CONCEPTS, PRINCIPLES AND THEORIES IN THE

CARE OF OLDER ADULTS

CHERRY JOYCE G. BASCO, RN, LPT

INTRODUCTION
• The term geriatric comes from the Greek words “geras,” meaning old age, and “iatro,” meaning
relating to medical treatment.
• 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.
• 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.
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
•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.
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)
• Old-old (above 85 years)
 B. DEMOGRAPHY OF AGING AND IMPLICATIONS ON HEALTH AND NURSING CARE

1. Global Aging

• Advanced Industrialized Societies are Growing Older

• Increase in Health care cost
• Increase demand for at home care
(Intropedia.com)

•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.
• It is known that all members of a species suffer a gradual, progressive loss of
function over time because of their biologic structure.
• Biologic theories look at aging from a genetic perspective.
• The programmed theory proposes that everyone has a “biologic clock” that starts
ticking at conception.
• 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 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.
• 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.
• 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.
• 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.
• The reliability theory of aging and longevity is a complex mathematical model of system
failures first used to describe failure of complex electronic equipment.
• The neuroendocrine theory focuses on the complicated chemical interactions set off by the
hypothalamus of the brain.
• The immunologic theory proposes that aging is a function of 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.

• The highly controversial disengagement theory was developed to

explain why aging persons separate from the mainstream of
society.
• The activity theory proposes that activity is necessary for
successful aging.
• 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.
• 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.