1. GERIATRIC NURSING MS. TEJASHRI LIGADE M.SC IN CRITICAL CARE NURSING

2. Introduction : Childhood, youth, adulthood & old age are different stages of life. With increasing age we become old. Birth, development, decline & death are last of life. Old age is also one part of this cycle. Definition : Ageing, the process of growing old, is defined as the gradual biological impairment of normal function, probably as a result of changes made to cells (mitotic cells, such as fibroblasts and post-mitotic cells, such as neurons) and structural component.

3. Geriatric nursing : Geriatric nursing is the specialty that concerns itself with the provision of nursing services to geriatric or aged individuals. Gerontology : Gerontology It is a science that deals with study of ageing process Geronotological nurse : A nurse who has specialization in geriatric or in the care of old people is called geriatric nurse or geronotological nurse.

4. Geriatric care : This is related to the disease process of old age and its aims at keeping old person at the state of self dependent as far as possible & to provide facilities to improve the life

5. CHANGES IN OLD AGE:  PHYSICAL CHANGES : Nervous system EENT Digestive system Cardio vascular system Respiratory system Integumentary system Musculoskeletal system Genitourinary system

6. Integumentary changes Decrease in elasticity of skin & dryness appears. Wrinkles appear. Age spots appear. Hairs of head, axilla, or pubic region become scanty grey / white. Thickening of nasal hair & hair on ears

7. Cardiovascular system Less blood circulation in heart. Increased blood pressure. Flexibility of heart valve diminishes. Blood vessels of head, neck, hands, & legs become prominent.

8. Respiratory system: Capacity of lungs decreases. Ineffective gas exchange

9. Genito -urinary system: Kidneys become impaired. Fluid & electrolyte imbalance. Capacity of urinary bladder decreases. Incontinence Enlargement of prostrate in males. Atrophy of reproductive organs in females.

10. Neurological system : Delayed neurological response. Change in sleeping habits. Frequent awakening. Gastrointestinal system Falling of teeth. Less secretion of saliva & gastric juices. Complaint of constipation. Improper digestion.

11. Sensory system: Diminished eye sight. Decrease in hearing capacity Presbyopia Decrease in ability of taste & smell. Tactile stimulations are affected. Immune system: Decrease in immunity. Susceptibility to infection increases.

12. Musculoskeletal system Reduction in height. Kyphosis Weak bones. Mobility decreases

13. Endocrine system Inactive thyroid gland. Decrease in alertness. More susceptible to cold. Secretions of estrogen, progesterone, testosterone decreases. Less secretion of insulin by pancreas

14. B) PSYCO-SEXUAL CHANGES C)PSYCO-SOCIAL CHANGES D)COGNITIVE & INTELLECTUAL CHANGES

15. THEORIES OF AGING: THEORIES OF AGING A) BIOLOGIC THEORIES *Genetic theories *Wear & tear theories *Immunity theories *Free-radical theories THEORIES OF AGING: THEORIES OF AGING B)PSYCO-SOCIAL THEORY *Activity theory *Human needs theory

16. PROBLEMS OF OLD AGE: A)PHYSIOLOGICAL Hypertension Coronary artery disease Stroke Urinary incontinence Immobility Self care deficiet

17. C) FINANCIAL PROBLEMS : Retirement D)SOCIAL PROBLEMS : Isolation

18. APPROACHES TO OLD AGE: COMMUNITY Banking Consumer affairs Counselling Education HEALTH Employment Financial aid Burial Religion SERVICES Transportation Volunteer works Day care Old age homes Preventive geriatrics

19. NURSING MANAGEMENT Activity intolerance r/t generalized weakness, immobility. Impaired adjustment r/t actual or perceived changes,medication,poor nutrition. anxiety r/t feelings of helplessness, threat to self concept, unresolved conflicts.

20. Body image disturbance r/t change in physical appearance & function, loss of body part. Altered family processes memory loss, situational or maturational crisis. Altered health maintenance r/t impaired ability to communicate, insufficient material resources, inadequate family support.

21. Altered nutrition less than body requirements r/t difficulty in self feeding,chewing,swallowing, altered mental status. Self care deficit r/t weakness, disease condition. Sexual dysfunction r/t performance activity, medical condition, physiological changes.

22. Social isolation r/t decreased self concept,memmory loss,decreased physical ability. Altered thought process r/t physiological or psycological stressors,sensory-perceptual limitations.

23. Knowledge deficit r/t slowed thought process,lack of support system. *Potential for injury r/t poor vision, unstable gait, altered mental status.

24. CURRENT TRENDS IN GERIATRICS:  Rehabilitation  Aging research centre  Organisations  Current status in India

25. FACILITIES FOR SENIOR CITIZENS (INDIAN GOVERNMENT): FACILITIES FOR SENIOR CITIZENS (INDIAN GOVERNMENT ) MINISTRY OF SOCIAL JUSTICE AND EMPOWERMENT MINISTRY OF RURAL DEVELOPMENT MINISTRY OF FINANCE MINISTRY OF HEALTH AND FAMILY WELFARE MINISTRY OF RAILWAYS MINISTRY OF CIVIL AVIATION ROAD TRANSPORT AND HIGHWAYS MISCELLANEOUS

26. CHALLENGES OF GERIATRIC CARE IN INDIA Few hospitals providing specialized care for old people. Private or apex hospitals are solitary ones Doctors and nurses neglect this prolific field Care is capital-intensive and does not yield much profit. No separate geriatric unit in hospitals. Concept not much popular among professionals,family members,community, media and government.

27. USEFUL SUGGESTIONS FOR EXTENDING LIFE: Eat a balanced diet which include fruits &vegetables. Exercise regularly. Get regular check up. Don’t smoke. Practice safety habits at home to prevent accidents.

28. Always wear seat belt in car. Stay in contact with family and friends. If you drink moderation is the key, do ask someone else to drive! Stay active through work & community. Plan long term housing & money needs.

29. Keep a positive attitude towards life. Do things that make you happy. “WE CANOT HEAL OLD AGE,BUT LET US PROTECT IT AND PROLONG IT” Sr.J. Ross.

30. If you respect the one who has moulded you to a fine being, then just hold their hand and lead them straight in to your home.They don”t need your money or luxury,they just need a shoulder to lean.help them, lead the last few days of their life that does not triger loneliness

31. Ageing & Demography : Ageing & Demography Large number of aged people in the population is the result of demographic change, The number of people above 60 years is assessed to be over 49 crores in world. By the year 2040 their number will be 140 crores. (WHO prediction) As compared to old man there are more old women. Because of increasing number of old age, many socioeconomic problems are arising.

32. Nutrients recommendations for old age: Nutrients recommendations for old age Nutrients Recommended daily intake for 50+ years Calcium (mg) 700 Phosphorus (mg) 550 Magnesium (mg) 270 Sodium (mg) 1600 Potassium (mg) 3500 Chloride (mg) 2500 Iron (mg) 14.8 PowerPoint Presentation: Zinc (mg) 9 Copper (mg) 1.2 Selenium ( μg ) 60 Iodine ( μg ) 140 Vitamin A ( μg ) 600 Thiamin (mg) 0.8 Riboflavin (mg) 1.1 Niacin (mg) 12 PowerPoint Presentation: V itamin B 6 (mg) 1.2 Vitamin B 12 ( μg ) 1.5 Folate ( μg ) 200 Vitamin C (mg) 40 Vitamin D* ( μg ) 10

33. Energy Requirement: Energy Requirement Age (years) Estimated energy requirement for males ( kcals per day) Estimated energy requirement for females (kcals per day) 19-50 2550 1940 51-59 2550 1900 60-64 2380 1900 65-74 2330 1900 75+ 2100 1810 Protein Requirement: Protein Requirement Age (years) Estimated protein requirement for males ( kcals per day) Estimated protein requirement for females (kcals per day) 19-50 55.5 45.0 51+ 53.3 46.5

34. Vitamin D : Vitamin D It is recommended that everyone over 65 years of age takes a vitamin D supplement (10µg/day). Good dietary providers of vitamin D (e.g. oily fish, margarine, eggs and fortified breakfast cereals) should also be eaten regularly. Calcium intake : Calcium intake Adequate intakes of calcium can help to slow age-related bone loss, which can result in osteoporosis and fracture Recommended intake of calcium per day = 700mg in adults over 50 years old.

35. Vitamin C: Vitamin C Vitamin C is needed for several functions in the body including: Formation and maintenance of healthy tissues Good wound healing. Anti-oxidant action i.e. helps to protect the body from damage caused by toxins. Vitamin C requirements for older people are the same as younger adults, but unfortunately intakes are often sub-optimal.

36. Folate and vitamin B12: Folate and vitamin B 12 Folate and vitamin B 12 are required together for many functions including cell division and good nerve function. Requirements for folate, vitamin B 12 and other B vitamins such as thiamin and riboflavin are either the same or slightly less than younger adults, however maintaining good intakes is important to prevent deficiency.

37. Iron : Iron Iron is important for many functions in the body including formation of red blood cells and transport of oxygen to tissues. Requirements for iron in females over 50 years old are significantly less than younger females as menstruation has normally ended by this age and they no longer lose iron in menstrual blood

38. Factors affecting Hereditary factors. Environmental factors. Abiotic factors Biotic factors Socioeconomic factors.

39. Factors affecting nutrition status of the elderly 1. Changes in normal physiology Dental problems, changes in taste and smell, and ability to digest and absorb nutrients can affect both the quality and quantity of food consumed and overall sub-optimal nutritional status.

40. 2. Increased prevalence of chronic disease Obesity, accidents and trauma, heart disease, cancer, arthritis, osteoporosis, diabetes, senile dementia, and the use of prescription drugs can result in physician-ordered changes in the diet, decrease in strength and ability to shop or cook, and disturbances in the ability of the body to utilize nutrients normally.

41. 3. Socioeconomic, psychological, and cultural factors : Low income,beliefs and superstitions regarding food and dietary habits, social isolation, depression and loneliness from loss of spouse, family members and friends can decrease the quantity and quality of the diet.

42. 4. Alcoholism and use of therapeutic drugs When alcohol is substituted for nutritious foods, it may interfere with absorption of some nutrients, notably folic acid. Long-term use of certain therapeutic drugs that interfere with absorption and metabolism of nutrients is an important cause of malnutrition in the elderly.

43. 1. Loss of taste 2. Loss of interest in food 3. Older people can lose interest in food for a variety of reasons. Depression due to loss of independence or bereavement, or simply eating alone can reduce appetite. 4. Poor appetite 5. Difficulty in chewing 6. Constipation

44. Drugs nutrient interaction : Drugs nutrient interaction It has been estimated that 76%-92% of elderly use at least one prescription or nonprescription drug daily. With increasing age, the body’s ability to metabolize medications decreases, therefore making it difficult for older adults to excrete multiple medications. Older people take various medications for heart disease, and to treat respiratory problems, gastrointestinal disorders and arthritis.

45. Drugs that alter nutrient intake: Drugs that alter nutrient intake Drugs either prescribed or over the counter may contribute undesirable side effects that can cause a reduction in food intake and thus nutrients entering the body. Listed below are drugs/medications likely to be commonly consumed by older people and have a marked effect on appetite, nausea, and taste.

46. PowerPoint Presentation: Central nervous system stimulants Dexamphetamine Methylphenidate Metformin Phenformin Drugs that alter taste Metronidazole

47. Drugs that can cause nausea Digoxin Theophylline Antibiotics (e.g. erythromycin, flagyl ) Anti-inflammatory drugs Other drugs that can reduce appetite Cardiac glycosides Glucagon Morphine (opiates) Indomethacin

48. National policy for old age : National policy for old age The National policy for old age was announced by govt. of India in January 1999.The principle area of intervention and action strategies were suggested in the policy sector include the following: Financial security for older persons working in the formal sector as well as working in the informal sector. Health care & nutrition to enable older person to cope with the health associated with ageing with particular emphasis on prevention. Shelter /housing keeping in view the lifestyle of older person. Emphasis upon education, training & information needs for older adults.

49. Functions of Gerontological nurse : The functions of geronotological nurse are mentioned on the basis of spelling of the word: G (guiding): Giving guidance to people of all ages regarding ageing process. E (elimination): eliminating ageism, or considering old age as disease. R (respecting): respecting the rights of older people. O (observing): observing the facilities provided to old people & improving them. N (noticing): noticing health hazards that may happen in old age & try to reduce them. T (teaching): teaching how to take care of old people,for those who are caring for them.

50. O (opening channels): opening the channels of development activities for the care of the aged. L (listening): listening attentively to the problems of old people & giving due importance to them. O (offering): offering positivism- presenting different possibilities of life. G (generating): generating energy for participation in the care of aged & researches for new supporting techniques. I (implementing): implementing activities for rehabilitation & re-adjustment. C (co-coordinating): coordinating different services related to the care of the aged. A (assessing): Assessing the needs & health of the old people. L (linking): linking, contacting services according to need.

51. PowerPoint Presentation: 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 & religious aspects of old age & giving them recognition. S (supporting): supporting the old people in accepting realities & preparing them mentally for impending death. E (education & encouraging): educating & encouraging old people for self care.

52. Responsibilities of Gerontological nurse : to improve the quality of life of old people. role in gerontological nursing: Care giver Health educator Coordinator of health services. Counselor & guardian

53. The nurse may have to perform different functions in relation to the above roles: Health assessment: In health assessment of old person, the following should be included: Daily activities of living. Activities related to use of equipment or procedure (telephone, bank account, food preparation) Health screening

54. Promoting good nutrition Promoting activity & exercise. Preventive care of elderly: In case of elderly, their physical & mental safety is very important. safety measures: Protection from unhealthy environment. Protection from mental tensions. Special care of personal health. Protection from physical & mental injuries, threats & fatigue. Providing rehabilitation services. Providing psychological support.

55. Spirituality & ageing: Spirituality is the power of the mind, it is the ability to look up to life, it is the attitude that we adopt to make our lives better. Spirituality teaches us to follow morals, rights and obligations thus making our lives fruitful and successful. Spirituality and old age go in tandem because this is the time people get free to relax and enjoy the fruits of their hard work. Spirituality is the cord that binds the mind, body and soul together.

56. Spirituality and religious participation are highly correlated with positive successful ageing. As much as diet, exercise, self efficacy & social connectedness stimulating an interest in understanding of why spirituality has such a positive effect on the quality of life & end of life. Older adults who are more religious tend to demonstrate greater wellbeing than those who are not. Spirituality tends to an important & adaptive role in ageing that seems to lead to a better quality of life & life satisfaction as well as longetivity.

57. Importance of spirituality : Importance of spirituality The effect of spirituality on health & old age are an area of active research. It has 3 major areas of importance: Mortality, Coping, and Recovery