Nancy Pares, RN, MSN
Metropolitan Community College
Nursing Program
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Most definitions= having lived a long time
Aged: old or advanced in years
Aging: process of growing older
We all age: not all are old in years, roles,
behaviors, health or physical limitations
Aging is an ongoing developmental process
that begins with conception and ends with
death
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Study of aging
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Geriatrics
◦ The biomedical science of old age and the
application of knowledge related to the biological,
biomedical, behavioral, and social aspects of aging
to the prevention, diagnosis, treatment, and care of
the older persons.
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Clinical: older adult age 65 or older
Older-old adults: age 85 or older
◦ 1996 33.2 million over 65, 3.8 million >85
◦ 2010-2030: baby boomers reach old age
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Three generations are affected by aging
◦ Parents, grandparents, great grandparents
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Systematic stereotyping and discrimination
Allows for separation and denial of the older
person’s humaness
Allows those who practice ageism to distance
themselves from their own aging
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Socioeconomic and cultural factors
◦ Roles: jobs, empty nest, spouse dies
◦ Personal relationships: children live away, friends
die
◦ Health: > chronic illness, ‘slow down’
◦ Agility: flexibility, CNS reactions slow
◦ Financial: medicare, fixed income
◦ Employment: must retire
◦ Independence: loss
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Non productive
Disengaged
Inflexible
Senile
Not able to learn new things
Retirement causes death
Sexless
Poor, disabled, ill…..
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Think about movies you have seen….
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Think about an older relative
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Visualize magazine pictures of the ‘50’s and
compare to present
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In the absence of disease, most aged are
alert with full functional capability
Modest impairments in memory and
learning after the age of ___?__ in people
free of major disease.
Short term memory, progressive slowing
of responses
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Long term memory remains intact
◦ Dependent on adequate O2 perfusion
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May not remember planned daily activities—
easily recalls childhood
Mild cognitive impairment (MCI)
◦ 40% will develop Alzheimer’s disease within 3 years
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Strategies to cope
◦ Mnemonics
◦ Behavioral memory training
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Temperature regulation
◦ Low tolerance to ______
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Pain perception and tactile perception
◦ Some research have found dulling, but these results
are not consistent
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If acute disease is causing delirium, re-orient
client
Depression
◦ Assess and provide for treatment
◦ Suicide rate high in elderly population
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Assess for TIA
Monitor BP
Medicate as ordered
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Forced vital capacity, vital capacity and max
breathing capacity decreases with age
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Atrophy of muscles
Increase in diameter of chest
Vertebral loss of calcium
Calcification of costal cartilage
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Loss of elastic tissue around alveoli and
alterations in pulmonary circulation--decreased diffusion across the alveolar
capillary membrane
Pulmonary blood flow
◦ Decreases due to reduction in cardiac output
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Exertional dyspnea
◦ Shortness of breath with exertion
◦ Ability to perform prolonged strenuous work
decreases with aging
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Lung disease
◦ Poses a threat to older adult
◦ Pulmonary secretions are handled less effectively
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Pneumonia vaccine
Influenza vaccine
Avoid distended bowel/bladder or
stomach
Allow adequate time for cares
Medications as needed
Adequate hydration
Lung sounds
◦ Proper breathing patterns-pursed lip
breathing for COPD
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Blood flow resistance increases as people age
Aging results in sclerosis of the endocardium
Heart becomes rigid-contractility impaired
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Coronary blood flow reduced by 35%
Valvular rigidity results in murmurs
Heart cells have decreased capacity to use
oxygen
Pulse increases and the pulse pressure
widens
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Decrease in resting cardiac output
◦ Amount of blood pumped each minute
◦ Between age 25 and 65 the resting CO falls 30-40%
◦ Cerebral blood flow is maintained, but other body
systems receive a diminished blood supply
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Peripheral vascular disease (PVD)
Hypertension
Chronic CHF (congestive heart failure)
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Assess peripheral pulses
Evaluate lifestyle factors
Teach about disease and treatment
Evaluate diet
Evaluate need for fluid restrictions
Teach about BP monitoring
Monitor BUN and creatine
Teach about need for exercise
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Decrease in function, cell mass and increase
in extracellular fluid
Decrease in filtration rate, plasma flow rate,
tubular reabsorption and secretion
Blood urea nitrogen (BUN) increases
Ability to concentrate or dilute urine is
diminished
Bladder capacity reduces by half
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Response to the stretch receptors in the
bladder wall that signal need to void may be
delayed until the pressure is high
Lax muscle tone may lead to incomplete
emptying
◦ Residual volume may lead to UTI
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Incontinence
◦ Conservative behavior treatment is first line therapy
◦ Prostate enlargement
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Assessment for bladder management
Peri care
MD referral for treatment options
Allow voicing of concerns
Do not allow self limitation of fluids
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Skin changes can be the most distressing
Dryness, loss of elasticity, uneven
pigmentation
Wrinkles
◦ Occurs when deep layer of skin loses moisture and
elasticity
◦ Can be determined by genetics and sun exposure
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Certain ethnic groups may maintain youthful
appearance
Itching
◦ Related to loss of oils in skin
◦ Tepid baths
◦ If persists, contact MD
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Hair loss
Nails
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Skin assessment for pressure ulcers, or
lesions
Adequate diet and fluids
Dry skin is vulnerable to break down
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Oral cavity
◦ Decrease in taste bud function
◦ Deterioration of teeth
◦ Decrease in saliva
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Muscles associated with chewing weaken
Peristalsis is slower
Gastric emptying is slower
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Glands secrete less volume and concentration
of hydrochloric acid
Gag reflex decreases
Gastric emptying slows
Liver size decreases after age 70
Liver enzymes decrease
Less Calcium is absorbed
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Constipation
◦ Frequent GI complaint due to slowed motility,
altered bacterial flora, medications and lack of
exercise
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Common GI problems
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Over or under nutrition
Constipation or diarrhea
Dehydration
Dental disorders
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General nursing interventions
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Assess nutritional status
Teach about proper nutrition
Inform about community resources
Assess fluid intake/output
Assess use of laxatives
Inform about benefits of exercise
Teach about oral hygiene
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Muscle mass and elasticity decrease
Bone demineralization
Joints undergo degenerative changes
Less endurance
ROM changes
Coordination changes
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Arthritis
◦ Most prevalent in men
◦ More severe in women
◦ Leading cause of disability
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Osteoarthritis
◦ Most common form of arthritis
◦ Caused by damage to the inside of joint surface
◦ Large wt bearing joints most affected
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Kyphosis
◦ Curvature of thoracic spine
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Teach benefits of weight bearing exercise
◦ Walking, biking, …
◦ Assistive devices to prevent falls
◦ Avoid prolonged bedrest
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Nursing interventions
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Adequate Ca, pro- and vitamin D
Avoid smoking, alcohol
Estrogen replacement for females
Safety of environment
Pain control
Exercise
Correct use of assistive devices
Complications of surgery
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Presbycusis
◦ Hearing loss
◦ 25% of adults over 69 and 50% >85 have hearing
loss
◦ Conduction deafness
 Blockage of ear canal caused by cerumen, infection or
abnormal structure
◦ Sensorineural
 Damage to nerve tissue from exposure to loud noises,
disease, certain drugs
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Macular degeneration
◦ Affects the macula which is responsible for sharp
central vision
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Cataract
◦ Clouding or opacity of normal transparent lens
◦ Surgical removal of the clouded lens
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Presbyopia
◦ Affects the shape of the lens
◦ Close work becomes difficult
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Glaucoma
◦ Atrophy of the optic nerve due to increased
pressure of the fluid in the eye
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General nursing interventions
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Assess ears for abnormalities
Evaluate medications for ototoxicity
Regular hearing tests
Monitor care of hearing aid
Instruct family on socialization and communication
needs of the elderly
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Reduce clutter
◦ Rugs, cords, furniture
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Vision
◦ Glasses, lighting
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Reaching distance
Non skid shoes, walkers, canes
Skin care
Environmental temperature
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Risk for falls increases with
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Changes in position
Unstable equipment
Waxed floors
Improper placement of food trays
restraints
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Most at risk
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History of falls
Osteoporosis
Prior stroke or sensory impairment
Anticoagulation therapy
Parkinson’s disease
Diabetes with peripheral neuropathies
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Movement toward Erikson’s ego integrity is
facilitated with older person
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Recognizes and accepts changes
Gives up roles and develops new ones
Develops a different self concept
Revises life goals
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Positive
◦ Rational actions, perseverance, positive thinking,
maintaining humor
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Negative
◦ Loss of identity, fulfillment, self esteem
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ADL (activities of daily living)
◦ Environmental, financial, community resources
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Assess the activities they do alone
Assess what they need help with
Functional assessment + diagnosis= nursing
interventions
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Basic
◦ Grooming, bathing, dressing, eating, elimination,
mobility
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Instrumental
◦ Prepare meals, shop, use the telephone,
housekeeping
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88% of older adults use > 1 medication
In long term care (LTC)
◦ >75% receive 4 or more meds
◦ >33% receive 7 or more meds
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Age slows the clearance of drugs and
increases the risk of adverse effects
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Decreased liver size, hepatic blood flow and
reduced enzyme activity
Polypharmacy
Older adults respond more vigorously to
drugs that act on the CNS
◦ Postural imbalance, uncoordinated movements,
respiratory depression, mental changes
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Nursing interventions
◦ Monitor drug regimen
 Amount, duration, purpose, ability to take
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Monitor vital signs
Monitor/record drug effects
Describe client cooperation
Teach no OTC without MD approval
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Independent living
Family provided assistance in home
Home health care
Assisted living facilities
Long term care facilities
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Protein
◦ Same unless ill then increase
◦ 12-20% of daily intake
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Carbohydrates
◦ Decrease simple, increase complex
◦ 55-60% of daily intake
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Minerals
◦ Decrease due to decrease in body mass
◦ Increase Ca intake
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water