CONCEPTS, PRINCIPLES AND

THEORIES IN THE CARE OF

OLDER ADULTS
CHAPTER 1
LEARNING OBJECTIVE
• Define aging and other terminologies used in the care of older adults
• Identify and understand the role of the Gerontological Nurse
• Identify people that involves the care for older adults
• Determine different theories of care for older adults and its nursing
implications
AGING
• Aging is a natural process.
• THINGS TO EMPHASIS:
-Health Promotion and Health Protection

• Aging is an inevitable and steadily progressive process that begins at

the moment of conception and continues throughout the remainder
of life.
• “looking gray and wrinkled”
• “losing one’s mind”
• “becoming sick and frail”
• “obtaining little satisfaction from life”
• “returning to childlike behavior”
• “being useless”
Types of Aging
➢ Chronological age- measured by the number of years lived.

➢ Biological age- predicted by the person’s physical condition and how well vital organ
systems are functioning.

➢ Psychological age- expressed through a person’s ability and control of memory,

learning capacity, skills, emotions and judgement.

➢ Social age- measured by age-graded behavior that conform to an expected status

and role within a particular culture or society.

➢ Subsets of Elderly:
• Young old- ages 65- 74
• Middle old- ages 75- 84
• Oldest old- ages 85- 99
• Elite old or centenarians- ages 100 & up
TERMS:
• Ageism -negative attitudes toward aging and older adults.
• Gerontology -is the study of aging
• Geriatrics- medical care of the aged.
• Social Gerontology -focuses on social aspects of aging.
• Geropsychology -seeks to address the concerns of older adults.
• Geropharmacology -study of pharmacology in relation to older
adults
ROLES OF GERONTOLOGICAL NURSE
• Caregiver -gives direct, hands- on care to older adults in a variety of
settings.
• Teacher -focuses on teaching modifiable risk factors and health
promotion.
• Manager -balances the concerns of the patient, family and
interdisciplinary team.
• Advocate -acts on behalf of older adults to promote their best
interests and strengthen their autonomy and decision-making.
• Researcher -uses evidenced-based nursing practices to improve the
quality of patient care in all settings
Older Adults and their Family
Identification of Family Members
• One can identify family members by looking for those individuals who
fulfill family functions. In aging families, family functions are
somewhat modified to address the special needs of the elderly and
focus on the following:

• Ensuring fulfillment of physical needs

• Providing emotional support and comfort
• Maintaining connections with family and community
• Instilling a sense of meaning to life
• Managing crises
• Who checks on you regularly?
• Who shops with or for you?
• Who escorts you to the clinic or physician?
• Who assists with or manages your problems?
• Who takes care of you when you are ill?
• Who helps you make decisions?
• Who do you seek for emotional support?
Family Roles
• Decision- maker- the person who is granted or assumes responsibility for
making important decisions or is called on in times of crisis.
• Caregiver- the person who provides direct services, looks after and assists
with personal care and home management
• Deviant- the “problem child” who has strayed from family norms. May be
used to fulfill family need for scapegoat or provide sense of purpose for family
members who compensate for the individual.
• Dependent- a person who depends on other family members for economic or
caregiving assistance.
• Victim- a person who forfeits his or her legitimate rights and may be
physically, emotionally, socially or economically abused by the family.
Family Caregiving
• Routine Care—regular assistance that is incorporated into the
daily routine of the caregiver
• Back-up Care—assistance with routine activities that is provided
only at the request of the main caregiver
• Circumscribed Care—participation that is provided on a regular
basis within boundaries set by the caregiver
• Sporadic Care—irregular participation at the caregiver's
convenience
• Dissociation– potential caregiver does not participate at all in care
THEORIES
I. BIOLOGIC -concerned with answering basic questions regarding
physiologic processes that occur in all living organism in time
• Stochastic Theories - aging as events that occur randomly and
accumulate over time

oError/Error Catastrophe Theory - errors can occur in the transcription

in any step of protein synthesis of DNA, and this eventually leads to
either the aging or the actual death of a cell and with the cyclic
transcription, thus the end product would not even resemble the
original cell and its functional ability would be diminished.
oFree Radical Theory - free radicals are found in environmental
pollutants such as ozone, pesticides, and radiation.
oCross-Linkage Theory - some proteins become increasingly cross-
linked or enmeshed and may impede metabolic processes by
obstructing the passage of nutrients and wastes between the
intracellular and extracellular compartments.
Ex: Elevated Blood Sugar

oWear and Tear Theory - cells wear out over time because of
continued use.
Ex: Being stress all the time = accelerate aging process
• Nonstochastic Theories - aging as certain predetermined, timed
phenomena
Life expectancies are seen as preprogrammed within a species-specific
range

oProgrammed or Hayflick Limit Theory – cells can only reproduce

themselves a limited number of times
oImmunity Theory - as a person ages, the immune system functions
less effectively
The term immunosenescence has been given to this age-related
decrease in function.
IMPLICATIONS FOR NURSING
• A nurse caring for older adults needs to have a clear understanding of
the difference between age-related changes and those that may
actually be pathologic

• Scientists are still in the process of discovering what is "normal" aging

• Recognition of life stress (physical and psychological)

• Gerontologic nurses can promote the health of older adult
clients such as:

• Smoking Cessation
• Education regarding sun exposure
• Advise clients to ingest a varied, nutritious diet using the food
pyramid as a guide, and suggest supplementation with antioxidants
such as vitamin C and E
• Daily routines need to incorporate opportunities that capitalize on
existing abilities, strengthen muscles, and prevent further atrophy of
muscles (perform ADLs, daily exercises even chair-based exercises,
walking,
II. SOCIOLOGIC THEORIES -focus on roles and relationships within
which individuals engage in later life. These theories focused on more
global, societal, and structural factors that influenced the Jives of aging
persons
oDisengagement Theory -conceptualized as a mutual agreement
between older adults and society on a reciprocal withdrawal.
oActivity/Development Task Theory - Activity is viewed by this theory
as necessary to maintain a person's life satisfaction and a positive
self-concept.
oContinuity Theory -being active, trying to maintain a sense of being
middle-aged, or willingly withdrawing from society does not
necessarily bring happiness.
oAge Stratification Theory - concept of interdependence between the
aging person and society at large

oPerson-Environment Theory -examines the concept of

interrelationships among the competencies of a group of persons,
older adults, and their society or environment.
IMPLICATION FOR NURSING
• All older adults cannot be grouped collectively as just one segment of
the population
• Older adults respond to current experiences based on their past life
encounters, beliefs, and expectations.
• Because older adults are individuals, their responses must be
respected. However, it is within the nurse's scope of practice to
identify maladaptive responses and intervene to protect the
integrity of the person.
• Withdrawal by older adults may be a manifestation of a deeper problem -
Depression
• Older adults may refuse to engage in a particular activity - fear of failure
or frustration in not being able to perform the activity
III. PSYCHOLOGICAL THEORIES -influenced by both biology and
sociology; address how a person responds to the tasks of his or her
age.

o Maslow’s Hierarchy of Human Needs -each individual has an innate

internal hierarchy of needs that motivates all human behaviors

ofully developed, self-actualized person displays high levels of all of the

following characteristics: perception of reality; acceptance of self,
others, and nature; spontaneity; problem-solving ability; self-
direction; detachment and the desire for privacy; freshness of peak
experiences; identification with other human beings; satisfying and
changing relationships with other people; a democratic character
structure; creativity; and a sense of values
oJung’s Theory of Individualism -personality development throughout
life: childhood, youth and young adulthood, middle age, and old age.
Self-realization is the goal of personality development

Midlife crisis refers to a period of emotional, and sometimes

behavioral, turmoil that heralds the onset of middle age.

**Successful aging is when a person looks inward and values oneself

for more than just current physical limitations or losses.
oErikson’s Eight Stages of Life - In each of the eight stages identified by
Erikson, a "crisis" occurs that impacts the development of the
person's ego

**attention needs to be focused on the developmental tasks

The task of middle adulthood is resolving the conflict between

generativity and stagnation
oPeck’s Expansion of Erikson’s Theory

A. ego differentiation versus work role preoccupation

task for older adults is to achieve identity and feelings of worth from
sources other than the work role.

Example:
-Onset of retirement
One may reduce feelings of self-worth
One may treat it as major defining source for self-esteem
B. Body transcendence versus body preoccupation
older person's view of the physical changes that occur as a result of the
aging process

Body transcendence is acceptance of inevitable physical decline as a

part of aging and placing more value on cognitive activities and social
relationships.
On the other hand, body preoccupation is focusing on bodily ailments,
to use them as a constant reminder of getting older and more infirm
C. Ego transcendence versus ego preoccupation
Ego transcendence means that older adults transcend self-concerns
and accept that they will eventually die (Cook-Greuter, 2000).

While the person's preoccupation with believing that little time has
been left and that they are ultimately going to die is described as ego
preoccupation
oSelective Optimization Theory with Compensation
- individuals develop certain strategies to manage the losses of
function that occur over time with three interacting elements

A. element of selection - Increasing restrictions to one's life to fewer

domains of functioning because of an age-related loss.
B. optimizatIon - people engage in behaviors to enrich their lives
C. compensation - literally "compensate" for any losses by developing
suitable, alternative
Example:

Rubenstein is a pianist that applied this theory in later years.

He reduced. his repertoire and played a smaller number of pieces
(selection);

second, he practiced these more often (optimization); and

third, he slowed down his speed of playing prior to fast movements,

thereby producing a contrast that enhanced the impression of speed in
the fast movements (compensation).
– selection: increasing restriction of one’s life to fewer
domains of functioning
– optimization: people engage in behaviors to enrich their
lives
– compensation:developing suitable, alternative
adaptations --behavior that offsets weakness
IMPLICATION FOR NURSING
• Nurses help to dispel many of the myths about "being old."
• Older adults should be encouraged to engage in a "life review"
process; this can be accomplished using a variety of techniques like
reminiscence, oral histories, and story telling.
• Looking back over life's accomplishments or failures is crucial in
assisting older adults to accomplish developmental tasks (as in ego
integrity), to promote positive self-esteem, and to acknowledge that
one "did not live in vain."
GUIDELINES FOR EFFECTIVE
DOCUMENTATION
CHAPTER 2
LEARNING OBJECTIVES
• To understand the importance of documentation in
different care system aside from hospital setting
• Identify and enumerate geriatric health care team
• Identify different courses offered that focus on
gerontology
DOCUMENTATION
A. Documentation for Quality Care
• Clinical documentation chronicles, support, and communicate the results
of the assessment.
• The recorded assessment provides the data needed for the careful
development of the individualized plan of care and the evaluation of
patient outcomes.

• Documentation is the major means for the nurse to demonstrate the

quality of care he or she provides.
DOCUMENTATION
B. Documentation Across Healthcare Settings

• begins as soon as the person enters the health care system

• while the format may change, the purposes do not.

DOCUMENTATION
C. Documentations in Acute Care and Acute
Rehabilitation Care Setting

• Documentation in the acute care setting has undergone significant

change in recent years especially with the mandates for upgrading to
the electronic medical record.
DOCUMENTATION
D. Documentation In Home Care

• The majority of the care that is provided in the home is by informal

caregiver’s family members and others.
Geriatric Health Care Team