HISTORICAL AND THEORIES OF THE Gerontology

GERONTOLOGICAL NURSING
 is the broad term used to define the study
The history and development of gerontological nursing of aging and/or the aged.
is rich in diversity and experiences, as is the population  -“Gero” –old age “Ology” -study of
it serves. There has never been a more opportune time o Older Age Group:
than now to be a gerontological nurse. No matter where o Young old –ages 6 5-74
nurses practice, they will at some time in their career o Middle Old –ages 75-84
care for older adults. The health care movement is o Old old –85 and up.
constantly increasing life expectancy; therefore, nurses
must expect to care for relatively larger numbers of Gerontophobia
older people over the next decades. With the increasing
numbers of acute and chronic health conditions  Fear of aging. Inability to accept aging adults in
experienced by elders, nurses are in key positions, and the society.
to promote positive aging.
Age Discrimination
The development of gerontological nursing as a specialty
is attributed to a host of nursing pioneers. The majority  Emotional prejudice among the older adult.
of these nurses were from the United States; however,
two key trailblazers were from England. Florence Ageism
Nightingale and Doreen Norton provided early
 Dislike of the aging and the older adult.
insights into the “care of the aged”. Nightingale
was truly the first geriatric nurse; Doreen Norton Geriatrics
focused her career on care of the aged and wrote often
about the unique and specific needs of elders.  Generic term relating to the aged, but
specifically refers to medical care for the aged.

Gerontological Nursing

 The aspect of gerontology that falls within the

discipline of nursing and the scope of nursing
practice.

Demographics of Aging

 “Graying of America” -a phenomenon faced by

all nations, not only the U.S.

Demographic Tidal Wave or A pig in a Python

 A bulge in the population moving slowly through

times.(1946-1964:Baby Boomer)
o 1 out of 8 Americans age: 65 years old
and up.
o 1997 –approximately 10% of the
world’s population (Age 60 and
above)
o It is expected that by 2025, the
number of persons 65 and older in
the United States will increase from
12% of the population (by 2000) to
19%
 In 2005, 13% of the U.S. population was over
age 60
o 18.3 million aged 65–74
o 12.9 million aged 75–84
o 4.7% aged 85 or older
 This number is estimated to increase:
o To 20 million in 2010 (6.8% of total),
o To 33 million in 2030 (9.2%), and
 o To almost 50 million in 2050 (11.6%)
(National Center for Health Statistics
[NCHS], 2006).
 By mid-21stcentury, old people will outnumber
young for the first time in history. All Nations
have an aging population. The greatest
increases will be in developing countries. Asian
countries have less time to prepare for
aging -because aging is occurring more
rapidly than economic growth. Adequate
healthcare services for the elderly may
simply be beyond the reach of many Asian
countries. They may not be able to afford a
large dependent elderly population. They
might not have the necessary institutions &
financial systems in place (e.g., efficient and
well-managed pension and healthcare
programs)(“The Future of Population in Asia:
Asia's Aging Population”; Sidney B. Westley and
Andrew Mason; January 2005)
Weight less, take fewer
medication, have fewer
chronic disease.
Feminization of Later Life
 Women comprise 55% of the older population
 Women have a longer life expectancy
 The average life expectancy of women in the
United States is 81 years
 The average life expectancy of men in the
United States is 75.2 years
 Male exposure to risk factors may account for
the differences
 Increases in female exposures to risk factors will
reduce difference in life expectancy
Majority of older adults enjoy good health but national
surveys reveal that: 20% of adults 65y/o & above report
a chronic disability.

Why the increase?

 Improved sanitation
 Advances in medical care
 Implementation of preventive health services
 In 1900s, deaths were due to infectious diseases
and acute illnesses
 Older population now faced with new challenge
o Chronic disease
o Health care funding
 Average75y/o has 3 chronic diseases& uses 5
types of medications
 95% of health care expenditures for older
Americans are for chronic diseases
 Changes in fertility rates
o Baby boom after WWII (1946 –1964)
 3.5 children per household
o Older population will explode between
2010 to 2030 when baby boomers reach
age 65 Chronic Conditions in seniors
LIFE EXPECTANCY:  80% have at least one chronic condition
 Two of the three leading causes of death
 Philippines: 69 years old
declined by one third
 US : 75.7 years old
o Heart disease and stroke
 Life Span: 115 years
 French women lived for 122 years (19 94) Majority of deaths (US) occur in people 65y/o & older
o Factors that affects life expectancy:
 Improved Sanitation  50% of deaths--caused by heart disease &
 Advances in Medical care cancer
 Implementation of preventive  In the past 50 years ---a noted decline in overall
health services. deaths
 CENTENARIANS o Due to the improvements in the
Predominant in lower prevention & early detection &
educated more treatment of diseases
impoverished, widowed  Heart disease & cancer are two top causes of
and more disabled death, regardless of age, race, gender or
population. ethnicity
  Positive health reports declined with advancing
age
 African American and Hispanic or Latinos -less
likely to report good health than their Caucasian
or Asian counterparts.
Majority of people 75y/o & over
 Remain functionally independent, and
 The proportion of older Americans with
limitations in activities is declining (CDC, 2007a).
70% of Physical Decline Related to Modifiable Risk
Factors
 Smoking
 Poor nutrition
 Physical inactivity
 Failure to use preventative and screening
services
 Reason for the decline in limitations to activity of
Older Adult:
Recent trends in health promotion & disease prevention
activities, such as:
 Improved nutrition,
 Decreased smoking,
 Increased exercise, and
 Early detection & treatment of risk factors such
as hypertension & elevated serum cholesterol
levels.
GERONTOLOGIC NURSE
The nurse must meet all of the following requirements:
 Currently hold an active registered nurse license
in US or its territories.
 Hold a baccalaureate or higher degree in
nursing.
 Have practiced 2000 hours within past 3 years
 Have had 30 contact hours of continuing
education Applicable to
gerontology/Gerontologic nursing within the
past 3 years.
GERONTOLOGIC NURSE PRACTITIONER
The nurse must meet the following requirements:
 Currently hold an active RN license in the US or
its territories
 Hold a master’s or higher degree in nursing.
 Have been prepared as a
 Nurse practitioner in either of the following:
o A GNP master’s degree in Program
 A formal postgraduate GNP track or program
Within a school of nursing granting graduate-
level academic credit
CLINICAL SPECIALIST IN GERONTOLOGIC NURSING
The nurse must meet all the following requirements:
 Currently hold an active RN license in the United
States or its territories
o Hold a master’s or higher degree in
gerontologic nursing
o Hold a master’s or higher degree in
nursing with a specialization in
gerontologic nursing.
 Have practiced a minimum of 12 months after
completion of the master’s degree
 Meet the following requirements in current
practice:
o If a clinical specialist must have
provided a minimum of 800 hours
( post-master’s) of direct client care or
clinical management in Gerontologic
Nursing within the past 24 months
o If a consultant, researcher, educator, or
administrator, must have provided a
minimum of 400 hours
THEORIES OF AGING
PSYCHOSOCIAL THEORIES OF AGING
 Attempt to explain aging in terms of
behaviour, personality and attitude change.
SOCIOLOGICAL THEORIES
 Changing roles, relationship, status and
generational cohort impact the older adult’s
ability to adapt.
A. Activity theory
o Havighurst and Albrecht (1953)
o Remaining occupied and involved is
necessary to satisfy late life.
o Activity engagement and positive
adaptation.
B. Disengagement Theory
o Cumming and Henry (1961 )
o Gradual withdrawal from
society and relationships
serves to maintain social
equilibrium and promote internal
reflection .
C. Subculture Theory
o Rose (1965)
o The elderly prefer to segregate
from society in an aging
subculture sharing loss of status
and societal negativity regarding
the aged.
D. Continuity Theory
 o Havighurst (1960 )
o Also known as Development
Theory-Personality influences
role and life satisfaction and
remains consistent throughout life.
o Personality types
 Integrated
 Armored Defended
 Passive Dependent
 Unintegrated
E. Age Stratification Theory
o Riley (1960)
o Society is stratified by age
groups that are the basis for
acquiring resources, roles, status
and deference from others.
F. Person-Environment Fit Theory
o Lawton (1982 )
o Function is affected by ego
strength, mobility, health,
cognition, sensory perception and
the environment.
Psychological theories
 Explain aging in terms of mental processes,
emotions , attitudes, motivation, and
personality development that is characterized
by life stage transitions.
A. Human needs
o Maslow’s (1954)
o Five basic needs motivate
human behaviour in a lifelong
process toward need fulfilment.-
Self –Actualization
B. Individualism Theory
o Jung (1960)
o Personality consists of an
ego and personal and
collective unconsciousness that
views life from a personal
or external perspective.
C. Stages of Personality Development
o Erikson (1963)
o Personality develops in eight
sequential stages with
corresponding life tasks. The eight
phases, integrity versus despair, is
characterized by evaluating life
accomplishments; struggles include
letting go, accepting care,
detachment, and physical and
mental decline.
D. Life-course /Lifespan Development
o Life stages are predictable and
structured by roles, relationship,
values and goals.
BIOLOGICAL THEORIES OF AGING
 Explains that physiologic processes that change
with aging
STOCHASTIC THEORIES
 Based on random events that cause
cellular damage that accumulates as the
organism ages .
A. Free Radical Theory
o Membranes, Nucleic acids and
proteins are damaged by free
radicals which causes cellular
injury,
o Exogenous Free radicals:
Tobacco smoke, Pepticides,
organic solvents, Radiation , ozone
and selected Medications.
o Older adults are more vulnerable to
free radicals
o Health Teaching :
 Decrease calories in order
to lower weight
 Maintain a diet high in
nutrients using anti-
oxidants
 Avoid inflammation
 Minimize accumulation of
metals in the body that
can trigger free radicals
reactions.
B. Orgel/ Error Theory
o Errors in DNA and RNA synthesis
occur with aging.
C. Wear and Tear Theory
o Cells wears out and cannot function
with aging.-Like a machine which
losses function when its parts wears
off.
D. Connective Tissue Theory/Cross link theory
o With aging, proteins impede
metabolic processes and cause
trouble with getting nutrients to
cells and removing cellular waste
products.
NON STOCHASTIC THEORIES OF AGING
 Based on the genetically programmed
events that cause cellular damage that
accelerates aging of the organism .
A. Programmed Theory
o Cells divide until they are no
longer able to and this triggers
to apoptosis or cell death.
o Shortening of the TELOMERES
–the distal appendages of the
chromosomes arm .
 o TELOMERASE –an enzyme, “cellular
fountain of youth”
B. Gene/Biological Clock Theory
o Cells have a genetically programmed
aging code.

C. Neuroendocrine theory
o Problems with the hypothalamus-
pituitary-endocrine gland feedback
system causes disease.
o Increased insulin growth factor
accelerates aging.
D. Immunologic/Auto immune Theory
o Aging is due to faulty immunological
function, which is linked to
general well-being.