NCM 114 – CARE OF OLDER ADULTS

TOPIC I. PERSPECTIVE OF AGING AGE DISCRIMINATION

• OLD defines as having lived or existed for a long time.
• The meaning of old is highly subjective. to a great degree,
it depends on how old we ourselves are.
• A recent study reveals that people younger than 30 years
view those older than 63 as “getting older.” People 65
years of age and older do not think people are “getting
older” until they are 75.
• Aging is the process of becoming older.
• Aging is a complex process that can be described
chronologically, physiologically, and functionally.
• Chronologic age is the number of years a person has
lived, is most often used when we speak of aging because
it is the easiest to identify and measure. Many people
who have lived a long time remain functionally and
physiologically young.
• Thus, chronologic age is not the most meaningful
measurement of aging.
• Society clings to 65 as the “retirement age” and resists
political proposals designed to move the start of Social
Security benefits to a later age.
CULTURAL CONSIDERATION
• The Role of the Family
➢ Cultural heritage may work as a barrier to
getting help for an older parent. Many cultures
emphasize the importance of intergenerational
obligation and dictate that it is the role of the
family to provide for both the financial and
personal assistance needs of older adults. This
can lead to high stress and excessive demands,
particularly on lower-income families.
➢ Nurses need to recognize the impact that
culture has on expectations and values and how
these cultural values affect the willingness to
accept outside assistance. Nurses need to be
able to identify the workings of complex family
dynamics and determine how decision making
takes place within a unique cultural context.
➢ Age discrimination reaches beyond emotions and
leads to actions; older adults are treated differently
simply because of their age.
➢ Examples of age discrimination include refusing to
hire older people, not approving them for home
loans, and limiting the types or amount of health
care they receive.
➢ Age discrimination is illegal.
➢ Aging can be a liberating experience. Aging seems to
decrease the need to maintain pretenses, and the
older adult may finally be comfortable enough to
reveal the real person that has existed beneath the
facade.
DEMOGRAPHICS
➢ The statistical study of human population.
➢ Demographers are concerned with a population’s
size, distribution, and vital statistics (birth, death,
age at death, marriages, race and many other
variables)
➢ Demographic research is important to many groups.
Demographic information is used by the
government as a basis for granting aid to cities and
states, by cities to project their budget needs for
schools, by hospitals to determine the number of
beds needed, by public health agencies to determine
the immunization needs of a community, and by
marketers to sell products.
➢ One important piece of demographic information is
life expectancy.
➢ Life expectancy is the number of years an average
person can expect to live. Projected from the time of
birth, life expectancy is based on the ages of all
people who die in a given year. If a large number of
infants die at birth or during childhood, the life
expectancy of that year’s group tends to be low.

GERONTOPHOBIA
➢ The fear of aging and the refusal to accept older
adults into the mainstream of society. THE BABY BOOMERS
➢ Strong forms are ageism and age discrimination. ➢ A major contributing factor to this rapid explosion
in the older adult population is the aging of the
AGEISM cohort, commonly called the Baby Boomers
➢ Ageism is the disliking of aging and older adults ➢ Age cohort is a term used by demographers to
based on the belief that aging makes people describe a group of people born within a specified
unattractive, unintelligent, and unproductive. time period.
➢ It is an emotional prejudice or discrimination
against people based solely on age.
➢ Ageism allows the young to separate themselves
physically and emotionally from the old and to view
older adults as somehow having less human value.
➢ Ageism can have a negative effect on the way health
care providers relate to older patients, which, in
turn, can result in poor health care outcomes in
these individuals.

PRELIM EXAMINATION REVIEWER

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HANAH A. UANANG
 NCM 114 – CARE OF OLDER ADULTS
AGING: MYTH VS FACT
AGING IS A DEVELOPMENTAL PROCESS
➢ 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
behavior and self-perception and reaction to
biologic changes.
➢ Functionally, aging refers to the capabilities of the
individual to function in society.
➢ According to Meilaender (2011), aging is a normal
stage of life in which our bodies begin to function
less effectively, making us more vulnerable to
disease. Evolutionary biologists refer to this
process as “senescence.”
➢ Senescence – aka biologic aging, it is the gradual
deterioration of function characteristics.
CONCEPTS OF 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 aging, it is the gradual
deterioration of function characteristics.
▪ Biological aging refers to the physical changes
that “slow us down” as humans get into middle
and older years.
▪ Aka physiologic aging.
3. PSYCHOLOGIC AGING
▪ Refers to the psychological changes, including
those involving mental functioning and
personality, that occur as human age.
4. 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
▪ Profoundly influenced by the perception of
aging that is part of a society’s culture.
5. COGNITIVE AGING
▪ Decline in cognitive processing that occurs as
people get older.
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HANAH A. UANANG
▪ Concerned with the basic processes of
learning and memory as well as with the
complex higher-order processes of language
and intellectual competence of executive
functioning.
▪ The concept of this is a term that describes a
process of gradual, longitudinal changes in
cognitive functions that accompany the aging
process.
PROBLEMS IN THE OLDER ADULT POPULATION
1. SELF – NEGLECT
➢ Abuse and neglect are usually something done
to someone, but, unfortunately, self-neglect is a
common problem in the older adult population.
➢ Self-neglect is defined as the failure to provide
for the self because of a lack of ability or lack of
awareness.
➢ Indicators of self-neglect include the following:
▪ The inability to maintain activities of
daily living such as personal care,
shopping, meal preparation, or other
household tasks.
▪ The inability to obtain adequate food
and fluid as indicated by malnutrition
or dehydration.
▪ Poor hygiene practices as indicated
by body odor, sores, rashes, or
inadequate or soiled clothing.
▪ Changes in mental function, such as
confusion, inappropriate responses,
disorientation, or incoherence.
▪ The inability to manage personal
finances as indicated by the failure to
pay bills or by hoarding, squandering,
or giving away money
inappropriately
▪ Failure to keep important business or
medical appointments
▪ Life-threatening or suicidal acts, such
as wandering, isolation, or substance
abuse.
2. ABUSE OR NEGLECT BY THE FAMILY
➢ Inappropriate behavioral responses include
abuse and neglect of the older family members
➢ Intentional abuse occurs when any person
deliberately plans to mistreat or harm another
person.
➢ Intentional abuse is most likely to occur in
families with preexisting behavioral or social
problems.
➢ Abusive behavior cannot be justified at any
time or in any way.
➢ Unintentional abuse or neglect is most likely to
occur when the caregiver lacks the necessary
knowledge, stamina, or resources needed to
care for an older loved one.
➢ Abuse can be physical, financial, psychological,
or emotional. Neglect and abandonment also
constitute forms of abuse
A. PHYSICAL ABUSE
Physical abuse is any action that causes
physical pain or injury. Abuse may involve a
physical attack upon a frail older adult who is
unable to defend himself or herself from
younger, stronger family members.
B. NEGLECT
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 NCM 114 – CARE OF OLDER ADULTS
Physical abuse involves one or more actions
that cause harm. Neglect is a passive form of
abuse in which caregivers fail to provide for the
needs of the older person under their care.
Neglect, whether intentional or unintentional,
accounts for almost half of the verified cases of
elder abuse
C. EMOTIONAL ABUSE
Emotional abuse is the most subtle and difficult
to recognize types of abuse. It often includes
behaviors such as isolating, ignoring, or
depersonalizing older adults.
D. FINANCIAL ABUSE
Financial abuse exists when the resources of an
older person are stolen or misused by a person
whom the older adult trusts
E. ABANDONMENT
Abandonment occurs when dependent older
persons are deserted by the person or persons
responsible for their custody or care under
circumstances in which a reasonable person
would continue to provide care.
F. RESPONSES TO ABUSE
Fear of being treated even worse or fear of
being institutionalized or abandoned may
prevent the victim from seeking help.
SIGNS THE OLDER PERSON MAY BE EXPERIENCING ABUSE
ABUSIVE BEHAVIORS IN HEALTH CARE SETTINGS
PRELIM EXAMINATION REVIEWER
HANAH A. UANANG
NURSING IMPLICATIONS IN CARING FOR OLDER ADULT
➢ Older must be supported to live in the setting of
their choice and receive services that promote
independence, meet their preferences and facilitate
social connection.
➢ Nurses should identify opportunities to support
healthy ageing initiatives that include reablement
programmes, in all settings.
➢ Nurses must be competent to recognize and
respond to deterioration, cognitive and functional
decline in older and be skilled and educated to
provide appropriate care.
➢ Nursing curriculums should be age-inclusive and
support clinical placements in aged care settings.
➢ Nurse-led models of care should be developed,
implemented, and evaluated to support healthy
ageing and inform policy for old ages
➢ Career development pathways should be developed
and implemented to support nurses to specialise in
healthy ageing for old Ages.
➢ Nurses should be skilled and educated to provide
quality palliative and end of life care for older Ages.
➢ Nurses play a significant role in promoting older
Ages functional, physical, social engagement and
mental wellness and providing high quality safe
care.
➢ Nurses should be educated and professionally
prepared to identify and challenge stereotypes that
promote ageist attitudes.
➢ Nurses play a key role in the identification and
mandatory reporting of elder abuse.
➢ Older Ages with diverse characteristics and life
experiences have equitable access to information
and services to meet their individual needs.
AGING IN THE PHILIPPINES
➢ According to a 2018 study by the Philippine
Institute for Development Studies (PIDS), the
Philippines is on its way to becoming an “ageing
society” in 2032.
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 NCM 114 – CARE OF OLDER ADULTS
REVIEW QUESTIONS
1. What are the myths related to aging? (SATA) 7. Which type of document indicates someone’s wishes by
a) Most older adults live in institutional settings. creating physician orders to be followed?
b) Most older adults suffer from a significant loss of a) Advance directive
intellectual function. b) Living will
c) Most older adults have frequent interaction with c) Durable power of attorney for health care
family and friends. d) POLST
d) Most older adults experience significant personality
changes.
e) Most older adults are seriously depressed.
f) Most older adults are sick, frail, and dependent on
others.

2. Which is true about Baby Boom generation?

a) Members were born between 1946 and 1964.
b) Members will all be aged 65 or older by 2025.
c) Members are reaching age 65 at the rate of about
200 cohort members each day.
d) It comprises about one third of the population
today.

3. What does the Durable Power of Attorney for health care

enable the health care agent to do?
a) Decide whether the older adult should be
resuscitated
b) Act only when the older adult is unable to act
for himself or herself
c) Determine when the older adult should be
hospitalized
d) Change care decisions if he or she thinks these
will benefit the older adult

4. What is one of the most significant changes that impact

the older adult and his or her family?
a) Loss of independence
b) Change in physical appearance
c) Decreased financial resources
d) Sensory and cognitive decline

5. A nurse is assessing an alert for an elderly woman who

was admitted to the emergency room accompanied by
her daughter with whom she resides. What observation
might arouse suspicion of elder abuse? (Select all that
apply.)
a) Bruises are observed on the arms and upper
body
b) The daughter answers all questions for her
mother
c) She has a body odor and soiled clothing
d) The woman states that she does not like to see
the doctor.
e) The daughter states her mother does not get
along with the grandchildren
f) Skin is intact with good turgor

6. A student nurse observes caregivers in a long-term care

facility where she is employed. Which observations
might indicate abusive behavior? (Select all that apply.)
Failing to close bedside curtains during care activities
Use of physical restraints to decrease wandering
behavior
a) Providing extra snacks as a reward for good
b) behavior
c) Laughing and talking with co-workers while
providing care
d) Speaking negatively about an older adult while
in the break room
e) Responding slowly to the call light of a
demanding older adult

PRELIM EXAMINATION REVIEWER

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HANAH A. UANANG
 NCM 114 – CARE OF OLDER ADULTS
TOPIC 2: THEORIES OF AGING
BIOLOGIC THEORIES
➢ Biologic theories of aging attempt to explain the
physical changes of aging.
➢ Concerned with answering basic questions
regarding physiological processes in all living
organisms over time.
➢ These theories generally view aging as occurring
from a molecular, cellular, or even a systems point
of view.
➢ Divided into 2 main divisions
o Stochastic - explain aging as events that
occur randomly and accumulate over time
o Nonstochastic – aging is predetermined,
timed phenomena.
STOCHASTIC THEORIES
ERROR CATASTROPHE THEORY
➢ Proposed by Leslie Orgel
➢ Nagkakaroon ng build up of errors sa cellular
molecules sa katawan ng isang tao na dapat
gagamitin sa function and reproduction ng mga cells
and nagiging fatal siya to the point na hindi na
makakasurvive yung mga cells.
➢ Nagkakaroon ng errors sa DNA and RNA protein
synthesis which can lead to cell death.
➢ Sa transcription of DNA siya nag ooccur
➢ Ang end result is hindi tugma sa original copy ng
genes or ng DNA
➢ Factors: Xray radiation
FREE RADICAL THEORY
➢ Proposed by Denham Harman
➢ It proposed that organisms age because they
accumulate oxidative damage.
➢ Free radical production can increase as a result of
environmental pollutants such as ozone, pesticides,
and radiation.
➢ The most important oxygen-containing free radicals
in many disease states are hydroxyl radical,
superoxide anion radical, hydrogen peroxide,
oxygen singlet, hypochlorite, nitric oxide radical,
and peroxynitrite radical.
➢ Oxidative stress is a bodily condition that happens
when your antioxidant levels are low.
➢ Free radicals are end products of oxidative
metabolism
➢ Oxidative metabolism is the dominant source of
energy for skeletal muscle
➢ Oxidative metabolism occurs in the mitochondrion
specifically sa may cristae (folded parts)
➢ In nervous and muscle tissue, to which free radicals
have a high affinity, a substance called lipofuscin has
been found and is thought to be indicative of
chronologic age.
➢ Lipofuscin, a lipid- and protein-enriched pigmented
material, has been found to accumulate in older
adults' tissues, and is commonly referred to as "age
spots."
➢ One free radical, named lipofuscin, has been
identified to cause a buildup of fatty pigment
granules that cause age spots in older adults.
➢ Individuals who support this theory propose that
the number of free radicals can be reduced by the
use of antioxidants, such as vitamins A, C, and E,
carotenoids, zinc, selenium, and phytochemicals.
CONNECTIVE TISSUE THEORY/CROSS-LINKAGE THEORY
➢ Referred to as the glycosylation theory of aging, was
proposed by Johan Bjorksten in 1942.
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HANAH A. UANANG
➢ According to this theory, an accumulation of cross-
linked proteins damages cells and tissues, slowing
down bodily processes resulting in aging.
➢ It is the binding of glucose to protein that causes
various problems.
➢ Cross-linkage agents have been found in
unsaturated fats; in polyvalent metal ions like
aluminum, zinc, and magnesium; and in association
with excessive radiation exposure.
➢ Some research supports a combination of exercise
and dietary restrictions in helping to inhibit the
cross-linkage process, as well as the use of vitamin
C prophylactically as an antioxidant agent.
➢ Cross-linkage theory proposes that as a person age
and the immune system begins to decrease in its
efficiency, the body's defense mechanism cannot
remove the cross-linking agent before it becomes
securely established.
➢ Cross linkage has been proposed as a primary cause
of arteriosclerosis, a decrease in efficiency of the
immune system with age, and the loss of elasticity
often seen in older adult skin.
➢ Primarily this involves collagen, which is a relatively
inert long-chain macromolecule produced by
fibroblasts. As new fibers are created, they become
enmeshed with old fibers and form an actual
chemical cross-link.
WEAR AND TEAR THEORY
➢ The wear and tear theory of aging is an idea
proposed by German biologist, Dr. August
Wiesmann, in 1882.
➢ The theory suggests that aging results from a
gradual deterioration of the cells and tissues of the
body via wear and tear, oxidative stress, exposure to
radiation, toxins, or other deterioration processes.
➢ Dr. Weismann believed that the body and its cells
were damaged by overuse and abuse.
➢ Under this theory, aging is viewed as almost a
preprogrammed process-a process thought to be
vulnerable to stress, or an accumulation of injuries
or trauma, which may actually accelerate it.
➢ "Death occurs because a worn-out tissue cannot
forever renew itself" – Weismann
➢ Proponents of this theory cite microscopic signs of
wear and tear that have been found in striated and
smooth muscle tissue and in nerve cells.
NONSTOCHASTIC THEORIES
PROGRAMMED THEORY OR HAYFLICK LIMIT THEORY
➢ This particular study included an experiment on
fetal fibroblastic cells and their reproductive
capabilities. The results of this landmark study
changed the way scientists viewed the biologic
aging process.
➢ Hayflick and Moorehead's study showed that there
are functional changes that do occur within cells and
are responsible for the aging of the cells and the
organism.
➢ The programmed theory proposes that everyone
has a “biologic clock” that starts ticking at
conception.
➢ As the program plays out, the person experiences
predictable changes such as atrophy of the thymus,
menopause, skin changes, and graying of the hair.
➢ Based on the conclusions of this experiment, the
Hayflick Limit Theory is sometimes called the
"Biological Clock," "Cellular Aging," or "Genetic
Theory."
➢ Programmed theories of aging assert that aging is an
essential and innate part of the biology of humans
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 NCM 114 – CARE OF OLDER ADULTS
and that aging is programmed into our body
systems (Stibich, 2020).
➢ Cells can only reproduce a limited number of times.
➢ The programmed theory of aging asserts that aging
and death are necessary parts of evolution, not of
biology. If a species did not have the genetic capacity
for aging and death, then it would not be forced to
replicate to survive (Stibich, 2020).
NEUROENDOCRINE THEORY
➢ Hypothalamus controls various chain-reactions to
instruct other organs and glands to release their
respective hormones
➢ When the stimulating and releasing hormones of the
pituitary and the hypothalamus are out of synch
with the endocrine glands, an increase in disease is
expected in multiple organs and systems
➢ The neuroendocrine theory examines the
interrelated role of the neurologic and endocrine
systems over the lifespan of an individual.
➢ The neuroendocrine system regulates and controls
many important metabolic activities.
➢ DEHYDROEPIANDROSTERONE: This hormone,
secreted by the adrenal glands, diminishes over the
lifetime of an individual. This can increase longevity,
bolstered immunity, and pwede kang pabatahin
physically.
➢ MELATONIN: is a hormone that is being
investigated for its role as a biologic clock. This has
been found to be a regulator of biologic rhythms and
a powerful antioxidant that may enhance immune
function. The level of melatonin production in the
body declines dramatically from just after puberty
until old age.
IMMUNITY THEORY
➢ The immune system is a network of specialized
cells, tissues, and organs that provide the body with
protection against invading organisms.
➢ It has been found that as a person ages, the immune
system functions less effectively.
➢ The term immunosenescence has been given to this
age-related decrease in function.
➢ Essential components of the immune system are T
cells, which are responsible for cell-mediated
immunity, and B cells, the antibodies responsible for
humoral immunity.
CHANGES IN CELL – MEDIATED IMMUNE FUNCTION AS A
RESULT OF AGING
PRELIM EXAMINATION REVIEWER
HANAH A. UANANG
PSYCHOSOCIAL THEORIES
➢ Sociologic theories focus on changing roles and
relationships.
➢ Psychosocial theories of aging do not explain the
physical changes of aging; rather they attempt to
explain why older adults have different responses to
the aging process
SOCIOLOGIC
DISENGAGEMENT THEORY
➢ Proposed by Elaine Cummings and William Earle
Henry in 1961.
➢ Was developed to explain why aging persons
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.
➢ Hinihiwalay daw ng mga matatanda ang sarili nila sa
society habang tumatanda sila.
➢ Critics of this theory believe that it attempts to
justify ageism, oversimplifies the psychosocial
adjustment to aging, and fails to address the
diversity and complexity of older adults.
ACTIVITY THEORY/DEVELOPMENTAL TASK THEORY
➢ Proposed by Robert Havighurst
➢ Proposes that activity is necessary for successful
aging.
➢ Active participation in physical and mental activities
helps maintain functioning well into old age.
➢ “Busy work” activities and casual interaction with
others were not shown to improve the self-esteem
of older adults.
DEVELOPMENTAL TASKS OF MIDDLE AGE
1. Achieving adult civic and social responsibility
2. Establishing and maintaining an economic standard of
living
3. Assisting teenage children to become responsible and
happy adults
4. Developing adult leisure-time activities
5. Relating oneself to one’s spouse as a person
6. Accepting and adjusting to the physiologic changes or
middle age
7. Adjusting to aging parents.
DEVELOPMENTAL TASKS OF LATER MATURITY
1. Adjusting to decreasing physical strength and health
2. Adjusting to retirement and reduced income
3. Adjusting to death of a spouse
4. Establishing an explicit affiliation with one’s age group
5. Meeting social and civil obligations
6. Establishing satisfactory physical living arrangement
THREE ASSUMPTIONS OF THIS THEORY
(1) it is better to be active than inactive,
(2) it is better to be happy than unhappy, and
(3) an older individual is the best judge of his or her
own success in achieving the first two assumptions
EIGHT STAGES OF DEVELOPMENTAL TASK
Infancy – Basic trust versus mistrust
Toddler – Autonomy versus shame and doubt
Preschool-age – Initiative versus guilt
School-age – Industry versus inferiority
Adolescence – Identity versus identity confusion
Young adulthood – Intimacy versus isolation
Middle age – Generativity versus stagnation
Older adulthood – Integrity versus despair
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 NCM 114 – CARE OF OLDER ADULTS
GEROTRANSCENDENCE THEORY
➢ According to this theory, as people age, they go
through a cognitive transition from a materialistic,
logical viewpoint to "oneness" with the
environment.
➢ Gerotranscendence theory is a way to look at aging
as a positive aspect of life. According to Lars
Tornstam, who took more than 20 years to develop
this theory, there are several ideas about human
aging that are often overlooked. The core of his
theory looks to include these forgotten elements.
➢ The goal of the Gerotranscendence theory is to
provide caregivers and the elderly with an
explanation of why perspectives change.
➢ This allows caregivers to provide assistance in a
way that is meaningful because they can better
recognize what the focus of an older adult may be.
For those who are aging, it is a way to understand
the changes in life that they are experiencing.
FOUR KEY POINTS TO CONSIDER
➢ There is an increased feeling of affinity with past
generations and a decreased interest in superfluous
social interaction.
➢ There is also often a feeling of cosmic awareness,
and a redefinition of time, space, life, and death.
➢ The individual becomes less self-occupied and at the
same time more selective in the choice of social and
other activities.
➢ The individual might also experience a decrease in
interest in material things. Solitude becomes more
attractive.
SUBCULTURE THEORY
➢ According to this theory, older people create a
distinct subculture inside society to protect
themselves against society's poor attitude about
aging and the resulting loss of status.
➢ Views older adults as their own “sub culture”, with
their own interests, norms, beliefs, habits, and
issues that separate them from the rest of society. A
response to rejection/negativity by society.
CONTINUITY THEORY
➢ Proposed by Robert Atchley
➢ This theory acknowledges that our personalities
have an impact on the roles we select and how we
perform them, which in turn has an impact on our
level of happiness in life. It implies that by the time
we reach old age, our personalities are fully formed
and tend to stay constant throughout our lives.
➢ It is one of the three major psychosocial theories
which describes how people developed in old age.
➢ 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.
➢ Elders attend to continue with important activities
elders perceive as continuous.
➢ Successful aging is characterized by how much
continuity the elder has with activities.
AGE STRATIFICATION THEORY
➢ Age stratification is a conceptual framework for
exploring both how individuals age over the life
course and what meaning is given to age in a society.
➢ This framework was developed by Matilda White
Riley.
➢ The key societal issue being addressed in this theory
is the concept of interdependence between the
aging person and society at large.
PRELIM EXAMINATION REVIEWER
HANAH A. UANANG
➢ This theory views the aging person as an individual
element of society and also as a member, with peers,
interacting in a social process. The theory attempts
to explain the interdependence between older
adults and society and how they are constantly
influencing each other in a variety of ways.
FIVE MAJOR CONCEPTS OF THIS THEORY
1. each individual progresses through society in
groups of cohorts that are collectively aging socially,
biologically, and psychologically;
2. new cohorts are continually being born, and each of
them experiences their own unique sense of history;
3. society itself can be divided into various strata
according to the parameters of age and roles;
4. not only are people and roles within every stratum
continuously changing, but so is society at large;
5. the interaction between individual aging people and
the entire society is not stagnant but remains
dynamic.
PERSON – ENVIRONMENT FIT THEORY
➢ One of the newer aging theories relates to the
individual's personal competence within the
environment in which he or she interacts.
➢ Theorized by Powell Lawton
➢ The system was developed by Jacquelynne Eccles
and her colleagues.
➢ examines the concept of interrelationships among
the competencies of a group of persons, older adults,
and their society or environment.
➢ Lawton (1982) identified these personal
competencies as including ego strength; level of
motor skills, individual biologic health, and
cognitive and sensory-perceptual capacities
NURSING IMPLICATIONS
➢ It is important to remember that all older adults
cannot be grouped collectively as just one segment
of the population.
➢ it is within the nurse's scope of practice to identify
maladaptive responses and intervene to protect the
integrity of the person.
➢ Using assessment skills and specific tools, nurses
can further investigate and plan appropriate
interventions to help resolve a potentially adverse
situation.
➢ Planning realistic activities for particular client
groups is crucial to successful group interaction.
➢ The health care provider can also gain insight into
how a particular group of older adults responds to
illness and views healthy aging. This knowledge and
insight can certainly assist in helping to plan not
only activities but also meaningful client teaching.
PSYCHOLOGIC
THEORY OF INDIVIDUALISM
➢ Proposed by Carl Jung in 1960
➢ A theory of personality development throughout
life: childhood, youth and young adulthood, middle
age, and old age
➢ An individual's personality is composed of the ego,
the personal unconsciousness, and the collective
unconsciousness.
➢ According to this theory, a person's personality is
visualized as oriented either toward the external
world (extroverted) or toward subjective, inner
experiences (introverted).
➢ it is at the onset of middle age that the person begins
to question values, beliefs, and possible dreams left
undone.
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➢ The phrase "midlife crisis" became popular based
on this theory and refers to a period of emotional,
and sometimes behavioral, turmoil that heralds the
onset of middle age.
➢ During this period, the individual often searches for
answers about reaching goals-questioning whether
a part of their personality or "true self" has been
neglected and whether time is running out for the
completion of these quests.
EIGHT STAGES OF LIFE THEORY
➢ Proposed by Erik Erikson
➢ The major focus of development in this theory is
with an individual's ego structure, or sense of self,
especially in response to the ways in which society
shapes its development.
SELECTIVE OPTIMIZAZTION AND COMPENSATION THEORY
SUMMARY OF ERIKSON’S THEORY: MIDDLE AND OLDER
ADULTHOOD
• STAGES AND AGES
A. Generativity versus self-absorption or stagnation
(40 to 65 years old; middle adulthood)
Mode: nurturing
Virtue: care
B. Ego integrity versus despair
(65 years to death; older adulthood)
Mode: Acceptance
Virtue: Wisdom
• CHARACTERISTICS OF STAGES
A. Mature adults are concerned with establishing and
guiding the next generation. Adults look beyond the
self and express concern for the future of the world
in general.
B. Older adults can look back with a sense of
satisfaction and acceptance of life and death.
• THEORY ADDENDUM
A. Self-absorbed adults will be preoccupied with their
personal well-being and material gains.
Preoccupation with self leads to stagnation of life.
B. Unsuccessful resolution of this crisis may result in a
sense of despair in which individuals view life as a
series of misfortunes, disappointments, and failures.
LIFE – COURSE (LIFE SPAN DEVELOPMENT) PARADIGM
➢ Proposed by Paul Baltes developed one of the
approaches to studying development called the
lifespan perspective.
➢ This approach is based on several key principles:
o Development occurs across one’s entire
life, or is lifelong.
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HANAH A. UANANG
o Development is multidimensional,
meaning it involves the dynamic
interaction of factors like physical,
emotional, and psychosocial development.
➢ Development is multidirectional and results in gains
and losses throughout life
➢ Development is plastic, meaning that characteristics
are malleable or changeable.
➢ Development is influenced by contextual and socio-
cultural influences.
o Normative age-graded influences
o Normative history-graded influences
o Non-normative life influences
➢ Development is multidisciplinary.
LIFESPAN VS LIFE EXPECTANCY
➢ Human Lifespan, or longevity, refers to the length of
time a person can exist under the most optimal
conditions.
➢ Oldest age documented is 122 years (Guinness
World Records, 2016)
➢ Life expectancy is the predicted number of years a
person born in a particular time period can
reasonably expect to live (Vogt & Johnson, 2016).
➢ Life expectancy in the Philippines is 71 years
(Demographic of Life Expectancy, 2020)
➢ Baltes’s (1987) theory of successful aging emerged
from his study of psychological processes across the
lifespan and, like earlier theories, focuses on the
individual. He asserts that individuals learn to cope
with the functional losses of aging through
processes of selection, optimization, and
compensation.
➢ Selection
o The adaptive task of the individual and
society to concentrate on those domains
that are of high priority.
➢ Setting goals
o Elective selection -refers to the delineation
of goals in order to match a person’s needs
and motives with the available or
attainable resources.
➢ Loss based selection
o refers to changes in goals or the goal
system, such as reconstructing one’s goal
hierarchy by focusing on the most
important goals, adapting standards, or
replacing goals that are no longer
achievable.
➢ Optimization
o Engaging in behaviors that enrich and
augment an individual’s general reserves.
o Make efforts to maintain and strengthen
those most useful skills
➢ Compensation
o Find ways to make up for (compensate) for
cognitive deficits to function adequately
o Using devices, strategies, and resources
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REVIEW QUESTIONS FOR THEORIES OF AGING
1. A friend asks the nurse what could be done to improve
the chance of a long life. Using current biologic theories
of aging, the nurse recommended that her friend discuss
this first with her physician, but advises that the
approach more likely to cause harm than good is which
one?
a) Intake of antioxidants, such as vitamins A, B6,
B12, C, and E
b) Replacing of hormones, such as HGH, DHEA,
and estrogen
c) Calorie-restricted diet
d) Intake of herbal and nutritional supplements

2. According to Erikson, what is the primary developmental

task of the older adult population?
a) Generativity versus stagnation
b) Trust versus mistrust
c) Intimacy versus isolation
d) Integrity versus despair
3. A friend tells you she thinks her father is experiencing a
“midlife crisis,” because he purchased a new red sports
car, started wearing trendy clothing, and is considering a
career change. Whose theory explains this behavior?
a) Newman’s
b) Jung’s
c) Habighurst’s
d) Erikson’

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 NCM 114 – CARE OF OLDER ADULTS
PHYSIOLOGIC CHANGES IN AGING AFFECTING VARIOUS SYSTEMS

INTEGUMENTARY

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MUSCULAR

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RESPIRATORY

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CARDIOVASCULAR

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HEMATOPOIETIC AND LYMPHATIC SYSTEMS

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GASTROINTESTINAL

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URINARY SYSTEM

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NERVOUS SYSTEM

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SPECIAL SENSES

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EARS TASTE AND SMELL

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ENDOCRINE

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REPRODUCTIVE

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 NCM 114 – CARE OF OLDER ADULTS
REVIEW QUESTIONS FOR PHYSIOLOGICAL CHANGES
1. Your older female patient is complaining because she is having frequent urinary tract infections. Which normal age-related change is most
likely to be a contributing factor?
a. Increased nocturnal urine production
b. Decreased perception of the need to void
c. Decreased bladder muscle tone
d. Urinary incontinence

2. Which are normal age-related changes? (Select all that apply.)

a. Decreased visual acuity
b. Increased heart rate
c. Decreased long-term memory
d. Increased gastric pH
e. Increased muscle mass
f. Decreased depth of respiration
g. Increased calorie requirements
h. Decreased serum albumin
i. Increased subcutaneous tissue
j. Decreased rate of peristalsis

3. What are patients who have had Parkinson disease for 10 years likely to exhibit? (Select all that apply.)
a. Rigidity and tremors when at rest
b. Hemiparesis and aphasia
c. Dementia
d. Unilateral tremors with movement
e. Tremors present during sleep

4. An older adult is coming to your clinic for treatment for a gastric ulcer. Which treatment would the nurse expect to be ordered?
a. Antibiotics
b. Stress-reduction classes
c. NSAIDs
d. Iron supplements before breakfast and dinner

5. What should the nurse explain when discussing expected changes in the female reproductive system to an older adult?
a. Increased pubic hair is expected
b. Uterine enlargement is normal
c. Vaginal tissues become more vascular
d. Production of vaginal secretions decreases

6. The nurse performs a skin assessment of an older adult. Which finding is abnormal and needs to be reported?
a. Increased patches of dark pigmentation on exposed skin
b. A dark, elevated patch that bleeds when touched
c. Deep wrinkles and frown lines around the mouth and eyes
d. Numerous brown or flesh-colored skin tags around the neck

7. The nurse encourages the patient to maintain a steady weight in the recommended range to decrease risk of which common endocrine
disease observed in older adults?
a. Hypothyroidism
b. Hyperthyroidism
c. Diabetes mellitus
d. Diabetes insipidus

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