GERIA NOTES

Older Adults:
Young Old - 65-74 years old
OUTLINE
Middle Old - 75-84 years old
Old Older - 85+ years old
I Terminologies
Presently 12.8% of the population
II Attitudes towards aging
2030: Will increase to 20% of the population
III Myths about aging
IV Theories of Aging
Attitudes Towards Aging
A Biological Theory
• Many elderly buy into the notion that they
i. Intrinsic Biological theory
themselves are no longer useful and are a burden
ii. Extrinsic Biological theory
to others.
B Psychosocial Theory
• The aging make little attempt to keep themselves
C Normal Aging Process
healthy and active after all, they are getting closer
V Socioeconomic Aspects of Aging
to the end of their lives.
A Age Cohorts
• They have no desire to try new things or to
B Poverty
challenge themselves or to eat or exercise
C Education
properly.
D Health Status
E Insurance Coverage • There is a great deal of research that
F Support System demonstrates aging individuals can learn, retain
VI The Aging Family memory and be actively involved in business and
VII Roles and Relationships their community.
VIII Changes in the older person and their implication • A lack of physical exercise, social involvement
to care and mental stimulation in older adults often leads
IX Patterns Of Health & Disease In The Older Adult to deterioration of minds and their bodies.
X Comprehensive Geriatric Assessment • The older person’s negative attitude towards
aging become self-fulfilling.
• Many studies show older people who are
physically active have less joint pain, lower BP,
less depression, fewer heart attacks and lower
TERMINOLOGIES
incidence of CA.
• Proper nutrition also has the same effect on the
Elderly: old aging
aging process; it delays the progression of
Aging: part of life changes that occurs as one grows older
debilitating illness or disability.
or maturation process; inevitable and steadily progressive
• Recent research even suggest that weight loss
process that begins at the moment of conception and
and exercise can reverse the severity of diabetes.
continuous throughout the remainder of life.
Geriatric: The term comes from the Greek meaning
Lack of Social Stimulation can also lead to Poor
“GERON” means “old man” & IATROS meaning “healer
Mental Health
or medicine”.
• Having interest in something not only stimulates
Geriatric means related to caring for old people.
an older person’s mind but also creates a better
Gerontology: means study of all aspects of the aging
mental attitude which results often in better
process & its consequences in humans, the scientific
health.
holistic study of the aging process & problems of aging.
• There is empirical evidence that using ones brain
Gerontology Nursing: Gerontological nursing is the
may prevent dementia in older age.
branch of nursing/specialty of nursing pertaining to older
adults. •

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MYTHS ABOUT AGING Driving

• Most older people feel miserable and depressed Myths:
most of the time. • Older drivers have most of the driving accidents
• Older people cannot work as effectively as Facts:
younger people. • Older drivers have fewer accidents per mile
• Older people cannot learn complex new skills and driven and tend to avoid speeding and driving at
experience. night. However, people over 70 are more likely to
• Most older people are sick and need help with die from crash injuries and should have their
daily activities. vision and hearing checked regularly.
• Older people are set in their ways and cannot AIDS
change. Myths:
Impaired Memory • Older people don’t need to worry
Myths: Facts:
• Most people aged 65 and older believe that they • Older people need to take the same precaution
have moderate and severe memory impairment. as younger people do. AIDS can happen to
• Moderate or severe disability somebody more than 50 years old.
Facts:
• Although short-term memory declines, long term Personality
memory remains fairly intact. Myths:
• A majority are not disabled. • Tend to become slow, grumpy (bad tempered
and miserable) and set in their ways
Learning New Tricks Facts:
Myths: • One of the constants of life; as people age they
• You can’t teach an “oldie” new tricks are likely to behave much compared to their adult
Facts: life. Age related changes don’t affect the ability to
• Older People can learn if given a bit more time. enjoy life.
They are more detail-oriented and careful. • Personality seems to be changing significantly. It
Sexuality might be due to sensory changes, depression
Myths: and reactions to medications or diet, lack of
• Older people have no interest or capacity for sex exercise, lack of sleep or boredom about getting
Facts: old and money.
• Although sexual capacity declines with age, it
does not disappear. Intimacy remains important Other Facts:
throughout our life. • Physical Activity - Exercise is imperative; can
Physical Activity reverse the severity of diabetes
Myths: • Falls - Common in seniors; fear of falling may
• Too old to take part in exercise or weight lifting lead to falls.
programs and it could actually hurt them. • Isolation - Isolation may lead to depression
Facts: • Gerontophobia – Fear of aging; getting old; of
• Physical activity at any age can strengthen your the elderly
heart, lungs, muscles; can lower your BP and • Ageism - Stereotyping and descriptions against
help slow bone loss. an individual or group on the basis of their age;
On Smoking this may be systematic or casual; coined in 1969
Myths: by Robert Neil Butler to describe discrimination
• Too late to stop smoking against seniors and patterned on racism and
Facts: sexism.
• Never too late to quit smoking • Butler defines ageism as a combination of three
Sleep connected elements; prejudicial attitude towards
Myths: older people and the aging process;
• The older the person gets the less sleeping they discriminatory practices against older people;
need. and institutional policies and practices that
Facts: perpetuates stereotypes about elderly people.
• Still good sleep and hygiene

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Negative discriminatory practices among people •

Factors Include:
of old age or “Age-Related Bias.” o Income
o Health Care
Cultural Factors/Ethnicity Respect and Health
o Poverty
Perception for Older Person
o Religious and spiritual beliefs
Respecting Cultural Diversity
• Each culture of elderly brings a unique history
• LISTEN to concerns
that has shaped and formed who they are and
• SHARE knowledge and build MUTUAL
how they view around them.
UNDERSTANDING
• There are common influences that cut across
• SEEK collaborative solution
racial lines however looking at cultural and racial
• RESPECT cultural diversity
concerns one must identify the cultural meaning
• Identify and build upon STRENGTHS.
and the dynamics of the aging process within
• Set children up for SUCCESS in learning
specific minority groups.
Where We Are Now • SHARE and CELEBRATE successes
• Current generation of the elderly as the “Quiet
PREPARING FOR OLD AGE “Preparing for the Golden
Revolution” defining them as a revolution of
Years”
older individuals representing the broadest range
Four Essential Preparations for Our Rusty Years
of ethnic, cultural, regional, religions, political and
1. Planning For the Stages Of Decline
socioeconomic diversity ever witnessed in a
2. Initiating Family Planning Conversation
certain society.
3. Making End-of-Life Arrangements
• “Kanlungan ni Maria Home for the Aged” in
4. Getting our Financial Ducks in a Row Portable Stage
NCR.
of Elder Decline
• “DSWD” – Home for the elderly Talon-Talon
Portable Stage of Elder Decline
Zamboanga City.
• As a result of poor adequate resources among
the poor, life expectancy is six years less than
other populated groups. Twice the total
population for elderly in the Philippines in favor of
living with relatives this is based on the idea of
*familia* “family is forever”. THEORIES OF AGING
Social factors among families include:
1. Biological Theory
1. High percentage that live below poverty level
• Attempts to explain physical aging as an
2. Inadequate health care brough by poverty cultural
involuntary process, which eventually leads to
factors
cumulative changes in cells, tissues & fluids.
3. High illiteracy rate
• 2 SUBTYPES:
4. Low occupational levels resulting from few
o Intrinsic biological theory
benefits and retirement plans.
o Extrinsic biological theory
Intrinsic Biological Theory
Traditional Asian culture often observes a form of “filial
• It maintains that aging changes arise from
piety” which demands family members, usually the eldest
internal predetermined causes.
son, to respect, care for and assume responsibility for
Extrinsic Biological Theory
elder parents. Unfortunately, this traditional attitude of
• It maintains that environmental factors leads to
respect often clashes now with dominant American
structural alterations, which in turn, cause
values.
degenerative changes.
- This cultural clash results in 75% living with their
children dropped to 66% lately. 66% lately.
Free-Radical Theory
Where We Are Going • Developed by Dunham Hartman MD in 1956.
• For the general population the implication for the • Free-radicals are molecules with an extra cellular
aging population will require competent individual charge, which alters the structure & function if the
training to respect and work with such a diverse cell membrane.
group.

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• Increased unstable free-radicals produces 2. Psychosocial Theory

harmful effects to biological systems, such as Disengagement Theory
Chromosomal & DNA changes. • Formulated by Cummings & Henry
• Oxidation of fat, proteins, & carbohydrates within • States that aging people are withdraw from
the body produces the free-radicals customary role & engage in more introspective,
self-focused activities.
Cross-link Theory/Connective Tissue Theory • Decrease participation in society resulting from
• The theory asserts that the molecules of collagen age related changes in health, energy, income &
& elastin, connective tissue components, from social roles.
bonds that increase the cell rigidity. • This theory includes 4 basic concepts:
• Chemical reaction occurs as a chemical bond o Aging person withdraw from society.
between cells it will separate normally bonded o Disengagement is biologically &
cells. psychologically intrinsic & inevitable.
o Disengagement is considered necessary
Immunological Theory for successful aging
• Some theorists suggest that the immune system o Disengagement is beneficial for older
is responsible for aging. An aging immune system adults & society.
is less able to attack & destroy body cells as if
they are foreign cells (antigen). Continuity Theory/Development Theory
• It results in destroying own body cells through • Personality remain same & behavior become
auto aggression or immunodeficiency. more predictable as people age.
• Mainly focus on personality and individual
Error Theory behavior over time.
• Focus on decreased bonding of protein cells in
response to stressors such as radiation. This Activity Theory
leads errors in synthesis of RNA & DNA… • The maintenance of optimal physical, mental &
social activity is necessary for successful aging.
Wear & Tear Theory
• Body cells, structures & function wear out through Adjustment Theory
exposure to internal & external stressors. • Defines aging as serious of adjustment to
Inherent in this theory is the idea that the more retirement, to grand parenthood, to changes in
you abuse your body, the faster it will wear out. income, to changes in social life & marital status
• Example: More stressors (taking more weight) in & to potential deterioration of health & wellbeing.
younger age ultimately to tearing like spinal cord
or joint problems. Gerotranscendence Theory
• Meaning of life is clear.
Genetic Theory/Gene Theory • Aware of Gods purpose; prayerful; training
• Lifespan is largely determined by the genes we younger people; more on what you can give to
inherit. others.
• According to the theory, our longevity is primarily
determined at the amount of conception and is Age Stratification Theory
largely reliant on our parents and their genes. • Group together as one Eg. (bingo socials, prayer
meetings.)
Neuroendocrine Control/Pacemaker Theory, Aging
Clock; Hormone Theory Selective optimization with Compensation Theory
• Results from the functional perturbations both in • Strategy for improving health and well-being in
neuronal control and endocrine output of the older adults and a model for successful aging
hypothalamic pituitary adrenal glands and their thing’s you can’t do before, you compensate
target organs. doing similar.
Person Environment Theory
• Providing a safe place to live to elderly according Functional Consequences Theory
to their needs, wants, providing opportunities and • Focuses on the needs that are unique to older
freedom. individuals.

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• It proposes the ability of older adults to maintain

maximal care is affected by the interaction of 2. POVERTY - inadequate income may affect the quality
normal age related changes additional risk of life for older adults. - delay seeking medical help. -
factors the individual encounters. may not follow through with the prescribed treatment
or medications.
Theory of Thriving - Poverty is considered a risk factor for declines in mental
• Good gerontological theory that integrates health among older people. Those at the lower level
knowledge, tells how and why phenomena are of socioeconomic status are often most likely to be
related leads to prediction and provide process diagnosed with psychological disorders like
and understanding. depression.
• Based on these criteria, the authors created this
theory with a holistic lifespan perspective for 3. EDUCATION - has been shown to have a strong
studying people in their environments as they relationship to health risk factors. The level of
age. education influences earning ability, information
absorption, problem-solving ability, value systems,
and lifestyle behaviors
Normal Aging Process - The level of education can affect the socioeconomic
Factors which influence aging: status of the adult. Those with higher education
1. Hereditary factors attainment tend to have more money and higher
2. Environmental factors: standard of living of course because they were
- Abiotic factors (Like pollutants, radiation etc…) employed during their younger years.
- Biotic factors (like living organisms.)
3. 3. Socio economic factors: like stressors 4. HEALTH STATUS - The health status of older
adults influences their socioeconomic
Socioeconomic Aspects of Aging status. Persons over 65 have an average of 2 chronic
• Socioeconomic aspect status of aging can affect conditions.
the psychological health of the aging individuals. - The most common chronic problems are arthritis (50%),
followed by hypertension (36%), heart disease
1. Age Cohorts - Persons who share the experience of a (32%), hearing impairments (29%), cataracts
particular event or time in history are grouped (17%), orthopedic impairments (16%), sinusitis
together in what is called a cohort. (15%) and diabetes.

Cohort - when we say cohort, this is a group of individuals - Functional Ability is measured by the individual’s ability
having a statistical factor such as age or class. to perform ADLs and instrumental activities of daily
living (IADLs).
a) Ages 55 to 64 - Person in this age group are generally - ADLs include six personal care activities: eating,
healthy and have resources to maintain housing toileting, bathing, transferring, dressing, and
b) Ages 65 to 74 - Older adults ages 65-74 are usually continence.
retired already so basically retirement causes income - IADLs refers to the following home-management
to decrease by about 35% or more, this reduction in activities: preparing meals, shopping, managing
income often offset by reduced expenditures money, using the telephone, doing light housework,
associated with working such as transportation, doing laundry, using transportation and taking
clothing and meals since they home na lang. medications appropriately. Nurses who work with
c) Ages 75 to 84 - Many people in this age group live older adults with prolonged independence by
alone, which affects their average household income. encouraging them to have self-management of
d) Ages 85 and older - This age cohort or group is chronic conditions.
already at risk for an increase in chronic diseases, - Self-management is learning and practicing the skills
resulting in decreased ability to perform daily necessary to carry on an active and emotionally
activities of daily living and increased expenses for satisfying life even if they have these chronic
assistance, assistive devices and medications. illnesses.
ADL - these are activities of daily living like bathing, eating
IADL Instrumental activities of daily living- things you do 5. INSURANCE COVERAGE - Health insurance is a
everyday not only to take care of oneself but also necessity for older adults because of medical
includes taking care of your home.

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problems- therefore medical expenses- increase with - The health of our older citizens can best be protected
age. and improved by both supporting and educating
the family as the primary vehicle for maintaining the
6. SUPPORT SYSTEMS - throughout life, people make health and well-being of all members of our aging
new acquaintances, develop friendships, and form society.
family circles. People identify with schools, churches, - The family of the elderly is the support system that
clubs, neighborhoods, and towns. These are the renders care and gives LOVE, STRENGTH, and
places and people they turn to when they need advice HOPE in the life of an individual chronically ill patient.
or help, want to celebrate, or are grieving. - This family could be the spouse, brothers, sisters and
sons/daughters.
THE
THEAGING
AGINGFAMILY
FAMILY
CHANGES IN THE OLDER PERSON AND THEIR
IMPLICATION TO CARE
What is a Family?
a basic social unit consisting of parents and their children, 1) Aging changes in Cardiovascular Structure
considered as a group, whether dwelling together or A. Cardiac Aging
not: the traditional family. - Enlargement of heart chambers and coronary cells
- a social unit consisting of one or more adults together occurs with age, as does increased thickening of the
with the children they care for: a single-parent family. heart walls, especially in the left ventricle.
- Any group of persons closely related by blood, as - Ventricles in the heart also begin to thicken and stiffen
parents, children, uncles, aunts, and cousins: to in correlation with continued steady production of
marry into a socially prominent family. collagen.
- Family members play an important role to their elderly, B. Vascular Aging
their support system when an elderly becomes - Aged arteries become extended and twisted. With age,
dependent on them and to maintain satisfaction in large arteries begin to dilate and stiffen, leading to
later life. hypertension.

FAMILY MEMBERS - form the nucleus of relationships 2) Aging of the Respiratory System
for the majority of the older adults and the support a. Alveoli
system if they become dependent. - The volume of blood distributed to pulmonary
- Intergenerational web: sons, daughters, stepchildren, circulation declines with age due to a decreasing
in-laws, nieces, nephews, grandchildren and number of capillaries per alveolus
great grandchildren. All these people may play an - Impairs efficient passage of oxygen from the alveoli to
important part in maintaining satisfaction in later life. the blood.
- Lung Elasticity With age, there is a decrease in the
\\ROLES
ROLES AND
AND RELATIONSHIPS
RELATIONSHIPS lungs’ elasticity, which in turn causes a change in the
elastic recoil properties of the lungs.
-Roles of members CHANGE. Grandparents may - Loss of elastic recoil causes the lungs to close
assume parental roles to their grandchildren or Adult prematurely, trapping air inside and preventing the
children may provide limited or extensive caring to lungs from emptying completely.
their own parents. This caregiving may be - The Chest Wall becomes stiffer with advancing age,
TEMPORARY or LONG-TERM. decreasing the ease with which the thoracic cavity
- Families are generally considered to be a vital resource can expand.
and integral part of an individual’s social network - The stiffness of the chest reduces its ability to expand
across the lifespan. during inhalation and contract during exhalation.
Family relationships, like all relationships, vary in
positive and negative qualities as they make an 3) Aging of the Gastrointestinal System
individual feel loved and cared for as well as irritated a. Pharynx and esophagus
and frustrated. - Overall, the gastrointestinal system appears to be
relatively preserved in aging with only minor
- Some issues and future directions: The family --most changes. The two gastrointestinal areas most
precious naturally occurring and cost effective affected by age are the upper tract (pharynx and
resources. Its role in protecting our elders must be esophagus) and the colon.
supported and augmented.

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- Stiffening of the esophageal wall affects the older b. Glands

patient’s ability to swallow. Dysphagia, reflux, - The biggest concern in older males is changes in the
heartburn and chest pain are common complaints. prostate gland. The lining and muscle layer of the
prostate gland become thinner with age, probably due
b. The Large Intestine to the reduced blood flow to the area. Benign
- The rectum, a colonic structure that is located before the Prostatic Hypertrophy (BPH)-- remains very
anus, shows age-related increase in fibrous common among aging males.
tissue. This increase reduces the rectum’s ability to c. Penis
stretch as feces pass through. - The penis begins to show fibrous changes in erectile
tissue around the urethra starting in the 30’s and
4) Urinary Structure changes with age 40’s. This fibrosis in erectile tissue -- increases in the
a. Kidneys amount of time it takes to achieve an erection in older
- With age, the kidneys shrink in length and males.
width. Changes in renal blood flow and glomerular d. Andropause
filtration rate (GFR) account for a majority of - A decline in testosterone levels and eventually
functional disability in the kidneys with age. deficiency significant enough to cause clinical
b. Bladder symptoms (American Society for Reproductive
- With age, the bladder decreases in size and develops Medicine).
fibrous matter in the bladder wall, changing its overall - Unlike menopause, andropause occurs gradually over
stretching capacity and contractility (Diogiovanna, time and does not occur in all aging males. Symptoms
2000). include: low libido; decreased energy, strength
c. Urination and stamina; increased irritability; and cognitive
- The amount of urine expelled from the body decreases changes.
with age.
6) Changes in the Nervous System
5) Changes in the Reproductive System a. The Aging Brain
For Female: - Memory changes can be observed by the fifth decade,
a. Ovaries but changes remain variable among individuals. The
- With age, the ovaries atrophy to such a small size that brain decreases in size and weight as men and
they can become impalpable during an exam. (Smith, women age.
1998). - Hallmark - forgetfulness
b. Uterus - 4A’s:
- Age-related decreases in uterine endometrial thickening a) Amnesia - loss of memory
during menstrual cycles occur as the result of b) Aphasia - difficulty in speaking
decreased estrogen and progesterone levels – c) Agnosia - difficulty of recognizing objects
decline in menstrual flow. d) Apraxia - difficulty in moving or carry out skilled
c. Vagina movement and gestures
- With age, the vagina becomes shorter and narrower and
the vaginal walls tend to thin and weaken . As a - Other A’s
result, the vagina can become very dry, causing a) Apathy - lack of motivation
intercourse to be very painful. b) Anosognosia - a neurological condition in which the
d. Menopause patient is unaware of their neurological deficit or
- The menopause transition is defined by declines in psychiatric condition.
estradiol along with the onset of variable menstrual c) Altered perception - misinterpretation of things and
cycles. Periods of amenorrhea trigger the move into situations
the late stages.
Nursing Management: talk slowly, do demonstrations,
For Male: and ask for a return demonstration.
a. Testes
- In aging, the testes decrease in both size and weight, - Other Information:
but with high variability among men. Although a Dementia - the loss of cognitive functioning, thinking,
decline in sperm production occurs in aging males, remembering, and reasoning to such an extent that it
the production never ceases, as a result, the older interferes with a person's daily life and activities
male remains fertile.

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Schizophrenia - Symptoms can include delusions, - most common visual concerns in aging -- presbyopia or
hallucinations, disorganized speech, trouble with the inability to focus on nearby objects, such as
thinking and lack of motivation; Has larger than newsprint. This is also called farsightedness.
normal head e. Hearing
b. The Aging Spinal Cord - Age-related hearing loss occurs as a result of changes
- Nerve Conduction in the inner ear . Aging changes that cause hearing
- According to Abrams and colleagues(1995), the aging loss include the alteration and decline in the ability to
spine may narrow due to pressure on the spinal cord hear high frequency sounds, and the ability to
resulting from bone overgrowth. Due to this discern.
narrowing, changes in sensation can occur. - Age-related hearing loss, also known as presbycusis--
most common sensory deficit in the older population.
7) Changes in the Muscle and Skeletal System
• A reduction in muscle mass occurs to at least 9) Changes in the Integumentary System
some degree in all elderly persons as compared • The greatest changes in aging skin - dermis.
to young healthy, physically active young adults • There is a general thinning of the dermal layer,
— sarcopenia. with loss of thickness averaging 20% in older
• Sarcopenia – associated with tremendous persons. This thinning of the dermis is due in
increases in functional disability and frailty. large part to a general loss of collagen-
a. Estrogen deficiency approximately 1% loss per year in adulthood.
- key contributor to bone loss and bone loss accelerates
in women after menopause due to a decline in 10) Changes in the Immune System
estrogen levels. a. Immunosenescence
- Also plays a role in bone loss among men – due to a - Refers to the aging of the immune system. Associated
decline in levels of estrogen, not testosterone. with increased incidence of infectious disease such
b. Osteoporosis as bronchitis and influenza.
- results from reductions in bone quantity and strength - It is also implicated in the increased incidence of tumors
that are greater than the usual age-related and cancer that occurs with age.
reduction. Bones of those with
- Osteoporosis is very porous – containing numerous 11) Cultural Factor/Ethnicity
holes or empty pockets – prone to fracture. • Factors such as Ethnicity/race, Nationality, Age,
Gender, Sexual orientation, Socio economic
8) Changes in the Sensory System status, Physical ability, Religious beliefs, Political
a. Touch beliefs, Lifestyle, Wide range of experiences, etc.
- The ability to touch and distinguish texture and sensation
tends to decline with age due to a decrease in the Chronic Illness in Older Person and It’s Behavioral
number and alteration in the structural integrity of Management & Health Education Common
touch receptors or Meissener’s corpuscles and Chronic Illness
pressure receptors or Pacinian corpuscles a. Hypertension
. Receptors that are related to the sense of touch are b. Chronic obstructive pulmonary disease
also known as mechanoreceptors. c. Chronic bronchitis (weak immune system)
b. Smell d. Emphysema
- A decrease in the number of olfactory neurons and e. Asthma
weakening of olfactory neural pathways to the brain f. Diabetes
lead to a reduction in the ability to identify and g. Dementia
distinguish aromas . A decrease in the sense of smell h. Cancer
is referred to as hyposmia i. Stroke
c. Taste
- Aging causes a decrease in taste, also known as PATTERNS OF HEALTH & DISEASE IN THE
OLDER ADULT:
hypogeusia, usually more noticeable around the age
of 60 with more severe declines occurring after the
1. Disease that occurs to varying degrees in most older
age of 70.
adults:
d. Vision
Cataracts - a cloudy area in the lens of your eye
Arteriosclerosis - narrowing of the arteries

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Benign prostatic hypertrophy (common for males) •

2. Disease with increased incidence with advancing - Disability

age • Impact that health problems have on an
Neoplastic disease - a condition that causes tumor individual’s ability to perform tasks, roles, and
growth, potentially malignant neoplasm like carcinoma, activities.
then the malignant neoplasm which is the cancer. • Example: The elderly can’t walk then he/she need
Diabetes mellitus a walker.
Dementia disorders
PHYSICAL ASSESSMENT
3. Disease that has more serious consequences in the Thorough physical assessment with system approach
elderly (review each body system) by: a) Taking a History
Pneumonia then b) Physical Examination
Influenza
Trauma (bone is already fracture) CIRCULATORY FUNCTION
• Family history
4. Very common chronic disease • Current problems with chest such as pain or
Arthritis (The most common and number 1 because discomfort, especially if associated with exertion;
50% of older adults experience it, according to national • Current diagnoses
health status) • Associated medications as well as over-the-
Hypertension counter and herbal medicines;
Heart disease
• Sources of stress;
• Adherence to current medical regimens
Functional disability:
• Physical examination
- Difficulty in performing his or her basic everyday task
a. Vital signs
or more complex tasks that are needed for
b. Blood pressure
independent living because of some physical
c. Listening to chest sounds
limitation.
d. Taking a pulse rate
- 2% of persons over 65 years have some limitation of
e. Blood Chemistry test
functions
f. Exercise stress test
- 25% of persons over 65 years require help with at
g. Blood and serum tests
least one ADL or IADL
h. Electrocardiograms (ECG)
i. Other tests for imaging and assessing the
COMPREHENSIVE GERIATRIC ASSESSMENT condition of the heart and blood vessels.
- This is a diagnostic process that is intended to
determine frail older adults including functional, RESPIRATORY FUNCTION
physical, cognitive, psychological, psychosocial, • Respiratory assessment:
and spiritual assessments status. a) Ask about current medications (including prescribed,
- From the assessment we can develop a plan for the over-the-counter, and herbal)
treatment and long term follow-up. b) Take a history of smoking behavior and exposure to
- The goal is to optimize the independence of Elderly environmental pollutants during the lifespan.
and prevent future disabilities. c) Current difficulties and anxieties associated with
- It is a multidimensional multidisciplinary breathing, decreased energy to complete everyday
assessment designed to evaluate an older person’s tasks, frequent coughing, and production of
functional ability, physical health, cognition and excessive sputum.
mental health.
Physical examination:
FUNCTIONAL ASSESSMENT - Observation of posture and breathlessness
- Identify an older adult’s ability to: (while walking or jogging)
• Perform self-care, self-maintenance, and - Listening to chest sounds
physical activities, and plan appropriate nursing - Lab test: Pulmonary function test, Chest X-ray,
interventions. By asking questions and observing and Sputum Analysis
if the older adult can do the ability.

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GASTROINTESTINAL FUNCTION Male:

• Usual diet or Appetite and changes in appetite; i) enlarged prostate and potential obstructions
• Occurrence of nausea, vomiting, indigestion, or ii) Bladder muscle tone and function
other stomach discomforts; iii) Renal failure (especially if diagnosed with diabetes
• Problems with bowel function such as diarrhea, and hypertension)
constipation (most concern) iv) Urine analysis test - for blood, bacteria and other
• Constipation problem: ask exercise, diet, and components such as ketones.
fluid intake, and whether the older adult is using
prescribed, over-the-counter, or herbal remedies NEUROLOGICAL FUNCTION
to deal with constipation • History or family history of stroke.
• Medication use including prescribed, over-the- • Medications (prescribed, over-the-counter, and
counter, and herbal remedies. herbal remedies).
Lab test: • Any medical diagnosis related to the neurological
a) Barium enemas - is a radiographic (Xray) examination system
of the lower gastrointestinal tract. The large intestine • Observe and ask about previous and current
including the rectum is made visible on X ray by filling the impairments in speech, expression, swallowing,
colon with liquid suspension called barium sulfate. The memory, orientation, energy level, balance,
barium highlights certain areas in the body to create a sensation, and motor function
clearer picture. • Assess the occurrence of sleep disturbance,
b) X-Ray tremors, and seizures (No caffeine after 6pm)
c) stool analysis • Must be early to bed because the longer that
d) examination of the colon they stay awake the immune system goes down
• Exercise - approved by the doctor. Simple ones
Oral health assessment rather than vigorous. (30 to 45 mins / 2x a week)
• Brushing,
• Flossing MUSCULOSKELETAL FUNCTION
• Regular contact with a dentist. • Check for osteoarthritis (most common) on aging
people (posture or walking)
Examination of the mouth should include: • Ask about the history of sore joints:
• Observing the condition of the tongue, teeth, and a. Which joints are affected?
gums for dehydration b. How long has there been pain?
• infection, and poor oral hygiene. c. What kind of pain is it?
• Check dentures to be sure they are well-fitting, d. Does it interfere with everyday activities?
particularly if a weight change has occurred. e. Is the pain managed?
f. If so, how is it managed?
GENITOURINARY FUNCTION g. Is there a history of bone and muscle injuries?
- Health history questions such as previous or current h. Has there been surgery?
difficulties related to the frequency and voluntary flow i. Are you trying alternative and complementary
of urine during either the day or night. therapies such as acupuncture or herbal remedies?
- If urine incontinence then ask questions such as stress, j. What are the pertinent lifestyle factors for this
urge, functional or overflow of continence. older adult, including participating in exercise and
- Ask about fluid intake, especially caffeine and alcohol physical activity?
(which affect bladder tone) • Observation:
- Observe the skin for dehydration Posture, stance, and walking
- Ask about medication use (prescribed, over-the-counter, • Assist by asking questions:
and herbal remedies - Does the older adult favor one side of the
- Lab test: body while walking?
- Are assistive devices such as canes and
Female: walkers being used? (Canes and walkers
i) Pelvic examination and pap smear - to check if there should be at the appropriate height in
are abnormal bleeding, vaginal discharge, urinary relation to body height)
symptoms..

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- Observe: walking and rising from a chair, • Ask questions about:

while attending to body language and facial a. Skin problems and concerns
expressions that indicate discomfort. b. Rashes, itching, dryness, frequent bruising, and any
- Observe and examine the kind of footwear open sores.
being worn. • Assessment in skin injury:
- Does the footwear offer adequate support a. Skin changes, signs and symptoms of infection, usual
while promoting good circulation? skin care, and problems with healing
b. Any loss of sensation, particularly in extremities, is a
The Up and Go Test: cause of concern
• provides a quick assessment of an older person’s • Older adult’s skin should be observed for:
mobility and overall function. a. Color, hydration (dry skin), circulation, and intactness.
• Measure a distance of 10 feet from the person’s b. Fingers and toenails for splitting and tears.
chair and ask him or her to rise, walk to the line, • Vitamin E - associated with aging because its
turn, walk back, and sit down. An average time to related to the cell wall; hinders oxidative
do this is 10 seconds. breakdown of lipid membranes in body tissues

Osteoporosis: COGNITIVE FUNCTION

- chronic back pain, muscle weakness, joint pain, loss of • Assess the attention span, memory (remember
height, and decrease in mobility past), language, visuospatial skills, and executive
- Bone density tests capacity.
• The most extensively used cognitive assessment
SENSORY FUNCTION tool is the mini mental state examination (MMSE)
- Diminished vision and hearing -- greatest impact on • It is originally developed to differentiate organic
older adults. This will have a-negative effects on from functional disorders and to measure
social interaction – social and psychological health. change in cognitive impairment. (MMSE)
• It measures orientation, memory, registration
- Screening procedures functional vision: (pag hindi na (new information), attention and calculation,
mabasa may PRESBYOPIA na si Lolo and Lola) short-term recall, language, and visuospatial
1. Ask the older adult to read a newspaper headline function.
and story and observe for difficulty and accuracy; • Short-term memory - progressive atrophy with
2. Ask the older adult to read the prescription bottle decrease in blood flow to brain may produce a
and again, observe for difficulty and accuracy. tendency to become forgetful
3. Ask questions:
• If a patient is disoriented, acknowledge but don’t
1. Is vision a problem?
agree. Mention the name of the patient based on
2. Does it interfere with everyday activities
the chart. Be firm.
or with hobbies and social life?
• Dementia is a permanent progressive decline in
3. Are magnification aids or enlarged
cognitive function.
printed material useful strategies?
• Alzheimer’s disease is the most common form
4. Is home lighting contributing to the
of dementia
problem?
5. Is it more difficult to see in the evening
PSYCHOLOGICAL ASSESSMENT
compared with other times of the day?
• Mental disorders
4. Question in assessing hearing problems:
• Depression is one of the common mental health
1. Are you experiencing a hearing problem or any ear
problems among older adults.
pain, ringing in the ears, or ear discharge?
2. Do you have a hearing problem now? • Observe:
3. Assess hearing aid. a. Sadness
5. Question in assessing taste, smell, and touch: b. Loss of interest or Lack of enjoyment of
1. Ask generally about satisfaction with taste and smell. previously enjoyed activities
2. The duration and extent of the problem. c. Loss of appetite
3. The impact of the problem on everyday life. d. Significant weight loss
e. Sleep disturbance
INTEGUMENTARY FUNCTION f. Feeling of Hopelessness/helplessness
g. Lack of motivation or energy
• Inspect the skin (basic elements of assessment)

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h. Restlessness Tertiary Rehabilitation

i. Fatigue - With such health deviations to regain and
j. Feelings of worthlessness maintain highest level of function and
k. Impaired ability to think clearly or concentrate independence.
l. Suicide ideation or attempt
Quaternary Prevention
SOCIAL ASSESSMENT - Experiencing illness but there is no identified
• Social functioning affects health, and health disease; to protect elderly from new medical
status affects the ability to socialize and interact invasion and suggest intervention which are
with others. ethically acceptable.
• Individuals with low quantity and quality of social
relationships have a higher morbidity and CARE SETTING
mortality risk compared with those who have a Acute Care – branch of secondary care where a patient
good quantity and quality of social contacts. receives active but short-term treatment for a severe
• Observe: injury or episodes of illness, an urgent medical condition
a. interaction between the older adult and family, or during recovery from surgery.
friends, neighbors, and community as a whole. Long-term Care – involves a variety of services designed
to meet a person’s health or personal care needs during
SPIRITUAL SUPPORT/ASSESSMENT a short or long period of time these services help people
• It is an integral part of comprehensive to live as independently and safety possible when they
assessment and provides a basis for an can no longer perform the day activities on their own;
individualized plan of care. provide a safe environment for chronically ill and
• Although there is a link between religiosity and functionally dependent.
spirituality, the two concepts are not Short Care – type of treatment that has a defined
synonymous. outcome (e.g. treatment for an injury)
• Religiosity refers to believing in God, organized
rituals, and specific dogma.
• Spirituality refers to broader ideas of belief that
encompass personal philosophy and an
understanding of meaning and purpose in life.
• Nurses may not be comfortable conducting a
spiritual assessment because it may seem
inappropriately invasive or because it is an area
that some nurses do not feel adequately prepared
to address as an unmet need.
• If the intake record indicates a formal religious
affiliation, then it is fairly straightforward to ask,
questions that address spirituality such as;
a. “Do you have any religious needs?” • “Would
Intermediate Care – an emerging concept in health care
you like to speak with a pastoral care worker?”
which may offer alternatives to hospital care for elderly not
b. “Are you having a spiritual need? Is there some
longer as six weeks but can be as little as one or two
way that I might help with your spiritual needs?”
weeks if the staff believe that is what you need to reach
c. “Have your health problems affected your
your goals.
feelings of meaning or purpose?”
Basic services – in-patient care to patients who have
LEVELS OF CARE need to for skilled nursing supervision and need
Primary supportive care, but who do not require continuing nursing
- Prevention of both Illness and disease care.
- Promotion of wellness; when both illness and Skilled Nursing Care – refers to a patient’s need to care
disease are absent or treatment that can only be performed a licensed nurse.
Secondary A nursing home is a facility for the residential care of
- Hospitalization or institutionalization to avoid elderly or disabled people. Nursing home can also be
chronicity. referred to as skilled nursing facility, rest homes,
convalescent homes or care.

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INDEPENDENT LIVING VS ASSISTED LIVING

Home care – services (as nursing or personal care)

provided to a homebound individual (as one who is
convalescing, disabled or terminally ill) home care as an
alternative to institutionalization.

Adult Day Care Center – typically a non-residential

facility that supports the health, nutritional, social, and
daily living needs of adults in professionally staffed group
setting. These facilities provide adults the transitional care
short-term rehabilitation following hospital discharge.

GORDON’S FUNCTIONAL HEALTH PATTERN IN

ELDERLY
Level I – able to perform full self-care
Level II – requires assistance or supervision of another
person
Level III – requires assistance or supervision of another
person
Level IV – completely dependent and does not participate
in activities.

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