NCMB 314 - GERIATRICS (CARE OF THE OLDER
ADULT) beg on the streets for sustenance
WEEK 1
Concept, Principles, History,
and Theories in the Care of
Older Adults
PERSPECTIVE OF OLDER ADULTS
THROUGH HISTORY
● Historically, societies have viewed their elder
members in a variety of ways. The members of
the current older population in the United States
have offered the sacrifice, strength, and spirit
that made this country great. They were the
proud GIs in world wars, the brave immigrants
who ventured into a new country, the bold
entrepreneurs who took risks that created wealth
and opportunities for employment, and the
unselfish parents who struggle to give their
children a better life. They have earned respect,
admiration, and dignity. Today older adults are
viewed with positivism rather than prejudice,
knowledge rather than myth, and concern rather
than neglect. This positive view was not always
the norm.
● In the time of Confucius, there was a direct
correlation between a person’s age and the
degree of respect to which he or she was
entitled. The early Egyptians dreaded growing
old and experimented with a variety of options
and schemes to maintain their youth. Opinions
were divided among the early Greeks. Plato
promoted older adults as society’s best leaders,
whereas Aristotle denied older people any role
in governmental matters. In the nations
conquered by the Roman Empire, the sick and
aged were customarily the first to be killed. And,
woven throughout the Bible is God’s concern for
the well-being of the family and desire for people
to respect elders (Honor your father and your
mother..Exodus 20:12). Yet the honor bestowed
on older adults was not sustained.
● Medieval times gave rise to strong feelings
regarding the superiority of youth; these feelings
were expressed in the uprisings of sons against
fathers. Although England developed Poor Laws
in the early 17th century that provided care for
the destitute and enabled older persons without
family resources to have some modest safety
net, many of the gains were lost during the
Industrial Revolution. No labor laws protected
persons of advanced age; those unable to meet
the demands of industrial work settings were
placed at the mercy of their offspring of forced to
THE HISTORY OF GERONTOLOGICAL
NURSING
● The history and development of gerontological
nursing is rich in diversity and experiences, as is
the population it serves. There has never been a
more opportune time than now to be a
gerontological nurse. No matter where nurses
practice, they will at some time in their career
care for older adults. The health care movement
is constantly increasing life expectancy;
therefore, nurses must expect to care for
relatively larger numbers of older people over
the next decades. With the increasing numbers
of acute and chronic health conditions
experienced by elders, nurses are in key
positions, and to promote positive aging.
● The development of gerontological nursing as a
specialty is attributed to a host of nursing
pioneers. The majority of these nurses were
from the United States; however, two key
trailblazers were from England. Florence
Nightingale and Doreen Norton provided early
insights into the “care of the aged”. Nightingale
was truly the first geriatric nurse, Doreen Norton
focused her career on the care of the aged and
wrote often about the unique and specific needs
of elders.
LANDMARKS IN THE DEVELOPMENT OF
GERONTOLOGICAL NURSING AS A
SPECIALTY:
1902 American Journal of Nursing (AJN) publishes
first geriatric article by an MD
1950 First geriatric nursing textbook, “Geriatric
Nursing (Newton), published First master’s
thesis in geriatric nursing completed by
Eleanor Pingrey Geriatric becomes a
 ○ “Ology”- study of Older Age Group:
specialization in nursing
○ Young old – ages 65-74
○ Middle Old – ages 75-84
1952 First geriatric nursing study published in
○ Old Old – 85 and up.
Nursing Research
● Gerontophobia
1961 ANA recommends specialty group for geriatric ○ fear of aging.
○ Inability to accept aging adults in society.
nurses
■ Age Discrimination
1962 ANA holds first National Nursing Meeting on ■ emotional prejudice among
Geriatric Nursing Practice older adults.
■ Ageism – dislike of aging and
1966 ANA forms a geriatric nursing division, First the older adult.
Gerontological Clinical Nurse Specialist ● Geriatrics
master’s program begins at Duke University ○ generic term relating to the aged, but
specifically refers to medical care for the
1968 First RN (Laurie Gunter) presents at the aged.
International Congress of Gerontology ● Gerontological Nursing
○ the aspect of gerontology that falls
1969 Development of standards for geriatric nursing within the discipline of nursing and the
practice scope of nursing practice.

1970 ANA creates the Standards of Practice for DEMOGRAPHICS OF AGING

Geriatric Nursing
● “Graying of America”
1973 ANA offers the first generalist certification in ○ a phenomenon faced by all nations, not
gerontological nursing only the U.S.
● Demographic Tidal Wave or A pig in a
1975 First nursing journal for the care of older adults Python
published : Journal of Gerontological Nursing ○ a bulge in the population moving slowly
by Slack,Inc. First nursing conference held at through times. (1946-1964 : Baby
the International Congress of Gerontology. Boomer)
■ 1 out of 8 Americans age: 65
1976 ANA Geriatric Nursing Division changes name years old and up.
to Gerontological Nursing Division ■ 1997 – approximately 10% of
the world’s population (Age 60
1981 ANA division of Gerontological Nursing and above)
publishes statement on scope of practice ■ It is expected that by 2025, the
number of persons 65 and older
1982 Development of Robert Wood Johnson in the United States will
Teaching Home Nursing Program increase from 12% of the
population (by 2000) to 19%
1983 First university chair in gerontological nursing ● In 2005, 13% of the U.S. population was over
in the United States (case western reserve) age 60
○ 18.3 million aged 65–74
1987 ANA revises Standards and Scope of ○ 12.9 million aged 75–84
Gerontological Nursing Practice ○ 4.7% aged 85 or older

1988 First Phd program in gerontological nursing ● This number is estimated to increase:
established ○ To 20 million in 2010 (6.8% of total),
○ To 33 million in 2030 (9.2%), and
1989 ANA certification established for Clinical ○ To almost 50 million in 2050 (11.6%)
Specialist in Gerontological nursing (National Center for Health Statistics
[NCHS], 2006).
1998 ANA certification available for geriatric
advanced practice nurses as geriatric nurse ● By the mid-21st century, old people will
practitioners or gerontological clinical nurse outnumber young for the first time in history. All
specialist Nations have an aging population. The greatest
increases will be in developing countries. Asian
● Gerontology countries have less time to prepare for aging -
○ is the broad term used to define the because aging is occurring more rapidly than
study of aging and/or the aged. economic growth. Adequate healthcare services
○ “Gero” – old age for the elderly may simply be beyond the reach
 of many Asian countries. They may not be able
to afford a large dependent elderly population.
They might not have the necessary institutions &
financial systems in place (e.g., efficient and
well-managed pension and healthcare programs)
(“The Future of Population in Asia: Asia's Aging
Population”; Sidney B. Westley and Andrew
Mason; January 2005)
WHY INCREASE?
● Improved sanitation
● Advances in medical care
● Implementation of preventive health services
● In the 1900s, deaths were due to infectious
diseases and acute illnesses
● Older population now faced with new challenge
○ Chronic disease
○ Health care funding
● Average 75y/o has 3 chronic diseases & uses 5
types of medications
● 95% of health care expenditures for older
Americans are for chronic diseases
● Changes in fertility rates
○ Baby boom after WWII (1946 – 1964)
● 3.5 children per household
○ Older population will explode between
2010 to 2030 when baby boomers reach
age 65
IMPACT OF BABY BOOMERS
● In anticipating needs and services for future
generations of older adults, gerontological
nurses must consider the realities of the baby
boomers, those born between 1946 and 1964,
which will be the next wave of senior citizens.
Their impact on the growth of the older
population is such that it has been referred to as
a demographic tidal wave. Baby boomers began
entering their senior years in 2011 and will
continue to do until 2030.
● Although they are a highly diverse group,
representing people as different as Bill Clinton,
Bill gates and Cher, they do have some clearly
defined characteristics that set them apart from
other groups:
○ Most have children, but this generation’s
low birth rate means that they will have
fewer biologic children available to
assist them in old age.
○ They are better educated than
preceding generations.
○ Their household incomes tend to be
higher than other groups, partly due to
two incomes (three out of four baby
boomer women are in the labor force).
○ They favor a more casual dress code
than previous generations of older
adults.
○ They are enamored with “high-tech”
products and are likely to own and use a
home computer.
○ Their leisure time is scarcer than other
adults, and they are more likely to report
feeling stressed at the end of the day.
○ As inventors of the fitness movement,
they exercise more frequently than other
adults.
Some assumptions can be made concerning the baby
boomer population as senior adults. They are informed
consumers of health care and desire a highly active role
in their care; their ability to access information often
enables them to have as much knowledge as their
health care providers on some health issues. They are
most likely not going to be satisfied with the conditions of
today’s nursing homes and will demand that their long-
term care facilities be equipped with bedside Internet
access, gymnasiums, juice bars, pools, and alternative
therapies. Their blended families may need special
assistance because of the potential caregiving demands
of several sets of stepparents and step-grandparents.
Plans for services and architectural designs must these
factors into consideration.
● LIFE EXPECTANCY:
○ US: 75.7 years old
○ Life Span: 115 years
○ French women lived for 122 years (1994)
○ Factors that affect life expectancy:
■ Improved Sanitation
■ Advances in Medical care
■ Implementation of preventive
health services.
● CENTENARIANS
○ Predominant in lower educated more
impoverished, widowed, and more
disabled population.
○ Weight less, take fewer medications,
and have fewer chronic diseases.
FEMINIZATION OF LATER LIFE
● Women comprise 55% of the older population
● Women have a longer life expectancy
● The average life expectancy of women in the
United States is 81 years
● The average life expectancy of men in the
United States is 75.2 years
● Male exposure to risk factors may account for
the differences
● Increases in female exposures to risk factors will
reduce the difference in life expectancy
Majority of older adults enjoy good health But
national surveys reveal that: 20% of adults 65y/o &
above report a chronic disability.
Chronic Conditions in Seniors
● 80% have at least one chronic condition
 ● Two of the three leading causes of death plus. By 2050, we expect our elderly to rise to
declined by one third 23,633,000 (15.3% of the total population).
○ Heart disease and stroke
THEORIES OF AGING
Majority of deaths (US) occur in people 65y/o & older
● 50% of deaths--caused by heart disease &
cancer PSYCHOSOCIAL THEORIES OF AGING
● In the past 50 years --- a noted decline in overall
deaths Due to the improvements in the Attempt to explain aging in terms of behavior,
prevention & early detection & treatment of personality, and attitude change.
diseases
● Heart disease & cancer are two top causes of SOCIOLOGICAL THEORIES OF AGING
death, regardless of age, race, gender or ● changing roles, relationships, status, and
ethnicity generational cohort impact the older adult’s
● Positive health reports declined with advancing ability to adapt.
age a) Activity theory
● African American and Hispanic or Latinos - less i) Havighurst and Albrecht
likely to report good health than their Caucasian (1953)
or Asian counterparts. ii) Remaining occupied and
involved is necessary to satisfy
The majority of people 75y/o & over late life.
● remain functionally independent, and iii) Activity engagement and
● the proportion of older Americans with limitations positive adaptation.
in activities is declining (CDC, 2007a). b) Disengagement Theory
i) Cumming and Henry (1961)
70% of Physical Decline Related to Modifiable Risk ii) Gradual withdrawal from society
Factors and relationships serves to
● Smoking maintain social equilibrium and
● Poor nutrition promote internal reflection.
● Physical inactivity c) Subculture Theory
● Failure to use preventative and screening i) Rose (1965)
services ii) The elderly prefer to segregate
● Reason for the decline in limitations to the from society in an aging
activity of Older Adult: subculture sharing the loss of
status and societal negativity
AGING POPULATION IN THE PHILIPPINES regarding the aged.
d) Continuity Theory
● According to Global Age Watch Index published i) Havighurst (1960)
by “Help Age”, the number of older people in the ii) also known as Development
Philippines is increasingly rapidly. In fact, it is Theory
growing faster than growth in the total population. iii) Personality influences role and
Consider that in 2000, there were an estimated life satisfaction and remains
4.6 million senior citizens (defined by law in the consistent throughout life.
Philippines as an individual who is 60 years old iv) 4 Personality types:
or older). This represented about 6% of the total (1) Integrated
population. The percentage has been increasing (2) Armored Defended
to grow to 6.5 million older people making up (3) Passive Dependent
about 6.9% of the total population in ten years. (4) Unintegrated
The National Statistics Office (NSO) projects e) Age Stratification Theory
that by 2030, older people will make up around i) Riley (1960)
11.5% of the total population. There will be ii) Society is stratified by age
increased demand for health services when groups that are the basis for
there is an increase in population. The leading acquiring resources, roles,
cause of morbidity is usually infection due to status, and deference from
aging of the body’s immune system. Visual others.
impairment, difficulty in walking, chewing, f) Person-Environment Fit Theory
hearing, osteoporosis, arthritis, and incontinence i) Lawton (1982)
are common health-related problems. The ii) The function is affected by ego
average life expectancy was 66 years in males strength, mobility, health,
and 73 years in females. Older women cognition, sensory perception,
compromised 53.8% of the population aged 60 and the environment.

PSYCHOLOGICAL THEORIES OF AGING
● Explain aging in terms of mental processes,
emotions, attitudes, motivation, and personality
development that is characterized by life stage
transitions.
○ Human needs
■ Maslow’s (1954)
■ Five basic needs motivate
human behaviour in a lifelong
process toward need fulfilment.
iii) Self – Actualization
● Individualism Theory
○ Jung (1960)
○ Personality consists of an ego
and personal and collective
unconsciousness that views life
from a personal or external
perspective.
● Stages of Personality Development
○ Erikson (1963)
○ Personality develops in eight
sequential stages with
corresponding life tasks. The
eighth phase, integrity versus
despair, is characterized by
evaluating life accomplishments;
struggles include letting go,
accepting care, detachment,
and physical and mental decline.
● Life-course/Lifespan Development
○ Life stages are predictable and
structured by roles, relationships,
values and goals
BIOLOGICAL THEORIES OF AGING
Explains that physiologic processes that change
with aging.
STOCHASTIC THEORIES OF AGING
Based on random events that cause cellular
damage that accumulates as the organism ages.
a. Free Radical Theory
■ Membranes, Nucleic acids, and
proteins are damaged by free
radicals which cause cellular
injury,
■ Exogenous Free radicals:
Tobacco smoke, Pesticides,
organic solvents, Radiation,
ozone, and selected
Medications.
■ Health Teaching:
● Decrease calories in
order to lower weight
● Maintain a diet high in
nutrients using anti-
oxidants
● Avoid inflammation
● Minimize accumulation
of metals in the body
that can trigger free
radicals reactions.
● Older adults are more
vulnerable to free
radicals.
b. Orgel/ Error Theory
■ Errors in DNA and RNA
synthesis occurs with aging.
c. Wear and Tear Theory
■ Cells wear out and cannot
function with aging.
■ Like a machine that losses
function when its parts wear off.
d. Connective Tissue Theory / Crosslink
theory
■ With aging, proteins impede
metabolic processes and cause
trouble with getting nutrients to
cells and removing cellular
waste products.
NON - STOCHASTIC THEORIES OF AGING
Based on the genetically programmed events
that cause cellular damage that accelerates aging of the
organism.
● Programmed Theory
○ Cells divide until they are no longer able
to and this triggers to apoptosis or cell
death.
○ Shortening of the TELOMERES
■ the distal appendages of the
chromosomes arm.
○ TELOMERASE
■ an enzyme, “cellular fountain of
youth”
● Gene/ Biological Clock Theory
○ Cells have a genetically programmed
aging code.
● Neuroendocrine theory
○ Problems with the hypothalamus-
pituitary-endocrine gland feedback
system causes disease.
○ Increased insulin growth factor
accelerates aging.
● Immunologic/ Autoimmune Theory
○ Aging is due to faulty immunological
function, which is linked to general well-
being.
TERMINOLOGIES
● Age Discrimination
○ emotional prejudice among older adults.
● Ageism
○ a negative attitude toward an aging or
older person.
● Apoptosis
○ a process of programmed cell death
marked by cell shrinkage.
● Baby boomers
○ A large group of people born between
1946 and 1964, in the time after the
Second World War.
● Centenarian
○ someone who is 100 years of age or
older.
● Elderly
○ usually described as those persons age
65 or over.
● Free radicals
○ chemical species that arise from atoms
as single unpaired electrons
● Geriatrics
○ medical care for the aged.
● Gerontological Nursing
○ A specialty within nursing practice
where the clients/patients/residents are
older persons.
● Gerontology
○ is the broad term used to define the
study of aging and/or the aged.
● Graying of America
○ similar to the aging of America, referring
to the increase in numbers of older
Americans.
● Nonstochastic theories of aging
○ theories stating that a series of
genetically programmed events occur to
all organisms with aging
● Stochastic theories of aging
○ theories stating that random events
occurring in one’s life cause damage
that accumulates with aging
● Telomerase
○ an enzyme that regulates chromosomal
aging by its action on telomeres