NCM 114 – Care for Older Adults Myth: The elderly do not pull their own weight.

MODULE 1  Fact: Older adults contribute greatly to society

Cross Cultural Caring ; Principles & Theories in the by supporting the arts, doing volunteer work,
Care of Older Adult and helping with grandchildren
 Fact: Paid employment is not the only measure
DEFINITION OF TERMS of value and productivity and older adults
 Geriatrics – a term associated with the medical continue to work into advanced old age.
care of older adults
o Gerontology – is a multidisciplinary & Myth: “It’s too late now to change my bad habits.
specialized area within various disciplines The horse is out of the barn.”
such as nursing, psychology and social  Fact: The risk of heart disease begins to fall as
work. soon as the elderly quit smoking
o Geriatric nursing - focuses on the care of  Fact: Exercise dramatically increases physical
the sick elderly fitness, muscle size, and strength in older adults.
o Gerontologic Nursing – includes not only
the care of a sick elderly but also health Myth: Older adults have no interest in sex
maintenance, prevention of illness and the  Fact: Although sexual activity does decrease in
promotion of quality life to assist the person some older adults, there are tremendous
to grow to an ideal state of life and well- differences. Most often, the human need
being. affection, physical contact continues throughout
life
Ageism is a stereotyping and discriminating against
individual or groups on the basis of aging. CARE OF THE OLDER PERSON
Categories of Aging:
Coined by Robert Neil Butler to describe discrimination  60 to 74 – Young old age
against older person.  75 to 84 – Old age
 85 - 100 – Old-old age
MYTHS OF AGING:
 Over 100 – Centenarians
Myth: Being Old, being Sick
 Fact: Only 5 % of older adults are frail enough
to require long-term care facilities
 Fact:: Most elder adults have chronic diseases
but function quite well.

Myth: Older Adults are set on their ways and can’t

learn new things
 Fact: Older Adults learn new things and should
be challenged to stay mentally active.
 Fact: Older adults who engage in challenging  Based on the statics female outlive males older
activities to keep their minds active are less adults.
likely to get set in their ways and are even less  In the Philippines, the # of older people is
likely to develop Alzheimer’s disease. increasing rapidly, faster than the growth of the
total population.
Myth: Health Promotion is wasted on Older Adults  The World Population Prospect 2019 - projects
 Fact: It is never too late to begin good lifestyle that in 2050, older people will make up around
habits such as eating a healthy diet and engaging 16.5% of the total population.
in exercise  The growing number of persons older than 65
 Fact: Although it may not be possible to reverse years of age impacts the health & social service
all the damage, it is never too late to stop bad agencies and health care providers.
habits such as smoking cigarettes or drinking too  Impact of baby boomers (people born between
much alcohol and enjoy better health outcomes. 1946 and 1964) - these people are well-
informed consumers of health care & will desire
a highly active role in their care
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  It will also have an impact on the government,  It’s also customary in Korea to have a big
the source of payment for many of the services celebration to mark an individual’s 60th and
older adults need. 70th birthdays. The hwan-gap, or 60th birthday,
 The older population has higher rates of is a joyous time when children celebrate their
hospitalization, surgery, and physician visits. parents’ passage into old age.

IMPLICATIONS OF AN AGING POPULATION In China

 The aging population demand for health  Chinese families traditionally view filial piety
services. and respect for one’s elders as the highest virtue,
 The aging family..... deriving from the Confucian tradition.
 Older parents are expected to have limited  “Placing your parents in retirement homes will
input into the lives of their older children. see you labelled as uncaring or a bad son,”
 Many grandparents care for their  “To abandon one’s family is considered deeply
grandchildren while parents are at work. dishonourable.”
 Older adults may enjoy independence &  However, this tradition is beginning to break
freedom from responsibilities that nuclear down in China, due to the country’s one-child
family life offers. policy, rising life expectancy and an aging
 Children are not required to meet the needs population.
of the aging parents for financial support,  Nursing homes are beginning to become a more
health services or housing. socially acceptable option for elderly care.

ETHINICITY – Regard for Elders In Western In Japan

cultures  The elderly are generally treated with the utmost
 The elderly are commonly removed from the respect.
community and relegated to hospitals and  Many Japanese families have several
nursing homes — aging can become a shameful generations living under one roof – one of the
experience. reasons for longevity
 Physical signs of human aging tend to be  There are more elderly citizens than young
regarded with distaste, and aging is often people in Japan
depicted in a negative light in popular culture if  Many Japanese live to be well over 100 years
it is even depicted at all. old.
 Some reasons attributed to the longevity include:
U.K. and U.S. o Strong community bonds
 elderly citizens live "lonely lives separated from o Plenty of exercises
their children and lifelong friends." o Healthy, low-fat diet
 As their health deteriorates, the elderly in these o Low-stress way of life
cultures often move to retirement communities,
assisted living facilities, and nursing homes. ( In ancient Rome
Anthropologist Jared Diamond)  Elders were a precious resource.
 Though the average life expectancy in ancient
In Greek and Greek-American culture Rome was around 25, some individuals did live
 Old age is honoured and celebrated, and respect into their 70s, and they were generally respected
for elders is central to the family. for their wisdom and experience.
 In many tribal communities, elders are respected  Older individuals had to earn that high status of
for their wisdom and life experiences. respect by living a virtuous life.
 Within Native American families, it’s common  The old were expected to act with moderation
for the elders to be expected to pass down their and dignity, at all times. The old had to be an
learnings to younger members of the family. example to the young, as it was thought the
young learned by example. This was ingrained
In Korea in Roman society.
 Younger members of the family have a duty to
care for the aging members of the family.
 Outside the family unit, Koreans are socialized
to respect and show deference to older
individuals as well as authority figures
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In India THEORIES of AGING
 Many Indians live in joint family units, with the 1. Biological /Physiological Aging Theory
elders acting as the head of the household. 2. Wear And Tear Theory
 The elders are supported by the younger 3. Somatic Theory
members of the family and they, in turn, play a 4. The Law Of Entropy Theory
key role in raising their grandchildren. 5. Nutrient-Deprivation Theroy
 Advice is always sought from them on a range 6. Cross-linking Theory
of issues, from investment of family money to 7. Rate of Living theory
traditional wedding rituals and intra-family 8. Free Radical Theory
conflicts. 9. Accumulative Waste Theory
 Their word is final in settling disputes. 10. Autoimmune Theory
 The elderly are often the most religious and 11. Error Theory
charitable members of the family.”
 Disrespecting the elders of the family or sending BIOLOGICAL /PHYSIOLOGICAL AGING
them to an old-age home has a social stigma in THEORY
India  deterioration theory
 body systems as used overtime “wear out "thus
In the Philippines they can no longer function correctly.
 Filipinos treat elders with the utmost respect.  CAUSES:
 The reason why there are only 13 nursing homes  Exposure to radiation, toxins, UV light.
in the 7,107 islands of the country is that we  The effect of body functioning
want them to age in their own homes.  Free radical produced by body metabolism
 There are programs that attend to the social,  Irreparable cellular system. Ex. Effects of
emotional, mental, physical, occupational, and radiation
recreational needs of the elder.
WEAR & TEAR THEORY
IMPLICATIONS OF CROSS-CULTURAL  Proposes that the human body wears out due to
CARING FOR GERONTOLOGICAL NURSING & use and time.
HEALTHY AGEING  Parts of the body such as cell and tissue
 An overview of culture & aging, as well as eventually wear out due from repeated use
strategies that Gerontological nurse can use to  Strategies to adapt to WEAR & TEAR
best respond to the changing face of aging, THEORY:
thereby promoting healthy ageing thus reducing  Be aware of stressors & emotional &
inequities physical reaction:
o Understand more about stress itself
LEARN Model – a tool of cultural assessment in o Determine how the body respond to
which the Gerontological nurse works with Elderly stress & find solution

SOMATIC THEORY
L – Listen carefully to what the elder is saying. And to  From the time of conception, body cells in our
the non verbal communication.
genes continue to reproduce. As cells divide,
there is a chance that some genes will be copied
E – Explain your perception of the situation & the incorrectly (mutation) à causes problems in the
problem. body’s functioning related to aging.

A – Acknowledge & discuss similarities and differences THE LAW OF ENTROPY THEORY
between your perception and goal’s and those with the  Entropy is the measure of disorder or
elders. randomness in a system such as the human body.
 The Law on Entropy
R- Recommend a plan that takes perspectives into  A system involving spontaneous process left to
account. itself, it inevitably deteriorates with time until its
state of disorder reaches a maximum (death)
 Entropy increases as the # of cells and the total
N – Negotiate a plan that is mutually acceptable. energy with in the body increased. (Kittle 1969).

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THE RELATIONSHIP OF ENTROPY TO THE RATE OF LIVING THEORY
CHARACTERISTICS OF A SPONTANEOUS Proposes that
PHYSICAL SYSTEM  Organisms with higher metabolic rate may
 Decay – a system will decay faster if insufficient actually live longer than a person with lower
work from the outside world is applied to the metabolic rate (SOHAL 1986),
system  Two Distinct Factors believed to govern
 Deteriorates – a soft system deteriorates length of life:
(worsen) faster than a hard one 1. A genetically determined metabolic
 Particles – addition of more particles increase potential.
entropy of the system. 2. Rate of metabolism.
 Complexity – increasing the complexity of a  Ways to Boost Metabolism:
system results in larger entropy.  Drink a lot of water
 Time – passage of time causes system entropy to  Do physical activities such as lifting and
increase automatically unless adequate standing activity.
reventropy is supplied  Get enough sleep.
 Random Activities – entropy increases, the
degree of random activities within the system FREE RADICAL THEORY
 System Entropy – if the system entropy  this theory proposes that accumulation of
increases the energy becomes less available for oxidative damage causes functional deterioration
useful work.  Invoke molecular damage caused by free
oxygen- derived free radicals: Reactive Oxygen
species (ROS) and reactive nitrogen species
WAYS TO REDUCE BODY DECAY (RNS).
 Physical – developing routine of aerobic and  Original Free Radical Theory ROS (Reactive
muscle building exercises . Oxygen Species) are irrelevant in a certain
 Mental – brain needs to be stimulated & stressed situations. Oxidative damage by ROS represents
on a regular basis. only a subtotal of damage.
 Nutritional – minimize food intake & to select  When it gives rise to accumulation, it gives rise
food of low caloric value. to accumulation of waste product (Accumulative
Waste Theory).
 Relaxation – allow to remove the entropy
 Modified Free Radical Theory- explains that
created during a normal day’s activities
there are hermetic effects for free radical theory:
 Mild radical effects
NUTRIENT - DEPRIVATION THEORY
 vascular changes in aging deprives cells of  reversible molecular stress
nutrients and oxygen  increase longevity.
 Severe radical effects
CROSS – LINKING THEORY  irreversible molecular damage
 Accumulation of crossed-linked proteins  decrease longevity
damages cells &tissues , slowing down bodily  Ways to slow Down the damage:
processes resulting in aging in which certain  Eating more antioxidant foods.
proteins in human cells interact randomly and  Cutting Calorie intake
produce molecules that get linked in such a way
as to make the body stiffer. ACCUMULATIVE WASTE THEORY
 These binding of glucose to protein cause  The by products and damaged mitochondria,
replicative damage or related decline in protein resulting from molecule oxidation accumulate in
turnover linked to loss of functioning proteins the non-dividing cells causing dysfunction,
further promoting age associated pathologies toxicity, aging and cell death.
 Examples:  Mechanism of Waste accumulation that
 Cataract- stiffening of eye senses affects cell:
 Wrinkles cross linking of protein collagen  Changes in the structural organization of the
 Researchers believe that if the concentration of cells causing delay In cellular functions and
sugar is high, then cross linking occurs. metabolic functions.
 What to do?  Accumulation of waste materials within the
 Keep the sugar level from spiking cell worsen the damage due to toxicity.

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 Non-dividing cells are more susceptible than 6. Adaptation theory - adaptation involves
the dividing cells’ careful tuning of functions at every level for
 Mechanisms for Damage repair: bodily integration ---à absence of the
1. Autophagy –cellular & proteins within the required adaptive genomic information à
cells undergo breakdown are recycled for aging
making a new protein and organelles 7. PSYCHOSOCIAL AGING THEORY
 How to Increase Autophagy:  Disengagement theory - after retirement
 Intermittent fasting ,older adult tends to withdraw from
 Acknowledge- know your trigger groups or society, making them less
 Exercise active.
 Certain drugs & supplements  Activity theory- Retirement may not be
harmful if older persons actively
AUTOIMMUNE THEORY maintain other roles like familial or
 proposes that decrease in immune function may recreational roles.
enhance immune response  Continuity theory- Old age is not
 causing the body to produce antibodies that viewed as a terminal part of life, rather
attacks itself. its a latter part is the It is the
 As immune system age it becomes harder to continuation of the earlier part of life.
distinguish themselves from foreign cells. 8. Disengagement theory
 In conclusion infectious diseases are prevalent in 9. Activity theory
elderly when compared to its counterparts. 10. Continuity theory
 The elderly are frequently present with 11. PSYCHOLOGICAL AGING THEORY
respiratory and urinary infections and usually  Carl Jung's Theory of Individualism
with poor prognosis. (Cunha et al, 2020) focus is toward the inner experience
 Coping Strategies:  Erikson's Development Theory (ego
 Eat healthy diet Practice stress integrity vs despair) preoccupation
management with acceptance of eventual death in
 Exercise regularly older adults who have sense of
 Sleep – practice sleep hygiene fulfillment

ERROR THEORY
 the cellular cant function normally causing
cellular breakdowns, deterioration, and
eventually death in the host.
 The structure of DNA is altered as people age.
 Due to alteration DNA cannot read correctly
resulting to translation and transcription
malfunction aging / illness/ cancer directly or
indirectly.
 Genetic Therapy Technique:
1. Killing of specific cells – the aim is to insert
DNA into the diseased cell causing the
selected cell to die.
2. Gene augmentation Therapy – stops the
cell from producing functioning products.
3. Gene Inhibition Therapy = introduction of
gene that inhibits expression of another gene
as in infectious disease and cancer.
4. PHYSIOLOGICAL AGING THEORY
5. Stress theory –effects of environmental
stressors (generation of free radicals à
disrupts DNA & CHON function à aging

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 NCM 114 – Care for Older Adults 4. atrophy of the inner ear structures & hearing loss
MODULE 2 (presbycusis)
Changes In Older Person & The Nursing Process in  Approximately 30% to 50% of people older
the Care of Older Adults than 65 have significant hearing loss
 Hearing loss increases with age and is
greater in men.
TOPICS :
 Changes in the older adults and its implications Nursing Implications:
to care. 1. Assess client’s ability to communicate
 Comprehensive Geriatric Assessment. 2. Check if the client is able to hear alarms and
 Nursing Diagnoses related to wellness. doorbells
3. Emphasize safe driving & taking public
CHANGES in the OLDER PERSON and their transportation
IMPLICATION to CARE 4. Encourage the client to engage in leisure &
recreational activities
PHYSIOLOGIC CHANGES
III. TASTE, SMELL & TOUCH
I. VISION (Age-related changes in the eye) 1. decrease in taste buds ( gradual)
1. thinning of the skin surrounding the eye  taste deficits result to weight loss,
2. decrease in musculature in the eyelids malnutrition, impaired immunity
 ectropion – bottom lid sags outward 2. atrophy of olfactory bulbs
 entropion – the lid turns inward  diminished sense of smell (hyposmia)
3. arcus senilis (corneal calcium deposits) 3. slower conduction of nerve impulses &
4. smaller pupil size diminished function of the peripheral nerve
 Changes in vision among older persons  decreased sensitivity to pain, temperature
are preceded by the following : extremes, and vibration
 Decreasing sensitivity to light
 Increased sensitivity to glare Nursing Implications:
 Altered color vision  Taste
 Presbyopia 1. Appetite enhancement strategies
 a universal age-related change in the 2. Check dentures for fit & cleanliness
lens of the eye involving loss of 3. Inspect mouth for ulcers or gingivitis
accommodation. 4. Identify possible offenders known to affect
 objects held closer than 1-2 feet become taste (ex. medications)
difficult to see. 5. Encourage fluid intake
5. decreased reading & color discrimination ability  Smell
6. atrophy of lacrimal glands – results in dry eyes 1. implement safety precautions
7. increased intraocular pressure o placing natural gas detectors
o placing smoke detectors
Nursing Implications: o date and label food containers
1. Urge older adults to schedule routine eye 2. house cleaning & personal hygiene
examinations 3. encourage daily waste disposal to prevent
2. Assess older client’s ability to perform ADL garbage smell
3. Consider safety measures like:  Touch
 adequate lighting o Focus assessment on:
 nonskid surfaces on stairs 1. the impaired sense of touch
 use of stair rails 2. the intactness of the skin
 toxic substances & medicines with labels 3. safety risks
that are readable
V. INTEGUMENTARY SYSTEM
II. HEARING (Age-related changes in the ear) 1. thinning of the 3 layers of the skin.
1. auricle tends to wrinkle & sag 2. loss of subcutaneous fat
2. drier and harder cerumen that accumulates in the  visible veins
ear canal & impacted cerumen  wrinkled, dry & sagging skin
3. dry ear canal & pruritus  skin prone to damage
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 3. loss of skin turgor 7. Slower amount of oxygen carried by the blood
4. nails grow more slowly, brittle, dull, yellow, or  slower & less efficient gas exchange
gray color  tendency to trap air(not able to exhale fully)
5. loss of eyelid elasticity  maximum breathing reduced.
6. epidermal mitosis slows by 30% & skin heals
more slowly Common Illnesses:
7. decrease melanocytes – hair appears gray or  Pneumonia
white, scalp, pubic & axillary hair declines due  Asthma
to the decline in the hormones  COPD
8. less efficient manufacturing of Vit. D from  Tuberculosis
sunlight
 Lung Cancer
9. photoaging - changes in pigmentation with an
accumulation of discoloration due to chronic
Nursing Implications:
exposure to UVA and UVB
1. Clean nostrils to ensure a patent airway.
2. Allow rest periods throughout the day.
Common Skin Problems
3. Avoid exposing the elderly to cold & flu germs.
 skin cancer
4. Encourage plenty of fluid intakes
 pressure ulcers 5. Proper nutrition
 cellulitis 6. Avoid smoking/ exposure to smoke
Nursing Implications: (to older adults at risk for skin VI. CARDIOVASCULAR SYSTEM (Changes that
problems) occur with aging)
1. Instruct client to avoid excessive use of soap, hot 1. More prominent arteries in the head, neck, and
water & brisk rubbing when bathing. Pat skin extremities.
dry instead of briskly rubbing. 2. Stiffening of the heart valves.
2. Lubricate the skin with a moisturizer multiple 3. Slight increase in the size of the heart, especially
times a day - dry skin causes itchiness the left ventricle.
3. Avoid prolonged pressure on bony prominences.  The aorta becomes elongated and dilated.
4. Protect skin from temperature extremes. 4. Increase peripheral resistance and decrease
5. Soak nails before trimming. cardiac output & BP increases to compensate.
6. Dress appropriately for weather and climate. 5. Natural pacemaker (the SA node) loses some of
7. Protect skin from sun exposure & risk of its cells & may result in a slightly slower heart
photodamage rate.
8. Evaluate and manage incontinence. 6. Less efficient oxygen utilization.
 If soiling occurs, the skin should be cleansed 7. Less elasticity of vessels.
per routine.  arterial stiffening – due to lipid deposits &
 Plastic-lined bed pads should not contact the calcification
person’s skin.  veins thicken
9. Monitor nutrition. 8. Altered electrical activity of the heart –
 Provide Vitamin C & Zinc to promote skin abnormal heart rhythms
healing. 9. Decreased cardiac output – produces renin &
10. Adequate fluid intake increases BP & retains sodium
10. Deposits of the "aging pigment," lipofuscin
V. RESPIRATORY SYSTEM (Changes that occur
with aging) Common Illnesses:
1. lungs appear larger due to loss of elasticity  Hypertension/ hypotension
(stiffening of elastin & the collagen connective  Hyperlipidemia
tissue) & lungs become more rigid.
 Metabolic syndrome – a condition characterized
2. weaker respiratory muscles
by elevated waist circumference, BP, fasting
3. increased chest wall stiffness
serum triglycerides & serum glucose
4. decreased ciliary action
5. decreased number of alveoli  MI
6. decreased respiration due to chest wall &  Angina
thoracic spine deformities.  Varicosities due to valvular reflux
 Postural or orthostatic hypotension

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Nursing Interventions: 4. More than 50% of the nephrons are lost before
1. Advise elderly to avoid/stop smoking age 80.
2. Encourage daily exercises 5. Blood urea nitrogen (BUN) may increase
3. Promote healthy diet – low salt, low cholesterol without serious symptoms.
calcium-rich foods 6. Less contractile detrusor muscle & inability to
4. Encourage the client to control his weight empty the bladder completely.
5. Schedule regular check-ups 7. Increased renal threshold for glucose
6. Advise to stay mentally active 8. Impaired thirst perception – due to fluid &
7. Socialize with others electrolyte balance.

VII. NEUROLOGIC SYSTEM Nursing Implications:

1. Brain decreases in size (approximately 7%) 1. Monitor intake and output.
2. Loss of neurons in the brain (up to 20% ). 2. Unless a patient is on fluid restrictions, he
3. Decrease in cerebral blood flow. should be offered fluids frequently.
4. Breakdown of nerves & reduction or loss of  Fluid intake should be no less than 2500 cc
reflexes or sensation every day.
5. Slowing of coordinated movements.  Reduce salt intake in the diet.
6. Deterioration of balance mechanisms.
7. The brain and spinal cord lose nerve cells and IX. GASTROINTESTINAL SYSTEM (Normal age-
weight ( atrophy) & nerve cells may begin to related changes in the older adult)
pass messages more slowly. 1. Wearing off or erosion of tooth surfaces – due to
8. Decline in ability to concentrate more than one frequent intake of acidic foods, tooth-to-tooth
task at a time. contact
9. Decreased reaction time in processing 2. Vertical hairline cracks – due to shrinkage of
information. dentine with loss of support for the enamel
10. “tip of the tongue” phenomenon 3. Oral mucosa becomes thin, smooth, dry, and
11. Diminished deep sleep. inelastic
12. Decrease in reflexes. 4. Decreased salivary production – results to dry
mouth
Common Illnesses: 5. Decreased blood supply to intestines & digestive
disorders/malabsorption syndrome
 Dementia
6. Decreased liver size & function - decreased
o Alzheimer’s Disease
metabolism, decreased drug detoxification
o Vascular dementia 7. Delayed gastric motility & emptying & diarrhea,
 Parkinson’s Disease or constipation, fecal incontinence
 Stroke / Transient Ischemic Attack (TIA)
 Multiple Sclerosis Common Illnesses:
 Esophageal disorders
Nursing Implications:  Dysphagia
1. Clients must remain active & engaged in life.  Gastroesophageal Reflux Disease
2. The elderly must develop hobbies and interests.  Gastritis
3. Eat a well-balanced diet.  Peptic and Duodenal Ulcer
4. Avoid stress & anxiety – enjoy life.  Crohn’s Disease
5. Physical exercise to remain or become fit.
6. Stay connected with at least one person on a Nursing Implications:
daily basis. Advise client to:
7. Encourage a consistent bedtime routine. 1. Eat a balanced diet that is high in fiber & low in
fat & processed carbohydrates
VIII. URINARY SYSTEM (Normal renal changes of 2. Maintain a normal weight.
aging) 3. Decrease the size of portions at mealtime
1. Kidneys shrink & become less efficient. 4. Avoid lying down for 2 – 3 hours after eating
2. Decreased ability to concentrate urine & risk for 5. Stop smoking or using tobacco products.
dehydration. 6. Limit the use of nonsteroidal anti-inflammatory
 Bladder capacity declines. agents
3. increased frequency in urination especially 7. Encourage to carry out daily oral self-
during the night examinations
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X. ENDOCRINE SYSTEM (Normal changes in Nursing Implications:
aging) 1. Get plenty of exercise & helps boost the immune
1. Decrease in cell mass and weight of pituitary system.
gland – due to atrophy, fibrosis & decreased 2. Eat healthy foods - good nutrition keeps the
vascularity immune system strong
2. Decline in the secretion of growth hormone - 3. Do not smoke - weakens the immune system
decreased bone density, decreased lean body 4. Limit intake of alcohol
mass & increased fat mass. 5. Look into safety measures to prevent falls and
3. Increase in serum concentration of Parathyroid injuries - a weak immune system can slow
hormone by about 30% - osteoporosis healing from falls and injuries
4. Lower calcium absorption in women – due to 6. Emphasize the importance of obtaining yearly
decrease in active calcium transport or diffusion influenza immunization.
5. Dilated pancreatic duct
6. Slow flow rate of pancreatic enzymes and XII. MUSCULOSKELETAL (Normal changes of
bicarbonate aging)
7. Insulin resistance may accompany age-related 1. Decrease in height is common (range of 2 to 4
glucose intolerance inches from spinal column) them thinner &
8. Decrease in estrogen levels à changes in the flatter
reproductive organs 2. Decreases in lean body mass - muscle atrophy
especially with a disease
Common Illnesses: 3. Bones become brittle/ may break easily - due to
 Diabetes Mellitus diminishing bone density & calcium loss
 Thyroid disorders 4. Joint degeneration with arthritic changes.
o Hyperthyroidism 5. Increase postural sway & difficulty maintaining
o Hypothyroidism balance.
6. Slower & shorter gait
Nursing Implications: 7. Foot problems like bunions, corns, calluses, can
1. Weight management contribute to gait problems and falls.
2. Encourage avoidance or reduction of alcohol 8. Deterioration of joint capsule & decrease in
intake ROM movements
3. Advise regular exercise
4. Refer to a dietician for basic food & meal plan Common Illnesses:
guides  Osteoporosis
 Osteomalacia
XI. IMMUNE SYSTEM (Normal changes of aging)  Osteoarthritis
1. Decreased number of B cells in the circulation  Kyphosis “ hunchback “
- tissues slower to repair / more vulnerable to
diseases Nursing Implications:
2. Production of IgE decline - decrease in allergic 1. Promote diet adequate in calcium & Vit D
reaction 2. Reduce or eliminate smoking/ alcohol intake
3. Decline in its ability to detect and correct cell 3. Encourage daily exercises
defects & results in an increase in the risk of  stretching 10 mins per day
cancer  active ROM
 weight-bearing exercises
Common Illnesses: 4. Monitor safety measures
1. Hypersensitivity
2. Primary Immunodeficiency disorders HEALTH PROMOTION in OLDER ADULTS
 HIV/ AIDS Facts about health & wellness promotion for older
3. Susceptibility to Infections adults
 pneumonia  Fitness is not a fad, but a goal to pursue by older
 UTI adults.
 Skin infections  Chronic illness can be prevented and slowed by
well-crafted physical and mental fitness regimes.
 Health promotion can be achieved through
patient education and counseling.
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  Keeping physically fit improves emotional 2. SOCIAL / EMOTIONAL HEALTH
health.  maintain a positive outlook on life
 Positive attitudes about lifestyle changes can  keep in touch with family & friends
vastly improve the older adult’s quality of life.  establish new relationships by joining church or
community social groups
1. PHYSICAL HEALTH
a) Exercise, including aerobic, strength training & 3. MENTAL HEALTH
flexibility components.  a loss of control over one’s life & circumstances
 Mobility fosters independence & freedom can impair mental health.
 Exercise programs should be prescribed by o Elderly must maintain independence / self-
the physician esteem/ self-respect
o type of exercises should consider  Facilitate self-care through provision of
person’s lifestyle, cardiac status, adaptive & assistive equipment
energy, endurance level, & mobility o Encourage decision-making through
limitations building in the perception of control
o most acceptable form of exercise is o Set attainable short- and long-term goals
walking with rewards
b) Good nutrition including adequate calcium &  Evaluate progress toward goal
Vit.D intake. Affects the overall well being & achievement.
health  Stress management
 Nutritional Screening Initiative (NSI) – o When an event has a likelihood of producing
determines risks for nutritional deficiencies: stress, it is best to avoid that event
o Diseases o use relaxation techniques
o Eating poorly
PSYCHOTHERAPY COMMONLY USED AMONG
o Tooth loss or mouth pain OLDER ADULTS
o Economic hardship a. One-on-One Therapy
o Reduced social contact & interaction  Provides a non-threatening & therapeutic
environment.
o Multiple medications
 Clients can express themselves to a nurse
o Involuntary weight loss or gain (anxiety relieving part)
o Need for assistance with self-care b. Psychodrama - is a form of human
o Elder at an advanced age development which explores, through dramatic
c) Health maintenance visits action, the problems, issues, concerns, dreams,
 Older adults must be examined at least once & highest aspirations of people, groups,
a year. systems, & organizations
o More frequent when health problem c. Occupational therapy
exist.  promotes health by enabling people to
o Must include immunizations. perform meaningful & purposeful
d) Adequate rest & sleep occupations.
 Sleep serves to rest body organs, conserve  includes (but are not limited to) work,
energy, preserve biorhythms & restore leisure, self care, domestic & community
mental & neurologic efficiency activities
 as people age, sleep patterns change d. Music therapy
 some have difficulty sleeping; others have  An interpersonal process that can promote
shorter sleeping time creativity, awareness, expression and
e) Avoidance of tobacco and alcohol communication
 Counseling about substance abuse as safety  Beneficial to the elderly patients
measure can be preventive or o For stress, it can dispel anxiety, tension
and fear.
 Interventional
o For depression, it can alleviate a sense
 Dental examinations – done on a regular
of loneliness and isolation, especially in
basis (at least once a year)
group
 good oral hygiene periodic assessment of o Sing-alongs or musical participation
denture fit & functionality of false dentures activities
5
 e. Art therapy
 Offers healing by providing social R – respect the rights of older adults and ensure others
connection, the experience of control and to do the same
the opportunity to both express
and manage emotions
O – oversee & promote the quality of service delivery
 Offers hope by facilitating nonverbal
communication
 Providing opportunity to create meaning N – notice & reduce risks to health & well-being
through life review
f. Animal-assisted therapy T – teach & support caregivers
 is a type of therapy that involves an animal
with specific characteristics becoming a O – open channels for continued growth
fundamental part of a person’s treatment.
 It is designed to improve the physical, L – listen & support
social, emotional, & or cognitive
functioning of the client, as well as provide
educational & motivational effectiveness of
O – offer optimism, encouragement & hope
the participants.
g. Recreational activities G – generate, support, use & participate in research
 a treatment service designed to remediate a
elderly person’s level of functioning and I – implement restorative & rehabilitative measures
independence in life
activities, to promote health and wellness. C – coordinate & manage care
 Gardening – involves cognitive benefits of
enhanced mood, reduced arousal &
improved concentration.
A – assess, plan, implement, & evaluate care in an
individualized, holistic manner
h. Play therapy
 is generally employed & provides a way to
express the older person’s experiences & L – link services with needs
feelings through a natural, self-guided, self-
healing process.
GERIATRIC ASSESSMENT
BARRIERS TO HEALTH PROMOTION Assessment of the health status of older persons.
1. Socioeconomic factors
2. Beliefs & attitudes of both patients & providers Purposes:
3. Specific motivation based on efficacy of beliefs 1. To provide a baseline data to gauge changes in
4. Access to resources condition & health status.
5. Financial limitations 2. To validate the health history & investigate
6. Lack of transportation current complaints.
3. To prevent recurrent & debilitating problems.
ROLES OF THE GERONTOLOGICAL NURSE: 4. To support the plan of care.
1. Healer
2. Caregiver Principles of Comprehensive Geriatric Assessment:
3. Educator 1. Physical, psychological & socioeconomic
4. Advocate factors interact in complex ways to influence the
5. Innovator health & functional status of the older person.
2. Comprehensive evaluation of an older person’s
FUNCTIONS OF THE GERONTOLOGICAL health status requires an assessment in each of
NURSE these domains.
3. Functional abilities should be a central focus of
the comprehensive evaluation.
G – guide persons of all ages toward a healthy aging
process

E – eliminate ageism
6
COMPONENTS OF COMPREHENSIVE  Common medical conditions to watch out
GERIATRIC ASSESSMENT for in older persons are HPN, Arthritis,
1. History taking Heart disease, DM & Cancer
a. types of history taking a. types of history 2. Functional Status
taking  it is central to assessment of older persons
 episodic and makes it different from assessment of
 complete younger persons.
b. accuracy of the history taking  measures the older person’s ability to
2. Health assessment perform self-care activities (ADL) & assume
A. History taking social roles in order to determine the
 entails an interview with the older status of health & well being of the older
person on certain aspects of health . person.
 requires a balance between encouraging  Barthel Index of ADL – assesses ability for
the person to share concerns and self-care
focusing the data gathering on  Katz Index of ADL – describes person’s
particularly important factors functional level at a specific point in time
i. Episodic health history  Lawton Scale – used to assess more
 nurse focuses questions & examination complex activities
on the chief complaints  PULSES profile – assessment of progress
ii. Complete health history made in rehab as well as to help identify the
 a comprehensive compilation of data severity of disability
from a variety of sources in order to  Basic ADLs (BADLs) consist of self-care
provide an in-depth profile on which to tasks, including
plan care.  Dressing/ Bathing
Accuracy of history taking  Eating/ feeding (chewing/ swallowing)
 Potential difficulties in obtaining a health  Ambulating (walking/ mobility)
history from older persons:  Toileting (complete act of urinating &
1. Communication difficulties defecating)
2. Underreporting of symptoms  Hygiene/ grooming ( brushing,
 fear of being labeled as a complainer combing, styling hair)
 fear of institutionalization  Instrumental activities of daily living
 fear of serious illness (IADLs) are not necessary for fundamental
3. vague or non-specific complaints functioning, but they let an individual live
 may be associated with cognitive independently in a community:
impairment, drug or alcohol use, atypical  Shopping for groceries or clothing
presentation of disease  Housekeeping
4. multiple complaints  Accounting/ Managing money
5. lack of time  Food preparation/taking medications as
prescribed
HEALTH ASSESSMENT  Telephone or other form of
1. Physical health communication usage
 Checks for the presence of illness or disease  Using technology (as applicable)
 Follows the same principles as health  Transportation within the community
assessment in general  Advanced ADL – assessment of activities
 Nurse should carefully note the chief that demand high cognitive functioning and
complaints in the patient’s own words à elderly is more responsive to subtle changes
minimizes the chance of misinterpretations - include such high-level functions as:
 Common handicaps/disabilities that must  Being gainfully employed
be reported during physical assessment
 Hobbies
1. Hearing impairment
 Socializing and involvement in activities
2. Vision impairment
3. Limited ROM in the community
4. Speech difficulty
5. Memory loss
6. Acute confusion
7
 3. Psychological function  caring enough to want to help to make
 involves assessment of cognitive and the situation better
affective status.  doing something which is not the usual -
 adequate mental & affective functioning is -- It’s not just “doing your job”
required in health history taking & problem 2. PROCESS - delivering quality care which
identification. promotes dignity by nurturing and supporting
 2 most common Psychological Impairment the older person’s self-respect and self-worth
1. Dementia through:
2. Depression  Communicating with older people by not
 Examples of psychological tests used for only talking with them, but listening to what
the elderly: they say.
 MMSE ( Mini Mental State  be able to interpret body language
Examination)  use eye contact
 Cornell Scale for Depression in  do not raise your voice
Dementia  speak slowly, use simple
 Mini-Cog  language
4. Social function  use the right language
 measured by the social network & social  listen
support of the older adult.  Assessment of need
 Social network – refers to the web of  Respect for privacy and dignity
relationships that the person has around  Engaging in partnership working with older
him/her, including family, relatives, & people, their families, carers & colleagues in
friends who give support in various the profession
moments  act as advocate to support them in fulfilling
their needs respect their decisions as you
WELLNESS DIAGNOSES FOR THE OLDER work hand in hand with them
ADULTS 3. PLACE – diverse environments in the
 Health perception- Health Management Pattern community or hospital where care is provided
 Readiness for enhanced immunization status for older people which is:
 Nutritional-Metabolic Pattern  committed to equality and diversity
 Readiness for enhanced nutrition  appropriate environment
 Elimination Pattern  resourced adequately
 Readiness for enhanced for urinary  effectively managed
elimination  Committed to equality and diversity
 Cognitive-Perceptual Pattern  providing care in a non-discriminating,
 Readiness for enhanced decision making non-judgmental & respectful way
 nurse familiarizes self with the likely
3 MAIN ELEMENTS IN PROVIDING CARE TO characteristics of groups & respond
OLDER PERSONS: accordingly
1. PEOPLE – these are nurses who are efficient  Appropriate environment
and able to deliver safe, effective, quality care  environment conducive to care that
by being: meets the needs of older people
 Competent - having the right KSA to care  safe, clean, tidy and quiet environment
for older people
 one that promotes independence
 Nurse must recognize & work within the
 Resourced adequately
limits of his competence
 Adequate number of nurses, staff and
 Assertive- challenging poor practice,
other hospital workers
including attitude & behavior and
 Also includes equipment, supplies,
safeguarding older people
medicines, etc
 Reliable & dependable
 Present a professional image which
demonstrates that the nurse is well-
Organized and manages time well
 Empathetic, compassionate and kind
 putting yourself in the person’s place
8
  Effectively managed  However, it has been observed that as long as
 Commitment from management at all elderly parents own land or have means of support,
levels within an organization they tend to maintain their own household. This
 Effective nurse managers and leaders household may either be nuclear or extended. In
make explicit the standard of care which either case, they are able to retain their authority
they expect to deliver over their adult children.”
 Provide excellence in the care of older  A strong attachment to one’s own home and
people the desire to maintain one’s autonomy are the
 Training of staff are identified & provided two most compelling reasons for the
for. preference of the elderly to stay in their own
dwellings.
LIVING ARRANGEMENT OF THE ELDERLY  They eventually live with their children when
 Assessments of living conditions is a special their health fails and their children would
component of assessing the health of older fulfill their moral obligation to care for and
persons support their frail parents.
 Factors that may affect living options of the older  Domingo et al. (1993) According to Centers
adult for Disease Control
1. income  According to the Centers of Disease Control:
2. health status  Usually when an older person is diagnosed
3. activity level with a chronic condition, there is an immediate
4. level of independence feeling of facing a loss of freedom and
5. family or other support systems autonomy, a sense that his/her days of living
independently at home are numbered.
CONTINUUM OF LIVING ARRANGEMENTS FOR  à the only alternative for some older adults
THE ELDERLY with serious, chronic health problems is the
 Independent living at home nursing home.
 Family provided at home  Fact: Older persons are more vulnerable to the
 Assisted living facilities problems of inadequate, unsafe housing.
 Home health care or hospice care  Home safety must be evaluated.
 Long term care facilities  What to evaluate?
1. Housekeeping
Assisted Living Facility (ALF) – consists of private 2. Stairways
apartments that either purchased or rented. 3. Floor .
Why ALF? 4. Bathroom
 lower in cost 5. Lighting
 more homelike 6. Stairways
Offer more opportunities for control, independence & 7. Outdoor area
privacy. 8. Traffic lanes
 a preferred transition between living independently
at home and residing in the nursing home. SUGGESTED PRODUCTS SPECIFICALLY MADE
TO HELP PEOPLE “AGE AT HOME”:
Home Health Care  Kitchen implements
 provides care in the home and eases the burden  devices that make opening jars and bottles,
that family members may feel. peeling and cutting vegetables easier
 it provides skilled nursing care  REACHERS – lobster claw –like devices for
Hospice care older adult having arthritis or other muscle
 method of providing palliative and supportive care or joinh that makes reaching or bending
when the older adult no longer wants active difficult
medical treatment.  Shower chairs and bath benches and hand-
Long-term care facilities held shower heads for bathing
 best living option when health needs of the elderly
 Elevated toilet seats
necessitate extensive or full-time supervision.
Socorro D. Abejo of the National Statistics
 Automatic lifts for stairwells, beds and chairs
Office…  Talking clocks, wristwatches, and calculators
 “Historically, the Filipino elderly have been for people with poor vision
dependent on their children or co-resident kin for
economic, social and physical support.

9
  Decreased # of macrophages- Inc. risk for
respiratory. Infection.
MODULE 2: PHYSIOLOGIC CHANGES  Decreased elasticity in the alveoli & lower long
ASSOCIATED WITH AGEING lobes Decreased gas exchange , increased
pooling of secretions.
VISION CHANGES:
 Decreased muscle strength & endurance-
PHYSIOLOGIC CHANGE:
Decreased ability to breathe deeply,
 Decrease in # of eyelashes  Increased risk for
diminished strength of cough.
eye injury.
 Decreased # of capillaries -Decreased gas
 Decreased tear production  Increased risk for
exchange.
eye irritation.
 Increased calcification of cartilage Increased
 Increased discoloration of lens  Decreased
rigidity of the rib cage.
color perception.
 Decreased tissue elasticity  Increased blurring.
 Decreased muscle tone  Decreased diameter CARDIOVASCULAR CHANGES
of pupil, increased refracted errors, decreased PHYSIOLOGIC CHANGE
night vision, increased sensitivity to glare,  Decrease cardiac muscle tone-> Decrease tissue
decreased peripheral vision oxygenation related to decreased cardiac output
& reserve.
INTEGUMENTARY CHANGES  Decreased cardiac output  increased chance of
PHYSIOLOGIC CHANGE. heart failure, decreased peripheral circulation.
 Decreased in n vascularity of the dermisInc.  Increased heart size, left ventricle enlargement-
pallor in white skin,  Compensation for decreased muscle tone.
 Decreased amount of melanin! Hair color  Decreased elasticity of the heart muscle & blood
(graying) vessels  decreased venous return, increased
 Decreased Sebaceous & sweat gland function dependent edema, increased incidence of
Increased dry skin Decreased Perspiration. orthostatic hypotension, increased varicosities
 Decreased Subcutaneous fat Increased & hemorrhoids.
wrinkling.  Decreased pacemaker cell HR 40-100 beats
 Increased thickness of epidermis- Inc. /min. increased incidence of ectopic or
susceptibility to trauma; premature heart beats increased risk for
 Increased. In localized pigmentation Increased. conduction abnormalities.
incidence of brown spot (senile lentigo) Increased  Decreased baroreceptor sensitivity Decreased
capillary fragility - Inc. purple patches (senile adaptation to changes in blood pressure
purpura)  Increased incidence of valvular sclerosis 
 Increase Density of hair growth decreased Increased rate for heart murmurs.
amount & thickness of hair on head and body.  Increased atherosclerosis Increased blood
Decreased rate of nail growth Increased pressure, weaker peripheral pulse.
brittleness of nail;
 Decreased peripheral circulation-Increased NUEROLOGIC CHANGES
longitudinal ridges of nails, Increased thickening PHYSIOLOGIC CHANGE:
& yellowing of nails.  Decreased # of brain cells  Slowed thought
 Increased androgen/estrogen ratio increased processes, decreased ability to respon to multiple
facial hair in women. stimuli & tasks
 Decreased number of nerve fibers  Decreased
reflexes , decreased coordination, decreased
RESPIRATORY SYSTEM CHANGES proprioception ( perception or awareness of the
PHYSIOLOGICAL CHANGE position and movement of the body Ex. Being
 Lowered tolerance to exercise leads to able to walk or kick without looking at our feet
diminished energy and endurance causes the or being able to touch your nose with your eyes
changes to occur closed.)
 Decreased body fluids Decreased ability to  Decreased amounts of neuroreceptors 
humidify resulting in a drier mucous Decreased perception of stimuli.
membranes.  Decreased peripheral nerve function 
 Decrease number of cilia - Decreased to trap Decreased, motor responses increased, risk for
debris. ischemic paraesthesia in extremities.
URINARY SYSTEM  Decreased saliva & gastric secretions, increased
PHYSIOLOGIC CHANGE gastric ph  Decreased digestion & absorption
 Decreased number of functional nephrons  of nutrients, altered absorption of some
Decreased filtration rate with decree's drug medications that are ph – dependent.
clearance.  Decreased gastric motility and peristalsis 
 Decreased blood supply  Decreased removal Increased flatulence , constipation & bowel
of body wastes, increased concentration of urine. impaction.
 Decreased muscle tone  Decreased volume of  Decreased liver size and enzyme production 
residual urine. Decreased ability to metabolize drugs, leading to
 Decreased tissue elasticity Decreased bladder increased risk for toxicity.
capacity.
 Delayed or decreased perception of need to void
 Increased incidence of incontinence. MUSCULOSKELETAL CHANGES
 Increased nocturnal urine production  PHYSIOLOGIC CHANGE:
increased the need to awaken to void or episodes  Decreased bone calcium  Increased
of nocturnal incontinence. osteoporosis., increased curvature of the spine
 Increased size of prostate (male)  increased (Kyphosis).
risk for infection, decreased stream of urine,  Decreased fluid in the intervertebral disks 
Increased hesitancy and frequency of urination. Decreased in height.
 Decreased blood supply to muscles  decreased
muscle strength.
 Decreased tissue elasticity  Decreased
GASTROINTESTINAL CHANGES mobility & flexibility of ligaments &
PHYSIOLOGIC CHANGE tendons.
 Increase dental caries & tooth loss  Decreased  Decreased muscle mass Decreased strength,
ability to chew normally, decreased nutritional increased risk for falls.
status.
 Decreased thirst perception Increased risk for
dehydration & constipation.
 Decreased gag reflex  increased incidence of Reference:
choking & aspiration.
 Decreased muscle tone at sphincters  Williams, Patricia. (2016). Basic geriatric nursing. 6th
Increased incidence of heartburn (esophageal ed. St. Louis, Missouri : Elsevier.
reflux) [Nsng/618.970231/W674/2016]
 NCM 114 – Geriatrics Lecture  Informed consent involves the patient’s right
MODULE 3 to autonomy and self-determination
 Three Elements of Informed Consent
Ethical Aspects of Care & Telehealth & Promotion of  Informed - sufficient information must be
Wellness Among Older Adults provided
 Competent - involves the capacity to
ETHICAL ASPECTS IN THE CARE AND weigh out the potential benefits in
HEALTH PROMOTION IN OLDER ADULTS comparison to the risks by applying
“rational reason”
 Voluntary - the patient is not coerced into
WHAT IS ETHICS IN GERIATRIC CARE? participation and that consent can be
 For the elderly, ethics is about how they want to withdrawn at any time
4. Privacy and Confidentiality
be treated and allowed to make their own
 Involves sharing only patient information on a
decisions.
need-to-know basis.
 For family members as caregivers, ethics is  There may also be instances when a clinician
about doing what is right even when no one is may be obligated to override the duty to
looking. maintain confidentiality
 For professionals providing eldercare, ethics is 5. Beneficence
about adherence to established canons of ethics  The principle of beneficence or “doing good “
promulgated by organizations. means that the highest good will be done for
older people in a particular situation.
KEY ETHICAL PRINCIPLES IN THE CARE OF 6. Nonmaleficence
OLDER ADULTS  Do no harm
1. The right to quality health care.  Concept originated from the Hippocratic Oath
 means that they have adequate access to  Applied to nursing by not causing injury,
quality care. whether it be a physical, psychological,
 they have a right to the same high standards emotional, or financial injury to patients (Silva
of health care as those in any age group & Ludwick,1999)
2. Respect for the individual person. 7. Justice
 Right to be treated equally, and in some cases
 Kant explicates this fundamental principle
equal access to treatment and allocation of
in ethics as follows :
resources
 “So act that you treat humanity in your 8. Veracity
own person and in the person of  truthfulness
everyone else, as an end and never  Principle of veracity also compels that the
merely as a means“ truth is completely told.
3. Autonomy or Self – determination  Quality of the relationship between nurse &
 Respecting the principle of autonomy means patient is based on trust & integrity
that older patients will be respected as  Fidelity
decision-makers about their own care. It involves an agreement to keep our promises.
 All competent older persons have a Fidelity refers to the concept of keeping a
perspective of their own best interests, commitment and is based upon the virtue of
shaped by their values and beliefs developed caring.
over a lifetime,that defines each individual  means to respect our words and duty to elder
as a unique person. patients
 If a patient lacks the capacity for such a
decision and has an advance directive, the WHAT IS AN ETHICAL DILEMMA?
person who has the durable power of Situations that produce conflicts:
attorney can make the decision.  Between nurses’ values and external systems
 Paternalism occurs when the nurse does not affecting their decisions
respect the patient’s right to autonomy by  Between rights of patients and nurses’
acting as if he or she knows what is best for responsibilities to those patients actual conflicts
the patient, rather than the patient (Silva & of interest arising when family members and
Ludwick, 1999). professional caregivers assist or represent the
 Paternalism disempowers the patient elderly

1
MEASURES TO HELP NURSES MAKE ETHICAL  There is no doubt that carebots will play a
DECISIONS necessary role in any future of caregiving, yet it
1. Encourage patients to express their desires. is important to pause here and state a few
2. Identify significant others who impact and are normative claims regarding that use.
impacted.  First, carebots are not an equivalent
3. Know thyself. replacement of human care. They may perform
4. Read. some tasks more efficiently, or reduce difficult
5. Discuss. burdens of informal caregivers, but ensuring that
6. Consult humans continue to care for humans in some
7. Share capacity is paramount.
8. Form an Ethics Committee  Children who were raised by their parents have a
9. Evaluate Decisions moral obligation of reciprocity to care for them
in
PHILIPPINE LAWS RELATED TO CARE OF THE
OLDER PERSONS ETHICAL CONSIDERATIONS:
1987 Philippine Constitution, Art. XV, sec. 4 1. Do good and minimize harm. This is a basic
 It is the duty of the family to take care of its moral obligation in healthcare, and it applies
older person members while the state may even more in the older adult care context. Why?
design programs of social security for them. Because more so than younger adults, older
 RA 7432 “Senior Citizens Act of 1992" adults face more critical and numerous
 An act to maximize the contribution of healthcare decisions.
senior citizens to nation-building, grant 2. The intention behind using a carebot should be
benefits & special privileges & for to serve older adults’ best interest. Their
 other purposes. primary charge is to improve care, all else
should be secondary.
CAREBOTS: A POTENTIAL SOLUTION TO 3. Older adult care belongs to a special, protected,
ELDERLY CARE class. Many older adults are more vulnerable
 To address this caregiving crisis and fill the and fragile than the general population and thus
caregiving void, technologists and caregivers are should be treated with greater respect and care.
turning to robotics and Artificial Intelligence 4. Act to preserve older adult’s autonomy and
(AI). Japan, whose Gray Wave is cresting now, agency. As older adults age, some tend to
leads the world in the adoption of caregiving experience reductions in their autonomy and
robots, typically called carebots. agency. It is crucial that carebots don’t reduce
 The most common carebots in Japan and them further.
worldwide are robotic companion “animals.” 5. Manipulation is never morally justified. Using
These companion animal-shaped carebots keep an older adult as a mere means to achieve one’s
older adults company and engaged by own ends is a definitive moral wrong.
interacting with them and responding to physical 6. Deception may lead to feelings of betrayal and
and audio ques with appropriate movements and distrust. Deception is a risky tool; when it is
sounds. Paro, a highly popular companion used too liberally it can create compounding
carebot “seal,” has demonstrated that it negative consequences.
decreases older adults’ loneliness, and 7. Deception should be the last resort. It is always
anecdotally makes older adults more calm, morally preferable to rely on another form of
talkative, and sociable. [7] response, for example, avoiding the question or
 Carebots have many uses. Robear, for example, redirecting the conversation.
is a large bear-like robot which can move older
adults into and out of bed, the bath, and other
hard to reach positions. [8] Further, startups like
CareCoach build and sell AI-enabled virtual
assistants to engage with older adults, keep tabs
on their movements and medical needs, and call
emergency services in times of crisis. [9]

2
 NCM 114 – Geriatrics PATTERNS OF ILLNESS
Module 4: Chronic Illnesses Among Older Adults  Certain commonly seen conditions are liable to be
disregarded by the individual, relatives or by the
WHAT IS CHRONIC DISEASE? doctor as they develop slowly.
 It is a condition viewed from a pathophysiologic  Recovery from illness is often slower, owing to
model à physical dysfunction of the body inter-current infections or to the debilitating nature
of the condition.
WHAT IS CHRONIC ILLNESS?  It is useful to identify underlying mechanisms that
 It reflects the human experience of the lead to true age-related changes, as opposed to
age-related disease.
symptoms & suffering & how the disease is
 Awareness of different pathological processes and
perceived, lived with and managed. (Lubkin &
of normal age-related physiological changes will
Larsen, 2002) assist the assessment and management of older
people.
OLDER ADULTS AND CHRONIC ILLNESS
Experiences of older adults: GENERAL GOALS OF CARE FOR THE
1. Powerlessness CHRONICALLY ILL PATIENTS
 inability to control an illness or disability 1. Promoting the highest possible quality of life à
 can be a result of normal aging changes, an establishing or maintaining client’s sense of
altered body image, or numerous losses. personal control
 results to loss of hope and dependence 2. Delaying deterioration and decline of health.
2. Stigma 3. Increasing capacity for self-care.
 mark of shame or discredit 4. Providing support in dying with comfort and
 older adult may feel ashamed of their dignity à client coping with long term discomfort
disability, disease or physical condition à or pain
social isolation
3. Hopelessness TAKE NOTE!!! In caring for the chronically-ill older
 feeling of futility and passive abandonment person, you need to focus on his/ her overall functional
of oneself to fate state, rather than on the state of disability.
4. Sensory deprivation
 As the person ages, sensory systems Quality of life – an individual’s perceptions of well-being
that stem from satisfaction or dissatisfaction with
gradually start to decline.
dimensions of life that are important to the individual
 sensory loss for older adults puts them at
 Most elderly people want to keep their
risk for sensory deprivation.
independence for as long as they can.
 Severe sensory impairments may result to
 They feel so good if they are still useful.
increased disorientation and confusion.
 Hobbies or volunteer work or even another career
5. Sleeplessness
keep them going on for many years.
 Staying close to friends and relatives after
PROBLEMS ASSOCIATED WITH CHRONIC retirement.
ILLNESS:
1. Patients become homebound DIMENSIONS OF HEALTH-RELATED QUALITY
 à social isolation
OF LIFE
2. Patients perceive themselves as burden
 Absence of distressing physical symptoms (eg,
3. Family experiences caregiver stress
pain, dyspnea, nausea, constipation)
4. Expensive – disease is usually long term
 Emotional well-being (eg, happiness, absence of
anxiety)
RISK FACTORS ASSOCIATED WITH CHRONIC
ILLNESS  Functional status (eg, capacity to do activities of
1. Malnutrition (undernourished/ obesity) daily living and higher-order functions, such as
2. Lack of exercise / physical activity pleasurable activities)
 diminished functional reserves  Quality of close interpersonal relationships (eg,
3. Cumulative effects of lifestyle habits such as with family members)
 eating salty & fatty foods  Participation in and enjoyment of social
 alcohol use activities
 smoking  Satisfaction with medical and financial aspects
 psychosocial stress of treatments
 Sexuality, body image, and intimacy
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SELECTED CHRONIC ILLNESSES AFFECTING  Modifiable risk factors
OLDER PERSONS RISK FACTORS PREVENTION
 Heart Disease 1. Smoking Don’t smoke
 Hypertension 2. Hypertension Regular check-up and
 Stroke/ CVA control of blood
 Diabetes pressure
 COPD 3. High Cholesterol Avoid fatty food, more
 Cancer exercise and cholesterol
 Dementia lowering drugs.
4. Diabetes Mellitus Treatment of Diabetes
HEART DISEASE 5. Obesity Avoid overeating, keep
 General term used to refer to problems that healthy weight
affect one or more components of the human 6. Lack of Exercise More exercise
heart. 7. Stress Relaxation
 Each year, 170,000 Filipinos die from
cardiovascular diseases, up from 85,000 more HYPERTENSION
than 20 years ago, according to a 2009 study by  Cardiovascular disease develops slowly and
the Department of Health. takes years to develop
 The most common cause of heart disease is the  Hypertension – major risk factor for other CV
narrowing or blockage of the arteries of the conditions.
arteries of the heart (Coronary Artery Disease)  “21% of Filipino adults are hypertensive” Dr.
which leads to a heart attack. Dante Morales (President of the Philippine
 Coronary Artery Disease – a process in which Society of Hypertension) , May 2012
the coronary artery vasculature is partially to  The recent Philippine National Nutrition Survey
totally occluded by atherosclerotic plaque, showed that High Blood Pressure prevalence has
resulting in disruption of blood flow to the heart significantly increased from 22.5 to 25.3
muscle. between 2003 and 2008.
 Non-modifiable risk factors include:  In the Philippines, hypertension is the leading
 Age - increased age related to length of cause of heart attacks, strokes and kidney
exposure to other risk factor failure.
 Family history  According to the latest WHO data published in
 Gender (men) May 2014 - Hypertension Deaths in
 Normal changes of aging that may lead to Philippines reached 20,986 or 4.03% of total
CAD deaths.
1. Muscles of the aged heart relax less  HPN is the single most important risk factor for
completely between beats à the pumping stroke causes about 50 per cent of ischemic
chambers (ventricles) become stiffer and strokes and also increases the risk of
may work less efficiently haemorrhagic stroke
2. Heart may not pump as vigorously or as  HPN does not show any obvious symptoms for a
effectively à becomes less responsive to long time.
adrenaline and cannot increase the strength  It is often diagnosed only when considerable
or rate of its contractions even during damage has already happened to the body’s
exercise blood vessels.
3. Heart does not get enough blood out to the  Changes of Aging and Hypertension
muscles to supply them with adequate  Blood pressure increases as arterial
oxygen resistance increases.
4. Walls of the arteries lose their elasticity and  Coronary arteries may become dilated,
stiffen. twisted and calcified. Circulation decreases
5. Veins thicken by 35% in most adults after age 60.
 Associated with is the presence of fatty
deposits in the inner walls of the arteries.
 There is lessened elasticity of the artery
walls.

2
 Decline in the ability of the kidneys to  2014 - 3.2 million cases of diabetes in the
excrete salt loads. Philippines
 To ascertain if older adult has hypertension:
 Elderly must rest for at least 5 mins before  Risk Factors:
taking the BP  Family History
 Take the BP in a seated or lying position.  Unhealthy Eating
 Ask client to stand for 2 mins, then take the  Lack of Exercise
second BP.  Overweight
 Pseudohypertension  Conditions or situations known to exacerbate
 BP cuff may not readily compress the glucose/insulin imbalance
calcified and thickened arteries. 1. Previously undiagnosed or newly diagnosed
type 1 diabetes
STROKE / CVA 2. Food intake in excess of available insulin
 Infarction of a part of the brain due to 3. Adolescence and puberty
insufficient blood supply or rupture of a blood 4. Exercise in uncontrolled diabetes
vessel. 5. Stress associated with illness, infection,
 The blood vessel affected determines the area trauma, or emotional distress
and the extent of damage.
 Neurologic dysfunction is long-lasting & often CHRONIC OBSTRUCTIVE PULMONARY
permanent DISEASE
 Prevalence of stroke in the 60–79 year old  It is a progressive disease that makes it hard to
group is 2% for men and 6.9% for women, breathe.
 Incidence of stroke in 80+ years age group is  Term used for 2 closely related diseases of the
9% for males and 13.8% of females (Go et al., respiratory system: chronic bronchitis &
2013) emphysema (often occur together in older
 According to the latest WHO data published in patients)
May 2014, Stroke deaths in Philippines reached  COPD affects millions of elderly people
63,261 or 12.14% of total deaths. worldwide, and this is more dangerous because
 Hypertension is said to be a principal risk factor the older people might suffer from weak
for stroke immune system or other chronic health
 Signs of Stroke conditions that may aggravate COPD.
 Sudden numbness or weakness of the face,  Chronic Obstructive Pulmonary Disease
arm or leg, especially on one side of the (COPD) and asthma are 2 of the leading causes
body of deaths in the Philippines and the world.
 Sudden confusion, trouble speaking or  (World Health Organization) - 600 million
understanding people worldwide suffer from COPD while 12%
 Sudden trouble seeing or blurred vision in of Philippine population of 90 million have
one or both eyes asthma.
 Sudden trouble walking, dizziness, loss of  Changes of Aging & COPD
balance or coordination  Lungs become stiffer and expand and
 Sudden severe headache with no known contract less easily.
cause  Muscles that support breathing become
weaker, making it harder to stretch the chest
DIABETES MELLITUS in order to breathe.
 A chronic disorder characterized by insufficient  Breathing becomes more shallowly to
production of insulin in the pancreas or when the compensate
body cannot effectively use the insulin it  Cough, it may not be very effective so that
produces. clearing the mucus from the lungs is
 This leads to an increased concentration of difficult.
glucose in the bloodstream (hyperglycemia).
 Diabetes affects 18% of people over the age of
65, and approximately 625,000 new cases of
diabetes are diagnosed annually in the general
population.

3
 ALZHEIMER’S DISEASE
 the most common form of dementia.
 It is a progressive, irreversible, degenerative
CANCER disease attacking the brain & resulting in
 Group of diseases characterized by uncontrolled impaired thinking, behavior, movement
cellular growth with local tissue invasion and coordination and memory.
systemic metastasis.  first described in 1906 by a neurologist (Dr.
 More than 100 types of malignant tumor are Alois Alzheimer) who observed neurofibrillary
represented by the term “cancer”. tangles & neuritic plaques in an autopsy of the
 Lung and breast cancer - commonly affects the brain.
elderly  Risk factors associated with Alzheimer’s
 Philippines, - 75% of all cancers occur after age disease (AD)
50 years, and only about 3% occur at age 14 1. lack of education
years and below. 2. smoking
 It is estimated that for every 1800 Filipinos, one 3. lack of physical activity
will develop cancer annually (if the current low 4. depression
cancer prevention consciousness persists) 5. high BP @ midlife
 Geriatric patients with lung cancer are clearly at 6. diabetes
greater risk for toxicity due to chemotherapy and 7. obesity
other interventions, particularly if they are frail  ETIOLOGY : Unknown, but it is believed that
or have serious comorbidity. reduced level of certain brain chemicals cause
 Lung cancer remains the leading type of cancer degeneration of nerve cells in the part of the
among Filipino men. brain responsible for memory & other thought
 Philippine Cancer Society - expressed concern processes.
over the rise in lung cancer incidences among  This degeneration is attributable to :
Filipino women. 1. INTRINSIC cause
 2010 - breast cancer became the most common  People with Alzheimer’s have a
cancer in the country with 16% of a total of common history of viruses or infections
50,000 cases resulting in death. such as herpes simplex, measles &
 Why do older people get cancer? polio.
 Some cancers can be inherited, and others  Genetics
are caused by long term exposure to cancer- 2. EXTRINSIC cause
causing substances (tobacco smoke).  Exposure to metals.
 The body works to repair and control this  It was found out that people with
damage, but when cells continue to grow Alzheimer’s have high aluminum
and divide and don’t die when they should, content in their blood.
cancer may develop.  CLINICAL MANIFESTATIONS of AD
 Most symptoms of aging have nothing to do 1. Significant forgetfulness
with cancer, but older folks who don’t report  Problems with long & short term
unusual changes to their doctor risk missing memory.
an early cancer that could be treated  Inability to remember details of one’s
successfully personal life (e.g. birthplace, name of
children ).
DEMENTIA 2. Impaired cognitive functioning.
 Incidence of dementia rises with age.  Persons with MCI (Mild Cognitive
 65-74 years old – 3% experience dementia Impairment) have complaints and
 75-84 years old – 19% objective evidence of memory problems.
 85 years old or older - 50%  they do not have deficits in ADL & do
 Dementia occurs due to degradation of the not meet the criteria for dementia
nerves endings that send impulses to the brain 3. Difficulty in performing familiar tasks ;
 Dementia is associated with higher mortality: misplacing objects constantly.
2.3 cases/100 person. 4. Decline in social functions.
 Dementia is a major cause of functional
dependence.

4
 Stages of Alzheimer’s disease:  Cholinesterase Inhibitor
 Stage I - Normal  Increases the amount of acethylcholine
o Common manifestations: which slows the mental decline in people
 No objective nor subjective with AD.
evidence of cognitive impairment.  Does not prevent the disease from getting
 No objective evidence of worse but may slow the progression of
impairment but subjective concern symptoms.
about memory loss.  Antioxidants (Vitamin E)
 Stage 2 – Forgetfulness  Helps prevent free radical damage (to the
o Common manifestation: brain can produce oxidative stress
 Can do familiar tasks in familiar contributes to devel’t of AD)
settings.  Conjugated Estrogen ( Estradiol)
 Stage 3 – Early confusional  Increases cerebral blood flow
o Clinical manifestations :  Has anti-inflammatory action
 Decreased ability to perform in  Has antioxidant properties
demanding employment and social  Promotes the nonamyloidogenic metabolism
interactions. of the amyloid precursor protein
 Deficit in memory and ability to  CARING FOR CLIENTS WITH
concentrate ALZHEIMER’S DISEASE
 Stage 4 – Late confusional  Promote functional independence and self-
o Clinical manifestations : care as long as possible.
 Increasing difficulty in performing  Provide a structured, predictable daily
complex tasks of daily life including routine.
money management.  Institute safety measures.
 Can bathe, dress, & travel in  Protect client from sources of infection.
familiar settings.
 Guard against learned helplessness
 Trouble speaking may begin.
 Stage 5 – Early dementia
o Clinical manifestations :
NURSING DIAGNOSIS RELATED TO CHRONIC
 No assistance required with eating
ILLNESS
or toileting.
 PHYSICAL
 Can recall own name and name of
 Impaired Physical Mobility r/t intolerance to
spouse & children.
activity/ decreased strength & endurance;
 Unable to recall phone number.
pain/ discomfort; perceptual/cognitive
 Difficulty choosing proper clothing.
impairment
 May require coaxing to bathe.
 Activity intolerance r/t bedrest/ immobility;
 Difficulty subtracting 3’s from 20.
generalized weakness; sedentary lifestyle
 Stage 6 – Mid dementia  Self-care deficit r/t decreased strength and
o Clinical manifestations : endurance; physical, perceptual or cognitive
 More deliberate gait, smaller steps. impairment
 Progressive deficits in independent
dressing, bathing, & toileting.
 PSYCHOSOCIAL
 Eventual urinary and fecal
 Social Isolation r/t absence of supportive
incontinence.
SO; alterations in physical appearance
 Stage 7 – Late dementia  Risk for loneliness
o Clinical manifestation :  Ineffective Role Performance
 Progressive loss of speech,  Impaired Home Management
locomotion, & consciousness.  Acute Confusion
 Medications for Alzheimer’s Disease
1. Cholinesterase inhibitor
2. Antioxidants (Vit. E)
3. Conjugated estrogen (estradiol)
4. NSAIDs
5. Ginkgo Biloba