1. Gerontology NUR101 FALL 2008 LECTURE # 20 K. BURGER, MSEd, MSN, RN, CNE PPP By Sharon Niggemeier RN MSN

2. 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

3. 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 ?

4. Older Adult Young Old 60-74 Middle Old 75-84 Old Old 85 & older Presently: 12.8% of population 2030: will increase to 20% of population

5. 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

6. 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.

7. Psychosocial Theories of Aging Disengagement Theory- withdrawn, introspective, self-focused – Older theory; not widely accepted.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.

8. 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.

9. Cognitive Changes Ability to perceive and understand one’s world Mild short term memory loss Long term memory remains intact Slower responses and reactions

10. What does it mean to “grow old gracefully” “Grow old along with me! The best is yet to be. The last of life, for which the first was made”. - Browning “Even the oldest tree some fruit may bear: And as the evening twilight fades away, the sky is filled with stars, invisible by day”. - Henry Wadsworth Longfellow

11. Cognitive Changes – Abnormal Aging Confusion Alzheimer’s disease Sundowning syndrome The 3 D’s: 1. Dementia Severe cognitive loss & memory loss 2. Depression 3. Delirium

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

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

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

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

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

17. Special Senses Changes Diminished vision Night blindness Diminished hearing Decreased taste & smell

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

19. Gastrointestinal Changes Digestive juices & nutrient absorption decrease Malnutrition & anemia common Decreased peristalsis resulting in constipation & indigestion Decreased insulin and thyroid production

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

21. 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 Decreased estrogen and testosterone levels

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

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

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

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

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

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

28. 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.