Care of the Older Adult PDF

CARE OF THE OLDER ADULT Concepts, Principles and Theories in the Care of Older Adults Topic Outline Overview Introduction History of Gerontological Nursing Definition of terms  OVERVIEW: The objectives of assessing and caring for older adults,...

CARE OF THE OLDER ADULT Concepts, Principles and Theories in the Care of Older Adults Topic Outline Overview Introduction History of Gerontological Nursing Definition of terms  OVERVIEW: The objectives of assessing and caring for older adults, including effective communication, using Gordon's functional patterns, and promoting health. Components of assessing older adults, including collecting subjective and objective data through nursing history, functional assessments, and physical exams while considering ethics, communication skills, and the patient's profile. Nursing management of older adults focuses on supporting cognitive function, promoting safety and independence, reducing anxiety, improving communication, and addressing social and nutritional needs.  Introduction: This introductory chapter recognizes the individuality, uniqueness, and potential for wellness of every person regardless of age. Brief background information is provided that will orient nursing students to critical issues affecting the present and future of the aged and the nurse’s role in their care. Learning Objectives: 1. Integrate principles and concepts of physical, social, natural and health sciences and humanities in the care of older adults. 2. Apply appropriate nursing concepts and actions holistically and comprehensively. 3. Explain major biological, sociological and psychological theories of aging. 4. Develop nursing interventions based on the psychosocial issues and biologic changes associated with older adulthood. 5. Describe characteristics of today’s elderly population. History of Gerontological Nursing 1960s: ANA forms gerontological nursing specialty 1970s: Veterans Administration (VA) funds Geriatric Research Education and Clinical Centers 1980s: The National Gerontological Nursing Association (NGNA) established 1990s: Hartford Foundation Institute for Geriatric Nursing established at NYU 21st century: “baby boomers” begin turning 65; growing interest in gerontological care Attitudes towards Aging Television, Media, Newspapers, Film industry, Commercials in magazines and on TV, Greeting card/birthday cards Three major misconceptions about aging 1. Disease in old age is normal 2. Older adults have no future and therefore health promotion efforts are wasted 3. Damage to health from poor diet and inactivity is irreversible DEFINITION OF TERMS: Aging – refers to the inevitable, irreversible decline in organ function that occurs over time even in the absence of injury, illness, environmental risks, or poor lifestyle choices. – is a development process. It is universal phenomenon with manifestation of increased risk of debility, disease and death. Ageism – prejudice against people of older age. – Based on negative misconception and stereotypes – Leads to discrimination, lower quality care, and preventable illness and disability. – Bias against older people – Based perception solely on their chronological age not on their functional status – Stereotyping characteristics of elderly Ex. weal, memory loss, poor, burden, dependent, unreliable, lonely DEFINITION OF TERMS: Gerontology – the study of the aging process including biologic, sociologic, and psychological changes. – Refers to the combined biologic, psychological, and psychological study of older adults within their environment – Carative aspect Geriatrics – medical specialty that focuses on treating and caring for old people. – Branch of medicine that is used to study old age – Focuses on physiology, pathology, diagnosis, and medical management to f the disorders and diseases of older adults – Curative aspect DEFINITION OF TERMS: Gerontological nursing – is the specialty of nursing pertaining to older adults. – Field of nursing that specializes in the nursing process – It includes assessment, nursing diagnosis, planning, implementation, and evaluation of older adults – All nursing settings from acute care, Intermediate, skilled care, extended facilities, and also in community – is a nursing process applied to older adults in all environments, including acute, intermediate, skilled care, and in the community. Senescence – biological process of aging or the breakdown of the physical body while growing older. DEFINITION OF TERMS: * Gerontological nurses work in collaboration with older adults, their families, and communities to support healthy aging, maximum functioning, and quality of life. * Gerontological nursing is an evidence-based nursing specialty that addresses the unique physiological, social, psychological, developmental, economic, cultural, spiritual, and advocacy needs of older adults. (Vetter, 2022) * Geriatric nursing is being more consistent with the specialty's broader focus on health and wellness, in addition to illness. Life span  the maximum length of time an organism can be expected to survive or last. Life expectancy  Average observed years of life of a specie from birth to death  Any stated age  MYTHS ON AGING MYTH FACT Being old means being sick. Only 5 % of older adults are frail enough to require long term care facilities. Most elder adults have chronic disease but functioning quite well. Older adults are set in their ways and cannot learn new things. Older adults learn new things and should be challenged to stay mentally active. Older adults who engage in challenging activities to keep their minds active are less likely to get set in their ways and are even less likely to develop Alzheimer’s disease. Health promotion is wasted on older adults. It is never too late to begin good lifestyle habits such as eating a healthy diet ang engaging in exercise. Although it may not be possible to reverse all the damage, it is never too late to stop bad habits such as smoking cigarettes or drinking too much alcohol and enjoy better health outcomes. You are too old to exercise. Exercise dramatically increases physical fitness, muscle size, and strength in older adults. Older adults are not interested in sex. Although sexual activity does decrease in some older adults, there are tremendous differences. Most often, the human need affection, physical contact continues throughout life. Older people don’t care how they look. Bladder problems of aging. “It’s too late now to change my bad habits. The horse is out of the The risk of heart disease begins to fall as soon as the elderly quit barn.” smoking. The elderly do not pull their own weight. Older adults contribute greatly to society by supporting the art, doing volunteer work, and helping with grandchildren. Paid employment is not the only measure of value and productivity and  MYTH REALITIES People consider themselves to be old at 65. People feel old based on their health and function rather than their chronological age. As people grow older, it is natural for them want 80% of the older adults is provided by their families. to withdraw from society In today’s society, families no longer care for Because older people are unique individuals, each of older people. them respond differently to society. By age 70. An individual’s psychological growth People never lose their capacity for psychological is complete. growth. In old age, there is inevitable decline in all A few areas of cognitive ability decline in older intellectual abilities. adulthood, but other areas show improvement. Older adults cannot learn complex skills. Older adults are capable of learning new things but the speed with which they process information slows with age. Older people decrease the level of their sexual If sexual activity in older adults decline, it is because activity because they are less able to perform of social reasons (example loss of partner) or risk sexually factor such as diseases and adverse medication effects.  REALITIES OF AGING: 1. Aging is a normal process common to all living organisms. Every living organism begins aging from the time of conception. The process of aging helps individuals achieve the mature cellular, organ and system functioning necessary for the accomplishment of developmental tasks throughout life. Every cell of every organism ages constantly and continuously. 2. Aging is a life-long process Aging is a life-long process that begins at conception. Age related changes are inevitable. These changes do affect lifestyle, but most changes can be managed in order for the older person to live a happy, productive life. A nurse who understands that aging is a normal, natural process that occurs in all individuals is more prepared to give nursing care than the nurse who views aging as a disease that must be tolerated.  3. Aging is highly individualized Aging is highly individualized and influenced by factors such as environment, genetics, health care and health promotion activity. The aging population encompasses those between 65 and 100 plus years. There is great diversity in years and in mental, physical, and psychological ability. No two older adults are alike. Nursing care must be individualized to meet specific individual needs. 4. Health habits are reversible Disease is not inevitable. In some instances, the disease is avoidable. Poor health habits are reversible. As the life span increases, more individuals older than 65 are interested in improving the quality of life and changing health habits to provide an even higher quality of life. More senior citizens  Introduction to Process of Aging  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.  Each phase comes with different responsibilities and expectations, which of course vary by individual and culture.  Children love to play and learn, looking forward to becoming preteens.  As preteens begin to test their independence, they are eager to become teenagers.  Introduction to Process of Aging  Teenagers anticipate the promises and challenges of adulthood.  Adults become focused on creating families, building careers, and experiencing the world as independent people.  Finally, many adults look forward to old age as a wonderful time to enjoy life without as much pressure from work and family life.  In old age, grandparenthood can provide many of the joys of parenthood without all the hard work that parenthood entails.  Introduction to Process of Aging  And as work responsibilities abate, old age may be a time to explore hobbies and activities that there was no time for earlier in life.  But for other people, old age is not a phase that they look forward to. Some people fear old age and do anything to “avoid” it by seeking medical and cosmetic fixes for the natural effects of age.  These differing views on the life course are the result of the cultural values and norms into which people are socialized, but in most cultures, age is a master status influencing self-concept, as well as social roles and interactions.  PERSPECTIVE ON AGING -Aging is a gradual, continuous process of natural change that begins in early adulthood. During early middle age, many bodily functions begin to gradually decline. -People do not become old or elderly at any specific age. Traditionally, age 65 has been designated as the beginning of old age. But the reason was based in history, not biology. Many years ago, age 65 was chosen as the age for retirement in Germany, the first nation to establish a retirement program. In 1965 in the United States, age 65 was designated as the eligibility age for Medicare insurance. This age is close to the actual retirement age of most people in economically advanced societies.  PERSPECTIVE ON AGING:  AGING IS A DEVELOPMENTAL PROCESS Sr Lety Kuan views life as a 3-pronged course 3 components of life course: 1. Acquisition 2. Struggle 3. Legacy Components are the sum of experiences an individual has gathered throughout existence (positive and negative) Continuous process that starts from conception up to old age Aging is a natural process. Constantly and continuously, every cell of every organism age. Aging is the continuum of events that occur from conception to death. It is a process of becoming older.  PERSPECTIVE ON AGING: ACQUISITION  Affects one’s capabilities to face challenges and struggles in life.  Good acquisition in early stage of life is crucial.  Usually handed over by parents, but as individual grow she/she now.  performs the acquisition alone or with others.  Environment and relationship with others shape how one acquires life.  Obstacles may present itself along the way to test acquisition.  positive acquisition o lightens the burden, resulting in successful problem solving and bright achievements. o cheerful disposition  negative acquisition o can lead to increased struggles, regrets, and dissatisfaction. o grumpy, antisocial demeanor PERSPECTIVE ON AGING: LEGACY  stage in life where a person has achieved self-actualization, radiating goodness accumulated over time.  when one has been inspiration for others and has made a big contribution to society LIFE PERSPECTIVE/ GRACEFUL AGING THEORY  Developed by Sr Lety Kuan  Good education is crucial in stablishing a good legacy. Good education is the best we can give to children.  Economic status is not a hindrance to establish a good legacy. What a child has grown up with (ex: presence/absence of affection, attention, etc) is what he/she will bring up it to adulthood Honesty and love are what matters in the upbringing of a person  Regardless of religion, as long as one is spiritual, one cannot be cruel or selfish (sharing is a key factor)  In terms of dealing with people without good acquisition, it is the therapeutic role of a nurse/caretaker to let them acquire what they missed early in life.  One must reflect the things they missed in the past in order to help them acquire it.  What the person lacks, the nurse must fill in Development Principles 1. Development is lifelong. 2. Development depends on history and context. 3. Development is multidimensional and multidirectional and involves a balance of growth and decline. 4. Development is plastic rather than rigid. Despite the normality and naturalness of this experience, many people approach aging as though it were a pathologic experience, witnessed by comments that associate aging with: “looking gray and wrinkled” “losing one’s mind” “becoming sick and frail” “obtaining little satisfaction from life” “returning to childlike behavior” “being useless” Ageism - negative attitude towards aging and older adults.  PERSPECTIVE ON AGING TYPES OF AGING. When a person becomes old can be answered in different ways: Chronologic age is based solely on the passage of time. It is a person’s age in years. Chronologic age has limited significance in terms of health. Nonetheless, the likelihood of developing a health problem increases as people age, and it is health problems, rather than normal aging, that are the primary cause of functional loss during old age. Because chronologic age helps predict many health problems, it has some legal and financial uses. Biologic age refers to changes in the body that commonly occur as people age. Because these changes affect some people sooner than others, some people are biologically old at 65, and others not until a decade or more later. However, most noticeable differences in apparent age among people of similar chronologic age are caused by lifestyle, habit, and subtle effects of disease rather than by differences in actual aging.  PERSPECTIVE ON AGING. Psychologic age is based on how people act and feel. For example, an 80-year-old who works, plans, looks forward to future events, and participates in many activities is considered psychologically younger. Most healthy and active people do not need the expertise of a geriatrician (a doctor who specializes in the care of older people) until they are 70, 75, or even 80 years old. However, some people need to see a geriatrician at a younger chronologic age because of their medical conditions.  PERSPECTIVE ON AGING Gerontology is the study of the aging process, including physical, mental, and social changes. The information is used to develop strategies and programs for improving the lives of older people. Some gerontologists have a medical degree and are also geriatricians. Geriatrics is the branch of medicine that specializes in the care of older people, which often involves managing many disorders and problems at the same time. Geriatricians have studied the aging process so that they can better distinguish which changes result from aging itself and which indicate a disorder. Some bioethicists argue that aging is, in fact, a natural developmental process for human beings (Meilaender, 2011). According to Meilaender (2011), aging is a normal stage of life in which our bodies begin to function less effectively, making us more vulnerable to disease Types of Aging 1. Chronological age - measured by the number of years lived. 2. Biological age - predicted by the person’s physical condition and how well vital organ systems are functioning. 3. Psychological age- expressed through a person’s ability and control of memory, learning capacity, skills, emotions and judgement. 4. Social age - measured by age - graded behavior that conform to an expected status and role within a culture or society. STAGES OF OLDER ADULTS / SUBSETS OF ELDERLY STAGE AGE Young old Between the ages of 65 and 74 Middle old Between ages 75 and 84 Oldest old (frail elderly) Between ages 85- 99 Elite old / Centenarians Ages 100 and up Gerontology is the study of aging and the aged. 1. Geriatrics- medical care of the aged. 2. Social Gerontology- focuses on social aspects of aging. 3. Geropsychology- seeks to address the concerns of older adults. 4. Geropharmacology- study of pharmacology in relation to older adults. 5. Financial Gerontology- combines knowledge of financial planning and services with special expertise in the needs of older adults. 6.Gerontological Rehabilitation Nursing - combines expertise in gerontological nursing with rehabilitation concepts and practice. 7. Gerontological Nursing - nurses advocating for the health of older persons at all levels of prevention. DEMOGRAPHICS OF AGING AND IMPLICATION TO HEALTH AND NURSING CARE DEMOGRAPHICS- Study of population based on factors such as age,race and sex.  DEMOGRAPHICS OF AGING AND IMPLICATION TO HEALTH AND NURSING CARE The aging of the population affects the demand for all health care services, including hospitals, and long-term care. Older persons use more health services than their younger counterparts because they have more health problems. They are also hospitalized more often and have longer lengths of stay than younger persons.lderly is small due to the high fertility rate. Life expectancy averages 63.5 years. What is the present Demography of Aging in the Philippines? Aging in the Philippines a. The country consists of approximately 103 million inhabitants, with less than 5% of the population 65 years and older. b. Currently, the age structure of the Philippines resembles many other developing countries because there is a greater proportion of younger Filipinos in comparison to older Filipinos. c. Despite the larger number of young Filipinos, the 60 years and older population of the Philippines is expected to increase by 4%, whereas the 80 years and older population is expected to increase by 0% from 2010 to 2030. The Philippines’s population increased by over 35% over the last two decades with the older adult population expected to overtake those aged 0– 14 years old by 2065. d. Currently, life expectancy of Filipinos is 57 years for males and 63 years for females. Females are projected to expect an increase of 4 years in life expectancy and males an increase of 4 years in life expectancy by 2030 DEMOGRAPHICS OF AGING AND IMPLICATION TO HEALTH AND NURSING CARE AGING  Normal process of time-related change  Starts at age 60 years old  Or elderly, older adult/person, late adulthood, or senior citizen  It is the fastest growing age group than the rest of population  Composed of 12.8%of the population  In 2030, it increases to 22%of population  Increasing aging population (very old people)  Because of declining fertility rate and rising life expectancy  Baby boomers- born between 1940-1960  DEMOGRAPHICS OF AGING AND IMPLICATION TO HEALTH AND NURSING CARE GLOBAL AGING  United Nations (2020) Global population aged 60 years old and above accounts to 962 million In USA, around 53.7 million aging population  Since the beginning of recorded history, young children have outnumbered their elders. In about five years’ time however, the number of people aged 65 or older will outnumber children under age 5. Driven by falling fertility rates and remarkable increases in life expectancy, population aging will continue, even accelerate  In 2010, an estimated 524 million people were aged 65 years and older– 8 percent of the population. By 2050, this number is expected to nearly triple to about 1.5 billion, representing 16 percent of the world’s population. Although more developed countries have the oldest population profiles, the vast majority of the older people—and the most rapidly aging populations—are in less developed countries. Between 2010 and 2050, the number of older people in less developed countries is projected to increase more than 250 percent, compared with a 71 percent increase in developed countries.  IMPACT OF AGING MEMBERS IN THE FAMILY “Aging can contribute poor family relationship in a number of ways.” -Caring for aging parents as well as to any aging beloved family members has multiple impacts on your family life, including emotional, physical, financial and structural effects. As you and your family make plans and you reflect on your future as a caregiver, take time to appreciate the strength you derive from working together and the unique bonds you share as family. EMOTIONAL EFFECT -Caring for your aging parents prompts a range of impulses and emotions. Katie Thomas and Mishelle Segur, co-owners and directors of Hearts and Hands Counseling, say that common responses include "Guilt for not being able to do more for parents; anger for having to set aside your own needs or shift your priorities; and fear and anxiety, including anticipatory grief and fear of financial strain."  IMPACT OF AGING MEMBERS IN THE FAMILY FINANCIAL EFFECTS -Caring for aging parents often means extra costs related to home health care, medical expenses not covered by insurance and extra insurance premiums for services such as long-term care. You also may need to take off extra time from work. STRUCTURAL EFFECTS -When you live with your aging parents or assume a high amount of daily care for them, you experience a change in your family roles. Thomas and Segur describe this as a "shift in family structure and hierarchy related to the matriarch or patriarch no longer being in their role." When this occurs, "someone new has to take their place." HEALTH STATUS OF OLDER ADULTS The older population experiences fewer acute illnesses than younger age groups and a lower deathrate from these problems. However, older people who do develop acute illnesses usually require longer periods of recovery and have more complications from these conditions. Chronic illness is a major problem for the older population. Most of the older adults have at least one chronic disease, and typically, they have multiple chronic conditions, termed comorbidity. Chronic conditions result in some limitations in activities of daily living and instrumental activities of daily living for many individuals. The older the person is, the greater the likelihood of difficulty with self-care activities and independent living. AGING SOCIETY - the societal aspect of aging is marked by the rapidly growing number and proportion of older people in the population. A. Industrialization  It is most difficult for the older worker who becomes unemployed to find a new job. B. Urbanization The small dwelling units’ characteristics of urban life and of shrinking two generation family make it difficult or impossible for grandparents to live with their children and this complicates the problem of older people in finding living arrangements that satisfy their needs. C. Lack of Facilities for Older People There are few opportunities for older people to find the health services they need, make new friends, learn and practice creative activities, retrain for new jobs, seek recreation, and participate in educational and community experiences. EFFECTS ON SOCIETY  The effect of aging on the economy is fundamental.  The growing number of older people can become financial dependents.  Older people derive their incomes from gainful employment, work-connected pensions, savings, help from relatives, and through government in the form of different payments or services in kind EFFECTS ON SOCIETY A. Employment  Importance of employment for older people: o It satisfies the needs of many for financial security and the feeling of usefulness. o It maintains their status as income producers rather than financial dependents. o It takes advantage of their capacities as producers of goods and services  Older workers are not hired because of: o slowing down o deterioration o resistance to new processes o susceptibility to injury  Retirement is a major adjustment 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. In addition, retirement can require adjusting to a reduced income and consequent changes in lifestyle. “Abrupt retirement is a death sentence to large numbers of old people, and a sick or morale breakdown to many others.” EFFECTS ON SOCIETY B. Living Arrangements  The well-being of the individual at any age depends upon his ability to satisfy his total needs in socially acceptable ways. Basic needs do not change with age, although the means of satisfying them may.  Most of the older people seem to wish to live in their own homes to enjoy continued status of independence, self-management and privacy, feeling of emotional security derived from familiar surroundings.  It is natural that they should like to be near long-time friends, near children if possible, and near shopping centers and familiar institutions.  For many older people, the home should be on one floor and should be as free as possible from health hazards.  THEORIES OF AGING Introduction Geriatric nursing  is the specialty that concerns itself with the provision of nursing services to geriatric or aged individuals. Due to their complexity, aged people always deserve personal attention. Nurses address physical, psycho social, cultural and family concerns as well as promoting health and emphasizing successful aging. Life expectancy is rising at rates which call for the proper preparation of nurses to take good care of the rapidly increasing number of the aged. Definition Aging can be defined as the time-related deterioration of the physiological functions necessary for survival and fertility. or Aging process is the process of growing old or developing the appearance and characteristics of old age.  Theories of ageing Each theory of aging attempts to provide a framework in which to understand aging from different perspectives. It is useful to the clinician because a framework and insight into differences among elderly patients are provided. The theories of aging are classified into – I. Biologic theories II. Psychosocial theories III. Developmental theories 1. Biological Theory: Biologic theories of aging attempt to explain why the physical changes of aging occur. Researcher try to identify which biologic factor have the greatest influence on longevity. It is divided into following types- A. The programmed theory/ Biological clock theory B. The run out of program theory C. Gene theory D. Molecular theory E. Cellular theories I. Biological Theories Programmed theory/ Biological clock theory Run out of program theory Gene theory Molecular theory Cellular theories Error theory Somatic mutation theory Free radical theory Clinker theory Wear and tear theory Biological Theories  Programmed theory/Biological clock theory: The programmed theory proposes that every person has a “Biologic clock” that starts ticking at the time of conception. In this theory each individual has a genetic program specifying an unknown but predetermined number of cell divisions. As the program plays out, the person experiences predictable changes such as atrophy of the thymus, menopause, and skin changes and graying of the hair. Aging has a biological timetable or internal biological clock. Run out of program theory: Every person has a limited amount of genetic material that will run out over time. All events are specifically programmed into genome and are sequentially activated. After maturation genes have been activated there are no more programs to be played and as cells age there may be chance of inactivation of genes that cannot be turned on. Gene theory: The gene theory proposes the existence of one or more harmful genes that activate overtime, resulting in the typical changes seen with aging and limiting the life span of the individual. Organism failure occurs in later life because of the presence of imperfect genes activated over lengthy periods of time. Two gene types, one supports growth and vigor, and the other supports senescence and deterioration. Molecular theory: The aging is controlled by genetic materials that are encoded to predetermine both growth and decline. 1. The error theory 2. The somatic mutation theory 1. The error theory = The error theory proposes that errors in ribonucleic acid protein synthesis cause errors to occur in cells in the body, resulting in a progressive decline in biologic function. = It is the result of internal or external assaults that damage cells or organs so they can no longer function properly. 2. Somatic mutation theory: = The somatic mutation theory proposes that aging result from deoxyribonucleic acid (DNA) damage caused by exposure to chemicals or radiation and this damage causes chromosomal abnormalities that lead to disease or loss of function later in life. = Exposure to x-ray radiation and or chemicals induces chromosomal abnormalities. Cellular theories: The cellular theories propose that aging is a process that occurs because of cell damage. When enough cells are damaged, overall functioning of the body is decreased. The free radical theory The crosslink or connective tissue theory Clinker theory The wear and tear theory 1. Free radical theory: This theory is given by Denham Harman 1956. The term free radical describes any molecule that has a free electron, and this property makes it react with healthy molecules in a destructive way. Free radical molecule creates an extra negative charge. This unbalanced energy makes the free radical bind itself to another balanced molecule as it tries to steal electrons. Balanced molecule becomes unbalanced and thus a free radical itself. Diet, lifestyle, drugs (e.g. tobacco and alcohol) and radiation. 2. Crosslink or connective tissue theory: Cell molecules from DNA and connective tissue interact with free radicals to cause bonds that decrease the ability of tissue to replace it. The results in the skin changes typically attributed to aging such as dryness, wrinkles, and loss of elasticity. Fibrous tendons, loosening teeth, diminished elasticity of arterial walls and decreased efficiency of lungs and GI tract. It is the binding of glucose (simple sugars) to protein, (a process that occurs under the presence of oxygen) that causes various problems. Senile cataract and the appearance of tough, leathery and yellow skin. 3. Clinker theory: The clinker theory combines the somatic mutation, free radical and cross link theories to suggest that chemicals produced by metabolism accumulate in normal cells and cause damage to body organs such as the muscles, heart, nerves and brain. 4. The wear and tear theory: Body is similar to a machine, which loses function when its parts wear out. As people age, their cells, tissues and organs are damaged by internal or external stressors. Good health maintenance practices will reduce the rate of wear and tear, resulting in longer and better body function. II. Psychosocial Theory Psychosocial theories of aging attempt to explain changes in behavior, roles and relationship that occur as individual age. This attempt to predict and explain the social interactions and roles that contribute to successful adjustment to old age in older adults. 1. The disengagement theory 2. The activity theory 3. The continuity theory 4. The subculture theory 1. Disengagement theory: Cummings and Henry (1961) stated that aging people withdraw from customary roles and engage in more introspective, self-focused activities. The disengagement theory was developed to explain why aging process separate from the mainstream of society. This theory proposes that older people are systematically separated, excluded, or disengaged from society because they are not perceived to be of benefit to the society as a whole. This theory further proposes that older adults desire to withdraw from society as they age, so the disengagement is mutually beneficial. 2. Activity theory: This theory proposes that activity is necessary for successful aging. Active participation in physical and mental activities helps maintain functioning well into old age. Purposeful activities and interactions that promote self-esteem improve overall satisfaction with life; even at the older age. The continuation of activities performed during middle age is necessary for successful aging. 3. Continuity theory: The continuity theory (Neugarten, 1964) state that personality remains the same and the behaviours become more predictable as people ages. Personality and behavior pattern developed during a life time determine the degree of engagement and activity in older adulthood. Personality is a critical factor in determining the relationship between role activity and life satisfaction. 4. Subculture theory: Rose (1965) theorized that older adults from a unique subculture within society to defend against society’s negative attitude toward aging and the accompanying loss of status. Older adults are a subculture with their own norms and beliefs. The subculture occurs as a response to loss of status. In the subculture, individual status is based on health and mobility, instead of on education, occupation and economic achievement. III. Development Theories Erikson’s Theory Havighurst’s Theory Newman’s Theory Peck’s Theory Jung’s theory Developmental Theory III. Development Theories Developmental theories or life-course theories. These theories trace personality and personal adjustment throughout a person’s life. Many of these theories are specific in identifying life- oriented tasks for the aging person. It is of following types: Erikson’s Theory Havighurst’s Theory Newman’s Theory Peck’s Theory Jung’s theory Erickson’s Theory  Erickson’s (1963) theory identifies eight stages of developmental tasks that an individual must comfort throughout the life span: Trust versus mistrust Autonomy versus shame and doubt Initiative versus guilt Industry versus inferiority Identity versus identity confusion Intimacy versus isolation Generativity versus stagnation Integrity versus despair Erickson’s Theory The last of these stages is the domain of late adulthood, but failure to achieve success in tasks earlier in life can cause problems later in life. The stage pertaining to older adults is: Ego integrity versus Despair. The task of this stage is acceptance of one’s life as meaningful and that death is part of life, versus despair, which is failure to accept the meaningfulness of one’s life, along with fear of death. Peck Theory: Peck expanded Erikson’s theory and focused more on later developmental stages. Body transcendence versus body preoccupation is a phase concerned with enjoyment of life in the face of physical discomforts associated with aging. Ego transcendence versus ego preoccupation is a phase concerned with the older adult’s ability to focus on the welfare of the future generation rather than on one’s own inevitable death. Jung’s theory: Jung’s theory proposes that the development continues throughout life by a process of searching, questioning and setting goals that are consistent with the individual’s personality. As individuals age, they go through a reevaluation stage at midlife, at which point they realize there are many things they have not done. At this age they begin to question whether the decision and choices they have made were the right choices for them. This is so called “midlife crisis”, which can lead to radical career or lifestyle changes or acceptance of the self as is. As aging continues, Jung proposes that the individual is likely to shift from an outward focus (wit concerns about success and social position) to a more inward focus. Successful aging includes acceptance and valuing of the self without regard to the view Havighurst’s Theory: Havighurst’s (1968) theory details the process of aging and defines specific task for late life, including: Adjusting to decreased physical strength and health, Adjusting to retirement and decreased income, Adjusting to the loss of a spouse, Establishing a relationship with one’s age group, Adapting to social roles in a flexible way, and Establishing satisfactory living arrangements. Havighurst’s Theory: Later maturity is Havighurst’s term for older adults. The task for later maturity is disengagement. Disengagement from tasks of middle age allows involvement in new roles such as grandparent, citizen, and friend. Newman’s theory Newman’s theory identifies the task of aging as coping with the physical changes of aging, redirecting energy to new activities and roles including retirement, grand parenting and widowhood accepting one’s own life; and developing a point of view about death.  PHYSIOLOGIC CHANGES IN AGING AFFECTING VARIOUS SYSTEMS 1. INTEGUMENTARY 2. MUSCULO-SKELETAL 3. RESPIRATORY 4. GASTROINTESTINAL 5. URINARY 6. NERVOUS 7. SPECIAL SENSE 8. ENDOCRINE 9. CARDIOVASCULAR 10. HEMATOPOIETIC AND LYMPHATIC Bibliography Smeltzer CS, Bare GB, Hinkle LJ, Cheever HK. Brunner & Suddarth’s textbook of Medical- surgical nursing. Volume I. Twelvth edition. NewDelhi:Wolters Kluwer (India) ; 2011. Lewis LS, Dirksen RS, Heitkemper MM, Bucher L. Lewis’s Medical Surgical Nursing Assessment and management of clinical problems. Second edition. 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