NCM 114 Care of Older Adults PDF

NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo OUTLINE Categories of Older People Perspective on Aging...

NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo OUTLINE Categories of Older People Perspective on Aging Young Old (65 – 74 years old) Aging is a Developmental Process Middle Old (75 – 84 years old) Old – Old (85 +) – Demography of Aging and Implications for Health and Centenarians (100 +) Nursing Care Global Aging Aging in the Philippines Aging in the Philippines The Philippines is a diverse country that will experience an increase in its aging Impact of Aging in the Family population soon. The country consists of approximately 103 million inhabitants, with Theories of Aging and its Nursing Implications less than 5% of the population 65 years Biologic Theories and older (Central Intelligence Agency, Physiologic Theories 2016). Currently, the age structure of the Philippines resembles many other developing countries because there is a Perspective on Aging greater proportion of younger Filipinos in Aging is a Developmental Process comparison to older Filipinos. The process of aging is unavoidable and unrelenting in human beings (J.S Schreck, The Philippines' population increased by 2014). over 35% over the last two decades with the older adult population (60 years and Aging is a gradual, continuous process of older) expected to overtake those aged 0– natural change that begins in early 14 years old by 2065 (Help Age Global adulthood. During early middle age, many Network, 2017a). Currently, life bodily functions begin to gradually decline expectancy of Filipinos is 57.4 years for (R. Stefanacci, 2022). males and 63.2 years for females. Females are projected to expect an Growing older, or chronological aging, is a increase of 4.0 years in life expectancy relentless and unstoppable process that and males an increase of 4.7 years in life happens to all humans (J.S Schreck, expectancy by 2030 (Help Age Global 2014). Network, 2017b). Senescence may be viewed most easily “Population ageing is not a bad thing. It as the passage of biological time as represents a story of our collective opposed to success as Filipinos. It means that we can chronological time. More specifically, it refers to “the conquer the challenges such as those time-dependent accumulation of damage at the related to income, health, and education,” molecular level that begins at fertilization and is said PIDS research fellow Michael Abrigo, eventually expressed as nonspecific vulnerability. one of the proponents of the study. impaired function, disease, and ultimately death” Impact of Aging Members in the Family (Carnes & Olshansky, 1993) Negative Emotional Effect Sadness Theories of Aging Anger Financial Strain 1. Biologic Fear and Anxiety 2. Sociologic Anticipatory Grief 3. Psychologic Emotionally Drained 4. Moral/Spiritual Resentment Perspective on Aging Positive Emotional Effect Demography of Aging and Implications for Health and Nursing Care Enrichment Sense of Giving Back Financial Effect: Extra Costs Struggle Effects: Changes in Family Roles, Work, Lack of Self – Time, Managing Behavioral Problems Overall Negative Effects: Relationship Theories of Aging and Its Nursing Implications Theories of aging can be divided into two categories: those that answer the question “Why do we age?” and those that address the question “How do we age?” Only a few broad, overarching theories attempt to  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo explain why we and nearly all living DNA strand breaks and base organism’s age. These theories compete, modifications that cause gene modulation. making it unlikely that more than one of Exogenous Sources of Free Radicals: them could be true. Over time, some Tobacco Smoke theories have fallen out of favor as others Pesticides have become more widely accepted. Radiation and Organic Solvents Ozone BIOLOGICAL THEORIES Selected Medications The biological theories are concerned with STOCHASTIC THEORIES: answering basic questions regarding the ORGE/ERROR THEORY physiological processes that occur in all living organisms as they chronologically In the 1960s, Leslie Orgel proposed what age. is now known as the error catastrophe theory of aging, arguing that errors in The biological theories explain the protein translation that reduce the fidelity physiologic processes that change with of the protein-translating enzymes would aging. In other words, how is aging lead to a feedback loop of increasingly manifested on the molecular level in the inaccurate protein synthesis, terminating cells, tissues, and body systems; how in the death of the organism. does the body–mind interaction affect aging; what biochemical processes impact The error catastrophe theory of aging aging; and how do one’s chromosomes states that aging is the result of the impact the overall aging process? Does accumulation of errors in cellular each system age at the same rate? Does molecules that are essential for cellular each cell in a system age at the same function and reproduction that eventually rate? reaches a catastrophic level that is incompatible with cellular survival. Two categories of Biological Theories: STOCHASTIC THEORIES: 1. Stochastic WEAR AND TEAR THEORY 2. Non-stochastic The wear and tear theory of aging is an Stochastic Theories: idea proposed by German biologist, Dr. - A stochastic or statistical perspective, which August Wiesmann, in 1882. identifies episodic events that happen throughout one’s life that cause random cell damage and The theory suggests that aging results accumulate over time, thus causing aging. from a gradual deterioration of the cells and tissues of the body via wear and tear, Non-stochastic Theories: oxidative stress, exposure to radiation, - The non-stochastic theories, which view aging as a toxins, or other deteriorative processes. series of predetermined events happening to all organisms in a timed framework. These Dr. Weismann believed that the body and hypothesize that aging is predetermined through its cells were damaged by overuse and programmed cell changes in the neuroendocrine or abuse. Under this theory, aging is viewed immunologic systems. as almost a preprogrammed process-a process thought to be vulnerable to STOCHASTIC THEORIES: stress, or an accumulation of injuries or FREE RADICAL THEORY trauma, which may accelerate it. Oxidative free radical theory postulates Death occurs because a worn-out tissue that aging is due to oxidative metabolism cannot forever renew itself" - Weismann. and the effects of free radicals, which are the end products of oxidative metabolism. STOCHASTIC THEORIES: Free radicals are produced when the body CONNECTIVE TISSUE THEORY uses oxygen, such as with exercise. This theory emphasizes the significance of how Known as cross-linking theory, also cells use oxygen. (Hayflick, 1985). referred to as the glycosylation theory of Free Radicals Causes: aging, was proposed by Johan Bjorksten Extensive cellular damage to DNA, which in 1942. can cause malignancy and accelerated aging due to oxidative modification of According to this theory, an accumulation proteins that impact cell metabolism. of cross-linked proteins damages cells Lipid oxidation that damages and tissues, slowing down bodily phospholipids in cell membranes, thus processes resulting in aging. affecting membrane permeability.  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo It is the binding of glucose to protein that numbers of melatonin receptors in the causes various problems. SCN The theory indicates that there may be According to this theory, normally genes that trigger youth and general well- separated molecular structures are bound being as well as other genes that together through chemical reactions. accelerate cell deterioration. Primarily this involves collagen, which is a NONSTOCHASTIC THEORIES: relatively inert long-chain macromolecule NEUROENDOCRINE THEORY produced by fibroblasts. As new fibers are created, they become enmeshed with old Hypothalamus controls various chain fibers and form an actual chemical cross- reactions to instruct other organs and link. glands to release their respective hormones. The result of this cross-linkage process is When the stimulating and releasing an increase in density of the collagen hormones of the pituitary and the molecule but a decrease in the capacity to hypothalamus are out of synch with the transport nutrients 'to, and to remove endocrine glands, an increase in disease waste products from the cells. is expected in multiple organs and systems. Cross-linkage agents have been found in unsaturated fats, in polyvalent metal ions NONSTOCHASTIC THEORIES: and in association with NEUROENDOCRINE THEORY NONSTOCHASTIC THEORIES: It describes the normal aging process of PROGRAMMED THEORY humans and animals as being related to faulty immunological function. Programmed theories of aging assert that There is a decrease immune function as a aging is an essential and innate part of the person age biology of humans and that aging is The older adults are more susceptible to programmed into our body systems infections as well as cancers. (Stibich, 2020). There is a loss of T-cell differentiation, so Cells can only reproduce themselves a the body incorrectly perceives old, limited number of times. irregular cells as foreign bodies and The programmed theory of aging asserts attacks them. that aging and death are necessary parts of evolution, not of biology. If a species PSYCHOSOCIAL THEORIES did not have the genetic capacity for aging - The sociological theories focus on changing roles and death, then it would not be forced to and relationships, it is related to various social replicate to survive (Stibich, 2020). adaptations in the lives of older adult. This theory proposes that every person has a "Biologic clock" that starts ticking at SOCIOLOGICAL THEORIES: the time of conception. DISENGAGEMENT THEORY Predictable changes occur. Aging has a biological timetable or internal Introduced by Cumming and Henry in biological clock. 1961 Two theorists viewed aging' as a NONSTOCHASTIC THEORIES: developmental task in and of itself, with its GENE/BIOLOGICAL CLOCK THEORY own norms and appropriate patterns of behavior. Each cell has a genetically programmed Identified appropriate patterns of behavior aging code that is stored in the organism’s were conceptualized as a mutual DNA. agreement between older adults and A significant amount of research has been society on a reciprocal withdrawal. done on circadian rhythms and their influence on sleep, melatonin, and aging. SOCIOLOGICAL THEORIES: The primary circadian clock in mammals ACTIVITY/DEVELOPMENTAL TASK THEORY is in the suprachiasmatic nucleus (or nuclei) Activity is viewed by this theory as (SCN), a pair of distinct groups of cells necessary to maintain a person's life located in the hypothalamus. satisfaction and a positive self-concept. The SCN receive light and dark input from By remaining active, the older person retina and demonstrate high neuronal stays young and alive and does not firing during the day and low firing at night. withdraw from society because of an age Melatonin is secreted by the pineal gland parameter. Essentially, the person actively and is the hormone linked to sleep and participates in a continuous struggle to wake cycles because there are large remain "middle-aged."  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo This theory is based on three assumptions: we reach old age, our personalities are (1) it is better to be active than inactive, fully formed and tend to stay constant (2) it is better to be happy than unhappy, and throughout our lives. (3) an older individual is the best judge of his or her It is one of the three major psychosocial own success in achieving the first two assumptions theories which describes how people developed in old age. How a person has been throughout life is SOCIOLOGICAL THEORIES: how that person will continue through the GEROTRANSCEDENDENCE THEORY remainder of life. Old age is not a separate phase of life, but According to this theory, as people age, rather a continuation and thus an integral they go through a cognitive transition from component. a materialistic, logical viewpoint to Elders attend to continue with important "oneness" with the environment. activities elders perceive activities as continuous. Gerotranscendence theory is a way to Successful aging is characterized by how look at aging as a positive aspect of life. much continuity the elder has with According to Lars Tornstam, who took activities. more than 20 years to develop this theory, there are several ideas about human PSYCHOLOGICAL THEORY: aging that are often overlooked. The core AGE STRATIFICATION THEORY of his theory looks to include these forgotten elements. In the 1970s, sociologists began to There are 4 key points to consider when examine the interdependence between looking at the gerotranscendence theory: older adults and society, recognizing that 1. Aging includes an increased feeling aging and society are interrelated and of togetherness with past generations cause reciprocal changes to individuals, while decreasing interest in social age group cohorts, and society. Riley and interactions that are superfluous at colleagues observed that society is best. stratified into different age categories that 2. There is an enhanced feeling of are the basis for acquiring resources, universal awareness, with an roles, status, and deference from others in understanding that space, time, and society. life can all be redefined. Even death tends to have a different definition. Age stratification transitioned aging theory 3. People as they age become less self- from a focus on the individual to a broader occupied and more selective of their context that alerted gerontologists to the social activities and other events they influence of cohort groups and the choose to pursue. socioeconomic and political impact on 4. Aging decreases personal interest in how individuals age (Marshall, 1996). material things, while time in solitude becomes a more attractive option. PSYCHOLOGICAL THEORY: HUMAN NEEDS THEORY SOCIOLOGICAL THEORIES: SUBCULTURE THEORY In this theory, Maslow surmised that a hierarchy of five needs motivates human According to this theory, older people behavior: physiologic, safety and security, create a distinct subculture inside society love and belonging, self-esteem, and self- to protect themselves against society's actualization. poor attitude about aging and the resulting loss of status. Movement is multidirectional and dynamic Views older adults as their own in a lifelong process toward need “subculture”, with their own interests, fulfillment. Self-actualization requires the norms, beliefs, habits, and issues that freedom to express and pursue personal separate them from the rest of society. A goals and be creative in an environment response to rejection/negativity by society. that is stimulating and challenging. This theory is less relevant today than it was when it was proposed in the 1960s. Maslow does not specifically address old age, physical, economic, social, and SOCIOLOGICAL THEORIES: environmental constraints can impede CONTINUITY THEORY need fulfillment of older adults. Maslow asserted that failure to grow leads to This theory acknowledges that our feelings of failure, depression, and the personalities have an impact on the roles perception that life is meaningless. we select and how we perform them, which in turn has an impact on our level of happiness in life. It implies that by the time PSYCHOSOCIAL THEORY:  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo PERSON-ENVIRONMENT-FIT THEORY have a corresponding life task that one may succeed at or fail to accomplish. Lawton’s (1982) person-environment fit Older adults experience the theory introduced functional competence developmental stage known as “ego in relationship to the environment as a integrity versus despair.” central theme. Stages throughout the life course. Each Functional competence is affected by represents a crisis to be resolved. multiple intrapersonal conditions such as ego strength, motor skills, biologic health, cognitive capacity, and sensory- perceptual capacity, as well as external conditions posed by the environment. The degree of competency may change as one ages, a-affecting functional ability in relationship to environmental demands. A person’s ability to meet these demands is a affected by his or her level of functioning and influences the ability to adapt to the environment. Those functioning at lower levels can tolerate fewer environmental demands. PECK’S Expansion of Erickson’s Theory PSYCHOSOCIAL THEORY: Erickson’s last two stages are expanded GEROTRANSCENDENCE THEORY to 7 Gerotranscendence has been tested in The final three of the development tasks several studies. In an ongoing longitudinal for old age: study based on the principles of 1. ego differentiation versus work role gerodynamics, Schroots (2003) is preoccupation investigating how people manage their 2. body transcendence versus body lives, cope with transformations, and react preoccupation to affective positive and negative life 3. ego transcendence versus ego events. preoccupation In nursing, Wadensten (2002) used the theory of gerotranscendence to develop LIFE-COURSE (LIFE-SPAN DEVELOPMENT) PARADIGM guidelines for care of older adults in a nursing home. The results indicate that German psychologist Paul Baltes, a these guidelines may be useful for leading expert on lifespan development facilitating the process of and aging, developed one of the gerotranscendence in nursing home approaches to studying development residents. called the lifespan perspective. PSYCHOLOGICAL THEORIES This approach is based on several key principles: THEORY OF INDIVIDUALISM Development occurs across one’s entire life or is lifelong. Jungs defined personality as being Development is multidimensional, composed of an ego or selfidentity with a meaning it involves the dynamic personal and collective unconsciousness. interaction of factors like physical, Personal unconsciousness is the private emotional, and psychosocial feelings and perceptions surrounding development. significant persons or life events. The Development is multidirectional and collective unconscious is shared by all results in gains and losses throughout life persons and contains latent memories of Development is plastic, meaning that human origin: characteristics are malleable or changeable. Development is influenced by 1. Origins Are Freudian contextual and sociocultural influences. 2. Self-Realization Is The Goal Of Personality Development is multidisciplinary. Development Normative age-graded influences 3. As Individual Ages, Each Is Capable Of Normative history-graded influences Transforming Non-normative life influences 4. Into A More Spiritual Being Lifespan vs. Life-expectancy STAGES OF PERSONALITY DEVELOPMENT THEORY Human Lifespan, or longevity, refers to According to Erikson (1963), personality the length of time a person can exist develops in eight sequential stages that under the most optimal conditions.  NCM 114 – CARE OF OLDER ADULTS PRELIM TOPICS HENNESY TURINGAN Ms. Chona Guillermo Oldest age documented is 122 years that would address older adults with (Guinness World Records, 2016) physical impairment and disability. Miller asserts that aging adults experience Life expectancy is the predicted number of environmental and biopsychosocial years a person born in a particular time consequences that impact their period can reasonably expect to live (Vogt functioning. & Johnson, 2016). Functional consequences theory assumes that quality of life is integrated with Life expectancy in the Philippines is 71 functional capacity and dependency years (Demographic of Life Expectancy, needs, and that positive consequences 2020) are possible despite age-related limitations. SELECTIVE OPTIMIZATION AND COMPENSATION This theory was used to create an THEORY assessment tool for the early detection of hospitalized elderly patients experiencing Baltes’s (1987) theory of successful aging acute confusion and to prevent further emerged from his study of psychological complications. processes across the lifespan and, like earlier theories, focuses on the individual. NURSING THEORIES OF AGING: He asserts that individuals learn to cope THEORY OF THRIVING with the functional losses of aging through processes of selection, optimization, and The theory of thriving (Haight et al., 2002) compensation. is based on the concept of failure to thrive SELECTION and Bergland and Kirkevold’s (2001) application of thriving to the experience of The adaptive task of the individual and wellbeing among frail elders living in society to concentrate on those domains nursing homes. that are of high priority. They discuss the concept in three Setting goals contexts: an outcome of growth and development, a psychological state, and ELECTIVE SELECTION an expression of physical health state. Failure to thrive first appeared in the aging refers to the delineation of goals to match literature as a diagnosis for older adults a person’s needs and motives with the with vague symptoms such as fatigue, available or attainable resources. cachexia, and generalized weakness. Other disciplines later defined LOSS BASED SELECTION undernutrition, physical and cognitive dysfunction, and depression as its major refers to changes in goals or the goal attributes (Braun, Wykle, & Cowling, system, such as reconstructing one’s goal 1988) hierarchy by focusing on the most important goals, adapting standards, or replacing goals that are no longer NURSING THEORIES OF AGING: achievable. THEORY OF SUCCESSFUL AGING OPTIMIZATION Baltes’s (1987) theory of successful aging emerged from his study of psychological Engaging in behaviors that enrich and processes across the lifespan and, like augment an individual’s general reserves. earlier theories, focuses on the individual. Make efforts to maintain and strengthen Aging individuals become more selective those most useful skills. in activities and roles as limitations present themselves; at the same time, COMPENSATION they choose those activities and roles that are most satisfying (optimization). Find ways to make up for (compensate) As people age, they pass through critical for cognitive deficits to function life points related to morbidity, mortality, adequately. and quality of life. Using devices, strategies, and resources. Selective optimization with compensation is a positive coping process that facilitates successful aging. NURSING IMPLICATIONS NURSING THEORIES OF AGING: FUNCTIONAL CONSEQUENCES Functional consequences theory was developed to provide a guiding framework