Gerontological Changes & Care

Gerontology: Scope & Definitions

• Gerontology = multidisciplinary study of the aging process and the health problems of older adults.
• Gerontological nursing (RN, APRN, NP) focuses on clinical care, prevention, health promotion and holistic support of older adults.
• Aging is continuous: begins at conception/birth → ends at death.
• Chronological age ≠ functional/biological age. Some people are “good 70,” others “bad 70” depending on comorbidities & lifestyle.
• Health-care delivery is shifting from hospital → community because >50\% of U.S. Medicare dollars are spent in the last year of life.

Ageism, Stereotypes & Myths

• Ageism = discriminatory assumptions based solely on age.
  • Legal note: U.S. protection begins at \ge 40; no protection for being “too young.”
• Common stereotypes (mostly false):
  • All elders are frail, forgetful, incontinent, lonely, tech-illiterate, financially dependent, uninterested in change.
  • Reality: <10\% of older adults have Alzheimer’s; many remain active, creative, financially secure.
  • Neuroplasticity persists → new learning remains possible.
• Trick-test alert: Forgetfulness & incontinence are not normal/inevitable parts of aging.

Theories of Aging

• Stochastic (wear-and-tear): Random cumulative DNA damage leads to cellular/tissue aging.
• Evolutionary: ↓ evolutionary pressure after reproductive years → harmful mutations accumulate.
• (Mentioned sarcastically/non-sarcastically in lecture; other theories exist but not detailed.)

Biological System Changes

Nervous System & Cognition

• Brain volume ↓ (neuronal atrophy, larger ventricles).
• Nerve conduction ↓ → slower reflexes/reaction, ↑ risk dizziness/falls.
• Intelligence & problem solving remain, recall may be slower.
• Driving: slower reactions offset by greater experience.

Respiratory

• Respiratory muscles weaken; ↓ alveoli number & cilia action.
• Outcome: ↓ gas exchange, ↑ pneumonia risk.

Cardiovascular

• Myocardial & vessel stiffening → ↓ stroke volume, ↓ cardiac output.
• ↓ max HR, ↑ arrhythmia risk, prolonged recovery after exertion.
• Peripheral vascular resistance ↑; veins dilate → venous stasis, edema.
• Postural hypotension common; managed by slow position changes.
• Incidence heart-failure rises sharply with age (>90 y.o. without HF is rare).

Renal / Urinary

• Kidney size, nephron number & GFR ↓.
• Bladder capacity & muscle tone ↓, incomplete emptying → ↑ UTIs.
• Aging kidney ↓ water conservation + ↓ thirst sensation → dehydration risk.
• BPH prevalence climbs with age; ≈85\% of men by 90 y.o.

Musculoskeletal

• Starting ≈35 y.o.: sarcopenia (muscle mass ↓ each decade) & slower healing.
• Osteoporosis risk ↑, especially post-menopausal women (estrogen ↓).

Vision

• Presbyopia (farsightedness) universal; cataracts & macular degeneration common.
• Periorbital tissue laxity, ↓ tears → dry eyes.

Hearing

• Skin elasticity ↓; ossicle & cochlear degeneration.
• Presbycusis: high-frequency loss; hearing aids amplify all sounds (speech + background noise).

Endocrine & Metabolic

• ↓ Basal metabolic rate, ↓ thyroid function → ↑ hypothyroidism prevalence.
• Pancreas: ↓ insulin production + ↑ insulin resistance → ↑ type 2 diabetes risk.
• Male: gradual testosterone ↓ ("andropause") affects muscle, energy, libido.
• Female: estrogen ↓ (peri-/post-menopause) → bone loss, CV risk shift.

Psychosocial Development (Erikson)

• Late adulthood task: Integrity vs Despair.
  • Integrity → wisdom, acceptance, life satisfaction.
  • Despair → bitterness, regret, unfulfilled feeling.
• “Season of losses”: friends, spouse, siblings may die → loneliness & grief.
• Adaptation varies; resilience, flexibility & coping strategies critical.

Functional Assessment

• ADLs: bathing, dressing, toileting, transferring, eating, continence.
• IADLs: shopping, cooking, cleaning, managing meds & money, transport, phone.
• Determines need for support services, rehab, home care vs institution.

Pharmacology & Polypharmacy

• 44\% of men & 57\% of women ≥65 take \ge5 Rx/OTC meds weekly.
• Age-related changes:
  • ↓ hepatic & renal blood flow → ↓ clearance.
  • Altered distribution (↓ lean mass, ↑ fat, ↓ plasma proteins).
• Dosing considerations: e.g., Acetaminophen max 4000\,\text{mg/day} adults → 2000\,\text{mg/day} elders.
• Risk factors for adverse drug reactions (ADR): number of meds, high doses, severity of illness, poor adherence.
• ADR cues: restlessness, falls, confusion, memory loss, incontinence.
• Role of primary care/provider continuity: regular med reconciliation & deprescribing.

Ethical, Financial & Societal Points

• U.S. life expectancy declined post-COVID; reflects chronic-disease, lifestyle & social issues.
• Caring for elders is costly; prevention & community-based care are priorities.
• Some cultures venerate elders; U.S. often undervalues them.
• Financial reality: many elders possess pensions/assets, contradicting dependency myth.

Key Nursing Actions & Exam Pearls

• Combat ageism; treat each elder individually.
• Expect slowed responses—not cognitive loss—unless pathology present.
• Manage orthostatic hypotension by gradual position changes.
• Screen for BPH, UTIs, dehydration, vision/hearing deficits.
• Evaluate ADLs/IADLs for discharge planning.
• Monitor renal/hepatic function before adjusting meds; use lower doses when indicated.
• Watch for polypharmacy & ADR signs; coordinate with prescribers.
• Reinforce Erikson’s Integrity vs Despair concepts for psychosocial questions.
• Remember that forgetfulness, incontinence, & isolation are not inevitable—investigate underlying causes.