Course Name: CARE OF OLDER ADULT

Course Code: NCM 114

Course Description: It deals with the concepts, principles and techniques of nursing care
management of those with the older persons
Course Credit: 3 units (2 units lecture & 1-unit RLE) Placement: 3rd Year, 1st Semester Course
Objectives: At the end of the course, given scenarios/situations, the student should be able to:
1. Utilize the nursing process in the care of patients with care of the older person
2. Discuss special concerns, issues and trends in caring for the older person
Course Outline:
A. Introduction to Gerontological Nursing 1. Definition of Terms 2. Concepts and Theories of
Aging 3. Roles of the Gerontological Nurse 4. Settings of Care 5. Normal Changes in Body
System During Aging
B. Assessment of Older Adults C. Health Promotion, Risk Reduction, and Disease Prevention E.
Illness and Disease Management F. Ethical/Legal Principles and Issues G. Future Trends in
Gerontological Nursing
Definition of Terms
1. Gerontology: is the broad term used to define the study of aging and/or the aged.
2. Geriatrics: is often used as a generic term relating to the aged, but specifically refers to medical
care of the aged.

Gerontological Nursing versus Geriatric Nursing: Gerontological nursing provides an all

encompassing view of the care of older adults. In 1976, the ANA Geriatric Nursing Division
changed its name to the Gerontological Nursing Di vision and published the Standards of
Gerontological Nursing (Ebersole & Touhy 2006; Meiner, 2011).

3. Gerontological nursing: A speciality within nursing practice where the clients/patients/residents

are older persons.
4. Middle old: Those persons age 75–84 years.
5. Old old: Those persons ages 85 years and over; sometimes called the oldest old, the very old, or
the frail elderly.
6. Young old: Those persons ages 65–74.
7. Social gerontology is concerned mainly with the social aspects of aging versus the biological or
psychological.
8. Geropsychology: refers to specialists in psychiatry whose knowledge, expertise, and practice are
with the older population.
9. Geropharmaceutics: also called geropharmacology, is a unique branch in which pharmacists
obtain special training in geriatrics.
10. Financial gerontology: is another emerging subfield that combines knowledge of financial
planning and services with a special expertise in the needs of older adults. Cutler (2004) defines
financial gerontology as “the intellectual intersection of two fields, gerontology and finance, each of
which has practitioner and academic components”.
11. Gerontological rehabilitation nursing combines expertise in gerontological nursing with
rehabilitation concepts and practice.

Concepts and Theories of Aging

AGING and AGEISM

Aging is a gradual, Continuous process of natural change that begins in Early adulthood. In elderly
many bodily functions begin to change. WHO defines old age as age group of 60 or above.
Aging is a process of general, irreversible, and progressive physical deterioration that occurs
over time. Aging can be defined as the time-related deterioration of the physiological functions
necessary for survival and fertility. Aging process is the process of growing old or developing the
appearance and characteristics of old age. According to the World Health Organization, among
those 13% are over 80 years old.There are almost 700 million people over the age 60 living in the
world today. …it is expected that by 2050 this number will be almost 2 billion and the number of
elderly will be higher than the number of children.

Gerontological versus Geriatric

The term Gerontological Nursing, which replaced the term Geriatric Nursing in the 1970’s, is seen
as being more consistent with the specialty’s broader focus on health and wellness, in addition to
illness (Wikipedia).

Classification of Aging
• Objectively, ageing is a universal process that begins at birth and is specified by the
chronological age criterion
• Subjectively, aging is marked by changes in behaviour and self- perception and reaction to biologic
changes. Functionally, aging refers to the capabilities of the individual to function in society.
• Young Old (60 – 74 yrs), middle old (75-84 years), and old-old (above 85 years). The life
expectancy of Indians are 65- 67 years.

CONCEPTS OF AGING
1. CHRONOLOGIC AGING
2. BIOLOGIC AGING
3. PSYCHOLOGIC AGING
4. SOCIAL AGING
5. COGNITIVE AGING
1. CHRONOLOGIC AGING • Chronological age refers to the actual amount of time a person has been
alive. • In other words, the number of days, months or years a person has been alive
2. BIOLOGIC AGING • Senescence or biological ageing is the gradual deterioration of function
characteristic • 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. • This aging is also known as physiologic aging.
3. PSYCHOLOGIC AGING • Psychological aging refers to the psychological changes, including
those involving mental functioning and personality, that occur as human age. • Chronological age
is not always the same thing as biological or psychological 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 identity, 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.
4. SOCIAL AGING • 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 differ from one individual to another. • It is also profoundly
influenced by the perception of aging that is part of a society’s culture. • If a society views aging
positively, the social aging experienced by individuals in that society will be more positive and
enjoyable than in a society that views aging negatively.
5. COGNITIVE AGING • Cognitive ageing is the decline in cognitive processing that occurs as
people get older. Age-related impairments in reasoning, memory and processing speed can
arise during adulthood and progress into the elder years. • Cognitive aging is concerned with the
basic processes of learning and memory as well as with the complex higher- order processes of
language and intellectual competence or executive functioning. • The concept of cognitive aging, a
term that describes a process of gradual, longitudinal changes in cognitive functions that
accompany the aging process.

THEORIES OF AGING • Each theory of aging attempts to provide a framework in which to

understand aging from different perspectives. • Each theory is useful to the clinician because
a framework and insight into differences among elderly patients are provided.
• The theories of aging are classified into
1. Biologic theories
2. Psychosocial theories
3. Developmental theories

1. BIOLOGIC THEORIES • Biologic theories of aging attempt to explain why the physical changes
of aging occur. • Researcher try to identify which biologic factor have the greatest influence on
longevity. • Theories include: A. The programmed theory/ Biological clock theory B. The run out of
program theory C. Gene theory D. Molecular theory E. Cellular theories

A. THE PROGRAMMED THEORY/ BIOLOGICAL CLOCK THEORY • The programmed theory proposes
that every person has a “Biologic clock” that starts ticking at the time of conception. • In this
theory each individual has a genetic program specifying an unknown but predetermined number
of cell divisions. • As the program plays out, the person experiences predictable changes such
as atrophy of the thymus, menopause, skin changes and graying of the hair • Aging has a
biological timetable or internal biological clock.

B. THE RUN OUT OF PROGRAM THEORY • Every person has a limited amount of genetic material
that will run out over time. • All events are specifically programmed into genome and are
sequentially activated. • After maturation genes have been activated there are no more programs
to be played and as cells age there may be chance of inactivation of genes that cannot be turned on.

C. GENE THEORY • The gene theory proposes the existence of one or more harmful genes that
activate overtime, resulting in the typical changes seen with aging and limiting the life span of the
individual. • Organism failure occurs in later life because of the presence of imperfect genes
activated over lengthy periods of time. • Two gene types, one supports growth and vigor, and the
other supports senescence and deterioration.

D. MOLECULAR THEORIES • The aging is controlled by genetic materials that are encoded to
predetermine both growth and decline. D.1. The error theory D.2. The somatic mutation theory

D.1.THE ERROR THEORY • The error theory proposes that errors in ribonucleic acid protein
synthesis cause errors to occur in cells in the body, resulting in a progressive decline in biologic
function. • Error theory Aging is a result of internal or external assaults that damage cells or
organs so they can no longer function properly.

D.2. THE SOMATIC MUTATION THEORY • The somatic mutation theory proposes that aging result
from deoxyribonucleic acid (DNA) damage caused by exposure to chemicals or radiation and this
damage causes chromosomal abnormalities that lead to disease or loss of function later in life. •
Exposure to x-ray radiation and or chemicals induces chromosomal abnormalities.

D.2. THE SOMATIC MUTATION THEORY • The somatic mutation theory proposes that aging result
from deoxyribonucleic acid (DNA) damage caused by exposure to chemicals or radiation and this
damage causes chromosomal abnormalities that lead to disease or loss of function later in life. •
Exposure to x-ray radiation and or chemicals induces chromosomal abnormalities.
E. CELLULAR THEORIES • The cellular theories propose that aging is a process that occurs
because of cell damage. • When enough cells are damaged, overall functioning of the body is
decreased.

E.1. The free radical theory E.2. The crosslink or connective tissue theory E.3. Clinker theory E.4.
The wear and tear theory E.1. THE FREE RADICAL THEORY • Denham Harman 1956. • The term
free radical describes any molecule that has a free electron, and this property makes it react
with healthy molecules in a destructive way. • Free radical molecule creates an extra negative
charge. • This unbalanced energy makes the free radical bind itself to another balanced molecule as
it tries to steal electrons. • Balanced molecule becomes unbalanced and thus a free radical itself.
• Diet, lifestyle, drugs (e.g. tobacco and alcohol) and radiation

E.2. THE CROSSLINK OR CONNECTIVE TISSUE THEORY/ GLYCOSYLATION THEORY OF AGING

• Cell molecules from DNA and connective tissue interact with free radicals to cause bonds
that decrease the ability of tissue to replace itself. • The results in the skin changes typically
attributed to aging such as dryness, wrinkles, and loss of elasticity. • Fibrous tendons, loosening
teeth, diminished elasticity of arterial walls and decreased efficiency of lungs and GI tract. • It is
the binding of glucose (simple sugars) to protein, (a process that occurs under the presence of
oxygen) that causes various problems. • Senile cataract and the appearance of tough, leathery
and yellow skin.

E.3. THE CLINKER THEORY • The clinker theory combines the somatic mutation, free radical and
cross link theories to suggest that chemicals produced by metabolism accumulate in normal
cells and cause damage to body organs such as the muscles, heart, nerves and brain.

E.4. THE WEAR AND TEAR THEORY • Body is similar to a machine, which loses function when its
parts wear out. • As people age, their cells, tissues and organs are damaged by internal or external
stressors. • Good health maintenance practices will reduce the rate of wear and tear, resulting in
longer and better body function.

THE NEUROENDOCRINE THEORY • Prof Vladimir Dilman and Ward Dean • This theory elaborates on
wear and tear by focusing on the neuroendocrine system. • This system is a complicated network of
biochemicals that govern the release of hormones which are altered by hypothalamus. • The
hypothalamus controls various chain-reactions to instruct other organs and glands to release
their hormones etc. The hypothalamus also responds to the body hormone levels as a guide to
the overall hormonal activity. Accordingly, as ages the secretion of many hormones declines
and their effectiveness is also reduced due to the receptors down- grading.

IMMUNOLOGIC THEORY • The immunologic theory proposes that aging is a function of changes
in the immune system. • The immune system weakens over time, making an aging person more
susceptible to disease, increase in autoimmune disease and allergies • Over time, cells involved in
immune function are less self- regulatory, resulting in cells being misidentified as foreign material
and being attacked by the immune system’s own defenses. Eg: rheumatoid arthritis (RA) and lupus.

THE MITOCHONDRIAL DECLINE THEORY • The power producing organelles. • Their primary job is to
create Adenosine Triphosphate (ATP) and they do so in the various energy cycles that involve
nutrients such as Acetyl-L-Carnitine, CoQ10 (Idebenone), NADH and some B vitamins etc. •
Enhancement and protection of the mitochondria is an essential part of preventing and slowing
aging.
THE MEMBRANE THEORY OF AGING • Professor Imre Zs. • It is the age-related changes of the cells
ability to transfer chemicals, heat and electrical processes that impair it. • As older the cell
membrane becomes less lipid (less watery and more solid). This impedes its efficiency to conduct
normal function and in particular there is a toxic accumulation.

CONCEPTS IN THE GENETIC THEORY OF AGING • Telomeres • Longevity genes • Cell senescence •
Stem cells • Epigenetics

2. PSYCHOSOCIAL THEORIES • Psychosocial theories of aging attempt to explain changes in

behaviour, roles and relationship that occur as individual age. • This attempt to predict and
explain the social interactions and roles that contribute to successful adjustment to old age in older
adults. A. The disengagement theory B. The activity theory C. The continuity theory D. The
subculture theory
A. DISENGAGEMENT THEORY • Cummings and Henry(1961) states that aging people withdraw from
customary roles and engage in more introspective, self-focused activities. • The disengagement
theory was developed to explain why aging process separate from the mainstream of society. • This
theory proposes that older people are systematically separated, excluded, or disengaged from
society because they are not perceived to be of benefit to the society as a whole.

B. THE ACTIVITY THEORY • This theory proposes that activity is necessary for successful aging. •
Active participation in physical and mental activities helps maintain functioning well into old
age. • Purposeful activities and interactions that promote self-esteem improve overall satisfaction
with life, even at the older age. • The continuation of activities performed during middle age is
necessary for successful aging (Lemon, Bengston and Peterson, 1972).

C. THE CONTINUITY THEORY • The continuity theory (Neugarten, 1964) state that personality
remains the same and the behaviours become more predictable as people ages. • Personality
and behaviour pattern developed during a life time determine the degree of engagement and
activity in older adulthood. • Personality is a critical factor in determining the relationship
between role activity and life satisfaction.

D. THE SUBCULTURE THEORY • Rose (1965) theorized that older adults from a unique subculture
within society to defend against society’s negative attitude toward aging and the accompanying
loss of status. • Older adults are a subculture with their own norms and beliefs. The subculture
occurs as a response to loss of status. • In the subculture, individual status is based on health and
mobility, instead of on education, occupation and economic achievement.

CONCEPT OF PSYCHOSOCIAL THEORIES • Disengagement theory views aging as a process of

mutual withdrawal in which older adults voluntarily slow down by retiring, as expected by
society. Proponents of disengagement theory hold that mutual social withdrawal benefits both
individuals and society. • Activity theory, on the other hand, sees a positive correlation between
keeping active and aging well. Proponents of activity theory hold that mutual social withdrawal
runs counter to traditional American ideals of activity, energy, and industry.

• Many of these theories are specific in identifying life- oriented tasks for the aging person. A.
Erikson’s B. Havighurst’s C. Newman’s D. Peck’s E. Jung’s theory

A. ERIKSON’S THEORY • Erickson’s(1963) theory identifies eight stages of developmental tasks

that an individual must comfort throughout the life span: o Trust versus mistrust o Autonomy
versus shame and doubt o Initiative versus guilt o Industry versus inferiority o Identity versus
identity confusion o Intimacy versus isolation o Generativity versus stagnation o Integrity versus
despair • The last of these stages is the domain of late adulthood, but failure to achieve
success in tasks earlier in life can cause problems later in life. • The stage pertaining to older
adults is : Ego integrity versus Despair. • The task of this stage is acceptance of one’s life as
meaningful and that death is part of life, versus despair, which is failure to accept the
meaningfulness of one’s life, along with fear of death.

B. PECK’S THEORY • Peck expanded Erikson’s theory and focused more on later developmental
stages. • Body transcendence versus body preoccupation is a phase concerned with enjoyment
of life in the face of physical discomforts associated with aging. • Ego transcendence versus ego
preoccupation is a phase concerned with the older adult’s ability to focus on the welfare of the
future generation rather than on one’s own inevitable death.

C. HAVIGHURST THEORY • Havighurst’s(1968) theory details the process of aging and defines
specific task for late life, including : o adjusting to decreased physical strength and health, o
adjusting to retirement and decreased income, o adjusting to the loss of a spouse, o establishing a
relationship with one’s age group, o adapting to social roles in a flexible way, and o establishing
satisfactory living arrangements. • Later maturity is Havighurst’s term for older adults. • The task
for later maturity is disengagement. Disengagement from tasks of middle age allows
involvement in new roles such as grandparent, citizen, friend.

D. NEWMAN’S THEORY • Newman’s theory identifies the task of aging as o Coping with the physical
changes of aging o Redirecting energy to new activities and roles including retirement,
grandparenting and widowhood o Accepting one’s own life; and o Developing a point of view about
death.

E. JUNG’S THEORY • Jung’s theory proposes that the development continues throughout life by a
process of searching, questioning and setting goals that are consistent with the individual’s
personality. • As individuals age, they go through a reevaluation stage at midlife, at which point
they realize there are many things they have not done. • At this age they begin to question
whether the decision and choices they have made were the right choices for them. This is so called
“midlife crisis”, which can lead to radical career or lifestyle changes or acceptance of the self as is. •
As aging continues, Jung proposes that the individual is likely to shift from an outward focus (wit
concerns about success and social position) to a more inward focus. • Successful aging includes
acceptance and valuing of the self without regard to the view of others.

CONCEPTS OF DEVELOPMENTAL THEORY

• The concepts based on the identification of traits and characteristics that may be developed
early in life or may change emphasis at different stages of development. • Those who succeed at
the final task also develop wisdom, which includes accepting without major regrets the life that
one has lived, as well as the inescapability of death. • However, even older adults who achieve a
high degree of integrity may feel some despair at this stage as they contemplate their past.

APPLICATION IN NURSING FIELD

• Physical theories of aging indicate that, although biology places some limitations on life and
life expectancy, other factors are subject to behaviour and life choices. Nursing can help
individuals achieve the longest, healthiest lives possible by promoting good health maintenance
practices and a healthy environment.
• Psychosocial theories help to explain the variety of behaviours seen in the aging population.
Understanding all of these theories can help nurses recognize problems and provide nursing
interventions that will helping aging individuals successfully meeting the development tasks of
aging. Cultural, spiritual, regional, socioeconomic, educational and environmental factors as well as
health status impact older adult’s perceptions and choices about their health care needs.

• Theories can predict patient outcomes hold the greatest promise for guiding nursing practice in
ways that help each individual patient age successfully.

• Theories can predict patient outcomes hold the greatest promise for guiding nursing practice in
ways that help each individual patient age successfully.

Roles of the Gerontological Nurse Provider of Care

Provider of care • Gives direct, hands-on care to older adults in a variety of settings. Older adults
often present with atypical symptoms that complicate diagnosis and treatment.

Teacher • Gerontological nurses focus their teaching on modifiable risk factors. • Many diseases
of aging can be prevented through lifestyle modifications such as a healthy diet, smoking
cessation, appropriate weight maintenance, increased physical activity, and stress management.
Nurses have a responsibility to educate the older adult population about ways to decrease the
risk of certain disorders such as heart disease, cancer, and stroke, the leading causes of death for
this group.

Manager • Gerontological nurses act as managers during everyday care as they balance the
concerns of the patient, family, nursing, and the rest of the interdisciplinary team. • Nurse
managers need to develop skills in staff coordination, time management, assertiveness,
communication, and organization. Nurse managers may supervise other nursing personnel.

Advocate • As an advocate, the gerontological nurse acts on behalf of older adults to promote
their best interests and strengthen their autonomy and decision making. • Nurses may also
advocate for patients through other activities such as helping family members choose the best
nursing home for their loved one or listening to family members vent their frustrations about
health problems encountered. Research Consumer • The appropriate level of involvement for
nurse at the baccalaureate level is that of research consumer. This involves gerontological nurses
being aware of current research literature, continuing to read and put into practice the results of
reliable and valid studies. Leader • Nurses acts as leaders during everyday practice as they
balance their concern of the patient, family, nursing and the rest of the interprofessional team. •
All nurses must be skilled in leadership, time management, building relationships,
communication and managing change.

References:
• https://www.slideshare.net/DohaRasheedy/biology-of-ageing
•https://www.slideshare.net/deepaninanayakkara/care-of-the-older-adult?next_slideshow=1
• https://www.slideshare.net/PrincyFrancisM/concepts-and-theories-of-aging?from_action=save
•https://www.slideshare.net/PrincyFrancisM/concepts-and-theories-of-aging
• https://www.slideshare.net/drzargari/agingrelated-changes
• Gerontological Nursing,COMPETENCIES FOR CARE(Kristen L. Mauk, PhD, RN, CRRN-A, APRN, BC)