TERM 1 STANDARD V: Ethics - decisions and action on behalf of

SAS #1 Introduction to Gerontological Nursing older adults…

Geriatric or Gerontology Nursing- deals with proper care STANDARD VI: Collaboration - w/older adults, caregiver,
and hospitalization of aged or geriatric patient. and family members.
Florence Nightingale- she was renowned as the first STANDARD VII: Research - evaluates research findings to
geriatric nurse superintendent position in an English improves gerontological nursing practice.
institution. STANDARD VIII: Resource Utilization - consider the factors
related to safety, effectiveness, and cost in planning.
Definition of terms:
Gerontology- is the study of aging or the aged.
Geriatrics- refer to medical care pf the aged. SAS #3 Biological and psycho-social theories of
Gerontological Nursing- aspect of gerontology that falls aging/nursing theories of aging.
within the discipline of nursing and the scope of nursing I. Biological theories of aging
practice. A. Stochastic theory- based on random events that cause
Old age- >65 y/o cellular damage that accumulates as the organisms aged.
Gerontological Rehabilitation Nursing- gerontological a) Free radical theory- membranes, nucleic acids,
nursing with rehabilitation concepts and practices. and proteins are damaged by free radicals, which
Social Gerontological - social aspects of the aging. causes cellular injury and aging.
Geropsychology - psychiatry whose knowledge, b) Error theory- error DNA and RNA synthesis occur
expertise,and practice are with the older population. with aging.
Financial Gerontology - financial planning and services with c) Wear and tear theory- cells wear out and cannot
a special expertise in the needs of alder adults. function with aging.
d) Connective tissue/cross-link theory- proteins
Roles of Gerontological Nurse: impede metabolic processes and cause troubles
 Provider of care with getting nutrient to cells and removing
 Teacher cellular waste products.
 Manager B. Non-stochastic Theories - genetically programmed
 Advocate events that cause cellular damage that accelerates aging of
 Researcher the organism.
a) Programmed theory- cells divide until they they are
SAS #2 standards and gerontologic nursing longer able to. And this triggers apoptosis or cell death.
practice/perspective of aging b) Neuroendocrine theory- problems with
Nursing care hypothalamus-pituitary-endocrine gland feedback
STANDARD I: Assessment - collects patient health data. system cause dse.; increase insulin growth factor
STANDARD II: Diagnosis - analyze the assessment data to accelerates aging
determine the diagnosis. c) Gene/biological clock theory- genetically
STANDARD III: Outcome Identification- identifies expected programmed aging code.
outcomes individualize to the older adult. d) Immunological theory- aging is due to faulty
STANDARD IV: Planning - develops plan of cares that immunological function, which is linked to general
prescribes intervention to attain outcomes. well-being.
STANDARD V: Implementation - implements the II. Psychosocial theories of aging
intervention. A. Sociological theories - changing roles, relationships,
STANDARD VI: Evaluation - evaluates the older adult status, and generational cohort impact the older adult’s
progress towards attainment of expected outcomes. ability to adapt.
Quality care a) Activity disengagement- remaining occupied and
STANDARD I: Quality of care - evaluates the quality of care involved is necessary to a satisfying late life. Promote
and effectiveness of nursing practice. internal reflection.
STANDARD II: Performance Appraised - the gerontological b) Subculture- segregate from society in an aging
nurse evaluates his/her own nursing practice in relation to subculture sharing loss of status and societal
professional practice standards and relevant statutes and negativity regarding the aged
regulation. c) Continuity remains consistent throughout life.
STANDARD III: Education - GN acquires and maintain Memory skills
current knowledge in nursing practice. d) Age stratification- society is stratified by age groups
STANDARD IV: Collegiality - contributes to professional that are the basis for acquiring resources, role status,
development of peer, colleagues and others. deference, from.
 e) Person-environment fir - affected by ego strength, - AN ACT TO MAXIMIZE THE CONTIBUTION OF
mobility, health, cognition, sensory perception, and SENIOR CITIZENS TO NATION BUILDING, GRANT BENEFITS,
the environment. AND SPECIAL PRIVILEGES AND FOR OTHER PURPOSES.
f) Gerontranscendence- The elderly transform from a Section 4: privileges for the senior citizens.
materialistic/rational perspective toward oneness with 1. 20% discounts in purchase of medication anywhere in
the universe. the country.
B. Psychological theories - Explain aging in terms of mental 2. 20% discount on admission fees charged by theaters,
processes, emotions, attitudes, motivation and personality cinema houses and concert halls, circuses, carnivals and
development that is characterized by life stage transitions. other similar places of culture, leisure, and amusements.
a) Human needs- Five basic needs motivate human 3. Exemption from the payment of individual income taxes.
behavior in a lifelong process toward need 4. Free medical and dental services in government
fulfillment. establishments anywhere in the country
b) Individualism- Personality consists of an ego and 5. Benefits and privileges given by the government GSIS,
personal and collective unconsciousness that SSS, PAG-IBIG.
views Tile from a personal or external
perspective. Republic Act NO. 9257
c) Stages of personality development- Personality “Expanded senior citizens act of 2003”
develops in eight sequential stages with
corresponding life tasks. The eighth phase Republic Act NO. 9994
integrity versus despair is characterized by “an act to maximize the contribution of senior citizens to
evaluating life accomplishments; struggles nation building, grant benefits. And special privileges and
include letting go, accepting care, detachment, for other purposes.”
and physical and mental decline.
d) Life-course/lifespan development- Life stages are Ethical principles:
predictable and structured by roles, relationships, Autonomy - right to make independence choice and
values, and goals. decision.
e) Selective optimization with compensation - Beneficence - doing act of mercy and kindness.
Individuals cope with aging losses through Nonmaliecence - requiring to act in such a manner as to
activity/role selection, optimization. and avoid causing harm to patients.
compensation. Fidelity - faithfulness and the practice off keeping promise.
Justice - fairly and equality.
SAS #4 medication of older adults Veracity - telling the truth.
 Pharmacokinetics- study of absorption, distribution, Confidentiality - nor disclosure of private or secret
metabolism, and excretion of drugs. information in which one is entrusted.
 Pharmacodynamics- effects of drug in the body and
mechanism of there action. Patient rights:
Poly-pharmacy- multiple drug taken. 1. Advance directives and living wills
Reasons for poly-pharmacy: -patient is no longer able to provide informed
1. Lack of communication consent.
2. Lack of information about OTC drugs 2. Durable power of attorney
3. Lack of information about client noncompliance - a legal document designating an alternative
4. Use of complementary therapies fear of telling health- decision maker in the event that the person is
workers provider. incapacitated.
5. Changes on daily habits 3. Patient’s bill of rights.
6. Changes in mental-emotional status that may affect - Right to appropriate medical care and humane
consumption patterns. treatment
7. Changes in health status - Right to informed consent
8. Financial limitations. - Right to privacy and confidentiality
- Right to information
SAS #5 ethical/legal principles and issues. - Right to choose health care provider and facility
SEC. 28. scope of nursing. - a person shall be deemed to be - Right to religious belief
practicing nursing within the meaning of this act when - Right to medical records
he/she singly or in collaboration with another, initiates and - Right to leave
performs nursing service. - Right to refuse participation in medical research
- Right to correspondence and to receive visitors
R.A. 7432 - Right to express grievances
 - Right to be informed of his//her rights and SAS #7 SPIRITUALITY AMONG OLDER ADULTS, ETHICAL
obligation as a patient DILEMMA

Ethics in practice Spirituality- wind, breath, or air which give life (Hebrew,
 Mistakes Latin, and Greek)
1. Honesty admitting the error occurred Religion- to tie/secure/bind/fasten together to create
2. Taking proper steps to correct the situation system of attitudes and beliefs. (Latin)
3. Apologizing for the mistake Gerotranscendence- the 9th stage of lifecycle development
4. Making amends as possible (erik arikson developed 8 stages of life cycle)
5. Evaluating how to prevent such mistakes in the 3 dimensions:
future 1. Cosmic
 Conflict of interest 2. Self-trancendent
3. Social selectivity

SAS #6 Levels of care among older adults Prayer- has positive impact on patient outcomes, such as
Long-term care fewer complications, less medication needed, and quicker
-refers to health, mental health, social, and residential return to health
services provided to a temporary or chronically disabled Taking spiritual history and assessment
person. 1. FICA
F - faith
ASSISTED LIVING- generally provide healthy meals, planned I - importance
activities, places to walk and exercise, and should offer C - community
pleasant surroundings where adults can socialize with A -address in care
others their own age in a safe and protected environment.
Risk of needing long-term care 2. HOPE
-age H-
-gender O - organized religion
-marital status P - personal spirituality
-lifestyle E - effects on medical care and end-of-life issues.
-health and family history
INTERMEDIATED CARE- Provides 24- hour per day direct Interventions of spiritual care; overlap w/
nursing contact and may be considered to be entry level cultural/psychosocial care
into nursing home care. a) Creative/expressive art
SKILLED CARE - for those older adults requiring more b) Music
intensive nursing care. c) Story
ALZHEIMER’S CARE- because of the higher incidence of AD d) Spiritual reminiscence
with advanced age, there is a growing need for units that e) Compassionate presence
provide nursing care for elders in the various stages of f) Humor
dementia that occur with Alzheimer's.
SAS # 8 settings of care for older adults/advocacy programs
Palliative care relevant to the care of older adult
- comprehensive management of the physical,
psychological, social, spiritual, and existential needs of HOME CARE- longer period of observation or care from
patients. It is for any time during a terminal illness. nurses may be candidates for home health care services.
 Health education
End-of-life care  Personal care
- services provided to terminally ill patient whose incurable  preventive services and early detection
dse has advance to a stage of near death.  Psychosocial support and social services
Providing physical comfort:  Building the capacity of family members to provide
-pain day-to-day care
-breathing problems  Transitional home health care
-skin irritations
-digestive problems HOSPICE FACILITIES -Caring for dying person and their
-temperature sensitivity families. The concept of the hospice is centered around
-fatigue holistic, interdisciplinary care.
DROP IN/DAY CARE CENTERS - who are unable to remain at -listen attentively, ask simple questions, allow time
home during day without supervision. for understanding, one person at a tme when speaking, use
Services provides by adult day care center: visual cues, collaborate w/ speech therapist as needed
1. Social activities  Patient who are cognitive impaired
2. Nutrition -use simple sentences to avoid further/long
3. Personal care explanation, ask one question at a time, allow time for
4. Health services patient to respond, be and attentive listener, include family
5. Transportation and friend in the conversation and use picture and
gestures.
INDEPENDENT LIVING - the form of senior housing, such as  Patient who are hearing impaired
with apartment complexes that are exclusively devoted to - check for hearing aid and glasses, reduce
the elderly. environmental noise, get patient attention before speaking,
face patient with mouth visible do not chew gum, speak at
FORSTER CARE/ GROUP HOMES - For those older adult normal tone,
who can do most of their ADLs, but mar have safety issues  Patient who are visually impaired
and require supervision with some activities such as -check for use of glasses or contact lenses, identify
dressing or taking medication. yourself when entering the room, speak in a normal tone
of voice, do not rely on gesture or non verbal
Republic Act NO. 9336 -the general appropriations act of communication, use indirect light, avoiding the glare
26, under section 332 mandates that all government
agencies and instrumentalities should allocate 1% of their Verbal communication - involves sending and receiving
total agency budget to programs and project for older messages by means of word
person and PWD. Fomal communication - is structured and precise
Informal communication- unstructured, and
PRESIDENTIAL PROCLAMATION AND EXECUTIVE ORDERS flexible.
PRESIDENTIAL PROCLAMATION NO. 470, SERIES OF 1994-
first week of October of every year as “elderly Filipino Non-verbal communication- take place without words.
week.” Research has shown that only 7% of communication comes
from actual words we use; the other 93% is nonverbal.
Presidential proclamation no. 1048, series of 1999,
international year of older persons.  Symbols -the represent of certain person or things,
like uniform style of a nurse. Colors help the patient
9 EXECUTIVE ORDER NO. 266, SERIES OF 2000 - Philippine distinguish the various caregiver.
plan of action for older persons(PPAOP) 1999-2004  Tone of voice
 Body languages - words and body languages
EXECUTIVE ORDER NO. 105, SERIES OF 2003 - conveying two different messages
implementation of the program providing for group homes  Space, distance, and position - public space is 12ft,
and foster homes for neglected, abandoned, abused, social space 4-12ft, personal space 1in-4ft, intimate
detached, and poor older persons and PWD space is the space within the body and 1in.
 Gestures- highly cultural and generational, helpful for
SAS # 9 COMMUNICATION WITH OLDER PERSONS people who cannot use words.
 Facial expression- the human face is the most
Good communication- active listening and part of healing expressive, and facial expression hve been shown to
process communicate across cultural and age barriers.
Poor communication - vulnerable and growing population.  Eye contact
 Pace or speed of communication.
Effective communication benefits:  Time and timing
 Help prevent medical errors  Touch
 Lead to improved health outcomes
 Strengthen patient-provider relationship SAS #10 barriers and teaching for effective communication
a. Language barrier- nurse and the patient do not share
Communicating with patient who have special needs: a common language, interaction between them is
 Patient who cannot speak clearly ( aphasia, dysarthria, strain and very limited.
muteness) b. Cultural differences -the patient’s culture may block
the effective nurse-patient interaction because
 perceptions on health and death are different focusing on the Baby Boomer generation and the
between patients. challenges that arise as they age.
c. Conflict- 2 or more parties not sharing common
ground 1. Generational Breakdown (as of 2021):
d. Setting in which care is provided - may lead to o Discusses different generations, including
reduction in quality of nurse-patient communication Baby Boomers, Generation X, Millennials,
because of increased workload and time constraints and Generation Z, providing their birth
restrict nurse from discussing their patient concern years and current age ranges.
effectively. 2. The 2030 Problem:
e. Internal noise, mental/emotional distress - fear and o Highlights the impending challenges of
anxiety can affect the person’s ability to listen to what caring for aging Baby Boomers by 2030.
the nurse is saying. This generation, aged 66-84 by that time,
f. Perception - patient cannot follow the instruction, will cause a significant increase in the
g. Difficulty with speech and hearing - people can elderly population, raising concerns about
experience difficulty inspeech and hearing following the availability of resources and long-term
conditiond like storke or brain injury. care services.
h. Medication - can have significant effect on o It predicts the rise in disability among
communication for example it may cause dry mouth, older adults and anticipates a shortage of
or excess salivation, nausea, and indigestion. family caregivers due to social changes
i. Noise- equipment or environment noise impedes such as rising divorce rates, fewer
clear communication. children, and more women in the
workforce.
Therapeutic communication techniques: 3. Long-Term Care Projections:
 To obtaine information o Projections to 2040 include an increase in
- make broad opening remarks long-term care needs, higher disability
- use open-ended questions rates, and a growing demand for both
-share observation and thoughts paid and unpaid care services.
-confrontation o The number of older adults needing care
- reflection is expected to double, and there will be
-encourage description significant pressures on family and
-validate what is being said institutional caregiving.
-offer your presence 4. Emerging Health Issues for Older Adults:
-summarizing o Emphasizes person-centered care, the
-use of interpretation importance of caregiver support, and
 To give support geriatric training for health professionals.
-supportive remarks o The presentation also highlights the need
-appropriately touch the patient for better data, particularly concerning
-parephrasing subpopulations like LGBT elders.
 To assists in analysis and problem solving 5. United Nations Program for Aging:
-acknowledge the person o Discusses the UN’s Open Ended Working
-sequencing Group on Ageing (OEWG) and efforts to
-ask for clarification address the human rights and care needs
-ask for alternative of older adults at an international level.
-use of transition
-comparison In summary, the presentation focuses on the growing aging
-use of silence population, particularly the Baby Boomers, and the urgent
 To instruct the patient need to address the care challenges they will face by 2030
-give information and beyond​ .
-orient the patient towards realaity
-query what the patient says SESSION 12: "Physiological Changes in Aging Affecting the
-with hold social reward Respiratory & Cardiovascular System"
-give social reward
Respiratory System:
SESSION 11: "Research Agenda on Aging" outlines several
key topics related to the aging population, particularly
  Functions: The respiratory system facilitates  Assessment:
breathing, oxygen delivery, and removal of carbon o Check for facial symmetry, reflex
dioxide. It also plays roles in temperature control, reactions, and alertness.
moisture regulation, and protection from irritants. o Monitor visual impairment (cataracts,
 Common Assessments: pupil response) and hearing acuity
o Chest movement and lung sounds (hearing aids, tinnitus).
o Cough quality and sputum analysis o Assess for sensory deprivation,
o Dyspnea, hypoxia, and the need for malnutrition, sleep disturbances, and
oxygen therapy signs of depression.
o Activity intolerance and anxiety levels
 Nursing Diagnoses & Goals: Special Senses:
o Ineffective airway clearance, impaired gas
exchange  Vision & Hearing:
o Goals include maintaining airway patency, o Visual acuity decreases with age; common
improving cough efficiency, and managing issues include cataracts, dry eyes, and
oxygen therapy. needing proper lighting.
o Hearing may diminish; cerumen buildup
Cardiovascular System: and tinnitus are concerns.

 Challenges of Aging: Differentiating between age- Nursing Diagnoses & Goals:

related changes and disease pathology (e.g.,
coronary artery disease, arteriosclerosis).  Diagnoses:
 Common Cardiovascular Issues: o Impaired physical mobility
o Coronary artery disease (CAD), angina, o Risk for injury
arrhythmias, anemia, heart failure, and o Disturbed sensory perception
blood pressure issues (hypertension and  Goals:
orthostatic hypotension). o Maintain safety, ensure adequate sensory
 Assessments: stimulation, and help patients achieve
o Peripheral circulation, heart sounds, optimal functional ability.
dysrhythmias, activity intolerance, and o Promote reality orientation and manage
signs of anemia or ischemia. sleep, hypothermia, and depression.
 Nursing Diagnoses & Goals:
o Risk of decreased cardiac output, activity This session emphasizes a detailed assessment approach
intolerance, and fatigue. and interventions to mitigate age-related impairments in
o Goals include reducing cardiac workload, the nervous system and special senses​ .
improving energy, and monitoring vital
signs and medications. SESSION 14: The Musculoskeletal System

The presentation highlights the need for comprehensive InAs people age, significant changes occur in the
assessments, nursing care plans, and interventions to musculoskeletal system, affecting the structure, strength,
manage the respiratory and cardiovascular changes that and function of bones, muscles, and joints. These changes
occur with aging​ . contribute to common issues like reduced mobility,
stiffness, and an increased risk of injury. Below are the
SESSION 13: "Physiological Changes in Aging Affecting the primary changes in the musculoskeletal system of older
Nervous System and Special Senses" adults:

Nervous System: 1. Bone Changes:

 Functions:  Bone Density Loss (Osteoporosis): As people age,

o Controls, regulates, and communicates bones lose minerals like calcium, leading to
vital processes, including mental activities reduced bone mass and density. This condition,
like thought, learning, and memory. known as osteoporosis, increases the risk of
o Composed of the brain, spinal cord, fractures, particularly in the hip, spine, and wrist.
nerves, and ganglia, working together for  Slower Bone Regeneration: Bone remodeling, the
sensory, integrative, and motor functions. process by which old bone is replaced by new
 bone tissue, slows down with age, making it can impact activities like walking, climbing stairs,
harder for bones to repair themselves after injury. or lifting objects.
 Shortening of the Spine: The vertebral bones in  Slower Recovery: Injuries, such as fractures or
the spine may lose density and compress over muscle strains, take longer to heal due to slower
time, causing older adults to shrink in height and cell regeneration and reduced bone and muscle
experience posture changes such as kyphosis (a repair capacity.
forward curving of the spine).
Prevention and Management:
2. Muscle Changes:
 Exercise: Regular physical activity, particularly
 Sarcopenia (Muscle Loss): Aging leads to a weight-bearing and resistance exercises, can help
progressive loss of muscle mass and strength, a maintain muscle strength, improve bone density,
condition called sarcopenia. This can begin as early and enhance joint flexibility.
as the 30s but accelerates in later years,  Diet: A diet rich in calcium and vitamin D supports
contributing to weakness and a decreased ability bone health, while protein helps maintain muscle
to perform daily activities. mass.
 Reduced Muscle Elasticity: Muscle fibers become  Fall Prevention: Installing home safety measures
less flexible, and the ability of muscles to contract and maintaining balance exercises can reduce the
decreases, leading to stiffness and reduced range risk of falls in older adults.
of motion.
 Decreased Muscle Endurance: Older adults often These changes in the musculoskeletal system are a natural
experience a reduction in muscle stamina, making part of aging, but proactive care can help mitigate their
them tire more easily during physical activities. impact and maintain mobility and independence.

3. Joint Changes: SESSION 15: PHYSIOLOGIC CHANGES AFFECTING THE

HEMATOPOIETIC AND LYMPHATIC SYSTEM
 Degeneration of Cartilage (Osteoarthritis): The
cartilage that cushions joints begins to wear down As people age, the hematopoietic (blood-forming) and
with age, leading to osteoarthritis. This causes lymphatic systems undergo physiological changes that can
pain, swelling, and reduced joint mobility, impact immune function, blood cell production, and the
particularly in weight-bearing joints such as the body’s ability to fight infections and recover from illness.
hips, knees, and spine.
 Reduced Synovial Fluid: The production of synovial Hematopoietic System Changes:
fluid, which lubricates joints, decreases with age,
contributing to joint stiffness and discomfort. The hematopoietic system is responsible for producing
 Joint Stiffness: Ligaments and tendons lose some blood cells (red blood cells, white blood cells, and platelets)
of their flexibility and elasticity, causing joints to in the bone marrow.
feel stiffer and less mobile.
1. Bone Marrow Changes:
4. Postural and Balance Changes: o Reduced Bone Marrow Cellularity: The
bone marrow becomes less cellular and
 Postural Instability: Age-related changes in more fatty with age, leading to a decline
muscles, bones, and joints can alter posture, in the production of blood cells,
leading to problems such as a stooped posture or particularly red blood cells and white
a forward head position. blood cells.
 Decreased Balance and Coordination: With muscle o Slower Regeneration: The ability of the
weakening and joint changes, older adults may bone marrow to regenerate after stress
experience balance problems, increasing the risk (such as blood loss or infection)
of falls. diminishes, making it harder for older
adults to recover from illnesses or injuries.
5. Reduced Physical Performance: 2. Red Blood Cells (Erythropoiesis):
o Decreased Erythropoiesis: The production
 Decreased Physical Strength and Endurance: The of red blood cells decreases with age,
combined effects of muscle and bone loss lead to which can contribute to anemia. This is
a decline in overall physical performance, which often due to reduced production of
 erythropoietin, the hormone that reducing the body’s ability to mount an
stimulates red blood cell production, as effective immune response.
well as nutrient deficiencies (e.g., iron, 3. Lymph Node Changes:
vitamin B12). o Reduced Lymph Node Size and Efficiency:
o Mild Anemia: Older adults may Lymph nodes shrink and become less
experience mild anemia, which can lead efficient in filtering out pathogens and
to fatigue, weakness, and reduced debris, reducing the body's ability to fight
physical endurance. off infections.
3. White Blood Cells (Immune Response): 4. Spleen Function Decline:
o Decreased White Blood Cell Production: o Reduced Immunologic Function of the
The production of white blood cells, Spleen: The spleen, which helps filter
particularly lymphocytes (a type of white blood and fight infection, may become
blood cell crucial for immune responses), less effective with age, further
declines with age. contributing to weakened immune
o Impaired Immune Function: The defense.
reduction in lymphocyte production and
function leads to a weaker immune Overall Impact:
response, making older adults more
susceptible to infections, slower to  Weakened Immune Response: The combined
recover from illness, and less responsive effects of these changes lead to
to vaccines. immunosenescence, a term describing the aging of
4. Platelets (Thrombopoiesis): the immune system. Older adults become more
o Stable Platelet Count: The overall number vulnerable to infections, cancers, autoimmune
of platelets (cells involved in blood diseases, and have a reduced response to
clotting) typically remains stable with age, vaccinations.
but platelet function may be impaired,  Increased Risk of Anemia: The decline in red blood
increasing the risk of abnormal clotting or cell production and efficiency contributes to a
bleeding in some individuals. higher prevalence of anemia, which can lead to
fatigue, dizziness, and other health problems.
Lymphatic System Changes:
Prevention and Management:
The lymphatic system, which includes lymph nodes, the
spleen, thymus, and lymphatic vessels, plays a key role in  Vaccination: Older adults are encouraged to stay
immune function and the removal of waste and excess up to date with vaccinations, as their immune
fluids from tissues. response is weakened.
 Nutritional Support: Ensuring adequate intake of
1. Thymus Involution: iron, vitamin B12, folate, and other nutrients can
o Thymic Atrophy: The thymus, a key organ help support red blood cell production and reduce
in the production of T-cells (a type of the risk of anemia.
white blood cell crucial for immune  Regular Monitoring: Routine blood tests to
defense), begins to shrink (atrophy) after monitor red and white blood cell counts can help
puberty and becomes significantly smaller detect and manage anemia and immune
in older age. This leads to a reduced deficiencies early.
output of new T-cells, weakening the
adaptive immune response. These changes in the hematopoietic and lymphatic systems
2. Decreased Lymphocyte Function: are part of the normal aging process, but careful
o Reduced T-cell Activity: The function of T- management can help maintain health and reduce
cells, particularly the ability to recognize complications.
and respond to new pathogens,
diminishes with age. This contributes to a SESSION 16: PHYSIOLOGIC CHANGES IN AGING AFFECTING
higher susceptibility to infections and THE ENDOCRINE
slower recovery from illness. SYSTEM
o Impaired B-cell Function: The production
and effectiveness of B-cells (which Aging brings about various physiological changes in the
produce antibodies) also decrease, endocrine system, which regulates hormone production
and secretion throughout the body. These changes can 4. Parathyroid Glands:
affect metabolism, energy levels, glucose regulation, bone
density, and overall homeostasis. Below are the key  Increased Parathyroid Hormone (PTH) Levels:
changes in the endocrine system of older adults: Aging can lead to higher levels of parathyroid
hormone (PTH), which regulates calcium and
1. Thyroid Gland: phosphate metabolism. Elevated PTH levels can
result in increased bone resorption (breakdown),
 Decreased Thyroid Function: The thyroid gland, leading to conditions such as osteoporosis and a
which produces hormones that regulate higher risk of fractures.
metabolism (thyroxine or T4 and triiodothyronine  Calcium Imbalance: Due to increased PTH levels
or T3), experiences reduced function in older and changes in vitamin D metabolism, calcium
adults. Although the levels of thyroid hormones absorption from the intestines may decrease,
may not decrease significantly, the gland’s ability further contributing to bone density loss.
to respond to regulatory signals can decline.
 Higher Prevalence of Hypothyroidism: Older adults 5. Sex Hormones (Estrogen, Progesterone, Testosterone):
are at a higher risk for hypothyroidism (low thyroid
hormone levels), which can lead to symptoms such  Menopause (Estrogen and Progesterone Decline in
as fatigue, weight gain, cold intolerance, and Women): In women, menopause marks a
slowed metabolism. significant drop in estrogen and progesterone
levels, leading to symptoms such as hot flashes,
2. Pancreas (Insulin and Glucose Regulation): mood swings, vaginal dryness, and increased risk
of osteoporosis and cardiovascular disease.
 Reduced Insulin Sensitivity (Insulin Resistance):  Andropause (Testosterone Decline in Men): In
Aging is associated with decreased sensitivity to men, testosterone levels gradually decline with
insulin, a condition known as insulin resistance. age, a process sometimes referred to as
This means that the body's cells become less andropause. This can lead to reduced muscle mass
responsive to insulin, leading to impaired glucose and strength, decreased libido, erectile
metabolism. dysfunction, fatigue, and mood changes.
 Higher Risk of Type 2 Diabetes: With reduced
insulin sensitivity and increased insulin resistance, 6. Pituitary Gland:
older adults are more prone to developing type 2
diabetes, especially when combined with lifestyle  Decreased Growth Hormone Production: The
factors such as reduced physical activity and poor production of growth hormone (GH), which
diet. promotes tissue repair, muscle growth, and fat
 Decreased Insulin Secretion: The pancreas may metabolism, decreases with age. This decline
produce less insulin with age, compounding the contributes to reduced muscle mass, increased fat
risk of blood sugar imbalances and diabetes. deposition, and slower tissue regeneration.
 Reduced Antidiuretic Hormone (ADH) Production:
3. Adrenal Glands: A decrease in ADH production can lead to
impaired water retention by the kidneys,
 Altered Cortisol Production: The adrenal glands increasing the risk of dehydration and electrolyte
produce cortisol, a hormone involved in stress imbalances in older adults.
response and metabolism regulation. Aging can
lead to changes in the daily pattern of cortisol 7. Pineal Gland:
secretion, potentially resulting in prolonged higher
cortisol levels in response to stress, which can  Reduced Melatonin Production: The pineal gland
affect metabolism, immune function, and produces melatonin, which regulates sleep-wake
cognitive health. cycles. Aging often leads to decreased melatonin
 Reduced DHEA Production: The adrenal glands production, contributing to sleep disturbances and
also produce dehydroepiandrosterone (DHEA), a altered circadian rhythms in older adults.
hormone involved in the production of sex
hormones. DHEA levels decline significantly with 8. Changes in Feedback Mechanisms:
age, which may contribute to decreased libido,
muscle mass, and bone density.  Altered Hormonal Feedback Loops: Aging can
disrupt the regulatory feedback loops that
 maintain hormone balance. For example, the Altered Gastric Acid Production: There can be a decline in
sensitivity of tissues to hormones can decrease, gastric acid secretion, which affects nutrient absorption
and the hypothalamus and pituitary glands may and may increase the risk of bacterial overgrowth.
become less responsive to hormonal signals,
leading to imbalances in various endocrine Changes in Liver Function: The liver may have reduced
functions. blood flow and metabolic function, impacting drug
metabolism and detoxification.
Impact on Health:
Altered Nutrient Absorption: Changes in the intestinal
 Metabolism and Weight Gain: Slower metabolism, lining can affect the absorption of nutrients, particularly
decreased thyroid function, and reduced muscle vitamins and minerals.
mass can lead to weight gain and increased fat
accumulation, especially around the abdomen. Increased Risk of GI Disorders: Older adults are at higher
 Bone Health: Reduced sex hormone levels, risk for conditions like gastroesophageal reflux disease
increased PTH, and decreased vitamin D activation (GERD), diverticulosis, and colorectal cancer.
lead to loss of bone density and a higher risk of
osteoporosis and fractures. Changes in Gut Microbiota: The diversity and composition
 Glucose Metabolism: Changes in insulin secretion of gut microbiota can change with age, influencing
and sensitivity increase the risk of type 2 diabetes digestion and immune function.
and related complications like cardiovascular
disease. Medications: Many older adults take multiple medications
 Decreased Stress Tolerance: Altered cortisol that can have gastrointestinal side effects, further
patterns and reduced adrenal function may impair complicating GI health.
the body's ability to cope with physical and
emotional stress. Addressing these changes involves focusing on diet,
hydration, and regular check-ups with healthcare providers
Prevention and Management: to manage symptoms and maintain gastrointestinal health.

 Hormone Replacement Therapy (HRT): In some PHYSIOLOGIC CHANGES IN AGING AFFECTING urinary
cases, hormone replacement therapy may be used system
to mitigate the effects of reduced sex hormones, Physiological changes in the urinary system due to aging
particularly in postmenopausal women. can significantly affect renal function and overall health.
 Diet and Exercise: A balanced diet rich in calcium Here are some key changes to consider:
and vitamin D, along with regular weight-bearing
exercise, can help support bone health and Decreased Renal Function: There is a gradual decline in the
metabolism. glomerular filtration rate (GFR), leading to reduced kidney
 Blood Sugar Monitoring: Regular monitoring of efficiency in filtering blood and excreting waste.
blood glucose levels is important for preventing
and managing diabetes in older adults. Changes in Nephrons: The number of functional nephrons
decreases with age, impairing kidney function and
increasing the risk of kidney disease.
While these endocrine changes are a normal part of aging,
proactive management can help mitigate their effects and
Altered Tubular Function: Tubular reabsorption and
promote better health and quality of life.
secretion may be less efficient, affecting electrolyte
balance and fluid homeostasis.
Gastrointestinal (GI) changes in geriatrics can significantly
impact health and quality of life. Here are some key
Reduced Bladder Capacity: The bladder may lose elasticity
changes to consider:
and capacity, resulting in more frequent urination (nocturia)
and increased urgency.
Decreased Motility: Aging often leads to slower gut motility,
which can result in constipation and other digestive issues.
Weakened Pelvic Floor Muscles: Muscle tone in the pelvic
floor may decrease, leading to issues such as urinary
Reduced Saliva Production: Salivary glands may produce
incontinence.
less saliva, affecting digestion and increasing the risk of
dental problems.
Changes in Prostate Function: In men, benign prostatic 3. Prostate Changes: Enlargement of the prostate
hyperplasia (BPH) is common, which can obstruct urine (benign prostatic hyperplasia) is common, leading
flow and cause urinary retention. to urinary symptoms such as frequency and
urgency.
Hormonal Changes: Decreased production of hormones 4. Decreased Semen Volume: There may be a
like estrogen in women can affect bladder and urethral reduction in semen volume and sperm motility
function, increasing the risk of incontinence. with age.
5. Changes in Sexual Response: Older men may
Decreased Sensation: There may be reduced sensitivity in experience longer refractory periods and require
the bladder, leading to difficulty recognizing the need to more stimulation to achieve orgasm.
urinate. 6. Increased Risk of Conditions: Aging men are at
higher risk for conditions that can affect
Increased Risk of Infections: Older adults may be more reproductive health, such as diabetes and
susceptible to urinary tract infections (UTIs) due to changes cardiovascular diseases.
in the urinary system and immune response. General Considerations:
 Emotional and Psychological Changes: Both men
Medication Effects: Many older adults take medications and women may experience emotional changes
that can affect urinary function, such as diuretics or related to ageing, impacting their sexual health
anticholinergics. and relationships.
 Health Conditions: Chronic illnesses and
Understanding these changes is crucial for managing medications can further influence reproductive
urinary health in older adults and can help guide health in older adults.
interventions to improve their quality of life. Understanding these changes can help in addressing
reproductive health concerns and improving overall well-
Physiological changes in the reproductive system due to being in older adults.
aging can vary between men and women. Here are some
key changes for each: Caring for older adults, whether in wellness or chronic
In Women: illness contexts, requires a comprehensive approach that
1. Menopause: The most significant change, typically emphasizes individualized care, support, and education.
occurring between ages 45 and 55, marks the end Here are key considerations for nursing care:
of menstruation and a decline in estrogen and Wellness Care
progesterone production. 1. Health Promotion:
2. Decreased Ovarian Function: Ovaries produce o Encourage Regular Screenings: Promote
fewer eggs, leading to irregular menstrual cycles screenings for common issues (e.g.,
and eventual cessation of menstruation. hypertension, diabetes, cancer).
3. Vaginal Changes: Decreased estrogen levels can o Vaccinations: Ensure vaccinations are up
cause vaginal atrophy, leading to dryness, thinning to date (e.g., influenza, pneumonia,
of the vaginal walls, and decreased elasticity. shingles).
4. Reduced Sexual Response: Changes in hormonal 2. Nutrition and Hydration:
levels can affect libido, arousal, and the ability to o Balanced Diet: Encourage a nutrient-rich
achieve orgasm. diet, emphasizing fruits, vegetables,
5. Bone Density Loss: The decrease in estrogen whole grains, and lean proteins.
contributes to a higher risk of osteoporosis, o Hydration: Monitor fluid intake and
impacting bone health. educate on the importance of staying
6. Changes in Body Composition: Aging may lead to hydrated.
an increase in body fat and a decrease in muscle 3. Physical Activity:
mass, which can affect hormonal balance. o Exercise Programs: Encourage
In Men: participation in regular physical activity,
1. Decreased Testosterone Levels: Gradual decline in such as walking, yoga, or strength training
testosterone levels can lead to reduced libido, tailored to their abilities.
erectile dysfunction, and changes in sperm 4. Mental Health:
production. o Social Engagement: Promote social
2. Changes in Erectile Function: The ability to achieve activities and community involvement to
and maintain erections may diminish due to prevent isolation.
vascular and nerve changes.
 o Cognitive Activities: Encourage activities recommend modifications to prevent falls
that stimulate cognitive function, such as or accidents.
puzzles or reading. By focusing on these key areas, nursing care for older
5. Education and Self-Management: adults can enhance their quality of life, support their
o Health Literacy: Educate older adults independence, and effectively manage chronic conditions.
about managing their health and
understanding medical conditions. telehealth has become an increasingly important tool for
o Goal Setting: Help them set achievable supporting older adults, especially in managing their health
health goals. and accessing care from home. Here’s an overview of its
Chronic Illness Care benefits, challenges, and the role of home-related agencies
1. Individualized Care Plans: and visiting nurse groups.
o Assessment: Conduct comprehensive Benefits of Telehealth for Older Adults
assessments to identify physical, 1. Accessibility:
emotional, and social needs. o Reduced Travel: Older adults can receive
o Personalized Goals: Develop care without needing to travel, which is
individualized care plans based on their particularly beneficial for those with
specific conditions and preferences. mobility issues.
2. Symptom Management: o Remote Consultations: They can access
o Pain Management: Assess pain levels specialists who may not be available
regularly and adjust interventions as locally.
needed. 2. Continuity of Care:
o Medication Management: Educate on o Regular Check-Ins: Telehealth allows for
medication purpose, adherence, and frequent monitoring and follow-ups,
potential side effects. Monitor for helping manage chronic conditions
polypharmacy issues. effectively.
3. Patient and Family Education: o Medication Management: Regular virtual
o Condition Education: Provide clear appointments can help in medication
information about their chronic illnesses reviews and adjustments.
and management strategies. 3. Enhanced Communication:
o Involve Family: Include family members in o Immediate Access: Older adults can easily
care planning and education to ensure a reach their healthcare providers with
support system. questions or concerns.
4. Coordination of Care: o Family Involvement: Family members can
o Interdisciplinary Approach: Collaborate join virtual visits to stay informed and
with healthcare providers, including involved in care decisions.
dietitians, physical therapists, and social 4. Cost-Effectiveness:
workers. o Reduced Costs: Telehealth can lower
o Follow-Up Care: Ensure regular follow-ups costs related to transportation and missed
and continuity of care, addressing any appointments.
changes in condition. Challenges of Telehealth for Older Adults
5. Emotional and Psychological Support: 1. Technology Barriers:
o Mental Health Screening: Regularly assess o Digital Literacy: Some older adults may
for signs of depression or anxiety, struggle with using technology or
providing referrals as needed. accessing the internet.
o Support Groups: Encourage participation o Equipment Access: Not all older adults
in support groups for shared experiences have access to smartphones, tablets, or
and coping strategies. computers.
6. Advance Care Planning: 2. Limited Physical Exams:
o Discuss Preferences: Engage in o Assessment Challenges: Certain
conversations about advance directives, conditions may require in-person
end-of-life care, and personal wishes examinations that telehealth cannot
regarding treatment. provide.
7. Home and Environmental Safety: 3. Privacy Concerns:
o Safety Assessments: Evaluate the home o Security Issues: Older adults may be
environment for safety hazards and concerned about the confidentiality and
security of their health information.
Role of Home-Related Agencies and Visiting Nurse Groups
1. Care Coordination:
o Integrated Services: Agencies can
coordinate care between telehealth visits
and in-person services, ensuring
comprehensive support.
o Home Health Assessments: Visiting nurses
can assess health status and recommend
telehealth services as needed.
2. Technology Support:
o Training and Assistance: Agencies can
provide training for older adults on using
telehealth platforms and devices.
o Equipment Provision: Some organizations
may lend devices to those in need or
assist in setting them up.
3. In-Home Services:
o Hands-On Care: Visiting nurses can deliver
essential health services at home, such as
wound care, medication administration,
and health monitoring.
o Health Education: Nurses can educate
patients about managing their conditions
and using telehealth effectively.
4. Emotional Support:
o Regular Check-Ins: Visiting nurses can
provide emotional support and
companionship, reducing feelings of
isolation.
o Mental Health Services: Agencies can
offer teletherapy options for mental
health support.
Conclusion
Telehealth, when combined with the services of home-
related agencies and visiting nurse groups, can significantly
enhance the healthcare experience for older adults. By
addressing barriers and leveraging technology, these
resources can improve access to care, support chronic
disease management, and promote overall wellness.

the musculoskeletal system, the muscular and skeletal

systems work together to support and move the body.
The bones of the skeletal system serve to protect the
body's organs, support the weight of the body, and give
the body shape. The muscles of the muscular system
attach to these bones, pulling on them to allow for
movement of the body.