NCM114 Lecture Care of Older Adults PDF

NCM114 LECTURE CARE OF OLDER ADULTS TOPIC OUTLINE: ⎯ T Gerontologist h Are people w...

NCM114 LECTURE CARE OF OLDER ADULTS TOPIC OUTLINE: ⎯ T Gerontologist h Are people who improve the quality of life and CONCEPTS, PRINCIPLES AND THEORIES IN THE e CARE OF OLDER ADULTS h promote the well-being of persons as they age e within their families, communities and societies A. PERSPECTIVE ON AGING PROCESS a ⎯ Aging is a Development Process r through research, education and application of B. DEMOGRAPHY OF AGING AND IMPLICATIONS t interdisciplinary knowledge of the aging process FOR HEALTH AND NURSING CARE i and ⎯ Global Aging aging populations (Association for s ⎯ Aging in the Philippines a Gerontology in Higher Education, n.d.) C. IMPACT OF AGING MEMBERS IN THE FAMILY p D. THEORIES OF AGING AND ITS NURSING u IMPLICATIONS Ageing/m Aging ⎯ Biologic Theories p Decline or loss (a “de-tuning”) of adaptation with ⎯ Psychosocial Theories m increasing age, caused by a time progressive a d decline of Hamilton’s forces of natural selection e (Flatt, 2012). u *Hamilton’s p forces of natural selection – is an evolutionary theory ofor mortality rate plateaus – “Aging does indeed f stop.” (Shahrestani, Mueller & Rose, 2016). It suggests the m possibility u that the physiology of adults undergoing aging may be s substantially different from the physiology of life c after aging. l e t Active Aging i - s is the process of optimizing opportunities for s health, participation, and security in order to u enhance quality of life as people age (World Gerontology Professional Nursing Care - Positive Aging Health Organization, 2016). Gerontology is the study of the aging process and individuals as they Positive Aging grow from middle age through later life - is described based on four characteristics: It includes: ✓ The mobilization of latent resources the study of physical, mental and social changes in older people as ✓ Psychological flexibility they age ✓ An affirmative decision-making style the investigation of the changes in society resulting from our aging ✓ And the propensity to generate optimistic population response to stressors inherent in age-related the application of this knowledge to policies and programs decline (Association for Gerontology in Higher Education, n.d.) Positive Aging Strategy Framework Geriatrics the study of health and disease in later life Comprehensive health care of older persons and the well-being of their informal caregiver (Association for Gerontology in Higher Education, n.d.) ALYSSA JANE LUALHATI 1 BSN 4C  NCM114 LECTURE CARE OF OLDER ADULTS Successful Aging - Aging has been viewed through various lenses throughout history, and over the last 50 years the definition of successful aging has evolved from early theories of activity and disengagement to theoretical approaches with a more direct focus - Successful aging must ultimately be about what older adults value, rather than the chimera of younger adult health in an older adult body (Glass, 2003 as cited by Martin, Kelly, Kahana, Kahan, Willcox, Willcox and Poon, 2015) Conceptualizing Aging - Aging can be seen from 3 dimensions Decline - By age 70 we identify only 50% of the smells - Night vision declines…by age 80 few can drive at night - By age 90 50% can not use public transportation Change - Hair, waistline, skin…change - Making love shifts from 3/week to 2/month - Our ability to love and be loved does not diminish - Our capacity for joy is undiminished Development - At 70 we are more CATEGORIES OF OLDER PEOPLE - Patient - Accepting of affect in ourselves ▪ Young old (65 to 74) 18.4 million - Likely to tolerate paradox ▪ Middle Old (75 to 84) 12.4 million ▪ Old-Old (85+) 4.2 million, the fastest growing group AGEING OUR CONCERN ▪ Centenarians (100+) 50,545 In almost every country, the proportion of people aged over 60 years is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates. GLOBAL AGEING INDICATORS Some current statistics: ▪ Older women outnumbering older men 20.6 million to 14.4 million ▪ With 143 women for every 100 men at age 65+; this ration increases from 117 for the 65 to 69 age group, & to 245 for the 85+ ▪ With almost 400,00 grandparents age 65+ having primary responsibility for their grandchildren who live with them Projections for 2030: ▪ The older population will more than double to 70 million ▪ The 85+ population will increase from 4.2 million in 2000 to 8.9 million ▪ Members of minority groups will represent 25% of the older population, up from 16% in 2000 ALYSSA JANE LUALHATI 2 BSN 4C  NCM114 LECTURE CARE OF OLDER ADULTS The older foreign born: AGING IN THE PHILIPPINES ▪ Accounted for 3.1 million of persons 65+ ▪ 1/3 from Europe; 31% from Latin America; 22% ▪ Total population= 109,035,343 persons (based on from Asia, and 8% from other parts of the world the 2020 census of population and housing (2020 ▪ Anticipated future foreign born elders will be from CPH), the Philippines had) Latin America or Asia ▪ Of this total, the household population comprised ▪ 2/3’s of all foreign born elders have been in the U. 99.7 percent or 108,667,043 persons S. over 30 years ▪ By gender: 55.02 million (50.6%) are males ▪ 53.65 million (49.4%) are females ▪ By age group: 33.4 million (30.7%) are under 15 y/o ▪ 69.40 million (63.9%) are 15- 64 y/o ▪ 5.86 million (5.4%) are 65 y/o & over AGEING AND HEALTH (WHO ,2022) The number and proportion of people aged 60 years and older in the population is increasing ▪ In 2019, the number of people aged 60 years and older was 1 billion. This number will increase to 1.4 billion by 2030 and 2.1 billion by 2050. KEY FACTS ✓ All countries face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift. ✓ In 2050, 80% of older people will be living in low- and middle-income countries ✓ The pace of population ageing is much faster than in the past. ✓ In 2020, the number of people aged 60 years and older outnumbered children younger than 5 years. ✓ Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22%. 10 FACTS ON AGEING AND THE LIFE COURSE (WHO, 2015) 1. The world’s population is rapidly ageing ▪ The number of people aged 60 years or older will rise from 900 million to 2 billion between 2015 and 2050 (moving from 12% to 22% of the total global population) 2. There is little evidence that older people today are in better health than their parents ▪ The proportion of older people in high-income countries needing help from another person to carry out basic activities such as eating and washing may have declined slightly over the past 30 years. ALYSSA JANE LUALHATI 3 BSN 4C  NCM114 LECTURE CARE OF OLDER ADULTS 4. Population ageing will increase health-care costs but not 3. The most common health conditions in older age are by as much as expected. noncommunicable diseases Although older age is generally associated with an ▪ Older people in low- and middle-income countries carry a increased need for health care, the link with health greater disease burden than those in the rich world. service utilization is weak. 4. When it comes to health, there is no ‘typical’ 5. 70 is not yet the new 60 ▪ older person Biological ageing is only loosely associated There is little evidence that older people today are with person age in years. experiencing life in better health than was the case for their parents or their grandparents. 5. Health in older age is not random ▪ Although some of the variations in older people’s health 6. Good health in older age is not just the absence of reflect their genetic inheritance, most is due to their disease physical and social environments, and the influence of Most people over the age of 70 experience a number of these environments on their opportunities and health health conditions at the same time, but continue to be behaviour. able to do the things that are important to them. 6. Ageism may now be more pervasive than sexism or 7. Families are important but alone cannot provide the care racism many older people need ▪ Ageism – discrimination against a person on the basis of EPA/Sanjeev Gupta While families will always play a their age - has serious consequences for older people central role in long-term care, changing demography and and societies at large. social norms mean it is impossible for families alone to meet the needs of care dependent older people. 7. Comprehensive public health action will require fundamental shifts in how we think about ageing and 8. Expenditure on older populations is an investment, not a health cost ▪ Health in older age shouldn’t be defined by the absence Rather than framing the expenditures on older of disease. Healthy Ageing is achievable by every older populations simply as a cost, they are better considered person. as investments. 8. Health systems need to be realigned to the needs of 9. It’s not all about genes older populations While Healthy Ageing starts at birth with our genetic ▪ Most health systems around the world are ill prepared to inheritance, only approximately 25% of the diversity in address the needs of older people longevity is explained by genetic factors. 9. In the 21st century, all countries need an integrated 10. Mandatory retirement ages do not help create jobs for system of long-term care youth ▪ The number of older people who need support for Policies enforcing mandatory retirement ages do not help activities of daily living in developing countries is forecast create jobs for youth, but they reduce older workers’ to quadruple by 2050. ability to contribute. 10. Healthy Ageing involves all levels and sectors of Ageing Explained (WHO, 2016) government ▪ Making progress on Healthy Ageing will also require a far At the biological level, ageing results from the impact of the better understanding of age-related issues and trends. accumulation of a wide variety of molecular and cellular damage over time. This leads to a gradual decrease in physical and mental capacity, a growing risk of disease, and ultimately, death. But Misconceptions on ageing and health these changes are neither linear nor consistent, and they are only loosely associated with a person’s age in years Some of the most important barriers to developing good public policy on ageing are pervasive misconceptions, Beyond biological changes, ageing is also associated with other negative attitudes and assumptions about older people. life transitions such as retirement, relocation to more appropriate housing, and the death of friends and partners. 1. There is no typical older person Darek Delmanowicz Older age is characterised by great Common health conditions associated with ageing diversity. Some 80 year-olds have levels of physical and Common conditions in older age include hearing loss, mental capacity that compare favourably with 20 year- cataracts and refractive errors, back and neck pain and olds. osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression, and dementia. Furthermore, as 2. Diversity in older age is not random people age, they are more likely to experience several A large proportion of the diversity in capacity and conditions at the same time. circumstance observed in older age is the result of the cumulative impact of advantage and disadvantage across Geriatric syndromes people’s lives. Characterized by the emergence of several complex health states that tend to occur only later in life and that 3. Only a small proportion of older people are care do not fall into discrete disease categories dependent Often the consequence of multiple underlying factors and Only a small proportion of older people are dependent on include frailty, urinary incontinence, falls, delirium and others for care. pressure ulcers Appear to be better predictors of death than the presence ALYSSA JANE LUALHATI 4 BSN 4C  NCM114 LECTURE CARE OF OLDER ADULTS or number of specific diseases ACTIVITIES PROMOTING HEALTHY AGING Factors influencing Healthy Ageing As we age our body change and we have to make changes Although some of the variations in older people’s health to accommodate our lives. Having a good night sleep are genetic, much is due to people’s physical and social makes the mind think more clearly. A good night sleep also environments including their homes, neighbourhoods, boosts your energy while controlling your weight. You can and communities, as well as their personal also make decisions with less stress. Sleeping well at night characteristics – such as their sex, ethnicity, or makes our immune system stronger to keep us healthier. socioeconomic status. Researchers have proved that a good nights sleep is Maintaining healthy behaviours throughout life, necessary for our health. Researchers have found that lack particularly eating a balanced diet, engaging in regular of sleep reduces the growth hormones in our bodies, since physical activity, and refraining from tobacco use all it changes muscles to fat. Sleep overall is most important, contribute to reducing the risk of non-communicable yet it stands behind activities. To improve your health, try diseases and improving physical and mental capacity. walking each day. Behaviours also remain important in older age. Strength training to maintain muscle mass and good nutrition can Walking will help to loosen our muscles, reduces stress and both help to preserve cognitive function, delay care depression along with anxiety. By reliving these things, it dependency, and reverse frailty. will help us to sleep for a longer and deeper period. So, Supportive environments enable people to do what is when we wake up in the morning we feel happier and more important to them, despite losses in capacity. The rested. availability of safe and accessible public buildings and transport, and environments that are easy to walk around When you exercise, you get a good night sleep, which are examples of supportive environments. promotes metabolism. Without the right amount of sleep, our bodies crave energy. Our body will release insulin or Challenges in responding to population ageing glucose into the bloodstream, which slows down Diversity in older age metabolism. This action causes the body to gain weight, There is no ‘typical’ older person. Some 80 year-olds rather than control weight. have physical and mental capacities similar to many 20 year-olds. Other people experience significant declines in When a person feels exhausted, they will feel weak and physical and mental capacities at much younger ages. A repressed from enjoying activities. This leads to additional comprehensive public health response must address this problems. Sleeping right balances out our bodies giving us, wide range of older people’s experiences and needs more energy leading to more activities that will satisfy our Health inequities sleep needs The diversity seen in older age is not random. A large part arises from people’s physical and social What to avoid: To rest proper and feel active you must environments and the impact of these environments on reduce your intake of caffeine, nicotine, harmful chemicals, their opportunities and health behaviour. The relationship such as over-the-counter meds that keep you awake, we have with our environments is skewed by personal alcohol and so on. The chemicals and substances will keep characteristics such as the family we were born into, our you awake. Try to avoid drinking anything after 8 p.m. in the sex and our ethnicity, leading to inequalities in health. A evening. Nicotine should be avoid if possible, yet if you must significant proportion of the diversity in older age is due smoke try to avoid smoking after 8 p.m to the cumulative impact of these health inequities across the life course. Public health policy must be crafted to Start a walking program in the morning to help wake you up, reduce, rather than reinforce, these inequities while boosting your energy. You will feel better since the Outdated and ageist stereotypes joints will feel flexible enough to move freely. In addition, Older people are often assumed to be frail or dependent, walking will help you burn fat and calories. You’ll notice a big and a burden to society. Public health, and society as a change in how you feel the rest of the day. Start out walking whole, need to address these and other ageist attitudes, at a slow steady pace for as far as your comfortable. Each which can lead to discrimination, affect the way policies day pick up the pace a bit and walk further. Just remember are developed and the opportunities older people have to when walking that you want to work up to a steady brisk walk experience Healthy Aging to make you sweat but not out of breath. Take a short walk A rapidly changing world before and after meals to calm your nerves, and burn calories Globalization, technological developments (e.g. in too, it will give you energy, relieve that stress from the long transport and communication), urbanization, migration day and help you sleep and changing gender norms are influencing the lives of older people in direct and indirect ways. For example, If you start a walking program for yourself, it is a lot more fun although the number of surviving generations in a family if you have someone to go with you. Talk to that neighbor you has increased, today these generations are more likely don’t know and maybe they’ll walk with you. Just think about than in the past to live separately. A public health it; you’ll be acquainted with someone new, talk about new response must take stock of these current and projected things will relieve stress and get in you exercise as well. This trends, and frame policies accordingly might help that neighbor too who maybe hasn’t seen or talked ALYSSA JANE LUALHATI 5 BSN 4C  NCM114 LECTURE CARE OF OLDER ADULTS to anyone in a couple of days and than they can sleep better organisms in a timed framework. at night. STOCHASTIC THEORIES After walking that brisk walk your doing be sure to cool down. When walking at a vigorous pace your heart rate will go up Studies of animals reflect that the effects of aging and it needs to be back to normal. Just walk a bit slow and are primarily due to genetic defects, development, relaxing until you’ve cooled down. environment, and the inborn aging process (Harman,2006; Goldsmith, 2011) If you can’t go to sleep at night instead of getting up and turning on the TV try pacing around the house. Do some a. Free Radical Theory stretching and shake your arms and legs. Even walking around the house can relax you especially when everyone This theory postulates that aging is due to oxidative else is in bed and you can relax more. metabolism and the effect of free radicals , which are the end products of oxidative ,metabolism. Free radicals are produced when the body uses oxygen, such as with exercise. This theory emphasizes the significance of how cells use oxygen. Free radicals are thought to react with proteins, lipids, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA), causing cellular damage. This damage accumulates over time and is thought to accelerate aging. Exogenous Sources of Free Radicals ✓ Tobacco smoke ✓ Pesticides ✓ Organic solvents ✓ Radiation ✓ Ozone ✓ Selected medications *Free radicals are highly reactive molecules that are generated as byproduct of various metabolic processes, BIOLOGIC THEORIES OF AGING environmental factors, and lifestyle choices. These molecules can cause damage to cellular components suc The biological theories of aging are concerned in as DNA, proteins, and lipids. Overtime, this damage answering basic questions about physiologic accumulates and leads to aging and age- related diseases. changes as all living organisms chronologically age b. Error/ Orgel Theory The Foci of Biological Theories of Aging: 1. Deleterious effects leading to decreasing function of This theory suggests that, overtime, cells accumulate the organism errors in their DNA and RNA protein synthesis that cause the 2. Gradually occurring age- related changes that are cells to die (Orgel, 1970) progressive over time 3. Intrinsic changes that can affect all the members of Environmental agents and randomly induced events can the species because of chronological age cause error, with ultimate cellular changes. It is well known that large amounts of X-ray radiation cause chromosomal *All organs in any organism do not age at the same time abnormalities. *Any single organ does not necessarily age at the same rate in different individuals of the same species This theory proposes that aging would not occur if destructive factors such as radiation did not exist and Two Categories of Biologic Theories: cause “errors” such as mutations and regulatory disorders. a. Stochastic or statistical perspective, which c. Wear and Tear Theory identifies episodic events that happen throughout one’s life that cause random cell damage and The Wear and Tear Theory proposes that aging is primarily accumulate over time, thus causing aging. the result of accumulated damage to tissues and organs that occurs as a consequence of normal daily use. b. Nonstochastic theories, which view aging as a series of predetermined events happening to all ALYSSA JANE LUALHATI 6 BSN 4C  NCM114 LECTURE CARE OF OLDER ADULTS It suggests that the body’s ability to repair and replace suggests that aging is more likely to be an evolved damaged cells and tissues gradually becomes less efficient beneficial characteristic and results from a complex over time, leading to the signs and symptoms of aging. structured process and not a series of random events. This theory emphasizes the importance of lifestyle factors, such as diet, exercise, and exposure to environmental stressors, in accelerating or decelerating the aging process. a. Programmed Theory d. Cross Linkage/ Connective Tissue Theory The Programmed Theory of aging proposes that the aging process is genetically programmed and follows a This theory proposes that over time, biochemical processes predetermined biological timeline. create connections between structures not normally connected; (occurs rapidly between 30 to 50 years of age). As people age, more of their cells start to decide to commit suicide or stop dividing. The Hayflick phenomenon, or human Note: No research has identified anything that could stop fibroblast replicative senescence model, suggests that cells these cross- links from occurring. Elastin dries up and cracks divide until they can no longer divide, whereupon the cell's with age; hence, skin with less elastin (as with the older adult) infrastructure recognizes this inability to further divide and tends to be drier and wrinkled. Over time, because of triggers the apoptosis sequence or death of the cell. decreased extracellular fluid, numerous deposits of sodium, chloride, and calcium build up in the cardiovascular system. According to this theory, there are specific genes and mechanisms within our cells that control the aging process Cross-linking refers to the formation of chemical bonds and determine the lifespan of an organism. These genes are between these proteins, which leads to the loss of flexibility believed to regulate various cellular processes such as DNA and function in tissues. Over time, the accumulation of these repair, cell division, and cell death. Over time, the cross-links in various organs and tissues impairs their normal programmed changes in gene activity lead to the progressive functioning and contributes to the aging process. This theory decline in cellular function and ultimately result in emphasizes the role of structural changes in the extracellular aging. matrix and how they affect the overall aging phenotype. b. Gene/Biological Clock Theory SUMMARY OF STOCHASTIC THEORIES This theory explains that each cell, or perhaps the entire THEORY DESCRIPTION organism, has a genetically programmed aging code that is Stochastic Theories Based on a random stored in the organism's DNA events that cause cellular damage that Slagboom and associates describe this theory as comprising accumulates as the genetic influences that predict physical condition, occurrence organism ages of disease, cause and age of death, and other factors that Free radical theory Membranes, nucleic contribute to longevity (Slagboom, Bastian, Beekman, acids, and proteins are Wendendorf, & Meulenbelt, 2000) damaged by free radicals, which causes This theory indicates that there may be genes that trigger cellular injury and aging youth and general well-being as well as other genes that Orgel/ error therapy Errors in DNA and RNA accelerate cell deterioration. synthesis occur with aging Why do some people have gray hair in their late 20s and Wear and tear theory Cells wear out and others live to be 60 or beyond before graying occurs? I is cannot function with known that melanin is damaged with ultraviolet light and is aging the ingredient that keeps human skin resilient and Connective tissue/ With aging, proteins unwrinkled. People who have extensive sun exposure have cross- link theory impede metabolic wrinkles earlier in life due to damage to collagen and elastin. processes and cause But why, if we know that people have a programmed gene or trouble with getting genes that trigger aging, wouldn't we prevent the gene(s) nutrients to cells and from causing the problems they are intending to promote? removing cellular waste products c. Neuroendocrine Theory NON- STOCHASTIC THEORIES This theory describes a change in hormone secretion, such as with the releasing hormones of the hypothalamus and the The non- stochastic theories of aging are founded stimulating hormones of the pituitary gland, which manage on a programmed perspective that is related to the thyroid, parathyroid, and adrenal glands, and how it genetics or one’s biological clock. Goldsmith (2004) influences the aging process. ALYSSA JANE LUALHATI 7 BSN 4C  NCM114 LECTURE CARE OF OLDER ADULTS The following major hormones are involved with aging: PSYCHOSOCIAL THEORIES OF AGING o Estrogen decreases the thinning of bones, and when women age, less estrogen is produced by the Is the dynamic interaction between both intermal ovaries. As women grow older and experience (psychological) and external (social) factors and menopause, adipose tissue becomes the major how they jointly affect an individual's well-being and source of estrogen. development. o Growth hormone is part of the process that increases bone and muscle strength. Growth The psychosocial theories will be separated into two hormone stimulates the release of insulin-like categories: growth factor produced by the liver. o Psychological Theory o Melatonin is produced by the pineal gland and is o Social Theory thought to be responsible for coordinating seasonal adaptations in the body The basic assumption of the psychological theories of aging is that development does not end when a person reaches The Neuroendocrine Theory of aging proposes that changes adulthood but remains a dynamic process throughout the in the neuroendocrine system, which includes the interplay lifespan.As people age, various adaptive changes help them between the nervous system and hormonal regulation, play a cope with or accept some of the biologic changes. significant role in the aging process. According to this theory, aging is caused by the dysfunction Some of the, adaptive mechanisms include memory, learning and decline in the neuroendocrine system over time. This capacity, feelings, intellectual functioning, and motivations to dysfunction leads to imbalances in hormone levels, which perform or not perform activities. Psychological aging, subsequently affect various physiological processes and therefore, includes not only behavioral changes but also contribute to the aging phenotype. developmental aspects related to the lives of older adults. d. Immunologic/Autoimmune Theory Psychological Theories o Maslow's Hierarchy of Human Needs This theory was proposed 40 years ago and describes the o Jung's Theory of Individualism normal aging process of humans and animals as being o Erikson's Eight Stages of Life related to faulty immunological function. o Selective Optimization with Compensation According to this theory, the immune system weakens overtime, making an aging person more susceptible to a. Maslow's Hierarchy of Human Needs disease. It also proposes that the increase in autoimmune diseases and allergies seen with aging is caused by changes Human motivation is viewed as a hierarchy of needs critical in the immune system. to the growth and development of all people. Individuals are viewed as active participants in life, striving for self- THEORY DESCRIPTION actualization. Non- stochastic theory Based on a genetically programmed events that Maslow's fully developed, self-actualized person displays cause cellular damage high levels of all the following characteristics: perception of that accelerates aging of reality; the organism o acceptance of self, others, and nature; Programmed theory Cells divide until they o spontaneity; are no longer able to, o problem-solving ability; self-direction; and this triggers detachment and the desire for privacy; freshness of apoptosis or cell death peak experiences; Gene/ biological clock Cells have genetically Identification with other human beings; theory programmed aging code o satisfying and changing relationships with other Neuroendocrine theory Problems with the people; hypothalamus-pituitary- o a democratic character structure; endocrine gland Creativity; feedback system cause o and a sense of values (Maslow, 1968). disease; increased insulin growth factor Maslow's ideal self- actualized person is probably only accelerates aging attained by about 1% of the population (Thomas & Chess, Immunological theory Aging is due to faulty 1977). Nevertheless, the person developing in a healthy way immunological function, is always moving toward more self-fulfilling levels. which is linked to general well- being ALYSSA JANE LUALHATI 8 BSN 4C  NCM114 LECTURE CARE OF OLDER ADULTS b. Jung's Theory of Individualism The task is to adjust or transcend the declines that may occur to maintain feelings of well-being. This task can be Development is viewed as occurring throughout successfully resolved by focusing on the satisfaction obtained adulthood, with self-realization as the goal of personality from interpersonal interactions and psychosocial activities. development. As individuals age, they can transform into a more spiritual being. (3) ego transcendence versus ego preoccupation: The third and final task, ego transcendence versus ego According to this theory, a person's personality is visualized preoccupation, involves acceptance of the individual's as oriented either toward the external world extroversion) or eventual death without dwelling on the prospect of it. toward subjective, inner experiences introversion). A balance Remaining actively involved with a future that extends between these two forces, which are present in every beyond a person's mortality is the adjustment that must be individual, is essential for mental health. made to achieve ego transcendence. Applying his theory to individuals as they progress through d. Selective Optimization with Compensation life, Jung proposed that it is at the onset of middle age that the person begins to question values, beliefs, and possible Physical capacity diminishes with age. An individual who dreams left unrealized. The phrase midlife crisis, popularized ages successfully compensates for these deficits through by this theory, refers to a period of emotional, and sometimes selection, optimization, and compensation. behavioral, turmoil that heralds the onset of middle age. This period may last for several years, with the exact time and These concepts of selection, optimization, and compensation duration varying from person to person. can be applied to any aspect of older adulthood to demonstrate successful coping with declining functions. As the person ages chronologically, the personality often begins to change from being outwardly focused, concerned This theory's central focus is that individuals develop certain about establishing oneself in society, to becoming more strategies to manage the losses of function that occur over inward, as the individual begins to search for answers from time. This general process of adaptation consists of three within. Successful aging, according to Jung's theory, is when interacting elements: a person looks inward and values himself or herself for more 1. selection, which refers to an increasing restriction than just current physical limitations or losses. The individual on one's life to fewer domains of functioning accepts past accomplishments and limitations. because of an age-related loss; 2. optimization, which reflects the view that people c. Erikson's Eight Stages of Life engage in behaviors to enrich their lives; and 3. compensation, which results from restrictions All people experience eight psychosocial stages during a caused by aging, requiring older adults to lifetime. Each stage represents a crisis, where the goal is to compensate for any losses by developing suitable, integrate physical maturation and psychosocial demands. At alternative adaptations. each stage, the person can resolve the crisis. Successful mastery prepares an individual for continued development. *Sociologic theories focus on changing roles and Individuals always have within themselves opportunity to relationships. In some respects, sociologic theories relate to rework a previous psychosocial stage into a more successful various social adaptations in the lives of older adults. One of outcome. the easiest ways to view the sociologic theories is within the context of the societal values at the time in which they were Because people were living longer, an obvious need arose to developed. identify additional stages for older adults. Peck (1968) expanded the eighth stage, ego integrity versus despair, into Social Theories three stages: o Activity Theory o Continuity Theory (1) ego differentiation versus work role preoccupation: o Age Stratification Theory During the stage of ego differentiation versus work role o Person-Environment Fit Theory preoccupation, the task for older adults is to achieve identity and feelings of worth from sources other than the work role. a. Activity Theory The onset of retirement and termination of the work role may Individuals need to remain active to age successfully. reduce feelings of self-worth. In contrast, a person with well- Activity is necessary to maintain life satisfaction and a differentiated ego, who is defined by many dimensions, can positive self-concept. find other roles to replace the work role as the major defining This theory is based on three assumptions: source for self-esteem. 1. It is better to be active than inactive; 2. it is better to be happy than unhappy; (2) body transcendence versus body preoccupation: 3. an older individual is the best judge of his or her own The second stage, body transcendence versus body success in achieving the first two assumptions preoccupation, refers to the older person's view of the physical changes that occur because of the aging process. ALYSSA JANE LUALHATI 9 BSN 4C  NCM114 LECTURE CARE OF OLDER ADULTS b. Continuity Theory f. Disengagement Theory According to this theory, the latter part of life is a continuation This theory, proposed by Elaine Cumming and William of the earlier part and therefore an integral component of the Henry, suggests that as individuals age, they naturally entire life cycle. When viewed from this perspective, the withdraw from society and disengage from social roles and theory is a developmental theory. activities. It was a controversial theory and is less widely accepted today, as many researchers emphasize the Individuals will respond to aging in the same way they have importance of continued social engagement and activity for responded to previous life events. The same habits, healthy aging. commitments, preferences, and other personality characteristics developed during adulthood are maintained in older adulthood. c. Age Stratification Theory Society consists of groups of cohorts that age collectively. The people and roles in these cohorts change and influence each other, as does. society at large. Therefore a high degree of interdependence exists between older adults and society. This theory views the aging person as an individual element of society and also as a member, with peers, interacting in a social process. The theory attempts to explain the interdependence between older adults and society, and how they constantly influence each other in a variety of ways. Riley (1985) identifies the five major concepts of this theory: 1. Each individual progresses through society in groups of cohorts that are collectively aging socially, biologically, and psychologically; 2. new cohorts are continually born, and each of them experiences their own unique sense of history; 3. society itself can be divided into various strata, according to the parameters of age and roles; 4. not only are people and roles within every stratum continuously changing but so is society at large; 5. the interaction between individual aging people and the entire society is not stagnant but remains dynamic. d. Person-Environment Fit Theory Everyone has personal competencies that assist the person in dealing with the environment. These competencies may change with aging, thus affecting the older person's ability to interrelate with the environment. The theory further proposes that, as a person ages, the environment becomes more threatening, and he or she may feel incompetent dealing with it. e. Socioemotional Selectivity Theory Developed by Laura Carstensen, this theory suggests that as people age, their social goals and motivations change. Younger individuals often prioritize information-seeking and future-oriented goals, while older adults place more emphasis on emotional satisfaction and meaningful social interactions. This shift is attributed to a growing awareness of limited time, leading older adults in relationships that are most emotionally rewarding. ALYSSA JANE LUALHATI 10 BSN 4C