GERIATRICS

Class 2010

4/7/2011 1400hours to 1600hours Facilitator : Qio V Theme: GERIATRICS

General Objectives
Define specified terms Explain the aging process and effects Explain the psychosocial influences of aging Describe the disease aspects of aging Discuss the medical and nursing management of the elderly

Definition
 Gerontology : The scientific study of the biological, psychological and sociological phenomena associated with old age and aging.  Geriatrics : The branch of medicine that focuses on health promotion and the prevention and treatment of disease and disability.  Medical treatment for seniors: the branch of medicine that deals with the illnesses and medical care of senior citizens.

Introduction
 Today's elders have offered the sacrifice, strength and spirit that made every country great.  They were the brave immigrants who ventured into an unknown land, the bold entrepreneurs who took risks that created wealth and opportunities for work and the unselfish parents who struggled to give their children a better life Witnessed and participated in profound informational , technological and social growth and change

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 The elderly have earned respect, admiration and dignity. How are elderly viewed today? They are viewed with positivism rather than prejudice, intelligence rather than myth and concern rather than neglect. Historically how have societies reacted to their aged members? Confucius: there is a direct correlation between a persons age and the degree of respect to which he or she was entitled

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 Taoism: viewed old age as the epitome of life, and the ancient Chinese believed that attaining old age was a wonderful accomplishment that deserved great honor  The early Egyptians: dreaded growing old and experimented with a variety of potions and schemes to maintain their youth. Early Greeks: opinions of the aged were divided among them; Plato promoted the aged as society's best leaders whereas Aristotle denied the elderly any role in governmental matters.

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 Ancient Romans : had limited respect for their elders; in the nations the Rome conquered, the sick and the aged were the first to be killed. Biblical view of the elderly: Woven throughout the Bible in Gods concern for the well being of the family and desire for people to respect elders (Honor your father and your mother . Exodus 20:12).  Many key Biblical figures, such as Moses and Abraham, made significant contributions in their advance years, yet the honor bestowed upon the aged was not sustained.

Why nurses need to study the theme?

 Nurses nurse people across the lifespan  Lots of changes occur during these stages in the lifespan that nurses need to be knowledgeable about to be able to give the best care and service. More so in the study of old age or GERONTOLOGY.  According to Erikson there are 8 stages of psychosocial development in the lifespan. Erikson discusses the psychosocial aspect of changes whereas the other theorists discuss the biological changes that occur.

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 the type, rate and degree of physical, emotional, psychological and social changes experienced during life are highly individualized; for these changes are influenced by genetic factors, environment, diet, health, stress, lifestyle choices and numerous other elements. There are also differences in the patterns of aging of various body systems within the same individual; it must be recognized that the pattern of aging is unique in each person.

GENERAL CHANGES
 Organs and system changes can be traced to changes at
the basic cellular level.  cells is gradually reduced leaving fewer functional cells in the body  Lean body mass is reduced, fat tissue increases until the sixth decade of life.  cellular solids and bone mass are decreased  Extracellular fluid remains constant , although intracellular fluid is decreased, resulting in less total body fluid, therefore, makes dehydration a significant risk to the elderly.

Some noticeable effects of the aging process

 appear after the fourth decade of life  Men experience hair loss and both sexes develop gray hair and wrinkles. The body's contours gain a bony appearance along with deepening of the hollows of the intercostal and supraclavicular spaces, orbits and axillae due to body fat atrophies.

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 Elongated ears, a double chin and baggy eyelids are among the obvious manifestations of the loss of tissue elasticity throughout the body  the loss of subcutaneous fat content , responsible for the decrease in skin fold thickness, also is responsible for a decline in the body's natural insulation, making older adults more sensitive to cold temperatures.

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 stature decreases, resulting in a loss approximately 2 inches in height by 80 years of age.

 body shrinkage is due to reduced hydration, loss of cartilage and thinning of the vertebrae, causing the long bones of the body which do not shrink to appear disproportionately long. Reduction in height can be further exaggerated by any curvature of the spine, hips and knees that may be present.

Changes in the Nervous System

It is difficult to identify with accuracy the exact impact of aging on the nervous system because of the dependence of this systems function on other body system.
For example, cardiovascular problems can reduce cerebral circulation and be responsible for cerebral dysfunction.

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 The decline in brain weight and a reduction in blood flow to the brain do not appear to affect thinking and behavior.  declining nervous system function may be unnoticed because changes are often nonspecific and slowly progressing.  There is a reduction in nerve cells The nerve conduction velocity is lower and is manifested by slower reflexes and delayed response to multiple stimuli

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 kinesthetic sense lessens  a slower response to changes in balance; a factor contributing to falls.  sleep becoming less prominent since the brain affect the sleep wake cycle; changes in the sleep pattern occur, with stages 3 and 4 of sleep becoming less prominent.

Integumentary System
 Often the most bothersome because they are obvious and clearly reflect advancing years  Flattening of the dermal- epidermal junction, reduced thickness and vascularity of the dermis, slowing of epidermal proliferation, and an increased quantity and degeneration of elastin fibers occur. Collagen fibers become coarser and more random, reducing skin elasticity.

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 the dermis becomes more avascular and thinner Becomes less elastic and more dry and fragile Subcutaneous fat is lost, lines, wrinkles and sagging become evident. Skin becomes irritated and breaks down more easily Reduction in melanocytes thus causing skin pigmentation . Commonly referred to as age spots more prevalent in areas of the body exposed to the sun.  skin immune response decline causing the elderly to be more prone to skin infection/s

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 progressive loss of pigment cells and atrophy and fibrosis of hair bulbs cause thinning and gray of scalp, pubic and axillary while hair in the nose and ears become thicker.  Growth of facial hair may occur in older women

Musculoskeletal System
 The variety of musculoskeletal changes occuring with age result in kyphosis, enlarged joints, flabby muscles and decreased height.  muscle mass, muscle strength and muscle movement are decreased; arm and leg muscles become flabby and weak  muscle tremors occur and are believed to be associated with degeneration of the CNS. Kyphosis: backward tilting of the head

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 tendons shrink and hardens which causes a decrease in tendon jerks Reflexes are lessened in the arms, totally lost in the abdomen, but are maintained in the knee Bone minerals and mass are reduced, contributing to the brittleness of the bones of older people, especially older women.

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 diminished calcium absorption Gradual resorption of the interior surface of the long bones and a slower production of new bones make fractures a serious risk to the elderly Long bones do not shorten with age but thinning disks and shortening vertebrae reduce the length of the spinal column causing reduction in height with age

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 kyphosis, and some flexion of the hips and knees may further decreased the height of the elderly.  limit joint activity and motion is caused by a deterioration of the cartilage surface of joints

The Cardiovascular System

Heart size does not change significantly with age Enlarged hearts are associated with cardiac disease Cardiac atrophy is caused by marked inactivity The aorta becomes dilated and elongated and there is a slight left ventricular hypertrophy. Any dysfunction associated with any cardiac disease is also the result of atrioventricular valves become thick and rigid as a result sclerosis and fibrosis.

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Physiological Changes The heart muscles loses its efficiency and contractile strengths Physiological stress is caused as the result in the reduction in cardiac output There is increased irregularity and a decrease in the number of pacemaker cells There is thickening of the shell surrounding the sinus node More time is required for the cycle of diastolic filling and systolic emptying to be completed since the isometric contraction phase and relaxation time of the left ventricle are prolonged: adults adjust to this change well. How?

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older adults in good physical condition have comparable cardiac function to younger persons who are in poor conditions the aging process affect the 3 layers of the heart differently: the tunica intima experiences the most direct changes including fibrosis, calcium and lipid accumulation and cellular proliferation. The changes contribute to the development of arthrosclerosis

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The tunica media experiences a thinning and calcification of elastin fibers and an increase in collagen , which cause a stiffening of the vessels The tunica adventitia is not affected by the aging process Vascular changes to the heart, kidney and pituitary gland is the result of the decreased elasticity of the arteries

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The increase in postural hypotension and postprandial hypotension is caused by the reduced sensitivity of the blood pressure regulating baroreceptors Postprandial hypotension: blood pressure reduction of at least 20mm Hg within 1 hour of eating. The reduced elasticity of the vessels with thinner skin and less subcutaneous fat, causes the vessels in the head, neck and extremities to become more prominent.

The Respiratory System

Structural changes occur e.g. calcification of costal cartilage makes the trachea and rib cage more rigid. the thoracic inspiratory and expiratory muscles are weaker due to the increase in anterior posterior chest diameter. There is hypertrophy of the bronchial mucous gland as the cilia are reduced in number further complicating the ability to expel mucous and debris

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there is a progressive loss of elasticity due to the reduced number of alveoli begins at 60 years There is decreased ability to expel foreign matter due to less lung expansion and insufficient basilar inflation There is increasing residual volume due to the less effective exhaling of the lungs; vital capacity is reduced, maximum breathing capacity also decreases; the elderly are at high risk for developing respiratory infection

The Gastrointestinal System

Altered by the aging process at all points More bother and concern to older persons Increase number of root cavities Tooth enamel becomes harder and more brittle the layer beneath the enamel called the dentin becomes more fibrous and decreased in production Tooth loss result as the bones that support the teeth decrease in density and height elderlies rely on dentures, but it may not regularly worn because of discomfort or poor fit

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taste becomes poor due to atrophy of the tongue affecting the taste buds Pipe smoking reduce taste efficiency more the sweet sensation on the tip of the tongue suffer a great loss than the sensations for sour, salt and bitter flavors. breaking down of starches takes long due to decrease in salivary ptyalin thus resulting in swallowing taking long.

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Food remains in the esophagus for a long time because the esophagus becomes slightly dilated and esophageal emptying is slower. there is increased gastric irritation in the elderly due to decline hydrochloric acid and pepsin and so as the atrophy of the gastric mucosa. Fat absorption is slower there is reduction in mucous secretions and elasticity of the rectal wall in the large intestine

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loss of tone of the internal sphincter affect bowel elimination: awareness of the need to evacuate the bowel is reduced by slower transmission of neural impulses to the lower bowel. reduced in weight and volume of the liver ( not a big deal really) since the older liver is less able to regenerate damaged cells. liver function tests remain within a normal range less efficient cholesterol stabilization and absorption cause an increased incidence of gallstones.

The Genitourinary System

Bladder muscles weaken and bladder capacity decreases resulting in retention of large volumes of urine. The micturition reflex is delayed urinary incontinence is not a normal outcome of aging, but incontinence may occur because of a weakening of the pelvic diaphragm, particularly in multiparious women

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the seminal vesicles are affected by age by a smoothing of the mucosa, thinning of the epithelium, replacement of muscle tissue with connective tissue and reduction of fluid - retaining capacity. increased fibrosis in the seminiferous tubules thinning of the epithelium thickening of the basement membrane and narrowing of the lumen venous and arterial sclerosis and fibroelastosis of the corpus spongiosum can affect the penis with age.

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The physical capacity to achieve erections or ejaculation is not lost in old age. atrophy of the vulva accompanied by the loss of subcutaneous fat and hair and a flattening of the labia Loss of elastic tissue and rugae the vaginal epithelium becomes thin and avascular Vaginal environment is more alkaline in older women.

Theories of Aging
1. Genetic programming and errors "Some theorists believe that people inherit genetic program that determines their specific life expectancy."( Eliopoulos,2005,pg 14.) 2. Cross linking "The theory proposes that cellular division is threatened as a result of radiation or chemical reaction in which a cross linking agent attaches itself to a DNA and prevents normal parting of the strands during mitosis" ( Eliopoulos,2005,pg15.)

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3. Free radicals "Are highly reactive molecules containing an extra electrical charge that are generated from oxygen metabolism. They can result from normal metabolism, react with other free radicals or oxidation of ozone, pesticides and other pollutants. These molecules can damage proteins, enzymes and DNA by replacing molecules that create genetic disorder" ( Eliopoulos,2005,pg 15.)

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4. Autoimmune reactions "The primary organs of the immune system: the thymus and bone marrow are believed to be affected by the aging process" (Eliopoulos,2005,pg16.) 5. Wear and tear "Attribute aging to the repeated use and injury of the body over time as it performs its highly specialized functions" ( Eliopoulos,2005,pg16.)

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6. Stress ''The effects of stress on physical and psychological health have been widely discussed. Stresses to the body can have adverse effects and lead to conditions such as gastric ulcers, heart attacks, thyroiditis and inflammatory dermatose''. (Eliopoulos,2005, pg16.) 7. Disease '' Bacteria, fungi, viruses and other organisms are thought to be responsible for certain physiologic changes during the aging process"(Eliopoulos,2005,pg16.)

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8. Neuroendocrine and neurochemicals 'Aging is the result of changes in the brain and endocrine glands. Some theorists claim that specific anterior pituitary hormone promote aging"(Eliopoulos,2005,pg16.) 9. Radiation '' The relationship of radiation and age continues to be explored'' ( Eliopoulos,2005,pg 16.)

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10. Nutrients '' The importance of good nutrition throughout life is a theme hard to escape in our nutrition conscious society. It is no mystery that diet impacts health and aging. Obesity is shown to increase the risk of many diseases and shorten life" (Eliopoulos,2005,pg16) 11. Environment '' The ingestion of mercury, lead, arsenic,radioactive isotopes and other substances can produce pathologic changes in human beings'' (Eliopoulos,2005,pg17.)

Psychosocial Theories
1. Disengagement theory 'It views aging as a process in which society and the individual gradually withdraw, or disengage from each other to the mutual satisfaction and benefits of both'' ( Eliopoulos,2005,pg 17.) 2. Activity theory ''proclaims that an older person should continue a middle aged lifestyle, denying the existence of old age and that society should apply the same norms to old age as it does to middle age and not advocate diminishing activity, interest and involvement as its members grow old" (Eliopoulos,2005,pg18.)

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3. Continuity theory '' Personality and basic patterns of behavior are said to remain unchanged as the individual ages" ( Eliopoulos,2005,pg18.) 4. Developmental task '' Some theorists have described the process of healthy psychological aging as the result of successful fulfillment of developmental tasks. Developmental tasks are the challenges that must be met and adjustments that must be made in response to life experiences that are part of an adults continued growth through the lifespan" (Eliopoulos,2oo5,pg18-19.)

Make own notes on the following:

Aging process and effects on the: 1. 2. 3. 4. Special senses Reproductive system Homeostasis and metabolism and The whole contents of lecture 2 objectives.

Reference

Eliopoulos,C. (2005).Gerontological Nursing (6thed.). Lippincott Williams and Wilkins.