Understanding Gerontology and Aging

• A man’s life is normally divided into five main stages
• Old age is often problematic
• With increasing age, people become old. Birth, development, decline, and death are the laws of life
• Aging is not merely the passage of time
• People age differently
• Slight, gradual changes are common, and most are not problems for people who experience them.

Gerontology vs Geriatrics

• Gerontology is the study of the physical, mental, social, and societal aspects of aging.
• Geriatrics refers to medical care for older adults
• Geriatric Nursing is focused on the care of older adults.

Roles of a Geriatric Nurse

• Direct Caregiver
• Teacher
• Leader
• Advocate
• Evidence Based Clinician

Aging

• The time-related deterioration of the physiological functions necessary for survival and fertility.
• A normal process of time-related change that begins with birth and continues throughout life.
• It is the process of growing old or developing the appearance and characteristics of old age.
• Aging expresses the continuous pressure and effect of time on our body, senses, and skin

Progeria

• Progeria, also known as Hutchinson-Gilford progeria syndrome (HGPS), is a rare genetic condition that causes a child's body to age fast.
• Most kids with progeria do not live past age 13.
• The disease affects both sexes and all races equally.
• It affects about 1 in every 4 million births worldwide.

Classifications of Aging

• Objectively, aging is a universal process, which begins at birth and is specified by the chronological age criterion.
• Subjectively, aging is marked by changes in behavior, self-perception, and reaction to biologic changes.
• Functionally, aging refers to the capabilities of the individual to function in society.

Five Types of Aging

• Chronological Aging refers to the actual amount of time a person has been alive.
• Number of days, months, or years a person has been alive.
• Biological Aging, also known as senescence or biological ageing, is the gradual deterioration of function characteristics.
• Biological aging is also known as physiologic aging.
• Biological aging refers to the physical changes that "slow people down" as humans get into middle and older years.
• Arteries might clog up, or problems with lungs might make it more difficult to breathe, are examples of biological aging.
• Psychological aging refers to the psychological changes, those involving mental functioning and personality, that occur as humans age
• Social aging refers to changes in a person's roles and relationships with relatives, friends, formal associations, such as the workplace and houses of worship
• Social aging differs from one individual to another, it also is powerfully influenced by the perception of aging that is part of society's culture.
• Cognitive aging is the decline in cognitive processing that is known to occur as people get older
• Age-related impairment in reasoning, memory, and processing speed can arise during adulthood and progress into the elder years.
• Cognitive aging describes a process of gradual, longitudinal changes in cognitive functions that accompany the aging process.

Age categories

• Young old: 65-74 years
• Middle old: 75-84 years
• Old old: 85-100 years
• Elite old: Over 100 years

Senior Citizen or Elderly

• This refers to any Filipino citizen who is a resident of the Philippines, and who is sixty (60) years old or above.
• It may apply to senior citizens with 'dual citizenship' status provided they prove their Filipino citizenship and have at least six (6) months of residency in the Philippines.

Older Adult

• Most developed world countries have accepted the chronological age of 65 years as a definition of 'elderly' or older person.
• This definition is somewhat arbitrary, it is often associated with the age at which someone can begin to receive pension benefits.
• There is no United Nations standard numerical criterion, but the UN agreed cutoff is 60+ years to refer to the older population.

Attitudes towards Aging

• Observation of family members, friends, neighbors, and personal experience with older adults are determining attitudes toward aging.
• Media such as newspapers, film industry, commercials in magazines and TV shape attitudes about aging.
• Ageism is a negative attitude toward aging or older adults.
• Need to take a look at the myths and realities
• To separate fact from fiction
• To gain value for the wisdom of lifetimes that older adults have to offer

Geriatric or Gerontological Nursing Background

• A field of nursing that specializes in the care of the elderly
• Florence Nightingale and Doreen Norton provided early insights into the care of the aged
• ANA established the Division of Geriatric Nursing Practice in 1966 with a goal to create standards for quality nursing care for the aged
• The standards and scope of gerontological nursing practice were developed in 1969 by ANA
• The term gerontological nursing replaced the term Geriatric Nursing in the 1970s
• Geriatric nursing is bound to be part of our professional future
• Older adults are the core business of health care; they account for the majority visits, admissions, and long-term care residents.

The Aging Population

• The global population aged 60 years or over numbered 962 million in 2017, more than twice as large as in 1980 when there were 382 million worldwide.
• The number of older persons is expected to reach nearly 2.1 billion by 2050.
• By 2030, older persons are expected to outnumber children under age 10 (1.41 billion versus 1.35 billion)
• In 2050, projections indicate that there will be more persons aged 60 or over than adolescents and youth at ages 10-24 (2.1 billion versus 2.0 billion).
• The number of persons aged 80 years or over is projected to increase more than threefold between 2017 and 2050, rising from 137 million to 452 million.
• Two-thirds (2/3) of the world's older persons live in the developing regions, where their numbers are growing faster than in the developed regions.
• By 2050, it is expected that nearly 8 to 10 of the world's older persons will be living in developing regions.

Aging in the Philippines

• The 60 years and older population of the United States will increase by 5.4% from 2010 to 2030.
• The Philippines' population increased by over 35% over the last two decades with an older adult population (60 years and older) expected to overtake those aged 014 years old by 2065
• The life expectancy of Filipinos is 57.4% years for males and 63.2 years for females.
• Females are projected to expect an increase of 4.0 years in life expectancy and males an increase of 4.7 years in life expectancy by 2030.

Impact of Aging Members in the Family: Emotional Effect

• Common emotions: "Guilt for not being able to do more for parents; anger for having to set aside your own needs or shift your priorities; and fear and anxiety; including anticipatory grief and fear of financial strain. Caring for children and aging parents at the same time can make you feel as if you do not have the emotional strength and resources for everyone.
• (+) "enrichment that comes with relationships between grandparents and grandchildren; increased opportunity to pass on stories and knowledge to younger generations; and the younger generations having a sense of being able to give back to parents and grandparents,” resulting in a "greater connection between family members."

Financial Impact

• Caring for aging parents often means extra costs related to home health care, medical expenses not covered by insurance, and extra insurance premiums for services such as long-term care.
• You may need to take off extra time from work
• Some families explore options for financial support that can make family life more enjoyable. There is no shame in utilizing what support is out there.

Structural Impact

• You experience a change in your family roles when you live with aging parents or assume a high amount of daily care for them.
• Thomas and Segur describe this as a shifting responsibility in family structure and new position is introduced.
• The shift can cause guilt and stress, as family members work to find a place in the new family dynamic, but it can also result in more open communication among family members
• The family structure shifts to being less hierarchical and more cooperative

Physical Impacts

• Prioritizing parents' care eases their pain and worry but might compromise health
• The time and effort of keeping up with parents' care may result in fewer visits to the doctor, resulting in undiagnosed problems or conditions getting worse.
• Caregiving for a parent with dementia can cause chronic stress and illness
• Time pressure might result in caregivers and their children skipping exercise and eating more convenience foods, which contribute to poor fitness and weight gain

Positive Impact

• "Thoughts frame our emotional state"
• One might feel as if you are in a rut when caring for aging parents
• This affects the family life and creates an environment of bitterness and resulting in more criticism and complaining.
• Some families have the opposite experience by creating a positive "wiring” in their brains to produce more potentially positive outcomes
• Good feelings are the product of caring for aging parents

Purpose of Nursing Principles and Theories

• Defines nursing practice
• comprehensive gerontological nursing should consider individual differences
• Tells how and why phenomena are related
• Leads to prediction
• Provides process and understanding
• Impacts a person throughout a lifetime of aging

Principles of Gerontology

• Consider individuality. Consult their preferences.
• Be patient, kind and sympathetic. Communicate effectively, and demonstrate respect.
• Encourage independence for choices and decisions.
• Assist elderly to achieve emotional stability.
• Stimulate mental acuity and sensory input and physical activity to uplift their self-esteem, self concept and confidence..
• Make elderly stay in the home interesting and lively
• Provide diversion/occupational therapy.
• Maintain privacy
• Handle them gently.
• Make them comfortable by providing a comfortable bed and bed linen etc. Keep the bed dry, smooth and unwrinkled.
• Encourage body hygiene to regulate body temperature.
• Assist them to take care of visual, auditory and dental aids.
• Protect from injuries, falls and accidents etc.
• Ensure adequate nutrition.
• Facilitate elimination. Encourage them to maintain external genitalia hygiene.
• Encourage them to do active range of motion exercises. Maintain body alignment and posture. Encourage mobility.
• Help elderly to establish good sleep patterns.
• Caution elderly about the use of drugs.
• Have them physically examined annually and whenever needed.
• Observe any psychophysical changes which alter their body image and behaviour.

Theories of Aging

• Biological theories
• Psychological theories
• Environmental theories
• Developmental theories

Biological Theories

• Stochastic Theories are based on random events that cause cellular damage, which accumulates as the organism ages
• Non-Stochastic Theories are based on genetically programmed events that cause cellular damage that accelerates aging.

Stochastic Theories

• Free Radical Theory damages membranes, nucleic acids, and proteins by free radicals, which causes cellular injury and aging.
• Orgel/Error theory: errors in DNA and RNA synthesis occur with aging
• Wear and Tear theory: cells wear out and cannot function with aging
• Connective Tissue/ Cross linking theory: with aging, proteins impede metabolic processes, causing cellular damage
• Trouble with nutrients getting to cells
• Trouble with removing cellular waste porducts

Non - Stochastic Theories

• Programmed theory: cells divide until they are no longer able to, and this triggers apoptosis or cell death
• Gene/Biological Clock Theory: cells have a genetically programmed aging code
• Neuroendocrine Theory: problems with the hypothalamus-pituitary-endocrine gland feedback system cause disease
• An increase in insulin growth factor accelerates aging
• Immunological Theory: aging is due to faulty immunological function, which is linked to general well-being

Psychosocial Theories

• Sociological Theories: changing roles, relationships, status, and generalizational cohort impact the older adult's ability to adapt.
• Psychological Theories explain aging in terms of mental processes, emotions, attitudes, motivation, and personality development that is characterized by life stage transitions.

Sociological Theories

• Activity Theory states that remaining occupied and involved is necessary to a satisfying life.
• Remaining occupied and involved leads to better aging.
• Disengagement refers to the Gradual withdrawal from society and relationships to maintain social equilibrium and promote internal reflection
• The elderly may prefer to segregate from society in an aging subculture, where they share loss of status and deal with societal negativity regarding the aged
• Health and mobility are key determinants of social status of the aged
• Continuity refers to the influence personality has on roles and life satisfaction and consistency throughout life.
• Past coping patterns recur as older adults adjust to physical, financial and social decline and contemplate death.
• Adaptation to those changes is often achieved by identifying with one's age group, finding a residence compatible with one's limitations, and learning new roles postretirement are major tasks.
• Age Stratification states that society is stratified by age groups that are the basis for acquiring resources, roles, status and deference from others.
• Age cohorts are influenced by their historical context and share similar experiences, beliefs, attitudes, and expectations of life-course transitions.
• Person-Environment-Fit says function is affected by ego strength, mobility, health, cognition, sensory perception, and environment. Competency changes one's ability to adapt to environmental demands
• Gerotranscendence is the idea that the elderly transform from a materialistic/rational perspective toward oneness with the universe.

Psychological Theories

• Human Needs: 5 basic needs motivate human behavior toward need fulfillment (Maslow's)
• Individualism: personality consists of an ego; it is the personal and collective unconsciousness that views life from a personal or an external perspective. It often leads to older adults search for life meaning and adapt to functional and social losses. (Jung's theory)

Environmental Theory

• Radiation Theory posits that excessive exposure to the suns radiation puts the skin at risk during the somatic mutation process.
• Stress theory of aging: Human aging is a disease syndrome arising from a between environmental stress and biological resistance and relative adaption to stressor agents that might include air, pollutant, chemical, psychological and sociological events. (Perlman 1954)

Developmental Theory

• Erikson found one’s life consists of eight stages.
• Each stage represents a turning point in life from birth to death, with its own developmental conflicts to be resolved.

Physiological Changes in Aging - Circulatory Functions

• Age-related changes in the heart muscle & blood vessels result in overall decreased cardiac function
• Reduced circulatory functions related to physical capacity
• Factors affecting circulatory function:
  • limited exercise and physical activities
  • Lifestyle
  • Smoking
  • Alcohol Consumption
  • Diseases of the circulatory system
• Assessment:
  • Family history
  • Current problems (chest pain; exertion discomfort)
  • Current diagnoses
  • Medication history (prescription, OTC, herbals)
  • Source of stress
  • Adherence to current medical regimen
  • Physical examination
  • Blood pressure
  • Chest sounds
  • Pulse rate
  • Stress test
  • Blood & Serum tests
  • ECG's & echocardiogram

Respiratory Functions

• Age-related changes to bones, muscles, lung tissue, and respiratory fluids contribute to respiratory difficulties
• Factors affecting respiratory function:
  • Disease
  • Injury
  • Restriction in mobility
  • Extended bed rest
• Assessment:
  • Current medications (prescription, OTC, or herbals)
  • Smoking behavior
  • Exposure to environmental pollutants
  • Difficulties in breathing
  • Signs of decreased energy levels
  • Coughing and production of excessive sputum
  • Observe posture and breathlessness
  • Auscultate chest sounds
  • Blood and pulmonary function tests
  • Chest x-rays
  • Sputum analysis

Gastrointestinal Function

• Age-related changes in this area are not dramatic and may not be easily noticed
• Factors affecting gastrointestinal function:
  • Decreased peristalsis (constipation)
  • Reduced gastric acid secretion
  • Lack of dietary fiber
  • Low levels of physical activity
  • Lack of fluids
  • Chronic constipation resulting in fecal impaction, incontinence and delirium
• Assessment:
  • Ask about usual diet
  • Appetite and the changes
  • Occurrence of nausea, vomiting, indigestion, or other stomach discomforts
  • Bowel functions (constipation & diarrhea)
  • Exercise, diet, fluid intake
  • Medications (prescription, OTC, herbal)
  • Oral health
    • Observe condition of tongue, teeth, and gums
    • Check dentures

Genitourinary Function

• Age-related changes have a major impact on everyday life
• Factors affecting genitourinary function:
  • Weak bladder muscle, with resulting reduction to the capacity of the bladder.
  • Infection
  • Childbirth & gynecologic surgery (incontinence)
  • Enlarged prostate
  • Chronic renal failure
• Assessment:
  • History of previous or current difficulties related to frequency & voluntary flow of urine either day or night
  • Identify type of incontinence: stress, urge, functional or overflow
  • Fluid intake
  • Caffeine and alcohol intake affects bladder tone
  • Observe skin (dehydration)
  • Medication use (prescription, OTC, herbals)
  • Diagnostic tests
  • Urinalysis (blood, bacteria, or ketones)
  • Ultrasonography

Sexual Function

• Age does not change the drive for sexual activity or sexual relationship
• Factors affecting sexual function:
  • Lack of partner
  • Medication use (prescription, OTC, herbals)
  • Decrease in speed & duration of erection (males)
  • Decreased vaginal lubrication (females)
  • Chronic illnesses (osteoarthritis)
  • Diminished positive self-image
  • Lack of privacy
• Assessment:
  • Ask about sexual activity

Neurological Function

• Affects all other body systems and typically includes decline in reaction time, kinetic & body balance and sleep disturbances
• Factors affecting neurological function:
  • Diseases (Alzheimer's, Parkinson's, Dementia)
  • Stroke
• Assessment:
  • Medications
  • Diagnosis (history & family history of stroke)
  • Observe & ask about previous & current impairment in:
    • Speech
    • Orientation
    • Balance
    • Expression
    • Energy level
    • Sensation
    • Swallowing
    • Memory
    • Motor Function
    • Occurrence of sleep disturbance, tremors, & seizures

Musculoskeletal Function

• Age-related changes lead to reduced tone, strength, and endurance
• Factors affecting musculoskeletal function:
  • Stiffening of connective tissues and erosion of articular surfaces of joint
  • Decline in hormone production
  • Diet
  • Disorders (osteoarthritis & osteoporosis)
  • Accidents
• Assessment:
  • History of musculoskeletal illnesses (OA, sore joints), injury, or history of surgery
  • Observe posture, stance, & walking
  • The use of assistive devices
  • Observe body language & facial expressions
  • Diagnostic test
  • Up & Go Test
  • Bone Density Test.

Sensory Function

• Age-related & disease-related changes in sensory function can have effects on quality of daily functions
• Factors affecting sensory function:
  • Problems in vision & hearing
    • Presbyopia – inefficient visual accommodation
    • Presbycusis – progressive hearing loss
• Assessment:
  • Assess for reading capacity
  • Observe for difficulty and accuracy
  • Use of magnification aids
  • Ask about any hearing problems
  • Observe for appropriate responses -Assess hearing devices
  • Ask for any medical condition
  • Medications (for side effects)

Integumentary Function

• Age-related changes include loss of elasticity, slower regeneration of cells, diminished gland secretion, reduced blood supply, and loss of fat
• Factors affecting integumentary function:
  • Decreased mobility and extended bed rest
  • Skin dryness and skin irritation
• Assessment:
  • Inspection of the skin (color, hydration, circulation, & intactness)
  • Ask for any skin injury and treatment
  • Ask for any history of diseases or infection
  • Assess nutritional status & body weight
  • Assess for loss of sensation

Endocrine and Metabolic Function

• Age-related changes include reduced hormone secretion and breakdown of metabolites
• Factors affecting function includes endocrine and metabolic disease
• Disease or illness (Diabetes Mellitus)
• Assessment:
  • Family history
  • Changes in weight and appetite
  • Fatigue, thirst, vision problems, slow wound healing, headaches, and other symptoms
  • Palpate for nodules at the neck (thyroid problems)
  • Assess for hyperthyroidism, including occurrence of nervousness, heat intolerance, weight loss, tremors, and palpitations
  • Assess for hypothyroidism:
    • Skin changes
    • Fatigue
    • Forgetfulness
    • Constipation
    • Cold sensitivity

Hematologic & Immune Function

• Age-related changes includes a decrease in blood cellular components
• Factors affecting Hematologic & Immune functions: -Anemia (decreased hemoglobin level) through decreased red blood cells -Iron deficiency. -Infections.
• Assessment:
  • Observe for skin color, quality of skin, and nail beds. -Assess diet (iron-deficiency)
  • Diagnostic testing
  • Complete Blood Count
  • Ask about vaccinations for flu and pneumonia.
  • Ask about recent and current infection
  • Ask about sexual activity

Cognitive assessment

• Cognitive decline is difficult to define. Varies among older adults and are difficult to separate from other co morbidities, other, age-related changes, the side effects of medication, and changes in intellectual activity. Cognitive assessment includes: -Qualities of attention -Memory -Language -Visuospatial skills
• Executive capacity
• Cognitive assessment tools: MMSE, Mini-Cog

Common Cognitive Disorder

• Alzheimer
• Most common form of dementia, leading to a permanent decline in cognitive function
• Assessment
• Emphasize individualization
• Ask for previous preferences directly from the client or family members.
• Assess social ability

Psychological Assessment

• Presents a wide spectrum from positive mental wellness to the problem of mental health; its two sides are as follows:
• The quality of life, encompassing all areas of everyday living, that is synonymous with healthy aging
• Depression, which is a state of low mental wellness To be clear about successful mental aging:
• Physical wellness
• Independence
• Functional ability
• A long life span
• Engagement in society
• Self-mastery
• Optimism
• A sense of one’s own purpose
• Achieving goals
• Recognizing depression as different from natural sadness
• Noting depressive trends or common causes

Depression

• Often associated with cognitive limitations; it remains undiagnosed in older adults
• Includes clinical depression (a serious consequence), can induce suicidal ideations or attempts

Depression Causes

• Widowhood in relation to death

• Loss of independence

• Signs include: sadness, not enjoying activities, weight loss, sleep disturbance, restlessness, fatigue and worthlessness- with an impaired ability to think clearly, and suicide attempts

• Clinical depression can be long term and is not the same as simple unhappiness, mixed-up confusion and psychosomatic ailments.

Social Assessment

• Social support affects overall wellness -Social life connects us and helps with the ability to interact with others; as one ages, the network decreases Information about the web and its significance should entail both:
• The assessment of nursing
• Assessment of support based on those connections

Assessment Tools

• Assessment of spiritual needs involves a holistic plan of care with a sense of well being
• Religiosity and spirituality are not the same thing Religoius belief is not nessisarily spiritual as well Guidelines for a spiritual Assessment: -Concepts of God or deitiy -The source of personal strength and hope, the significance of religious practices and rituals.
• Relationship between spiritual belief and well being

Obesity

• Became a major health issue and associated with chronic diseases and disability: assessment is key to overall function.
• Assess overweight patients with dietary review
• Obesity causes medical problems.

Communications

It helps:

• Links to one another and the environment and is a key factor in relation to coexist with each other
• Provides the ability to receive and send information

Communications with Elderly

Why it's important -Helps maintain physical and emotional well being.

• Helps the perception of good control of ones environment and achievement in the modern world.
• Communicates needs, wishes, and helps express feelings
• Communication helps us understand and cope with situations

Fears and Apprehensions

Afraits of not being heard, not wanting to be seen as a complainer

Tips for Communication

• Use the righ addressing style
• Ensure comfort during conversation time
• Establish repport beforehand
• Be patient and dont interrupt
• Use active listening skills and compassion
• Avois medical jargon and confusing terminoligy

General Talking Practices

• Allow adequate time to have a patient interaction -Minimize auditory and visual distractions -Face the person at eye level -Allow visual contact, but dont pressure eye contact -Listen and avoid interruption -Speak slowly and clearly without using a normal tone -Use simple short words and sentences, sticking to the current topic and giving the chance to answer questions - Simplify instructions and write them down -Show Charts, models and pictures to get a clearer picture for understanding of the message - Summarize the most important and vital information often -Give the patient an opportunity to speak, answer questions and say their mind. _Schedule the patient interaction earlier on a certain day -Greet the patient for a more inviting experience -Sit in a quiet, relaxing and calming environment for the patient
• Ensure the ability have reading is easier and more enjoyable

Be prepared to physically assist the patient in walking to where ever they need to go - Check at convenient times to see how they are doing - Use touch to help them fell relaxed and focused to what you have to say

   -Give them a goodbye that makes them feel welcome. Thank them for making the visit to begin with

General Factors

Communications are related to common issues with aginig

• Physical wellnes
• Depression
• Lack/loss of vision
• Hearing loss due to age or environment

Compensating Hearing Issues:

Ensure clear hearing

• Clear speaking in normal tone

• Avoid any visual blocks like hand in front of the mouth

• Write to allow the patient to respond better

• Notify the patient to give them a chance to follow and not be left behind

Visual Issues

• Adequate light and reduced glares can make interactions easier
• Ensure reading glasses
• If they are have reading, offer to read for them or do not just printed materials.
• Ensure a big print with a readable print style