GERIATRIC NURSING: LECTURE

NCMB 314 | 1ST SEMESTER | A.Y 2024-2025

GERIATRICS ▪ Due to the improvements in the
● From the Greek word Geras, meaning “old prevention & early detection &
age”. treatment of diseases
● Generic term relating to the aged, but o Heart disease & cancer are two top
specifically refers to medical care for the aged. causes of death, regardless of age, race,
● Branch of medicine that deals with the gender, or ethnicity.
diseases and problems of old age. o Positive health reports declined with
GERONTOLOGY advancing age.
o African American and Hispanic or
● Is the broad term used to define the study of
Latinos - less likely to report good
aging and/or the aged.
health than their Caucasian or Asian
● “Gero” means old age; “Ology” means study
counterparts.
of.
• Majority of people 75y/o & over
● Olger Age Group:
o remain functionally independent, and
○ Young Old – Ages 65-74
o the proportion of older Americans with
○ Middle Old – Ages 75-84
limitations in activities is declining
○ Old Old – 85 and up
(CDC, 2007a).
• 70% of Physical Decline Related to Modifiable
GERONTOPHOBIA
Risk Factors
● Fear of aging.
o Smoking
● Inability to accept aging adults in the society
o Poor nutrition
o Physical inactivity
AGE DISCRIMINATION
o Failure to use preventative and
● Emotional prejudice among older adults. screening services
o Reason for the decline in limitations to
AGEISM
the activity of Older Adult
● Dislike of the aging and the older adult.
● Prejudice against the old just because they are
old. ADDITIONAL NOTES:

SENESCENCE ● According to the Global Age Watch Index

• Defined as a change in the behavior of an published by “Help Age”, the number of
organism with age, leading to decreased older people in the Philippines is
power of survival and adjustment, as well. increasing rapidly. It is growing faster
than growth in the total population.
CENTENARIANS Consider that in 2000, there were an
estimated 4.6 million senior citizens
• Predominant in lower educated more
(defined by law in the Philippines as an
impoverished, widowed, and more disabled
individual who is 60 years old or older).
population.
● This represented about 6% of the total
• Weight less, take fewer medications, and have
population. The percentage has been
fewer chronic diseases.
increasing to grow to 6.5 million older
LIFE EXPECTANCY people making up about 6.9% of the total
population in ten years.
• the average number of years that a person can
● The National Statistics Office (NSO)
be expected to live.
projects that by 2030, older people will
• US: 75.7 years old
make up around 11.5% of the total
• LIFE SPAN: 115 years
population. There will be increased
• French women lived for 122 years (1994)
demand for health services when there is
an increase in population.
AVERAGE LIFE EXPECTANCY – 47 YEARS (2004)
● The leading cause of morbidity is usually
• Figure had increased to 77.8 years infection due to the ageing of the body’s
immune system.
FACTORS THAT AFFECT LIFE EXPECTANCY ● Visual impairment, difficulty in walking,
• Improved Sanitation chewing, hearing, osteoporosis, arthritis,
• Advances in Medical care and incontinence are common health-
• Implementation of preventive health services. related problems.
● The average life expectancy was 66 years
CHRONIC CONDITIONS IN SENIORS in males and 73 years in females.
• 80% have at least one chronic condition. ● Older women comprised 53.8% of the
• Two of the three leading causes of death population aged 60 plus.
declined by one-third: ● By 2050, we expect our elderly to rise to
o Heart disease and stroke 23,633,000 (15.3% of total population).
• Majority of deaths (US) occur in people 65y/o
& older
o 50% of deaths -caused by heart disease GERONTOLOGICAL NURSING
& cancer. ● The aspect of gerontology that falls within the
o In the past 50 years - a noted decline in discipline of nursing and the scope of nursing
overall deaths. practice.
● This specialty of nursing involves assessing
the health and functional status of older
JERAMIE MACABUTAS - BSN 3-YA-16
GERIATRIC NURSING: LECTURE
NCMB 314 | 1ST SEMESTER | A.Y 2024-2025
adults, planning and implementing health ○ Dehydration and cracking of the skin
care and services to meet the identified needs ○ Decreased sweat production
and evaluating effectiveness such as care. ○ Decreased numbers of functional
NURSING CARE OF OLDER ADULTS melanocytes resulting in gray hair and
● Gerontological nursing is provided in acute atypical skin pigmentation.
care, skilled and assisted living, the ○ Loss of subcutaneous fat
community, and home settings. ○ A general decrease in skin thickness
● Goals of care include: ○ An increased susceptibility to pathological
○ Promoting and maintaining functional conditions.
status, and ○ Growth of hair and nails decreases; nails
○ Helping older adults identify and use their become brittle with age.
strengths to achieve optimal ● MUSKULO-SKELETAL
independence. ○ Decreased height
ROLES OF THE GERONTOLOGICAL NURSE ○ Decreased ROM joints
○ Increased postural sway/ difficulty balance
● Provider of care
○ Shrinking vertebral disc, slight kyphosis
→ Should be educated about disease ○ Loss of bone mass, bones more brittle
processes & syndromes commonly seen in
(increased resorption)
the older population.
○ Muscle Atrophy/ decreased lean body mass
● Teacher/ Educator
○ Joint degeneration (Cartilage surface)
→ Should focus their teaching on modifiable ○ Foot problems: bunions, coms, and
risk factors & health promotion. calluses
● Manager ● RESPIRATORY
→ They balance the concerns of the patient, ○ Decreased chest wall compliance.
family, nursing & the rest of the ○ Decreased maximal breathing capacity.
interdisciplinary team. ○ Decreased number of alveoli.
→ Must be skilled in leadership, time ○ Decreased elasticity
management, building relationships, ○ Decreased parenchyma
communication & managing change. ○ Impaired cough reflex because of defective
→ They may also supervise other nursing mucociliary function.
personnel. ○ Increased vulnerability to hypoxia and
● Advocate emphysema.
→ Acts on behalf of the older adults to: ○ Increased susceptibility to respiratory
■ Promote their best interests and infections
■ Strengthen their autonomy & decision ● CARDIOVASCULAR / HEMATOPOIETIC &
making LYMPHATIC
→ It does not mean making decisions for ○ Cardiac output decreases.
older adults but empowering them to ○ Aorta becomes dilated and elongated.
remain independent and retain their ○ Resistance to peripheral blood flow
dignity, even in difficult situations. increases by 1% per year.
● Research Consumer ○ Blood pressure increases
→ Must remain abreast of current research ○ Decrease cardiac output • Less elasticity of
literature, reading & putting into practice the vessel.
the results of reliable & valid studies. ○ More prominent arteries in the head, neck,
→ The use of EVIDENCE-BASED PRACTICE and extremities.
RESEARCH can improve the quality of ○ Stroke volume decreases by 1% per year
patient care in all settings: ● GASTROINTESTINAL
■ Best method for delivery of care. ○ Decrease esophageal motility.
■ Based on clinical guidelines derived ○ Atrophy of gastric mucosa
from research. ○ Decrease stomach motility, hunger
■ Coding system indicates the strength contractions, and emptying time.
of the research. All nurses should: ○ Less production of hydrochloric acid,
■ Read professional journals specific to lipase, and pancreatic enzymes.
their specialty. ○ Fewer cells on the absorbing surface of the
■ Continue their education by attending intestine.
seminars & workshops. ○ Slower peristalsis.
■ Participate in professional ○ Decreased taste sensation
organizations. ○ Esophagus more dilated
■ Pursue additional formal education or ○ Reduced saliva and salivary ptyalin
degrees. ● URINARY
■ Obtain certification. ○ Decrease in nephrons
○ Between ages 20 and 90, renal blood flow
decreases by 53%, and glomerular
PHYSIOLOGIC CHANGES IN AGING AND CHANGES
filtration rate decreases by 50%.
IN MIND
○ Weaker bladder muscles
PHYSIOLOGIC CHANGES IN AGING ○ Decreases the size of renal mass
● INTERGUMENTARY EFFECTS ○ Decrease tubular function
○ Wrinkling ○ Decrease bladder capacity
○ Decrease of the skin’s immune ● NERVOUS
responsiveness. ○ Decrease brain weight

JERAMIE MACABUTAS - BSN 3-YA-16

GERIATRIC NURSING: LECTURE
NCMB 314 | 1ST SEMESTER | A.Y 2024-2025
○ Reduced blood flow in the brain
PHYSICAL SIGNS OF AGING
○ Changes in sleep pattern
○ Decrease conduction velocity 1. Increased susceptibility to infection.
○ Slower response and reaction time 2. Greater risk of heat stroke or hypothermia.
● SPECIAL SENSES 3. Slight decrease in height as the bones of
○ HEARING our spines get thinner and lose some
■ Atrophy of hair cells of the organ of height.
Corti. 4. Bones break more easily.
■ Tympanic membrane sclerosis and 5. Joint changes, ranging from minor
atrophy. stiffness to severe arthritis.
■ Increased cerumen and concentration 6. Stooped posture
of keratin.
○ SIGHT PSYCHOLOGICAL CHANGES
■ More opaque lens. 1. Most older adults report good mental
■ Decrease pupil size. health and have fewer mental health
■ More spherical cornea problems than other age groups.
○ SMELL 2. Some older adults experience mental
■ Impaired ability to identify and health problems such as depression,
discriminate among odors. anxiety, schizophrenia, or dementia.
○ TASTE
■ High prevalence of taste impairment, HEART
although most likely due to factors • Blood vessel loss elasticity with age.
other than normal aging. • Fatty deposits build up against artery walls
○ TOUCH leading to hardening of arteries.
■ Reduction in tactile sensation.
● ENDOCRINE BONES, MUSCLES AND JOINTS
○ Decrease thyroid activity. • Bones shrink in size and density.
○ ACTH secretion decreases • Prone to fracture because of bone loss.
○ The pituitary gland decreases in volume by • Muscles, tendons, and joints lose strength
approximately 205 in older persons. and flexibility.
○ Gonadal secretion declines with age, DIGESTIVE SYSTEM
including gradual decreases in • Swallowing and digestive reflexes slow
testosterone, estrogen, and progesterone. down.
○ TSH decreases • Esophagus contracts less forcefully.
○ Insufficient release of insulin by beta cells • Reduce the flow of secretions that help
of the pancreas. digest food
● REPRODUCTIVE
○ MALE KIDNEYS AND URINARY TRACT
■ Fluid-retaining capacity of seminal • Less efficient in removing waste from the
vesicles reduces. bloodstream.
■ Possible reduction in sperm count.
• Kidneys become smaller as they lose cells as
■ Venous and arterial sclerosis of the
you age.
penis.
• Chronic diseases like diabetes or high blood
■ Prostate enlarges in most men
pressure can cause more kidney damage.
○ FEMALE
■ Fallopian tubes atrophy and shorten.
BRAIN AND NERVOUS SYSTEM
■ Ovaries become thicker and smaller.
• Naturally lose cells
■ Cervix becomes smaller
• The number of brain cells decreases
■ Drier, less elastic vaginal canal
• Reflexes slow down
■ Flattening of labia
■ Endocervical epithelium atrophies • Distraction and coordination affected
■ Uterus becomes smaller in size
■ Endometrium atrophies EYES
■ More alkaline vaginal environment • Vision changes occur
■ Loss of vulvar subcutaneous fat and • Lens stiffens
hair. • Colors perceived differently
• Eyes less capable of producing tears
• Lenses become clouder
ADDITIONAL NOTES:
EARS
Functional decline is a common occurrence in
• Hearing loss as you age (difficult to hear
older adults. It is sometimes episodic and
higher pitches voices).
progressive concerning the disability in their
• More frequently accumulating earwax.
previous functional status based on activities of
daily living (ADL). It is also in concurrence with
HAIR, SKIN, AND NAILS
weakness, a complex syndrome engaging not
• Skin becomes dry and brittle.
only physical decline but other multi-factorial
• The fat layer under the skin thins resulting
changes with aging.
in less sweating.
• Decrease physical activity.

JERAMIE MACABUTAS - BSN 3-YA-16

GERIATRIC NURSING: LECTURE
NCMB 314 | 1ST SEMESTER | A.Y 2024-2025
name with an image, making notes or lists,
• Hair and nails grow slower and become
and placing objects in consistent locations.
brittle.
Memory deficits can result from a variety of
• Thin hair
factors other than normal aging.
WEIGHT
INTELLIGENCE
• Decrease the level of physical activity.
• In general, it is wise to interpret the findings
• Slow metabolism may contribute to weight
related to intelligence and the older
gain.
population with much caution because results
• Extra calories will end up being stored in fat.
may be biased from the measurement tool or
method of evaluation used.
CHANGES TO THE MIND • Early gerontological research on intelligence
• Psychological changes can be influenced by and aging was guilty of such biases. Sick old
general health status, genetic factors, people cannot be compared with healthy
educational achievement, activity, and persons; people with different educational or
physical and social changes. cultural backgrounds cannot be compared,
• Sensory organ impairment can impede and one group of individuals who are skilled
interaction with the environment and other and capable of taking an IQ test cannot be
people, thus influencing psychological status. compared with those who have sensory
Feeling depressed and socially isolated may deficits and may not have ever taken this type
obstruct psychological function. of test.
• Recognizing the variety of factors potentially • Longitudinal studies that measure changes in
affecting psychological status and the range of a specific generation as it ages and that
individual responses to those factors, some compensate for sensory, health, and
generalizations can be discussed. educational deficits are relatively recent, and
they serve as the most accurate way of
PERSONALITY determining intellectual changes with age.
• Basic intelligence is maintained; one does not
• Drastic changes in basic personality normally
become more or less intelligent with age. The
do not occur at one age. The kind and gentle
ability for verbal comprehension and
old person was most likely that way when
arithmetic operations are unchanged.
young; likewise, the cantankerous old person
• Crystallized intelligence, which is the
probably was not mild and meek in earlier
knowledge accumulated over a lifetime and
years.
arises from the dominant hemisphere of the
• Excluding pathologic processes, the
brain, is maintained through the adult years;
personality will be consistent with that of
this form of intelligence enables the individual
earlier years; possibly, it will be more openly
to use past learning and experiences for
and honestly expressed.
problem-solving.
• The alleged rigidity of older persons is more a
• Fluid intelligence, involving new information
result of physical and mental limitations than
and emanating from the nondominant
a personality change.
hemisphere, controls emotions, retention of
• For example, an older person’s insistence that
non-intellectual information, creative
her furniture is not rearranged may be
capacities, special perceptions, and aesthetic
interpreted as rigidity, but it may be sound
appreciation; this type of intelligence is
safety practice for someone coping with poor
believed to decline in later life. Some decline in
memory and visual deficits. Changes in
intellectual function occurs in the moments
personality traits May occur in response to
preceding death. High levels of chronic
events that alter self-attitude, such as
psychological stress are associated with an
retirement, death of a spouse, loss of
increased incidence of mild cognitive
independence, income reduction, and
impairment.
disability. No personality type describes all
older adults. Morale, attitude, and self-esteem LEARNING
tend to be stable throughout the lifespan. • Although learning ability is not seriously
MEMORY altered with age, other factors can interfere
with the older person’s ability to learn,
• The three types of memory are:
including motivation, attention span, delayed
o Short-term, lasting from 30 seconds to 30
transmission of information to the brain,
minutes.
perceptual deficits, and illness.
o Long-term, involving that learned long
• Older persons may display less readiness to
ago; and
learn and depend on previous experience for
o Sensory, which is obtained through the
solutions to problems rather than experiment
sensory organs and lasts only a few
with new problem-solving techniques.
seconds.
• Differences in the intensity and duration of the
• Retrieval of information from long-term
older person’s physiologic arousal may make
memory can be slowed, particularly if the
it more difficult to extinguish previous
information in the consciousness while
responses and acquire new material.
manipulating other information-working
• The early phases of the learning process tend
memory function is reduced.
to be more difficult for older persons than
• Older adults can improve some age-related
younger individuals; however, after a longer
forgetfulness by using memory aids
early phase, they are then able to keep an equal
(mnemonic devices) such as associating a
pace.
JERAMIE MACABUTAS - BSN 3-YA-16
GERIATRIC NURSING: LECTURE
NCMB 314 | 1ST SEMESTER | A.Y 2024-2025
• Learning occurs best when the new times the client may need to be tested to
information is related to previously learned ensure accurate results.
information. Although little difference is • Many tools are available, but the nurse should
apparent between the old and the young in use only those that are valid, reliable, and
verbal or abstract ability, older persons do relevant to the practice setting.
show some difficulty with perceptual-motor KATZ INDEX OF INDEPENDENCE
tasks. • A useful tool to describe the client’s functional
• Some evidence indicates a tendency toward level.
simple association rather than analysis • Katz Index of Independence in Activities of
Because generally a greater problem to learn Daily Living, commonly referred to as the Katz
new habits when old habits exist and must be ADL, is the most appropriate instrument to
unlearned, relearned, or modified, older assess functional status as a measurement of
persons with many years of history may have the client's ability to perform activities of daily
difficulty in this area. living independently.

ATTENTION SPAN
• Older adults demonstrate a decrease in
vigilance performance (i.e. the ability to retain
attention longer than 45 minutes).
• They are more easily distracted by irrelevant
information and stimuli and are less to
perform complicated tasks or require
simultaneous performance.

NURSING CARE OF THE OLDER ADULT IN

WELLNESS
ASSESSMENT
• Assess potential health hazards to identify
risk factors for illness and injury.
• Risk Factors:
o Habits
o Lifestyle patterns
o Personal and family medical history
o Environmental conditions
• Comprehensive Geriatric Assessment (CGA):
o Physical health
MINIMENTAL STATE EXAMINATION
o Mental health •
o Functional status • Mini-Mental State Exam (MMSE) is a widely
o Social functioning used test of cognitive function among the
o Environment elderly; it includes tests of orientation,
attention, memory, language and visual-
spatial skills.

FUNCTIONAL STATUS ASSESSMENT

• Functional status is considered a significant
component of an older adult’s quality of life.
Assessing functional status has long been
viewed as an essential piece of the overall
clinical evaluation of an older person.
• Functional status assessment is a
measurement of the older adult’s ability to
perform basic self-care tasks, or ADLs, and
tasks that require more complex activities for
independent living, referred to as IADLs.
• Determination of the degree of functional
independence in these areas can identify a
client’s abilities and limitations, leading to
appropriate interventions.
• The client’s situation determines the location
and time when any of the scales or tools should
be administered, as well as the number of

JERAMIE MACABUTAS - BSN 3-YA-16

GERIATRIC NURSING: LECTURE
NCMB 314 | 1ST SEMESTER | A.Y 2024-2025
PAR-Q AND YOU o Subjective: Determine the level of
• Physical Activity Readiness Questionnaire understanding of any treatments or
(PAR-Q) is a common method of uncovering therapy required for management of
health and lifestyle issues before an exercise health deficits or activities; include
program starts. The questionnaire is short and assessment of performance of activities of
easy to administer and reveals any family daily living (ADLs) and /or instrumental
history of illness activities of daily living (IADLs).
o Objective: Observe for cues that indicate
effective management of deficits,
including the physical environment in
which the client resides.

NUTRITIONAL/METABOLIC PATTERN
• This pattern encompasses the evaluation of
dietary and other nutrition-related indicators.
o Subjective: Determine the older adult’s
description, patterns, and perception of
food and fluid intake and adequacy for
maintaining a healthy body mass index.
o Objective: Observe general appearance and
GORDON 11 BASIC FUNCTIONAL HEALTH various body system indicators of
PATTERNS OF OLDER ADULT nutritional status. Note the height, weight,
• Physical Activity Readiness Questionnaire and fit of clothes.
(PAR-Q) is a common method of uncovering
health and lifestyle issues before an exercise COPING/STRESS-TOLERANCE PATTERN
program starts. The questionnaire is short and • This pattern encompasses the client’s reserve
easy to administer and reveals any family and capacity to resist challenges to self-
history of illness integrity, and his or her ability to manage
difficult situations.
SELF-PERCEPTION/SELF-CONCEPT PATTERN o Subjective: Assess ways to handle big and
• This pattern encompasses a sense of personal little problems that occur in everyday life.
identity; body language, attitudes, and view of o Objective: Observe the use of coping skills
self in cognitive, physical, and affective and stress-reducing techniques and note
realms; and expressions of sense of worth and their effectiveness.
emotional state.
• Perceptions of self should be explored with COPING/PERCEPTUAL PATTERN
direct questions and asked with sensitivity. • This pattern encompasses self-management
Emotional patterns can be identified during of pain, the presence of communication
this exploration of perceptual patterns. difficulties, and deficits in sensory function
o Subjective: Determine the client’s feelings o Subjective: Inquire about difficulties with
about his or her competencies and sensory function and communication, as
limitations, withdrawal from previous well as the assessment of any cognitive
activities, self-destructive actions, changes.
excessive grieving, and increased o Objective: Assess usual patterns of
dependency on others. communication and note the client’s
o Objective: Identify verbal and nonverbal ability to comprehend.
cues related to the above subjective data.
VALUE/BELIEF PATTERN
ROLES/RELATIONSHIP PATTERN • This pattern encompasses elements of
• This pattern encompasses the achievement of spiritual well-being that the older adult
expected developmental tasks. perceives as important for a satisfactory daily
• Basic needs for communication and living experience and the philosophic system
interactions with other people, as well as that helps him or her function within society.
meaningful communication and satisfaction o Subjective: Identify the older adult’s
in relationships with others are examined. values and beliefs about spirituality, with a
o Subjective: Determine family structure, special emphasis on how this influences
history of relationships, and social health promotion behaviors.
interactions with friends and o Objective: Determine what is important in
acquaintances the older adult’s life to support coping
o Objective: Examine the family dynamics of strategies.
interdependent, dependent, and
independent practices among members. ACTIVITY/EXERCISE PATTERN
• This pattern encompasses information related
HEALTH PERCEPTION/HEALTH MANAGEMENT to health promotion that encourages the older
PATTERN adult to achieve the recommended 30 minutes
• This pattern encompasses the perceived level daily of physical activity on most days of the
of health and current management of any week.
health problems. o Subjective: Screen for safety-related
exercise and physical activity, using

JERAMIE MACABUTAS - BSN 3-YA-16

GERIATRIC NURSING: LECTURE
NCMB 314 | 1ST SEMESTER | A.Y 2024-2025
screening measures such as the physical EVALUATION
activity readiness questionnaire (PAR-Q). • Determining the effectiveness of the care plan.
o Objective: Obtain vital signs and conduct • Check established goals.
cardiopulmonary and musculoskeletal • Establish appropriate and realistic revised
system assessments. goals and realistic steps to achieve them

REST AND SLEEP PATTERN

• This pattern encompasses the sleep and rest Hi! This reviewer is mostly from the canvas module. I
patterns over 24 hours and their effect on hope this will help you all. Keep studying!
function. - Gem
o Subjective: Assess usual sleep patterns,
including bedtime and arousal time,
quality of sleep, sleep environment, and
distribution of sleep hours within 24 hours
o Objective: Have a client keep a sleep diary
that includes naps and rest periods.

SEXUALITY/REPRODUCTIVE PATTERN
• This pattern encompasses the older adult’s
behavioral expressions of sexuality.
o Subjective: Assess the client’s satisfaction
or dissatisfaction with current
circumstances related to sexual function
and intimacy, including perceived
satisfaction or dissatisfaction with
sexuality or sexual experiences.
o Objective: Discuss current sexual
relationship. When none is present, elicit
the meaning this has for the client’s
overall emotional and physical well-being.

ELIMINATION PATTERN
• This pattern encompasses bowel and bladder
excretory functions.
o Subjective: Assess lifelong elimination
habits and excretory selfcare routines.
o Objective: Perform abdominal and rectal
examination; external genitalia and pelvic
examination may be indicated.

PLANNING
• Exploring older adults’ ideas and beliefs
concerning health needs.
• Reading current literature regarding the latest
updates for specific health promotion
• Current health policy information that will
safeguard client rights.
• Understanding and use of behavior change
theories.

IMPLEMENTATION
• Adopting a proactive stance toward an action
plan for health promotion of the older
individual.
• Activities, locations, and means of
disseminating health promotion.
• Annual health promotion screening.
• Program that provides vaccinations for older
adults.
• Screening for cancer, diabetes, and other
conditions.
• Monthly health talks provided in senior
centers.
• Housing sites
• Continuing retirement communities.
• Advocate and educate about health promotion.
• Safe medication use

JERAMIE MACABUTAS - BSN 3-YA-16