Seminar on

Geriatric Consideration
in Nursing

Submitted To:-

Submitted By:-

Mrs.Dr. Ratna
Philip

Mrs. Udaya
Sree.G

M.Sc (N), Ph.D.,

Principal,

M.Sc., Nursing Ist Year

MAMATHA COLLEGE OF NURSING

KHAMMAM

MAMATHA COLLEGE OF NURSING

KHAMMAM

GERIATRIC CONSIDERATIONS IN
NURSING
I. Introduction
Geriatrics is a sub-specialty of internal medicine and family medicine that
focuses on health care of elderly people. It aims to promote health
by preventing and treating diseases and disabilities in older adults. There
is no set age at which patients may be under the care of a geriatrician, or
physician who specializes in the care of elderly people. Rather, this
decision is determined by the individual patient's needs, and the
availability of a specialist.
Geriatrics, the care of aged people, differs from gerontology, which is the
study of the aging process itself. The term geriatrics comes from the
Greek meaning "old man" and meaning "healer". However, geriatrics is
sometimes called medical gerontology.
Life expectancy is rising at rates which call for the proper preparation of
nurses to take good care of the rapidly increasing number of the aged.

II. Definition
Geriatric nursing is the specialty that concerns itself with the provision
of nursing services to geriatric or aged individuals.
It outlines the state of art guidelines for geriatric care that are useful to
a nurse practitioner and clinical nurse specialist who encounters aging
person in practice. Due to their complexity, aged people always deserve
personal attention. Nurses address physical, psycho social, cultural and
family concerns as well as promoting health and emphasizing successful
aging.
-The ANA Congress on Nursing practice

III. Geriatric Nursing: A Growing Specialty

The greatest area of potential job growth and evidence based practice for
the future may well be geriatrics. According to the World Health
Association, the world's population aged 60 and over will more than
triple from 600 million to 2 billion in the next forty years. The fastest
growing group is those over the age of 80. This increase in population is
global. No longer will a concern of the more developed nations, the
number of elders rise in developing countries from 400 million in 2000 to
1.7 billion by 2050. The challenge that all nations face is how to promote
healthy, active aging and quality of life, without over-medicalizing and
over-burdening our health care systems.
There is a growing demand for a skilled geriatric nursing workforce to
provide quality care across a wide range of health care settings. The
exponential growth in the health care costs for older adults creates a call
greater accountability. There is mounting pressures for health care
providers and settings to demonstrate cost effectiveness and safe, quality
outcomes. Building nursing expertise in geriatric practice has been
embraced by national nursing organizations around the globe. From
expanding geriatric education in schools of nursing, to mandating
evidence based geriatric practice in accreditation standards for health care
settings, the push is on!

IV. Role of a Geriatric Nurse

The Nurses Role in Caring for Older Adults
Generalists
Direct care providers
Case managers
Nurse leaders
Educators
Patient advocates
Administrators
Advanced practice geriatric nurses
Primary care providers focus on
Health promotion
Disease prevention
Long-term management of chronic conditions

V. Typical Job Responsibilities of a Geriatric Nurse

Geriatric nursing requires a lot of work with physicians, and a good deal
of your job will be in a support role to the physicians that serve your
patients. One of the ways you will provide support to physicians is
through assistance with examinations. Additionally, you will frequently
be required to carry out treatments, including administering prescribed
drugs and other remedies. You will also be responsible for preparing
patients for treatments and setting up equipment. You will be expected to
maintain an organized, updated chart for patients in your care so that
physicians will have an accurate record on which to base their
recommendations for care.
The remaining duties of a geriatric nurse fall under mental health and
more general care. You may find yourself required to change sheets, feed
patients, and bathe them. Additionally, your job may include interpersonal
communication with the patient as well as the patients family for moral
support and decision making.

VI. Most Common Geriatric problems

Some of the most common geriatric problems include declining mental
and physical health. Specifically, issues like arthritis, heart disease,
anxiety and depression tend to affect elderly people to a greater degree
than they do other people. Several geriatric problems can be corrected or
cured by medical and mental health professionals while progressive
disorders, such as Alzheimers disease, cannot be cured.
Nurses specializing in geriatric medicine regularly treat a variety of
health issues that affect older adults. Some doctors also help patients
avoid certain geriatric health problems, such as stroke and organ failure,
by helping patients make lifestyle changes, which include exercise, a
healthy diet and eliminating bad habits like smoking and alcohol abuse.
Without
attention
and
treatment,
common geriatric problems
like diabetes, high cholesterol and hypertension can become lifethreatening for geriatric patients.
Other geriatric problems, such as hormonal changes, sleep disorders, skin
changes and nutritional deficiencies, may require medical intervention
and many are addressed by changes in diet and exercise. More serious
problems, such as prostate cancer, liver failure, kidney failure and heart

disease, may even require surgical treatment. Mild geriatric problems

such as dry mouth, vision problems and sexual dysfunctions are often
treatable with medication and are not considered to be life-threatening.

VII. Common characteristics for geriatric patients

There are many common characteristics many geriatric patients share. As
people age, they often lose some physical and mental function and are at
an increased risk for injury and certain illnesses. While many conditions
and medical concerns can affect patients of any age, geriatric patients
often require different care and testing due to their age.
Heart disease and other cardiovascular problems are a major concern
for elderly patients. Advanced age weakens the heart, and arteries become
harder due to plaque build-up and loss of flexibility. These issues make it
harder for the heart to pump blood throughout the body, which can lead to
high blood pressure, heart attack, and other serious problems. Geriatric
patients should strive to eat a healthy diet, get regular exercise, and have
their blood pressure and heart checked regularly so their doctors can
promptly diagnose and treat any heart-related problems.
Older patients often suffer from bone, joint and muscle-related
health concerns, such as arthritis and osteoporosis that limit their
abilities to move and make them more susceptible to injury. Many
medications prescribed to elderly people increase the risk of falling, so
these patients should be monitored closely and follow safety precautions
to prevent dangerous falls that could result in bone fractures. Calcium and
vitamin D helps promote bone strength, and exercise and stretching help
improve flexibility and muscle strength.
Vision and hearing tend to decline with age, so geriatric patients usually
require more frequent eye and ear examinations than younger patients do.
Wearing glasses or contacts or using hearing aids can help seniors
compensate for partial loss of these senses. The elderly often require
more frequent dental visits as well due to brittle teeth or gum problems
caused by less saliva.
Urinary incontinence is a common concern for geriatric patients. While
some bladder control problems are the result of aging, seniors who
experience these problems should discuss them with their doctors to rule
out underlying age-related serious conditions, such as prostate problems
in
men.
Lifestyle
changes
and
medications
can
help
many geriatric patients gain control of their bladders.

Neurons in the brain responsible for memory start to decline as people

age, so many geriatric patients experience problems with memory that
may get progressively worse or develop into more serious conditions,
such as dementia and Alzheimer's. Depression is another major concern
among geriatric patients. Many older people develop depression as a
result of losing loved ones, health problems, lack of fulfilment they once
received from jobs or raising children, or just generally growing older.

VIII. Geriatric assessments

Geriatric assessments, which are tests performed on elderly patients,
often include evaluations for depression or psychological disturbances.
Geriatric mental health testing may be performed at clinics or by a private
physician. Elderly patients with dementia often undergo short-term
memory tests. A physician may also perform geriatric assessments on a
patient as part of routine medical care. Examples of routine geriatric
assessments include hearing and eye examinations, as well as testing for
heart-related problems.
Performing a comprehensive assessment is an ambitious undertaking.
Below is a list of the areas geriatric providers may choose to assess:
Current symptoms and illnesses and their functional impact.
Current medications, their indications and effects.
Relevant past illnesses.
Recent and impending life changes.
Objective measure of overall personal and social functionality.
Current and future living environment and its appropriateness to
function and prognosis.
Family situation and availability.
Current caregiver network including its deficiencies and potential.
Objective measure of cognitive status.
Objective assessment of mobility and balance.

 Rehabilitative status and prognosis if ill or disabled.

Current emotional health and substance abuse.
Nutritional status and needs.
Disease risk factors, screening status, and health promotion activities.
Services required and received.

IX. Major Considerations in Geriatric Nursing

Elderly people generally want to live independently as long as possible,
which requires them to be able to engage in self-care and other activities
of daily living. Following are the some of the great concern to
Geriatricians and their patients.
i) Practical concerns
ii) Functional abilities
iii) Independence
iv) Quality of life issues
To evaluate the medication regimens of older patients who might
be at risk in practical considerations, clinicians should combine
an evidence-based approach with knowledge of the potential
effects of drug therapy. The evaluation should also be performed in
the context of:
The patients history of health problems
An appropriate laboratory assessment.
A gait and balance assessment.
A comprehensive physical evaluation, including:
A vision examination.
A measurement of postural blood pressure.
A targeted neurologic, musculoskeletal, and
Cardiovascular examination

A geriatrician may be able to provide information about elder

care options, and refers people to home care services, skilled nursing
facilities, assisted living facilities, and hospice as appropriate.
Geriatric health care often involves treating patients with cardiovascular
disease. The risk of coronary heart disease increases with age. Factors
such as poor diet and obesity in elderly patients may contribute to heartrelated issues.
Impaired vision is another other main concern in geriatric health. Vision
problems or even blindness may result as a complication from diabetes.
The elderly are more likely to develop these complications if diabetes is
not properly managed.
The effects of aging can also contribute to hearing loss. This is why it is
more common for the elderly to rely on the use of hearing aids. Other
treatment options, such as cochlear implants may help elderly patients
with hearing loss.
Addressing mental health issues may be a fundamental part of geriatric
care. Many elderly individuals suffer from depression, primarily due to
lack of social interaction. Feelings of isolation may occur when an elderly
person is housebound. In extreme cases of depression, suicide among the
elderly is a concern.
Other mental health concerns in geriatric medicine are memory loss and
dementia. Cognitive reasoning may be compromised as a result of
dementia due to aging. Advanced dementia may cause symptoms such as
delusions and hysteria. Alzheimer's disease may be mild to advanced, and
generally requires treatment such as medication and cognitive therapy.
Nutrition is a chief concern for many elderly individuals. In many cases,
an elderly person who lives alone or is housebound may not receive
adequate nutrition. Lack of proper nutrition may also be due to the
inability to cook for him. Providing home care for an elderly individual
who cannot look after himself may be a solution.

X. Nursing Diagnosis and Care

i) Cardiovascular System and Nursing diagnosis

Left ventricle hypertrophy

Decreased force of contraction, contractile efficiency, stroke
volume
Decreased baroreceptor sensitivity and beta adrenergic response
Arterial stiffening and all thickening, decreased compliance
Decreased O2 uptake by tissues

Assessment

Assess BP (lying, sitting, standing) & pulse pressure

Cardiac assessment: rate/rhythm/heart sounds
-note altered landmarks, distant heart sounds, extra heart sounds
(S3 in CHF)
Palpate cartoid artery, peripheral pulses for symmetry
Monitor heart rate and rhythm, note irregularity, ECG
Assess for dyspnea with exertion, exercise intolerance

Nursing Care plan

Referral for irregularities in heart rhythm, decreased or asymmetry

of pulses
Safety precautions for orthostatic hypotension
- Rise slowly from lying or sitting position
-Wait 1-2 minutes after position change to stand or transfer
-Monitor for overt signs of hypotension: change in
sensorium/mental status, dizziness, orthostasis -Institute Fall
prevention strategies

Implications
Decreased cardiac reserve & output
Slow recovery from tachycardia
Fatigue, SOB
Increased premature or ectopic beats
Risk of valvular dysfunction & systolic murmurs, conduction
abnormalities
Risk of postural & diuretic-induced hypotension
Strong arterial pulses, diminished peripheral pulses;cool
extremities
Risk of inflamed varicosities

ii) Respiratory System and Nursing diagnosis

Decreased response to hypoxia & hypercarbia/li>

Diminished ciliary & macrophage activity
Increased airway reactivity
Decreased muscle strength & endurance
Drier mucus membranes
Decreased alveolar function, vascularization, elastic recoil
Thorax & vertebrae rigid

Assessment

Respirations - rate, pattern, breath sounds throughout lung fields

Note thorax appearance, chest expansion
Assess cough, deep breathing, exercise capacity
Monitor arterial blood gases, pulse oximetry
Monitor secretions, sedation, positioning which can reduce
ventilation/oxygenation

Nursing Care plan

Maintain patent airway through repositioning, suctioning,
bronchodilators
Prevention of respiratory infections with pulmonary
Incentive spriometry as indicated, particularly if unable to
ambulate or decline in function
Education on cough enhancement, avoidance of environmental
contaminants, smoking cessation
Maintain hydration and mobility
Provide oxygen as needed

Implications

Decreased cough, deep-clearance

Risk of infection & bronchospasm (airway obstruction)
Altered pulmonary function - lower maximal expiratory flow (FEV,
FEV1/FVC1
- increased residual volume
- reduced vital capacity
- unchanged total lung capacity
Dyspnea after exertion, decreased exercise tolerance
PO2, SpO2 decreased. Decreased capacity to maintain acid-base
balance
Respiratory rate12-24
Decreased respiratory excursion & chest/lung expansion with less
effective exhalation

iii) Genitourinary System and Nursing diagnosis (For

kidney)

Decreased functional reserve when water/salt overload/deficit

Decreased blood flow, oxygenation, glomerular filtration rate
(often < 50%, measured by creatinine clearance)
Tubule degeneration
- Reduced response to vasopressin
- Impaired capacity to dilute, concentrate, acidify urine; impaired
sodium regulation
Reduced bladder elasticity, muscle tone, capacity
Weakend urinary sphincter
Decreased or delayed perception of voiding signal
Increased nocturnal urine production
In males, benign prostatic hypertrophy

Assessment

Assess renal function, particularly in acute/chronic illness

Monitor blood pressure (orthostatic)
Assess for dehydration, volume overload, electrolyte imbalances,
proteinuria- See addendum at end of table
Determine source of fluid/electrolyte imbalance, monitor
laboratory data
Assess choice/dose/need for nephrotoxic agents (e.g.,
aminoglycoside antibiotics, radiocontrast dye) and renally excreted
medications. Palpable bladder after voiding due to retention
Assess for urinary incontinence, UTI
Assess for abnormal urine stream, urinary retention with BPH
Assess fall risk in nocturnal or urgent voiding

Nursing Care plan

Maintain hydration, baseline fluid/electrolyte balance. Prepare for

fluid/electrolyte correction as indicated
Monitor drug levels of renally cleared medications
Calculate creatinine clearance - see addendum
Monitor for normal renal function: constant serum creatinine level
to baseline
Safety precautions in nocturnal or urgent voiding & postural
hypotension, institute fall prevention strategies
Referral to incontinence specialists with follow-up for incontinence
management
Referral to renal or urology as indicated

Caution providers regarding medications that increase urinary

retention in BPH, renal toxic drugs
See addendum at end of table for signs and symptoms of
dehydration, UTI, electrolyte imbalances

Implications
Risk of renal complications in illness; susceptibility to acute
ischemic renal failure & embolism
Risk of dehydration, volume overload, hyperkalemia (with
potassium-sparing diuretics), hyponatremia (with thiazide
diuretics), hypernatremia (with NSAIDs). See addendum
Reduced excretion of acid load
Risk of postural hypotension
Decreased drug clearance
Risk of nephrotoxic injury by drugs
In bladder, increased post-void residual urine
Risk of urinary tract infection (UTI), incontinence (not a normal
finding)
Nocturnal polyuria- risk for falls
In males, risk of urinary hesitancy dribbling, frequency,
incontinence (BPH)

iv) Gastrointestinal System and Nursing diagnosis

Decreased thirst perception

Decreased esophageal motility & lower esophageal sphincter
pressure
Decreased stomach motility; mucosal atrophy
Decreased small intestine motility, villi, digestive enzyme secretion
Decreased large intestine blood flow, motility, defecation sensation
Decreased liver size, blood flow, enzymatic metabolism of
drugs; increased biliary lipids

Assessment
Assess abdomen (note smaller liver), bowel sounds

Monitor weight, dietary intake, elimination patterns, fluid intake

Assess dentition, chewing & swallowing abilities, eating
habits/nutrition
Assess lungs for basilar crackles, infection from aspiration
Evaluate poor food intake

Nursing Care plan

3 day calorie count, consultation with dietician for poor
intake/unplanned weight loss.
Monitor drug levels and liver function tests if on medications
metabolized in liver; electrolytes, BUN/creatinine, albumin
(nutritional indicator and if low effects drug levels like digoxin)
Monitor for signs of dysphagia, coughing or choking with
solids/liquids. Speech &/or swallowing evaluation as indicated
Monitor for signs of aspiration particularly if decline in
function/weakness; GERD
Monitor nutrition/diet intake, fluid intake, elimination particularly
if immobile. Maintain mobility.
Provide laxatives if on constipating medications, e.g., narcotics

Implications

Risk of dehydration, electrolyte imbalances, poor nutritional intake

Risk of dysphagia, hiatal hernia, aspiration
Delayed emptying of stomach with risk of maldigestion
Gastroesophageal Reflux Disease (GERD)
Constipation, flatulence common
Risk of fecal impaction
Risk of adverse drug reactions due to slowed liver metabolism

Decreased absorption of fat, carbohydrate, protein, vitamin B12,

iron, folate, calcium, and vitamin D with risk of anemia,
osteoporosis, malnutrition
In mouth, risk of gingivitis, tooth loss with chewing impairment

v) Musculoskelatal System and Nursing diagnosis

Narrowed intervertebral disks

Decreased bone mass
Lean body mass replaced by fat with redistribution of fat
Decrease in muscle mass & regeneration of muscle fibers
Increased latency/contraction time of muscle
Increased hip/knee flexion
Tendon & ligament stiffening
In joints, articular cartilage erosion; increased bone overgrowth &
calcium deposits

Assessment

Assess functionality, mobility, symmetry and strength, fine & gross

motor skills, ADLs.
Ensure joint stabilization and slow movements in ROM exam to
prevent injury
"Get-up-and-Go" test

Nursing Care plan

Maintain maximal function, encourage/provide active or passive

ROM
Assess for pain and provide pain medication to enhance
functionality
Demonstrate/encourage muscle strengthening exercises
Referrals to physical/occupational therapy
Fall risk interventions, avoid restraints.

Implications

Giat & balance instability common

Risk of osteoporosis & fractures, osteoarthritis
Decreased total body water & intercellular/interstitial fluid
Decreased muscle strength & agility; slowed reflexes and reaction
time-fall risk
Decreased endurance

Joint stiffness with decreased mobility

Risk of injury, pain on ROM, joint subluxation, crepitus

vi) Nervous System & Cognition and Nursing diagnosis

In CNS, decrease in neurons, brain size, neurotransmitters

Slowed nerve impulse conduction. Decreased peripheral nerve
function

Assessment

Assess baseline; periodic reassess of functional status during acute

illness.
Assess baseline cognition and periodic reassessment
Monitor orthostatic blood pressure

Nursing Care plan

Monitor for delirium during acute illness
Institute fall prevention strategies
Rise slowly from lying, sitting positions; wait 1-2 minuted prior to
transfer

Implications
Risk of poor balance, postural hypotension, falls, injury
Decreased proprioception; potential for extrapyramidal Parkinsonlike gait
Ischemic paresthesia in extremities common
Slowed thought processing, response to stimuli, reflexes.
Risk of mild cognitive impairment, delirium in acute illness.

XI. Journals
1. Watters, J. M. (2002). Surgery in the elderly. Canadian Journal
of Surgery, 45,104108. Evidence Level V: Literature Review.
2. Krassie, J., & Roberts, D. C. (2001). The independent older
Australian: Implications for food and nutrition
recommendations. Journal of Nutrition, Health & Aging, 5(1),
1116. Evidence Level V: Program Evaluation.
3. Conn, V. S., Minor, M. A., Burks, K. J., Rantz, M. J., &
Pomeroy, S. H. (2003). Integrative review of physical activity
intervention research with aging adults.Journal of the
American Geriatrics Society, 51(8), 11591168. Evidence Level I:
Systematic Review.
4. Fielding, R. A., LeBrasseur, N. K., Cuoco, A., Bean, J., Mizer,
K., & Singh, M. A. F. (2002). High-velocity resistance training
increases skeletal muscle peak power in older women. Journal
of the American Geriatrics Society, 50(4), 655662. Evidence
Level II: Single Experimental Study.
5. Park, H. L., OConnell, J. E., & Thomson, R. G. (2003). A
systematic review of cognitive decline in the general elderly
population. International Journal of Geriatric Psychiatry,
18(12), 11211134. Evidence Level I: Meta-analysis.

XII. Theory of Application

A major focus of health promotion is to minimize the loss of
independence associated with functional decline and illness. The
predominant health problems of older adults are chronic rather
than acute and are exacerbated by the normal changes of aging
and the increased risk of illness associated with old age.
The field of geriatrics/gerontology has matured to the point
where there is now a recognized body of literature on care of
older. There also now is a consensus in geriatric nursing and
medicine as to what constitutes best practice in care of older
adults. Failure to implement these geriatric care standards for
older adults is unacceptable.
The content of this document is organized as follows:
A) Gerontological nursing competency statements necessary for
nurses to provide high-quality care to older adults and their
families.
B) These 19 gerontological nursing competency statements are
divided into the nine Essentials identified in the AACN
document The Essentials of Baccalaureate
Education for Professional Nursing Practice (AACN, 2008),
with rationale, suggestions for content, teaching strategies,
resources, and glossary of terms.

XIII. Summery
Geriatric Nursing is the best source for clinical information and
management advice relating to the care of older adults. Geriatric
Nursing is written for nurses and nurse managers who work in
hospitals, long-term care facilities, senior centres, or in home
care.
A geriatric nurse deals with the effects of aging, as well as the
illness that brings the patient to the facility. Diminished hearing
or vision, slower mental processing and slower pace are often
part of the patient's daily life. The nurse must display patience
and understanding, allowing a little more time for answers or
action from a geriatric patient.
XIV. Conclusion
End-of-life care can be provided in a health care or home
setting, requiring all health care professionals to be aware of the
real and potential urologic complications. An individual
receiving end-of-life care may encounter many health
complications. Whatever the cause, these health symptoms may
be distressing to the patient. Consistent with the position of the
National Institutes of Health (2004), nursing interventions to
manage health complications for these vulnerable individuals
must acknowledge individual preference while implementing
the intervention that best meets the individual's social,
emotional, psychological, and physical needs. It is essential that
nurses have an adequate knowledge of how these patients and
their families perceive geriatric care to assure interventions are
appropriate, respectful, and reflective of each patient's desires.

XV. BIBILOGRAPHY
1. Phipps., Medical & Surgical Nursing., 8th Edition published by
Deborah L. Vogel., Page Nos: 10, 20

2. Patricia A. Potter ., Fundamentals of Nursing., 6th Edition

published by Elsevier, A division of Reed Elsevier India., Page
Nos: 21, 236

3. Barbara Kozier., Fundamentals of Nursing ., 7th Edition

published by Pearson Education., Page Nos: 9

4. Kenny, R. A. (2003). Syncope. In W. R. Hazzard, J. P. Blass, J.

B. Halter, J. G. Ouslander, & M. E. Tinetti (Eds.), Principles of
geriatric medicine and gerontology(pp. 15531562).NY:
McGraw-Hill. Evidence Level V: Literature Review.

5. Dunn, D. (2004). Preventing perioperative complications in an

older adult.Nursing2004, 34, 3641. Evidence Level V:
Literature Review.

6. Mick, D. J., & Ackerman, M. H. (2004). Critical care nursing

for older adults: Pathophysiological and functional
considerations. Nursing Clinics of North America, 39, 473493.
Evidence Level V: Literature Review.

7. Beyth, R. J., & Shorr, R. I. (2002). Principles of drug therapy in

older patients: Rational drug prescribing. Clinics in Geriatric
Medicine, 18, 577592. Evidence Level V: Literature Review.