SEMINAR OUT LINE

 DEFINITION OF RELATED TERMS.

 Gerontology
 Geriatrics
 Gerontoligical nursing
 Geriatric nursing
 Aging
 Old age

 PROFILE OF OLD AGE POPULATION

 CHANGES IN OLD AGE

1) Physical changes
 Nervous system
 ENT
 Digestive system
 Cardiovascular system
 Respiratory system
 Integumetry system
 Musculoskeletal system
 Genitourinary system
 Endocrine system
2) Psychosexual changes
3) Psycho-social changes
 Widowhood
 Retirement
 Chronic illness
 Relocation
 Death of friend and family
4) Cognitive and intellectual changes

 THEORIES OF AGING
 Biologic theories
 Psycho- social theory
  PROBLEMS OF OLD AGE

I. Physiological
 Hypertension, Coronary artery disease, Stroke, Urinary incontinence, Osteoporosis,
Accidents, Altered nutrition, Immobility, Self care deficit

II. Psychological
 Delirium, Dementia, Depression, Anxiety, Stress, Elder abuse

III. Financial problem

 Retirement

IV. Social problem

 Isolation

 APPROACHES TO GERIATRICS

 HEALTH MAINTENANCE

 CURRENTS TRENDS IN GERIATRICS

 REFERENCE
INTRODUCTION:

Aging is a universal process. In the words of Seneca "old age is an incurable disease".
But more recently Sir James sterling Ross Commented" your do not heal old age, you protect it,
you promote it and you extend it. These are in fact the principles of Preventive Medicine.

Expectation of life at birth for males and females has increased more in recent years. In
India, it is projected to be 67 years in 2011-16 for males and 69 years for females. A projection
beyond 2016 made by United Nations has indicated that 21 % of the Indian population will be
60+ by 2050 which was 6.8% in 1991.

Demographic transition has been accompanied by changes in society and economy.

Instead of strong family ties in India, the position of a large no. of old persons has become
vulnerable due to which they cannot take for granted that their children will be able to look after
them.

Industrialization, urbanization, education and exposure to western life styles are bringing
changes in values and life style. Much higher costs of bringing up and educating children and
pressures for gratification of their desires affect transfer of share of income for the care of
parents. Due to shortage of space in urban areas with higher rents, migrants prefer to leave heir
parents in their native places. Changing roles and expectations of women, their concepts of
privacy and space, desire not is encumbered by caring responsibilities of old people for long
periods.

The contribution of elderly populations to demographic figures is increasing day by day.

Increasing problems of health care, psycho-social, personal and socio-economic factors
associated with the elderly further overwhelms this.

Old age is not a disease in itself, but the elderly are vulnerable to long term diseases of
insidious onset such as cardiovascular illness, CVA, cancers, diabetes, musculoskeletal and
mental illnesses. They have multiple symptoms due to decline in the functioning of various body
functions.

The Govt. should also effectively plan Health Care Services for the elderly and prepare a
feasible implementation design relevant to country needs. The problems associated with the
aging of the population are that of absence of facilities for medical treatment and of providing
 economic and social support hence information on morbidity profile of this population is essential
for planning its health care facilities.

DEFINITION OF TERMS

GERONTOLOGY
Gerontology is the branch of science that deals with aging and the problems of aging.

GERIATRICS
Geriatrics is defined as “ the study of the medicine aspects of old age, and the application of
knowledge related to the biological, behavior, biomedical and social aspect of aging to
prevention, diagnosis, treatment and the care of old person. – Butler 1987

GERONTOLIGICAL NURSING
Gerontoligical nursing involves the care of aging people and emphasizes the promotion of
highest possible quality of life and wellness.

AGING
Aging is a process of becoming older, a process that is genetically determined and
environment modulated.

OLD AGE
The definition of old age varies depending upon the individual’s frame of reference. The
active healthy person of age 65 may consider, 75yrs as the beginning of Old age. When the
retirement age set at 65 yrs through social security legislation.

GERIATRIC NURSING
It involves care of the sick aged.

PROFILE OF AGING

Profile of aging in India:

Aging is – universal phenomenon

Older population in India 60 + population:

1951………. 5.43% of total population
2001……….7.7% of total population

Out of them live:

 40% ……….below poverty line
30% ……… just above subsistence

Illnesses status:
Visual impairment………… 88%
Locomotors disabilities….. 40%
Neurological diseases…… 18.7%
CVS Diseases…………… 17.4%
RTI Disease……………… 16.1%
Skin disease………………..13.3%
Diabetes…………………….15.23%
Dyspepsia…………………..11.03%
Depression…………………..8.5%

CURRENT STATUS IN INDIA

 90% of older are from unorganized sector, with no social security at the age of 60.
 30% of older person live below the poverty line, another 33% just marginally, 80%
live in rural areas.
 73% are illiterate, and can only be engaged in physical labour.
 50% of women over to 60 are widows, many of them with no support.
 By the year 2050, India will be the most populous country with 1.7 billion people.

Profile of aging in America:

The older population of 20th century America has multiplied dramatically in proportion and
numbers. (4.1% in 1900 to 12.2% in 1993, 3.1 million in 1900 to 32.8 million in 1991) the median
age of population has expanded from 28 in 1970 to 33 in 1990.

Living environment: : 94% most older adults live independently and 6% live in institutions.
About 20% orders need to spend some time nursing homes. 80% older adults living in their own
homes and their rented homes. Migration among the elderly 5% more than 17% of the population
over 65 years of age living in poverty. Older adults accounted for 36% of the total personal health
care expenditure.

Health status of elderly: although most persons consider themselves to be in good health, 4
out of 5 suffer from at least one chronic illness. In later life acute conditions occurs with less
frequency, while chronic illness are more common. Of the 30 million (14.5%) had difficulty with at
least one of five activities of daily living.
Heart disease followed by cancer and stroke account for more than75% of elderly deaths.
On the average, older people are hospitalized three times more frequently and remain in the
hospital 50% longer than people under age 65.

Top ten chronic conditions rate per 1000 people.

Disease name Rate per 1000 Disease name Rate per 1000
people people
 1. Arthritis 483.0 6. Deformity / orthopedic 155.2
2. Hypertension 380.6 7.Chronic sinusitis 153.4
3. Hearing impairment 286.5 8. Diabetes 88.2
4. Heart disease 278.9 9. visual impairment 81.9
5. Cataracts 156.8 10.vericose veins 78.1

CHANGES IN OLD AGE

1. PHYSICAL CHANGES

A. NERVOUS SYSTEM
Enlargement of the ventricular system, as people get older the volume of ventricles get
increased (cells surrounding the ventricles are lost).
Reduced brain weight and volume probably caused by the loss of neurons. (Common brain
disorders are Alzheimer’s disease, Parkinson’s disease, and stroke)

B. ENT.
The richness of human experience is perceived through the sense, especially through
vision and hearing. As people age increases their ability to perceive the information received from
their senses is impaired or distorted.

a) VISION
 Sclera become yellow and less elastic
 Retina receive less light
 Diminished capacity of tearing
 Visual activity decreases
 Night vision decreases

Age related changes may give rise to two conditions: -

1. Senile entropion (lid margin turns in ward),
2. Senile ectropion (eye lid margin turns out wards)

b) HEARING
Person age 60 to 74, 25% having hearing loss and above 75, 50% experiences hearing
loss.
Impaired hearing: - refers to a condition in which the person has enough residual hearing to
process some but not all speech information through the hearing or through the assistance of a
hearing aid.
Presbycusis: term used to describe hearing loss associated with normal aging. It may include
impaired for high frequency tones, impairment of sound localization.
Tinnitus: it is a continues or intermittent sound that is perceived, heard in various ways, such a
whistling or blowing.
 c) SMELL AND TASTE:-
Aging generally reduces but not extinguish the sense of smell.
Elderly people have a higher threshold for sensing sour. Bitter and salt tastes for sweet do not
undergo any age related changes. A higher threshold means that it takes more sensory
stimulation to trigger the sensory experience of taste. I.e. commonly people like sweet, then it
became very difficult for D.M patient.

 DIGESTIVE SYSTEM
Many physiological changes occurs in GI tract with aging, but it is often difficult to separate
these from pathological or disease status.
a) Oral cavity: - as person ages, there is an atrophy of oral mucosa, increased infection in teeth
and gums and loss teeth. After age of 50, there is decreased production of saliva, which leads to
slow digestion at starch. Also there is reduction in taste.
b) Esophagus: - causes smooth muscle weakness, which can result in delayed emptying and
possible esophageal dilation. It gives some people an unpleasant feeling of fullness in their chest
under the sternum. The result can be diminished pleasure in eating.
c) Stomach: - decrease in gastric secretion and presence of some atrophic gastritis, with
diminished level of hydrochloric acid, gastric mucosa, and pepsin, so there is impaired digestion
and absorption of iron, vitamin B-12, and protein.
d) Small intestine: - decreases in function and atrophy of the small intestine may affect protein, fat.
Carbohydrates absorption as well as potential malabsorbtion of other nutrients such as calcium
and vitamin D.
e) Gall bladder: - common bile duct undergoes a progressive dilation with age. The presence of
gall stone increaser with age.
f) Liver: - metabolism decreases as there is decrease number of hepatic cells and marked
decreased in alcohol intolerance.
g) Pancreas: - in elderly pancreas is displaced lower in the body and also there is dilation of
pancreatic duct at the head, body and tail of pancreas.
 CARDIOVASCULAR SYSTEM
 Most common changes in the cardiovascular system associated with increased age is a stiffening
of structure. Cardiac muscle fibers and other structures become calcified and thickened. Increase
in the deposition of collagen and lipids contribute to stiffness of the heart muscle. The valve of the
heart also becomes thicker and more rigid.
 Biochemical changes of aging heart include a reduction of mitochondrial enzyme activity. The
blood vessels are less distensible with aging.
 RESPIRATORY SYSTEM
 Age related changes in the structure can influence comfort and functioning. Connective tissue
changes cause the older nose to have a retracted columella (lower edge of the septum) which
can impair flow of air through nasal cavity. This can lead to mouth breathing.
 Osteoporosis of the ribs and the vertebrae and calcification of cartilages causes increased
stiffness or rigidity, decreased mobility, and reduced compliance of chest wall.
  Muscular changes: - muscles involved in respiration weaken with age like any other muscles.
Development at kyphosis due to atrophy of muscles.
 Vital capacity decreases by 25%.
 INTEGUMETRY SYSTEM
Two types of predictable changes occur in the skin.
1. Intrinsic aging,
2. Photo aging
 In intrinsic aging -there is systemic decrease on circulation, the loss of cells and loss of
elastic collagen fibers and muscle mass. The number of pressure and light touch sensors
decreases with age, which predisposes to mechanical and chemical injuries. Subcutaneous
atrophy of face, hand, etc.
Skin decreases the production of sweat, sebum, and vitamin D. as aging process there is loss
of hair color and a thinning of pubic, axillary and scalp hair.
 In photo aging- the effect of environmental damage became more evident, and there is more
profound aging in skin areas exposed to sun light many of the changes related to photo aging are
preventable or in some cases, reversible. It is stimulated that 90% of elderly people have skin
cancer.

 MUSCULO SKELETEL SYSTEM

 Normal age related change includes decreased height, muscle atrophy, slowed movement,
diminished strength and stiffening of joints.
 Common disorders associated with aging include osteoporosis and degenerative joint
diseases resulting in pathological fracture.

 GENITOURINARY
 Age related changes that occur in GU system focus mainly on maintaining urinary continence.
This problem can be isolating and embarrassing.
 Normal changes are loss at nephrone and renal mass, diminished blood flow, decreased
creatinine clearance, a decline in the endocrinal functions of the kidney.
 Bladder changes include replacement of smooth muscle and elastic tissue with fibrous
connective tissue, reduction in bladder capacity and loss of bladder control. In women, the
external genitalia and vagina atrophy and less elastic, in man erectile dysfunction.

 ENDOCRINE SYSTEM
 Age related changes occur in both the reception and the production of hormones and effect the
functioning of the pituitary and thyroid glands, adrenal cortex, gonads and pancreas. As a result
of aging, the target organs loss their ability to respond to the hormones produce by the different
glands.
 Common disorder includes type-II D.M., thyroid disorders and cancer at the breast and
reproductive organs.

2) PSYCHO-SEXUAL CHANGES
  Sexual functioning involves all the physiologic and psychosocial aspect of reproduction, interest
in sexual activity, and response to sexual stimulation. Personal and emotional needs of older
adults are very similar to younger adults age related changes
 A loss of reproductive ability at the onset of menopause in women is the age related changes in
sexual functioning. Others are related changes in sexual functioning includes diminished
reproductive abilities in older men and alteration in both males and females responses to sexual
stimulation.

FEMALE REPRODUCTIVE FUNCTIONING:

o Female reproductive functioning in governed by hormonally regulated cycles, called menses.
Reproductive abilities decline around the 5th decade, when frequency of ovulation diminishes
and menstrual cycle became shorter and more irregular menopause, the cessation of means
the typically occurs around the age of 41-51 years, is a clear indicator that reproduction no
longer can be accomplished.
o Because of greatly diminished estrogen following changes occur and affect sexual
functioning.
 Cervix, uterus and fallopian tubes atrophy
 The vaginal wall and mucosa became thinner
 The vagina diminishes in length and width
 The amount of vaginal lubrication during sexual excitement is diminished
 The labia loss their fullness owing to diminished subcutaneous fat
 Pubic hair became sparse
 Breast became less firm and more pendulous.

MALE REPRODUCTIVE FUNCTIONING

Male reproductive functioning depends on the secretion of hormones, the production
and release sperm, and the motility of sperm through the penile urethra. Circulating
testosterone decline in most men as a result of age related changes. Sperm production
decrease by 6th decade. The degenerative changes that affect the prostate gland include
diminished secretion, atrophy of the gland cells, and the formation of hard masses around the
prostatic urethra.
Eriksson’s old age is integrity Vs despair.

3) PSYCHO-SOCIAL CHANGES
Psycho-social changes are often the most challenging demanding of coping energy.
The life events of older adulthood might be unknown, unexpected and in fact unwanted or
even feared. Many events associated with old age involve rather gains. The losses of older
adulthood are likely to be the losses of significant others and object that have been part of
life for many decades.

LIFE EVENTS OF OLDER ADULTHOOD

I.) WIDOHOOD
 For most of the older couples, widowhood is inevitable for one of the two partners, and
chances are greater that the women will be widowed rather than the man. Common
consequences are
 Loss of helper
 Loss of companion
 Loss of sexual partner
 Emptiness, loneliness, grief
 Changes in responsibilities
 Dependency on others

II.) RETIREMENT: -
Social attitudes can influence adjustment to retirement, which is an age related events. It gives rise to
 Loss of income
 Loss of identity
 Loss of status or authority
 Loss of purpose in life
 Loss of peer contact

III) CHRONIC ILLNESS:-

Another major life adjustment for many older adults is coping with chronic illness and functional
limitations. Most functional limitations necessitate only minor adjustments and daily living but some
functional consequences are:-
 Functional impairment
 Sensory decline
 Medications side effect
 Dependency
 Loss of money
 Loss of ability to drive

IV). RELOCATION:-

Another area of psycho-social adjustment for older adult is the decision to move from family home.
Relocation to a nursing home is a common and significant life event of older adults. It leads to mainly
 Loss of space
 Change of neighborhood
 Move from friends

V). DEATH OF FRIENDS OR FAMILY: -

The loss of family and friend became more inevitable with each advancing age. Loneliness and social
isolation are two consequences of these losses. It can also be threat to on mortality.

4) COGNITIVE AND INTELLECTUAL

  Cognitive speed and memory performance decline with age. There is evidence that
poor health, fewer years of education, lower activity and high B.P predict faster
cognitive decline.
 Intellectual process such as reasoning and abstract thinking remain the same through
out the life unless they are affected by physical or mental detoriation.
 Creativity does not decline with age.

THEORIES OF AGING
a) BIOLOGICAL THEORIES
Biological theories of aging address questions about the basic aging processes that affect all living
organisms. These theories answer how do cells age and what triggers the process of aging. ‘Leyonard
hayflic’ one of the first gerontologists to propose a theory of aging, explain is related changes that are:-
 Deleterious:-reduce function
 Progressive:-that occurs gradually.
 Intrinsic:-not attribute to modifiable environmental changes
 Universal:-that affect all members of species.

a. GENETIC THEORIES
It emphasize the role of genes in causing age changes .in humans, the programme allows for a
maximum of about 110 years (genetic programme).hay flick estimate that normal human cell divide 50
times in this number of years. Moreover cells are genetically programmed to stop dividing after
achieving 50cell division, after which they detoriate.some genetic theories called mutation theory,
suggests that aging is the result of mutation of somatic cells or alterations in DNA repair mechanism.

b. WEAR AND TEAR THEORIES:-

It stated that, the wear and tear theory suggest that organizing have fixed amount of energy available,
and they will wear out on a scheduled basis. When enough cells wear out, the body does not function
well. The processes aggravated by harmful stress factors, such as smoking, poor diet, muscular
strength, or large intake of alcohol. This theory of aging is supported by microscopic signs of wear and
tear in the cells at striated skeletal tissue, heart muscle and all nerve cells. e.g.:-machine warranty.

c. IMMUNITY THEORIES
This theory based on the knowledge of that immune system particularly the thymus and immuno
competent cells in the bone marrow it affected by the aging process, because of the age related
diminished functioning of immune system. The older person has fewer defenses against foreigt
organisms and is more susceptible to disease, such as cancer and infection.

d. FREE- RADICAL THEORY

The free radical theory was proposed in the mid 1950’s and still provides a basis for research on aging.
Free radical they do not contain DNA, and therefore they can cause genetic disorder and produce waste
products that accumulate in the nucleus and cytoplasm. Free radical theory postulates that protective
mechanism decreases, or free radical formulation increases with advancing age. This attack the
molecules, they damage the cell membrane and aging occurs.

B. PSYCHO-SOCIAL THEORY

i) ACTIVITY THEORY:-
The activity theory proposed that older people would remain psychologically and socially fit. if they
remained active. This theory is based on the belief that one’s self concept is affirmed through activities
associated with various roles.

ii) HUMAN NEEDS THEORY

Maslow’s hierarchy is one of the theories used by the gerontologist. People continuously move between
the levels, but they always strive towards higher level.

PROBLEMS OF OLD AGE

1. PHYSIOLOGICAL
It is estimated that 45% of the elderly have chronic diseases and disabilities. Most common
diseases in this segment of population are (dr. arvind kasturi- health action June 2007)
hypertension, cataract, osteoporosis, coronary artery disease, diabetes mellitus, constipation
and COPD.

a) HYPERTENSION
Marked by an intermittent or sustained elevation of diastolic or systolic pressure. In
older adults hypertension is often results from vasoconstriction associated with aging,
which produces peripheral resistance.

b) CORONARY ARTERY DISEASE:-

Plaque deposits, narrowing of lumens of coronary artery, reducing blood flow are
common causes.

c) STROKE: - it is caused by blockage of blood supply to the brain. Reduced blood flow
leads to insufficient oxygen and nutrient supply. After stroke many patients became
dependent on others in daily activities and self care.
 d) URINARY INCONTINENCE: - it refers to the condition where a person passes urine
involuntary. It is a common problem in elderly, especially in females, cause; weakened
pelvic floor muscle.

e) OSTEOPOROSIS: - osteoporosis is a metabolic bone disease, particularly common in the

elderly. As ageing occurs, there is gradual loss of calcium which leads to a reduction in bone
density. The affected bones become thinner, and fractures may occur which may result in loss of
independence or lead to other complication

f) ACCIDENTS:-
 As their activity level changes, do the things that are considered safe. Sensory deficits such
as vision, altered perception, poor hearing, decrease sense of smell, slower response, loss of
taste, are some of the reason for older accidents.
 older people should be encouraged to perform safety checks periodically

g) ALTERED NUTRITION:-
Malnutrition due to decrease sense of taste and smell.
 Decrease appetite
 Poor food choices
 Physical limitation
 Social isolation

h) IMMOBILITY
Physical activity is the key points for healthy aging. A planned exercise is also important for adults.
i) SELF CARE DEFICIT
i.e. bathing, dressing etc. during the aging process people physical or mental functioning that
enabled them to maintained and direct their activities. So we need to determine the level of
assistance required.

2. PSYCHOLOGICAL PROBLEMS
a) DELIRIUM
It is a condition in which it affects the cerebral circulation and cause disturbance in cognitive
functions. The onset may be rapid and can include disturbed intellectual function. Disorientation
at time and place, worsened memory, liable mood, poor judgment etc. it can alter the level of
consciousness.
Prompt detection
 Treating the condition as a medical emergency can prevent permanent damage.
 Monitoring level of consciousness

b.) DEMENTIA
  Estimated that 4 million older adults suffer from dementia. Alzheimer’s is the most common
cause of dementia in older adults. Chances increase double every 5 years. After the age of
60.
 The greatest risk for suicide for a person with dementia is in the early stage of disease when
the individual is aware of the changes experienced.

c.) DEPRESSSION
Referred as common cold of elderly, but least treatment. It is the most frequent problem that
psychiatric treats in the elderly and at increase in the incidence with age, severity of depression
also higher in older adults. Some older adults who are depressed demonstrate cognitive deficits
secondary to the effects of depressions.

d) ANXIETY
Anxiety in older person is quite common. Overseas research found that, anxiety symptoms
present 20% community. Main areas of anxiety are
 Health
 Finance
 Life stressors
FOR COPING WITH ANXIETY
 Be optimistic and think positively
 Practice healthy life style and learn relaxation technique.
 If you are annoyed by a person, handle it positively and directly.

e) STRESS
Common sources of stress for elderly includes
 Changes of lifestyle and financial status after retirement
 Caring of grand children
 Caring of sick spouse
 Death
 Chronic illness
 Dependency
Management:
 An active social life
 Engaging in voluntary work
 Positive thinking
 Seek help from professionals

g) ELDER ABUSE
Abuse is an any act that causes harm. Abuse of elderly especially disturbing because the abused
are helpless to fight back and often unable to call help or because they love family to much.
FORMS
 Physical abuse: - violence that occur in bodily harm
  Material abuse: - elderly persons money or property
 Active neglect: - the intentional with holding the foods, hearing aids etc.
 Positive neglects: - an unintentional failure to care may results of inadequate skills or knowledge

3 .FINANCIAL PROBLEMS
RETIREMENT
This causes financial as well as psychological problems. It depends upon the person who cop up
and has bank balance. If he retires with minor benefits, this may affects any person. Some may
go for part time job.

4. SOCIAL PROBLEMS:
ISOLATION
Defined as loneliness experienced by an individual.
 It can be either self isolation or social isolation. The reason may be physical, psychological, and
financial. Social; is a risk factor for loneliness.
 Role changes (work to retirement, spouse to widow, parent to grand parent) may cause an
elderly person to question his or her worth to society. Behavior associated with confusion,
dementia, and alcoholism may leads to social isolation.

APPROCHES TO GERIATRICS
1. Family Physicians: - to keep watch on the older adults health patters or problems to have a
family physician is important. Doing the physical assessment and nutritional assessment also
important in geriatric care. It will help to identify the risk factors.
2. Conducting Medical Camps
3. Community Health Services: - when working with community based older adults, nurse’s
focuses on maintaining independence, preventing risk to health, and well being, establishing
meaningful life styles.

SERVICES are:-
a) Banking: - many banks offer free checking accounts and special service to senior citizens,
pension checks can be deposited in to checking accounts directly. This all will help the older
adults from traveling.
b) Consumer Affairs: - the elder are frequent victim of unscrupulous people who are victim of
profit by making convincing but invalid promises. Consumer protection agencies are there to
provide useful information to prevent and offer counseling if problem do arise.
c) Counseling: - financial problems, the need to locate new housing, strained family relationship,
widowhood, retirement may necessitate professional counseling. Local service agencies,
religions organization, and private therapists are there to offer assistance.
d) Education:-some public schools after literacy, vocational and personal interest courses for
older adults. Many colleges have free tuitions for the elderly.
 e) Employment:-state employment services and the over 60 employment counseling conduct
programmes their provide employment counseling and job placement.
f) Financial aids:-the social security administrations may be able to help older person obtain
retirement income, disability benefits,etc.various communities after discounts to senior citizens
theaters, transport etc.
g) Burial:-various agencies provide financial assistance for burial and funeral assistance. Social
security administration provides a small payment for burial expense to those who have insured by
that programme.
h) Religion:-churches not only a place for worship but also a community that can provide a
tremendous fellowship, support and assistance to persons at old age. Many religious group after
nursing homes or home visitations etc.

i) Transportation:-older patients are after given discounts for transportations.

j) Volunteer works:-the mental knowledge they possessed by older persons makes the
especially good at volunteer work. Not only do older volunteers provide valuable service to other
but they may also achieve a sense at self worth e.g.:-in hospitals, organizations, schools etc.
k) Daycare:-adult daycare programmes are the fastest growing community based long term
care.
l) Preventive geriatrics:-conducting annual medical check-ups early detection and treatments.
m) Old age homes:-“senior citizens home retirement home”
Why old age homes are developed.
 Migration of young couples from the rural areas.
 Unwilling to give to up the responsibility to their children’s.
 Movement at children’s to other countries.
1) Free type:-no one to look after Janaseva foundation
2) Paid type:-care is provided for a fee.

ASSESSMENT
Assessment is an important step in nursing management. Complete physical examination,
ability of person to do things, coping mechanism, social activities, family support, financial
condition, support system e.t.c. To be assessed properly before planning.

AGING RESEARCH CENTRE

 This centre is providing a service that allow researcher in this field to find
information that is related to study of the aging process. They also engage in many
research areas such as system biology, a study of an entire organism as it ages and
effect of hormonal changes on aging process.
 Healthy aging research network are centers for the disease control and prevention.
ORGANIZATIONS
 British geriatric society
 Charity organization
 Indian geriatric society –kochi
Help age India- 1860
 National and local government to bring about policy that is beneficial for elderly.
 Make society aware concerns of aged and promote better understanding.
 Help the elderly to aware there own right.
Indian association of gerontology -1982
 To promote knowledge by both research and training in biological, clinical, psycho-
social aspect at gerontology.
 To organize scientific meeting.

HEALTH MAINTANCE:

PRIMARY PREVENTION:
Health promotion and specific protection
Primary prevention is broken down into counseling, immunization, and
chemoprophylaxis.

Counseling:
1. encourage smoking cessations
2. encourage physical activities
3. identify alcohol abuse in elderly people
4. evaluate and counsel on dental health

Immunizations:
1. Against pnemococcal pneumonia and influenza
It is recommended that the pneumococcal vaccine be given at least once to all
people over age 65 years. Individuals immunized before age 65 may be candidates for
revaccinations, provided at least 6 or more years have passed since the last dose.
2. Tetanus:
It is an important but frequently forgotten component of health maintenance,
especially in elderly people. The mortality rate of tetanus exceeds 50% in those over
age 65.

Chemoprophylaxis:
The risk and benefits of oral anticoagulation therapy should be considers for older
adults at risk of cardiovascular disease, particularly stroke.
a. contraindicated if patient is at risk for GI bleeding
b. should be discussed with older adults with regard to prevention of deep vein
thrombosis, non valvular atrial fibrillation, cardiomyopathy, mechanical
prosthetic heart valves, acute MI, valvular heart disease,
c. Calcium, vitamin D, and other agents such as selective estrogen receptor
modulators may be considered for those at risk for osteoporosis.

SECONDARY PREVENTION:
 Early diagnosis and adequate treatment
Secondary prevention is the detection of disease in an early stage

SCREENING RECOMMANDATION:
1. The recommendation for bowel cancer screening is for early stool samples for
occult blood and sigmiodoscopy every five years after age 50.
2. Monthly breast self examination, yearly breast examination by a healthy care
provider and yearly mammography are suggested for breast cancer screening for
women over age 40.
3. yearly screening for tuberculosis via skin test is recommended for older adult at
increased risk
4. Yearly rectal examinations and blood test for prostate specific antigen ( PSA) are
recommended in men average 50 to screen for prostate disease.
5. Annual examination with papanicolaou (pap)
6. Yearly visual screening is important to assess for visual changes, glaucoma and
cataracts.

TERTIARY PREVENTION:
Disability on rehabilitation
Tertiary prevention addresses the treatment of established disease to avoid
complication and death. The major areas of focus for the older adult are complications
of immobility and rehabilitation.

REHABILITATION:-
 Essential to geriatrics rehabilitation is communication, specially improving sensory
impairment. The prevention of falls and osteoporosis can improve the health and
longevity. Addressing malnutrition can promote healing and vitalize the patient to
participate in a formal rehabilitation program. Depression is common because of
various problems.
 Educating the process and using these guidelines in our practice will enhance the
quality of life of geriatrics.
 Provisions of rehabilitation to India are by ministry of social and justice and
empowerment.
 Senior citizen club- 500 Rs for registration and 300 Rs. For reniew.

SOME OF SUGGESTION FOR EXTENDING LIFE

 Eat a balance diet which includes fruit and vegetables.
 Exercise daily.
 Get regular health checkups.
 Don’t smoke.
 Practice safety habits at home to prevent falls and fracture.
 Always wear seat belt in car.
 Stay in contact with family and friend.
 When you drink let some one else drive.
  Keep appositive attitude towards life.
 Do things that make you happy.

REFERENCE
1. Ann Schmidt Luggen/core Curriculum for Gerontoligical Nursing/National
Gerontoligical nursing association/ Mosby’s publication/Pp. 316-350.
2. Miller/Nursing care of older adult’s theory and practical/2nd edition/Lippincott
Publication/ Pp. 3-5, 28-35, 58, 94,148,170.
3. Charlotte Eliopoulos/Gerontoligical Nursing/5th edition/Lippincott publication/Pp. 201-
212,244-251,323-328.
4. Frances F Roger’s/ Geriatric Nursing Care Plans/ Mosby’s Year Book/1991/Pp. 3-6,
12,42,48,50.
5. Annette G.L/Gerontology Nursing/2nd ed. /Mosby’s publication / 1996 /Pp. 899-955.
6. health action/ june/2007/p.g.no.4-15
7. http.//www.google. com.
8. file://localhost/H:/benefits.htm
9. journal health of geriatric/june/2006/P. 9
 Demography of Indian Aging,
2001-2051

1. Abstract:
India is the second largest country in the world, with 72 million elderly persons
above 60 years of age as of 2001, compared to China's 127 million. One of the
objectives of this paper is to assess the emerging scenario of elderly for the first half of
the 21st century. According to projections, the elderly in the age group 60 and above
is expected to increase from 71 million in 2001 to 179 million in 2031, and further to
301 million in 2051; in the case of those 70 years and older, they are projected to
increase from 27 million in 2001 to 132 million in 2051. Among the elderly persons 80
and above, they are likely to improve their numbers from 5.4 million in 2021 to 32.0
million in 2051. The increasing number and proportion of elderly will have a direct
impact on the demand for health services and pension and social security payments.
Mobilizing resources for geriatric care and providing sufficient maintenance for the
elderly will emerge as a major responsibility for heath-care providers and pension
economists.
----------------------------------------------------------------------------------------------
S. Irudaya Rajan PhD, Centre for Development Studies, Thiruvananthapuram, Kerala,
India
Journal of Aging & Social Policy Volume: 15 Issue: 2/3 ISSN: 0895-9420 Pub Date:
12/8/2003

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