NCM 114 - Prelims part 1 (20240827212838).docx

**Republic Act No. 8425** provides for the institutionalization and enhancement of the social reform agenda by creating the National Anti-Poverty Commission (NAPC). Through its multi-dimensional and cross-sectoral approach, NAPC provides a mechanism for older persons to participate in policy formula...

**Republic Act No. 8425** provides for the institutionalization and enhancement of the social reform agenda by creating the National Anti-Poverty Commission (NAPC). Through its multi-dimensional and cross-sectoral approach, NAPC provides a mechanism for older persons to participate in policy formulation and decision-making on matters concerning poverty alleviation. **Republic Act No. 10155,** known as \"The General Appropriations Act of 2012\", under Section 28 mandates that all government agencies and instrumentalities should allocate one percent of their total agency budget to programs and projects for older persons and persons with disabilities. **Republic Act No. 9994**, known as \"Expanded Seniors Citizen Act of 2010\", an act granting additional benefits and privileges to senior citizens. further amending Republic Act No. 7432 and otherwise known as \"an act to maximize the contribution of senior citizens to nation building, grant benefits and special privileges and for other purposes (Senior Citizen Act of 1992, Act No. 7432). **Presidential Proclamations and Executive Orders** Presidential Proclamation No. 470, Series of 1994, declaring the first week of October of every year as \"Elderly Filipino Week.\" Presidential Proclamation No. 1048, Series of 1999, declaring a \"Nationwide Observance in the Philippines of the International Year of Older Persons\". Executive Order No. 105, Series of 2003, approved and directed the implementation of the program providing for group homes and foster homes for neglected, abandoned, abused, detached, and poor older persons and persons with disabilities. **The Philippine Plan of Action for Senior Citizens (2011-2016)** This plan aims to ensure giving priority to community-based approaches which are gender-responsive, with effective leadership and meaningful participation of senior citizens in decision-making processes, both in the context of family and community. This plan of action aims to ensure active aging for senior citizens where preventive and promotive aspects of health are emphasized in communities and where health services are accessible, affordable and available at all times. Envisioning a population of senior citizens who are self-sufficient and self-reliant, this plan aims to promote financial security and financial independence of senior citizens by developing community-based local delivery systems to address their needs. Health and Care The Department of Social Welfare Development (DSWD) has issued Administrative Order No. 4 series of 2010, \"Guidelines on the Home Care Support Services for Senior Citizens\", establishing community-based health care services for older persons. The RA 9994 provides health care services for poor older persons such as free medical services on government hospitals, discounted services on private hospitals and clinics, free vaccines, discounted medicines, and mandatory PhilHealth coverage. **Older People\'s Associations (OPAs)** The Philippine Constitution supports the formation of community based organizations. The DSWD have facilitated the formation of older people\'s associations in every city and municipality. They are also tasked to provide technical assistance to support and strengthen OPAS. **Social Pension** Under the RA 9994, the Philippine Government provides a social pension of Php500 per month to poor older persons aged 77 and over who are not yet receiving any government or private pension. The Department of Social Welfare and Development is the lead agency tasked with identifying and reviewing social pension beneficiaries. **Senior citizens** Refer to the resident citizens of the Philippines at least 60 years old, including those who have retired from government offices and private enterprises and have a yearly income of not more than 60 thousand pesos, subject to review by NEDA every three years. As privileges for the Senior Citizens, they shall be entitled to the following: a. the grant of twenty percent discount from all establishments relative to the utilization of transportation services, hotels and similar lodging establishments, restaurants and recreation centers and purchase of medicine anywhere in the country: Provided, that private establishments may claim the cost as tax credit. b. a minimum of twenty percent discount on admission fees charges by theaters, cinema houses and concert halls, circuses, carnivals and other similar places of culture, leisure; and amusement; c. exception from the payment of individual income taxes; Provided that their annual taxable income does not exceed to the poverty level as determined by the National Economic Development Authority (NEDA) for that year; d. exemption from training fees for socio-economic programs undertaken by the OSCA as part of its work. e. free medical and dental services in government establishment anywhere in the country, subject to guidelines to be issued by the DOH, the GSIS; f. to the extent practicable and feasible, the continuance of the same benefits and privileges given by the GSIS, SSS and PAG-IBIG, as the case may be, as are enjoyed by those in actual service. Furthermore, the 20 percent discount privilege is exclusive and limited to the benefit of the senior citizen. **Medical Dental Care** A Senior Citizen is entitled to free medical and dental services in government establishment anywhere in the country, subject to guidelines to be issued by the DOH, GSIS, and SSS. The DOH shall direct the government establishments in the entire country to provide free medical/dental services where capability and facility for such services are available. The term \"free\" shall mean free of charge on medical/dental where capability and facility for such services are available. The term **\"medical services\"** shall refer to services pertaining to the medical care/attendance and treatment given to senior citizens. It shall include health examinations, medical/surgical procedures within the competence and capability of DOH establishments and ancillary procedures as required. The term **\"dental services\"** shall refer to services pertaining to dental care/attendance and remedy given to senior citizens. It shall include oral examination, curative services like permanent and temporary fillings, extractions and gum treatment. **Professional services** shall refer to services rendered or extended by medical, dental and nursing professionals, which shall also include services rendered by surgeons, EENT practitioners, gynecologists, urologists, neurologists, psychiatrists, psychologists and other allied specialists. **Counseling services** shall refer to advice given by health professionals, e.g. psychologists, psychiatrists, nutritionists, nurses and other allied health professionals in support to specific treatment of illnesses. The following are the health services that may be availed for free in any government establishments, subject to availability of facilities and manpower/technical expertise of the receiving government establishment: a\. Medical and dental services b\. Out-patient consultations C. Available diagnostics and therapeutic procedures d\. Use of operating rooms, special units, and central supply items. e\. Accommodations in the charity ward Professional and counseling services Characteristics of the Older Adult Population - Older adults are generally defined as individuals aged 65 years and older. Older individuals are currently categorized as follows: - young-old: 65 to 74 years - old: 75 to 84 years - oldest-old: 85+ The profile, interests, and health care challenges of each of these subsets can be vastly different. For example a 70-year old may desire cosmetic surgery because looking young means so much to him/her; a 78-year old may be concerned that her arthritic knees are limiting her ability to join the Zumba classes where she meets her circle of friends; an 87-year old may be desperate to find a way to correct her impaired vision and hearing so that she can still enjoy watching television programs like \"FPJ\'s Ang Probinsyano\" or \"Tawag ng Tanghalan sa It\'s Showtime\", and the like. In addition to chronological age, or the years a person has lived since birth, **[functional age]** is a term used by the Gerontologists to describe physical, psychological, and social function; this is relevant in that how older adults feel and function may be more indicative of their needs than their chronological age. **[Perceived age]** is another term that is used to describe how people estimate a person\'s age based on appearance. Studies have shown a correlation between perceived age and health, in addition to how others treated older adults based on perceived age and the resultant health of those older adults (Sutin, Stephen, et al: 2014) It has been observed that people who excessively smoke and those who are heavy alcohol drinkers appear many years older than their chronological age. How people feel or perceive their own age is described as age identity. Some older adults will view peers of similar age as being older than themselves and be reluctant to join senior groups and other activities because they see the group members as \"old people\" and different from themselves. Any stereotype held about older people must be avoided; if anything. greater diversity rather than homogeneity will be evident. Further, generalizations based on age need to be eliminated as behavior, function, and self-image can reveal more about priorities and needs than chronological age alone. Not all persons of the same age will be similar in terms of language style, familiarity with current terms (e.g. \"millennial terms\"), use of technology, education, and life experience. Communication style and method must be based on assessed language competency, style and preference of the individual. - As there is significant growth in the number of older people and life expectancy has increased, it is important for gerontological nurses to be as concerned with adding quality to the lives of older adults as they are with increasing the quantity of years. More years to life means little if those additional years consist of discomfort, disability, and a poor quality of life. This has led to a hypothesis advanced by James Fries, a professor of medicine at Stanford University, called the \"compression of morbidity\" (Fries, 1980; Swartz, 2008). This hypothesis believes that if the onset of serious illness and decline would be delayed, or compressed, into a few years prior to death, people could live a long life and enjoy a healthy, functional state for most of their lives. - On marital status and living arrangements among older adults, there are certain characteristics observed as follows: - The higher survival rates of women, along with the practice of women marrying men older than themselves, make it no surprise that more than half of women older than 65 years are widowed, and most of their male contemporaries are married. - Married people have a lower mortality rate than do unmarried people at all ages, with men having a larger advantage. - Most older adults live in a household with a spouse or other family member/s. Among Filipinos, family support is provided to older adults in the form of co-residence. The Philippine Constitution states that families have a duty to care for elderly members. Retirement or nursing homes or living alone in late life are uncommon. - Most older adults have contact with their families and are not forgotten or neglected. - On income and employment, poverty remains to be the greatest obstacle to a secured old age. The Philippine government has enacted laws that cater to the needs and provides privileges and benefits to older persons. However, the effectiveness of such welfare services can only be confirmed by the level of satisfaction of their intended beneficiaries the older adults. There is a very small percentage of the total elderly population who are qualified for any form of pension. Thus, older people continue to work for as long as they are able. To address this issue, the government has provided training of elderly on livelihood development service. This program aims to develop economic self- reliance and social responsibility among the elderly. The senior citizens are given proper training and assistance by the DSWD on their barangay leaders. Financial assistance in the form of a loan without interest rate is also given to the elderly who want to engage in a particular business. They are assisted all throughout their endeavors to ensure that everything is done properly, from paper work to the business operations. Later on, they are left to run the livelihood program by themselves. In addition, the elderly are trained to become \"Community gerontologists\" (CG). The training includes a number of practical methods such as massaging, reflexology, herbal medicine, basic assessment and vital statistics check-up. However, according to a survey made by the DSWD, the level of awareness of the senior citizens regarding these programs seems to be low, resulting in poor participation. The improper implementation of these programs and small number of communities implementing them can also be the reason for the low level of participation of the elderly. - On health status, the older population experience fewer acute illness than younger age groups and a lower death rate from these problems. However, those who develop acute illnesses usually require longer period of recovery and have more complications from these conditions. **Chronic illness is a major problem for the older population.** Most older adults have at least one chronic disease, and typically they have multiple chronic conditions, termed comorbidity, that requires them to manage the care of several conditions simultaneously like arthritis, high blood pressure, hearing impairments, heart conditions, visual impairments (including cataracts), deformities or orthopedic impairments, diabetes mellitus, varicose veins, dementia, and many more. **Implications of an Aging Population** The growing number of persons older than 65 years impacts health on social service agencies and health care providers, including gerontological nurses, that serve this group. As the older adult population grows, these agencies and providers must anticipate future needs and services and the implications on the national economy. In anticipating needs and services for future generations of older adults, gerontological nurses must consider the realities of the baby boomers, those born between 1946 and 1964 who will be the next wave of senior citizens. Their impact on the growth of the older population is such that it has been referred to as a \"demographic tidal wave\". Baby boomers began entering their senior years in 2011 and will continue to do so until 2030. Although they are a highly diverse group, representing people as different as Gloria Macapagal-Arroyo, Joseph \"Erap\" Estrada, Susan Roces, Bill Gates, they do have clearly defined characteristics that set them apart from the other groups: - Most have children, but this generation\'s low birth rate means that they will have fewer biologic children available to assist them in old age. - They are better educated than preceding generations with slightly more than half having attended or having graduated from college. - Their household incomes tend to be higher than other groups, partly due to two incomes (many baby boomer women are in the labor force), and many own their own homes. - They favor a more casual dress code than do previous generations of older adults. - They are enamored with \"high-tech\" products, are likely to own a computer, cellphones, and spend several hours online daily. - Their leisure time is lesser than other adults, and they are more likely to repeat feeling stressed at the end of the day. - As investors of the fitness movement, they exercise more frequently than do other adults. **There are some assumptions that can be made concerning the baby boomer population as senior adults, which are as follows:** - They are informed consumers of health care and desire a highly active role in their care; their ability to access information often enables them to have as much knowledge as their health care providers on some health issues. - They are most likely not satisfied with the condition of today\'s Senior Citizen\'s Centers, home for the aged and the like, and will demand internet access, television, area for dancing and doing exercises like Zumba classes which is very popular among them nowadays. - Their extended families may need special assistance because of the potential caregiving demands of several sets of stepparents and step grandparents. Plans for services and structural designs must take these factors into consideration. Moreover, the growing number of persons older than 65 years also 0s impacts the government that is the source of payment for many of the services older adults need. The older population has higher rates of hospitalization, surgery, and physician visits than other age groups, and this care is more likely to be paid by government funds like PHILHEALTH, than private health insurances or older adults themselves. As the percentage of the advanced age population grows, society will face an increasing demand for the provision of and payment for services to this group. In this era of budget deficits, shrinking revenues, and increased competition for funding of other special interests, questions may arise about the going ability of the government to provide a wide range of services for older adults. Another concern is availability and accessibility of government support especially to older adults who live in far-flung areas in the 7,107 islands of the Philippines, Gerontological nurses must take active participation in discussions and decisions pertaining to the rationing of services so that the rights of older adults are expressed and protected. Likewise, gerontological nurses must assume leadership in developing cost -- effective methods of care delivery that do not compromise the quality of services to older adults. **Chapter 2** **Theories of Aging** **Learning objectives:** After reading this chapter, you should be able to: 1. Discuss the major theories of aging, namely: a. Biological Theories of Aging - Stochastic Theories; Nonstochastic Theories b. Sociologic Theories of Aging - Disengagement Theory - Activity theory - Continuity theory - Age Stratification Theory - Subculture Theory c. Psychological Theories of Aging - Developmental Tasks - Gerotranscendence d. Nursing Theories of Aging - Functional Consequences Theory - Theory of Thriving - Theory of Successful Aging 2. Identify factors that promote positive, healthy aging process. 3. Describe ways in which gerontological nurses can apply theories of aging in providing comprehensive, holistic care to older persons. **Terminologies:** - **Aging.** The process of growing older that begins at birth. - **Nonstochastic Theories.** Explain biological aging as resulting from a complex predetermined factors or process. - **Stochastic Theories**. View the effects of biological aging as resulting from random assaults from both the internal and external environment. - **Biologic Aging Theories.** Biologic aging is the progressive loss of function. It can be viewed as a balance of positive factors such as healthy diet, regular exercise, and coping resources and negative factors such as obesity, unhealthy lifestyle (e.g., smoking), chronic illness, and stress that exceeds the individual\'s coping resources. Biologic aging is a multifactorial process involving genetics, oxidative stress, diet, and environment. Research on biologic aging are attempts directed at increasing both the average life span and the quality of life of adults including the older persons. Efforts are directed towards developing new anti-aging therapies to slow down or reverse age-related changes that result in chronic illness and disability. Based on numerous laboratory studies in rodents, caloric restriction (reducing dietary intake by 25% to 50%) has been consistently shown to significantly extend the life span. Caloric restriction in rodents results in a decrease in metabolic activity, but whether this accounts for the increase in longevity is not known. It may be that caloric restriction results in changes in body composition, metabolism, and hormones that are conducive to long life. However, whether this is also true for humans remains to be determined. (Harper, Hughes, Robine, 2004). The process of biologic aging differs not only from species to species but also from one human being to another. Furthermore, the rate of aging among different body systems within one individual may vary, with one system showing marked decline while another demonstrates no significant change. The two categories of Biologic Aging Theories are: 1. Stochastic Theories 2. Nonstochastic Theories The Stochastic Theories of Biologic Aging are as follows: 1. Cross-Linking Theory 2. Free Radicals and Lipofuscin Theory 3. Wear and Tear Theories 4. Evolutionary Theories 5. Biogerontology Theory The Nonstochastic Theories of Biologic Aging are as follows: 1. Apoptosis (Programmed Cell Death Theory) 2. Genetic Theories 3. Autoimmune Reactions (Immunologic Theory) 4. Neuroendocrine and Neurochemical Theories 5. Radiation Theories 6. Nutrition Theories 7. Environmental Theories **Stochastic Theories of Biologic Aging** Propose that aging is due to chance. 1. **Cross-Linking Theory** -- Avers that over time and as a result of exposure to chemicals and radiation in the environment, cross-links form between lipids, proteins, and carbohydrates as well as nucleic acids. These cross-links result in decreased flexibility and elasticity, and this increases rigidity in tissues (e.g., blood vessels, skin, lungs, tendons, heart, muscles, etc.) Such changes in cell structure may explain the observable cosmetic changes associated with aging, such as wrinkles of the skin and decreased distensibility of arterial blood vessels. 2. **Free Radicals and Lipofuscin Theories** Proposes that a free radical is a highly reactive atom or molecule that carries an unpaired electron and thus seeks to combine with another molecule, causing an oxidative process. This process, also called \"oxidative stress\", can ultimately disrupt cell membranes and alter DNA and protein synthesis. - Common diseases such as atherosclerosis and cancer are associated with oxidative stress, Cellular integrity, function, and regeneration mechanisms are injured. - Free radicals are natural byproducts of normal cellular processes and are also created by such environmental factors as smog, tobacco, smoke, radiation, pesticides and other pollutants. - There are numerous natural protective mechanisms to prevent oxidative damage. Recent research has focused on the roles of various antioxidants, including vitamin C and E, beta-carotene, and selenium, to slow down the oxidative process and ultimately the aging process. - However, the optimal doses of these substances have not been established. These substances are currently being investigated for their usefulness in preventing diseases related to aging such as oral, esophageal, and reproductive cancers; coronary artery disease, and cataracts. - Moreover, there has been considerable interest in the role of lipofuscin \"age pigments, a lipoprotein by-product of oxidation that can be seen only under a fluorescent microscope in the aging process. Because lipofuscin is associated with the oxidation of unsaturated lipids, it is believed to have a role similar to that of free radicals in the aging process. As lipofuscin accumulates, it interferes with the diffusion and transport of essential metabolites and information bearing molecules in the cells. A positive relationship exists between an individual\'s age and the amount of lipofuscin in the body. 3. **Wear and Tear Theories --** Attribute aging to the repeated use and injury of the body over time as it performs its highly specialized functions. Like any complicated machine, the body will function less efficiently with prolonged use and numerous insults (e.g., smoking, poor diet, substance abuse). Physical and psychological stresses to the body can have adverse effects and lead to conditions such as gastric ulcers, heart attacks, thyroiditis, and inflammatory dermatoses. However, because individuals react differently to life\'s stresses one person may be overwhelmed by a moderately busy schedule whereas another may become frustrated when faced with a slow, dull pace the role of stress in aging is inconclusive. 4. **Evolutionary Theories** -- These theories of aging are related to genetics and hypothesize that the differences in the aging process and longevity of various species occur due to interplay between the processes of mutation and natural selection (Ricklefs, 1998; Gavrilov and Gavrilova, 2002). Attributing aging to the process of natural selection links these theories to those that support evolution. There are several general groups of theories that relate aging to evolution, namely: a. **Mutation Accumulation Theory** The \"Mutation Accumulation Theory\" suggests that aging occurs due to a declining force of natural selection with age. In other words, genetic mutations that affect children will eventually be eliminated because the victims will not have lived long enough to reproduce and pass this to future generations. Genetic mutations that appear late in life, however, will accumulate because the older individuals they affect will have already passed these mutations to their offspring. b. **Antagonistic Pleiotropy Theory** The \"Antagonistic Pleiotropy Theory\" suggests that accumulated mutant genes that have negative effects in late life may have had beneficial effects in early life. A particular gene can have multiple effects some positive and some negative. More mutations occur with aging and these will ultimately result in functional failure. c. **Disposable Soma Theory** The \"Disposable Soma Theory\" proposes that aging is related to the use of the body\'s energy rather than to genetics. It claims that the body must use energy for metabolism, reproduction, maintenance of functions, and repair, and with a finite supply of energy from food to perform these functions, some compromise occurs. Through evolution, organisms have learned to give priority of energy expenditure to reproductive functions that could maintain the body indefinitely; thus, decline and death ultimately occur. 5. **Biogerontology Theory --** This theory believes that bacteria, fungi, viruses, and other organisms are responsible for certain physiologic changes during the aging process. In some cases, these pathogens may be present in the body for decades before they begin to affect body systems. Although there is no evidence exists to link these pathogens with the body\'s decline, interest in this theory has been stimulated by the fact that human beings and animals have enjoyed longer life expectancies with the control or elimination of certain pathogens through immunization and the use of antimicrobial drugs, **Nonstochastic Theories of Biologic Aging** Hypothesize that aging changes result from a complex predetermined process that genes program age-related molecular and cellular events. 1. **Apoptosis (Programmed Cell Death Theory)** Proposes that there is an impairment in the ability of the cell to continue dividing. Apoptosis is the process of programmed cell death that continuously occurs throughout life due to biochemical events (Green, 2011). In this process, the cell shrinks and there is nuclear and DNA fragmentation, although the membrane maintains its integrity. According to this theory, this programmed cell death is part of the normal developmental process that continues throughout life. 2. Genetic Theory One of the genetic theories, \"The Programmed Theory of Aging\" advocates that animals and humans are born with a genetic program or biological clock that predetermines the life span (Hayflick, 1965). Various studies support this idea of a predetermined genetic program for life span. For example, studies have shown a positive relationship between parental age and filial life span. Additionally, studies of in vitro cell proliferation have demonstrated that various species have a finite number of cell divisions. Fibroblasts from embryonic tissue experience a greater number of cell divisions than those derived from adult tissue, and among various species, the longer the life span, the greater the number of cell divisions. These studies support the theory that senescence the process of becoming old -is under genetic control and occurs at cellular level. (Harvard Gazette Archives, 2001; Martin, 2009; University of Illinois at Urbana-Champaign, 2002). Another genetic theory of aging is \"the error theory.\" This theory holds that genetic mutations are responsible for aging by causing organ decline as a result of self-perpetuating cellular mutations. Mutation of DNA Perpetuation of mutation during cell division Increasing number of mutant cells in the body Malfunction of tissues, organs, and systems Decline in body functions The error theory proposes a genetic determination for aging Other theorists think that aging results when a growth substance fails to be produced leading to the cessation of cell growth and reproduction. Others hypothesize that an aging factor responsible for development and cellular maturity throughout life is excessively produced, thereby hastening aging. Some hypothesize that the cell\'s ability to function and divide is impaired. Although minimal research has been done to support the theory, aging may be the result of a decreased ability of RNA to synthesize and translate messages. 3. **Autoimmune Reactions (Immunologic Theory)** Proposes declining functional capacity of the immune system as the basis for aging. It believes that aging is not a passive wearing out of systems but an active self destruction mediated by the immune system. It is based on observing an age-associated decline in B and T cell functioning, accompanied by a decrease in resistance and an increase in autoimmune diseases with aging. Some studies have the finding that the immune system becomes more diversified with age and demonstrates a progressive loss of self-regulatory pattern. The result is an autoimmune response in which cells normal to the body are mistaken as foreign and are attacked by the person\'s own immune system. The primary organs of the immune system, the thymus and the bone marrow, are believed to be affected by the aging process. The immune response declines after young adulthood. The weight of the thymus decreases throughout adulthood, as does the ability to produce T-cell differentiation. The level of the thymic hormone declines after age 30 and is undetectable in the blood of persons older than 60 years (Goya, Console, Herenu, Brown, and Rimoldi, 2002; Williams, 1995). Related to this is a decline in the humoral immune response, a delay in the skin allograft rejection time, a reduction in the intensity of delayed hypersensitivity and a decrease in the resistance to tumor cell challenge. The bone marrow stem cells perform less efficiently. The reduction in immunologic functions is evidenced by an increase in the incidence of infections and many cancers with age. Some theorists believe that the reduction in immunologic activities also leads to an increase in autoimmune response with age. One hypothesis regarding the role of autoimmune reactions in the aging process is the cells undergo changes with age, and the body misidentifies these aged, irregular cells as foreign agents and develops antibodies to attack them. An alternate explanation for the reaction could be that cells are normal in old age, but breakdown of the body\'s immunochemical memory system causes it to misinterpret normal cells as a foreign substances. Antibodies are formed to attack rit the body of these \"foreign\" substances, and cells die. 4. **Neuroendocrine and Neurochemical Theories** Propose that aging occurs because of functional decline in neurons are Ped hormones. It believes that neural and endocrine changes may trige marty cellular and physiologic aspects of aging. It hypothesizes that in aging there is organism\'s loss of responsiveness neuroendocrine to various signals. The main focus of this theory is the functional changes of the hypothalamic - pituitary system. These changes are accompanied by a decline in functional capacity in other endocrine organs, such as the adrenal and thyroid glands, ovaries and testes. Neuroendocrine and neurochemical theories suggest that aging is the result of changes in the brain and endocrine glands. Some theorists claim that specific anterior pituitary hormones promote aging. Others believe that an imbalance of chemicals in the brain impairs healthy cell division throughout the body. 5. **Radiation Theories** The relationship between radiation and age continues to be explored Research using rats, mice, and dogs has shown that a decreased life span results from nonlethal doses of radiation. In human beings, repeated exposure to ultraviolet light is known to cause solar elastosis, the \"old age\" type of skin wrinkling that results from the replacement of collagen by elastin. Ultraviolet light is also a factor in the development of skin cancer. Radiation may induce cellular mutations that promote aging. 6. **Nutrition Theories** The importance of good nutrition throughout life is a theme hard to escape in our nutrition - conscious society. It is no mystery that diet impacts health and aging. Obesity is shown to increase the risk of many diseases and shorten life (NIDDK, 2001; Preston, 2005; Taylor and Ostbyte, 2001). The quality of diet is as important as the quantity. Deficiencies of vitamins and other nutrients and excesses of nutrients such as cholesterol may cause various disease processes. Recently, Increased attention has been given to the influence of nutritional supplements on the aging process, vitamin E, bee pollen, ginseng, potu kola, peppermint, and kelp are among the nutrients believed to promote a healthy, long life (Margolis, 2000; Smeeding, 2001). Although the complete relationship between diet and agiring is not well understood, enough is known to suggest that a good diet may minimize or eliminate some of the ill effects of the aging process. 7. **Environmental Theories** Several environmental factors are known to threaten health and are thought to be associated with the aging process. The ingestion of mercury, lead, arsenic, radioactive isotopes, certain pesticides, and other substances can produce pathologic changes in human beings. Smoking and breathing tobacco smoke and other air pollutants also have adverse effects. Finally, crowded living conditions, high noise levels, and other factors are thought to influence how we age. **Sociologic Theories of Aging** Describe the aging individual in terms of his or her social group/culture. 1. **Disengagement Theory** - The basis of this theory arises from the fact that human beings are mortal and must eventually leave their place and role in society. Therefore, it is their responsibility to look for suitable replacement. - It views aging as a process in which society and the individual gradually withdraw, or disengage, from each other, to the mutual satisfaction and benefit of both. The benefits to individuals that they can reflect and be centered on themselves have been freed from social roles. - The value of disengagement to society is that some orderly means is established for the transfer of power from the old to the young, making it possible for society to continue functioning after its individual members die. The theory does not indicate whether society or the individual initiates the disengagement process. - However, it has been observed that many older persons desire to remain engaged and do not want their primary satisfaction to be derived from reflection on younger years. Senators, Supreme Court Justices, College Professors, and many senior volunteers are among those who commonly derive satisfaction and provide a valuable service to society by not disengaging. - Because the health of the individual, cultural practices, societal norms, and other factors influence the degree to which a person will participate in society during or her later years, some critics of this theory claim that disengagement will not be necessary if society improves the health care and financial means of older adults and increase the acceptance, opportunities, and respect afforded to them. - The disengagement theory is quite controversial, because disengagement is ve necessarily a process be expected from all aging persons. 2. **Activity Theory** - Assumes that the same norms exist for all mature individuals. The degree to which the individual \"acts like\" or \"looks like\" a middle aged is the determinant of the aging process. - One must constantly struggle to remain functional and take on new activities to replace lost one. - At the opposite pole from the disengagement theory, the activity theory asserts that an older person should continue a middle-aged lifestyle, denying the existence of old age as long as possible, and that society should apply the same norms to old age as it does to middle age and not advocate diminishing activity, interest as its members grow old (Havighurst, 1963). - This theory suggests ways of maintaining activity in the presence of multiple losses associated with the aging process including substituting intellectual activities for physical activities when physical capacity is reduced, replacing the work role with other roles when retirement occurs, and establishing new friendships as old ones are lost. - Declining health, loss of roles, reduced income, a shrinking circle of friends, and other obstacles to maintaining an active life are to be resisted and overcome instead of being accepted. - This theory has some merit. Activity is generally assumed to be more desirable than inactivity because it facilitates physical, mental, and social well-being. - Like a self-fulfilling prophecy, the expectation of a continued active state during old age may be realized to the benefit of older adults and society. Because of society\'s negative view of inactivity, encouraging an active lifestyle among the aged is consistent with societal values. Also supportive of the activity theory is the reluctance of many older persons to accept themselves as old. - A problem with the activity theory is its assumption that most older person desire and are able to maintain a middle -- aged lifestyle. Some aging persons want their world to shrink to accommodate their decreasing capacities of the preference the less active roles. - Many older adults lack the physical, emotional, social, or resources to maintain active roles in society. Aged people who are expected to maintain an active middle-aged lifestyle in an income of less than half that of middle -- aged people may wonder if society is giving them conflicting messages - More research and insights are needed regarding the effects on the older adults of not being able to fulfill expectations to remain active. 3. **Continuity Theory** - Accounts for the continuous flow of phases in the life cycle and does not limit itself to change. - It assumes that persons will remain the same unless there are factors that stimulate change or necessitate adaptation. - The continuity theory of aging also referred to as the developmental theory, relates personality and predisposition toward certain actions in old age to similar factors during other phases of life cycle (Neugarten, 1964). - Personality and basic patterns of behavior are said to remain unchanged as the individual ages. For instance, party-goers at the age of 20 will most likely be party goers at 70 years of age, whereas young recluses will probably not be active in the mainstream of society when they age. Patterns developed over a lifetime will determine whether individuals remain engaged and active or become disengaged and inactive. - The recognition that the unique features of each individual allows for multiple adaptations to aging and that the potential exists for a variety of reactions gives this theory validity and support. - Aging is a complex process, and the continuity theory considers these complexities to a greater extent than most other theories. Although the full implications and impact of this promising theory are at the stage of research, it offers a reasonable perspective. Also, it encourages the young to consider that their current activities will lay a foundation for their own future old age. 4. **Age Stratification Theory** - This theory suggests that society is stratified by age groups (Riley, Johnson, and Foner, 1972). Persons within a similar age group generally have similar experiences, beliefs, attitudes, and life transitions that offer them a unique shared history. - New age groups are continually being formed with the birth of new individuals thus the interaction between society and the aging population is dynamic. As \'each group ages, they have their own unique experience with and influence on society, and there is an interdependence\' between society and the group. 5. **Subculture Theory** - Views older adults as a group with distinct norms, beliefs, expectations, habits and issues that separate them from the rest of society (Rose, 1965). Their formation of a subculture is a response to the negative attitudes and treatment by society. - Older persons are accepted by and more comfortable among their own age group. A component of this theory is the argument for social reform and greater empowerment of the older populations so that their rights and needs can be respected. - As the population of older adults become more diverse, their needs better addressed, and their power recognized, the question can be raised that this theory is less relevant today than it was in the 1960s when it was first introduced. **[Psychological Theories of Aging]** Explore the mental processes, behavior and feelings of persons throughout life span, along with some mechanisms people use to meet the challenges they face in old age. A. Theory of Developmental Tasks Describes the process of healthy psychological aging as the result of successful fulfillment of developmental tasks. Developmental tasks are the challenges that must be met and adjustments that must be made in response to life experiences that are part of an adult\'s continued growth through the life span. Erikson\'s Developmental Tasks **Stage** **Satisfactorily Fulfilled** **Unsatisfactorily Fulfilled** ------------------ ------------------------------ -------------------------------- Infancy Trust Mistrust Toddler Autonomy Shame Early Childhood Initiative Guilt Middle Childhood Industry Inferiority Adolescence Identity Identity diffusion Adulthood Intimacy Isolation Middle Age Generativity Self-absorption Old Age Integrity Despair +-----------------------------------+-----------------------------------+ | **Ego Integrity** | **Despair** | +===================================+===================================+ | Views life with a sense of | Believes they have made poor | | wholeness and derives | choices during life and wish they | | satisfaction from past | live life longer. | | accomplishments. | | | | Inability to accept one\'s fate. | | Views death as an acceptable | | | completion of life. | Gives rise to feeling with | | | frustration, bitterness, anger, | | Accepts one\'s one and m only | discouragement, and a sense that | | life cycle. | one\'s life has been worthless. | | | | | Bringing serenity and Wisdom. | | +-----------------------------------+-----------------------------------+ To achieve ego integrity, the older adult must have: a. at least one companion in life. b. stable financial status c. productive social, civic and religious activities Refining Erikson\'s description of old age tasks, Robert Peck (1968) detailed three specific challenges facing the older adults that influence the outcome of ego integrity or despair: a. Ego differentiation vs. role preoccupation: to develop satisfaction from oneself as a person rather than through parental or occupational roles. b. Body transcendence versus body preoccupation: to find psychological pleasures rather than become absorbed with health problems or physical limitations imposed by aging. c. Ego transcendence versus ego preoccupation; to achieve satisfaction through reflection on one\'s past life and accomplishments rather than be preoccupied the finite number of years left to live. Robert Butler and Myrna Lewis (1982) outlined additional developmental tasks of later life: a. Adjusting to one\'s infirmities. b. Developing a sense of satisfaction with a life that has been lived. c. Preparing for death. B. **Gerotranscendence** It suggests that aging entails a transition from a rational, materialistic meta perspective to a cosmic and transcendence vision (Tornstam, 2005). As peop age, they are less concerned with their physical bodies, material possessions meaningless relationships, and self-interests and instead desire a life of man significance and a greater connection with others. There is a desire to shed rain and invest time in discovering hidden facets of oneself. **[Nursing Theories of Aging ]** 1. Functional Consequences Theory 2. **Theory of Thriving** This theory proposes that everything that impacts people throughout their live must be linked to create a holistic view of aging (Haight, Barba, Tesh, and Courts 2002). - The theory is based on the failure to thrive concept as it related to older adults nursing homes (Newbern and Krowchuk, 1994); the clinical characteristics of olde persons experiencing failure to thrive include disconnectedness, inability to find meaning in life, problems with social relationships, and physical and cognitive dysfunction. - In contrast, thriving is possible when harmony exists between individuals and their physical and human environments. - The process of thriving is continuous and enables aging individuals to find meaning in life and adapt to changes. This theory reinforces the importance of nurses considering the many factors that can impact healthy and quality of life for older adults. 3. **Theory of Successful Aging** Flood (2005) integrated Roy\'s Adaptation Model, other aging Literature, and the Theory of Gerotranscendence to develop a nursing theory to guide the care of older adults. - The Adaptation Model by Sister Callista Roy, saw the individual as biopsychosocial being that continuously interacts with and adapts to the changing internal and external environment (Roy and Andrews, 2008). Roy viewed health on a continuum and involves the person becoming an integrated, whole individual. Roy assumes that the person has four modes of adaptation: physiologic needs, self-concept, role function, and interdependence. Furthermore, Roy assumes that there is a dynamic objective for existence with the ultimate goal of achieving dignity and integrity. - The Theory of Successful Aging not only considers successful aging in terms of the older adult\'s physical, mental, and spiritual well-being but also includes the individual\'s self-appraisal. Flood hypothesizes that people with high levels of personal control and a positive affect will experience higher levels of wellness in aging due to their ability to participate in health-promoting activities. Higher levels of physical health, in turn, contribute to deeper spirituality. These factors contribute to greater life satisfaction and the aging individual\'s positive perception of his or her status. - By aiding older adults in achieving high levels of health and personal control over their lives, nurses can help aging individuals to have a positive view of their lives, which in turn can promote their ability to cope and achieve greater life satisfaction with age. **Six Positive Lifestyle Factors that Promote Good Health** (Kirsti A. Dyer MD, MS, FT Updated: June 11, 2018) \"When you want to live a long and healthy life, there are things you can modify as well as things you can\'t. While you couldn\'t choose your genes, you can make choices that will reduce your life\" (Dyer, K. 2018). **Six lifestyle modifications that have the best evidence of giving more healthy years according to Dyer (2018):** 1. [Getting Regular and Adequate Amounts of Sleep ] - Getting a regular amount of sleep is important to give the body a chance to restore and regenerate. Not only does it recharge the proverbial \"batteries\" but it also attends to all the metabolic functions required by the body, such as regenerating old cells, getting rid of wastes and repairing cell damage. - Sleeping less than seven hours a night has been shown to have negative effects throughout the body. 200 Those who sleep 7-8 hours a night also slow down aging process. Sleep not only replenishes energy levels, but it also increases the strength of the immune system. 2. [Eating Regular Well-balanced Meals, Including Breakfast ] - A healthy balanced diet can help provide energy and lower risks for the leading killer diseases such as heart disease, hypertension, diabetes, and cancers. It can also help maintain a normal weight. Certain diseases or conditions have proven relationships with specific nutrition or dietary elements. - These different diseases can be affected positively and negatively by what one eats. However, it\'s also important not to jump on every diet fad. The basics are summed up by Michael Pollan who says \"Eat food. Not too much. Mostly plants.\" Our diet affects the quality of digestion and state of health. The classic saying, \"You are what you eat,\" is very true! The inner does reflect the outer. A positive health state that can contribute longevity is supported by: a\. reducing saturated fats in the diet b\. limiting daily fat consumption to less than 30% of calorie intake c\. avoiding obesity d\. decreasing the amount of animal foods eaten e\. substituting natural complex carbohydrates for refined sugars f\. increasing the consumption of whole grains, vegetables and fruit. 3. [Engaging in Regular Physical Activity ] - Thirty minutes a day of regular physical activity contributes to health by reducing the heart rate, decreasing the risk for cardiovascular disease, and reducing the amount of bone loss that is associated with age and osteoporosis. Strength training is also an important part of maintaining your body. Once you are past age 65, the requirements don\'t go down, and you may benefit by adding balance exercises and flexibility exercises. - In addition, exercise improves sleep and greater ability to cope with stress. All of these have beneficial effects that can affect a healthy aging process. 4. [Maintaining a Healthy Body Weight ] - Obesity is associated with a shorter lifespan and also with an increased risk of other major diseases. The good news is that just being somewhat overweight does not reduce one\'s longevity. One can keep weight in balance by eating a healthy diet and not loading up on empty calories. - Physical activity helps the body use calories more efficiently, thereby helping in weight loss and maintenance. Additionally, 60 minutes of regular physical activity will help in maintaining weight. 5. [Not Using Tobacco Products, Including Smoking or Chewing ] - In the Philippines, 10 people die every hour because of smoking-related diseases. This translates to 240 deaths every day or 87,600 deaths every year. (The Manila Times on Feb. 12, 2015) by Dr. Mary Assunta. - In 2017, the number of smoking-related deaths rose to 117,700 every year (World Health Organization, Dec. 5, 2017). - If one want to live an enjoyable life for however long he/she lives, don\'t smoke or chew tobacco. Chronic exposure to the nicotine in tobacco may accelerate coronary artery disease, peptic ulcer disease, reproductive disturbances, esophageal reflux, hypertension, fetal illnesses, delayed wound healing, and death. 6. [Using Alcohol in Moderation or Not at All] [ ] - Moderate alcohol consumption (one drink for women, two for men) is associated with a lower risk or heart disease. Higher levels of alcohol can lead to health and behavioral problems, including an increased risk for high blood pressure, stroke, heart disease, some cancers, accidents, violence, suicide, and deaths in general. **In addition, it has been proven by studies that the following factors contribute to a long and healthy life:** A. Play and Laughter - Laughter causes a release of endorphins, stimulates the immune system and reduces stress. Finding humor in daily routines and experiencing joy despite problems contribute to good health. It has been suggested that since the time of Solomon that a \"cheerful heart is good medicine, but a crushed spirit dries up the bones\" (Proverbs 17:22). - Fun - happiness leads to a more efficient immune system and digestive system. Those who are truly happy rarely face illness or disease, In fact, those who are happy are also least likely to suffer from insomnia and they definitely won\'t have depression or any psychological disorder. Just remember, no matter what you do, just remember to have fun..! LIVE, LOVE, LAUGH\.... B. Faith A strong faith, church attendance, and prayers are directly related to lower rates of physical and mental illness. Religion and spirituality can have positive effec on the length and quality of life. Some research suggest that religious people are happier. This may be because they have regular socialization opportunities at church functions. C. Empowerment Losing control over one\'s life can threaten self-confidence and diminish self-care independence. Maximum control and decision-making can have a positive effect on morbidity and mortality. D. Stress Management Stresses that may accompany aging are numerous, such as the onset of chronic conditions, retirement deaths of significant others, and change in body appearance, can have significant detrimental effects. Minimizing stress when possible and using effective stress management techniques interventions (e.g., meditation, deep breathing, relaxation techniques). Overall, the developmental tasks of aging can be summarized as: Coping with losses and changes Establishing meaningful roles Exercising independence and control Finding purpose and meaning in life.