NCM 114 Gerontologic Nursing PDF SY 2024-2025

HISTORY OF GERONTOLOGICAL NURSING Nursing administration in long term care, geropsychiatric nursing, geriatric rehabilitation and other areas of sub Begins with AGRICULTURE – prior to this hunte...

HISTORY OF GERONTOLOGICAL NURSING Nursing administration in long term care, geropsychiatric nursing, geriatric rehabilitation and other areas of sub Begins with AGRICULTURE – prior to this hunter-gatherer specialization have evolved. The specialty has indeed societies existed; food supply was short, frequent advanced rapidly. movement is a necessity. It heightened the awareness of the complexities of These are the reason meant that extremely few reached gerontological nursing. Elderly people exhibit great diversity “old age” in terms of health status, cultural background, lifestyle, living It was argued that in a society with a life expectancy of 14 arrangement and socioeconomic status. (such as 10,000 BC) being “40” was old. 1904 – American Journal of Nursing printed first article on PIONEERS IN GERONTOLOGICAL NURSING the “Care of the Aged” serves as the principles that Virginia Stone (1912 – 1993) continue to guide gerontological nursing practice today. It Mary Opal Wolanin (1920 – 1997) featured “The Old Nurse” which emphasizes the value of Doris Schwartz (1917 – 1999) the aging nurse’s years of experience. Irene Burnside (1924 – 2003) 1906 – the term “Gerontology was founded. THINGS TO REMEMBER! 1935 – Federal Old Age Insurance Law (known as Social Security Law) old persons had an alternative to alms Ageism – a term coined by Robert Butler; pointing a houses, could independently purchase room and board. It negative connotation on older people that they are no longer was operated with women called themselves as nurses useful or beneficial in society. and residences that later became known as nursing Empty Nest Syndrome – lack of income due to reduced no. homes. of hrs. at work. Many years care of the aged was an unpopular branch of Polypharmacy – multi-drug management nursing practice. Older adult Age – 65yrs old Geriatric nurses were thought to be inferior in capabilities, Gerontologic Age – starts at 60-65 yrs. Old neither good enough for acute settings nor ready to "go to Common misconception – all older adults have cognitive pasture”, low-income salaries, negativism in educational decline programs, experience with older persons were inadequate DIFFERENT SUBFIELDS OF GERONTOLOGICAL NURSING in both quantity and quality. GERONTOLOGY 1961- ANA recommended the specialty group for geriatric the scientific study of old age, the process of aging and the nurses was formed. particular problems of old people. 1962 – First National Meeting, ANA Conference Group on Gerontologist are responsible for education other health Geriatric Nursing Practice, became the Division of professionals, community practitioners as well as the Geriatric Nursing in 1966, gaining full recognition as a community at large about the process of aging and how to nursing specialty. Important contribution was the age well by giving informative presentations, publishing Development of Standards for Geriatric Nursing Practice, books and articles about aging and health, and producing first published in 1970. relevant is and television. 1970 – increase awareness of their role in promoting Is multidisciplinary and is concerned with physical, mental healthy aging experience for all individuals and ensuring and social aspects and implications of aging. Geriatrics is a the wellness of older adults. medical specialty focused on care and treatment of older 1975 – the first 74 nurses achieved the recognition of persons. geriatric nursing practice certification. The Birth of Journal of Gerontological Nursing – as the first professional journal CLINICAL GERONTOLOGY to meet the specific needs and interest of gerontological a unit within the Department of Public Health and Primary nurses. Care Clinical Gerontology aim to understand how best to 1976 – Geriatric Nursing Division became the maintain health in older populations. It aims to quantify the Gerontological Nursing Division combined role of lifestyle, environmental and geriatric Due to profound growth, 32 articles on the topic of nursing factors in the etiology of major disabling diseases of later care of the aged were listed in the Cumulative Index to life, focusing in particular on cardiovascular disease, cancer Nursing Literature in 1956. and osteoporosis and to identify effective prevention strategies. Clinical Gerontologist presents timely material Growing number of nursing schools were including relevant to the needs of mental health professionals and all gerontological nursing course in their undergraduate practitioners who deal with the aged client. programs offering advanced degree with major in this area. SOCIAL GERONTOLOGY A specialization that centers on the social aspects of By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  growing old. The goal of social gerontologist is to help SOCIAL GERONTOLOGY older adults improve their communication and interactions Focus on the social aspect of growing old. with others. They will be able to help older adults live ENVIRONMENTAL GERONTOLOGY active, independent lifestyles, provide counseling and therapy to clients to help them cope with psychological, Attempts to understand and also optimize the relationship between ageing people and their physical and social emotional, social and financial challenges that come with environments. aging, they also provide therapy and advise client's families and loved ones as necessary. JURISPRUDENTIAL GERONTOLOGY GERIATRIC GERONTOLOGY Focuses on the ways that law interacts with the ageing experience. A specialty that focuses on health care of elderly people. It aims to promote health by preventing and treating ROLE OF A GERONTOLIGCAL NURSE disease and disabilities in older adults. Geriatrics refers to G – (guiding) guidance to people of all ages regarding the medical care for older adults, an age group that is not easy ageing process. to define precisely. "Older" is preferred over "elderly" but E – (eliminating) the ageism or notion of old age as disease. both are equally imprecise: >65 is the age often used but most people do not need geriatrics expertise in their care R – (respecting) the right of old people. until age 70, 75 or even 80. O – (observing) the facilities provided to old people and EXPERIMENTAL GERONTOLOGY improving them. multidisciplinary journal for the publication of work from all N – (noticing) health hazards that may happen in old age areas of bio gerontology, with an emphasis on studies and try to reduce them. focused at the systems level of investigation, such as T – (teaching) them how to take care of old people, for those whole organisms (e.g., invertebrate genetic models) who are caring for them (family member, friends, community immune endocrine and cellular systems as well. The health workers, voluntary organization). journal also publishes studies unto the behavioral and O – (opening channels) of development activities for the cognitive consequences of aging, where a clear biological care of the aged. causal link is implicated. Studies that came up in the L – (listening) attentively to the problems of old people and journal aimed at bridging the gap between basic and giving importance to them. clinical aspects of gerontology, such as papers on the basic aspects of age-related diseases, are welcomed as is O – (offering) positivism, presenting different possibilities to research orientation toward the modulation of the aging life. process. Original research manuscripts, special issues, G – (generating) energy for the participation in the care of short reports, reviews, mini reports on clinical studies do aged and researches for new supporting techniques. not fall within the scope of the journal. I – (implementing) activities for rehabilitation and PREVENTIVE GERONTOLOGY readjustment. The study of individual and population health strategies C – (coordinating) with different services related to care of across the life span aimed at maximizing both the quality the aged. of human longevity must no aim not just to retard chronic A – (assessing) the needs and the health of the old people. disease but also to prevent functional decline, The study and practice of those elements of lifestyle, environment L – (linking) contacting services according to need. and health care management that will provide the maximal N – (nurturing) prepare future nurses for the care of the longevity of highest. aged. Prevention in the elderly focuses on the following areas: o Primary and Secondary Prevention of Disease U – (understanding) every old person as an invaluable asset o Tertiary prevention of the society. o Prevention of Frailty Prevention of Accidents R – (recognizing) the moral and religious aspect of old age. o Prevention of Iatrogenic complications S – (supporting) the old people in accepting realities. BIOGERONTOLOGY E – (educating and encouraging) old people for self-care. Concerns the biological ageing process, its origins, as well MAJOR ROLES OF A GERONTOLOGICAL NURSE as, potential ways to intervene in the process. HEALER BIOMEDICAL GERONTOLOGY Nursing plays a significant role in helping individuals stay An attempt to slow, prevent, and reverse the process of well, overcome or cope with diseases, restore function, and ageing. purpose in life & mobilize internal & external resources. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  Gerontological nurses recognize that most human beings Divided into 2 sections: value health, are responsible and active participants in o Standards of Practice – describes the application of their health maintenance & illness management, desire the steps of the nursing process with practice: harmony & wholeness with their environment. Assessment, Diagnosis, Outcome Identification, Holistic approach is essentially viewed in context of their Planning, Implementation, Evaluation biological, emotional, social, cultural, and spiritual o Standards of Professional Performance elements. ANA STANDARDS OF GERONTOLOGICAL NURSING PRACTICE (NURSING CARE) CARE PROVIDER/ CAREGIVER Conscientious application of nursing process to care of STANDARD I: ASSESMENT - collects patient health data. elders. STANDARD II: DIAGNOSIS – analyzes the assessment Inherit in this role is the active participation of older adults data in determining diagnoses. and their significant others and promotion of highest STANDARD III: OUTCOME IDENTIFICATION – the degree of self-care in elderly. gerontological nurse identifies expected outcomes individualized to the older adult. LEADER & MANAGER STANDARD IV: PLANNING – develops a plan of care that ADVOCATE prescribes interventions to attain outcomes. Advocacy including aiding older adults in asserting their STANDARD V: IMPLENTATION – implements the rights and obtaining required services, facilitating a intervention identified in the plan of care. community or other group efforts to affect change and STANDARD VI: EVALUATION – evaluates the older adults achieve benefits for older adults. progress towards attainment of expected outcomes. EDUCATOR/TEACHER ANA STANDARDS OF GERONTOLOGICAL NURSING PRACTICE (QUALITY CARE) Formal and informal opportunities to share knowledge, skills related to care of older adults. STANDARD I: QUALITY OF CARE – the gerontological Educating others including normal aging, pathophysiology, nurse systematically evaluates the quality of care and geriatric pharmacology and resources. effectiveness of nursing practice. Essential to this role is effective communication involving STANDARD II: PERFORMANCE APPRAISAL – the listening, interacting, clarifying, coaching, validating, and gerontological nurse evaluates his/her own nursing practice evaluating. in relation to professional practice standards and relevant RESEARCHER/INNOVATOR statutes and regulations. STANDARD III: EDUCATION – the gerontological nurse assumes an inquisitive style, making conscious decision acquires and maintains current knowledge in nursing and efforts to experiment for an end result to improve practice. gerontological practices. STANDARD IV: COLLEGIALITY – contributes to SCOPE & STANDARS OF GERONTOLOGICAL NURSING PRACTICE professional development of peers, colleagues, and others. SCOPE STANDARD V: ETHICS – decision and actions on behalf of older adults are determined in an ethical manner. gerontological nursing is an evidence-based specialty practice that address the unique physiological, STANDARD VI: COLLABORATION – collaborates with psychosocial, developmental, economic, cultural, and older adults, the older adult’s caregiver, and all members of spiritual needs related to the process of aging and care of interdisciplinary team to provide comprehensive care. the older adults. Collaborate with older adults and their STANDARD VII: RESEARCH – interprets, applies, and significant others to promote autonomy, wellness, optimal evaluates research findings to improve gerontological functioning, comfort, and quality of life from healthy aging nursing practice. to end of life. Leads to interprofessional teams in a holistic, STANDARD VII: RESOURCE UTILIZATION – considers person-centered approach in the specialized care of the the factors related to safety, effectiveness, and cost in older adults. planning and delivering patient care. STANDARDS THEORIES OF AGING: BIOLOGICAL THEORIES authoritative statements that identify the responsibilities for A theory used as an explanation for phenomena pertaining which gerontological nurses are accountable, reflect the to the life science, or study of living organisms. values and priorities of gerontological nursing are written in Attempts to explain why the physical changes of aging measurable terms and provide a framework for the occur. Researchers try to identify which biologic factor have evaluation of gerontological nursing practice. The standards the greatest influence on longevity. remain stable over time as they reflect the philosophical All aging begins with genetics. Aging changes the values of the nursing profession and specialty. biochemical and physiological processes in the body. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  PROGRAMMED THEORY OF o Telomerase may be used to help with wound healing or ERROR THEORY OF AGING the immune response. AGING 1. Programmed Theory 1. Wear and Tear Theory ENDOCRINE THEORY Programmed 2. Rate of Living Theory Biologic clocks act through hormones to control the pace of Senescence Theory 3. Cross Link Theory aging. Hormones affect growth, metabolism, temperature, Telomeric Theory 4. Free Radical Theory inflammation, and stress. 2. Endocrine Theory 5. Error Catastrophic Theory Example – menopause which is the decrease of level of 3. Immunology Theory 6. Somatic Mutation Theory estrogen and progesterone with manifestations of hot PROGRAMMED THEORY: BIOLOGICAL CLOCK THEORY flushes and insomnia. The program theory proposes that every person has a IMMUNOLOGIC THEORY “Biologic Clock” that starts ticking at the time of A programmed decline in the immune system leads to an conception. increased vulnerability to diseases, aging, and death. Each individual has a genetic program specifying an Example – decreased T cells (helper cells) in adults leads unknown but predetermined number of cell divisions. to an increased risk for diseases/autoimmune diseases in As the program plays out, the person experiences adults and older adults. predictable changes such as atrophy of the thymus, RUN OUT OF PROGRAM THEORY menopause, skin changes, and graying of the hair, Every person has a limited amount of genetic material that Aging has a biological timetable or internal biological will run out over time. clock. All events are specifically programmed into genome and are The result of sequential switching “off” or “on” of specific sequentially activated. gene (e.g., “Hayflick’s Limits”). After maturation genes have been activated there are no Fibroblasts removes from umbilical cord and cultured. more programs to be played and as cells age there may be They are then divided and repeated until 50 divisions chance of inactivation of genes that cannot be turned on. and will not divide past this point. PROGRAMMED THEORY: TELOMERIC THEORY GENE THEORY The gene theory purposes the existence of one or more Extension of the “Hayflick Limit” harmful gene that activates overtime, resulting in the typical Telomeres are specialized DNA sequences at the end of changes seen with aging and limiting the life span of the chromosomes and shorten with each cell division. individual. When the telomeres become too short, the cell enters the Organism failure occurs in late life because of the presence senescence stage. of imperfect genes activated over lengthy periods of time. In the normal process of DNA replication, the end of the Two gene types chromosome is not copied exactly, which leaves an un- o Supports growth and vigor replicated gap. o Supports senescence (reach old age) and deterioration The enzyme, telomerase, fills the gap by attaching bases (illnesses) to the end of the chromosomes. As long as the cells have enough telomerase to the do the THEORIES OF AGING: MOLECULAR THEORIES job, they keep the telomeres long enough to prevent any Aging is controlled by genetic materials that are encoded to important information from being last as they go through predetermine both growth and decline. each replication. ERROR THEORY With time, telomerase levels decrease and with Proposes that errors in Ribonucleic Acid (RNA) protein decreasing telomerase levels, the telomeres become synthesis cause errors to occurs in the cells in our body, shorter and shorter. Shortened telomeres are usually resulting in a progressive decline in biologic function. found in Atherosclerosis, Heart Disease, Hepatitis, It is the result of internal or external assaults that damage Cirrhosis cells or organs so they can no longer function properly. 90% of cancer cells have been found to possess SOMATIC MUTATION THEORY telomerase. Proposes that aging results from Deoxyribonucleic Acid o Telomerase prevents the telomere from shortening (DNA) damage caused by exposure to chemicals or o This allows the cancer cells to reproduce, resulting in radiation and this damage causes chromosomal tumor growth abnormalities that lead to disease or loss of function later in Research areas: life. o Measuring telomerase may help detect cancer Genetic mutations occur and accumulate with increasing o Stopping telomerase may fight cancer by causing age, causing cells to deteriorate and malfunction. death of cancer cells. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  Accumulation of mutations result in: chemical produced by metabolism accumulates in normal o When the damage exceeds the repair, the cell cells and cause damage to body organs such as the malfunctions and this can lead to senescence. muscles, heart, nerves, and the brain. o Exposure to x-ray radiation and or chemicals induces WEAR AND TEAR THEORY chromosomal abnormalities. Body is similar to a machine, which loses function when its THEORIES OF AGING: CELLULAR THEORIES parts wear out. As people age, their cells, tissues, and organs are damaged Proposes that aging is a process that occurs because of by internal or external stressors. cell damage. When enough cells are damaged. Overall Good health maintenance practices will reduce the rate of functioning of the body is decreased. wear and tear, resulting in longer and better body function. FREE RADICAL THEORY Example – wearing out of the skeletal system such as in Given by Denham Harman 1956 osteoarthritis. The term free radical describes any molecule that has a RATE OF LIVING THEORY free electron, and this property makes it react with healthy molecules in a destructive way. Oldest theory of aging People have a finite number of breaths, heartbeats, or other Free radical molecule creates an extra negative charge. measures. The unbalance energy makes the free radical bind itself to In ancient times, people believed that just as a machine will another balanced molecule as it tries to steal electrons. begin to deteriorate after a certain number of uses, the Balanced molecules become unbalanced and thus a free human body deteriorates in direct proportion to its use. radical itself. Modern version of this theory recognized that the number of Diet, lifestyle, drugs (e.g., Tobacco and alcohol), and heartbeats does not predict the lifespan. radiation Speed at which an organism processes oxygen. Accumulated damage caused by oxygen radicals causes Tiny mammals with rapid heartbeats metabolize oxygen cell to stop functioning and eventually organs also stop quickly and have short lifespan. Tortoises, metabolize functioning. oxygen very slowly and have a long lifespan. An oxygen radical is a byproduct of normal metabolism The greater an organism’s basal metabolic rate, the shorter produced when cells turn food and oxygen into energy. the lifespan. This free radical in need of mate, takes an electron from another molecule, which in turn becomes unstable. This Free radicals or other metabolic byproducts play a role in reaction produces a series of compounds, some of which senescence. are harmful. All these damages within the body caused by THEORIES OF AGING: PSYCHOLOGICAL THEORIES oxygen free radicals cause aging. Psychosocial theories of aging attempt to explain changes The antioxidant molecule (red) destroys the damaging free in behavior, roles, and relationships that occur as individuals radical (purple). The membrane repairs itself but the DNA age. remains damaged, impairing the cell’s function. The This attempt to predict and explain the social interactions antioxidant molecule now has an unpaired electron and and roles that contribute to successful adjustment to old age thus becomes a new radical. in older adults. CROSSLINK OR CONNECTIVE TISSUE THEORY DISENGAGEMENT THEORY Cell molecules from DNA and connective tissue interact Elaine Cumming & Warren Earl Henry (1961) with free radicals to cause bonds that decrease the ability People lose social ties to those around them as they of tissue to replace it. approach death, their ability to engage with others decrease The results in the skin changes typically attributed to aging over time. such as dryness, wrinkles, and loss of elasticity. As a person begins to disengage, they are freed from the Fibrous tendons, loosening teeth, diminished elasticity of social norms that guide interactions. Losing touch with arterial walls and decreased efficiency of lungs and GI norms reinforces and fields the process of disengagement. tract. Varies between men and women due to their different social It is the binding of glucose (simple sugars) to protein (a roles. Men are centrally instrumental role while women are process that occurs under the presence of oxygen) that socioemotional. causes problems. Aging is an EGO change that causes knowledge and skills Senile cataract and the appearance of cough, leathery and to deteriorate. yellow skin. When both individual and society are ready for The clinker theory combines the somatic mutation, free disengagement, complete disengagement results. When radical theory, and crosslink theory to suggest that neither is ready, continuing engagement results. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  Men’s central role is work, while women’s is marriage and ideas, and beliefs that remain constant throughout the life family. If an individual abandons their central role, they course. lose space in social life, resulting in crisis and Provides the individual a way to make future decisions demoralization unless they assume the different roles based on their internal foundation of the past. required by someone who is disengaged. External structures of an individual refer to relationships and Individuals become ready to disengage when they are social roles provide a support for maintaining a stable self – aware of the shortness of life and the scarcity of their own concept and lifestyle. time, but not all individuals are disengaged. SOCIOEMOTINAL SELECTIVITY THEORY Engagement means to be involved with people and Social networks become more selective as we age. activities. People limit their contacts to familiar partners with whom Disengagement means withdrawing from engagement. they have the most rewarding relationship. Older people will need to withdraw from social contact and Withdrawal from social contact with individuals that are will disengage because of reduced health and loss of peripheral to their lives while they maintain or increase special opportunities. contact with close friends and some family members. The benefit is thought to be in providing time for reflecting Socioemotional selectivity theory focuses on the types of on life accomplishment, orderly transfer of power from old goals that individuals are motivated to achieve. to young and proper function of a growing society. SELECTIVE OPTIMIZATION WITH COMPENSATION THEORY ACTIVITY THEORY State that successful aging is linked with three main factors: Robert J. Havighurst (1961) – an academic educator and o Selection – based on the concept that older adults have scholar a reduced capacity and loss of function which require a Proposes that activity is necessary for successful aging. reduction in performance in most life demands. Active participation in physical and mental activities help o Optimization – it is possible to maintain performance in maintain functioning well into old age. some areas through continued practice and Purposeful activities and interactions that promote self- technology. esteem improve overall satisfaction with life, even at the o Compensation – involves altering and modifying how older age. one carries out previous asks in order to increase the The continuation of activities performed during middle age level of functioning. The process of selective is necessary for successful aging. optimization with compensation is likely to be effective Active participation in physical and mental activities help whenever loss is prominent in a person’s life. maintain functioning well into old age. THEORIES OF AGING: PSYCHOSOCIAL THEORIES Positive relationship between activity and life satisfaction will increase one person’s self – concept and improves PERSONALITY THEORY adjustment later in life. Reichard, Livson, and Peterson (1962) CONTINUITY THEORY Addresses aspects of psychological growth without delineating specific tasks or expectations of older adults. Neugarten (1964) The personalities of older men were classified into five major States that personality remains the same and the categories according to their patterns of adjustment to behaviors become more predictable as people age. aging. Personality and behavior patterns developed during a Healthy adjusted individuals: lifetime determines the degree of engagement and activity o Mature men – are considered well balanced people in older adulthood. who maintain close personal relations. Personality is a critical factor in determining the o Rocking chair – personalities are found in passive relationship between role activity and life satisfaction. disposition. Normal adults will usually maintain the same activities, o Armored men – have well integrated defense behaviors, and relationships as they did in their earlier year mechanisms which serve as adequate protection. of life. Less successful in aging: Older adults try to maintain the continuity of lifestyle by o Angry men – are bitter about life, themselves, and other adapting strategies that are connected to their past people. experiences. o Self-haters – are similar to angry men except that most Deals with the internal structure and the externals of their animosity is turned inward on themselves. structure of continuity to describe how people adapt to DEVELOPMENTAL TASK THEORY their situation and set their goals. The activities and challenges that one must accomplish at Internal structure of an individual refers to personality, specific stages in life to achieve successful aging. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  Primary task of old age is being able to see one’s life as 4th Stage: Esteem Stage having been lived with integrity (Erikson, 1963). o Once a person feels like they belong, the need to be Absence of achieving that sense of having live well will put important can arise. the older adult at risk for becoming preoccupied with o Esteem needs can be classified as external or internal. feelings of regret and despair. o Internal esteem needs are related to self - esteem, such as the need to respect yourself & achieve. o External esteem needs are those such as social status, reputation & recognition. 5th Stage: Self-actualization Stage o the summit of Maslow's Hierarchy of needs o It can be defined as the quest of reaching your full potential. o Unlike some of the lower needs, this need is never fully satisfied due to the fact that people can grow and change and continue to challenge themselves. o People in this stage tend to have needs such as: According to human psychologist Abraham Maslow, our mortality, creativity, spontaneity, problem solving, lack actions are motivated in order to achieve certain needs. of prejudice, acceptance of facts, truth, justice, wisdom People are motivated to fulfill basic needs before moving and meaning. on to other, more advanced needs. People need to satisfy JUNG’S THEORY their most important needs first, and when they have Carl Jung discovered the analytical psychology which rests achieved this, they can move on to the next important upon the assumption that occult phenomena can do need. influence the lives of everyone. Maslow first introduced his theory of hierarchy in his 1943 It is where the body, mind, and soul are brought together by paper “A Theory of Human Motivation” and his subsequent the lining of the personal unconscious and the collective book “Motivation and Personality”. unconscious. 1st Stage: Physiological Stage Human Psyche – whole mind – includes conscious and o The stage required to sustain life. Includes breathing, unconscious excretion the desire for food, water, sex, sleep and The theory posits human mind divided into three parts: homeostasis. These are considered to be the "basic" 1. Ego needs of human life. o The hub of consciousness that forms all unrepressed o Maslow's theory suggests that if these fundamental perceptions, thoughts, feelings, and memories. needs are not satisfied then, one must surely be o Center of consciousness, but is not the core of motivated to satisfy them. personality. o Higher needs are not recognized until these "basic" o In a psychologically healthy person, the ego takes a needs have been satisfied. secondary position to the unconscious self. 2nd Stage: Safety Stage o Example – when Kathy walks into a room, her ego o Once physiological needs have been met, attention & perceives the color of the walls, the people in the room, desire turns to safety & security. In order to be free and what they’re doing and the song playing in the from the threat of psychological & physical harm, background. But the ego can only hold a select amount needs may be fulfilled by: of information and the remaining data sinks into the ✓ Living in a safe area unconscious. ✓ Financial reserves CONSCIOUS - Images are those that are sensed by the ✓ Job security ego, whereas unconscious elements have no relationship ✓ Good health with the ego. Healthy individuals are in contact with their o Cannot move up the pyramid to the next stages if feel conscious world, but they also allow themselves to threatened. Once threat is addressed then move up experience their conscious self and thus to achieve the pyramid. individuation. 3rd Stage: Love/Belonging Stage 2. Personal Unconscious o once a person has met the lower physiological and o The experience and memories unique to the individual safety needs, the higher needs can be addressed. that are not currently in, but are readily available to the o It is also referred to as the social needs stage. These conscious mind. are the needs related with interaction and can include o Example – Rhea feels uncomfortable in the room where family, friendship and sexual intimacy. she just walking. She doesn’t like it. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  3. Collective Unconscious PHYSICAL ASSESSMENT o The self is the center of personality that is largely To provide baseline data to gauge changes in conditions unconscious. and health status. o Anything that is not presently conscious, but it can be. It includes both memories that are easily brought to To validate the health history and investigate current mind those that have been repressed for some complaints. reason, To prevent current and debilitating problems. o Refers to our “Psychic Inheritance” – the reservoir of To support the plan of care our experience as the species, a kind of knowledge HISTORY we are all born with (the collective memories of the Types and Characteristics of Health Histories entire human race). We are not directly conscious of Complete health history it but it influences all our experiences and behaviors. o Comprehensive o So many cultures have the same symbols recurring o Date on past and present health status in their myths, religion, art, and dreams. the common o Multidimensional symbols are referred to as “archetypes”. o Non-emergency ERIKSON’S EIGHT STAGES OF LIFE THEORY o Lengthy, in depth It is believed that personality developed in a series of Episodic health history stages. o Based on a specific health history Described the impact of social experience across the o Brief and specific data whole lifespan. Interval, or follow up, health history Interested in how social interaction & relationships played o Followed up interview from an episodic visit a role in the development & growth of human beings. o Ensures recovery or treatment is altered to promote Based on what is known as the "Epigenetic Principle." It recovery or relief symptoms suggests that people grow in a sequence that occurs over Emergency health history time & in the context of a larger community. o Basic, specific data obtained from multiple resources, Conflict during each stage: often other than from the patient, in order to treat the Each stage experience conflict that serves as a turning emergency. point in development. o Minimal depth with focus on immediacy, quick Conflicts are centered on either developing a resolution, or lifesaving treatment. psychological quality or failing to develop that quality - the KATZ INDEX OF INDEPENDENCE IN ACTIVITIES OF DAILY LIVING potential growth is high but so is the potential for failure. The index ranks adequacy of performance in the six Once conflict is resolved, they emerge from the stage with functions of bathing, dressing, toileting, transferring, psychological strengths that will serve them well for the continence, and feeding. rest of their lives. If they fail to deal effectively with the Most appropriate instrument to assess functional status as conflict, they may not develop the essential skills needed a measurement of the client’s ability to perform ADLs for a strong sense of self. independently. IMPORTANT Clients are scored yes or no for independence in each of the AGE CONFLICT OUTCOME EVENTS 6 functions. INFANCY (birth to 18 months) Trust vs Mistrust Feeding Hope A score of 6 indicates full EARLY CHILDHOOD (2- Autonomy vs Toilet training Will function, 4 3years) Shame and doubt indicates PRESCHOOL (3- Initiative vs Guilt Exploration Purpose moderate 5years) SCHOOL AGE (6-11 Industry vs impairment, School Confidence and 2 or less years) Inferiority ADOLESCENCE (12-18 Identity vs Role Social indicates Fidelity severe years) confusion relationships YOUNG ADULTHOOD Intimacy vs functional Relationships Love impairment. (19-40 years) Isolation MIDDLE ADULTHOOD Generativity vs Work and Care (40-65 years) Stagnation parenthood Ego Integrity vs MATURITY (65 – death) Reflection on life Wisdom Despair By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  COGNITIVE ASSESSMENT TOOLS geriatric clinic, which works with largely white male patient population. Used to identify cognitive impairment Determine whether a full dementia evaluation is needed to assess for a possible dementia syndrome. The assessment results can prompt further testing or be used in conjunction with interview and other observational data to support a clinical diagnosis of dementia. Providers may use multiple screening tools to effectively assess cognitive function or track progress overtime. MINI-COG Measures short term recall clock drawing. Short term recall is the ability to hold a small amount of information in the mind for a short period of time. MEMORY IMPAIRMENT SCREEN (MIS) Measures a four-item recall. Patient is asked to place four words into four categories and then say the words 2 to 3 minutes later. GENERAL PRACTITIONER ASSESSMENT OF COGNITION (GPCOG) The GPCOG cognitive screening tool includes recall and clock drawing. GPCOG also includes a caregiver or family member interview (informant review) that reviews the AD8 DEMENTIA SCREENING INTERVIEW patient’s working memory, mental flexibility, and self- control. Working memory is short-term memory used to THE AD8 ADMINISTRATION AND SCORING GUIDELINES accomplish a task, like remembering a grocery list. Mental A spontaneous self-correction is allowed for all responses flexibility is being able to switch from thinking about one without counting as an error. thing to another. The questions are given to the respondent on a clipboard for Screening administer time is about 2-5 minutes self–administration or can be read aloud to the respondent Informant interview administer time is about 1-3 minutes either in person or over the phone. It is preferable to Advantages identified by the Alzheimer’s association: administer the AD8 to an informant, if available. If an o Developed for and validated in primary care informant is not available, the AD8 may be administered to o Informant component is useful when initial complaint the patient. is informant-based When administered to an informant, specifically ask the o Little or no education bias respondent to rate change in the patient. Disadvantages identified by the Alzheimer’s association: When administered to the patient, specifically ask the o Patient component scoring is limited to pass or fail. patient to rate changes in his/her ability for each of the items, o Informant component alone has limited accuracy. without attributing causality. o Lacks data on any language or culture biases. If read aloud to the respondent, it is important for the SAINT LOUIS UNIVERSITY MENTAL STATUS (SLUMS) clinician to carefully read the phrase as worded and give emphasis to note changes due to cognitive problems (not Is a cognitive test produced by the U.S Department of physical problems). There should be a one second delay Veterans Affairs. It consists of 11 items and measures between individual items. orientation, short-term memory, and attention and included a clock drawing test and figure recognition. No timeframe for change is required. Administer time is about 7 minutes. The final score is a sum of the number items marked “Yes, A change”. Advantages identified by the Alzheimer’s association: o No education biases A screening test in itself is insufficient to diagnose a o Tests orientation, attention, numeric calculation, dementing disorder. The AD8 is, however, quite sensitive to recall, verbal fluency, executive function (clock detecting early cognitive changes associated many drawing), figure recognition (naming), and recall of common dementing illnesses including Alzheimer disease, contextual verbal information (story) vascular dementia, Lewy body dementia and frontotemporal dementia. Disadvantages identified by the Alzheimer’s association: o Limited used and evidence Scores in the impaired range (see below) indicate a need for o Student in the U.S. Department of Veterans Affairs further assessment. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  Scores in the “normal” range suggest that a dementing patient to complete thus a 15-item version was developed. disorder is unlikely, but a very early disease process It has a high correlation with depressive symptoms. cannot be ruled out. More advanced assessment may be Of the 15 items, 10 indicates the presence of depression warranted in cases where other objective evidence of when answered positively while the other 5 are indicative of impairment exists. depression when answered negatively. Based on clinical research findings from 995 individuals Accomplished for 5 to 7 minutes making it ideal for people included in the development and validation samples, the who are easily fatigued or limited in their ability to following cut points are provided: concentrate for longer periods of time. o 0 – 1: Normal cognition This does not measure suicidality. o 2 or greater: Cognitive impairment is likely to be It is widely used with healthy, medically ill, mild to present moderately cognitive impaired older adults with extensively used in community, acute care, and long-term care settings. PHYSIOLOGICAL CHANGES Normal changes of aging are universal, inevitable, and irreversible but these age-related changes vary among PAIN ASSESSMENT FOR OLDER ADULTS elderly. These age-related changes are associated by many factors that can be prevented and is reversible. Patient’s self-report is the most reliable measure of pain Identifying normal changes in elderly are important in intensity as there no biological markers of pain. nursing assessment and care. Having competence in Pain is strongly associated with depression and can result identifying these normal changes affect health, functionality, in decreased socialization, impaired ambulation and and therapeutic strategies. Thus, normal changes should be increased healthcare utilization and costs. differentiated from pathological process to allow Older adults tend to minimize or not report their pain or are development of appropriate interventions. unable to due to sensory and or cognitive impairments. Knowledge and competence in different normal changes of A significant barrier in treating pain in older adults is aging from pathological sign and symptoms will prevent inadequate pain assessment. misinterpretation of age-related changes as those caused A proactive, consistent approach must be taken to screen by disease. Avoiding misinterpretation, costly and assess older adults for persistent pain. uncomfortable, and time-consuming therapies to reverse normal aging can be avoided. Aging cells – function less, old cells decrease and must die, a normal part of the body’s functioning, the decrease makes dehydration a significant risk to older adults. Aging organ – a decline in one’s organ function whether due GERIATRIC DEPRESSION SCALE (GDS) to a disorder or to aging itself can affect the function of A self-report measure of depression in older adults. another. Users respond in a yes or no format. o Atherosclerosis narrows blood vessels to the kidneys, Originally developed as a 30-item instrument and a new and it functions less well because blood flow to them is version proved both time consuming and difficult for some decreased. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  PHYSIOLOGICAL CHANGES OF THE SKIN PHYSIOLOGICAL CHANGES OF THE MUSCLES & BONES Systemic changes: Muscles: o Loss of cells, decreased circulation o Lose bulk of strength o Decreased in light – touch sensation o Less flexibility o Atrophy of subcutaneous tissue o Declines muscle tone and elasticity o Hypertrophy of abdomen, thighs, and upper arms o Replaced with fatty tissue – soft, flabby spots, little rolls o Diminished response to skin injury o Endurance and strength are decreased Photoaging Bones: o Due to environmental damage, there is an increase o Shrink in size and density – porous and brittle appearance of aging o Weak and susceptible to fracture o Telangiectasia (dilation of small blood vessels o Shorter in height, loss of collagen (elastosis) resulting to reddish vascular lesion) o Stoop imposture – degenerative changes: dehydration o Actinic keratoses (skin tumor) – small scaly patches intervertebral disc) o Seborrheic keratosis (benign) – epidermal growths o Loose calcium – joints become stiffer, fraying and Loss of elasticity cracking ligaments o Wrinkled, dry, easily bruised o Bone strength and mass reduced, compressed, o Loss of elastin fibers decrease in height o Thinning of dermis and epidermis EFFECTS o Sagging More susceptible to falls and compression fractures due to o Fine wrinkling: leathery, lax, dry, blotchy skin changes in mineral absorption Decrease in the production of natural oils Sarcopenia affects all muscle including the respiratory o Fragile, itchy (pruritus), inflammation muscle (decrease efficiency of breathing) and GI tract o Aged spots occur (constipation) fulfillment o Skin tags commonly benign (acrochordons) Wear and tear theory regarding cartilage destruction activity o Fewer sebaceous gland to lubricate the skin doesn’t hold up as osteoarthritis is also frequently seen in o Decrease subcutaneous fat sedentary elders. o Easily gets chilly, cold on hot days CONSIDERATIONS o Less moisture of skin related to eccrine (secretes Balanced diet, regular exercise – improves muscle tone and sweats) and sebaceous (oil sebum) glands strength PHYSIOLOGICAL CHANGES OF THE HAIR Give them time to accomplish a task Gray hairs Increase calcium intake and Vitamin D in diet o Caucasians 50% than African Americans Physical strengthening reduces the rate of progressive o Men gray earlier deterioration o Gradual decrease in melanin production’ Promote walking, exercise on stationary bike (builds bone o Heredity and hormones influence density), and assistive device o Hair thinning (pubic, ancillary) PHYSIOLOGICAL CHANGES OF THE HEART AND BLOOD VESSELS o Decreased growth o Decreased vitamin D production Related to decrease level of activity – lead to decreased demand of oxygen EFFECTS Heart muscle is less efficient – required to work harder to Negative self-esteem pump (arteries stiffen – atherosclerosis) blood to all sections Inability to regulate body temperature of the body. Greater susceptibility to sunburns Blood vessels lose some of the elasticity or hardened fatty Increase in bruising deposits form on the inner walls of arteries (atherosclerosis) Requires more emollient and moisturizers – due to diet and less exercise – results to fatigue, shortness CONSIDERATIONS of breath, decreased physical exertion Avoid direct sunlight Maximum hear rate decreases (longer heart rate) Use of moisturizing cream or sunscreen Ages 20 to 90yrs old – decreased myocardial cells by 40- Apple retinol A vitamin 50%, but for women maintains with age Bathe in warm water Aorta and other arteries become thicker and stiffer – Use mild soap or moisturizer decreased systolic blood pressure with a aging resulting to Outdoors: protecting clothing hypertension Smoker: advice to quit Valves between chambers of the heart thickens and stiffens By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  – results to murmur (common to older adults) Deep breathing exercise to improve and increase lung Pacemaker of heart loses cells and develops to fibrous capacity. tissue and fat deposits – changes cause slow heart rate NORMAL AGE -RELATED CHANGES FUNCTIONAL IMPLICATIONS and heart block (common: aberrant heart rhythms and Decreased cough reflex Nose elongates extra heart beats) Decreased removal of Stiffer pharynx and larynx Quick changes in position cause dizziness from orthostatic mucus, dust, and irritants Decreased cilia hypotension Decreased vital capacity Increased anteroposterior chest CONSIDERATIONS diameter Decreased chest expansion reduces recoil Encourage to maintain a normal weight Rigidity of chest wall Decreased endurance Perform exercise regularly Fewer alveoli Hyperinflation of apices: Stop smoking Airway resistance underinflation of based Reduce salt, sugar, and fatty foods in diet PHYSIOLOGICAL CHANGES OF THE DIGESTIVE TRACT Increase in fiber intake and fluids in moderation Maintain healthy sleep Gradual slowing of the system leading to problems in digestion Get quality sleep Decreased secretion of saliva (less bacteria) and enzymes Manage stress Elderly’s mouth feels drier, gums recede from teeth Ger regular health screening tests disposes to decay and infection PHYSIOLOGICAL CHANGES OF THE LUNGS AND CHEST WALL Teeth darkens, brittle, and easier to break Ages 20-70 lung capacity – 40% decline and chest wall Constipation due to low fiber diet, lack fluids and exercise, become stiffer adverse effect of medications, long laxative used Elderly breathing muscles and diaphragm become weaker Delay emptying time of stomach – resulting to a feeling of Age related changes affect the lungs’ ability to absorb and being full with small portions of food utilize oxygen from air Decrease mucus intestine and gastric juices – complains of Affects ability to cough and take deep breaths – prone to heartburn or sensitivity to spicy food fatigue and shortness of breath on exertion – susceptible Increased prevalence of atrophic gastritis and achlorhydria to infections Liver is less efficient in metabolizing drugs and repairing Lungs become stiffer, muscle strength and endurance damaged liver cells diminish, chest wall becomes rigid Diverticula in colon can cause pain Total lung capacity remains constant but vital capacity CONSIDERATIONS decreases and residual volume increases Encourage to eat a balanced diet, high in fiber (fruits, whole Alveolar surface area decreases up to 20% grains, vegetables) and fluids Alveoli collapse sooner on expiration Avoid eating heavy meals instead of small frequent meals Increase in mucus production and decrease in activity and while eaten slowly number in cilia Encourage to brush teeth and spaces between twice a day Body is less efficient in monitoring and controlling Advise to visit dentist or hygienist on regular basis breathing Encourage to include physical activity in daily routine EFFECTS Advise not to ignore the urge to have a bowel movement Decrease lung functioning – can cause older person to feel PHYSIOLOGICAL CHANGES OF THE URINARY TRACT easily feel tired after minor physical exertion. Loss of bladder control (urinary incontinence) Aerobic exercise will help to compensate for changes Reduced kidney ability to filer and reabsorb PHYSIOLOGICAL CHANGES OF LUNG ELASTICITY Prostate enlargement Decrease elasticity, recoil properties of the lungs – causes Hormonal imbalances – vaginal itching, burning, discomfort the lungs to close prematurely, trapping air inside, during intercourse preventing the lung from emptying completely. Kidney’s mas reduce by 25-30%, glomeruli reduce by 30- As a result, unexpired air remains in the lungs and 40%, thus reduce the ability to filter and concentrate urine consequently during the next inhalation less air can be and to clear drugs inspired. Reduced hormonal response (vasopressin) CONSIDERATIONS Impaired ability to conserve salt – risk for dehydration Regular exercise program Reduced bladder capacity – increase residual urine and Quitting smoking frequency – increase chances of urinary infections, Seeking health advise about diaphragmatic breathing incontinence, and obstruction By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  Gradual loss of nephrons 30-50% - decrease absorption Involution (shrinking) of the thymus gland begins after of tubules, reduced glomerular filtration rate adolescence (30yrs old) Decrease in renal blood flow – more time for filtration and No longer detected in the blood (60yrs old) urine may be more diluted Less response to skin test once foreign substance is Decreased bladder capacities: injected – diminished response to antigen o Women: develop lax sphincter – incontinence, PHYSIOLOGICAL CHANGES OF SEXUALITY AND THE decreased bladder tone REPRODUCTIVE SYSTEM o Men: enlargement of prostate – benign prostatic hypertrophy, potential for urinary retention WOMEN: The “climacteric” occurs (defined as the period during with PHYSIOLOGICAL CHANGES OF THE ENDOCRINE SYSTEM reproductive capacity decreases i.e., ovarian failure) then In most glands of the body there is some atrophy and finally stops – loss of estrogen and progesterone: FSH and decreased secretion association with age, but the clinical LH increases implications of this are not known. This is also described as the transition from peri-menopause What may be different is hormonal action. Hormonal (age 40s) to menopause alterations are variable and gender dependent. Thinning and graying of pubic hair Most apparent in – glucose homeostasis, reproductive Loss of subcutaneous fat in external genitalia giving them a function, calcium metabolism shrunken appearance Subtle in - adrenal function and thyroid function Ovaries and uterus decrease in weight and size Decline activity of thyroid and pancreas to produce insulin. Skin is less elastic + loss of glandular tissue gives breast a Body’s capacity to utilize sugar and fats declines – onset sagging appearance of diabetes Other physical changes may include hot flashes (can cause Decrease energy – decreased ability to handle stress sleep deprivation if they occur at night), sweats, irritability, Insulin resistance prevents efficient conversion of glucose depression, headaches, myalgias, sexual desire is variable into energy The symptoms are typically present for about 5 years. Decrease in aldosterone and cortisol may affect immune Atrophy of vaginal tissues due to low estrogen levels – and cardiovascular function thinning and dryness occurs agglutination of labia majora Endocrine: Alteration in hormone regulations leads to a and minora may occur decrease ability to respond to stress Vaginal dryness – sex uncomfortable Thyroid: thyroid hormone – temperature, intolerance, Ovulation cases and estrogen level drop by 95% decreased target organ sensitivity, decreased cell Vaginal walls become thinner and lose elasticity mediated immunity Women experience a decrease in production of vaginal Thymus: involution of thymus gland – slower ability to lubrication respond to inflammatory process MEN: Cortisol or glucocorticoids: increased anti-inflammatory Testosterone decreases, testes become softer and smaller hormone – effect on glucose metabolism Erections are less firm and often require direct stimulation to Pancreas: increased fibrosis, decreased secretions and retain rigidity enzymes Though fewer viable sperm are produced and their motility CONSIDERATIONS decreases, men continue to produce enough viable sperm Reduce caloric intake, avoid junk food, reduce sugar and to fertilize ova well into older age. fat intake Less seminal fluid may be ejaculated. Prevent unwanted weight gain They may not experience orgasms every time they have Include physical activity in daily routine sex. Eat healthy diet The prostate gland enlarges, this often results in compression of the urethra which may inhibit the flow of PHYSIOLOGICAL CHANGES OF THE IMMUNE SYSTEM urine. Less antibodies production – prone to infections and Impotence is a concern – no erection or not firm mortality rate (higher than children) Testosterone level decrease up to 35% Older adults are 3x more likely to die of pneumonia or Decreased rate of sperm production sepsis, 5-10 times die of urinary tract infections, 15-20 Sperm count diminishes times die of appendicitis Testes becomes smaller Thymus gland: produces WBC – attacks and isolates foreign materials CONSIDERATIONS Share age-related changes and how it affects the partner By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  Verbalize concerns to their physician offering specific Types of Memory Task: treatment like estrogen cream for vaginal dryness or oral Recall (retrieving information) – declines as ages medications for erectile dysfunction. Recognition (matching information) – better than recall, PHYSIOLOGICAL CHANGES OF THE NERVOUS SYSTEM does not decline with age, long term memory decline as Decreased number of neurons and neurotransmitter ages depends on the extent to difficulty with encoding (Alzheimer is the most common type of pre-senile and information, very long-term memory spans months or years senile dementia) which cause nerve cell death and tissue is stable until age 70 loss through the brain the cortex in the brain shrivels up VISUAL – spatial ability and involves damages in the areas of thinking, planning, o Declines identifying incomplete figures, recognizing and remembering. embedded objects or arranging blocks into a design Memory tends to become less efficient o Affect both the ability to perceive and ability to Elderly takes long to learn new things or remember familiar reproduce figures in three dimensions. words or names. CONCEPTUALIZATION: Messages take slightly longer time to pass from the nerves o Mental flexibility and capacity for abstraction do appear to the muscles then takes longer time to react to these to decline with age messages. o Greatest age differences appear among those who are Decrease perception of pain; increase time to react to it. 70 or older ATTENTION: GENERAL INTELLIGENCE: o Involves sustained attention (ability to focus) and o Measures of intelligence – older adults display *classic selective attention (ability to distinguish relevant from aging pattern* irrelevant information) o Performance scores measures problem solving ability o Older adults appear to perform tasks requiring declines sustained attention or selective attentions extremely o Verbal scores measure knowledge (comprehension, well into old age. arithmetic, vocabulary-stable) LANGUAGE: SEMANTIC KNOWLEDGE REACTION TIME: o Declines with age but at >70 years becomes o Test of reaction time declines in the processing of significant information among adults age 40. The more complex o Involves word retrieval and tested by having the required processing, the larger the age differences respondents name common objects in processing time (10 seconds) difference are not o Linguistic abilities not affected – phonologic detected. knowledge (sound of language), lexical knowledge o Short term memory loss is common and determining (name of item and word meaning), syntactic whether “forgetfulness” is benign or precursor of knowledge (combine words correctly) dementia. MEMORY: o Average 70yrs old can take up to 4 times longer than a o 45yrs old, overall complaints of memory problems 20yr old in test involving basic memory skills. increase steadily. o Older adults are slower in reaction time than younger o Reveals deficiency between subjective report of adults. memory failure and objective abilities PERSONALITY: o Subjective impressions are poor predictor of objective o Aging does not affect personality performance o Remains fairly constant throughout the lifespan o With this discrepancy, reflects the nature of memory o Preserved and pronounced as age increases and the manner of assessing the competency GENERALLY: o Efficiency of memory may differ depending on the o Elderly becomes more and more like the person they situation or context were in their youth. o Example: reliable call of visual images like paintings o A talkative teenager becomes a talkative older person. accompanied by poor recall of verbal words o The personality of the elderly can be a reflection of what o Performs less well on task involving (three phases) she or he used to be during his or her teenage years. encoding, retention, and retrieval of information o Except for the gradual changes in the physical o Encoding: getting information into the system – takes appearance, the elderly feels no different from how more time to encode information, slower rate of they feel now compared to when they were young. encoding due to changes in vision, hearing, and other senses that reduce the efficiency of memory – reason for age related declines in short term memory. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  NORMAL AGE -RELATED CHANGES FUNCTIONAL IMPLICATIONS CONSIDERATIONS Nerve cell degeneration and Some degree of recent Increase lighting atrophy (20-40%) memory loss (age- Use blinds or shades to reduce glare Decrease in neurotransmitters associated benign) Use high contrasting colors lie door frames, stair edges, Decrease in rate of nerve cell Learning occurs as usual handrails to improve visibility conduction impulses but more slowly regular vision screening – to detect age related conditions PHYSIOLOGICAL CHANGES OF THE EYES like presbyopia, cataracts, macular degeneration, and glaucoma Less able to produce tears (dry eyes) reduce clutter, keep environment tidy and free of obstacles Retina gets thin to prevent tripping hazards Lenses are less clear and turn yellowish – decreased color patient education on vision changes perception encourage use of assistive device Focusing on objects that are close up becomes difficult to accommodate teach safe practices - avoid reading in dim light, use proper eye protection, eye exercise Pupil size reduces and become sensitive to glare and trouble adapting to different levels of light PHYSIOLOGICAL CHANGES OF THE NOSE Reduce corneal sensitivity and reflex At the age of 50, the sense of smell rapidly decreases Arcus senilis: cloudy ring around the iris At the age of 80, the sense of small is reduced by half Reduced pigment in the iris Lack of ability to smell spoiled food can lead to indigestion Presbyopia: decreased ability to focus and accommodate and food poisoning Yellowing and reduced lens flexibility Nasal mucosa function – mucus membranes lining the nasal Difficulty discriminating blue – green colors (decreased passages tend to be dry and less efficient, thus reduce the short wavelength discrimination) ability to trap and filter particles and pathogens Decreased pupillary size and response to light and dark Decreased ciliary function – cilia are tiny hair like structures Decreased tolerance to glare in peripheral vision activity, impair clearance of mucus and increase the risk of Not all older people have impaired vision respiratory infections Loss of ability to see items that are close up begins in the Thinning of nasal tissues – due to aging, leads to inability to 40s. withstands irritant and infections CORNEAL FLATTING: Changes in nasal cartilage – nasal septum (division of nasal o Corneal surface flattens, admitting less light in the cavity) become les resilient and prone to structural changes, eyeball affects nasal airflow and contribute to nasal congestion o Reduces the transmitted light into the elderly eye by Altered nasal airway – changes in shape and nasal cavity one third due to cartilage degeneration and surrounding structures – LENS TRANSPARENCY: affect nasal air flow and nasal obstruction o Diminishes and weakens available light to receive Increase nasal resistance – combined effects of decreased colors with short wavelengths like blue and violet. mucosal function, thinning of nasal tissues, changes in o New lens fibers naturally multiply at the edge of the nasal structures leading to increase nasal resistance, lens making breathing through the nose more difficult. o Older fibers move to the center to create a dense Altered sense of smell – with age, changes in olfactory center of the lens. receptors and bulb which is involved in processing smell. o Lens accumulates, yellow substances which filter out Increased risk of nasal infections – mucosal defense the blue part of the color spectrum. mechanism and altered nasal structure, older adults are o Blue appears more green susceptible to nasal infection and sinusitis o Warmer colors like reds and oranges seem stronger PHYSIOLOGICAL CHANGES OF THE EARS in comparison LESS EFFICIENT RETINA: Presbycusis – age related hearing loss, common, involves o Most sensitive part of the retina function less gradual decline in hearing ability with high frequency o Decreased blood supply and cumulative effects of sounds. due to degeneration of the sensory cells in the radiation damage cochlea (inner ear) and changes in the auditory nerve. o Decreased spatial discrimination of black and white Decreased cochlear function – the hair cells in the cochlea, contrast and flicker sensitivity crucial in converting sound vibrations into electrical signals, o Less able to tolerate glare and have trouble adapting become damaged or degenerate over time leading to a to darkness and bright light. reduced ability to hear and process sounds. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2  Changes in the auditory nerve – experience degenerative ORAL MUCOSA CHANGES: changes which can affect the transmission of sound o Thinning of oral mucosa – mucus membrane lining the signals from the inner ear to the brain. mouth can become thinner and less elastics with age, Stiffer ossicles – small bones in the middle ear (ossicles) leading to increased susceptibility to irritation, sores, can become stiffer with age, which may affect their ability and infections. to transmit sound vibration efficiently. o Altered taste sensation – changes in taste buds and Accumulation of cerumen – increased buildup of earwax their function can occur leading to a reduced taste (cerumen) due to changes in the composition and sensitivity or changes in taste perception. production of earwax which can contribute to hearing loss o Increased risk of oral infections – combination of dry or discomfort. mouth, changes in musical tissue, and potential BALANCE CHANGES: difficulties with oral hygiene can increase the risk of oral o Vestibular dysfunction – helps control balance and infections such as candidiasis (Thrush). spatial orientation, can deteriorate with age. This is FUNCTIONAL CHANGES: due to changes in the vestibular apparatus in the o Chewing and swallowing difficulties – reduced ability to inner ear and the central nervous system’s chew effectively due to tooth loss or dental issues can processing of balance information. affect nutrition. Difficulty swallowing (dysphagia) cam o Reduced vestibular sensitivity – decreased in the also be a concern often related to decreased muscle sensitivity of the vestibular system, leading to an tone and changes in the oral cavity. increased risk of dizziness and balance problems. o Speech changes – changes in dentition, oral tissues, o Decreased proprioception – age-related changes in and muscle tone can affect speech clarity and proprioception (the sense of body position) can articulation. contribute to balance difficulties, as the body’s ability CONSIDERATIONS to sense and adjust to changes in position is reduced. Oral hygiene – emphasize regular brushing, flossing, and STRUCTURAL CHANGES: professional dental cleaning. o Thinning of the tympanic membrane – eardrum may Hydration – to help manage dry mouth and maintain well become thinner and less flexible with age, which can oral health. Using saliva substitutes or oral moisturizers. affect sound transmission. Dietary adjustments – diet that is easy to chew and swallow. o Calcification of the ossicles – undergo calcification Soft food modification to texture can help individuals with can impair their movement and contribute to chewing difficulties. conductive hearing loss Regular dental visits – encourage regular dental checkups o Changes in the ear canal – becomes narrower or less to monitor and address any oral health issues. Support elastic and the skin may become drier, can affect patients in maintaining their dental appointments. earwax production and contribute to hearing Education and support – educate patients and their families problems about the importance of oral health and its impact on overall PHYSIOLOGICAL CHANGES OF THE MOUTH health. Tooth wear and loss – teeth may experience wear and tear Assistive device – use dentures or other dental prosthetics due to years of use, leading to enamel erosion, tooth CHANGES IN SENSES sensitivity, and increased risk of decay. Older adults may PAIN AND TOUCH lose teeth due to dental caries (cavities), periodontal With age, skin is not as sensitivity as in youth disease, or other factors. Contributing factors include – loss of elasticity, loss of Gum changes – recedes over time, which can expose pigment, reduced fat layer tooth roots and increase sensitivity. Gingival tissue may become thinner and less resilient, leading to a greater risk SAFETY IMPLICATIONS of periodontal disease Lessened ability to recognize dangerous level of heat Bone density loss – bone supporting the teeth (alveolar Lessened ability of body to maintain temperature bone) can lose density with age, which may contribute to Tendency to develop bruises and skin tears more easily tooth mobility and loss Dry mouth (xerostomia) – reduced saliva production is common in older adults, due to medication, age-related changes in salivary glands and leads to difficulties with chewing and swallowing as well as an increased risk of dental caries and oral infections. By: Baja, Sheena Marie UV MAIN – BSN 3 – A2