NCM114 Care of Older Adults PDF

○ The aim is to improve the quality of life and manage the physical and mental health of older...

○ The aim is to improve the quality of life and manage the physical and mental health of older adults. Gerontology = scientific study of the process of aging and the Course: NCM114 Care of Older Adults problems of aged person Lecturer/s: Mrs. Ma. Lorena Babao Greek word “geron” which means “old man” Transcribed by: Clouie Mae A. Decena, SN It includes biologic, sociologic, psychologic, and economic aspects PRELIM PERIOD ○ It is more multidisciplinary and theoretical Chapter 1: Aging is a Developmental Process compared to geriatrics. ○ Gerontologists study the aging process Aging = is a normal stage of life in which our bodies begin to function itself—how and why people age, how aging affects less effectively, making us more vulnerable to disease people on multiple levels, and how society Aging is a passage of biological time as opposed to responds to the elderly population. chronological time ○ This field includes the social and psychological ○ Biological time = circadian rhythm, the way you impacts of aging, such as ageism, eldercare, and adapt to happenings policies related to the elderly. Biological aging refers to how the body ○ It also explores economic and cultural aspects has changed and aged physically over related to aging populations, such as retirement, time, which can be influenced by social security, and healthcare systems. lifestyle, genetics, environmental factors, and overall health. Classification of Older Adults ○ Chronological time = process of events 65+ Old Ages (childhood-adolescent-adult) 65 to 74 years old Young Old Chronological aging refers to the actual 75 to 84 years old Middle Old number of years a person has lived, 85+ years old Old, Old Frail Elderly which is simply based on the calendar. ○ A person's biological age might not match their Gerontologic Nursing = specialty of nursing that involves: chronological age. Assessing the health and functional status of older adults It is a time dependent accumulation of damage at the ○ Physical health, mental health, cognitive function, molecular level that begin at fertilization and is eventually and ability to perform activities of daily living expressed as nonspecific vulnerability, impaired function, (ADLs) disease, and untimely death ○ Identifying specific healthcare needs, potential Evolutionary biologist perspective = that the primary risks (such as fall risk), and areas that require purpose of human’s life is to procreate and to be a carrier of intervention DNA Planning and implementing health care and services to meet ○ The idea is that organisms, including humans, are the identified needs driven by natural selection to survive only long ○ Gerontologic nurses create care plans tailored to enough to ensure the successful reproduction and each individual's needs nurturing of offspring, thus passing on their genes. ○ These plans may involve managing chronic ○ Aging, therefore, is seen as the body's gradual diseases (like diabetes or hypertension), decline after its reproductive years, as there is less medication management, nutrition support, and evolutionary benefit to maintaining perfect health rehabilitative services. beyond this point. ○ Nurses also work to promote healthy aging, Scientific perspective = the exploration of aging as a prevent complications, and address issues like disease becomes complex. Aging is viewed as a biological pain management or mobility challenges. condition that can be manipulated, treated, and delayed Evaluating the effectiveness of such care ○ Aging is understood as a complex set of changes ○ Nurses continually monitor patient outcomes to that occur in the body over time, leading to decline determine whether the care plan is effective. in function and increased vulnerability to diseases. ○ Adjustments to care are made based on the ○ Scientific perspectives increasingly view aging as patient’s response to treatment and changes in a process that might be influenced or slowed, akin their condition, ensuring that the care remains to a biological condition that can be managed or appropriate and beneficial for the older adult. treated. Aging is a natural process And it is the duty of the doctors to treat it and scientists to discover “Autumn of Life” (Dapithapon ng Buhay) ways to delay it Senescence = decline of all biologic functioning and ability to adapt to metabolic stress Aging can be delayed but in the end, life will always lead to death Changes in dynamic biological, physiological, psychological, through aging. behavioral, and social processes in relation to the environment Geriatrics = study of the aging process ○ This involves the body's gradual loss of efficiency Greek word “geras” which means “old age” in repairing cells, responding to disease, and Branch of medicine that deals with diseases and problems of maintaining optimal function. old age ○ It deals with diagnosis, treatment, and Characteristics of Aging management of diseases and conditions Older adults represent increasing diverse population associated with aging. Major Characteristics of the Older Adults includes: ○ It is more clinical and medical in nature. 1. Demographic ○ Geriatricians (doctors specializing in geriatrics) 2. Socioeconomic focus on the prevention, treatment, and care of 3. Ethnicity age-related conditions such as dementia, arthritis, 4. Health frailty, and other chronic diseases. (1) Demographic Ages 65 years old and above are considered old adult  85 years old and above are the fastest growing of all age ○ "(a) Senior citizen or elderly refers to any resident groups in the US, projecting to reach 19 million by the year citizen of the Philippines at least sixty (60) years 2050 old;” Baby Boomers represent the large increase in the US With the total population of 115, 991, 754 million as of starting 2011 August 27, 2024 (which is projected to reach 125 million by ○ They have better education, higher household 2030). 8.5 million are senior citizens (2020) of these, 55.5 % income, very active lifestyle as compared to are female, while 44.5% million are male previous generation of seniors ○ Baby Boomers = 1946 to 1964 115,991,754 = total population (2) Socioeconomic Seniors in the USA Gender Proportion of Americans 65 years of age and older has ○ Women tend to live longer than men, so a higher tripled in the past 100 years proportion of older adults are female. ○ Life expectancy varies by gender and race (with Marital status women typically living longer than men, and racial ○ Many older adults, especially women, may be disparities affecting overall life expectancy.) widowed, which can affect their living ○ Life expectancy has risen dramatically in the past arrangements and emotional well-being. 100 years (due to advances in medicine, public Education health, and living conditions.) ○ Baby Boomers and current older adults generally have better education than previous generations, Leading Causes of Death in Older Adults in PH (DOH, PSA) which impacts their health literacy and 1. Heart Disease (Rheumatic Fever) decision-making. 2. Malignant Neoplasms (Cancers) Income (pension) 3. Cerebrovascular Diseases (Stroke) ○ Many older adults rely on pensions, social security, 4. Diabetes or savings. Financial security is crucial for 5. Hypertensive Diseases maintaining independence and health. Living arrangements Region with the Most Elders (2022, PSA) ○ In the US, many older adults live independently, 1. 14.9% Region 4A (Cavite,Laguna, Batangas, Rizal, Quezon) though some move to retirement communities or 2. 12.4% National Capital Region (NCR) long-term care facilities. 3. 11.4% Central Luzon (Pampanga, Bulacan, Tarlac) ○ In the Philippines, it is common for older adults to 4. 7.4% Central Visayas (Cebu, Bohol) live with their children due to the close-knit family 5. 7.3% Western Visayas (Iloilo, Bacolod, Aklan) structure, which provides social and emotional support. Swaroop’s Index (SI) = is the proportion of deaths of people aged 50 years and up. (3) Ethnicity The higher the Swaroop Index of a population, the greater The growing population of adults consist primarily of the proportion of deaths who were able to reach the age of increasing number of minorities 50 years old. 2050 ○ This can be an indicator of improved life ○ Higher portion of the white population expectancy and better overall health conditions ○ Non-white is expected to increase that allow people to live longer. ○ Older Hispanics is the fastest increasing Recognizing that the rise of the aging population entailed an population increase in demand for health services, housing, income, security, and other social services (4) Health ○ A higher Swaroop Index suggests that there is a Chronic health problems and disabilities increase as age significant portion of the population living to older increase ages, which can increase the demand for Nurses needs to be aware that promoting health and healthcare services tailored to older adults, wellness, assessment and promoting functional abilities of including chronic disease management, preventive Activities of Daily Living (ADL) must continue for them to care, and geriatric care. enjoy life ○ With an aging population, there may be a greater Healthy People 2020 is a national health goal in US that need for age-friendly housing and assisted living includes new objectives for the health of older adults facilities. Housing that accommodates the needs ○ UN and WHO form 2010 to Healthy People 2030 of older adults, such as accessibility features and Started 2020 safety modifications, becomes increasingly important. Chapter 2: Demographic Profile of the Older Population ○ Older adults may require adequate pension systems, social security, and other forms of 1980 = 382 million financial support to ensure a stable income as they Now = 8.2 billion age. This can impact public policies and retirement planning. Geriatric Population (Worldmeter) ○ There will be an increased demand for social Japan 27% services that support aging populations, such as Italy 23% elderly care programs, community support, and Portugal 22% social engagement activities to address the needs Germany 21% of seniors and enhance their quality of life. Finland 21% Formula: Bulgaria 21% SI = number of deaths among those: Seniors in the Philippines 50 𝑦𝑒𝑎𝑟𝑠 𝑜𝑙𝑑 𝑎𝑛𝑑 𝑜𝑣𝑒𝑟 𝑖𝑛 𝑐𝑎𝑙𝑒𝑛𝑑𝑎𝑟 𝑦𝑒𝑎𝑟 The Philippines Statistics Authority (PSA) defines Senior 𝑇𝑜𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠, 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟 𝑥 1000 Citizen as any person aged 60 years old or over (by virtue of RA 9994, Section 3A) ○ RA 9994 = Expanded Senior Citizens Act of 2010 Example: In 2022, there were 25,575 total deaths, and 10,273 of them were ○ Disruption in the signaling between cells, affecting 50-year-olds and over tissue coordination and response to stress, impacts how cells behave as individuals, groups, 10,273 and the surrounding microenvironment. 𝑆𝐼 = 25,575 𝑥 1000 = 401. 6813 ≈ 402 ○ Causes: Aging and chronic inflammation (inflammaging), secretions from senescent cells Chapter 3: Impacts of Aging Members in the Family (SASP). ○ Consequences: Suppressed immune response, Different Effects: increased risk of cancer and age-related diseases, 1. Emotional Effects impaired tissue repair and homeostasis. 2. Financial Effects 2. Deregulated nutrient-sensing 3. Structural Effects ○ Impaired ability to sense nutrient availability, 4. Physical Effects leading to imbalance and inability to regulate 5. Positive Effects metabolism ○ Causes: Age-related disruptions in The Biology of Aging nutrient-sensing pathways (e.g., mTOR, https://youtu.be/xHlNXzfCv0o?si=kiRgBTTg67LRaOlS insulin/IGF-1 signaling, AMPK, sirtuins). IIS pathway = cell-signaling pathway Aging is an inevitable, time-dependent decline in the physiological regulated by hormones that include integrity and function of various organ systems caused by the insulin-like peptides, transmembrane accumulation of cellular damage. This drives a progressive loss of receptors as well as their substrates, biological function and eventually impairs the function of the entire and downstream effectors. organism. mTOR pathway = a cellular pathway Aging is a major contributor to diseases like cancer. involving the regulation of growth and metabolism that has been proposed as Factors Contributing to Aging a key aspect of longevity Internal factors: AMPK pathway = senses low levels of ○ Intrinsic biological processes ATP; shuts down anabolic pathway, ○ Interactions with the external environment activates catabolic pathway External factors: ○ Consequences: Metabolic imbalances, increased ○ Sunlight (UV radiation) risk of obesity, diabetes, cardiovascular issues, ○ Toxins in the air (fumes, tobacco) and accelerated aging. ○ Chemicals in water 3. Stem cell exhaustion ○ Exercise and environmental stress ○ Definition: Decline in the ability of stem cells to ○ Diet regenerate tissues and organs. ○ Causes: Age-related loss of stem cell function, 4 factors of hallmark DNA damage, telomere shortening, chronic Common denominators of aging in different organisms inflammation. Manifest during normal aging ○ Consequences: Reduced tissue repair and Aggravation should accelerate aging regeneration, muscle weakness, bone fragility, and Amelioration should retard aging and increase lifespan decreased immune function. 4. Cellular senescence 9 Hallmarks of Aging ○ Permanent cell cycle arrest, leading to 1. Altered intracellular communication accumulation of senescent cells 2. Deregulated nutrient-sensing Senescence Associated Secretory 3. Stem cell exhaustion Phenotype (SASP) 4. Cellular senescence Inflammation and immunosuppression 5. Mitochondrial dysfunction Accumulation of senescent cells in 6. Loss of proteostasis tissues 7. Telomere attrition Contribution to age-related diseases 8. Epigenetic alteration ○ Cells stop dividing due to DNA damage. 9. Genomic instability Cellular senescence = intrinsic loss of the capacity of the cell to proliferate ○ Normally, apoptosis removes them, but aging weakens the immune system. ○ Accumulating senescent cells secrete harmful factors, worsening inflammation. ○ Causes: DNA damage, telomere shortening, other stressors. ○ Consequences: Accumulation of senescent cells, secretion of pro-inflammatory factors (SASP), chronic inflammation, and age-related diseases. 5. Mitochondrial dysfunction ○ Definition: Impaired mitochondrial function and increased production of free radicals. ○ Causes: Aging reduces mitochondrial efficiency, leading to more ROS production. ○ Consequences: Decreased energy production, increased oxidative damage, and impaired cellular function. 6. Loss of proteostasis ○ Definition: Maintenance of properly folded proteins and removal of damaged or misfolded proteins. 9 Hallmarks of Aging 1. Altered intercellular communication  Proteostasis = maintenance of cellular Over time, the accumulation of damage to cells and tissues protein activity accomplished by the causes aging and eventual death, because the body cannot coordination of many different pathways maintain itself indefinitely. Proteotoxicity = a toxic or adverse effect with an underlying mechanism of (2) Endocrine Theory protein damage. Changes in the body’s hormone production, controlled by the ○ Causes: Aging disrupts protein synthesis, folding, hypothalamus and pituitary glands, contribute to aging. and degradation; oxidative stress and cellular Role of Hormones: stressors contribute to misfolding. ○ Hormones act as catalysts, speeding up or slowing Chaperone = protein that helps nascent down biochemical reactions in the body. protein in the folding process ○ They maintain homeostasis, helping regulate ○ Consequences: Accumulation of misfolded things like body temperature and metabolism. proteins leading to diseases like Alzheimer’s and ○ Hormones are essential for growth and Parkinson’s, impaired cellular function. development throughout life, and changes in 7. Telomere attrition hormonal balance as we age affect the body's ○ Definition: Shortening of telomeres at ability to function properly. chromosome ends with each cell division, acting As we age, hormone levels and the body’s responsiveness as a buffer zone. to hormones decline, leading to aging symptoms like slower ○ Causes: Continuous cell division leads to telomere metabolism, loss of muscle mass, and reduced ability to loss; critically short telomeres lead to senescence. repair tissues ○ Consequences: Limits cell replication, contributing to tissue dysfunction and aging. (3) Free Radical Theory ○ Telomeres protect chromosome ends but shorten Also called Mitochondrial Free Radical Theory with replication. Unstable free radicals (groups of atoms) result from oxidizing ○ Telomerase slows this but is not enough to prevent organic materials, such as carbohydrates and proteins. aging. These radicals cause biochemical changes in the cells, and ○ Telomeres are protective caps at the ends of the cells cannot regenerate themselves. chromosomes that shorten with each cell division. ○ Free radicals are byproducts of metabolic activities They act as a buffer zone, protecting the essential in the body, they are unstable molecules with genetic information. unpaired electrons, cause damage to cells and 8. Epigenetic alterations accelerate aging. ○ Definition: Changes in gene expression due to Free radicals form when our body chemical modifications of DNA or associated metabolizes oxygen and breaks down proteins, not involving changes to the DNA food (oxidation). These radicals are sequence itself. highly reactive and steal electrons from ○ Causes: Environmental factors (diet, stress, other molecules, causing oxidative toxins), age-related loss of epigenetic regulation. stress. ○ Consequences: Malfunctioning cells, age-related Free radical production may increase diseases, and disrupted gene expression. because of environmental pollutants ○ Inflammatory environments cause more epigenetic such as ozone, pesticides, and changes radiation. Normally, they are neutralized 9. Genomic instability by enzymatic activity or natural ○ Definition: Accumulation of DNA damage within antioxidants. If they are not neutralized, cells, including mutations, DNA breaks, and they may attach themselves to other chromosomal rearrangements. molecules in cell membranes (of ○ Causes: External factors (radiation, toxins), unsaturated lipids like the mitochondria, internal factors (metabolic byproducts like ROS). lysosomes, and nuclear membranes) ○ Consequences: Disruption of normal cell function, This action monopolizes the increased cancer risk, and cell dysfunction. receptor sites on the ○ The accumulation of DNA damage with age affects membrane, thereby inhibiting the ability of our body to produce essential the interaction with other functional proteins that are needed to carry out substances that normally use various functions. this site (Lipid Peroxidation) ○ DNA repair mechanisms weaken with age, leading If excessive fluid is either lost or gained, to genomic instability. the internal homeostasis is disrupted, ○ This accumulation of errors increases cancer risk. and cell death may result. Although these molecules do not contain Biological Theories of Aging DNA themselves, they may cause 1. Wear and Tear Theory mutations in the DNA–RNA 2. Endocrine Theory transcription, thereby producing 3. Free Radical Theory mutations of the original protein. 4. Genetic Theory This damage affects cell membranes, DNA, and proteins, 5. Crosslinking Theory causing cells to malfunction and contributing to aging and 6. Immunologic Theory diseases like cancer. Antioxidants, found in foods like fruits and vegetables, help neutralize free radicals and reduce (1) Wear and Tear Theory damage Humans, like automobiles, have vital parts that run down ○ The body does have naturally occurring with time, leading to aging and death. antioxidants, or protective mechanisms. Vitamins The faster an organism lives, the quicker it dies. C and E are two of these substances that can ○ The faster and more intensely the body is used inhibit the functioning of the free radicals or (like living fast), the quicker it wears down and possibly decrease their production in the body. eventually fails (dies). Exposure to external stressors (like chemicals, pollution, (4) Genetic Theory trauma) and internal stressors (like natural metabolic waste) Also known as Hayflick Limit Theory, Biological Clock leads to cell damage and wear. Theory, or Cellular Aging Theory  ○ Based on a study completed in 1961 by Hayflick This stiffness leads to the loss of flexibility and function in and Moorehead. tissues and organs, contributing to visible signs of aging like This study included an experiment on wrinkles and internal issues like reduced organ function. fetal fibroblastic cells and their ○ Collagen = connective tissues reproductive capabilities. A combination of exercise and dietary restrictions in helping This study contradicted earlier studies to inhibit the cross-linkage process as well as the use of by Carrel and Ebeling, in which chick vitamin C prophylactically as an antioxidant agent embryo cells were kept alive indefinitely in a laboratory; the conclusion from this (6) Immunologic Theory 1912 experiment was that cells do not The immune system is a network of specialized cells, wear out but continue to function tissues, and organs that provide the body with protection normally forever against invading organisms. An organism is genetically programmed for a predetermined ○ Its primary role is to differentiate self from nonself, number of cell divisions, after which the cell or organism thereby protecting the organism from attack by dies. pathogens. ○ Aging and the lifespan of organisms are The immune system weakens with age, making it harder for programmed in their genes. the body to fight infections and more likely to attack itself ○ Cells have a limited number of times they can (autoimmune diseases). divide, called the Hayflick limit. After a certain ○ As a person ages, the immune system functions number of divisions, cells can no longer replicate, less effectively. which leads to aging and eventual death. ○ Immunosenescence = age-related decrease in Hayflick limit = the maximum number of function. times a cell can divide before dying A decrease in immune function may result in an increase in (40-60 times before apoptosis) autoimmune responses, causing the body to produce Apoptosis = programmed cell death antibodies that attack itself. When damage to protein synthesis occurs, faulty proteins ○ As people age, T-helper cells (which help B cells, will be synthesized and will gradually accumulate, causing a the main immune cells) become less effective. progressive decline. This weakens the immune response, making it ○ Dunctional changes occur within cells and are harder to fend off viruses and infections. responsible for the aging of the cells and the T lymphocytes = responsible for organism. cell-mediated immunity ○ A cumulative effect of improper functioning of cells B lymphocytes = antibodies responsible and eventual loss of cells in organs and tissues for humoral immunity are therefore responsible for the aging ○ Additionally, the immune system may start phenomenon. attacking its own tissues, leading to autoimmune Over time, genetic damage accumulates, and the body starts diseases (like lupus or rheumatoid arthritis). to produce faulty proteins, which gradually leads to a decline Decrease in humoral immune response, often predisposing in bodily functions and aging. older adults to: Life expectancy was generally seen as preprogrammed ○ (1) decreased resistance to a tumor cell challenge within a species-specific range; this biologic clock for and the development of cancer, humans was estimated at 110 to 120 years ○ (2) decreased ability to initiate the immune process and mobilize the body’s defenses against (5) Crosslinking Theory aggressively attacking pathogens, and Cross-linkage theory proposes that as a person ages and ○ (3) heightened production of autoantigens, often the immune system becomes less efficient, the body’s leading to an increase in autoimmune-related defense mechanism cannot remove the cross-linking agent diseases. before it becomes securely established. A weakened immune system leaves the body more With age, some proteins become increasingly cross-linked or vulnerable to infections, diseases, and slower recovery from enmeshed and may impede metabolic processes by illnesses. An overactive immune system, on the other hand, obstructing the passage of nutrients and wastes between the can attack healthy cells, leading to autoimmune conditions. intracellular and extracellular compartments. ○ This primarily involves collagen, which is a Psycho (Social) Theories relatively inert long-chain macromolecule 1. Disengagement theory produced by fibroblasts. 2. Activity theory ○ As new fibers are created, they become 3. Continuity theory enmeshed with old fibers and form an actual chemical cross-link. (1) Disengagement Theory ○ An increase in the density of the collagen molecule Also called Person-Environment Fit Theory but a decrease in its capacity to both transport Developed in the early 1960s nutrients to the cells and remove waste products Aging involves mutual withdrawal (disengagement) between from the cells. the older adult and others in the older adult’s environment Irreversible aging of proteins such as collagen is responsible ○ As people age, both they and society tend to for the ultimate failure of tissues and organs naturally disengage or withdraw from each other. ○ Aging results from proteins, especially collagen ○ The older adult might withdraw from social roles (which makes up connective tissues), forming and relationships (like retiring from work or cross-links (bonds between proteins). reducing social interactions). As cells age, chemical reactions cause proteins to form ○ Society also plays a role by expecting less active strong bonds, or "cross-links," with each other. These links participation from older individuals (such as make tissues stiffer and less elastic. stepping aside to allow younger generations to ○ Cross-linkage agents have been found in take over roles). unsaturated fats; in polyvalent metal ions such as As a person ages, the environment becomes more aluminum, zinc, and magnesium; and in threatening, and he or she may feel incompetent dealing with association with excessive radiation exposure. it. In a society constantly making rapid technologic Many of the medications ingested by the advances, this theory helps explain why an older person older population (such as antacids and might feel inadequate and may retreat from society. coagulants) contain aluminum  Critics argue that disengagement isn’t universal; not all older Final stage of Erik Erikson’s Stages of Psychosocial adults want or need to withdraw from social or active roles, Development (1959), which focuses on older adults and some thrive with continued engagement. Individuals who attain ego integrity view life with a sense of wholeness and derive satisfaction from past (2) Activity Theory (Havighurst) accomplishments The best way to age is to stay active physically and mentally ○ Views death as an acceptable completion of life ○ Aging successfully is related to staying active ○ Accepts one’s one and only life cycle This theory sees activity as necessary to maintain a person’s ○ Those who achieve ego integrity reflect on their life satisfaction and positive self-concept. By remaining lives with a sense of fulfillment and satisfaction, active, the older person stays engaged and gains accepting their life as a whole and viewing death satisfaction with aging. as a natural conclusion. This theory is based on three assumptions: Individuals who despair often believe that they made poor ○ (1) It is better to be active than inactive; choices during life and wish they could live life over ○ (2) it is better to be happy than unhappy; and ○ Individuals in despair feel regret, believing they ○ (3) an older individual is the best judge of his or made poor life choices, and may fear death due to her own success in achieving the first two unresolved issues assumptions The Activity Theory, introduced by Robert Havighurst, emphasizes that staying active—both mentally and physically—is key to aging well. ○ Older adults who remain involved in social, recreational, and intellectual activities tend to have better physical and mental health outcomes. ○ This theory argues that staying engaged in meaningful activities (like hobbies, work, volunteering, or exercise) leads to more life satisfaction and a better quality of life in old age. Remaining active helps older adults maintain their identity and sense of purpose, countering feelings of loneliness or irrelevance. Some older adults may prefer or need less activity due to health or personal preferences, so the theory may not apply to everyone. (3) Continuity Theory This theory is a developmental theory Individuals maintain their values, habits, and behavior in old age ○ People tend to maintain their established habits, values, personality traits, and behaviors throughout their lives, even into old age. ○ How a person has been throughout life is how that person will continue to be through the remainder of life ○ As people age, they try to maintain or continue previous habits, preferences, commitments, values, beliefs, and the factors that have contributed to their personalities An individual who is accustomed to having others around will continue to do so, and the individual who prefers not to be involved with others is more likely to disengaged ○ Older adults will generally continue to engage with the world in ways that are consistent with how they lived earlier in life. ○ For example, someone who has always been socially active and enjoyed having people around will likely seek continued social involvement in old age. 3 Biologic Theories ○ Conversely, someone who preferred solitude or 1. Stochastic independence earlier in life is more likely to a. Error theory continue that pattern and disengage from social b. Free radical interaction as they age. c. Crosslinkage According to this theory, the latter part of life is a continuation d. Wear and tear of the earlier part and therefore an integral component of the 2. Non-Stochastic entire life cycle. a. Programmed theory The theory highlights the importance of personal continuity b. Immunity theory in how individuals experience aging. Rather than 3. Emerging experiencing a complete transformation in old age, people a. Neuroendocrine control/pacemaker typically carry forward their established patterns. b. Metabolic/caloric restriction It may oversimplify the complexity of aging, as people can c. DNA-related research change and adapt in response to new challenges or environments. Biologic Theories = generally view aging as occurring from a molecular, cellular, a systems point of view Psychological Theory Biologic theories are not meant to be exclusionary. Theories maybe combined to explain phenomena Ego Integrity and Despair (Erik Erikson)  The foci of biologic theories include explanations of the Basal Cell Carcinoma = a form of cancer that affects the mitotically following: active stem cells in the stratum basale of the epidermis. Main culprit is ○ Deleterious effects leading to decreasing function UV rays, but exposure lo others such as radiation and arsenic can also of the organism lead to this type of cancer. Uneven patch, bump, growth, or scar on the ○ Gradually occurring, age-related changes that are skin surface progressive over time ○ Intrinsic changes that can affect all members of a Squamous Cell Carcinoma = a cancer that affects the keratinocytes species because of chronologic age of the stratum spinosum and present as lesions commonly found on the scalp, ears, and hands. The second most common skin cancer. It is Senescence = a change in the behavior of an organism with age, more aggressive than basal cell leading to a decreased power of survival and adjustment. It has several psychosocial aspects, like: Psychosocial Aspect Activities of Daily Living Fear of Aging Negative Images in Society >??? Specialized Needs of the Elderly 1. Aging is not synonymous with disease 2. Effects of aging are a primary contributor to disability. 3. Functional assessment framework for assessing the elderly 4. Nursing interventions focus upon facilitating the highest quality of life 5. Need to compensate for/recognized the related changes 6. Early interventions prevent complications and maximize life quality Chapter 5: Physiologic Changes in Aging Affecting Various Systems Aging affects all systems in the body Musculo-Skeletal System Integumentary System = coupled with a combination of hormonal The muscle fibers become smaller with aging changes and alterations in lifestyle, the structure and chemical Muscle strength diminishes in proportion to the decline in composition of many tissues will be affected. muscle mass Loss of skin elasticity with fat loss in the extremities, Major age-related change is the loss of calcium - pigmentation changes, and glandular atrophy (oil, moisture, decalcification of bones, degenerative joint changes, sweat glands) dehydration of intervertebral disks, fat tissue increases Thinning of hair with hair turning gray-white (facial hair ○ Protein synthesis also slows decreases in men and increases in women) ○ Reabsorption continues without the continued Slower nail growth, atrophy of epidermal arterioles formation of new bones Changes include: ○ Little or no new formation of collagen fibers ○ Stem cell production declines with age ○ Higher fracture rate ○ Epidermal cells slow down reproduction ○ Larger, centrally located medullary cavities of the ○ Glandular activity declines long bones and thinner walls of compact bone ○ Become larger and more irregular. This causes thinner, more translucent skin ○ Reduction in the secretion of sebum (a waxy secretion that coats the Surface of hairs) ○ Vascularity and circulation decrease in the subcutaneous tissues ○ Vascular supply to the nailbeds decreases ○ Fingernails may flake and develop ridges. Toenails become discolored or abnormally thickened ○ Drugs administered are absorbed more slowly ○ Dull, brittle, hard, and thick nails, with a slowed growth rate ○ Spots and lesions are often present ○ Smooth brown, irregularly shaped spots (senile lentigo) ○ Perspiration production decline ○ Skin dry and flaky Skeletal muscle decreases (atrophy), resulting in decreased number of muscle fiber and decrease in the size of Years of sun exposure contribute to the aging of the skin and lead to remaining fibers premalignant and malignant lesions Skeletal muscles are postmitotic, they cannot reproduce to produce new fibers. The fibers are now replaced with fat Melanoma = Characterized by the uncontrolled growth of melanocyte. tissue Develops from a mole, appears asymmetrical brown and black patches Loss of muscle strength with uneven borders and a raised surface. The most fatal of all skin Postmenopausal women experience a greater rate of bone cancers, as its highly metastatic and can be difficult to detect before it demineralization than older men (maintain calcium intake) has spread to other organs Older men with poor nutrition and decreased mobility are also at risk for bone demineralization.  ○ Slowing down of peristalsis and alterations in secretions (leads to constipation, encourage small frequent feeding) ○ Less tolerant of certain foods and having discomfort from delayed gastric emptying ○ Lower Gl tract lead to constipation, flatulence, or diarrhea Taste buds become less sensitive (food isn't appetizing) Loss of teeth, gums may be prone to certain disease Salivary glands do not produce enough saliva Ingested food moves slowly through the alimentary canal because of reduced strength and muscular tissue tone, neurosensory feedback is dampened, slowing the transmission of messages that stimulate the release of enzymes and hormones. Respiratory System Effects on Digestive Organs There is a decreased ability of the organs to acquire and Stomach = the mucous membrane thins with age resulting deliver oxygen to the arterial blood, which results in the in lower levels of mucus, hydrochloric acid, and digestive inability to maintain high level of physical activity. enzyme. This reduces the digestion of proteins and may A number of structural changes occurs, including: result in chronic atrophic gastritis. Cartilage in the walls of the trachea and bronchi undergoes Small Intestine = the walls became atrophied with age, progressive calcification causing them to become which alters the shape of the villi and reduces the surface increasingly rigid with aging (resulting in a decrease in area across which absorption occurs. maximum breathing capacity) Large Intestine = same with the walls of SI; the thinning of Walls of alveoli deteriorate (gas exchange) the walls results in outpockets from the wall, known as A number of structural changes occurs, including: diverticulosis. ○ Lungs lose some of the elastic recoil, thereby less Pancreas = the number of secretory cells decreases which resistance to expansion result in a decreased level of fat digestion. ○ Decrease cough reflex, decreased cilia, increased Liver = the liver also reduces in size, but it does not show anterior-posterior chest diameter any significant reduction in the ability to perform its various ○ Increased chest wall rigidity functions in healthy elderly people. A decline in cardiac ○ Increased risk of respiratory infections output contributes to a decrease in hepatic blood flow Decreased cough reflex leads to risk of URTI since mucous Gallbladder = the gallbladder is unaffected by aging, but is not expectorated, especially with cough, pneumonia, and incidence of gallstones increases with age. Bile become asthma more lithogenic possibly because of an increase in biliary ○ Management: cholesterol related to diet and hormonal changes Use facemask Do handwashing Take rest (no heavy exercise, do not exert too much force Cardiovascular System There is thickening of blood vessel wall, narrowing of the vessel lumen, loss of vessel elasticity (tortuous). ○ Atherosclerosis ○ Reduced cardiac output ○ Reduced strength of myocardium Lower cardiac output (due to decrease contractile strength of the myocardium) Decrease number of heart muscle fiber, increase in elasticity and calcification of heart valves, decrease baroreceptor sensitivity Decreased efficiency of venous valves, increased pulmonary vascular tension, increase systolic blood pressure, decreased peripheral circulation Urinary System The heart size decreases in the absence of clinical disease In the urinary system, the organs undergo different changes. In the conduction system, the SA node becomes fibrotic, the Kidneys = there is a decrease in the number of cells number of pacemaker cells decreases by age, which may resulting to thickening of the connective tissue capsule cause sinus node dysfunction, resulting in sinus bradycardia. surrounding the organ and a decrease in the thickness of the ○ SA nodes = pace makers cortical region. ○ Risk for fainting (syncope), bradycardia Bladder/Urethra = the muscle tissue weakens and is less The elastin in the vessel wall decreases (which causes elastic (less able to expand and contact). The bladder thickening and rigidity especially in coronary arteries) which capacity decreases which makes involuntary bladder increases the risk of atherosclerotic build up contractions lead to urgency and frequency of urination. Systolic blood pressure (SBP) increased because of loss of Other changes include: arterial distensibility. DBP remains the same or maybe ○ Decrease level of estrogen after menopause elevated slightly, thus the pulse pressure widens ○ Increase in prevalence of prostatic hypertrophy Decrease response to stress ○ Among men, enlargement of prostate ○ Among women, a reduced sphincter tone Digestive System Changes in the digestive system include: ○ Increase in the amount of fatty tissue in the abdomen  related to the decreased density of cutaneous receptors for touch sensation. Hematopoietic or Lymphatic System In the lymphatic system, there is declining immunocompetence. ○ Altered immune status is responsible for infections, cancer, and autoimmune processes ○ Thymic atrophy (which occurs naturally aging) affects T lymphocyte function ○ Diminished T cell mediated (cellular) and B lymphocyte (humoral) immunity ○ Reduction in total body water (less fluid in the bloodstream so blood volume decreases) ○ Speed with w/c the red blood cells are produced in response to stress or illness is reduced (slower response to blood loss and anemia) ○ Some white blood cells important to immunity (neutrophils) decrease in their number and ability to fight off bacteria (reduce the ability to resist infection) Reproductive System In the reproductive system, sexual activity declines with the loss of a partner, primarily for wome as a result of widowhood and for men, as a result of poor health, erectile dysfunction, medications and emotional factors. Females ○ Vaginal narrowing and decreased elasticity ○ Decreased vaginal secretions, involution, and decreased tone ○ Decreased estrogen production ○ Degeneration of ovaries ○ Atrophy of vagina, uterus, and breasts Males ○ Less firm testes but may continue to produce Nervous System viable sperm up to 90 years of age In the nervous system, there is degeneration of the nerve ○ Diminished production of testosterone cells, a decrease in neurotransmitters, and a decrease in ○ Erection is less firm and slow to develop rate of nerve conduction of impulses. Other changes include: Nutritional Health ○ Voluntary reflexes are slower, less ability to In nutritional health, the elderly requires fewer calories but respond to multiple stimuli require more nutrient-rich, healthy diet in response to ○ Changes in the sleep-wake cycle alterations in body mass and a more sedentary lifestyle. ○ Recommendations include reducing fat intake Endocrine System while consuming sufficient protein, vitamins, The endocrine system is composed of ductless glands that minerals and dietary fiber for health and secrete 40 major hormones that control numerous processes prevention of disease throughout the body. ○ Budgetary constraints and physical limitations may The changes brought about by aging include: interfere with food shopping and meal preparation ○ Alteration in hormone production with decreased ability to respond to stresses ○ The thyroid has diminished secretions ○ Cortisol, glucocorticoids = increased anti inflammatory hormone ○ Pancreas = increased fibrosis, decreased secretion of enzymes and hormones, decreased sensitivity to insulin Special Senses Among special senses, there is a question of loss versus deprivation Vision = diminished ability to focus on close objects; inability to tolerate glare, difficulty adjusting to changes of light intensity, decreased ability to distinguish colors. There is yellowing of the cornea and development of a noticeable surrounding ring made up of fat deposits, (known as arcus senilis). There is an altered color perception and macular degeneration (which is primary cause of loss of vision) Hearing = decreased ability to hear high-frequency sounds Taste and Smell = decreased ability to taste, fewer taste buds Touch = decreased skin receptors, decreased vestibular sensitivity, decline balance because of decreased sensory input, slowing of motor responses, musculoskeletal limitations, sensitivity to light touch diminished and maybe  ○ Medications of older adults (Polypharmacy) ○ Ethical principles SYLLABUS ○ Long-term care ○ Palliative care PRELIMS ○ Advance directives/DNR Concepts and Principles in the Care of Older Adult ○ End-of-life care ○ Perspective of aging ○ Spirituality among older persons ○ Demography of aging and implications for health ○ Ethical dilemmas and nursing care Communicating with older persons ○ Impact of aging members in the family ○ Information sharing Different theories of aging and its nursing implications ○ Formal/Therapeutic communications ○ Biologic theories ○ Informal/Social communication ○ Physiologic theories ○ Non-verbal communication Physical and physiologic changes in aging affecting the ○ Acceptance, dignity, and respect in communication various bodily systems and its rationale ○ Barriers to communication ○ Integumentary ○ Skills and techniques ○ Musculoskeletal Geriatric health care team ○ Respiratory ○ Gerontologist/Geriatrician ○ Cardiovascular ○ Nurse Gerontologist ○ Hematopoietic and Lymphatic ○ Occupational Therapist ○ GI ○ Physical Therapist ○ Urinary ○ Speech Therapist ○ Nervous ○ Case Manager ○ Special senses ○ Family/S.O. ○ Endocrine ○ Nursing and interdisciplinary care conference team ○ Reproductive Research agenda on aging Nursing care of older adult in wellness ○ National: NIH Publication 2030 problems on caring ○ Assessment for aging baby boomers ○ Subjective data ○ International: UN Program on Aging Nursing history ○ Other current researches on aging Functional Health Patterns Trends/Issues and Challenges on the care of older patients ○ Objective data ○ Home care Psychological assessment ○ Hospice facilities Physical assessment ○ Drop in/Daycare centers ○ Retirement living/Home/Village MIDTERMS Values, traditions, and wisdoms of older adults Nursing care of the older adult in wellness ○ "My Lolo and Lola: Our Heritage Heroes" ○ Planning for health promotion, maintenance, and Telehealth and older persons home health consideration Entrepreneurial opportunities Planning for successful aging ○ Home health agencies Home care and hospice ○ Visiting nurse groups Community-based services Assistive living Special care units Geriatrics units ○ Implementation Physical care of older adults Aging skin and mucous membranes Elimination Activity and exercise Sleep and rest Psychological care of the older adults Cognition and perception Engagement with life Self-perception and self-concept Coping and stress Values and beliefs Sexuality and aging Nursing care of older adults in chronic illness A. Disturbance in sensory perception (dulling of special senses) B. Chronic confusion (forgetfulness) C. Impaired verbal communication Core elements of evidence-based gerontological nursing practice ○ Standards ○ Competencies ○ Principles ○ Issues/Concerns FINALS Ethico-Legal considerations in the care of the older adult ○ Laws affecting senior citizens/older persons (RA 7432, RA 9257, RA 9994)