CARE OF OLDER PERSONS

Demographics of Aging

In the Philippines, the number of older people is increasing rapidly, faster than growth in the total
population. In 2000, there were 4.6 million senior citizens (60 years or older), representing about 6% of
the total population. In two decades, this has grown to 9.4 million older people or about 8.6% of the
total population. The World Population Prospects 2019 projects that by 2050, older people will make up
around 16.5% of the total population.
 Demographics of Aging
In the Philippines, the number of older people
is increasing rapidly, faster than growth in the
total population.
In 2000, there were 4.6 million senior citizens
(60 years or older), representing about 6% of
the total population.
In two decades, this has grown to 9.4 million
older people or about 8.6% of the total
population.
The World Population Prospects 2019 projects
that by 2050, older people will make up around
16.5% of the total population.
Demographics of Aging
 Theories of Aging
• Biologic

• Sociologic

• Psychologic

• Moral/Spiritual
 Biologic Theories
Concerned with answering basic questions regarding the
physiological processes that occur in all living organisms as
they chronologically age
 Biologic Theories

1) deleterious effects leading to decreasing function of the

organism

2) gradually occurring age-related changes that are

progressive over time

3) intrinsic changes that can affect all member of a species

because of chronologic age
 Biologic Theories

Stochastic: Explain aging as events that occur randomly and

accumulate over time

Non stochastic: View aging as certain predetermined, timed

phenomena
 Stochastic Theories

A. Error Theory
Originally proposed in 1963 based on the following:
1)errors can occur in the transcription in any step of the protein synthesis of
DNA
2) error causes the reproduction of an enzyme or protein that is not an exact
copy
3) As transcription errors to occur, the end product would not even resemble
the original cell, thereby compromising its functional ability
More recently the theory has not been supported by research - not all aged
cells contain altered or mis specified proteins nor is aging automatically or
necessarily accelerated if mis specified proteins or enzymes are introduced into
a cell
 Stochastic Theories

B. Free Radical Theory

• Accumulation of free radicals (byproducts of metabolism--can increase as a
result of environmental pollutants) damage cell membrane, decreasing its
efficiency
• Free radicals are also implicated in the development of plaques associated
with Alzheimer’s
Stochastic Theories
 Stochastic Theories

C. Cross-Linkage Theory
Some proteins in the body become cross-linked, thereby not
allowing for normal metabolic activities causing accumulation
of waste products that in turn results to decreased tissue
function
 Stochastic Theories

D. Wear & Tear Theory

• Proposed first in 1882
• Cells simply wear out over time because of continued use-
-rather like a machine
 Non Stochastic Theories

A. Programmed (Hayflick Limit)

Theory
• Based on lab experiments on fetal
fibroblastic cells and their
reproductive capabilities in 1961
• Cells can only reproduce themselves a
limited number of times ( Cell clock)
• Life expectancies are seen as
preprogrammed within a species-
specific range (Limitation)
 Non Stochastic Theories

B. Immunity Theory
• Immunosenescence: Age-related functional
diminution of the immune system
• A programmed decline in the immune system
lead to increased vulnerability to disease, aging
and death
• Lower rate of T-lymphocyte (“killer cells”)
proliferation in response to a stimulus that
results to a decrease in the body’s defense
against foreign pathogens
 Non Stochastic Theories

B. Immunity Theory
Change include a decrease in humoral immune response, often
predisposing older adults to:
1)decreased resistance to a tumor cell challenge and the
development of cancer
2) decreased ability to initiate the immune process and mobilize
defenses in aggressively attaching pathogens
3) increased susceptibility to auto-immune diseases
 EMERGING THEORIES OF AGING
A. Neuroendocrine Control
• examines the interrelated role of the neurologic and endocrine
systems over the life-span of an individual
• there is a decline, or even cessation, in many of the components
of the neuroendocrine system over the lifespan
B. Metobolic Theory of Aging (Caloric Restriction) - proposes that all
organisms have a finite amount of metabolic lifetime and that
organisms with a higher metabolic rate have a shorter lifespan
C. DNA-Related Research - Mapping the human genome (“…there may
be as many as 200 genes responsible for controlling aging in
humans”); discovery of telomeres
 SOCIOLOGIC THEORIES OF AGING
A. Disengagement Theory (Cumming & Henry—1961)
• Its major premise is that, with aging,
there is a mutual severing of the ties
between the individual and society, and
that this is a good thing for both
• Disengagement theory would suggest that
those who were already gradually
withdrawing from society would have less
difficulty during bereavement than those
who have not yet begun the process of
withdrawal, as the bereavement
experience would not seem as abrupt to
them
 SOCIOLOGIC THEORIES OF AGING
B. Activity Theory (Developmental Task
Theory) - Havighurst, Neugarten, Tobin
(1963)
Activity is viewed by this theory as
necessary to maintain a person’s life
satisfaction and a positive self-concept
The theory is based on assumptions that it is
better to be active than inactive, it is better
to be happy than unhappy, and an older
individual is the best judge of his or her own
success in achieving the first two
assumptions
 SOCIOLOGIC THEORIES OF AGING
B. Continuity theory
How a person has been throughout life is how
that person will continue through the
remainder of life

Old age is not a separate phase of life, but

rather a continuation and thus an integral
component
 SOCIOLOGIC THEORIES OF AGING
C. Age Stratification Theory
Riley--1985
• Society consists of groups of
cohorts that age collectively
• The people & Roles in these cohorts
change & influence each other, as
does society at large
• Thus, there is a high degree of
interdependence between older
adults & society
 SOCIOLOGIC THEORIES OF AGING
D. Person-Environment Fit Theory
Lawton, 1982
Individuals have personal competencies that assist in dealing with the
environment:
• ego strength
• level of motor skills
• individual biologic health
• cognitive & sensory-perceptual capacities
As a person ages, there may be changes in competencies & these changes alter
the ability to interrelate with the environment
Significant implications in a society that is characterized by constantly changing
technology
 PSYCHOLOGIC THEORIES OF AGING
A. Maslow’s Hierarchy of Human Needs
Maslow’s fully 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
primacy; freshness of peak experiences;
identification with other human beings, a
satisfying and changing relationships with other
people; a democratic character structure;
creativity; and a sense of values.
 PSYCHOLOGIC THEORIES OF AGING
B. Jung’s Theory of Individualism
Self-realization is the goal of personality development
as individual ages, each is capable of transforming into a more spiritual being
 PSYCHOLOGIC THEORIES OF AGING
C. Erikson’s Eight Stages of Life
• the final psychological conflict for Erikson was ego integrity vs. despair:
coming to term with life
• Ego Integrity described a state of feeling whole and accepting of one's
achievements and choices, adaptation to both the victories and the failures
incident to any human life
• An ability to view one's life in the broad context off all humanity
contributes to the contentment that accompanies integrity
• Despair follows from a perception of having made many wrong choices and
having too little time to pursue different courses
• Despair renders difficult the acceptance that death is near and the
individual may be overwhelmed with bitterness
 PSYCHOLOGIC THEORIES OF AGING
D. Peck’s Expansion of Erikson’s Theory
Erikson’s last two stages are expanded to 7
The final three of the developmental tasks for old age:
1. ego differentiation: finding other sources of self-worth for those who had
invested heavily in careers/children

2. body transcendence: emphasizing the compensating rewards of

cognitive/emotional/social adaptive skills to surmount physical limitations

3. ego transcendence: facing the reality of death constructively through

efforts to make life more secure, meaningful, and rewarding for younger
generations
 PSYCHOLOGIC THEORIES OF AGING
D. Peck’s Expansion of Erikson’s Theory
Erikson’s last two stages are expanded to 7
The final three of the developmental tasks for old age:
1. ego differentiation: finding other sources of self-worth for those who had
invested heavily in careers/children

2. body transcendence: emphasizing the compensating rewards of

cognitive/emotional/social adaptive skills to surmount physical limitations

3. ego transcendence: facing the reality of death constructively through

efforts to make life more secure, meaningful, and rewarding for younger
generations
 PSYCHOLOGIC THEORIES OF AGING
E. Selective Optimization with Compensation

Baltes--1987

Individuals develop strategies to manage losses of function that occur over

time
3 Interacting Elements:
• 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
 Physiologic changes of aging

Age is an issue of mind

over matter.
If you don't mind, it
doesn't matter."
Mark Twain
(1835-1910)
 Physiologic changes of aging
Changes in Physiology with
Aging
• Older people may exhibit
no changes in baseline
function, but may have
decreased ability to adapt
to stress.
• Various body systems lose
reserve capacity with aging
at different rates.
 Physiologic changes of aging
Changes in Vision and Hearing
• Significant visual & hearing impairment is present
in up to 75% of elderly people
• Often not reported to the physician
• May limit ability to function
• May lead to social isolation
• May interfere with ability to communicate
• May appear demented
 Eyes
Loss of fat – sunken appearance; eye bags
– Presbyopia
– Slower adaptation to darkness
– Diminished tolerance to glare
– Increasing impairment to colour discrimination
– Increased lens density
– Macular degeneration
– Degeneration of tear gland
 Symptoms
Cannot get glasses clean

Difficulty night driving

Difficulties reading

Double vision (in one eye)

Symptoms
 Symptoms
Age-Related Macular Degeneration
• Increased age
• Female gender
• Lighter iris color
• Race
• Smoking
• Sunlight Exposure
 Ears
Loss of elasticity in inner ear
leading to loss of high frequency
hearing.
Sounds from speech is distorted
due to poor quality amplification
Sensorineural hearing loss –
presbycusis.
Conductive hearing loss may also
occur.
 Ears
• 60% of elderly over 65
have some degree of
hearing impairment.
• 90% of people over 75 have
some degree of hearing
impairment!
• 75% of all people with
hearing loss could benefit
from an appropriate hearing
aid.
 Signs of hearing loss
• Ringing or buzzing in the ears
• Talking louder than necessary
• Turning up volume on the TV or radio
• Complaints that other people “mumble”
• Confusion of similar sounding words
• Watching a speaker’s face intently
• Difficulty “hearing” someone behind you
• Having difficulty on the telephone
• Inappropriate responses in conversation
 Changes in Cardiovascular Physiology
• Changes in cardiac output (CO):
• Maximal heart rate decreased with aging (max. heart rate = 220 -
age)
• Increased end-diastolic and end-systolic left ventricular volumes
• Diastolic dysfunction
• Decreased early diastolic filling
• Increased reliance on atrial contraction
• Increased vulnerability to congestive heart failure, especially with
atrial fibrillation
• Decreased compliance of peripheral blood vessels
• predisposes to systolic hypertension, left ventricular
hypertrophy of heart
• Increased incidence of atherosclerotic cardiovascular
disease
• Increased incidence of degeneration of cardiac conduction
system
 Changes in Cardiovascular Physiology
• Chest pain less frequent
• - Exertional dyspnea or fatigue
more common
• - ‘Gastrointestinal’ symptoms
more common
• - Confusion, dizziness, other
CNS symptoms
• Decrease in capacity to cope with
the demands of physical activity.
• Simple daily tasks become less
achievable.
 Respiratory system
• Decreased elasticity
• Decreased vital capacity
• Increased residual volume
• Decreased structural support for small airways
• Decreased number of small airways open during normal breathing
• Decreased Lung surface area
• Increased Chest wall stiffness
 Respiratory system
• Increased residual volume
• Decreased structural support for small airways
• Decreased number of small airways open during normal breathing
• Decreased Lung surface area
• Alveolar function unchanged with age
• Noticeable change is reduction in lung compliance
• Also loss of elasticity and reduction in strength of muscles of rib cage
reduces usable lung capacity to 82% maximum value by age 45; 62% at age
65; and 50% at age 85
• Over time some alveoli replaced by fibrous tissue
• Gas exchange reduced
• Main problems arise with increased demand (exercise)
 Renal System
Loss of diurnal excretory pattern increasing nocturia
Loss of nephrons
Reduced plasma blood flow and GFR
Serum Creatinine will not reflect the GFR as the muscle
mass is reduced.
Relative excess of antidiuretic hormone (ADH)
Alterations in renal potassium handling
Main problem is reduced ability to respond to salt load or
depletion
Urinary incontinence
Renal System
 Musculoskeletal Changes
• Decrease in muscle weight relative to total body weight
• Changes in water content of cartilage
• Bone loss in both sexes but more pronounced in women
• Chronic pain
• Decrease in functional ability contributing to morbidity
• Lack of independence leading to decreases in quality of
life
Musculoskeletal Changes
 Neurologic changes
• Short-term memory and the ability to learn new material
tend to be affected relatively early.
• Verbal abilities, including vocabulary and word usage, may
begin to decline later.
• Intellectual performance—the ability to process
information (regardless of speed)—is usually maintained
if no underlying neurologic or vascular disorders are
present.
• Reaction time and performance of tasks may become
slower because the brain processes nerve impulses more
slowly.
 Neurologic changes
• the number of nerve cells in the brain may decrease,
although the number lost varies greatly from person to
person, depending on the person’s health.
• some types of memory are more vulnerable to loss, such
as memory that holds information temporarily
• As people age, blood flow to the brain may decrease by an
average of 20%.
 Neurologic changes
• As people age, the disks between the back bones
(vertebrae) become hard and brittle, and parts of the
vertebrae may overgrow. As a result, the disks lose some
of their capacity to cushion, so more pressure is put on
the spinal cord and on the branches of the nerves that
emerge from it (spinal nerve roots). The increased
pressure may injure nerve fibers at the point where they
leave the spinal cord. Such injury can result in decreased
sensation and sometimes decreased strength and balance.
 Neurologic changes
• As people age, peripheral nerves may conduct impulses
more slowly and release neurotransmitters is impaired,
resulting in decreased sensation, slower reflexes, and
often some clumsiness. Nerve conduction can slow
because the myelin sheaths around nerves degenerate.
Myelin sheaths are layers of tissue that insulate nerves
and speed conduction of impulses
 Digestive system
Age Related Changes of Taste
General decrease in taste due to
decreased central sensation.
Decreased salivary volume.
Formation of fissures and furrows on the
tongue.
 Digestive system
• Smooth muscle contraction diminished.
• Deterioration of structures in mouth common.
• Decline in efficiency of liver.
• Reduced ability to aid in digestion and metabolism of certain drugs
• Impaired swallowing.
• Stomach sphincter valve loss.
• Decrease in nutrient absorption.
• Constipation is common.
• Poor fitting dentures.
• Increase in heartburn.
• Malnutrition due to deterioration of small intestine.
 Endocrine changes
• Alteration in the production, secretion, and catabolism of
hormones.
• the amount of human growth hormone that is produced
declines with age, resulting in the reduced muscle mass
commonly observed in the elderly.
• menopause and the decline of ovarian function
• Low levels of estrogens and progesterone are also
associated with some disease states, such as
osteoporosis, atherosclerosis, and hyperlipidemia, or
abnormal blood lipid levels.
 Endocrine changes
• Decline in testosterone levels rarely affecting sperm
production until very old age, the quantity, quality, and
motility of their sperm is often reduced.
• Decrease production of thyroid hormones, causing a
gradual decrease in the basal metabolic rate (reduces the
production of body heat and increases levels of body fat)
• blood glucose levels spike more rapidly and take longer to
return to normal in the elderly