Part 1 NCM 114 Lecture Module PDF

Lesson 1 Concepts, Principles and Theories in the Care of the Older Adult Introduction Aging is universal. It impacts all persons regardless of biological sex, gender identity, race, ethnicity, religious membership, geographical location, or political...

Lesson 1 Concepts, Principles and Theories in the Care of the Older Adult Introduction Aging is universal. It impacts all persons regardless of biological sex, gender identity, race, ethnicity, religious membership, geographical location, or political affiliation. It is an undeniable fact that all human beings must age, and all must eventually die. Despite efforts by some who have claimed to have pinpointed the symptoms, discovered an effective intervention and treatment, or found a “cure,” the aging process remains the ultimate mystery of life from conception to death. Our society tends to endorse youth, fitness, and vigor which creates a reductionistic and authentic view of developmental maturation, or the process by which humans change, grow, and development across the life-span, as confined to the first few decades of life. This can create a misconception that aging and human development as confined to the first 18 years of life. However, this is not realistic. Humans age and develop from the moment of conception until the moment of final death. Aging is a continuum of short- and long-term developmental change and stability on an intra-individual level or development within or unique to the individual, as well as an inter-individual level of development between persons or unique to populations of people. Part 1 Specific Objectives At the end of the lesson, the students should be able to: 1. Identify mortality data according to race, gender, and age.  2. Describe leading causes of disability among older. 3. Identify common myths of aging. 4. Describe the effects of chronic disease. 5. Evaluate the natural history of disease using principles of epidemiology. 6. Understand theoretical perspectives on aging and factors influencing demographics and their impact on nursing care of older populations. Lesson 1: Concepts, Principles and Theories in the Care of the Older Adult Lesson Proper A. Perspective of Aging The process of aging is unstoppable and inflexible in human beings. Is aging a normal stage of human development or a disease that can be treated, delayed, or perhaps even cured? This part of this module explores the aging process from different perspectives and discusses the possible impacts of those varying perspectives in determining health and nursing care. From a biological perspective, all humans grow, experience puberty, mature, and age as the course of a normal, healthy life. If we do not view the other stages of our development to be diseases or conditions to overcome, why do many people, including scientists, seek to frame aging as a problem that needs solving or a disease that needs curing? There are several answers to this question that can be explored through humanistic and scientific lenses. From a humanistic perspective, the primary answer is that aging is inextricably linked to death. Although biological theories of aging are very persuasive, most humans do not view their sole purpose in life as procreation of the species. Rather, human beings generally desire a complete life, understood in the terms of the full life cycle (Meilaender, 2011). They want to not only procreate, but to parent their children and bond with their grandchildren. They want to gain wisdom through life experiences often only presented in their older years. The humanistic view also challenges ageism and the stigma associated with old age. In particular, it challenges the arguments of bioethicists, health care policymakers, economists, and clinicians who opine that ageism is necessary to a sustainable healthcare model (Shaw, 1994; Shortt, 2001). In this argument, ageism is defined in a value-neutral manner as the allocation of resources on the basis of age-related ability to benefit. The argument for ageism, in this case, is a moral obligation to distribute health care resources in a way that achieves maximum benefit and is seen to be just (Shaw, 1994). In contrast, to those persons opposed to age-based health policy and rationing, ageism holds a fa r more negative connotation. Those proponents call for eliminating clinical services where evidence-based rationale are less valued than an individual clinician's bias about the patient's age, providing better information to older adults regarding less costly end-of-life care, and ensuring that adequate provision is made for older adults to access primary, home, and long-term care (Shortt, 2001). From a scientific perspective, the exploration of aging as a disease becomes complex. Some scientists argue that reframing aging as a disease change how the medical and scientific responds to it. 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). By identifying genes that control aging rates and enabling regulators in the United States and Europe to license medicines for the treatment of aging, it is possible that humans could live longer lives (Kelland, 2010; McMurdo, 2000) 1. 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. ▪ Aging can be defined as the time-related deterioration of the physiological functions necessary for survival and fertility. Aging process is the process of growing old or developing the appearance and characteristics of old age. ▪ 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. ▪ Ageism allows the young to separate themselves physically and emotionally from the old and to view older adults as somehow having less human value. ▪ 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. ▪ Affects nursing, health care, and all areas of our society- including housing, education, business and politics  ▪ Gerontological/ Geriatric Nursing - The term Gerontological Nursing, which replaced the term Geriatric Nursing in the 1970’s, is seen as being more consistent with the specialty’s broader focus on health and wellness, in addition to illness (Wikipedia) ▪ 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. Classification of Aging Objectively, ageing is a universal process that begins at birth and is specified by the chronological age criterion. Subjectively, aging is marked by changes in behavior and self- perception and reaction to biologic changes. Functionally, aging refers to the capabilities of the individual to function in society. ▪ Young Old (60 – 74 yrs.), middle old (75-84 years), and old-old (above 85 years). Concepts of Aging a. Chronologic Aging b. Biologic Aging c. Psychologic Aging d. Social Aging e. Cognitive Aging Chronologic Aging -Chronological age 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. Biological aging refers to the physical changes that “slow us down” as human get into middle and older years. For example: arteries might clog up, or problems with lungs might make it more difficult for us to breathe. This aging is also known as physiologic aging. Psychologic Aging -Psychological aging refers to the psychological changes, including those involving mental functioning and personality, that occur as human age. Chronological age is not always the same thing as biological or psychological age. Some people who are 65, can look and act much younger than some who are 50. Psychological ageing may be seen as a continuous struggle for identity, i.e. for a sense of coherence and meaning in thoughts, feelings and actions. Success depends on a lucky synchronization of changes through life in different parts of the personal self. Social Aging -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. Social aging differs from one individual to another. It is also profoundly influenced by the perception of aging that is part of a society’s culture. If a society views aging positively, the social aging experienced by individuals in that society will be more positive and enjoyable than in a society that views aging negatively. Cognitive Aging - Cognitive ageing is the decline in cognitive processing that occurs as people get older. Age related impairments in reasoning, memory and processing speed can arise during adulthood and progress into the elder years. Cognitive aging is concerned with the basic processes of learning and memory as well as with the complex higher- order processes of language and intellectual competence or executive functioning. The concept of cognitive aging, a term that describes a process of gradual, longitudinal changes in cognitive functions that accompany the aging process. Subfields of gerontology: ▪ Social gerontology – is concerned mainly with the social aspects of aging versus the biological or psychological. ▪ Geropsychology – is a branch of psychology concerned with helping ▪ Geropharmacology – study of pharmacology as it relates to older adults. CGP (certified geriatric pharmacist) ▪ Gerontological rehabilitation nursing – is to assist older adults to regain and maintain the highest level of function and independence possible while preventing complications and enhancing quality of life. 2. Aging is a development process Growing older, or chronological aging, is a relentless and unstoppable process that happens to all humans. For that reason alone, some bioethicists argue that aging is, in fact, a natural developmental process for human beings (Meilaender, 2011) From a biological perspective, all humans grow, experience puberty, mature, and age as the course of a normal, healthy life. As human beings grow older, they go through different phases or stages of life. It is helpful to understand aging in the context of these phases. A life course is the period from birth to death, including a sequence of predictable life events such as physical maturation. B. Demography of Aging and its implications for Health and Nursing Care 1. Objectives 2. Global aging 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 The Top 50 With the Largest Number of Older Adults Ran # 65+ (in % 65+ (of total # total population k Country millions) population) (in millions) 1 China 166.37 11.9 1398.03 2 India 84.90 6.1 1391.89 3 United States 52.76 16.0 329.15 4 Japan 35.58 28.2 126.18 5 Russian Federation 21.42 14.6 146.73 6 Brazil 17.79 8.5 209.33 7 17.78 21.4 Germany 83.10 8 Indonesia 15.16 5.6 268.42 9 13.76 22.8 Itlay 60.34 10 France 13.16 20.3 64.83 11 United Kingdom 12.24 18.3 66.83 12 Pakistan 9.31 4.3 216.57 13 9.17 7.2 Mexico 126.58 14 Spain 8.99 19.1 47.07 15 8.35 5.1 Bangladesh 163.67 16 South Korea 7.83 15.1 51.85 Thailand 17 7.61 11.5 66.37 18 Turkey 7.27 8.8 82.61 19 Ukraine 6.94 16.5 42.04 20 Poland 6.72 17.5 38.40 21 Viet Nam 6.72 7.0 95.66 22 Canada 6.44 17.2 37.41 23 Philippines 5.51 5.1 108.12 24 Nigeria 5.43 2.7 200.96 25 Iran 5.12 6.1 83.91 26 Argentina 5.10 11.4 44.94 27 Colombia 4.63 11.4 44.94 28 Australia 4.00 15.8 25.31 29 Ethiopia 3.92 3.5 112.08 30 Egypt 3.86 3.9 99.06 31 Romania 3.52 18.2 19.36 32 South Africa 3.51 6.0 58.62 33 Taiwan 3.27 13.9 23.59 34 Netherlands 3.27 18.9 17.34 35 Myanmar 3.19 5.9 54.05 36 Algeria 2.67 6.2 43.41 37 Peru 2.66 8.4 31.78 Democratic Republic of 38 the Congo 2.60 3.0 86.79 39 Morocco 2.53 7.1 35.59 40 North Korea 2.44 9.5 25.67 41 Greece 2.33 21.8 10.70 42 Chile 2.26 11.8 19.11 43 Portugal 2.24 21.8 10.27 44 Belgium 2.15 18.7 11.46 45 Malaysia 2.11 6.4 32.75 47 Sweden 2.05 19.9 10.29 48 Venezuala 1.95 6.8 28.52 49 Hungary 1.89 19.3 9.77 50 Sri Lanka 1.71 7.8 21.90 3. Aging in the Philippines 2020: In the Philippines, people aged 60 years old and over are regarded as senior citizens. They made up 8.5 percent (9.22 million) of the household population in 2020, higher than the 7.5 percent (7.53 million) recorded in 2015. There were more females (55.5%) than males (44.5%) among the senior citizens, in 2020. The same trend was observed in 2015. The Situation of Older adults in the Philippines is unlike the older adults in developed countries like Japan, Italy, etc. Older people suffer from both degenerative and communicable diseases due to the ageing of the body’s immune system. The leading causes of morbidity are infections, while visual impairment, difficulty in walking, chewing, hearing, osteoporosis, arthritis and incontinence are other common health-related problems. Older Adults increases the demand for health services 4. Demographics of Aging Demographers -people who study population trends. They use population pyramids -a graphic technique for illustrating population trends, to do this. The number of older adults in developed nations will increase even more by 2050. The number of older Asian Americans, Native Americans, and (especially) Latina/o individuals, will continue to increase -The number of U.S. people over 85 will increase by 500% between 2000 and 2050. The sheer number of older Americans will place enormous pressure on federal income support systems (especially Social Security), health care (especially Medicare, Medicaid, and long-term care), and other human services 5. Implications of the Demographics of Aging The world is experiencing a seismic demographic shift—and no country is immune to the consequences. While increasing life expectancy and declining birth rates are considered major achievements in modern science and healthcare, they will have a significant impact on future generations. Today’s graphic relies on OECD data to demonstrate how the old-age to working-age ratio will change by 2060, highlighting some of the world’s fastest aging countries. 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. Populations are getting older in all OECD (Organization for Economic Cooperation and Development) countries, yet there are clear differences in the pace of aging. For instance, Japan holds the title for having the oldest population, with ⅓ of its citizens already over the age of 65. By 2030, the country’s workforce is expected to fall by 8 million—leading to a major potential labor shortage. In another example, while South Korea currently boasts a younger than average population, it will age rapidly and end up with the highest old-to- young ratio among developed countries. 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. Israel’s notably higher increase of 67% is due to the country’s high fertility rate, which is comparable to ―baby boom numbers seen in the U.S. following the second World War. As countries prepare for the coming decades, workforce shortages are just one of the impacts of aging populations already being felt. Managing the risks here are many other social and economic risks that we can come to expect as the global population continues to age: The Squeezed Middle: With more people claiming pension benefits but less people paying income taxes, the shrinking workforce may be forced to pay higher taxes. Rising Healthcare Costs: Longer lives do not necessarily mean healthier lives, with those over 65 more likely to have at least one chronic disease and require expensive, long-term care. Economic Slowdown: Changing workforces may lead capital to flow away from rapidly aging countries to younger countries, shifting the global distribution of economic power. The strain on pension systems is perhaps the most evident sign of a drastically aging population. Although the average retirement age is gradually increasing in many countries, people are saving insufficiently for their increased life span resulting in an estimated $400 trillion deficit by 2050. Pensions under pressure A pension is promised, but not necessarily guaranteed. Any changes made to existing government programs can alter the lives of future retirees entirely but effective pension reforms that lessen the growing deficit are required urgently. Towards a better system Certain countries are making great strides towards more sustainable pension systems, and the Global Pension Index suggests initiatives that governments can take into consideration, such as: Continuing to increase the age of retirement Increasing the level of savings—both inside and outside pension funds increasing the coverage of private pensions across the labor force, including self-employed and contract employees, to provide improved integration between various pillars Preserving retirement funds by limiting the access to benefits before the retirement age Increasing the trust and confidence of all stakeholders by improving transparency of pension plans Although 59% of employees are expecting to continue earning well into their retirement years, providing people with better incentives and options to make working at an older age easier could be crucial for ensuring continued economic growth. Live long and prosper As 2020 marks the beginning of the Decade of Healthy Ageing, the world is undoubtedly entering a pivotal period. Countries all over the world face tremendous pressure to effectively manage their aging populations, but preparing for this demographic shift early will contribute to the economic advancement of countries, and allow populations—both young and old—to live long and prosper. Explore the latest strategic trends, research and analysis Worldwide, the working-age population will see a 10% decrease by 2060. With a rapidly aging global population due to declining birth rates and increased life expectancy, a smaller workforce will slow down economies and raise healthcare costs. Our Older adults struggle with poverty. According to the Department of Social Welfare and Development (DSWD), a nearly a third (31.4%) of older people were living in poverty in 2000. Currently, this number is estimated to be 1.3 million older people. More than half of all older people (57.1%) were employed in 2000. More males were employed (63.6%) than women (37.4%). The majority of those employed (41%) were involved in primary economic activities such as farming, forestry work and fishing. According to the latest World Social Protection Report 2017-19, just 39.8% of people older than the statutory pensionable age in the Philippines receive an old-age pension (contributory, noncontributory or both).  Implications of Older increasing older adult population ▪ The need for more resources for older adults to live happy and healthy lives ▪ More facilities to take of older adults ▪ The need for competent gerontologic nurse – 6. Causes of Aging According to Harman, “Aging is the progressive accumulation of changes with time that are associated with or responsible for the ever-increasing susceptibility to disease and death which accompanies advancing age” and “the sum of the deleterious free radical reactions going on continuously throughout the cells and tissues constitutes the aging process or is a major contributor to it”. According to Hayflick, “The common denominator that underlies all modern theories of biological aging is change in molecular structure and, hence, function”. While many authors believe that free radicals and oxidative stress play an insignificant role in aging (if any), it is hard to disagree with the clearly expressed view that aging is the generated by multiple causes damage to the structures and functions of the molecules, cells, organs, etc., of an organism. Such causes of aging include but are not limited to oxidative stress, glycation, telomere shortening, side reactions, mutations, aggregation of proteins, etc. In other words, it is the progressive damage to these structures and functions that we perceive and characterize as aging. This damage leads to development of pathological conditions and, as a consequence, to death. Hence, in agreement with the view expressed by Hayflick and Holliday, we know the general cause of aging. This may be called the standard or general (GTA) theory of aging. Since it becomes more and more clear that aging is due to a significant number, or even a myriad, of causes, the term unified theory of aging is applicable as well. Those who disagree with it have to clearly define  what else aging could be from a mechanistic point of view, regardless of their more philosophical views about why we age and why and how life, aging, and death came into being. C. Impact of Aging Members in the Family Issues concerning old age can affect family members in a lot of ways. These include: Sadness: Seeing your loved ones getting weaker and farther from who they used to be can bring the greatest sadness to our lives. Resentment: There are times when family members resent their senior loved ones for things they weren’t able to achieve from taking care of them. ▪ Extended life spans are leading to more older family members. ▪ More people are living with chronic conditions and need some degree of care and assistance ▪ The number of people in the younger generations is decreasing in proportion to the number of older members ▪ There is an increasing number of widows who may be unprepared to provide for their own needs and will need assistance ▪ The role of women is changing. As women increasingly must work outside the home, many are attempting to meet the demands of their parents, home, children and workplace ▪ People who care for a family member or friend say there are many rewards:  The opportunity for personal growth and the development of new skills.  Proving to yourself that you can meet new challenges.  The satisfaction of knowing you have you have helped someone who needs you and done the best you could to improve their quality of life.   Strengthening the relationship with the person you care for and knowing how much they appreciate your help. Receiving the acknowledgement of your family and friends. Challenges of caring Caring can be very demanding and often restricts the lives of individual carers and their families. We advocate for practical reforms that will help protect carers from the problems too often associated with caring. a. Financial hardship 50% of primary carers are on a low income and many find it hard to cover living expenses, save money or build up superannuation. The extra costs of caring can be enormous. Caring families often have to find money for extra expenses like heating and laundry, medicines, disability aids, health care and transport. b. Health and wellbeing Caring can be emotionally taxing and physically draining. Carers have the lowest wellbeing of any large group measured by the Australian Unity Wellbeing index. Carers often ignore their own health and are 40% more likely to suffer from a chronic health condition. Some health problems, like back problems, anxiety and depression, can be directly linked to caring. Many carers are chronically tired and desperately need to refresh with just one night of unbroken sleep, a day off or an extended period with no caring responsibilities  c. Social isolation and relationships o Many carers feel isolated, missing the social opportunities associated with work, recreation and leisure activities. The demands of caring can leave little time for other family members or friends. o Carers often have to deal with strong emotions, like anger, guilt, grief and distress, that can spill into other relationships and cause conflict and frustration. ` Disadvantage Many carers miss out on important life opportunities, particularly for paid work, a career and education. Caring can take the freedom and spontaneity out of life. A family crisis may occur when the aging person is no longer able to live alone. Most families find that there is no perfect solution. The two most common options: ▪ bringing the aging parent into the home of one of the children ▪ placing the parent in a long-term care facility 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/WorldPopulationAgeing2019 -Highlights.pdf