PERSPECTIVES OF AGING

What is aging?

- Aging, the normal process of time-related change, begins with

birth and continues throughout life
- Aging, the normal process of time-related change, begins with
birth and continues throughout life

AGING
▪ is not a disease
▪ occurs at different rates

▪ among individuals
▪ within individuals
▪ does not generally cause symptoms

▪ The older segment of the American population is growing more rapidly than the rest of the
population:
The U.S. Census Bureau projects that by the year 2030, there will be more people older than
65 years of age (22%) than people younger than 18 years of age (21%).
THE NUMBER OF OLDER PEOPLE IS GROWING!

In the Philippines, the number of older people is increasing rapidly, faster than growth in the
total population. In 2000, there were 4.6 million senior citizens (60 years or older), representing about
6% of the total population. In two decades, this has grown to 9.4 million older people or about 8.6% of
the total population. The World Population Prospects 2019 projects that by 2050, older people will
make up around 16.5% of the total population.
IMPLICATIONS ON HEALTHCARE

According to the National Center for Health Statistics, life expectancy, the average number of years
that a person can be expected to live, has risen dramatically over the past century.

In 1900, the average life expectancy was 47.3 years, but by 1998 that figure had increased to 76.7
years. According to data from the National Vital Statistics System, in 1998 a 75-year-old man could
be expected to live until the age of 85, and a 75-year-old woman could be expected to live until the
age of 87 (National Center for Health Statistics, 2000).
By 2030, people older than 65 years of age will account for 22%of the population, compared with
13% in 2001 (Fig. 12-1).

✓ Health professionals will be challenged to design strategies that address the higher prevalence
of illness within this aging population.
✓ HEALTH CARE COST OF AGING

IMPACT OF AGING IN THE FAMILY

✓ Planning for care and understanding the psychosocial issues confronting the older person
must be accomplished within the context of the family.
✓ If dependency needs occur, the spouse often assumes the role of primary caregiver.
✓ In the absence of the surviving spouse, an adult child usually assumes caregiver
responsibilities and may eventually need help in providing care and support.
✓ The family is an important source of support for older people
✓ Social attitudes and cultural values often dictate that adult children should provide services and
financial support and assume the burden of care if their aged parents are unable to care for
themselves.
 ✓ Regardless of the amount of responsibility and love an adult child exhibits toward dependent
elderly parents, strains do develop if care continues for a long period.
✓ relationship between aged parents and their adult children shows that the quality of the
parent–child relationship declines with the poor health of the parent. Under certain
circumstances of high risk, strains in intergenerational relationships can result in elder abuse
(Hoban & Kearney, 2000; Phillips, 2000; Tumolo, 2000). MAY LEAD TO ELDER ABUSE
THEORIES OF AGING
Theories of Aging:
Attempt to explain the phenomenon of aging as it occurs over the lifespan
Aging is viewed as a total process that begins at conception senescence: a change in the behavior of
an organism with age leading to a decreased power of survival and adjustment
Theories of Aging: Types
▪ Biologic
▪ Sociologic

▪ Psychologic
▪ Moral/Spiritual
THEORIES OF AGING
- Based on information in: Madison, H.E. (2002).“Theories of Aging”. In Lueckenotte, A.G. (ed),
Gerontologic Nursing. St. Louis: Mosby.
- Theories of Aging:
- attempt to explain the phenomenon of aging as it occurs over the lifespan
- aging is viewed as a total process that begins at conception
- senescence: a change in the behavior of an organism with age leading to a decreased power
of survival and adjustment
BIOLOGIC THEORIES:
 Concerned with answering basic questions regarding the physiological processes that occur in
all living organisms as they chronologically age
- Foci of Biologic Theories
- Explanations of:
o 1) deleterious effects leading to decreasing function of the organism
o 2) gradually occurring age-related changes that are progressive over time
o 3) intrinsic changes that can affect all member of a species because of chronologic age
o all organs in any one organism do not age at the same rate
o any single organ does not necessarily age at the same rate in difference individuals of
the same species
Biologic Theories: Divisions
 Stochastic: Explain aging as events that occur randomly and accumulate over time
 Stochastic Theories:
➢ Error Theory
▪ Originally proposed in 1963
▪ Basis: 1)errors can occur in the transcription in any step of the protein synthesis of DNA
• 2) error causes the reproduction of an enzyme or protein that is not an exact copy
• 3) As transcription errors to occur, the end product would not even resemble the
original cell, thereby compromising its functional ability
▪ More recently the theory has not been supported by research
▪ not all aged cells contain altered or misspecified proteins
▪ nor is aging automatically or necessarily accelerated if misspecified proteins or enzymes
are introduced into a cell
 ➢ Free Radical Theory
❖ Free radicals are byproducts of metabolism--can increase as a result of environmental pollutants
❖ When they accumulate, they damage cell membrane, decreasing its efficiency
❖ The body produces antioxidants that scavenge the free radicals
❖ In animal studies, administration of antioxidants postpones the appearance of diseases such as
cardiovascular disease and CA
❖ Free radicals are also implicated in the development of plaques associated with Alzheimer’s
➢ Cross-Linkage Theory
❖ Some proteins in the body become cross-linked, thereby not allowing for normal metabolic
activities
❖ Waste products accumulate
❖ Result: tissues do not function at optimal efficiency
➢ Wear & Tear Theory
❖ Proposed first in 1882
❖ Cells simply wear out over time because of continued use--rather like a machine
❖ Would seem to be refuted by the fact that exercise in OA’s actually makes them MORE functional,
not less
 Nonstochastic: View aging as certain predetermined, timed phenomena
➢ Programmed (Hayflick Limit) Theory
 Based on lab experiments on fetal fibroblastic cells and their reproductive
capabilities in 1961
 Cells can only reproduce themselves a limited number of times.
 Life expectancies are seen as preprogrammed within a species-specific range
➢ Immunity Theory
 Immunosenescence: Age-related functional diminution of the immune system
 Lower rate of T-lymphocyte (“killer cells”) proliferation in response to a stimulus
 & therefore a decrease in the body’s defense against foreign pathogens
 Changes include a decrease in humoral immune response, often predisposing older
adults to:
o 1)decreased resistance to a tumor cell challenge and the development of cancer
o 2) decreased ability to initiate the immune process and mobilize defenses in
aggressively attaching pathogens
o 3) increased susceptibility to auto-immune diseases

EMERGING THEORIES OF AGING

 Neuroendocrine Control (Pacemaker) Theory
▪ “…examines the interrelated role of the neurologic and endocrine systems over the life-
span of an individual”. (p. 24)
▪ there is a decline, or even cessation, in many of the components of the neuroendocrine
system over the lifespan
▪ Research has shown:
o the female reproductive system is controlled by the hypothalamus. What are the
mechanisms that trigger changes?
o adrenal glands’ DHEA hormone
o melatonin (from pineal gland) --a regulator of biologic rhythms and a powerful
antioxidant. Declines sharply from just after puberty
 Metabolic Theory of Aging/Caloric Restriction
▪ “…proposes that all organisms have a finite amount of metabolic lifetime and that organisms
with a higher metabolic rate have a shorter lifespan”. (p. 24)
▪ Rodent-based research has demonstrated that caloric restriction increases the lifespan and
delays the onset of age-dependent diseases
 DNA-Related Research
▪ Major Developments:
 o Mapping the human genome (“…there may be as many as 200 genes responsible
for contolling aging in humans”)
o Discovery of telomeres

SOCIOLOGIC THEORIES OF AGING

- Changing FOCUS of Sociological considerations of aging:
- 60’s focus on losses and adaptation to them
- 70’s broader global, societal, and structural factors influencing lives of OA’s
- 80’s-90’s exploration of interrelationships between OA’s and their physical, political,
environmental & socioeconomic mileau

 Disengagement Theory
"aging is an inevitable, mutual withdrawal or disengagement, resulting in decreased interaction
between the aging person and others in the social system he belongs to". The theory claims that it
is natural and acceptable for older adults to withdraw from society.”
▪ Cumming & Henry--1961
▪ Aging seen as a developmental task in and of itself, with its own norms & appropriate
patterns of behavior
▪ “appropriate” behavior patterns involved a mutual agreement between OA’s and society on
a reciprocal withdrawal.
▪ No longer supported
 Activity/Developmental Task Theory
successful ageing occurs when older adults stay active and maintain social interactions.
▪ Havighurst, Neugarten, Tobin ~1963
▪ “Activity is viewed by this theory as necessary to maintain a person’s life satisfaction and a
positive self-concept”. (p.27)
▪ Theory based on assumptions:
o it’s better to be active than inactive
o it is better to be happy than unhappy
o an older individual is the best judge of his or her own success in achieving the first two
assumptions
 Continuity Theory
▪ 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
 Age Stratification Theory
▪ Riley--1985
▪ Society consists of groups of cohorts that age collectively
▪ The people & Roles in these cohorts change & influence each other, as does society at large
▪ Thus, there is a high degree of interdependence between older adults & society
 Person-Environment Fit Theory
▪ Lawton, 1982
▪ Individuals have personal competencies that assist in dealing with the environment:
o ego strength
o level of motor skills
o individual biologic health
o cognitive & sensory-perceptual capacities
▪ As a person ages, there may be changes in competencies & these changes alter the ability to
interrelate with the environment
▪ Significant implications in a society that is characterized by constantly changing technology
PSYCHOLOGIC THEORIES OF AGING
 Maslow’s Hierarchy of Human Needs
▪ Maslow--1954
▪ “…each individual has an innate internal hierarchy of needs that motivates all human
behaviors”. (p. 29
▪ depicted as a pyramid; the ideal is to achieve self-actualization, having met all the “lower” level
needs successful
▪ “Maslow’s fully developed, self-actualized person displays high levels of all of the following
characteristics: perception of reality; acceptance of self, others, and nature; spontaneity;
problem-solving ability; self-direction; detachment and the desire for primacy; freshness of
peak experiences; identification with other human beings….
▪ …satisfying and changing relationships with other people; a democratic character structure;
creativity; and a sense of values.
▪ Only about 1% of us are truly ideal self-actualized persons

 Jung’s Theory of Individualism

According to Carl Jung, Individuation is the development of consciousness. It is the process by
which an unformed person develops into a unique Individual. The Individual is one who chooses
not to be limited by collective norms. ... The formed Individual rejects conformity for the sake of
conformity

Jung believed that the human psyche had three parts: the ego, personal unconscious and
collective unconscious.
▪ Carl Jung--1960
▪ origins are Freudian
▪ Self-realization is the goal of personality development
▪ as individual ages, each is capable of transforming into a more spiritual being

 Erikson’s Eight Stages of Life

▪ 1993
▪ Stages throughout the life course. Each represents a crisis to be resolved.
▪ For OA’s:
o 40 to 65 (middle adulthood): generativity versus self-absorption or stagnation
o 65 to death (older adulthood): ego integrity versus despair
▪ “Self-absorbed adults will be preoccupied with their personal well-being and material gains.
Preoccupation with self leads to stagnation of life”
▪ “Unsuccessful resolution of the last crisis may result in a sense of despair in which individuals
view life as a series of misfortunes, disappointments, and failures”. (p.30)

 Peck’s Expansion of Erikson’s Theory

Clearly, the preferred traits are those listed first in each pair: valuing wisdom, mental flexibility, ego
differentiation, body transcendence, and ego transcendence. They allow growth and development
▪ Erikson’s last two stages are expanded to 7
▪ The final three of the developmental tasks for old age:
o ego differentiation versus work role preoccupation
o body transcendence versus body preoccupation
o ego transcendence versus ego preoccupation
 Selective Optimization with Compensation
▪ Baltes--1987
▪ Individuals develop strategies to manage losses of function that occur over time
▪ 3 Interacting Elements:
o selection: increasing restriction of one’s life to fewer domains of functioning
o optimization: people engage in behaviors to enrich their lives
o compensation:developing suitable, alternative adaptations
 PHYSIOLOGICAL CHANGES WITH AGING
Senescence
 All post maturational changes and the increasing vulnerability individuals face as a result of these
changes.
 The group of effects that lead to a decreasing expectation of life with increasing age
 Differs from other biological processes:
- Its characteristics are universal
- Changes come from within the individual
- Associated processes occur gradually
- Changes have a deleterious effect on the individual.
-
Ultimately…you die.
U.s. death rates:
- Leading cause among oa’s--heart disease
- Higher for older men than for older women
- Higher for African Americans than whites

Age-related physiological changes

 …all people age, but not at the same rate

At age 75, the average person, compared to age 30:

 92% of brain weight
 84% of basal metabolism
 70% kidney filtration rate
 43% of maximum breathing capacity
 We are not the people we once were!

1. Integumentary system

Functions of the skin

 Protection
 Temperature regulation
 Sensation, and
 Excretion
Changes in the skin

 “to most people, the condition of the skin, hair, and connective tissue collectively represents the
ultimate indicator of age”. (kart & kinney, p. 74)

Changes in the skin

 The epidermis and dermis become thinner.
 Elastic fibers are reduced in number, and collagen becomes stiffer.
 Subcutaneous fat diminishes, particularly in the extremities.
 Decreased numbers of capillaries in the skin result in diminished blood supply. (wrinkling and
sagging )
 Hair pigmentation decreases, resulting in gradual graying.
 The skin becomes drier and susceptible to irritations because of decreased activity of the
sebaceous and sweat glands.
 Skin: wrinkling
 Muscles of the face are capable of tremendous movement. “Smiles, laughter, frowns,
disappointment, ager, rage, and surprise are all recorded. The hand of time captures these
expressions and outlines them on the face….by the age of 40, most people bear the typical
lines of their expressions.” (kart & Kinney, p. 75)

Skin--wrinkling:
 Loss of subcutaneous fat
- Vulnerability to pressure sores
- Less insulation of body to cold (also affected by diminished blood flow to skin & extremities) &
heat

Pressure sores

Skin & nails

 Atrophic changes in sweat glands
 Thickened fingernails & toenails
 Generalized loss of body hair and head hair
 Decrease in # of functioning pigment-producing cells-->graying
- Some remaining pigment cells enlarge--> “age spots”
- Skin changes increase. Vulnerability to infections/disorders
Age spots or liver spots

2. Musculoskeletal system

Skeletomuscular system changes

 “Arthritis & allied bone and muscular conditions are among the most common of all disorders
affecting people 65 years of age and over.” (kart & Kinney, p. 76)
 Arthritis: a generic term that refers to an inflammation or degenerative change in a joint
- Occurs worldwide & is one of the oldest known diseases
Skeletomuscular system changes
 A gradual, progressive decrease in bone mass begins before the age of 40 years.
 The muscles diminish in size and lose strength, flexibility, and endurance with decreased
activity and advanced age.
 Back pain is common.
 Beginning in middle age, the cartilage of joints progressively deteriorates.
Arthritis
 Osteoarthritis
- Cause not known
- Also referred to as degenerative joint disease
- A gradual wearing a way of joint cartilage that results in the exposure of rough underlying
bone ends
- Can do damage to internal ligaments
- Most commonly associated w/ weight bearing jnts
Rheumatoid arthritis
 A chronic, systemic, inflammatory disease of connective tissue
 2-3 times more common among women than men
 Currently viewed as an autoimmune disease
 May occur at any age -- most common onset between 20 & 50
Musculoskeletal, cont’d:
 Osteopenia --> osteoporosis:
- Gradual loss of bone that reduces skeletal mass without disrupting the proportions of
minerals & organic materials
- For many, it is asymptomatic
- Bones most critically involved: vertebra, wrist, hip
Musculoskeletal, cont’d:
 Sarcopenia:
- Loss of muscle mass that occurs with aging
- Cause not completely understood
- Preventable/reversible with regular physical activity

3. Cardiovascular system

Cardiovascular system
 In the absence of disease, the heart tends to maintain its size
 Heart valves tend to increase in thickness with age
 Bp tends to go up with age
- Systolic stabilizes at about age 75
- Diastolic stabilizes at about 65 then may gradually decline
Cardiovascular system
 Heart disease is the leading cause of death in the aged.
 The heart valves become thicker and stiffer, and the heart muscle and arteries lose their
elasticity.
 Although function is maintained under normal circumstances, the cardiovascular system has
less reserve and responds less efficiently to stress.
Cardiovascular system
 The maximum cardiac output decreases by about 25% from age 20 to age 80.
 Under conditions of stress, both the maximum cardiac output and the maximum hr diminish
gradually.
Atherosclerosis vs. Arteriosclerosis
 Atherosclerosis
- Developed by an overwhelming # of people in industrialized nations
- A narrowing of arterial passageways as a result of the development of plaques on their
interior walls
- Reduces the size of the passageway--even to the pt of closing it off. A cause of ischemic
heart tissue (tissue deprived of adequate blood supply)
Arteriosclerosis:
- A generic term referring to the loss of elasticity of arterial walls
- Often referred to as “hardening of the arteries”
- Considered a general aging phenomenon

4. Respiratory system
Respiratory changes
 Airways & tissues become less elastic & more rigid with age
 Osteoporosis may alter the size/shape of the chest cavity
 Power of respiratory & abdominal muscles becomes reduced--hinders diaphragmatic
movement
Respiratory changes
 Age-related changes in the respiratory system affect lung capacity and function and include
increased anteroposterior chest diameter, osteoporotic collapse of vertebrae resulting in
kyphosis (increased convex curvature of the spine), calcification of the costal cartilages and
reduced mobility of the ribs, diminished efficiency of the respiratory muscles, increased lung
rigidity, and decreased alveolar surface area.
Kyphosis

Respiratory changes
 Increased rigidity or loss of elastic recoil in the lung results in increased residual lung volume
and decreased vital capacity.

 *residual lung volume

 *vital capacity

Respiratory changes
 Gas exchange and diffusing capacity are also diminished.
 Decreased cough efficiency, reduced ciliary activity, and increased respiratory dead space
make the older person more vulnerable to respiratory infections.

5. Gastrointestinal system

Gastrointestinal system
 Atrophy of secretion mechanisms
 Decreasing motility of the gut
 Loss of strength/tone of muscular tissue & supporting structures
 Changes in neurosensory feedback
- Enzyme & hormone release
- Innervation of the tract
- Diminished response to pain & internal sensations

Gastrointestinal system
 The older adult is at increased risk for impaired nutrition.
 Periodontal disease leading to tooth decay and loss of teeth is common.
 Salivary flow diminishes, and the older person may experience a dry mouth.
 A preference for sweet and salty foods results from a decrease of taste receptors.

Gastrointestinal system
 Gastric motility may decrease, resulting in delayed emptying of stomach contents.
 Diminished secretion of acid and pepsin reduces the absorption of iron, calcium, and vitamin
b12.
 Absorption of nutrients in the small intestine also appears to diminish with age.

Gastrointestinal system
 The function of the liver, gallbladder, and pancreas is generally maintained, although
absorption and tolerance to fat may decrease.
 Constipation is common in aged people.
  When mild, the symptoms involve abdominal discomfort and flatulence, but more serious
consequences include fecal impaction that contributes to diarrhea around the impaction, fecal
incontinence, and obstruction.

 The phenomenon of referral is common in the gi--i.e. Signs & symptoms often associated
with one part of the tract may actually be associated with another part of the tract.
“Discomfort perceived as originating in the stomach may actually be coming from the lower
gi tract.” (p. 79)
 The gi symptoms often have their origins in psychosocial factors

6. Sleep
Sleep
 Sleep disturbances frequently occur in older people, affecting more than 50% of adults 65
years of age or older.
 The elderly often experience variations in their normal sleep–wake cycles, and the lack of
quality sleep at night often creates the need for napping during the day.
Sleep
 Many factors affect sleep quality in older adults including respiratory problems during sleep,
restless leg syndrome, nocturia, pain, osteoarthritis, heart failure, incontinence, prostate
hypertrophy, menopause-related problems, pruritus, allergies, depression, dementia, social
isolation, loneliness, being bedridden, experiences of loss, drug use, and living in nursing
homes (e.g., inadequate lighting, keeping light on during the night, noises).

Nutritional health

Nutritional health
 The social, psychological, and physiologic functions of eating influence the dietary habits of
older adults.
 Increasing age alters nutrient requirements; older adults require fewer calories and a more
nutrient-rich, healthy diet in response to alterations in body mass and a more sedentary
lifestyle.

Nutritional health
 Decreased physical activity and a slower metabolic rate reduce the number of calories needed
by older adults to maintain an ideal weight.
 As stated previously, age-related changes that alter pleasure in eating include a decrease in
taste and smell.

Nutritional health
 Older adults are likely to maintain a taste for sweetness but require more sugar to achieve a
sweet flavor. They also may lose the ability to differentiate sour, salty, and bitter tastes.

… What are the physiologic changes that takes place involving the following systems?
Hematopoietic and lymphatic
Urinary
Nervous
-special senses
-endocrine
 Physiologic Changes with Aging
GENITO -URINARY SYSTEM

URINARY SYSTEM
“The bladder of an elderly person has a capacity of less than half (250ml) that of a young adult (600
ml) and often contains as much as 100 ml of residual urine”

Micturition reflex is delayed-- usually activated when bladder is half full; in OAs, not until bladder is
nearly at capacity
GENITAL SYSTEM CHANGES

“The genital system is characterized by a number of age-related changes in physiology and anatomy.
On the whole, very few age-specific disorders are associated with this body system. With the
exception of declining levels of testosterone, most of the problems of sexuality and aging are
sociogenic or psychogenic”.
Female genital tract

• External genitalia
o Folds become less pronounced
o Skin becomes thinner
o Vascularity & elasticity decrease
o Becomes more susceptible to tissue trauma & itching
o # of glands decrease, as does level of secretion
• Internal reproductive organs
o Uterus decreases in size & becomes more fibrous
o Uterus has fewer endometrial glands
o Cervix reduced in size
o Uterine tubes become thinner
o Ovaries take on an irregular shape
o Ovulation stops--menopause (50% between ages 45 and 50)
Male Genital System

• Continues to produce germ cells (sperm) and sex hormones (testosterone) well into old age,
declining with advancing age
• Size & firmness of the testes decrease
• Reduced sperm production due to age-related fibrosis which constricts the blood supply
• Fibrosis may also affect the penis since erection is a purely vascular phenomenon
• The genitourinary system continues to function adequately in older adults, although kidney
mass is decreased, primarily because of a loss of nephrons.
• Changes in renal function may be attributable to a combination of aging and pathologic
conditions such as hypertension.
• The changes most commonly seen include a decreased filtration rate, diminished tubular
function with less efficiency in reabsorbing and concentrating the urine, and a slower
restoration of acid– base balance in response to stress.
 NERVOUS SYSTEM

• Homeostasis is difficult to maintain with aging, but older people have a tremendous ability to
adapt and function adequately, retaining their cognitive and intellectual abilities in the absence
of pathologic changes.
• However, normal aging changes in the nervous system can affect all parts of the body.
• Nerve cells in the brain decrease but the decrease is compensated for by other neurons.
• Overall, the decreases contribute to a small loss of brain mass.
• Chemical changes include a decrease in the synthesis and metabolism of the major
neurotransmitters.
• Because nerve impulses are conducted more slowly, older people take longer to respond and
react.
• The autonomic nervous system performs less efficiently, and postural hypotension, may occur.
• Neurologic changes can affect gait and balance, which may interfere with mobility and safety.
• Adequate nutrition and absorption of vitamin B12 is important for neurologic health.
• Mental function may be threatened by physical or emotional stresses.

Senses

• People interact with the world through their senses.

• Losses associated with old age affect all sensory organs, and it can be devastating not to be
able to see to read or watch television, hear conversation well enough to communicate, or
discriminate taste well enough to enjoy food.
• Nearly half of older men and one third of older women report difficulty hearing without a
hearing aid.
• Most older adults have a decrease in visual acuity, a narrowing of the visual field, and may
have trouble seeing at night

Sensory Loss Versus Sensory Deprivation

• In contrast to sensory loss, sensory deprivation is the absence of stimuli in the environment or
the inability to interpret existing stimuli.
• Sensory deprivation can lead to boredom, confusion, irritability, disorientation, and anxiety.
• A decline in sensory input can mimic a decline in cognition that is in fact not present.
• In some situations, one sense can substitute for another in observing and interpreting stimuli.
IF YOU ARE THE NURSE HANDLING A PATIENT WITH SENSORY DEPRIVATION, WHAT
INTERVENTIONS CAN YOU PERFORM?

• Nurses can enhance sensory stimulation in the environment with colors, pictures, textures,
tastes, smells, and sounds.
• The stimuli are most meaningful if they are appropriate for older adults and the stimuli are
changed often.
• Cognitively impaired people tend to respond well to touch and to familiar music.
VISION

• As new cells form on the outside surface of the lens of the eye, the older central cells
accumulate and become yellow, rigid, dense, and cloudy, leaving only the outer portion of the
lens elastic enough to change shape (accommodate) and focus at near and far distances.
• As the lens becomes less flexible, the near point of focus gets farther away.

PRESBYOPIA

• The pupil dilates slowly and less completely because of increased stiffness of the muscles
of the iris, thus the older person takes more time to adjust when going to and from light and
dark settings and needs brighter light for close vision.
HEARING

• Auditory changes begin to be noticed at about 40 years of age.

• Environmental factors, such as exposure to noise, medications, and infections, as well as
genetics, may contribute to hearing loss as much as age-related changes.

PRESBYCUSIS

• Gradual sensorineural loss that progresses from the loss of the ability to hear high-
frequency tones to a generalized loss of hearing.
• It is attributed to irreversible inner ear changes.
• Older adults often cannot follow conversation because tones of high-frequency consonants
(the sounds f, s, th, ch, sh, b, t, p) all sound alike.
TASTE AND SMELL

• The senses of taste and smell are reduced in older adults.

• Changes in the sense of smell, generally greater than the loss of taste, are related to cell loss
in the nasal passages and in the olfactory bulb in the brain.
• Environmental factors such as long-term exposure to toxins (e.g., dust, pollen, and smoke)
contribute to the cellular damage.
ENDOCRINE SYSTEM

• Alterations occur in both the reception and the production of hormones

• Prelease of insulin by the beta cells of the pancreas slows, causing an increase in blood sugar
• Thyroid changes may lower the basal metabolic rate

WHICH OF THE FOLLOWING TERM REFERS TO THE CARE OF THE AGING PEOPLE?
GERONTOLOGY
- the study of the physical aspects of aging, as well as the mental, social and societal
implications of aging
- Gerontology is multidisciplinary and is concerned with physical, mental, and social aspects
and implications of aging.
GERIATRICS
- the branch of healthcare that focuses on our unique needs as we age
- Geriatrics is a medical specialty focused on care and treatment of older persons.
NURSING CARE OF THE OLDER ADULT IN WELLNESS
Activity of daily living

Basic care activities that include

- Mobility
- Bathing
- Hygiene
- Grooming
- Dressing
- Eating
- Toileting
Exercise in older adults

• Researcher indicates that high intensity, progressive resistance training can improve muscle
strength and size in frail elderly clients
• Exercise programs should be individually planned and should be take into account the client’s
general health status, physiologic disorders (if present) physical environment, and other factors
Nutrition and the Older Adult

• Elders must follow a balanced diet, often with lowered intakes of sugar, caffeine, and sodium
• There are no universally accept dietary guidelines specific to older adults
• It is important that nurses be knowledgeable about community services designed to help older
clients meet their nutritional needs
Strengths of Older Adults

• Physiologic changes may result in losses, causing impairments in communication, vision and
learning, mobility, cognition, or psychosocial skills.
• The strengths of each individual (including past coping skills) must be identified and utilized
when planning care.
Health Promotion and Disease Prevention

• Older adults must be alerted to means of preventing disease and reducing risks
• Being knowledgeable about self-care and participating in screening tests are important
components of health maintenance
 Memory Decline due to Normal Aging, Depression or Dementia

Normal age-related Memory Depression-Related Memory Dementia-Related Memory

Decline Problems Problems
Uses notes and other memory May not try to keep up Needs instruction to use memory
aids aids
No lasting mood change Consistent depressive mood Emotional lability and
associated shallowness
Behavior may or may not change Behavior change is greater than Behavior change may be
impairment appropriate
Nocturnal drop in performance Nocturnal drop in performance Nocturnal drop in performance
unusual unusual common
“don’t know” answers common “don’t know” answers common Guesses or “near miss” answers
common
Recent remote memory losses Recent and remote memory Recent memory impaired, remote
are equal losses are equal is intact
Memory gaps for specific events Memory gaps for specific events
common unusual

PLANNING FOR SUCCESSFUL AGING

STRESS AND COPING IN THE OLDER ADULT

• Coping patterns and the ability to adapt to stress develop over the course of a lifetime and
remain consistent later in life.
• A person’s abilities to adapt to change, make decisions, and respond predictably are also
determined by past experiences.
• The older person often has fewer choices and diminished resources to deal with stressful
events.
• Common stressors of old age include normal aging changes that impair physical function,
activities, and appearance; disabilities from injury or chronic illness; social and environmental
losses related to loss of income and decreased ability to perform previous roles and activities;
and the deaths of significant others.
• Many older adults rely strongly on their families and spiritual beliefs for comfort during stressful
times.

LIVING ARRANGEMENTS

• Many older adults have more than adequate financial resources and good health even until
very late in life; therefore, they have many housing options.
• More than 90% of older adults live in the community, with a relatively small percentage (3.4%)
residing in nursing homes and a comparable percentage living in some type of senior housing.
• Eighty-one percent of those older than 65 years own their homes.
• Twenty-eight percent of noninstitutionalized older people live alone, and widowed women
predominate.
LIVING AT HOME OR WITH FAMILY

• Most older adults want to remain in their own homes; in fact, they function best in their own
environment.
• The family home and familiar community may have strong emotional significance for them, and
this should not be ignored.
• However, with advanced age and increasing disability, adjustments to the environment may be
required to allow older adults to remain in their own homes or apartments.
• Many services and organizations can assist older adults to successfully “age in place” in their
own homes or in assisted living facilities.
• Sometimes older adults or couples move in with adult children.
• This arrangement provides security for the older adult and privacy for both families.
CONTINUING CARE RETIREMENT COMMUNITIES

• Continuing care retirement communities (CCRCs) offer three levels of living arrangements and
care that provide for aging in place.
• CCRCs consist of independent single-dwelling houses or apartments for people who can
manage their day-to-day needs, assisted living apartments for those who need limited
assistance with their daily living needs, and skilled nursing services when continuous nursing
assistance is required.

ASSISTED LIVING FACILITIES

• Assisted living facilities are an option when an older person’s physical or cognitive changes
necessitate at least minimal supervision or assistance.
• Assisted living allows for a degree of independence while providing minimal nursing assistance
with administration of medication, assistance with ADLs, or other chronic health care needs.
LONG-TERM CARE FACILITIES

• Many types of nursing homes, nursing facilities, or long-term care facilities offer continuous
nursing care.
• The actual number of older people who reside in long-term care facilities has risen owing to the
large increase in older adults and the use of nursing homes for short-term rehabilitation.
THE RELATIONSHIP BETWEEN WELLNESS AND AGING
Promoting wellness in older adults is an ideal; however, nurses may not believe it is achievable in
practice because of barriers such as the following:

• Older adults may be pessimistic about their ability to improve their health and functioning.
• Survival needs, and a multitude of health problems may take precedence over the “luxury” of
being able to focus on wellness and quality of life.
• Despite the purported emphasis on wellness and health promotion, health care environments
focus more on treating disease than on preventing illness and addressing whole-person needs.
• Older adults and health care providers often mistakenly attribute symptoms to aging rather
than identify and address the contributing factors that are reversible and treatable.
 • Health care providers may not believe that older adults are capable of learning and
implementing health-promoting behaviors that are inherent in wellness-oriented care.
• Because many of these barriers arise from myths, misperceptions, and lack of knowledge,
accurate information about older adults and the relationship between aging and wellness is an
indispensable tool for addressing these barriers.

A NURSING THEORY FOR WELLNESS-FOCUSED CARE OF OLDER ADULTS

• During the 1980s, this author proposed a model for gerontological nursing.
• This model has emphasized the significant role of nurses in using health education
interventions to promote optimal health, functioning, and quality of life for older adults.

Assessing Health of Older Adults

- Assessment of health and functioning of older adults is an essential and complex component
of nursing care