GERIATRIC CONSIDERATION IN NURSING

Aging ,the normal process of time related change , begins with birth and
continues throughout life .The number of people who live to be very old will
also increase .Health professionals will be challenged to design strategies that
address the higher prevalence of illness within this aging population .

NORMAL AGE RELATED CHANGES:1)Physical aspects of aging .

2)Psychosocial aspects of aging
1) PHYSICA L ASPECTS OF AGING:Nervous system Musculoskeletal system
Sensory systemGenitourinary system
Respiratory system
Reproductive system
Gastrointestinal system
Endocrine system
Cardiovascular system
Integumentary system
2)PSYCHOSOCIAL ASPECTS OF AGING :1) Retirement
2)Loneliness

3)Role changes
4) Depression and Suicide

PHYSICAL ASPECTS OF AGING:NERVOUS SYSTEM :- 1. There is loss of number of neurons with age , but no

more changes in the neurotransmitter levels.

2. Decrease muscle tone ,motor speed and nerve conduction .
3. Decrease gait speed , step length and arm swing.
4. Reduction in cerebral blood flow
5. Decreased blood flow and oxygen utilization to brain .
Nursing consideration:- Because of these changes in combination with sensory
changes , fall prevention techniques are essential to teach like:1.Environmental safety techniques include nonslip surfaces, sufficient light .
2.Chair of the proper height with armrests and elevate toilet seats.

Sensory system :-Vision :-1.Decrease visual acuity and decrease peripheral

vision .
2.Decreased tears, color discrimination due to the yellowing of lens :short wave

length colors such as blue and green

3.lens become less flexible , the near point of focus gets farther away.This is
presbyopia.
Nursing consideration :-1.Make sure objects are in the patient visual field and
do not move objects around .
2. Allow the person to focus and adjust to the environment .
3. Wear the sunglass and use night lights to help with dark adaption problems.
4. Encourage use of isotonic eye-drops as needed.
Hearing :- 1.Hearing loss increase with age and is greater in men and
decreased speech discrimination , especially with background noise .
2.Older people are often unable to follow conversation because tones of high
frequency constants (letters f, s, th, ch, b, t, p )all sounds alike .
3. Hearing loss may cause the older person to respond inappropriately ,
misunderstanding conversation , and avoid social interaction .
Nursing consideration :- 1.Suggest hearing testing for further evaluation and
face the person directly so he / she can lip read .
2. Use gestures and objects to help with verbal communication.
3. Touch the person to get his or her attention before talking .
4. Speak clear and slowly
Smell :- 1.Changes in smell are due to nasal sinus disease preventing odors
from reaching smell receptors ,a decrease the nerve fibers .
2. Discrimination of fruity odors seems to persist the longest.
Nursing consideration:-1. At mealtime , name food items and give the person
time to think of the smell / taste of the food .
2.Suggest use of stronger spics and flavoring to stimulate smell.

Taste :- 1. Taste buds decrease with age and lost half of their taste buds
Nursing consideration :-1. Encourage good oral hygiene .
2. Vary the texture of food .
3. Serve food attractively.
Respiratory system :-1. With age , there is weakening of the intercostal
respiratory muscles , and the elastic recoil of the chest wall diminishes.
2.Residual volume and functional residual volume increase.
3.There is a decrease in the mucous transport .Therefore ,there is resulting
decreased clearance of mucus and forigen bodies , including bacteria.

4. Pulmonary oxygen decrease with age due to ventilation perfusion

mismatches.
5. Increase lung rigidity and reduced mobility of ribs.
6.Decrease cough efficiency and increased dead space make the older person
more vulnernable to respiratory infection.
Nursing consideration :-Maintain appropriate fluid intake and encourage for
regular exercises.
2. Stay away from people who are ill.
3. Encourage for eat lots of fruits and vegetables ,which contains vitamins and
build up immune system.
4. Teach measure to prevent pulmonary infection avoid crowds during cold
and flu season .
Gastrointestinal system :- Periodontal disease leading to tooth decay and
loss of teeth is common.
2. Salivary flow diminishes , and the older person may experience a dry mouth .
3. Gastric motility may decrease resulting in delayed emptying of stomach
contents.
4. Diminishes secretion of acid and pepsin reduces the absorption of iron ,
calcium , vitamin B-.12
5.Dysphagia and dysfunction of smooth muscles of the GI. Moreover,
constipation is common in aged people , the systems involve abdominal
discomfort and flatulence .
6. Decrease liver weight and abdominal muscle strength
Nursing consideration :-Avoiding heavy activity after eating :eating high fiber ,
low fat diet ;ingesting an adequate amount of fluid ;establishing regular bowel
habitats.
2. Avoiding the use of laxative and antacids.
Cardiovascular system:- 1.With age , the valves of the heart become thick
and rigid as a result of fibrosis, compounding any cardiac disease already
present. 2. Blood vessels also become thick and rigid , resulting in elevated BP.
3. Maximum heart rate and aerobic capacity decrease with age.
4. Decline in maximum oxygen consumption.
5. Slower response to stress,once the pulse rate is elevated, it taken longer time
to return to baseline .

6. Subtle changes in artery walls result in a less flexible vasculature.

Nursing consideration :- 1.Encourage regular blood pressure evaluation .
2.Encourage regular aerobic exercise :walking ,biking .
3. Exposure to cool and wind should be avoided because of the risk factor of
dizziness.

Genitourinary system:-1.Decrease in kidney mass ,primarily because of a

loss of nephrons .
2. Changes in kidney function include a decrease filtration rate ,diminishes
tubular function with less efficiency in resorbing and concentrating the urine
and slower restoration of acid base balance in response to stress.
3.Women often suffer from stress and urge incontinence or both .
4. Benign prostate hyperplasia which is a common finding in older men ,cause
a gradual increase urine retention or over flow incontinence.
5. Decrease bladder capacity .
Nursing consideration :-1.avoidance of bladder irritating substances such as
caffeinated , carbonated acidic beverages and water intake should be increased
to avoid concentrated urine ,which cause urinary urgency.
2. Pelvic floor exercises, first described by kegel , can also useful in reducing
the systems of stress and urge incontinence.
Musculoskeletal system :-1.Progressive decrease bone mass and excessive
loss of bone density results in osteoporosis.
2. Inadequate calcium intake and Increased collagen formation , which cause
loss of resilience of elasticity of joint .
3. Muscles diminishes in size and lose strength, flexibility and decreased
activity .
Nursing consideration :-Calcium supplements , vitamin D ,estrogens, and
weight bearing exercise are often prescribed for the person who is at high risk
for osteoporosis.
Integumentary system :-1.With aging , thinning of all three layers of the
skin epidermis , dermis and subcutaneous tissue - leads to greater fragility of
the skin and decrease ability of skin to function as a barrier to external function.
2. Less efficient thermoregulation of heat because of fewer sweat glands.
3. Drier skin because of decrease number of sebaceous glands results in
reduced oil production.

4. Other changes include reduced sensory input , decrease elasticity and

impaired cell related immune response.
5. Elastic fibers are reduced in number , and collagen becomes stiffer.
6.Decrease number of capillaries in the skin result in diminishes blood supply.
7. Hair pigmentation decreases , resulting in gradual graying .
Nursing consideration:-Excessive use of soap , which can be drying to the skin
, should be avoided.
2. Careful skin evaluation and lubrication are necessary to prevent breakdown.
3.Avoid exposure to the sunand long soaks in the tub.
4. Encourage use of sunscreen during outdoor activities.
5. Heat regulation needs to be controlled by proper clothing and avoidance of
extreme hot and cold to skin because damage may occur without feeling it.4.
Encourage use of sunscreen during outdoor activities.

Reproductive system:-In females :-menopause leads to decrease in the size

of ovaries and hormone production .This results in uterine involution , vaginal
atrophy and loss of breast mass.
2.Thinning of vaginal wall , along with a narrowing in size and a loss of
elasticity ;decreased vaginal secretion , resulting vaginal dryness, itching and
decreased acidity.
3. Decrease pubococcygeal muscle tone ; resulting in a relaxed vagina and
perineum.
4. Decrease size of labia and clitoris.
In male: Testosterone production and androgens diminishes.
2.Serum levels may be low.
3. Decrease sperm count and size of genital organs.
Nursing consideration:Suggest the use of additional lubricants during sexual
intercourse.
2. Use of vacuum penile pump , local injection or placement of vaso
stimulating medication into the urethral opening and use of an oral medication
sildenafil citrate.

Endocrine system:-1.Elevated vasopressin(antidiuretic hormone)

2.Elevated levels of follicle stimulating hormoneand luteinizing hormone

because of reduced end organ response.

Nursing consideration:-1)Encourage routine screening for elevated blood sugar.
2)Provide dietary education on well balanced.

PSYCOSOCIAL ASPECTS OF AGING

Retirement:-Retirement often has associations of passivity and seclusion and
often , leads to psychological stresses . These include role changes with the
spouse or family and problems of social isolation . The most powerful factors
that influence the retired persons satisfaction with life are health status , the
option to working and sufficient income .Retirement alters identity ,power ,
status and friendship .
Role changes:-Aging is associated with many role changes and transitions.
Some roles such as spouse , friend or employee-may be lost , while new role
such as widow or volunteer may arise . Such changes require role adjustment .
After retirement , the division of labor and household management may
changes.
Loneliness :-Any lose that creates a deficit in intimacy and interpersonal
relationship can lead to loneliness Retirement , poor health , inactivity also may
contribute to loneliness . The older adults needs caring , personal contact to
avoid loneliness.
Depression and suicide :-Changes in neurotransmitters , multiple losses
and decrease internal and external resources contribute to its incidence . Risk
factor for depression include a recent major loss , isolation from family /friends
, feeling of hopelessness , and absence of an identifiable role in life and loss of
a partner .
BILIOGRAPHY:-Lippinoctt;Manual of nursing practice ,Edition;7th Page
162-165.
Basheer .P. shebeer :Advanced nursing practice . edition:1st, Page742-748
Ansari javed :A text book of medical surgical nursing -2, Edition :2nd, page
1075-1081.
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