Care of the Older Adult

NCMP114
1st Sem- 2021- 2022

Prepared by:

Maria Lourdes M. Vargas, RN,MAN

Learning Objectives:
■ At the end of the session, the students
will be able to:
■ Define terms related to Elderly Care
■ Enumerate the roles of Gerontological
Nurse
■ Trace the historic development of
gerontologic nursing as a specialty
■ Differentiate the Different Theories of
Aging
Definition of Terms:
■ Aging

■ The process of growing old or maturing.

■ Geriatrics

■ The branch of medicine or social science

dealing with the health and care of old
people
■ Geriatric Nursing
■ Nursing care of the aged patients given in
the home, the hospital, or special
institutions such as nursing homes.
■ The branch of nursing concerned with the
care of the older population, including
promotion of healthy aging as well as
prevention, assessment, and management
of physiological, pathological,
psychological, economic, and sociological
problems.
■ Gerontology:
■ Study of all aspects of aging and its
consequences

■ Gerontologic nursing:
■ specialized nursing with knowledge of
illness and health of the aging
■ Ageism:
■ when older adults are stereotyped
AGEISM
■ What are some stereotypic
characteristics of the elderly that you
have heard? Or believe?
Dependent ?
Frail ?
Poor ?
Lonely ?
Unreliable r/t memory loss ?
Rigid; narrow-minded ?
Unable to learn ?
Overview of Gerontologic
Nursing:
■ History and evolution:
■ 1900 - number of older adults has grown
steadily
■ 1900-1940 – found 23 writings about
regarding older adults
■ 1925 – Care of the Aged written in AJN and
is now thought to be one of the earliest
references to the need for adult care
specialty.(Burnside,1988)
■ 1962 – Geriatric Nursing Conference group was
established during the ANA convention

■ 1966 – ANA established the Division of Geriatric

Nursing Practice as “ concerned with the
assessment of nursing needs of older people;
planning and implementing nursing care to
meet those need; and evaluating the
effectiveness of such care”
■ 1976 – the Division of Geriatric Nursing
Practice was changed to the “Division of
Gerontologic Nursing Practice to reflect the
the nursing roles of providing care to
healthy, ill, and frail older persons.”

■ 1984 – the division becomes the “Council

of Gerontologic Nursing to encompass
issues beyond clinical practice.”
 Roles of a Gerontological
Nurse:
■ A generalist nurse may practice in a wide
variety of environments, including the
home and community.
■ Identify older client’s strengths and assist
them with maximizing their independence.
■ The generalists consults with the advance
practice nurse and other interdisciplinary
health professionals for assistance in
meeting the complex care needs of older
adults.
■ GNP – Gerontologic Nurse Practitioner
■ Has completed a basic entry-level
educational program
■ GNS – Gerontologic Nurse Specialist
■ has a Master’s degree
■ Focused on the advanced knowledge and
skills required to care for older adults in a
wide variety of settings.
■ function as a clinician, educator,
consultant, administrator, or researcher to
plan care or improve the quality of nursing
care for older adults and their families.
Older Adult
■ Young Old 65-74
■ Middle Old 75-84
■ Old Old 85 & older

■ Presently: 14.9% of
present population

■ 2040: will increase

to 30% of
population
 Gender and Marital Status:
■ Women live longer than men for a variety of
reasons, including :
■ Reduced maternal mortality
■ Decreased death rates from accidents
■ Increased death rates in men from all chronic
diseases except diabetes
■ The protective effects of estrogen versus that of
testosterone, are also hypothesized to play a
role in female longevity
(Robson,2015;Williams,2017)
 Gender and Marital Status:
■ Older men are much more likely to be
married than older women ( 70% of men
vs 45 % of women)
■ In 2016, 34% of women were widows
■ Nearly half (46%) of older women over the
age of 75 live alone
■ Marital status is an important determinant
of health and well being because if
influences income, mobility, housing,
intimacy, and social interaction
Living Arrangement:
- More older adult prefer to live in
their own homes
(Aging in place)
- 3.1% of adult older than 65 are
institutionalized in long term
facilities or nursing homes
- - 29% of noninstitutionalized
older adult live alone (women
comprise most of this group)
THEORIES OF AGING
■ NO one definition or theory exists that
explains all aspect of aging

■ COMPLEX PHENOMENA we call AGING (

Gerhard and Cristofalo, 1992;Hayflick,
1996)
■ Theories provide a springboard for
discussion and research
 Human aging is influenced by a
composite of biologic, psychologic,
social, functional, and spiritual factors.

Aging may be viewed as a continuum

of events that occur from conception to
death. ( Ignatavicius and Workman,
2005)
■ Theories of Aging attempt to explain this
phenomenon of aging as it occurs over
the lifespan, which is thought to be a
maximum of approximately 120 years.(
Cetron & Davies, 1998)
Human Aging is viewed as a total process
that begins at conception.

Senescence defines as a change in the

behavior of an organism with age, leading
to a decreased power of survival and
adjustment, occurs as well.
BIOLOGIC THEORIES OF
AGING:
■ Are concerned with answering basic
questions regarding the physiologic
processes that occur in all living
organisms as they chronologically age.

■ These theories generally view aging as

occuring from a molecular, cellular, or
even, a systems point of view.
■ Are not meant
to be
exclusionary,
theories may
be combined to
explain
phenomena
(Hayflick,
1996)
 FOCI OF BIOLOGIC THEORIES
1. Deleterious effects leading to decreasing
function of the organism
2. Gradually occurring age-related changes
that are progressive overtime
3. Intrinsic changes that can affect all
members of a species because of
chronologic age
■ Biologic Theories can be subdivided into
Two Main Division:

1. Stochastic Theories

2. Nonstochastic Theories
Stochastic Theory
■ Event that occur randomly and
accumulate over time
 Stochastic Theories:
■ Error Theory
■ Free Radical Theory
■ Cross-Linkage Theory
■ Wear and Tear Theory
Error Theory
■ The Error Theory is based on the idea
that errors can occur in the transcription
of the synthesis of DNA.
■ These errors are perpetuated and
eventually lead to systems that do not
function at the optimum level. The
organism’s aging and death are
attributed to these events. (Sonneborn,
1979)
Free Radical Theory:
■ Lipofuscin, a lipid
and protein
enriched
pigmented
materials, has
been found to
accumulate in
older adults
tissues, and is
commonly referred
to as “age spots”.
■ Age spots
■ The body has a naturally occuring
Antioxidants or Protective Mechanism
■ Vitamin C and E are two of these
substances that inhibit the functioning
of the free radicals or possibly decrease
their production in the body.
■ Antioxidants postpones the the
appearance of disease such as CVD and
Cancer
■ Antioxidants also appear to have an effect
on the decline of the immune system and
on degenerative neurologic diseases, both
of which affect morbidity and mortality
(Hayflick, 1996)
■ Free radicals are byproducts of
metabolism. When these byproducts
accumulate, they damage the cell
membranes, which decreases its
efficiency.

■ The body produces antioxidants that

scavenge the free radicals ( Hayflick,
1996)
 Cross-Linkage Theory
■ With age, according to this theory, some
proteins in the body become cross-linked.
■ This does not allow for normal metabolic
activities, and waste products accumulate
in the cells.
■ The end result is that tissues do not
function at optimum efficiency ( Hayflick,
1996)
Wear and Tear Theory
■ The wear and tear theory equates
human with machines.

■ It hypothesizes that aging is the result of

use.
 Nonstochastic Theory
■ View aging as certain predetermined,
timed phenomena

1. Programmed Theory
2. Immunity Theory
 Programmed Theory or
Hayflick Limit Theory
■ Hayflick and Moorehead demonstrated
that normal cells divide a limited number
of times; therefore they hypothesized
that life expectancy was preprogrammed
(Hayflick, 1996)
 Immunity Theory
■ Chancges occur in the immune system,
specifically in the T lymphocytes, as a
result of aging.
■ These changes leave the individual more
vulnerable to disease (Phipps et al, 2003)
 Biological Theories of Aging
■ Programmed Aging theory- genetics and
heredity responsible for how an
individual ages
■ Cross-Linkage Theory- deterioration of
organs/cells causing decreased mobility
■ Somatic Mutation Theory- DNA changes
result in physical decline
■ Stress Theory-causes structural &
chemical changes thru the lifespan
Theories of Aging
■ Most experts believe that a
combination of genetic and
stochastic (random) events are
responsible for aging.
■ Any single limited theory is
insufficient.
 Sociologic Theories of Aging
■ Disengagement Theory
■ as individual age, they withdrawn from society and
society supports this withdrawal (Cumming and
Henry, 1961)
- withdrawn
- introspective
- self-focused
- Older theory; not widely accepted.
■ Activity Theory
- satisfaction depends on involvement
in new interests /activities or maintenance
of high levels of functioning.
■ Continuity theory-characteristics, values
remain constant thru life… repeat
behaviors that brought success in the
past
 Psychosocial Theories of Aging
■ Erikson - ego integrity vs despair
Life review or reminiscence
Acceptance and happiness with past life

■ Havighurst - maintenance of social

contacts & relationships…
be flexible & adapt
Nursing Theories
Theory of Successful aging (Calista Roy)
= ability to adapt to the changes associated with
aging.

Health Promotion Model (Nola Pender)

= health is multi dimensional in nature and
influenced by the person’s environment,
gerontologic nurses can use effectively this model to
guide health teaching and improve adherence to
healt promotion and disease prevention guideline
Comfort Theory
midrange nursing theory developed vby
Katharine Kolcaba during 1990s.
composed of 3 components
1. relief
2. ease
3. transcendence
Comfort is the holistic outcome of nursing
interventions
 Cognitive Changes
■ Ability to perceive and
understand one’s world
■ Mild short term memory loss
■ Long term memory remains
intact
■ Slower responses and
reactions
 What does it mean to “grow old
gracefully”

“Grow old along with me! The best is yet to be. The last of
life, for which the first was made”. - Browning

“Even the oldest tree some fruit may bear:

And as the evening twilight fades away, the sky is filled
with stars, invisible by day”. - Henry Wadsworth Longfellow
 Cognitive Changes –
Abnormal Aging
■ Confusion
■ Alzheimer’s disease
■ Sundowning syndrome
■ The 3 D’s:
1. Dementia Severe cognitive loss &
memory loss
2. Depression
3. Delirium
 Theories about Sundowning
Possible Causes for increasing confusion:
■ Person can’t see well in dimming light

■ Hormone imbalances r/t biological clock

■ Person tired @ end of day; decreased coping

■ Restlessness because daytime activities are

decreasing
■ Caregivers communicate their own fatigue &
stress to clients
 General Physiological Changes
■ All systems decline in overall functioning
■ Decreased physiological reserves
■ Modified pace & more frequent rest
periods
 Integumentary Changes
■ Decreased skin
elasticity-wrinkling
■ Increased dryness
■ Thickened nails
■ Thinning of hair
(baldness)
■ Decreased SQ fat
Musculoskeletal Changes
■ Stiff joints & less
flexibility
■ Mobility slows &
posture stoops
■ Muscle mass, tone &
strength decrease
■ Bone
demineralization
 Neurological Changes
■ CNS responds slower
■ Rate of reflex
response decreases
■ Sense of balance
declines
■ Night sleep shortens
■ Temp. regulation &
pain perception less
efficient
Special Senses Changes
■ Diminished vision
■ Night blindness
■ Diminished
hearing
■ Decreased taste &
smell
 Cardiopulmonary Changes
■ Blood vessels less
elastic
■ Fatty plaque deposits
occur
■ Cardiac reserve
decreases
■ Less efficient lung
clearing
■ Increased resp. rate,
diminished depth
Gastrointestinal Changes
■ Digestive juices &
nutrient absorption
decrease
■ Malnutrition & anemia
common
■ Decreased peristalsis
resulting in constipation
& indigestion
■ Decreased insulin and thyroid
production
Dentition Changes
■ Tooth decay
continues

■ Missing teeth or ill

fitting dentures
effect eating
habits
Genitourinary
■ Renal blood flow decreases
■ Waste products excreted more slowly
■ Fluid/Electrolyte balance is fragile
■ Bladder capacity decreases 50%
■ Hypertrophy of prostate gland
■ Atrophy, decreased secretions & thinning of
female genital tract
■ Decreased estrogen and testosterone levels
Adjusting to Changes of Aging
■ Rest more
■ Curtail driving
■ Cane/walker for
mobility
■ Diet/nutritional
changes
■ Ageism
Adjusting –
Older Adult is making many psychosocial
adjustments

■ Retirement
■ Reduced income
■ Spouse’s health
■ Social roles
■ Living arrangements
■ Role reversal
Common health problems
■ Heart disease,
cancer, stroke
■ Poly-Pharmacy
■ Accidents, falls
■ Arthritis
■ Chronic illness
■ Elder Abuse
 Elder Abuse
■ Any deliberate action or negligence that
harms elderly individuals:
-physical
-sexual
-psychological
-emotional
-financial
Role of the Nurse in Promoting
Health: Teaching
■ Nutrition
■ Exercise
■ Immunizations
■ Annual Physicals
■ Medications
Nursing Dx
■ Risk for loneliness
■ Altered dentition
■ Risk for falls
■ Knowledge deficit
■ Confusion
■ Sexual dysfunction
■ Wandering
Summary
■ Nurses have to provide care to an
increasing geriatric population.
■ Geriatric patients have specific needs
due to physiological and cognitive
changes.
■ Nursing care needs to be tailored to the
those needs.