Basic Nursing: Foundations of
Skills & Concepts
Chapter 28
NURSING CARE
AND THE OLDER
CLIENT
Gerontology

The study of the effects of normal aging
and age-related diseases on human
beings.
Demographic Profile of Older
Adult Population
Clinical delineation is 65 years of age or
older.
 Older-old adults are 85 or older.
 By the year 2030, the number of older
adults in the United States will reach 70.2
million.

Characteristics of the Older
Adult Population
Rapidly growing.
 Although many stereotypes and myths
are associated with aging, elders are in
fact very diverse in their characteristics.

Stereotyping Older Adults

Health professionals must be diligent in
avoiding age prejudice, as believing
stereotypes can influence interactions
between older adults and caregivers.
Major Theories of Aging:
Biological
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Somatic Mutation Theory (Changes associated with
aging are the result of decreased function and efficiency
of cells and organs)
Programmed Aging Theory (Genetic clock determines
speed of aging)
Cross-linkage, or Collagen, Theory (Loss of flexibility
results in diminished functional motility)
Immunity Theory (Diminishing of thymus results in
impaired immunologic function)
Stress Theory (Stress causes structural and chemical
changes that eventually result in irreversible tissue
damage).
Major Theories of Aging:
Psychosocial
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Activity Theory (Life satisfaction depends on
maintaining an involvement with life by developing new
interests, hobbies, roles, and relationships).
Disengagement Theory (Decreased interaction between
older person and others in the social system is
inevitable, mutual, and acceptable to both the individual
and society).
Continuity Theory (Successful methods used
throughout life for adapting and adjusting to life events
are repeated. Traits, habits, values, associations, and
goals remain stable, regardless of life changes).
Myths about Aging
Senility is a result of aging.
 Incontinence is a result of aging.
 Older adults are no longer interested in
sexuality.
 Most people spend their last years in
nursing homes.
 All elderly persons are financially
impoverished.

Realities of Aging
Dementia is disease-related, not agerelated.
 Incontinence is not present among all
aged.
 Sexuality is a lifelong need.
 10% to 40% of elderly in the U.S. may
spend some time in extended care
facilities.

Activities of Daily Living

Basic care activities that include:
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Mobility.
Bathing.
Hygiene.
Grooming.
Dressing.
Eating.
Toileting.
Exercise and the Older Adult
Research indicates that high-intensity,
progressive resistance training can
improve muscle strength and muscle size
in frail elderly clients.
 Exercise programs should be individually
planned and should take into account the
client’s general health status, physiologic
disorders (if present), physical
environment, and other factors.

Nutrition and the Older Adult
Elders must follow a balanced diet, often
with lowered intakes of sugar, caffeine,
and sodium.
 There are no universally accept dietary
guidelines specific to older adults.
 It is important that nurses be
knowledgeable about community services
designed to help older clients meet their
nutritional needs.

Strengths of Older Adults
Physiologic changes may result in losses,
causing impairments in communication,
vision and learning, mobility, cognition, or
psychosocial skills.
 The strengths of each individual (including
past coping skills) must be identified and
utilized when planning care.

Health Promotion and Disease
Prevention
Older adults must be alerted to means of
preventing disease and reducing risks.
 Being knowledgeable about self-care and
participating in screening tests are
important components of health
maintenance.

Polypharmacy

The problem of clients taking numerous
prescription and over-the-counter
medications for the same or various
disease processes, with unknown
consequences from the resulting
combination of chemical compounds and
cumulative side effects.
Physiologic Changes Associated
with Aging: Overview
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Respiratory System
Cardiovascular System
Gastrointestinal System
Reproductive System:
Female
Reproductive System:
Male
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Endocrine System
Musculoskeletal System
Integumentary System
Nervous System
Urinary System
Sensory Changes
Respiratory System: Changes
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Muscles of respiration
become less flexible.
Decrease in functional
capacity results in
dyspnea on exertion or
stress.
Effectiveness of cough
mechanism lessens,
increasing risk of lung
infection.
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Alveoli thicken and
decrease in number and
size.
Structural changes in the
skeleton can decrease
diaphragmatic
expansion.
Cardiovascular System:
Changes
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Cardiac output and
recovery time decline.
The heart requires more
time to return to normal
rate after a rate increase
in response to activity.
Heart rate slows.
Blood flow to all organs
decreases.
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Arterial elasticity
decreases, causing
increased rise in blood
pressure.
Veins dilate and
superficial vessels
become more prominent.
Gastrointestinal System:
Changes
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Tooth enamel thins.
Periodontal disease rate
increases.
Taste buds decrease in
number, and saliva
production diminishes.
Effectiveness of the gag
reflex lessens, resulting
in increased risk of
choking.
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Arterial elasticity
decreases, causing
increased rise in blood
pressure.
Veins dilate and
superficial vessels
become more prominent.
Reproductive System: Female:
Changes
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Estrogen production
decreases with onset of
menopause.
Ovaries, uterus, and
cervix decrease in size.
Vagina shortens,
narrows, becomes less
elastic; vaginal lining
thins.
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Supporting musculature
of the reproductive
organs weakens,
increasing risk of uterine
prolapse.
Breast tissue diminishes.
Libido and the need for
intimacy and
companionship in older
women remains
unchanged.
Reproductive System: Male:
Changes
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Testosterone production
decreases, resulting in
decreased size of
testicles.
Impotency may occur.
Although more time is
require to obtain
erection, the older man
often finds hat he and his
partner can enjoy longer
periods of lovemaking
prior to ejaculation.
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Prostate gland may
enlarge.
Libido and need for
intimacy and
companionship remain
unchanged in older
males.
Sperm count and
viscosity of seminal fluid
decrease.
Endocrine System: Changes
Alterations occur in both the reception
and the production of hormones.
 Release of insulin by the beta cells of the
pancreas slows, causing an increase in
blood sugar.
 Thyroid changes may lower the basal
metabolic rate.
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Musculoskeletal System:
Changes
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Muscle mass and elasticity diminish, resulting in
decreased strength, endurance, coordination, and
increased reaction time.
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Bone demineralization occurs, causing skeletal
instability and shrinking of intervertebral disks.
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Joints undergo degenerative changes, resulting in
stiffness, pain, and loss of range of motion.
Integumentary System:
Changes (i)
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Subcutaneous tissue and elastin fibers diminish,
causing skin to become thinner and less elastic.
Hyperpigmentation or liver spots.
Diminished secretions and moisturization.
Body temperature regulation diminishes.
Capillary blood flow decreases, resulting in slower
wound healing.
Blood flow decreases, especially to lower extremities.
Integumentary System:
Changes (ii)
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Vascular fragility causes senile purpura.
Cutaneous sensitivity to pressure and temperature
diminishes.
Melanin production decreases, causing gray-white hair.
Scalp, pubic, and axillary hair tin, and women display
increased facial hair.
Nail growth slows, nails become more brittle, and
longitudinal nail ridges form.
Nervous System: Changes
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Neurons in the brain
decrease in number.
Cerebral blood flow and
oxygen utilization
decrease.
Time required to carry
out motor and sensory
tasks requiring speed,
coordination, balance,
and fine-motor hand
movements increases.
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Short-term memory may
somewhat diminish
without much change in
long-term memory.
Night sleep disturbances
occur due to more
frequent and longer
wakeful periods.
Deep-tendon reflexes
decrease, although
reflexes at the knees
remain fairly intact.
Dementia
An organic brain pathology characterized
by losses in intellectual functioning.
 The clinical manifestations associated
with dementia are never considered
normal aging changes.
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Urinary System: Changes
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Nephrons in the kidneys
decrease in number and
function.
Glomerular filtration
decreases.
Blood urea nitrogen
increases.
Sodium-conserving
ability diminishes.
Bladder capacity
decreases.
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Renal function increases
when the older client lies
down.
Bladder and perineal
muscles weaken.
Incidence of stress
incontinence increases in
older females.
Prostate may enlarge in
older males, causing
urinary frequency and
dribbling.
Sensory Changes: Vision
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The lens becomes less
pliable and less able to
increase its curvature in
order to focus on near
objects.
Accommodation of pupil
size decreases, resulting
in both decreased
adjustment to changes in
lighting and decreased
ability to tolerate glare.
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Vitreous humor changes
in consistency, causing
blurred vision.
Lacrimal glands secrete
less fluids, causing
dryness and itching.
Lens yellows, causing
distorted color
perception.
Sensory Changes: Hearing
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The pinna becomes less flexible, hair cells in
inner ear stiffen and atrophy, and cerumen
(earwax) increases.
Number of neutrons in the cochlea decrease
and blood supply lessens, causing
degeneration.
Presbycusis, the impairment of hearing in older
adults, is often accompanied by a loss of tone
discrimination.
Financing Elder Care in the
21st Century
Medicare
 Medicaid
 Omnibus Budget Reconciliation Act
 Balanced Budget Act of 1997
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