FACTORS THAT AFFECT NORMAL FUNCTIONING OF THE OLDER PERSONS

At the end of 2 hours, the reporters will be

able to:
 Show demographic profile of the elderly, globally and locally
 Define the aspects of aging process
 Explain the physical, physiological, biological, social and psychological/emotional changes in
elderly
 Understand the role of nurse’s in caring for geriatric client

DEMOGRAPHICS OF AGING
 Age is the length of time that a person has lived or existed
 The demographic aging aka “Aging Population”
-a summary term for the shifts in the age distribution of a population towards older ages
 According to WHO (World Health Organization)
-number of people aged >65 is projected to grow from an estimated number of 524 M (2010) to 1.5 B (2050)
- by 2030, the number of people >65 years is expected to significantly outnumber children younger than 5
years of age
 According to the National Council on Aging
• 92% of seniors have at least 1 chronic disease and 77% have at least 2
 Heart disease, stroke, cancer, and diabetes are among the most common and costly chronic health
conditions causing 2/3 of deaths each year
 Cognitive health- focused on a person’s ability to think, learn and remember
 Dementia- most common cognitive health issue facing the elderly; the loss of those cognitive functions
 47.5 M people worldwide have dementia
 A common mental disorder among seniors is depression, occurring in 7% of the elderly population
 Older adults account for over 18% of suicides deaths in the United States
 Aging causes bones to shrink and muscle to lose strength and flexibility
 Seniors are more susceptible to losing their balance, bruising and fracturing a bone
 Osteoporosis and osteoarthritis- 2 diseases that contribute to frailty
 Falls are not inevitable
 They can be prevented through education, increased physical activity and practical modifications within the
home
 Sensory impairments (vision and hearing)
-extremely common for older Americans >70

 According to the CDC, 1 out of 6 older adults has a visual impairment and 1 out of 4 has hearing impairment
 New technologies are enhancing assessment of hearing loss and wear ability of hearing aids
 Oral Health
-one of the most important issues for the elderly
 The CDC’s Division of Oral Health
-found 25% of adults over the age of 65 no longer have their natural teeth
 Cavities and tooth decay can lead to difficulty maintaining a healthy diet and low self-esteem
 Oral health issues: dry mouth, gum disease and mouth cancer
 In the Philippines according to the
Commission on population or POPCOM
-number of people aged >60 in the
Philippines is expected to grow
 The number of elderly Filipinos >60 years old is projected to increase by 0.23% in the year 2018
 According to NSO projects that by 2030, older people will make up around 11.5% of the total population in
the Philippines
 In the Philippines an ageing population increases the demand for health services
 Older people suffer from both degenerative and communicable diseases due to the ageing of the body’s
immune system
 Leading causes of morbidity:
 infections
  while visual impairment
 difficulty in walking
 chewing
 hearing
 osteoporosis
 arthritis
 incontinence
Key Statistics on the Philippine’s Population of Older People:

Major contributors to socioeconomic and psychological problems for seniors:

 Loneliness from losing a spouse and friends
 Inability to independently manage regular activities of living
 Difficulty coping and accepting physical changes of aging

 Frustration with ongoing medical problems

and increasing number of medications
 Social isolation as adult children are engaged in their own lives
 Feeling inadequate from inability to continue to work
 Boredom from retirement and lack of routine activities
 Financial stresses from the loss of regular income
 According to American Psychological Association
-socio economic status affects overall human functioning, including physical and mental health
 Low socio economic status (lower educational achievement, poverty and poor health)
-affect society as a whole
 People at the age >65 years comprise nearly 13% of the population of a country
 The older adult population is projected to double between 2012 and 2060, from 43.1-92 M
 Social economic status
-Key factor in determining the quality of life of older populations, nearly 14.6% of whom live below official
poverty thresholds
 Factors that can affect financial standing:
 Declines in health
 Death of a spouse
Retirement and Income
The majority of older adults do not work and have fewer options for continued income
They are at risk for rising costs of living, which may place them at an economic disadvantage and potentially at lower
levels of social economic status
In 2014, 61% of persons age >65 years received at least half of their income from Social Security
Health and Economic Status
 Recent studies indicate that the quality of care afforded to older adults with medical conditions is
substandard
 About 1 in 10 persons age >50 who report that a disability has reduced or eliminated their ability to work are
assisted by social insurances
 Individuals age >60 years with low socio economic status who self-reported feeling lonely is at greater risk of
functional decline (activities of daily living, developing difficulties with upper extremities and death)
 1 in 3 persons with a chronic illness such as arthritis, diabetes mellitus, asthma, cancer, chronic obstructive
pulmonary disease, stroke, hypertension, coronary heart disease or psychiatric issues) and low socio
economic status is unable to afford food, prescribed medications, or both
Psychological Health and Well-Being
 Socio-economic status- affects the psychological health of aging individuals
 Poverty -a risk factor for declines in mental health among older people
 Lower level of socioeconomic status is most likely to be diagnosed with a psychological disorder
 Malnutrition is associated with an increased likelihood of depression for elderly women compared to men
 Population projections suggest that there will be a significant increase in depression and dementia
diagnoses among the elderly within the next 25 years, because the primary risk factor for both mental health
issues is increasing age
 Older women with dementia is at increased risk of physical abuse and neglect by family caregivers
Factors to elder abuse in persons with dementia:
 Poverty
 Low levels of education of both the victim and caregiver
 Social isolation
 Alcohol abuse by the caregiver
AGING PROCESS
 Aging - a series of time related processes occurring in the adult individual that ultimately bring life to close
 It influences an organism’s entire physiology, impacts function at all levels and increase susceptibility to all
major chronic diseases
 Aging is a process of growing old
 It is a normal phenomenon which includes growth and maturity of the body
 The UN generally uses 60+ years to refer to the older population (WHO, 2014).
Old Age Groups (Ayranci & Ozdag, 2004) :
 Biological aging- concerned with changes occurring in the structure and functions of the human body
 Physiological aging- concerned with individual and behavioural changes
 Emotional aging- describes changes in one’s attitude and lifestyle dependent on one’s self-perception of
being old
 Functional aging- the comparison of individuals of
the same age group in terms
of those within the group being unable to maintain their functions in society
Phases of Aging:
 Young-old
-approximately 65–74
 Middle-old
-ages 75–84
 Old-old
-over age 85
FAMILY AND THE ELDERLY
 Families are the cornerstone of all human societies which have been discovered in every human culture
 It is a place where a person finds and expects the most encouragement, comfort and security and help if
needed
 Elderly are most happy with family life especially with their children
 Researches in many cultural settings show that older people prefer to be in their own homes and
communities
 Families are fragmented into small units due to marriage, divorce, step family relations
 Family's trend is to live separately, family member seeking job and studying in different places
 This creates fewer young family members available to provide care to the elderly people
 There is a decline in physical and cognitive functioning in old age
Quality of Life of the Elderly
 In old age, the quality of life is determined by the ability to maintain autonomy and independence
 Most of the elderly rely on their family member for assistance
 In nursing home, the quality of care received by residents is only physical care and safety measures to
maintain quality of care.
 Loneliness, social exclusion and family rejection also comprise the quality of life of elderly
 Family involvement has been associated with better physiological and psychosocial well-being and higher
provision of certain types of treatment

 The importance of family rises with advance age as elderly need more support and help in their later life
 During chronic illness or crisis the demand may even exceeds in everyday life of old people
 Family assists and helps in variety of physical task such as bathing, dressing, giving medication and feeding
them
 Family support influences the care individuals receive when living in nursing homes
 Family members ensure that best possible quality care is provided to their elderly in order to promote their
well-being
 Supportive roles of family results in quality care
 Family support-a key source of assistance, care, and advocacy, resulting in better care for nursing home
residents
 When time is perceived as limited, individuals prefer social networks comprised of family members and
formal resources that can provide meaningful interaction and assistance
 Social network of family and friends buffer stress and promote well- being, reducing loneliness and improve
the quality of life of elderly
 The way to enhance social support is to involve family member actively in the care of their relatives
Family Visits
 Family visit
 -commonly done to meet the elderly ones
 Helps in the assessment of a family member
 Family involvement in elderly care include:
 providing hands-on care with new roles of assessing health and needs of elderly
 advocating for elderly
 providing emotional support and sustaining strong relationship with elderly through regular family
visits
 Important for staff to understand the previous history and personality of residents in order to provide
individualized care
 It improves quality of life through quality care and relationships gained through social network and visits in
which both gets mutual enjoyment from visits
 Involving family member in care and decision of elderly motivate them and increase frequencies of visit
 It enhances communication, with staff and gives sense of community, improved relationship of residents,
family and staff
 Higher life satisfaction has been reported by residents who receive at least monthly visits from family and
the quality of the social environment is important to resident satisfaction and feeling “at home”
CHANGES IN AGING
 Aging is inevitable
 It reflects many changes that occur throughout human life, since birth till death
 Different changes occur in the human body
 In older age, change in whole system takes place
 Poor immune system and more susceptible to different diseases
Physical/ Biological Changes
 Primary aging
-biological factors such as molecular and cellular changes
 Secondary aging
- occurs due to controllable factors such as lack of physical exercise and poor diet
The most obvious manifestations of changes in physical appearance:
 wrinkles appearing on the face
 the greying of hair
 slowing down of reactions
 restriction of movement and sense organs
 prone to chronic illnesses
 Age-related physical changes:
 hearing impairment
 weakening vision
 increasing probability of arthritis, hypertension, heart disease, diabetes, and osteoporosis
 Hearing and vision problem
- makes communication difficult
 Changes in taste and smell
 Changes in bone and muscles takes place
 Bone loss, fracture and muscles pain increases
 High chance of losing teeth and stomach upset, less bowel movement
 Constipation- most common problem
 Changes in circulation- heart becomes slow to pump the blood (high chance of stroke)
 Menopause- main changes that occur in old age women
Age-Associated Cardiovascular Changes
A. Etiology
1. Arterial wall thickening and stiffening, decreased compliance
2. Left ventricular and atrial hypertrophy
3. Sclerosis of atrial and mitral valves.
4. Strong arterial pulses, diminished peripheral pulses, cool extremities
C. Parameters of Cardiovascular Assessment
1. Cardiac assessment: ECG; heart rate, rhythm, murmurs, heart sounds (S4 common, S3 in disease)
2. Palpate carotid artery & peripheral pulses for symmetry
3. Assess BP (lying, sitting, and standing) and pulse pressure
Age-Associated Changes in the Pulmonary System
A. Etiology
1. Decreased respiratory muscle strength: stiffer chest wall with reduced compliance
2. Diminished ciliary & macrophage activity, drier mucus membranes: decreased cough reflex
3. Decreased response to hypoxia and hypercapnia
C. Parameters of Pulmonary Assessment
 1. Assess respiration rate, rhythm, regularity, volume, depth, and exercise capacity
2. Auscultate breath sounds throughout lung fields
3. Inspect thorax appearance, symmetry of chest expansion; Obtain smoking history
4. Monitor secretions, breathing rate during sedation, positioning, arterial blood gases, and pulse oximetry
5. Assess cough, need for suctioning
D. Nursing-Care Strategies
1. Maintain patient airways through upright positioning/repositioning and suctioning
2. Provide oxygen as needed; maintain hydration and mobility
3. Incentive spirometry as indicated, particularly if immobile or declining in function
4. Education on cough enhancement, smoking cessation
Age-Associated Changes in the Renal and Genitourinary Systems
A. Definition
To determine renal function (GFR)
B. Etiology
1. Decreases in kidney mass, blood flow, GFR (10% decrement/decade after age 30); Decreased drug
clearance
2. Reduced bladder elasticity, muscle tone, capacity
3. Increased post void residual, nocturnal urine production
4. In males, prostate enlargement with risk of BPH
E. Nursing-Care Strategies
1. Monitor nephrotoxic and renal cleared drug levels
2. Maintain fluid/electrolyte balance. Minimum 1,500-2,500 mL/day from fluids and foods for 50- to 80-kg
adults to prevent dehydration
3. For nocturnal polyuria: limit fluids in evening, avoid caffeine, use prompted voiding schedule
4. Fall prevention for nocturnal or urgent voiding
Age-Associated Changes in the Oropharyngeal and Gastrointestinal Systems
A. Etiology
1. Decreases in strength of muscles of mastication, taste, and thirst perception
2. Decreased gastric motility with delayed emptying
3. Atrophy of protective mucosa
4. Mal-absorption of carbohydrates, vitamins B12 and D, folic acid, calcium
5. Impaired sensation to defecate
6. Reduced hepatic reserve. Decreased metabolism of drugs
C. Parameters of Oropharyngeal and Gastrointestinal Assessment
1. Assess abdomen, bowel sounds
2. Assess oral cavity; chewing and swallowing capacity, dysphagia (coughing, choking with food/fluid intake).
If aspiration, assess lungs (rales) for infection and typical/atypical symptoms
3. Monitor weight, calculate BMI, compare to standards
4. Determine dietary intake, compare to nutritional guidelines
5. Assess for GERD; constipation and fecal incontinence; fecal impaction by digital examination of rectum or
palpation of abdomen
D. Nursing-Care Strategies
1. Monitor drug levels and liver function tests if on medications metabolized by liver; Assess nutritional
indicators
2. Educate on lifestyle modifications and over-the-counter (OTC) medications for GERD
3. Educate on normal bowel frequency, diet, exercise, recommended laxatives; Encourage mobility, provide
laxatives if on constipating medications
4. Encourage participation in community-based nutrition programs; educate on healthful diets.
Age-Associated Changes in the Musculoskeletal System
A. Definition:

Sarcopenia: Decline in muscle mass and strength associated with aging

B. Etiology
1. Sarcopenia with increased weakness and poor exercise tolerance
2. Lean body mass replaced by fat with redistribution of fat
3. Bone loss in women and men after peak mass at 30 to 35 years
4. Decreased ligament and tendon strength. Intervertebral disc degeneration; Articular cartilage erosion;
Changes in stature with kyphosis, height reduction
D. Nursing-Care Strategies
1. Encourage physical activity through health education and goal setting to maintain function
2. Pain medication to enhance functionality. Implement strategies to prevent falls
 3. Prevent osteoporosis by adequate daily intake of calcium and vitamin D, physical exercise, smoking
cessation
4. Advise routine bone-mineral density screening
Age-Associated Changes in the Nervous System and Cognition
A. Etiology
1. Decrease in neurons and neurotransmitters
2. Modifications in cerebral dendrites, glial support cells, synapses
3. Compromised thermoregulation
C. Parameters of Nervous System and Cognition Assessments
1. Assess, with periodic reassessment, baseline functional status
2. Evaluate, with periodic reassessment, baseline and sleep disorders
3. Assess impact of age-related changes on level of safety and attentiveness in daily tasks
4. Assess temperature during illness or surgery
D. Nursing-Care Strategies
1. Institute fall preventions strategies
2. To maintain cognitive function, encourage lifestyle practices of regular physical exercise, intellectual stimulation,
and healthful diet
3. Recommend behavioral interventions for sleep disorders
Age-Associated Changes in the Immune System
A. Definition
Immune response dysfunction with increased susceptibility to infection, reduced efficacy of vaccination,
chronic inflammatory state
B. Nursing Care Strategies
1. Follow CDC immunization recommendations for pneumococcal infections, seasonal, influenza, zoster, tetanus,
hepatitis for the older adult
Psychological Changes
 “Psychological wellbeing is considered as a core of successful aging
 The ability to be self-determined and to exercise control over one’s life is critical to both psychological and
physical well-being and health
 Different diseases or mental condition like depression, memory loss, mood changes, and dementia occurs
 Old people may have fear of many things related with their health condition, injuries, as well as about family
and friends
 Problem with memory make them difficult to remember simple things what happened just earlier
 Memory generally declines with age
 However, poor cognitive ability can be improved by using different methods or extra activities like chess,
crossword puzzles or playing simple games
 Exercises like swimming, walking, yoga helps to maintain the cognitive function
 Social involvement is the important factor to maintain it
 Elderly can be more active and have the healthy brain
 Those who have been involving in physical as well as social activities have less chance of depression and
healthy cognitive skills
Social Changes
 Social role identifies and define individuals position and validate their existence in social groups such as
families, workplace and communities
 The different roles remain in place but the participation in that role generally depends on the health status,
financial resources and mobility in the community
 Older adults continue to participate in way of these social roles even faced with diminished capacities
 Retirement is one of the social changes
 It is difficult for older adult to leave the position where they get respect, regular income and social network of
friends, colleagues and acquaintance
 It causes transition from the daily recognition to one with limited recognition and possible isolation
 Numerous studies have shown that socialization is important for physical and psychological well-being
 Personal heath declines and the ability to socialize reduced
 Older adults have strong desire to be independent and do not accept help from others
 Due to decline in the health status they reached at the point where they need to accept support and help
from others
 Family member especially children gives assistance to them

CHALLENGES FACED BY THE ELDERS

Ageism
 The loss of independence is one potential part of the process, as are diminished physical ability and age
discrimination
  Senescence- aging process, including biological, emotional, intellectual, social, and spiritual changes
Mistreatment and Abuse
 A major social problem
 The elderly sometimes become physically frail
 Frailty renders dependent on others for care—sometimes for small needs like household tasks, and
sometimes for assistance with basic functions like eating and toileting
 This makes the care providing situation more complex
Signs of Elder Abuse