Gerontological Nursing

Objectives
• By the end of this session the student will be able to:
• Describe the overview of ageing.
• Know the terminology of ageing.
• Describe the classifications of ageing.
• Discuss the concept of ageing.
• Discuss the misconception about aging.
• Describe the different types of theories of ageing.
Contents
• Overview of ageing.
• Terminology of ageing.
• Classifications of ageing.
• Concept of ageing.
• Misconception about aging.
• Theories of ageing.
Overview & Theories of Aging
 Overview of Aging
• Aging, the normal process of time-related change, begins with birth
and continues throughout life.
• The greatest growth in the older adult population is for those aged 85
years and older; this population is projected to more than double from
6 million in 2013 to grow to 14.6 million in 2040 (Administration on
Aging [AoA], 2014).
Overview of Aging cont…
• Life expectancy—the average number of years that
a person can expect to live varies by gender and race.
• Women are living longer than men and white women having
the longest life expectancy.
Overview of Aging cont…
• Life expectancy has risen dramatically in the past 100 years.
• In 1900, average life expectancy was 47years, and by 2009, that figure
had increased to 78.8 years.
• Although many older adults enjoy good health, most have at least one
chronic illness, and many have multiple health conditions.
• Chronic conditions, many of which are preventable or treatable, are
the major cause of disability among older adults.
 Overview of Aging cont…
• Most deaths in the United States occur in people 65 years of age and
older. However, improvements in the prevention, early detection, and
treatment of diseases have impacted the health of people in this age
group.
• In the past 60 years, there has been a significant decline in overall
deaths —specifically, deaths from heart disease and cancer, the two
leading causes of deaths.
Overview of Aging cont…
• In addition, deaths from chronic lower respiratory diseases, stroke,
influenza, pneumonia, and sepsis, have declined (Kochanek, Murphy,
Xu, et al., 2014).
• Deaths from chronic lower pulmonary diseases surpassed stroke
recently, making these diseases the third leading cause death.
• Deaths from Alzheimer disease (AD) among those 65 years of age and
older have risen and are projected to be approximately 1.6 million
annually by 2050 (Weuve, Hebert, Scherr, et al.,
 Overview of Aging cont…
• Many chronic conditions commonly found among older
people can be managed, limited, and even prevented.
• Older people are more likely to maintain good health and
functional independence if encouraged to do so and if
appropriate community-based support services are available
(Miller, 2015).
• Nurses are challenged to promote positive lifelong health
behaviors, because the impact of unhealthy behaviors and
choices can result in chronic disease.
Terminology
• Geriatrics: a field of practice that focuses on the physiology,
pathology, diagnosis, and management of the disorders and diseases of
older adults
• Gerontologic/geriatric nursing: the field of nursing that relates to the
assessment, planning, implementation, and evaluation of older adults
in all environments, including acute, intermediate, and skilled care, as
well as within the community
• Gerontology: the combined biologic, psychological, and sociologic
study of older adults within their environment
• 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
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 is 65- 67 years
CONCEPTS OF AGING
• CHRONOLOGIC AGING
• BIOLOGIC AGING
• PSYCHOLOGIC AGING
• SOCIAL AGING
• COGNITIVE AGING
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
BIOLOGIC AGING
• 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 breath.
• This aging is also known as physiologic aging.
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.
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.
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.
Misconception about aging
• Old age begins at 65 years of age.
• Most older adults live in nursing homes.
• Most older people are senile and demented.
• Most older people feel miserable and depressed.
• Older people can not work as effectively as younger people.
• Older people experience a decline in intellectual ability and cannot
learn new skills.
• Most older people are sick and need help for daily activities.
Misconception about aging cont…
• Older people are set in their ways and cannot change.
• Older adults are not interested in sex.
• Older adults do not care about their looks and
appearance.
• Majority of older adults are isolated and are lonely.
• Bladder problems are a part of aging process.
 Misconception about aging cont…
• Nurses have a great responsibility in dispelling these myths.
• Society must be made aware of the value of aged people, their
experience and wisdom which can be a great asset to the society.
• The modern society is slowly beginning to view ageing as a normal
part of the developmental process, a lifelong continuum that begins at
conception and culminates with death.
• Health care professional nurses can help the older adult to make this
final phase rewarding and meaningful.
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
• Biologic theories
• Psychosocial theories
• Developmental theories
 Theories of aging
• Aging is a normal process of human development.
• Patterns of aging (what happens, how and when) vary greatly
among older people.
• Although there are specific changes which are identified as part
of normal aging process, each person ages in his own way.
Theories of aging-
• How a person ages, depends on his life experience, available
support system, and previous coping skills.
• Various theories have been proposed to explain the process of
normal aging.
• A set of biological, psychological and developmental theories
of aging have been developed and no single theory is
universally accepted.
 Biological theories
• Biological theories attempt to explain physical aging as an
involuntary process, which eventually leads to cumulative changes in
cells, tissues and fluids.
• Intrinsic biological theory says that age changes arise from internal
causes.
• Extrinsic biological theory tells that environmental factors lead to
structural changes which in turn cause degenerative changes.
Biological theories –
Cross link theory
• According to this theory, strong chemical bonding between
organic molecules in the body causes increased stiffness,
chemical instability, insolubility of connective tissue and
deoxyribonucleic acid.
• These organic molecules are derived from lipid proteins,
carbohydrates and nucleic acid.
Biological theories –
Free radical theory
• It states that increased instable free radicals produce effects
harmful to biological system such as chromosomal changes,
pigment accumulation and collagen alteration.
• The free radicals are derived from environmental pollutants,
oxidation of dietary fat, proteins, carbohydrates and elements .
Biological theories –
Immunologic theory
• This theory states that an ageing immune system is less able to
distinguish body from foreign cells.
• As a result, it begins to attack and destroy body cells as if they were of
foreign origin.
• This can lead to disease such as diabetes mellitus, rheumatic heart
disease and arthritis.
• These occurs because of alteration of B and T cells of the humoral and
cellular systems.
Psychosocial theories
• Psychosocial theories try to explain age-related changes in cognitive
function such as intelligence, memory, learning and problem solving.
• Sociological theories attempt to explain changes that affect
socialization and life satisfaction.
Psychosocial theories – types
• Activity theory states that successful aging and life satisfaction depends on
maintaining a high level of activity.
• Continuity theory states that an individual remain the same despite the life
change.
• This theory focuses more on personality and individual behaviour over
lifetime.
• Disengagement theory states that progressive social disengagement occurs
with age.
• Social exchange theory explains that social behaviour involves doing what
is valued and rewarded by society.
Other theories
• Developmental theory describes specific life stages and the
tasks associated with each stage.
• Environmental theory states that the factors in the
environment such as industrial carcinogens, sunlight,
infection etc. bring changes in the ageing.
• Genetic theory describes ageing is an involuntary inherited
process that changes cellular or tissue structures.
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.
ASSIGNMENT
• Write an assignment on nursing theories on
gerontology
 REFERENCES
• REFERENCES
• • Smeltzer CS, Bare GB, Hinkle LJ, Cheever HK. Brunner & Suddarth’s textbook of
Medical-surgical nursing. Volume I. Twelvth edition. NewDelhi:Wolters Kluwer (India) ;
2018.
• • Lewis LS, Dirksen RS, Heitkemper MM, Bucher L. Lewis’s Medical Surgical Nursing
Assessment and management of clinical problems. Second edition. Volume 1.India: Reed
Elsevier; 2015.
• • Goldsmith TC. Evolution of Aging Theories: Why Modern Programmed Aging Concepts
Are Transforming Medical Research. Biochemistry (Mosc). 2016 Dec;81(12):1406-1412.
• • Walker RF. Developmental theory of aging revisited: focus on causal and mechanistic
links between development and senescence. Rejuvenation Res. 2018 Aug;14(4):429-36.
•