Geriatric Nursing

Introduction

Geriatric nursing is the evidence-informed, person-centred nursing care of older adults across hospitals, primary care, rehabilitation, home care, long-term care, and palliative settings. It combines general nursing competence with knowledge of ageing, multimorbidity, frailty, function, cognition, medication risk, social context, and the goals of the older person. The overlapping term gerontological nursing is also widely used in education and professional literature.

This aiMOOC is designed for university students in Nursing, Gerontology, and related health disciplines. You will learn to assess an older adult comprehensively, distinguish expected age-related changes from illness, identify common geriatric syndromes, plan safe interventions, communicate without ageist assumptions, and coordinate care across professions and settings.

Learning Outcomes

By the end of this course, you should be able to:

Comprehensive geriatric assessment: Organize a multidimensional nursing assessment that includes physical health, cognition, mood, function, medications, nutrition, sensory ability, social support, environment, and personal goals.
Geriatric syndromes: Recognize interacting problems such as falls, delirium, incontinence, frailty, pressure injury, functional decline, and medication-related harm.
Clinical reasoning: Prioritize nursing actions when several chronic conditions, acute symptoms, and functional risks occur together.
Person-centred care: Integrate autonomy, values, culture, communication needs, and shared decision-making into the care plan.
Interprofessional care: Coordinate effectively with medicine, pharmacy, physiotherapy, occupational therapy, dietetics, social work, speech and language therapy, and other services.
Patient safety: Apply evidence-informed strategies to reduce preventable harm while avoiding unnecessary restriction of independence.

Foundations of Geriatric Nursing

Ageing, Health, and Heterogeneity

Older adults are not a single homogeneous group. Two people of the same chronological age may differ greatly in physiological reserve, mobility, cognition, social support, disease burden, and goals. Good geriatric nursing therefore avoids making clinical decisions from age alone.

Ageing is associated with changes in many body systems, but disease and disability are not inevitable consequences of getting older. A nurse must distinguish expected physiological changes from new pathology. For example, reduced renal reserve may alter medication handling, while sudden confusion is not a normal feature of ageing and requires assessment for an acute cause.

The World Health Organization emphasizes healthy ageing as maintaining the functional ability that enables well-being. Its Integrated Care for Older People approach focuses on person-centred, coordinated care and on maintaining intrinsic capacity and functional ability.

Person-Centred Care and Ageism

Person-centred geriatric nursing begins by asking what matters to the older person, not only what is the matter medically. You should explore goals, routines, preferences, cultural values, relationships, risk tolerance, and the outcomes the person considers meaningful.

Ageism includes stereotypes, prejudice, and discrimination based on age. In clinical care it may appear as talking over an older patient to a relative, assuming pain or confusion is simply due to age, using patronizing language, or excluding the person from decisions. Respectful communication, supported decision-making, and individualized assessment are practical ways to counter ageism.

When communication is difficult, first look for reversible barriers such as hearing loss, visual impairment, pain, fatigue, language differences, or an unfamiliar environment. Do not assume that slow responses mean lack of capacity.

Comprehensive Geriatric Assessment

A Multidimensional Nursing View

A comprehensive geriatric assessment brings together several domains rather than treating each diagnosis in isolation. In nursing practice, the assessment should include the following areas:

Medical assessment: Acute symptoms, chronic conditions, pain, vital signs, recent hospitalizations, and atypical presentations.
Functional status: Ability to perform activities of daily living and instrumental activities of daily living.
Mobility: Gait, balance, transfers, assistive devices, activity tolerance, and fall history.
Cognition and mood: Baseline cognition, acute change, attention, memory, depression symptoms, sleep, and behavior.
Medication review: Prescription medicines, over-the-counter products, supplements, adherence, administration ability, interactions, and treatment burden.
Nutrition and hydration: Weight change, appetite, oral health, swallowing, food access, hydration, and nutrition risk.
Continence: Urinary and bowel patterns, reversible causes, skin effects, and impact on dignity and participation.
Sensory function: Hearing, vision, communication aids, and environmental barriers.
Skin integrity: Pressure injury risk, moisture, mobility, nutrition, perfusion, and existing wounds.
Social context: Living situation, relationships, caregiving, isolation, finances, transport, and safeguarding concerns.
Environment: Home hazards, equipment, accessibility, lighting, footwear, and safe use of mobility aids.
Goals and preferences: What the person wants to preserve, regain, avoid, or prioritize.

The Hartford Institute for Geriatric Nursing provides short evidence-based nursing assessment resources in its Try This series. These are screening and assessment supports; they do not replace clinical judgment or diagnosis.

Function, Activities of Daily Living, and Mobility

Functional status is often more useful for care planning than a diagnosis list alone. Activities of daily living include basic self-care such as bathing, dressing, toileting, transferring, continence, and feeding. Instrumental activities of daily living involve more complex tasks such as managing medicines, finances, shopping, cooking, transport, and communication.

A decline in function can be an early sign of acute illness. Ask what the person could do before the current problem, what has changed, and over what time period. Preserve independence whenever safely possible: encourage the person to do what they can rather than automatically completing tasks for them.

Frailty and Physiological Reserve

Frailty describes increased vulnerability to stressors because physiological reserve is reduced across multiple systems. It is not the same as chronological age, disability, or having many diagnoses, although these can overlap.

For nurses, frailty matters because a relatively minor stressor such as a urinary infection, medication change, dehydration, or brief bed rest may lead to disproportionate decline. Nursing priorities include early recognition of change, prevention of immobility, adequate nutrition and hydration, medication review, orientation, sleep support, and realistic rehabilitation goals.

Major Geriatric Syndromes

Delirium, Dementia, and Depression

Delirium is an acute disturbance of attention and cognition that develops over hours or days and tends to fluctuate. It is commonly triggered by one or more underlying causes such as infection, medication effects, metabolic disturbance, pain, dehydration, hypoxia, urinary retention, constipation, or environmental stress. Hypoactive delirium may present with withdrawal, reduced movement, slow responses, or poor intake and can be missed.

Dementia is a syndrome of acquired, usually progressive cognitive decline that interferes with daily function. A person with dementia can also develop delirium. When an acute change occurs in a person with known dementia, do not assume it is simply progression of dementia.

Depression can affect sleep, appetite, motivation, concentration, and function. It can coexist with both dementia and physical illness. Screening findings require appropriate clinical evaluation rather than automatic labeling.

NICE recommends assessment with a validated delirium tool when indicators are present; its current guidance names the 4AT for many hospital and long-term-care settings, with critical-care-specific tools used in critical care. Nursing care also includes identifying and addressing contributing causes, orientation, hydration, pain management, sensory support, sleep protection, mobility, and family involvement where appropriate.

Falls and Fall Prevention

Falls are common and can lead to injury, fear of falling, reduced mobility, and loss of independence. Fall risk is usually multifactorial. Relevant factors include previous falls, gait or balance problems, muscle weakness, postural hypotension, vision problems, unsafe footwear, environmental hazards, cognitive impairment, continence urgency, and medicines that impair alertness or blood pressure.

A strong nursing response combines assessment with targeted action. Review the circumstances of previous falls, observe transfers and gait, check for postural symptoms, review medicines with the clinical team, support safe activity, ensure needed sensory aids are available, and adapt the environment without creating unnecessary restriction. Physical restraints are not a routine fall-prevention strategy and can cause harm; follow evidence-based local policy and use the least restrictive safe approach.

Datei:The Timed Up and Go (TUG) Test.webm

Polypharmacy and Medication Safety

Polypharmacy means the use of multiple medicines. The number of medicines alone does not determine whether prescribing is appropriate; the key question is whether each medicine has a current indication, provides expected benefit, fits the person's goals, and can be used safely.

Age-related changes in renal function, body composition, homeostatic reserve, and sensitivity to some medicines can increase the risk of adverse effects. Medication reconciliation should include prescriptions, over-the-counter products, supplements, and medicines prescribed by different clinicians.

For every medicine, ask: What is it for? Is it still needed? Is the dose appropriate? Are there interactions or duplications? Could it contribute to falls, confusion, bleeding, constipation, urinary retention, hypotension, or poor appetite? Can the person obtain, understand, and administer it correctly?

The 2023 American Geriatrics Society Beers Criteria identify medications that may be potentially inappropriate for many adults aged 65 and older in specific circumstances. They are a clinical decision support resource, not an automatic stop list, and should support individualized shared decision-making. Because the criteria were developed primarily for United States practice, use them together with local prescribing guidance and the individual clinical context. Deprescribing should be planned, monitored, and coordinated with the prescriber and pharmacist.

Nutrition, Hydration, and Swallowing

Older adults may be at nutritional risk because of illness, poor appetite, dental problems, swallowing difficulty, depression, medication effects, limited income, reduced mobility, social isolation, or difficulty shopping and cooking. Nursing assessment should look for unplanned weight loss, reduced intake, dehydration signs, oral problems, swallowing symptoms, and the person's access to preferred food and fluids.

If dysphagia is suspected, follow local procedures for swallowing assessment and involve appropriately trained professionals. Avoid making unverified texture modifications on your own. Positioning, oral care, alertness, pacing, and assistance with meals can all affect safety and intake.

Continence

Urinary or fecal incontinence should not be dismissed as a normal consequence of ageing. Assessment should consider onset, pattern, urgency, mobility, cognition, fluid intake, constipation, urinary retention, medicines, infection symptoms, environment, and the ability to reach and use the toilet.

Nursing care aims to preserve dignity and function. Interventions may include scheduled or prompted toileting when appropriate, easier access to the toilet, clothing adaptations, management of constipation, skin protection, hydration support, and referral for further assessment.

Skin Integrity and Pressure Injury Prevention

Pressure injuries arise from sustained pressure, often combined with shear, and risk increases when mobility, perfusion, nutrition, skin condition, or sensory awareness are impaired. Nursing assessment should include regular skin inspection and an individualized appraisal of mobility, continence, nutrition, support surfaces, and repositioning needs.

Prevention is not a single intervention. It combines pressure redistribution, movement or repositioning suited to the individual, moisture management, adequate nutrition and hydration, device checks, and early response to skin changes.

Acute and Chronic Care

Atypical Presentation of Illness

Older adults may present with less typical symptoms than younger adults. Acute illness may first appear as functional decline, falls, reduced appetite, new incontinence, lethargy, or delirium rather than a textbook symptom pattern. This makes baseline information and trend recognition especially important.

When an older person's function or cognition changes suddenly, treat the change as clinically significant. Check observations, pain, hydration, oxygenation, elimination, medicines, recent procedures, and other likely causes according to your scope of practice and local escalation pathway.

Hospitalization and Functional Decline

Hospital care can unintentionally accelerate deconditioning through bed rest, sleep disruption, unfamiliar surroundings, restricted movement, undernutrition, and loss of normal routines. Nursing care should therefore include purposeful mobility, adequate intake, orientation, sleep protection, access to hearing aids and glasses, and preservation of self-care.

The question is not only, "Is the disease improving?" but also, "Can this person still stand, transfer, walk, eat, communicate, toilet, and manage the tasks needed for discharge?"

Chronic Conditions and Multimorbidity

Many older adults live with several chronic conditions at once. Disease-specific recommendations can conflict, create excessive treatment burden, or fail to match the person's priorities. Nursing contributes by identifying symptom burden, functional impact, adherence difficulties, treatment complexity, caregiver strain, and signs that one intervention is worsening another problem.

Care plans should be coordinated around shared goals. For one person the priority may be longer survival; for another it may be maintaining cognition, walking to the garden, avoiding hospitalization, remaining at home, or reducing medication burden.

Communication, Ethics, and Safeguarding

Capacity, Consent, and Supported Decision-Making

Decision-making capacity is specific to the decision and the time at which it is made. Cognitive impairment does not automatically mean that a person lacks capacity for every decision. Nurses should support understanding by addressing hearing and vision needs, using clear language, allowing time, reducing distractions, and checking comprehension.

Follow the laws and professional standards of your jurisdiction for consent, capacity assessment, substitute decision-making, advance care planning, and documentation. When uncertainty exists, escalate appropriately rather than making assumptions based on age or diagnosis.

Elder Mistreatment and Safeguarding

Elder mistreatment can include physical, psychological, sexual, or financial abuse; neglect; and abandonment. Warning signs may include unexplained injuries, poor hygiene, untreated health problems, fearfulness, unusual financial changes, or inconsistent explanations.

If you suspect mistreatment, prioritize immediate safety, speak with the older person privately when possible, document objective findings, and follow local safeguarding and mandatory-reporting procedures. Do not conduct an independent investigation beyond your role.

Family and Caregivers

Family members and other caregivers can provide valuable information about baseline function, routines, communication, and recent changes. They may also experience significant strain. Include caregivers with the older person's consent while keeping the older adult at the centre of decision-making.

Assess what the caregiver can realistically provide, whether they understand the care plan, and whether they need training, respite, social support, or referral. A discharge plan is unsafe if it assumes unpaid care that is unavailable or unsustainable.

Care Transitions and Palliative Approaches

Discharge and Transitional Care

Transitions between hospital, home, rehabilitation, and long-term care are high-risk periods for medication discrepancies, information loss, functional decline, and missed follow-up. A nursing discharge process should verify the medication list, current function, equipment needs, wound or symptom plans, follow-up appointments, warning signs, transport, caregiver understanding, and who to contact if problems arise.

Use teach-back to confirm understanding. Written information should be readable, prioritized, and consistent with verbal teaching.

Palliative and End-of-Life Nursing

Palliative care focuses on quality of life and relief of suffering for people with serious illness and can be integrated alongside disease-directed treatment. Geriatric nursing contributes through symptom assessment, communication about goals, psychosocial support, family support, skin and mouth care, medication monitoring, and attention to comfort and dignity.

Do not assume that age alone determines prognosis or treatment limits. Goals-of-care discussions should reflect the person's values, health state, likely benefits and burdens of treatment, and applicable legal and ethical standards.

Interprofessional Geriatric Practice

Older adults with complex needs often benefit from coordinated interprofessional care. Nurses frequently connect observations across the day and therefore play a central role in identifying change, communicating priorities, and monitoring whether a care plan works in practice.

A useful team question is: Which problem is most threatening to the person's function, safety, comfort, or stated goals right now, and which profession is best placed to help?

Examples of collaboration include:

Pharmacy: Medication reconciliation, interactions, deprescribing support, and administration problems.
Physiotherapy: Mobility, strength, balance, transfers, and rehabilitation.
Occupational therapy: Activities of daily living, home safety, equipment, and adaptation.
Dietetics: Malnutrition risk, nutrition planning, and complex dietary needs.
Speech and language therapy: Swallowing and communication assessment where within professional scope.
Social work: Caregiver support, finances, safeguarding, housing, and community resources.
Medicine: Diagnosis, treatment of acute and chronic disease, and shared medical decision-making.

Clinical Reasoning Case

Mrs. A is 84 and lives alone. Before admission she walked with a cane, prepared simple meals, managed her own medicines, and spoke with her daughter daily. She is admitted after a fall. On the second hospital day she becomes quieter, eats little, needs help transferring, and seems unsure where she is. Her daughter says this is a major change from baseline. She has several chronic conditions and takes nine regular medicines.

As a student nurse, avoid reducing this case to a single diagnosis. Build a problem representation that includes the acute cognitive change, recent fall, new functional decline, poor intake, medication burden, living situation, and baseline independence. Immediate priorities include assessment for delirium and underlying causes, fall-related injury and pain, hydration and nutrition, safe mobility, medication review, sensory needs, and escalation of deterioration according to local policy.

A good care plan would also ask what Mrs. A wants to regain before discharge, whether her home remains safe, whether she can again manage medicines and meals, and what support her daughter can realistically provide.

Evidence-Informed Professional Resources

Use current local policies and clinical guidelines in practice. The following resources are useful starting points for further study:

WHO Integrated Care for Older People: Person-centred pathways for maintaining intrinsic capacity and functional ability.
WHO Ageism: Background on recognizing and reducing age-based stereotypes prejudice and discrimination.
NICE Delirium Guideline: Prevention, recognition, assessment, and management of delirium in hospital and long-term care.
Hartford Institute for Geriatric Nursing Try This Series: Nursing assessment tools and best-practice resources for older adults.
National Institute on Aging Medication Safety: Practical guidance on medicines, interactions, and polypharmacy.
American Geriatrics Society Guidelines and Recommendations: Professional geriatric guidance, including the Beers Criteria.
CDC STEADI: Fall-risk screening, assessment, and intervention resources for older adults.
National Institute on Aging Elder Abuse: Types, warning signs, and routes to help.

Interactive Tasks

Quiz: Test Your Knowledge

Diesen aiMOOC als Battle spielen

Which finding most strongly suggests delirium rather than normal ageing? (Acute fluctuating change in attention) (!Gradual greying of hair) (!Stable preference for an afternoon rest) (!Longstanding need for reading glasses)

What is the best starting point for person-centred geriatric nursing? (Identify the older person's goals and priorities) (!Base the plan on chronological age) (!Ask the family to make every decision) (!Focus only on the primary diagnosis)

Which area belongs in a comprehensive geriatric assessment? (Functional status) (!Only laboratory values) (!Only the admitting diagnosis) (!Only the nurse's risk score)

What is the most appropriate interpretation of polypharmacy? (Multiple medicines require review for appropriateness and risk) (!Every medicine must be stopped) (!Medicine count alone proves unsafe prescribing) (!Supplements never need to be reviewed)

Which action best supports fall prevention? (Identify individual risk factors and target them) (!Keep every older patient in bed) (!Remove all walking aids) (!Use age alone to predict falls)

Which statement about frailty is correct? (Frailty reflects increased vulnerability to stressors) (!Frailty is identical to chronological age) (!Frailty means a person must live in a care home) (!Frailty can be diagnosed from appearance alone)

Which nursing action helps prevent hospital-related functional decline? (Support safe mobility and self-care) (!Complete every activity for the patient) (!Discourage walking throughout admission) (!Keep sensory aids stored away)

What should you do when an older adult with dementia develops sudden confusion? (Assess for delirium and an acute cause) (!Assume the dementia has simply progressed) (!Wait several weeks before reassessment) (!Avoid asking family about baseline function)

Which approach is most appropriate when elder mistreatment is suspected? (Follow safeguarding procedures and document objective findings) (!Investigate secretly without involving the care team) (!Confront the suspected person alone) (!Ignore concerns unless physical injury is severe)

What is a key feature of safe discharge planning for an older adult? (Confirm function medications support and follow-up) (!Assume the home situation has not changed) (!Give instructions only to the family) (!Delay mobility assessment until after discharge)

Memory Game

Delirium	Acute fluctuating disturbance of attention and cognition
Frailty	Increased vulnerability to stressors because of reduced physiological reserve
Polypharmacy	Use of multiple medicines requiring review of benefit burden and risk
ADL	Basic self-care activities such as bathing dressing and feeding
IADL	Complex daily activities such as shopping transport and medication management
Ageism	Stereotyping prejudice or discrimination based on age

Drag and Drop

Match the correct terms.	Topic
Acute fluctuating inattention	Delirium
Maintaining independence in self-care	Functional nursing goal
Review of all medicines and supplements	Medication reconciliation
Reduced reserve and vulnerability to stressors	Frailty
Private assessment and safeguarding escalation	Suspected elder mistreatment

...

Crossword Puzzle

Delirium	What acute syndrome causes fluctuating attention and cognition?
Frailty	What term describes increased vulnerability to stressors from reduced reserve?
Mobility	What domain includes gait transfers and safe movement?
Continence	What term describes control of bladder and bowel function?
Autonomy	What ethical principle supports a person's right to make informed choices?
Polypharmacy	What term describes the use of multiple medicines?

LearningApps

Cloze Text

Geriatric nursing is guided by

rather than chronological age alone. A sudden fluctuating change in attention should raise concern for

. The ability to bathe dress and feed oneself is part of

. Increased vulnerability to relatively small stressors is described as

. Reviewing all prescribed and non-prescribed medicines helps reduce harm from

. Fall prevention works best when interventions address

. Maintaining mobility during hospitalization can reduce

. Hearing and vision aids can improve communication and reduce

. Suspected mistreatment requires objective documentation and use of local

. Safe discharge planning should connect current function medicines equipment and

.

Open-Ended Tasks

Easy

Baseline Function Interview: Interview a classmate acting as an older adult and write five questions that establish baseline mobility self-care cognition and social support before an acute illness.
Ageism Language Audit: Collect five examples of age-related language from health education or media and rewrite each example in respectful person-centred language.
Medication List Review: Create a fictional medication list containing prescriptions over-the-counter products and supplements and identify the questions a nurse should ask during reconciliation.
Fall Hazard Photo Study: Photograph or sketch a simulated home environment and label environmental features that could increase or reduce fall risk.

Standard

Comprehensive Assessment Map: Build a concept map for the Mrs. A case that links medical functional cognitive medication nutritional social and environmental findings.
Delirium Observation Video: Produce a short teaching video that contrasts acute fluctuating delirium with a stable cognitive baseline without portraying stereotypes of older people.
Mobility Observation Project: Observe a supervised mobility assessment in simulation or clinical skills teaching and write a reflection on gait transfer safety patient confidence and nursing communication.
Caregiver Interview: With consent and according to course ethics rules interview a caregiver about transition-of-care challenges and summarize two nursing actions that could reduce burden.

Advanced

Interprofessional Case Conference: Lead a simulated case conference for a frail older adult with falls polypharmacy and poor intake and negotiate a shared priority plan across at least four professions.
Evidence Appraisal: Critically appraise one current guideline or systematic review relevant to delirium falls pressure injury nutrition or medication safety and explain how it should change nursing practice.
Quality Improvement Proposal: Design a small quality-improvement project to reduce one geriatric safety problem on a ward including a process measure an outcome measure and a plan for patient involvement.
Community Age-Friendly Field Study: Visit or virtually audit a public service health facility or community setting for accessibility communication and support of older adults and produce evidence-based recommendations.

Learning Assessment

Integrated Case Analysis: Given a hospitalized older adult with a fall new confusion poor intake and several medicines identify the three highest nursing priorities justify the order and propose targeted assessments.
Delirium Transfer Task: Compare how you would assess sudden confusion in a person with known dementia versus a cognitively intact older adult and explain what should remain the same in both cases.
Medication Safety Reasoning: Analyze a medication scenario with dizziness constipation and recurrent falls and explain how nursing observations should inform an interprofessional medication review.
Function-Centred Care Plan: Design a care plan that treats an acute illness while preserving mobility self-care sleep nutrition communication and independence.
Ethics and Autonomy Scenario: Evaluate a disagreement between an older adult and family about discharge risk using autonomy capacity supported decision-making safety and local legal requirements.
Transition of Care Synthesis: Create a discharge handover that integrates medication reconciliation functional status equipment nutrition warning signs follow-up and caregiver capacity.

Evidence of Learning

Evidence of learning in geriatric nursing includes both knowledge and performance. You should be able to demonstrate:

Knowledge: Accurate explanation of ageing heterogeneity geriatric syndromes frailty delirium polypharmacy function safeguarding and transitions of care.
Assessment skill: A structured multidimensional assessment that identifies baseline status acute change risk factors strengths and personal goals.
Clinical reasoning: Prioritization that connects symptoms function medicines environment and patient preferences rather than treating findings in isolation.
Communication: Respectful non-ageist interaction use of supported communication and effective teach-back.
Practical products: Care plans concept maps handovers medication reconciliations fall-prevention plans or quality-improvement proposals.
Teamwork: Clear interprofessional communication and appropriate referral based on the older person's needs.
Transfer: Application of geriatric principles to new settings such as acute care rehabilitation community care long-term care and palliative care.

OERs on the Topic

The overlapping term gerontological nursing is commonly used in English-language professional literature. The following English Wikipedia article provides an open background resource.

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Geriatric Nursing

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