Gerontology NUR101 FALL 2009 LECTURE # 20 K. BURGER, MSEd, MSN, RN, CNE PPP By Sharon Niggemeier RN MSN Rev kburger1207

Gerontology Gerontology: Study of all aspects of aging and its consequences Ageism: when older adults are stereotyped Gerontologic nursing: specialized nursing with knowledge of illness and health of the aging

AGEISM What are some stereotypic characteristics of the elderly that you have heard? Or believe? Dependent ? Frail ? Poor ? Lonely ? Unreliable d/t memory loss ? Rigid; narrow-minded ? Unable to learn ?

Older Adult Young Old Middle Old Old Old 85 & older Presently: 12.8% of population 2030: will increase to 20% of population

Biological Theories of Aging Programmed Aging theory- genetics and heredity responsible for how an individual ages Cross-Linkage Theory- deterioration of organs/cells causing decreased mobility Somatic Mutation Theory- DNA changes result in physical decline Stress Theory-causes structural & chemical changes thru the lifespan

Theories of Aging Most experts believe that a combination of genetic and stochastic (random) events are responsible for aging. Any single limited theory is insufficient.

Psychosocial Theories of Aging Disengagement Theory- withdrawn, introspective, self-focused – Older theory; not widely accepted. Continuity theory-characteristics, values remain constant thru life… repeat behaviors that brought success in the past Activity Theory- satisfaction depends on involvement in new interests /activities or maintenance of high levels of functioning.

Psychosocial Theories of Aging Erikson - ego integrity vs despair Life review or reminiscence Acceptance and happiness with past life Havighurst - maintenance of social contacts & relationships… be flexible & adapt Successful aging = ability to adapt to the changes associated with aging.

Cognitive Changes Ability to perceive and understand one’s world Mild short term memory loss Long term memory remains intact Slower responses and reactions Dementia = Abnormal aging Severe cognitive loss & memory loss

Cognitive Changes – Abnormal Aging Confusion and depression Alzheimer’s disease Sundowning syndrome

Theories about Sundowning Possible Causes for increasing confusion: Person can’t see well in dimming light Hormone imbalances r/t biological clock Person end of day; decreased coping Restlessness because daytime activities are decreasing Caregivers communicate their own fatigue & stress to clients

General Physiological Changes All systems decline in overall functioning Decreased physiological reserves Modified pace & more frequent rest periods

Integumentary Changes Decreased skin elasticity-wrinkling Increased dryness Thickened nails Thinning of hair (baldness)

Musculoskeletal Changes Stiff joints & less flexibility Mobility slows & posture stoops Muscle mass & strength decrease Bone demineralization

Neurological Changes CNS responds slower Rate of reflex response decreases Sense of balance declines Night sleep shortens Temp. regulation & pain perception less efficient

Special Senses Changes Diminished vision Diminished hearing Decreased taste & smell

Cardiopulmonary Changes Blood vessels less elastic Fatty plaque deposits occur Cardiac reserve decreases Less efficient lung clearing Increased resp. rate, diminished depth

Gastrointestinal Changes Digestive juices & nutrient absorption decrease Malnutrition & anemia common Decreased peristalsis resulting in constipation & indigestion

Dentition Changes Tooth decay continues Missing teeth or ill fitting dentures effect eating habits

Genitourinary Renal blood flow decreases Waste products excreted more slowly Fluid/Electrolyte balance is fragile Bladder capacity decreases 50% Hypertrophy of prostate gland Atrophy, decreased secretions & thinning of female genital tract

Adjusting to Changes of Aging Rest more Curtail driving Cane/walker for mobility Diet changes Ageism

Adjusting – Older Adult is making many psychosocial adjustments Retirement Reduced income Spouse’s health Social roles Living arrangements Role reversal

Common health problems Heart disease, cancer, stroke Poly-Pharmacy Accidents, falls Arthritis Chronic illness Elder Abuse

Any deliberate action or negligence that harms elderly individuals: -physical -sexual -psychological -emotional -financial

Role of the Nurse in Promoting Health: Teaching Nutrition Exercise Immunizations Annual Physicals Medications

Nursing Dx Risk for loneliness Altered dentition Risk for falls Knowledge deficit Confusion Sexual dysfunction Wandering

Summary Nurses have to provide care to an increasing geriatric population. Geriatric patients have specific needs due to physiological and cognitive changes. Nursing care needs to be tailored to the those needs.