Gerontolgical Nursing

Concepts, Principles and Theories in the Care of Older Adults

A. Perspectives on Aging
1. Aging is a Developmental Process
a) Aging

 Aging is a natural process common to all living organisms

 Various factors influence the aging process

 Unique data and knowledge are used in applying the nursing process to the older
populations

 The elderly share the similar self-care and human needs with all other human beings

 Gerontological Nursing strives to help older adults achieve optimum levels of

physical, psychological, social and spiritual health so that they can achieve
wholeness

b) Understanding Aging as a Developmental Process

According to the American Journal of Clinical Nutrition, the human life span, or the
maximum length of time possible for human life, is 130 years.

Cycle
of Life
 Throughout the human life cycle, the body constantly changes and goes through
different periods known as stages. The major stages of the human life cycle are
defined as follows:

 Pregnancy. The development of a zygote into an embryo and then into a fetus in

preparation for childbirth.

 Infancy. The earliest part of childhood. It is the period from birth through age one.
 Toddler years. Occur during ages two and three and are the end of early childhood.

 Childhood. Takes place from ages four to eight.

 Puberty. The period from ages nine to thirteen which is the beginning of

adolescence.
 Older adolescence. The stage that takes place between ages fourteen and eighteen.

 Adulthood. The period from adolescence to the end of life and begins at age
nineteen.

 Middle age. The period of adulthood that stretches from age thirty-one to fifty.
 Senior years, or old age. Extend from age fifty-one until the end of life.

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

The country consists of approximately 103 million inhabitants, with less than 5% of the
population 65 years and older (Central Intelligence Agency, 2016). Currently, the age structure
of the Philippines resembles many other developing countries because there are a greater
proportion of younger Filipinos in comparison to older Filipinos. Despite the larger number of
young Filipinos, the 60 years and older population of the Philippines is expected to increase by
4.2%, whereas the 80 years and older population is expected to increase by 0.4% from 2010 to
2030 (Help Age Global Network, 2017b). In contrast, the 60 years and older population of the
United States will increase 5.4% from 2010 to 2030 (Help Age, 2015). The Philippines’s
population increased by over 35% over the last two decades with the older adult population (60
years and older) expected to overtake those aged 0–14 years old by 2065 (Help Age Global
Network, 2017a). Currently, life expectancy of Filipinos is 57.4 years for males and 63.2 years for
females. Females are projected to expect an increase of 4.0 years in life expectancy and males
an increase of 4.7 years in life expectancy by 2030 (Help Age Global Network, 2017b). The
improvement in life expectancy can be attributed to advances in public health in the Philippines,
which have eradicated many of the diseases that once caused earlier mortality in Filipinos
(Coscoluella & Faustino, 2014).
1. Global Aging

The world is on the brink of a demographic milestone. Since the beginning of recorded
history, young children have outnumbered their elders. In about five years’ time, however,
the number of people aged 65 or older will outnumber children under age 5. Driven by
falling fertility rates and remarkable increases in life expectancy, population aging will
continue, even accelerate (Figure 1). 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.

The remarkable improvements in life expectancy over the past century were part of a shift
in the leading causes of disease and death. At the dawn of the 20th century the major
health threats were infectious and parasitic diseases that most often claimed the lives of
infants and children. Currently, noncommunicable diseases that more commonly affect
adults and older people impose the greatest burden on global health.

Figure 1

2. Aging in the Philippines

This entry provides the distribution of the population according to age. Information is
included by sex and age group as follows: 0-14 years (children), 15-24 years (early working
age), 25-54 years (prime working age), 55-64 years (mature working age), 65 years and over
(elderly). The age structure of a population affects a nation's key socioeconomic issues.
Countries with young populations (high percentage under age 15) need to invest more in
schools, while countries with older populations (high percentage ages 65 and over) need to
invest more in the health sector. The age structure can also be used to help predict potential
political issues.

a) Living arrangements of the elderly in the Philippines

Data were obtained from the 1996 Survey on the Near Elderly and Elderly, among a
nationally representative sample of 2285 persons aged over 50 years, and 1131
aged over 60 years. Findings indicate that:

 5.5% of the elderly lived alone,

 7.9% lived with a spouse only,
 and 9.8% lived with persons other than a spouse or children.
 28.4% lived with single children, and
 28.5% of elderly persons and couples lived with 1 or more ever-married
children.
 13.4% of persons and couples lived with never- and ever-married children.

There were more rural people who lived alone. Among those living alone, a high
proportion were separated or divorced women. About 1 in 4 elderly believed that
the widowed should live alone. About 1 in 3 believed that a widow should live with a
child.

 About 40% of married persons believed that the best arrangement was living by
themselves, even though few did so. The elderly living with a child tended to
own the house.
 69.2% coresided with a child, and
 76.8% coresided or lived next door to a child. Coresidence with a child was
unaffected by the number of living children. Coresidence increased with age and
was more common among males, married, and urban residents.
 28.6% lived with a single son and
 21.7% lived with a single daughter. More parents received money from a non-
coresident child. The proportion of parents who gave money to children was
lower than the proportion who received money from children.
 92.5% of the elderly cared for a grandchild.
 A large proportion of elderly both accepted the concept of homes for the aged
and would live in an institutional setting.
b) Terminologies

 Centenarian – a person who has lived to be 100 years of age

 Genrontology – the study of the aging process
 Geriatrician – a physician who has special, formal post graduate education in
geriatric medicine
 Geriatrics – the specialty of geriatric medicine
 Life Expectancy – the number of years one can be expected to live based on a
specific age or year of birth according to statistical probability
 Life Span – the total number of years the human is likely to live or has lived
 Longevity – living a long time

c) Chronological Classifications of Age Group

Age Classification
65-74 Young Old
75-84 Old
85-94 Old-old
Elite-
old/chronologically
95 and older
gifted
C. Impact of Aging Members in the Family

Whether you and your parents live together or thousands of miles apart, you might find yourself
increasingly responsible for their day-to-day care. Caring for aging parents has multiple impacts
on your family life, including emotional, physical, financial and structural effects.

1. Emotional - Caring for your aging parents prompts a range of impulses and emotions. "Guilt
for not being able to do more for parents; anger for having to set aside your own needs or
shift your priorities; and fear and anxiety, including anticipatory grief and fear of financial
strain." Caring for children and aging parents at the same time can make you feel as if you
do not have the emotional strength and resources for everyone.There are also positive
emotional effects of caring for aging parents, such as "enrichment that comes with
relationships between grandparents and grandchildren; increased opportunity to pass on
stories and knowledge to younger generations; and [the] younger generations having a
sense of being able to give back to parents and grandparents," resulting in a "greater
connection" between family members.

2. Financial - Caring for aging parents often means extra costs related to home health care,
medical expenses not covered by insurance and extra insurance premiums for services such
as long-term care. You also may need to take off extra time from work. There are also some
of the positive impacts of caring aging parents who are not in the Old/Old-old category to
your finances. You will no longer need to hire extra help to look for your children, you will
save money from getting helper to clean the lawn and do some basic house chores, and if
your parent is still strong enough, they can still go to the market to buy meats and
vegetables.

3. Structural - When you live with your aging parents or assume a high amount of daily care for
them, you experience a change in your family roles. This shift can cause guilt and stress, as
family members work to find a place in the new family dynamic, but it can also result in
more open communication among family members. Grandparents, parents and children get
creative, brainstorming about how to utilize community resources such as church groups,
social service organizations and community groups. In these cases, the family structure
shifts to being less hierarchical and more cooperative.

4. Physical - Prioritizing parents' care can ease their pain and worry, but might impact your
health. The time and effort of keeping up with parents' care means you may visit your
doctors less, resulting in undiagnosed problems or conditions getting worse. Caregiving for a
parent with dementia can cause chronic stress and illness. Time pressure might result in
caregivers and their children skipping exercise and eating more convenience foods, which
contribute to poor fitness and weight gain. Everything from mild depression to severe and
chronic depression can inflict caregivers, which can cause premature aging and shorten their
life span. Families who share responsibilities and secure outside help experience less stress
and have the time and resources to maintain their health and relationships with all
members of the family. However, some families have the opposite experience by creating
 what she describes as a positive "wiring" in their brains to produce more potentially positive
outcomes. These people reflect on what makes them feel good for caring for their aging
parents. They consider what moments in their days make them smile. They revel in the
moments with loved ones that increase their sense of self-worth and they end up creating
closer bonds with both the older and younger generations.

Ref: https://mom.com/kids/4870-how-does-caring-aging-parents-affect-family-life

MORBIDITY AND MORTALITY

 Although normal aging does not imply disease, the incidence of chronic diseases increases
with increasing age.
 Another major problem is comorbidity.
 The major causes of death in people ages 65 and older are not much different from younger
adults except for causes of accidents.
 Other difference in mortality relate to heart disease.
Major Causes of Death

CAUSE PERCENTAGE IN OLDER

ADULT POPULATION
Cardiovascular 47
Cancer 20
Cerebrovascular 11
Accident (CVA)/Stroke

Lung Disease 6
Accidents (Fall) 2

Table 1. Leading Causes of Death Among Older Persons Aged 60 Years and Above

(Philippine Health Statistics, 2000)

Ref: https://www.mhlw.go.jp/bunya/kokusaigyomu/asean/asean/kokusai/siryou/dl/h19_philippines.pdf

PERCENTAGE OF
OLD PEOPLE
TOTAL DEATH RATE PER
FROM THE
RANK CAUSES OF MORTALITY NUMBER OF 100,000 OLD
TOTAL DEATHS
DEATHS PEOPLE
IN THE
POPULATION
1 Cardiovascular Diseases, all
71,874 1,547.35 66.13
forms
2 Pneumonia 21,069 453.59 64.56
3 Malignant Neoplasm, all forms 17,898 385.32 49.15
4 Tuberculosis, all forms 14,081 303.14 51.10
5 COPD 11,268 242.58 70.85
6 Diabetes Mellitus 5,587 120.28 51.99
7 Gastric, duodenal, peptic and
gastrojejunal ulcers and other
5,280 76.73 56.24
diseases of the digestive
system
8 Accidents and injuries, all
3,927 85.51 12.28
causes
9 Nephritis, nephritic syndrome
3,774 81.25 47.39
and nephrosis
10 Septicemia 1,795 38.64 44.20
GOVERNMENT EFFORTS AND PROGRAMS

Statutes and Legislations

 Republic Act No. 344 or the Accessibility Law of 1982 provides for the minimum requirements
and standards to make buildings, facilities, and utilities for public use accessible to persons with
disability, including older persons who are confined to wheelchairs and those who have difficulty
in walking or climbing stairs, among others.
 Republic Act No. 7432 or the Senior Citizens Act of 1991 was entitled “An Act to Maximize the
Contribution of Senior Citizens to Nation-Building, Grant Benefits and Special Privileges and for
Other Purposes.” It allows senior citizens to render community services (eg, consultancy
services, teaching and 8 specialized lectures) and provides for the granting of a 20 percent
discount for senior citizens on fares for domestic transportation, services from hotels, lodging
houses, restaurants, theaters, recreation centers and purchase of drugs and medicines
anywhere in the country. It establishes the Office of Senior Citizens Affairs (OSCA) at the City or
Municipal Mayor’s Office and exempts senior citizens from training fees for socio-economic
programs undertaken by the OSCA and from payment of individual income tax.
 Republic Act No. 8425 provides for the institutionalization and enhancement of the social
reform agenda by creating the National Anti-Poverty Commission (NAPC). Through its multi-
dimensional and cross-sectoral approach, NAPC provides a mechanism for senior citizens to
participate in policy formulation and decision-making on matters concerning poverty alleviation.
 Republic Act No. 9257, otherwise known as the Expanded Senior Citizens Act of 2003, increases
the coverage of the benefits and privileges for senior citizens by making it mandatory for
business establishments to grant the 20 percent discount on goods and services.
 Republic Act No. 9336, known as The General Appropriations Act of 2006, under Section 32
mandates that all government agencies and instrumentalities should allocate 1 percent of their
total agency budget to programs and projects for older persons and persons with disabilities.

Challenges that need critical attention

 Full implementation of RA 9257 “Expanded Senior Citizens Act of 2003” and other elderly
policies and the need to refocus programs to empower communities, instead of individuals.
 Limited and inadequate data on senior citizens with particular emphasis on geographical and
sex-disaggregated data collection in every LGU, including researches.
 Understanding the issues and implications that the ageing population brings about to the
society.
 Preparation of the populace for an ageing process that is both satisfying and productive for the
individual.
 Development and improvement of service infrastructure and management of centers and
institutions in an environment based on both traditional and modern institutions that will be
able to meet present and future needs of an ageing citizenry.
 Delivery of social and human services needed by the growing number of senior citizens in
Filipino society.
Issues and Gaps

 The rising number of senior citizens who are victims of violence and abandonment due to in-
and-out-migration of younger family members.
 The noncompliance of some residential buildings and establishments in terms of making their
facilities accessible to senior citizens.
 Despite of efforts to advocate strict compliance with RA 9257 or the “Expanded Senior Citizens
Act of 2003”, many drugstores and food establishments fail to extend the full benefit of the 20
percent senior citizens’ 16 discount