Comprehensive Nursing Report: Aging Process, Care for Elderly Patients

This report provides a comprehensive overview of the aging process and its associated complexities, focusing on the nursing care required for elderly patients. It begins by outlining the predictable changes that occur with age, encompassing psychological, emotional, physical, social, and cognitive aspects. The report emphasizes the importance of assessing each patient's unique needs and planning care based on their individual responses to these changes. It delves into various age-related issues, including chronic infections, alcohol withdrawal, sensory and neurological changes (vision, hearing), and cardiovascular and musculoskeletal changes. Furthermore, it highlights the significance of cognitive assessments, particularly in relation to dementia and mild neurocognitive disorders. The report also addresses fall risk factors, malnutrition, and changes in the gastrointestinal, hepatic, respiratory, and renal systems. It emphasizes the role of behavioral and psychological factors in determining health outcomes and the importance of social support. The report integrates relevant research and scholarly insights, including the importance of an interdisciplinary approach to care planning and implementation, and the range of services available to older people across the continuum of care. The case of Mr. Jungala is used to illustrate the practical application of these concepts, including assessment, planning, and intervention strategies.

Running head: AGING PROCESS
Student name
Student No.
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Title: Care for the Elderly and the Aging Process

AGING PROCESS
From the day one is conceived, they undergo a predictable growth and development
with specific needs. The aging people face expected age related changes. According to
Lazarus and Harridge (2018), these changes could be psychological, emotional, physical
changes, social changes, predictable developmental changes and cognitive. The process of
aging is accompanied by controlled and synchronized psychological changes and
performances over one’s lifetime. Many people associate the aging process with onset of
diseases. Researcher and scholars claim that these diseases are influenced and linked with
changes in the lifestyle activities among the old. These lifestyle activities may include change
in diet, reduced exercise and physical inactivity (Hoppner and Urban, 2018). The aging
people react to the changes they are experiencing in different ways, with some of these
changes leading to health and adaptive responses, while other changes could be maladaptive,
unhealthy and dysfunctional. It is therefore necessary that nurses access all clients according
to their age related changes and also plan their care based on their reactions and responses the
changes expected as they age.
The first stage at age intervention is accessing the old person so as to come up with
quality care plan sensitive to their needs. According to the National Institute on Aging
(2018), advanced age is a risk factor for different chronic infections. Especially in cases
where one is alcoholic, one could also be prone to different infections and situations. For the
case of Mr. Jungala, who got injured after falling, led to injuries. The falling could have been
because he was drunk. As per the description given about Jungala, he drinks almost 3 times a
weak. The nurses should therefore carry out an assessment to determine if the falling was out
of his drunkenness. Researchers claim that alcohol withdrawal lead to complications which
demand for a lot of health care resources. They also associate alcohol withdrawal with
increases mortality and morbidity. According to a research on alcohol withdrawal risk
assessment conducted by Knight and Lappalainen (2017) factors such as clinical setting of

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withdrawal and the individual characteristics influence how one is affected by the alcohol,
with withdrawal seizures (WS) being thought to occur at the range of 6 to 15 percent and
delirium tremens (DT) occurring at the range of 4 to 15 percent. Knight and Lappalainen
(2017) claim that withdrawal seizures occur between 5 and 10 percent of alcoholics.
Considering the case of Jungala, who has been taking alcohol for sometime, higher rates
could be observed.
There are different complexities associated with aging. Sensory and neurological
changes include reduced heating, vision, sense of smell and touch and also night blindness.
According to Elsawy and Higgings (2014), glaucoma, cataracts, muscular degeneration,
presbyopia and diabetic retinopathy are the leading causes of vision impairment among the
elderly. Presbycusis is among the leading chronic condition among the old in the many
nations (especially the United States). In the United States the elderly are periodically
screened for any hearing defects as a way of maintaining quality health care among the
elderly. Aging is associated with cardiac changes like reduced stroke volume, cardiac output
and venous return. The aging experience changes in their musculoskeletal systems. This
includes decrease in muscular strength, bones and joints degeneration, the intervertebral
space increases (leads to loss of height among the old) and decrease in muscular tone. The
elderly have challenges with their renal functioning (Guo et al. 2017). These challenges may
include decrease in blood supply to the renal parts, tubular and glomerular functioning
decrease, changes in creatinine clearance and the renal size.
Most importantly, for the care of Jungala, cognitive assessment is important. Estrada-
Orozco et al. (2018) think that cognitive heath of a great concern as people age especially due
to the comorbidities that come with aging. Dementia is an increasing burden for people aged
above 65 years. As one ages, there are changes that occur in their cognitive domain whereby
most of them might go unnoticed especially when the changes are small and the

AGING PROCESS
environmental demands for the elderly are small. Other changes, however, force one to
generate strategies and corrective measures to compensate for the faults observed in one’s
life. Cognitive disorders are classified as mild neurocognitive disorder when the effect on the
brain functionality is not so much that the individual faces difficulties as they undertake their
day to day activities. Major Neurocognitive disorder is when one’s functionality, including
their social, family and work life are affected. Mild neurocognitive disorder is thought to
affect more than 20 percent of adults aged 65 years and above and almost 25 percent of these
with mild cognitive disorder suffer from major cognitive disorder after 3 years of diagnosis.
Prince et al (2015) claim that there are a range of factors that lead to progression of mild
cognitive disorder to major cognitive disorder. They also claim that most of these factors are
modifiable. Diagnosis of cognitive disorders should be done at early stages as most of its
causes can be reverse. Some of its causes include excess alcohol, depression, sleep disorders,
deficiency of some vitamins and thyroid diseases. Mr. Jungala was a drunkard (though not
stated how much he could take), had stress about her daughter and also being an Aboriginal,
who are prone to chronic infections, needed this assessment.
Falls are very common among aging people leading to injuries and accounting for 4
percent hospital admission and 14 percent emergency admissions for the old. Phelan,
Mahoney, Voit and Stevens (2014) think that approximately 30 to 40 percent of the older
people fall every year. According to Mathers et al. (2015) fall among the older people could
lead to acute diseases, chronic infections like Parkinson’s disease and also affect the person’s
interaction with the environment. Fall is a threat the older people as it affects the quality of
their lives, their self care ability and also causes decline in their involvement in social and
physical activities. Due to the pains Mr. Jungala was experiencing he is unable to take part in
any social or physical activities. When assessing fall, nurses categorize fall risk factors as
either extrinsic or intrinsic. Extrinsic fall risk factors are external to a person while intrinsic

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risk factors originate within the individual. The individual factors could include age related
changes, cognitive deficits, lack of balance or strength, chronic conditions, acute illness or
personal behaviours. Environmental of extrinsic factors could include medications, footwear,
neighbourhood features and under the influence of drugs. Mr. Jungala’s fall could not be as a
result of cognitive problems or any other intrinsic factor. According to his record, he was
under some medication and he was also a drunkard. These two could be the cause of his fall.
We are told (from the context) that he tripped on kid’s tonka trunk the he fall. This also could
be the primary cause of his fall with drunkenness and these medications being secondary
causes of is fall.
Older people with chronic and acute infections seek medical care services have
problems with their functionality. Muszalik, Kornatowaski, Zielinska-Wieczwska, Kedziora-
Kornatowska and Dijkstra (2015) think that the aged people have increased health issues
which reduce their functional efficiency. This calls for a thorough understanding of the
psychological, medical and social needs of the elderly so as to plan for their care. According
to Muszalik et al. (2015) there is an undergoing research on medical science to come up with
methods to assess the functional needs and performance of the elderly generation. The
psychometric tool is the recent invention used to assess the health needs of the elderly.
Malnutrition is common among the older people, currently affecting 16 percent of
those aged less than 65 years and 2 percent of older people aged above 65. Malnutrition
among the elderly has been associated with impaired muscle activity, reduced bone mass,
poor immunity, anaemia, poor healing of wounds, increased readmission rates, increased
mortality and anaemia. As people age, they experience changes in their gastrointestinal tract.
Chronic infections such as diabetes (which Jungala has) has effects on the intestines. Caloric
reduction and esophageal mortality can lead to neuronal loss which in turn affects the gut

AGING PROCESS
system. Older people have reduced gastric acid secretion. For the case of Jungala, being
diabetic, he was under strict diabetes medication and nutrition.
Normal aging process affects the liver functioning. The blood flow to the liver and its
functioning are reduced, affecting the hepatic metabolism which could result to accumulation
of chemicals in the body. The elderly are faced with some skin challenges such as loss of skin
turgor, the skin becomes more fragile, hair and skin becomes dry, the skin loses its elasticity
and starts thinning, thickening of nails, reduced activity of sweat glands and nasal and ear
hair thickens (Williams, 2015). The elderly experience changes in their respiratory systems,
which include decreased air exchange rates, the mucus membranes become more fragile and
dry, the expansion and contraction rates of the lungs decrease, diminished cough reflex and
the efficiency of the body immunity decreases, putting one at a greater risk of respiratory
infections. The elderly are faced with changes in electrolytic and fluid balance. This is
associated with reduced action of the hormones that control these fluids and electrolytes,
urine becomes more dilute, change in body water and intracellular fluids.
As stated earlier, older people have got issues with their sight. Vision problems
among the elderly could be as a result of age related muscular degeneration (AMD) which
affects the macula. AMD leads to difficulties in tasks such as writing, identifying colors and
reading. The risk factors for AMD are family history, smoking, race and age. As one ages,
their eye lenses lose their flexibility and are covered by cloudy areas. In this situation one is
said to have cataracts (Gentry, Synder, Barstow and Hamson-Utley, 2018).. One starts to
develop poor vision, night blindness and poor identification of colours. Cataracts are
estimated to be prevalent among elderly people above 72 years. This defect could be solved
through a lens replacement surgery. Diabetic retinopathy is as a result of damage blood
vessels serving the retina among diabetic individuals. The blood vessels leak fluid or bleed
and could lead to permanent blindness if not treated. Its symptoms include involuntary

AGING PROCESS
movements of the eye and double vision. At early stages one is required to control their blood
glucose level but laser treatments are required at advanced stages. Other eye related defects
include glaucoma, dry eye syndrome and low vision. Though not stated if Jungala had issues
with his vision, being diabetic puts him at a risk of diabetic retinopathy. This could be the
cause of his fall or contributed to the fall.
According to the National Institute of Aging (2018), behavioral and psychological
factors play a big role in determining one’s health in their life time. Researchers claim that
more than 50 percent of the deaths among the elderly can be prevented by changing the
people’s lifestyles such as smoking which lead to complications like obesity. Social and
socioeconomic factors also affect the health and well-being of the elderly, such as loneliness.
Research on behavioural, social and biological science has brought light in to the people’s
understanding about healthy aging (Williams, 2015). Behavioural science has come up with
insights on social and psychological factors that promote and/ or confer health and adaptive
aging. However according to Rabie and Klopper (2015) the old people require high quality
health care. These people are unable to conduct self-care hence decreasing the quality of their
lives. Improving the quality of care for the elderly improves their quality of life and prevents
self neglect. Social support is also important in maintaining a normal living for the old,
especially when living alone. According to Jangala, he has sufficient support from his family
and friends and therefore social support is not a problem to him.
According to Rowe et al. (2016), there are different considerations to make when
caring for the old regardless of whether the care is at home or in a hospital setting. When
caring for the old, one should realize that the amount of care on one depends on physical
conditions and how old one is, as a person gets more old, there needs become more complex.
It is unfortunate that most of the old people claim that their needs are not met by those caring
for them. This is because these carers do not take time to observe and learn the behaviours of

AGING PROCESS
the old, their needs and what exactly is needed of them. According to researchers most
elderly people do not receive the care they deserve, creating a big gap which the nurses and
care givers must fill. Just like any other person, the elderly have their basic inner needs, but
for their case it is more (Bouchard, Blair & Katzmarzyk, 2015). The care givers must realize
that the old people have the same rights as anyone else, they are entitled to good health care
and freedom. However, caring for the old people especially providing personal care could be
challenging.
The leading challenges in the care for the old people is lack of good management of
Medicare expenditures according to the MedPAC (2014). Effective management must
include the older person, health care providers and family carers. All these parties should
collaborate to identify the goals and needs of the old person, come up with an individualized
care plan that can attain quality health care and also work together to implement this health
care plan. Sometimes the care providers can use evidence based approaches in management
of the health care though these models have been accused of being slow and sporadic.
Different researchers have come up with different and effective ways to enhance and promote
delivery of care services to the old but implementation and dissemination of these approaches
has been faced by challenges such as lack of funding.
The transitional care model is a nurse coordinated care model that was developed to
focus on community based elderly people with multiple chronic conditions. Several trials on
this model at different hospitals showed improvements in the health, quality of health
outcomes and also in the patient’s experiences as pertains their care, although the cost of care
was high (Rosset, 2018). The Interventions to Reduce Acute care Transfer (INTERACT) is a
program than involves decision support, quality improvement tools, variety of
communication and advanced care plan, designed focusing on nursing home care givers to
help reduce rehospitalization of residents. This program was tested in a nursing home where

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it was discovered that it reduced the number of rehospitalizations by 25 percent in a saved
more than $ 117 000.
According to Gutierrez, da Siva and Shimizu (2014) the management of the elderly
care has been a subject of discussion among researchers and health care professionals. The
elderly need assessment in their biopsychological need so as to prevent occurrence of adverse
health outcomes. According to Frankel and Quill (2017) the only better way to understand the
biopsychological approach in caring for the elderly is seeing it in action especially in a
hospital setting. The elderly, due to their multifaceted and complex needs, most of them have
affected uniquely by their environment, disease and aging process. This is the reason these
people need skilled, knowledgeable sensitive, positively motivated and respectful nurses to
care for them (Attaallah, Klymko and Hopp, 2016). The nurses are very essential in providing
care for the elderly. They help promote and ensure optimum health care is delivered and also
examine and detect any problems in the client’s health and health care procedures. They also
help prevent more complications in the health of the elderly and deterioration of the
conditions of the infection. The nurse has to plan, identify needs implement and evaluate the
care plan. The nurse needs to access the patient’s mental, physical and cognitive skills so as
to understand and be aware of the complication even before the start of the care process
(Brunner-La Rocca et al. 2016). They also have to understand the patient’s mental status and
if the patient has ever had any chronic health complications.

AGING PROCESS
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