Gerontology - study of the aging process
Geriatrics - diagnosis and treatment of diseases and problems associated with aging
Gerontological nursing - assessment of health and functioning of older adults

Older adults 65 and older - elderly
Frail elderly over 75 years of age
By 2020 - 20% will be over 65
80% have 1 chronic condition, 50% have 2 or more chronic conditions

Short term declines
Long term minimal change
Affected by changes in environment
Lack of stimulation or overstimulation can result in confusion

Physiologic changes in the older adult are normal, however they do make the older adult more vulnerable!
Know changes and expectations specific to this age
Vulnerable to disease – decreased reserve, less flexible, less effective defenses – less efficient use of O2 decreases physical activity
Other individuals complain of difficulties sleeping – shorter stages, napping

Maslow's Hierarchy of Needs

Chronic Conditions:
Most older individuals have at least one chronic condition
Hypertension - 51%
Arthritis - 48%
Heart disease - 31%
Cancer - 21%
Diabetes - 16%

Myths and Stereotypes:
Physically unattractive
Decreased sexual activity
Forgetful, confused, unfriendly
Socioeconomic level
Outdated - ageism

Stochastic versus Nonstochastic
Stochastic - -random cellular changes over time
Nonstochastic - genetic programmed aging
Apoptosis - predetermined cell death, aging is programmed into the cell
"Wear and tear" theory
Free radical theory

Psychosocial theories:
Activity theory
Continuity theory

Developmental tasks:
Adjust to decreasing health, strength
Retirement, reduced income - loss of work role versus opportunities volunteer
Loss - death of friends and family, loss health, job, identity, income, independence, home...
New self perception - acceptance versus younger clothing, cosmetic surgery, understate age vs. realistic view of abilities
Living arrangements - acute care, home health, assisted living, familial, adult daycare, hospice, extended care facilities (last home)
Redefining relationships with children - role reversal, decision making, sandwich generation,
Maintaining quality of life -

Psychosocial changes:
Retirement - not time of passivity, time of change, affects family, identity perception change
Social isolation - loss of work role, loss of support, loss of driving priviledges, incontinence, Meals on Wheels, church groups
Sexuality - touch, libido, menopause, medications, orientation, privacy, discomfort with subject
Housing and environment - supports needs of client colors, one floor, wheelchair accessible, rugs...
Death - loss of spouse, not afraid of death, afraid of being a burden, unfinished business

Nursing care related to psychosocial needs:
Therapeutic communication
Touch - agitation decreases with touch, conveys caring, deprived of family, respect cultural boundaries
Reality orientation - restoring a sense of reality, improving awareness, elevating independence
Validation therapy - respecting the individual's feelings in the time and place that is real to them instead of correction
Reminiscence - expresses personal identity, supports self esteem, one on one or in groups
Body-Image interventions - assistance with dressing, grooming, odors


7). Generativity versus Stagnation
8). Integrity versus dispair?

Assessment of the older adult:
Physical and psychosocial
Effects of disease and disability
Decreased efficiency of homeostatic mechanisms
Standards for health and illness
Altered presentation of disease processes
Allow extra time - longer complex history, slower response time, sensory difficulties...if can't hear nurse may think confused

Sit or stand at eye level
Face the client
Provide diffuse, bright, nonglare light
Use of assistive devices - glasses, hearing aid

If hearing impaired:
Speak to client, low tone, no background noise, use good ear, hearing aid, cerumen impaction

Provide culturally congruent care:
How to address?
Eye contact, touch, proximity
Cultural perceptions of aging

*Use caution in the interpretation of signs and symptoms of the disease process and lab results

The older adult may have altered presentations of illnesses:
Dementia is not always the reason for confusion
Illness can exascerbate chronic dehydration
The ill older adult may be afebrile
Pain is often under treated especially in confused adults
New decline in abilities or incontinence may be sign of new illness
Less muscle mass and obesity can interfer with drugs, different providers can increase possibility of interactions
Fatigue may indicate anemia, hypothyroid, depression, neurologic or cardiac problems

*First when assessing perform a general survey, quick triangular assessment:
Work of breathing

If the patient is stable continue the assessment and obtain history
If the patient is compromised stabilize with appropriate interventions first, then complete H&P

Delirium versus dementia versus depression:
Delirium is generally abrupt onset, potentially reversible
Worse at night
Lasts hours to 1 month
Alertness, attention, orientation impaired
Recent and immediate memory impaired
Thinking disorganized, fragmented
Associated with acute physical illness, pneumonia, UTIs

Dementia slow, insidious onset
Alzheimer's 50%, Diffuse Lewy Body disease 15%, frontal temporal dementia 15%, vascular dementia 10%
No diurnal effects
Alertness, attention, orientation normal
Recent and remote memory impaired
Thoughts diminished, judgment impaired
Struggles to hide deficits

Depression treatable
10-15% community residents
11-45% of acute care
50% of nursing home residents

Senior Smart Program at USC the future of elder care

Elder Care Abuse



Potter, P. A., & Perry, A. G. (2009). Fundamentals of Nursing (7th ed.). St. Louis, Missouri: Mosby Elsevier.

Gerontological nursing

Nurse, See Me


Myths about the elderly


Elder Care Abuse

Senior Smart Program


AARP What's Old?