Introduction to Care of Older Adults (PDF)

Lesson 1: Introduction to Care of Older Adults THURSDAY, September 12, 2024 TERMS TO REMEMBER 1. GLOBAL AGING - Per another UN report,1 in 6 people...

Lesson 1: Introduction to Care of Older Adults THURSDAY, September 12, 2024 TERMS TO REMEMBER 1. GLOBAL AGING - Per another UN report,1 in 6 people in the world will be over the age of 65 in 2050. AGING 2. AGING IN THE PHILIPPINES - The Philippines is Normal process of time-related change begins with birth expected to have an aging population by 2032 – with the and continues throughout life. proportion of individuals aged 65 and above projected to The process of growing old or developing the appearance exceed 7%, according to the United Nations (UN). and characteristics of old age. Department of Economic and Social Affairs. In 2020, it AGEISM was at 5.5%, according to data from the World Bank. Process of systematic stereotyping and discrimination 3. CATEGORY OF OLDER ADULT against people because they are older in years. o Young Adult – 65-74 GERIATRICS o Old – 75-84 The study of health and disease in later life, and the o Oldest Old – 85-100 comprehensive health care of older persons and the well- o Elite Old – 100 and above being of their informal caregiver. GERONTOLOGY OLDEST FILIPINO The study of aging processes and individuals as they  Francisca Montes-Susano, grow from middle age through later life. o 124 years old Sept 11, 1897 - Nov 22, 2021 GERONTOLOGIC/GERIATRIC NURSING o Kabankalan, Negros Occidental An evidence-based nursing specialty that addresses the OLDEST FILIPINO unique physiological, social, psychological,  Maria Branyas Morera developmental, economic, cultural, spiritual, and o The oldest living person as of May 2023 advocacy needs of older adults. o She is 116 years old  Although gerontology and geriatrics have differing o Born on 4th March 1907, the American-Spanish emphases, they both have the goal of understanding supercentenarian is the world’s oldest person. She is aging so that people can maximize their functioning and currently living in a nursing home in Olot, Catalonia, achieve a high quality of life. Spain, and even runs her own Twitter account. Maria Branyas Morera was verified as the world’s oldest CLASSIFICATIONS OF AGING living person by Guinness World Record on 17 1. OBJECTIVELY January 2023 and was aged 115 at the time. o aging is a universal process that begins at birth and is specified by the chronological age criterion. 2. SUBJECTIVELY PERSPECTIVES OF AGING o aging is marked by changes in behavior and self- perception and reaction to biological changes. 3. FUNCTIONALLY o aging refers to the capabilities of the individual to function in society. PRINCIPLES OF GERONTOLOGIC NURSING Aging is a natural process common to all living organisms. Various factors influence the aging process. Unique data and knowledge are used in applying the nursing process to the older population. Older adults share similar self-care and human needs with all other human beings. Gerontological nursing strives to help older adults achieve wholeness by reaching optimum levels of physical, psychological, social, and spiritual health.  “A nurse has to be creative to come up with a care program that fits not only a person’s age, but also his/her functional capacity.”  “The number one thing I tell my students and co nurses is that there should be respect and dignity afforded to older adults. They are persons and they are our parents.” – Dr. Lydia Manahan DEMOGRAPHY OF AGING LIFE EXPECTANCY 72.3 years (life expectancy at birth, both sexes combined) 74.3 years (life expectancy at birth, females) 70.3 years (life expectancy at birth, males) With 117,337,368 population (2023), 13th world ranking. 1 NCM 112 Care of Older Adults CIRUJALES ROMER BSN3B  Lesson 1: Introduction to Care of Older Adults THURSDAY, September 12, 2024 GOVERNMENT POLICIES RELATED TO THEORIES OF AGING OLDER PEOPLE 1. BIOLOGICAL THEORIES OF AGING o Stochastic and Non-stochastic Theories 2. SOCIOLOGIC THEORIES OF AGING o Disengagement Theory o Activity Theory o Continuity Theory o Age Stratification Theory o Subculture Theory 3. PSYCHOSOCIAL THEORIES OF AGING o Developmental Tasks BIOLOGICAL THEORIES OF AGING biologic aging is the progressive lass of function a multi-factoral process involving genetics, oxidative stress, diet and environment The process of biologic aging differs not only from species to species but also from one human being to another. The rate of aging from different body systems within one individual may vary with one systems showing marked decline while another demonstrates no significant change a. Stochastic theory - view the effects of biological aging as resulting from random assaults from both the external and internal environment 1. Cross linking theory - also referred to as the glycosylation theory of aging proposed by Johan TERMS TO REMEMBER Bjorksten in 1942 that an accumulation of cross-linked proteins damages cells and tissues, slowing down bodily FUNCTIONAL AGE - Term used to describe physical, processes resulting in aging. psychological, and social functions. 2. Free radicals and lipofuscin theory - Free radical damage can also lead to the buildup of a pigment called PERCEIVED AGE - Term used to describe how people estimate lipofuscin. Lipofuscin is often called the aging pigment a person’s age based on appearance. because over time its accumulation can be observed in a wide variety of body tissues including in the liver, heart, SENESCENCE - The normal aging process. kidneys, and brain SENELITY - Aging process characterized by severe mental deterioration. BABY BOOMERS - Those born between 1947-1964, they have begun entering their senior years in 2011 and will continue to do so until 2030, the so-called demographic tidal wave. they are highly diverse, better educated, fewer children, higher incomes, and comfortable communicating via emails and text messages. 2 NCM 112 Care of Older Adults CIRUJALES ROMER BSN3B  Lesson 1: Introduction to Care of Older Adults THURSDAY, September 12, 2024 3. Wear and tear theory - is an idea proposed by German PHYSIOLOGIC CHANGES IN AGING biologist, Dr. August Wiesmann, in 1882 that aging 1. Integumentary results from a gradual deterioration of the cells and - As you age, you are at increased risk for skin injury Your tissues of the body via wear and tear, oxidative stress, skin is thinner, more fragile, and you lose some of the exposure to radiation, toxins, or other deteriorative protective fat layer. You also may be less able to sense processes touch, pressure, vibration, heat, and cold 4. Evolutionary theory - Evolutionary theory shows us - Some age-related changes are benign, such as graying that we can understand the change over time in all living hair. Others result in declines in function of the senses things in terms of variation, selection, and some form of and activities of daily life and increased susceptibility to reproduction or retention. and frequency of disease, frailty, or disability. In fact, 5. Biogerontology - genes dictate cellular longevity, advancing age is the major risk factor for a number of programmed cell death, or apoptosis, is determined by a chronic diseases in humans "biological clock" via genetic information in the nucleus of - Primary factors contributing to wrinkled, spotted skin the cell. include normal aging, exposure to the sun (photoaging) b. Non-stochastic theory and pollution, and loss of subcutaneous support (fatty - Explains biological aging as a complex predetermined tissue between your skin and muscle). Other factors that factors of process contribute to aging of the skin include stress, gravity, 1. Apoptosis (programmed cell death theory) - the daily facial movement, obesity, and even sleep position. process of programmed cell death. It is used during early 2. Musculoskeletal development to eliminate unwanted cells, for example, - Muscles may become rigid with age and may lose tone, those between the fingers of a developing hand in adults, even with regular exercise. Bones become more brittle apoptosis is used to rid the body of cells that have been and may break more easily. Overall height decreases, damaged beyond repair mainly because the trunk and spine shorten. Breakdown 2. Genetic theories - one of the basic principles of biology. of the joints may lead to inflammation, pain. stiffness, The main concept of this theory is that traits are passed and deformity. from parents to offspring through gene transmission. - loss of bone, degraded articular cartilage, and Genes are located on chromosomes and consist of DNA. degenerate, narrowed intervertebral discs are primary They are passed from parent to offspring through features of an ageing skeleton, and together they reproduction contribute to pain and loss of mobility. 3. Autoimmune reaction (Immunologic theory) - - One of the most striking effects of age is the involuntary Immunological Theory. The immune system is loss of muscle mass, strength, and function, termed programmed to decline over time, which leads to an sarcopenia. Muscle mass decreases approximately 3-8% increased vulnerability to Infectious disease and thus per decade after the age of 30 and this rate of decline is aging and death. even higher after the age of 60. 4. Neuroendocrine and neurochemical theories - "The 3. Respiratory effectiveness of the body's homeostatic adjustments - Your lungs mature by the time you are about 20-25 years old. declines with aging- leading to the failure of adaptive After about the age of 38, it is normal for your lung function to mechanisms, aging, and death.” This theory has also decline gradually as you age. This can make breathing slightly been referred to as the aging clock theory and the more difficult as you get older. pacemaker theory. - There are several body changes that happen as you get 5. Radiation theories - denotes those researches, older that may cause a decline in lung capacity: Alveoli theories, experiments, and problems-chiefly problems- can lose their shape and become baggy. The diaphragm which occupied physicists and chemists and astronomers can, over time, become weaker, decreasing the ability to between around 1800 and precisely 1900 and which gave Inhale and exhale. This change will only be significant way to quantum theory at the end of 1900 or at the latest when exercising. in 1913 when quantum theory was established. - The lung parenchyma loses its supporting structure 6. Nutrition theories - Nutrition is the biochemical and causing dilation of air spaces senile emphysema". physiological process by which an organism uses food to Respiratory muscle strength decreases with age and can support its life. It provides organisms with nutrients, impair effective cough, which is important for airway which can be metabolized to create energy and chemical clearance. structures. Failure to obtain the required amount of - Age-related changes in the respiratory system primarily nutrients causes malnutrition arise from the loss of elasticity and a decline in chest wall 7. Environmental theories - This theory prioritizes compliance, making an increase in work of breathing, environmental factors, such as fresh air, clean water, residual volume and functional residual capacity. efficient drainage, cleanliness of the patient and core area, and sunlight, as essential for human health and healing 3 NCM 112 Care of Older Adults CIRUJALES ROMER BSN3B  Lesson 1: Introduction to Care of Older Adults THURSDAY, September 12, 2024 4. Cardiovascular - Aging causes cardiovascular changes including increased arterial stiffness, left ventriculor (LV) diastolic 6. Gastrointestinal dysfunction, decreased heart rate variability and a - Our digestive system moves food through our bodies reduction in maximal heart rate, increasing the risk of through a series of muscle contractions. As we age, this early mortality process can slow down. When that happens, more water - The heart muscle cells degenerate slightly. The valves from the food is absorbed into the body, which can lead inside the heart, which control the direction of blood flow, to constipation. thicken and become stiffer. - Due to its significant reserve capacity, the gastrointestinal - Increased stiffness of central arteries, particularly of the system is more resilient to the effects of aging than other thoracic aorta, also characterizes human vascular aging. organ systems in the body. Typical gastrointestinal Human and animal studies suggest that the reduced system changes include a slowing or halting of functions distensibility of large elastic arteries results primarily from and an increased risk of digestive tract infections. the loss of elastic fibers, as well as an increase in collagen - Aging has little effect on the secretion of stomach juices - But over time, our blood vessels become less flexible. because the digestive system has a lot of reserve built That loss of flexibility can make it harder for blood to get into it. Aging has less effect on its function than it does where it's needed, cause an increase in blood pressure, on the function of other organ systems Nonetheless, and create faster pressure waves, placing extra stress on aging is a factor in several digestive system disorders. the heart and increasing the likelihood of heart failure or other cardiac diseases. 7. Urinary - Clinical urodynamic studies have demonstrated that advancing age is associated with a reduced bladder 5. Hematopoietic & Lymphatic capacity, an increase in uninhibited contractions, - The hematopoietic and lymphoid tissues are found decreased urinary flow rate, diminished urethral pressure throughout the body and function to produce red blood profile, and increased postvoid residual urine volume. cells, platelets, and white blood cells including - The elastic tissue becomes stiffer and the bladder inflammatory cells that react to various stimuli, such as becomes less stretchy. The bladder cannot hold as much infectious agents. traumatic injury, and other various urine as before. The bladder muscles weaken. The conditions. urethra can become partially or totally blocked. - Three key changes occur in the aged hematopoietic - With aging, many subjects exhibit progressive decreases system: in glomerular filtration rate (GFR) and renal blood flow 1) HSC functional decline, (RBF), with wide variability among Individuals. The fall in 2) increased clonal hematopoiesis, and GFR is due to reductions in the glomerular capillary 3) myeloid skewing and impaired lymphopoiesis. plasma flow rate, and the glomerular capillary - On a cellular level, aged lymphatic vessels have a ultrafiltration coefficient decrease in the glycocalyx and looser cell-to-cell gap - As people get older the ladder changer The elastic junctions, which causes leakier vessels. Skin cancer and bladder tissue may get toughen and become less psoriasis are two skin disorders that are aggravated in the stretchy. A less flexible bladder cannot hold as much as elderly before and might make you go to the bathroom more often 4 NCM 112 Care of Older Adults CIRUJALES ROMER BSN3B  Lesson 1: Introduction to Care of Older Adults THURSDAY, September 12, 2024 8. Nervous - As you age, your brain and nervous system go through natural changes. Your brain and spinal cord lose nerve cells and weight (atrophy). Nerve cells may begin to pass messages more slowly than in the past. Waste products or other chemicals such as beta amyloid can collect in the brain tissue as nerve cells break down - Different aspects of brain function may be affected at different times: Short-term memory and the ability to learn new material tend to be affected relatively early. - Verbal abilities, including vocabulary and word usage, may begin to decline later - Intellectual performance the ability to process information (regardless of speed) is usually maintained if no underlying neurologic or vascular disorders are present. Reaction time and performance of tasks may become slower because the brain processes nerve impulses more slowly. - These disorders include depression, stroke, an underactive thyroid gland (hypothyroidism), and degenerative brain disorders such as Alzheimer disease. As people age, the number of nerve cells in the brain may decrease Continuous… 5 NCM 112 Care of Older Adults CIRUJALES ROMER BSN3B  Lesson 1: Introduction to Care of Older Adults THURSDAY, September 12, 2024 9. Special Senses 11. Reproductive – Special senses include vision, hearing, taste, and smell. – Age affects the fertility of men and women. Special senses are processed via cranial nerves and differ – At an individual level, many conditions related to from the pathway utilized in processing general senses. reproductive aging, including sexual dysfunction, – Sensitivity to the five tastes often declines after age 60. subfertility or infertility, conditions related to sex- steroid In addition, your mouth produces less saliva as you age. deficiency, genitourinary disorders, pelvic floor disorders, This can cause dry mouth, which can affect your sense of and cancers of the reproductive and accessory organs taste. Your sense of smell can also diminish, especially motivate middle-aged and older men. after age 70. – If the central nervous system or the brain deteriorate, as a result of age or illness then this flow of sensory information can also deteriorate. As we age the level of stimulation required to make the brain aware of a sensation also rises (effectively reducing the sensitivity of our senses).  Understanding the Effects of Aging on the Sensory System Effects of Aging on the Female Reproductive System 10. Endocrine – Around menopause, changes in the female reproductive – Hormones of the endocrine system are a vast topic with organs occur rapidly. Menstrual cycles stop, and the numerous hormones involved, affecting virtually every ovaries stop producing estrogen. organ in the human body. Human physiologic processes – After menopause, the tissues of the labia minora, clitoris, such as homeostasis, metabolic demand, development, vagina, and urethra become thin. This thinning can result and reproduction are all possible because of hormones in chronic irritation and dryness of the vagina. Vaginal and the processes mediated by their actions. discharge and urinary tract infections are more likely to – In women, estrogen levels decline with menopause. In develop. men, testosterone levels usually decrease gradually. – Also, after menopause, the uterus, fallopian tubes, and Decreased levels of growth hormone may lead to ovaries become smaller. decreased muscle mass and strength. Decreased – Age-related changes in reproductive organs do not melatonin levels may play an important role in the loss of interfere with sexual pleasure. However, vaginal dryness normal sleep-wake cycles (circadian rhythms) with aging. after menopause can cause pain during sexual activity,  What are the physiological changes in the endocrine and some women feel a decrease in the desire to have system in the elderly? sex. – Because there is less estrogen to stimulate milk ducts, the breasts decrease in size. The connective tissue that supports the breasts also decreases. The loss of support contributes to changes in breast shape. Fibrous tissue in the breasts is replaced with fat, making the breasts less firm.  Did You Know...? Some women enjoy sexual intercourse more after menopause Effects of Aging on the Male Reproductive System Although testicular morphology, semen production, and fertility are maintained up to a very old age in men, there is clear evidence of decreased fecundity with advancing age and an increased risk of specific genetic disorders related to paternal age among the offspring of older men The tubes that carry sperm may become less elastic (a process called sclerosis). The testes continue to produce sperm, but the rate of sperm cell production slows. The epididymis, seminal vesicles, and prostate gland lose some of their surface cells. But they continue to produce the fluid that helps carry sperm. 6 NCM 112 Care of Older Adults CIRUJALES ROMER BSN3B  Lesson 1: Introduction to Care of Older Adults THURSDAY, September 12, 2024 There may be problems getting an erection. This is a general slowing, instead of a complete lack of function.  Older men are more likely to have good sex if they continue to be sexually active during middle age. Coverage: PHYSIOLOGIC CHANGES IN AGING II.Nursing Care of the Older Adult in Wellness A. Assessment 1. Subjective data o Nursing history o Functional health patterns 2. Objective Data o Psychological Assessment o Physical Assessment B. Nursing Diagnosis/es C. Planning for Health Promotion, o Health Maintenance and Home o Health Considerations D. Implementation 1. Physical Care of Older Adults o Aging Skin and Mucous Membranes o Elimination o Activity and Exercise o Sleep and Rest o Nutrition 2. Psychosocial care of Older Adults o Cognition and Perception Engagement with Life o Self-Perception and Self-Concept o Coping and Stress o Values and Beliefs o Sexuality and Aging Midterm Examination 7 NCM 112 Care of Older Adults CIRUJALES ROMER BSN3B