GERONTOLOGICAL

NURSING AND HOME-

BASED CARE

10 HOURS
NURSING DEPARTMENT

C. KURIA
 Objectives
Main General
• Equip you with the • Apply concepts of
knowledge, skills and gerontological nursing
attitudes to be able to in providing care
Promote health, Prevent • Provide care for the
illness, Manage and elderly persons
Rehabilitate Elderly and • Identify social services
participate in HBC. available for the
elderly
• Participate in HBC
activities
 DEFINATION OF TERMS

Geriatrics- It’s a field of practice that focuses on

the physiology, pathology, diagnosis, and mgt of
the disorders and diseases of older adults
Gerontologic/geriatric nursing- it’s the field of
nursing that relates to the assessment, planning,
implementation, and evaluation of older adults
in all environments, including acute,
intermediate, and skilled care as well as within
the community
 Gerontology- is the branch of biomedical sciences
that studies aging biologic, psychological, and
sociologic
Aging- A progressive deterioration of physiological
function, an intrinsic age-related process of loss of
viability and increase in vulnerability.
composed of several features:
1) Rapid increase in mortality with age;
2) Physiological changes that typically lead to a
functional decline with age;
3) Increased susceptibility to certain diseases with age.
NB; Traditionally, age 65 has been designated as
the beginning of old age
Geriatrician- is a doctor who specializes in care
of the elderly and the diseases that affect them.
Elder abuse - the physical, emotional, or financial
harm to an older person by one or more of the
individual’s children, caregivers, or others
including neglect
Geriatric syndrome- common conditions found in
older adults that tend to be multifactorial & do
not fall under discrete ds category eg falls,
delirium, frailty, urinary/fecal incontinence
Senescence- Cells loose ability to divide and grow
leading to decrease in regeneration capacity and
function over time.
Negligence - failure to take proper care over
something.
Malfeasance - intentional conduct of
wrongdoing/illegal behavior, by a public official
or a person in a position of authority.
-Actions that are not just unethical but also
unlawful, such as fraud, embezzlement, or
corruption.
Misfeasance- the improper performance of an
act that is lawful in itself. When someone
lawfully undertakes an action but performs it in
a way that causes harm or damage due to
carelessness, negligence, or lack of skill
Beneficence: This principle states that health
care providers must do all they can to benefit
the patient in each situation.
Veracity- being honest and telling the truth. Trust
r/ship established between a patient and a
health care provider
Justice- being impartial and fair.
ie; equitable access to care, nurses being
available to render care and that the recipients of
care (i.e., patient, family, or community) know
that care is available to them
Autonomy- the ability of the person to make his or
her own decisions.
Life expectancy- the average number of years that
a person can expect to live. Varies with gender
and race. (2018); Male 64.4, female 68.9 and total
life expectancy is 66.7 in Kenya
Principles - a fundamental truth or proposition
that serves as the foundation for a system of
belief or behavior or for a chain of reasoning.
Standard - is a repeatable, harmonized, agreed
and documented way of doing something.
 CORE ELEMENTS OF GERIATRIC
NURSING
• Evidence-based practice:–Nursing practice
decision-making follows research
• Standards for nursing practice: Nurses must
evaluate practices against standards to ensure
highest quality of care.
• Medication mgt- Monitoring and adjusting rx as
per pt needs
• Family and caregiver support-participate in care
• Patient centered care- involve elderly patient,
preferences
• Principles/Professional Competencies -
promote highest quality of care based on
scientific data
• Comprehensive Assessment- Physical, Mental,
Emotional, Social health
• Cultural Competence- respect diverse cultures
• Individualized care- facilitate advanced directives
 PRINCIPLES OF GERONTOLOGICAL
NURSING PRACTICE
• Aging is a natural process common to all living
organisms.
• Various factors influence the aging process.
• Unique data and knowledge are used in applying
the nursing process to the older populations.
• The elderly share similar self-care and human needs
with all other human beings.
• Gerontological nursing strives to help older adults
achieve optimum levels of physical, psychological,
social and spiritual health so that they can achieve
wholeness.
1. Holistic Care
•Physical Health: Addressing chronic conditions, managing pain,
promoting mobility, and ensuring proper nutrition.
•Mental Health: Recognizing and treating conditions such as
depression, anxiety, and dementia.
•Social Well-being: Facilitating social connections, addressing
loneliness, and supporting the elderly in maintaining meaningful
relationships.
•Spiritual Needs: Understanding and respecting the spiritual beliefs
and needs of older adults.
2. Individualized Care
•Personalized Care Plans: Tailoring care plans to the specific needs,
preferences, and goals of each older adult.
•Cultural Competence: Respecting cultural, religious, and personal
values in care delivery.
3. Promoting Independence
•Empowerment: Encouraging self-care and decision-
making to the extent possible, promoting autonomy.
4. Interdisciplinary Collaboration
•Team Approach: Collaborating with a multidisciplinary
team that may include physicians, social workers, physical
therapists, and family members to provide comprehensive
care.
5. Evidence-Based Practice
•Current Best Practices: Utilizing up-to-date research and
evidence to guide clinical decision-making.
•Continuous Education: Engaging in ongoing education to
stay informed about the latest developments in
gerontological care.
6. Ethical and Legal Considerations
•Advocacy: Acting as an advocate for the rights and needs
of older adults.
•Informed Consent: Ensuring that patients understand
their care options and are involved in decisions about their
treatment.
•Dignity and Respect: Treating older adults with dignity
and respect, regardless of their condition.
7. Safety and Risk Management
•Fall Prevention: Implementing strategies to prevent falls and
injuries.
•Medication Management: Monitoring and managing medication
use to prevent adverse effects.
•Environment Safety: Ensuring that the living environment is safe
and supportive.
8. End-of-Life Care
•Palliative Care: Providing comfort-focused care for those with
life-limiting conditions.
•Advance Care Planning: Facilitating discussions about end-of-
life wishes and advance directives.
•Support for Families: Offering support and resources to families
during end-of-life care.
9. Health Promotion and Disease Prevention
•Preventive Care: Encouraging vaccinations, screenings,
and healthy lifestyle choices.
•Chronic Disease Management: Assisting with the
management of chronic conditions to prevent
complications.
10. Cultural Sensitivity
•Respect for Diversity: Recognizing and respecting
cultural differences in aging, health beliefs, and practices.
•Inclusive Care: Providing care that is inclusive and
respectful of all backgrounds and identities.
 FACTORS INFLUENCING AGING

• Heredity- genes that maintain organism

structure and function throughout life
• Nutrition- poor nutrition will enhance aging of
an individual
• Health status- someone with a chronic
condition eg cancer, HIV/AIDS may age faster
• Life Experience eg smoking/alcohol intake
• Environment- individuals in rural areas age
faster than those in urban areas.
• Activity
• Stress
BODY SYSTEM CHANGES IN THE
ELDERLY
Intrinsic aging (within the person) - normal
aging process, genetically programed &
essentially universal within a species

Extrinsic aging results from influences outside

the person eg air pollution and excess
exposure to sunlight
 1. Cardiovascular system
Age-related changes reduce the efficiency of the
heart & contribute to ↓sed compliance of the heart
muscle. eg myocardial hypertrophy, fibrosis,
stenosis of valves & ↓sed pacemaker cells.
These changes leads to;
Decreased cardiac output
Diminished ability to respond to stress; HR and
stroke vol do not increase with mxm demand
Slower heart recovery
increased BP
 2. RESPIRATORY SYSTEM
• The respiratory system seems to be able to
compensate best for the functional changes of
aging.
• Healthy, nonsmoking older adults show very
little decline in respiratory function
• The following are resp. changes with aging;
Increase in residual lung volume
decrease in muscle strength, endurance, & vital
capacity
Decrease gas exchange and diffusing capacity
Decreased cough efficiency- take adequate
fluids to liquify secretions
 3. INTERGUMENT SYSTEM
• The functions of skin; temp regulation,
sensation, and excretion. Aging affects
these functions & appearance
Decreased subcutaneous fat, interstitial
fluid, muscle tone, glandular activity &
sensory activities, resulting in protection
against trauma, sun exposure and temp
extremes
Diminished secretion of natural oils and
perspirations
Cappilary fragility
 4. REPRODUCTIVE SYSTEM

Females; there is vaginal narrowing &

decreased elasticity; decreased vaginal
secretions
Male; less firm testes and decreased sperm
production
In both; Slower sexual response
May require vaginal estrogen replacement;
gynaecology/urology review. Use a
lubricant with sexual intercourse
 5. MUSCULOSKELETAL SYSTEM

• There is loss of borne density, loss of

muscle strength & size; prone to fractures
• degeneration of joint cartilage; joint pain
• height loss; kyphosis, back pain
• Osteoporosis due to low estrogen levels;
pathological fractures
Nursing care; encourage exercise regularly,
eat high calcium diet and limit phosphorus
intake, calcium and Vit D supplements
 6. GENITOURINARY SYSTEM

• Male; benign prostate hyperplasia; urinary

retention, irritative voiding, feeling of
incomplete bladder emptying, multiple
nighttime voiding
• Urinary retention may presidspose them to
UTIs
• Female; relaxed perinealmuscles; detrusor
instability-urge incontinence, urethra
dysfunction-stress urinary incontinence
• Nursing care;
• Advise them to limit drinking b4 bedtime
• not to wait for long periods btn voiding
• wear easily manipulated clothing-
incontinence
• Take adequate fluids- UTI
• pelvic floor exercises
• Refer for urology review
 7. GIT SYSTEM
• Diminished sense of smell as a result of
neurologic changes
• Difficult chewing and swallowing due to
lack of teeth and diseases
• Dry mouth
• Reduced GIT motility; delayed esophageal
and gastric emptying- early satiety
NB// These patients are at risk of
fluid/electrolyte imbalance, constipation,
heartburn
• Nursing care;
• Advise on mouthwash, brush, floss and
massage gums
• Receive regular dental care
• Eat small, frequnt meals
• Sit up and avoid heavy activity after
eating
• High-fiber diet, take adequate fluids
 8. NERVOUS SYSTEM

• Homeostasis is difficult to maintain with

aging; the structure, chemistry and function
of the nervous system change with
adevanvced aging.
• Nerve cells in the brain decrease; loss of
brain mass→learning takes longer
• ↓se in synthesis and metabolism of major
neurotransmitters; nerve impulses are
conducted slowly thus taking older pple time
to respond & react
• Slowed reaction time puts older pple at risk
for falls & injuries as well as driving errors
• Mental function mayb threatened by
physiscal or emotional stress. A sudden
onset of confusion mayb the first symptom of
an infection or change in physical condition
• Neuroligic changes can affect gait and
balance, which may interfere with mobility
and safety
• Nursing DX; Risk of fall related to impaired
neurological function
• Impaired physical mobility secondary
impaired neurological function as evidenced
by patient’s poor gait & loss of balance.
• Nursing care;
• Pace teaching
• With hospitalization; encourage visitors
• Encourage slow rising from a resting
position
• Nurse in raised siderails
 9. SENSORY SYSTEM
• Vision; Diminished ability to focus on close
objects- holds objects away from face
• Inability to tolerate glare;
• Difficult adjusting to changes of light
• Dicreased ability to distinguish colors
• Nursing interventions; Wear eyeglasses
and use sunglasses outdoors
• Avoid abrupt changes from dark to light
• Avoid night driving
• Use large-print books
• Hearing;
• Dicreased ability to hear high-frequency
sounds; tympanic membrane thinning
• They tend to give inappropriate responses;
asks pple to repeat words; strains forward
to hear
• Nursing interventions;
Recommend a hearing exam
Reduce background noise
Use non-verbal cues
• Taste and Smell;
• Dicreased ability to taste and smell
• There is cell loss in nasal passage & in
the olfactory bulb in the brain
• They tend to consume too much salt and
sugar; encourage loss of lemon, spices,
herbs. Recommend smoking cassation
 ASSESSMENT OF AN ELDERLY
CLIENT
• Hx taking- take a comprehensive hx to
include sources of support, where they live
• Physical examination
• Functional assessment
• Mental status exam
 PSYCHOSOCIAL ASPECTS OF
AGING
• Successful psycholgical aging is reflected in
the ability of older pple to adapt to physical,
social, and emotional losses to achieve life
satisfaction
• Fear of aging & the inability of many to
confront their own aging process may trigger
ageist beliefs
• Retirement & perceived nonproductivity are
also responsible for -ve feeling . They may feel
they are in competition with children for
 MENTAL HEALTH PROBLEMS IN
GERAITRICS
• Changes in cognitive ability, forgetfulness,
and mood swings are not part of normal
aging. A thorough assessment may reveal
a treatable, reversible physical or mental
condition.
• Changes in mental status mayb related to
many factors such as alterations in diet,
fluid and electrolyte balance, fever, or low
O2 associated with cardiovascular and
pulmonary ds
• There4, healthcare professionals must recognize,
assess, refer, collaborate, treat, and support older
adults who exhibit noticeable changes in intelect
or affect
1. Depression
It’s the most common affective or mood disorder
of old age.
It may follow a major loss, chronic illness or pain
S/S; feeling of sadness, fatigue, diminished
memory & conc, feeling of guilty or worthless,
sleep disturbance, loss of appetite, restlessness, wt
loss. RX; exs, ↑se interpersonal interactions,
cognitive therapy, antidepressants
2. Substance abuse
Substance abuse mayb related to
depression
Can be alcohol or even medicines; keep old
drugs out of reach
3. Delirium
Also called acute confusional state, begins
with confusion and progresses to
disorientation
Patients may experience an altered level of
consciousness, ranging from stupor to
excessive activity
Thinking is disorganized and attention is short
Hallucinations, delusions, fear, anxiety, and
paranoia mayb evident
4. Dementia
a syndrome in which there is deterioration
in memory, thinking, behaviour and the
ability to perform everyday activities.
Remind them when to take medications if
they are on RX
 GERIATRIC SYNDROMES
• These are conditions do not fit under a
discrete ds category hence require a
multidisciplinary & comprehensive
assessment to identify the underlying cause
a) Impaired mobility
Common causes; strokes, Parkinson’s ds,
osteoarthritis, diabetic neuropathy,
osteoporosis...
Encourage them to be active and where
bedrest is unavaidable; perfom active range -
of motion or passive range-of-motion
b) Dizziness
The causes mayb build up of earwax,
dysfunction of the cerebral cortex,
cerebellum, brainstem, vestibular system
Dizzines can lead to loss of balance and
risk of fall
c) Falls and Falling
The incidences of fall rises with increasing
age
Injuries rank the 7th cause of death for older
pple.
Cause are multfactorial, both extrinsic; poor
lighting, and intrinsic; physical illnesses,
neurological changes, or sensory impairment
Nurses; encourage families and patients to
make lifestyle/environmental changes to
prevent falls
d) Urinary incontinence
Mayb acute, occuring during an illness or
chronic developping over a period of years
Older patients may not report this unless
specifically asked
Cuses mayb; deliriums & dehydration,
immobility, infection, inflammation, impaction
and pharmaceuticals
e) Increased susceptibility to infection
eg pneumonia, COVID-19, TB
This mayb attributed to blunted response of
host defenses
 ETHICAL & LEGAL ISSUES
AFFECTING THE OLDER ADULTS
• Nurses play an important role in supporting &
informing patients & families when making RX
decisions
• As advocates, nurses should encourage end-of-
life discussions & educate older pple to prepare
advance directives b4 incapacitation
• Advanced directive- is a formal, legally,
endorsed document that provides instructions 4
care (living will) or names a proxy decision
maker ( durable power of attorney).
• It’s to be implemented if the signer becomes
incapacitated
• The signed document should be signed by the
person &two witnesses & a copy retained by
the physician in his/her medical records
• If no advance arrangements had been done
and the person becomes incapacitated, the
court mayb petitioned for a hearing, the judge
upon realizing that the person is indeed
incompetent will appoint a guardian who is
given powers to make financial or personal
decisions for that person
 THE ROLE OF A GERIATRIC
NURSE
• Advocacy
• Teacher
• Researcher
• Caregiver
• Innovator
ROLE OF FAMILY & COMM IN
CARE OF THE ELDERLY
 THEORIES OF AGING
• The many theories of aging attempt to
provide a framework in which to
understand aging from diff perspectives.
Developmental theory
• Developed by Erick Erickson
• He developed the concept of 8 stages of life, with
each stage representing a crucial turning point in the
life span stretching from birth to death
• According to him, ego integrity versus despair sets in
from 65 years of age
• Ego integrity is associated with pride and acceptance
of ones life style and a believe that choices made
were the best
• Despair implies that the older person feels
dissatisfied and disappointed in life achievement.
 PSYCHOSOCIAL THEORIES
It is described using three theories
Disengagement theory – views aging as a process
of mutual withdrawal in which older adults voluntarily
slow down by retiring, as expected by the society.
The elderly person achieves life satisfaction
Activity theory – Individuals who led active lives as
young and middle aged adults will probably remain
active as older adults, while those who were less
active may become disengaged as they age.
Continuity theory- proposes that successful
adjustment to old age rests with the ability of a
person to continue with life pattern across lifetime