Gerontology and Geriatrics PDF

 Introduction to Gerontology and Geriatrics  Definition of Gerontology and Geriatrics  Gerontology: the study of aging  Geriatrics: the medical care of older adults  The Aging Population:  Demographic changes and the growing elderly population  Factors influencing longevity (lifestyle...

 Introduction to Gerontology and Geriatrics  Definition of Gerontology and Geriatrics  Gerontology: the study of aging  Geriatrics: the medical care of older adults  The Aging Population:  Demographic changes and the growing elderly population  Factors influencing longevity (lifestyle, genetics, healthcare)  Myths and Stereotypes about Aging: Common misconceptions and their impact on older adults All older adults are alike: This stereotype ignores individual differences in health, personality, and abilities. Aging inevitably leads to cognitive decline: While cognitive changes can occur, dementia is not a normal part of aging. Many older adults maintain sharp minds and continue to learn new things. Older adults are frail and dependent: This stereotype underestimates the capacity of many older adults to live independently and actively. Older adults are a financial burden: This misconception overlooks the contributions older adults make to the economy through volunteering, caregiving, and consumer spending. Older adults are lonely and isolated: While social isolation can be a challenge for some, many older adults have strong social connections and engage in fulfilling activities. Older adults are not interested in sex or intimacy: Sexual desire and activity can continue throughout the lifespan.  Implications for healthcare and caregiving 1. Increased Healthcare Utilization 2. Financial Strain on Healthcare Systems 3. Need for Specialized Care  The Global Phenomenon of Population Aging  The world is experiencing a significant demographic shift, characterized by a rising proportion of older adults. This trend, often referred to as population aging, has profound implications for societies, economies, and healthcare systems.  Key factors driving population aging: Declining fertility rates: Aging baby boomer generation Increasing life expectancy: Aging baby boomer generation:  Implications of Population Aging 1. Economic impact- increased healthcare costs, pension burdens, and labor shortages. 1. Social implications - Growing demand for elder care services, potential for social isolation, and intergenerational relationships. 1. Demographic transition - Shifts in age structures and dependency ratios. Rapid urbanization: The increasing number of older adults living in urban areas presents unique challenges and opportunities. Family structure: The role of family caregivers in supporting older adults, and the potential strain on family resources. Healthcare system preparedness: The need for age- friendly healthcare services and policies.  Theories of Aging A. Biological, sociological, and psychological theories Biological Theories of Aging 1. Wear and Tear Theory 2. Cross-Linkage Theory 3. Free Radical Theory: 4. Mitochondrial Theory 5. Telomere Theory: 6. Cellular Senescence Theory 7. Immunologic Theory  Sociological Theories of Aging 1. Age Stratification Theory 2. Life Course Theory 3. Political Economy of Aging Theory 4. Activity Theory 5. Continuity Theory 6. Age Stratification Theory 7. Person-Environment Fit Theory  Psychological Theories of Aging 1. Disengagement Theory: 2. Activity Theory 3. Continuity Theory 4. Socioemotional Selectivity Theory 5. Maslow’s theory 6. Jung’s theory 7. Erickson’s Eight stages of life  Wear and Tear Theory  Gradual deterioration  Accumulative damage  Reduced capacity Limitations Not all tissues age at the same rate Neglects cellular repair mechanisms Doesn't explain all aspects of aging  Cross-Linkage Theory  cross-linking theory of aging /glycosylation theory of aging attributes aging to chemical changes that happen in the body. These changes happen gradually as proteins, structural molecules, and DNA develops detrimental chemical bonds (also known as cross-links) to each other.  Cross-Linkage Theory  When these cross-links between molecules occur, they lose basic levels of functionality. As cross-linked proteins accumulate over time they will damage cells and tissues, resulting in increased tissue stiffness and slowing down processes within the body.  Cross-Linkage Theory  Chemical Changes: The theory suggests that harmful chemical bonds (cross-links) form between proteins, sugars, and other molecules over time  Tissue Stiffening: As cross-links accumulate, tissues become stiffer and less flexible, impairing their function Examples of Effects: This theory is linked to age-related conditions like cataracts (clouding of the eye lens), skin changes (wrinkles, loss of elasticity), and arthritis.  Free Radical Theory Free radical theory proposes that ageing is the cumulative result of oxidative damage to the cells and tissues of the body that arises primarily as a result of aerobic metabolism. Oxidative stress is an imbalance between two different types of molecules in your body: free radicals and antioxidants  Mitochondrial Theory  Extramuscular alterations accompanying the aging process with a potential impact on myocyte mitochondrial function are also discussed. We conclude with presenting methodological and safety considerations for the design of clinical trials targeting mitochondrial  Telomere Theory progressive shortening of telomeres, protective caps at the end of chromosomes, contributes to cellular aging and ultimately, organismal aging Telomeres: These are repetitive DNA sequences that protect the ends of chromosomes from degradation and fusion.  Cellular Senescence Theory - proliferation-like activity of growth-promoting pathways (such as mTOR and MAPK) in non-proliferating cells....The senescence-associated secretory phenotype (SASP) is one of the numerous hyperfunctions.  Immunologic Theory - Specialized in cells, tissues and organs that provides the body with protection against invading organism. - T lymphocytes-cell-mediated immunity - B lymphocytes- invasion of an organism  Functional Changes  Reduced sweat gland activity: Leads to decreased thermoregulation and increased risk of overheating or hypothermia.  Decreased melanocyte activity: Results in graying hair, age spots, and increased sensitivity to sunlight.  Slower nail growth: Nails become thicker, more brittle, and prone to fungal infections.  Clinical Manifestations  Dry skin: Reduced sebum production and decreased skin hydration.  Wrinkling and sagging: Loss of elasticity and collagen.  Age spots: Increased melanin production in localized areas.  Senile purpura: Easy bruising due to thinning skin and fragile blood vessels.  Skin tears: Increased risk of skin tears due to thinner, more fragile skin.  Decreased sensation: Reduced nerve endings can impair the perception of pain, temperature, and pressure  Sociological Theories of Aging 1. Age Stratification Theory 2. Life Course Theory 3. Political Economy of Aging Theory  Age Stratification Theory emphasizes the significance of age as a social category that shapes individuals' lives and their interactions with other age groups. suggests that society is divided into social groups or strata based on age. These age groups or cohorts share common experiences, roles, and expectations. 1 examines how an individual's life unfolds within a specific social, historical, and cultural context. 1 Life Course Theory  It emphasizes the interconnectedness of life stages and the influence of social structures on individual experiences  Life Course Theory examines how an individual's life unfolds within a specific social, historical, and cultural context. 1  Political Economy of Aging Theory  This theory highlights the potential for age- based inequalities and disparities in resources, access to services, and social participation.  Political Economy of Aging Theory  theoretical perspective that examines the relationship between aging, social structure, and power. It focuses on how economic and political factors shape the experiences and opportunities of older adults  Activity Theory  Individual need to remain active to age successfully  Activity is necessary to maintain life satisfaction and a positive self-concept  Continuity Theory  Individuals respond to aging the same way they have responded to previous life events.  The same habits commitment, preferences, and the other personality characteristics develop during adulthood  Age Stratification Theory  People and roles in these cohorts change and influence each other, as the society at large  There is a high degree of interdependence exist b/n older adults and society.  Person-Environment Theory Everyone has personal competencies that exist the person in dealing with the environment. Psychological Theories of Aging 1. Disengagement Theory: 2. Activity Theory 3. Continuity Theory 4. Socioemotional Selectivity Theory 5. Maslow’s Hierarchy of Human Needs 6. Erickson’s Eights Stages of Life 7. Jung’s Theory of Individualism  Disengagement Theory as individuals age, they naturally withdraw from social roles and relationships. This mutual withdrawal is seen as a normal and inevitable part of the aging process.  Disengagement Theory  Gradual withdrawal: Older adults progressively disengage from social roles and relationships  Mutual disengagement: Both the individual and society contribute to this process.  Increased self-focus: Disengagement allows for greater introspection and contemplation.  Activity Theory  It focuses on understanding human activity as a complex system involving individuals, tools, and the environment.  is a framework that emphasizes the importance of social and cultural contexts in shaping human behavior and cognition  Continuity Theory -older adults tend to maintain their previous lifestyle, personality, and social interactions as they age. Rather than undergoing drastic changes, individuals strive to preserve their sense of self and identity  Continuity Theory  Internal continuity- Maintaining consistent personality, attitudes, and beliefs over time  External continuity: Persisting in familiar roles, activities, and environments  Adaptive strategies: Older adults employ strategies to cope with changes while preserving continuity  Life satisfaction: Continuity is linked to higher levels of life satisfaction and well-being  Socioemotional selective theory  that individuals prioritize emotionally meaningful goals as they perceive their time horizon shortens. Essentially, as people age and perceive their remaining time as limited, they focus more on emotional satisfaction and less on acquiring new information or experience  Maslow’s Hierarchy of Human Needs  Human motivation is viewed as a hierarchy of needs critical to the growth and development of all people.  Individuals are viewed as active participants in life, striving for self-actualization  Erickson’s Eights Stages of Life All people experience eight psychosocial stages during a lifetime.  Jung’s Theory of Individualism  Development is viewed as occurring throughout adulthood with self realization as the goal of personality development  As individuals age they can transform into a more spiritual being.  I.B Planning for Health Promotion, Health Maintenance, and Home Health Considerations  Components of Planning 1. Needs Assessment  Identify the specific health needs and priorities of the target population.  Assess existing resources and services available in the community.  Analyze barriers to accessing healthcare.  Assessment Tools for Nursing Care of the Older Adult: Wellness 1. Comprehensive Geriatric Assessment (CGA) 2. Functional Assessment Tools 3. Nutritional Assessment Tools 4. Cognitive Assessment Tools 5. Depression Screening Tools 6. Social and Environmental Assessment Tools  A comprehensive evaluation of an older adult's physical, functional, cognitive, social, and environmental status. Includes assessment of activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive function, m Includes assessment of activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive function Comprehensive Geriatric Assessment (CGA) - A comprehensive evaluation of an older adult's physical, functional, cognitive, social, and environmental status. - Includes assessment of activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive function, mood, and social support  Functional Assessment Tools - Timed Up and Go (TUG): Measures physical function and balance - Berg Balance Scale: Assesses balance and fall risk - Timed "Up and Down Stairs" Test: Evaluates lower extremity function and mobility  Nutritional Assessment Tools Mini Nutritional Assessment (MNA) -Screens for malnutrition risk Malnutrition Universal Screening Tool (MUST) - Assesses malnutrition risk  Cognitive Assessment Tools Mini-Mental State Examination (MMSE) -Screens for cognitive impairment Mini-Mental State Examination (MMSE) - Screens for cognitive impairment  Depression Screening Tools Geriatric Depression Scale (GDS) - Screens for depression in older adults Patient Health Questionnaire-9 (PHQ-9) -Screens for depression symptoms Social and Environmental Assessment Tools Social Determinants of Health (SDOH) Assessment - Evaluates factors like housing, education, and income that impact health Home Safety Assessment - Identifies potential hazards in the home environment 2. Goal Setting  Develop clear and measurable goals for health promotion, maintenance, and home care.  Ensure alignment with broader health objectives and community needs. 3. Program Development  Design interventions that address identified needs and promote healthy behaviors.  Consider the target population's cultural, social, and economic factors.  Develop strategies for delivering services, such as home visits, community health centers, or telehealth 4. Resource Allocation  Identify and secure necessary resources, including personnel, equipment, and funding.  Prioritize resource allocation based on identified needs and program goals. 5. Collaboration  Build partnerships with healthcare providers, community organizations, and government agencies.  Coordinate efforts to maximize impact and avoid duplication of services. 6. Evaluation  Develop a plan for monitoring and evaluating program outcomes.  Collect data on program reach, effectiveness, and efficiency.  Use evaluation findings to make necessary adjustments to the program.  I. C Implementation 1. Physical Care aging skin and mucous membrane elimination activity and exercise sleep and rest 2. Psycho-social care 2. Psycho-social care a. Cognition and perception b. Engagement with life c. Self-perception and self-concept d. Coping and stress e. Values and beliefs f. Sexuality and aging  Expected output  Develop a short term plan of activities Plan of activities in caring older  Goal: To improve the overall well-being and quality of life of older adults in the community.  Target Population: Older adults aged 65 and above residing in [Location].  Timeframe: [Month, Year] to [Month, Year]  Week 1-2: Needs Assessment  Conduct focus group discussions with older adults and caregivers to identify their needs and priorities.  Assess the availability of existing resources and services in the community.  Identify potential barriers to accessing healthcare and social services.  Week 3-4: Program Development  Develop a comprehensive plan based on the identified needs and available resources.  Include activities such as:  Health screenings (e.g., blood pressure, blood sugar, cholesterol)  Nutrition education and cooking demonstrations  Exercise classes or physical activity programs  Mental health support groups  Caregiver training and support  Social activities and outings  Week 5-8: Implementation  Recruit volunteers and staff to assist with program activities.  Establish partnerships with local healthcare providers, community organizations, and government agencies.  Implement planned activities according to schedule.  Monitor attendance and participation rates.  Week 9-10: Evaluation  Collect data on program outcomes, including changes in health status, quality of life, and satisfaction levels.  Analyze the data to assess the effectiveness of the program.  Identify areas for improvement and make necessary adjustments.  PHYSIOLOGIC CHANGES IN AGING Integumentary System Diseases 1. Skin Thinning: Loss of collagen and elastin, leading to decreased skin elasticity and increased susceptibility to injury. 2. Dry Skin: Reduced sebum production, causing dryness, itching, and increased risk of cracking. 3. Age Spots: Dark, flat spots on the skin caused by sun damage. 4. Actinic Keratosis: Precancerous lesions that often appear as rough, scaly patches on sun-exposed skin  Integumentary System Diseases 5. Skin Cancer: Increased risk of skin cancers, such as basal cell carcinoma, squamous cell carcinoma, and melanoma, due to sun exposure and decreased skin elasticity. 6. Nail Changes: Thickening, brittleness, or discoloration of nails. 7. Hair Loss: Thinning or loss of hair, often due to hormonal changes or medical conditions. 8. Pressure Ulcers: Sores caused by prolonged pressure on the skin, often occurring in bedridden or immobile individuals.  Integumentary System Disease 8 Common Skin Conditions in Elderly Adults 1. Easy bruising 2. Dryness and itching 3. Age spots 4. Skin tags 5. Shingles 6. Bed sores 7. Skin tears  Integumentary System Diseases 1. Easy bruising 2. Dryness and itching 3. Age spots 4. Skin tags 6. Shingles 7. Bed sores 8. Skin tears  Musculoskeletal System 1. Osteoporosis: Weakening of bones, leading to an increased risk of fractures. 2. Osteoarthritis: Joint inflammation and degeneration. 3. Sarcopenia: Loss of muscle mass and strength. 4. Spondylitis (arthritis of the neck) 5. Carpal tunnel syndrome- common condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist  Musculoskeletal System s/s Mgt 1. Osteoporosis Back pain, caused by a broken or collapsed bone in the spine. Loss of height over time. A stooped posture. A bone that breaks much more easily than expected 2. Osteoarthritis Pain ,Stiffness Tenderness, Loss of flexibility Grating sensation, Bone spurs, Swelling 3. Sarcopenia weakness, fatigue, loss of energy, balance problems, and Make healthy food trouble walking and standing, Difficulty performing daily choices activities.Walking slowly. Exercise Trouble climbing stairs. Poor balance and falls. Decrease in muscle size. 4. Spondylitis Description: condition in which the immune system attacks the joints, causing inflammation, bone fusion, and excess bone formation.  Respiratory System 1. Chronic Obstructive Pulmonary Disease (COPD): A group of lung diseases, including chronic bronchitis and emphysema, that cause airflow obstruction. 2. Pneumonia: Inflammation of the lungs often caused by infection. 3. Sleep Apnea: A disorder characterized by pauses in breathing during sleep.  Cardiovascular System 1. Coronary Artery Disease: Narrowing of the arteries that supply blood to the heart, leading to heart attacks. 2. Heart Failure: Weakening of the heart muscle, causing it to pump blood less efficiently. 3. Stroke: Occurs when blood flow to the brain is interrupted. 4. Atrial Fibrillation: Irregular heart rhythm that can increase the risk of stroke.  Hematopoietic System Diseases 1. Anemia: A decrease in the number of red blood cells, leading to fatigue, weakness, and shortness of breath. 2. Leukemia: A cancer of the blood-forming cells in the bone marrow. 3. Thrombocytopenia: A decrease in the number of platelets, leading to increased risk of bleeding. 4. Polycythemia Vera: A condition characterized by an overproduction of red blood cells.  Lymphatic System Diseases 1. Lymphoma: Cancer of the lymphatic system, affecting the lymph nodes, spleen, and other lymphatic tissues. 2. Multiple Myeloma: A cancer of plasma cells, a type of white blood cell. 3. Autoimmune Hemolytic Anemia: A condition where the body's immune system attacks and destroys red blood cells.  Gastro-intestinal System 1. Gastroesophageal Reflux Disease (GERD): Acid reflux that can cause heartburn and other symptoms. 2. Constipation: Difficulty passing stools. 3. Diverticular Disease: Small pouches (diverticula) that form in the colon.  Urinary- Women 1. Urinary Incontinence: Loss of bladder control, which can be stress incontinence (leakage when coughing or sneezing), urge incontinence (sudden urge to urinate), or mixed incontinence. 2. Pelvic Organ Prolapse: When the pelvic organs (bladder, uterus, or rectum) sag or protrude into the vagina. 3. Endometrial Atrophy: Thinning of the uterine lining, which can lead to vaginal bleeding and discomfort.  Urinary-Men 1. Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland, which can cause difficulty urinating, frequent urination, and weak urine flow. 2. Erectile Dysfunction: Inability to achieve or maintain an erection. 3. Low Testosterone: Decreased levels of testosterone can lead to fatigue, decreased libido, and other symptoms.  Nervous System 1. Alzheimer's Disease: A progressive brain disease that causes memory loss and cognitive decline. 2. Dementia: A general term for cognitive decline that interferes with daily activities. 3. Stroke: Can cause brain damage and lead to physical and cognitive impairments. 4. Parkinson's Disease: A progressive neurological disorder characterized by tremors, stiffness, and slow movements.  Endocrine System 1. Type 2 Diabetes: A metabolic disorder characterized by high blood sugar levels. 2. Hypothyroidism: Underactive thyroid gland, leading to fatigue, weight gain, and other symptoms. 3. Hyperthyroidism: Overactive thyroid gland, leading to rapid heartbeat, weight loss, and other symptoms.  Female reproductive changes Ovaries No viable follicles remain Uterus most noticeable change in the uterus before menopause is a decrease in the degree of endometrial thickening during menstrual cycles. Since this decline is due to reduced ovarian hormone production, this change is observed most frequently during menstrual cycles that accompany ovarian cycles with no ovulation Vagina significantly reduce its role as a barrier against abrasion and microbes because as the vagina becomes smaller, thinner, and less elastic External increased risk of developing vaginal infections, age Structures : -related shrinkage of the labia majora may also play a contributing role Genitalia Breasts Shrinkage of glandular material, increases in fat , and weakening of fibrous materials in the breasts reduce their firmness and support  Male reproductive channges Andropause; Male reproductive changes testicular tissue, sperm production, and erectile function FERTILITY The testes continue to produce sperm, but the rate of sperm cell production slows. The epididymis, seminal vesicles, and prostate gland lose some of their surface cells. But they continue to produce the fluid that helps carry sperm. URINARY FUNCTION The prostate gland enlarges with age as some of the prostate tissue is replaced with a scar like tissue. This condition, called benign prostatic hyperplasia (BPH), affects about 50% of men. BPH may cause problems with slowed urination and ejaculation. Erectile dysfunction ED t is normal for erections to occur less often than when a man was younger Aging men are often less able to have repeated ejaculations. Thank you for listening