Concepts, Principles, and Theories in the Care of Older

Adults
A. AGING IS A DEVELOPMENTAL PROCESS
Aging
̶ a gradual, continuous process of natural change that begins in early adulthood. During early middle
age, many bodily functions begin to gradually decline.
̶ Who is Old?
̶ People do not become old or elderly at any specific age.
̶ Senior Citizens (60 years old) = Old Age. Reason: Based in history, not biology. Many
years ago, age 65 was chosen as the age for retirement in Germany, the first nation to
establish a retirement program. The age set by the Germany was close to the actual
retirement age of most people in the world and it was also an arbitrary number set by the
Social Security Administration.
̶ Older Age Group
•Young Old: 65-74 years old
•Middle Old: 75-84 years old
•Old Old/ Very Old/ Frail Elderly: 85 years old and above
̶ However, these numbers merely provide a guideline and do not actually define the
various strata of the aging population. Among individuals, vast differences exist between
biological and chronological aging, and between the physical, emotional, and social aspects of
aging. How and at what rate a person age depends upon a host of different factors.
̶ Kumbaga numerical definition lang sya ng aging. Marami pang ibang paraan para
masabi na ang isang tao ay tumatanda na.

DIFFERENT AGING PROCESSES/ DIMENSIONS OF AGING

• Chronological Age- solely based on person’s age in year. It has limited significance in terms of
health. Old age as a risk factor to many diseases. Tulad ng sabi, yung likelihood ng pagkakaroon
ng health problem tumataas habang tumatanda ang isang tao.
• Biological Age- pertains to the changes in the body that commonly occur as people age.
Physiologic changes. Habang tumatanda nagccause ng alterations sa body den eventually will
cause alterations in the functions of the different organ system.
• Psychological Age- based on how people act and feel. Dito na pumapasok yung sinasabi nila na
bata parin mag isip at mamuhay. Example: Lolo Ante is 70 years old, walang ibang ginagawa
kundi mag basa ng dyaryo, mamahinga sa rocking chair, tuwing inaaya sa activities ang
sasabihin “masyado na akong matanda para dyan.”. On the other hand, we have Lolo Berto na
75 years old tapos nakikipagsabayan parin sa mga apo or anak.
• Functional Age- combination of the chronological, biological, and psychological aging.
• Social Age- refers to changes in one’s roles and relationships.
MYTHS VS FACTS ABOUT AGING

MYTH
Are pretty much all alike
Generally are alone and lonely.
Tend to be sick, frail, and dependent on
others.
Often cognitively impaired.
FACT
Are a very diverse group
Typically maintain close contact with family.
Usually live independently.
May experience some decline in cognitive
abilities but is usually not severe enough to
 Concepts, Principles, and Theories in the Care of Older
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cause problems in daily living.
Suffer from depression. Have lower rates of diagnosable depression.
Become more difficult and rigid with Tend to maintain a consistent personality
advancing years throughout the life span.
Can barely cope with the inevitable declines Typically adjust well to the challenges of
associated with aging. aging.

Healthy Aging
̶ refers to the postponement or reduction in the undesired effects of aging.
̶ goals: physically and mentally fit which will lead to lesser chance of acquiring illness and remain
active and independent.
̶ Efforts needed:
̶ Good nutrition
̶ Cessation from smoking and alcohol use
̶ Active lifestyle
̶ Positive attitudes towards life
̶ Stress reduction/ management
The sooner a person develops these habits, the better. However, it is never too late to begin. In
this way, people can have some control over what happens to them as they age.

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

B1. Global Aging

Disengagement theory which states that 'ageing is an inevitable, mutual withdrawal or disengagement,
resulting in decreased interaction between the aging person and others in the social system he /she
belongs to'.

Aging Population (Globally)

Social historian:
Philippe Aries (1962) pointed out that someone's age in medieval society was not based on
chronological years, but on factors such as their strength, abilities, and appearance. This was because
there was a lack of official documentation to keep track of one's age.
However, age is a more formalised idea today. We can confidently say that anyone who is above 60 or
65 years of age is older than someone who is, for example, 50 years old. Accordingly, a population ages
when there is a shift in its age composition, such that the number of older people increases.

Definition of aging population

- An ageing population is one wherein the proportion of older people increases.
Aging and health by WHO:
- Between 2015 and 2050, the proportion of the world's population over
60 years old and over will nearly double from 12% to 22%.

- As older adults increase there is also increase in

the demand for health needs and health
providers.
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Reasons Behind the Aging of the World’s Population:
1. A decline in fertility rates
-This is the number of live births in a year per woman, as a proportion of the total female population of
childbearing age (15-50 years).  The total fertility rate (TFR) is considered a measure of population
growth. In other words, people are having fewer children, and are having them at later ages. 

1.1 Improved Educational Opportunities for Women

According to Oxford University's Our World in Data project, the social empowerment of women,

particularly through increased education, has been shown to decrease fertility rates. Increased
education also contributes positively to other factors that decrease fertility rates, such as higher use
of contraception, better childhood health and women's participation in the workforce.

1.2 Lower Child Mortality

Historically, high child mortality — including infant deaths and deaths by early childhood illnesses —
kept population growth low and fertility rates high. As child mortality rates have declined (dramatically
in some countries) fertility rates have fallen.

1.3 Better Access to Contraception and Family Planning Advice

For some areas of the world, the sharpest declines in fertility rates have come from the introduction of
safe, reliable access to contraception. This may include confidential access if local cultural norms or
family members impede a woman's right to access birth control. The increased availability of sexual
health education and family planning resources has also impacted fertility rates.

2. An increase in life expectancy.

LIFE EXPECTANCY - The average number of years a person is expected to live on the basis of the current
mortality rates and prevalence distribution of health states in a population. – WHO (World Health
Organization)
Reasons for changes in life expectancy:
- Improved sanitations
- Advances in medical care
- Implementation of preventive health services
Life expectancy on a global level:
Men: 69.9 years; 65 years old and above can expect to live for an additional 17 years (between 2015-
2020)
Women: 72.3 years (5 years longer than men)
Note: To determine that the country is aging, there should be at least 10% of the population of 60
years old and above in a country

B2. Aging in the Philippines

 Concepts, Principles, and Theories in the Care of Older
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Abstract
• The Philippines is a varied country with an aging population. Policymakers and government
officials must prepare for predicted increase in the number of eldery people
• Culture and history influence residents’ attitudes toward aging and encourage informal
caregiving for elderly relatives
• Research on aging and current policies must be improved to address the needs of the ageing
population.
Overview
• The Philippines was colonized by the Spanish in the 16 th century, The islands were later seceded
to the United States during the Spanish American war. Various Historical events have shaped the
society and heritage in the Philippines, including colonialism and the US-Philippines War.
• The Philippines gained independence from Japan on 4 July, 1946. During the 1970s and into the
1980s, the Philippines was in a state of martial law under President Ferdinand Marcos.
• In 1986, the People Power Revolution evicted Marcos and the Phlippines transitioned into a
presidential constitutional republic. Philippine society is an
• Amalgamation of the different countries that once governed its many islands. English and
Tagalog (Pilipino) are the official languages of the nation. The majority(82.9%) of Filipinos
identify Catholicism as their religion.
• Amalgamation of the different countries that once governed its many islands. English and
Tagalog (Pilipino) are the official languages of the nation. The majority(82.9%) of Filipinos
identify Catholicism as their religion.
Demography
• The Philippine’s population is expected to increase by over 35% over the last two decades. The
older adult population (60 years and older) expected to overtake those aged 0-14 years old by
2065. Life expectancy of Filipinos is 57.4 years for males and 63.2 years for females
Research on Aging
 Aging in the Philippines remains a subject severely under-theorized in research. Main
universities house research institutions that study a variety of topics. University of the
Philippines manila is the only major institution with an established center specifically for aging
research. Research focuses on perceptions of aging, quality of life, and older adults in the
workforce
Perceptions Regarding Aging
 Many Filipinos view the aging process from direct interactions with their family members and
older Filipinos in their surrounding community. Living in multigenerational households and
communities shape perceptions of aging as a responsibility. There is a general positive outlook
that aging is a period of increased productivity and promising experiences
 Filipino elders’ perceptions of aging are derived from the unique life experiences and social units
that encompass their lives. These experiences, either negative or positive, form their views on
aging and outlook on life.
 Older Filipinos view aging in a more positive light due to the respect and dignity that are
attained with maturation
Quality of Life
Older Filipinos in the Philippines generally report positive health, community participation, and financial
security.
Increased age was directly correlated with better subjective well-being in Filipinos. Religion and
spirituality in older Filipinos may enhance their outlook on life and assist them in overcoming hardships.
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Older Filipinos report adequate life satisfaction and well-being, but social and financial inequalities may
act as a hindrance.
Services should equally be made available to older adults living in the low income or rural areas.
Barriers to access community and health support services should be reduced for older adults.
Workforce and Aging
Research examining employed older Filipinos found that recognition of employee progress impacts older
worker’s happiness in the workplace. Positive mental and physical health had a beneficial impact on job
satisfaction. Enhancing job satisfaction in the work environment can potentially retain older workers and
benefit the economy
Social Welfare and Health
A major area of policy focus for older Filipinos is in social welfare. Almost a quarter of Filipinos living in
poverty are older adults who do not have the financial means necessary to sustain an adequate quality
of life. Older Filipinos may have to sacrifice their financial assets to care for younger family members.
Access to health care services can help improve the quality of life for older Filipinos. The 2010 Expanded
Senior Citizens’ Act provides health service benefit to older people, such as discounted pharmaceuticals
and vaccinations, However, the availability of these resources depends on the health services providers.
Workforce
Working- age Filipinos must often remain in the workforce longer to financially support younger
dependents. By working longer, older Filipinos can support their dependents and possibly invest in
savings for retirement. It Is important that institutions promote policies that acknowledge the unique
needs of older workers. Older workers are often at a greater disadvantage than younger workers
because they are less likely to obtain an adequate education and attain salaried positions in the
workforce. Offering training programs to enhance worker education and skills may allow older Filipino
workers to qualify for better position with higher pay levels.
Policy and Caregiving
A lack of institutional care in the Philippines means that older Filipinos are often cared for by family
members at home.
Caregivers is expected of Filipino families, but those who are of lower socioeconomic status may be
financially strained. Policies should address the demands of Filipino informal caregiver by offering paid
family leave of even payment.
Emerging Issues
The Philippine government must recognize that national policies for older Filipinos, like the Senior
Welfare Act, must be modified to address the unique demands of its aging citizens

C. IMPACT OF AGING MEMBERS IN THE FAMILY

Introduction
 The family is undergoing significant change in our society.
 Families today face historically unprecedented situations. Because of the life span extension, it is
not uncommon for four or five generations of a family to be alive at one time
 It is estimated that 80% of older adults who need care will receive assistance from their families.
 Middle-aged family members often become the caregivers. The generation in their 40s and early
50s is sometimes called the “sandwich” generation
 women are likely to be the most affected.sons contribute financially, but the brunt of the emotional
and physical care burden falls to the daughters
 A family crisis may occur when the aging person is no longer able to live alone
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 The two most common options are bringing the aging parent into the home of one of the children
or placing the parent in a long-term care facility

Factors needed to be considered

1. The amount of care needed by the parent
2. the availability of a willing and able family member
3. the amount of available space in the child’s home
4. the added financial and emotional burden of an additional household member
5. the wishes of the parent, the child, and the child’s family
6. the interpersonal dynamics within the family

 Loss of independence is probably the most significant issue that aging parents and their children
must face.
 Aging persons find it difficult to accept that they can no longer do the things they once did. It is also
distressing for the family to watch their loved ones change.
 If the older family member requires a substantial amount of physical care, the demands on family
members can be intense.
 many children feel duty-bound to care for their aging parents.
 If the children determine that they are unable to care for their parent and instead opt for nursing
home placement

THE NURSE AND FAMILY INTERACTIONS

 In hospitals and nursing homes, family members come and go.
 Some families show a great deal of interest and concern for their aging members, visit
regularly and interact with the patient and the staff.
 Other older individuals may never have family members visit them
 Most families we interact with fall somewhere between these extremes. Few families are perfect,
and few are terrible.
 Coping with the stresses related to aging is difficult for both the aging individual and for the
family. We as nurses need to examine the stresses affecting the family so that we can best
respond to the needs of all family members.

SELF NEGLECT
 self-neglect is a common problem in the older adult population. Self-neglect is more likely to be
seen when an older person has few or no close family or friends, but it can occur despite their
presence.
 Self-neglect is defined as the failure to provide for the self because of a lack of ability or lack of
awareness.

Indicators of self-neglect include the following:

1. The inability to maintain activities of daily living
2. The inability to obtain adequate food and fluid
3. Poor hygiene practices
4. Changes in mental function
5. The inability to manage personal finances a
6. Failure to keep important business or medical appointments
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7. Life-threatening or suicidal acts

 Self-neglect is often connected with some form of mental illness or dementia.

 Once the problem is recognized, legal action through the courts may be needed to place the
person in the custody of a family member or adult protective services.

ABUSE OF NEGLECT OF THE FAMILY

 The American Psychological Association estimates that 4 million older Americans are the victims of
abuse or neglect every year, and states that most elder abuse takes place at home.
 Increased demands on limited resources, physical exhaustion, or mental fatigue can result in
deviant behaviors on the part of the caregiver
 Intentional abuse occurs when any person deliberately plans to mistreat or harm another
person.
 Unintentional abuse or neglect is most likely to occur when the caregiver lacks the necessary
knowledge, stamina, or resources needed to care for an older loved one.
 Continuous demands on caregivers can virtually make them prisoners within their own homes.
 Unable to cope with the stress of these continual demands, caregivers may strike out at older
adults, lock them in a room, restrain them in a chair, or leave them unattended.
 When stress is high and the coping ability is low, caregivers may not be able to identify any
better options.
 Abuse can be physical, financial, psychological, or emotional. Neglect and abandonment also
constitute forms of abuse.

PHYSICAL ABUSE
Physical abuse is any action that causes physical pain or injury. Abuse may involve a physical attack upon
a frail older adult who is unable to defend himself or herself from younger, stronger family members.
The inappropriate use of drugs, force-feeding, and the use of physical restraints or punishment of any
kind are examples of physical abuse.

Warning signs of physical abuse

 Bruising
 Lacerations
 broken teeth
 broken glasses
 Sprains
 Fractures
 burn marks
 wounds in various stages of healing
 unexplained injuries
 torn or bloody underwear
 signs of vaginal trauma
 delay in seeking medical treatment or history of “doctor shopping,”
 refusal by the caregiver to let visitors see the older adult.
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NEGLECT
 Neglect is a passive form of abuse in which caregivers fail to provide for the needs of the older
person under their care.
 Intentional
 Unintentional
 Neglect includes situations in which caregivers fail to meet the hygiene or safety needs of the older
adult.
 Failure to provide necessary medical care may constitute neglect because, with no means of
accessing care, the older person may suffer or die.
 Neglect may be deliberate on the part of the caregiver, or it may result from lack of knowledge,
inadequate financial resources, or an insufficient support system.

EMOTIONAL ABUSE
 Emotional abuse is the most subtle and difficult to recognize type of abuse.
 It often includes behaviors such as isolating, ignoring, or depersonalizing older adults.
 Emotional abusers may forbid visitors and isolate the older person from more responsible and
sympathetic friends or family members.
 Emotional abusers can use verbal or nonverbal means to inflict their damage
 Verbal abuse includes shouting or voicing threats of punishment or confinement.
 Displeasure, disgust, frustration, or anger can be communicated nonverbally through sighing,
head shaking, door slamming, or other negative body language.
 Emotional abuse is insidious in that it can damage the older adult’s sense of self-esteem and can
even destroy the will to live without leaving any obvious signs.

Signs of emotional abuse

 lack of eye contact
 trembling,
 Agitation
 evasiveness or hyper vigilance.

FINANCIAL ABUSE
 Financial abuse exists when the resources of an older person are stolen or misused by a person
whom the older adult trusts.
 Abusive caregivers often abandon the older person once all of his or her assets are gone.

Signs of financial abuse

 unusual banking activity
 Such as large or frequent withdrawals
 missing bank statements
 missing valuable personal belongings
 signatures on checks or documents that do not match the older adult

ABANDONEMENT
 Abandonment occurs when dependent older persons are deserted by the person or persons
responsible for their custody or care under circumstances in which a reasonable person would
continue to provide care.
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 Abandonment usually leaves the older person physically, emotionally, and financially defenseless.

RESPONSES TO ABUSE
 Fear of being treated even worse or fear of being institutionalized or abandoned may prevent the
victim from seeking help. Older people who manifest signs of abuse must be assessed carefully .
 All questioning about and assessment of abuse must be done with great tact and sensitivity.
 Information obtained must be kept confidential and shared only with agencies as authorized by the
patient or necessitated by law.
 It is wise to avoid using the term abuse when working with older adults, because they may become
defensive and will probably deny it. Using words such as problems or concerns is more likely to
yield truthful information.
 Physical abuse and financial abuse are criminal offenses. Nurses have a moral, legal, and ethical
responsibility to report any suspected cases of abuse.

ABUSE BY UNRELATED CAREGIVERS

 People who are hired to provide for the safety and well-being of older adults can sometimes
become their greatest threat. Increased use of unrelated caregivers exposes older adults to
additional risks.
 In home settings, unscrupulous caregivers have been known to take money and personal
belongings from defenseless older people under their care.
 They may physically abuse older persons and threaten them with physical harm if the abuse is
reported.
 When they are discovered, they often disappear, only to reappear somewhere else and repeat
their pattern of abuse.
 Even health care institutions are not immune to problems of elder abuse.
 Nurses are mandated reporters of elder abuse, which means it is against the law if you suspect
elder abuse and do not report it.
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 Nurses who work with older adults should become knowledgeable about the services available
in their communities.
 Resources may include education programs designed to improve an awareness of elder abuse,
support groups for caregivers, respite care programs, and senior day care centers.

SUPPORT GROUPS
 Caregivers of older adults are often isolated from other people. The demands of providing care
prevent caregivers from getting the rest, encouragement, and support they need. Caregivers who
want or need to share their experiences and frustrations have started forming support groups to
help one another cope with stress.

RESPITE CARE
 Respite care allows the primary caregiver to have time away from the demands of caregiving,
thereby decreasing stress and the risk for abuse.
 Respite care gives the primary caregiver the opportunity to attend church, go shopping, conduct
personal business, obtain medical care, or simply participate in leisure activities. Respite care may
be provided by family members, volunteers, or one of the many service agencies that have
proliferated within the past few years.