CONCEPTS IN THE CARE OF OLDER CLIENT

1. Gerontology – the study of aging process that draws from the biologic, psychological and
sociologic sciences. Study of all aspects of aging and its consequences
2. Geriatrics – is the practice that focuses on the physiology, pathology, diagnosis and management
of the disorders and diseases of older adults.
3. Aging is the progressive, generalized impairment of function resulting in a loss of adaptive
response to stress and a growing risk of morbidity and mortality.
4. Gerontologic nursing – the field of nursing that relates to the assessment, planning,
implementation and evaluation of older adults in all environments, including acute, intermediate
and skilled care, as well as within the community.
5. Chronological age, defined as the number of years since someone was born.
6. Biological aging, which refers to the physical changes that “slow us down” as we get into our
middle and older years.
• For example, our arteries might clog up, or problems with our lungs might make it more
difficult for us to breathe.
7. Psychological aging, refers to the psychological changes, including those involving mental
functioning and personality that occur as we age. Some people who are 65, for example, can look
and act much younger than some who are 50.
8. Social aging refers to changes in a person’s roles and relationships, both within their networks of
relatives and friends and in formal organizations such as the workplace and houses of worship.
https://www.verywellhealth.com/what-is-chronological-age-2223384

PRINCIPLES IN CARING OF OLDER ADULT

1. The patient’s presentation is frequently complex.

o Example: The elderly patient with vague complaints such as the “WADAO and
“TADAO” sisters. One is “Weak and Dizzy All Over,” and her sister is “Tired and Dizzy
All Over.”
 o Although these complaints may herald serious, life threatening diseases, they are a
source of frustration for many practitioners. Get used to it.
2. Common diseases present unusually in this age group.
o A classic example is an MI presenting with NO chest pain, but with dyspnea or
weakness.
o Faced with either of these complaints, the wise provider will consider cardiac causes.
3. Co-morbid diseases may confound the presentation.
o Consider hypertension, diabetes, and auto-immune and cardiac diseases.
o Chief complaints such as syncope, altered mental status, and fever may be caused or
influenced by these conditions.
4. Polypharmacy is common and may be a factor in the presentation, diagnosis and
management.
o The one- or two-page med list speaks for itself. Accept the fact it will drive you crazy
o The elderly are twice as likely as younger patients to suffer adverse drug effects
o Up to 5% of hospital admissions for the elderly are caused by adverse drug effects.
o Drug actions, including metabolism and clearance, are altered due to physiologic
changes of aging.
5. Recognition of possible cognitive impairment is important.
o 30% to 40% elderly patients will have cognitive impairment
o Failure to recognize this may result in inadequate work-up and improper disposition.
o Mental status assessment, should be a routine part of the examination of the geriatric
patients.
6. Some diagnostic tests may have different normal values.
o Familiarity with the list of unchanged and commonly abnormal laboratory values in the
elderly can prevent costly mistakes due to false assumptions.
7. The likelihood of decreased functional reserve must be anticipated.
o Cardiac output and reserve decline with age.
o The immune system may become sluggish in response to infection.
o Special senses of touch, sight, hearing, taste and smell can be diminished by aging.
8. Social support systems may not be adequate, and patients may need to rely on
caregivers.
o Discharging someone to a poor home environment is a sure way to guarantee a return
back to your urgent care.
o An elderly with no definite source for food to eat, dress to wear, and how to make a
follow-up visits may influence your disposition decision.
9. A knowledge of baseline functional status is essential for evaluating new complaints.
o Information obtained from the patient, family, primary care physician and old records
can be used to establish a baseline.
o Making the assumption that a patient with confusion, aphasia, weakness or acute
delirium has always been that way can lead to missed diagnoses and unwise
disposition.
10. Health problems must be evaluated for associated psychosocial adjustment.
o The highest rate of successful suicide is in elderly men.
 o Be on lookout for depression, anxiety, alcohol and substance abuse even in the geriatric
population.

https://blog.thesullivangroup.com/10-principles-geriatric-care

1_PERSPECTIVE ON AGING

What is the role of the older person in your life?

How do you interact with the older people?
What is their role in your community?

CONCEPTS IN THE CARE OF OLDER CLIENT

1. Gerontology – the study of aging process that draws from the biologic, psychological and
sociologic sciences. Study of all aspects of aging and its consequences
2. Geriatrics – is the practice that focuses on the physiology, pathology, diagnosis and management
of the disorders and diseases of older adults.
3. Aging is the progressive, generalized impairment of function resulting in a loss of adaptive
response to stress and a growing risk of morbidity and mortality.
4. Gerontologic nursing – the field of nursing that relates to the assessment, planning,
implementation and evaluation of older adults in all environments, including acute, intermediate
and skilled care, as well as within the community.
5. Chronological age, defined as the number of years since someone was born.
6. Biological aging, which refers to the physical changes that “slow us down” as we get into our
middle and older years.
• For example, our arteries might clog up, or problems with our lungs might make it more
difficult for us to breathe.
7. Psychological aging, refers to the psychological changes, including those involving mental
functioning and personality that occur as we age. Some people who are 65, for example, can look
and act much younger than some who are 50.
8. Social aging refers to changes in a person’s roles and relationships, both within their networks of
relatives and friends and in formal organizations such as the workplace and houses of worship.
https://www.verywellhealth.com/what-is-chronological-age-2223384

PRINCIPLES IN CARING OF OLDER ADULT

1. The patient’s presentation is frequently complex.
o Example: The elderly patient with vague complaints such as the “WADAO and
“TADAO” sisters. One is “Weak and Dizzy All Over,” and her sister is “Tired and Dizzy
All Over.”
o Although these complaints may herald serious, life threatening diseases, they are a
source of frustration for many practitioners. Get used to it.
2. Common diseases present unusually in this age group.
o A classic example is an MI presenting with NO chest pain, but with dyspnea or
weakness.
o Faced with either of these complaints, the wise provider will consider cardiac causes.
3. Co-morbid diseases may confound the presentation.
o Consider hypertension, diabetes, and auto-immune and cardiac diseases.
o Chief complaints such as syncope, altered mental status, and fever may be caused or
influenced by these conditions.
4. Polypharmacy is common and may be a factor in the presentation, diagnosis and
management.
o The one- or two-page med list speaks for itself. Accept the fact it will drive you crazy
o The elderly are twice as likely as younger patients to suffer adverse drug effects
o Up to 5% of hospital admissions for the elderly are caused by adverse drug effects.
o Drug actions, including metabolism and clearance, are altered due to physiologic
changes of aging.
5. Recognition of possible cognitive impairment is important.
o 30% to 40% elderly patients will have cognitive impairment
o Failure to recognize this may result in inadequate work-up and improper disposition.
o Mental status assessment, should be a routine part of the examination of the geriatric
patients.
6. Some diagnostic tests may have different normal values.
o Familiarity with the list of unchanged and commonly abnormal laboratory values in the
elderly can prevent costly mistakes due to false assumptions.
7. The likelihood of decreased functional reserve must be anticipated.
o Cardiac output and reserve decline with age.
o The immune system may become sluggish in response to infection.
o Special senses of touch, sight, hearing, taste and smell can be diminished by aging.
8. Social support systems may not be adequate, and patients may need to rely on
caregivers.
o Discharging someone to a poor home environment is a sure way to guarantee a return
back to your urgent care.
o An elderly with no definite source for food to eat, dress to wear, and how to make a
follow-up visits may influence your disposition decision.
9. A knowledge of baseline functional status is essential for evaluating new complaints.
o Information obtained from the patient, family, primary care physician and old records
can be used to establish a baseline.
 o Making the assumption that a patient with confusion, aphasia, weakness or acute
delirium has always been that way can lead to missed diagnoses and unwise
disposition.
10. Health problems must be evaluated for associated psychosocial adjustment.
o The highest rate of successful suicide is in elderly men.
o Be on lookout for depression, anxiety, alcohol and substance abuse even in the geriatric
population.

https://blog.thesullivangroup.com/10-principles-geriatric-care

Sociologists’ three different perspectives in aging are:

 Functionalism – the theory that all aspects of a society serve a function and are necessary for
the survival of that society.
 Symbolic interactionism – the view of social behavior that emphasizes linguistic or gestural
communication and its subjective understanding, especially the role of language in the
formation of the child as a social being.
 Conflict theory – first claimed by Karl Marx, is a theory that society is in a state of perpetual
conflict because of competition for limited resources. 

Functionalism:
Disengagement Theory is under this perspective, which suggests that withdrawing from society and
social relationships is a natural part of growing old.

Main points of Disengagement Theory

1. Every person expects to die one day, and because we experience physical and mental decline
as we approach death, it is natural to withdraw from individuals and society.
2. As the older adult withdraw from individual and society, they receive less reinforcement to
conform to social norms. Therefore, this withdrawal allows a greater freedom from the
pressure to conform.
3. Social withdrawal is gendered, meaning it is experienced differently by men and women.
o Men focus on work.
o Women focus on marriage and family
o When men/women withdraw they will be unhappy and directionless until they adopt a
role to replace their accustomed role that is compatible with the disengaged state
(Cummings and Henry 1961).

 Criticisms typically focus on the application of the idea that seniors universally naturally
withdraw from society as they age, and that it does not allow for a wide variation in the way
people experience aging (Hothschild 1975).

Symbolic Interactionism
The social withdrawal that Cummings and Henry recognized (1961), and its notion that elderly people
need to find replacement roles for those they’ve lost, is addressed anew in:

Activity Theory
  According to this theory, activity levels and social involvement are key to this process, and key
to happiness (Havinghurst 1961; Neugarten 1964; Havinghurst, Neugarten, and Tobin 1968).
 According to this theory, the more active and involved an elderly person is, the happier he or
she will be.
 Critics of this theory point out that access to social opportunities and activity are not equally
available to all.
 Moreover, not everyone finds fulfillment in the presence of others or participation in activities.
 Reformulations of this theory suggest that participation in informal activities, such as hobbies,
are what most effect later life satisfaction (Lemon, Bengtson, and Petersen 1972).

Continuity Theory
 According to this theory, the elderly make specific choices to maintain consistency in internal
(personality structure, beliefs) and external structures (relationships), remaining active and
involved throughout their elder years.
 Just like asking yourself what I want to do with myself when I reached that age.
 Will I continue with what I am doing now till I get old?
 This is an attempt to maintain social equilibrium and stability by making future decisions on the
basis of already developed social roles (Atchley 1971; Atchley 1989).
 One criticism of this theory is its emphasis on so-called “normal” aging, which marginalizes
those with chronic diseases such as Alzheimer’s.

2_AGING AS A DEVELOPMENTAL PROCESS

Aging is a gradual, continuous process of natural change that begins in early adulthood. During
early middle age, many bodily functions begin to gradually decline. People do not become old or
elderly at any specific age. Traditionally, age 65 has been designated as the beginning of old age.

Old age can be broken into three stages: The bones become

Young old (55–65 years of age) more brittle as they lose
Middle old (66–85) calcium and other
Old (85 and older). minerals.

 According to Meilaender (2011), aging is a normal stage of life in which our bodies begin to
function less effectively, making us more vulnerable to disease.
 The process of aging is unavoidable and unrelenting in human beings.
  Growing older, or chronological aging, is a relentless and unstoppable process that happens to
all humans.
 As we grow older, we must be aware that we have to pass through different phases or stages
of life.
 A life course is the period from birth to death, including a sequence of predictable life events
such as physical maturation.
 Each phase comes with different responsibilities and expectations, which of course vary by
individual and culture.
 Children love to play and learn, looking forward to becoming preteens.
 As preteens begin to test their independence, they are eager to become teenagers.
 Teenagers anticipate the promises and challenges of adulthood.
 Adults
o Become focused on creating families, building careers, and experiencing the world as
independent people.
o Several adults look forward to old age as a wonderful time to enjoy life without as much
pressure from work and family life.
o In old age, grandparenthood can provide many of the joys of parenthood without all the
hard work that parenthood entails.
o And as work responsibilities subside:
 Old age may be a time to explore hobbies and activities that there was no time
for earlier in life.
o But for other people, old age is not a phase that they look forward to….so getting old
depends on the perspective of the older person.
o Some people fear old age and do anything to “avoid” it by seeking medical and
cosmetic fixes for the natural effects of age.
 These differing views on the life course are the result of the cultural values and norms into
which people are socialized, but in most cultures, age is a master status influencing self-
concept, as well as social roles and interactions.

 Aging is a lifelong process and entails maturation and change on physical, psychological, and
social levels.
 Age, much like race, class, and gender, is a hierarchy in which some categories are more
highly valued than others.
o For example, while many children look forward to gaining independence, Packer and
Chasteen (2006) suggest that even in children, age prejudice leads to a negative view
of aging.
o This, in turn, can lead to a widespread segregation between the old and the young at
the institutional, societal, and cultural levels (Hagestad and Uhlenberg 2006).

Three kinds of aging as distinguished by Gerontologists:

1. Biological factors

 Senescence – 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” (Carnes & Olshansky, 1993, p. 75).
 It is senescence that causes diseases of aging.

a. Primary aging is based on molecular and cellular changes.

Signs of aging (Physical markers of Age)
 Skin becomes thinner, drier, and less elastic.
  Wrinkles form.
 Hair begins to thin and gray.
 Men prone to balding start losing hair.
 gradual decrease in male sexual performance
 declining energy
 food sensitivity
 loss of hearing and vision

At what age does your body start to decline?

Three things tend to happen to our muscles as we age, "The first is muscle strength and
power decline linearly from around 30 or 35 to 50 years, then faster between 50 and 60
or 65, then drop off after 65." (Professor Raeburn, 2006)

b. Secondary aging occurs due to controllable factors such as lack of physical exercise
and poor diet. (Whitbourne and Whitbourne 2010).

 The way people perceive physical aging is largely dependent on how they were socialized.
 If people can accept the changes in their bodies as a natural process of aging, the changes
will not seem as frightening.

2. Psychological
 Psychological aging may be seen as a continuous struggle for identity, i.e. for ii sense of
coherence and meaning in thoughts, feelings and actions. Success depends on a lucky
synchronization of changes through life in different parts of the personal self.
 Male or female, growing older means confronting the psychological issues that come with
entering the last phase of life.
 Moving into adulthood take on new roles and responsibilities as their lives expand, but an
opposite curve can be observed in old age.
 Because of their declining health and limited mobility, most elderly have the tendency to
withdraw from the society – spending most of their time looking back – reflecting on what
they have made out of their lives.

A. Psychological changes: Four common problems that can affect elderly patients
are:
 Depression
 anxiety disorders
 substance abuse
 Psychotic disorders.

3. Social aging refers to the changes in a person's roles and relationships as the person ages.
a. Social change refers to the ways in which a society (rather than an individual)
 Develops over time to replace beliefs
 Attitudes and behavior with new norms and expectations.

b. Social Issues Affecting Older People
 Familial and marital or companion status.
 Living arrangements.
 Financial status.
 Work history.
 Education.
  Typical daily activities (for example, how meals are prepared, what activities
add meaning to life, and where problems may be occurring)
 Need for and availability of caregivers.

Developmental Tasks of an Older Adults

 Adjusting to decreasing health and physical strength

 Adjusting to retirement and reduced or fixed income
 Adjusting to death of a spouse, children, siblings, friends
 Accepting self as aging person
 Maintaining satisfactory living arrangements
 Redefining relationships with adult children and siblings
 Finding ways to maintain quality of life.
(Pearson p.173)

Lesson 3_Demography of Aging and Implications for Health and Nursing Care

Key facts

 Between 2015 and 2050, the proportion of the world's population over 60 years will nearly
double from 12% to 22%.
 By 2020, the number of people aged 60 years and older will outnumber children younger than
5 years.
 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.
 All countries face major challenges to ensure that their health and social systems are ready to
make the most of this demographic shift.
 According to the Office of Disease Prevention and Health Promotion, the first Baby Boomers
(those born between 1946 and 1964) turned 65 in 2011. By 2030, it is projected that more than
60% of this generation will be managing more than 1 chronic condition.
 According to the Global Health and Aging report presented by the World Health Organization
(WHO), “The number of people aged 65 or older is projected to grow from an estimated 524
million in 2010 to nearly 1.5 billion in 2050, with most of the increase in developing countries.”
In addition, by 2050, the number of people 65 years or older is expected to significantly
outnumber children younger than 5 years of age.
The Impact of the Aging Population on Nursing

 We have all heard the term “baby boomer.” Managing these chronic conditions, along with a
patient’s level of disability, will increase the financial demands on our health care system.
 The cost increases with the number of chronic conditions being treated, taking into account the
expected twice as many hospital admissions and physician visits for Baby Boomers by 2030.

 Recent demographic shifts will have major implications for the U.S. healthcare system, both in

terms of the delivery of patient care and the practice of nursing.
 This will lead to extended treatment of long-term chronic conditions
 Challenging the healthcare system's ability to provide efficient care. (Nov 18, 2016)
 Resource needs will continue to increase across all health care settings
 A shortage of health care professionals is expected
 The diversity of caregivers lags behind the growing diversity of patients
 Care has been focused on a single disease versus addressing comorbidity
 The sustainability and structure of federal programs in relation to the increasing aging
population are a concern
 Changes in family structure may lead to fewer family caregivers
 Our health care system also needs to prepare for new technology (especially because of the
higher cost) by increasing training of health care workers and examining how technology will
impact hospital infrastructure.

 https://www.pharmacytimes.com/publications/issue/2016/January2016/The-Aging-
Population-The-Increasing-Effects-on-Health-Care

 Older adults have specific health needs that nurses will need to anticipate and adjust to
accommodate to ensure optimal patient outcomes. Some of those include:
1. Multiple chronic conditions. 
 As the human lifespan increases, so does the prevalence of chronic
illnesses:
 68 percent of older adults have at least two chronic diseases. 2 
 It is estimated that by 2040, almost 160 million people in the US, most
of them elderly, will be living with chronic conditions. 3 
 Managing multiple chronic conditions successfully involves an
awareness of potential behavior changes, medication interaction and
potential side effects, and strategies for relieving pain and other
symptoms.
 These chronic conditions may include:
 Hypertension
 high cholesterol
 arthritis
 diabetes
 dementia
  congestive heart failure

 Heart disease Have been the leading chronic

 Stroke conditions that have had the
greatest impact on the aging
 Cancer
population, especially in high-
income countries

 Incidence of obesity and falls are also increasing.

2. A need for home-based care. 

 Elderly and ill patients will require more in-home care because they
may no longer be able to handle tasks related to patient compliance.
 Elderly and ill patients may need help with:
 Simple physical therapy exercises
 organizing pills
 diet and meal planning and preparation
 administering their own injections
 doing blood-pressure tests
 Other requirements of their care plan.

3. The reality to be able to attend the needs of the elderly:

 Their family members or other caregivers may also need to be
educated on how to help elderly patients fulfill these responsibilities.
 The demographic shift toward a greater population of seniors indicates
a need for more nurses to be educated in Gerontological issues.
 These realities point to specific areas in which nursing is transforming
in order to continue to successfully deliver health care that meets the
specific needs of elderly patients.
 The Geriatric Nursing Education Consortium advocates for enhanced
instruction and coursework in geriatrics in Bachelor of Science in
nursing programs. Nurses who have additional education in this area of
health care will be better able to anticipate, prepare for, and meet the
needs of the influx of geriatric patients.
 Nursing education at the bachelor’s level and up emphasizes
leadership, communication, and critical thinking skills, because these
abilities are necessary in all settings, they are particularly important
when working with geriatric patients.
 Nurses will potentially serve as the primary care provider for senior
patients with multiple chronic issues that do not require substantial
physician intervention, requiring nurses to take on a larger role in
patient care planning and treatment.
 Nurses effective communication skills will be required as family
members step in to help out with care for senior patients.
 Nurses will need to be able to clearly explain treatment plans, answer
questions, and address the concerns of both patients and their
caregivers.
4. Recognizing and Acting on Career Opportunities
 One way that nurses can prepare for this demographic shift is to
proactively consider potential areas for professional development and
opportunity.
 Nurses may consider specializing in geriatrics or related fields to fill the
need for expertise and leadership in these areas.
 Nurses may also focus on designing clinical and administrative home
care plans for elderly patients as part of a health care organization’s
overall strategy for effective patient care delivery.
 Nurses can focus on educating future generations of nurses in the
treatment of senior patients.
 Make sure you are prepared to handle the demands an aging
population will make on the nursing profession.

https://online.stmary.edu/msn/resources/impact-of-aging-population-on-nursing

Title of the Lesson: Lesson 4_Global Aging and Aging in the Philippines
Duration: one (1) hour
Lesson Proper
 
What is global aging?
Unprecedented changes are occurring worldwide as fertility and mortality rates decline in most
countries and as populations age.

The global population aged 60 years or over numbered 962 million in 2017, more than twice as large
as in 1980 when there were 382 million older persons worldwide. The number of older persons is
expected to double again by 2050, when it is projected to reach nearly 2.1 billion.

Is Global Aging a major problem?

The global population is aging—by 2050, one in six people will be over the age of 65. As our aging
population nears retirement and gets closer to cashing in their pensions, countries need to ensure
their pension systems can withstand the extra strain.
 
Why is aging population important?
Population aging now affects economic growth, formal and informal social support systems, and the
ability of states and communities to provide resources for older citizens. We can think about preparing
for older age on both an individual and societal level.
 
What country has the most senior citizens?
Ran Country # total population (in millions)
k

1 China 1398.03

2 India 1391.89
3 United 329.15
States

4 Japan 126.18

Managing the risks

 There are many other social and economic risks that we can come to expect as the global
population continues to age:

 The Squeezed Middle: With more people claiming pension benefits but less people
paying income taxes, the shrinking workforce may be forced to pay higher taxes.
 Rising Healthcare Costs: Longer lives do not necessarily mean healthier lives, with
those over 65 more likely to have at least one chronic disease and require expensive,
long-term care.
 Economic Slowdown: Changing workforces may lead capital to flow away from rapidly
aging countries to younger countries, shifting the global distribution of economic power.

 The strain on pension systems is perhaps the most evident sign of a drastically aging
population. 

 Although the average retirement age is gradually increasing in many countries, people
are saving insufficiently for their increased life span—resulting in an estimated $400
trillion deficit by 2050.

 Pensions under pressure

 A pension is promised, but not necessarily guaranteed. 

 Any changes made to existing government programs can alter the lives of future
retirees entirely—but effective pension reforms that lessen the growing deficit are
required urgently.

 Towards a better system

 Certain countries are making great strides towards more sustainable pension systems,
and the Global Pension Index suggests initiatives that governments can take into
consideration, such as:

o Continuing to increase the age of retirement

o Increasing the level of savings—both inside and outside pension funds.
o Increasing the coverage of private pensions across the labor force, including
self-employed and contract employees, to provide improved integration
between various pillars
o Preserving retirement funds by limiting the access to benefits before the
retirement age.
 o Increasing the trust and confidence of all stakeholders by improving
transparency of pension plans.
o Although 59% of employees are expecting to continue earning well into their
retirement years, providing people with better incentives and options to make
working at an older age easier could be crucial for ensuring continued economic
growth.

 Live long and prosper

 As 2020 marks the beginning of the Decade of Healthy Ageing, the world is undoubtedly
entering a pivotal period.

 Countries all over the world face tremendous pressure to effectively manage their aging
populations, but preparing for this demographic shift early will contribute to the
economic advancement of countries, and allow populations—both young and old—to
live long and prosper.

 Unprecedented changes are occurring worldwide as fertility and mortality rates decline
in most countries and as populations age. 

 These changes affect individuals, families, governments, and private-sector

organizations as they seek to answer questions related to health care, housing, social
security, work and retirement, caregiving, and the burden of disease and disability.

A growing elderly population in the Philippines

 Republic Act 9994, also known as the Expanded Senior Citizens Act of 2010, defines senior
citizens as individuals aged 60 years old and above. 
 According to the Philippine Statistics Authority, there were 7.5 million senior citizens in the
country, accounting for 7.5 percent of the total population, as of its latest census in 2015.
 Quoting a study conducted by the Coalition of Services of the Elderly, former senator Benigno
“Bam” Aquino IV said there are already eight million senior citizens in the country and only 32
percent or 2.5 million receive social pension of just P500 a month, while 38 percent or more
than three million do not receive any pension at all.

 
 

 In 2018, the Department of Social Welfare and Development disclosed that P19.28 billion had
been allocated for about three million elderly. 
 But RA 9994 specifies that seniors qualified to receive the P500 monthly pension under the
Social Pension Program of the DSWD are those who are frail, sickly or with disability; without
any pension from other government agencies; and without a permanent source of income or
source of financial assistance/compensation to support their basic needs.

Self-Check 4 
1. What is global aging?
2. Why is aging population important?
 3. What Republic Act defines senior citizens as individuals aged 60 years old and above. It is
also known as the Expanded Senior Citizens Act of 2010

Answer:
1. Unprecedented changes are occurring worldwide as fertility and mortality rates decline in most
countries and as populations age.
2. Aging population is important because it affects economic growth, formal and informal social
support systems, and the ability of states and communities to provide resources for older
citizens.
3.  
4. Republic Act 9994

rs To Perpetuity

 
 

1. PHYSIOLOGICAL CHANGES.

Describe and identify at least one clinical implication of each of the following key aspects of physiologic aging: the rule of
fourths, normal physiologic changes, functional reserve, reduced stamina and fatigue, increased physiologic diversity,
the relationship between environment and function, and immobility in older persons.

It is evident even from casual observation of physical activities, such as walking, that elderly people exhibit a
deterioration of physiological processes.
 Visual and hearing problems
 smell and taste losses
 susceptibility to illnesses
 Leading Cause of Death
o heart diseases
o cancer
o pneumonia
2. PHYSICAL THEORIES OF AGEING
 Cross link theory
 Free radical theory
 Immunologic theory
 Wear and tear theory
https://www.physio-pedia.com/Theories_of_Ageing
3. Cognitive Changes in elderly
 Decline in mental processes – may experience memory lapses or disorientation.

SOCIAL THEORIES OF AGING

 Disengagement Theory
 Activity Theory
 Social breakdown Reconstruction Theory

4. Social Theories of Aging

 Social Breakdown -Reconstruction Theory
 This theory states that aging is promoted through negative psychological functioning brought about by the
negative views of the society about elderly and inadequate provision of services for them.
 Social reconstruction can occur by changing the society’s view of the elderly and by providing adequate social
services for them.

5. Society provides inadequate support services, and funds for the elderly.
 Society views elderly as incompetent; obsolete Society develops label for the elderly: useless; ineffective;
helpless
 Elderly’s skills deteriorate
 Elderly labels self as incompetent

6. What Elderly wants?

 Society provides support systems for the elderly: family support; housing; health services; economics; nutrition and
social services.
 Society views elderly as competent; important Society develops positive label for the elderly: helpers; self-
controlled; wise; competent
 Elderly’s skills improve
 Elderly labels self as competent

7. Issues Facing the Elderly ABUSE

 “Having someone else look after aging parents is a tough decision to make, and is made even tougher by fact that
one of four nursing homes has been blamed for the death or serious injury to a resident each year, according to
government figures.”
 It can happen in the family •It can happen in nursing homes
o Physical
o psychological (like verbal abuse)
 NEGLECT! When people who are supposed to care for them ignore their needs and concerns
o Sexual
o Financial
o Self-neglect

8. Issues Facing the Elderly

 LONELINESS
o Death of a husband or wife and many friends.
o Children are busy with work and may not even come to visit them.
o Grandchildren are busy with school.
o Physically weak elderly may feel that they are burden so they try to stay away even if people are around.
o Loneliness leads to depression – they feel alone and unproductive.

 POVERTY
 o They cannot earn anymore and they do not have money.
o May receive retirement pension but may not also be enough because of their increasing medical needs.
o As such many even try to continue working even after reaching the retirement age.

 HEALTH
o Diminished sensory and motor abilities
o Tendency to acquire various illnesses such as heart disease, Alzheimer's, cancer, etc.

 DISCRIMINATION
o Job discrimination – employers prefer younger applicants because ….inexperienced workers have cheaper
salaries …employers believe that the elders could only stay in work for a short time because of their
declining physical condition ….elderly are thought of as slower and less capable.
o Social discrimination – maybe excluded from family or community services because they are seen as
incapable. Medical Discrimination - Some doctors treat them without much care because they think they
don’t deserve such because they are already old.

9. EFFECTS OF AGEING
A. PHYSICAL
1. INTEGUMENTARY
 Decreased skin turgor
 Dry, itchy, cracked skin
 Easy bruising and tearing of the skin
 Inadequate sweating
 Increased nail thickness and decreased nail growth
 Less elastic and dry
 Loss of elasticity and subcutaneous fat
 Loss of fat tissue-wrinkling
 Loss of pigment in hair and skin
 No new growth of skin cells
 Reduction in the blood flow of the skin
 Seborrheic dermatitis and keratosis formation
 Thickening of nails
 Thinning of hair
 Thinning of the epidermis

2. Musculoskeletal
 Brittle bones
 Change of gait, with shortened step and wider base
 Decrease in deep tendon reflexes
 Decrease in muscular coordination
 Decrease in physical strength
 Decrease in strength
 Decreased mobility, range of motion, flexibility, and stability
 Gradual shortening of vertebrae
 Increased brittleness of the bones
 Increased stiffness
 Joint capsule components deteriorate
 Joint pain and stiffness
  Kyphosis of the dorsal spine
 Muscle mass decreases
 Muscles atrophy
 Posture and stature changes causing a decreased in height
 Slow overall mobility
 Weight loss

3. Neurologic
 Changes in mental status
 Changes in sleep patterns, such as decreased total sleep with earlier risings
 Decreased blood flow to the brain dizziness, memory loss
 Decreased temperature regulation
 Decreased reflux actions
 Difficulty with fine motor movement
 Dizziness and syncope
 Increased susceptibility to hypothermia and hyperthermia
 Loss of balance
 Peripheral numbness
 Slight tremors
 Slow response to stimuli
 Slowed reflexes

4. Cardiovascular system
 Atherosclerosis
 Decreased ability to cough and expectorate sputum
 Decreased cardiac output
 Decreased compliance of the heart muscle
 Decreased depth of respirations and oxygen intake
 Decreased efficiency of blood return to the heart and decreased cardiac output.
 Decreased heart rate
 Decreased resting heart rate
 Decreased rib mobility and lung tone
 Decreased size and number of alveoli
 Decreased strength and function of respiratory muscles
 Decreased stretch and compliance if the chest wall
 Energy and endurance diminish
 Fatigue due to less myocardial perfusion
 Heart valve become thicker and more rigid
 Increased blood pressure
 Lowered tolerance to exercise
 Peripheral edema due to venous stasis
 Risk of IHD
 Susceptible of postural hypotension

5. Respiratory system
 Increased respiratory rate
 Decreased pulmonary elasticity
 Accumulation of secretion
  Chronic respiratory diseases
6. Gastro intestinal system
 Decreased absorption of carbohydrates, proteins, fats and vitamins
 Decreased absorption of nutrients
 Decreased appetite, thirst, and oral intake
 Decreased lean body weight
 Decreased need for calories
 Decreased peristalsis-Constipation
 Decreased secretion of gastric juice & enzymes
 Decreased stomach-emptying time
 Difficulty in chewing and swallowing food
 Digestive disturbances
 Dysphagia/regurgitation
 Increased tendency toward constipation
 Tooth decay
 Tooth loss

7. URINARY SYSTEM
 Decreased UOP
 Fluid & electrolyte imbalances
 Frequency in urination due to decreased bladder capacity
 Incontinence
 UTI due to incomplete emptying
 Prostate enlargement in male

8. REPRODUCTIVE SYSTEM
 Male slow production of sperm decreased libido problems of erection small & less firm sperm
 Female menopause sagging of breast decreased libido decreased vaginal secretions-dyspareunia
uterine prolapse
 Decreased testosterone production and decreased size of testes
 Changes in the prostate leading to urinary problems
 Decreased secretion of hormones with the cessation of menses
 Vaginal changes, including decreased muscle tone and lubrication

9. HEMATOLOGICAL AND IMMUNE SYSTEM

 Hemoglobin and hematocrit levels remain within normal range but average toward the low end of
normal
 Lymphocyte counts tend to be low.
 Decreased resistance to infection and disease
 Prone to increased blood clotting

10. ENDOCRINE SYSTEM

 Decreased secretion of hormones, with specific changes related to each hormone function
 Decreased metabolic rate
 Decreased glucose tolerance
 Resistance to insulin in peripheral tissues

11. RENAL SYSTEM

 Decreased kidney size, function, and ability to concentrate urine
  Decreased glomerular filtration rate
 Decreased capacity of the bladder
 Increased residual urine and increased incidence of infection and incontinence
 Impaired medication excretion

12. SPECIAL SENSES

 Decreased visual acuity
 Decreased accommodation in eye
 Decreased peripheral vision and increased sensitivity to glare
 Increased adjustment time to changes in light
 Presbyopia and cataract formation
 Possible loss of hearing ability
 Inability to discern taste of food
 Decreased smell acuity
 Changes in touch
 Decreased pain awareness
13. Special senses
 Diminished vision
 Diminished hearing
 Decreased smell &taste
 Decreased cutaneous sense
 Loss of balance of the body


B. PSYCHOSOCIAL ASPECTS OF AGING

 Adjustment to retirement and loss of income
 Changes in role function
 Coping with change and new life situations
 Changes in social life
 Diminished quantity and quality of relationships
 Coping with loss
 Adjustment to potential deterioration in physical and mental health and well-being
 Threat to independence functioning
 Loss of skills and competencies developed early in life

C. CONCERNS OF THE OLDER POPULATION

 Adequate income
 Functional limitations from chronic illness or disability
 Ability to maintain independence
 Becoming a burden to loved ones
 Isolation
 Dependence on governmental and social systems
 Access to social support system

D. ELDER ABUSE AND NEGLECT

A. Description
1. Involves physical, psychological, financial, and social abuse.
2. Can involve a violation of the client’s rights
3. Individuals at most risk include those who are dependent because of immobility or altered mental status
4. Factors that contribute to abuse and neglect include:
  Long-standing family violence
 Caregiver stress
 Individual’s increasing dependence

B. Types
1. Abuse
a. The willful infliction of pain, injury or mental anguish
b. Unreasonable confinement or willful deprivation of services, including medical care
c. Can include:
 failure to prevent injury
 verbal assaults
 the demand to perform demeaning tasks
 theft
 mismanagement of personal belongings
2. Neglect: the lack of provision of services necessary for physical or mental health
3. Self-neglect
a. The person chooses to avoid medical care or other services that would promote optimal functioning
b. Unless declared legally incompetent, an individual has the right to refuse care
4. Exploitation: illegal or improper use of individual’s resources
5. Assessment of abuse and neglect
 Abrasions, lacerations, bruises
 Burns
 Sprains, fractures, dislocations
 Pressure sores
 Injuries inconsistent with history
 Frequent falls
 untreated medical problems
 inappropriate dress and poor hygiene
 Excessive drowsiness
 overmedication or undermedication
 Malnutrition
 Dehydration
 expression of fear in response to touch

C. Implementation
 Assess for signs of abuse and neglect
 Report cases of abuse and neglect
 Initiate protective services
 Assess for dysfunctional family systems
 Promote family functioning and initiate appropriate contact with resources.

USE OF RESTRAINTS
 Physical restraints used to prevent injury are to be avoided, and alternate methods to provide safety must be
assessed prior to the used of physical restraints.
 A physician’s order must be obtained for the use of restraints.
 Discuss the used of restraints with the patient and family.
 Obtain client and family consent for the use of restraints.
 Use the least restrictive device for restraint
 Use only restraint that have been manufactured as safe restraint
 Observed the client frequently, and monitor for alterations in skin integrity and circulation as a result of the restraint
  Restraints need to be removed at frequent intervals (per agency policy) to assess for complications and to allow for
mobility and range of motion
 Always follow the institutional policy regarding the use of restraints

MEDICATIONS
A. Major problems with prescription medications include:
 Adverse effects
 Medication interactions
 Medication errors
 Noncompliance
 Cost
B. Determine the client’s use of over-the-counter medications
C. Keep the use of the medication to the minimum
D. Medication dosages are normally prescribed at one third to one half of the normal adult dosages
E. Closely monitor for adverse effects and response to therapy because of the increased risk of medication toxicity
F. Note that a common sign of adverse reaction in the elderly is an acute change in mental status
G. Assess for medication interaction in client taking multiple medication
H. Advise the client to use one pharmacy and to notify the consulting physicians of the medications taken
I. Administration of medication
 Place the client in a sitting position
 Check for mouth dryness because medication mat stick and dissolve in the mouth
 Administer liquid preparations if the client has difficulty swallowing tablets
 Crush tablets if necessary and give with textured food (nectar, apple sauce)if not contraindicated
 Do not crush enteric coated tablets and do not open capsules
 If administering a suppository, do not insert suppository immediately after removing from the refrigerator
 A suppository may take longer to dissolve because of decreased body core temperature
 When administering parenteral medication, monitor the site because it may ooze medication or bleed because
of decreased tissue elasticity
 Do not use an immobile limb for administering parenteral medication
 Monitor client compliance with taking prescribed medications
 Monitor for safety in correctly taking medications
 Use a medication cassette to facilitate proper administration of medication

DEMENTIA
A. Description
1. Organic syndrome with progressive deterioration in intellectual functioning
2. Long- and short-term memory loss occurs, with impairment in judgment, abstract thinking, problem solving
ability, and behavior
3. Results in a self-care deficit
4. The most common type of dementia is Alzheimer’s disease

B. ALZHEIMER’S DISEASE
1. An irreversible form of senile dementia
2. Individuals with Alzheimer’s disease experience cognitive deterioration and progressive loss of ability to carry
out the activities of daily living
3. The client experiences a steady decline in physical and mental functioning that frequently requires caregivers to
seek outside resources for assistance

C. ASSESSMENT
1. Begins with mild memory impairment
2. The client has difficulty remembering names, appointments, and where things are
 3. The client is indifferent and occasionally irritable
4. As the disease progresses, moderate memory impairment particularly of recent events occurs
5. The client develops a decrease in orientation, is restless and paces about.
6. As the progression of the disease continues, the client develops severely impaired cognitive function,
disorientation, delusions, and agitation
7. Limb rigidity and flexion posture
8. Urinary and fecal incontinence

D. IMPLEMENTATION
1. Identify and reinforce retained skills
2. Assist the client and family members to manage memory deficits and behavior changes
3. Encourage the family members to express feelings about caregiving
4. Provide caregiver support and identify the resources and support groups available.
5. Provide continuity of care
6. Orient the client to the environment
7. Furnish the environment with familiar possessions
8. Acknowledge the client’s feelings
9. Monitor activities of daily living
10. Remind the client how to perform self-care activities
11. Maintain independence as much as possible
12. Provide consistent routines
13. Provide exercise with supervision, such as walking with an escort
14. Avoid activities that tax the memory
15. Allow plenty of time to complete the task
16. Use constant encouragement in a step-by-step approach
17. Provide mental stimulation with simple games or activities
18. Provide activities that distract and occupy time, such as listening to music, coloring and watching TV
E. IMPLEMENTATION FOR SPECIFIC BEHAVIOR
1. Wandering
a. Provide a safe environment
b. Prevent unsafe wandering
c. Provide close supervision
d. Close and secure doors
e. Use identification bracelets and electronic surveillance device
2. Communication
a. Adapt to the communication level of the client
b. Use a calm and reassuring voice
c. Use pantomime gestures if the client is unable to understand spoken words
d. Use slow, clear, verbal communication techniques
e. Use short words and simple sentences
f. Call the client by name, identify self, and wait for a response
g. Ask only one question at a time and give one direction at a time
h. Repeat question if necessary, but do not rephrase because this may cause confusion in the client
i. Stand directly in front of the client and maintain eye contact
j. Listen and observe the emotion expressed by the client.
3. Impaired judgment
a. Eliminate throw rugs, toxic substances, dangerous electrical appliances, or any other objects that can
present a risk of injury
b. Reduce hot water heater temperature
4. Altered thought processes
a. Orient the client frequently
b. Place a calendar and a clock in a visible place
 c. Call the client by name
d. Place familiar objects in the room
e. Maintain familiar routines
f. Make tasks simple and allow time for the client to complete the task
g. Allow the client to reminisce
5. Altered sleep pattern
a. Allow the client to wander in a safe place until he or she becomes tired
b. Prevent shadows in the room
c. Avoid the use of hypnotics and sedatives because they cause confusion and aggravate the sundown effect
6. Agitation
a. Assess the precipitant of the agitation
b. Reassure the client
c. Remove items that can be hazardous during the time of agitation
d. Approach the client slowly and calmly from the front; then speak, gesture, and move slowly
e. Use touch gently
f. Take the client to a less stressful environment
g. Distract the client with questions about the problem, and gradually turn the attention to something else
h. Do not argue with the client or restraint the client

DEPRESSION
A. Description
1. A functional disorder of mood that is not linked with aging
2. The depression may be manifested by cognitive impairment or may be the cause of a decline in mental status
3. Depression can be identified by feelings of sadness, hopelessness, and worthlessness, and decreased interest
in activities
B. Assessment
1. Difficulty of concentrating
2. Feeling of adequacy and sadness
3. Difficulty of sleeping or excessive sleeping
4. Weight gain or loss
5. Vegetative symptoms
6. Constipation
7. Loss of interest in activities
8. Decreased endurance and energy
9. Preoccupation with physical health
10. Thoughts of death or suicide

C. Implementation
1. Assess for signs associated with depression
2. Monitor for the risk of suicide and notify the physician
3. Implement safety precautions for suicide risk
4. Provide and reinforce positive experiences
5. Provide variation in the daily schedule, but limit changes, because change is anxiety producing for the older
client
6. Allow the client to talk and reminisce
7. Maintain reality
8. Initiate counselling as appropriate

PAIN
A. Description
1. Pain can occur from numerous causes and most often occurs in the musculoskeletal system as a result of
degenerative changes
 2. The failure to alleviate pain in the older adult client can lead to functional limitations affecting the ability to
function independently
B. Assessment
1. Agitation
2. Moaning
3. Crying
4. Restlessness
5. Verbal reporting of pain

C. Implementation
1. Monitor the client for signs of pain
2. Identify the pattern of pain
3. Identify the precipitating factors for pain
4. Monitor the impact of the pain on activities of daily living
5. Provide pain relief through measures such as:
6. distraction
7. Relaxation
8. Massage
9. Biofeedback
10. Administer pain medication as prescribed and instruct the client to their use
11. Evaluate the effects of pain –reducing measures

IMPAIRED VISION AND HEARING

A. Description
1. Because of physiological changes that occur with the aging process, clients developed decreased visual and
hearing acuity
2. Such condition as loss of sight and hearing, cataracts, glaucoma, and presbyopia can develop
B. Assessment for Cataract
1. Opaque or cloudy white pupil
2. Gradual loss of vision
3. Blurred vision
4. Decreased color perception
5. Vision that is better in dim light with pupil dilation
6. Photophobia
7. Absence of red reflex

ALTERED SKIN INTEGRITY

A. Description
1. Physiological changes include:
 thinning of the epidermis
 Easy bruising and tearing of the skin
 Reduction in blood flow to the skin
2. Altered skin integrity often occurs in the bedridden or immobile client
B. Assessment and implementation: regarding Decubitus

IMPAIRED MOBILITY
A. Description
1. Usually occurs as a result of multiple types of problems and diseases
2. Impaired mobility can occur as a result of decreased physical function related to:
 Cardiovascular
 Pulmonary
 Musculoskeletal
  Neurological disease
 Accidents
B. Assessments
1. Existing disease process
2. Ambulation ability
3. Ability to care for self

C. Implementation
1. Assess risk of injury
2. Determine cause of mobility restriction
3. Assess mobility restrictions related to disease process
4. Monitor limitations related to all self-care activities
5. Maintain activity through exercise and guided activities
6. Provide rest periods between activities and in the afternoon
7. Break activities up to last no longer than 20 minutes
8. Perform activities that require a high level of energy in the morning
9. Determine the best assistive aid or adaptive device for client
10. Demonstrate and monitor the safe use of the assistive device
11. Monitor skin integrity
12. Provide range-of-motion exercise to prevent deformities and contractures
13. Monitor respiratory status and encourage deep breathing to promote lung expansion
D. Read on information on canes and walkers

FRACTURED HIP
A. Description
1. The most disabling type of fracture for the older adult
2. Usually caused by falls with direct trauma to the hip
B. Assessment and Implementation
1. Refer to musculoskeletal system specifically the site usually affected in older adults

PNEUMONIA
A. Description
2. The causes of pneumonia in older client include:
3. The effects of the aging process on the respiratory system
4. Weakness and the inability to cough
5. Malnutrition
6. Use of medication
B. Assessment
1. Acute change in mental status
2. Confusion
3. Cough
4. Fever
5. Increased respiratory rate
6. Chest pain
7. Dyspnea
8. Chest radiographic information
C. Implementation
1. Monitor vital signs
2. Assess lung sounds
3. Administer oxygen as prescribed
4. Administer respiratory therapy as prescribed
5. Administer antibiotics as prescribed
 6. Provide adequate rest with some progressive activity
7. Mobilize the bedrest client as soon as possible
8. Provide adequate nutrition and hydration
9. Encourage the client to receive immunization against influenza and pneumococcal pneumonia to prevent
infection

CULTURAL FACTORS. 
Culture encompasses the set of beliefs, moral values, traditions, language, and laws (or rules of behavior) held in common
by a nation, a community, or other defined group of people.

RISK FACTORS FOR OLDER PEOPLE

Anxiety and depression in older people may occur for different reasons, but physical illness or personal loss can be
common triggers.

Factors that can increase an older person's risk of developing anxiety or depression include:
1. an increase in physical health problems/conditions e.g. heart disease, stroke, Alzheimer's disease
2. chronic pain
3. side-effects from medications
4. losses: relationships, independence, work and income, self-worth, mobility and flexibility
5. social isolation
6. significant change in living arrangements e.g. moving from living independently to a care setting
7. admission to hospital
8. Particular anniversaries and the memories they evoke.
9. Everyone is different and it's often a combination of factors that can contribute to a person developing anxiety or
depression.

"Geriatric syndrome" is a term that is often used to refer to common health conditions in older adults that do not fit into
distinct organ-based disease categories and often have multifactorial causes.
The list includes conditions such as:
 Cognitive impairment
 Delirium
 Incontinence
 Malnutrition
 Falls
 gait disorders
 pressure ulcers
 sleep disorders
 sensory deficits
 fatigue
 dizziness

These conditions are common in older adults, and they may have a major impact on quality of life and disability. Geriatric
syndromes can best be identified by a geriatric assessment.

 Geriatric assessment is a diagnostic process, the term is often used to include both evaluation and management.
 Geriatric assessment is sometimes used to refer to evaluation by the individual clinician (usually a primary care
clinician or a geriatrician) and at other times is used to refer to a more intensive multidisciplinary program, also
known as a comprehensive geriatric assessment (CGA).
 Comprehensive geriatric assessment (CGA) is defined as a multidisciplinary diagnostic and treatment process that
identifies medical, psychosocial, and functional limitations of a frail older person in order to develop a coordinated
plan to maximize overall health with aging.