Aripin, Alshamme N.

BSN III - H
NCM114j Care of the Older Adults 2. DISENGAGEMENT THEORY
Week 1 : Module 1 ○ gradual withdrawal from the society and
relationships serves to maintain social
Definition of terms equilibrium and promote internal
reflection
GERONTOLOGY GERIATRICS 3. SUBCULTURE THEORY
○ the elderly prefer to segregate from the
A broad term used to This is often used as a
society in an aging subculture sharing
generic term relating to
define the study of aging the loss of status and societal negativity
the aged, but specifically
or the aged. This include refers to the medical care regarding the aged
biopsychosocial aspects of the aged. 4. CONTINUITY THEORY
of aging. ○ personality-influences roles and life
satisfaction and remains consistent
throughout life
Demographics of Aging ○ past coping patterns recur as older
adults adjust to physical, financial and
AGING social decline and contemplate death
➢ normal developmental processes 5. PERSON-ENVIRONMENT-FIT
➢ occurring throughout human life span ○ function is affected by ego strength,
➢ causes a mild progressive decline in body mobility, health, cognition, sensory
system functioning perception, and the environment
○ due to DNA ○ competency changes one's ability to
adapt to environment demands
CHRONOLOGICAL AGE 6. GEROTRANSCENDENCE
➢ Refers to the number of years the person has ○ the elderly transforms from a
lived. materialistic/rational perspective
➢ Most commonly used objective method towards oneness with the universe
➢ Serves as criterion in the society for certain ○ successful transformation includes an
activities such as driving, employment and the outward focus, impending death,
collection of retirement benefits. substantive relationships,
➢ THREE CATEGORIES: intergenerational connectedness and
➔ Young Old (Ages 65-74) unity with the universe
➔ Middle Old (Ages 75-84) 7. AGE-STRATIFICATION
➔ Old ages (Ages 85-100) ○ individual in different generations have
➔ Elite Old (over 100) different experiences that may cause to
age in different ways
PHYSIOLOGIC AGE
● Refers to determination of age by the body
function. PSYCHOLOGICAL THEORIES
explain aging in terms of mental processes,
FUNCTIONAL AGE emotions, attitudes, motivation, and personality
● Refers to a person’s ability to contribute to development that is characterized by life
society and benefits others and himself. transitions
1. Human Needs — five basic needs motivate
Theories of Aging human behavior in a lifelong process toward
need fulfillment
SOCIOLOGICAL THEORIES OF AGING ○ Maslow surmised that a hierarchy of
Changing roles, relationships and status impact the needs will motivate human behavior:
older adults ability to adapt. physiologic, safety and security, love
and belonging, self-esteem, and
1. ACTIVITY THEORY self-actualization.
○ remained occupied and involved is 2. Individualism — personality consists of an ego
necessary to a satisfying late-life and a personal and collective unconsciousness
 Aripin, Alshamme N. BSN III - H
that views life from a personal or external 3. Connective Tissue Theory/Cross link —
perspective. proposes biochemical processes create
○ Older adults search for life meaning and connections between structures not normally
adapt to functional and social losses. connected. (e.g. wrinkles)
3. Stages of Personality Development — (Erik 4. Neuroendocrine Theory — describes a change
Erikson) — personality develops in eight in hormone secretion such as releasing
sequential stages with corresponding life tasks. hormones of the hypothalamus and the
○ The eight phase, integrity vs. despair, is stimulating hormone of the pituitary gland which
characterized by evaluating life manage thyroid, parathyroid, and adrenal glands
accomplishments; struggles include and how they influence the aging process
letting go, accepting care, detachment, ○ Also known as “Aging clock” or
and physical and mental decline. pacemaker theory
4. Life-Course/Life Span Development — life
stages are predictable and structured by roles,
relationships, values and goals.
○ Persons adapt to changing roles and
relationships. Age group norms and
characteristics are an important part of
the life course.
5. Selective Optimization with Compensation —
Individuals cope with aging losses through
activity/role selection, optimization, and
compensation.
○ Critical life points include morbidity,
mortality, and quality of life. Selective
optimization with compensation
facilitates successful aging.
○ e.g. he loves to play basketball the way
he compensate is to be a coach

ENVIRONMENTAL THEORIES
(external factors)

1. Radiation Theory — this theory states that

humans age because cells accumulate free
radical damage overtime.
2. Stress Theory — Human aging is a disease
syndrome arising from a struggle between
environmental stress and biological resistance
and relative adaptation to the effects of stressor
agents. (air pollutants, chemicals, psychological
and sociological events)

BIOLOGICAL THEORIES
(within the body)

1. Free Radical Theory — postulates that aging is

due to oxidative matabolism and the effects of
free radicals (drugs, alcohol, cigarretes)
2. Wear and Tear Theory — cumulative changes
occuring in cells age and damage cellular
metabolism (e.g. arthritis overuse of body part)

NCM114j Care of the Older Adults
Week 2: Module 2
SOCIO-ECONOMIC ASPECTS OF AGING
1. Age Cohorts — Persons who share the
experience of a particular event or time in history
are grouped together in which is called a cohort.
○ Ages 55 - 64
■ (still maintain resources they
need coz they can still work)
○ Ages 65 - 74
■ (forced to retire = source of
income is lower/not enough than
while working)
○ Ages 75 - 84
■ (high maintenance of meds due
to chronic illnesses)
○ Ages 85 and older
■ (bigger expenses needed &
living alone)
■ Instrumental Activities of Daily
Living (IADL) — beyond oneself,
(e.g. maintaining the house)
■ Activities of Daily Living (ADL)
— Basic & essential needs (e.g.
walking, eating)
2. Poverty — Inadequate income may affect the
quality of life for older adults, delay seeking
medical help, and may not follow through with
the prescribed treatment or medications.
3. Education — Has been shown to have a strong
relationship to health risk factors. The level of
education influences earning ability, information
absorption, problem-solving ability, value
systems, and lifestyle behaviors.
4. Health Status — Persons over 65 have an
average of 2 chronic conditions.
5. Insurance Coverage — Health Insurance is a
necessity for older adults because of medical
problems therefore medical expenses increase
with age.
6. Support Systems — Throughout life, people
make new acquaintances, develop friendships,
and form family circles. People identify with
schools, churches, clubs, neighborhoods, and
towns. These are the places that they turn to
when they need advice or help, want to
celebrate, or are grieving.
Aripin, Alshamme N. BSN III - H
○ No support system = depression
THE AGING FAMILY
Family — a basic social unit consisting of parents and
their children, considered as a group
Roles & Relationships (changes)
- The family of the elderly is the support system
that renders care and gives love and strength,
and hope in the life of an individual chronically ill
patient.
- This family could be the spouse, brothers,
sisters and sons/daughters.
AGING OF PHYSIOLOGICAL SYSTEMS
Cardiovascular
● Cardiac Aging
○ Enlargement of heart chambers and
coronary cells occurs with age, as does
increased thickening of heart walls,
especially in the left ventricle — causing
decline in ventricle flexibility and an
overall increased of heart weight of
about 1.5 grams/year in women and 1.0
gram/year in men measured from age
30 to age 90 years
○ Heart Ventricles — thicken and stiffen
in correlation with continued steady
production of collagen.
○ Decline in the number of myocardial
cells and subsequent enlargement of
the remaining cells
● Vascular Aging
○ Aged arteries become extended and
twisted. Alterations also occur in
endothelial cells, and arterial walls
thicken due to increased levels of
collagen and decreased levels of elastin
○ Stiffened Large Arteries — leading to
hypertension—increased blood
velocity from the aorta to the
systemic arterial system
○ Declined Vascular tone due to
deterioration in endothelium regulation
of vascular relaxation
Structural changes with age
● Decreased myocardial cells,
decreased aortic distensibility,
decreased vascular tone
 Aripin, Alshamme N. BSN III - H
■ Reduces its ability to expand
● Increased heart weight, increased
myocardial cell size, increased left during inhalation and con- tract
ventricle wall thickness, increased during exhalation
artery stiffness, increased elastin
levels, increased collagen levels,
increased left atrium size

Functional changes with age

● Decreased diastolic pressure (during

initial filling), decreased diastolic
filling, decreased reaction to
B-adrenergic stimulus
● Increased systolic pressure,
increased arterial pressure, increased
wave velocity, increased left
ventricular end-diastolic pressure,
elongation of muscle contraction
phase, elongation of muscle
relaxation phase, elongation of Gastrointestinal
ventricular relaxation ● Mouth
○ Atrophy of muscles and bones of the
No change with age
jaw and mouth that control mastication,
● Ejection fraction, stroke volume, dental decay & tooth loss — difficulty
cardiac output, overall systolic chewing.
function ● Esophagus
○ Declined upper esophageal sphincter
Respiratory pressure
● Flatter & Shallower Alveoli ■ Increased time for the upper
○ Decrease in the amount of tissue esophageal sphincter to relax
dividing individual alveoli. ■ Decreased intensity of
○ Decrease in the alveolar surface area. esophageal contractions
■ age-related reduction in alveolar potentially caused by loss of
surface area impairs efficient muscle abilities and nerve
passage of oxygen from the innervations
alveoli to the blood ○ Stiffening of the esophageal wall and
● Lost of Lung Elasticity less sensitivity to discomfort and pain in
○ During expiration, elastic recoil helps to the esophagus.
keep the lungs open until all air is ■ Affect the ability to swallow in
expelled and the lungs are forced to the older patient
collapse due to the action of the ■ Absent gag reflex
respiratory muscles. ● Stomach
■ Loss of elastic recoil causes the ○ Declines in peristaltic contractions
lungs to close pre- maturely, ○ Slower gastric emptying in
trapping air inside and premenopausal women
preventing the lungs from ■ linked to increased
emptying completely. progesterone levels during the
● Chest Wall menstrual cycle
○ Increase in stiffness due to a loss of ● Large Intestines
rib elasticity as well as age-related ○ Loss of enteric, or intestinal, neurons
calcification of the cartilage that and a loss of inhibitory nerve
attaches the ribs to the breastbone connection to the smooth muscle
cause changes in motility via a
decreased ability to inhibit colonic

contractions and/or by decreased
colonic relaxation.
○ Longer colonic transit time (the
amount of time needed for fluid and
excrement to travel the length of the
colon).
■ Increased fibrosis in the colon
○ Increased fibrous tissue in Rectum
reduces the rectum’s ability to stretch as
feces pass through
● Sphincter — thins
○ However, the internal anal sphincter
thickens with age, possibly as a
compensatory mechanism.
Nonetheless, it shows a decline in
contractile abilities
Aging women experience a greater risk of
anal sphincter changes due to laxity of the
pelvic floor, decreased pressure in the rectum,
and even menopause
● Liver
○ Liver’s size & its blood flow and
perfusion can decrease by 30% to
40%.
○ Due to the liver’s large reserve
capacity and the hepatocytes’ ability
to regenerate after damage, no
functional changes result from the
changes in structure
○ Decreased drug clearance due to the
observed declines in liver size and blood
flow as well as age-related changes in
the kidneys (highly variable).
● Gallbladder
○ Declines in emptying rates so that less
bile is secreted when food is digested
○ Increased bile volume has been
correlated with gallstones in older
adults. This increase in bile volume is
more common in older women than
men
○ Bile ducts tend to widen with age,
allowing potential gallstones to pass
through more easily; however, the duct
near the opening of the small
intestine becomes narrower, trapping
the gallstones and leading to abnormal
changes
● Pancreas
○ Decreases in weight & shows some
histological changes such as fibrosis
and cell atrophy (do not affect function)
Aripin, Alshamme N. BSN III - H
Urinary Structure
● Kidney
○ Shrink in length and weight. At 30
years of age, the average kidney weighs
150 to 200 g. By age 90, weight has
declined to between 110 and 150 g
○ 30%-40% decrease of glomeruli by
age 90, due to glomerulosclerosis
■ Remaining glomeruli decrease
in size but increase in
basement membrane
thickness
● Bladder
○ Decreases in size and develops fibrous
matter in the bladder wall, changing
overall stretching capacity and
contractibility
○ Declined filling capacity of the bladder
and with the ability to withhold voiding
○ Detrusor contraction declines
● Ureter & Urethra
○ Length of the urethra and the pressure
needed to close off the urethra
declines in women
○ The urethra thins and striated muscle
that controls sphincters also thins and
weakens
○ Prostate enlargement around the
bladder and urethra can cause urinary
dysfunction.
● Urination
○ Amount of urine decreases with age
correlating with increases of around
50–100 ml in postvoid residual (PVR)
with age.
Reproductive
➔ Female: menopause and subsequent declines in
estrogen
➔ Male: associated with androgen deficiency and
physical syndromes such as impotence.
● Neuroendocrine function
○ Change in gonadotropin levels occurs
before ovarian age-related changes,
implicating involvement of the
hypothalamus.
○ FSH levels begin increasing before
menopause occurs and continue to
increase throughout and after
menopause.
○ Estradiol levels tend to increase right
before and while transitioning into
menopause and then drastically
decrease during menopause

● Decreased estrogen levels affects:
○ Skin contains less collagen and
becomes thin, sweat and sebaceous
glands become dry, hair follicles begin to
dry
○ Bones lose calcium and undergo
increased bone resorption, breasts
loose connective tissue but gain adipose
tissue, lipoproteins increase,
○ Bladder function decreases
○ Cardiovascular function and blood
pressure change and
○ Absorption and metabolism of
nutrients become less efficient
● Ovaries
○ Impalpable
○ Decreased Ovarian follicles — leading
to decline fertility
● Uterus
○ Decreased in size: impalpable (>75yo)
○ Decreases in uterine endometrial
thickening during menstrual cycles
occur as the result of decreased
estrogen and progesterone levels
■ Leads to a decline in
menstrual flow, eventually
causing missed menstrual
cycles and permanent cessation
of ovulation and menstruation
○ Weakened supporting ligament attached
to uterus — causing uterus tilted
backward.
Nervous System
● Aging Brain
○ Memory changes can be observed by
the fifth decade, but changes remain
variable among individuals. There is
also great variation in the type of
memory affected
● Overall Structural Changes
○ The brain decreases in size and weight
as men and women age
○ At birth, the brain weighs ap-
proximately 357 grams.
○ Brain weight peaks at about 1,300
grams around the age of 20-55 y/o.
○ After age 55 there is a decline in brain
weight.
○ This decline can result in a brain weight
that is 11% smaller than that observed in
the young adult brain
Aripin, Alshamme N. BSN III - H
○ Ventricles within the brain enlarge
throughout the aging process.
○ Ventricle size at age 90 may be as much
as three to four times ventricle size at
age 20.
○ Ventricle enlargement may help to
explain some 35% loss of brain volume
● Spinal Cord
○ spinal cord cells declines after 60
Muscle
● Sarcopenia
○ muscle mass reduction
○ decrease by as much as 40% between
the ages of 20 and 60 years with the
greatest loss occurring in the lower
limbs
● Muscle Strength
○ muscle’s capacity to generate force, is
thought to be secondary to declines in
muscle mass
○ decreases of 50% or more occurring in
persons in their ninth decade or beyond
● Muscle Quality
○ arm muscle quality declined more
among males than females, yet leg
muscle quality declined on females
Skeletal System
● Bone
○ remodeling - periodic replacement of
old bone with new bone
○ primary purpose of bone remodeling
may be to attenuate if not prevent the
accumulation of old bone
● Bone loss
○ loses the ability to maintain this balance
between bone resorption and formation.
The BMU is in negative balance in
which bone loss occurs.
○ Negative BMU balance begins as early
as the third decade, long before
menopause in women
● Joints
○ Immovable Joints:
■ collagen between the bones of
immovable joints becomes
coated with bone matrix.
■ As a result, the space between
bones gets even narrower and
the bones may eventually fuse
together completely.
 Aripin, Alshamme N. BSN III - H
■ Consequently, the joints ○ Collagen fibers in the eye begin to
become stronger. Therefore, thicken and muscle cell numbers
with age immovable joints decrease with age that reduce the
actually improve. ability of the pupil and iris to work
○ Cartilaginous Joints together to constrict and dilate hence,
■ Stiffening of the cartilage the eye is unable to appropriately adapt
comprising cartilaginous joints. to changing light intensities
■ Ligaments also become stiffer ● Hearing
and less elastic. ○ External canal: Shrinkage of cerumen
■ Reduction in the amount of glands causes dryer cerumen, there is
movement allowed by the often blockage of the external canal and
cartilaginous joints. a decreased ability to hear
■ vertebrae weaken thus the ○ Middle Ear: loses elasticity and the
weight of the body forces the ossicles tend to shrink
intervertebral disk to expand ○ Inner Ear: loss of elasticity in the basilar
into the vertebrae, forming a membrane as well as degeneration of
concave region the organ of Corti, manifested as
● shortening of the spinal increased shrinkage and loss of hair
column and a decrease cells
in body height.
○ Synovial Joints Integumentary System
■ decline around 20 years of age ● Skin
■ As a person ages both the joint
capsule and the ligaments
become shorter, stiffer, and less
able to stretch.
■ cartilage lining the bones
becomes calcified, thinner, and
less resilient
■ < balance
Sensory System
● Declined Touch
○ Decrease in the number and alteration
in the structural integrity of touch
receptors, or Meissner’s corpuscles,
and the pressure receptors, or the
Pacinian corpuscles
● Smell
○ Around the 60s and 70s there is a
decline in olfaction (sense of smell)
which reduced ability for both odor
detection and identification, especially
among males.
○ Decreased sense of smell = hyposmia
● Taste
○ Decrease in taste, also known as
Immune System
hypogeusia, usually more noticeable
around the age of 60 with more severe
declines occurring over the age of 70
● Vision
○ Dry eye syndrome may be explained by
age-related decline in the amount of
tears produced by the conjunctiva
 Aripin, Alshamme N. BSN III - H

NCM114j Care of the Older Adults Functional Assessment

Week 3: Module 3
CHRONIC ILLNESSES IN OLDER PERSONS & ● identify an older adult’s ability to perform
self-care, self-maintenance, and physical
ITS BEHAVIORAL MANAGEMENT & HEALTH
activities, and plan appropriate nursing
EDUCATION
interventions.
● Disability refers to the impact that health
● Hypertension
problems have on an individual’s ability to per-
● Chronic Obstructive Pulmonary Disease (COPD)
form tasks, roles, and activities, and it is often
● Chronic Bronchitis
measured by asking questions about the per-
● Emphysema
formance of activities of daily living (such as eat-
● Asthma
ing and dressing) and instrumental activities of
● Diabetes
daily living (such as meal preparation and
● Dementia
hobbies) (Verbrugge & Jette, 1994).
● Cancer
● Stroke WHO (1980) ICIDH CLASSIFICATION
International Classification of Impairment,
Disability and Handicap (ICIDH)
PATTERNS OF HEALTH & DISEASE
Impairment
A. Diseases that occur to varying degrees in most ● Any loss or abnormality of
older adults psychological, physiological, or
○ Cataracts anatomical structure or function.
Disability
○ Arteriosclerosis
● Any restriction or lack (result- ing from
○ Benign Prostatic Hypertrophy (male) impairment) of ability to per- form an
B. Diseases with increased incidence with activity in the manner or within the
advancing age range considered normal for a human
○ Neoplastic Disease being.
○ Diabetes Mellitus Handicap
○ Dementia Disorders ● A disadvantage for a given individual,
resulting from impairment or disability
C. Disease that have more serious consequences
that limits or prevents the fulfillment of
in the elderly a role that is normal (depending on
○ Pneumonia age, sex, and social and cultural
○ Influenza factors) for that individual.
○ Trauma (bone will take up 6mos-1yr to
heal)
Physical Assessment
D. Very Common Chronic Diseases
○ Arthritis
I. Circulatory Function
○ Hypertension
○ Family History
○ Heart Disease
■ Current problems with chest
E. Functional Disability
pain or discomfort, especially if
○ 32% of persons over 65 years have
associated with exertion;
some limitations of functions
■ Current diagnosis and
○ 25% of persons over 65 years require
associated medications as well
help with at least one ADL or IADL
as over-the-counter and herbal
(Instrumental Activities of Daily Living)
medicines
■ Sources of stress and
COMPREHENSIVE GERIATRIC ASSESSMENT
adherence to current medical
regimens.
● A multidimensional and multidisciplinary ○ Physical Examination
assessment designed to evaluate an older
person’s functional ability, physical health,
cognition and mental health.

■ Blood pressure, listening to
chest sounds, and taking a
pulse rate.
○ Others:
■ Exercise stress test
■ Blood and serum tests,
electrocardiograms, and other
tests for imaging and assessing
the condition of the heart and
blood vessels.
● Respiratory Function
○ Hx. of smoking behavior and exposure
to environment pollutants
○ Current difficulties and anxieties
associated with breathing, decreased
energy to complete everyday tasks,
frequent coughing, and production of
excessive sputum.
○ Physical examination includes:
■ Observation of posture and
breathlessness, and listening to
chest sounds.
○ Others: Pulmonary Function Test
(Spirometry), CXR & Sputum analysis
● Gastrointestinal Function
Smooth muscle changes mean decreased
peristaltic action and reduced gastric acid
secretion, which may affect gastric comfort
and appetite.
○ Diet, appetite, occurrence of nausea,
vomiting, indigestion, or other stomach
discomforts; and problems with bowel
function.
○ Barium enema X-ray, Stool analysis, &
Colon examination
○ Oral Health Assessment
● Genitourinary Function
○ Health hx. questions
■ Any previous or current
difficulties related to the
frequency and voluntary flow of
urine during either the day or
night.
■ If incontinence is a problem,
then questions should focus on
the type of incontinence: stress,
urge, functional or overflow
○ Pelvic Examination & Pap Smear
○ Urinalysis for blood, bacteria & other
components such as ketones
● Neurological Function
Aripin, Alshamme N. BSN III - H
Dementia is a collection of diseases where
the changes in brain cells and activity lead to
progressive loss of mental capacity.
Alzheimer’s disease is the most common
disease of dementia.
○ Hx. or Family history of stroke
○ Current impairments in speech,
expression, swallowing, memory,
orientation, energy level, balance,
sensation, and motor function. Other
areas of assessment relate to the
occurrence of sleep disturbance,
tremors, and seizures
● Musculoskeletal Function
The stiffening of connective tissue
(ligaments and tendons) and erosion of
articular surfaces of joints create
restrictions in joint mobility. Declines in
hormone production contribute to bone loss,
and the ability to heal is reduced.
○ Hx. of sore joints
○ Observation of posture, stance, and
walking
○ Up & Go Test — provides a quick
assessment of an older person’s
mobility and overall function.
■ The nurse should measure a
distance of 10 feet from the
person’s chair and ask him or
her to rise, walk to the line, turn,
walk back, and sit down. An
average time to do this is 10
seconds.
● >10s may indicate
functional problems with
ambulation.
● Sensory function
○ Diminished vision & hearing
Presbyopia refers to an age-related change
in vision. The lens of the eye becomes less
elastic and this creates less efficient
accommodation of near and distant vision.
Presbycusis refers to age-related
progressive hearing loss.
Age-related macular degeneration, the
deterioration of central vision, is the leading
cause of severe vision loss in older adults
in the United States.
● Integumentary Function
○ Rashes, itching, dryness, frequent
bruising, and any open sores.
 Aripin, Alshamme N. BSN III - H
○ Observe: Color, Hydration, Circulation
and Intactness

Cognitive Assessment

○ Attention, Memory, & Language

○ The most extensively used cognitive
assessment tool is the
■ Mini Mental State Examination
(MMSE) — screening tool for
cognitive impairment

Psychological Assessment

Two areas of psychological assessment: quality of life,

which may include several positive mental health
constructs, and depression, a common mental health
problem
● Quality of Life — environmental and material
components, and physical, mental, and social
well-being
● Depression — Geriatric Depression Scale
(GDS) is an excellent tool to evaluate
depression.
○ The interviewer asks the older person a
set of 30 questions. A score of 0–30 is
possible, with 0–9 being normal, 10–19
indicating mild depression, and 20–30
indicating severe depressive symptoms.

Social Assessment

● Collecting information on the presence of a

social network and on the interaction between
the older adult and family, friends, neighbors,
and community.

Spiritual Assessment

Religiosity- believing in God, organized rituals

● Spirituality- ideas of belief that encompasses
personal philosophy and an understanding of
meaning & purpose in life.

PROBLEMS RELATED TO THE ELDERLY

1. Physiologic Functioning
2. Behavioral
○ Anxiety, Depression, Polypharmacy
3. Safety