Nursing implication

for
physical aspects of ageing
Nursing implication for physical aspects of
ageing
• The focus of nursing care is to assist the older clients to function as independently as
possible and to support their individual strength.
• The nurse must work hand in hand with the family and other disciplines of health care to
prevent complications of illness, to secure a safe and comfortable environment and to
promote health.
• The use of advanced practice nurses who have been educated in geriatric nursing concepts
has proved to be very effective when dealing with the complex care needs of an older
patient.
• When best practices are used and current scientific knowledge applied to clinical problems,
there is significantly less deterioration in the overall health of aging patients (ANA, 2010).
Nursing implication for physical aspects of ageing
cont…
• In addition to specialists, nurses who work in all areas of adult medical surgical nursing
encounter older adult patients.
• Nurses must be knowledgeable and skilled in meeting the complex needs of these
patients.
• Nurses and caregivers who work with older patients must understand that aging is not
synonymous with disease and that the effects of the aging process alone are not the
only or even the primary contributors to disability and disease.
• Aging is a highly individualized and multifaceted process (Cline, 2014)
Nursing implication for physical aspects of ageing
cont…
• Functional assessment is a common framework for assessing older adults.
• Age-related changes, as well as additional risk factors such as disease and the effects
of medications, can reduce function.
• Assessing the functional consequences of aging and proposing practical
interventions help maintain and improve the health of older adults.
• The goal is to help older adults sustain maximum functional level and dignity despite
physical, social, and psychological losses.
• Early intervention can prevent complications of many health problems and help
maximize the quality of life.
Subjective examination
• Demographic Data (Height, Weight, Gender, Age)
• Chief Complaints
• History Of Pain / Symptoms
• History Of Fall : Yes / No
• Past Medical / Surgical History
• Psychosocial History: Cognition, Memory, Depression
• Functional History: Independent, With Or Without Walking Aids
• Socio Economic Status : Kuppuswami / Prasad / Standard Of Living Index
Objective examination on observation
• Vitals
• General Condition
• Built
• Nutrition
• Skin / Nail Condition
• Limb/any deformity
• Pallor/ Icterus/ Cyanosis/ Clubbing/ Oedema
• Type of Breathing
• Chest Movements
• Posture/Gait
• Any Wound
• Assistive Devices (If Any)
Alteration in the sensory
perception/communication
(vision, hearing, touch, smell and taste)
• Impairment of vision related to ageing (cataract, long sightedness), vitamin A
deficiency (night blindness) leading to difficulty in reading , accidental falls etc.
• Provide bright light for reading.
• Use lamps that do not have glare.
• Use dim light in bedroom and bathroom all through the night.
• Provide safety rails at the sides of the bed to protect from fall.
• Place the furniture in a convenient place away from the passage especially in corridors.
• Regular eye check-up and correction of eye glasses with appropriate lens for short sight
and long sight.
• Treatment of any eye infection in their early stage.
 Alteration in the sensory
perception/communication
(vision, hearing, touch, smell and taste)
• Impairment of hearing related to ageing process, disease conditions, toxicity of drugs.
• Face the client while speaking so as to enable the client for lip reading
• Talk slowly and distinctly/ clearly.
• Use simple language and short sentences
• Lower the pitch of the voice
• Use non-verbal communication (facial expression, use of hands, writing etc.)
• When giving instructions, get feedback from the client to make sure that the client has
received the same message that you wanted to communicate
 Alteration in the sensory
perception/communication
(vision, hearing, touch, smell and taste)
• Impairment of hearing related to ageing process, disease conditions, toxicity of drugs.
Cont……………..
• Get the cleaning of the auditory canal to remove accumulation of ear wax (cerumen).
• Periodical check up to detect other problems causing impairment of hearing (e.g. otitis
media)
• Teach the traffic rules to prevent road accidents while walking on the busy roads.
 Alteration in the sensory
perception/communication
(vision, hearing, touch, smell and taste)

• Inability to recognise the temperature variations of the liquids (e.g. water) and other hot
articles causing burns and scalds.
• Check the temperature of the water/ liquids before giving to the clients for drinks, bath,
enema, hot and cold applications on the skin (e.g. hot water bottles).
• Daily observation of the skin for its colour, integrity (break in the continuity of the skin)
• Do not apply hot applications directly over the skin.
• Do not apply any type of pressure on the skin that may cause ulcer or blister on the skin.
 Alteration in the sensory
perception/communication
(vision, hearing, touch, smell and taste)
• Alterations in smell and taste. Inability to recognise the presence of bad smell, poisonous
gas, spoiled food etc. related to ageing, environmental factors, smoking, certain
medications, decreased salivation.
• Create the meal time as a pleasant occasion. Avoid conflicts.
• Provide food with good flavour to increase the appetite
• Create a pleasant atmosphere by maintaining the room as clean as possible. For example
remove the bed pan from the sight.
• Serve the food attractively. Appetite is increased by the sight and smell of the food.
 Alteration in the sensory
perception/communication
(vision, hearing, touch, smell and taste)
• Alterations in smell and taste. Inability to recognise the presence of bad smell, poisonous
gas, spoiled food etc. related to ageing, environmental factors, smoking, certain
medications, decreased salivation. Cont……..
• Check the gas leaks from the gas cylinders.
• Clients with decreased sensation of smell are prone for poisoning if gas cylinders are kept
open.
• Maintain good oral hygiene.
• Care is taken to clean the mouth before and after food intake.
• Supply vitamins, particularly vitamin B complex to those clients taking broad spectrum
antibiotics.
Problems affecting the integumentary
system
• Impaired skin integrity related to aging process, malnutrition, environmental changes,
poor hygiene, chronic illness, pressure, friction, mobility deficits, incontinence of urine,
self-care deficits, knowledge deficits.
• Special attention to pressure points.
• Frequent change of position.
• Soft, smooth and unwrinkled bed.
• Avoid prolonged exposure of the skin to hot and cold applications.
• Keeping the skin always dry and clean especially in clients with fever, incontinence of
urine, excessive discharges from body cavities.
• Adequate nutrition (well balanced diet)
Problems affecting the integumentary
system
• Impaired skin integrity related to aging process, malnutrition, environmental changes,
poor hygiene, chronic illness, pressure, friction, mobility deficits, incontinence of urine,
self-care deficits, knowledge deficits. Cont…….
• Through cleaning of the skin (e.g. daily bath, frequent back care)
• Take enough protection from cross infection.
• Health teaching to clients, client’s family and others about care of the skin.
• Active and passive exercise. Adequate fluid intake.
• Prompt treatment of skin diseases.
• Cut long nails to prevent skin injury by scratching the skin.
• Avoid application of drying agents (e.g. spirits, detergent soaps etc.)
Problems affecting the integumentary
system
• Impaired skin integrity related to aging process, malnutrition, environmental
changes, poor hygiene, chronic illness, pressure, friction, mobility deficits,
incontinence of urine, self-care deficits, knowledge deficits. Cont…….
• Lifestyle practices are likely to have a large impact on skin changes.
• Strategies to promote healthy skin function include not smoking, avoiding exposure to
the sun, using a sun protection factor of 15 or higher, wearing protective clothing, using
emollient skin cream containing petrolatum or mineral oil, avoiding hot soaks in the
bathtub, and maintaining optimal nutrition and hydration (Carpenter, 2015).
• Older adults should be encouraged to have any changes in the skin examined, because
early detection and treatment of precancerous or cancerous lesions are essential for
the best outcome
 Problems affecting the musculoskeletal
system
• Impaired mobility of bones and joints related to fracture of bones (falls, osteoporosis,
arthritis, osteoarthritis), injury, pain, infection, muscle atrophy, malnutrition, muscle
disuse, neurological disorders and disease conditions, alteration in the function of the
sensory organs.
• Active and passive exercise to promote mobility of joints.
• Encourage ambulation (unless contraindicated)
• Prevent fatigue by maintaining balance between exercise and rest period.
• Provide side rails to beds to prevent accidental falls from bed.
• Physiotherapy to prevent deformities.
• Provide adequate lighting in the passages, bathrooms etc. to prevent falls.
 Problems affecting the musculoskeletal
system
• Impaired mobility of bones and joints related to fracture of bones (falls, osteoporosis,
arthritis, osteoarthritis), injury, pain, infection, muscle atrophy, malnutrition, muscle
disuse, neurological disorders and disease conditions, alteration in the function of the
sensory organs. Cont….
• Familiarize the client with his surroundings.
• Avoid slippery floors.
• Never leave the client alone.
• Control the body weight within the normal limits.
• Teach the client/relatives about intake of adequate nutrition.
• Instruct the client to minimize sudden movements, e.g. to get out of bed, the client should
sit for 1 to 2 min, then come down to a standing position.
 Problems affecting the musculoskeletal
system
• Encourage older adults to participate in a regular exercise program. The benefits of
regular exercise cannot be overstated.
• Aerobic exercises are the foundation of programs of cardiovascular conditioning;
however, resistance and strength training and flexibility exercises are essential
components of an exercise program.
• Even late in life, in adults who may be frail (weak and delicate), it is believed that exercise
has benefits of increasing strength, aerobic capacity, flexibility, and balance.
• In addition, older adults who are hospitalized benefit from getting out of bed as soon as
possible (Oster & Oster,2015).
 Problems affecting the nervous system

• Impaired memory (dementia). slow speech and cognitive processing, reduced sensory
perception (vision, hearing etc.), slow body movements (bradykinesia), impaired heat
regulation (function of thalamus) etc. related to ageing process, brain damage, disease
conditions (Parkinson’s disease).
• Assessment of the vital signs frequently
• Use an effective communication process.
• Always face the client, use short sentences, ask for a feedback to determine whether the
client has understand what is communicated.
• Provide with hearing aids, eye glasses for the client to improve his sensory perceptions.
Problems affecting the nervous system

• Impaired memory (dementia). slow speech and cognitive processing, reduced sensory
perception (vision, hearing etc.), slow body movements (bradykinesia), impaired heat
regulation (function of thalamus) etc. related to ageing process, brain damage, disease
conditions (Parkinson’s disease). Cont…………..
• Arrange for a comfortable bed without wrinkles.
• A water bed is very useful to prevent bedsore.
• Take care of the adequate nutritional requirements
• Adequate treatment of disease conditions
• Administration of medicines in time (clients may forget to take the medications in time)
Problems affecting the nervous system
• Impaired memory (dementia). slow speech and cognitive processing, reduced sensory
perception (vision, hearing etc.), slow body movements (bradykinesia), impaired heat
regulation (function of thalamus) etc. related to ageing process, brain damage, disease
conditions (Parkinson’s disease). Cont…………..
• Never leave the client alone
• Help the client to perform his activities of daily living (ADL)
• Always give recognition for his successful adaptation and adjustment made everyday
• Daily observation include vital signs, mental status, orientation, bodily movements,
specially the coordination
• Arrange all articles in the client’s unit in such a way that the client will not wander for his
articles.
Problems affecting the nervous system
• Impaired sleep (insomnia)
• Practice sleep hygiene such as avoiding use of the bed for activities other than sleeping
(or sex), maintaining a consistent bedtime routine, avoiding or limiting daytime
napping, and limiting alcohol intake to one drink a day.
• Avoiding stimulants such as caffeine and nicotine after noon; curbing the amount of
liquids in the evening to avoid nocturia; and engaging in regular physical activity
(Daglar et al., 2014).
 Problems affecting the cardiovascular system
• Dyspnoea on exertion (cardiac failure), oedema on the dependent areas, e.g. when a client
is in standing position the oedema appears on the ankles. Hypertension, palpitation,
anxiety etc. related to ageing, disease conditions of the heart.
• Provide complete bed rest, cardiac position and salt free diet
• Frequent vitals monitoring. Assess for cyanosis, maintain I/O chart
• Allow ambulation with doctors order only.
• No physical and mental stress.
• The client should not lift any weight, should not push any article by holding the breath,
should not climb steps.
• Administer oxygen inhalation if cyanosis present
• Assist for ADL
• Adequate treatment for disease conditions (diabetes mellitus, obesity, hypertension will
precipitate a heart attack)
Problems affecting the respiratory
system
• Dyspnoea even at rest (asthma), cough with expectoration, cyanosis, haemoptysis,
anxiety etc. related to aging process and disease condition
• Provide fowler’s position.
• Apply suction if secretions present in the respiratory tract.
• Ask to cough out the sputum.
• Give steam inhalation to bring out sputum.
• Maintain hydration, encourage to drink water at least 2liter per day.
• Administer oxygen if cyanosis present.
• Provide frequent mouth care.
• Isolate if any infection present.
Problems affecting the respiratory system
cont..
• Provide postural drainage to bring out the secretions.
• Serve small and frequent feeds
• Provide psychological support, adequate treatment for disease condition, help to
perform ADL.
• Daily assessment for vitals, cyanosis, crepitus.
• Additional activities that help older adults maintain adequate respiratory function
include regular exercise, appropriate fluid intake, pneumococcal vaccination, yearly
influenza immunizations, and avoidance of people who are ill.
• Hospitalized older adults should be frequently reminded to cough and take deep
breaths, particularly postoperatively, because their decreased lung capacity and
decreased cough efficiency predispose them to atelectasis and respiratory infections.
 Problems affecting the endocrine system
• Unnoticed injury to feet due to altered sensory perception related to diabetes mellitus.
• Daily examination of limbs for cuts, blisters, reddened areas, scratches etc.
• Do not allow the client to walk bare foot.
• Use well fitting shoes and socks.
• Keep the feet clean and dry always.
• Give greater attention to the areas between toes.
• Cut short nails (finger & toes) to prevent scratches and causing injury.
• Care must be taken not to cause injury while cutting nails.
• Soak the nails in water before cutting.
• Check the temperature of the water given for bath to prevent scald.
 Problems affecting the endocrine system
• Unnoticed injury to feet due to altered sensory perception related to diabetes mellitus.
Cont………….
• Control of diabetes mellitus through regulation of diet in case of non-insulin dependent
DM. teach the client and his relatives with the help of brochures.
• Check the urine/blood periodically for sugar to evaluate dietary control.
• Encourage some exercise to control blood glucose level and improve circulation to limbs.
Discourage smoking, since smoking reduce circulation to lower extremities.
• Give psychological support.
 Problems affecting the endocrine system
• Hypoglycaemia due to depletion of glucose among insulin dependent clients
• Prompt action can protect the client from going into insulin coma.
• Administer sugar drinks if the client is conscious, if unconscious administer I.V. glucose
• Teach the client and relatives about the signs and symptoms of hypoglycaemia (profuse
sweating, convulsions, disorientation, unconsciousness etc.)
• Teach the client to stock small amount of sugar always with him/her.
• Demonstrate administration of insulin.
• Clients with diminished vision should avoid self administration of insulin.
• They should seek help to prevent overdose.
 Problems affecting the gastrointestinal system
• Altered gastrointestinal function due to anorexia (loss of appetite), dyspepsia
(indigestion), nausea, vomiting, regurgitation (backflow), dysphagia (difficulty in
swallowing), choking, aspiration of gastric content into the respiratory passage,
constipation, inadequate/over nutrition, greater sensitivity to medications causing
diarrhoea, sedentary lifestyle, etc. related to aging process and disease condition.
• Assess the ability to swallow the food, before start feeding.
• Try with a sip of water.
• Position in an upright position
• Always keep a suction apparatus ready to use in case of aspiration
• Create a pleasing surrounding and serve food attractively
• Give mouth care before and after every feed
• Encourage a small bite of food every time to prevent choking.
• Give liquid and solid food alternatively
 Problems affecting the gastrointestinal system
• Altered gastrointestinal function due to anorexia (loss of appetite), dyspepsia
(indigestion), nausea, vomiting, regurgitation (backflow), dysphagia (difficulty in
swallowing), choking, aspiration of gastric content into the respiratory passage,
constipation, inadequate/over nutrition, greater sensitivity to medications causing
diarrhoea, sedentary lifestyle, etc. related to aging process and disease condition.
Cont…………..
• Place the food in the mouth on the unaffected side, if the client is hemiplegic.
• Give small frequent feeds. Check the body wt. to evaluate adequacy of food intake.
• Encourage 1.5 to 2 litre water intake per day to prevent constipation
• Assess for periodontal disease, gingivitis, halitosis (bad breath), peptic ulcer, hiatus hernia,
ulcerative colitis etc. that affect the ingestion, digestion and assimilation of food.
Problems affecting the gastrointestinal system ...
• Practices that promote gastrointestinal health include regular tooth brushing and
flossing;
• receiving regular dental care;
• drinking sufficient fluids;
• eating small, frequent meals that are high in fiber and low in fat;
• avoiding heavy activity or lying flat after eating;
• and avoiding the use of laxatives and antacids.
• Understanding that there is a direct correlation between loss of smell and taste
perception and food intake,
• helps caregivers intervene to maintain the nutritional health of older patients.
Problems affecting the gastrointestinal system...
• Mealtime should be kept simple and calm.
• Provide familiar foods that look appetizing and taste good.
• Cut food into small pieces to prevent choking.
• Liquids may be easier to swallow if they are thickened.
• Hot food and beverages are served warm, and the temperature of the foods should be
checked to prevent burns.
• When lack of coordination interferes with self-feeding, it may become necessary to
feed the patient.
• Forgetfulness, disinterest, dental problems, lack of coordination, overstimulation, and
choking all serve as barriers to good nutrition and hydration.
 Problems affecting the Genito-urinary system
• Retention of urine related to lack of privacy, decreased production of urine,
administration of narcotics, anaesthesia effect, presence of urinary catheter, spinal
injury, faecal impaction, surgery on the pelvic organ and perineum, lack of pelvic
muscle tone, muscle spasm, prostrate hypertrophy, urethral stricture etc.
• Provide privacy (unless contraindicated, leave alone) .
• Unless contraindicated, allow the client to resume normal position.
• Provide clean bathroom, clean; warm and dry bed pan.
• Offer urinal or bedpan at regular intervals (4 hourly).
• Open the tap and let the water flow freely.
• The sound of running water stimulates the micturition.
Problems affecting the Genito-urinary system
• Retention of urine related to lack of privacy, decreased production of urine,
administration of narcotics, anaesthesia effect, presence of urinary catheter, spinal
injury, faecal impaction, surgery on the pelvic organ and perineum, lack of pelvic
muscle tone, muscle spasm, prostrate hypertrophy, urethral stricture etc.
cont…………………
• Pouring cold water on perineum, applying ice pieces onto the inner aspects of the
thigh, sitting on the commode keeping the feet in the basin filled with water,
• gentle stroke on the lower abdomen stimulate urination
• Give enough time for voiding, never show hurry.
• Provide psychological support.
• Provide simple diuretics as fluids, lemon juice, weak tea etc.
• Correction of the underline cause is necessary.
• Catheterisation if ordered under strict aseptic way.
Problems affecting the Genito-urinary system
• Retention with overflow (partial incontinence or dribbling of urine after micturition)
related to sphincter damage caused by surgery on the pelvic organs, weak perineal
muscles (due to child birth), tumours such as prostrate glands, fibroid uterus, faecal
impaction, continuous cough, anxiety, effect of medication, urinary tract infection etc.
• Establish a regular voiding schedule e.g. offer bedpan or urinal every 2 hours, whether
the client demand or not.
• Male client may keep the urinal in position while he is in bed.
• Those who can walk, may do some active exercise to improve muscle tone of the
perineum and abdominal muscle.
• Application of condom drainage may help the male clients to prevent bed wetting.
Problems affecting the Genito-urinary system

• Complete incontinence related to neurological disorder, paralysis of the body,

unconsciousness, effect of medications such as narcotics, sedations.
• Provide special care to prevent bedsore.
• Provide back care and change position every 2 hourly.
• Change the bed linen as necessary.
• Self retaining indwelling catheter may be inserted with the permission of the physician
and connected to a sterile uro bag.
Problems in general
• Inability to perform ADL due to poor physical health related to aging and disease
condition.
• Asses the ability to perform ADL. Relive anxiety.
• Assist in such a way that client should feel that he/she has done everything by self.
• While assisting in performance of ADL,
• teach the client and family to perform those activities.
• Conserve energy by giving resting period in between.
• Stop any procedure for some time and give rest, whenever the client complaint of any
type of discomfort.
Problems in general
• Isolation from the social life due to poor physical health, disease, non-cooperation
from family leading to depression.
• Never leave the client alone. Provide re-assurance.
• Provide clean and appropriate dress suitable for the occasion.
• Educate the family to send the aged people to various social activities to reduce
boredom and depression.
• Provide assistive devices e.g. hearing aid, walking device, spec etc.
• Socialization with friends can be comforting, visits, and phone calls are encouraged.
Problems in general
• Isolation from the social life due to poor physical health, disease, non-cooperation
from family leading to depression. Cont…
• Recreation is important, and people with dementia are encouraged to participate in
simple activities.
• Hobbies and activities such as walking, exercising, and socializing can improve quality of
life.
• The nonjudgmental friendliness of a pet may provide stimulation, comfort, and
contentment.
• Care of plants or a pet can also be satisfying and an outlet for energy.
Problems in general
• Cessation of smoking and alcohol abuse which is harmful for leading a normal life.
• Never compel the person to stop all of a sudden.
• First of all make the person aware of its ill effect on their health.
• Undoing a habit is done by replacing with such activities helpful for a healthy life.
• Teach the family about withdrawal symptoms and to take medical assistance in such
situation.
• Provide plenty of recreational facilities.
• Reassure and appreciate for the little success in the recovery process.
Problems in general
• Increased susceptibility to infections due to reduced immunity
• Build up general health to improve the immunity.
• Make sure the diet contain all the essential nutrients.
• Avoid cross infection
• Restrict visitors if any one suffering from contagious disease.
• Use barrier nursing.
• Have regular medical check up to identify and treat any disease condition in its earlier
phase.
Problems in general
• Take longer to become sexually aroused, longer to complete intercourse, and longer
before sexual arousal can occur again.
• Many nonpharmacologic, pharmacologic, and surgical methods are available to improve
sexual relationships.
• Assessment and communication require sensitivity and expert knowledge in the field of
sexual dysfunction.
• If sexual dysfunction is present, referral to a gynecologist, urologist, or sex therapist may
be needed.
Community Care
• Identify health, social or economic needs.
• • Refer elderly person to professional or agency best able to meet needs.
• • Explain diagnosis and treatment to the patient and family
• • Evaluate compliance with and response to treatment.
• • Use clinic and home visits for health promotion.
• • Teach and advise patient and family
• • Evaluate elderly person’s ability to live independently
• • Become advocate for elderly persons
• • Encourage elderly to become advocate on his own self.
 Health promotion activity
• Regular medical check up.
• Adequate and appropriate treatment of diseases.
• Adequate nutrition.
• Good personal and environmental hygiene.
• Good personal appearance (clean and appropriate dress, daily shaving, cutting of
hair)
• Providing adequate time for rest and sleep.
• Assistance in meeting the activities of daily living (ADL).
 Health promotion activity cont…
• Passive and active exercises.
• Daily walking, jogging etc. as the health permits.
• Participation in the outdoor and indoor games.
• Participation in the household works.
• Encouragement to participate in those activities he/she is used with.
• Rehabilitation of the physically handicapped.
ANY QUESTION ????
HAVE A GOOD DAY
S