NCM 114 Care of the Older Adult

Concepts, principles and theories in the care Life expectancy has increased rapidly since the Age of Enlightenment.

of older adult In the early Early 19th Century: Life expectancy began to rise in
early industrialized countries.
A. AGING IS A DEVELOPMENTAL PROCESS Global Inequality: During this period, a significant disparity in
health emerged. Rich countries experienced good health, while
Aging is associated with changes in dynamic biological, physiological, poor countries continued to suffer from low life expectancy.
environmental, psychological, behavioral, and social processes. Some Recent Trends: Over the past few decades, this global health
age-related changes are benign, such as graying hair. Others result in inequality has decreased.
declines in function of the senses and activities of daily life and No country today has a lower life expectancy than the countries
increased susceptibility to and frequency of disease, frailty, or with the highest life expectancy in 1800.
disability. In fact, advancing age is the major risk factor for a number Many countries that previously had poor health are now catching
of chronic diseases in humans. up rapidly.
Aging to refer to the passing of time for an individual—the inevitable Since 1900 the global average life expectancy has more than doubled
chronological change in our age from year to year. and is now above 70 years. The inequality of life expectancy is still
very large across and within countries. in 2019 the country with the
“Aging” to refer to other things— a progression of physical decline, a lowest life expectancy is the Central African Republic with 53 years, in
change in family roles (e.g., becoming a grandparent), a change in Japan life expectancy is 30 years longer.
work status (retirement), or forgetting where you left your keys. While
some of these may be associated with increasing age.
DIFFERENCES IN LIFE EXPECTANCY ACROSS THE
Aging is not associated with physical decline for all individuals at all WORLD
points in time. Life expectancy is a measure of premature death and it shows large
differences in health across the world.

B. DEMOGRAPHY OF AGING AND IMPLICATIONS FOR HEALTH AND The population of many of the richest countries in the world have life
expectancies of over 80 years. In 2019 the life expectancy in Spain,
NURSING CARE Switzerland, Italy, and Australia was over 83 years. In Japan it was the
highest with close to 85 years.
GLOBAL AGEING
Population ageing is a global phenomenon: Virtually every country in In the countries with the worst health life expectancy is between 50
the world is experiencing growth in the size and proportion of older and 60 years. The population of the Central African Republic has the
persons in their population. lowest life expectancy in 2019 with 53 years.
Population ageing has been fastest in Eastern and South-Eastern Asia RANK COUNTRY RATE
and Latin America and the Caribbean.
Rapid aging in East Asia is due to regions economic development ,
higher life expectancy, sharp declines in fertility rates and increasing
life expectancies.
Throughout most of the world, survival beyond age 65 is improving
Conventional indicators of population ageing that are based on
chronological age (years since birth), with a fixed threshold of “old
age” at age 65, show that populations are becoming older in all
regions of the world. AGING IN THE PHILIPPINES
According to a 2018 study by the Philippine Institute for Development
New measures of population ageing based on prospective age (years Studies (PIDS),
of life remaining), with a dynamic threshold of “old age” that rises By 2032: The Philippines will have an "ageing society" with 7% of
progressively with increasing life expectancy, point toward a slower the population aged 65 or older.
process of population ageing than what is indicated by the By 2069: The Philippines will become an "aged society" with 14%
conventional measures. of the population aged 65 or older.
Michael Abrigo says that Population ageing is a sign of progress,
Indicators that incorporate both demographic and economic showing improvements in income, health, and education.
information suggest that the extent of population ageing depends on
age-patterns of production and consumption. The current life expectancy for Philippines in 2020 is 71.28 years, a
·The consumption of older persons is financed in various ways around 0.18% increase from 2019.
the world, including through public transfers, private transfers and
income from assets and labour. The life expectancy for Philippines in 2019 was 71.16 years, a 0.18%
increase from 2018
Population ageing will put increased financial pressure on old-age
support systems The life expectancy for Philippines in 2018 was 71.03 years, a 0.23%
increase from 2017.
Population ageing does not lead inevitably to macroeconomic decline
—with well-chosen policies, just the opposite may be true. The life expectancy for Philippines in 2017 was 70.87 years, a 0.23%
increase from 2016.
Philippines has rank # 123 with the rate of 68.3

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 C. IMPACT OF AGING MEMBERS IN THE FAMILY •Free radical Theory – membrane, nucleic acids and proteins are
damaged by free radicals which causes cellular injury and aging.
•Orgel/Error Theory – Errors in DNA and RNA synthesis occur with
Caring for aging parents has multiple impacts on the family life, aging.
including emotional, physical, financial and structural effects. As •Wear and Tear Theory – cells wear out and cannot function with
family members make plans and reflect on future as a caregiver/s, aging.
they take time to appreciate the strength derive from working together •Connective tissue/Cross – link Theory – with aging, proteins impede
and the unique bonds share as family. metabolic processes and cause trouble with getting nutrients to cells
and removing cellular waste products.
•ERRORS IN RNA is due to disease related defects of 3 types
1.Emotional Effects - Caring for aging parents prompts a range of impulses and 1) defects n RNA
emotions. "Guilt for not being able to do more for parents; anger for having to set 2) defects in RNA- binding proteins
aside own needs or shift priorities; and fear and anxiety, including anticipatory grief 3) defects in proteins responsible for RNA assembly
and fear of financial strain."
B. NON- STOCHASTIC THEORIES
Thomas and Segur also identify positive emotional effects of caring based on genetically programmed events that cause cellular damage
for aging parents, such as "enrichment that comes with relationships that accelerates aging of the organism.
between grandparents and grandchildren; increased opportunity to
pass on stories and knowledge to younger generations; and [the] •Programmed Theory – cells divide until they are no longer able to,
younger generations having a sense of being able to give back to and this triggers apoptosis or cell death.
parents and grandparents," resulting in a "greater connection" •Gene/Biological Clock Theory – cells have a genetically programmed
between family members. aging code.
•Neuroendocrine Theory – problems with the hypothalamus –
pituitary – endocrine gland feedback system cause disease,
increased insulin growth factor accelerates aging.
2. Financial Effects - Caring for aging parents often means extra costs related to •Immunological Theory – aging is due to faulty immunological
home health care, medical expenses not covered by insurance and extra function, which is linked to general well – being.
insurance premiums for services such as long-term care.
Thomas and Segur say that some families explore options for financial support
that can make family life more enjoyable, emphasizing that "there is no shame in
utilizing what support is out there."
•Human Needs Theory
• Theory of Individualism
•Stages of Personality Development Theory
3. Structural Effects - When a person live with his/her aging parents or assume a •Life – Course (Life Span Development) Paradigm
high amount of daily care for them, he/she experience a change in family roles. •Selective Optimization with Compensation Theory
Thomas and Segur describe this as a "shift in family structure and hierarchy
related to [the] matriarch or patriarch no longer being in their role." When this
occurs, "someone new [has] to take their place."
Human Needs Theory. Maslow surmised that a hierarchy of five needs
This shift can cause guilt and stress, as family members work to find motivates human behaviour: physiologic, safety & security, love &
a place in the new family dynamic, but it can also result in more open belonging, self – esteem and self – actualization.
communication among family members.
Although Maslow does not specifically address old age, it is clear that
physical, economic, social and environmental constrains can impede
need fulfillment of older adults. Maslow asserts that failure to grow
4. Physical Effects - Prioritizing parents' care can ease their pain and worry, but leads to feelings of failure, depression and the perception that life is
might impact health. Families who share responsibilities and secure outside help meaningless.
experience less stress and have the time and resources to maintain their health
and relationships with all members of the family.

Jung proposes a life – span view of personality development rather

than attainment of basic needs. Jung defines personality as being
5. Positive Effects - some families have the opposite experience by creating what composed of an ego or self – identity with a personal and collective
he/she describes as a positive "wiring" in their brains to produce more potentially unconsciousness.
positive outcomes. These people reflect on what makes them feel good for caring
for their aging parents. They consider what moments in their days make them As individuals age, Jung proposes that elders engage in an “inner
smile. They revel in the moments with loved ones that increase their sense of self- search” to critique their beliefs and accomplishments. Successful
worth and they end up creating closer bonds with both the older and younger aging means acceptance of the past and an ability to cope with
generations. functional decline and loss of significant others
Neugarten (1968) supports Jung’s association of aging and
introspection and asserts that “interiority”( inner character or nature)
D. THEORIES OF AGING AND ITS NURSING IMPLICATIONS promotes positive inner growth. Subsequent theorists also describe
introspection as a part of healthy aging. (Eriksonnnn, 1063;
Havighurst et al, 1968)

A. STOCHASTIC THEORIES
based on random events that cause cellular damage that accumulates
as the organism ages.

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 Functional consequences Theory – Environmental and
Erikson’s Theory: Focuses on individual development. biopsychosocial consequences impact functioning. Nursing’s role is
Progression: Requires successful completion of tasks at prior risk reduction to minimize age – associated disability in order to
stages to move to the next. enhance safety and quality of living.
Older Adults: Experience the developmental stage “ego integrity
versus despair”. Theory of thriving – failure to thrive results from a discord between
Final Phase: Characterized by evaluating one’s life for meaning. the individual and his or her environment or relationships. Nurses
Expanded Description: Older adults struggle with letting go, identify and modify factors that contribute to disharmony among
accepting care, detaching from life, and facing physical and these elements.
mental decline (Erikson, Erikson, & Kivnick, 1986).
Butler and Lewis (1982): Challenges of late life include adjusting
to infirmity, developing satisfaction with one’s life, and preparing
for death. Aging is a process that begins at conception and continues for as
long as we live. At any given time throughout our lifespan, the body
reflects:
its genetic component and
its environmental experience.
The central concepts of the life-course perspective blend key
elements in psychological theories such as life stages, tasks, and In other words, our bodies reflect our genetic capacity to adapt and
personality development with sociological concepts such as role repair, as well as the cumulative damage from disease processes.
behavior and the interrelationship between individuals and society. Aging highlights our strengths and our weaknesses.
The central tenet of life – course is that life occurs in stages that are In our society we currently think of the "young old" as being around 65
structured according to one’s roles, relationships, internal values and to 74 years of age, the "middle old" 75 to 84 and the "old old" 85 years
goals. Individuals may choose their goals but limited by external +. With advancing age, all of the body systems eventually
constraints. Goal achievement is associated with life satisfaction demonstrate reduced efficiency, slowed building & replacement and
(Buhler, 1933). actual loss of tissue. While an individual' s aging experience is
unique, there are generalizations which can be observed for each of
Individuals must adapt to changed roles and relationships that occur the body systems.
throughout life, such as getting married, finishing school, completing
military service, getting a job and retirement(Cunningham &
Brookbank, 1988). Successful adaptation to life change may E. PHYSIOLOGIC CHANGES IN AGING VARIOUS SYSTEMS
necessitate revising beliefs in order to be consistent with societal
expectations.
1. INTEGUMENTARY
The primary function of the skin is to protect the organism from the environment.
It accomplishes this by providing a barrier that regulates temperature, retains fluid
and absorbs shock and ultraviolet radiation, among other things. As we age, the
dermis decreases in thickness by about 20%. As it thins it loses vascularity( many
According to Baltes’s Theory (1987), individuals learn to cope with the superficial veins), cellularity( stem cells that develop new blood cells) and
functional losses of aging through process of selection, optimization sensitivity. Its ability to exchange or retain internal heat is diminished. The skin
and compensation. Aging individuals become more selective in becomes thin, fragile and slow to heal. Sweat and sebaceous glands are reduced
activities and roles as limitations present themselves; at the same both in number and effectiveness. Sensory neurons are decreased by 30% from
time they choose those activities and roles that are most the age of 10 years to 90 years old.
satisfying(optimization).
Subcutaneous fat deposition is altered in the elderly. Muscle, blood vessels and
Finally, individuals adapt by seeking alternatives when functional bone become more visible beneath the skin due to thinning of subcutaneous fat
limits prohibit sustaining former roles of activities. on the extremities. Fat deposition occurs mainly on the abdomen and thighs.
As people age, the pass through critical life points related to
morbidity, mortality and quality of life. The outcome of these critical
junctures may result in lower or higher order functioning that is 2. MUSCULO – SKELETAL
associated with higher or lower risk, respectively, for mortality. Muscle mass is a primary source of metabolic heat. When muscles contract, heat
Selective optimization with compensation is a positive coping is generated. The heat generated by muscle contraction maintains body
process that facilitates successful aging. (Baltes & Baltes, 1990) temperature in the range required for normal function of its various chemical
processes.
As early as the third decade of life there is a general reduction in the size, elasticity
and strength of all muscle tissue. The loss of muscle mass continues throughout
In a quest for a theoretical framework to guide caregiving in nursing the elder years. Muscle fibers continue to become smaller in diameter due to a
homes, Wadensten (2002) and Wadensten and Carlsson (2003) decrease in reserves of ATP( adenosine triphosphate- source of energy),
studied 17 Nursing Theories that were generated from 1960’s to the glycogen, myoglobin and the number of myofibrils. As a result, as the body ages,
1990s and found that none of the theorists offer advice on how to muscular activity becomes less efficient and requires more effort to accomplish a
apply their theory to caring for the older adult. Wadensten wrote that given task. The elderly are less efficient at creating the heat necessary to drive the
existing “Nursing theories do not provide guidance on how to care for important biochemical reactions necessary for life.
older people or on how to support them in the developmental process
of aging. There is a need to develop a nursing care model that more
than contemporary theories, takes human aging into consideration”
(2002). Others concur that nursing needs to develop more situation –
specific theories of aging to guide practice.

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3. RESPIRATORY 11. REPRODUCTIVE
Lung function diminishes with age. The major contributing factors are the Unlike women, men do not experience a major, rapid (over several months)
progressive loss of elastic recoil within lung tissue, the chest wall becomes stiff, change in fertility as they age (like menopause). Instead, changes occur gradually
and there is a decrease in alveolar surface area. These changes diminish the during a process that some people call andropause. Aging changes in the male
efficiency of gas exchange and make it more difficult to exercise. reproductive system occur primarily in the testes

4. CARDIOVASCULAR
Despite cardiovascular disease, often combined with a slowdown in the
autonomic nervous response, the cardiovascular function of a resting healthy
elder is usually adequate to meet the body's needs. Cardiac output of healthy
exercising elders can usually be maintained, allowing moderate continued
physical activity throughout their lives.

5. HEMATOPOIETIC( FORMATION OF BLOOD CELLS) AND LYMPHATIC(

LYMPATHIC VESSELS- VEINS
Aging is associated with a marked increase in a number of diseases, including
many types of cancer. Due to the complex and multi-factorial nature of both aging
and cancer, accurate deciphering of causative links between aging and cancer
remains a major challenge.

6. GASTROINTESTINAL
gastrointestinal symptoms can be quite common and range from mild
constipation or acid reflux to more serious conditions like infectious colitis(
swelling of large intestine) or bowel ischemia.( injury to intestines due to lack of
blood supply) Older adults more likely to use medication, such as certain heart
medication or non – steroidal anti - inflammatory drugs to treat pain, that can
increase the risk of gastrointestinal ulceration or bleeding. Risk of developing
colon cancer or diverticulitis( dis. In the intestines) also increases by age.

8. NERVOUS
the nervous system changes with age. There is loss of neurons in both the brain
and spinal cord. There is loss of neuronal dendrites which reduces the amount of
synaptic transmission. The sense of smell, taste, sight, touch and hearing are all
diminished over time. Depression can be the result of impaired synaptic activity.

9. SPECIAL SENSES
aging can affect all of the senses, but usually hearing and vision are most
affected. Devices such as glasses and hearing aids, or lifestyle changes can
improve the persons’ ability to hear and see.

10. ENDOCRINE
Old age is accompanied by a generalized reduction in hormone production and
activity. This reduction affects most metabolic functions of the body. Water,
mineral, electrolyte, carbohydrate, protein, lipid and vitamin disorders are all more
common in the elderly. Nutrition and the ability to use food for energy is seriously
affected in the elder population.
Diabetes is common in the elderly. There are many causes but a primary
mechanism involves the inability of skeletal muscle to absorb glucose. Over time
skeletal muscle becomes less responsive to insulin.
Recent research indicates that the elderly are at risk for nutritional deficiencies due
to anorexia. Age related anorexia has been linked to a lower satiety threshold.
Elders feel "full" sooner which may be due to changes in hormone receptor or
trigger mechanisms.

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