MODULE 1.

CONCEPTS, PRINCIPLES, AND THEORIES IN THE CARE OF OLDER ADULT

Topics:

 Perspectives on Aging
 Demography of Aging
 Impact of Aging Members in the family
 Theories of Aging
 Physiological Changes in Aging

Learning objectives:

1. Describe the global aging phenomenon and its implications to nursing practice
2. Understand the theories of aging
3. Enumerate the physiological changes of aging

AGING - Aging is a natural process that begins at birth and ends at death. It can be defined as the sum of
changes that normally occur in an organism with the passage of time.

Impact of Aging Members of the Family

 Emotional effects

 Positive emotional effects

 Financial effects

 Structural effects

 Physical effects

Theories of Aging

The Programmed Theory- This considers aging to be the result of a sequential switching on and off of
certain genes, with senescence being defined as the time when age-associated deficits are manifested.
The programmed theory implies that aging follows a biological timetable. The programmed theory is
the idea that aging is genetically programmed to occur with time, and this process of deterioration
eventually leads to death.

Endocrine Theory, where biological clocks act through hormones to control the pace of aging. Various
endocrine changes trigger processes associated with aging. Specifically, there are anatomic changes,
which can occur in endocrine glands or tissue due to cell apoptosis, autoimmune destruction, or
neoplastic transformation. Over time, aging and pathologic processes alter and potentially deplete
endocrine system storages that were previously preserved during growth to adulthood. In women, the
most dramatic effect occurs during menopause. We all know that the endocrine system which produces
the body's different hormones, regulates all biological processes in the body.

Immunological Theory, which states that the immune system is programmed to decline over time,
leading to an increased vulnerability to infectious disease and thus ageing and death.

The Damage or Error Theories

1.)Wear and tear theory, where vital parts in our cells and tissues wear out resulting in aging. The wear
and tear theory of aging, one of several theories, asserts that the effects of aging are caused by
progressive damage to cells and body systems over time. ... 1 Essentially, our bodies "wear out" due to
use. Once they wear out, they can no longer function correctly. Several research studies have been
conducted to test the wear and tear theory. For example, some studies have found that an increase in
stress or illness lowers the life expectancy of organisms, therefore concluding that aging is accelerated
with this increased stress.

2.)Rate of living theory, which supports the theory that the greater an organisms rate of oxygen basal,
metabolism, the shorter its life span. The rate of living theory postulates that the faster an organism's
metabolism, the shorter its lifespan. The rate of living theory of aging states that people (and other
living organisms) have a finite number of breaths, heartbeats, or other measures, and that they will die
once they've used those up

3.)Cross-linking theory, according to which an accumulation of cross-linked proteins damages cells and
tissues, slowing down bodily processes and thus result in aging. The cross-linking theory of aging (also
known as the glycosylation theory of aging) attributes aging to chemical changes that happen in the
body. These changes happen gradually as proteins, structural molecules, and DNA develops detrimental
chemical bonds (also known as cross-links) to each other.

4.)Free radicals theory, which proposes that superoxide and other free radicals cause damage to the
macromolecular components of the cell, giving rise to accumulated damage causing cells, and eventually
organs, to stop functioning. The free radical theory proposes that ageing is the cumulative result of
oxidative damage to the cells and tissues of the body that arises primarily as a result of aerobic
metabolism.

Psychosocial theories

1. Disengagement theory-

The disengagement theory of ageing states that "aging is an inevitable, mutual withdrawal or
disengagement, resulting in decreased interaction between the aging person and others in the social
system he belongs to". The theory claims that it is natural and acceptable for older adults to withdraw
from society.

Disengagement theory outlines a process of disengagement from social life that people experience as
they age and become elderly.

2. Activity Theory - Is another theory that describes the psychosocial aging process.

The activity theory, also known as the implicit theory of aging, normal theory of aging, and lay theory of
aging, proposes that successful ageing occurs when older adults stay active and maintain social
interactions. According to the activity theory of aging there is a positive relationship between a person's
level of activity and life satisfaction, which in turn increases how positively a person views himself or
herself.

Activity theory emphasizes the link between activity and well-being, specifically life satisfaction (Lemon
et al., 1972). The theory suggests that both the frequency of participation in activities and their level of
intimacy are important for life satisfaction.
Physiological changes of aging

Cardiovascular system changes - Decreased cardiac output; diminished ability to respond to stress;
slower heart recovery rate; increased blood pressure; orthostatic hypotension

Health Promotion Strategies:

• Exercise regularly;

• Pace activities;

• Avoid smoking;

• Eat a low-fat, low salt diet; p

• Participate in stress-reduction activities;

• Check blood pressure regularly;

• Medication adherence;

• Weight control;

• Encourage slow rising from a resting position

Respiratory system changes -Increase in residual lung volume; decrease in vital capacity; decrease gas
exchange and diffusing capacity; decreased cough efficiency

Health Promotion Strategies:

• Exercise regularly;

• Avoid smoking;

• Take adequate fluids to liquefy secretions;

• Receive yearly influenza immunization;

• Avoid exposure to upper respiratory tract infections

Integumentary system changes - Decreased protection against trauma and sun exposure; decreased
protection against temperature extremes; diminished secretion of natural oils and perspirations

Health Promotion Strategies:

• Avoid solar exposure (clothing, sunscreen, stay indoor);

• Dress properly for temperature;

• Maintain a safe indoor temperature; Shower preferably to tub bath;

• Moisturize skin

Reproductive system changes - Female: Vaginal narrowing and decreased elasticity; decreased vaginal
secretions. Male: Decreased size of penis and testes. Male and Female: Slower sexual response
Health Promotion Strategies:

• May require vaginal estrogen replacement;

• Gynecology/urology follow-up;

• Use a lubricant with intercourse

Musculoskeletal system changes - Loss of bone density; loss of muscle strength and size; degenerated
joint cartilage

Health Promotion Strategies:

• Exercise regularly;

• Eat a high-calcium diet;

• Limit phosphorus intake;

• Take calcium and vitamin D supplements as prescribed

Urinary system changes Male: Benign prostatic hyperplasia. Female: Relaxed perineal muscles, detrusor
instability (urge incontinence), urethral dysfunction (stress urinary incontinence)

Health Promotion Strategies:

• Seek referral to urology specialist;

• Have ready access to toilet;

• Wear easily manipulated clothing;

• Drink adequate fluids;

• Avoid bladder irritants, such as caffeinated beverages, alcohol, artificial sweeteners;

• Pelvic floor muscle exercises;

• Biofeedback

Gastrointestinal System changes Decreases salivation; dysphagia; delayed esophageal and gastric
emptying; reduced gastrointestinal motility

Health Promotion Strategies:

• Use ice chips, mouthwash;

• Brush, floss and massage gums daily;

• Receive regular dental care;

• Eat small, frequent meals;

• Sit up and avoid heavy activity after eating;

• Limit antacids;
 • Eat a high-fiber,

• Low-fat diet;

• Limit laxatives;

• Toilet regularly;

• Drink adequate fluids

Nervous system changes Reduced speed in nerve condition; increases confusion with physical illness
and loss of environmental cues; reduced cerebral circulation

Health Promotion Strategies:

• Pace teaching;

• With hospitalization, encourage visitors;

• Enhance sensory stimulation;

• With sudden confusion, look for cause

Vision Diminished ability to focus on close objects; inability to tolerate glare; difficulty adjusting to
changes of light intensity; decreased ability to distinguish colors

Health Promotion Strategies:

• Wear eyeglasses,

• Use sunglasses outdoors;

• Avoid abrupt changes from dark to light;

• Use adequate in door lighting with area light and night lights;

• Use large-print books;

• Use magnifier for reading;

• Avoid night driving;

• Use contrasting colors for coding;

• Avoid glare of shiny surfaces and direct sunlight

Hearing - Decreased ability to hear high frequency sounds

Health Promotion Strategies:

• Recommend a hearing examination;

• Reduce background noise; face person;

• Enunciate clearly;
 • Speak with a low-pitched voice;

• Use nonverbal cues

Taste & Smell - Decreased ability to taste and smell

Health Promotion Strategies:

• Encourage use of lemon, spices, herbs