Geriatric Psychology: Aging, Physiological and Psychological Changes, and Elder Care

Geriatrics and Aging

Definition and Scope

Geriatrics is the medical and psychological specialty focused on the care of older adults, particularly those in advanced old age. It encompasses biological, psychological, physiological, and sociological aspects of aging. The term senescence describes the period when the body begins to age and weaken, marking the final stage of the lifespan. Old age is often defined as above 65–67 years, but modern gerontologists categorize it as:

• Early-old: 60–75 years

• Middle-old: 76–90 years

• Late-old: 90 years and older

As people live longer and health care improves, these categories are evolving. Geriatrics aims to maximize independence and shorten periods of illness and disability.

Anticipated Increase in Advanced Old Age Population

• The population of Americans aged 90 and older is rapidly increasing, with projections to quadruple over four decades.

• Older adults are more likely to be women, have higher rates of widowhood, poverty, and disability.

• Many older adults continue to make significant contributions, such as academic achievements and professional accomplishments.

Theories of the Aging Process

Cellular and Biological Theories

Multiple theories explain the aging process, each focusing on different mechanisms:

• Free Radical Theory: Unpaired ions (free radicals) increase with age, causing oxidative stress and cellular damage.

• Biological Clock (Apoptosis): Cells have a programmed lifespan; apoptosis is the process of programmed cell death.

• Wear-and-Tear Theory: The body, like a machine, wears out over time; some parts are not easily replaced.

• Immune Theory: The aging immune system struggles to distinguish healthy from defective cells, leading to increased susceptibility to illness and autoimmune responses.

Additional info: Other theories include telomere shortening, antagonistic pleiotropy, and disposable soma theory.

Physiological Changes in Advanced Old Age

Bones and Cartilage

• Loss of body water and bone mass leads to decreased height.

• Collagen becomes rigid, elastin brittle, reducing cell function.

• Loss of estrogen decreases calcium utilization, increasing risk of osteoporosis and fractures.

Blood Vessels

• Arterial walls thicken, narrowing arteries and reducing oxygen supply.

• Heart and arteries become less elastic, raising blood pressure and risk of dizziness, fainting, and stroke.

Lungs

• Ribs and cartilage become more rigid, making breathing harder.

• Osteoporosis reduces chest cavity size; lung tissue loses elasticity, decreasing lung volume and oxygen exchange.

• Older adults are more vulnerable to respiratory infections.

Kidneys and Bladder

• Decreased blood flow and scarring reduce filtration rate, leading to toxin accumulation.

• Bladder capacity decreases, causing urinary frequency and incontinence.

• Enlarged prostate in men may cause urinary retention.

Metabolism

• Muscle mass decreases, body fat increases, affecting glucose and lipid metabolism.

• Increased risk for cardiovascular disease and diabetes.

Digestion, Taste, and Smell

• Decreased gastrointestinal motility causes swallowing difficulties and constipation.

• Digestive enzymes decrease, leading to poor appetite.

• Loss of taste buds and sense of smell reduces appetite.

• Reduced gag reflex increases choking risk.

Teeth

• Tooth loss and gum changes affect chewing and nutrition.

• Regular dental care is essential.

Skin

• Skin becomes thinner, less elastic, and more prone to injury.

• Decreased sweat gland function impairs temperature regulation.

Eyes

• Loss of elasticity and fat causes eye irritation.

• Decreased optic nerve cells and rod cell function impair vision, especially at night.

• Cataracts and glaucoma are common; regular screening is recommended.

Ears

• Degeneration in ear bones and hair cells reduces hearing, especially high frequencies.

• Untreated hearing loss affects mental, physical, and social well-being.

Nervous System

• Neurons atrophy, brain volume shrinks, and impulse transmission slows.

• Motor responses and reaction times are delayed.

Sexuality in the Geriatric Adult

Sexual Needs and Health

Sexuality remains important throughout life. Ageism, or prejudice against older adults, often falsely assumes a lack of sexual interest. Medications, chronic illness, and reduced mobility can affect sexual function. Education about medication effects and STI prevention is essential.

Factors Influencing Sexuality

• Attitude, previous experiences, body image, mental function, social contact, environment, privacy

• Health factors: incontinence, mobility reduction, menopause, impotence, chronic illness, medications

Sexual Responses in Women

• Menopause causes vaginal dryness and decreased tissue expansion.

• Regular sexual activity, lubricants, exercise, and nutrition help maintain sexual health.

• Ability to achieve orgasm continues, though intensity may decrease.

Sexual Responses in Men

• Testosterone decreases, affecting erection and sperm production.

• Ability to attain erection may be delayed; anxiety can contribute to dysfunction.

• Intensity of orgasm may decrease, but pleasure is retained.

Impact of Illness

• Prostate cancer and treatments can affect sexual function.

• Postoperative instructions should address sexual health.

Psychological Changes and Challenges

Self-Image and Role Changes

• Societal emphasis on youth can foster negative self-image.

• Role changes, such as becoming a caregiver, can be abrupt and stressful.

• Geropsychology provides interventions for psychological challenges in older adults.

Cultural Considerations

• Culture affects self-worth and health in aging.

• Ageism can lead to depression and loss of usefulness.

• Disengagement is the process of withdrawing from social contacts and relinquishing independence.

Cognitive Impairments

• Dementias, such as Alzheimer disease, cause memory loss and dependence.

• Resources and organizations support diagnosis and management.

Developmental Tasks of the Geriatric Adult

Ego Integrity vs. Despair

• Reflecting on accomplishments brings ego integrity and satisfaction.

• Unresolved conflicts lead to despair, anxiety, and illness.

• Adjusting to retirement and frailties of aging are major developmental tasks.

Health-Promoting Activities

Physical Exercise

• Regular exercise promotes mental and physical health.

• Reduces risks of disease, weakness, falls, and cognitive impairments.

Occupational Activities

• Part-time work, volunteering, hobbies, and travel help maintain active mind and body.

Nutrition

• Adequate nutrition is essential; challenges include dental loss, slowed digestion, and meal preparation.

• Community services like Meals on Wheels and senior centers provide support.

Prevention of Illness

• Regular checkups, immunizations, and monitoring chronic illnesses are important.

• Access to medical care can be challenging due to immobility and transportation issues.

Mental Health

• Late-life depression is common, often due to isolation, loss, and low self-esteem.

• Engaging in pleasurable activities and social support helps prevent depression.

Environmental Controls

• Safe environments reduce risk of falls and fractures.

Elder Abuse

Definition and Prevention

• Elder abuse includes physical, mental, emotional, sexual, or financial neglect or mistreatment.

• Caregiver strain can contribute to abuse; health-care workers should offer support and resources.

• Signs include depression, isolation, bruises, burns, undernutrition, dehydration, and missed appointments.

Polypharmacy and Medication Errors

Risks and Management

• Polypharmacy is the use of multiple medications, increasing risk of interactions and side effects.

• Decreased organ function delays drug excretion, increasing toxicity risk.

• Careful monitoring and education are essential.

Placement Alternatives and Activities of Daily Living (ADLs)

Aging in Place

• Most older adults prefer to remain in their own homes.

• Home modifications (ramps, safety bars, lighting, medical alert systems) support independence.

Assisted Living and Nursing Homes

• Assisted-living facilities provide support for ADLs, cleaning, meals, and recreation.

• Nursing homes offer varying levels of care; selection should consider cost, services, and environment.

Activities of Daily Living (ADLs)

• Eating

• Toileting, bathing, grooming

• Cooking

• Shopping

• Taking medications

Concerns Related to Living Arrangements

• Access to health care

• Personal space and privacy

• Peer-group activity

• Rehabilitation and therapies

Principles of Elder Care

• Encourage confidence and self-image

• Empower geriatric adults

• Include family and social support

• Monitor exercise, nutrition, and health concerns

Key Terms and Definitions

Term	Definition
Activities of Daily Living (ADLs)	Basic self-care tasks essential for independent living
Aging in Place	Ability to live safely and independently in one's own home
Ageism	Prejudicial attitudes and discriminatory practices against older people
Alzheimer Disease	Progressive dementia with memory loss and cognitive decline
Apoptosis	Programmed cell death
Atrophy	Decrease in size of cells or organs
Biological Clock	Programmed lifespan of cells
Disengagement	Withdrawal from social contacts and relinquishing independence
Elder Abuse	Intentional infliction of harm or neglect
Free Radical	Unpaired ion causing oxidative stress
Geriatrics	Medical specialty for older adults
Immune Theory	Impaired immune response with aging
Osteoporosis	Thinning of bone, increasing fracture risk
Senescence	Period when body begins to age and weaken
Wear-and-Tear Theory	Body wears out over time

Review Questions and Applications

Theories of Aging: Matching

Theory	Summary
Free Radicals	Ions break free more frequently with age, causing oxidative stress
Biological Clock	Cells have a programmed lifespan; break down and are phagocytized
Immune	Aged immune system destroys both healthy and defective cells
Wear and Tear	Cells wear out or break down with use over time

Physiological Changes: Fill in the Blanks

• The ribs and cartilage become more rigid, and thus the respiratory muscles work harder.

• Age-related osteoporosis and reduced height of the vertebrae results in a smaller chest cavity.

• Lung tissue loses elasticity, which adds to reduced lung volume.

• Surface area within the lung is also reduced, which impairs oxygen exchange.

Terms and Definitions: Matching

Term	Definition
Ageism	Prejudicial attitudes and discriminatory practices against older people
Glaucoma	Atrophy of the optic nerve and increased intraocular pressure
Atrophy	Decrease in size
Senescence	Period in which the body begins to age and weaken
Apoptosis	Breaking down of the cell membrane leading to cell death
Disengagement	Process of withdrawing from social contacts and giving up independence

Kidneys and Bladder: Age-Related Changes

• A. Decreased filtration rate and accumulation of toxins in the bloodstream

• C. Urinary retention in men who have enlarged prostates

• D. Incontinence or urine leakage with activity

Taste and Appetite: Age-Related Changes

• C. Taste buds change to be more sensitive to the taste of bitter with aging

• D. Sense of smell declines with aging contributing to loss of appetite

• F. Digestive enzymes decrease resulting in poor appetite and digestive disturbances

Formulas and Equations

While no specific formulas are provided in the text, the following equation is relevant for calculating Body Mass Index (BMI), which is important in geriatric nutrition:

$BMI = \frac{\text{weight (kg)}}{\text{height (m)}^2}$

Additional info: BMI is used to assess nutritional status and risk for chronic diseases in older adults.

Summary of Healthy People 2030 Goals for the Aged

• Provide access to preventive health services

• Manage chronic illnesses

• Diagnose and manage dementias

• Encourage health-promotion activities

• Reduce nonessential medication use

• Reduce hospital visits for common conditions

• Increase hearing and vision screening

• Train caregivers

• Improve housing, transportation, and care coordination

Clinical Application Example

Case Study: Mr. J. (77) and Mrs. J. (84) have different fitness and activity levels. To help them age in place safely:

• Modify the home for accessibility (ramps, safety bars, lighting)

• Arrange for regular health checkups and screenings

• Provide support for ADLs and nutrition

• Encourage socialization and engagement in activities

• Monitor medication schedules and health status

Additional info: Community resources, caregiver support, and technology (medical alert systems) can further enhance safety and independence.