Basic Geriatric Nursing

• Gerontology - comes from the Greek words “gero,”

meaning related to old age, and “ology,” meaning
the study of. Thus, gerontology is the study of all
aspects of the aging process, including the clinical,
Until the middle of the nineteenth century, only psychologic, economic, and sociologic problems of
two stages of human growth and development were older adults and the consequences of these
identified: childhood and adulthood. In many ways, problems for older adults and society.
children were treated like small adults. No special • The term gerontics, or gerontic nursing, was coined
attention was given to them or to their needs. by Gunter and Estes in 1979 to define the nursing
care and the service provided to older adults.
As time passed, society began to view children
Gerontic nursing encompasses a holistic view of
differently. People learned there are significant
aging with the goal of increasing health, providing
differences between children of different ages, and
comfort, and caring for older adult needs.
children’s needs change as they develop. Childhood is
now divided into substages (i.e., infant, toddler, Chronologic age - the number of years a person has lived,
preschool, school age, and adolescence). is most often used when we speak of aging because it is
the easiest to identify and measure.
Until recently, society also viewed adults of all ages
interchangeably. Categorizing the Aging Population
Age (Years) Category
• Until the 1960s, sociologists, psychologists, and 55 to 64 Older
health care providers focused their attention on 65 to 74 Elderly
meeting the needs of the typical or average 75 to 84 Aged
adult: people between 20 and 65 years of age. 85 and older Extremely aged
• In the late 1960s, research began to indicate that Or
adults of all ages are not the same. At the same 60 to 74 Young-old
time, the focus of health care shifted from illness 75 to 84 Middle-old
to wellness. Disability and disease were no 85 and older Old-old
longer considered unavoidable parts of aging.

Older adults now constitute a significant group in

society, and interest in the study of aging is increasing.
The study of aging will be a major area of attention for
years to come. The fear of aging and the refusal to accept older
adults into the mainstream of society is known as
gerontophobia.

• Geriatric - comes from the Greek words “geras,” • Teenagers buy antiwrinkle creams
meaning old age, and “iatro,” meaning relating to • Thirty-year-old women consider facelifts
medical treatment. Thus, geriatrics is the medical • Forty-year-old women have hair transplants
specialty that deals with the physiology of aging and • Long-term marriages dissolve so that one spouse
with the diagnosis and treatment of diseases can pursue someone younger
affecting older adults. Geriatrics, by definition,
The extreme forms of gerontophobia are ageism and
focuses on abnormal conditions and the medical
age discrimination.
treatment of these conditions.
 A. Ageism - Ageism is the disliking of aging and
older adults based on the belief that aging makes
people unattractive, unintelligent, and
unproductive. It is an emotional prejudice or
discrimination against people based solely on
age. Like other forms of prejudice, ageism occurs
because of myths and stereotypes about a group
of people who are different from us. Ageism can
have a negative effect on the way health care
providers relate to older patients, which, in turn,
can result in poor health care outcomes in these
individuals.
B. Age Discrimination - Age discrimination reaches
beyond emotions and leads to actions; older
adults are treated differently simply because of
their age. Examples of age discrimination include
refusing to hire older people, not approving
them for home loans, and limiting the types or
amount of health care they receive. Age
discrimination is illegal.
Demographics is the statistical study of human
populations. Demographers are concerned with a
population’s size, distribution, and vital statistics. Vital
statistics include birth, death, age at death, marriage(s),
race, and many other variables. The collection of
demographic information is an ongoing process.
Demographic information is used by the
government as a basis for granting aid to cities and
states, by cities to project their budget needs for schools,
by hospitals to determine the number of beds needed,
by public health agencies to determine the immunization
needs of a community, and by marketers to sell products.
One important piece of demographic
information is life expectancy. Life expectancy is the
number of years an average person can expect to live.
Projected from the time of birth, life expectancy is based
on the ages of all people who die in a given year.
According to the U.S. Department of State, for
the first time in recorded history, the number of people
over age 65 is projected to exceed the number of
children under age 5. By 2060, this is expected to
increase to 92 million people age 65 or older, roughly
20% of the total population.
The Administration on Aging projects that
minority populations will represent 26.4% of the older
population by 2030, an increase from 16% in 2000. It is
projected that by 2030, the white non-Hispanic
population will increase by 77%. During the same time
period, the percentage of minority persons of the same
age cohort is expected to grow by 223% (Hispanics,
342%; African Americans, 164%; American Indians,
Eskimos, and Aleuts, 207%; and Pacific Islanders, 302%).
A major contributing factor to this rapid
explosion in the older adult population is the aging of the
cohort, commonly called the Baby Boomers. The most
significant cohort today is the group known as Baby
Boomers. This cohort consists of people who were born
after World War II between 1946 and 1964.
Age cohort - a term used by demographers to describe a
group of people born within a specified time period.
The older adult population is not equally
distributed throughout the United States. Climate, taxes,
and other issues regarding the quality-of-life influence
where older adults choose to live. All regions of the
country are affected by the increase in life expectancy,
but not to the same degree.
In 2012, 72% of men over age 65 were married
compared to 45% of older women. The percentage of
married people drops significantly as age progresses, but
the percentage of men over age 90 who are married
remains high at 40%. At age 65, 37% of women were
widows compared with only 12% of men. By age 90, 80%
of women were widows compared to only 49% of men.
The percentage of older adults who are separated or
divorced has increased to 12%.
2|Dablio, Nikka
 In 1970, only 28% of senior citizens had
graduated from high school. By 2012, 81% were high
school graduates or more, and 24% had a bachelor’s
degree or higher. Completion of high school varied by
race and ethnicity, with whites (86%) completing high
school at higher rates, followed by Asians (74%), African-
American and American Indian/Alaskan Natives (69%),
and Hispanics (49%).
The stereotypical belief that many older adults
are poor is not necessarily true. The economic status of
older persons is as varied as that of other age groups.
In 2011, over 3.6 million (8.7%) older adults lived
at or below the poverty level, with another 2.4 million
classified as “near poor.” Older women were more likely
to be impoverished than older men.
Economic well-being is usually measured in
terms of income, which is the amount of money a
household receives on a weekly, monthly, or yearly basis.
However, this measurement is not always a reliable
indicator of financial security in older adults. People
older than 65 years of age generally have more
discretionary income (i.e., money left after paying for
necessities such as housing, food, and medical care)
available than do younger people. Younger individuals,
particularly those with growing families, may have a
higher income, but they also have higher
nondiscretionary demands.
Older individuals often try to keep their homes,
despite the physical or economic difficulties in doing so.
A house is more than just a physical shelter; it represents
independence and security. The home holds many
memories. Being in a familiar neighborhood close to
friends and church is important.
For some older people, keeping the family home
is not a sensible option for many reasons. Many of the
houses owned by older adults are in central cities with
high crime rates. Expenses, such as increasingly high
property taxes and ongoing maintenance costs, often
present excessive strain on older persons with limited
financial resources. Home maintenance, including even
simple tasks such as housecleaning, becomes
increasingly difficult with advancing age or illness.
• Independent or assisted-living centers are
becoming common. These centers combine
privacy with easily available services. Most
consist of private apartments that are either
purchased or rented. Health care services may
include assistance with hygiene, routine
medication administration, and even preventive
health clinics.
• Life-lease or life-contract facilities are another
housing option. For a large initial investment and
substantial monthly rental and service fees,
older persons or couples are guaranteed a
residence for life. Independent residents occupy
apartment units, but extended-care units are
either attached to this apartment complex or
located nearby for residents who require skilled
nursing services. If one spouse needs skilled
care, the other may continue to live in the
apartment and can easily visit the hospitalized
loved one.
• Some older adults qualify for government-
subsidized housing if they meet certain financial
standards and limits. Government-subsidized
housing units may be simple apartments without
any special services, or they may have limited
services, such as access to nursing clinics and
special transportation arrangements.
• Some older adults who are not related to each
other are forming group-housing plans. In this
3|Dablio, Nikka
 type of arrangement, two or more unrelated
people share a household in which they have
private bedrooms but share the common
recreational and leisure areas, as well as the
tasks involved in home maintenance. Some
communities offer services to help match people
who are interested in this option.
• A more formal type of group home called a
community-based residential facility (CBRF) is
available in some communities. For a monthly
fee, this type of facility provides services such as
room and board, help with activities of daily
living, assistance with medications, yearly
medical examinations, information and referrals,
leisure activities, and recreational or therapeutic
programs.
• Older adults that require more extensive
assistance may need placement in nursing
homes or extended care facilities. Nursing homes
provide room and board, personal care, and
medical and nursing services. They are licensed
by individual states and regulated by both
federal and state laws. Three levels of care are
provided by nursing homes: skilled care,
intermediate care, and custodial care.
• Subacute care facilities provide comprehensive
inpatient care designed for individuals who have
an acute illness, injury, or exacerbation of a
disease process.
• Specialty care facilities, such as residences
designed to meet the special needs of people
with Alzheimer disease or other memory loss
and their families are gaining in popularity
around the country.
Medicare is the government program that
provides health care funding for older adults and
disabled persons. Medicare has four distinct programs,
none of which pays all of the health care costs.
A. Medicare Part A is hospital insurance. It covers
inpatient hospital care; skilled nursing care
following hospitalization; some home health
services, such as visiting nurses and
occupational, speech, or physical therapists; and
hospice services, but only after the patient pays
an initial deductible and any co-payments
B. Medicare Part B is medical insurance. It is
optional, but most people choose this coverage.
This plan covers 80% of the “customary and
usual” rates charged by physicians after
deductibles are met. In addition to physicians’
fees, Medicare Part B covers medically necessary
ambulance transport; physical, speech, and
occupational therapy; home health services
when medically necessary; medical supplies and
equipment; and outpatient surgery or blood
transfusions.
C. Medicare Part C, Medicare Advantage Plans, are
optional plans offered by private companies
approved by Medicare to individuals who are
eligible for Part A and enrolled in Part B. These
plans allow beneficiaries to receive their
Medicare benefits through private insurance
companies.
D. Medicare Part D, prescription drug coverage,
went into effect during 2006. It is a voluntary
plan available to anyone enrolled in Part A or B
of Medicare. It cannot be used if someone
chooses a Medicare Advantage Plan (Part C) that
has prescription drug coverage. Under Part D,
prescription drugs are distributed through local
pharmacies and administered by a wide variety
of private insurance plans.
E. Supplemental Medicaid (Title 19) assistance may
be available for those older adults who meet
certain financial need requirements. Many of
those who have assets do not qualify; they are
left with a Medicare gap (or “medigap”) that
they must pay themselves.
The costs of health care have increased
dramatically in recent years. The United States spends
more money on health care than any other country in the
world, yet health care is not provided for all U.S. citizens.
Many other nations do a better job of meeting their
citizens’ health care needs.
4|Dablio, Nikka

Not all older people use the available health care
resources equally. Most health care services are
consumed by the very ill or terminally ill minority, many
of whom happen to be older adults. One quarter of all
Medicare dollars are spent on services for 5% of
Medicare patients in their last year of life.
All adults who are 18 years of age or older and of
sound mind have the right to make decisions regarding
the amount and type of health care they desire. Such
important decisions are best made during a stress-free
time when the individual is alert and experiencing no
acute health problems. A person’s wishes can best be
communicated using advance directives, which are
legally recognized documents that specify the types of
care and treatment the individual desires when that
individual cannot speak for himself or herself
Areas typically addressed in advance directives include:
• Do not attempt to resuscitate (DNAR) or allow
natural death (AND) orders;
• directives related to mechanical ventilation;
• directives related to artificial nutrition and
hydration.
Two formal types of advance directive are recognized in
most states:
• The durable power of attorney for health care;
and
• the living will. Information about both of these is
typically provided when a person enters the
hospital.
These documents are designed to help guide the
family and medical professionals in planning care.
Durable power of attorney for health care
transfers the authority to make health care decisions to
another person, called the health care agent. The agent
may act only in situations in which the person is unable
to make decisions for himself or herself. Because the
health care agent must be trusted to follow through with
the older person’s wishes, the agent specified in the
document is usually a family member or friend.
A living will inform the physician that the
individual wishes to die naturally if he or she develops an
illness or receives an injury that cannot be cured. Living
wills prohibit the use of life-prolonging measures and
equipment when the individual is near death or in a
persistent vegetative state.
Laws and specifics differ from state to state.
Nurses should be aware of the legal standing of such
documents in the particular state where they practice
and should understand any legal ramifications
engendered by these documents.
POLST, or physician orders for life-sustaining
treatment, is a legal document that has been adopted by
several states and takes the person’s wishes further by
creating actual doctor’s orders to be carried out by
emergency personnel.
• CPR (whether to attempt resuscitation or allow
natural death);
• medical interventions (comfort care, limited
interventions, or full treatment including when
to transfer to hospital);
• antibiotics (use freely, use for comfort, or don’t
use at all); and
• artificial nutrition (no tube feeding, trial of tube
feeding, or long-term tube feeding)
The POLST is printed on bright paper, the color
of which is determined by the state, and signed by the
physician and patient.
5|Dablio, Nikka

The family is undergoing significant change in
our society. Many factors, including increasing divorce
rates, single parenting, and a mobile population, are
creating a less stable, less predictable family structure.
Blended families, extended families, and separated
families all present challenges. In addition to these
societal changes, the demographic changes discussed
previously are having, and will continue to have,
repercussions that we can only begin to appreciate
Categorizing the Aging Population
Age (Years) Generation
80+ Parents
60+ Children
40+ Grandchildren
20+ Great-grandchildren
Less than 20 Great-great-
grandchildren
When we as nurses care for older adults,
particularly in hospital or nursing home settings, we see
the person only as he or she is now. We often forget that
these people have not always been old. They lived, loved,
worked, argued, and wept as each of us does. Often, the
older adults we care for are very ill or infirm, and, as
nurses, we tend to focus on their physical needs, cares,
and treatments. In our preoccupation with our duties,
we can easily lose our perspective of the older patient as
both a person and a member of a family.
Self-neglect is more likely to be seen when an
older person has few or no close family or friends, but it
can occur despite their presence.
Self-neglect is defined as the failure to provide
for the self because of a lack of ability or lack of
awareness. Indicators of self-neglect include the
following:
1. The inability to maintain activities of daily living
such as personal care, shopping, meal
preparation, or other household tasks
2. The inability to obtain adequate food and fluid as
indicated by malnutrition or dehydration
3. Poor hygiene practices as indicated by body
odor, sores, rashes, or inadequate or soiled
clothing
4. Changes in mental function, such as confusion,
inappropriate responses, disorientation, or
incoherence
5. The inability to manage personal finances as
indicated by the failure to pay bills or by
hoarding, squandering, or giving away money
inappropriately
6. Failure to keep important business or medical
appointments
7. Life-threatening or suicidal acts, such as
wandering, isolation, or substance abuse
Self-neglect is often connected with some form
of mental illness or dementia. Once the problem is
recognized, legal action through the courts may be
needed to place the person in the custody of a family
member or adult protective services.
Intentional abuse is most likely to occur in
families with preexisting behavioral or social problems.
Highrisk families include those that have a history of
family conflict and those with a history of violence or
substance abuse, those with mental impairment of
either the dependent person or caregiver, and those with
severe financial problems or unemployment.
Not all forms of abuse are intentional, but even
unintentional abuse is devastating to older adults.
Unintentional abuse or neglect is most likely to occur
when the caregiver lacks the necessary knowledge,
stamina, or resources needed to care for an older loved
one.
Abuse can be physical, financial, psychological,
or emotional. Neglect and abandonment also constitute
forms of abuse.
Physical abuse is any action that causes physical
pain or injury. Abuse may involve a physical attack upon
a frail older adult who is unable to defend himself or
herself from younger, stronger family members.
6|Dablio, Nikka
 Neglect is a passive form of abuse in which
caregivers fail to provide for the needs of the older
person under their care. Neglect, whether intentional on
unintentional, accounts for almost half of the verified
cases of elder abuse.
Emotional abuse is the most subtle and difficult
to recognize type of abuse. It often includes behaviors
such as isolating, ignoring, or depersonalizing older
adults.
Emotional abusers can use verbal or nonverbal
means to inflict their damage. Verbal abuse includes
shouting or voicing threats of punishment or
confinement. Emotional abusers often threaten older
adults with all manners of horrors if they tell anyone
about their plight.
Financial abuse exists when the resources of an
older person are stolen or misused by a person whom the
older adult trusts. Children and grandchildren may take
money from the older adult, rationalizing that money is
owed to them for providing care or that it will eventually
be theirs anyway.
Some actions that senior citizens can take to protect
their financial assets include:
1. arranging for direct deposit of Social Security,
pension, and any other benefit checks;
2. taking great care in the selection of anyone
appointed as the power of attorney or giving
advice regarding a will;
3. keeping ATM pin numbers secure—do not write
them in a location where others may see them,
and do not give the number to anyone;
4. having written agreements regarding
expectations and fees for any services;
5. keeping valuables in a secure location such as a
safe deposit box; and
6. remembering that home helpers or attendants
are employees not friends—pay the fair and
agreed wage, and keep tips and gifts for special
occasions.
Abandonment occurs when dependent older
persons are deserted by the person or persons
responsible for their custody or care under
circumstances in which a reasonable person would
continue to provide care. Abandonment usually leaves
the older person physically, emotionally, and financially
defenseless. Older adults who have been abandoned by
their families usually become wards of the state.
It is natural to think that an older person
suffering from one or more forms of abuse would
complain, but this is rarely the case. Fear of being treated
even worse or fear of being institutionalized or
abandoned may prevent the victim from seeking help.
Signs the Older Person May Be Experiencing Abuse:
• Excessive agreement or compliance with the
caregiver
• Signs of poor hygiene such as body odor,
uncleanliness, or soiled clothing or
undergarments
• Malnutrition or dehydration
• Burns or pressure sores
• Bruises, particularly clustered on trunk or upper
arms
• Bruises in various stages of healing that may
indicate repeated injury
• Inadequate clothing or footwear
• Inadequate medical attention
• Lack of food, medication, or care
• Verbalization of being left alone or isolated
• Verbalization of fear of the caregiver
• Verbalization of a lack of control in personal
activities or finances
Nurses have a moral, legal, and ethical responsibility
to report any suspected cases of abuse.
People who are hired to provide for the safety
and well-being of older adults can sometimes become
their greatest threat. Increased use of unrelated
caregivers exposes older adults to additional risks. The
salaries paid to nursing assistants and housekeepers are
low, the hours are long, and the work is emotionally and
7|Dablio, Nikka
physically demanding. It can be difficult to find caring,
responsible people who are willing to provide this
service.
Abusive Behaviors in Health Care Settings
• Use of sedative or hypnotic drugs that are not
medically necessary
• Use of restraints when they are not medically
indicated
• Use of derogatory language, angry verbal
interactions, or ethnic slurs
• Withholding of privileges such as snacks or
cigarettes
• Excessive roughness in handling during care or
during transfers
• Delay in taking a resident to the bathroom or
allowing a resident to lie in body waste
• Consumption of a resident’s food
• Theft of money or personal belongings
• Physical striking or any other assaultive behavior
toward a resident
• Violation of a resident’s right to make decisions
• Failure to provide privacy
Nurses are mandated reporters of elder abuse,
which means it is against the law if you suspect elder
abuse and do not report it.
The demands of providing care prevent
caregivers from getting the rest, encouragement, and
support they need. Caregivers who want or need to share
their experiences and frustrations have started forming
support groups to help one another cope with stress.
These support groups may be specialized (e.g., for
caregivers of people with Alzheimer disease) or more
general in nature.
Respite care allows the primary caregiver to have
time away from the demands of caregiving, thereby
decreasing stress and the risk for abuse. Respite care
gives the primary caregiver the opportunity to attend
church, go shopping, conduct personal business, obtain
medical care, or simply participate in leisure activities.
Respite care may be provided by family members,
volunteers, or one of the many service agencies that
have proliferated within the past few years.
1) What are myths related to aging? (Select all that
apply.)
1. Most older adults live in institutional settings
2. Most older adults suffer from a significant loss
of intellectual function.
3. Most older adults have frequent interaction with
family and friends.
4. Most older adults experience significant
personality changes.
5. Most older adults are seriously depressed.
6. Most older adults are sick, frail, and dependent
on others.
2) Which is true of the Baby Boom generation?
1. Members were born between 1946 and 1964.
2. Members will all be age 65 or older by 2025.
3. Members are reaching age 65 at the rate of
about 200 cohort members each day.
4. It comprises about one third of the population
today
3) When was Medicare legislation established?
1. 1940s
2. 1950s
3. 1960s
4. 1970s
4) What is the overall percentage of senior citizens who
1. approximately 1%
2. approximately 3.6%
3. approximately 11%
4. approximately 17%
5) What does the Durable Power of Attorney for health
care enable the health care agent to do?
1. Decide whether the older adult should be
resuscitated
2. Act only when the older adult is unable to act
for himself or herself
3. Determine when the older adult should be
hospitalized
4. Change care decisions if he or she thinks these
will benefit the older adult
6) What is one of the most significant changes that
impact the older adult and his or her family?
1. Loss of independence
2. Change in physical appearance
8|Dablio, Nikka
 3. Decreased financial resources
4. Sensory and cognitive decline
7) A nurse is assessing an alert for an elderly woman
who was admitted to the emergency room
accompanied by her daughter with whom she
resides. What observation might arouse suspicion of
elder abuse? (Select all that apply.)
1. Bruises are observed on the arms and upper
body.
2. The daughter answers all questions for her
mother.
3. She has body odor and soiled clothing.
4. The woman states that she does not like to see
the doctor.
5. The daughter states her mother does not get
along with the grandchildren.
6. Skin is intact with good turgor.
8) A student nurse observes caregivers in a long-term
care facility where she is employed. Which
observations might indicate abusive behavior?
(Select all that apply.)
1. Failing to close bedside curtains during care
activities
2. Use of physical restraints to decrease
wandering behavior
3. Providing extra snacks as a reward for good
behavior
4. Laughing and talking with co-workers while
providing care
5. Speaking negatively about an older adult while in
the break room
6. Responding slowly to the call light of a
demanding older adult
9) Which type of document indicates someone’s wishes
by creating physician orders to be followed?
1. Advance directive
2. Living will
3. Durable power of attorney for health care
4. POLST
10) The Medicare program that provides for prescription
drug coverage is:
1. Part A.
2. Part B.
3. Part C.
4. Part D.
11) A patient with type 2 diabetes mellitus requests
information on when she will be eligible for Social
Security benefits. The patient was born in 1962. The
nurse should tell the patient she will be eligible for
Social Security benefits at what age?
1. 65
2. 67
3. 70
4. 72
12) The nurse is receiving report on a patient born in
1952. The nurse knows this patient is a member of
which generation?
1. Generation Y
2. Generation X
3. Baby Boomers
4. Silent Generation
13) A patient requests information about life-contract
facilities. Which characteristic of life-contract
facilities is generally the deciding factor for the older
adult when considering this type of housing?
1. High initial cost
2. Low monthly rental fees
3. Readily available skilled nursing care
4. A home to pass on to his or her children
14) The nurse is caring for a patient following a hip
replacement who is preparing for discharge. The
nurse knows the patient will require daily physical
and occupational therapies as well as assistance with
activities of daily living and chores. Which type of
care would be MOST appropriate for this patient?
1. Acute care
2. Skilled care
3. Custodial care
4. Intermediate care
15) The nurse is caring for a 72-year-old patient
following a massive myocardial infarction who will
require cardiac rehabilitation. Which statement, if
made by the patient, indicates an understanding of
Medicare reimbursement for a stay in a skilled care
facility?
1. "It is important that I work hard so I am ready
to be discharged in less than 100 days."
2. "I should plan to sell my home since I am
permanently moving to the rehabilitation
facility."
3. "I guess I'll just go home to die since I do not have
the money to pay for this rehabilitation facility
stay."
9|Dablio, Nikka
 4. "My doctor says I will need 90 days of rehab. I'm
not sure how I'll pay for the 60 days Medicare
does not cover."
16) The nurse is preparing to discharge a patient on a
ventilator following an acute exacerbation of chronic
obstructive pulmonary disease (COPD) who requires
frequent wound care, dressing changes, and
breathing treatments. To which facility would it be
MOST appropriate to discharge this patient?
1. Skilled care facility
2. Subacute care facility
3. Assisted living facility
4. Home with a home health aide
17) The terminally ill patient confides in the nurse that
he is afraid his children will disagree on how to care
for him after he is no longer able to make his wishes
known. Which document would be BEST for the
nurse to recommend?
1. Living will
2. Advanced directive
3. "Do Not Resuscitate" order
4. "Allow Natural Death" order
18) The home health nurse is discussing health insurance
options with a patient who now qualifies for
Medicare. The patient suffers from multiple sclerosis
and requires frequent hospitalizations, doctor visits,
and physical and occupational therapy. However, the
patient chooses to use herbal and folk remedies
rather than prescription medications. The nurse
should recommend which Medicare plan(s) to this
patient? (Select all that apply.)
1. Part A
2. Part B
3. Part C
4. Part D
5. Part E
6. Part F
19) The home health nurse caring for a patient with
Medicare Part B insurance knows which services are
covered by this plan? (Select all that apply.)
1. Hospital stays
2. Physical therapy
3. Outpatient surgery
4. Ambulance transport
5. Home health services
6. Prescription medications
20) Which personal behavior is a demonstration of
gerontophobia?
1. A 17-year-old girl decides to dye her hair a darker
color
2. A 63-year-old woman takes a Caribbean cruise
with a friend
3. A 43-year-old woman wears her teenage
daughter's clothes
4. A 56-year-old woman buys a membership to a
fitness center
21) Several nursing students are discussing career
options. Which student statement demonstrates
ageism?
1. "I would work in a clinic that serves a mixture of
older and younger patients"
2. "If I were to care for older patients, I would need
knowledge about chronic health problems"
3. "I have always loved children. I can't wait to get
a job in a pediatric hospital"
4. "Working with older adults could be rewarding,
but I couldn't really use all of my skills"
22) An older adult widow who lives alone in her own
home is having difficulty with driving,
grocery shopping, cooking, and home maintenance.
What type of living arrangement would be
most suitable for her?
1. Extended care facility
2. Nursing home
3. Subacute care facility
4. Assisted living
23) An older adult patient is having an argument with her
daughter. Which statement represents
the most significant issue that older adult patients
and their families must face?
1. "You can't tell me what to do. I'm your mother"
2. "I can't afford my medication. You should lend
me money"
3. "Will you drive me to the doctor? I'm afraid to go
by myself"
4. "You never come and visit me except on
holidays"
24) The police bring an older adult patient to the hospital
because he was wandering in the street
and unable to remember his address. His clothing is
soiled and he appears malnourished and
dehydrated. What would the nurse do first?
1. Attempt to locate the patient's family or friends
10 | D a b l i o , N i k k a
 2. Notify social services about potential abuse
and/or neglect
3. Offer food and fluids and assist with hygiene
needs
4. Assess for physical injury, abuse, and self-
neglect
25) An older adult suffers an unexpected stroke and
arrives in the emergency department in a
comatose state. Several days later, the patient
remains in a coma with a poor prognosis. Family
members are distraught and cannot agree on how to
proceed. What is the best action to help the
family to reach consensus?
1. Encourage the family to elect one person to
assume durable power of attorney
2. Help the family to understand the Patient
Protection and Affordable Care Act (PPACA)
3. Review the patient's rights covered by the
Vulnerable Elder Rights Protection Program
4. Help the family to review the patient's living
will to find out what the patient would want

11 | D a b l i o , N i k k a
 Basic Geriatric Nursing
There is no single universally accepted definition
of aging. Aging is best looked at as a series of changes
that occur over time, contribute to loss of function, and
ultimately result in the death of a living organism.
No one has identified a single unified rationale
for why we age and why different people live lives of
different lengths.
Although there is no question that aging is a
biologic process, sociologic and psychological
components play a significant role. All of these areas—
genetic, biologic, environmental, and psychosocial—
have produced theories that attempt to explain the
changes seen with aging.
Biologic theories of aging attempt to explain the
physical changes of aging. It is known that all members
of a species suffer a gradual, progressive loss of function
over time because of their biologic structure. Many of
the biologic theories of aging overlap because most
assume that the changes that cause aging occur at a
cellular level.
Some biologic theories look at aging from a
genetic perspective.
• Programmed theory - proposes that everyone
has a “biologic clock” that starts ticking at
conception. In this theory, each individual has a
genetic “program” specifying an unknown but
predetermined number of cell divisions. As the
program plays out, the person experiences
predictable changes such as atrophy of the
thymus, menopause, skin changes, and graying
of the hair.
• Runout-of-program theory - proposes that every
wear-and-tear theory presumes that the body is
similar to a machine, which loses function when
its parts wear out. As people age, their cells,
tissues, and organs are damaged by internal or
external stressors. When enough damage occurs
to the body’s parts, overall functioning
decreases person has a limited amount of
genetic material that will run out eventually
• Rate of living theory - proposes that individuals
have a finite number of breaths or heartbeats
that are used up over time.
• Gene theory - proposes the existence of one or
more harmful genes that activate over time,
resulting in the typical changes seen with aging
and limiting the life span of the individual.
The molecular theories propose that aging is
controlled by genetic materials that are encoded to
predetermine growth and decline.
• Error theory - proposes that errors in ribonucleic
acid protein synthesis cause errors to occur in
cells in the body, resulting in a progressive
decline in biologic function.
• Somatic mutation theory - similar but proposes
that aging results from deoxyribonucleic acid
(DNA) damage caused by exposure to chemicals
or radiation and that this damage causes
chromosomal abnormalities that lead to disease
or loss of function later in life.
Cellular theories propose that aging is a process that
occurs because of cell damage.
• Free radical theory - provides one explanation
for cell damage. Free radicals are unstable
molecules produced by the body during the
normal processes of respiration and metabolism
or following exposure to radiation and pollution.
These free radicals are suspected to cause
damage to the cells, DNA, and the immune
system.
• Crosslink or connective tissue theory - which
proposes that cell molecules from DNA and
connective tissue interact with free radicals to
cause bonds that decrease the ability of tissue to
replace itself. This results in the skin changes
typically attributed to aging such as dryness,
wrinkles, and loss of elasticity.
• Wear-and-tear theory - presumes that the body
is similar to a machine, which loses function
 when its parts wear out. As people age, their
cells, tissues, and organs are damaged by
internal or external stressors. When enough
damage occurs to the body’s parts, overall
functioning decreases
• Reliability theory of aging and longevity - a
complex mathematical model of system failures
first used to describe failure of complex
electronic equipment. It is used as a model to
describe degradation (disease) and failure
(death) of human body systems.
• Neuroendocrine theory focuses on the
complicated chemical interactions set off by the
hypothalamus of the brain. Stimulation or
inhibition of various endocrine glands by the
hypothalamus initiates the release of various
hormones from the pituitary and other glands,
which, in turn, regulate bodily functions,
including growth, reproduction, and
metabolism. With age, the hypothalamus
appears to be less precise in regulating
endocrine function, leading to age-related
changes such as decreased muscle mass,
increased body fat, and changes in reproductive
function.
• Immunologic theory proposes that aging is a
function of changes in the immune system.
According to this theory, the immune system—
an important defense mechanism of the body—
weakens over time, making an aging person
more susceptible to disease.
Psychosocial theories of aging do not explain the
physical changes of aging; rather they attempt to explain
why older adults have different responses to the aging
process.
• Disengagement theory - developed to explain why
aging persons separate from the mainstream of
society. This theory proposes that older people are
systematically separated, excluded, or disengaged
from society because they are not perceived to be of
benefit to the society.
• Activity theory - proposes that activity is necessary
for successful aging. Active participation in physical
and mental activities helps maintain functioning well
into old age
These theories trace personality and personal
adjustment throughout a person’s life. Many of these
theories are specific in identifying life-oriented tasks for
the aging person.
• Erikson’s theory - identifies eight stages of
developmental tasks that an individual must
confront throughout the life span: (1) trust
versus mistrust; (2) autonomy versus shame and
doubt; (3) initiative versus guilt; (4) industry
versus inferiority; (5) identity versus identity
confusion; (6) intimacy versus isolation; (7)
generativity versus stagnation; and (8) integrity
versus despair.
• Havighurst’s theory - details the process of aging
and defines specific tasks for late life, including:
(1) adjusting to decreased physical strength and
health; (2) adjusting to retirement and
decreased income; (3) adjusting to the loss of a
spouse; (4) establishing a relationship with one’s
age group; (5) adapting to social roles in a
flexible way; and (6) establishing satisfactory
living arrangements.
• Newman’s theory identifies the tasks of aging as:
(1) coping with the physical changes of aging; (2)
redirecting energy to new activities and roles,
including retirement, grandparenting, and
widowhood; (3) accepting one’s own life; and (4)
developing a point of view about death.
• Jung’s theory proposes that development
continues throughout life by a process of
searching, questioning, and setting goals that are
consistent with the individual’s personality.
Thus, life becomes an ongoing search for the
“true self.”
Nursing can help individuals achieve the longest,
healthiest lives possible by promoting good health
maintenance practices and a healthy environment.
Understanding all of these theories can help
nurses recognize problems and provide nursing
interventions that will help aging individuals successfully
meet the developmental tasks of aging.
2|Dablio, Nikka
 2. Hippocampus
3. Hypothalamus
1) A friend asks the nurse what could be done to 4. Anterior pituitary gland
improve the chance of a long life. Using current 7) The nurse in the long-term care facility frequently
biologic theories of aging, the nurse recommended observes older adults being separated from their
that her friend discuss this first with her physician, Seleniumfriends and family and excluded from
but advises that the approach more likely to cause society. This phenomenon is described in which
harm than good is which one? psychosocial theory of aging?
1. Intake of antioxidants, such as vitamins A, B6, 1. Activity theory
B12, C, and E 2. Life-course theory
2. Replacing of hormones, such as HGH, DHEA, 3. Developmental theory
and estrogen 4. Disengagement theory
3. Calorie-restricted diet 8) The nurse in the long-term care facility who cares for
4. Intake of herbal and nutritional supplements primarily older adults knows these adults are in
2) The same friend asks how long humans can live. which stage of Erikson's developmental tasks?
What is the nurse’s best reply? 1. Trust versus mistrust
1. 100 years 2. Integrity versus despair
2. 105 years 3. Industry versus inferiority
3. 110 years 4. Generativity versus stagnation
4. 120 years 9) The student nurse studying aging knows which
3) According to Erikson, what is the primary theory was originally used to describe failures in
developmental task of the older adult population? electronic equipment?
1. Generativity versus stagnation 1. Error theory
2. Trust versus mistrust 2. Wear-and-tear theory
3. Intimacy versus isolation 3. Run-out-of-program theory
4. Integrity versus despair 4. Reliability theory of aging and longevity
4) A friend tells you she thinks her father is 10) The nurse working with aging individuals knows the
experiencing a “midlife crisis,” because he purchased use of antioxidants to slow the aging process
a new red sports car, started wearing trendy corresponds to which theory?
clothing, and is considering a career change. Whose 1. Crosslink theory
theory explains this behavior? 2. Free radical theory
1. Newman’s 3. Somatic mutation theory
2. Jung’s 4. Connective tissue theory
3. Havighurst’s 11) The patient in the clinic tells the nurse she has heard
4. Erikson’s about the dangers of free radicals and requests more
5) The patient in the clinic tells the nurse she can "feel information. The nurse bases his response on an
her biologic clock ticking." The nurse knows the understanding that free radicals have been
patient views aging based on which theory? associated with which age-related change(s)? (Select
1. Gene theory all that apply.)
2. Programmed theory 1. Hypothyroidism
3. Rate of living theory 2. Atherosclerosis
4. Somatic mutation theory 3. Rheumatoid arthritis
6) The aging patient requests information on the causes 4. Type 2 diabetes mellitus
for the age-related changes he sees in his body. In 5. Peripheral vascular disease
order to educate the patient using the 6. Chronic obstructive pulmonary disease (COPD)
neuroendocrine theory of aging, the nurse should 12) The patient requests information on ways to prevent
discuss which structure in the brain? the damage associated with free radicals.
1. Cerebellum
3|Dablio, Nikka
 Information on which antioxidants would be most 3. Decreased interest and involvement in social
appropriate for the nurse to include? (Select all that interactions
apply.) 4. Adjustment to retirement and loss of income
1. Zinc 17) The nurse is designing a group activity for a group of
2. Copper older women who have mild loss of
3. Selenium self-esteem and a reluctance to socialize. None have
4. Vitamin A serious cognitive or physical impairments.
5. Vitamin C Based on the activity theory, which activity will the
6. Vitamin B12 nurse suggest?
13) The nurse working in the long-term care facility plans 1. A weekly knitting group to make hats for
care based on Havighurst's theory of aging. Which premature infants
task(s) should the nurse facilitate his patients to 2. A daily game of unfolding and refolding a stack
achieve? (Select all that apply.) of towels
1. Adjusting to the loss of a spouse 3. A weekly activity to sort buttons into different
2. Preserving and increasing strength color groups
3. Adjusting to a decrease in income 4. A daily group discussion about local politics
4. Stabilizing one's self in one's social roles 18) According to Jung's theory, which statement by an
5. Looking back on one's life with pride and older adult indicates successful aging?
contentment 1. "I have a strong belief that there is life after
14) The nurse is doing patient teaching for a 50-year-old death. So, I am not afraid of dying"
woman. Based on the application of the 2. "I never experienced travel around the world,
programmed theory of aging, which brochure is the but I traveled in my imagination"
nurse most likely to offer the patient? 3. "I lost my wife several years ago; I still miss her,
1. "Perimenopause and Menopause: Most but I focus on the good memories"
Frequently Asked Questions" 4. "Well, when I look back at my life, I am happy
2. "Do the Benefits Outweigh the Risks of to say that I did it my way"
Antioxidant Supplements?"
3. "Exercise, Food, Sleep, and Fun: Healthy Lifestyle
Tips for Older Adults"
4. "Healthy Nutrition Is More Than Just Counting
Calories and Losing Weight"
15) Two nursing students are exhausted after studying
about the biologic theories of aging. They
decide to have some fun and perform an action that
is based on the rate of living theory. Which
action do they perform?
1. Go for a leisurely walk in the sunshine
2. Hold their breath for as long as they can
3. Share an apple and an orange
4. Give each other a facial and then use anti-aging
cream
16) According to the disengagement theory, what is the
nurse most likely to observe while
assessing an older adult?
1. Dryness of the skin with wrinkles and loss of
elasticity
2. Decreased muscle mass and increased body fat

4|Dablio, Nikka
 Basic Geriatric Nursing
It is important to recognize that although age-
related changes are predictable, the exact time at which
they occur is not. Just as no two individuals grow and
develop at exactly the same rate, no two individuals
show the signs of aging at the same time. Some people
are chronologically quite young but appear old.
The most severe cases of this occur in a rare
condition called progeria. When they are only 8 or 9 years
of age, children with progeria have the physiology and
appearance of 70-year-olds.
Nurses must learn that each aging person is
unique. The type and extent of changes seen with aging
are specific and unique to each person. Nurses must
avoid falling into the trap of stereotyping older adults.
Stereotyping is dangerous because it leads us to accept
as inevitable some changes that are not inevitable.
Stereotyping can also cause us to mistake early signs of
disease as a part of aging.
The five leading causes of death among older adults are:
1. Heart disease,
2. Cancer,
3. Chronic lower respiratory disease,
4. Cerebrovascular disease, and
5. Alzheimer disease
The integumentary system, which includes the
skin, hair, and nails, undergoes significant changes with
aging. Because many of these structures are visible,
changes in this system are probably the most obvious
and are evident to both the aging individual and others.
1. Epidermis - - the outermost layer of the skin, is an
important structure that provides protection for
internal structures, keeps out dangerous chemicals
and microorganisms, functions as part of the body’s
fluid regulation system, and helps regulate body
temperature and eliminate waste products (also
contains melanocyte).
• Melanocyte - produce the pigment
melanin, which provides protection from
ultraviolet radiation.
2. Dermis contains collagen and elastin fibers,
which give strength and elasticity to the tissues.
3. Subcutaneous tissue - provides insulation to
regulate body temperature.
• Hair and nail follicles
• Sensory nerve receptors
• Sebaceous – oil-producing
• Eccrine – sweat-producing
• Areolar connective tissue - connects the
skin to the muscles.
• Adipose Tissue – provides a cushion over
tissue and bone.
• White blood cells - available to protect the
body from microbial invasion through the
skin.
• Blood vessels - supply the tissue with
nourishment and assist in the process of
heat exchange.
Hair and nails are composed of dead keratinized
cells. The amount of melanin produced by the follicle and,
like skin pigmentation, is hereditary.
With aging, the epidermis becomes more fragile,
increasing the risk for skin damage such as tears,
maceration, and infection.
• Senile lentigo – when melanocyte cluster forms
areas of deepened pigmentation; these areas
are often referred to as age spots or liver spots.
More often seen on body areas that are most
exposed to sunlight.
• Seborrheic keratosis – slightly raised wart like
macules with distinct edges; ranging in color
from light tan to black, often observed on the
upper half of the body.
• Cutaneous papilloma – also called skin tags, are
small, brown or flesh-colored projections of skin
that are most often observed on the necks of
older adults.
 • Xerosis – a decrease in the function of sebaceous Assess for skin Institute measures to
and sweat gland secretion increases the breakdown or changes in reduce pressure over
likelihood of dry skin. color or pigmentation. bony prominences;
• Pruritus – itching; s often more severe on the possible dermatology
lower extremities because of diminished referral.
Assess areas where skin Keep skin dry. Pad
circulation.
surfaces touch and trap surfaces to reduce
• Senile Purpura - red, purple, or brown areas moisture (under breasts, friction. Report abnormal
commonly seen on the legs and arms; this is due adipose rolls, etc.) for observations for
to the capillary walls becoming increasingly signs of maceration or treatment.
fragile with age and may hemorrhage. yeast infection.
Determine adequacy of Modify skin care to
Integumentary Changes Associated with Aging
hygiene and need for reduce drying. Refer to
Physiologic Change Results toenail trimming podiatrist
Decreased vascularity of Increased pallor in white
dermis skin
Decreased amount of Decreased hair color
melanin (graying)
• Basal Cell Carcinoma and Melanoma - Cases of
Decreased sebaceous Increased dry skin;
basal cell carcinoma is commonly observed in
and sweat gland function decreased perspiration
Decreased subcutaneous Increased wrinkling older adults who have spent significant amounts
fat of time in the sun. Older men are most at risk for
Decreased thickness of Increased susceptibility melanoma, a potentially fatal form of skin cancer
epidermis to trauma because of its ability to metastasize. The unusual
Increased localized Increased incidence of appearance of moles should be suspected to be
pigmentation brown spots (senile melanoma. Irregular shapes, irregular borders,
lentigo) changes in color, changes in size or symptoms,
Increased capillary Increased purple patches such as itchiness or bleeding, are all considered
fragility (senile purpura) abnormal.
Decreased density of hair Decreased amount and
• Pressure Ulcers - Shrinkage in the cushion
growth thickness of hair on head
provided by subcutaneous tissue along with
and body
vascular changes places the older adult at
Decreased rate of nail Increased brittleness of
growth nails increased risk for pressure ulcers (breakdown of
Decreased peripheral Increased longitudinal the skin and tissues located over bony
circulation ridges of nails; increased prominences). This is a significant problem for
thickening and yellowing immobilized people such as those who are
of nails bedridden or confined to wheelchairs.
Increased Increased facial hair in • Inflammation and Infection - Skin inflammation
androgen/estrogen ratio women and infection often occur on visible body
Nursing Assessments and Care Strategies Related to surfaces, such as the face, scalp, and arms,
Integumentary Changes making the conditions distressing to older adults.
Nursing Assessments Care Strategies a. Rosacea - appears as redness, dilated
Monitor skin Adjust room temperature
superficial blood vessels, and small
temperature. and provide adequate
“pimples” on the nose and center of the
clothing or covers to
face. It may spread to cover the cheeks and
prevent chilling.
Assess skin turgor over Provide adequate fluid to chin.
sternum or forehead, not prevent dehydration. b. Contact and allergic dermatitis - appear as
forearm. Check tongue rashes or inflammation that is either
for furrows.

2|Dablio, Nikka
 localized to certain areas of the body or
generalized.
c. Seborrheic dermatitis - an unsightly skin
condition characterized by yellow, waxy
crusts that can be either dry or moist.
Caused by excessive sebum production,
seborrheic dermatitis can occur on the scalp,
eyebrows, eyelids, ears, axilla, breasts, groin,
and gluteal folds.
d. Herpes zoster – shingles
e. Fungal, yeast and bacterial infections
f. Infestation with scabies (mites)
• Hypothermia - The decrease in subcutaneous
tissue reduces the older adult’s ability to
regulate body temperature. his loss of insulation
is most likely to result in hypothermia if the
person is exposed to an environment that is too
cold.
The musculoskeletal system is made up of bones,
cartilage, ligaments, tendons and muscles, which form a
framework for the body.
A. Content of Bones
• Protein - for optimal bone mass gain during
growth and also for preserving bone and muscle
mass with ageing)
• Calcium - for bone strength, muscle contraction,
myocardial contraction, blood clotting, and
neuronal activity
• Phosphorus - for the formation of healthy bones
B. How to keep our long bones strong?
• Adequate dietary intake of these nutrients is
important.
• Apply stress to the long bones to keep the
minerals in the bones. This needed stress is best
provided by weight-bearing activities, such as
standing and walking.
• Keeping the calcium in balance
C. Hormones
• Calcitonin - produced by the thyroid gland, slows
the movement of calcium from the bones to the
blood, lowering the blood calcium level.
• Parathyroid hormone (PTH) - increases the
movement of calcium from the bones to the
blood, increasing the blood calcium level. PTH
also increases the absorption of calcium from
the small intestine and kidneys, further
increasing the blood calcium level.
• Insulin and thyroxine - aid in the protein
synthesis and energy production needed for
bone maintenance.
• Estrogen and testosterone - produced by the
ovaries and testes, respectively, help retain
calcium in the bone matrix.
The spinal column consists of a series of small
bones, called vertebrae, which stack up to form a strong,
flexible structure.
• Spinal column - supports the head and allows for
flexible movement of the back.
• Segments of the spinal column - cervical,
thoracic, lumbar, and sacral vertebrae.
• Spinal cord - the nerve tissue that extends
downward from the brain, passes through the
vertebral canal, which runs through an opening
in each vertebra. The bones of the spinal column
protect this nerve tissue from injury.
• Fibrous pads - intervertebral disks, are located
between the vertebrae and cushion the impact
of walking and other activities.
A. Terminologies
• Joints - places where bones meet
• Cartilage – lines the synovial joints to allow free
movement of the joint surfaces.
• Bursa – found in joins which is a fluid sac that
provides lubrication to enhance joint mobility
• Tendons - structures that connect the muscles to
the bone
• Ligaments - structures that connect bones to
other bones
B. Types of synovial Joints
• Condyloid joint - also known as ellipsoid joints,
are composed of an egg-shaped bone known as
a condyle that fits into a similarly shaped cavity.
It only allows forward-backward and side to side
movement and do not allow rotation. Examples
of your condyloid joint include the wrist joint
3|Dablio, Nikka
 (radiocarpal joint) and the temporomandibular
joint.
• Ball and Socket joint - an articulation (as the hip
joint) in which the rounded head of one bone fits
into a cuplike cavity of the other and admits
movement in any direction. This is also called
enarthrosis.
• Gliding Joint - the gliding joint is a synovial joint
built between two bones that meet on flat
articular surfaces allowing sliding or gliding
motion. Example of a gliding joint include joints
between two vertebras, ankle joints and
acromioclavicular joints.
• Saddle Joint - a saddle joint is a type of biaxial
and movable joint that allows movements on
two planes–flexion or extension and abduction
or adduction. Example of a saddle joints in the
human body include the carpometacarpal joint
of the thumb.
• Pivot Joint Pivot joint - also called rotary joint is
a freely moveable joint (diarthrosis) that allows
only rotary movement around a single axis. An
example of pivot joints are the pivot joints in the
neck.
• Hinge Joint Hinge joints - a type of joint that
functions much like the hinge on a door, allowing
bones to move in one direction back and forth
with limited motion along other planes. The
fingers, toes, elbows, knees, and ankles contain
hinge joints.
A. Three types of muscle tissue in the body
• Involuntary muscles - cannot be stimulated by
conscious effort
o Cardiac muscle - located only in the heart, is
responsible for the pumping action of the
heart that maintains the blood circulation.
o Smooth muscle - found in the walls of hollow
organs such as the blood vessels, stomach,
intestines, and urinary bladder.
• Voluntary Muscle - actions can be controlled by
conscious effort
o Skeletal muscle - accounts for the largest
amount of muscle tissue in the body which
move the bones of the skeleton.
B. Two general exercises to maintain muscle mass and
muscle tone.
• Isometric exercise - involves muscle contraction
without body movement. This helps maintain
muscle tone and strength but does little to
increase muscle size.
• Isotonic exercise - involves muscle contraction
with body movement. This exercise maintains
muscle tone and strength and increases muscle
mass if it is done repetitively. An example of
isotonic exercise is aerobic exercise.
C. How are muscle movement controlled?
• Muscle movement is controlled by impulses
from the parietal lobes of the cerebrum and is
coordinated by impulses from the cerebellum.
• Muscle sense is a term used to describe the
brain’s ability to recognize the position and
action of the muscles without conscious effort
• Receptor cells in the muscles, called
proprioceptors, send information to the brain
that enables it to integrate all body movements.
Muscles are connected to bones by tendons.
Contraction or relaxation of muscles causes the bones to
move.
Musculoskeletal Changes Associated with Aging
Physiologic Change Result
Decreased bone calcium Increased osteoporosis;
increased curvature of
the spine (kyphosis)
Decreased fluid in Decreased height
intervertebral disks
Decreased blood supply Decreased muscle
to muscles strength
Decreased tissue Decreased mobility and
elasticity flexibility of ligaments
and tendons
Decreased muscle mass Decreased strength;
increased risk for falls
• The intervertebral disks shrink as the thoracic
vertebrae slowly
• Connective tissues tend to lose elasticity, leading to
restriction of joint mobility.
• Loss of flexibility and joint mobility begins as early
as the teen years and is common with aging
4|Dablio, Nikka
• Muscle tone and mass typically decrease with aging, categories: (a) medications that increase bone
and these decreases are directly related to strength and density (anabolic drugs); and (b)
reductions in physical activity and exercise medications that inhibit bone loss (antiresorptive
• Hormonal changes, particularly the decrease in medications). Commonly prescribed antiresorptive
testosterone level, tend to reduce muscle mass in medications include alendronate (Fosamax),
aging. risedronate (Actonel), ibandronate (Boniva),
• Reduced blood supply to the muscles because of raloxifene (Evista), and calcitonin (Calcimar).
aging or disease can lead to changes in muscle B. Degenerative Joint Disease
function. • Osteoarthritis - The exact cause of osteoarthritis
• Neuronal changes in the areas of the brain is unknown; however, risk factors have been
responsible for muscle control can result in identified, including age, obesity, joint injury or
alterations of muscle sense overuse, genetic predisposition, and muscle
• As a person ages, muscle mass decreases, and the weakness. After years of normal joint use, the
proportion of body weight resulting from fatty, or cartilage on the bones’ articulating surfaces thins
adipose, tissue increases and begins to wear out. Bony particles or spurs
(osteophytes) may form within the joint, causing
Nursing Assessments and Care Strategies Related to pain, swelling, and restriction of joint
Musculoskeletal Changes movement. Pain may occur with activity or
Nursing Assessment Care Strategies exercise of the affected joints and may worsen
Assess strength and Provide assistance as
with emotional stress. Osteoarthritis is treated
functional mobility needed, modify physical
with a combination of exercise, weight control,
environment, initiate
safety precautions to joint protection, physical or occupational
decrease risk for falls, therapy, and medications. Medication therapy
encourage range of may include nonsteroidal anti-inflammatory
motion (ROM) exercise, drugs (NSAIDs) or by injecting corticosteroids
refer to physical or into the joints. In severe cases, arthroscopic
occupational therapy. removal of bone fragments or surgical joint
Assess nutritional intake. Educate regarding replacements may be necessary.
importance of calcium • Rheumatoid Arthritis - a collagen disease that
intake, administer results from an autoimmune process, affecting
supplements as ordered. more women than men. This disease causes
Determine activity Encourage regular low-
inflammation of the synovium, damage to the
patterns. impact exercise.
cartilage and bone of joints, and instability of
ligaments and tendons that support the joints.
RA is characterized by periods of exacerbation
A. Osteoporosis - excessive loss of calcium from bone (sometimes called flares), during which the
combined with insufficient replacement. symptoms are severe and cause further damage,
Characterized by porous, brittle, fragile bones that and remission, during which the progress of the
are susceptible to breakage. Common fracture sites disease—and the damage it causes—halts. RA
include the hip (usually the femoral neck), ribs, can result in muscle atrophy, soft tissue changes,
clavicle, and wrist. Osteoporosis is best prevented and bone and cartilage changes. Symptoms of RA
and treated by lifestyle modifications and include: pain and stiffness, particularly after rest;
medications. Lifestyle modifications include a well- warm, tender, painful joints; fatigue; sense of
balanced diet with adequate amounts of calcium and feeling unwell; and occasional fevers.
vitamin D, regular weight-bearing exercise, smoking Treatments for RA include lifestyle changes such
cessation, and restriction of alcohol intake. as stress reduction, balanced rest and exercise,
Medications for osteoporosis generally fall into two and joint care using splints to support joints.

5|Dablio, Nikka
 • Bursitis - inflammation of the bursa and the
surrounding fibrous tissue, can result from
excessive stress on a joint or from a localized
infection. Bursitis commonly results in joint
stiffness and pain in the shoulder, knee, elbow,
and hip, ultimately leading to restricted or
reduced mobility. Treatment includes resting the
joint and administering NSAIDs. Corticosteroid
preparations are occasionally injected into the
painful areas to reduce inflammation.
• Gouty Arthritis - caused by an inborn error of
metabolism that results in elevated levels of uric
acid in the body. Crystals of these acids deposit
within the joints and other tissues, causing
episodes of severe, painful joint swelling. Chills
and fever may accompany a severe attack.
Attacks of gout become more frequent with age.
Untreated, this disease can result in joint
destruction. Recommendations may include
reduction of body weight and decreased intake
of alcohol and foods rich in purines, such as liver
or dried beans or peas.
The respiratory system is typically divided into
two parts: the upper respiratory tract and the lower
respiratory tract. The entire respiratory tract is lined with
mucous membranes.
The upper respiratory tract includes the air passages
of the nose, mouth, and throat, all of which are located
above the chest cavity.
• Mucous membranes - line the nasal passages and
warm and humidify the air that passes through the
nose.
• Cilia and mucus in the nasal passages - trap
particulate matter (bacteria and debris) and sweep it
toward the pharynx
• pharynx - located at the back of the oral cavity, has
three segments: the oropharynx, nasopharynx, and
laryngopharynx
• Eustachian tubes – help maintain proper air pressure
in the middle ear
• Larynx - composed of cartilage rings and folds of
tissue, called vocal folds.
• Epiglottis - the uppermost cartilage ring, prevents
food from entering the airway
The lower respiratory tract includes the lower
trachea, bronchial passages, and alveoli, all of which lie
within the chest cavity.
• Trachea - a cartilaginous passageway connecting the
larynx to the bronchial passages. The trachea
branches into two major bronchi; these further
divide like the branches of a tree into smaller and
smaller bronchioles. At the ends of the bronchioles
are the alveoli, or air sacs, which are the functional
units of respiration.
• Surfactant – a special protein substance that
prevents the surfaces of the alveoli to adhere if they
touched when the alveoli were empty.
• Ventilation – the movement of air into and out of the
alveoli. It requires the action of muscles, primarily
the diaphragm and the intercostal muscles.
• Inhalation or Inspiration - During inhalation, the
diaphragm contracts and moves downward although
the intercostal muscles pull the ribs upward and
outward. These combined activities increase the size
of the chest cavity until the air pressure inside the
lungs is lower than the atmospheric pressure and air
is drawn into the lungs.
• Exhalation or Expiration - When the diaphragm and
intercostal muscles relax, the diaphragm moves
upward and the ribs move inward, making the chest
cavity smaller. As the chest cavity becomes smaller,
the pressure in the lungs becomes greater than the
atmospheric pressure. Air is forced out of the lungs
until the pressure in the lungs equals the
atmospheric pressure.
Respiratory Changes Associated with Aging
Physiologic Change Results
Decreased body fluids Decreased ability to
humidify air resulting in
drier mucous
membranes
Decreased number of Decreased ability to trap
cilia debris
6|Dablio, Nikka
 Decreased number of Increased risk for
macrophages respiratory infection
Decreased tissue Decreased gas exchange;
elasticity in the alveoli increased pooling of
and lower lung lobes secretions
Decreased muscle Decreased ability to
strength and endurance breathe deeply;
diminished strength of
cough
Decreased number of Decreased gas exchange
capillaries
Increased calcification of Increased rigidity of rib
cartilage cage; decreased lung
capacity
Nursing Assessments and Care Strategies Related to
Respiratory Changes
Assess breathing depth Position to facilitate ease
and effort. of respiration. Encourage
incentive spirometer or
nebulizer as ordered.
Assess cough and sputum Encourage adequate fluid
production. intake. Encourage
smoking cessation and
avoidance of
environmental
pollutants.
Assess for signs and Teach avoidance of
symptoms of respiratory individuals with active
infection. infection. Teach careful
hand washing and
disposal of contaminated
secretions. Encourage
annual influenza
vaccination.
Pulmonary Function Changes Commonly Observed
with Aging
• Diminished breath sounds
• Lower maximum expiratory volume
• Increased residual volume
• Reduced vital capacity
A. Chronic Obstructive Pulmonary Disease - an
umbrella term for the commonly occurring
respiratory disorders of emphysema and chronic
bronchitis. COPD is common in people who have a
history of smoking or who have had a high level of
exposure to environmental pollutants. Individuals
with COPD manifest symptoms such as productive
cough, wheezing, cyanosis, and dyspnea on exertion.
• Emphysema - characterized by changes in
alveolar structure. The alveoli lose elasticity,
become overinflated, and are ineffective in gas
exchange.
• Chronic bronchitis - involves inflammation of the
trachea and bronchioles. Chronic irritation leads
to excessive mucus secretion and a productive
cough.
B. Influenza - often referred to as the flu, is a highly
contagious respiratory infection caused by a variety
of influenza viruses. The virus is usually spread
through airborne droplets and moves quickly
through groups of people who live or work in close
contact with one another. The incubation period is
brief, often only 1 to 3 days from the time of
exposure. The onset of symptoms is sudden;
symptoms include chills, fever, cough, sore throat,
and general malaise and may be dramatic and leave
the victim feeling severely ill. Immunization should
be obtained yearly, because the vaccine is different
from the previous year.
C. Pneumonia - acute inflammation of the lungs caused
by bacterial, viral, fungal, chemical, or mechanical
agents. In response to the agent, the alveoli and
bronchioles become clogged with a thick, fibrous
substance that decreases the ability of the lung to
exchange gases. Pneumonia can progress to a state
in which the exudate fills the lung lobes, which then
become consolidated or firm. Pneumonia can be
detected by radiologic examination. Breath sounds
exhibit characteristic changes.
• Viral pneumonia - sometimes called walking
pneumonia, is most commonly seen following
influenza or another viral disease. Symptoms
include headache, fever, aching muscles, and
cough with mucopurulent sputum.
• Bacterial pneumonia - can be caused by a
number of organisms, most commonly
Staphylococcus, Streptococcus, Klebsiella, and
Legionella. The symptoms of bacterial
pneumonia are abrupt and dramatic in onset.
Chills, fever up to 105° F, elevated WBC count
(leukocytosis), tachycardia, and tachypnea are
common, as is pain with respiration, or dyspnea.
7|Dablio, Nikka
 • Aspiration Pneumonia - an inflammatory process
of the bronchi and lungs caused by inhalation of
foreign substances, such as food or acidic gastric
contents. Aspiration of large amounts of feeding
solution is likely to trigger coughing or choking
episodes and dyspnea. If these fluids are not
removed immediately by suction, respiratory
distress and death may be the result.
D. Tuberculosis - an infectious disease caused by the
bacillus Mycobacterium tuberculosis, which spreads
by means of airborne droplets. An infected person
coughs or sneezes, releasing contaminated droplets
into the air. When these droplets are inhaled by
other people, the bacillus lodges in their lungs, and
the disease spreads. The symptoms of tuberculosis
include cough, night sweats, fever, dyspnea, chest
pain, anorexia, and weight loss. The cough may be
nonproductive or productive. Sputum may be green
or yellow; with hemoptysis, the presence of blood
may impart a rusty color. Treatment today consists
of drug therapy using a variety of antimicrobial
agents, such as isoniazid, rifampin, ethambutol, and
streptomycin.
E. Lung Cancer or bronchogenic cancer - Lung cancer
results from exposure to carcinogenic, or cancer-
causing agents, particularly tobacco smoke, air
pollution, asbestos, and other hazardous industrial
substances. Cough, chest pain, and blood-tinged
sputum are typical symptoms, which can easily be
missed because they resemble those of pneumonia
and other common respiratory conditions of older
adults. The treatment of choice is surgical resection
of the lungs.
The heart is a muscular organ located centrally in
the thoracic cavity between the lungs.
• Sternum - breastbone, protects its anterior surface
• Apex – the heart’s tip; projects toward the left side
of the body and extends directly above the
diaphragm.
• Pericardial membranes - form a sac around the
heart.
o Epicardium or visceral pericardium - innermost
membrane on the surface of the heart
o Parietal pericardium - middle membrane
o Fibrous pericardium - outermost membrane
Pericardial cavity - space between the epicardium
and the parietal pericardium; contains a small
amount of serous fluid that prevents the membrane
surfaces from rubbing together during cardiac
activity
• Myocardium - cardiac muscle
• Tricuspid Valve – separates the right atrium and right
ventricle
• Mitral Valve – separates the left atrium and left
ventricle
• Endocardial tissue – lines the chambers and valves
• Endothelial tissue - continues out from the heart and
lines all of the blood vessels
• Arteries - blood vessels that carry blood away from
the heart.
• Aorta - the largest artery in the body, leaves the
heart and branches into a series of progressively
smaller arteries and capillaries.
• Arterial walls
o Endothelium or tunica intima - innermost layer,
this layer is a continuation of the endocardial
tissue that lines the inside of the heart.
o Tunica media - middle layer, composed of
smooth muscle and connective tissue. This
smooth muscle is controlled by the autonomic
nervous system and dilates or constricts the
artery to maintain the blood pressure.
o Tunica externa - outermost layer, composed of
strong fibrous tissue that protects the vessels
from bursting or rupturing under high pressure.
• Veins - vessels that carry blood toward the heart.
With the exception of the four pulmonary veins (two
from each lung), veins carry deoxygenated blood.
• Venules - the smallest veins, are connected to the
smallest capillaries.
• Valves - created by endothelial tissue folds, to aid in
the return of blood to the heart, veins use this
system.
• Coronary arteries and veins - supplies the heart with
blood enriched with oxygen and nutrients
8|Dablio, Nikka
 Assess apical and Observe closely for
To function effectively, the cardiovascular peripheral pulses. abnormal sounds and
irregularity of rhythm;
system must work in a controlled, organized, and
determine presence and
rhythmic manner.
strength of peripheral
• Sinoatrial Node - a group of specialized cells in the pulses comparing both
right atrium. sides of the body. When
assessing lower
• Atrioventricular node – where impulses generated in
extremities, start distally
the sinoatrial node travel across the atria
and move toward trunk.
• Systole - When the cells of the heart’s electrical Assess blood pressure Hypotension is likely to
system depolarize, the myocardium depolarizes and lying, sitting, and occur while changing
the heart contracts standing. position; encourage
• Diastole - heart relaxes patient to change
positions slowly and to
seek assistance if dizzy.
Cardiovascular Changes Associated with Aging Assess ability to tolerate Instruct patient to rest if
Physiologic Change Results activity short of breath or
Decreased cardiac Decreased tissue fatigued.
muscle tone oxygenation related to
decreased cardiac output
and reserve Orthostatic hypotension occurs because the
Increased heart size, left Compensation for circulation does not respond quickly to postural changes.
ventricular enlargement decreased muscle tone
Decreased cardiac output Increased chance of
heart failure; decreased A. Coronary Artery Disease - The coronary arteries
peripheral circulation supply blood to the heart. If these vessels become
Decreased elasticity of Decreased venous narrowed or obstructed because of atherosclerosis,
heart muscle and blood return; increased the heart may not receive adequate oxygen and
vessels dependent edema; nutrients. Once circulation to the heart muscle
increased incidence of decreases significantly, the amount of oxygen
orthostatic hypotension; delivered to the heart decreases and ischemia
increased varicosities and occurs. The pain that may be experienced with
hemorrhoids
ischemia is referred to as angina pectoris (literally,
Decreased pacemaker Heart rate 40 to 100
chest pain). When one or more coronary arteries
cells beats per minute;
increased incidence of become totally obstructed by atherosclerosis or
ectopic or premature embolus, the person is said to have a myocardial
beats; increased risk for infarction (MI), or heart attack.
conduction abnormalities
Signs and Symptoms of Myocardial Infarction
Decreased baroreceptor Decreased adaptation to
in Older Adults
sensitivity changes in blood
• Sudden-onset dyspnea
pressure
Increased incidence of Increased risk for heart • Chest tightness or heaviness (usually not
valvular sclerosis murmurs crushing pain)
Increased atherosclerosis Increased blood • Anxiety and confusion
pressure, weaker • Syncope
peripheral pulses • Back pain
Nursing assessments and care strategies related to • Jaw (tooth) pain
cardiovascular changes
Nursing Assessments Care Strategies
9|Dablio, Nikka
B. Coronary Valve Disease - The heart valves become
less pliable over time. In addition, calcium deposits
may develop on the valves, preventing them from
sealing completely. This can result in mitral valve
prolapse, mitral regurgitation, and, ultimately, heart
failure (HF). Symptoms of mitral valve prolapse
include chest pain, palpitations, fatigue, and dyspnea
C. Cardiac Arrhythmias - Heart block is a common
conduction disturbance caused by disruption of the
electrical conduction system of the heart. This
disruption can be caused by fibrotic tissue infiltration
or MI. Sinus node dysfunction, sometimes called sick
sinus syndrome, is the primary conduction disorder
seen in older adults. This condition causes a
disturbance in the rate and rhythm of heart
contraction, resulting in symptoms such as
lightheadedness, fatigue, palpitations, and syncope.
D. Heart Failure - The older term congestive heart
failure was used as it described the disease process:
the patient’s lungs are often congested, and edema
appears because the heart’s pumping action is
ineffective. HF is not a single disease but rather a
syndrome that accompanies and results from many
other disorders. A variety of cardiovascular diseases
can contribute to the development of HF. HF is
associated with a wide range of symptoms,
depending on the type and severity of the underlying
disease. Older adults who experience mild
symptoms, such as dyspnea, orthopnea, or
paroxysmal nocturnal dyspnea, often decrease their
activity spontaneously
Signs and Symptoms of Heart Failure
• Dyspnea (shortness of breath) with exertion
• Orthopnea (dyspnea at rest when recumbent)
• Coughing or wheezing with exertion or at rest
• Fatigue, weakness, or generalized muscle
weakness with minimal exertion
• Peripheral edema
• Weight gain without an increase in food intake
(as a result of fluid retention)
• Nausea, vomiting, or anorexia
• Paroxysmal nocturnal dyspnea (extreme
orthopnea during sleep)
E. Cardiomegaly - enlargement of the heart, which is
often related to chronic HF. Because arteries and
veins lose elasticity with age, the heart must pump
harder to move blood through the vessels. The
muscles of the left ventricle hypertrophy in an
attempt to improve the output of blood from the
heart to meet the body’s tissue demands for
oxygenated blood.
F. Peripheral Vascular Disease - In arteriosclerosis, the
walls of the arteries become less elastic and plaque
forms in the lumen, further restricting blood flow. If
the lumen becomes too narrow, blood flow to
peripheral sites, particularly the lower extremities,
may be restricted. This decreased blood flow
deprives the tissue of oxygen and nutrients and
causes ischemia. If the lumen is completely
obstructed, tissue death may result.
G. Occlusive Peripheral Vascular Problems - Thrombus
formation (clotting) in the lumen of a vein. These
clots can form quickly because of sluggish blood flow
within the vessels. Increasing the patient’s activity
and using antiembolism stockings help prevent
problems related to venous stasis or pooling.
Thrombi form most often in lower extremity veins,
where they irritate and inflame the vessel and cause
thrombophlebitis. Signs of thrombophlebitis include
edema, swelling, warmth over the affected area,
aching, and cyanosis or pallor. a thrombus breaks
loose from the vein and travels in the circulatory
system, it is referred to as an embolus. Emboli can be
life-threatening.
H. Varicose Veins - when blood pools in the veins and
dilates or stretches them. Varicosities can result in
leg cramps or a dull, aching pain in the legs.
I. Aneurysm - the pouching or ballooning of arteries, is
common in older adults who suffer from
arteriosclerotic blood vessel changes. As parts of the
muscular walls of the arteries develop plaque and
become rigid, other areas of the vessels stretch,
dilate, and weaken. The walls of the dilated areas
become thin and prone to rupture.
J. Hypertensive Disease
• Essential (Primary) - the more common form, has
no known cause. Many factors, including
heredity, diet, obesity, stress, smoking,
increased serum cholesterol levels, and
abnormal sodium transport, are known to
contribute to essential hypertension. It is
diagnosed based on two elevated blood pressure
determinations on three separate days. A
reading of 140/90 mm Hg is considered the
10 | D a b l i o , N i k k a
 upper limit of normal in adults. Essential C. Platelets - more properly called thrombocytes, are
hypertension cannot be cured, but it can be not whole cells but pieces of cells. They are produced
treated. when large cells called megakaryocytes fragment
• Secondary - occurs as a result of a coexisting and enter the circulation.
disease process or other known cause. Renal,
vascular, and endocrine pathologic conditions
are among the most common causes of The major components of the immune system—
secondary hypertension. lymphocytes and antibodies—are formed by the lymph
system to protect the body from pathogenic
microorganisms, malignant cells, and foreign proteins.
The two major fluids of the body are blood and
A. Lymph Vessels, Fluid, and Nodes - Lymph vessels are
lymph. These fluids flow through the body within two
located in most tissue spaces. These permeable
parallel circulatory systems.
vessels absorb fluid and proteins from the tissues.
B. Spleen and Thymus - The spleen is responsible for
The general functions of blood include producing lymphocytes and monocytes, which enter
the bloodstream. It also contains fixed plasma cells,
transportation of nutrients, waste products, blood gases,
which produce antibodies to foreign antigens, and
and hormones; regulation of fluid-electrolyte balance,
acid-base balance, and body temperature; and fixed macrophages, which phagocytize pathogens
protection against pathogenic attack by the WBCs and and other foreign substances in the blood.
C. Lymphocytes and Immunity - produced in the
against excessive blood loss through clotting
mechanisms. embryonic bone marrow. These cells are responsible
for the recognition of antigens located on a foreign
• Plasma - liquid of the blood, a substance in which cell and for humoral immunity.
many other substances can dissolve and be
transported
• Albumin - the most abundant plasma protein, is Hematopoietic and Lymphatic Changes
important in the maintenance of osmotic pressure Associated with Aging
needed to regulate blood pressure and volume. Physiologic change Results
Increased plasma Increased risk for
• Fibrinogen - prothrombin, fibrinogen itself, and
viscosity vascular occlusion
other clotting factors that circulate until they are
Decreased red blood cell Increased incidence of
required by the body. production anemia
• Globulins - function as transport agents for lipids and Decreased mobilization Less effective
fat-soluble vitamins; the γ-globulin fraction is of neutrophils phagocytosis
composed of antibodies that provide immunity from Increased immature T- Decreased immune
pathogens. cells response response
A. Erythrocytes (RBC) - formed in the red bone marrow Lower serum albumin Edema; increased levels
by stem cells; contain a protein called hemoglobin, levels of medications that are
which carries oxygen from the lungs to all parts of highly protein bound
the body. Nursing Assessments and Care Strategies Related to
B. Leukocytes (WBC) - have protective functions: they Hematopoietic and Lymphatic Changes
destroy dead or damaged tissue, detoxify foreign Monitor laboratory tests, Report abnormal findings
including Hgb, Hct, WBC, promptly to primary care
proteins, protect from infectious disease, and
and differential. provider
function in the immune response. WBCs are
Assess nutritional intake Administer nutritional
produced in the lymphatic tissue of the spleen, for adequacy of protein, supplements as ordered.
lymph nodes, thymus, and red bone marrow. The iron and vitamins; assess
five types of WBCs are neutrophils, eosinophils, for peripheral edema.
basophils, lymphocytes, and monocytes.
11 | D a b l i o , N i k k a
A. Anemia - defined as inadequate levels of RBCs or
insufficient hemoglobin.
• Iron-deficiency anemia - results from inadequate
nutritional intake, blood loss, malabsorption, or
increased physiologic demand
• Pernicious anemia - associated with decreased
intake or absorption of vitamin B12.
• Folic-acid-deficiency anemia - usually caused by
poor nutrition, chronic alcohol abuse, or
malabsorption syndromes, such as Crohn
disease
B. Leukemia - the result of excessive production of
immature WBCs. There are both acute and chronic
varieties, and leukemia is also classified by the type
of abnormal cells present.
The GI tract begins at the mouth and ends at the
anus. Each part of the GI tract performs its own distinct
functions
Where food normally enters the body prepared
for digestion.
• Mastication - The teeth mechanically process food by
biting, tearing, grinding, and chewing the food
• The incisors are used to bite, the canines to tear, and
the premolars and molars to chew and grind.
• Each tooth is composed of a crown, which is the part
visible above the gingiva (gum), and a root
• Periodontal membrane - lines the tooth socket and
holds the teeth in place
• Enamel – an extremely hard casing protects the
crown of the tooth.
• Pulp Cavity - contains blood vessels and nerve
endings.
The tongue is a highly flexible structure
controlled by and composed primarily of skeletal muscle.
• Papillae - contain the taste buds, are located on the
upper surface of the tongue.
• Cranial nerves - control the movement of the tongue
and carry the impulses for taste perception.
Three pairs of salivary glands excrete saliva into
the oral cavity. Saliva is composed primarily of water but
also contains the enzyme amylase, which begins the
digestion of starch.
A hollow muscular tube that passes from the
pharynx through the flat layer of diaphragm muscle and
to the stomach. The esophagus is located above the
diaphragm, and the stomach is located immediately
below the diaphragm
• Peristalsis – a wavelike motion of the smooth
musculature that propels material through the entire
GI tract.
• Lower esophageal sphincter - also called the cardiac
sphincter is where the esophagus meets the
stomach. It allows food to enter the stomach but
prevents the stomach contents from moving
backward (refluxing) into the esophagus.
A muscular sac in which both mechanical and
chemical digestion take place. Special stomach glands
secrete mucus; others secrete enzymes, intrinsic factor,
and hydrochloric acid.
• Mucous membranes – lines the stomach which helps
prevent damage to the muscle walls.
• Gastric juice or digestive juice - mixture of enzymes
and acids
• Chyme - refers to processed food in the stomach
• Pyloric sphincter – releases chyme into the small
intestine.
The small intestine is more than 20 feet long and
is divided into three segments called the duodenum, the
jejunum, and the ileum (in order of progression away
from the stomach). Absorption of nutrients occurs
primarily in the small intestine.
• Bile - produced in the liver and stored in the
gallbladder, breaks down fat by emulsifying it.
• Pancreatic juice - contains enzymes that break down
proteins.
• Villi - fingerlike projections of the lining of the small
intestine that are rich in capillaries and lymphatic
12 | D a b l i o , N i k k a
 vessels, increase the surface area of the lining. As the Decreased liver size and Decreased ability to
digested nutrients pass over these villi, they are enzyme production metabolize drugs, leading
absorbed into the blood and lymph by the capillary to increased risk for
network and lymphatics. toxicity
• Ileocecal valve - located between the ileum of the Nursing assessments and care strategies related to
small intestine and the cecum of the large intestine; gastrointestinal changes
Nursing assessments Care strategies
prevents waste products from moving backward into
Assess oral cavity for Educate regarding
the small intestine.
dentition, condition of importance of good oral
mucous membranes and hygiene; stress need for
hygiene adequate fluid intake.
The large intestine is approximately 5 feet long
Dental referral as
and is divided into segments called the ascending, necessary.
transverse, descending, and sigmoid colon and the Assess swallow and gag Encourage posture that
rectum. The major functions of the large intestine are reflexes. facilitates swallowing.
absorption of water, minerals, and vitamins, and storage Consult with speech
and elimination of indigestible wastes. therapy for swallow
studies and safe dietary
• Effluent - discharge of waste products. regimen.
• Peristalsis - causes the effluent to enter the rectum, Monitor weight changes. Measure and record
its presence there triggers the defecation reflex, in weight at least one time
which strong peristaltic movements propel the mass per month, more often if
from the rectum and through the anus fluid balance issues
• Gastrocolic reflex - occurs when the stomach is present.
distended with food, stimulating vigorous peristalsis Assess intake of nutrients Educate regarding
of the rectum and a desire to defecate and fluid. recommended dietary
intake. Establish calorie
count and intake and
Gastrointestinal Changes Associated with Aging output if problems are
Physiologic Change Results suspected.
Increased dental caries Decreased ability to Assess bowel sounds and Establish bowel routines.
and tooth loss chew normally; bowel elimination Teach importance of
decreased nutritional patterns. adequate fluid, fiber, and
status activity. Administer
Decreased thirst Increased risk for laxatives, stool softeners,
perception dehydration and suppositories, or enemas
constipation as needed to prevent
Decreased gag reflex Increased incidence of constipation and
choking and aspiration impaction.
Decreased muscle tone Increased incidence of Assess effectiveness of Observe for therapeutic
at sphincters heartburn (esophageal medications. effects (or lack thereof);
reflux observe for signs of
Decreased saliva and Decreased digestion and toxicity.
gastric secretions; absorption of nutrients;
increased gastric pH altered absorption of
some medications that
are pH-dependent A. Hiatal Hernia - s the protrusion of the stomach into
Decreased gastric Increased flatulence, the thoracic cavity through the esophageal opening
motility and peristalsis constipation, and bowel in the diaphragm. Some demonstrate no symptoms;
impaction others complain of severe distress that may be
intermittent or continuous. Reflux episodes usually
13 | D a b l i o , N i k k a
 occur after meals, especially when the person lies
down immediately after eating. Complaints may
include heartburn, acid reflux, or generalized
epigastric distress.
• Gastroesophageal reflux disease (GERD) - a
major problem that can occur with hiatal
hernias. With GERD, the gastric contents move
backward into the esophagus, where they
increase the risk for aspiration.
B. Gastric and Ulcers
• Chronic atrophic gastritis - an inflammatory
change in the mucous membranes of the
stomach in which the mucosa becomes thin and
abnormally smooth and may develop
hemorrhagic patches.
• Peptic ulcer - refers to both gastric and duodenal
ulcers. A bacterium, Helicobacter pylori or H.
pylori, has been implicated as the major cause of
gastric ulcers. Older adults suffering from ulcers
are more likely to complain of generalized pain
and to exhibit a decreased activity level,
decreased appetite, and weight loss. Vomiting,
melena (dark “tarry” stool containing blood),
and generalized signs of anemia may result from
gastric bleeding.
C. Diverticulosis and Diverticulitis
• Diverticula - are small pouches or sacs that
develop because of weaknesses in the intestinal
mucosa.
• Diverticulitis - involves inflammation of one or
more diverticula. This inflammation may result in
bowel obstruction, perforation, or abscess
formation.
D. Cancer - Carcinoma of the colon is more common in
women, whereas rectal carcinoma is more common
in men. Any changes in bowel elimination should be
viewed with suspicion, especially signs of obstruction
or bleeding.
E. Hemorrhoids - sometimes called piles. Pain and small
amounts of bright red blood at the rectum are
common complaints. Most patients with
hemorrhoids do not require surgery. Diet changes,
stool softeners, or bulk laxatives are usually effective
in reducing problems related to constipation and
hemorrhoids.
F. Rectal Prolapse - Bulging of the rectum through the
anus. Some form of medical intervention may be
needed if this condition causes distress. Surgery may
be performed to strengthen the musculature.
Insertion of a wire loop at the anal sphincter may be
attempted in very old people.
The urinary system consists of two kidneys, two
ureters, the urinary bladder, and the urethra. The urinary
system supports homeostasis by eliminating wastes and
excessive fluid from the body.
Two bean-shaped organs located on each side of
the spine behind the peritoneal lining of the abdomen
and at the lower edge of the rib cage.
• Nephrons - the functional portion of the kidney.
• Glomerulus of the nephron – where blood is filtered;
this filtrate is destined to become urine.
• Ureters - tubes of smooth muscle that allow urine to
drain from each kidney into the bladder.
• Bladder - a hollow muscular sac located below the
peritoneum and normally entirely within the pelvic
cavity.
• Internal sphincter - located at the outlet from the
bladder into the urethra. Control of the internal
sphincter is involuntary
• External urethral sphincter - comes under voluntary
control at approximately 2 to 3 years of age.
Voluntary contraction of the external sphincter
prevents urine from leaving the body.
• Urinary meatus – the point of exit.
Urine is approximately 95% water, with the
remainder composed of waste products and salts. Urine
is normally clear, and its color ranges from pale yellow to
dark amber. It may be alkaline or acidic, depending on
the diet of the individual. High protein diets tend to make
the urine more acidic; vegetarian diets tend to lead to
alkaline urine. Acidic urine is less compatible with
bacterial growth than is alkaline urine and may help
reduce the risk for a UTI.
Urinary Changes Associated with Aging
14 | D a b l i o , N i k k a
 Physiologic Change Results C. Chronic Renal Failure - may be a result of other
Decreased number of Decreased filtration rate chronic health conditions, such as hypertension, DM,
functional nephrons with decrease in drug chronic UTIs, or urinary tract obstructions. The
clearance symptoms of chronic renal failure are extensive and
Decreased blood supply Decreased removal of often mimic those of other conditions. These
body wastes; increased symptoms include changes in urine output, muscle
concentration of urine
weakness, edema, nausea and vomiting, itchy and
Decreased muscle tone Increased volume of
dry skin, and numerous neurologic symptoms.
residual urine
Decreased tissue Decreased bladder
elasticity capacity
Delayed or decreased Increased incidence of The nervous system processes and controls body
perception of need to incontinence functions and links us with the outside world. Through
void the nervous system, we perceive sensations and detect
Increased nocturnal urine Increased need to changes in our environment. We store information about
production awaken to void or the world within the nervous system and use this
episodes of nocturnal information to respond to the world.
incontinence
Increased size of prostate Increased risk for • The nervous system is composed of highly
(male) infection; decreased specialized cells called neurons. Each neuron consists
stream of urine; of a cell body, which contains the cell nucleus;
increased hesitancy and multiple dendrites, which are fibers that transmit
frequency of urination impulses (messages) to the cell body; and one axon,
Nursing Assessments and Care Strategies Related to which carries impulses away from the cell body.
Urinary Changes • Synapse – a small gap that separates axons and
Nursing Assessments Care Strategies dendrites.
Monitor for signs of drug Promptly notify primary • Neurotransmitters – special chemicals that is
toxicity care provider of relevant
released by the axon to stimulate a receptor site on
observations.
another nerve cell. This allows the nerve impulse to
Assess for urinary Palpate bladder after
frequency voiding or use Doppler to move from one nerve cell to another.
determine whether
bladder is emptying
completely. Composed of the brain and the spinal cord
Assess for signs and Obtain a urine specimen A. Medulla oblongata - extends from the spinal column
symptoms of urinary for analysis. to the pons of the brain. This area controls many vital
tract infection.
functions, including heart rate, constriction of blood
Assess frequency and Establish a toileting
vessels (affecting blood pressure), and respiration.
timing of episodes of schedule based on
incontinence. assessment data. Reflex centers for coughing, vomiting, swallowing,
and sneezing are also located in this area.
B. Pons and Midbrain - The pons also exerts control
Common Disorders Seen with Aging over respiratory patterns and works with the
A. Urinary Incontinence - the involuntary loss of urine, medulla to regulate breathing rhythm. The midbrain
is not a routine or normal occurrence with aging. integrates visual and auditory reflexes and helps
Incontinence may occur as a result of physiologic maintain balance and equilibrium
changes, other medical problems such as UTIs, C. Hypothalamus - The hypothalamus, a small area of
neurologic problems, or changes in the ability to the brain above the pituitary gland, is the
function. coordinating center for the autonomic nervous
B. Urinary Tract Infection system. It also secretes releasing and inhibiting

15 | D a b l i o , N i k k a
 hormones that affect the secretions of the pituitary
gland (such as growth-hormone-releasing factor)
and thus results in various effects on the endocrine
system
D. Cerebrum - the largest part of the human brain. It is
divided into lobes, which are named according to the
cranial bones under which they lie.
• Frontal lobes - control voluntary motor activity,
judgment, planning, organization, problem
solving, and behavior regulation.
• Broca area - controls the movements related to
speech, is found on the left frontal lobe in right-
handed individuals.
• Parietal lobes - interpret impulses and
sensations from the skin and muscles. In
addition, they are responsible for facial, shape,
and color recognition.
• Temporal lobes - receive auditory (hearing) and
olfactory (smelling) impulses and are devoted to
new memory, learning, music, and emotions.
• Occipital lobes - deal with vision, depth
perception, and three-dimensional perception.
Consists of the cranial and the spinal nerves and
includes the somatic nervous system and the autonomic
nervous system. The peripheral nervous system is a relay
system that detects changes in both the internal and
external environments and relays this information to the
central nervous system.
• Schwann cells - form the protective myelin sheath of
the axons to prevent messages from short-circuiting
each other in the peripheral nervous system and to
speed impulse conduction
Neurologic Changes Associated with Aging
Physiologic Change Results
Decreased number of Slowed thought
brain cells processes, decreased
ability to respond to
multiple stimuli and tasks
Decreased number of Decreased reflexes,
nerve fibers decreased coordination,
decreased
proprioception
Decreased amounts of Decreased perception of
neuroreceptors stimuli
Decreased peripheral Decreased motor
nerve function responses, increased risk
for ischemic paresthesia
in extremities
Nursing Assessments and Care Strategies Related to
Neurologic Changes
Nursing Assessments Care Strategies
Assess alertness level, Report abnormal findings
cognition, and functional to primary care provider.
abilities. Refer for neurologic
evaluation.
Assess balance and Educate regarding safety
reflexes. precautions and use of
assistive devices.
Structure tasks to reduce
confusion; allow
adequate time to
perform tasks.
A. Parkinson Disease - also called paralysis agitans, is a
progressive, degenerative disorder of the central
nervous system. Specific neurons in the brain that
produce the neurotransmitter dopamine are lost.
Symptoms usually begin after age 40 years and
appear gradually. The initial signs of the disease tend
to be unilateral and include slight tremors on one
side, in addition to a more general weakness and
slowing down. As the disease progresses, these
tremors become typical and obvious at rest,
decrease with conscious movement, and are totally
absent during sleep. Emotional stress or fatigue
often worsens the tremors. Tremor increases, the
body becomes more rigid, and movements become
slower. The face takes on a flat, open-mouthed,
masklike expression, and eye blinking decreases in
frequency. Speech slows and may be unclear.
Swallowing may be affected, etc. hehe.
B. Dementia - a general term for a permanent or
progressive organic mental disorder. Characterized
by personality changes; confusion; disorientation;
deterioration of intellectual functioning; and
impaired control of memory, judgment, and
impulses. Dementia can be a result of drug
intoxication, trauma, disease processes, hormonal
imbalances, and vitamin deficiencies.
• Vascular dementia - previously known as multi-
infarct dementia, is the second most common
16 | D a b l i o , N i k k a
 form of dementia. It results from hemorrhage or
ischemic brain lesions, and the exact symptoms
depend on the area of the brain affected.
Persons with hypertension or other types of
cerebrovascular disease are most likely to
develop this form of dementia
• Dementia with Lewy bodies (DLB) - caused by
microscopic protein clumps in the brain (Lewy
bodies) that cause damage to nerve cells. In
addition to classic symptoms of dementia, visual
hallucinations are characteristic of this form of
dementia. Many individuals with this form of
dementia develop Parkinson-like symptoms.
• Parkinson Disease Dementia (PDD) - usually
occurs with progression of Parkinson disease
caused by protein clumps in the substantia nigra
of the brain and can resemble both DLB and
Alzheimer disease.
• Mixed dementia - can occur when more than one
form of dementia is present. This will present as
primarily one type of dementia (e.g., Alzheimer)
with features of other dementias.
D. Alzheimer Disease - senile dementia, Alzheimer type
is the most common form of dementia. Alzheimer
disease is a chronic, progressive, degenerative
disease in which large numbers of brain cells and
tissues are affected by atrophy, beta-amyloid
plaques, and neurofibrillary tangles. The brain level
of the neurotransmitter acetylcholine decreases,
leading to a disturbed ability to reason and retain
new information.
E. Transient Ischemic Attack - brief episodes of
cerebrovascular insufficiency that are usually the
result of cerebral blood vessel obstruction. Such
obstruction is usually caused by an embolus or
atherosclerotic plaque. Common symptoms include
blurred, tunnel, or double vision; blindness; vertigo;
transient numbness and weakness; aphasia or
slurred speech; and gait disturbances. Most episodes
last only a few minutes, but some may persist as long
as 24 hours.
F. Stroke - formerly called a cerebrovascular accident
(CVA), is a disturbance of the blood supply to the
brain. Most strokes are related to atherosclerosis,
hypertension, diabetes, or a combination of these.
• Ischemic - where there is lack of blood and
oxygen flow caused by embolus or thrombus,
comprising 87% of all strokes.
• Hemorrhagic - weakened vessels or aneurysms
that rupture spontaneously or as a result of
hypertension.
–
The eyes are two globe-shaped structures
located in the orbits of the skull on each side of the nose.
• Conjunctiva – smooth mucous membrane that lines
the eyelids
• Lacrimal glands – produces tears located at the
upper and outer corners of the eye.
• Lysozyme - inhibit the growth of bacteria
• Lacrimal sac – where tears leave the eye at the
medial corner.
• Sclera - outermost layer of the eye, commonly called
the white of the eye
• Cornea - anterior part of the sclera, a transparent
structure that refracts or bends light rays
• Choroid - middle layer of the eye, contains pigments
that absorb light and keep the interior of the eye
dark.
• Iris - located in the anterior portion of the choroid,
the colored portion
• Pupil - an opening in the iris through which light
enters the eye
• Lens - a transparent oval disk
• Ciliary Body - muscles that change the shape of the
lens to refract light waves
• Retina - innermost layer of the eye
• Rods and cones – visual receptors that use chemical
changes in their pigments to detect light.
The eye functions much like a camera. Light
waves enter the eye through the cornea and then pass
through the aqueous humor, lens, and vitreous humor to
the retina. When light waves strike the retina, they
stimulate the receptors in the cones and rods. The rods
react chemically to the amount of light and regulate
nerve impulses to the brain based on this information.
Different cones respond to different wavelengths of light
rays (different colors) and thus determine the perceived
color of objects.
17 | D a b l i o , N i k k a

Vision Changes Associated with Aging
Physiologic Change Results
Decreased number of Increased risk for eye
eyelashes injury
Decreased tear Increased risk for eye
production irritation
Increased discoloration Decreased color
of lens perception
Decreased tissue Increased blurring
elasticity
Decreased muscle tone Decreased diameter of
pupil; increased
refractive errors;
decreased night vision;
increased sensitivity to
glare, decreased
peripheral vision
Nursing Assessments and Care Strategies Related to
Neurologic Changes
Nursing Assessments Care Strategies
Assess for signs of Encourage regular use of
irritation, inflammation, synthetic tear
and dryness. preparations to help
reduce irritation caused
by inadequate tear
production.
Assess visual acuity. Encourage or schedule
regular professional eye
examinations. Educate
regarding importance of
adequate light with
minimum glare. Explain
importance of using
eyeglasses appropriately
for reading or distance,
particularly when driving.
Assess ability to detect Provide adequate lighting
objects within the and contrast in colors to
environment. highlight important
structures such as the
edge of stairs, light
fixtures, faucets, etc
A. Blepharitis - a chronic inflammation of the eyelids, is
one of the most common disorders of the eye.
Symptoms of blepharitis include burning, itching,
and sensitivity to light. Discomfort is often worse on
awakening. Blepharitis can be caused by
Staphylococcus bacteria, by sebaceous gland
dysfunction, or in conjunction with skin conditions,
such as seborrhea or rosacea.
B. Diplopia - double vision, is not normal and indicates
some disturbance of the nervous system that
requires further investigation by the primary care
provider
C. Cataracts - cause a clouding of the lens of the eye,
are increasingly common with aging. Factors that
increase the risk for cataracts include smoking,
alcohol, diabetes, and prolonged sunlight exposure.
Cataracts develop over time and result in
progressive, painless vision loss. The amount of
vision loss depends on the degree of lens opacity and
the area of the lens that is affected.
D. Glaucoma - s a disease characterized in most cases
by increased fluid pressure (intraocular pressure)
within the eye that may result in damage to the
retina. Initially, peripheral vision is affected. Tunnel
vision and, eventually, permanent blindness may be
the result.
E. Age-Related Macular Degeneration and Retinal
Detachment - The neovascular form of macular
degeneration, also called wet AMD, results from
abnormal growth of tiny blood vessels
(neovascularization) under the retina. These vessels
ruin vision by leaking fluid and blood, which cause
the retina to become swollen and distorted. This
form is more likely to cause severe vision loss.
–
The ear is composed of three distinct portions: outer
ear, middle ear, and inner ear. The two main functions of
the ear are the detection of sound and the maintenance
of balance.
• Outer Ear
o Pinna or auricle – curved structure made out of
cartilage
o External ear canal
• Middle Ear
o Eardrum or tympanic membrane
o Eustachian tube - connects the middle ear to the
nasopharynx and where air pressure is
controlled.
o Bones: malleus (hammer); incus (anvil); and
stapes (stirrup)
18 | D a b l i o , N i k k a
 o Oval Window - the opening into the inner ear
• Inner Ear
o Cochlea - contains the hearing receptors, which
consist of hair cells with fine movable projections
that are set in motion when sound waves reach
their fluid surroundings
o Vestibule
o Semicircular canals
Auditory Changes Associated with Aging
Physiologic Change Results
Decreased tissue Decreased ability to
elasticity distinguish high-
frequency sounds
Decreased joint mobility Decreased hearing ability
Decreased ceruminous Increased risk for
cells in external ear canal cerumen impaction
causing conductive
hearing loss
Atrophy of vestibular Increased problems with
structures and in the balance; decreased
inner ear number of hair cells
Nursing Assessments and Care Strategies Related to
Auditory Changes
Nursing Assessments Care Strategies
Assess hearing and Refer for audiometric
balance. testing as needed
Inspect ear canal for Administration of
cerumen impaction. prophylactic drops may
reduce likelihood of
impaction formation.
Irrigation may be needed
if impaction is present.
Assess functioning of Check that batteries are
hearing aid if used. working and that device
is not plugged with
cerumen. Keep an
amplifying device on
each patient care unit to
use with hard of hearing
individuals who do not
have a functional hearing
aid.
Assess for social isolation Encourage socialization
or behavioral background in areas without
noise. excessive changes
A. Otosclerosis - a hardening or fixing of the stapes to
the oval window, interferes with sound-wave
transmission into the inner ear
B. Tinnitus - ringing in the ears, is commonly reported
by aging people. Tinnitus may be a result of trauma
to the ear, pressure from cerumen against the
eardrum, otosclerosis, presbycusis, or Ménière
disease.
C. Deafness - inability to hear sounds fully, may be
temporary or permanent, depending on the cause.
Deafness can be unilateral (affecting one ear only) or
bilateral (affecting both ears).
• Conductive hearing loss - occurs when
something interferes with transmission of the
sound waves. A plug of cerumen (earwax) in the
external canal, eardrum rupture or scarring, the
presence of fluid or an infection in the middle
ear, etc. hehe
• Nerve or sensorineural deafness - occurs when
either the receptors in the inner ear or the
cranial nerves are damaged or destroyed.
• Central deafness - caused by trauma or disease
in the temporal lobes of the brain. This may be a
result of tumors, stroke, or injury.
D. Ménière disease - a chronic disorder of the inner ear
observed in people after age 40. Persons suffering
from this disorder experience severe vertigo (not
simple dizziness) to the point that they may be
unable to stand or walk. They may also report
nausea, tinnitus, hearing loss, and a sensation of
pressure in the ear. Diaphoresis, vomiting, and
nystagmus (rapid, involuntary eye movement) may
also be observed.
–
• The receptors for our sense of taste are located in
the papillae, or taste buds, on the superior surface of
the tongue. In these papillae are chemical receptor
cells that are sensitive to salty, sweet, sour, and
bitter chemicals When mixed with moisture, such as
saliva or water, food releases chemicals that are
detected by these receptors. Foods get their subtle
flavors by their unique interaction with various
receptors.
• The detection of odors occurs when the olfactory
receptors in the upper nasal cavities respond to
19 | D a b l i o , N i k k a
 airborne chemicals. When vapors escape from food o Gonadotropic hormones include follicle-
or other volatile substances, they enter the nose and stimulating hormone and luteinizing hormone, -
stimulate the receptors. responsible for gonad maturation and function,
and prolactin, which supports lactation
• Posterior pituitary - the site of connection between
Olfactory Changes Associated with Aging the nervous system and the endocrine system.
Physiologic Change Results • Antidiuretic hormone – this maintains fluid
Decreased number of Decreased ability to taste balance in the body by causing the kidneys to
papillae on tongue
reabsorb fluid; in the absence of the antidiuretic
Decreased number of Decreased ability to
hormone, the kidneys excrete more fluid.
nasal sensory receptors and to detect
smells
Nursing Assessments and Care Strategies Related to
The thyroid gland surrounds the trachea and is
Olfactory Changes
located just below the larynx (voice box).
Nursing Assessments Care Strategies
Assess ability to smell Teach importance of • The thyroid hormones triiodothyronine and thyroxin
and taste. storing food properly and increase metabolic rate; regulate the metabolism of
checking expiration
fat, carbohydrates, and protein in the cells; and
dates. Keep drugs and
increase body temperature.
chemicals separated
from foods.
The parathyroid glands are located on the
posterior surface of the lobes of the thyroid gland. PTH,
an antagonist of calcitonin, stimulates the movement of
The endocrine system and the nervous system
calcium and phosphorus from the bones into the blood.
perform the major integrating and regulating functions
of the body.

• Hormones – chemical substance secretes by the
endocrine glands that regulates body processes. It is
secreted directly into the capillaries of the
bloodstream, where they circulate until they reach
their target organs and cause specific effects.
The pancreas is both an exocrine and an
endocrine gland. It functions as an exocrine gland during
digestion by secreting pancreatic fluid into the
duodenum

The adrenal glands are located on the top of

Referred to as the master gland of the body
because of the many functions it regulates. It is located
within the skull cavity and is connected directly to the
hypothalamus
• Anterior pituitary
o Growth hormone – increases the rate of protein
synthesis and aids in the transport of amino acids
to cells. In adults, this hormone also participates
in fat release from adipose tissue and the use of
this fat as energy.
o Thyroid-stimulating hormone - stimulates the
normal growth and activity of the thyroid gland.
Adrenocorticotropic hormone (corticotropin)
stimulates the activity of the adrenal cortex.
each kidney.
• Adrenal medulla - the inner portion of the gland;
secretes epinephrine and norepinephrine, which are
the major neurotransmitters of the sympathetic
portion of the autonomic nervous system
• Adrenal cortex - the outer portion of the gland;
releases mineralocorticoids, glucocorticoids, and
small amounts of sex hormones. The
mineralocorticoid aldosterone is important in the
regulation of fluid and electrolyte balance and blood
pressure maintenance.
20 | D a b l i o , N i k k a
 • Type 2 – diabetes mellitus, results from a
• Estrogen and progesterone - hormones secreted by combination of resistance to insulin action and
the ovary are responsible for maturation of the ova, inadequate compensatory insulin secretion
stimulation of the uterine endometrium, and the • Other specific types – identified by their unique
development of the secondary female sexual etiologies, including genetic defects or
characteristics syndromes, exocrine diseases of the pancreas,
• testosterone – secreted by the testes, responsible diseases of the endocrine system, drugs or
for sperm maturation, and development of chemicals, infections, or other uncommon
secondary male sexual characteristics. immune-mediated disorders.
• Gestational – exists only during pregnancy
B. Hypoglycemia - a potentially serious problem for
Endocrine Changes Associated with Aging people receiving insulin or oral hypoglycemic agents.
Physiologic Change Results Signs of hypoglycemia include headache, nausea,
Decreased pituitary Decreased muscle mass weakness, tremors or trembling sensations, pallor,
secretions (growth anxiety, irritability, tachycardia, sweating, and
hormone) hunger.
Decreased production of Decreased metabolic rate C. Hypothyroidism - reduced function of the thyroid
thyroid-stimulating
gland. The symptoms of hypothyroidism include cold
hormone
intolerance, dry skin, dry and thin body hair,
Decreased insulin Increased risk for type 2
constipation, depression, and lack of energy.
production or increased diabetes mellitus
insulin resistance Because many of these changes are commonly
Decreased production of Increased blood calcium observed with aging, the changes may not be
parathyroid hormone levels (seen with recognized as signs of hypothyroidism.
osteoporosis)
Nursing Assessments and Care Strategies Related to
Endocrine Changes In both men and women, the genital and urinary
Nursing Assessments Care Strategies systems are located close to each other.
Monitor laboratory Educate patient
values, paying special regarding dietary needs
attention to minerals, and self-testing of blood The primary female sexual organs include the
such as calcium and glucose. ovaries, fallopian tubes, uterus, and vagina. These
sodium levels, and blood structures, which are necessary for normal human
glucose. reproduction, are located in the pelvic cavity between
Assess for body Notify primary care the bladder and the bowels.
temperature, weight, provider of assessment
hair distribution or findings.
behavioral changes, The male organs of reproduction consist of the
which may indicate testes, a series of ducts and glands, and the penis, which
endocrine imbalance.
contains the passageway by which sperm, the male sex
cells, leave the body in the ejaculate. The testes are
suspended in a tissue sac called the scrotum, which
A. Diabetes Mellitus hangs between the thighs. The testes produce the
• Type 1 – defined as being a result of either hormone testosterone, which is responsible for sperm
autoimmune destruction of the β cells of the production and maturation. The prostate gland is located
pancreas or unknown idiopathic causes. just below the urinary bladder. The prostate produces an
alkaline secretion that increases sperm motility, and it
contracts to aid in sperm ejaculation.

21 | D a b l i o , N i k k a
 Reproductive Changes Associated with Aging
Physiologic Change Results
Female
Decreased estrogen Decreased vaginal
levels secretions
Decreased tissue Decreased pubic hair;
elasticity increased vaginal tissue
fragility; increased tissue
irritation; decreased size
of uterus; decreased
vaginal length and width;
decreased size of vaginal
opening; increased pain
with intercourse
(dyspareunia); decreased
breast tissue mass
Male
Decreased testosterone Decreased amount of
levels facial and pubic hair
Decreased circulation Decreased rate and force
of ejaculation; decreased
speed gaining an erection
Nursing Assessments and Care Strategies Related to
Reproductive Charges
Nursing Assessments Care Strategies
Assess for signs and Report unusual vaginal
symptoms of infection or discharge to primary care
inflammation. provider. Administer
treatment as prescribed
Assess factors that may Discuss normal
interfere with sexual physiologic changes and
activity the possible effects of
medications on sexual
function. Educate
females regarding use of
artificial lubrication.
Possible referral of males
to primary care provider
for pharmacologic
treatment of erectile
dysfunction.
A. Uterine Prolapse - Prolapse of the uterus (into the
vagina) is commonly observed in older women. This
is particularly a problem for those who have had
many pregnancies or for those who delivered
children with little medical assistance. Urinary
frequency, urinary retention, recurrent UTIs, back
pain, and constipation may be symptoms.
B. Vaginal Infection - Change in vaginal pH may lead to
increased incidence of vaginal infections, particularly
yeast infections. This is most often manifested by
increased vaginal discharge, irritation, odor, and
itching
C. Breast Cancer - Any sign of dimpling; masses; nipple
retraction; or breast drainage, discharge, or bleeding
is suspicious and requires further medical attention
D. Prostate Cancer - There are no obvious changes in
function to indicate the presence of prostate cancer.
Therefore, it is important for aging men to have
regular medical examinations
1) Your older female patient is complaining because
she is having frequent urinary tract infections. Which
normal age-related change is most likely to be a
contributing factor?
1. Increased nocturnal urine production
2. Decreased perception of the need to void
3. Decreased bladder muscle tone
4. Urinary incontinence
2) Which are normal age-related changes? (Select all
that apply.)
1. Decreased visual acuity
2. Increased heart rate
3. Decreased long-term memory
4. Increased gastric pH
5. Increased muscle mass
6. Decreased depth of respiration
7. Increased calorie requirements
8. Decreased serum albumin
9. Increased subcutaneous tissue
10. Decreased rate of peristalsis
3) What are patients who have had Parkinson disease
for 10 years likely to exhibit? (Select all that apply.)
1. Rigidity and tremors when at rest
2. Hemiparesis and aphasia
3. Dementia
4. Unilateral tremors with movement
5. Tremors present during sleep
4) An older adult is coming to your clinic for treatment
for a gastric ulcer. Which treatment would the nurse
expect to be ordered?
1. Antibiotics
22 | D a b l i o , N i k k a
 2. Stress-reduction classes
3. NSAIDs
4. Iron supplements before breakfast and dinner
5) What should the nurse explain when discussing
expected changes in the female reproductive system
to an older adult?
1. Increased pubic hair is expected
2. Uterine enlargement is normal
3. Vaginal tissues become more vascular
4. Production of vaginal secretions decreases
6) The nurse performs a skin assessment of an older
adult. Which finding is abnormal and needs to be
reported?
1. Increased patches of dark pigmentation on
exposed skin
2. A dark, elevated patch that bleeds when
touched
3. Deep wrinkles and frown lines around the mouth
and eyes
4. Numerous brown or flesh-colored skin tags
around the neck
7) The nurse encourages the patient to maintain a
steady weight in the recommended range to
decrease risk of which common endocrine disease
observed in older adults?
1. Hypothyroidism
2. Hyperthyroidism
3. Diabetes mellitus
4. Diabetes insipidus
8) Which statement is true regarding falls in the
elderly?
1. Most falls occur in the garage.
2. Hip fractures resulting from falls are a leading
cause of placement in long-term care facilities.
3. Fall risk decreases with addition of medications.
4. Sedatives reduce the risk of falls.
9) Appropriate nursing care for a patient with urinary
incontinence is to:
1. Insert an indwelling Foley catheter.
2. Order oxybutynin chloride (Ditropan).
3. Encourage fluids to decrease the urine
concentration so it is less irritating.
4. Recommend herbal approaches to reduce
incontinence.
10) A nursing intervention for a patient with constipation
is to:
1. Avoid the urge to defecate.
2. Limit fluid intake.
3. Give prune juice with a noncarbonated drink.
4. Encourage bran cereal or whole-grain breads.
11) A patient with dysphagia is:
1. Fed only for pleasure.
2. At low risk for nutritional deficits.
3. At higher risk for pneumonia.
4. Able to drink thin liquids.
12) Age-related eye changes may include:
1. Increased visual accommodation.
2. Macular degeneration.
3. Non-preventable blindness as a result of
glaucoma.
4. Decreased ability of pupil to respond to light
changes.
13) Nurses' knowledge of sexuality in the older adult
population should include:
1. Chronic illness may affect the ability to
participate in sexual activity.
2. Sexual response time is unchanged.
3. Ability to achieve orgasm declines.
4. Dryness of the vaginal walls is associated with
pelvic inflammatory disease.
14) What is the initial nursing intervention in preventing
polypharmacy?
1. Obtain a thorough medication history.
2. Discontinue all herbal preparations.
3. Refer the patient to a geriatric practitioner.
4. Consult a pharmacist to review all medications.
15) What should the nurse include in the teaching plan
for self-medication practices of older adults?
1. Eliminate unnecessary medications.
2. Substitute herbal preparations for certain
prescribed medications.
3. Develop a drug reminder system and schedule.
4. Pharmacy shop for the cheapest medications.
16) Which age-related changes predispose the elderly
patient to drug toxicity and extended duration of
action of drugs? (Select all that apply.)
1. Decreased body water
2. Increased ratio of muscle to fat
3. Low serum albumin
4. Reduced blood flow to liver
17) Which mental change is associated with aging?
1. Confusion
2. Gradual decline in cognitive skills
3. Depression
23 | D a b l i o , N i k k a
 4. Inappropriate behavior 25) Alcoholism is often overlooked in the elderly. Cues to
18) An elderly patient has acute confusion after alcoholism include: (Select all that apply.)
undergoing abdominal surgery. The patient most 1. Delirium.
likely has: 2. Self-neglect.
1. Delirium. 3. Frequent falls.
2. Anxiety. 4. Mental confusion.
3. Dementia. 26) An elderly patient who experiences nighttime
4. Depression confusion wanders from his room into the room of
19) A patient is taking a psychotropic medication for another patient. Which intervention will best
agitation associated with dementia. What is a decrease this patient's nighttime confusion?
common side effect of psychotropics? 1. Administering a sedative at the hour of sleep
1. Accelerated hypertension 2. Leaving a night-light on during the evening and
2. Orthostatic hypotension night shifts
3. Diarrhea 3. Assigning a nursing assistant to sit with him until
4. Chest pain he falls asleep
20) Alzheimer's disease may be suggested in its early 4. Allowing the patient to share a room with
stages by: another elderly patient
1. Magnetic resonance imaging (MRI). 27) A patient with Alzheimer disease (AD) has been
2. Computed tomography (CT). prescribed oral donepezil 10 mg. The nurse should
3. Positron emission tomography (PET). give priority to assessing the patient for which sign of
4. Autopsy. an adverse effect of this drug?
21) Medications taken early in Alzheimer's disease to 1. Skin rashes
improve memory and alertness work by: 2. Cardiac dysrhythmias
1. Increasing dopamine in the frontal lobe. 3. Decreased blood pressure
2. Decreasing dopamine in the frontal lobe. 4. Gastrointestinal (GI) bleeding
3. Increasing acetylcholine in the cerebral cortex. 28) A 62-year-old woman is admitted to an assisted-
4. Decreasing acetylcholine in the cerebral cortex. living facility with symptoms of forgetfulness,
22) A patient with dementia wanders throughout the irritability, difficulty following directions, and neglect
skilled nursing facility. A nursing intervention for of her personal hygiene. These would suggest which
wandering may include: stage of AD?
1. Administering a sedative. 1. Late
2. Maintaining a regular activity program. 2. Early
3. Locking the patient's room from the outside. 3. Moderate
4. Keeping a staff member with the patient when 4. Moderate to severe
wandering 29) The nurse is planning care for a patient with
23) A patient with depression may be prescribed a(n): dementia. Which would be an appropriate
1. Phenytoin (Dilantin). intervention to include in this patient's care plan?
2. Lorazepam (Ativan). 1. Speak loudly and slowly.
3. Quetiapine (Seroquel). 2. Restrain the patient for safety.
4. Amitriptyline hydrochloride (Elavil). 3. Involve the patient in new activities.
24) A patient in the middle stage of Alzheimer's disease 4. Increase verbal and environmental cues.
(AD) may exhibit which characteristic or behavior? 30) A patient has been diagnosed as having dementia.
1. Mild depression Which symptom should the LPN/LVN expect?
2. Hallucinations 1. Patient tends to confabulate.
3. Weight loss 2. Patient tends to have flight of ideas.
4. Impaired mobility 3. Patient's speech tends to be slurred.

24 | D a b l i o , N i k k a
 4. Patient tends to be oriented to time, place, and 3. Formation of aneurysms
person. 4. Neuron loss in frontal and temporal lobes
31) The LPN/LVN reads on a patient's chart that the 5. Decreased production of neurotransmitters
patient is exhibiting the sundowning phenomenon. 35) The nurse is planning care for a patient with early AD.
Which behavior should the nurse expect? Interventions for which patient problems are
1. On sunny days, the patient is disoriented. appropriate for this patient's care plan? (Select all
2. On cloudy days, the patient is disoriented. that apply)
3. The patient becomes disoriented in the 1. Pain
evening. 2. Airway patency issues
4. The patient is very disoriented in the morning 3. Nutritional deficiencies
only. 4. Reduced cardiac output
32) The patient with dementia presents to the clinic for 5. Caregiver stress and fatigue
a routine examination. The patient's daughter, who
is her full-time caregiver, states to the nurse, "I just
don't know how much longer I can go on caring for
Mom full time. My kids feel neglected, my marriage
is suffering, and I feel so run down." What is the best
response by the nurse?
1. "You must stay strong for your mother. You are
all she has."
2. "Your mother's dementia will improve once we
correct the cause."
3. "You should discuss the many medications
available for treating and reversing dementia."
4. "As your mother's condition continues to
deteriorate, we should discuss alternative care
resources."
33) The nurse administers an emergent dose of
intravenous (IV) haloperidol to a patient with
delirium who is combative and is putting herself and
others at risk. Which priority instruction should she
give the unlicensed assistive personnel immediately?
1. "Please get a telemetry monitor and attach it to
this patient."
2. "Let's put a bed alarm under the patient's sheets
right away."
3. "Move everything away from the patient's bed,
including the patient's phone and bedside table.
4. "Please apply restraints to the patient's wrists
and ankles and secure them to the immobile
parts of the bed."
34) The nurse is caring for a patient recently diagnosed
with AD. The nurse knows this patient's symptoms
are caused by which changes in the brain? (Select all
that apply)
1. Neurofibrillary tangles
2. Development of gumma

25 | D a b l i o , N i k k a