Concepts, Principles and Theories in the Care of Older Adults

Introduction

 The term geriatric comes from the Greek words “geras,” meaning old age, and “iatro,” meaning relating to medical treatment. Thus,
geriatrics is the medical specialty that deals with the physiology of aging and with the diagnosis and treatment of diseases affecting older
adults. Geriatrics, by definition, focuses on abnormal conditions and the medical treatment of these conditions.

 The term gerontology comes from the Greek words “gero,” meaning related to old age, and “ology,” meaning the study of. Thus,
gerontology is the study of all aspects of the aging process, including the clinical, psychologic, economic, and sociologic problems of older
adults and the consequences of these problems for older adults and society. Gerontology affects nursing, health care, and all areas of our
society—including housing, education, business, and politics.

 The term gerontics, or gerontic nursing, was coined by Gunter and Estes in 1979 to define the nursing care and the service provided to
older adults. Gerontic nursing encompasses a holistic view of aging with the goal of increasing health, providing comfort, and caring for
older adult needs.

 Definition of Terms

 1. Gerontology: is the broad term used to define the study of aging and/or the aged.

 2. Geriatrics: is often used as a generic term relating to the aged, but specifically refers to medical care of the aged.

 3. Gerontological nursing: A specialty within nursing practice where the clients/patients/residents are older persons.

 4. Middle old: Those persons age 75–84 years.

 5. Old old: Those persons ages 85 years and over; sometimes called the oldest old, the very old, or the frail elderly.

 6. Young old: Those persons ages 65–74.

 7. Social gerontology is concerned mainly with the social aspects of aging versus the biological or psychological.

 8. Geropsychology: refers to specialists in psychiatry whose knowledge, expertise, and practice are with the older population.

 9. Geropharmaceutics: also called geropharmacology, is a unique branch in which pharmacists obtain special training in geriatrics.

 10. Financial gerontology: is another emerging subfield that combines knowledge of financial planning and services with a special
expertise in the needs of older adults. Cutler (2004) defines financial gerontology as “the intellectual intersection of two fields, gerontology
and finance, each of which has practitioner and academic components”.

 11. Gerontological rehabilitation nursing combines expertise in gerontological nursing with rehabilitation concepts and practice.

A. Perspectives on Aging

 Aging is a Developmental Process

Aging is a complex process that can be described chronologically, physiologically,

and functionally. Chronologic age, 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. These individuals
remain physically fit, stay mentally active, and are productive members of society. Others are
chronologically young but physically or functionally old. Thus, chronologic age is not the
most meaningful measurement of aging.

 AGING and AGEISM

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

 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 years), middle old (75-84 years), and old-old (above 85 years).
 B. Demography of Aging and Implications on Health and Nursing Care

1. Global Aging

Demographics is the statistical study of human populations. Demographers are concerned with a population’s size, distribution,
and vital statistics. Vital statistics include birth, death, age at death, marriage(s), race, and many other variables. The collection of
demographic information is an ongoing process. The world is on the brink of a demographic milestone. The world is facing a situation
without precedent: We soon will have more older people than children and more people at extreme old age than ever before. As both the
proportion of older people and the length of life increase throughout the world, key questions arise. Will population aging be accompanied
by a longer period of good health, a sustained sense of well-being, and extended periods of social engagement and productivity, or will it
be associated with more illness, disability, and dependency? How will aging affect health care and social costs? Are these futures
inevitable, or can we act to establish a physical and social infrastructure that might foster better health and wellbeing in older age? How will
population aging play out differently for low-income countries that will age faster than their counterparts have, but before they become
industrialized and wealthy?

A better understanding of the changing relationship between health with age is crucial if we are to create a future that takes full
advantage of the powerful resource inherent in older populations. To do so, nations must develop appropriate data systems and research
capacity to monitor and understand these patterns and relationship, specifically longitudinal studies that incorporate measures of health,
economic status, family and well-being. And research needs to be better coordinated if we are to discover the most cost-effective ways to
maintain healthful life styles and everyday functioning in countries at different stages of economic development and with varying resources.

Population aging is a powerful and transforming demographic force. We are only just beginning to comprehend its impacts at the
national and global levels. (https://www.who.int/ageing/publications/global_health .)

 2. Aging in the Philippines

The Philippines is a diverse country that will experience an increase in its aging population in the near future. The main issues
surrounding population aging, as well as family caregiving and policies that are of concern to older adults in the Philippines. Policymakers
and government leaders must plan for the expected growth in the numbers of older adults, which is likely to increase the demand for
services and support for elders and their caregiving families. The Philippines’ unique history and rich culture shapes its citizens’ views on
aging and bolsters expectations of informal caregiving for older family members. Research on aging in the Philippines and current policies
must be enhanced to adequately address the needs of the country’s aging citizens.

Aging in the Philippines remains a subject that is severely under-theorized in research. Although older Filipinos do appear in the
country’s national reports, current empirical studies incorporating older adults appears to be lacking in the Philippines. The main
universities in the Philippines house research institutions that study a variety of topics; however, the University of the Philippines Manila is
currently the only major institution where there is an established center specifically for aging research. The majority of research centered
on older Filipinos appears to focus on perceptions of aging, quality of life of older Filipinos, and older adults in the workforce.

(Badana, Adrian NS & Andel, Ross (2018). Aging in the Philippines, The Gerontologist, Volume 58, Issue 2, pages 212–218).

 C. Impact of Aging Members in the Family

The family is undergoing significant change in our society. Many factors, including increasing divorce rates, single parenting, and
a mobile population, are creating a less stable, less predictable family structure. Blended families, extended families, and separated
families all present challenges. The problems encountered in such situations can differ widely, depending on the respective ages of the
family members. In some families, the “children” who are attempting to provide care for the oldest members are likely to be older than 65
themselves. They may have health problems of their own that make caregiving difficult or impractical. Middle-aged family members often
become the caregivers. The generation in their 40s and early 50s is sometimes called the “sandwich” generation because its members are
caught in the middle—trying to work, to raise their own children, and perhaps provide assistance to one or two generations of aging family
members. Sometimes, they are also trying to help raise grandchildren by giving financial or physical assistance.

The ability of the family to adapt and cope with an additional member of the household varies greatly from situation to situation. If
the older family member requires a substantial amount of physical care, the demands on family members can be intense. Regardless,
many children feel duty-bound to care for their aging parents. This sense of obligation may be based on cultural, religious, or personal
beliefs.

 D. Theories of Aging and its Nursing Implications

Aging is best looked at as a series of changes that occur over time, contribute to loss of function, and ultimately result in the
death of a living organism. Like other living organisms, humans age and then die. The maximal life expectancy for humans today appears
to be 120 years, but why is this so? Theories of aging have been considered throughout history as mankind has sought to find ways to
avoid aging. The quest for a “fountain of youth” has motivated explorers, such as Ponce de Leon. The search for the extension of youth
has led some people to seek the potions of conjurers, often more poisonous than beneficial.

Some individuals fail to meet genetic expectations, whereas others significantly exceed expectations. Biologic and environmental
factors are being studied to explain these variations.

Although there is no question that aging is a biologic process, sociologic and psychological components play a significant role.
All of these areas—genetic, biologic, environmental, and psychosocial—have produced theories that attempt to explain the changes seen
with aging. Despite extensive interest in this topic, the specific causes and processes involved in aging are not completely understood.
Because we do not have definitive and reproducible evidence indicating exactly why we age, all of the following remain theories.
 1. Biologic Theories

Biologic theories of aging attempt to explain the physical changes of aging. Researchers try to identify which biologic factors
have the greatest influence on longevity. It is known that all members of a species suffer a gradual, progressive loss of function over time
because of their biologic structure. Many of the biologic theories of aging overlap because most assume that the changes that cause aging
occur at a cellular level. Each theory attempts to describe the processes of aging by examining various changes in cell structures or
function.

 Some biologic theories look at aging from a genetic perspective. The programmed theory proposes that everyone has a “biologic clock”
that starts ticking at conception. In this theory, each individual has a genetic “program” specifying an unknown but predetermined number
of cell divisions. As the program plays out, the person experiences predictable changes such as atrophy of the thymus, menopause, skin
changes, and graying of the hair. A closely related theory is the runout-of-program theory, which proposes that every person has a limited
amount of genetic material that will run out eventually, and the rate of living theory, which proposes that individuals have a finite number of
breaths or heartbeats that are used up over time. The gene theory proposes the existence of one or more harmful genes that activate over
time, resulting in the typical changes seen with aging and limiting the life span of the individual.

 The molecular theories propose that aging is controlled by genetic materials that are encoded to predetermine growth and decline. The
error theory proposes that errors in ribonucleic acid protein synthesis cause errors to occur in cells in the body, resulting in a progressive
decline in biologic function. The somatic mutation theory is similar but proposes that aging results from deoxyribonucleic acid (DNA)
damage caused by exposure to chemicals or radiation and that this damage causes chromosomal abnormalities that lead to disease or
loss of function later in life.

 Cellular theories propose that aging is a process that occurs because of cell damage. When enough cells are damaged, overall functioning
of the body is decreased. The free radical theory provides one explanation for cell damage. Free radicals are unstable molecules produced
by the body during the normal processes of respiration and metabolism or following exposure to radiation and pollution. These free radicals
are suspected to cause damage to the cells, DNA, and the immune system. Excessive free radical accumulation in the body is purported to
contribute to the physiologic changes of aging and a variety of diseases, such as arthritis, circulatory diseases, diabetes, and
atherosclerosis. 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.

 One variation of this theory is the crosslink or connective tissue theory, which proposes that cell molecules from DNA and connective
tissue interact with free radicals to cause bonds that decrease the ability of tissue to replace itself. This results in the skin changes typically
attributed to aging such as dryness, wrinkles, and loss of elasticity. Another variation, the Clinker theory, combines the somatic mutation,
free radical, and crosslink theories to suggest that chemicals produced by metabolism accumulate in normal cells and cause damage to
body organs, such as the muscles, heart, nerves, and brain.

 The wear-and-tear theory presumes that the body is similar to a machine, which loses function when its parts wear out. As people age,
their cells, tissues, and organs are damaged by internal or external stressors. When enough damage occurs to the body’s parts, overall
functioning decreases. This theory also proposes that good health maintenance practices will reduce the rate of wear and tear, resulting in
longer and better body function. In a similar vein, the reliability theory of aging and longevity is a complex mathematical model of system
failures first used to describe failure of complex electronic equipment. It is used as a model to describe degradation (disease) and failure
(death) of human body systems. The neuroendocrine theory focuses on the complicated chemical interactions set off by the hypothalamus
of e brain.

 The immunologic theory proposes that aging is a function of changes in the immune system. According to this theory, the immune system
— an important defense mechanism of the body— weakens over time, making an aging person more susceptible to disease. The
immunologic theory also proposes that the increase in autoimmune diseases and allergies seen with aging is caused by changes in the
immune system.

2. Psychosocial Theories

 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. Some of the most prominent psychosocial theories of aging are the disengagement theory, the activity
theory, life-course or developmental theories, and a variety of other personality theories.

 The highly controversial disengagement theory 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. This theory further proposes that older adults desire to withdraw from society as they age; the disengagement
is mutually beneficial. 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.

 The activity theory proposes that activity is necessary for successful aging. Active participation in physical and mental activities helps
maintain functioning well into old age. Purposeful activities and interactions that promote self-esteem improve overall satisfaction with life,
even at an older age. “Busy work” activities and casual interaction with others were not shown to improve the self-esteem of older adults.

 Life-course theories are perhaps the theories best known to nursing. These theories trace personality and personal adjustment throughout
a person’s life. Many of these theories are specific in identifying life-oriented tasks for the aging person. Four of the most common theories
—Erikson’s, Havighurst’s, Newman’s, and Jung’s—are worth exploring.

 Erikson’s theory identifies eight stages of developmental tasks that an individual must confront throughout the life span: (1) trust versus
mistrust; (2) autonomy versus shame and doubt; (3) initiative versus guilt; (4) industry versus inferiority; (5) identity versus identity
 confusion; (6) intimacy versus isolation; (7) generativity versus stagnation; and (8) integrity versus despair. The last of these stages is the
domain of late adulthood, but failure to achieve success in tasks earlier in life can cause problems later in life. Late adulthood is the time
when people normally review their lives and determine whether they have been negative or positive overall. The most positive outcomes of
this life review are wisdom, understanding, and acceptance; the most negative outcomes are doubt, gloom, and despair.

 Havighurst’s theory details the process of aging and defines specific tasks for late life, including: (1) adjusting to decreased physical
strength and health; (2) adjusting to retirement and decreased income; (3) adjusting to the loss of a spouse; (4) establishing a relationship
with one’s age group; (5) adapting to social roles in a flexible way; and (6) establishing satisfactory living arrangements.

 Newman’s theory identifies the tasks of aging as: (1) coping with the physical changes of aging; (2) redirecting energy to new activities and
roles, including retirement, grandparenting, and widowhood; (3) accepting one’s own life; and (4) developing a point of view about death.

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