CARE OF THE OLDER ADULTS LECTURE
CLINICAL INSTRUCTOR: DR. RUBY CORAZON EDIZA
FIRST SEMESTER | PRELIMINARY LESSONS
BY ALTEA A. AYA-ON
A man’s life is normally divided into five main stages
➔ Old age is not without problems
➔ With increasing age, we become old, birth,
development, decline, and death are the laws of
life.
➔ Again is not merely the passage of time.
➔ It is important to recognize that people age
differently.
➔ As a general rule, slight, gradual changes are
common, and most of these are not problems for
the person who experiences them.
➔ Both deal with aging but geriatrics focuses on
the care of aging people while gerontology is
the actual study of the aging process. A
geriatrician or geriatric physician and
gerontology nurse work to promote health in
older adults while preventing and treating
diseases prone to them.
➔ Scientific and medical disciplines, respectively,
are concerned with all aspects of health and
disease in the elderly and with the normal aging
process.
➔ Is concerned primarily with the changes that
occur between maturity and death and with the
factors that influence these changes. It
addresses the social and economic effects of an
aging population and the physiological and
psychological aspects of aging to learn about
the aging process and possibly minimize
disabilities.
➔ Gerontology is the study of aging and/or the
aged, this includes the biophysical social of
aging.
➔ Geriatrics, social gerontology, geropsychology,
geropharmacology, gerontology nursing, and
gerontological rehabilitation.
➔ Deals with prevention and treatment of diseases
once assumed to be invertible in the elderly.
➔ Geriatrics relates to the medical care of the
aged.
➔ The discipline of nursing and scope of nursing
practice
➔ It involves nurses advocating for the health of
older adults at all levels of prevention.
➔ A nurse who has a specialization in geriatrics or
in the care of old people is called geriatric nurse
or gerontological nurse.
➔ Work with healthy elderly persons in their
communities, acutely ill elders requiring
hospitalization and treatment, and chronically ill
or disabled elders in long-term facilities, skilled
care, home care, and hospice.
➔ Scope: from the time of “old age” until death.
➔ This is related to the disease process of old age
and it aims at keeping old persons in a state of
self-dependence as far as possible and
providing facilities to improve their quality of life.
➔ The time-related deterioration of the
physiological functions necessary for survival
and fertility.
➔ Is a normal process of time-related change
begins with birth and continues throughout life.
➔ Is the process of growing old or developing the
appearance and characteristics of old age.
➔ Expresses the continuous pressure and effect of
time on our body, senses and skin.
➔
➔ Also known as Hutchinson-Gilford progeria
syndrome (HGPS), is a rare genetic condition
that causes a child’s body to age fast. Most kids
with progeria do not live past age 13. The
disease affects both sexes and all races equally.
It affects about 1 in every 4 million births
worldwide.
➔ Aging is a universal process that begins at birth
and is specified by the chronological age
criterion.
➔ Aging is marked by changes in behavior and
self-perception and reaction to biologic changes.
➔ Aging refers to the capabilities of the individual
to function in society.
➔ Chronological age refers to the actual amount of
time a person has been alive.
➔ In other words, this refers to the number of days,
months, or years a person has been alive
CARE OF THE OLDER ADULTS LECTURE
CLINICAL INSTRUCTOR: DR. RUBY CORAZON EDIZA
FIRST SEMESTER | PRELIMINARY LESSONS
BY ALTEA A. AYA-ON
CATEGORIES AGE IN YEARS
Young old 65-74
Middle old 75-84
Old old 85-100
Elite old Over 100
➔ Senescence or biological ageing is the gradual
deterioration of function characteristics.
➔ This aging is also known as physiologic aging.
➔ Futhermore, biological aging refers to the
physical changes that “slow us down” as human
get into middle and older years.
➔ For example: arteries might clog up, or problems
with lungs might make it more difficult for us to
breathe.
➔ Refers to the psychological changes, including
those involving mental functioning and
personality, that occur as human age
➔ Some people who are 65, can look and act
much younger than some who are 50.
➔ Psychological ageing may be seen as a
continuous struggle for identify, i.e. for a 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.
➔ Social aging refers to changes in a person’s
roles and relationships, both within their
networks of relatives and friends and in formal
organizations such as the workplace and houses
of worship.
➔ Social aging differs from one individual to
another.
➔ It is also profoundly influenced by the perception
of aging that is part of society’s culture.
➔ Cognitive aging is the decline in cognitive
processing that occurs as people get older
➔ Age-related impairment in reasoning, memory,
and processing speed can arise during
adulthood and progress into the elder years.
➔ The concept of cognitive aging, a term that
described a process of gradual, longitudinal
changes in cognitive functions that accompany
the aging process.
➔ Refers to any Filipino citizen who is a resident of
the Philippines, and who is sixty (60) years old
or above. It may apply to senior citizens with
“dual citizenship” status provided they prove
their Filipino citizenship and have at least six (6)
months of residency in the Philippines.
➔ Most developed world countries have accepted
the chronological age of 65 years as a definition
of ‘elderly’ or older person.
➔ While this definition is somewhat arbitrary, it is
many time associated with the age at which one
can begin to receive pension benefits.
➔ At the moment, there is no United Nations
standard numerical criterion, but the UN agreed
cutoff is 60+ years to refer to the older
population.
➔ Observation of family members, friends,
neighbors, and your own experience with older
adults.
➔ Media like newspapers, film industry,
commercials in magazines and on TV.
➔ Ageism: negative attitude toward aging or older
adults.
➔ Examine:
◆ To take a look at the myths and realities
◆ To separate fact from fiction
◆ To gain av value for the wisdom of
lifetimes that older adults have to offer
➔ It is a field of nursing that specializes in the care
of the elderly
➔ Florence Nightingale and Doreen Norton
provided early insights into the care of aged
➔ ANA established the Division of Geriatric
Nursing Practice in 1966 with a goal to create
standards for quality nursing care for the aged
➔ The standards and scope of gerontological
nursing practice were developed in 1969 by
ANA
➔ The term gerontological nursing replaced the
term Geriatric Nursing in the 1970s
➔ Geriatric nursing is bound to be part of our
professional future
➔ Older adults are the core business of health care
representing the majority visits, hospital
admission, and long-term care residents.
➔ The global population aged 60 years or over
numbered 962 million in 2017, more than twice
as large as in 1980 when there were 382 million
older persons worldwide. The number of older
persons is expected to double again by 2050,
when it is projected to reach nearly 2.1 billion.
➔ In 2030, older persons are expected to
outnumber children under age 10 (1.41 billion
versus 1.35 billion); in 2050, projections
CARE OF THE OLDER ADULTS LECTURE
CLINICAL INSTRUCTOR: DR. RUBY CORAZON EDIZA
FIRST SEMESTER | PRELIMINARY LESSONS
BY ALTEA A. AYA-ON
indicated that there will be more older persons
aged 60 or over than adolescents and youth at
ages 10-24 (2.1 billion versus 2.0 billion).
➔ The number of persons aged 80 years or over is
projected to increase more than threefold
between 2017 and 2050, rising from 137 million
to 452 million.
➔ Two-thirds (⅔) of the world’s older persons live
in the developing regions, where their numbers
are growing faster than in the developed
regions. In 2050, it is expected that nearly 8 to
10 of the world’s older person will be living in
developing regions.
➔ Each of the 201 countries or areas with at least
90,000 inhabitants in 2017 is projected to see an
increase in the proportion of persons aged 60 or
over between 2017 and 2050.
1. The country consists of approximately 103
million inhabitants, with less than 5% of the
population 65 years old and older (central
intelligence agency, 2016).
2. The age structure of the Philippines resembles
many other developing countries
3. Despite the number of young Filipinos, the 60
years and older population are expected to
increase by 4.2%, whereas the 80 years and
older is expected to increase by 0.4% from
2010 to 2030.
➔ In contrast, the 60 years and older population of
the United States will increase by 5.4% from
2010 to 2030 (Help Age, 2015).
➔ The Philippines’ population increased by over
35% over the last two decades with an older
adult population (60 years and older) expected
to overtake those aged 014 years old by 2065
(Help Age Global Network, 2017).
➔ currently, the 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.
5.4% (US) → 35% (PH) → 57.4% (4.7 years Male) →
63.2 (4 years Female)
YOUNG <7% of population is aged
65 or older
AGING 7-13% of population is
aged 65 or older
AGED 14-20% of population is
aged 65 or older
SUPERAGED >21% of population is
aged 65 or older
Examples by stage of
Aging:
YOUNG Philippines
AGING China (11.72% are 65+
as of 2019)
AGED Republic of Korea (15%
are 65+ as of 2019)
SUPERAGED Japan (27.9%% are 65+
as of 2019)
➔ Population aging- the inevitable increase in the
share of older person
➔ By mid 21st century, old people will outnumber
young for the first time in history
➔ Advancement in medical care:
◆ Advancement in disease control and
health technology
◆ Implementation of preventive health
services
➔ Lower infant and child mortality rates
➔ Improved sanitation
➔ Better living conditions
➔ Baby born after WWII (1946-1964)
➔ From 2.4 to 3.5 children per household
➔ Older population will explode between 2010 to
2030 when baby boomers reach age 65- starting
11
➔ The anticipated increase has been called both a
demographic tidal wave and a pig in python.
1. Impact: referred to as demographic tidal wave
2. Gerontologic nurses must consider the realities
of the baby boomers
3. They have informed consumers of health care &
desire a highly active role in their care
4. Their blended families may need special
assistance due to the potential caregiving
demands.
➔ Many baby boomers want to be informed health
care consumers and are comfortable
communicating via e-mail and text messages.
They may prefer electronic appointment
reminders and reports from diagnostic tests
rather than telephone calls, and they appreciate
links to fact sheets about their conditions and
treatments. However, some members of this
generation are not tech savvy and prefer
traditional communication means, so it is
important to ask about the preferred style of
communication during the assessments.
CARE OF THE OLDER ADULTS LECTURE
CLINICAL INSTRUCTOR: DR. RUBY CORAZON EDIZA
FIRST SEMESTER | PRELIMINARY LESSONS
BY ALTEA A. AYA-ON
➔ Impact: the government
➔ Is the source of payment for many of the
services older adults need
➔ Has higher rates of hospitalization, surgery, and
physician visits
➔ Less than 5% of older adults is in a nursing
home, assisted living community or other
institutions
➔ Society will face an increasing demand for the
provision of and payment for services for this
group
➔ Gerontological nurses must be actively involved
in discussions and decisions pertaining to the
rationing of services so that the rights of older
adults are expressed and protected. Likewise,
gerontological nurses must assume leadership
in developing cost-effective methods of care
delivery that do not compromise the quality of
services to other adults.
➔ Gerontological nurses need to be advocates in
ensuring that cost-containment efforts do not
jeopardize the welfare of older adults.
1. Resource needs will continue to increase across
all health care settings
2. A shortage of health care professionals is
expected
3. The diversity of caregivers lags behind the
growing diversity of patients
4. Care has been focused on a single disease
versus addressing comorbidity
5. The sustainability and structure of federal
programs in relation to the increasing aging
population are a concern
6. Adapting and adjusting to UHC
➔ Common 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.
➔ (+) “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.”
➔ 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.
➔ Some families explore options for financial
support that can make family life more
enjoyable, emphasizing that “there is no shame
in utilizing what support is out there.
➔ 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,
➔ Thomas and Segur describe this as a “shift in
family structure and hierarchy related to
matriarch or patriarch no longer being in their
role.” when this occurs, “someone new has to
take their place.
➔ The 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
➔ The family structure shifts to being less
hierarchical and more cooperative
➔ Prioritizing parents’ care can ease their pain and
worry but might impact your health
➔ The time and effort of keeping up with parents’
care mean 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
➔ “Our thoughts frame our emotional state”
➔ When you care for aging parents, you might feel
as if you are in a rut
➔ This, in turn, affects your family life, creating an
environment of bitterness and resulting in more
criticism and complaining.
➔ However, some families have the opposite
experience by creating 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
CARE OF THE OLDER ADULTS LECTURE
CLINICAL INSTRUCTOR: DR. RUBY CORAZON EDIZA
FIRST SEMESTER | PRELIMINARY LESSONS
BY ALTEA A. AYA-ON
➔ They consider what moments in their days make
them smile
➔ Defines our practice
➔ In gerontological nursing they must be
comprehensive yet consider individual
differences
➔ Tells how and why phenomena are related
➔ Leads to prediction
➔ Provides process and understanding
➔ Must be holistic and take into account all that
impacts on a person throughout a lifetime of
aging
➔ Cultural, spiritual, regional, socioeconomic,
educational, environmental factors, and health
status impact the older adults perceptions and
choices about their health care needs
➔ Limited work has been done to identify nursing
specific aging theories
➔ Aging is a distinct discipline that requires that
have an interdisciplinary perspective.
➔ There is no single universally accepted definition
of aging
➔ Aging is best looked at as a series of changes
that occurs over time, contribute to loss of
function, and ultimately result in the death of
living organism
➔ The maximal life expectancy for humans today
appears to be 120 years
➔ Theories of aging have been considered
throughout history as mankind has sought to find
ways to avoid aging
➔ The quest for a “fountain of youth” has motivated
explorers such as
◆ Ponce de Leon- The search for the
extension of youth has led some people
to seek the potions of conjurers, often
more poisonous than beneficial
➔ Theories abound to help explain and give some
logical order to our observations.
➔ The theory refers to the idea that aging is a
biological function that serves an evolutionary
purpose and is controlled by a biological clock or
program. It explains that each cell has a
genetically programmed aging code that is
stored in the organism’s DNA and is described
as comprising genetic influences that predict the
physical condition, the occurrence of disease,
cause and age of death, and other factors that
contact tribute to longevity. Biologic theories of
aging attempt to explain why physical changes
associated with aging occurs. They are
concerned about finding answers to fundamental
concerns about the physiological processes that
living beings go through as they are.
➔ View aging as certain predetermined, time
phenomena. These hypothesize that aging is
predetermined by programmed cell changes, as
well as alterations in the neuroendocrine and
immune systems. Also, it views aging as a
series of predetermined events happening to all
organisms in a timed framework. According to
Goldsmith (2004), aging is more likely to be an
evolved beneficial characteristic and results from
a complex structured process and not a series of
random events.
◆ Programmed theory
◆ immunologic/autoimmune theory
◆ Neuroendocrine theory
◆ Gene/biological clock theory
➔ There are functional changes that do occur
within cells and are responsible for the aging of
the cells and the organism. The study further
supported the hypothesis that a cumulative
effect of improper functioning of cells and
eventual loss of cells in organs and tissues is
therefore responsible for the “aging
phenomenon”
Examples:
◆ Increased cell apoptosis causes organ
dysfunction
◆ Short telomeres in genes to cause cells
to die or apoptosize
➔ Immune system is programmed to decline over
time, leading to an increased vulnerability to
infectious disease and thus aging and health.
Accompanying these changes is a decrease in
the body’s defense against foreign pathogens,
which manifests itself as an increased incidence
of infectious diseases and an increase in the
production of autoantibodies, which lead to a
propensity to develop autoimmune-related
diseases.
Examples:
◆ A person with decreased immune
function in the elderly age may be
predisposed to the thymus gland
shrinking, altered lymphocyte function,
and decreased cell-mediated and
humoral immune response.
◆ Loss of T-cell differentiation increases
the risk for autoimmune disease.
➔ Aging is a biological function that serves an
evolutionary purpose and is controlled by a
biological clock or program. It explains that each
cell has a genetically programmed aging code
that is stored in the organism’s DNA and is
described as comprising genetic influences that
predict the physical condition, the occurrence of
CARE OF THE OLDER ADULTS LECTURE
CLINICAL INSTRUCTOR: DR. RUBY CORAZON EDIZA
FIRST SEMESTER | PRELIMINARY LESSONS
BY ALTEA A. AYA-ON

disease, cause and age of death, and other benefits from eating real plants and other foods.
factors that contract tribute to longevity. Supplements appear not to be as effective.

Examples:
◆ The circadian rhythm or sleep-wake
cycle changes with aging, producing
more fragmented sleep and leading to
decreased levels of melatonin which
decreased our quality of sleep.
◆ Each disease has a genetic component
to it, thus the occurrence of the disease
depends on the genes that you have. If
your father is diabetic, you are likely to
be diabetic too.
➔ Aging occurs randomly and persistently with
time, through random error, free radicals,
cross-links, “clinkers,” and wear and tear.
➔ Process within the body involves several
complexities, which makes some errors
possible. Such mistakes might happen at any
time during DNA sequencing or protein
synthesis. Slight changes in the body’s
processes might have negative effects,
especially if they accumulate over time. Aging is
believed to be caused by the accumulation of
errors in the cell molecules.
➔ The effects of aging are caused by progressive
damage to cells and the body system over time.
Essentially, our bodies “wear out” due to use.
They wear out, they once can longer function
currently.
➔ Chemical changes like this happen in your body
and can lead to aging. The process is slow and
complicated, but over time, more and more
proteins, DNA, and other structural molecules in
the body develop inappropriate attachments,
called cross-links, to one another. These
cross-linked molecules don’t function properly
and when enough cross-linked molecules
accumulate in a specific tissue- such as
cartilage, lungs, arteries, and tendons- it can
cause problems.
➔ When crossling occurs, tissues become stiffer,
and when tissues stiffen they don't function as
efficiently. Many of the symptoms of aging have
to do with the stiffening of tissues. Cataracts, for
example, are stiffening of your eyes’ lenses.
Cross-linking of skin protein collagen has been
found to be partially responsible for wrinkles and
other age-related skin changes, and researchers

➔ Byproduct of normal cell function. When cells

create energy, they also produce unstable
oxygen molecules. These molecules are called
free radicals to have a free electron, which
makes the molecule highly unstable. Free
radicals bond to other molecules if the body,
causing proteins and other essential molecules
to not function as they should.
➔ Can be formed through this natural process but
they can also because by diet, stress, smoking,
alcohol, exercise, inflammation drugs, exposure
to the sun, or air pollutants.
➔ Asserts that many of the changes that occur as
our bodies age are caused by free radicals. believe that cross-linking of protein the walls of
Damage to DNA, protein crosslinking and other the arteries account for atherosclerosis or the
changes have been attributed to free radicals. hardening of arteries that increase your risk for
Over time, this damage accumulates and heart attack and stroke, among other conditions
causes us to experience aging.
➔ It is a good idea to eat a healthy diet, not smoke,
limit alcohol intake, get plenty of exercises and
avoid air pollution and direct exposure to the
sun. taking these measures is good for your ➔ Theorist considers how changing roles,
health in general, but can also show the relationships, and status within impact an older
production of free radicals down. adult’s ability to adopt.
➔ Assert that societal norms can affect how
individuals perceive and enact their role within a
➔ Substances found in plants soak up free radicals
community.
like sponges and are believed to minimize free
radical damage if your body has plenty of
antioxidants available, it can minimize the ➔ States that staying occupied and involved is
damage caused by free radicals. There is some necessary to have a satisfying late life
evidence that we can only get the full antioxidant
CARE OF THE OLDER ADULTS LECTURE
CLINICAL INSTRUCTOR: DR. RUBY CORAZON EDIZA
FIRST SEMESTER | PRELIMINARY LESSONS
BY ALTEA A. AYA-ON

➔ Suggested that being active helps to prolong

middle age and delay the adverse effects of old
age.
➔ Contrast to Activity Theory
➔ Asserted that aging is characterized by gradual
disengagement from society and relationships
➔ Separation is desired by society and older adults
and that it serves to maintain equilibrium
➔ This theory focuses on the individual’s
personality development
➔ Ego vs Despair is what older adults go through.
This stage starts by the age of 65 and ends until
death. In this stage the older adults would look
back on the lives that they have lived. The
dissatisfaction of life lived would result to despair
while satisfaction would lead to Ego integrity.

➔ In this theory Baltes claims that an individual can

➔ Theorized that older adults form a unique
subculture within society to defend against
society’s negative attitude toward aging and the
accompanying loss of status.
have successful aging amidst functional loss
brought by aging when he or she learns to cope
with the situation. In a way that with the present
limitation the individual would choose to select
and adjust activities that they have no limitations
on

➔ Society is stratified into different age categories

that are the basis for acquiring resources, roles,
status, and deference from others in society.
➔ Highlighted the importance of cohorts and the
associated socioeconomic and political impact
on how individuals age.

➔ Theory explains aging in terms of mental

processes or how a person thinks, a person’s
emotions, attitude, motivation, and personality
development that is characterized by life stage
transition.

➔ According to human needs theory, a person

needs to achieve the 5 hierarchy of needs of
Maslow in order to achieve a positive
psychological outcome in the present as well as
during aging.
➔ If an individual has secured physiological factors
such as food shelter, and clothing, is not afraid
of his/her safety, is loved, has a sense of
belongingness, has self-esteem and have
self-actualization this would guarantee that the
person will not develop negative psychology or
mindset.
➔ Whereas if the person failed to achieve those
needs most likely the individual would develop
feelings of failure, depression and the perception
that life is meaningless.