N. Elec.

2: Care of the Older Adult

MODULE 2:
DYNAMICS OF THE
AGING PROCESS

ERLINDA M. GUZMAN, RN, MAN

Instructor
 OVERVIEW/INTRODUCTION:
• Aging is associated with changes in dynamic biological,
physiological, environmental, psychological, behavioral, and social
processes. Some age-related changes are benign, such as graying hair.
Others result in declines in function of the senses and activities of
daily life and increased susceptibility to and frequency of disease, frailty,
or disability. In fact, advancing age is the major risk factor for a number
of chronic diseases in humans.
 OVERVIEW/INTRODUCTION:
• Studies from the basic biology of aging using laboratory animals — and
now extended to human populations — have led to the emergence of
theories to explain aging. While there is no single “key” to explain
aging, these studies have demonstrated that the rate of aging can be
slowed, suggesting that targeting aging will coincidentally slow the
appearance and/or reduce the burden of numerous diseases and
increase health span.
 LEARNING OUTCOMES:
At the end of the module, students should be able to:
1. Explain the basic concepts of the dynamics of the aging process.
2. Apply the life course perspective to the aging process to show how the experience
of aging depends on cultural factors, such as the conceptualization of the
lifespan, as well as lifespan changes in affective experience.
3. Identify core physical and psychosocial factors and the mechanisms by which they
affect health and well-being in older adults.
4. Examine the significance of resilience, the process by which older individuals
adapt to challenges associated with disability and declining health.
5. Utilize the dynamics of aging process in the nursing care and practice in various
clinical situations.
THE FRAMEWORK OF
LIFE COURSE
 LIFE COURSE FRAMEWORK
• Is a framework that was developed to help individuals and
families of all abilities and at any age or stage of life
develop a vision for a good life, think about what they need
to know and do, identify how to find or develop supports, and
discover what it takes to live the lives they want to live.
• Individuals and families may focus on their current situation
and stage of life but may also find it helpful to look ahead to
start thinking about life experiences now that will help
move them toward an inclusive, productive life in the future.
 LIFE COURSE FRAMEWORK

• The framework is designed to help any

citizen think about their life, not just
individuals known by the service system.
• Even though the framework was originally
developed for people with disabilities, it is
designed universally, and can be used by any
family making a life plan, whether they
have a member with a disability or not.
 FOUNDATION OF THE
LIFE COURSE FRAMEWORK
Core Belief: All people have the right to live, love, work, play and pursue their life aspirations just as
others do in their community.
• ALL People
• ALL people, regardless of age, ability or family role, are considered in our vision, values, policies
and practices for supporting individuals and families. All families have choices and access to
supports they need, whether they are known to the disability service system or not.
• Family System and Cycles
• People exist and have give-and-take roles within a family system, which adjust as the individual
members change and age. Individuals and families need supports that address all facets of life and
adjust as roles and needs of all family members change as they age through the family cycles.
• Life Outcomes
• Individuals and families focus on life experiences that point the trajectory toward a
good quality of life. Based on current support structures that focus on self-determination,
community living, social capital and economic sufficiency, the emphasis is on planning for
life outcomes, not just services.
• Life Domains
• People lead whole lives made up of specific, connected, and integrated life domains
that are important to a good quality of life, including daily living, safety and security, etc.
• Life Stages and Trajectory
• Individuals and families can focus on a specific life stage, with an awareness of how prior,
current and future life stages and experiences impact and influence life trajectory. It is
important to have a vision for a good, quality life, and have opportunities, experiences
and support to move the life trajectory in a positive direction.
• Individual and Family Supports
• Supports address all facets of life and adjust as roles and needs of all family members
change. Types of support might include discovery and navigation (information, education,
skill building); connecting and networking (peer support); and goods and services (daily living
and financial supports).
• Integrated Delivery of Supports
• Individuals and families utilize an array of integrated supports to achieve the envisioned
good life, including those that are publicly or privately funded and based on eligibility,
community supports that are available to anyone, relationship based supports, technology, and
that take into account the assets and strengths of the individual and family.
• Policy and Systems
• Individuals and families are satisfactorily involved in policy making so that they influence
planning, policy, implementation, evaluation and revision of the practices that affect them.
Every program, organization, system and policy maker must always think about a person in the
context of family.
THE THEORY OF AGING
THE THEORY OF AGING
SECRETS OF AGING

• Why do some people live longer than other? Why is

there such a discrepancy in functionality at very old
age?
• Several factors may contribute to reaching old age.
Lifestyle choices including diet, exercise, socialization,
and coping with stress play a large part. Genetics also
play a role, especially in those surviving over the age
of 80.
 THEORIES OF AGING
MORAL/ BIOLOGIC
SPIRITUAL

THEORIES OF
AGING

PSYCHOLOGIC SOCIOLOGIC
 THEORIES OF AGING
1. BIOLOGIC - concerned with answering basic questions regarding
physiologic processes that occur in all living organisms over time
2. SOCIOLOGIC - focused on the roles and relationships within which
individuals engaged in later life
3. PSYCHOLOGIC - influenced by both biology and sociology; address
how a person responds to the tasks of his or her age
4. MORAL/SPIRITUAL - examine how an individual seeks to explain and
validate his or her existence
BIOLOGIC THEORIES
BIOLOGIC THEORIES OF AGING

NON BIOLOGIC THEORIES STOCHASTIC

STOCHASTIC OF AGING
 BIOLOGIC THEORIES OF AGING
• Stochastic or statistical perspective, which identifies episodic events that happen
throughout one’s life that cause random cell damage and accumulate over time,
thus causing aging
1. STOCHASTIC THEORIES
- based on random events that cause cellular damage that accumulates as the
organism ages.
2. NON-STOCHASTIC theories, which view aging as a series of predetermined
events happening to all organisms in a timed framework.
STOCHASTIC THEORIES
WEAR and TEAR ERROR
THEORY THEORIES

STOCHASTIC
THEORIES

CROSS-LINKAGE FREE RADICAL

THEORY THEORY
 STOCHASTIC THEORIES
1. ERROR THEORY - is based on the idea that errors can occur in the
transcription of the synthesis of DNA. These errors are perpetuated and
eventually lead to systems that do not function at the optimum level. The
organism’s aging and death are attributed to these events.
 STOCHASTIC THEORIES
2. FREE RADICAL THEORY - aging are caused by free radicals. Damage
to DNA, protein cross-linking and other changes have been attributed to free
radicals. Over time, this damage accumulates and causes us to experience aging.
 STOCHASTIC THEORIES

3. WEAR AND TEAR THEORY -

effects of aging are caused by
progressive damage to cells and body
systems over time. Essentially, our
bodies "wear out" due to use. Once
they wear out, they can no longer
function correctly.
 STOCHASTIC THEORIES

4. CROSS-LINKAGE THEORY - an accumulation

of cross-linked proteins damages cells and tissues,
slowing down bodily processes resulting in aging.
In this theory, it is the binding of glucose (simple
sugars) to protein, (a process that occurs under the
presence of oxygen) that causes various problems.
Once this binding has occurred the protein becomes
impaired and is unable to perform as efficiently.
 NON-STOCHASTIC THEORIES

NON-
PROGRAMMED STOCHASTIC IMMUNITY
THEORY THEORIES THEORY
 NON-STOCHASTIC THEORIES
1. PROGRAMMED THEORY -
aging is an essential and innate part of
the biology of humans and that aging
is programmed into our body systems.
Otherwise, we would live forever. The
three main systems that are connected
with aging are the endocrine
(hormonal) system, the immune
system, and our genes.
 NON-STOCHASTIC THEORIES
• 2. IMMUNITY THEORY -
asserts that the process of human
aging is a mild and generalized
form of a prolonged autoimmune
phenomenon. In other words,
aging—which involves a highly
complex series of processes—is
suspected to be largely controlled
by the immune system.
 NEUROENDOCRINE
CONTROL OR
PACEMAKER THEORY

EMERGING
THEORIES
METABOLIC
DNA-RELATED OF AGING THEORY OF
RESEARCH AGING/CALORIC
RESTRICTION
EMERGING THEORIES OF AGING

1. NEUROENDOCRINE CONTROL OR
PACEMAKER THEORY - states that “The
effectiveness of the body's homeostatic adjustments
declines with aging—leading to the failure of adaptive
mechanisms, aging, and death.” The neuroendocrine
system controls many essential activities with regard to
growth and development. Scientists are studying the
roles that the hypothalamus and the hormones DHEA
(dehydroepiandrosterone) and melatonin play in the
aging process.
 EMERGING THEORIES OF AGING
2. METABOLIC THEORY OF
AGING/CALORIC RESRTICTION - Calorie
restriction (CR) extends life span and retards age-
related chronic diseases. The mechanism or
mechanisms through which this occurs are unclear. CR
reduces metabolic rate and oxidative stress, improves
insulin sensitivity, and alters neuroendocrine and
sympathetic nervous system function in animals.
Whether prolonged CR increases life span (or
improves biomarkers of aging) in humans is unknown.
 EMERGING THEORIES OF AGING

3. DNA RELATED RESEARCH - two

developments are occurring at this time in
relationship to DNA and the aging process. First,
as scientists continue to map the human genome,
they are identifying certain genes that play a role
in the aging process. Second is the discovery of
telomeres, located at the ends of chromosomes,
which may function as the cell’s biologic clots.
SOCIOLOGIC THEORIES
 SOCIOLOGIC THEORIES OF AGING
PERSON -
ENVIRONMENT
FIT THEORY

AGE
STRATIFICATION DISENAGEMENT
SOCIOLOGIC THEORY
THEORY
THEORIES OF
AGING

ACTIVITY/
CONTINUITY
DEVELOPMENTAL TASK
THEORY
THEORY
 SOCIOLOGIC THEORIES OF
AGING
1. DISENGAGEMENT THEORY - 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.
SOCIOLOGIC THEORIES OF
AGING

2. ACTIVITY/DEVELOPMENTAL
TASK THEORY - individuals needs to
remain active to age successfully. Activity is
necessary to maintain life satisfaction and a
positive self-concept.
 SOCIOLOGIC THEORIES OF
AGING
3. CONTINUITY THEORY -
individuals will respond to aging in the
same way they have responded to previous
life events. The same habits, commitments,
preferences, and other personality
characteristics developed during childhood
are maintained in older adulthood.
 SOCIOLOGIC THEORIES OF
AGING
4. AGE STRATIFICATION THEORY -
society consists of group of cohorts that age
collectively. The people and roles in these
cohorts change and influence each other, and
does society at large. Therefore a high degree of
interdependence exists between older adults and
society. Age stratification based on an ascribed
status is a major source inequality, and thus may
lead to ageism. Ageism is a social inequality
resulting from age stratification.
 SOCIOLOGIC THEORIES OF
AGING
5. PERSON-ENVIRONMENT FIT THEORY
- focuses on the interaction between characteristics
of the individual and the environment, whereby the
individual not only influences his or her
environment, but the environment also affects the
individual. Each individual has personal
competencies that assist the person in dealing with
the environment. These competencies may change
with aging, thus affecting the older person’s ability to
interrelate with the environment.
 PSYCHOLOGICAL
THEORIES OF AGING
 PSYCHOLOGICAL THEORIES OF AGING
PECK’S EXPANSION
OF ERICKSON’S
THEORY
SELECTIVE
ERIKSON’S EIGHT OPTIMIZATION
STAGES OF LIFE WITH
COMPENSATION
PSYCHOLOGIC
AL THEORIES
OF AGING
MASLOW’S JUNG’S THEORY
HIERARCHY OF OF
HUMAN NEEDS INDIVIDUALISM
 PSYCHOLOGICAL THEORIES OF
AGING
1. MASLOW’S THEORY OF HUMAN NEEDS - human motivation is
viewed as a hierarchy of needs that are critical to the growth and development of
all people. Individuals are viewed as active participants in life, striving for self-
actualization.
2. JUNG’S THEORY OF INDIVIDUALISM - development is viewed as
occurring throughout adulthood, with self-realization as the goal of personality
development. As an individual ages, he or she is capable of transforming into a
more spiritual being.
 PSYCHOLOGICAL THEORIES OF
AGING
3. ERIKSON’S EIGHT STAGES OF LIFE - all people experience eight
psychosocial stages during the course of a lifetime. Each stage represents a crisis,
where the goal is to integrate physical maturation and psychosocial demands. At
each stage the person has the opportunity to resolve the crisis.
4. PECK’S EXPANSION OF ERICKSON’S THEORY - seven developmental
tasks are identified as occurring during Erickson’s final two stages. The final three
of these developmental tasks identified for old age are (1) ego differentiation
versus work role preoccupation, (2) body transcendence versus body
preoccupation, and (3) ego transcendence versus ego preoccupation
 PSYCHOLOGICAL THEORIES OF
AGING
5. SELECTIVE OPTIMIZATION WITH COMPENSATION - physical
capacity diminishes with age. An individual who ages successfully compensates
for these deficits through selection, optimization, and compensation. It is
recommended that seniors select and optimize their best abilities and most
intact functions while compensating for declines and losses.
 Summary of Erickson’s Theory: Middle
and Older Adulthood
GENERATIVITY VS. SELF-ABSORPTION OR STAGNATION - 40 to 65
years old; middle adulthood. Mature adults are concerned with establishing and guiding
the next generation. Adults look beyond the self and express concern for the future of
the world in general.
Self absorbed adults will be preoccupied with their personal well-being and maternal
gains. Preoccupation with self leads to stagnation of life.
EGO INTEGRITY vs. DESPAIR - 65 years to death; older adulthood. Older adults
can look back with a sense of satisfaction and acceptance of life and death.
Unsuccessful resolution of this crisis may result in a sense of despair in which
individuals view life as a series of misfortunes, disappointments, and failures.
 The following with major hormones are
involved with aging:
• Estrogen - is responsible for making skin look younger due to the hyaluronic acid it
produces. Estrogen not only affects your skin but also your muscle mass, metabolism,
and energy levels.
• Growth hormone - serves important roles in adult life, including maintenance of
lean body mass and bone mass, promoting lipolysis, thereby limiting visceral adiposity,
and regulating carbohydrate metabolism, cardiovascular system function, aerobic
exercise capacity, and cognitive function.
• Melatonin - decline gradually over the life-span and may be related to lowered sleep
efficacy, very often associated with advancing age, as well as to deterioration of many
circadian rhythms. Melatonin exhibits immunomodulatory properties, and a
remodeling of immune system function is an integral part of aging.
 NURSING THEORIES OF AGING
1. FUNCTIONAL CONSEQUENCES THEORY - environmental and
biopsychosocial consequences impact functioning. Nursing's role is risk reduction
to minimize age-associated disability in order to enhance safety and quality of living.
This theory was developed to provide a guiding framework that would address older
adults with physical impairment and disability.
Nursing's goal is to maximize functioning and minimize dependency to improve the
safety and quality of living.
 NURSING THEORIES OF AGING
2. THEORY OF THRIVING – proposed that the environment contributor
to how people age. They asserted that people thrive when they are in harmony
with their environment and personal relationships and fail to thrive when there
is discord. This theory has helped bring together elements of earlier theorists
in ways that make it accessible for nursing practice.
Nurses identify and modify factors that contribute to disharmony among these
elements.
PHYSIOLOGIC ASPECT
OF AGING
 AGING-RELATED CHANGES
• Physical changes related to “Normal” aging ARE NOT diseases.
• We all change physically, as we grow older.
• Some systems slow down, while others lose their "fine tuning."
• People who live an active lifestyle lose less muscle mass and flexibility as they age.
• As a general rule, slight, gradual changes are common, and most of these are not
problems to the person who experiences them.
• Steps can be taken to help prevent illness and injury, and which help maximize the
older person's independence, if problems do occur.
 CLINICAL APPROACH TO AGING-
RELATED CHANGES
• Not what disease caused the problem, but what combination of physiologic
change, impairments and diseases are contributing, and which ones can be
modified.
• What is “normal” in the aging process - primary aging
• More susceptibility to disease - secondary aging
• More heterogeneity in the elderly population - DIVERSE
• Onset indeterminable and progression varied
• Genetic and environmental factors
• Lifestyle is a primary factor
 AGING-RELATED CHANGES
• In humans, some functions like hearing and flexibility begin to deteriorate
early in life (Bowen and Atwood, 2015), most of our body's functional
decline tends to begin after the sexual peak, roughly at age 19. Contrary
to demographic measurements of aging that show mortality rates increasing
exponentially, the human functional decline tends to be linear (Strehler,
2009).
 AGING-RELATED CHANGES
• Aging is characterized by changes in appearance, such as a gradual
reduction in height and weight loss due to loss of muscle and bone mass, a
lower metabolic rate, longer reaction times, declines in certain memory
functions, declines in sexual activity--and menopause in women--, a
functional decline in audition, olfaction, and vision, declines in kidney,
pulmonary, and immune functions, declines in exercise performance, and
multiple endocrine changes (Craik and Salthouse, 1992; Hayflick, 1994, pp.
137-186; Spence, 1995).
 AGING-RELATED CHANGES
• Although the immune system deteriorates with age, called immune-senescence,
a major hallmark of aging is an increase in inflammation levels, reflected in
higher levels of circulating pro-inflammatory cytokines and that may contribute
to several age-related disorders such as Alzheimer's disease, atherosclerosis and
arthritis (Franceschi et al., 2000; Bruunsgaard et al., 2001).
• Some age-related changes, such as presbyopia, also called farsightedness, which
may be caused by the continuous growth of the eyes' lenses and appears to be
universal of human aging (Finch, 1990, pp. 158-159; Hayflick, 1994, p. 179), and
menopause, are inevitable yet the incidence of most age-related changes vary
considerably between individuals.
 AGING-RELATED CHANGES
• Clearly, the incidence of a number of pathologies increases with age.
These include type 2 diabetes, heart disease, cancer, arthritis, and kidney
disease. Also note how the incidence of some pathologies, like sinusitis,
remains relatively constant with age, while the incidence of others, like
asthma, even decline. Therefore, it is important to stress that aging is not
merely a collection of diseases. With age we become more susceptible to
certain diseases, but as described above we also become more likely to die,
frailer, and endure a number of physiological changes, not all of which lead
to pathology.
BODY SYSTEMS
 SENSORY SYSTEM-HEARING
• Hearing
• Loss is usually in ability to hear high frequency sounds.
• Hearing loss can lead to social isolation and should be addressed.
• Hearing aids cannot address all types of hearing loss.
• How to help mitigate effects of hearing loss:
• Lower the pitch of your voice.
• Speak directly to the person so that they can see your face.
• Eliminate background noise.
SENSORY SYSTEM - VISION
• Vision
• Not all older people have impaired vision. Loss of ability to see items that are close
up begins in the 40’s. Size of pupil grows smaller with age: focusing becomes less
accurate. Lens of eye yellows making it more difficult to see red and green colors.
Sensitivity to glare increases. Night vision not as acute.
• How to help mitigate the effects of vision loss:
• Increase lighting. Use blinds or shades to reduce glare. Maintain equal levels of lighting.
The lens of the eye loses fluid and becomes less flexible, making it more difficult to
focus at the near range. Dry eyes are quite common.
 SENSORY SYSTEM - TASTE AND
SMELL
• Taste and Smell
• Some loss in taste and smell as one ages, but loss is usually minor and not until after age 70
• Many older people often complain of food being tasteless
• Possible causes:
• Loneliness at meals
• Unwilling/unable to cook
• Dental problems
• Financial barriers
 SENSORY SYSTEM -
PAIN AND TOUCH
• Pain and Touch
• With age, skin is not as sensitive as in youth
• Contributing factors include:
• Loss of elasticity
• Loss of pigment
• Reduced fat layer
• Safety Implications:
• Lessened ability to recognize dangerous levels of heat
• Lessened ability of body to maintain temperature
• Tendency to develop bruises, skin tears more easily
 BRAIN AND CENTRAL
NERVOUS SYSTEM
• Without illness, a person can expect high mental competence well past age 80.
• Physical reactions are slowed due to increased “lag” time of neurons
transmitting information: Slowing manifests itself in the learning process.
• Unfamiliar or high stress activities cause an older person to perform more slowly.
• Throughout adulthood, there is a gradual reduction in the weight and volume
of the brain. This decline is about 2% per decade. Contrary to previously held
beliefs, the decline does not accelerate after the age of 50, but continues at about
the same pace from early adulthood on. The accumulative effects of this are
generally not noticed until older age.
 BRAIN AND CENTRAL
NERVOUS SYSTEM
• There is neuronal loss in the brain throughout life (the amount & location varies).
• Loss is chiefly gray matter not white matter
• There is some evidence that although some neuronal loss occurs with age, many neurons have
↑ dendrite growth which may (at least partially) compensate for neuronal loss in some areas of
the brain.
• Slowed neuronal transmission
• Changes in sleep cycle: takes longer to fall asleep, total time spent sleeping is less
than their younger years, awakenings throughout the night, increase in frequency of
daytime naps
 BRAIN AND CENTRAL
NERVOUS SYSTEM
• Sense of smell markedly decreases
• Intellectual functioning defined as “Stored” memory increases with age.
• Problem solving skills increase with age.
• Older people are able to learn very well.
• How to help:
• Allow time
• Minimize distractions
• Use it or lose it
MUSCLES AND BONES
• Muscles and Bones
• Loss of elasticity of connective tissue can cause pain and impair mobility
• No way to prevent these changes
• Maintain bone health through diet, exercise and getting adequate rest
• Always consider medication side effects when assessing mobility concerns
• How to help:
• Encourage use of assistive devices if indicated
• Modify environment to reduce fall risk
• Encourage activity- take walks etc.
 GI TRACT
• Basal and maximal stomach acid production diminish sharply in old age. At
the same time, the mucosa thins. Very little seems to happen to the small bowel.
• Decline in number of gastric cells results in decreased production of HCL (an
acidic environment is necessary for the release of vitamin B12 from food
sources).
• Decrease in amount of pancreatic enzymes without appreciable changes in
fat, CHO, or protein digestion → breakdown of sugar, fats, starches and helps
making hormones.
 GI TRACT
• Diminished gastric (eg pepsinogen) & pancreatic
enzymes result in a hindrance to the absorption of
other nutrients like iron, calcium, & folic acid.
• Hepatic blood flow, size & weight decrease with age.
Overall function, however, is preserved, but may be less
efficient in the setting of drug overload.
• Some sources claim that one can expect atrophy &
decrease in the number of (especially) anterior
(salty/sweet) taste buds, but this is controversial.
 GI TRACT
• Constipation is more common in older adults due to slowed circulation,
reduced sense of thirst, lessened activity level and decreased tone in stomach
& intestines which results in slower peristalsis and constipation.
• Emotions play a significant role in appetite and digestion.
• How to help:
• Encourage activity
• Encourage socialization and emotional well-being
• Encourage intake of fluids
 SKIN-EPIDERMIS
• The number of epidermal cells decreases by
10% per decade and they divide more slowly
making the skin less able to repair itself
quickly.
• Epidermal cells become thinner making the
skin look noticeably thinner.
• Changes in the epidermis allows more fluid to
escape the skin.
 SKIN-IN
BETWEEN
• The rete-ridges of the dermal-epidermal
junction flatten out
• Making the skin more fragile and making it
easier for the skin to shear.
• This process also decreases the amount of
nutrients available to the epidermis by
decreasing the surface area in contact with the
dermis.
= slower repair/turnover
 SKIN-DERMIS
• These changes cause the skin to wrinkle and sag.
• The dermal layer thins.
• Less collagen is produced.
• The elastin fibers that provide elasticity wear out.
• Decrease in the function of sebaceous & sweat
glands contributes to dry skin.
• The fat cells get smaller. This leads to more
noticeable wrinkles and sagging.
SKIN – TOES & NAILS

• Toes & nails become thicker &

more difficult to cut.
• Grow more slowly.
• May have a yellowish color.
 SKIN – HAIR
• Men:
• Most men loose the hair about their temples during their 20s.
• Hairline recedes or male pattern baldness may occur.
• Increased hair growth in ears, nostrils, & on eyebrows.
• Loss of body hair.
• Women:
• Usually do not bald, but may experience a receding hairline.
• Hair becomes thinner.
• Increased hair growth about chin & around lips.
• Loss of body hair.
 HEART
• Heart/Circulatory System
• Deposits of the "aging pigment," lipofuscin,
accumulate.
• The valves of the heart thicken and become
stiffer.
• The number of pacemaker cells decrease and
fatty & fibrous tissues increase about the SA
node. These changes may result in a slightly
slower heart rate.
HEART
• A slight increase in the size of the heart, especially the
left ventricle, is common. The heart wall thickens, so the
amount of blood that the chamber can hold may
actually decrease.
• Age changes make the heart less able to pump efficiently.
• Less blood pumped results in lowered blood oxygen levels.
The limits of the heart to exert itself are reduced with age.
• Medications processed and eliminated differently than
in young adults.
 BLOOD VESSELS
Blood vessels
• Arteries lose elasticity with age making heart have to pump harder to circulate
blood, this is mainly due to:
• Thickening & stiffening in the media of large arteries is thought to be
caused by collagen cross-linking.
• Smaller arteries may thicken/stiffen minimally; their ability to dilate & constrict
diminishes significantly.
• In veins, age-related changes are minimal and do not impede normal functioning.
BLOOD VESSELS
• Effects:
• The aorta becomes thicker, stiffer, and less flexible. This makes the
blood pressure higher resulting in LV hypertrophy.
• Increased large artery stiffness causes a fall in DBP, associated with a
continual rise in SBP. Higher SBP, left untreated, may accelerate large
artery stiffness and thus perpetuate a vicious cycle.
• Baroreceptors (stabilize BP during movement/activity) become less
sensitive with aging. This may contribute to the relatively common finding
of orthostatic hypotension.
KIDNEY
• Renal blood vessels become smaller & thicker reducing renal blood flow.
• Decreased renal blood flow from about 600ml/min (age 40) to about
300ml/min (age 80)
• Kidney size decreases by 20-30% by age 90.
• This loss occurs primarily in the cortex where the glomeruli (# of gloms decrease by 30-
40% by age 80) are located.
• Decreased GFR. Typically begins to decline at about age 40. By age 75 GFR
may be about 50% less than young adult. Current research shows that this is not
true for all elders, however.
 KIDNEY
• There is a decline in the number of renal tubular cells, an increase in tubular
diverticula, & a thickening of the tubular walls is decreased ability to
concentrate urine & clear drugs from the body.
• Overall kidney function, however, remains normal unless there is excessive
stress on the system.
• The muscular ureters, urethra, & bladder lose tone & elasticity. The bladder
may retain urine.
• This causes incomplete emptying.
• Decline in bladder capacity from about 500-600mL to about 250ml so less urine
can be stored in the bladder.
• This causes more frequent urination.
• The warning period between the urge and actual urination is shortened or lost as one ages.
 ENDOCRINE SYSTEM
• In most glands of the body there is some atrophy & decreased secretion with
age, but the clinical implications of this are not known.
• What may be different is hormonal action. Hormonal alterations are variable &
gender-dependent.
• Most apparent in:
• Glucose homeostasis
• Reproductive function
• Calcium metabolism
• Subtle in:
• Adrenal function
• Thyroid function
 REPRODUCTIVE SYSTEM
WOMEN
• The “climacteric” occurs (defined as the period during with reproductive capacity
decreases (ie, ovarian failure) then finally stops = loss of estrogen &
progesterone; FSH & LH ↑↑). This is also described as the transition from
peri-menopause (~age 40s) to menopause.
• Thinning & graying of pubic hair
• Loss of subQ fat in external genitalia giving them a shrunken appearance
• Ovaries & uterus decreases in size & weight
• Skin is less elastic + loss of glandular tissue gives breasts a sagging appearance
 REPRODUCTIVE SYSTEM
WOMEN
• Other physical changes may include hot flashes (can cause sleep deprivation
if they occur at night), sweats, irritability, depression, headaches,
myalgias. Sexual desire is variable. The symptoms are typically present for
about 5 years
• Atrophy of vaginal tissues due to low estrogen levels = thinning & dryness
occurs; agglutination of labia majora & minora may occur.
 REPRODUCTIVE SYSTEM
MEN
• Testosterone decreases, testes become softer & smaller
• Erections are less firm & often require direct stimulation to retain rigidity
• Though fewer viable sperm are produced & their motility decreases, men
continue to produce enough viable sperm to fertilize ova well into older age.
• Less seminal fluid may be ejaculated
• They may not experience orgasms every time they have sex
• The prostate gland enlarges; this often results in compression of the urethra
which may inhibit the flow of urine.
MUSCULOSKELETAL SYSTEM-
MUSCLES
• Sarcopenia (↓ muscle mass & contractile force) occurs with
age. Some of this muscle-wasting is due to diminished
growth hormone production, but exactly how much is due
to aging versus disuse is unclear.
• Sarcopenia is associated with increased fatigue & risk of
falling (so may compromise ADLs).
• Sarcopenia affects all muscles including, for example, the
respiratory muscles (↓ efficiency of breathing) & GI tract
(constipation).
 MUSCULOSKELETAL SYSTEM-
BONES
• Bone/Tendons/Ligaments:
• Gradual loss of bone mass (bone resorption > bone formation) starting around age 30s.
• Decreased water content in cartilage
• The “wear-&-tear” theory regarding cartilage destruction & activity doesn’t hold up as
osteoarthritis is also frequently seen in sedentary elders.
• Decreased water in the cartilage of the intervertebral discs results in a ↓ in
compressibility and flexibility. This may be one reason for loss of height.
• There is also some decrease in water content of tendons & ligaments contributing
to ↓ mobility.
 RESPIRATORY SYSTEM
• How well the lungs supply the body with oxygen seems to relate directly to age.
• The amount of oxygen delivered to the bloodstream and the rate of blood flow
declines with age.
• Even with the lung capacity remaining normal, the lung tissues seem to lose facility
for making the oxygen-to-blood transfer to the bloodstream.
• Since older people cannot breathe as fast, there is less oxygen entering the blood per
minute. Less oxygen in the system cuts down the amount of work that can be done.
• The number of cilia & their level of activity is reduced.
• Glandular cells in large airways are reduced.
 RESPIRATORY SYSTEM
• Decreased number of nerve endings in larynx.
• The cough reflex is blunted thus decreasing the effectiveness of cough.
• Decreased levels of secretory IgA in nose & lungs results in decreased ability to
neutralize viruses.
• The number of FUNCTIONAL alveoli decreases as the alveolar walls become
thin, the aveoli enlarge, are less elastic.
• Decreased elasticity of the lungs may be due to collagen cross-linking.
• The loss of elasticity accounts for "senile hyperinflation"; unlike in smokers,
there is little or no destruction of the alveoli.
• VC is diminished by about 20%. RV increases by about 50%.
 HEMATOLOGIC SYSTEM
• A decrease in total body water is observed with aging. Blood volume therefore
decreases.
• The number of red blood cells are reduced, but not significantly.
• Most of the white blood cells stay at the same levels, but lymphocytes decrease in
number and effectiveness.
• Overall, cell counts and parameters in the peripheral blood are not significantly
different from in young adult life.
• However, the cellularity of the bone marrow decreases moderately. For
example, 30% cellularity on an iliac crest biopsy (which would be very low for a
young adult) is not unusual in an older person.
 IMMUNE SYSTEM
• The efficiency of the immune system declines with age, but this is variable
among persons.
• Nonspecific defenses become less effective
• The ability of the body to make antibodies diminishes.
• Autoimmune disorders are increased in older adults. Not everyone believes
that the increased incidence of autoimmune disease is an expected part of aging,
but all acknowledge the increase in findings of positive rheumatoid factor, anti-
nuclear antibody, and false- positive syphilis screens in healthy older adults.
 IMMUNE SYSTEM
• The thymus gland (which produces hormones that activate T cells) atrophies
throughout life.
• The peripheral T-cells proliferate much less exuberantly in old age.
• Common infections are often more severe with slower recovery & decreased
chances of developing adequate immunity.
PSYCHOLOGICAL
ASPECT OF AGING
 PSYCHOSOCIAL ASPECTS OF AGING
• Psychosocial problems occur at any age
• Depressive illness is considered to be most common psychiatric diagnosis
• Many times the prescription & diagnosis remain unmet
• Mental disorders are believed to be a sign of mental weakness among elders
• Depression is co-existed with many of their medical illness (CV disorders/respi disorders)
Promotion of Mental Health
• Controlled physical & mental activities → Optimum nutrition → Strong support system →
Regular schedules of activities/interests
PREVENTION OF MENTAL ILLNESS

• Avoidance of social isolation

• Seeking when symptoms occur
• Use of essential prescribed medications
• Appropriate health/mental health care on time
RISK FACTORS OF GERIATRIC
DEPRESSION
• Advancement in age
• Living in long- term care settings
• Women
• Co-morbid physical illness/disability
• Unmarried
• Lack of social support/death of spouse
• Urban area
• Low socio- economic status
 COMMON SYMPTOMS:
• Apathy
• Lack of interest in pleasurable activities
• Withdrawal from friends
• Anorexia resulting in weight loss
• No pleasure in life
• Not sleeping well
• Feeling of worthlessness/hopelessness
• Increased dependency
• Multiple vague somatic complaints: pain, weakness, SOB, functioning prob, etc)
• Other behavioral changes: Grief reaction/crying spells
PHYSICAL ILLNESS SHOWS
DEPRESSION SYMPTOMS:
• Metabolic disorders
• Endocrine disorders
• Neurological disorders
• Cancer
• Cardiovascular changes
• Pulmonary changes
• Anemia
• Vascular diseases
 MANAGEMENT OF
DEPRESSION:
• Ensure client safety (Self-destructive behaviors/suicidal ideations)
• Meet the physical needs
• Empathizing the emotional responses of the individuals
• Social-based interventions
• Group format interventions
• Reminiscence groups
• Psychopharmacologic/Symptoms- based drug
• Teaching alternative coping skills
 CLIENT EDUCATION:
• Assertiveness, problem solving, and stress management techniques
• Medication regimen, monitoring the side effects, and management of side
effects.
• Include family members when possible
• Use group format
• Provide ongoing educational sessions
 SUICIDE (RISK):
• Psychopathology associated to affective symptoms
• 76% elders who attempted suicide have a diagnosis of affective diagnosis
• Passive/sub-intentioned suicides are common among elders
– Refusing necessary medications
– Ignoring the necessary life-saving measures
– Involve in risk-related behaviors (driving recklessly)
 RISK FACTORS:
• Age (75-85) • Recent personal loss
• Low socioeconomic status • Economic/social/prestige loss
• Male gender • Family history of suicide
• Living alone • Unemployment/widow
• Chronic illnesses • Prior attempts/threats
• Chronic pain • Social isolation
• Substance misuse • Chronic sleep problems
DEFINING CHARACTERISTICS
• Hopelessness/helplessness
• Psychomotor agitation/retardation
• Verbalization of suicidal ideation
• Ruminations about death
• Hostile behavior
• Impulsive behavior
• Social isolation; withdrawn behavior
• Depressed/flat affect
• Cognitive disturbances/impaired concentration
 MANAGEMENT:
• Focusing on current hazard/crisis to which the client is responding (eg; Loss
of loved one etc)
• Limit any immediate danger (removing implements, providing close
supervision)
• Discuss the situation with the family/caregivers
• Negotiating a no-suicide contract
SOCIAL ASPECT OF
AGING
 IMPORTANCE:
• People communicate with one another all the time and not only with
words but through various other means as well.
• Example: “We are appreciated or accepted by others through a smile, clap, or
pat on the shoulder”
• Our social life takes into account the language we use, the gestures we make
the interaction and relationships we have with one another.
• Social aspects of life include the support we give and concerned moves we
make to help one another especially those in distress.
THE SOCIAL ASPECTS OF LIFE:
• Make us share with others
• Make us consider others as our alter ego.
• Interlink individuals
• Make us care for the needy, oppressed, abandoned, aged, and those who have
no one to care for them.
• Allow us to recognize the dignity of every human being.
• Help us mix with everyone.
DIFFERENT MANIFESTATIONS OF SOCIAL
BEHAVIOR OF THE AGING PERSON
Manifestations of a socially healthy aging person:
• Happy to growing older and able to manage the aging syndrome with dignity and simplicity.
• Has a sense of humor
• Can mix with any group
• Open to share what he/she has in all aspect.
• Does not entertain false rumors
• Maintains good personal hygiene
• Find ways and means to be busy
• Enjoys life
• Honest about his/her feelings
• Stay connected with friends and relatives
DIFFERENT MANIFESTATIONS OF SOCIAL
BEHAVIOR OF THE AGING PERSON
Manifestations of a socially unhealthy aging person:
• Cranky and cantankerous (irritable, uncooperative, argumentative)
• Sensitive and narrow-minded
• Quick tempered, irritated and complain
• Cannot get along with others
• Feeling of being neglected by everyone and isolates himself
• Demands respect, attention seeker
• Neglects personal grooming, old fashioned
• Feeling of insecurity and afraid of death through words
• Afraid to be alone
• Greedy to grab anything you give/offer with critical comments accompanying acceptance
 OLD AGE AND THE ELDERLY HAVE A
VARIETY OF EXPECTATIONS AND NAMES. . . .
FEW ARE POSITIVE:
• Geezer/ old man • time of loss
• twilight years • smelly
• boring • time of pain
• empty years • senile
• old battle-ax • dependent
• golden years • respected
• useless • demanding
• time of our life • demented
• out of touch • loss of autonomy
 CULTURE AND AGING
• Growing old is generally feared
• Elderly are not often respected nor
revered
• Nuclear families do not include the
elderly
• Ageism at times is practiced
• Elderly often seen as sick, senile,
and useless
• Have great respect for the aged
• Extended families include elderly
• Big family decisions required
everyone’s input
• Devotion to extended family
• Elderly have tremendous influence
over family decisions
• Grandparents often raise their
grandchildren
 SUCCESSFUL AGING
WHAT IS SUCCESSFUL AGING?
• Basically, it is finding purpose and acceptance with life as it is - with little regret or
remorse
FIVE FACTORS OF SUCCESSFUL AGING
1. LIFE SATISFACTION: rewarding, few regrets, positive attitude about past and future
2. SOCIAL SUPPORT SYSTEM: network of family and friends
3. GOOD PHYSICAL AND MENTAL HEALTH
4. FINANCIAL SECURITY
5. PERSONAL CONTROL OVER ONE’S LIFE: independence, dignity, and self-
worth
 EXERCISES:
• Formulate at least 3 nursing care plan on each aspect of aging to have a successful
and healthy aging process:
1. Physical
2. Psychological
3. Social
• What programs or initiatives that you as a nurse will implement for each aspect of
aging? Discuss each.
 RESOURCES:
Textbooks:
 Kane, Robert L., Resnick, Barbara, Essentials of Clinical Geriatrics 6th Edition (2009), Mc-Graw-Hill
Companies, Inc.
 Mauk, Kristen L., Gerontological Nursing: Competencies for Care 2nd edition (2010), Jones and Barlett
Publishers
 Natividad, J. N., Kuan, L. G., S. R. Bonito, A. O. Balabagno, et. al., Caring for the Older Person (2005),
University of the Philippines, Office of Academic Support and Instructional Services
 Tabloski, Patricia A., Essentials Of Gerontological Nursing 1st Edition (2006), Pearson education Inc.
 Walker, Lynne, Patterson, Elizabeth, et. al., General PRACTICE Nursing (2010), Mc-Graw-Hill
Companies, Inc.
Internet Sources:
http://www.info@jbpub.com/
http://www.doh.gov.ph/