GERONTOLOGY: THE AGING ADULT

Introduction: Age Categories

3. Activities of Daily Living (ADLs)

• ADLs:

  • Basic activities which most older adults can perform include eating, dressing, walking, and bathing.B&C

• Instrumental Activities of Daily Living (IADLs):

  • Tasks that are more complex, typically become increasingly difficult with age. Examples include managing finances, sustaining household duties, shopping, preparing and serving meals.

Gerontology

Key Points

4.Nursing in the 21st Century

• Baby Boomers (1946–1964) are reaching age 65+

• More people are living 85–100+ years

• Healthcare demand is increasing

Why it matters

More older adults =
➡ more chronic illness
➡ more long-term care needs
➡ more nursing involvement required

5. Common Changes in Aging

Key Points

As people age, the body slows down — physically, mentally, and emotionally.

Physical & Functional Decline

• ↓ Organ function

• ↓ Reaction time

• ↓ Tactile sensation (less sensitive to touch/pain)

• ↓ Wound healing & recovery

• ↓ Vision & hearing

• ↓ Balance & coordination

• Stiff joints / unsteady gait

These changes increase fall risk and injury risk.

Effects of Aging on Body Systems

• The slide lists major body systems affected by aging.
  You will see details later, but right now the goal is to recognize them.

  Body Systems Impacted:

  🟦 Physical Systems

  • Integumentary (skin)

  • Musculoskeletal

  • Nervous

  • Cardiovascular

  • Respiratory

  • Gastrointestinal

  • Urinary

  • Endocrine

  • Immune

  • Reproductive (male & female)

  🟦 Sensory

  • Eyes

  • Ears

  • Other senses ↓ with age

  📌 Nursing Importance:

  Aging affects every system, so assessment must be head-to-toe w/ extra caution.

8. Musculoskeletal System Changes

• Kyphosis (postural changes)
  Forward curvature of spine → causes hunched posture

• Sarcopenia
  Loss of muscle mass + strength → weakness, falls

• Additional effects to keep in mind:

  • ↓ Bone density → osteoporosis risk ↑

  • ↓ Mobility + slower gait

  • Joint stiffness & pain more common

  • Increased fall + fracture risk+

Geriatric Care Settings #1

Factors that determine living/residential placement:

1. Recovery time (acute/chronic illness)

2. Ability to care for self (ADLs, IADLs)

3. Financial + physical self-support

4. Family support availability

5. Access to healthcare & rehab

6. Need for protection/supervision

Why this matters in nursing:

• Helps determine best care environment

• Guides discharge planning

• Prevents unsafe home return

🧠 Think: Living placement depends on ABILITY + SUPPORT + HEALTH NEEDS

Geriatric Care Settings #2

Types of Care Settings for Older Adults:

✔ Home care

• Care delivered in client’s residence

• Best when client is mostly independent but needs support

✔ Senior centers

• Social interaction, meals, activities, respite care

✔ Resident housing / Apartments

• Independent living with safety & community support

✔ Long-term care options (higher need):

1. Assisted-living facility
   → For those who cannot perform ALL IADLs but still can do most ADLs

2. Rehabilitative care facility
   → Short-term recovery after illness/injury

3. Long-term care facility (LTC)
   → For chronic illness, high support & supervision

4. Subacute care facility
   → Higher level of medical care than LTC, but not ICU-level

11. Helping the Older Adult Meet Basic Needs

Why some older adults need assistance:

Aging brings cumulative losses, affecting:

• Physical ability (mobility, strength, senses)

• Financial stability

• Emotional coping

• Social support

Nursing Responsibilities:

✔ Identify changes in needs early
✔ Adjust care and environment to support independence
✔ Understand each client is UNIQUE — no single plan fits all

Important Concept:

Nutritional Needs #1

What nurses must evaluate when assessing nutrition:

A good assessment asks:
Can they get food? Can they prepare it? Can they eat it safely?

Nutritional Needs #2

Special considerations in elderly nutrition:

📌 Nurses should assess chewing ability & swallowing before diet changes.
📌 Thickened liquids or soft foods may be needed for safety.

🧠 Key idea:

Medication Administration

Age-related changes affecting medication use:

Toxicity risk ↑ especially with kidney or liver decline.

Personal Hygiene Needs

Areas requiring nursing support:

• Skin care → fragile, dry, easily injured

• Oral hygiene → denture care, prevents infection

• Hair care → self-esteem + dignity

• Nail & foot care → diabetic foot risk, poor circulation

• Shaving & grooming → dignity + comfort

• Clothing needs → adaptive or easy-fastening clothes help independence

🧠 Why this matters:

Regular hygiene assessments help detect early decline.

Elimination Needs

Common elimination problems in older adults:

• Constipation

• Bladder or bowel incontinence

• Difficulty voiding

Why these issues happen:

• ↓ GI motility + fluid intake

• ↓ mobility + weakened pelvic muscles

• Medications → many cause constipation

• Enlarged prostate in males → urinary difficulty

Nursing Priorities:

• Monitor bowel pattern

• Encourage fluids & fiber

• Promote mobility

• Assess continence & provide toileting schedule

Mental Health Concerns #1

1) Anxiety

Older adults may experience anxiety due to:

• Loss of health and independence

• Loss of home, routine, familiarity

• Loss of family, partner, social connections

Behavioral signs:

• Withdrawal

• Confusion

• Irritability / combative behavior

• Maladaptive coping (agitation, anger, refusal of care)

2) Depression

Often related to cumulative losses over time.

Risk factors include:

• Chemical imbalance

• Dehydration

• Poor nutrition

• Financial stress

• Death of spouse/loved ones/pets

• Chronic or debilitating illness

• Medication side effects

• Lack of exercise

• Alcohol/drug misuse

🧠 Key point:

Mental Health Concerns #2

3) Substance Abuse

May develop due to:

• Loneliness

• Depression

• Low self-worth / purpose

• Polypharmacy → high risk of med interactions

• Can be hidden easily when patient lives alone

🧠 Red flag:

Emotional and Psychological Support

Nursing interventions to support mental well-being:

🧠 Summary line:

Communication

Age-related communication challenges:

📌 Nursing Strategies:

• Face the patient, speak CLEAR + SLOW

• Use glasses/hearing aids if available

• Avoid high-pitch speech — use lower tone

• Use written communication if needed

🧠 Memory cue:

Safety #1

Key Concept: Proprioception

Age-related change:

Loss of proprioception = ↓ balance control.

Example from slide:
Older adults may lose balance when looking up at a clock or high shelf.

Nursing Action:

• Let client hold your arm gently when walking

• Do NOT push or pull them

• Avoid quick turns or sudden movements

🧠 Fall prevention is priority — always.

— Safety #2

Safety Devices

Used in home or healthcare settings to prevent injury.

Restraints = last resort

🧠 NCLEX high-value sentence:

Physical Activity and Exercise

MOST recommended exercise for older adults:

💠 Walking

Benefits of exercise:

Risks of inactivity:

• Kyphosis

• Osteoporosis

• Contractures

• Pressure injuries

• Constipation

• Renal + pulmonary complications

• Cardiovascular disorders

• Depression + social isolation

🧠 Quick recall:

Sexuality

Key points:

✔ Older adults often maintain sexual desire + capability
✔ Physical changes may require adaptation, not abstinence
✔ Affection (touch, intimacy, closeness) remains important
✔ Sexual expression supports emotional well-being, connection, identity

Nursing attitude:

• Never assume sexual inactivity

• Encourage open discussion without judgement

• Respect privacy, dignity, relationships

🧠 Key concept:

Elder Abuse #1

Elder abuse includes:

• Physical, emotional, sexual abuse

• Financial exploitation

• Neglect (physical or emotional)

• Violation of rights, property, freedom

Higher risk in:

• Adults who are oldest-old (80+)

• Depend on caregivers

• Cognitively impaired

• Physically disabled

• Socially isolated

Most common abusers:

Caregivers — often family members or those close to the patient.

🧠 Easy recall:

Elder Abuse #2

Signs & Symptoms of Elder Abuse:

Additional red flags:

• No or irregular healthcare visits

• Client appears fearful or guarded around caregiver

• Senior talks less about self + avoids eye contact

• Unexplained weight loss or poor self-care

🧠 Big NCLEX takeaway: