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Concepts, Principles, and Theories in the CAre of Older Adult A. Perspective in Aging Learning Objectives - Identify the demographic profile of aging - Describe the ageing population of the Philippines a. Situation of older people b. Key facts on the statistics on the Ph...

Concepts, Principles, and Theories in the CAre of Older Adult A. Perspective in Aging Learning Objectives - Identify the demographic profile of aging - Describe the ageing population of the Philippines a. Situation of older people b. Key facts on the statistics on the Philippines’ population of older adult - Describe the characteristics of the older population in terms of: a. Life expectancy b. Marital status and living arrangements c. Income and employment d. Health status Demographic Profile of Older Adult Population - Clinical definition is 65 years old of age or older - Older-old adults are 85 or older - Rapidly growing - Older adults are diverse in characteristics Gerontology (geron=old man; logy=study) - This term was coined by Mechnikov in 1903. It is the specialized branch of medical science dealing with the comprehensive study of the elderly adult Gerontology - the study of all aspect of individual and its consequences. The study of old age, the process of aging, and the particular problems of old people Geriatrics - the subdivision of medicine that is concerned with old age and its disease, branch of medicine that deals with the diseases of old age and the medical care and treatment of aging people Gerontological Nursing - the care of elderly adults. Care of elderly needs skilled assessment and creative adaptations of nursing interventions. Is the specialty of nursing pertaining to older adults SITUATION OF OLDER ADULT IN THE PHILIPPINES A. The number of older people is growing as reported by the National Statistics Office now PSA. The elderly are expected to comprise 7.7% of total population in 2025. The life expectancy for both sexes is 68.5 years, for males, it is 65.3 years and for females 72,0 years (WHO, 2017) The total population as of 2017 was 104, 256,076 (World Health Organization). B. Older people need care and support. An aging population increases demand for health services (DOH). Older people suffer both degenerative and communicable diseases due to the aging of the body body's immune system. The leading causes of morbidity are infections, while visual impairment, difficulty walking, chewing, hearing, osteoporosis, arthritis, and incontinence are common health related problems. (Philippine Health Statistics). C. Older people struggle with poverty. According to the DSWD, 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 or even more. More than half of all older people (571%) were unemployed 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. KEY FACTS The following are the key statistics on the Philippine population of older people 2012 2050 Older people (total) 5,905,000 23,633,00 Older people as % of total 6.1% 25.3% population Life expectancy (males) 66 Life expectancy (females) 73 Share of population older than 65 in the Philippines from 2015-2035 2015 4.51% 2020 5.48% 2025 6.48% 2030 7.53% 2035 8=72% The statistics show a projection of the aging population in the Philippines from 2015 to 2035. In 2035, percentage of the population of the Philippines above 65 is forecasted to be at 8.72% 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: 60 to 75 years Old: 75 to 84 years Older-old: 85 years and above The profile, interests and health care challenge of each of these subsets can vastly different. Example: a 70 yr old may desire cosmetic surgery because looking young means so much to him/her. In addition to chronological age, or the year 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 show how others treated older adults based on perceived age and the resultant health of those older adults. How people feel or perceived 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 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 of lives of older adults as they are with increasing the quantity of years. James Fries - A professor of medicine at Stanford University formulated a hypothesis called compression of morbidity ✓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 families, family support is provided to older adults in the form of co-residence. 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. The elderly are trained to become "Community Gerontologists". The training includes a number of practical methods such as massaging, reflexology, herbal medicines, basic assessment and vital statistics check-up. ✓On health status, the older population experience fewer acute illnesses than younger age groups and a lower death rate from these problems. Chronic illness is a major problem for the adult 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 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. 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". CHARACTERISTICS OF BABY BOOMERS 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 gadgets 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. 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. Geriatric Nursing The specialty that concerns itself with the provision of nursing services to geriatric or aged individuals Defined as the specialized nursing care of the older adults that occurs in any setting in which nurses use, knowledge, expertise, and caring abilities to promote optimal functioning Purposes of Geriatric Nursing To provide opportunity for continuous development throughout the lifespan To support for maximum levels of independence To enhance the quality of life for aged persons through the promotions of health To make their lifestyle less restrictive To provide for peaceful death Theories of Aging Biological Theories of Aging - Stochastic Theories - Nonstochastic Theories Sociological Theories of Aging - Disengagement Theory - Activity Theory - Continuity Theory - Age Stratification Theory - Subculture Theory Psychological Theories of Aging - Developmental Tasks - Gerotranscedence Nursing Theories of Aging - Functional Consequences Theory  - Theory of Thriving - Theory of Successful Aging 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 Biological Aging Theories It is the progressive loss of function It 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 Based on numerous laboratory studies in rodents, caloric restrictions (reducig dietary intake by 25% to 50%) has been consistently shown to significantly extend the life span The process of biologic aging differs not only from species but also from one human being to another Two Categories of Biologic Aging Theories: Stochastic Theories - propose that aging is due to chance 1. Cross-Linking Theory 2. Free Radicals and Lipofuscin Theory 3. Wear and Tear Theories 4. Evolutionary Theories 5. Biogerontology Theory Nonstochastic Theories - 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) 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 Cross-Linking Theory  - Avers that over time and as a result of exposure to chemicals and radiation in the environment, cross-links from 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, muscle, etc.) such changes in cell structure may explain observable cosmetic changes associated with aging Free-Radicals and Lipofuscin - 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 which can ultimately disrupt cell membranes and alter DNA and protein synthesis - Free radicals are natural by products of normal cellular processes and are also created by such environmental factors as smog, tobacco, smoke, and other pollutant - These are numerous environmental natural protective mechanisms to prevent oxidative damage such as antioxidants including vitamin C and E, beta carotene, and selenium - Lipofuscin age pigments is a lipoprotein by-product of oxidation. It is associated with the oxidation of unsaturated lipids and is believed to have a role similar to that of free radicals in the aging process Wear and Tear Theories - Attribute aging to the repeated use and injury of the body over time as it performs highly specialized functions - Physical and psychological stresses to the body can have an adverse effects and lead to conditions such as gastric ulcers, heart attacks, thyroiditis, and inflammatory dermatoses Evolutionary Theories - These theories of aging related to genetics and hypothesize that the differences in the aging process and longevity of various species occur due to interplay between the process of mutation and natural selection. Attributing aging to the process of natural selection links these theories to those that support evolution - Mutation Accumulation Theory - aging occurs due to a declining force of natural selection with age - Antagonistic Pleiotropy Theory - accumulated mutant genes that have negative effects in late life may have had beneficial effects in early life - Disposable Soma Theory - aging is related to the use of the body’s energy rather than to genetics Biogerontology  - 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 Nonstochastic Theories of Biologic Aging Apoptosis - 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 - According to this theory, this programmed cell death is part of the normal developmental process that continues throughout life Genetic Theory - “The Programmed Theory of Aging” advocates that animals and humans are born with a genetic program or biological clock that predetermines the life span - “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. It proposes a genetic determination for aging - Aging results when a growth substance fails to be produced leading to the cessation of cell growth and reproductive - An aging factor is responsible for development and cellular maturity throughout life is excessively produced, thereby hastening aging - Cell’s ability to function and divide is impaired Autoimmune Reactions (Immunologic Theory) - Proposes declining functional capacity of the immune system as the basis for aging - 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 - The immune response declines after young adulthood Neuroendocrine and Neurochemical Theories - Proposes that aging occurs because of functional decline in neurons and associated hormones - In aging there is organisms loss of responsiveness of neuroendocrine to various signals. The main focus of this theory is the functional changes in the brain and endocrine glands - Specific anterior pituitary hormones promote aging  Radiation Theories - The relationship between radiation and age continues to be explored - 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 - Radiation may induce cellular mutations that promotes aging Nutrition Theories - Diet impacts health and aging. Obesity is shown to increase the risk of many diseases and shorten life - The quality of diet is as important as the quantity - Recently, increased attention has been given to the influence of nutritional supplements on the aging process - Although the complete relationship between diet and aging 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 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, certain pesticides, and other substance can produce pathologic changes in human beings - Smoking and breathing tobacco smoke and other air pollutants also have adverse effects - Crowded living conditions, high noise levels, and other factors are thought to influence how we age Sociological Theories of Aging Describe the aging individual in terms of his or her social group/culture 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 value of disengagement to society is that some elderly 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 - (decreased interaction between older person and others in the social system is inevitable, mutual, and acceptable to both the individual and society) 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 - This theory suggests ways of maintaining activity in the presence if 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, new friendships as old ones are lost - (life satisfaction depends on maintaining an involvement with life by developing new interests, hobbies, roles, and relationships) Continuity Theory - Assumes that person will remain the same unless there are factors that stimulate change - Also referred to as the developmental theory, related personality and predisposition toward certain actions in old age to similar factors during other phases of life cycle - Personality and basic patterns of behavior are said to remain unchanged as the individual ages - Aging is a complex process, and the continuity theory considers these complexities to a greater extent than most other theories - ( successful methods used throughout life for adapting and adjusting to life events are repeated. Traits, habits, values, associations, and goals remain stable, regardless of life changes) Age Stratification Theory - This theory suggests that society is stratified by age groups. Persons within a similar age groups 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 Subculture Theory - Views older adults as a group with a distinct norms, beliefs, expectations, habits and issues that separate them from the rest of society  - Older persons are accepted by and more comfortable among their own age group - As the population of older adults become more diverse, their needs better addressed, and their powers 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 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 Confusion Adulthood Intimacy Isolation Middle Age Generativity Self-absorption Old Age Integrity Despair Developmental Task of the Older Adult by Erikson Ego Integrity vs Despair Ego Integrity Despair  Views life with a sense of wholeness and Believes they have made poor choices derives satisfaction from past during life and wish they live life longer accomplishments Views death as an acceptable completion of Inability to accept one's fate life Accept one’s one value and only life cycle Gives rise to feeling with frustration, bitterness, anger, discouragement, and a sense that 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 tha older adults that influence the outcome of ego integrity of 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 vs body preoccupation - to find psychological pleasures rather than become absorbed with health problems or physical limitations imposed by aging c. Ego transcendence vs ego preoccupation - to achieve satisfaction through reflection on one’s past life and accomplishments rather than be preoccupied with the finite number of years left to live Robert Butler and Myrna Lewis (1982) outlined additional developmental tasks of later life: - Adjusting to one’s infirmities - Developing a sense of satisfaction with a life that has been lived - Preparing for death Gerotranscendence It suggests that aging entails a transition from a rational, materialistic, meta-perspective to a cosmic and transcendence vision. As people age, they are less concerned with their physical bodies, material possessions, meaningless relationships, and self-interests and instead desire a life of more significance and a greater  connection with others, there is a desire to shed roles and invest time in discovering hidden facets of oneself Nursing Theories of Aging Functional Consequences Theory The functional consequences theory for promoting wellness in older adult integrates theories from aging and holistic nursing. It advocates that nurses can promote wellness by addressing individuals holistically, recognizing the interconnection of body, mind, and spirit The consequences of age-related changes and risk factors can result in either positive or negative functional consequences (i.e., wellness outcomes) for older adults Theory of Thriving Proposes that everything that impacts people throughout their lives must be linked to create a holistic view of aging The theory is based on the failure to thrive concept as it is related to older adults in nursing homes; the clinical characteristics of older 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 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 The Theory of Successful Aging not only considers successful aging in terms of older adult’s physical, mental, and spiritual well-being but also includes the individual’s self-appraisal Sept 7 Lecture activity: creative presentation of health promotion in older adults Six Positive Lifestyle Factors that Promote Good Health “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) Dyer (2018) shares these six lifestyle modifications that have the best evidence of giving more healthy years Six positive lifestyle factors that promote good health 1. Getting regular and adequate amount of sleep getting a regular amount of sleep is important to give the body a chance to restore and regenerate sleeping less than 7 hours a night has been shown to have negative effects throughout the body those who sleep 7-8 hours a night also slow down the aging process. sleep increase the strength of the immune system 2. eating regular well-balanced meal, including breakfast healthy balanced diet can gelp provide energy and lower risks for the killer diseases such as heart disease, hypertension, diabetes, and cancer these different disease can be affected positively and negatively by what one eats. 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 foodd eaten e. substituting natural complex carbohydrates for refined sugars f. inreasing 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 fir cardiovascular disease, and reducing the amount of bone loss that is associated with age and osteoporosis once you are past 65, the requirements don’t go down, and you may benefit by adding balance exercises and flexibility exercises 4. maintaining a healthy body weight obesity is associated with a shorter lifespan and also with an increased risk of other major diseases 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 maintain weight 5. not using tobacco products, including smoking or chewing  in the philippines, 10 peopole die every hour because of smoking-related duping. this translates to 240 deaths everyday or 87,600 deaths 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, amd 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 of heart disease. Higher levels of alcohol can lead to health and behavioral problems, including an increased risk for 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: 1. Play and laughter Laughter causes a release of endorphins, stimulates the immune system and reduce stress. Finding humor in daily routines and experiencing joy despite problems contribute to good health Fun-happiness leads to a more efficient immune system and digestive system Those who are happy are also at least likely to suffer from insomnia and depression or any psychological disorder 2. 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 effects on the length and quality of life Some research suggests that religious people are happier. This may be because they have regular specialization opportunities at church functions 3. 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 4. Stress Management Stresses may accompany aging are numerous such as the onset of condition, retirement deaths of significant others, and change in body appearance, cam have significant detrimental effects Minimizing stress when possible and using effective stress management techniques are useful 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 ✓Application in Nursing Practice What are the appropriate nursing actions to assist aging person experience a sense of ego integrity and psychosocial well being: 1. Learn about patient’s stories; ask about family backgrounds, faith, work histories, hobbies, achievements and life experiences Encourage patient to discuss these topics, and listen with sincere interest Remember: the elderly needs to someone to talk to 2. Build on lifelong interests and offer opportunities for patients to experience new pleasures and interests 3. Accept patients' discussion of their regrets and dissatisfactions. Help them to put these in perspective of their total lives and accomplishments 4. Encourage reminiscence activities between patients and their families. Help families and staff to understand the therapeutic value of reminiscence 5. Respect patients’ faith and assist them in the fulfillment of spiritual needs 6. Use humor therapeutically. “Laughter contributes to good health” 7. If patients reside in an institutional setting (e.g., home for the aged), personalize the environment to the maximum degree possible 8. Recognized the unique assets and characteristics of each patient Life Changes and Events in Old Age Growing old maybe complex and complicated because the older individuals may need to face many life transitions like retirement, reduced income, possible housing changes, frequent losses through deaths of significant persons, and a declining ability to function. Therefore, the gerontological nurse is face with the challenge in providing holistic care to older adults as they go through the complex and arduous adjustments involved in aging. LEARNING OBJECTIVES Discuss ageism and its consequences Discuss changes that occur in aging families in terms of: a. changes in family roles and relationships: parenting and grandparenting b. loss of spouse c. retirement: loss of work role, reduced income Discuss the impact of age-related changes in health and functioning on roles. Describe cumulative effects of life changes and event: shrinking social world, awareness of mortality. Describe the responses of the older adults to life changes and events: life review and life story, self-reflection, strengthening inner resources.List nursing measure to assist individuals in adjusting to challenges and changes of aging. TERMINOLOGIES Ageism - Applying prejudices to older adults due to their age. Inner resources - Strength within the person that can be drawn upon when needed. Life review - A process of reminiscing or reflecting on one's life. Retirement - The period in which one no longer works. AGEISM - The prejudices and stereotypes that are applied to older people sheerly on the basis of their age..." (Butler, Lewis and Sutherland, 1991). Rather than showing appreciation for the vast contributions of older adults and their wealth of resources and wisdom, society is best with prejudices and lacks adequate provision for them, thus derogating their dignity. Older adults are oftentimes stereotyped by the following misconceptions: Old people are sick and disabled. Most old people are in the homes for the aged or nursing homes or homes of their children Dementia comes with old age People are either very tranquil or very cranky as they age Old people have lower intelligence and are resistant to change Old people are not able to have sexual intercourse and are not interested in sex. There are few satisfaction in old age. Gerontological nurses and other concerned groups have the responsibility to increase social awareness of the realities of aging by giving information to families and the public on the facts regarding aging and the problems and rights of older adults. Myths about Aging Senility is a result of aging. Incontinence is a result of aging. Older adults are no longer interested in sexuality. Most people spend their last years in nursing homes. All elderly persons are financially impoverished. Realities of Aging Dementia is disease-related, not age-related. Incontinence is not present among all aged. Sexuality is a lifelong need. 10% to 40% of elderly in the U.S. may spend some time in extended care facilities. CHANGES IN FAMILY ROLES AND RELATIONSHIPS 1. Parenting The dynamic parental role changes to meet the growth and development needs of both parent and child. Although parents who are freed from the responsibilities and worries of rearing children have more time to pursue their own interests, they are also freed from the meaningful, purposeful, and satisfying activities associated with child-rearing, and this frequently results in a profound sense of loss. However, this lessening of the parenting role and the changes in family function are not necessarily negative. 2. Grandparenting In addition to experiencing changes in the parenting role that come with age, many older adults enter a new role as grandparents. Filipinos' extended life expectancy enables more people to experience the role of grandparents and spend more years in that role than previous generations. Many older grandparents, and: a. Most are baby boomers, a great number are likely to be college educated and employed than previous generations of grandparents b. They are spending more on grandchildren than previous generations. Grandchildren can bring considerable joy and meaning to the lives of older adults. In turn, grandparents who are not burdened with the same daily child-rearing responsibilities of parents can offer love, guidance, and enjoyment to the family's young. In addition to older adults having to adapt to new family lifestyles and structures, children and grandchildren may need to adapt to grandparents who have different lifestyles from previous generations. Grandparenthood is a learned role and some older individuals may need guidance to become effective grandparents. Older adults may need to be guided in thinking through issues such as: Respecting their children as parents and not interfering in the parent-child relationship. Calling before visiting Establishing rules for babysitting Allowing their children to establish their own traditions within their family and not expecting them to adhere to the grandparents' traditions LOSS OF SPOUSE - The death of a spouse is a common event that alters family life for many older persons. The loss of that individual with whom one has shared more love and life experiences and more joys and sorrows than anyone else may be intolerable. The death of a spouse affects more women then men. When the initial grief of the husband's death passes, most widows adjust quite well. The likelihood of an older adult remarrying after the loss of a spouse diminishes with age. On the part of gerontological nurses, they may facilitate adjustment to widowhood by identifying sources of friendships and activities. RETIREMENT - It is another of the major adjustments of an aging individual. This transition brings the loss of a work role and is often an individual's first experience of the impact of aging. a. Loss of the Work Role Work is often viewed as the dues required for active membership in a productive society. Individuals are described in terms of their work role rather than their personal characteristics. When one's work is one's primary interest, activity, and source of social contacts, separation from work leaves a significant void in one's life. Aging individuals should be urged to develop interests unrelated to work. Retirement is facilitated by learning how to use, appreciate, and gain satisfaction from leisure time throughout and unemployed lifetime. Enjoying leisure time is a therapeutic outlet for life stresses throughout the aging process. Therefore, to provide holistic care, gerontological nurses must understand the realities and reactions encountered when working with retired persons. The phases of retirement described by Robert Atchley decades ago continue to offer insight into this complicated process: Preretirement Phase: When the reality of retirement is evident preparation for leaving one's job begins, as does fantasy regarding the retirement role.  Retirement Phase: Following the retirement event, a somewhat euphoric period begins, a "honeymoon period" in which fantasies from the preretirement phase are tested. Retirees attempt to do everything they never had time simultaneously. Disenchantment Phase: As life begins to stabilize, a letdown sometimes a depression, is experienced. The more unrealistic the preretirement fantasy, the greater degree of disenchantment. Reorientation Phase: As realistic choices and alternative sources of satisfaction are considered, thedisenchantment with the new retirement routine can be replaced by developing a lifestyle that provides some satisfaction. Retirement routine Phase: An understanding of the retirement role is achieved, and this provides a framework for concern, involvement, an action in the older person's life. Termination of Retirement: The retirement role is lost as a result of either the assumption of a work role or dependency due to illness or disability. Different nursing interventions may be required each phase of retirement: 1. Assisting aging individuals with their retirement preparation during the preretirement phase is a preventive intervention that enhance the potential for health and well being in late life. 2. Counseling regarding the realities of retirement. 3. Being supportive of the retirees during the disenchantment phase without fostering self-pity. 4. Appreciating and promoting the strengths of the stability phase may reinforce an adjustment to retirement. 5. When the retirement phase is terminated due to disease or disability, the tactful management of dependency and the respectful appreciation of losses are extremely important. Gerontological nurses' evaluation of their own attitudes toward retirement are beneficial. Does the nurse see retirement as a period of freedom, opportunity, and growth or as of loneliness, dependency, and meaninglessness? b. Reduced Income In addition to the adjustment in work role, retirement often requires older adults to live on a reduced income. Retirement income is less than half the income earned while fully employed. A reduction in income is a significant adjustment for many older persons because it triggers other adjustments. Therefore, making financial preparations for old age many years before retirement is extremely important. CHANGES IN HEALTH AND FUNCTIONING The changes in appearance and bodily function that occur during the aging process make it necessary for the aging individual to adjust to a new body image. Nursing Implications in Helping Older Persons Maintain Social Connections Nurses should attempt to intervene when they detect isolation and loneliness in an older person. The person's faith community may also provide assistance Nurses can help the older adult locate and join social groups and perhaps even accompany the individual to the first meeting. A change in housing may be necessary to provide safe environment conducive to social interactions Frequently, pets serve as significant and effective companions for socialization Medication administration should be planned so that during periods of social activity analgesics will provide relief AWARENESS OF MORTALITY Widowhood, the death of friends, and the recognition of declining functions heighten the older person’s awareness of the reality of their own deaths During the earlier years, individual intellectually understand they will not live forever, but their behaviors often deny this reality As the reality becomes acute with advancing age, interest in fulfilling dreams, deepening religious convictions, strengthening family ties, and providing for the on going welfare of family, and leaving a legacy are often apparent signs The thought of impending death may be more tolerable if people understand that their life has had depth and meaning COMMON CHANGES IN AGING Human aging, physiological changes that take place in the human body leading to senescence, the decline of biologic functions and the ability to adapt to metabolic stress. In humans, the physiological developments are normally accompanied by psychological and behavioral changes, and other changes involving social and economic factors, also occur. The type, rate, and degree of physical, emotional, psychological, and social changes experienced during life are highly individualized; such changes are influenced by genetic factors, environment, diet, health, stress, lifestyle choices, and numerous other elements. LEARNING OBJECTIVES State common age-related changes in the body in terms of: a. Cellular changes b. Physical appearance c. Respiratory System d. Cardiovascular System e. Gastrointestinal System f. Urinary System g. Reproductive System h. Musculoskeletal System i. Nervous System j. Sensory system k. Endocrine system l. Immune system m. Integumentary system n. Thermoregulation Describe psychological changes (changes to the mind) experienced with age Discuss nursing actions to promote health and reduce risks associated with age-related changes (nursing implications of age-related changes). TERMINOLOGIES Crystallized Intelligence - knowledge accumulated over a lifetime; arises from the dominant hemisphere of the brain. Fluid intelligence - Involves new information emanating from the non-dominant hemisphere; controls emotions, retention of non-intellectual information, creative capacities, special perceptions, and aesthetic appreciation. Immunosenescence - The aging of the immune system.Presbycusis: Progressive hearing loss that occurs as a result of age-related changes to the inner ear. It is characterized by difficulty in understanding high-pitched sounds (e.g., woman's voice). Presbyesophagus - A condition characterized by a decreased intensity of propulsive waves and an increased frequency of non-propulsive waves in the esophagus. Presbyopia - The inability to focus or accommodate properly due to reduced elasticity of the lens. Changes to The Body of an Older Adult A. CELLULAR CHANGES Organ and system changes can be traced to changes at the basic cellular level. The number of cells is gradually reduced, leaving fewer functional cells in the body. One example is, metabolism is decreased to about 95% capacity by age 50, and to 85% by age 70. This effect also ties in with a decrease in hormonal secretions. A decrease in metabolism has several effect. a. Toleration of cold is less. b. A tendency to gain weight increases. c. There is a decreased efficiency in the body's use of glucose. B. PHYSICAL APPEARANCE Many physical changes of aging affect a person's appearance. Men experience hair loss and both sexes may develop gray hair and wrinkles. As body fat atrophies, the body's contours gain a bony appearance along with the deepening hollows of the intercostal and supraclavicular space, orbits, and axillae. Elongated ears, double chin, and baggy eyelids are among the more obvious manifestations of the loss of tissue elasticity throughout the body. Skinfold thickness is significantly reduced in the forearm and on the back of the hands. Stature decreases, resulting in a loss of approximately 2 inches in height by 80 years of age. Body shrinkage is due to reduced hydration, loss cartilage, and thinning of the vertebrae. The decrease in the stature causes the long bones of the body, which do not shrink, to appear disproportionately long. Any curvature of the spine, hips, and knee that may be present can further reduce height. These changes in physical appearance are gradual and subtle. Further differences in physiologic structure and function can arise from changes to specific body system. C. RESPIRATORY SYSTEM The tip of the nose slightly rotates downward; septal deviations can occur. Mouth breathing during sleep becomes more common as a result, contributing to snoring and obstructive apnea. The submucosal glands have decreased secretions, reducing the ability to dilute mucus secretions; the thicker secretions are more difficult to remove and give the older person a sensation of nasal stuffiness.  The anterior-posterior chest diameter increases, often demonstrated by kyphosis. Reduced breathing capacity, reduced vital capacity, increased residual volume. Decreased cough reflex. Decreased ciliary activity. These changes increase the risk for respiratory problems (hypoxia, infections) among adults. In capsule: Respiratory Changes in Aging PO2 reduced as much as 15% between ages 20 and 80. Loss of elasticity and increased rigidity. Forced expiratory volume reduced. Blunting of cough and laryngeal reflexes. By age 90 years, approximately 50% increase in residual capacity. Alveoli are fewer in number and larger in size. Thoracic muscles are more rigid. Reduced basilar inflation. D. CARDIOVASCULAR SYSTEM Throughout the adult years, the heart muscles loses its efficiency and contractile strength resulting in reduced cardiac output under conditions of physiologic stress. Pacemaker cells become decreased in number, become increasingly irregular, and the shell surrounding the sinus nodes thickens. Incomplete valve closures can result in systolic and diastolic murmurs in older adults. Endocardial thickening, thickened heart valves, decreased myocardial strength. These lead to decreased cardiac output. ✓VASCULAR CHANGES Decreased elasticity of blood vessels. This leads to increased blood pressure (BP). Atherosclerotic plaques develop. This may result to ischemia. Decreased efficiency of baroreceptors (receptors that are sensitive to changes in blood pressure). This increases risk for postural hypertension. When older persons are faced with an added demand on their hearts, they note the difference. Tachycardia in older people will last for a longer time in younger people. Stroke volume may increase to compensate for these situations, which results in elevated BP. In capsule: Cardiovascular Changes in Aging More prominent arteries in head, neck, and extremities. Valves become thicker and more rigid.  Stroke volume decreases by 1% each year. Heart pigmented with lipofuscin granules. Less efficient 02 (oxygen) utilization. Aorta becomes dilated and elongated Cardiac output decreases. Resistance to peripheral blood flow increases by 1% per year Blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output. Less elasticity of blood vessels. E. GASTROINTESTINAL SYSTEM Tooth enamel becomes harder and more brittle with age. Gums become less elastic and less vascular. Taste sensations become less acute with age because the tongue atrophies, affecting the taste buds. Loss of papillae and sublingual varicosities on the tongue are common findings. Saliva often is diminished in quantity (one third of the amount of saliva they produced in younger years) and is of increased viscosity as a result of some of the medications commonly used to treat geriatric condition. Salivary ptyalin is decreased, interfering with the breakdown of starches. Diminished muscle strength and tongue pressure can interfere with mastication and swallowing Esophageal motility is affected by age.Presybesophagus may occur. The stomach believed to have reduced motility in old age, along with decreases in hunger contractions. The gastric mucosa atrophies. Fat absorption is slower. Minimal loss of digestive enzymes. This leads to decreased absorption of nutrients. Decreased peristalsis. This leads to constipation. With advancing age, the liver has reduced weight and volume but this seems to produce no ill effects. The older liver is unable to regenerate damaged cells. Less efficient cholesterol stabilization and absorption cause an increased incidence of gallstones. The pancreatic ducts become dilated and distended, and often the entire gland prolapses In capsule: Gastrointestinal Change in Aging Decreased taste sensations. Esophagus is more dilated. Decreased esophageal motility. Reduced saliva and salivary ptyalin. Atrophy of gastric mucosa. Decreased stomach motility, hunger contractions, and emptying time.  Less production of hydrochloric acid, pepsin, lipase, and pancreatic enzymes. Fewer cells on absorbing surface of intestines. Reduced intestinal blood flow. Slower peristalsis. Liver small in size F. URINARY SYSTEM It is affected by changes in the kidneys, ureters, and bladder. The renal mass becomes smaller with age, with subsequent cortical loss. Renal tissue growth declines and strerosclerosis promotes atrophy of the kidneys. Decreased blood flow to the kidneys. This causes reduction in glomerular filtration rate (GR). Reduced number of nephrons and decreased creatinine clearance. Hyponatremía and nocturia are common among older people. The decrease in tubular function also causes decreased reabsorption of glucose from the filtrate, which can cause +1 proteinurias and glycosurias not to be of major diagnostic significance. Urinary frequency, urgency, and noctupia accompany bladder changes with age. Bladder muscles weakens and bladder capacity decreases. The micturition reflex is delayed. Although urinary incontinence is not a normal outcome of aging, some stress incontinence may occur because of a weaking of pelvic diaphragm, particularly in multiparous women. In capsule: Urinary Tract Changes in Aging Decreased size of renal mass. Decrease in nephrons. Decreased tubular function. Between ages 20 and 90, renal blood flow decreases 53%, and glomerular filtration rate decreases 50%. Decreased bladder capacity. Weaker bladder muscles. G. REPRODUCTIVE SYSTEM ✓ MALES As men age, the seminal vesicles are affected by smoothing of the mucosa, thinning of the epithelium, thickening of the basement membrane, and narrowing of the lumen. These structural changes can cause a reduction in sperm count in some men. Increases in follicle-stimulating and luteinizing hormone levels occur along with decreases in both serum and bioavailable testosterone levels. The older man does not lose the physical capacity to achieve erections or ejaculations, although orgasm and ejaculation tend to be less intense.  Prostatic enlargement occurs in most older men. Three fourths of men aged 65 years and older have some degree of prostatism, which causes problems with urinary frequency. ✓ FEMALES The female genitalia demonstrates many changes with age, including atrophy of the vulva from hormonal changes, accompanied by the loss of subcutaneous fat and hair and flattening of the labia. The vaginal environment is more alkaline in older women and is accompanied by a change in the type of flora and a reduction in secretions. Thus, there is a reduced vaginal lubrication. The cervix and endometrium atrophies, the uterus shrinks, however the endometrium continues to respond to hormonal stimulation for incidents of postmenopausal bleeding in older women on estrogen therapy. The uterus and ovaries are not palpable during an exam. Despite these changes, the older woman does not lose the ability to engage in and enjoy intercourse or other forms of sexual pleasure. Estrogen depletion also causes a weakening of pelvic floor muscles, which can lead to an involuntary release of urine when there is an increase in intra-abdominal pressure. ✓ For both male and female older persons, there is a minimal change in amount of sexual response. Although there is an increase in time for full sexual response. ✓ There is an increased refractory period in males. Refractory period - In men, the penis becomes flaccid after an orgasm. A man doesn't think about sex or get aroussa. His body does not respond to sexual stimulation and he is unable to reach orgasm again, until the refractory period is over. The length of refractory period is different for every man. Younger men may need only a few minutes of recovery time, but older men usually have a longer refractory period sometimes between 12 to 24 hours. For some men, the refractory period can last a few days. Women do not have refractory periods the way men do. But fatigue after an orgasm can make them lose interest in sex temporarily. This can happen after one orgasm or multiple orgasms. In capsule: Changes in the Reproductive Structures in Aging A. MALE Fluid-retaining capacity of seminal vesicles reduces. Possible reduction in sperm count. Venous and arterial sclerosis of penis. Prostate enlarges in most men. B. FEMALE Fallopian tubes atrophy and shorten. Ovaries becomes thicker and smaller. Cervix becomes smaller. Drier, less elastic vaginal canal. Flattening of labia. Endocervical epithelium atrophies. Uterus becomes smaller in size. Endometrium atrophies. More alkaline vaginal environment. Loss of vulvar subcutaneous fat and hair. H. MUSCULOSKELETAL SYSTEM The kyphosis, enlarged joints, flabby muscles, and decreased height of many older persons result from the variety of musculoskeletal changes occurring with age. Muscle fibers atrophy and decrease in number with fibrous tissue replacing muscle tissue. This results to decreased muscular strength and function. Overall muscle mass, muscle strength, and muscle movements are decreased; the arm and leg muscles which become particularly flabby and weak, display these changes well. Sarcopenia - The age-related loss of muscle mass, strength, and function, is mostly seen in inactive persons; thus, the importance of exercise to minimize the loss of muscle tone and strength cannot be emphasized. a. Muscle tremor may be present and are believed to be associated with degeneration of the extrapyramidal system. b. The tendons shrink and harden which causes a decrease in tendon jerks. c. Reflexes are lessened in the arms, are nearly totally lost in the abdomen, but are maintained in the knee. d. Muscle cramping usually occurs, for various reasons. e. Bone mineral and bone mass are reduced which contribute to the brittleness of the bones of older people especially for women who experience an accelerated rate of bone loss after menopause. f. Bone density decrease at a rate of 0.5% each year after the third decade of life. g. There is diminished calcium absorption, a gradual resorption of the interior surface of the long bones, and a slower production of new bone on the outside surface. These changes make a fracture a serious risk to the older adults. Although long bones do not significantly shorten with age, thinning disks and shortening vertebrae reduce the length of the spinal column, causing a reduction in height with age.  A deterioration of the cartilage surface of the joints and the formation of points and spurs may limit joint activity and motion (stiffness of joints). In capsule: Skeletal Changes in Aging Shortening of the verterbrae. Between ages 20 to 70, height decreases approximately 2 inches. Bones become more brittle. Slight knee flexion. Decrease in bone mass and bone mineral. Slight kyphosis. Slight hip flexion. Slight wrist flexion. Impaired flexion and extension movements. I. NERVOUS SYSTEM The impact of aging on the nervous system is greatly influenced by function of other body systems. For instance, cardiovascular problems can reduce cerebral circulation and be responsible for cerebral dysfunction. There is a decline in brain weight and a reduction blood flow to the brain; however, these structural changes do not appear to affect thinking and behavior. Declining nervous system function may be unnoticed because changes are often nonspecific and slowly progressing. Degeneration and atrophy of neurons. This causes loss of memory, especially recent memory. The nerve conduction velocity is lower. Kinesthetic sense lessens. There is slower response to changes in balance, a factor contributing to falls. Slower recognition and response to stimuli. Decreased nerve acuity and sensation. This makes the elderly unaware of tissue trauma like burns or pressure. The hypothalamus regulates temperature less effectively. The elderly has low tolerance to cold. Brain cells slowly decline over the years particularly after 55 years. Decision-making and judgement ability remain intact. Ability to learn is possible up to 200 years of life. Although, intelligence starts to decline at age 75 years. Sleep regulation are altered with aging. Frequent awakening during sleep is not unusual, although only a minimal amount of sleep is actually lost. In capsule: Neurologic Changes in Aging Decreased conduction velocity. Slower response and reaction time. Decreased brain weight.  Decreased blood flow to brain. Changes in sleep pattern. j. Sensory system k. Endocrine system l. Immune system m. Integumentary system n. Thermoregulation GERIATRIC ASSESSMENT Objectives To illustrate the importance of physical, cognitive, and psychosocial assessments for older adults To describe activities of daily living (ADLs) and instrumental activities of daily living (IADLs) To demonstrate gait assessment and falls risk assessment with an older adult To demonstrate cognitive and depression screening with an older adult INTRODUCTION Comprehensive geriatric assessment Multidimensional process AIMS To recognize common geriatric disorder To plan effective treatment program To improve overall health and functional outcomes To reduce vulnerability to subsequent illness To improve quality of life BASIC ADL INDEX Kulang an ppt gaiz…..