Geriatric nursing ppt

Geriatric Nursing

1. Geriatric Nursing & Theories Of Ageing Mr.Vikas A nil Ghadge RJS College of Nursing

2. INTRODUCTION A man life is normally divided into five main stages namely infancy childhood adolescence adulthood and old age. In each of these stages an individual has to find himself in different situations and face different problems. The old age is not without problems, in old age physical strength deteriorates, mental stability diminishes, and money power become bleak coupled with negligence from the younger generation.

3. Normal aging processes Ageing is not merely the passage of time .it is the manifestation of biological events that occur over a span of time. It is important to recognize that people age differently .the ageing body does change. Some system slow down, while others lose there “fine tuning “As a general rule, slight, gradual changes are common, and most of these are not problems to the person who experiences them .sudden and dramatic changes might indicate serious health problems.

4. Normal aging has four aspects Biological aspect of ageing Psychological aspects of ageing Socio-cultural aspects of ageing Sexual aspects of ageing

5. 1. BIOLOGICAL ASPECT OF AGEING Individual are unique in there psychological and physical and ageing processes. As the individual ages, there is a quantitative loss of cells and changes in many of enzymatic activities within cells. Age related a change occur at different rate in different people.

6. NERVOUS SYSTEM Decreased the number of brain cells. Decrease in cell of the nerve fibres. Decreased neurotransmitter. Risk of injury due to diminished hearing, vision touch, Decreased pain sensation, Decreased balance, Decreased appetite leading to malnutrition due to diminished sense of smell and taste. Incontinence of urine and stool due to decreased sphincter tone. Forgetfulness due to diminished short term memory. Lowered self esteem due to kyphosis .

7. SENSORY SYSTEM Sensory losses with old age affect all sensory organs and can be devastating to the person who cannot see to read or watch television hear conversation well enough to communicate, or discriminate taste well enough to enjoy food.

8. SENSORY LOSSES VERSUS SENSORY DEPRIVATION Sensory losses can often be helped by assistive devices such as glasses and hearing aids. In contrast, sensory deprivation is the absence of stimuli in the environment or the ability to interpret existing stimuli (perhaps as a result of a sensory loss). This deprivation can lead to boredom, confusion, irritability, disorientation, and anxiety. Meaningful sensory stimulation offered to the older person is often helpful in correcting this problem.

9. VISION As new cells form on the outside surface of the lens of the eye, the older central cells accumulate and become yellow, rigid, dense, and cloudy, leaving only the outer portion of the lens elastic enough to change shape (accommodate) and focus at near and far distances. As the lens becomes less flexible, the near point of focus gets farther away. This condition,“ PRESBYOPIA ”.

10. Eye disease most commonly:- Cataracts , Glaucoma, Diabetic retinopathy, And age –related macular degeneration in its most severe forms, is the most common cause of blindness. In adults older than 55 years of age in the United States, and it is estimated to affect more than 10 million Americans. RISK factors include sunlight exposure, cigarette smoking, heredity, and people with fair skin and blue eyes are much more prone to the diseases. Sunglasses and hats with visors provide some protection. Yearly eye checkups ensure early detection, which makes surgical much more successful.

11. HEARING PRESBYCUSIS , is a loss of the ability to hear high-frequency tones attributed to irreversible inner ear changes, occurs in midlife. Older peoples are unable to follow conversation B/O tones of high – frequency consonants (letters like F, S, TH, CH, SH, B T P) all sound alike. Hearing loss may cause the older person to respond inappropriately. Misunderstand conversation and to avoid social interaction. This behaviour may be erroneously interpreted as confusion. Wax builds up or other correctable problems may be responsible for major hearing difficulties. A properly prescribed and fitted hearing aid may be useful in reducing hearing deficits.

12. TASTE AND SMELL There are 4 basic tastes: -sweet, sour salty, and bitter sweet tastes are particularly dulled in older people. Blunted taste may contribute to the preference for salty, highly seasoned foods, but herbs, onions, garlic and lemon should be encouraged as substitutes for salt to flavour food.

13. Integumentry system Decreased elasticity Decreased Secretions of natural oil and perspiration Thinning of skin Decreased heat regulation Protection against trauma and solar expose The number of pressure and light touch sensors decrease with age Immune vascular and thermoregulatory response of the skin decreased with age. Loss of hair colour and thinning of pubic, axillary and scalp hair

14. CARDIOVASCULAR SYSTEM Hypertension Isolated systolic hypertension Primary hypertension Secondary hypertension congestive heart failure coronary artery disease arteriosclerosis, Hypertension intermittent claudication (leg pain caused by walking) peripheral vascular disease, orthostatic hypotension

15. RESPIRATORY SYSTEM Decreased gas exchange Decreased physical ability Increased potential for infection or aspiration Decreased elasticity of alveolar sacs Skeletal changes of chest Slower mucus transport Decreased cough strength Dysphasia

16. MUSCUSOSKELETAL SYSTEM Decreased physical activity due to decreased muscle size and tone. Decreased mobility due to decreased range of motion in joints affecting gait, posture, balance and flexibility Increased risk of fall due to joint instability osteoarthritis, joint pain, reduced ability for activities of daily living of fracture due to osteoporosis.

17. GENITOURINARY SYSTEM GENITOURINARY SYSTEM Nocturnal Polyurea Decreased number of nephrons Impairing ability to concentrate urine and Eliminate medications which are excreted out by the kidney .

18. GASTROINSTESTINAL SYSTEM Difficulty in chewing Dry mouth Difficulty in digesting starches and fatty food Decreased appetite Malnutrition Feeling of fullness heart burn after meals Constipation pernicious anaemia

19. REPRODUCTIVE SYSTEM Changes in women Decreased breast tissue Sexual dysfunctions Decreased sexual desire Vaginal narrowing and decreased elasticity Decreased vaginal secretions

20. Cont… Changes in men In male decreased size of penis and testes Erectile ability undergoes changes. Takes longer time for erection, amount of semen is reduced and the intensity of ejaculation is lessened. It is not clear that whether the increase in importance is age related.

21. 2. PSYCHOLOGICAL ASPECTS OF AGING Intellectual functioning Fluid abilities or abilities involved in solving novel problems tend to decline from adult period to old age. High degree of regularity in intellectual functions presents on most of the old age people. Intellectual abilities of older people do not decline, but do become absolute. There formal educational experience is reflected in their intelligence performance.

22. Cont… Learning ability The ability to learn is not decline by age The slowing of reaction time with age and over arousal of central nervous system are noted in old age. May leads to lower level of performance in tasks which requires high efficiency. Ability to learn continues throughout the life, although strongly influenced by personal interests and preferences. Accuracy of performance diminishes.

23. Loss and grief By the time individuals reach 60-70 years of age they have experienced numerous losses, and morning has become a lifelong process. It is impossible for some of the older age people to complete the grief process in response to one loss before the other loss occurs. Because the grief is cumulative, this can result in bereavement over load.

24. Attachment to others The need for attachment is consistent throughout the life span. Well being of senior citizens can be contributed through socialization and companionship.

25. Dealing with death Death anxiety among the elderly is more of a myth than reality The feeling of abandment , pain and loss may leads to fear or anxiety in elderly

26. Psychiatric disorder The later life constitute a time of especially high risk for emotional distress Dementia depressive disorder, delirium, sleeps disorder etc at the most common psychiatric illness seen among elderly

27. 3. SOCIOCULTURAL ASPECTS OF AGING Old age brings many important socially induced changes, some of those change have the potential for negative effect on both the physical and mental well being of older persons. They want protections from hazards and wariness of everyday tasks. They want to be treated with respect and dignity and also want to die with respect and dignity .  

28. In developing countries and Asian countries the aged are awarded a position of honor that place emphasis on family cohesiveness. In industrialized countries many negative stereotyped perspectives on aging still persisting, aged are always tries or sick, slow and forgetful, isolated and lonely, unproductive etc. Emplacement is one of the area where the aged faces discrimination .although compulsory retirements has been eliminated, discrimination still persist in hiring and promoting the aged employees. The status of elderly may improve with time as the number of elder person increases worldwide.

29. 4. SEXUAL ASPECTS OF AGEING Menopause may begin anytime during the 4os or early 50s Gradual decline in the functioning of the ovaries and subsequent reduction in the production of estrogen The walls of the vagina become thin and inelastic and vaginal lubrication decreases. Orgasmic uterine contractions become septic.

30. Cont… All these changes result in vaginal burning, pelvic aching, irritability etc. In some women these changes result in vaginal burning in avoidance of sexual intercourse These symptoms are more likely to occur infrequent intercourse of only one time a month or less Regular and more frequent sexual activity result in a greater capacity for sexual performance.

31. Changes in male Testosterone production decline gradually as they increase As a result of these hormonal changes the erection takes place slowly and requires more genital stimulation to achieve. The volume of ejaculate decreases and the force of ejaculation lessen The testis become smaller, but most men continue to produce viable sperm well in to old age.

32. FACTORS AFFECTING AGEING Three types of factor that mainly affect aging Genetic and environmental factor Life style Disease

33. 1. Genetic and environmental factor The ageing processes depends on a combination of both genetic and environmental factors recognizing that every individual has his or her own unique genetic make and environment, which interact with each other ,that is why the ageing processes can occur at such different rates in different people. Environmental stress associated with exposure to excessive heat and light trigger the activity of aging genes.

34. 2. Life style However many environmental conditions, such as the quality of health care that you receive, have substantial effect on aging. A healthy lifestyle is an especially important factor in healthy ageing and longevity.

35. Behaviour of a healthy lifestyle Not smoking Drinking alcohol in moderation Exercising Getting adequate rest Eating a diet high in fruits and vegetables Coping with stress Having a positive outlook

36. Ageing processes in men Ageing processes in men is mainly brought about by over consumption of alcohol and heavy smoking. Lack of exercise, inadequate rest or sleep, mental stress show symptoms of early aging. Other factors like regular consumption of excessive spicy food and caffeine renders an old look. Sloth and sluggish lifestyle makes one feel old.

37. Disease Ageing and disease related in subtle and complex ways. Several conditions that were once thought to be part of normal ageing have now shown to be due to disease processes that can be influenced by lifestyle.

38. Theories of aging Biological theories Non-biological theories Disengagement Theory Activity Theory Selectivity Theory Continuity Theory

39. 1. Biological theories At present, the biological basis of ageing is unknown. Most scientists agree that substantial variability exists in the rates of ageing across different species, and that this to a large extent is genetically based. In model organisms and laboratory settings, researchers have been able to demonstrate that selected alterations in specific genes can extend lifespan (quite substantially in nematodes, less so in fruit flies, and less again in mice) Even in the relatively simple and short-lived organisms, the mechanism of ageing remain to be elucidated.

40. 2. Non-biological theories a)Disengagement Theory This is the idea that separation of older people from active roles in society is normal and appropriate, and benefits both society and older individuals. There are research data suggesting that the elderly who do become detached from society as those were initially reclusive individuals, and such disengagement is not purely a response to ageing.

41. Activity Theory In contrast to disengagement theory, this theory implies that the more active elderly people are, the more likely they are to be satisfied with life. The view that elderly adults should maintain well- being by keeping active has had a considerable history • However, this theory may be just as inappropriate as disengagement for some people as the current paradigm on the psychology of ageing is that both disengagement theory and activity theory may be optimal for certain people in old age, depending on both circumstances and personality traits of the individual concerned.

42. Selectivity Theory Mediates between Activity and Disengagement Theory, which suggests that it may benefit older people to become more active in some aspects of their lives, more disengaged in others.

43. d)Continuity Theory The view that in ageing people are inclined to maintain, as much as they can, the same habits, personalities, and styles of life that they have developed in earlier years. Continuity theory is Atchley's theory that individuals, in later life, make adaptations to enable them to gain a sense of continuity between the past and the present, and the theory implies that this sense of continuity helps to contribute to well-being in later life.

44. HEALTH PROBLEMS IN OLD AGE/ COMMON HEALTH PROBLEMS IN ELDERLY Mental health problems among older adults Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. As well as the typical life stressors common to all people, many older adults lose their ability to live independently because of limited mobility, chronic pain, frailty or other mental or physical problems, and require some form of long-term care. In addition, older people are more likely to experience events such as bereavement, a drop in socioeconomic status with retirement, or a disability. All of these factors can result in isolation, loss of independence, loneliness and psychological distress in older people.

45. Dementia Dementia is a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. It mainly affects older people, although it is not a normal part of ageing. It is estimated that 47.5 million people worldwide are living with dementia. The total number of people with dementia is projected to increase to 75.6 million in 2030 and 135.5 million in 2050, with majority of sufferers living in low- and middle-income countries.

46. Depression Depression can cause great suffering and leads to impaired functioning in daily life. Unipolar depression occurs in 7% of the general elderly population and it accounts for 5.7% of YLDs among over 60 year olds. Depression is both under diagnosed and undertreated in primary care settings. Symptoms of depression in older adults are often overlooked and untreated because they coincide with other problems encountered by older adults.

47. ABUSE Elder abuse is a general term used to describe certain types of harm to older adults. Other terms commonly used include: "elder mistreatment", "senior abuse", "abuse in later life", "abuse of older adults", "abuse of older women", and "abuse of older men".

48. Types of abuse 1 . Physical abuse 2. Psychological abuse 3. Financial abuse 4. Sexual abuse 5. Neglect

49. 1. Physical abuse: (hitting, slapping, burning, pushing, restraining or giving too much medication or the wrong medication) 2. Psychological abuse: (shouting, swearing, frightening, blaming, ignoring or humiliating a person)

50. Financial abuse: (the illegal or unauthorized use of a person’s property, money, pension book or other valuables) 4. Sexual abuse: (forcing a person to take part in any sexual activity without his or her consent - this can occur in any relationship)

51. Neglect: (where a person is deprived of food, heat, clothing or comfort or essential medication) an older person may either suffer from only one form of abuse, or different types of abuses at the same time.

52. Facilities and agencies for elderly Some numbers of facilities are provided to the older persons by government and NGOs Some scheme facilities and agencies working in the field of old age solutions are mentioned Social assistance programs National policy for older person (NPOP) National council for older person (NCOP )

53. National old age pension scheme National family benefits scheme Pension for freedom fighters Old age homes 60 + 60 declared as senior citizen

54. Concessions and facilities Rebate on income tax More intrest in saving in bank Concession in fair Telephone connection under n- oyt category Separate ramps and queues, booking reservation window, counters for elderly Insurance and pension scheme Employment scheme after retirement

55. Health care Geriatric clinics Special camps fix day service foe aged Separate registration and medicine counter Free supply of medicine to BPL elderly Free diagnosis/x-ray ECG Medical insurance Ambulance service Training to medical nursing paramedical for care of elderly

56. Legal support Legal protection for older person through maintenance and welfare of parents and senior citizen bill 2007 Free legal aid/cells NGOs and voluntary agencies Help age India. Delhi (regional centers across India) Rajasthan voluntary health association Jaipur

57. Voluntary health association TTT institution Chennai Healthy service societies Hyderabad Ramakrishna math and mission, belurmath, Howrah west Bengal Sambandh, Bhubaneswar, Orissa Missionary of charity (mother Tarrasa centre) Kolkata  

58. Nurses Role in ageing G [ Guiding] : giving guidance to people of all ages regarding ageing process. E [Eliminating] : eliminating the ageism or notion of old age as disease. R [Respecting] : respecting the right of old people. O [Observing] : observing the facilities provided to old people and improving them. N [Noticing] : noticing health hazards that may happen in old age and try to reduce them. T [Teaching] : teaching how to take care of old people, for those who are caring for them (family member, friends, community health workers, voluntary organization) O [Opening Channels] : opening the channels of development activities for the care of the aged.

59. Cont… L [Listening] : listening attentively to the problem of old people and giving importance to them. O [Offering] : offering positivism, presenting different possibilities to life. G [Generating] : generating energy for the participation in the care of aged and researches for new supporting techniques. I [Implementing] : implementing activities for rehabilitation and re adjustment. C [Coordinating] : co- ordinating different services related to care of the aged. A [Assessing] : assessing the needs and the health of the old people. L [Linking] : linking contacting services according to need.

60. Cont… N[Nurturing ] : prepare future nurses for the care of the aged. U [Understanding] : understanding every old person as an invaluable asset of the society. R [Recognizing] : recognizing the moral and religious aspect of old age. S [Supporting] : supporting the old people in accepting realities. E [Education And Encouraging] : educating and encouraging old people for selfcare .

61. BIBLIOGRAPHY Shebeer.P . Basheer S. YaseenKhan ; A concise Text Book of ADVANCED Nursing Practice:I st edition Bangalore:emeses medical publisher; 2012. Page no 742-51. 2. Krishnakumari ; Community health nursing –Principles and Practices: Ist edition Jabalpur; Kumar Publishing house , publishers of medical and nursing book,2008. Page no 479-90. 3. Park k. Textbook of preventive and social medicine: 21 st edition New Delhi banarsidas bhanot publishers: 2012. 4. Potter perry Fundamental of Nursing: 6 th edition: published by Elsevier,A division Reed Elsevier India Private Limited. Page no 237-57 5. Long Phipps Cassmeyer , Medical-Surgical Nursing: 3 rd Edition: Publisher A lison Miller. Page no 47-69.

62. Thank you