Seminar

On
Nursing Assessment – History
and Physical Assessment.
Ageing; Demography; Myths
and Realities.

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INTRODUCTION
 The term geriatric comes from the Greek words “geras,” meaning old age, and “iatro,”
meaning relating to medical treatment. Thus, geriatrics is the medical specialty that deals with
the physiology of aging and with the diagnosis and treatment of diseases affecting older adults.
Geriatrics, by definition, focuses on abnormal conditions and the medical treatment of these
conditions

In terms of age the word old is often used for those who are over 65 years of age.
However, the older age group is often divided into the young old (age 65-74), the middle old
(age 75-84) and the very old, or frail elderly (age 85 and above).

Obviously, these numbers provide merely a guideline and do not actually or clearly define a
true picture of the various strata of the aging population.

Differences certainly exist in individuals between biological aging and chronological aging, and
between the physical and emotional or social aspects of aging.

WHAT IS GERIATRIC ASSESSMENT?

A geriatric assessment is a comprehensive evaluation designed to optimize an older person's

ability to enjoy good health, improve their overall quality of life, reduce the need for
hospitalization and/or institutionalization, and enable them to live independently for as long as
possible.

An assessment consists of the following steps:

1. An examination of the older person's current status in terms of:

 their physical, mental, and psycho-social health.

 their ability to function well and independently perform the basic activities Often of
daily living such as dressing, bathing, can preparing meals medication management, etc
 their living arrangements, their social network, and their access to support services.

2. An identification of current problems or anticipated future problems in any of these areas.

3. The development of a comprehensive 'Care Plan’ which addresses all problems identified,
suggests specific interventions or actions required, and makes specific recommendations
regarding resources needed to provide the necessary support services.

4. The management of a successful linkage between these resources and the older person and
that person's family so that provision of the necessary services is assured.
5. An ongoing monitoring of the extent to which this linkage has, or has not. addressed the
problems identified, and the modification of the Care Plan as needed.

NURSING ASSESSMENT

The history and physical examination is the foundation of the medical treatment plan. The
interplay between the physiology of aging and pathologic conditions more common the aged
complications and delays diagnosis and appropriate intervention, often with disastrous
consequences

History
General considerations

The history may take more time because of sensory or cognitive impairment or simply because
an older patient has had time to accrue numerous details. Several sessions may be required.

The patient may be recognized as the primary source of information. If doubts arise about the
accuracy, other sources should be contacted with due respect paid to the sensitivities and
confidentiality of the patient. When interviewing the patient and caregiver together, ask
questions first to the patient, then to the caregiver.

If the patient's response to initial questions is inappropriate, turn to the mental status exam
immediately

Thepatient should be dressed and seated. The physician should also be seated and facing the
patient at eye level, speaking clearly with good lip movement. If the patient is severely hearing
impaired and an amplifier is not available, write questions in large print.

Use honorifics(i.e, Mr, Mrs, Miss, or Ms.) unless the patient specifically requests you to do
otherwise.

Areas requiring special emphasis

Function- pay attention to deficits in basic and instrumental activities of daily living (ADL).
Prepare to assess those systems in the physical examination, looking for reversible conditions
that could upgrade function, eg: treatment of arthritis to improve dressing capability

Medications: polypharmacy and excessive dosages are common causes of iatrogenic illness. A
“paper bag” test is often useful to explore this possibility, i.e., ask the patient or caregiver to
gather all medications into a paper bag and bring it to the office visit. Be sure to include over-
the counter (OTC) preparations.

Review of systems – cardiovascular illness is the major cause of death in older adults and these
systems should be investigated thoroughly. Of particular importance also are: weight change
and gastrointestinal symptoms, headache ( temporal arthritis), dizziness and falls, sleep
pattern, sensory impairment, constipation and other changes in bowel habits ( colon cancer),
urinary pattern and incontinence, sexual dysfunction, depression, cognitive impairment,
transient paralysis, paresthesia or visual changes ( transient ischemic attack), musculoskeletal
stiffness or pain ( osteoarthritisor polymyalgia rheumatica)

Social history: assessment of lifestyle, affect, cognition, function, values, health beliefs, cultural
factors and caregiver issues is also important. Consultation with a social worker in obtaining this
information and adapting the care plan is often critical but the initial identification of need for
such consultation is part of the primary care evaluation . a home visit is often very valuable.

Nutritional history – performing the basic nutritional assessment will identify patients at risk of
malnutrition and in need of referral for diabetic consultation

PHYSICAL EXAMINATION
GENERAL CONSIDERATIONS
Limit the time the patient is in the supine position as this may cause back pain for persons with
osteoarthritis or khyphosis and shortness of breath for those with cardiopulmonary disease-
having several pillows on hand for these patients will be greatly appreciated

Multiple sessions may be required for a complete physical exam due to patient fatigue. While
they are important, the rectal and pelvic exams may be deferred to a later session, if not
urgently required.

Areas requiring special emphasis

General observation and vital signs

Check :

a. Signs of ADL deficits, poor hygiene, disheveled appearance

b. Rectal temperature if patient is seriously ill because of blunted immune response
c. Orthostatic changes in blood pressure and pulse
d. Osler’s maneuver if systolic BP is greater than 160 to screen for “pseudohypertension” –
positive if radial artery is palpable with cuff inflated above systolic BP level
 e. Weight
f. Signs of malnutrition or trauma
g. Skin – neoplasm, nipple retraction, peau d’ orange

HEENT – visual acuity, lens exam for cataracts, fundoscopy ( glaucoma. Hypertension, diabetic
retinopathy), visual fields, extraocular movements ( stroke).

a. Gross auditory acuity, otoscopy to determine possible reversible causes of hearing loss
and disequilibrium ( cerumen impaction, serous otitis media, ruptured tympanic
membrane)
b. Inspect the mouth after removal of dentures to assess conditions that may after
nutrition ( neoplasm, stomatitis, oral health,adequacy of dentures)
c. Palpate temporal artery for tenderness, thickening or nodularity in the patient
complaining of headaches.

Neck

a. Dix- Hallpike positional test maneuver for benign positional vertigo

b. Jugular venous pulseis better observed on the right side since compression of the left
innominate vein by an elongated aortic arch may cause false distension on the left.

Cardiovascular

a. PMI may be displaced by kyphoscoliosis, so palpation is less reliable to determine

cardiomegaly. Atrial and ventricular arrhythmias are common. Systolic murmurs are
frequently present and most are due to benign aortic sclerosis. Symptoms, risk of
morbidity and special characteristics that suggest aortic stenosis or endocarditis
should guide evaluation. Diastolic murmurs are always important, as are right and
left ventricular S3 gallops.
b. Signs of arterial insufficiency (hair loss, bruits, decreased pulses) and venous
disease (stasis skin changes and edema) are common. Arterial ulcers present distally
with claudication and ischemia while venous ulcers present painlessly and are
usually located near the medial malleoli. Most peripheral edema is venous
insufficiency not congestive heart failure (CHF) although the latter is common and
 should be ruled out. (The effects of diuretics on perfusion and electrolyte balance
usually outweigh cosmetic benefit.)

b. Lungs-Age-related changes in pulmonary physiology and age-associated pulmonary

pathology often result in rales that may not indicate pneumonia or pulmonary
edema. For this reason, it is important to document a baseline exam at a time when
the patient is not ill. Localized wheezes may indicate an obstructing bronchial lesion
(carcinoma).

c. Breast exam--Tumors may be easier to palpate because of atrophy and less

fibrocystic disease. Remember, men may have gynecomastia or malignancy.

Abdomen

a. Patients who are unable to lie flat (kyphoscoliosis or cardiopulmonary disease)

may give the impression of distension. This phenomenon and commonly occurring
pulmonary hyperaeration may cause the liver edge to be palpable below the costal
margin without hepatomegaly. This must be assessed by percussion.

b. Peritoneal signs may be blunted or absent in frail elderly patients .

c. Palpation will assess urinary retention (bladder can be percussed also) or aortic
aneurysm. Ventral, inguinal and femoral hernias should be checked for reducibility.
The sigmoid colon will often be palpable and a fecal impaction may present as a left
lower quadrant mass.

Extremities
 Arthritis (rheumatoid, degenerative and crystalline), deformities, contractures, injuries,
podiatric care, poor hygiene all increase the risk of pain, infection and gait disturbances.
Although basic gait assessment adds little time to the examination, it yields information that
has impact on independent function and guides consultation with rehabilitation professionals .
Invest in a good pair of nail clippers. Do not hesitate to comment on style and fit of shoes or to
refer to a podiatrist.

Rectal

Assess for diseases of the prostate, fecal impaction, integrity of sacral reflexes in
persons with impotence, spinal stenosis or posterior column findings, hemoccult.

Pelvic examination

Assess for pelvic prolapse, uterine, adnexal or vaginal neoplasm, infections, estrogen deficit.
The lithotomy position may produce discomfort in the osteoarthritic patient. An alternative is
the left lateral decubitus position with the right hip flexed more than the left. Pap smears
should be done in elderly women, but the recommended frequency is debated.

d. Speculum examination may be painful and difficult due to atrophic changes and
vaginal stenosis. A pediatric speculum is often necessary and, occasionally, the
examination is so difficult that gynecologic consultation is indicated.

Neurological

a. Mental status examination should be performed in all patients to establish a

baseline in the event of future dysfunction . This need not occur in the first session.
b. Deep tendon reflexes and vibratory sense may be decreased normally.
c. Deficits of language, coordination and other subtle focal findings may indicate
cerebrovascular disease that is responsible for cognitive impairment or deficits in
instrumental ADL's.
d. Extrapyramidal signs (muscle rigidity, tremor) may indicate either adverse effects
of neuroleptic medication or Parkinson's disease. In most instances, intention
 tremor and some resting tremors are benign conditions. Unilateral tremors may
indicate stroke. A resting tremor with a "pill-rolling" character is worrisome as is any
tremor that impairs function.

The physical assessment of elderly people is done under the following heads:

Skin and Hair

Assessment procedure Normal findings Abnormal findings

Inspect and palpate skin Lentigenes: hyper Mole that bleeds or has
lesions. Wear gloves when pigmentation in sun exposed changed in shape or color or
palpating lesions. Note area appear brown, with a diameter wider than a
whether lesions are flar or pigmented, round or pencil eraser
raised, palpable or non rectangular patches. Often
palpable. Also note colour, called liver spots
size. and exudates, if any Irregularly shaped lesion or
Venous lakes – reddish scaly, elevated
vascular lesions on ears or lesions( squamous cell
other facial areas resulting carcinoma)
from dilation of small red
blood vessels
Waxy or raised lesion,
Skin tags – acrochordans, especially on sun- exposed
flesh-colored pedunculated areas
lesion ( basal cell carcinoma)

Large vesicles or bulla

Seborrheic Keratosis- tan , overlying erythema, pruritic
brown, or reddish flat lesions
commonly found on fair-
skinned persons in sun
exposed areas. Herpes Zoster vesicles
( shingles ) draining clear fluid
Cherry Angiomas: small, or pustules atop an
round red spots erythematous base following
a clear linear patern and
accompanied by pain.
 Ring worm
Senile Purpura : vivid purple ( dermatormycosis): reddish
patches( lesions should bot rings with vesicles and scaling
blanch to touch )
Note color, texture integrity, Somewhat pale, transparent Torn skin ( possibly the result
and moisture of skin and skin with an overall decrease of abrasive tape used to hold
sensitivity to heat and cold. in body hair on lower bandages or tubes in place)
extremities is normal. Dry skin
is common

Extremely thin, fragile skin

Skin may wrinkle and tent with excessive purpura
when pinched ( possibly from cortico steroid
use )
Dry warm skin, furrowed
tongue, and sunken eyes from
dehydration.
Inspect and palpate hair and Thinning and graying of scalp. Patchy or asymmetric hair loss
scalp Some women have mild hair is abnormal
growth in upper lip

HEAD AND NECK

Assessment procedure Normal findings abnormal findings

Inspect head and neck for Atrophy of facial and neck Asymmetry of mouth or eyes
symmetry and movement. muscles possibly from Bell’s palsy or
Observe facial expression CVA
Reduced range of motion of
head and neck Marked limitation of
movement or crepitation in
back of neck from cervical
Shortening of neck due to arthritis
vertebral degeneration and
development of buffalo hump Involuntary facial or head
at top of cervical vertebrae movement from and extra
pyramidal disorders as
parkinsonism

THROAT AND MOUTH

Assessment procedure Normal findings Abnormal findings
Inspect the gums and buccal Decreased salivary gland Saliva decreasing medications
mucosa for color and secretion is commonly seen in include antihistamines,
consistency the elderly. Gums and mucosa antipsycotics,
should be pink without antihypertensives
swelling, bleeding, or lesions.
Resorption of gums ridge Foul smelling breath may
commonly results in poorly indicate periodontal disease
fitting dentures.
Whitish or yellow tinged
patches in mouth or throat
may be candidiasis
Examine the tongue observe Tongue should be pink and A swollen, red, painful tongue
symmetry and size moist indicates vitamin B or
riboflavin deficiency
Observe the client swallowing A mild decrease in swallowing Coughing, drooling, pocketing,
food or fluids ability is normal or spitting out food after
intake are all possible signs of
dysphasia
Depress the posterior third of Slightly sluggish in some older Absence of gag reflex may be
the tongue, and note gag adults the result of a neurologic
reflex disorder and indicates the
need to be alert for signs of
aspiration pneumonia

NOSE AND SINUSES

Assessment procedure Normal findings Abnormal findings

Inspect the nose for color and Nose and nasal passages are Edema, redness, swelling, or
consistency inflamed, and skin and clear drainage, which may
mucous membranes are intact indicate allergies or rhinitis
Evaluate the sense of smell. Slightly diminished sense of Client reports feelings of
Have the client close the eyes smell and ability to detect inadequate breath intake,
and smell a common odours which may result from nasal
substance, such as mint, polyps, a deviated septum or
lemon, or soap allergic or infective phinitis
Palpation : palpate the frontal Area is free of lesions and Client reports pain and
and maxillary sinuses for pain dryness, inflammation is
consistency and to elicit evident
possible pain
EYES AND VISION

Assessment procedure Normal findings Abnormal findings

Inspect eyes, eyelids, The skin around the eyes Eyelids that droop downwards
eyelashes, and conjunctive feels thin, and wrinkles and do not shut completely
appear normal according to suggest ectropion
the age
Eyelids close easily, and Eyelids that turn inward may
eyelashes turn outward cause eyelashes to rub against
the eyeball and suggest
entropion
Client may have some dryness Abnormalities in blinking may
resulting from diminished tear result from parkinson’s
production that occurs with disease
aging Dull, blank starring may be a
sign of hypothyroidism
Inspect the cornea and lens An arcus senilus, a cloudy or A yellowish or brownish
grayish ring around the iris, discoloration of the lens is
and decreased pigment in iris usually a cataract
are age related changes
Inspect the pupils with a Overall decrease in size of An irregular shaped pupil may
penlight or similar device, test pupil and ability to dilate in indicate removal of a cataract.
papillary reaction to light dark and constrict in light may Asymmetric response may be
occur resulting in poorer night due to neurologic condition
vision and decreased
tolerance to glare
Test vision: ask the client to Impaired near vision is A significant decrease in
read from a newspaper. Use indicative of presbyopia, a central vision to the extent
on;y roomlight for initial common finding in older needed for daily activities may
reading adults. Also slight difference signal a cataract. Macular
in peripheral vision and degeneration, difficulty in
difficulty in differentiating seeing with one eye, diabetic
blues and greens retinopathy, noticeable loss of
vision, including cloudiness

Ear and hearing

Assessment procedure Normal findings Abnormal findings

Inspect the external ear. Hair may become coarser and Inflammation, drainage, or
Observe for shape, color, and thicker in the external ear, swelling may be there from
hair growth. Also look for especially in men. Ear lobes infection
lesion or drainage may be pendulous
Perform an otoscopic Cerumen accumulation Hard dark brown cerumen
examination to determine increases signals impaction. A darkened
quantity, color and hole in the tympanum, or
consistency of cerumen patches indicates perforation
Perform voice whisper test The inability to hear high
frequency sounds or to
discriminate a variety of
simultaneous sounds,
presbycusis, degeneration of
hair cells in inner ear.

Thorax and Lungs

Assessment procedure Normal findings Abnormal findings

Inspect shape od thorax. Note Increase in normal respiratory Respiratory rate exceeding 25
respiratory rate, rhythm, and rate of 16-25, increased breaths/ min. pulmonary
quality of breathing reliance on diaphragmatic infection
breathing and increased effort
in breathing. Anatomic
changes in costal cartilage,
respiratory muscles and lung
tissues
Percussion: percuss lung Normal sound as in adults Consolidation of infection will
tones as you would do in cause dullness to percussion
younger adults
Auscultation: auscultate lung Vesicular sounds should be Rales and rhonchi: pulmonary
sounds heard in overall areas of gas edema, pneumonia, or
exchange restrictive disorders.
Diminished breath sounds,
wheezes, crackles, rhonchi:
consolidation caused by
pneumonia

Heart and blood vessels

Assessment procedure Normal findings Abnormal findings

Blood pressure : take blood BP increases as elasticity More than 10mm hg drop in
pressure to detect actual or decreases in arteries with systolic and diastolic pressure
potential orthostatic proportionate greater and an increase in heart rate
hypotension and therefore increase in systolic pressure of 20beats /min: orthostatic
the risk of falling. hypotension
Exercise tolerance: evaluate Maximal heart rate with Rise in ppulse rate 20 beats/
either by reviewing results of exercise is less than in a min and which doesn’t return
stress testing or by observing younger adult to baseline within 2 min:
the client’s ability to move Rise in pulse should be no exercise intolerance
from a sitting to standing greater than 10 to 20
position breaths/min. pulse rate
should return to the baseline
rate within 2 min
Pulse : determine the Proximal pulses may be easier Insufficient or absent pulses:
adequancy of blood flow by to palpate due to loss of arterial insufficiency
palpating the arterial pulses in supporting surrounding tissue
all locations.
No unusual sound should be A bruit is abnormal: high risk
Arteries and veins: auscultate heard. of CVA with coronary
the carotid, abdominal, and embolism
femoral arteries
Evaluate arterial and venous Aching or pain not particularly
sufficiency of extremities: associated with activity is
elevate the legs above the characteristic of venous
heart level and observe for insufficiency. Arterial ulcers
color, temperature and size of are usually at ends of toes and
the legs, and skin integrity are often round and covered
with black eschar and with
very little drainage. Venous
ulcers are irregularly shaped
wound edges located on the
medial aspect of the leg.
Diffuse erythema. Cellulites
Inspect and palpate vein in Prominent bulging is common Unilateral warmth,
standing position tenderness, and swelling may
be indications of
thrombophlebitis
Still: without heaves. Heaves : right or left,
Heart: inspect and palpate Thrills: visible palpable ventricular aneurysm. Thrill:
precordium pulsation aortic, pulmonary stenosis
Auscultate heart sounds Extra heart sounds: S3, S4 : fluid overload of heart
calcification of valves, fibrotic failure, aortic stenosis, MI
change in the heart muscles

Abdomen
Assessment procedure Normal findings Abnormal findings
Nutritional status : measure Antral cells and intestinal villi Malnutrition: weight less than
and record height, weight. atrophy and gastric 80 percent of ideal weight. 10
Note changes and problems production of HCl decreases percent loss in body weight
with swallowing or chewing over past six months or 5
percent loss over oone month
hb< 12g/dl. Voitamin B12
level < 100 microgram/ml
Review lab values: 24 hour Poor nutrition: serum
food and fluid diary noting cholesterol <160mg/l, serum
albumin< 3.5gldl
Assess GI motility and 5-30 sounds/ min are heard Absence of bowel sounds
auscultate bowel sounds
Inspect and percuss abdomen Liver, pancrease, kidneys Anorexia, abdominal pain,
normally decrease in size impaired protein digestion,
gastritis, peptic ulcer
Abdominal distention
cramping, diarrhea lactose
intolerance, bruits over aorta
– aneurysm
Palpate the bladder Empty bladder is not palpable Distended bladder with
or perusable associated small volume uribe
loss: overflow incontinence

Genitalia

Assessment procedure Normal findings Abnormal findings

Inspect external genitalia Pubic hair is usually sparse Redness, swelling of urethral
and labia are flattened meatus, infection
Ask the patient to cough in
lithotomy position Leakage – stress incontinence
Wome: test for prolapse No prolapsed, vaginal Malignancy, vulvar dystrophy,
pelvic examination secretions white clear UTI
odourless
Men : incpect in standing Pubic hair thinner. Scrotal skin Scrotal oedema, masses or
position: observe and palpate slightly dark. No swelling bulges
for inguinal swelling or bulges bulges

Anus, rectum

Assessment procedure Normal findings Abnormal findings

 Inspect the anus and rectum Anus is darker than Lesions, swelling and bleeding
surrounding skin
Palpate the anus and rectum No masses Palpation on internal masses:
haemorrhoids, rectal
prolapsed, cancer

PHYSICAL ASSESSMENT OF ELDERLY PATIENTS

Name :

Age :

Gender :

Education :

Occupation:

Marital status:

Diagnosis:

HEALTH ASSESSMENT : SYSTEM WISE

1. HEAD and SCALP: dandruff/dry/scaly
2. FACE: anxious/ dull/depressed
3. EYES: vision/eye discharge
4. EARS: hearing acquity/wax impaction
5. MOUTH: bad smell/stomatitis/no. of teeth
6. NECK: gland enlargement/lymph node palpable
7. CHEST: chest expansion equal/breathing/dyspnoea
8. ABDOMEN: scar/shape/distended
9. EXTREMITIES: range of motion/walking aids/gait/coordination/temos/balance

Respiratory System
 Inspection: Chest movement/use of accessory muscles/shape-barrel/pigeon
Palpation: Tracheal midline/deviated fremitus
Percussion: Breathing sounds/dullness
Auscultation: Wheeze/rhonchi/rales adventurous sounds

Cardiovascular system
1. Inspection: Cynosis/capillary refill
2. Auscultation: S1 S2/gallop
3. Palpation: Peripheral pulses palpable/varicosities
4. Percussion: Dullness

Gastro-Intestinal System
Inspection: Scars/distention/shape/hernia
Auscultation: Bowel sounds present/absent
Palpation: Organomegaly/tenderness
Percussion: Dullness/free fluid/ascites

Neurological System
1. Consciousness/unconsciousness/oriented
2. Memory/loss of memory/recent/normal
3. Confusion/disoriented/dementia

Cranial Nerves Examination

1. Vision: Uses glasses/normal/cataract/presbyopia/ glaucoma/blurring/diplopic/pupil-

reactive non reactive
2. Smell: Present/anosmia
3. Taste: Present/differentiate/absent
4. Face: Symmetrical
5. Hearing: Normal/deafness/hearing aid/presbyausis
6. Neck: Stiffness/normal
7. Sensation: Present/absent / paresthesia
Motor System
1. Gait: Normal/unsteady
2. Coordination: Tremors/ataxia/normal
3. Relfex: Biceps.....+/-
a. Triceps.....+/-
b. Quadriceps.....+/-
c. Babinski ... +/-

Musculo Skeletal System

1. Spine abnormalities: Scoliosis/lordosis/kyposis
2. Flexion, extension: Normal/absent

Genito-Urinary System
1. Bladder distention: Present/absent
2. Urine: Dysuria/nocturia/polyuria/incontinence
3. Prostate: Normal/enlarged
4. Menstrual bleeding: Present/menopause/absent
5. Leukorrhea: Present/absent
6. Elimination: Bowel incontinence/constipation

Integumentary
1. Skin colour: Fair/moderate/dark
2. Turgor/texture: Wrinkle/dry/moist
3. Hair: Hypo pigmentation/loss of hair/baldness
4. Ails: Brittle/koilonychias/paranychia

Activities of daily living

Daily functional abilities

1. Eating: Feeding self/assisted feeding
2. Dressing: Self/needs assistance
3. Bathing : self/needs assiatance/ sponge: self/others
4. Toileting: needs assiatance/self
5. Nutrition: loss of weight/ overweight/ loss of appetite/ normal
 6. Assistive device: crutches/walker/wheel chair/ hearing aids

Social history
Vocation : currently employed/retired/ duration of retirement

Habits and life style

Exercise: walking/ weight bearing exercise / no exercise

Sleep : insomnia/ normal/ interrupted/duration/ day or night

Sleep pills: yes or no

Tobacco: cigarette/ beedi/ others

Alcohol: yes or no / daily/ weekly/ occasionally

History of falls : yes or no

Health care coverage: government insurance/ private policies

Social network
Relationship: relationship with spouse/living alone/ separated

Religious involvement: spends most of the limit/ limited time

Living environment: living alone/ staying at old age home/ paying guest

AGEING

Aging, the normal process of time-related change, begins with birth and continues
throughout life. The older segment of the American population is growing more rapidly than
the rest of the population: the U.S. Census Bureau projects that by the year 2030, there will be
more people older than 65 years of age (22%) than people younger than 18 years of age (21%) .
As the older population increases, the number of people who live to be very old will also
increase. Health professionals will be challenged to design strategies that address the higher
prevalence of illness within this aging population. Many chronic conditions commonly found
among older people can be managed, limited, and even prevented. Older people are more
likely to maintain good health and functional independence if appropriate community-based
support services are available

DEMOGRAPHY

According to the National Center for Health Statistics, life expectancy, the average
number of years that a person can be expected to live, has risen dramatically over the past
century. In 1900, the average life expectancy was 47.3 years, but by 1998 that figure had
increased to 76.7 years. According to data from the National Vital Statistics System, in 1998 a
75-year old man could be expected to live until the age of 85, and a 75-year old woman could
be expected to live until the age of 87 (National Center for Health Statistics, 2000). By 2030,
people older than 65 years of age will account for 22% of the population, compared with 13% in
2001. More than 70% of elders receive most of their care from informal caregivers. Because
many of the baby boomers (those born between 1940 and 1960) tended to have children later
in life, these children will face the competing demands of caring for their aging parents while
caring for their own dependent children (Spillman, 2001). Although most older adults enjoy
good health, in national surveys as many as 40% of adults age 65 and older report disability.
Chronic disease is the major cause of disability, and heart disease, cancer, and stroke continued
to be the three most significant causes of death in persons 65 years of age and older in the
United States between 1980 and 1998. Alzheimer's disease accounted for almost 44,000 deaths
in 1999 (National Center for Health Statistics, 2000).

HEALTH CARE COSTS OF AGING

There are serious concerns about whether there will be sufficient health services
available as more and more persons in the United States become eligible for publicly funded
health programs. The two major health programs in the United States are Medicare and
Medicaid, both of which are overseen by the Centers for Medicaid and Medicare Services
(CMS), formerly the Health Care Financing Administration (HCFA). Medicare is funded by the
Federal government, whereas Medicaid is funded jointly by the Federal and state governments
to provide health care for the poor. Medicaid is the dominant public payer of nursing home
costs. Eligibility and costs for these services vary from state to state. Medicare funding covered
32% of the costs of hospital services and 22% of the costs of physician services in the United
States in 1998. Nursing home care, in contrast, was financed primarily by Medicaid (46%) and
out-of-pocket payments (33% ) (National Center for Health Statistics, 2000).
 MYTHS AND REALITIES

Americans view aging as a dreaded time of life. When we think about aging we focus on
poor health. We worry about running out of money. We fear loneliness and death. We see
birthdays as something to dread, not celebrate. We worry about being ,over the hill or,old and
senile. We turn down job applicants who are >too old. And we scoff at older adults who are in
love

The negative beliefs and stereotypes we have about older adults are a form of prejudice
called ageism. Ageism is very common in America. Like other forms of prejudice, ageism hurts
both individuals and society. Ageism prevents people from reaching, or maintaining their full
potential.

This fact sheet describes some of the prejudices our society has about aging. Ten of the
most common myths of aging are explored. A description of what is really true follows each
myth.

Myth #1 Senility is a Normal Part of Aging

Getting a little forgetful is a normal part of aging. It is normal to forget to stop for milk at
the store, or to forget someone's name. It is not normal to become so forgetful that it is
impossible to manage the tasks of everyday life.

Senility, or dementia as it is more commonly called today is a severe form of memory

loss. It is not normal. There are a variety of causes of dementia. Some dementias are more
severe than others. Some can even be reversed. Malnutrition, depression, dehydration, and
drug interactions can all lead to dementia. Depression can be treated with talk therapy or
medication, and the dementia from depression may be reversed. Once the person receives
proper nutrition and or adequate liquids, the dementia may lift. Physicians should always be
informed of all medications a person is taking to avoid the dementia that can result from bad
combinations of drugs.
 More severe and long-term forms of dementia are caused by diseases such as
Parkinson's, Creutzfeldt Jakobs, strokes, or brain injuries. Alzheimer's disease is the most
common kind of dementia and causes severe memory loss and confusion.

Alzheimer's disease creates physical changes in the brain that lead to severe dementia.
People with Alzheimer's disease eventually fail to recognize their own family members. They
even fail to recognize themselves. There is no cure for Alzheimer's disease and the cause is still
unknown. But, Alzheimer's is not a normal part of aging. Researchers estimate that about 4
million older adults have Alzheimer's disease. That means that 31 million older adults do not
have Alzheimer's disease. It is true that the risk of developing Alzheimer's increases with age.
Nearly one in three people over the age of 85 is a victim of Alzheimer's disease. Becoming old
and senile is a myth. Alzheimer's is not a normal part of aging.

Myth #2 Most old people are alone and lonely.

This is not true at all! Friends and family are very important in the lives of older adults.
In fact, the number of close friends remains relatively stable throughout life. It's true, the
number of casual friends may decrease, but the number of close friends stays the same. People
who have many close friends throughout life continue to have many close friends as they age.
Those who have only a small circle of friendships earlier in life, keep a small circle of friends
later on.

Families remain close even in the later years. In fact, 80% of parents over the age of 65 see at
least one of their adult children every 1 to 2 weeks. More than half of older parents have seen
an adult child within the past 24 hours. Over 50% of all older adults live within a 10-minute
drive of one or more of their grown children.

Grandparents also have frequent interactions with their grandchildren. Grandparent-

grandchildren contacts are often centered on a special event such as attending a birthday party
or school activity. Three out of four grandparents see their grandchildren at least every week or
two. Half see their grandchildren every few days.

Myth #3: Most old people are in poor health.

 Another myth of aging is that being old means being sick. Yes, physical changes occur
with age. Thinning hair and sagging skin are normal physical changes that happen with age.
Older adults have a higher risk of developing certain diseases. Arthritis, heart disease,
osteoporosis, diabetes, and cancer are more common among older adults than younger people.
But even when they have one of those diseases, older adults make changes in their lives so they
can remain independent. In general, older people describe themselves as pretty healthy. More
than two- thirds of people over 65 years of age told researchers that they are in good, very
good, or excellent health. More than half of those over 85 years of age said that they are in
good, very good, or excellent health

Myth #4: Old people are more likely to be victims of crime.

The notion that older people are "prisoners in their own homes" because they are afraid
of crime is a great exaggeration. In fact, older adults are less likely than younger people to be
robbed, assaulted, or raped. In spite of this reality, older adults are more fearful of crime. There
are good reasons to be afraid. Crime is a serious problem in many neighborhoods. In those
neighborhoods, everyone is at risk, not just older people. Many older adults are afraid because
they live alone in urban or inner city neighborhoods or are alone out on the farm or ranch.
Older adults fear they could not defend themselves because they are not as strong as an
attacker might be. They are afraid that they cannot run fast enough to get away safely. The
truth is that older adults are more at risk of crime at the hands of their family members or
caregivers than from strangers. Family members or caregivers may physically abuse or steal
from an older adult in their care.

Myth #5: Most older people live in poverty.

In 1959, one in three older adults lived in poverty. That is why the federal government
improved Social Security and strengthened the laws protecting private pensions. Medicare, and
programs for nutrition, housing, and transportation were also developed in the 1960s to help
older Americans. Those programs have been very successful in reducing poverty among the
elderly. Today only one in ten older adults lives in poverty.

Myth #6: Elders become more religious with age.

 Not true. The Lifetime Stability Theory predicts that people generally remain the same
throughout their lives. This simply means that if someone is religious during their early
adulthood, they will most likely be religious as older adults. They didn't more religious just
because they got older. They were always religious. The same applies to those who are not
religious. People who are not committed to religious practices throughout their lives are not
likely to become involved in religious activities simply because they are older. Research has
found a slight decrease in organized religious activities among older adults who were actively
involved in their religion in their younger years. Older adults may be less involved in religious
activities because of transportation problems such as difficulty driving at night. They may also
have problems getting into places of worship because of stairs. When they are not able to
attend and participate in religious activities, older adults find other ways to worship. They
spend more time reading, watching religious programs on television or listening to religious
programs on the radio.

Myth #7: Older workers are less productive than younger workers.

Employers know that this is simply not true. Nearly half of all American businesses
employ retired workers. Older employees produce high quality work. They draw on years of
experience to solve problems. Older workers are known to be highly motivated, are flexible
about work schedules, and have low rates of absenteeism. Given the opportunity, older
workers are excellent mentors for younger workers..

Myth #8: Retirees suffer decline in health and early death.

Thinking back on how retirement used to be it is easy to understand how this myth got
started. In fact, until recent years, this myth was really a fact. Early in the 20th century, life
expectancy was about 46 years. In 1900, an American male's life span included 8 years of
education, 32 years of work and just over one year of retirement. Today, with a life span of
nearly 74 years, an adult is more like to work a few more year-39 versus 32 years-but can
expect to spend nearly 14 years in retirement. Most of those years are spent in good health. In
fact, millions of people retire, take a few months or year off, and then return to the work force.
Others, who retire from stressful or dangerous jobs, find retirement a healthy choice. In the
early years of the 21st Century, older Americans can look forward to longer lives, more years
spent in retirement and better health than ever before.
Myth #9: Most old people have no interest in or capacity for sexual relations.
Just like many other aspects of life, sexual behavior in later life mirrors sexual behaviors
in young and middle adulthood. Researchers have found that good health, not age, is the key to
sexual relationships throughout life. The way older adults express sexuality may change over
the years. In later years, older adults may prefer touching and cuddling to maintain sexual
intimacy.

Myth #10: Most old people end up in nursing homes.

This is perhaps one of the greatest untruths about aging. Fears of aging and the media
continue to feed this untruth. The reality is that on any given day, only about 5% of older adults
are living in a nursing home, or long-term care facility. Nursing homes today are more likely to
be rehabilitation centers where people stay to recover from a stroke, heart attack, or fall. In
fact, 25% of older adults may temporarily move to a long-term care facility for rehabilitation.
They live in the nursing home for a short period of time-from a few days to a few months-and
then return home again. Currently, three out of every four Americans will never reside in a
nursing home. Older adults remain in their homes, in their communities. Their families and
friends, with the help of community services, provide the kinds of support they need to remain
at home.

CONCLUSION

Gerontology nursing or geriatric nursing specializes in the care of older or elderly adults.
Geriatric nursing addresses the physiological, developmental, psychological, socio-economic,
cultural, and spiritual needs of an aging individual.

As people age, they require more specialized care and attention to manage the various
health challenges they face. Since aging is a normal and fundamental part of life, providing
nursing care for elderly clients should not only be isolated to one field but is best given through
a collaborative effort that includes their family, community, and other health care team.
Through this, nurses may be able to use the expertise and resources of each team to improve
and maintain the quality of life of the elderly.
Geriatric nursing care planning centers on the aging process, promotion, restoration, and
optimization of health and functions; increased safety; prevention of illness and injury;
facilitation of healing.

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3. Dr. Kanniammal C, A textbook of medical and surgical nursing I, vita sta publications,
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