Geriatric Care

SEMINAR ON

GERIATRIC CARE

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GERIATRIC OR GERONTOLOGICAL NURSING-

Childhood, youth, adulthood and old age are different stages of life. With increasing age we become old. Birth, development, decline and death are the laws of life. Whether we want it or not, we have to pass through these stages. Old age is also one part of this cycle.

What is ageing? Old age or ageing expresses the continuous pressure and

effect of time on our body, senses and skin. Due to continuous functioning, the cells, tissues and organs of our body degenerate. In the later part of life, we have to face many physical and mental problems. Hence old age is the result of physical and psychological fatigue caused by continuous functioning. Just like problems or defects occur in machines due to continuous functioning, or workload, with increasing age, problems also arise in human body.


Ageing and DemographyLarge 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 2040, their number will be 140 crores. (According to the prediction of (W.H.O).

As compared to old men, there are more old women.Because of the increasing number of old people, many

socio-economic problems are arising. The main problems are of housing, their livelihood and medical treatment.

French doctor Jean Martan Carcot was the first person who had studied about old age diseases, in the year 1881.


National Policy for Older Persons

The Government of India in January-1999 announced the National Policy for older persons. The principle areas of intervention and action strategies suggested in the policy sector include the following:

Financial security for older persons working in the formal sector as well as those working in the informal sector.

Health care and nutrition to enable older persons to cope with the health, associated with ageing, with particular emphasis on prevention.

Shelter/housing keeping in view the life style of older persons.Emphasis upon education, training and information needs for

older persons.Priority attention to vulnerable groups such as the destitute,

widows and disabled older persons.


Establishment of welfare fund for older persons.Protection of life and property of older persons.Concessions, rebates and discounts to older persons.Participation of NGOs in the care of aged.Strengthening the family and reinforcing inter-

generational relationship between children and older persons.

Formation of self-support group of older persons.Development of the manpower for the caring of aged.Creative use of media in the sector for care of old

persons.Establishment of a separate bureau for older persons in

the ministry


Gerontology This is a science dealing with ageing process.Geriatric Care This is related to the disease process of old

age and it aims at keeping old persons at a state of self-dependence as far as possible and to provide facilities to improve their quality of life.

Gerontoiogical Nurse- A nurse who has specialization in geriatrics or

in the care of old people is called geriatric nurse or gerontoiogical nurse.


Functions of Gerontoiogical Nurse-

G (Guiding): Giving guidance to people of all ages regarding ageing process.

E (Eliminating): Eliminating ageism or considering old age as disease.

R (Respecting): Respecting the rights of old people. O (Observing): Observing the facilities provided to old

people and improving them.N (Noticing): Noticing health hazards that may happen in

old age and try to reduce them. T (Teaching): Teaching how to take care of old people, for

those who are caring for them (family members, friends, community health worker, voluntary organization, etc.).

O (Opening Channels): Opening the channels of developmental activities for the care of the aged.


L (Listening): Listening attentively to the problems of old people and giving due importance to them.

0 (Offering): Offering positivism – Presenting different possibilities of life. G (Generating): Generating energy for the participation in the care of aged and

researches for new supporting techniques. I (Implementing): Implementing activities for rehabilitation and re-

adjustment. C (Co-coordinating): Co-coordinating different services related to the care of

the aged. A (Assessing): Assessing the needs and health of the old people. L (Linking): Linking, contacting services according to need. N (Nurturing): Preparing 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 and religious aspects of old age and

giving them recognition. S (Supporting): Supporting the old people in accepting realities and preparing

them mentally for impending death. E (Education and Encouraging): Educating and encouraging old people for

self care.


Factors Affecting Ageing

Hereditary Factors Hereditary diseases, the capacity for longevity and physical capacities influence the ageing process. Environmental FactorsThree types of environmental factors affect ageing:a) Abiotic FactorsFactors affecting ageing process like climate, radiation, chemical and

physical elements of pollution, etc. are included in this.b) Biotic FactorsIn this, living organisms present in the environment like pathogens,

parasites, the availability and quality of food etc. are included. They all influence the ageing of the person.

C) Socio-economic FactorsSeveral socio-economic factors responsible for creating adverse living or

working conditions increase "the wear and tear" of life. Such tensions make people grow old early.


Common Ageing ChangesPhysical Changes-Changes, which may occur in different systems, are as follows:1. Integumentary System Decrease in elasticity of skin and dryness appears Wrinkles appear Age spots appear Hair of head, axilla or pubic region become scanty grey/white Hair growth on women's face Thickening of nasal hair and hair on ears2. Cardiovascular System Less blood circulation in heart Increased blood pressure Flexibility of heart valve diminishes Blood vessels of head, neck, hands and legs become prominent.3. Respiratory System The capacity of lungs becomes less. Ineffective gas exchange The chances of cough increases More chances of respiratory infections


4. Genito-Urinary System The kidney function may be impaired Fluid and electrolyte imbalance Capacity of urinary bladder decreases Incontinence Enlargement of prostate in males Atrophy of reproductive organs in females Vaginal secretion decreases5. Gastro-intestinal System Falling of teeth Less secretion of saliva and gastric juice Complaints of constipation Digestion becomes weak6. Musculo-Skeletal System Height reduces (In most of persons above 70 years height decreases unto

two inches) Kyphosis, swelling in joints Bones become weak Mobility decreases, if proper exercise is not done


7. Endocrine System Thyroid gland becomes less active Alertness decreases More susceptible to cold Secretion of testosterone, oestrogen, progesterone decreases. Less secretion of insulin by pancreas8. Neurological System Sensitivity becomes less/reaction is delayed Change in sleeping habits Frequent awakening9. Sensory System Eyes become weak Hearing capacity decreases Complaint of presbyopia Ability to smell is reduced Ability to taste is reduced Tactile sensations are affected10. Immune System Ability to prevent diseases or resistance power decreases Probability of infections increases


2. Psychosocial Changes The psychosocial changes occurring in old age cannot be

separated from physical changes. Because of decreased activity of sensory organs, person is not able to work with full efficiency in his environment. Due to this, psychosocial state is affected. Person feels the sense of 'uselessness'. Social and psychological changes of old age are as follows

a) Personality Because of the experiences and happenings of life, person's

personality is affected. But in old age, no remarkable changes occur in the basic personality structure. Changes may occur in the personality due to death of life partner, decreased or end of self-dependence, loss of source of income, incapacity, etc.

b) Memory Memory power may decrease with increasing age. Recalling of

less frequently used information is difficult. In some old people, the tendency to repeat facts and information increases. Confused memory also may be found.


Some Forms of Old Age Abuse Old people may have to undergo a lot of neglect. Some main forms of

neglect or abuse are following:Physical Abuse Beating and physical punishment Sexual abuse Restraining or locking them in the house Teasing them for physical conditions or diseasesPsychological Abuse Giving mental torture Abusive language Calling by names (disrespectful words like old man etc.), making fun of

them, threaten them. Forced isolation Treat them as childrenMaterial Abuse Snatching their property illegally Economic exploitation Misuse or wasting their property for personal pleasures


Active NeglectNot providing food purposely or giving less food Neglecting their likes and dislikesSpoiling or removing their dentures, glasses, hearing aid

etc.Forbid them to play with grand childrenEncouraging grand children to insult grand parentsPassive NeglectBecome lazy or neglecting the care of old people. Neglect

may be due to ignorance also.Social AbuseNeglecting their adviceOverlooking their experiences Not providing them proper place or honour on social occasions.


Adjustment in Ageing

a. Family Changes : Family is such a unit through which maximum satisfaction may

be obtained. But in old age the person's family status is changed. A father, who was the chief of the family till now, may have to become dependent on his children. A mother may have to subject herself to the rule of daughters-in-law. If one of the partners is dead, the other has to face loneliness. The decision making process in the family changes and the control is transferred.

b. Retirement In Indian context, retirement is a symbol of old age. In the

retirement process, the person may pass through the following phase:

1. Remote Phase Even when retirement is near or approaching, person does not get

ready for it.2. Near Phase When retirement is very near, making imaginary plan for it (day

dreaming)


3. Honeymoon Phase Just after retirement person wants to do all those things,

which he could not do so far or was always desirous of doing. But health and financial resources may cause problems (not in all people) in fulfilling his dreams or imaginations.

4. Disenchantment Phase The problems/realities of retired life may dispirit the person.

His excessive dream regarding retired life may result in more disappointments. At this stage, person may begin to come out of false imaginations.

5. Stability Phase Person understands the realities of retired life. He makes

adjustments to his new roles.6. Termination Phase This happens either by taking up some work again or due to

illness or incapacity.


Responsibilities of Nurse in Ageing

Care giverHealth educator Coordinator of health servicesCounselor and guardian (Those people who

protect the old person or take responsibilities as his guardian, spokesman or responsible person).


Health AssessmentDaily activities of living (bathing, excretion,

clothing, urinary control, ability to eat etc.).Activities related to use of equipment (Telephone,

bank account, food preparation, etc., his ability in these activities).

Health Screening: Ability to see and hear, dental problems, blood pressure, examination of breasts and uterus, cancer testing, examination of skin, etc. should be done.

In laboratory tests; blood examination, urine analysis, cholesterol, blood sugar, thyroid, etc. tests should be conducted


2.Arranging / Promoting Good Nutrition3.Promoting Activity and Exercise4.Preventive Care of Elderly5.Providing Psychological Support


Ageing: New Nursing ChallengesGerontological psychiatric nurse specialist in old age

home and nursing homes.Care manager and family counselor of chronic old

patients in the community.Pre admission assessor of nursing homes hospitals.Nurse Director of old age care giving training centre,

old age day care centre.Counselor of old patients in surgical wards.Pre-retirement counselor / educator.


Theories of Aging: Biological Theories: Intrinsic Factors: Several theories assume that individuals inherit a genetic

program that determines their specific life expectancy. In fact, various studies have shown a positive relationship between parental age and filial life span. Genetic mutations are also thought to be responsible for aging, a pattern depicted below, laboratory experiments which have accelerated mutation rates have not produced proportionate increases in the rate of aging, thus reducing support of this theory. Some theorists believe that a growth substance fails to be produced causing the cessation of cell growth and reproduction.

Extrinsic Factors: Disease producing organisms are often associated with biological aging. Bacteria, fungi, viruses, and other organisms are thought to be responsible for certain physiological changes during the aging process. Although no conclusive evidence presently exists to link these pathogens with the aging process, interest in this theory has been stimulated by the fact that humans and animals have been shown to live longer with the control or elimination of certain pathogens via immunization and the use of antimicrobial drugs.


Psychological Theories: Psychological and social changes during the aging process

are closely united, and they have a significant impact on each other. It is difficult to explain mental processes, behavior and feelings without the perspective of social roles, positions and norms. A theory of aging that is purely social or psychological would be most unusual, and it is more appropriate to approach these aging factors as psychosocial theories. Probably the most controversial and widely discussed is the disengagement theory, developed by Elaine cumming and William Henry. This theory views aging as a process whereby society and individual gradually withdraw or disengage, from each other, to the mutal satisfaction and benefit for both. The benefit to individual is that they can reflect and be centered on themselves, having been freed from societal roles. The value of disengagement for society is that some orderly means is established for the transfer of power from old to young, making it possible to society to continue functioning after its individual members have died.


Bibliography:Springhouse, mastering geriatric care, USA.1997.1-

447.Charlotte Eliopoulos, Geriatric nursing, UK.1-335.Park.k, Preventive and social medicine, 19th edition,

India (Jabalpur).2007; 475.Gulani k, Community health nursing principles and

practices. Delhi; 469-472.www.google.com Search-Geriatric care.

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Geriatric Care