Understanding the Elderly

Old age (elderly) begins after retirement , usually between 65-75 years (Potter
& Perry, 2005).

Understanding the elderly (Seniors) is a phase of decreased ability to sense

and physical, which began with some changes in life. As where in the know, when
a person reaches adulthood, he has the capability of reproduction and childbirth.
When living conditions change, one will lose this task and function, and enter the
next, namely old age, then die. For normal human beings, who is the person, they
must be ready to accept new conditions in each phase of their life and try to adjust
to their environmental conditions (Darmojo, 2004 in Psychologymania, 2013).

B. Aging Process

The aging process is a natural process, natural and certainly will be

experienced by all people who are blessed with longevity (Nugroho, 2000).

Aging is normal, with physical changes and predictable behavior that

occurs in all people when they reach the age of a certain stage of chronological
development (Stanley and Patricia, 2006).

C. Aging Process Theory

The aging process theory according to Potter and Perry (2005) is as follows:
 Biological Theory
1. Free radical theory
Free radicals are examples of metabolic waste products that can cause
damage if accumulated. Normally free radicals will be destroyed by
protective enzymes, but some have escaped and accumulated in the organs
of the body. Free radicals found in the environment such as motor vehicles,
radiation, ultraviolet light, result in changes in pigment and collagen in the
aging process. Free radicals do not contain DNA. Therefore, free radicals
can cause genetic disorders and produce waste products that accumulate in
the nucleus and cytoplasm. When free radicals attack molecules, cell
membrane damage will occur; aging is thought to be due to accumulative
cell damage which ultimately disrupts function. Support for the theory of
 free radicals is found in lipofucin, a pigmented waste material rich in fat
and protein. The role of lipofucine in aging may be its ability to interfere
with cell transport and DNA replication. Lipofusin, which causes age spots,
is by oxidation products and therefore seems to be related to free radicals.
2. Cross-link theory
Cross-link theory and connective tissue state that collagen and elastin
molecules, components of connective tissue, form long compounds increase
cell regeneration, cross-linkage is thought to be due to chemical reactions
that cause compounds between normally separate loops (Ebersole & Hess,
1994 in Potter & Perry, 2005).
3. Immunological theory
Immunity theory is directly related to the aging process. During the aging
process, the immune system will also experience a setback in defense
against foreign organisms that enter the body so that in lamsia it will be
very young to experience infection and cancer. changes in the immune
system are caused by changes in lymphoid tissue so that there is no balance
in T cells to produce antibodies and decreased immunity. In the immune
system an autoimmune body will form. Changes that occur are the transfer
of the integrity of the body's system to fight the immune system itself.

 Psychosocial Theory
1. Theory of Disengagement
This theory describes the elderly h ole withdrawal from society's role and
responsibilities. The elderly will be said to be happy if social contact has
been reduced and responsibility has been taken by the younger generation.
The benefit of reducing social contact for the elderly is to be able to
provide time to reflect back on the achievements that have been
experienced and to face expectations that have not been achieved.
2. Activity Theory
This theory argues that if an elderly person leads to successful aging, he
must continue to move. The opportunity to play a role in a way that is
meaningful to the life of someone who is important to him is an important
component of well-being for the elderly. Research shows that the loss of
the role function of the elderly negatively affects life satisfaction, and
 continuous mental and physical activity will maintain health throughout
life.
3. Continuity Theory
Continuity theory tries to explain about the possible continuation of the
behaviors often do clients in adulthood. Life behaviors that endanger
health can last up to old age and will further reduce the quality of life.

D. Task for Elderly Development

According to Patricia Gonce Morton et al., 2011 the task of family development
is:
 Decide where and how to live for the rest of your life.
 Maintain supportive, intimate and satisfying relationships with life
partners, family and friends.
 Maintain an adequate and satisfying home environment related to
health and economic status
 Prepare adequate income
 Maintain maximum level of health
 Get comprehensive health and dental care
 Maintain personal hygiene
 Maintain adequate communication and contact with family and friends
 Maintain social, civil and politician involvement
 Start a new hobby (other than previous activities) that improves status
 Recognize and feel that he is needed
 Discover the meaning of life after retirement and when facing self-
illness and the life partner and death of a spouse and loved ones; adjust to
the person you love
 Build a meaningful life philosophy and find comfort in philosophy or
religion.

E. Elderly Limitation
According to the WHO World Health Organization in Psychologymania, 2013 Elderly
limitations include:
 Middle age (middle age) is a group aged 45-59 years.
  Advanced age (elderly) between the ages of 60-74 years.
 Older people between 75-90 years old.
 Very old age above 90 years

F. Aging Process Pathway

G. Signs and symptoms
Signs and symptoms according to Patricia Gonce Morton et al, 2011, namely:
1. Organic Change
a) The amount of connective tissue and collagen increases.
b) Cellular elements in the nervous system, muscles, and other vital
organs disappear .
c) The number of cells that function normally decreases .
d) The amount of fat increases.
e) The use of oxygen decreases.
f) During rest, the amount of blood pumped decreases .
g) Less amount of pulmonary air .
h) Decreased hormone excretion.
i) Sensory activity and perception decrease
j) Absorption of fat, protein and carbohydrates decreases.
k) The arterial lumen thickens

2. Nerve System
Sign:
 a) Decreased number of neurons and increased size and number of
neuroglial cells.
b) Decreased nerves and nerve fibers.
c) Brain atrophy and increased cranial dead space
d) Thickening of leptomeninges in the spinal cord.
Symptoms:
a) Increased risk of neurological problems; cerebrovascular injury,
parkinsonism
b) Conduction of nerve fibers across the synapse is slower
c) Moderate moderate decline in short-term memory
d) Disturbance of gait patterns; legs stretched, short steps, and bent
forward
e) Increased risk of hemorrhage before symptoms appear

3. Hearing System.
Sign:
a) Loss of auditory neurons
b) Hearing loss from high frequency to low frequency
c) Serumen enhancement
d) Ear angioslerosis
Symptoms
a) Decreased sharpness of hearing and social isolation (specifically,
decreased ability to hear consonants)
b) Difficulty listening, especially if there is a disturbing background
noise, or if the conversation is fast.
c) Cerumen impaction can cause hearing loss
4. Vision System
Sign:
a) Decreased function of stem cells and cone cells
b) Pigment buildup .
c) Decreased eye movement speed .
d) Ciliary muscle atrophy .
 e) Increased lens size and lens lensing
f) Decreased tear secretion .
Symptoms:
a) Decreased sharpness of vision, field of vision, and adaptation to light
/ darkness
b) Increased sensitivity to blinding light
c) Increased incidence of glaucoma
d) Impaired depth perception with increased incidence of falls
e) Less able to distinguish blue, green, and violet
f) Increased dryness and eye irritation.

5. Cardiovascular system
Sign:
a) Atrophy of muscle fibers lining the endocardium
b) Vascular atherosclerosis
c) Increased systolic blood pressure .
d) Decreasing compliances of the left ventricle .
e) Decreased number of pacemaker cells
f) Decreased sensitivity to baroreceptors .
Symptoms:
a) Increased blood pressure
b) Increased emphasis on atrial contractions with S4 is heard
c) Increased arrhythmias
d) Increased risk of hypotension in changes in position
e) Menuver valsava can cause a decrease in blood pressure
f) Decreased tolerance
6. Respiration system
Sign:
a) Decreased lung tissue elasticity .
b) Chest wall calcification .
c) Ciliary atrophy .
 d) Decreased respiratory muscle strength .
e) Decreased arterial oxygen partial pressure (PaO2) .
Symptoms:
a) Decreased efficiency of ventilation exchanges
b) Increased susceptibility to infection and atelectasis
c) Increased risk of aspiration
d) Decreased ventilatory response to hypoxia and hypercapnia
e) Increased sensitivity to narcotics

8. Internal Gastrointest System

Sign:
a) Decrease in liver size .
b) Decreased muscle tone in the intestine .
c) Emptying the esophagus is slower
d) Decreased gastric acid secretion .
e) Atrophy of the mucous layer
Symptoms:
a) Changes in intake due to decreased appetite
b) Discomfort after eating because the food is slowing down
c) Decreased absorption of calcium and iron
d) Increased risk of constipation, esophageal spasm, and diverticular disease
9. Reproduction system
Sign:
a) Atrophy and fibrosis of the cervical and uterine walls
b) Decreased vaginal elasticity and lubrication
c) Decreased hormone and oocytes .
d) Involvement of mammary gland tissue .
e) The proliferation of glandular and stromal tissue
Symptoms:
a) vaginal dryness and burning and pain during coitus
b) decreased semina fluid volume and ejaculatory strength
c) decreased testicular elevation
 d) prostate hypertrophy
e) breast connective tissue is replaced with fat tissue, so breast
examination is easier to do

10. Urination System

Sign:
a) Decreased kidney period
b) There is no glomerulus
c) Decreasing the number of functioning nephrons
d) Changes in small blood vessel walls
e) Decreased bladder muscle tone
Symptoms:
a) Decrease in GFR
b) Decreased sodium saving ability
c) Increased BUN
d) Decreased kidney blood flow
e) Decreased bladder capacity and increased residual urine
f) Increased urgency
10. Endocrine System
Sign:
a) Decreased testosterone, growth hormone, insulin, androgens,
aldosterone, thyroid hormones
b) Decrease in thermoregulation
c) Decreased fever response
d) Increased nodularity and fibrosis of the thyroid
e) Decreased basal metabolic rate
Symptoms:
a) Decreased ability to tolerate stressors such as surgery
b) Decreased sweating and chills and temperature regulation
 c) Decreased insulin response, glucose tolerance
d) Decreased sensitivity of kidney tubules to antidiuretic hormones
e) Weight gain
f) Increased incidence of thyroid disease

11. Integumen Skin System

Sign:
a) Loss of thickness of the dermis and epidermis
b) Papilla leveling
c) Atrophy of sweat glands
d) Decreased vascularity
e) Cross-link collagen
f) The absence of sub-cutaneous fat
g) Decrease in melanocytes
h) Decreased proliferation and fibroblasts
Symptoms:
a) Thinning of the skin and very vulnerable to tears
b) Dryness and pruritus
c) Decreased perspiration and ability to regulate body heat
d) Increased wrinkles and skin weakness
e) There is no fat pad that protects the bone and causes pain
f) Wound healing is getting longer
12. Musculoskletal System
Sign:
a) Decreased muscle mass
b) Decreased myosin adenosine tripospat activity
c) Worsening and dryness of the joint cartilage
d) Decreased bone mass and osteoblast activity
Symptoms:
a) Decreased muscle strength
b) Decreased bone density
c) Decreased height
d) Pain and stiffness in the joints
 e) Increased risk of fracture
f) Changes in walking and posture
H. Supporting investigation
According to Stanley and Patricia, 2011 Routine laboratory checks that need to be
examined in elderly patients for early detection of health problems that are often
found in elderly patients who have not known any specific disorders / diseases
(degenerative diseases), namely:
1. Routine hematological examination
2. Regular urine
3. Glucose
4. Lipid profile
5. Alkaline phosphate
6. Liver function
7. Kidney function
8. Thyroid function
9. Routine fecal examination

I. Assessment
The nurse examines changes in the development of physiological, cognitive and
social behavior in the elderly

a. Physiological changes
 Normal aging physical changes that need to be studied:

System Normal Findings

Integumen Skin color The pigmentation is spotted /

stained in areas exposed to
sunlight, pale even though it is
not anemic

Humidity Dry, scaly conditions

Temperature Cooler extremities, decreased

 perspiration

Texture Decreased elasticity, wrinkles,

multiple conditions, sagging

Fat distribution Decreased amount of fat in the

extremities, increased number
of diabdomen

Hair Thinning hair

Nail Decreased growth rate

Head and neck Head Nasal bones, face sharpens, &

angular

Eye Decreased visual acuity,

accommodation, adaptation in
the dark, sensitivity to light

ear Decreased tone, reduced mild

reflexes, hearing loss

Mouth, Decreasing taste, aropi papilla

pharynx lateral edge of the tongue

neck Nodular thyroid gland

Thoraxs & Increased antero-posterior

lungs diameter, increase in chest
rigidity, increased RR with
decreased lung expansion,
increased airway resistance

Heart & Systolic increases, changes in

vascular cyst FHR at rest, peripheral pulses
are easily palpated, cold lower
extremities
 Breast Reduced breast tissue,
conditions hang and relax

Digestive Decreased salivary runny

system secretions, peristatics, digestive
enzymes, constipation

Sist woman Decreased estrogen, uterine

reproduction size, vaginal atrophy

man Decreased testosterone, number

of sperm, testes

Sist urination Decreased renal filtration,

nocturia, decreased bladder
capacity, incontenence

woman Incontenence of urgency &

stress, decreased perineal
muscle tone

man Frequent urination & urine

retention.

Musculoskeletal Decreased muscle mass &

system period, bone demineralization,
shortening of the fossa due to
narrowing of the intravertebral
cavity, decreased joint
mobility, range of motion

Neorologyist Decreased reflex rate,

decreased ability to respond to
multiple stimuli, insomnia,
short sleep periods

 Functional status assessment:

 Functional status assessment is a measurement of a person's ability to carry out daily
life activities independently. The Katz index is a tool that is widely used to determine
the results of actions and prognosis in the elderly and chronic diseases. This format
describes the client's functional level and measures the effects of actions expected to
improve functions. This index stretches the strength of implementation in 6 functions:
bathing, dressing, toileting, moving, continents and eating.
 Level of Elderly Independence:
A: independence in terms of eating, continents, moving, to the bathroom, dressing and
bathing
B: independence in all activities of daily living, except for one of the additional
functions
C: independence in all activities of daily living, except bathing and one additional
function
D: independence in all daily living activities, except bathing, dressing and an
additional function
E: independence in all daily living activities, except bathing, dressing, to the
restroom and one additional function
F: independence in all activities of daily living, except bathing, dressing, to the
restroom
G: Dependence on the six functions

b. Cognitive changes
Most psychological and emotional trauma in the past emerged due to misconceptions
because the elderly suffered cognitive impairment. However, changes in the structure
and physiology that occur in the brain during aging do not affect adaptive abilities &
functions in real terms (ebersole & hess , 1994)
Assessment of cognitive status
 SPMSQ (short portable mental status quetionnaire)
It is used to detect the presence and level of intellectual damage consisting of 10
things that assess orientation, memory in relation to self-care abilities, distant memory
and chemistry .
 MMSE (mini mental state exam)
Test cognitive aspects of mental function, orientation, registration , attention and
calculation, recall and language. The possible high-grade value is 30, with a value of
 21 or less usually an indication of cognitive impairment which requires further
investigation.
 Depression Inventory Bec
Contains 13 things that describe various geodes and attitudes related to depression.
Each thing is stretched using a 4-point scale to indicate the intensity of the symptoms
c. Psychosocial changes
Elderly people must adapt to psychosocial changes that occur in aging.
Although these changes vary, but some changes usually occur in the majority of the
elderly.
 Social Assessment
The relationship between the elderly and family plays a central role at all levels
health and well-being of the elderly. A short screening tool that can be used to assess
the social function of the elderly is APGAR Family. The instrument is adjusted to be
used on clients who have more intimate social relations with their friends or with
family. A value of <3 indicates that family dysfunction is very high, grades 4 - 6
family dysfunction is moderate.
A: Adaptation
P: Partnership
G: Growth
A: Affection
R: Resolve
 Home Security
The nurse is obliged to observe the environment of the elderly home to ensure that
there is no danger that will put the elderly at risk of injury. Environmental factors that
must be considered:
 Adequate lighting on stairs, entrances & at night
 Clean road
 The kitchen and bathroom settings are right
 Stable and anti-slip footwear
 Anti-slippery fabric or doormat
 Sturdy handle on stairs / bathroom

J. Nursing Diagnosis That Might Appear

 Nursing diagnoses that may appear according to Wilkinson, 2011 ( Based on
NANDA 2011 )
 Self-care deficit: dressing, eating, elimination
 Perceptual sensory disorders (type of vision, hearing, tactile,
olfactory)
 Nutritional imbalance: less than the body's needs
 Knowledge deficit is related to cognitive retention,
misinterpretation, lack of interest in learning, lack of memory, unfamiliarity
with information sources
 Risk of injury
 Soc ial interaction,
 Memory damage

BIBLIOGRAPHY

Patricia Gonce Morton et.al. (2011). Critical Nursing: holistic ed care approach.8 ; language
transfer, Nike Esty wahyuningsih. Jakarta: EGC

Potter and Perry. ( 2005 ) . The fundamentals of nursing: Concepts, Processes and Practices . Jakarta:
EGC.

Psychologymania. (2012). Understanding of the elderly . Accessed on Monday, April 01,

2013. http://www.psychologymania.com/2012/07/pengertian-lansia-lebih-usia.html

Stanley, Mickey and Patricia Gauntlett Beare. (2006). Gerontik Nursing Textbook . Jakarta: EGC.
Wilkinson, Judith. (2011). Pocket book nursing diagnoses: NANDA diagnosis, NIC intervention, NOC
outcome criteria, ed. 9. Interpreting, Esty Wahyuningsih; editor of the Indonesian
edition, Dwi Widiarti. Jakarta: EGC.