GERIATRIC

OR
GERONTOLOGICAL
NURSING
OR
GERIATRIC CARE

Presented by
Manoj Kumar Garg
INTRODUCTION
Childhood, youth, adulthood and old age are different
stages of life. With increasing age we become old. Birth,
development, decline and death are the laws of life. Whether we
want it or not, we have to pass through these stages. Old age is
also one part of this cycle.

What is ageing?
Old age or ageing expresses the continuous pressure and
effect of time on our body, senses and skin. Due to continuous
functioning, the cells, tissues and organs of our body degenerate.
In the later part of life, we have to face many physical and mental
problems. Hence old age is the result of physical and
psychological fatigue caused by continuous functioning. Just like
problems or defects occur in machines due to continuous
functioning, or workload, with increasing age, problems also arise
in human body.
Manoj Kumar Garg
 Ageing and Demography
Large number of aged people in the population is the
result of demographic change.
The number of people above 60 years is assessed to
be over 49 crores in world. By 2040, their number
will be 140 crores. (According to the prediction of
(W.H.O).
As compared to old men, there are more old women.
Because of the increasing number of old people,
many socio-economic problems are arising. The main
problems are of housing, their livelihood and medical
treatment.
French doctor Jean Martan Carcot was the first
person who had studied about old age diseases, in the
year 1881. Manoj Kumar Garg
 National Policy for Older Persons

The Government of India in January-1999

announced the National Policy for older persons. The
principle areas of intervention and action strategies
suggested in the policy sector include the following:
Financial security for older persons working in the
formal sector as well as those working in the informal
sector.
Health care and nutrition to enable older persons to cope
with the health, associated with ageing, with particular
emphasis on prevention.
Shelter/housing keeping in view the life style of older
persons.
Emphasis upon education, training and information needs
for older persons.
Priority attention to vulnerable groups such as the
destitute, widows and disabled older persons.
Manoj Kumar Garg
 Establishment of welfare fund for older persons.
Protection of life and property of older persons.
Concessions, rebates and discounts to older persons.
Participation of NGOs in the care of aged.
Strengthening the family and reinforcing inter-
generational relationship between children and older
persons.
Formation of self-support group of older persons.
Development of the manpower for the caring of
aged.
Creative use of media in the sector for care of old
persons.
Establishment of a separate bureau for older persons
in the ministry`
Manoj Kumar Garg
Gerontology
This is a science dealing with ageing
process.
Geriatric Care
This is related to the disease process of
old age and it aims at keeping old persons at a
state of self-dependence as far as possible and to
provide facilities to improve their quality of life.
Gerontoiogical Nurse-
A nurse who has specialization in geriatrics
or in the care of old people is called geriatric
nurse or gerontoiogical nurse.

Manoj Kumar Garg

 Functions of Gerontological Nurse
G (Guiding): Giving guidance to people of all ages regarding ageing process.
E (Eliminating): Eliminating ageism or considering old age as disease.
R (Respecting): Respecting the rights of old people.
O (Observing): Observing the facilities provided to old people and improving
them.
N (Noticing): Noticing health hazards that may happen in old age and try to
reduce them.
T (Teaching): Teaching how to take care of old people, for those who are
caring for them (family members, friends, community health worker,
voluntary organization, etc.).
O (Opening Channels): Opening the channels of developmental activities for
the care of the aged.
L (Listening): Listening attentively to the problems of old people and giving
due importance to them.
0(Offering): Offering positivism Presenting different possibilities of life.

Manoj Kumar Garg

 G (Generating): Generating energy for the participation in the care of
aged and researches for new supporting techniques.
I(Implementing): Implementing activities for rehabilitation and re-
adjustment.
C (Co-coordinating): Co-coordinating different services related to the
care of the aged.
A (Assessing): Assessing the needs and health of the old people.
L (Linking): Linking, contacting services according to need.
N (Nurturing): Preparing future nurses for the care of the aged
U (Understanding): Understanding every old person as an invaluable
asset of the society.
R (Recognizing): Recognizing the moral and religious aspects of old age
and giving them recognition.
S (Supporting): Supporting the old people in accepting realities and
preparing them mentally for impending death.
E (Education and Encouraging): Educating and encouraging old people
for self care.
Manoj Kumar Garg
 Factors Affecting Ageing
Hereditary Factors
Hereditary diseases, the capacity for longevity
and physical capacities influence the ageing process.
Environmental Factors
Three types of environmental factors affect ageing:
a) Abiotic Factors
Factors affecting ageing process like climate, radiation, chemical and
physical elements of pollution, etc. are included in this.
b) Biotic Factors
In this, living organisms present in the environment like pathogens,
parasites, the availability and quality of food etc. are included. They
all influence the ageing of the person.
c) Socio-economic Factors
Several socio-economic factors responsible for creating adverse living
or working conditions increase "the wear and tear" of life. Such
tensions make people grow old early.
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 Common Ageing Changes
A. Physical Changes-
Changes, which may occur in different systems, are as follows:
1. Integumentary System
Decrease in elasticity of skin and dryness appears
Wrinkles appear
Age spots appear
Hair of head, axilla or pubic region become scanty grey/white
Hair growth on women's face
Thickening of nasal hair and hair on ears
2. Cardiovascular System
Less blood circulation in heart
Increased blood pressure
Flexibility of heart valve diminishes
Blood vessels of head, neck, hands and legs become prominent.
3. Respiratory System
The capacity of lungs becomes less.
Ineffective gas exchange
The chances of cough increases
More chances of respiratory infections Manoj Kumar Garg
4. Genito-Urinary System
The kidney function may be impaired
Fluid and electrolyte imbalance
Capacity of urinary bladder decreases
Incontinence
Enlargement of prostate in males
Atrophy of reproductive organs in females
Vaginal secretion decreases
5. Gastro-intestinal System
Falling of teeth
Less secretion of saliva and gastric juice
Complaints of constipation
Digestion becomes weak
6. Musculo-Skeletal System
Height reduces (In most of persons above 70 years height decreases
unto two inches)
Kyphosis, swelling in joints
Bones become weak
Mobility decreases, if proper exercise is not done

Manoj Kumar Garg

7. Endocrine System
Thyroid gland becomes less active
Alertness decreases
More susceptible to cold
Secretion of testosterone, oestrogen, progesterone decreases.
Less secretion of insulin by pancreas
8. Neurological System
Sensitivity becomes less/reaction is delayed
Change in sleeping habits
Frequent awakening
9. Sensory System
Eyes become weak
Hearing capacity decreases
Complaint of presbyopia
Ability to smell is reduced
Ability to taste is reduced
Tactile sensations are affected
10. Immune System
Ability to prevent diseases or resistance power decreases
Probability of infections increases

Manoj Kumar Garg

Manoj Kumar Garg
B. Psychosocial Changes
The psychosocial changes occurring in old age cannot be
separated from physical changes. Because of decreased activity
of sensory organs, person is not able to work with full efficiency
in his environment. Due to this, psychosocial state is affected.
Person feels the sense of 'uselessness'. Social and psychological
changes of old age are as follows
1.Personality
Because of the experiences and happenings of life, person's
personality is affected. But in old age, no remarkable changes
occur in the basic personality structure. Changes may occur in
the personality due to death of life partner, decreased or end of
self-dependence, loss of source of income, incapacity, etc.
2. Memory
Memory power may decrease with increasing age. Recalling
of less frequently used information is difficult. In some old
people, the tendency to repeat facts and information increases.
Confused memory also may be found. Manoj Kumar Garg
3. Intelligence
If the old person is not sick, usually his intelligence is not
affected. Because of old age person neither becomes more
intelligent, nor less intelligent; yet because of the increase in
knowledge and experience, the person's status of intelligence
becomes more fertile.
4. Sexuality
Physical incapacity, less secretion of hormones, degeneration of
reproductive organs, lack of privacy, hesitation or death of life
partner, ignorance relating to sexuality in old age, etc. affects the
sexuality of persons in old age. This is to be remembered that in
old age sexuality, attachment, warmth, intimacy and emotions
are more important than physical act.

Manoj Kumar Garg

Some Forms of Old Age Abuse
Old people may have to undergo a lot of neglect. Some main
forms of neglect or abuse are following:
Physical Abuse
Beating and physical punishment
Sexual abuse
Restraining or locking them in the house
Teasing them for physical conditions or diseases
Psychological Abuse
Giving mental torture
Abusive language
Calling by names (disrespectful words like old man etc.), making
fun of them, threaten them.
Forced isolation
Treat them as children
Material Abuse
Snatching their property illegally
Economic exploitation
Misuse or wasting their property for personal pleasures
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Active Neglect
Not providing food purposely or giving less food
Neglecting their likes and dislikes
Spoiling or removing their dentures, glasses, hearing aid
etc.
Forbid them to play with grand children
Encouraging grand children to insult grand parents
Passive Neglect
Become lazy or neglecting the care of old people.
Neglect may be due to ignorance also.
Social Abuse
Neglecting their advice
Overlooking their experiences
Not providing them proper place or
honour on social occasions. Manoj Kumar Garg
Adjustment in Ageing
a. Family Changes :
Family is such a unit through which maximum satisfaction
may be obtained. But in old age the person's family status is
changed. A father, who was the chief of the family till now,
may have to become dependent on his children. A mother
may have to subject herself to the rule of daughters-in-law. If
one of the partners is dead, the other has to face loneliness.
The decision making process in the family changes and the
control is transferred.
b. Retirement
In Indian context, retirement is a symbol of old age. In the
retirement process, the person may pass through the following
phase:
1. Remote Phase
Even when retirement is near or approaching, person does not
get ready for it.
2. Near Phase
When retirement is very near, making imaginary plan
Manoj Kumar Garg for it

(day dreaming)
3. Honeymoon Phase
Just after retirement person wants to do all those
things, which he could not do so far or was always
desirous of doing. But health and financial resources may
cause problems (not in all people) in fulfilling his dreams
or imaginations.
4. Disenchantment Phase
The problems/realities of retired life may dispirit the
person. His excessive dream regarding retired life may
result in more disappointments. At this stage, person may
begin to come out of false imaginations.
5. Stability Phase
Person understands the realities of retired life. He
makes adjustments to his new roles.
6. Termination Phase
This happens either by taking up some work again or
due to illness or incapacity.
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Responsibilities of Nurse in Ageing

Care giver
Health educator
Coordinator of health services
Counselor and guardian (Those people who
protect the old person or take responsibilities
as his guardian, spokesman or responsible
person).

Manoj Kumar Garg

 FUNCTION OF NURSE
1. Health Assessment
Daily activities of living (bathing, excretion,
clothing, urinary control, ability to eat etc.).
Activities related to use of equipment (Telephone,
bank account, food preparation, etc., his ability in
these activities).
Health Screening: Ability to see and hear, dental
problems, blood pressure, examination of breasts and
uterus, cancer testing, examination of skin, etc.
should be done.
In laboratory tests; blood examination, urine
analysis, cholesterol, blood sugar, thyroid, etc. tests
should be conducted
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2. Arranging / Promoting Good Nutrition
3. Promoting Activity and Exercise
4. Providing Psychological Support
5. Preventive Care of Elderly
Protection from unhealthy environment
Protection from mental tensions
Special care of personal health
Protection from physical and mental injuries, threats
and fatigue
Providing rehabilitation services

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Ageing: New Nursing Challenges
Gerontological psychiatric nurse specialist in old age
home and nursing homes.
Care manager and family counselor of chronic old
patients in the community.
Pre admission assessor of nursing homes hospitals.
Nurse Director of old age care giving training centre,
old age day care centre.
Counselor of old patients in surgical wards.
Pre-retirement counselor / educator.

Manoj Kumar Garg

 Theories of Aging:
Biological Theories:
Intrinsic Factors: Several theories assume that individuals inherit a
genetic program that determines their specific life expectancy. In fact,
various studies have shown a positive relationship between parental
age and filial life span. Genetic mutations are also thought to be
responsible for aging, a pattern depicted below, laboratory experiments
which have accelerated mutation rates have not produced proportionate
increases in the rate of aging, thus reducing support of this theory.
Some theorists believe that a growth substance fails to be produced
causing the cessation of cell growth and reproduction.
Extrinsic Factors: Disease producing organisms are often associated
with biological aging. Bacteria, fungi, viruses, and other organisms are
thought to be responsible for certain physiological changes during the
aging process. Although no conclusive evidence presently exists to link
these pathogens with the aging process, interest in this theory has been
stimulated by the fact that humans and animals have been shown to
live longer with the control or elimination of certain pathogens via
immunization and the use of antimicrobial drugs.

Manoj Kumar Garg

 Psychological Theories:
Psychological and social changes during the aging
process are closely united, and they have a significant impact
on each other. It is difficult to explain mental processes,
behavior and feelings without the perspective of social roles,
positions and norms. A theory of aging that is purely social or
psychological would be most unusual, and it is more
appropriate to approach these aging factors as psychosocial
theories. Probably the most controversial and widely
discussed is the disengagement theory, developed by Elaine
cumming and William Henry. This theory views aging as a
process whereby society and individual gradually withdraw or
disengage, from each other, to the mutal satisfaction and
benefit for both. The benefit to individual is that they can
reflect and be centered on themselves, having been freed from
societal roles. The value of disengagement for society is that
some orderly means is established for the transfer of power
from old to young, making it possible to society to continue
functioning after its individual members have died.
Manoj Kumar Garg
 Bibliography:
Springhouse, mastering geriatric care, USA.1997.1-
447.
Charlotte Eliopoulos, Geriatric nursing, UK.1-335.
Park.k, Preventive and social medicine, 19th edition,
India (Jabalpur).2007; 475.
Gulani k, Community health nursing principles and
practices. Delhi; 469-472.
www.google.com
Search-Geriatric care.

Manoj Kumar Garg