Topic 1.

The Concepts, Principles and Aging in the Care of Older Adults

LEARNING OBJECTIVES:

At the end of the lesson, the student will be able to:

[Link] relevant principles of social, physical, natural, and health sciences
and
humanities in each health and nursing situation.
2 Discuss appropriate community health nursing concepts and actions
holistically and
comprehensively.

INTRODUCTION

Gerontology nursing or geriatric nursing specializes in the care of older or

elderly
adults. Geriatric nursing addresses the physiological, developmental,
psychological,
socio-economic, cultural and spiritual needs of an aging individual. Since aging
is a
normal and fundamental part of life. Providing nursing care for elderly clients
should
not only be isolated to one field but is best given through a collaborative effort
which
includes their family, community, and other health care team. Through this,
nurses
may be able to use the expertise and resources of each team to improve and
maintain
the quality of life of the elderly.
Geriatric nursing care planning centers on the aging process, promotion,
restoration,
and optimization of health and functions; increased safety; prevention of illness
and
injury; facilitation of healing.

Time allotment/ duration: 3 hours

Core-Related values and Biblical Reflection:
Excellence: Competence
Matthew 7:7: Ask, and it will be given to you; seek and you will find; knock, and it be
opened to you.
LEARNING CONTENT
Topic Content: The Concepts, Principles and Theories in the Care of Older Adults
A. Perspectives on Aging
a. Medical Terms related to Gerontology
b. Gerontological Nursing Role
c. Classification of Various Ages
d. Geriatric Health Team

B. Aging is a Development Process

C. Philippine Government Policies Related to Older People

B. Demography of Aging and Implications for Health and Nursing Care

1. Global Aging
2. Aging in the Philippines

C. Impact of Aging Members in the Family

F. Physiologic Changes in Aging Affecting Various Systems
1. Integumentary
2. Musculo-skeletal
3. Respiratory
4. Cardiovascular
5. Hematopoietic & Lymphatic
6. Gastrointestinal
7. Urinary
8. Nervous
9. Special Senses
10. Endocrine
11. Reproductive

References:
[Link]
%20chronological%20aging,beings%20(Meilaender%2C%202011).&text=It%20is
%20senescence%20that%20causes%20diseases%20of%20aging.
Patricia A. Williams RN MSN CCRN - Basic Geriatric Nursing (2015), Mosby
Mary Ann Anderson - Caring for Older Adults Holistically (2007)

TERMINOLOGIES

GERONTOLOGY -the study of old age, the process of aging and the problems of
old age.

GERIATRICS- is a branch of medicine that deals with problems and diseases of

old age
and the medical care and treatment of aging people.

GERIATIC NURSING – focuses on the care of the sick \ ill elderly.

 branch of medicine dealing with physiological characteristics of aging
and
the diagnosis and treatment of diseases affecting the aged.

GERONTONIC NURSING- nursing care pertaining to an older person.

Gerogogy – teaching the older adult

Senescence – to grow old, the state of growing old

Senile pertaining to or characteristics of old age or the process of aging.
Senior Citizen - age of 60 years of age.
Functional Age- is a term used by Gerontologist to describe the physical,
psychological
 and social function, this I relevant how older adults feel and
function
may be more indicative of their needs than their chronological
age.
Perceived Age- term that used to describe how people estimate a person’s age
based on
appearance.

GERONTOLOGICAL NURSING – is the specialty of nursing pertaining of older

adults.
 Concerned with assessment of the health and functionals status of
older
adults; diagnosing, planning and implementing home care and
services
to meet the identified needs; and evaluate the effectiveness of such
care.
 It is a more holistic view of the nursing care of the older person.
 A term most used by nurses specializing in this field.
 Involves in the care of the aging people and emphasizes the
promotion of
the optimum quality of life and wellness.

AGEISM – defined as the prejudices and stereotypes that are applied people on
the basis
of their age, instead of showing appreciation for the vast contribution
of the
aged and their wealth of resources, society filled with prejudices and
lacks
adequate provisions for the elderly derogating their dignity.

Stereotypes of the elderly

*Old people are sick and disabled.
*Most of the elderly are in nursing homes.
*Senility accompanies aging.
*Individuals either get to be very tranquil or very cranky as age
progress.
*The elderly have lower intelligence and are resistant to change.
*The elderly are unable to have sexual intercourse and are
uninterested
in sex anyhow.
*There are only a few satisfactions in aging.

GERONTOLOGICAL NURSIGN ROLE

 Healer
 Caregiver
 Innovator
 Educator
 Advocate
Geriatric Health Care Team

A. Gerontologist/ Geriatrician
B. Nurse Gerontologist
C. Occupational Therapist
D. Physical Therapist
E. Speech Therapist
F. Case Manager
G. Family/ Significant others
H. Nursing and Interdisciplinary care Conference Team
 Different generations are the following
[Link] Generation (born 1901 – 1927)
2. Silent Generation (born 1928- 1945)
[Link] Boomers (1948-1964)
[Link] X (BORN 1965- 1980)
5. Millennials (1981-1995)
6. Generation Z (born 1996-1910)
[Link] Alpha (born2011-2025)

FURTHER CLASSIFICATION OF AGE

Young adult- 20 – 40 years of age
Middle adult - 40- 65 years of age

Older Adult
*Young-old - 65 -75 yrs. old
*old 75- 85 yrs. Old
*Old-old 100 yrs. Old
*Elite old over yrs. Old

AGING is a DEVELOPMENT PROCESS

More people live longer than ever before, thus there is an increasing
growth rate
of the older population- 65 years of age and older. NSO projects that by
2020,
older people will comprise 11.5% of the total population.

Older individuals are currently categorized as follows

Young-old: 65 to 74 years
Old 75 to 84
Oldest-old 85+

Growing older, chronological aging is an unstoppable process that happens

to all
humans. For that reason alone, some bioethicists argue that aging is
in
fact a natural developmental process for human beings.
Aging is a normal stage of life in which our bodies begin to function less
effectively,
making us more vulnerable to disease.

Evolutionary biologists refer to this process as “senescence.” Senescence

may be
viewed most easily as the passage of biological time as opposed to
chronological time. More specially, it refers to “the time- dependent
accumulation of damage at the molecular level that begins at
fertilization
and is eventually expressed as nonspecific vulnerability, impaired
function,
disease, and ultimately death”.

It is a senescence that causes diseases of aging. Even if a person ages well,

Because of senescence that person will still ultimately die of some cause.
Chronological age is the year the person has lived in since birth. Functional
age
 is used to describe physical, psychological and social function.

Perceived age is used to describe how people estimate a person’s age based
on appearance. Women in general have higher life expectancy than men.

Older people need care and support. An aging population increases the
demand
for health services. Older people suffer from both degeneration and
communicable diseases due to the aging of the body’s immune system.
The leading causes of morbidity are infections, while visual impairment,
difficulty in walking, chewing, hearing, osteoporosis, arthritis and
Incontinence are common health-related problems.

The chronic disorders that are most prevalent in older people are the ones
that
have a significant impact on independence and the quality of daily life. A
great number of older people struggle with poverty, and it is projected
that
this number has significantly increased.

Married people have a lower mortality rate than unmarried people at all ages,
with
men having larger advantage.

Among Filipinos, family support is provided to older adults in the form of co-
residence.
The Philippine Constitution states that families have a duty to care for
elderly
members.

The “baby boomers” those born between 1946- 1964 will be the next wave of
senior citizens. They began entering their senior years in 2011 and will
continue
to do so until 2030 – called DEMOGRAPHIC TIDAL WAVE.

The “baby boomers” are characteristically informed consumers of health care

and
desire a highly active role in their care. And they feel comfortable
communicating
via e-mail and text messages. They are highly diverse, and better
educated,
have fewer children and may have higher incomes that previous
generations.

Gerontological nurses will be challenged in recognizing diversity among older

adults
as they assist these individuals in health promotions and disease
management
activities locally and globally.

Gerontological nurses need to be advocates in ensuring that it is cost-effective

effort.
do not sacrifice the welfare of older adults.

PHILIPPINE GOVERNMENT POLICIES RELATED TO OLDER PEOPLE

The Philippine Government has enacted laws that cater to the needs and
provides
privileges and benefits to older people. To name a few:
 a. Republic Act No. 344 – Accessibility Law of 1982
Provides for the minimum requirements and standards to make buildings,
facilities and utilities for public use are accessible to people with disability,
including older people who are confined to wheelchairs and those who have
difficulty in walking or climbing stairs.

b. Republic Act No. 7876 – An Act Establishing a Senior Citizens Center in all
Cities
and Municipalities of the Philippines and Appropriating
Funds.
Provides for the establishment of the Senior Citizen’s Center to cater to
older people’s socialization and interaction needs as well as to serve as a
venue for the conduct of other meaningful activities. In coordination with
other agencies like DSWD and NGOs, we shall provide necessary technical
assistance in the form of social, recreational services, health and personal
care services, spiritual services. Livelihood services and volunteer resource
services.

c. Republic Act No. 8425 – National Anti-Poverty Commissions (NAPC)

It’s a multi-dimensional and cross-sectoral approach that provides a
mechanism
for older people to participate in policy formulation and decision-making on
matters concerning poverty alleviation.

D. Republic Act No. 10155- The General Appropriations Act of 2012.

Mandates that all government agencies and instrumentalities should
allocate
one percent of their total agency budget to programs and projects for older
persons with disabilities.

E. Republic Act No. 9994 – Expanded Seniors Citizen Act of 2012

An act granting additional benefits and privileges to senior citizens,
amending
Republic Act No. 7432 known as “An Act to maximize the contribution of
senior
citizens to nation building, grant benefits and special privileges and for the
other purposes – Senior Citizen Act of 1992, Act No. 7432.

Presidential Proclamations and Executive Orders

Presidential Proclamation No. 470, Series of 1994
Declaring the 1st week of October of every year as “Elderly Filipino
Week.”

Presidential Proclamation N0.1048 Series of 1999, declaring a “Nationwide

Observance
In the Philippines of the International Year of Older Persons”

Executive Order No. 105, Series of 2003 approved and directed the
implementation
of the program providing for group homes and foster homes for
neglected,
abandoned, abused, detached and poor older people with disabilities.
 CHANGES IN OLDER ADULT

AREA FINDINGS
General Changes decrease functional cells in the body
decrease intracellular fluid
loss of subcutaneous fat
Integumentary *Increase drying due to decease sebaceous
System gland
activity and tissue fluid
*Pallor - reduced vascularity
*Fragility of the skin- - decreased thickness
and
vascularity of the dermis and
decrease
subcutaneous fat.
*Progressive wrinkling and sagging of the
skin.

Presence of brown ‘age spots” on exposed

body
Part
*Lentigo senilus
*Decrease sweat gland activity
*Scalp, pubic and axillary hair becomes gray
and
thinner.
*Nails grow slower with thicken ridges.

Cardiovascular *Heart size is unchanged in the absence of

System Pathology
*Valves becomes thick and rigid
*Decrease elasticity and increased rigidity of
Blood vessels
*Deceased cardiac output and stroke volume
especially during increase of activity or
unusual
demands results in shortness of breath on
exertion and pooling of blood in the
 extremities.
*Increase in peripheral resistant
*Increase in systolic and diastolic pressure
*Orthostatic pressure

Nervous System *Decrease nerve cell, cerebral blood flow

and
Metabolism
*Decrease conduction of nerve fibers –
slowed
reflexes and delayed responses.
Respiratory System *Decease lung expansion
*Increase residual capacity and decrease
vital
Capacity (less effective exhalation)
*High risk for respiratory infection.
*Decrease capacity to expel foreign or
accumulated matter (increased risk of
aspiration)
*Difficult, short heavy and rapid breathing
(dyspnea) after intense exercise
Musculoskeletal *Atrophy and decrease in the number of the
System muscle fibers -lower speed and power of
skeletal
muscle contractions.
*Tendons shrink and harden.
*Decrease bone minerals and mass
(osteoporosis)
Increase risk for fractures.
*Deterioration of bone cartilage – joint
stiffness
*Decrease muscle reaction and coordination
–
resulting to impaired balance
Sensory\Perceptual Decrease or loss of visual acuity due to
degeneration leading to capacity (cataract)
thickening and inelasticity (presbyopia)
*Increase sensitivity to glare and decrease
capacity to adjust to darkness because of
ciliary
Muscle changes, rigid pupil sphincter and
reduction of pupil size.
*Fatty deposits

PRIMARY CHANGES OF AGING

SKIN
Loss of subcutaneous supporting tissue
Sensitive to pressure and trauma
Wrinkle and sag
Decreased sebaceous secretions.
Dry, flabby, prone in itching
 Thinning and graying hair
Atrophy of tiny arterioles near epidermis
Impaired vasomotor homeostasis mechanism
Poor temperature regulation (feels cold even in warm climate)

MUSCULOSKELETAL
Increased fat substitution for muscle
Muscle atrophy
Decreased muscular strength and function
Loss of Ca from bones especially in vertebral bodies, increased
propensity to
Fracture.
Deterioration of cartilage
Wear, friction, stiffness of joints

PULMONARY
Reduced chest wall compliances (results from increased calcification of
costal
cartilage and decreased strength of intercostal and
accessory
muscle and diaphragm)
Reduced breathing capacity
Reduced vital capacity
Increased residual volume
Decreased cough reflex
Decreased ciliary activity

CARDIAC
Endocardial thickening
Thickened heart valve
Decreased cardiac output

Vascular
Decreased elasticity of blood vessel, increased BP
Atherosclerotic plaque, ischemia
Increased Peripheral Vascular Resistance (decreased vascular flexibility
Increased efficiency of baroreceptors

RENAL
Decreased blood flow
Reduced GFR (glomerular filtration rate)
Reduced nephron
Decreased creatinine clearance
Increased propensity to toxic effects of drugs
High risk for fluid electrolyte imbalance (dehydration and dizziness
occur even
within short time of food and fluid deprivation.

NERVOUS SYSTEM
Degeneration and atrophy of neurons
Decreased nerve acuity and sensation, unaware of tissue trauma (burns
\
Pressure)
Loss of memory (especially recent memory)
Reduced concentration ability
 Decreased attention span
Decision-making and judgement ability remain intact
Ability to learn is possible up to 200 years of life
Decreased muscle coordination decreases ability to perform fine motor
activities and those requiring coordination.

GASTROINTESTINAL
Minimal loss of digestive enzymes
Decreased absorption
Decreased peristalsis; constipation
Anorexia

ENDOCRINE
Decreased utilization of insulin
Cessation of progesterone
Decreased, then plateau of estrogen
Gradual decline in testosterone
Reduced BMR (basal metabolic rate)

SEXUAL
Minimal change in amount of sexual response
Increase in time for full sexual response
Reduced vaginal lubrication
Increased refractory periods in males

SENSORY
VISION
Loss of accommodation (presbyopia)
Loss of color sensitivity (especially purple)
Decreased dark adaptation
Decreased peripheral vision
Reduced sensitivity to glare

HEARING
Decreased threshold for high frequencies
Loss of hearing of higher pitches
Difficulty in speech discrimination
Degeneration of cochlea and auditory pathways.

TASTE and SMELL (decrease)

Loss of appetite
Prefers salty diet

TOUCH (decreased)
Safety hazard

DENTAL
Gums become less elastic, less vascular
Recede from remaining teeth, exposing areas of teeth not covered with
enamel.
COMMON CHANGES IN AGING

. Ageing process and physiological changes

Changes in nervous system
Ageing is associated with many neurological disorders, as the capacity of
the brain to transmit signals and communicate reduces. Loss of brain
function is the biggest fear among elderly which includes loss of the very
persona from dementia (usually Alzheimer’s disease). Multiple other
neurodegenerative conditions like Parkinson’s disease or the sudden
devastation of a stroke are also increasingly common with age.

Alzheimer’s and Parkinson’s diseases are the progressive

neurodegenerative diseases associated with ageing. Alzheimer’s is
characterized by progressive cognitive deterioration along with a change in
behavior and a decline in activities of daily living. Alzheimer’s is the most
common type of pre-senile and senile dementia. This disease causes nerve
cell death and tissue loss throughout the brain, affecting nearly all its
functions. The cortex in the brain shrivels up and these damages the areas
involved in thinking, planning and remembering. The shrinkage in a nerve
cell is especially severe in the hippocampus (an area of the cortex that
plays a key role in the formation of new memories) as well as the ventricles
(fluid-filled spaces within the brain) also grow larger. Alzheimer’s disease
causes an overall misbalance among the elderly by causing memory loss,
changes in personality and behavior-like depression, apathy, social
withdrawal, mood swings, distrust in others, irritability and aggressiveness.

. Cognition
A mild decline in the overall accuracy is observed with the beginning of the
60s that progresses slowly, but sustained attention is good in healthy older
adults. Cognitive function declines and impairments are frequently
observed among the elderly.

Impaired cognition among elderly is associated with an increased risk of

injuries to self or others, the decline in functional activities of daily living
and an increased risk of mortality. Mild cognitive impairment is
increasingly being recognized as a transitional state between normal
ageing and dementia.

Memory, learning and intelligence

. The brain’s volume peaks at the early 20s and it declines gradually for the
rest of the life. In the 40s, the cortex starts to shrink. , and people start
noticing the subtle changes in their ability to remember or to do more than
one task at a time. It also
affects intelligence, especially fluid intelligence (problem-solving with a
novel material requiring complex relations) declines rapidly after
adolescence. Perceptual motor skills (timed tasks) decline with age.

Special senses
Vision
Ageing includes a decline in accommodation (presbyopia), glare tolerance,
adaptation, low-contrast activity, attentional visual fields and color
discrimination. Changes occur in central processing and in the components
of the eye. These numerous changes affect reading, balancing and driving.
Presbyopia -
 Hearing
Ageing causes conductive and sensory hearing losses (presbycusis); the
loss is primarily high tones, making consonants in speech difficult to
discriminate.
Presbycusis-

Taste acuity
Losing sense of taste is a common problem among adults. Taste acuity
does not diminish but salt detection declines. Perception of sweet is
unchanged and bitter is exaggerated. The salivary glands get affected, and
the volume and quality of saliva diminish. All the changes combine to make
eating less interesting. Studies show that the physiological decline in the
density of the taste acuity and papillae results in a decline of gustatory
function. In fact, studies done on taste dysfunction show that ageing-
associated changes in the density of taste acuity may affect taste function
differently in different regions of the tongue. Taste perception declines
during the

normal ageing process. A study done on the healthy elderly shows that
after about 70
years of age, taste threshold begins to increase resulting in dysgeusia.
Chewing problems associated with loss of teeth and use of dentures also
interfere with taste sensation and cause reduction in saliva production.

. Smell
As we get older, our olfactory function declines. Hyposmia (reduced ability
to smell and to detect odors) is also observed with normal ageing. The
sense of smell reduces with an increase in age, and this affects the ability
to discriminate between smells. A decreased sense of smell can lead to
significant impairment of the quality of life, including taste disturbance and
loss of pleasure from eating with resulting changes in weight and digestion.

It has been reported that more than 75% of people over the age of 80
years have evidence of major olfactory impairment. Many long-term
studies show evidence of a decline in olfaction considerably after the
seventh decade. Another study found that 62.5% of 80–97-year-olds had
olfactory impairments. However, it is widely accepted that taste disorders
are far less prevalent than olfactory losses with age. Ageing also causes
atrophy of olfactory bulb neurons. Central processing is altered, resulting in
decreased perception and less interest in food.

Touch
As we age, our sense of touch often declines due to skin changes and
reduced blood circulation to touch receptors or to the brain and spinal
cord. Minor dietary deficiencies such as the deficiency of thiamine may
also be a cause of changes. The sense of touch also includes awareness of
vibrations and pain. The skin, muscles, tendons, joints and internal organs
have receptors that detect touch, temperature or pain.

A decline in the sense of touch affects simple motor skills, hand grip
strength and balance. Studies have shown that muscle spindle (sensory
receptors within the muscle that primarily detects changes in the length of
this muscle) and mechanoreceptor (a sense organ or a cell that responds
to mechanical stimuli such as touch or sound) functions decline with
ageing, further interfering with balance.

References:
[Link]
%3A_Introductory_Sociology_(OpenStax)/13%3A_Aging_and_the_Elderly/
13.05%3A_Theoretical_Perspectives_on_Aging
[Link]
physiological-changes.