UNIT 1: CONCEPTS, PRINCIPLES, AND THEORIES IN THE CARE OF OLDER ADULTS

Introduction

Getting old is inevitable, no matter how you want to escape with it, this is part of the age developmental
process. The older adults feel pain, sadness, boredom, loneliness, and sensitivity in some situations. As nursing
students, you may be allowed to handle older persons to be taken care of in the actual setting. As future nurse
practitioners, you may analyze the factors affecting older people's normal functions concerning their socio-
cultural uniqueness as an older person.

This particular module divided into four (4) lessons:

• Lesson 1- Perspectives on Aging
• Lesson 2- Aging is a Developmental Process
• Lesson 3- Demography of Aging and Implications for Health and Nursing Care
• Lesson 4- Global Aging & Aging in the Philippines

Objectives/Competencies
Upon completion of this module, you may expect to:
1. Compare and contrast sociological theoretical perspectives in aging.
2. Differentiate the different theories related to the care of older adults.
3. Discuss the factors influencing the demographics of aging.
4. Discuss the techniques and principles of a comprehensive geriatric assessment.
5. Identify the impact of an aging population on professional nursing.

Lesson 1.1_Perspective of Aging

Concepts in the Care of Older Person/Clients

Definition of Terms
1. Gerontology – the aging process that draws from the biological, psychological, and sociological
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
older adults' disorders and diseases.
3. Aging – is the advanced generalized impairment of function resulting in a loss of adaptive response
to stress and a growing risk of morbidity and mortality.
4. Gerontologic nursing is related to assessing, planning, implementing and evaluating older adults in
all environments, including acute, intermediate, and skilled care, and within the community.
5. Chronological age - is the number of years since someone was born.
6. Biological aging – the physical changes that "slow us down" as we get into our middle and older
years, our arteries might clog up, or our lungs' problems might make it more difficult for us to breathe.
7. Psychological aging includes psychological changes involving mental functioning and personality that
occur as we age.
8. Social aging – is the changes in a person's roles and relationships, both within their networks of
relatives and friends and informal organizations such as the workplace and worship houses.
Principles in caring for an adult
1. The patient’s presentation is frequently involved.
2. The patient verbalized multiple chronic conditions, mental health issues, medication-related
problems, and social vulnerability.
3. Common diseases present unusually in this age group.
a. I am presenting Myocardial Infarction with NO chest pain, but with dyspnea or weakness.
b. May be considered cardiac causes.
4. Comorbid diseases may confound the presentation.
a. Comorbidity – is the presence of more than one disorder in the same person.
b. These are the examples of Comorbidity; Hypertension, Diabetes Mellitus, and auto-immune
disease, then cardiac diseases.
c. Chief complaints such as syncope, altered mental status, and fever may be caused or
influenced by these conditions.
5. Polypharmacy – is a practice among the elderly.
a. Polypharmacy is the simultaneous use of multiple drugs to treat a single ailment or condition.
b. Polypharmacy can cause by various factors, including Self-medicating, without an accurate
understanding of effects and reactions.
6. Alteration in drug actions, metabolism, and clearance occurs due to physiologic changes of aging.
7. Recognition of possible cognitive impairment is essential.
a. 30 – 40% of elderly patients experienced cognitive impairment.
b. Failure of the nurse to recognize cognitive impairment may result in inadequate work-up and
improper disposition.
c. Mental status assessment should be a routine part of the examination of geriatric patients.
8. Some diagnostic tests may have different typical standards.
9. These are issues in unmovable, and commonly abnormal laboratory values in the elderly can prevent
costly mistakes due to false assumptions.
10. The likelihood of decreased functional reserve must anticipate.
a. There is a decline in cardiac output with age.
b. The immune system may become sluggish in response to infection.
c. Special senses of touch, sight, hearing, taste, and smell can diminish when getting old.
11. Inadequate social support systems so the older adults may need to rely on caregivers.
a. Discharging someone to a low home environment is a sure way to guarantee a return back to
your urgent care.
b. An elderly with no definite source for food to eat, dress to wear, and how to make follow-up
visits may influence your decision.
12. Functional status –is essential for evaluating new complaints.
a. Data obtained from the patient, family, primary care physician, and old records can establish
data.
b. The patient with confusion, aphasia, weakness, or acute delirium has always been that way
can lead to missed diagnoses and unwise disposition.
13. Evaluate the health condition of the older person related to psychosocial change.
a. The highest rate of successful suicide occurs in older men.
 b. Keep on monitoring for depression, anxiety, alcohol, and substance abuse, even in the
population of the elderly.

Sociologists' three different perspectives in Aging

● Functionalism –describes that all aspects of a society serve a function and are necessary for society's
survival.
● Symbolic interactionism – the view of social behavior emphasizes linguistic or gestural
communication and its subjective understanding, especially the role of language in forming the child as
a social being.
● Conflict theory – is a theory that society is perpetually conflicted because of competition for limited
resources.

Sociologic Theories of Aging

1. 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
● Each person expects to die one day, the physical and mental experience that we have declined with
the approaching death; it is natural to withdraw from individuals and society.
● As older adults withdraw from individual and society, they receive less reinforcement to conform to
social norms.
● So, this withdrawal allows greater freedom from the pressure to conform.
●Social withdrawal is experienced differently by men and women.
○ Men focus on work
○ Women focus on marriage and family
○ When men/women withdraw, they will be unhappy and directionless until they adopt a role to
replace their used part compatible with the disengaged state (Cummings and Henry 1961).
★ Criticisms typically focus on applying the idea that seniors universally naturally withdraw
from society as they age.

2. Activity Theory
● Describes that activity levels and social involvement are critical to this process, and it is the key to
happiness in life.
● It also explains that the more active and involved an older adult is, the happier life.
★ Criticisms of this theory point out that access to social opportunities and activity is not
equally available.
★ The theory's reforms suggest that participation in informal activities, such as hobbies, most
affects later life satisfaction (Lemon, Bengtson, and Petersen 1972).

3. Continuity Theory
- the older adult makes specific choices to maintain consistency in interpersonal structure, beliefs) and
external systems (relationships), remaining active and involved throughout their more senior years.
● What I wanted myself to be when I reached that age.
● Will I continue with what I am doing now till I get old?
This question is an attempt to maintain social equilibrium and stability by making future decisions
based on already developed social roles (Atchley 1971)
★ One criticism of this theory is its emphasis on so-called “normal” aging, which marginalizes
those with chronic diseases such as Alzheimer’s.

Lesson 1.2_Aging is a Developmental Process

• Aging is a gradual, continuous process of natural change that begins in early adulthood.
• It is a life course, from birth to death, including a sequence of predictable life events such as physical
maturation.
• During early middle age, many bodily functions begin to decline gradually.
• People do not become old or elderly at any specific age.
• Traditionally, age 65 has designated as the beginning of old age.
• Old age is breaking into three stages:
o Young old (55–65 years of age)
o Middle old (66–85)
o 85 years and older.
o Old old (85 and older).
• The bones become brittle when they lose calcium and other minerals.
• Aging is a normal stage of life in which our bodies begin to function less effectively, making us more
vulnerable to disease. (Meilaender,2011)
• 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 from womb to tomb, a sequence of predictable life events such as physical
maturation.
• Each stage has different responsibilities and expectations, vary by individual and culture.

For the Adults

• The adults become focused on creating families, building careers, and experiencing the world as
independent people.
• Several adults look forward to old age without pressure from work and family life.
• Grandparenthood can provide many of the joys of parenthood without all the hard work that
parenting entails 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.

Three kinds of aging as distinguished by Gerontologists:

1. BIOLOGICAL AGING
  Senescence – refers to “the time-dependent accumulation of damage at the molecular level
that begins at fertilization and eventually expressed as nonspecific vulnerability, impaired
function, disease, and ultimately death” (Carnes & Olshansky, 1993, p. 75).
- Therefore, it is senescence that causes diseases of aging.

a. Primary aging base 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 are prone to balding start losing hair.
• the 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:

1. The first is muscle strength and power decline linearly from around 30 or 35 to 50 years.
2. Faster between 50 and 60 or 65.
3. Drop off after 65." (Professor Raeburn, 2006)

b. Secondary aging occurs due to controllable factors such as lack of physical exercise and a low diet.
(Whitbourne and Whitbourne, 2010).
• The way people perceive physical aging is mostly dependent on how they were socialized.
• If people can accept their bodies' changes as a natural aging process, the changes will not seem
frightening.

2. PSYCHOLOGICAL AGING may see as a continuous struggle for identity.

• Such as 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.
• Older adults report good mental health and have fewer mental health problems than other age
groups.
• The older adults experience a mental health problem, such as:
• depression
• anxiety
• Schizophrenia, or dementia.
• The suicide rate for men over 85 is higher than that of any other age group.

3. SOCIAL AGING refers to the changes in a person's roles and relationships as age advances.
• Social change refers to how older adults deals society (rather than an individual)
• Develops over time to replace beliefs
• Changes Attitudes and behavior in new norms and expectations.

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 prepared, what actions add meaning to life, and
where problems may be occurring)
• Need for and availability of caregivers.

Developmental Tasks of Older Adults

Having hurst lists typical developmental tasks faced by people aged over 60 years of age:
• adapting to a decline in physical strength
• adjusting to retirement and reduced income
• coming to terms with the death of a spouse
• maintaining social relations with people in your age
• accepting and adapting to changing social roles and establishing reasonable physical living
arrangements
• Such developmental tasks arise in response to changes in the biological condition of the body related
to age, cultural traditions, and individual aspirations (Pearson p.173)

Lesson 1.3_Demography of Aging and its Implications

Key facts
•All countries face significant challenges to ensure that their health and social systems are ready to
make the most of this demographic shift.
• By 2030, projected that more than 60% of this generation would be managing more than one chronic
condition.
• Also, by 2050, the number of people 65 years or older is expected to outnumber children younger
than five.

The Impact of the Aging Population in Nursing

• Considering the expected twice as many hospital admissions and physician visits for Baby Boomers by
2030.
• Recent demographic shifts will have significant implications for the U.S. healthcare system, delivering
patient care, and nursing practice.
• This significant implication in the health care system will lead to the extended treatment of long-term
chronic conditions.
• Challenging the healthcare system's ability to provide efficient care. (Nov 18, 2016)
• A shortage of health care professionals must expect in all settings.

• The diversity of caregivers’ lags behind the growing variety of patients.

• Care has focused on a single disease versus addressing comorbidity.
• The sustainability and structure of federal programs about the increasing aging population are a
concern.
• Changes in family structure may lead to fewer family caregivers.
• The health care system also needs to prepare for new technology (mainly because of the higher cost)
by increasing healthcare workers’ training and examining how technology will impact hospital
infrastructure.

1. Multiple chronic conditions.

• As the human lifespan increases, so do the prevalence of chronic illnesses:
• Sixty-eight percent of older adults have at least two chronic diseases.
• It estimated that by 2040, almost 160 million people in the US, most of them elderly, will be living
with chronic conditions.
• Managing multiple chronic conditions involves an awareness of potential behavior changes,
medication interaction and possible side effects, and strategies for relieving pain and other symptoms.
These chronic conditions may include:
• Hypertension
• high cholesterol
• arthritis
• dementia
• congestive heart failure
• Incidence of obesity and falls are also increasing
• Among the chronic diseases that have had the most significant impact on the aging population,
especially in high-income countries:
• Heart Disease
• Stroke
• Cancer
• Diabetes

2. A need for home-based care

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

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

• To educate on helping elderly patients fulfill these responsibilities.
• The demographic shift toward a more significant population of seniors indicates a need for more
nurses to educate in Gerontological issues.
• To continue successfully deliver health care that meets the particular needs of elderly patients.
• The Geriatric Nursing Education Consortium advocates enhanced instruction and coursework in
geriatrics in Bachelor of Science in nursing programs.
• To emphasize leadership, communication, and critical thinking skills.
• To 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’ practical communication skills would require as family members step in to help out with care
for senior patients.
• Nurses will need to clearly explain treatment plans, answer questions, and address the concerns of
both patients and their caregivers.

4. Recognizing and Acting on Career Opportunities

• To consider potential areas for professional development and opportunity proactively
• To specialize in geriatrics or related fields to fill the need for expertise and leadership.
• To 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.
• To handle the demands an aging population will make on the nursing profession.

Lesson 1.4_Global Aging and Aging in the Philippines

What is global aging?

- Unprecedented changes occur worldwide as fertility and mortality rates decline in most
countries and as populations age.
- The global population is more than twice as large as in 1980 when there were 382 million
older persons worldwide.
- The number of older persons expects to double again by 2050 when projected to reach nearly
2.1 billion.

Is Global Aging a significant problem? Is it YES or NO? Let’s find out.

• The global population is aging—by 2050, one in six people will be over 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 the aging population significant?

• Population aging now affects economic growth, formal and informal social support systems, and
states’ and communities’ ability to provide older citizens resources. We can think about preparing for
older age on both an individual and societal level.

What country has the most senior citizens?

Rank Country # total population (in millions)
1. China- 1398.03
2. India - 1391.89
3. United States- 329.15
4. Japan- 126.18

Managing the risks

The Squeeze Midd
•The higher number of people claiming pension benefits but fewer people paying income tax.
Rising Healthcare Costs:
•The 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:
•The changing workforces may lead capital to flow away from rapidly aging countries shifting the
global economic power distribution
Pensions under pressure
•A pension promise, any changes made to existing government programs can alter future retirees’ lives
entirely.
Towards a better system
The Global Pension Index suggests:
• We are preserving retirement funds by limiting access to benefits before the retirement age.
• We are increasing the trust and confidence of all stakeholders by improving the transparency of
pension plans
Live long and prosper
• As 2020 marks the beginning of the Decade of Healthy Aging, the world is undoubtedly entering a
pivotal period.
• Countries worldwide face tremendous pressure to manage their aging populations effectively, but
preparing for this demographic shift early will contribute to nations’ economic advancement and allow
communities—both young and old—to live long and prosper.
• Unprecedented changes occur worldwide as fertility and mortality rates decline in most countries
and as populations age.
As they seek to answer questions related to:
• health care
• housing
• social security
• work and retirement
• caregiving

The burden of disease and disability. These changes affect the:

• individuals
• families
• governments
• private-sector organizations

A growing elderly population in the Philippines

• The Republic Act 9994, also known as the Expanded Senior Citizens Act of 2010, defines senior
citizens as individuals aged 60 years old and above
• 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
assistance.
• In 2018, the Department of Social Welfare and Development disclosed that P19.28 billion had
allocated 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 allowance from other government agencies
• No permanent source of income or source of financial assistance/compensation to support
their basic needs.