Gerontological NursingA. Principles of Gerontology

B. Nutrition and Aging

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Gerontology and Geriatrics

• The terms are not interchangeable!• Gerontology is concerned with the social, psychological,

and biological aspects of aging.• Geriatrics is the study of disease in the elderly.

3Geriatrics

• First proposed as a distinct specialty in 1909 by Dr. Ignatz Nascher when he viewed aging as a physiological process and not mere deterioration.

• Geriatrics is concerned with the decline of major body systems in the elderly.

• A geriatric specialist treats disease in the elderly client and attempts to decrease the effects of aging on the body.

4Gerontology

• Developed into an organized field in the 1940s.• Acknowledged that there exist experts in the elderly in

many fields and findings must be integrated. • Studying the physical, mental and social changes in people

as they age• Study of physical process of aging• Study of the effects of the aging population on society and

the effects of society on the elderly• Identification of appropriate treatment and management of

the elderly

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History of Gerontological Nursing

“You must not treat a young child as you would a grown person, nor would you treat an old person as you would one in the prime of life.”

…“Relation of old age to disease…” American Journal of Nursing, 1904

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Historical Influences

• 1935: Federal Old Age Insurance Law• 1961: ANA recommends formation of geriatric nursing

specialty• 1966: Geriatric Nursing Division of ANA formed• 1970: Publication of Standards for Geriatric Nursing

Practice• 1975: Certification of first nurses in Gerontological

Nursing

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Principles of Gerontological Nursing Practice

• Aging is a natural process• Various factors influence the aging process• Nursing of the elderly requires unique information and

skills• There are common needs shared by the elderly and all

ages• Gerontological nursing’s goal is to promote optimum

levels of physical, psychological, social and spiritual health

Competent nursing of the elderly patient

• Holistic: incorporate physical, mental, emotional, and spiritual well being

• Use every opportunity to offer suggestions for healthy aging

• Include health promotion

in every plan of care of the

elderly patient• Close the gap between “life span”

and “healthy life span”

Benefits of healthy aging

• Increased creativity and confidence• Increased coping ability• Increased gratitude and appreciation• Increased insight and acceptance

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Role of the ANA inGerontological Nursing Care

• Responsible for defining scope and standards of nursing practice

• Established the Division of Geriatric Nursing Practice in 1966 with the goal of creating standards for quality nursing care for the elderly

• Changed the name to Division of Gerontological Nursing Practice in 1976

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The Aging Population

• Persons older than 65 comprise 12% of the US population

• Increasing life expectancy• 20% of the population will be older than 65 by 2020

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Subsets of the Elderly

• Young-old: 65 to 74 years

• Old: 75 to 84 years

• Old-old: 85 to 100 years

• Elite old: over 100 years

13The Baby Boomers

• Born between 1946 and 1964• Most have children, but fewer in number• Best educated generation yet• Higher income• Favor more casual

dress• Enjoy technology• Less leisure time• Interest in health

and fitness

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Accomplishments of Old Age

• Adequate nutrition• Maintaining safety• Preserving body’s normal

functions• Meeting and coping with

crises• Adapting to change• Learning new skills

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Recognizing Inner Resources of the Elderly

• Promotes normalcy, independence and individuality

• Reduces risks associated with dependency, e.g., failure to thrive

• Recognizes individual attributes of wisdom, experience and competence

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Associated Costs and Funding

• In 2005, long term health care accounted for 12% of all healthcare expenditure

• 70% of this figure was covered by Medicaid and Medicare

• 18% was paid by patients and families

17Myths of Aging

• “Old” means being sick• Older people cannot learn new information• Health promotion is wasted on older people• The elderly do not pull their own

weight• It is too late to change bad habits

in the elderly• Older people have no interest

in sex

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Common Characteristics of Centenarians (1)

• Biocognitive Theory (Mario Martinez)• Absence of envy• Live in the present, being optimistic about the present and

the future• No sense of aging, don’t tell their age (prevents being

“pegged”)• Usually underweight, not obese• Active• No concept of retirement or middle age, no marker for

biology to follow

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Common Characteristics of Centenarians (2)

• Rarely seek medical advice unless complaint is significant

• Usually die by accident or in sleep…death is peaceful and without lamenting

• Low protein, high complex carbohydrate diet• Live in subcultures that revere the elderly• Drink alcohol prudently, not addictively• There are no atheists, a belief in a benign, not wrathful,

power

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Common Characteristics of Centenarians (3)

• Longevity in the family is not a requirement• Definite sense of humor• Forgive easily• They are negotiators• Have commitment to community, a sense of service• Fearless about life’s challenges• Believe they are loveable

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Value of Theories of Aging

• Insight into understanding the process of aging• Promote aging in a healthy fashion• Postpone or minimize negative effects• Emphasis is not on prolonging life• Goal is to• Keep the client healthy• Keep the client active• Maximize quality of life

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Biological Theories of Aging

• Biological theories attempt to explain these variations:• Rate of aging

varies between

individuals• There is variation

in rates of aging

within one

individual

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Genetic Theories of Aging

• Premise: life expectancy is inherited due to a genetic program

• Cellular theory—senescence takes place at the cellular level

• Error theory—decline is caused

by genetic mutations within

each organ• Failure of a growth substance

or excessive production of an

aging substance

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Psychosocial Theories of Aging

• These theories integrate an individual’s• Mental capacities• Methods of behavior• Personal feelings• Coping mechanisms• Values, attitudes and beliefs

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Disengagement Theory

• Society and the individual mutually agree to withdraw from one another

• The individual is free to become introspective• Society enjoys the benefit of transferring power and

resources to the

young and continues

Is this a “win-win” on an ice floe?

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Disengagement theory problems…

“I don’t want to!”

27Activity Theory

• “Longevity through denial”• Perpetuating the middle-age

lifestyle• Maintaining an active life

while adjusting for biological

change• Gradually substitute mental

activities for physical ones

28Continuity Theory

• AKA Developmental

Theory• “PNC”—people never

change• Recognizes the unique

qualities of each

individual• Those qualities guide

the individual through the

aging process and adaptation to

change

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Developmental Tasks Theory

• Specific tasks must be completed in each stage of life before moving on successfully

• If successful, the person

finds meaning in each

stage and in life as a whole

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Developmental Tasks Throughout the Lifespan

• Coping with loss and change• Establishing meaningful roles• Exercising independence and

control• Finding purpose and meaning

in life

31Major Tasks of the Elderly(Robert Butler and Myrna Lewis)

• Adjustment to infirmities• Satisfaction with the life lived• Preparation for death

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Specific Challenges of the Elderly(Robert Peck)

• Ego differentiation vs role preoccupation• Body transcendence vs body preoccupation• Ego transcendence vs ego preoccupation

All contribute to the effectiveness of completing ego integrity vs despair

33Nutrition and aging

• Nutritional needs change as the individual ages• Failure to adjust nutrition accordingly can contribute to

the aging process

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Reduced calorie need in the older adult

• Less lean body mass and

increased adipose tissue• BMR declines 2% for each

decade of life• Activity level

usually declines

with age

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Dehydration risk factors

• Age related physical changes: decreased total body water due to less lean body mass

• Reduced access to fluids• Fear of incontinence and nocturia• Increased insensitive fluid loss

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Specific threats to Hydration

• Reduced intracellular fluid with age• Reduced margin of safety• Minimum 1500 mL per day• Reduced thirst sensation• Fear of incontinence• Decreased availability of fluid• Physical impairment• Altered mood or cognition• GI distress

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Signs of early Dehydration

• Patient may present with altered mental status, lethargy, syncope

• Mild dehydration: decreased skin turgor, dry mucous membranes, orthostatic hypotension

• Symptoms consistent with mild dehydration may exist in patients who are

normally hydrated

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Advanced dehydration

• Dark urine with decreased output• Confusion, lethargy• Headache, light-headedness• Eyes sunken• Dry mucous membranes and

axillae• Furrows in tongue• Postural changes in vital signs

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Tufts University MyPlate for older adults

• Dark green vegetables, colorful vegetables, dried beans—2 ½ cups every day

• Fresh, frozen, dried, canned fruits—

1 ½ cups every day• Grains—6 ounces every day• Protein foods—5 ounces every day• Dairy—3 cups every day

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Tufts additions to traditional food guide

• Acknowledges the possible need for supplements

• Includes physical activity as part

of daily routine

• Water is included

• Recommendations for protein unchanged

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Role of protein in the diet of the elderly client

• Sarcopenia—age related loss of muscle mass, strength, and function

• Protein breakdown exceed

protein synthesis as the

body ages• RDA is unchanged:

0.8g/kg body weight

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Dietary supplements—nursing considerations

• Some elderly clients take supplements for nonconventional reasons

• Clotting is affected by fish oils, garlic, ginseng, ginko biloba, baby aspirin

• Quality and content of many supplements are neither regulated nor standardized

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Body measurements (anthropometrics)

• Weight—unintentional loss of 5% in 1 month or 10% in 6 months is significant

• Height• Body mass index = (weight in pounds x 703)

(height in inches)2

44Nutritional history

• Use of Mini Nutritional Assessment (MNA)• “Tell me what you ate yesterday.”• Risk factors:• Inability to feed oneself• Chewing, swallowing problems, mouth pain• Changes in taste• Leaves > 25% food uneaten at most meals

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Strategies to improve nutrition--1

• Indigestion, food intolerance—client may chose to use antacids or limit food intake• Have several small meals instead of 3 large ones• Avoid fried foods• Remain in high Fowler’s position for at least

30 minutes• Adequate fluid for motility promotion

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Strategies to improve nutrition--2

• Anorexia• Identify the cause• High calorie diet• Referral to social programs• Psychological/psychiatric

referral• Weight loss > 5% in 1 month

and >10% in 6 months is

significant

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Potential causes of anorexia

• Polypharmacy• Pain• Dysphagia• Dependency• Cognitive impairment

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Strategies to improve nutrition--3

• Dysphagia• Careful swallowing assessment• Sit in upright position• Allow sufficient time to eat• No residual food in mouth before

taking additional food• Small portions• Suction machine available• Thickened liquids

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Strategies to improve nutrition--4

• Constipation• Fluids• Fruits, vegetables• Activity• Increase fiber intake cautiously• Consider laxatives only when other methods are

unsuccessful

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Nursing diagnoses--nutrition

• Imbalanced nutrition—more/less than body requirements (also, “Risk for”)

• Impaired swallowing; Risk for aspiration• Excess/deficient fluid volume

(also, “Risk for”)• Failure to thrive (adult)• Impaired skin integrity

(also, “Risk for”)