NCM 114 Geriatric Nursing Theories of Aging PDF

NCM 114 – Geriatric Nursing THEORIES OF AGING WEAR-AND-TEAR THEORY continuation… presumes that the body is similar to a machine, which...

NCM 114 – Geriatric Nursing THEORIES OF AGING WEAR-AND-TEAR THEORY continuation… presumes that the body is similar to a machine, which loses function when its parts wear out. DAMAGE THEORY as people age, their cells, tissues, and organs are FREE RADICAL THEORY damaged by internal or external stressors. when enough damage occurs to the body’s parts, free radicals are unstable molecules produced by overall functioning decreases. the body during the normal processes of respiration this theory also proposes that good health and metabolism or following exposure to radiation maintenance practices will reduce the rate of wear and pollution. and tear, resulting in longer and better body function. - these free radicals are suspected to cause the more you use, mas mabilis masira (especially if damage to the cells, DNA, and the immune walang maintenance) system. as we grow old, normal functioning ng katawan natin unstable molecules nagdedecrease na rin byproduct of metabolism examples: RELIABILITY THEORY OF AGING AND LONGEVITY - hydrogen peroxide, nitric oxide aging is defined as a phenomenon of increasing risk as we grow old, onti na lang yung na-eexcrete of failure with the passage of time. - causes damage sa mga normal molecules na if the risk of failure is not increasing with age, then nagccause ng degeneration there is no aging in terms of reliability theory, even if the calendar age of a system is increasing CROSSLINK THEORY the more your experience physiological failure, the cell molecules from DNA and connective tissue higher chance your lifespan will be low interact with free radicals to cause bonds that sumasakit na mga joints, lumalabo na paningin, need decrease the ability of tissue to replace itself mo na ng assiatance sa dati mong ginagawa, - this results in the skin changes typically attributed meaning you are facing the stage of older adults to aging such as dryness, wrinkles, and loss of elasticity. NEUROENDOCRINE THEORY “you’re doing something that you are not supposed focuses on the complicated chemical interactions to do” set off by the hypothalamus of the brain. example, glucose has nothing to do with protein, in - hormones crosslink theory sugar reacts to protein (collagen) - decreased production of growth hormones = - inhibits normal function of collagen resulting to atrophied muscles (decrease muscle mass) aging - sex hormones = menopause (women) if exposed sa radiations or other factors na nag- with age, the hypothalamus appears to be less aactivate ng crosslink, mas mapapabilis yung aging precise in regulating endocrine function, leading to age-related changes such as decreased muscle CLINKER THEORY mass, increased body fat, and changes in combines the somatic mutation, free radical, and reproductive function. crosslink theories - aging is the result of cumulative damage to cells IMMUNOLOGIC THEORY and tissues over time, specifically due to the the immune system—an important defense accumulation of metabolic byproducts or mechanism of the body— weakens over time, "clinkers" that the body can't effectively clear making an aging person more susceptible to disease. out. as we grow old, nagdedecrease ang production ng basically, the combination of all the three problems B-cells and T-cells example, an older adult has multiple production of supplements and vaccinations are important free radicals that causes wrinkles, while the other problem, digestive function of the patient is not CALORIE INTAKE THEORY functioning well since there’s a lot of somatic cells produced (and crosslink) low calorie diet combined with high nutrient intake and exercise leads to metabolic efficiency slow metabolism, if madami calorie intake and hindi RATE OF LIVING THEORY naman nagagamit – magiging fats na lang proposes that individuals’ lifespan is inversely related - low caloric intake with high-densed nutrients to its metabolic rate. The faster an individual’s metabolism, the shorter its lifespan is likely to be. PSYCHOSOCIAL THEORIES mas mabilis na metabolism, mas shorter ang lifespan explain why older adults have different responses to the aging process NCM 114 – Geriatric Nursing DISENGAGEMENT THEORY the last of these stages is the domain of late most controversial adulthood, but failure to achieve success in tasks explain why aging persons separate from the earlier in life can cause problems later in life. mainstream of society late adulthood is the time when people normally older people are systematically separated, excluded, review their lives and determine whether they have or disengaged from society because they are not been negative or positive overall. perceived to be of benefit to the society the most positive outcomes of this life review are critics of this theory believe that it attempts to justify wisdom, understanding, and acceptance ageism, oversimplifies the psychosocial adjustment to the most negative outcomes are doubt, gloom, and aging, and fails to address the diversity and despair. complexity of older adults. this theory further proposes that older adults desire to HAVIGHURST’S THEORY withdraw from society as they age; the delineates specific tasks for late life disengagement is mutually beneficial very introvert - kadalasan yung may mga strict parents, nadadala nila up until they reached older adult stage - experiences like bullying experienced ageism ACTIVITY 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 an older age “busy-work” activities and casual interaction with others were not shown to improve the self-esteem of older adults. Specific tasks for late life: - mga biglaan lang gagawin, gagawin lang out of ✓ adjusting to decreased physical growth and nothing strength older adults need attention and they love to share ✓ adjusting to retirement and decrease income their experiences to the new generation ✓ adjusting to the loss of spouse - will help them to boost their confidence ✓ establishing relationship with one’s age group ✓ adapting social rules in a flexible way LIFE-COURSE THEORY ✓ establishing satisfactory living arrangements traces personality and personal adjustment - contended throughout a person’s life NEWMAN’S THEORY ERIKSON’S THEORY the theory asserts that every person in every situation, eight stages of psychosocial development no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness—a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world. aging is not just a decline in physiologic changes, this is a normal process of adaptation towards aging and human development part of human development to become old Identifies the tasks of aging as: ✓ coping with the physical changes of aging ✓ redirecting energy to new activities and roles, including retirement, grandparenting, and widowhood; ✓ accepting one’s own life ✓ developing a point of view about death NCM 114 – Geriatric Nursing JUNG’S THEORY SUPPLEMENTS proposes that development continues throughout life proposed to replace or enhance nutritional status; by a process of searching, questioning, and setting often marketed as “natural” remedies goals that are consistent with the individual’s include substances such as ginseng (cognitive), coral personality. calcium (supplement for bones), Echinacea (improve always questioning what’s next after another immune system), and other herbal preparations life becomes an ongoing search for the “true self.” no proof of effectiveness as individuals age, they go through a reevaluation not regulated by the Food and Drug Administration, stage at midlife, at which point they realize there are so there is no control regarding the amount of active many things they have not done. ingredients, purity, and quality at this stage, they begin to question whether the high risk for interaction with prescription medications; decisions and choices they have made were the physician must be notified if these products are used right choices for them – Midlife Crisis Jung proposes that the individual is likely to shift from CALORIE-RESTRICTED DIET an outward focus to a more inward focus proposes that significant calorie reduction can successful aging, according to Jung, includes extend life; based on studies in rats, mice, fish, and acceptance and valuing of the self without regard to worms; not proven in humans the view of others. severe calorie restriction can result in inadequate consumption of necessary nutrients IMPLICATIONS FOR NURSING studies show that severely underweight persons have physical theories of aging indicate that, although a higher risk for some diseases and even death biology places some limitations on life and life dietary changes should be discussed with a physician expectancy, other factors are subject to behavior or nutritionist to ensure that adequate nutrition is and life choices. maintained nursing can help individuals achieve the longest, healthiest lives possible by promoting good health maintenance practices and a healthy environment. psychosocial theories help explain the variety of behaviors seen in the aging population. understanding all of these theories can help nurses recognize problems and provide nursing interventions that will help aging individuals successfully meet the developmental tasks of aging. ALTERNATIVE AND COMPLEMENTARY THERAPIES TO SLOW OR REVERSE AGING ANTIOXIDANT THERAPY proposed as a method of neutralizing free radicals, which may contribute to aging and disease processes includes a number of vitamins (vitamins A, B6, B12, C, and E) and minerals (beta carotene; folic acid; and selenium) generally safe when consumed as fruits and vegetables as part of the overall diet high doses of some antioxidants may cause more harm than benefits no proof that antioxidants are effective discuss with physician before starting use HORMONE THERAPY proposed to replace a reduction in hormones, which naturally decrease with aging includes hormones, such as dehydroepiandrosterone (DHEA), estrogen, testosterone, melatonin, and human growth hormone (HGH) little evidence to support claims made by advocates may actually cause more harm than provide benefits usually requires prescription or supervised medical administration NCM 114 – Geriatric Nursing PHYSIOLOGIC CHANGES IN AGING - protects us from heat, cold, changing environment AFFECTING VARIOUS SYSTEMS - scalp is sensitive changes in body function with age are part of a - cilia, protects us from foreign substances continuum that starts the moment life begins. Hair pigment, or color, is related to the amount of from the moment of conception, tissues and organs melanin produced by the follicle and, like skin develop in an orderly manner. pigmentation, is hereditary. by approximately age 18, the human body reaches - decrease melanin, gray hair full anatomic and physiologic maturity Nails are rigid structures that protect the sensitive, the peak years of physiologic function last from the nerve-rich tissue at the tips of the fingers and toes. late teens through the thirties—the so-called PRIME - gives agility for our fingers to move OF LIFE. Nails also aid dexterity in fine finger manipulation. in 50s to 60’s, these physiologic changes become more apparent. beyond 70’s, they are significant and no longer deniable. heredity, environment, and health maintenance significantly affect the timing of age-related changes. some are quite young but appear old. The most severe cases is called progeria. - 8 or 9 years of age children with progeria have the physiology and appearance of 70-year-old LEADING CAUSES OF DISABILITY AMONG OLDER ADULTS epidermis protection Arthritis dermis sebaceous gland and eccrine Heart Disease sweat glands for sweat and oil Stroke subcutaneous tissue temperature regulation, blood Hypertension vessels Diabetes Cancer NORMAL AGING CHANGES Thinning of skin – decrease subcutaneous tissues LEADING CAUSES OF DEATH AMONG OLDER - often due to prolonged exposure to chemicals ADULTS (e.g., detergents, liquid soaps) Heart disease Uneven pigmentation – depletion of melanin Cancer production Chronic lower respiratory disease - dark spots/ localized pigmentation Cerebrovascular disease Wrinkling, skin folds, and decreased elasticity Alzheimer disease - dermis has elastic fibers and collagen – responsible for skin nourishment SKIN Dry skin – decrease collagen production Largest organ of the body decrease function of sebaceous gland and eccrine glands, decline of muscle mass which absorbs water FUNCTIONS Hair color tends to fade (gray), and hair distribution Protection patterns change. - from trauma, UV lights, radiations Fingernails grow more slowly and become thick and Sensation brittle Fluid balance Sweat gland function decreases - preventing excess water loss through skin by Capillary walls become increasingly fragile with age evaporation and may hemorrhage, leading to senile purpura - - through perspiration red, purple, or brown areas commonly seen on the Temperature regulation legs and arms. (because of fragility of capillary wall) - through convection HAIR AND NAILS Hair and nails are composed of dead keratinized cells. By 70 years of age, the body has approximately 30% - hair for beautification fewer cells than at age 40 NCM 114 – Geriatric Nursing - implications n pagbaba ng cell replication – skin COMMON DISORDERS (may cause delayed wound healing) BASAL CELL CARCINOMA - skin replacement Commonly observed to older adults who spent Total body fluid decreases with age (decrease significant amount of time in the sun. muscle mass which absorbs more water than fats) – Older men are more at risk for melanoma Plasma and extracellular volume remain somewhat Older men should be taught to screen themselves for constant, but intracellular fluid decreases changes in the skin. - increased fluid within the extracellular may cause - use of screen protection edema Suspicious changes should be documented and Decrease in subcutaneous tissue reported for further evaluation by the physician Increased fragility and increased potential for injury - decreased subq tissues (will cause friction against bone and skin and may cause pressure ulcer) Reduced healing ability - decreased cell regeneration Melanocytes activity declines with age – Senile Lentigo - localized/uneven pigmentation Seborrheic keratosis – Keratinocytes - because of rapid production of keratinocytes (main reason) – nagkakaron ng abnormal formation ng SK within the skin MELANOMA - being connected to melanocytes because of Watch skin spots for the following: activity - Asymmetry - there are some people with seborrheic keratosis, - Border irregularity may prolonged exposure to sunlight - Color changes Cutaneous papilloma – skin tags (benign) - Diameter - because of friction - Evolving SENILE LENTIGO PRESSURE ULCER SEBORRHEIC KETOSIS Breakdown of the skin and tissues located over bony prominences This is a significant problem for immobilized people such as those who are bedridden or confined to wheelchairs Changing position every 2 hours helps keep blood flowing and prevent further skin damage INFLAMMATION AND INFECTION CUTANEOUS PAPILLOMA Skin inflammation and infection often occur on visible body surfaces, such as the face, scalp, and arms, making the conditions distressing to older adults - decreased in healing ability Common types of inflammation include rosacea and various forms of dermatitis Rosacea appears as redness, dilated superficial blood vessels, and small “pimples” on the nose and center of the face NCM 114 – Geriatric Nursing HYPOTHERMIA The decrease in subcutaneous tissue reduces the older adult’s ability to regulate body temperature. Treatment of vasodilation includes lifestyle modification, for example avoidance of triggers such as stressful situations, extreme heat, sun exposure, spicy foods, and alcoholic beverages. Oral and topical medications or light and laser treatments may provide some benefits. - much better na treatment if it disturbs their body image for older adults, least priority intervention: medication lifestyle modifications muna medications for patients with rosacea MUSCOSKELETAL SYSTEM azaleic acid – topical The skeletal bones provide a rigid structure that gives metronidazole – oral the body its shape. doxycycline – oral Red bone marrow in the cavities of spongy bones - vasoconstricts (give first topical as we consider produces red blood cells (RBCs), platelets, and WBCs pt’s liver function) Ribs (respiratory, heart, some part of digestive system) and pelvis (urinary, reproductive) protect easily damaged internal organs. Common dermatitis in older adults are contact, Muscles provide a power source to move the bones. allergic and seborrheic Combined functions of bones and muscles (agility) Contact and allergic dermatitis appear as rashes or allow free movement and participation in the inflammation that is either localized to certain areas activities necessary to maintain an active life of the body or generalized - older adults nahihirapan na kahit sa paliligo contact dermatitis - may limitations na sa movements nila - they sometimes don’t attend sa gatherings - may cause them pain because of declined function BONES Bone consists of protein and the minerals - hardening, important sa ossification process Calcium is necessary for bone strength, muscle contraction, myocardial contraction, blood clotting, Seborrheic dermatitis is an unsightly skin condition and neuronal activity. characterized by yellow, waxy crusts that can be - calcium ions either dry or moist - activates clotting factor 8,9,10 - release of neurotransmitters Vitamin D is needed for the absorption of calcium and phosphate through the small intestine. - foods rich in calcium and phosphorus: milk (fortified milk), nuts and legumes (in moderation because there are components na hindi applicable sa older adults lalo na if may arthritis) Infectious diseases of the skin and nails commonly seen in older adults include herpes zoster (shingles); fungal, yeast, and bacterial infections; and infestation with scabies (mites). NCM 114 – Geriatric Nursing Vitamins A and C are needed for ossification. Tendons are structures that connect the muscles to the bone. Ligaments are structures that connect bones to other bones. Hormones also play an important role in bone maintenance. - Calcitonin, produced by the thyroid gland, slows the movement of calcium from the bones to the blood, lowering the blood calcium level.  promotes lower blood calcium levels - Parathyroid hormone (PTH) increases the movement of calcium from the bones to the blood, increasing the blood calcium level.  promotes higher blood calcium levels  produced by pancreas - Insulin and thyroxine aid in the protein synthesis and energy production needed for bone maintenance.  produced by pancreas and thyroid gland - Estrogen and testosterone, produced by the ovaries and testes, respectively, help retain MUSCLES calcium in the bone matrix. Controlled and coordinated movement of bones and muscles allows us to perform the variety of VERTEBRAE movements required for activities of daily living. The spinal column supports the head and allows for Special effort and practice allow us to perform flexible movement of the back. special activities such as dancing, playing sports, and The spinal cord, the nerve tissue that extends playing the piano. downward from the brain, passes through the vertebral canal The bones of the spinal column protect this nerve tissue from injury. types of muscles: cardiac, smooth and skeletal Cardiac Muscle located only in the heart, is responsible for the pumping action of the heart that maintains the blood JOINTS, TENDONS AND LIGAMENTS circulation Joints are the places where bones meet. Cartilage allows free movement of the joint surfaces. Smooth Muscle Many of these joints contain a bursa (for lubrication), found in the walls of hollow organs such as blood which is a fluid sac that provides lubrication to vessels, stomach, intestines, and urinary bladder enhance joint mobility. NCM 114 – Geriatric Nursing Skeletal Muscle - chin to chest for shoulder and neck accounts for the largest amount of muscle tissue in - flexion and extension of the toes the body Educate regarding importance of calcium intake the major function of skeletal muscle is to move the Administer supplements as ordered bones of the skeleton Encourage regular low-impact exercise - pilates, tai chi, walking, yoga EXPECTED AGE-RELATED CHANGES Refer to physical or occupational therapy Loss of calcium This change begins between age 30 and 40 - may cause muscle sprain Skeletal bones become thinner and relatively weaker - osteoclast (bone breakdown) is more active, osteoblast (bone renewal) is less active Women lose approximately 8% of skeletal mass each decade, whereas men lose approximately 3%. Decalcification of various parts of the skeleton, such as the epiphyses, vertebrae, and jaw bones. The intervertebral disks shrink (there is fluid to support vertebrae in between, but with aging, fluid decreases) as the thoracic vertebrae slowly change with aging – Kyphosis. Connective tissues tend to lose elasticity, leading to restriction of joint mobility. Muscle tone and mass typically decrease with aging (depletion of estrogen and progesterone) - related to reductions in physical activity and exercise. Decreased in endurance and agility. Absorption and metabolism of drugs can be significantly different from those in younger persons - kaya maintenance drugs yung binibigay NURSING CARE ASSESSMENT Assess the strength and functional mobility - ano yung mga kaya pang gawin ni patient Assess nutritional intake - baka yung problems dahil sa decrease calcium intake etc. Determine activity patterns - to know ano mga particular adjustments na pwedeng gawin particularly sa physical therapy NURSING CARE STRATEGIES Provide safe environment - prone sila sa fall and injury - floor should not be slippery - put things on the side like cabinets etc. Encourage ROM exercises - walking (best way for lower extremities)