Concepts, Principles and Theories in the Care of the Older Adult PDF

Concepts, Principles and Theories in the Care of the Older Adult By: Ma. Cristina M. Federico, RN, MAN  Perspective of Aging From a biological perspective, all humans grow, experience puberty, mature, and age as the course of a normal, healthy life. From a humanis...

Concepts, Principles and Theories in the Care of the Older Adult By: Ma. Cristina M. Federico, RN, MAN  Perspective of Aging From a biological perspective, all humans grow, experience puberty, mature, and age as the course of a normal, healthy life. From a humanistic perspective, the primary answer is that aging is inextricably linked to death. From a scientific perspective, If scientists view aging as a biological condition that can be manipulated, treated, and delayed, it becomes the duty of doctors to treat it and scientists to discover ways to delay it (Kelland, 2010).  Definition of Terms Aging- is a gradual, continuous process of natural change that begins in early adulthood. In elderly many bodily functions begin to change. WHO defines old age as age group of 60 or above. Aging is a process of general, irreversible, and progressive physical deterioration that occurs over time. Ageism- is the disliking of aging and older adults based on the belief that aging makes people unattractive, unintelligent, and unproductive. It is an emotional prejudice or discrimination against people based solely on age. Geriatrics- Is often used as a generic term relating to the aged, but specifically refers to medical care of the aged. Greek word means “geras”, meaning old age, and “iatro” meaning relating to medical treatment. Deals with the physiology of aging and with the diagnosis and treatment of disease affecting older adults. By definition, focuses on abnormal conditions and the medical treatment of these conditions. Gerontology- Is the broad term used to define the study of aging and/or the aged. Greek words “gero” meaning related to old age, and “ology”, meaning the study of. Thus, gerontology is the study of all aspects of the aging process, including the clinical, psychologic, economic, and sociologic problems of older adults and the consequences of these problems for older adults and society. Gerontological nursing provides an all-encompassing view of the care of older adults. In 1976, the ANA Geriatric Nursing Division changed its name to the Gerontological Nursing Division and published the Standards of Gerontological Nursing (Ebersole & Touhy 2006; Meiner, 2011). Gerontological nursing: A specialty within nursing practice where the clients/patients/residents are older persons. Is a discipline of nursing practice, involves nurses in advocating for the health of older persons at all levels of prevention. includes all older adults from the time of “old age” until death.  Concepts of Aging Chronologic Aging -refers to the actual amount of time a person has been alive. In other words, the number of days, months or years a person has been alive. Biologic Aging -Senescence or biological ageing is the gradual deterioration of function characteristic. Psychologic Aging -refers to the psychological changes, including those involving mental functioning and personality, that occur as human age. Social Aging -refers to changes in a person’s roles and relationships, both within their networks of relatives and friends and in formal organizations such as the workplace and houses of worship Cognitive Aging - Cognitive ageing is the decline in cognitive processing that occurs as people get older.  Subfields of gerontology: Social gerontology – is concerned mainly Geropharmacology – study of pharmacology as it with the social aspects of aging versus the relates to older adults. CGP (certified geriatric biological or psychological. pharmacist) Geropsychology – is a branch of psychology Gerontological rehabilitation nursing – is to assist older adults to regain and maintain the highest level of concerned with the mental health and well function and independence possible while preventing being of older adults. complications and enhancing quality of life. Demography of Aging and its implications for Health and Nursing Care GLOBAL PERSPECTIVE ON AGING POPULATION According to World Population Prospects 2019 (United Nations, 2019), by 2050, 1 in 6 people in the world will be over the age of 65, up from 1 in 11 in 2019 There were 703 million persons aged 65 years or over in the world in 2019. Between 2019 and 2050, the share of older persons is projected at least to double in four regions: Northern Africa and Western Asia, Central and Southern Asia, Latin America and the Caribbean, and Eastern and South- Eastern Asia Globally, a person aged 65 years in 2015-2020 could expect to live, on average, an additional 17 years In countries where public transfers are relatively low, such as many in Southern Asia and South-Eastern Asia, individuals and families face greater pressure to finance their consumption during old-age. It is important to establish social protection programmes that can be sustained over the long term to prevent poverty, reduce inequality (United Nations, 2019) To maximize the benefits and manage the risks associated with population ageing, governments should support continuing and lifelong education and health care for all; encourage savings behaviour and healthy lifestyles throughout the life course; promote employment among women, older persons and others traditionally excluded from the labour force, including through a gradual increase in the official retirement age; and support family friendly policies to facilitate work-life balance and increased gender equality in both public and private life. (United Nations, 2019)  PHLIPPINE DEMOGRAPHICS ON AGING POPULATION 2019 2050 Population aged 60 and above (total) 9,433,000 23,863,000 Population aged 60 and above (% of total 8.6 16.5 population) Older women aged 60+ (% of total population) 4.83 9.40 Life expectancy (males) 67.08 71.88 Life expectancy (females) 75.31 79.5 Old-Age Dependency Ratio (Age 65+ / Age 15- 8.6 17.7 64) Rural older people (% of total population) 6.48 Urban older people (% of total population) 6.54 Older persons living alone aged 60 and 5.4 above (% of total population aged 60+) Implications of the Demographics of Aging The demographic debacle By 2050, there will be 10 billion people on earth, compared to 7.7 billion today—and many of them will be living longer. As a result, the number of elderly people per 100 working-age people will nearly triple—from 20 in 1980, to 58 in 2060. A declining workforce Globally, the working-age population will see a 10% decrease by 2060. It will fall the most drastically by 35% or more in Greece, Japan, Korea, Latvia, Lithuania, and Poland. On the other end of the scale, it will increase by more than 20% in Australia, Mexico, and Israel.  Managing the risks Economic Slowdown: Changing workforces may lead The Squeezed Middle: With more people claiming capital to flow away from rapidly aging countries to pension benefits but less people paying income taxes, the younger countries, shifting the global distribution of shrinking workforce may be forced to pay higher taxes. economic power. Pensions under pressure Rising Healthcare Costs: Longer lives do not necessarily A pension is promised, but not necessarily guaranteed. Any mean healthier lives, with those over 65 more likely to changes made to existing government programs can alter have at least one chronic disease and require expensive, the lives of future retirees entirely but effective pension long-term care. reforms that lessen the growing deficit are required urgently. Impact of Aging Challenges of caring Members in the Financial hardship Family Sadness: Seeing your loved ones getting Health and wellbeing weaker and farther from who they used Social to be can bring the greatest sadness to Disadvantage our lives. The two most common options: Resentment: There are times when family members resent their senior loved bringing the aging parent into the home of ones for things they weren’t able to one of the children achieve from taking care of them. placing the parent in a long-term care facility  Process of Aging (Development Aspects of Aging) According to John Santrock there are 8 developmental stages in a life span development. His research focuses on family processes and children psychosocial development. The following are the stages of development; ❑ Pre-natal period from conception to birth Development happens quickly during this stage (tremendous growth from a single cell to an organism complete with brain and behavioral capabilities) Time between conception and birth Divided into 3 stages: -germinal -embryonic –feta ❑ Infancy Birth to 18-24 months Time of extreme dependence on adults Many psychological activities are just beginning ( language, symbolic thought, sensory- motor coordination & social learning) ❑ Early Childhood End of infancy to 5-6 years old (preschool years-grade 1) Young children learn to become more self- sufficient and care for themselves, develop school readiness skills and spend many hours in play with peers ❑ Middle and Late Childhood from 6-11 years old (elementary school years) Fundamental skills of reading, writing, and arithmetic are mastered Child is formally exposed to larger world and its culture Achievement becomes a more central theme of the child’s world and self-control increases ❑ Adolescence 10-12 years old to 18-22 years old Begins with rapid physical changes (dramatic gains in height in weight, changes in body contour, and development of sexual characteristics such as enlargement of breasts, development of pubic and facial hair, deepening of voice) Pursuit of independence & identity are prominent Thought is more logical, abstract & idealistic More time is spent outside family ❑ Early adulthood Late teens or early 20s to 30s Time of establishing personal & economic independence, career development, selecting a mate, learning to live with someone in an intimate way, starting a family & rearing children. ❑ Middle Adulthood 40 to 60 years old time of expanding personal & social involvement & responsibility Assisting next generation in becoming competent & mature individuals, reaching & maintaining satisfaction in a career ❑ Late Adulthood 60s and above Time for adjustment to decreasing strength and health, life review, retirement and adjustment to new social roles On the other hand Robert Havighurst identified six major age periods. Although many theorists are responsible for contributing to the Developmental Tasks Theory, it was Robert Havighurst who elaborated on this development theory in the most systematic and extensive manner. Robert Havighurst defines developmental tasks as one that “arises at certain period in our life, the successful achievement of which leads to happiness and success with later tasks while failure leads to unhappiness, social disapproval, and difficulty with later task”. Havighurst, 1972) Infancy and Early Childhood (0-5) 1. Learning to walk 2. Learning to take solid foods 3. Learning to talk 4. Learning to control the elimination of body wastes 5. Learning sex differences and sexual modesty 6. Acquiring concepts and language to describe social and physical reality 7. Readiness for reading 8. Learning to distinguish right from wrong and developing a conscience Middle Childhood (6-12) 1. Learning physical skills necessary for ordinary games 2. Building a wholesome attitude toward oneself 3. Learning to get along with age mates 4. Learning an appropriate sex role 5. Developing fundamental skills in reading, writing and calculating 6. Developing concepts necessary for everyday living 7. Developing conscience, morality, and a scale of values 8. Achieving personal independence 9. Developing acceptable attitudes toward society  Adolescence (13-18) 1. Achieving mature relations with both sexes 2. Achieving a masculine or feminine social role 3. Accepting one’s physique 4. Achieving emotional independence of adults 5. Preparing for marriage and family life 6. Preparing for an economic career 7. Acquiring values and an ethical system to guide behavior 8. Desiring and achieving socially responsible behavior Early Adulthood (19-29) 1. Selecting a mate 2. Learning to live with a partner 3. Starting a family 4. Rearing children 5. Managing a home 6. Starting an occupation 7. Assuming civic responsibility Middle Adulthood (30-60) 1. Helping teenage children to become happy and responsible adults 2. Achieving adult social and civic responsibility 3. Satisfactory career achievement 4. Developing adult leisure time activities 5. Relating to one’s spouse as a person 6. Accepting the physiological changes of middle age 7. Adjusting to aging parent Later Maturity (61-and over) 1. Adjusting to decreasing strength and health 2. Adjusting to retirement and reduced income 3. Adjusting to death of spouse 4. Establishing relations with one’s own age group 5. Meeting social and civic obligations 6. Establishing satisfactory living quarters References: Provision of Care for Filipino Older Persons and Responding to the Needs of Aging Societies by Plenee Grace Castillo https://www.un.org/en/development/desa/population/events/pdf/expert/29/session8/EGM_26Feb2019_S8_ PleneeGraceJCastillo.pdf WHO Guidelines on Integrated Care for Older People (ICOPE) https://www.who.int/ageing/publications/guidelines-icope/en/ World Population Ageing 2019 https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing201 9-Highlights.pdf