depicts a series of facial pictures that change with the intensity of pain level, particularly the brow,
mouth and eyes

B. Visual Analog Scale (VAS)

• Provides a numerical rating of pain, usually on a scale from 0 to 10, with 10 being the worst possible
pain and 0 representing no pain at all
B. Functional Status

1. Get Up and Go Test

2. Katz Index of ADL
3. FANCAPES

TIMED UP AND GO TEST

- A simpler measure of gait and balance is the “get up and go” test, which can be completed in a
couple of minutes. ; higher number of seconds=slow.

https://www.youtube.com/watch?v=j77QUMPTnE0

KATZ INDEX OF ADL

- The Katz Index of ADLs (Katz et al., 1963) is a well-known, widely used clinical and research
instrument used to assess ability to perform self-care.
https://www.youtube.com/watch?v=wMHBugrstoA&t=I3ls

FANCAPES

- Focuses on physical functioning and evaluates the individual’s ability to meet his or her needs
and how much assistance is needed to meet the needs.
• Fluid
• Aeration (oxygenation)
• Nutrition
• Cognition, communication
• Activity/abilities
• Pain
• Elimination
• Skin/socialization
 PSYCHOLOGICAL ASSESSMENT

A. Cognitive Assessment

1. Mini Mental State Exam (MMSE)

2. Mini Cog Test

MINI MENTAL STATE EXAM (MMSE)

- The Mini-Mental State Examination (MMSE) is the most widely used brief screening instrument to detect
cognitive impairment.
- Test orientation
- Takes about 7 mins, 17 items, Maximum of 30 items in total
- Schizophrenia, Delirium, affective disorder

MINI COG TEST

- A brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various
settings.
- Takes about 3 minutes
 - for dementia

https://youtu.be/DeCFtuD41WY

ADMINISTRATION BEST PRACTICES:

DO NOT
DO:
• Use the word “test” or “memory”
• Instead: “We’re going to do something that requires some concentration”
• Allow patient to give up or prematurely skip questions
• Deviate from standardized instructions
• Offer multiple choice answer
• Be soft on scoring
• Deduct points when necessary
• Never use the words “dementia” or “Alzheimer’s disease”
o Screening tools are not diagnostics
o Using these terms are premature at this stage and can contribute to anxiety/fear
• Avoid
o Being unnecessarily wordy
o Overexplaining or rationalizing the process

• Focus on health and well being

• Smile, be relaxed, practiced, comfort

B. Affective Assessment

GERIATRIC DEPRESSION SCALE

- The Geriatric Depression Scale is widely used by nurses to assess symptoms of depression.
SOCIOLOGICAL ASSESSMENT

A. Social Network Assessment

LUBBEN SOCIAL NETWORK SCALE

- This measure is a questionnaire to assess the type, size, closeness, and frequency of contacts in
a respondent’s current social network.
- Brief instrument designed ...
 LUBBEf¥ SOCIAL NETWORK SCALE — REYtSED (LSNS-R)

FAMILY: Considering the people in w'hom you are refered h5 hirth. zriarrioge. adoption, etc...

I . How many relatives do you sec or hear from at least once a month?
0 = none 1 = one 2 = rn'ci 3 - Ihryy ‹irJiiur 4 = /iiv ifiru eijthi 5 = fiine ur triorr

2. How oRen do you see or hear from the relative with whom you hove the mosl contact?
0 = Ie.cs Ihan monthly I - monthly 2 =/en’ time.r o iitonth 3 - u-eefJj’ 4 = {en’ times o need
5 = deity

3. How many relatives do you feel or ease with that you can talk about private marten?
0 = none I = one 2 = tn'n 3 = rfiree r›r Jitter 4 —— (tie Ihr eight $ —— nitie r›r more

4. How many relatives do you ferl close io such Ihai you could call on ihcm for hrlp?
0 = note I = one 2 = fu'o 3 — Ihree or Jâur 4 — fhe ifiru eight 5 = itine or more

5. When one of your relatives has an imporianl derision to make, how often do they talk to you about it?
0 = nevrt- 1 = .teldnnr 2 = .sometime.t 3 = omen 4 = ivzy’ n/tcn 5 = olw'oi:v

fl. How often is one of your relatives available for you io talk Io when you have an important derision Io make?
0 = ne her 1 = .teldom 2 = sometime.‹ 3 = o/iezi 4 = yen' o/ien 5 = onrsJ:s

FRIENDSHI PS: Con.ordering of/ o/j-oiir/rien‹Zv including tlote ii'1io live in i'oiir neighhnrhood...

7. How many of your r i‹»«s do you sec or hear from at least urns a nx›nth?
0 = none 1 = one 2 = rwo 3 = Ihree or Jâur 4 — fite iftro eigJr I = ziizte cir mow

8. How often do you sec or hear from the friend wilh whom you have the nest contact"
0 = /e.ts than monrlA• 1 = month/r 2 =/cii' time.t o month 3 = u-eefJr 4 = en times o nacl
5 - dci(i'

11. When one of y‹xir friends has an imJx›rtanl decision io make. how oflcn do they talk to you about
it? 0 = nevvr 1 = .tef‹fnm 2 = tomriimc.t 3 = ‹*/ieii 4 = very’ n/ien 5 = nfi•'oi:t

I2. How oflcn is one of your friends available for you to talk to when you have an imjx›ruint decision to
make? 0 = nerer I = seldom 2 = sometimes 3 = a/ien 4 = ›'en' o/ien
'S = o/»’ois

LSNS-R total score is on equalh u sighted sum of three tsi-elt'e items. Srorrs rouge]‘rom 0 to 6h.
 ETHNOGERIATRICS AND HEALTH CARE
Ethno- race, people, culture

Ethnicity- state of belonging to a

ETHNOGERIATRICS

• Component of geriatrics that considers the "influence of ethnicity and culture on the health and well being
of older adults" - America Geriatric Society
• Address the growing diversity of older adults and of health care providers
• Focused on the importance of cultural issues in health
• Aid providers in meeting the complex needs of a more diverse older patient population Expanding
older population globally

• Global increase in the absolute and relative size of the older population
o 420 million in 2000
o 974 million in 2030
• Result of decreased fertility and increasing life expectancy Worldwide, the

number of older persons has tripled over the last 50 years It will more than triple

again the next 50 years

• 1950: 205 million persons aged 60

• 2000: increased approx 3 x to 606 million
• 2050: projected to reach nearly 2 billion

Globally, Europe has the highest proportions of older adults

• Projected to remain so far at least the next 50 years

• 2000: 20% of European populations was 60 years +
• 2050: 37% of Europe's population will be 60 years +

STATISTICS

Black people – 8% to 12.2%

Asian/Pacific Islander – 2.4% to 6.5%

Hispanic – 3.7% to 16.4%

Native American/Alaskans – .4% to .5%

ETHNOGERONTOLOGY

• Study of causes, processes, and consequences of race, national origin, culture, minority group status,
and ethnic group

CULTURE
 • System of norms, values, beliefs and attitudes that shape and influence perception and behavior
• The sum total of the way of living
• Used to discuss different societies or national origins
• Reflects differences in groups according to geographic regions or other characteristics that comprise
subgroup within a nation

What is culture?

• Learned: culture is learned through the process of enculturation

• Shared: shared by the members of a society
• Patterned: we live, think in patterned behaviors, system, etc.
• Mutually constructed: through a constant process of society interaction
• Symbolic: based on symbols and symbolic meaning
• Arbitrary: culture not based on natural laws; created by humans on the "whims" of society. Examples:
alphabets, definitions of beauty
• Internalized: habitual, taken for granted, seems "natural"

Why consider culture?

• Cultural groups differ in their explanations of diseases and treatment including:

✓ The nature and cause of disease
✓ What is proper, preferred and effective treatment
✓ The likely health outcomes
✓ Beliefs about health and illness are divided into 3 theoretical categories:
1. Magico religious theory – health illness and effectiveness of treatment are believed to be caused
by actions of a higher power. God or supernatural forces. Health is viewed as a blessing or reward
from a higher source; illness as punishment for breaking rules/displeasing. Tx: meditation, praying,
fasting, wearing amulets
2. Balance in harmony
3. Biomedical
• Older patients may have traditional health beliefs and behaviors
• Better understanding of the behaviors, beliefs, values and attitudes of our patients and clients
• Avoid stereotypes, prejudices and biases
• Development and delivery of services that meet the needs of our patients and clients

ACCULTURATION

• Degree to which individuals have moved from their original system of cultural values and beliefs toward a
new system

CULTURAL COMPETENCE

• Ability of nurses to understand and accept the cultural backgrounds of clients and provide care that best
meets the client's needs – not the nurse's needs

Stages of Cultural Competence

1st unconscious incompetence

 • Common to beginning nurses, assumption that everyone is the same care to culturally diverse patient
populations

2nd conscious incompetence

• Nurse begins to understand the vast differences between patients from many cultural
backgrounds, but lacks the knowledge to provide competent care

3rd conscious competence

• Knowledge regarding various cultures is actively obtained, but this knowledge is not easily integrated into
practice, because the nurse is somewhat uncomfortable with culturally diverse interventions

4th unconscious competence

• Naturally integrate knowledge and culturally appropriate interventions into practice

Steps in Becoming Culturally Competent

• Identification of cultural biases

• Acquire knowledge regarding population-specific, health related cultural values, beliefs and behaviors
• Explore disease incidence, prevalence and mortality rates among cultural groups
• Cultural history
• Acquisition of cultural competence

HEALTHCARE SYSTEM

• Has its own culture (e.g., knowledge, beliefs, skills, values) based on scientific assumptions and
processes, producing definitions and explanations of disease

BIOMEDICAL MODEL OF HEALTH

Advantages:

• Advancement in technology
• Effective treatment
• Extend life expectancy
• Improve quality of life

Disadvantages:

• Relies on professional health workers and technology

• Narrow view of health (individual focus rather than holistic view)
• Not every condition can be treated
• Expensive

WESTERN BIOMEDICAL MODEL

 • Treatment of medical problems with little respect for the impact of treatment on the older adult's life

THE SOCIAL MODEL OF HEALTH

• A conceptual framework which improvements in health and well-being are achieved by directing efforts
towards addressing the social, economic and environmental determinants of health

5 Key Principles (A.R.E.A.S)

• Addresses the broader determinants of health

• Reduce social inequalities
• Empower individuals and communities
• Access to health care
• Inter-sectoral collaboration
Advantages

• Promoted good health and assists in preventing diseases

• Promotes overall wellbeing
• Relatively inexpensive
• Focuses on population groups that are in need
• Education is passed on
• Health isn't the responsibility of just the individual but also health sectors

Disadvantages

• Not every condition can be prevented

• Does not promote the development of technology and medical knowledge
• Does not address the health concerns of an individual
• Health promotion messages can be ignored

COMMON ISSUES IN ELDERLY CARE

• Use of complementary and alternative therapy

• “a group of diverse medical and health care systems, practices and products that are not presently
considered to be part of conventional medicine.” - National Center for Complementary and
Alternative Medicine (NCCCAM)

The Four Categories of CAM:

1. Biologically-based products
2. Energy therapies
3. Manipulative and Body-based methods
4. Mind-Body medicine
− Aloe vera for minor burns,
− Ginseng as laxative and diuretic
− Gingko biloba to improve blood flow and short term memory
COMMON ISSUES

End-of-life care

- Advance directives
- Living will
• Advance directives are legal documents that state the patient's wishes when the patient becomes unable to
speak for themselves
• Advanced directives are created ahead of any medical incapacitation in order to ensure that the patient has the
ability to make their own decisions when they are unable to do so. (Morrison, 2010)

Ethical Issues with Advanced Directives

• Determining that a patient is incompetent to make personal decisions is one of the first issues when addressing
advance directives. Courts and medical personnel can assist in the determination of competency to make
decisions

Living Will

• A living will is a legal document that discloses a persons individual needs and requests when unable to
make competent decisions of their own
• Living will should be validated by two witnesses that are not related to the patient. (Morrison, 2010)

DYING PERSON'S BILL OF RIGHTS

• I have the right to be treated as a living human being until I die

• To maintain a sense of hopefulness, however changing its focus may be
• To be cared for by those who can maintain sense of hopefulness, however challenging this might be
• Express my feelings and emotions about my approaching death, in my own way
• To participate in decision concerning my care
 • Expect continuing medical and nursing attention even though cure goals must be changed to comfort
goals
• Not to die alone
• To be free from pain
• Have my questions answered honestly
• Not to be deceived
• Help for me and for my family accepting my death
• To die in peace in dignity
• Retain my individuality and not be judged for my decisions
• Discuss and enlarge my religious or spiritual experiences
• The sanctity of human body will be respected after death
• Cared for by caring, sensitive, knowledgeable people

CULTURAL VIEWS OF DEATH

• Circular pattern rather than linear

• Prior bad memories of health care make older adults concerned about making end-of-life decisions
• End-of-life care may be made by family even if the older adult is competent to make decisions
• Involve nondisclosure of terminal illness to protect the elderly
• Autopsy and organ donation are not acceptable
• Advance directives, withdrawal of life prolonging treatment, use of hospice services and organ donation is
common
• Well-being of the family may be considered over the well-being of the client

HEALTH CARE PRACTICES OF DOMINANT CULTURAL GROUPS

Native Americans

Origin of belief Focus of health View of illness Components of

care
for healing
• Health beliefs • Mind-body-spirit • Sometimes seen • Herbs from
and views of integration as a result of an native plants
death are older individual's • Spiritual healing
than the country offenses • Harmony
and vary by tribe with
environment
• Ritual purification
ceremony may be
needed to heal

African Americans

Origin of belief Focus of health View of illness Components of

care
for healing
• Integrated with • Interaction of • Result of a • Power of
American multiple causes physical cause, religion,
Indian, of such as Christian in
some
 Christian, and health as opposed infection, weather, cases; and use of
other European to just physical and other herbs, or "root
traditions environmental working"
• Many Africans factors, or from sin • Use of healers
grew up with little or great offense is rare
health care • May use
home
remedies
• Experiences of
segregation may
make older adults
skeptical and
distrustful of health
care providers

Asian Americans

Origin of belief Focus of health View of illness Components of

care
for healing
• Classical Chinese • Balance • Threat to the soul • Herbs and diet
medicine between yin and may be seen as a
influenced yang to method of
traditions in preserve health unblocking the free
Japan, Korea and • Interaction of flow of chi or vital
Southeast Asia basic elements of energy
• In parts of Asia, the environment • Use of
Taoism and (water, fire, earth, acupuncture,
Buddhism have metal and wood) tai chi,
influenced the moxibustion
healing and cupping
traditions • Illness should be
addressed not
only through
medicine, but also
through social and
psychological
means

Latin Americans

Origin of belief Focus of health View of illness Components of

care
for healing
• Most Latino • Religion is • Multidimensional • Interaction of the
Americans an important in nature biomedical
practice the component model with
biomedical model, of health complementary
but among some and alternative
elders there therapies provides
 may be

reminiscences of the framework for

other beliefs health care

SAMPLE CULTURAL HISTORY QUESTION

• In what country were you born?

• How long have you been in this country?
• What language did you first learn to speak?
• What language is used at home?
• How do you identify yourself (ethnic/racial background or culture)?
• What is the role of spirituality, faith or religion in your life?
• What customs or traditions are important to you?
• What does your culture/region teach you about aging?

PLANNED STRUCTURE OF ACTIVITIES (PSA)

PHYSICAL ASSESSMENT

TECHNIQUES USED
● inspection
● palpation
● percussion - use of percussion hammer or fingers to assess density of a cavity or organ
● auscultation -listen and assess the sound produced by various body organs (heart, lungs, bowel,

ORDER OF ASSESSMENT:
IAPEPA - stomach only - to avoid disruption or triggering gaseous chuchu
IPAPEA - other body parts

Skin and Nails(inspection and?)

- this examination includes a search for premalignant and malignant lesions, tissue ischemia, and pressure
injuries.
- In Geriatic clients there some consideration such as:
- ecchymoses - difference from hematoma: solid swelling of clotted blood; cause by trauma ;
ecchymoses is just bleeding in the skin
- uneven tanning
- longitudinal ridges
- nail plate fractures - occurs due to aging
- black splinter hemorrhages
- onychomycosis - fungal infection mura syag mag yellowish, magbaga. 50% 70 years old
- onychocryptosis
- psoriasis
- unexplained bruises - not only abuse, but is more susceptible due to age
HEAD & NECK

Face
Normal Age-related findings may include the following:
- eyebrows that drop below the superior orbital rim
- common in elderly
- loss of the angle between the submandibular line and neck
- wrinkles - so naga decrease ang oil ng skin so mag ka cause ng wrinkles
- dry skin

Nose
Normal Age-related findings may include the following:
- Progressive descent of the nasal tip
- cartilage separates, lowering the nose making it bigger
- not really klaro for filipinos, more on enlarging
Eyes
Normal Age-related findings may include the following:
- arcus senilis
- common in 60 years old
- grayish ring around cornea
- does not affect vision
- ectropion
- inversion of lower eyelid margins, mag labas ang red part sa eyelids
- does not affect vision rin
- enophthalmos
- loss of orbital fat
- sinking of the eyes
- not a sign of dehydration

Mouth
Normal Age-related findings may include the following:
- darkened teeth
- yellow upper part, translucent pababa
- xerostomia
- aka dry mouth ; tongue
- affects quality of life; should be assessed
Neck
Normal Age-related findings may include the following:
- loss of the angle between the submandibular line and neck
- loss of collagen, elastic fibers, and hyaluronic acid

Chest and Back (IPAPEA)

- INSPECTION
- inspect the shape and symmetry of the thorax
- examine for kyphosis (forward rounding of the back)
- due to weakness of spinal bones
- PALPATION
- examine for tenderness
- examine for signs of osteoporotic fractures: severe low back, hip and leg pain with
sacral tenderness
- respiratory excursion: asymmetry

BACK PERCUSSION
 Resonance long, loud, low pitched Normal lung

Flat short, doft, high pitched Atelectasis

Dull medium intensity lobar pneumonia

hyper resonant very loud pneumothorax

Tympanic musical large pneumothorax

RESPIRATORY SYSTEM
- note the extent of respiratory excursion
- normal breath sounds
- VESICULAR
- base of the lungs
- very low pitched sounds; like a low sigh
- BRONCHOVESICULAR
- between our scapulae
- blowing sound; low-pitched sound
- TUBULAR/BRONCHIAL
- at trachea
- high pitched sound na
- adventitious breath sounds
- wheezes
- whistling sounds, merong mucus, solid tumor
- crackles/ rales
- popping sound
- presence of fluid in the area
- normal in eldrely in the BASE OF THE LUNGS
- Stridor
- harsh shrill sound
- Pleural friction rub
- grating sound or squeaking sound
Cardiovascular System
- systolic murmurs at the base may indicate AORTIC VALVE SCLEROSIS
- note for diastolic murmurs
- Note for signs of artificial insufficiency (hair loss, bruits, decreased pulses
- Note for signs of venous disease (skin changes and edema) are common.

Breasts
- Suggest an annual breast examination
- note for tumors
- not for inverted nipples, which may indicate the presence of breast cancer
- normal if maglabas pag mag apply ng pressure
- Menopause
- involution and increased fat deposition, decreases connective tissue, and disappearance of lobular units ;
more on fats ang breast

GASTROINTESTINAL SYSTEM
- the abdomen is palpated to check for weak abdominal muscles
 - make sure dili bag-ong kaon and busog
- normal aorta is palpable; you can feel the pulsation
- flicking of fingers (light
- Assess the abdomen for the enlargement of liver and spleen.
- Frequency and quality of bowel sounds are checked.
- suprapubic area is percussed for tenderness, discomfort, and evidence of urinary retention
Inspection, palpation, percussion and ausculation (IPPA)⇾inspection, auscultation, percussion, and palpation
(IAPP)
-
REPRODUCTIVE SYSTEM
Female
- Position: lithotomy or left lateral decubitus position
- Assess for pelvic prolapse, uterine, adnexal or vaginal neoplasm, infections, estrogen deficit
- Pap smears should be done in elderly women
- Palpable ovaries may indicate cancer
- - usually if palpable ang ovaries kay may presence na ng cysts.
- Ask to cough to check for urine leakage
- weak bladder and pelvic floor muscles
- normally in lithotomy position
- to check this we usually utilize interview nalang

MALE
- enlarged prostate gland: benign prostatic hyperplasia
- Erectile dysfunction
- can interfere with urination
- due to medicine or disorders such as diabetes
- more susceptible to urinary tract infections (changes in prostate gland can lead to UTI)
- better if male nurses mag interview to promote comfort
- ask if there is dribbling sound (putol-putol) during urination (indicates prostatic hyperplasia)

MUSCULOSKELETAL SYSTEM
Inspection
- Inspects the muscle for size. Measures the muscle with tape.
- compares each muscle on one side of the body to the same muscle on the other side for any apparent
discrepancies
- dominant muscles are more formed/palpable than non-dominant
- Inspects the muscles and tendons for contractures and fasciculation.
- usually mga post stroke patient
- Inspects any tremors of the hands and arms by having the patient hold the arms out in front of the body

Palpation
- Palpates muscles at rest to determine muscle tonicity
- Palpates muscle while the patient is doing an active range of motion. checks flaccidity, spasticity, and
smoothness of movement. (Flexion and extension movement)
- Palpates muscle while the patient is doing a passive range of motion
- Tests muscle strength. compares the right side with the left side.

Evaluation tools
a. KATZ INDDEX OF INDEPENDENCE IN ADL - appropriate instrument to assess functional status as
a measurement of the client’s ability to perform activities of daily living
- bathing UNSA TOHHH
- 6 functions - 6 full function, 4 moderate, 2 severe impairment
b. TINETTI GAIT AND BALANCE TOOL
 - a test designed to assess the gait and balance of older adults
- to assess risk for fall
- 2 parts: gait = 12 points ; balance unsa toh
- below 19 = high risk for falls
- 19-24 = moderate risk for fall
- 25-28 = low risk for fall
c. GET UP AND GO TEST
- clinical performance - based measure of lower extremity function, mobility and fall risk
- letting patient rise from sitting position, and walk 3 feet then turn around and return to chair
then sit down
Bones
-Inspects the skeleton for normal structure and deformities
-palpates the bone to locate any areas of edema or tenderness

Joints
- inspects the joints for swelling.
- palpates each joint for tenderness, swelling, crepitation and presence of nodules
- assesses joints, for a range of motion, and smoothness of movement
- Documents pertinent findings in the patient’s record

COMMON CONDITIONS IN THE HANDS

1. HEBERDEN NODES
a. non-swollen bumps
b. closest to the fingertips or bony overgrowth at distal interphalangeal joints
c. sign of osteoarthritis
2. BOUCHARD NODES
a. swelling is at middle joint of finger
b. sign of osteoarthritis
3. BOUTONNIERE DEFORMITY
a. opposite of swan neck
b. distal interphalangeal ang nag flex while the proximal ang nag hyperextend
c. seen in rheumatoid arthritis
4. SWAN-NECK DEFORMITY
a. hyperextension of proximal interphalangeal joint
b. also rheumatoid arthritis

COMMON CONDITIONS IN THE FEET

1. BUNION aka hallux abducto valgus
a. one of the most common
b. abduction of the first mata
2. HAMMER TOE
a. hyperflexion of the proximal interphalangeal joint
3. CLAW TOE
a. hyperflexion of the proximal and distal UNSA DAW YAWA
FUNCTIONAL ASSESSMENT
older px are more likely than younger px to have unrecognized co-morbidities and impairments that increase
risk of medical morbidity, functional decline, and mortality

mostly 80% of the people na nagkakaroon ng osteoarthritis ay ang mga matatanda