NCM 114

• “GERONTOLOGY”(= geron- old man ; logy – study) This term was coined by Mechnikov in 1903“. It
is the specialized branch of medical science dealing with the comprehensive study of the elderly adult”
- Gerontology is the study of all aspect of individual and its consequences.

- Geriatrics is the subdivision of medicine that is concerned with old age and its diseases.
• “GERONTOLOGIC NURSING” - is the care of elderly adults. Care of elderly needs skilled assessment
and creative adaptations of nursing interventions
Demographic Profile of older adult population
• Clinical definition is 65 years old of age or older.
• Older-old adults are 85 or older.
• Rapidly growing.
Common Problems of elderly people
1. Cataract: vision loss
2. Uterine prolapsed
3. Hearing loss
4. COPD/Asthma
5. UTI/urinary retention
6. Loose tooth: problem of chewing
7. Cancer: lung, breast, colorectal, prostate etc
8. Osteoporosis
9. Arthritis
10. Nutritional problems
11. Sleep disturbance
12. Multiple drug use
13. Dementia and multiple drug use
14. Economic insecurity
15. Others:
Active Ageiging
• Health: When the risk factors for chronic diseases and functional decline are kept low while the
protective factors are kept high, people will enjoy both a longer quantity and quality of life.
• Participation:When labor market, employment, education, health and social policies and
programs support their full participation in socio-economic, cultural and spiritual activities, people
will continue to make a productive contribution to society
• Security: When policies and program address the social, financial and physical security needs and
rights of people as they age, elderly are ensured of protection, dignity and care in the event that
they are no longer able to support and protect themselves.
GERIATRIC NURSING
•  Geriatric nursing is the specialty that concerns itself with the provision of nursing services to geriatric or
aged individuals.
• It is defined as the specialized nursing care of the older adults that occurs in any setting in which nurses
use, knowledge, expertise and caring abilities to promote optimal functioning.
PURPOSES OF GERIATRIC NURSING
• To provide opportunity for continuous development throughout the lifespan.
• To support for maximum levels of independence.
• To enhance the quality of life for aged persons through the promotion of health.
• To make their lifestyle less restrictive.
• To provide for peaceful death
CONCEPTS & THEORIES OF AGING
1.BIOLOGICAL THEORIES
- Environment and the body’s constant need to manufacture energy and fuel metabolic activities cause toxic by-
products to accumulate.Based on random events that cause cellular damage, which accumulates as organism ages.
1. Gene theory
2. Somatic theory
3. Orgel theory/ Error theory
4. Somatic theory
5. Cellular aging theory
2.NON-GENETIC THEORY
• Free radical theory
• Autoimmune theory
• Cross link theory
• Wear and tear theory
3.PSYCHOSOCIAL THEORIES
• Disengagement theory
• Activity theory
• Continuity theory
• Adjustment theory / Social exchange theory
4.ENVIRONMENTAL THEORY
• Stress theory
• Pollution theory
• Exposure theory
5.NURSING THEORY
6.RADIATION THEORY
-Developmental theory
THEORIES OF AGING
1.Biological Theories of Aging-Biological theories attempt to explain physical aging as an involuntary process,
which eventually leads to cumulative changes in cells, tissues and fluid.
2.Intrinsic Biological Theory-Intrinsic biological theory maintains that aging changes arise from internal,
predetermined causes.
3.Extrinsic Biological Theory- Extrinsic biological theory maintains that environmental factors lead to structural
alterations, which, in turn, cause degenerative changes. 
4.Free-radical theory- Emphasizes the mechanism of oxygen use at the cellular level. Free-radicals are molecule
with an extra cellular charge.
This charge creates a reaction that alters the structure or function of the cell membrane. Increased unstable free-
radicals produces harmful effect to biological systems, such as chromosomal changes, pigment accumulation and
collagen alteration. 
5.The cross-link theory and connective tissue theory- asserts that the molecules of collagen and elastin,
connective tissue components, from bonds that increase cell rigidity.
Cross-linkage is thought to results from chemical reaction that creates chemical bonds between normally separate
molecules in the body.
6.Autoimmune theory- An aging immune system is less able to distinguish body cells from foreign cells; as a
result, it begins to attack and destroy body cells as if they were foreign.
This theory proposes that decrease in immune function may result in an increase in autoimmune response causing
the body to produce antibodies that attack itself.
AUTO IMMUNE THEORY Postulates that with age, the immune system produces auto-anti-bodies that causes cell
death or cell changes that fosters the aging process(WALFORD,1969)
7.Wear-and-Tear Theory- Body cells, structures and functions wear out or are over used through exposure to
internal and external stressors.
Repeated injury or overuse; internal and external stressors, including trauma, chemicals and build up of naturally
occurring waste. Effects from the residual damage accumulate, the body can no longer resist stress and death occurs.
8.Error Theory- Error theory focus on the phenomenon of decreased bonding of protein cells that occurs
spontaneously or in response to stressors such as radiation.
This stressors results in errors in the synthesis of RNA and DNA and produces cells with impaired function.
Mistranscription and mintranslation of certain genes products. Results in self amplifying error producing
derangements(Strchler ,1977) Initial error will , most likely result in further errors of similar types.42

43. Cont… The productions of faulty products of other genes which accumulate with aging.Eg. Enzyme with
decrease catalytic activity in the later life.
9.Somatic Mutation Theory- This theory suggests that cells exposed to chemicals or radiation results in alteration
within the DNA molecule.
Mutation results from these alterations accumulate overtime and become more evident with age and increasing
cellular impairment
10.DNA Damage Theories- Aging is caused by accumulated damage to DNA, which in turn inhibits cells ability to
function and express the appropriate genes.
This leads to cell death and overall aging of the organism.
11.WEAR ANDTEAR THEORY:
Postulates that an organisms” wears out” with use.
Damage begins at the level of molecules in our cells.
DNA that make up our genes sustains repeated damage from toxins.
Bodies have the capacity to repair the damage but not all are accurately corrected.
Damage cells progressively accumulates
12.Free radical theory:
• Free radical is a molecule with an unpaired ,highly reactive electron.
• One type of free radical generated in our body is oxygen free radical.
• This free radical grabs the molecule from any other molecule and damage the other molecule Molecules
that are damaged by free radicals are : Fat , proteins antenna.(both of nucleus and mitochondria).
• Under normal condition natural defense mechanism prevent most of the oxidative damage.
• This theory purpose that little by little small damage accumulate and contribute to deteriation of tissues
and organs
13.CROSS LINKAGE THEORY: Also called as collagen theory.
• With age, our proteins, DNA and other structured molecules develop inappropriate cross links to one
another
• This unnecessary links decreases the elasticity of proteins and other molecules.
• Programmed Cellular Aging Theory- Suggest that aging may be result of an impairment of the cells in
translating necessary RNAs as a result of increased turnoffs of DNA.
3 distinct components
1. Cells that can reproduce.
2. Cells that can not reproduce
3. Intercellular substance/ materials
PROGRAMMED AGING THEORY: Aging and death, according to this theory, are not a result of wear and
tear or exposure, but are a programmed, natural and necessary part of genetics. In short, we are
programmed to age and die.
14.Psychosocial Theories of Aging- Psychosocial theories of aging attempt to explain age – related changes in
cognitive function, such as intelligence, memory, learning and problem solving.
15.Disengagement Theory- This theory states that aging people withdraw from customary roles and engage in
more introspective, self-focused activities.
• This theory includes 4 basic concepts:
1. Aging person and society mutually withdraw from each other.
2. Disengagement is biologically and psychologically intrinsic and inevitable.
 3. Disengagement is considered necessary for successful aging.
4. Disengagement is beneficial for older adults
16.Continuity Theory- The continuity or developmental theory states that personality remains the same and
behavior become more predictable as people age. This theory focuses more personality and individual behavior over
time.
17.Activity Theory- Successful aging and life satisfaction depend on maintaining high level of activity.
According to this perspective, the maintenance of optimal physical, mental and social activity is necessary for
successful aging this theory also assumes that older adults have the same needs as middle-age persons.
18.Adjustment Theory- Adjustment theory defines aging as a series of adjustment to retirement, to
grandparenthood, to change in income, to changes in social life and marital status and to potential deterioration of
health and well being. 
19.Social Exchange theory:
• Po stulates that social interaction between individuals and groups continues as long as everyone profits
from the interaction.
• When there is no longer profit from the social exchange, imbalance occurs in the interaction and one
individual is perceived as having more power than the other. The decrease in the social interaction of the
aged is the result of exchange relationship that gradually erode the power of the aged.
20.Continuity theory:
• Negatron , 1964
• In spite of aging process , personality and basic patterns of behavior are considered to be constant in the
individual.
• Patterns and activity levels develop over a life time will largely determine whether an individual remain
engaged and active or disengaged and inactive as they age.
• This theory encourages young people to consider their current activities as a foundation for their own future
aging process.
Functional Consequences
• Theory Environmental and biopsychosocial consequences impact functioning.
• Theory of Thriving: Failure to thrive caused by discord between the individual and environment or
relationships.
• Disharmony cause failure to thrive.
21.Nursing Theory of aging Miller (2004) has developed the functional consequences theory.
• Older adults experiences functional consequences because of age related changes and additional risk
factors.
• Without interventions, many functional consequences are negative; with them, however, functional
consequences can be positive.
• The role of gerent logic nurse is to identify the factors that causes negative functional consequences and to
initiate interventions that will result in positive ones.

COGNITIVE ASPECTS OF AGING

• Factors affecting cognition
1. Sensory changes and disease associated with ages.
2. Pain from chronic disease
3. Sleep deprivation
4. Medications side effects
5. Changes in mental functioning-
6. Range of interests, and understanding.
7. Increased repetitive thoughts and vulnerability to stress.
CHANGES IN MEMORY
• Short –term memory loss, which is associated with decreased judgement, insight, and orientation.
• Gradual memory loss.
• Learning and intelligence.
• Aging may affect learning.
• Hesitancy in answering questions or repeating information.
• Intelligence does not declines as on age.

PSYCHOSOCIAL ASPECTS OF AGING

• Retirement
• Role changes
• Loneliness
• Depression and suicide
Stress and coping elderly
• Common stress of old age includes:
1. Normal aging changes that impair physical function, activities and appearance.
2. Disabilities and chronic illness.
3. Social and environment losses of income, roles and activities.
4. Death or illness of significant others.
5. Physical and sexual abuse.
6. Depression, heavy drinking, or insufficient sleep.
7. Social issues, such as social defeat, or relationship conflict.
Some suggestions may help to reduce the stress
1. Take one task at a time.
2. Be realistic
3. Meditation – 5-10 min of meditation can bring some relief
4. Exercise
5. Hobbies
6. Be flexible and clam
7. Adopt healthy life style
8. Share feelings with family members or friends
END NOTE
• For older adults with chronic illnesses, stochastic theories of aging help nurses to better manage physical
illness and conditions.
• Psychosocial aging theories help nurses assist older adults and their families recognize that their life has
been one of integrity and meaning, and facilitate peaceful death with dignity.
• Aging continues to be explained from multiple theoretical perspectives, which collectively reveal that aging
is a complex phenomenon still much in need of research.

PPT 2:
Perspective on Aging
Aging is a developmental process
• Sr. Lety Kuan of Life course
1. Acquisition
2. Struggle
3. Legacy
4. Sum of experience
5. Continuous process
Acquisition
• Affects one capabilities to face challenges and struggles in life.
• Good acquisition is early stage of life crucial
• Usually handed over by parents, but as individual grow she/she now performs the acquisition alone or with
others.
• Environment and relationship with others shape how one acquires life.
• Obstacles may present itself along the way to test acquisition.
Positive acquisition
• Lightens the burden, resulting in successful problem solving and bright achievements.
• Cheerful disposition
Negative acquisition
• Can lead to increase struggles, regrets and dissatisfaction
• Grumpy and antisocial behavior
Struggle
• Struggle is a part of life force.
• Allows us to be mature.
Legacy
• Stage in life where a person achieve self-actualization, radiating goodness accumulated overtime
• When one has been inspiration for others and has made a big contribution to society.
LIFE PERSPECTIVE/GRACEFUL AGING THEORY
• Proposed by Sr. Letty Kuan
• Good education is crucial in establishing a good legacy.
-good education is the best we can give to children.
• Economic status is not a hindrance in establish good legacy.
-what a child has grown up with (ex. Presence/ absence of affection, attention etc.) is what he/she will bring up
to adulthood.
-honesty and love are what matters in the upbringing of a person.
• Regardless of religion, as long as one is spiritually connected, one cannot be cruel or selfish (sharing is a
key factor).
• The therapeutic role of the nurse is to facilitate the client what the person lacks and must fill in