PRINCIPLES OF GREIATRIC CARE

General Principles of Geriatric Care

➢ Consider individuality
➢ Be patient, kind and sympathetic
➢ Encourage to make his/her choices, decisions,
and independence.
➢ Assist to achieve emotional stability.
➢ Stimulate mental acuity and sensory input and
physical activities.
➢ Make the elderly stay at home with interesting
activities. CARE OF OLDER ADULTS
➢ Provide diversion and/or occupational therapy.
Aging - a progressive functional decline, or a gradual
➢ Provide privacy.
deterioration of physiological function with age,
➢ Handle gently.
including a decrease in fecundity, or the intrinsic,
➢ Keep comfortable.
inevitable, and irreversible age-related process of loss of
➢ Encourage to maintain body hygiene.
viability and increase in vulnerability. (Lopez-Otin et. al,
➢ Assist to take care of visual, auditory, and dental
2013)
aid.
➢ Protect from injury, falls and accidents. Geriatric - specializes in the care of older people, which
➢ Ensure adequate nutrition. often involves managing many disorders and problems at
➢ Facilitate elimination. the same time.
➢ Encourage ROM and other like excercises.
Gerontological Nursing - one of the fields of nursing that
➢ Help to establish good sleep pattern.
deals with proper care and hospitalization of aged or
➢ Handle with caution in giving medication.
geriatric patients.
➢ General check-up/physical examination annually
or whenever needed. Geriatrician - a person who studies the aging process so
➢ Observe any psychological changes. that they can better distinguish which changes result from
➢ Maintain the dignity of elderly aging itself and which indicate a disorder.
Gerontology - study of the aging process, including
physical, mental and social changes. The information is
Principles of Gerontological Nursing Practice
used to develop strategies and programs for improving
the lives of older people.

Jeanne Louise Calment, oldest a person has ever been

recorded to have lived was (Born in February 21, 1875;
Died on August 4, 1997) of France. Calment lived to be
122 years, 164 days old.

Francisca Susano, oldest living person in the Philippines,

aged 124 years old and 6 days.
Born in Kabankalan City, Negros Occidental on Sept. 11,
1897.
Perspective In Aging Chronologic age
Aging is a Developmental Process Chronologic age is based solely on the passage of time.
➢ Aging is a lifelong process and entails maturation The likelihood of developing a health problem increases
and change on physical, psychological, and social as people age, and it is health problems, rather than
levels (Riley, 1978). normal aging, that are the primary cause of functional loss
➢ Aging is a gradual, continuous process of natural during old age.
change that begins in early adulthood. During
early middle age, many bodily functions begin to
gradually decline. Biologic age
➢ Age, much like race, class, and gender, is a
hierarchy in which some categories are more Biological age refers to changes in the body that
highly valued than others. commonly occur as people age.
➢ Each person experiences age-related changes Because these changes affect some people sooner than
based on many factors. others, some people are biologically old at 65, and others
➢ Most people begin to see signs of aging after fifty not until a decade or more later.
years old, when they notice the physical markers
of age.
➢ The difficulty or relative ease with which people Psychological age:
adapt to these changes is dependent in part on the
meaning given to aging by their particular culture. Psychological age is based on how people act and feel.
➢ A culture that values youthfulness and beauty For example, an 80- year-old who works, plans, looks
above all else leads to a negative perception of forward to future events, and participates in many
growing old. activities is considered psychologically young. o
➢ Conversely, a culture that reveres the elderly for
their life experience and wisdom contributes to a
more positive perception of what it means to grow Functional age
old. Functional age is closely related to psychological age.
➢ The effects of aging can feel daunting, sometimes Functional age is an individual's level of capacities
the fear of physical changes (like decline energy, relative to others of his age for functioning in a given
food sensitivity, and loss of hearing and vision) is human society.
more challenging to deal with than the changes
themselves.
➢ The way people perceive physical aging is largely
Social age
dependent on how they were socialized.
➢ If people can accept the challenges in their bodies Social age refers to the roles and social habits of an
as a natural process of aging, the changes will not individual with respect to other members of a society
seem as frightening.
Most people do not need the expertise of a geriatrician
➢ People not become old or elderly at any specific
until they are 70, 75, or even 80 years old.
age.
➢ Tradition Despite the increase in average life expectancy, the
➢ ally, age 65 has been designated as the beginning maximum life span—the oldest age to which people can
of old age, but the reason was based in history, not live—has changed little since records have been kept.
biology. Many years ago, age 65 was chosen as
Madame Jeanne Calment had the longest documented
the age for retirement in germany, the first.
lifespan: 122 years (1875 to 1997).

When a person becomes old can be answered in different

ways:
Several factors influence life expectancy: must plan for the expected growth in the numbers of older
adults, which is likely to increase the demand for services
➢ Heredity
and support for elders and their caregiving families. The
➢ Lifestyle
Philippines’ unique history and rich culture shapes its
➢ Exposure to toxins in the environment
citizens’ views on aging and bolsters expectations of
➢ Health care
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
Demography of Aging and Implications for Health aging citizens.
and Nursing Care
Global Aging & Aging in the Philippines
The country consists of approximately 103 million
inhabitants, with less than 5% of the population 65 years
Global Aging and older. Currently, the age structure of the Philippines
resembles many other developing countries because there
➢ The world’s older population continues to grow at is a greater proportion of younger Filipinos in comparison
an unprecedented rate. to older Filipinos.
➢ Today, 8.5 percent of people worldwide (617
million) are aged 65 and over. Despite the larger number of young Filipinos, the 60
➢ In nearly all regions of the world, the population years and older population of the Philippines is expected
ages 65 and older is growing faster than the total to increase by 4.2%, whereas the 80 years and older
population, challenging existing health services, population is expected to increase by 0.4% from 2010 to
family relationships, social security, and pension 2030.
programs. The Philippines population increased by over 35% over
➢ The World Population Prospects 2019 projects the last two decades with the older adult population (60
that by 2050, older people will make up around years and older) expected to overtake those aged 0–14
16.5% of the total population. years old by 2065.
Currently, life expectancy of Filipinos is 57.4 years for
Life Expectancy in the World males and 63.2 years for females. Females are projected
to expect an increase of 4.0 years in life expectancy and
males an increase of 4.7 years in life expectancy by 2030.
The improvement in life expectancy can be attributed to
advances in public health in the Philippines, which have
eradicated many of the diseases that once caused earlier
mortality in Filipinos. Compared to developed countries,
which have a low fertility rate of about 1.7 children per
woman, there is a high fertility rate of 3.1 children per
woman in the Philippines. Although the dependency ratio
of the Philippines has been steadily decreasing since the
1960s, the nation still contains a greater proportion of
dependents to working-age people when compared to
other Asian countries
Aging in the Philippines
The Philippines is a diverse country that will experience Situation of older people in the philippines
an increase in its aging population in the near future. The
➢ The number of older people is growing
aim of this article is to provide an overview of the main
➢ Older people need care and support
issues surrounding population aging, as well as family
➢ Older people struggle with poverty
caregiving and policies that are of concern to older adults
in the Philippines. Policymakers and government leaders
Impact of Aging Members in the Family situation and ensure the provision of a safe
retirement for their loved ones.
Aging Affects Everyone
➢ Filipino elders’ perceptions of aging are derived
➢ Physical and financial challenges of aging does from the unique life experiences and social units
not just affect the elderly who are facing them first that encompass their lives. These experiences,
hand. either negative or positive, form their views on
➢ Health issues have a tremendous impact on aging and outlook on life. Although older
everyone around elderly such as chronic health Filipinos do acknowledge the physical and
conditions, cognitive and mental health, sensory functional declines that might occur with
impairments and malnutrition. Not only their increasing age, they view aging in a more positive
spouses or partners, but also their extended light due to the respect and dignity that are
families, friends, and communities. attained with maturation.
➢ Many Filipinos view the aging process from
direct interactions with their family members and
older Filipinos in their surrounding community. Physiologic Changes in Aging Affecting Various
➢ Living in multigenerational households and Systems
communities shape perceptions of aging as a
responsibility, due to the establishment of family
roles, adult engagement in the workforce, and Integumentary
➢ family ties.
➢ Many of the older individuals experience a For many people, and particularly for older adults, skin is
decline in their physical and cognitive the most visible indicator of the combined effects of
functioning. This has made them lose the ability biologic aging, lifestyle, and environment.
to live independently, forcing them to seek long- Thus, the skin, hair, and nails have not only physiologic
term care services from institutions like long-stay functions but also many social functions. Physiologically,
hospitals, nursing homes, residential care and the skin directly affects all of the following processes:
assisted living facilities.
➢ Families with older people often carry the burden ➢ Thermoregulation
of caring for these individuals, accumulating ➢ Excretion of metabolic wastes
significant costs when they do. ➢ Protection of underlying structures
➢ In less developed countries where affordable ➢ Synthesis of vitamin D
long-term care facilities are not available, families ➢ Maintenance of fluid and electrolyte balance
with elderly adults withdraw from their ➢ Sensation of pain, touch, pressure, temperature,
employment or school commitments just to care and vibration
for these family members and make ends meet.
They may end up with significant debt due to their
hospitalization, medication maintenance, and AGE-RELATED CHANGES THAT AFFECT THE
home care adjustment costs. SKIN
➢ Impact of having an aging family member often
varies on how well they handle the changes and
demands of day- to-day living. Most families
with a solid economic background and strong
financial support from the government seek long-
term nursing services to care for the elderly.
Unfortunately, this may not apply to families with
fewer resources and unemployed family
members.
➢ Demands of an elderly individual are often
unpredictable and changing. Thus, families
should be prepared for this day to balance the
- The skin is the largest, as well as the most visible, body Beginning around the age of 25 years, the number of
organ. active melanocytes decreases by 10% to 20% each
decade. Although this decline occurs in both sun-exposed
- Structurally, the skin comprises three layers: the
and sunprotected skin, the density of melanocytes in
epidermis, the dermis, and the subcutaneous tissue.
exposed skin is double or triple that in unexposed skin.
- Hair, nails, and sweat glands are also parts of the
With increased age, the number of Langerhans cells,
integumentary system.
which serve as macrophages, also decreases in both sun-
As with many other aspects of functionality, it is difficult exposed and sun-protected skin; the decrease ranges from
to distinguish between changes that are strictly 50% to 70% in sun-exposed skin.
attributable to aging and those that occur because of risk
Another age-related change is a decrease in the moisture
factors. Genetics, lifestyle, and environmental factors
content of the outer epidermal layer.
exert a significant effect on skin throughout the lifespan
and have a cumulative effect in older adults. Papillae give the skin its texture and connect the
epidermis to the underlying dermis. With increased age,
the papillae retract, causing a flattening of the dermal–
Epidermis epidermal junction and diminishing the surface area
between the epidermis and dermis.
This age-related change slows the transfer of nutrients
between the dermis and epidermis. In contrast to other
epidermal changes that are more prominent on exposed
skin surfaces, this change occurs to some degree on all
skin surfaces.

Dermis

- is the relatively impermeable outer layer of skin

- serves as a barrier, preventing both the loss of body
fluids and the entry of substances from environment.
- It’s density varies, depending on the part of the body it
covers.
- The epidermis comprises layers of cells that undergo a
continual cycle of regeneration, cornification, and
shedding.
- Epidermal cells develop in the innermost layer of the
epidermis and continually migrate to the surface of the
skin where they are shed. With increasing age, these cells
The primary functions of the dermis are:
become larger and more variable in shape, and the rate of
epidermal turnover gradually decreases. - Provision of support for structures within and below this
layer
- Nourishment of the epidermis, which has no blood
Melanocytes are epidermal cells that give the skin its
supply of its own Coloration
color and provide a protective barrier against ultraviolet
radiation. - Sensory perception
- Temperature regulation.
Collagen, • the storage of calories
- 80% of the dermis • insulation of the body
- gives elasticity and tensile strength • and regulation of heat loss.
- prevent tearing, overstretching of skin. With increased age, some areas of subcutaneous tissue
atrophy, particularly in the plantar foot surface and in
sun-exposed areas of the hands, face, and lower legs.
Elastin,
This increased body fat is more pronounced in women
- 5% of the dermis, than in men and is most noticeable in the waists of men
and the thighs of women. Age-related changes also affect
- maintains skin tension and allows for stretching in the cutaneous nerves responsible for sensations of
response to movement. pressure, vibration, and light touch.

The dermal ground substance, Sweat and Sebaceous Glands

- which has a water-binding capacity, - Eccrine glands, which are important for
- determines skin turgor and elastic properties. thermoregulation, open directly onto the skin surface and
are most abundant on the palms, soles, and forehead.

Blood vessels
- Apocrine glands are larger than eccrine glands and open
- in the deep plexus - thermoregulation into hair follicles, primarily in the axillae and genital area.
- in the superficial plexus - supply nutrients to the The sole function of these glands is to produce secretions,
epidermal layer. which create a distinctive body odor when they
decompose
- Both eccrine and apocrine glands decrease in number
Cutaneous nerves and functional ability with increased age.
- pain, pressure, temperature, and deep and light touch. - Sebaceous glands are present in the dermal skin layer
over every part of the body except the palms of the hands
and the soles of the feet. These glands continually secrete
Beginning in early adulthood, dermal thickness gradually sebum—a substance that combines with sweat to form an
diminishes, with collagen thinning at a rate of 1% per emulsion.
year.
- Functionally, sebum prevents the loss of water and
Elastin increases in quantity and decreases in quality serves as a mild retardant of bacterial and fungal growth.
because of age-related and environmentally induced The secretion of sebum begins to diminish during the
changes. The dermal vascular bed decreases by third decade, with women having a greater decline than
approximately one-third with increased age; this men. In younger adults, sebum production is closely
contributes to the atrophy and fibrosis of hair bulbs, related to the size of the sebaceous glands; however, in
sweat, and sebaceous glands. Additional agerelated older adults, the sebaceous glands increase in size but
changes in the dermis include a decrease in the number of produce less sebum.
fibroblasts and mast cells.

Nails
Subcutaneous Tissue and Cutaneous Nerves
- Nail growth begins to slow in early adulthood, with a
The subcutis is the inner layer of fat tissue that protects gradual decrease of 30% to 50% over the individual’s
the underlying tissues from trauma. Additional functions lifespan.
include:
- Other age-related changes affecting the nails include the radiation. Collagen changes also interfere with the tensile
development of longitudinal striations and a decrease in strength of the skin, causing it to be less resilient and
lunula size and nail plate thickness. more susceptible to damage from abrasive or tearing
forces. In addition to advanced age, risk factors
- The nails become increasingly soft, fragile, and brittle
associated with skin tears include immobility;
and are more prone to splitting. In appearance, the older
polypharmacy; poor nutrition; and sensory, cognitive, or
nail is dull, opaque, longitudinally striated, and yellow or
functional impairment (LeBlanc & Baranoski, 2009).
gray.

Response to Ultraviolet Radiation

Hair
The age-related decrease in melanocytes causes older
- The most noticeable changes being baldness and gray
adults to tan less deeply and more slowly when exposed
hair. By the age of 50 years, approximately 50% of people
to ultraviolet radiation, and the increased variability in
have graying hair and approximately 60% of white men
melanocyte density in exposed and unexposed skin may
have a noticeable degree of baldness.
cause a mottled and irregular appearance in the skin’s
- Graying of the hair results from a decline in melanin overall pigmentation.
production and the gradual replacement of pigmented
A positive functional consequence of age-related
hairs by nonpigmented ones.
melanocyte changes is a decrease in the occurrence of
- Patches of coarse terminal hair developing over the moles beginning around the fourth decade.
upper lip and lower face in older women and in the ears,
Increased incidence of skin cancers in older adults. Other
nares, and eyebrows of older men.
factors that increase the susceptibility of older adults to
- Progressive loss of body hair, initially in the trunk, then skin cancers are increased age, decreased number of
in the pubic area and axillae. Langerhans cells, and cumulative exposure to ultraviolet
radiation.
- In addition, some men are genetically predisposed to
baldness, which is attributable to a change in production
from coarse terminal hair to fine vellus hair.
Comfort and Sensation
Dry skin is one of the most universal complaints of older
FUNCTIONAL CONSEQUENCES AFFECTING adults; indeed, it has been observed in up to 85% of
SKIN WELLNESS noninstitutionalized older people.

Susceptibility to Injury Age-related changes, such as diminished output of sebum

and eccrine sweat, contribute to a decrease in the moisture
•Progressive degenerative changes of the skin combine content of the skin.
with the effects of long-term exposure to the sun and
other detrimental environmental conditions to increase Risk factors that may contribute to dry skin include stress,
the susceptibility of older adults to skin disorders such as smoking, sun exposure, dry environments, excessive
skin tears, pressure ulcers, stasis dermatitis, autoimmune perspiration, adverse medication reactions, excessive use
skin conditions, and drug reactions (Farage, 2009). of soap, and certain medical conditions (e.g.,
hypothyroidism)
•In addition, skin lesions often develop, as discussed in
the sections on Skin Cancer and Assessment. Tactile sensitivity begins to decline around the age of 20
years, eventually causing older adults to have a
•Because of the flattened dermal–epidermal junction, diminished and less intense response to cutaneous
older skin more susceptible to bruises, tearing and shear- sensations. This decline is attributable, at least in part, to
type injuries. age-related changes in Pacinian and Meissner’s
•The age-related decrease in dermal thickness compounds corpuscles, which are the skin receptors
the effects of the flattened dermal–epidermal junction,
further increasing the susceptibility of older skin to injury
and the effects of mechanical stress and ultraviolet
Thermoregulation is also affected by age-related is the age-related change that has the most significant
reductions in eccrine sweat, subcutaneous fat, and dermal overall impact, has been studied the most, and is most
blood supply. These age-related changes interfere with amenable to interventions aimed at prevention and
sweating, shivering, peripheral vasoconstriction and management.
vasodilation, and insulation against adverse
environmental temperatures. Thus, older adults are more
at risk for the development of hypothermia and heat- Bones
related illnesses.
Bones provide the framework for the
entire musculoskeletal system and work in conjunction
Cosmetic Effects with the muscular system to facilitate movement.
The overall cosmetic effect of age-related skin changes is Additional functions of bone in
that the skin looks paler, thinner, more translucent, and is
irregularly pigmented. •storing calcium,

•Additional indicators of age-related skin changes •producing blood cells,

include: •and supporting and protecting body organs and tissues.
• sagging,
•wrinkling, Bone growth reaches maturity in early adulthood, but
•and various growths and lesions. bone remodeling continues throughout one’s lifetime.
The following age-related changes affect this remodeling
process in all older adults:
Musculoskeletal •Increased bone resorption (i.e., breakdown of bone that
is necessary for remodeling)
Mobility is one of the most important aspects of
physiologic function because it is essential for •Diminished calcium absorption
maintaining independence and because serious
consequences occur when independence is lost. For older •Increased serum parathyroid hormone
adults, mobility is influenced by age-related changes to •Impaired regulation of osteoblast activity
some extent, but risk factors play a much larger role.
Because of the many risks that affect mobility, falls and •Impaired bone formation secondary to reduced
fractures are an unfortunately common occurrence in old osteoblastic production of bone matrix
age. Older adults, then, have the dual challenge of •Fewer functional marrow cells due to replacement of
maintaining mobility skills and avoiding falls and marrow with fat cells
fractures. For these reasons, safety is an integral aspect of
mobility. •Decreased estrogen in women and testosterone in men.

AGE-RELATED CHANGES THAT AFFECT Muscles

MOBILITY AND SAFETY Skeletal muscles, which are controlled by motor neurons,
The bones, joints, and muscles are the body structures directly affect all activities of daily living (ADLs). Age-
most closely associated with mobility, but many related changes that have the greatest impact on muscle
additional functional function include

aspects are involved in safe mobility. Neurologic - Decreased size and number of muscle fibers
function, for example, influences all facets of - Loss of motor neurons
musculoskeletal performance, and visual function
influences the ability to interact safely with the - Replacement of muscle tissue by connective tissue and,
environment. In the musculoskeletal system, osteoporosis eventually, by fat tissue
- Deterioration of muscle cell membranes and a skill affected by the following age-related changes of the
subsequent escape of fluid and potassium nervous system: altered visual abilities; a decline in the
righting reflex; impaired proprioception, particularly in
- Diminished protein synthesis
women; and diminished vibratory sensation and joint
The overall effect of these age-related changes is a position sense in the lower extremities. In addition, age-
condition called sarcopenia, which is a loss of muscle related changes in postural control cause an increase in
mass, strength, and endurance. body sway, which is a measure of the motion of the body
while standing. Finally, because of the age-related
slowing in reaction time, older adults walk more slowly
Joints and Connective Tissue and are less able to respond in a timely manner to
environmental stimuli. Researchers have found that older
Numerous age-related changes affect the function of all adults can learn to compensate for age related changes in
musculoskeletal joints, including non–weight-bearing the central nervous system to avoid falls (Doumas, Rapp,
joints. & Krampe, 2009).
In contrast to the bones or muscles, which benefit from
exercise, the joints are harmed by continued use and
begin to show the effects of wear and tear during early Osteopenia and Osteoporosis
adulthood. In fact, degenerative processes begin to affect Loss of bone mass is an age-related change that affects all
the tendons, ligaments, and synovial fluid during early adults as they age.
adulthood, even before skeletal maturity is reached.
Because of the widespread availability of simple imaging
Some of the most significant age-related joint changes techniques, called bone densitometry, in recent years,
include the following: bone mass density is now routinely evaluated in adults
● Diminished viscosity of synovial fluid beginning around their 6th decade.

● Degeneration of collagen and elastin cells

● Fragmentation of fibrous structures in connective tissue When a T-score is between 1 and 2.5 standard deviations
below this range, the condition is called osteopenia; when
● Outgrowths of cartilaginous clusters because of a T-score is lower than this, the condition is called
continuous wear and tear osteoporosis.
● Formation of scar tissue and areas of calcification in the Osteoporosis is usually asymptomatic; however, it can
joint capsules and connective tissue cause pain, loss of height, dowager’s hump, and increased
● Degenerative changes in the articular cartilage resulting risk of fractures. In addition to being diagnosed according
in extensive fraying, cracking, and shredding, in addition to bone densitometry scores, osteoporosis is diagnosed
to a pitted and thinned surface. when a fracture occurs in the absence of trauma.

Consequences of these changes include impaired flexion Prevalence of osteoporosis increases with age, with 6% at
and extension, decreased flexibility of the fibrous the age of 50 years and 50% after the age of 80 years
structures, diminished protection from forces of (Rahmani & Morin, 2009).
movement, erosion of the bones underlying the Although osteoporosis has been recognized as a common
outgrowths of cartilage, and diminished ability of the condition among postmenopausal women for many
connective tissue to transmit the tensile forces that act on decades, only in recent decades has it been recognized as
it. a condition that affects men too.

Nervous System •Both men and women reach peak bone mass in their mid-
Maintenance of balance in an upright position is a 30s, but there are significant differences in patterns of
complex bone loss between men and women.
•Women have a period of bone mass stability between Joint function begins to decline during early adulthood
peak level and the onset of menopause, when declining and progresses gradually to cause the following changes
estrogen levels significantly affect bone mass. During the in range of motion:
first decade after the onset of menopause, the annual rate
● Decreased range of motion in the upper arms
of bone loss may be as great as 7%, but after menopause,
it is between 1% and 2%. ● Decreased lower back flexion
•By contrast, the annual rate of bone loss in men is only ● Decreased external rotation of the hip
about 1% after peak bone mass has been reached. In
summary, osteoporosis occurs in both men and women, ● Decreased hip and knee flexion
but women have a much greater percentage of bone loss ● Decreased dorsiflexion of the foot.
over their lifetime and experience greater bone loss at an
earlier age.
Susceptibility to Falls and Fractures

FUNCTIONAL CONSEQUENCES AFFECTING The combination of age-related changes and multiple

MUSCULOSKELETAL WELLNESS interacting risk factors doubly jeopardizes older adults by
increasing the probability of both falls and fractures.
Older adults can partially compensate for age-related
changes that affect musculoskeletal function through Fractures are not unique to older adults, but they do differ
health promotion interventions, such as good nutrition in many respects from those that occur in younger
and physical activity. populations. First, bones of older adults can be fractured
with little or no trauma, whereas bones of healthy
The functional consequences of osteoporosis, however, children and younger adults are usually fractured in
are quite serious, as are the functional consequences that response to a forceful impact.
result from the many risk factors that contribute to falls
and fractures in older adults. As with many other aspects
of function in older adulthood, cumulative and interacting Fear of Falling
effects of risk factors rather than age-related changes
most significantly affect function and quality of life. Since the early 1980s, gerontologists have recognized a
syndrome associated with increased anxiety about falling.
The phrase post-fall syndrome was initially used to
Effects on Musculoskeletal Function describe a distinct gait pattern adopted by older people
who have fallen and been admitted to the hospital for
•Muscle strength, endurance, and coordination are post-fall injuries (Murphy & Isaacs, 1982).
affected to some extent by age-related changes, even in
the absence of risk factors. In recent years, there has been much research on fear of
falling, which is the most common reported fear among
•Beginning around the age of 40 years, muscle strength older adults and has been identified as a public health
declines gradually, resulting in an overall decrease of problem that is of equal importance to falls
30% to 50% by the age of 80 years, with a greater decline
in muscle strength in the lower extremities than in the Studies have found that fear of falling is associated with
upper extremities. older age, depression, previous falls, use of walking aids,
balance impairment, and limitations in ADLs (Sharaf &
•Diminished muscle strength is attributed primarily to Ibrahim, 2008; Kempen et al., 2009).
age-related loss of muscle mass. In addition, a person’s
current level of activity and lifelong patterns of exercise Although fear of falling can have a protective effect when
can influence muscle strength at any age. it causes older adults to take precautions, studies indicate
that excessive concerns about falls leads to activity
•Muscle endurance and coordination diminish as a result limitations and alterations in gait that actually decrease
of age related changes in the muscles and central nervous walking stability and can increase falls risk (Delbaere,
system. Because of these changes, older adults Sturnieks, Crombez, & Lord, 2009).
experience muscle fatigue after shorter periods of
exercise compared with their younger counterparts.
Studies have also found that fear of falling leads to Even under stressful conditions, the heart in healthy older
depression, increased anxiety, functional limitations, and adults is able to adapt, but the adaptive mechanisms may
decreased quality of life (Boyd & Stevens, 2009; Iglesias, differ from those of younger adults or be slightly less
Manca, & Torgerson, 2009; Schmid et al., 2009). efficient.
Include:
Cardiovascular Amyloid deposits, lipofuscin accumulation, basophilic
degeneration, mycocardial atrophy or hypertrophy,
The cardiovascular system:
valvular thickening and stiffening, and increased amounts
Maintain homeostasis by, of connective tissue.

➢ Bringing oxygen and nutrients to organs and Thickening of the atrial endocardium, thickening of the
tissues atrio-ventricular valves, and calcification of at least part
➢ Transport carbon dioxide and other waste of the mitral annulus of the aortic valve.
products to other body systems for removal
Changes result in:
Interfere with the ability of the heart to contract
completely = more time is required to complete the cycle
of diastolic filling and systolic emptying
Less responsive to impulses from sympathetic nervous
system

NEUROCONDUCTION MECHANISM
Include:
Decrease in the number of pacemaker cells
Increased irregularity in the shape of pacemaker cells
Increased deposits of fat, collagen, and elastic fibers
AGE-RELATED CHANGES THAT AFFECT around the sinoatrial node.
CARDIOVASCULAR FUNCTION
It is difficult to determine whether cardiovascular VASCULATURE
changes are attributable to normal aging or other factors.
Age-related changes affect two of the three vascular
Why? layers, and functional consequences vary, depending on
No technology to detect asymptomatic pathologic which layer is affected.
cardiovascular processes Example:
Currently, many studies of age- related changes are Changes in tunica intima = atherosclerosis
longitudinal and include subjects who have been
carefully screened for asymptomatic cardiovascular Changes in tunica media = hypertension
disease
Tunica externa does not seem to be affected by age-
related changes

MYOCARDIUM & NEUROCONDUCTION CHANGES IN TUNICA INTIMA WITH

MECHANISM INCREASING AGE

Age-related changes in cardiac physiology are minimal. Thickens because of fibrosis, cellular proliferation, and
lipid and calcium accumulation, the endothelial cells
become irregular in size and shape.
Changes result in: RISK FACTORS THAT AFFECT
CARDIOVASCULAR FUNCTION
arteries to dilate and elongate which causes the arterial
walls to be more vulnerable to atherosclerosis Many factors affect cardiovascular function by increasing
the risk for heart disease.
CHANGES IN TUNICA MEDIA WITH
INCREASING AGE RISK FACTORS:
Increase in collagen and a thinning and calcification of Stress, Weight, Lipids, Diabetes, Blood pressure,
elastin fibers, resulting in stiffened blood vessels. Physical activity, smoking cessation, inadequate intake of
fruit and vegetable, and excessive alcohol consumption
Changes result in:
Others: age, race, gender, heredity
Particularly pronounced in the aorta, where the diameter
of the lumen increases to compensate for the age-related Psychosocial and socioeconomic
arterial stiffening
Increased peripheral resistance, impaired baroreceptor
FUNCTIONAL CONSEQUENCES AFFECTING
function, diminished ability to increase blood flow to
CARDIOVASCULAR WELLNESS
organs.
Healthy older adults:
Changes result in:
No significant cardiovascular effects when at rest
Veins
Cardiovascular function is less efficient when engage in
➢ Undergo similar changes but to lesser degree
exercise
➢ Thicker, more dilated, and less elastic.
➢ Valves less effective in returning blood to heart, Older adults who have risk factor for cardiovascular
Further influenced by reduction in muscle mass disease
and concurrent reduction demand for oxygen
Experience negative functional consequences associated
with pathologic process
BAROREFLEX MECHANISMS
Definition: EFFECTS ON CARDIAC FUNCTION
Physiologic process that regulate blood pressure by Cardiac output is an important measure of cardiac
increasing or decreasing the HR and peripheral vascular performance,
resistance to compensate for transient decreases or
increases in arterial pressure. reduced in cardiac output although common in older adult
is associated primarily with pathologic conditions than
age related changes.
CHANGES IN BAROREFLEX MECHANISM Except, older women has slight decrease in CO at rest.
WITH INCREASING AGE Healthy older adults do not experience decline in CO..
Include:
Arterial stiffening and reduced cardiovascular EFFECTS ON PULSE AND BLOOD PRESSURE
responsiveness to adrenergic stimulation.
Normal pulse rate for healthy older adults is slightly
Changes result in: lower
Blunting of the compensatory response to both Older adults are likely to have harmless ventricular and
hypertensive and hypotensive stimuli in older adults, so supraventricular arrhythmias (age-related)
the heart rate does not increase or decrease as efficiently
as in younger adults. Atrial fibrillation –commonly occurs in older adult but is
associated with pathologic condition rather than age-
related changes.
In terms of blood pressure, there is an age-related linear UPPER RESPIRATORY STRUCTURES
increase in systolic BP from age 30-40, and there is also
Age-related changes of the upper respiratory structures
a progressive decrease in diastolic pressure from age 50
can influence both comfort and function
years
With increasing age:
Upper airways changes occurs such as calcification of
EFFECTS ON THE RESPONSE OF EXERCISE
cartilage, which causes the trachea to stiffen
A negative functional consequence that affects
CHEST WALL AND MUSCULOSKELETAL
cardiovascular performance in healthy older adults is a
STRUCTURES
blunted adaptive response to physical exercise.
With increasing age:
4 to 5 x increase in basal demands on cardiovascular
system ➢ the ribs and vertebrae become osteoporotic
➢ the costal cartilage calcifies
Adaptive response involves:
➢ and the respiratory muscles weaken.
Respiratory, cardiovascular, musculoskeletal, and
Changes results in:
autonomic nervous systems
➢ Diminished respiratory efficiency
➢ Reduced maximal inspiratory and expiratory
EFFECTS ON CIRCULATION force.
Functional consequences also can affect circulation to the
brain and the lower extremities.
LUNG STRUCTURE AND FUNCTION
Older adults are prone to developing stasis edema of the
With increaing age:
feet and ankles, and they are more likely to develop
venous stasis ulcers Lungs become smaller and flabbier and their weight
diminishes by approximately 20%
Air volumes are altered because of the age- related
PATHOLOGIC CONDITION AFFECTING
changes in the chest wall and in lung elastic recoil.
CARDIOVASCULAR SYSTEM
Gas exchange is more likely to be compromised in the
Orthostatic and postprandial hypotension
lower, rather than the upper, lung regions.

PHYSIOLOGIC CHANGES IN AGING

AFFECTING VARIOUS SYSTEM
Respiratory
The primary functions of respiration are to supply oxygen
to and remove carbon dioxide from the blood. Adequate
respiratory performance is essential to life
AGE-RELATED CHANGES THAT AFFECT
RESPIRATORY FUNCTION
RISK FACTORS THAT AFFECT RESPIRATORY
➢ As with other physiologic functions, it is difficult WELLNESS
to distinguish the effects of age-related changes
from those caused by disease processes and ➢ Tobacco use
external influences ➢ Secondhand smoke and other environmental
factors
➢ Compromised respiratory function (frailty,
diminished functional status, or serious illnesses,
 that further compromise their body’s ability to Oral Cavity
defend against respiratory infections
Age-related changes of the oral mucosa include loss of
elasticity, atrophy of epithelial cells, and diminished
blood supply to the connective tissue
FUNCTIONAL CONSEQUENCES AFFECTING
RESPIRATORY WELLNESS Age-related neuromuscular changes that can affect
mastication and swallowing include diminished muscle
In the absence of smoking and other risk factors:
strength and reduced tongue pressure
Healthy older adults:
Esophagus and Stomach
➢ Do not experience any significant functional
➢ Esophagus and Stomach The second phase of
consequences rt respiratory function when
digestion occurs when a combination of
performing ordinary activities
propulsive and non propulsive waves propels food
through the pharynx and esophagus into the
stomach.
When under conditions of physical stress: ➢ Presbyphagia refers to the slowed swallowing that
Older adults may experience dyspnea and fatigue due to is associated with age-related changes and can
less efficient in gas exchange increase the risk for aspiration

Older adults who smoke:

Experience the negative consequences but the effects are Intestinal Tract
cumulative and the consequences are likely to be more Age-related changes that occur in the small intestine
serious include atrophy of muscle fibers and mucosal surfaces;
reduction in the number of lymphatic follicles

PHYSIOLOGIC CHANGES IN AGING Liver, Pancreas, and Gallbladder

AFFECTING VARIOUS SYSTEM Liver, Pancreas, and Gallbladder The liver assists in
Gastrointestinal digestion by producing and secreting bile, which is
essential for the utilization of fats. It also plays an
Digestion of food and maintenance of nutrition are important role in the metabolism and storage of
influenced to a small degree by age-related medications and nutrients.
gastrointestinal changes and to a large degree by risk
factors that commonly occur in older adulthood. These age-related changes can increase the susceptibility
Although older adults can easily compensate for age- of older adults to the development of cholelithiasis
related changes in the digestive tract, they have more (gallstones). In addition, a higher level of cholecystokinin
difficulty compensating for the many factors that can suppress the appetite.
interfere with their ability to obtain, prepare, and enjoy FUNCTIONAL CONSEQUENCES AFFECTING
food. DIGESTION AND NUTRITION
AGE- RELATED CHANGES THAT AFFECT Ability to Procure, Prepare, and Enjoy Food
DIGESTION AND EATING PATTERNS
Ability to Procure, Prepare, and Enjoy Food Activities
Smell and Taste involved in procuring, preparing, consuming, and
Both senses, taste and smell, affect food enjoyment, and enjoying food depend on the skills of cognition, balance,
both these senses decline in older adults because of a mobility, and manual dexterity, as well as on the five
combination of age-related changes and risk factors. senses.

Additional conditions that can interfere with olfaction Ability to Procure, Prepare, and Enjoy Food
include smoking or chewing tobacco, viruses, Ability to Procure, Prepare, and Enjoy Food Activities
neurodegenerative diseases, poor oral health, periodontal involved in procuring, preparing, consuming, and
disease, nasal sinus disease, trauma, and medications enjoying food depend on the skills of cognition, balance,
mobility, and manual dexterity, as well as on the five Biologic Theories of Aging
senses.
Cultural and Socioeconomic Factors
Immunologic Theory
Ethnic background, religious beliefs, and other cultural
factors strongly influence the way people define, select, ➢ The immune system is a network of specialized
prepare, and eat food and beverages. Cultural factors also cells, tissues, and organs that provide the body
can influence eating patterns and selection of food in with protection against invading organisms. Its
relation to health status primary role is to differentiate self from nonself,
thereby protecting the organism from attack by
Psychosocial Factors pathogens.
➢ It has been found that as a person ages, the
Psychosocial factors are likely to affect an older person’s
immune system functions less effectively. The
appetite and eating patterns. Any changes in mealtime
term immunosenescence has been given to this
companionship, as may occur through loss or disability of
age-related decrease in function.
a spouse, are likely to have a negative impact on eating
patterns
Environmental Factors
Environmental factors affect the enjoyment of food and
the ability to obtain and prepare it. Many barriers to food
enjoyment have been identified in the dining
environments of longterm care facilities and other
institutional settings

Hematopoietic
Hematopoiesis: The production of all types of blood cells IMMUNOLOGIC THEORY
including formation, development, and differentiation of Essential components of the immune system:
blood cells. Prenatally, hematopoiesis occurs in the yolk
sack, then in the liver, and lastly in the bone marrow. ➢ B lymphocytes, the antibodies responsible for
humoral immunity.
Aging Hematopoiesis ➢ T lymphocytes, which are responsible for cell-
•One of the more notable age-related changes is mediated immunity.
hematopoietic and specifically immunological decline The changes that occur with aging are most apparent in T
•Maintaining the health of the growing elderly population lymphocytes, although changes also occur in the
is limited by the associated decline in immune function, functioning capabilities of B lymphocytes.
impairing responses to pathogens and reducing Changes in Cell-Mediated Immune Function
vaccination efficacy. Secondary to Aging
•Decreased immune function is not compartmentalized; ➢ Increase in autoantibodies because of altered
reduced immune cell function (and in some cases cell immune system regulation
numbers) has been observed in both the myeloid and ➢ Low rate of T-lymphocyte proliferation in
lymphoid lineages response to a stimulus
➢ Reduced response to foreign materials, resulting
in an increased number of infections.
➢ Generalized T-lymphocyte dysfunctions, which
reduce the response to certain viral antigens,
allografts, and tumor cells
These changes include a decrease in humoral immune
response, often predisposing older adults to have:
1. decreased resistance to a tumor cell challenge and
the development of cancer
2. decreased ability to initiate the immune process
and mobilize the body’s defenses against
aggressively attacking pathogens
3. heightened production of autoantigens, often
leading to an increase in autoimmune related
diseases.
Reactive oxygen species (ROS) serve as cell signaling
molecules for normal biologic processes. However, the
Mitochondrial Free Radical Theory generation of ROS can also provoke damage to multiple
Free Radicals cellular organelles and processes, which can ultimately
disrupt normal physiology.
Free radicals are byproducts of fundamental metabolic
activity within the body.
Lipofuscin

Lipid Peroxidation ➢ A lipid and protein enriched pigmented material,

found to accumulate on older adults’ tissue
is oxidative damage that affects cellular membranes, ➢ “Age spots”
lipoproteins, and other molecules that contain lipids in
conditions with oxidative stress. ... Lipid peroxidation is
a chain reaction and is created by free radicals influencing Neutralization of Free Radicals
unsaturated fatty acids in cell membranes, leading to their
damage. Natural antioxidants
➢ Vitamin C
➢ Vitamin E
Antioxidant Medicine
➢ Harman was the first to suggest about the
administration of chemicals terminating the
propagation of free radicals

Cross-Linkage Theory
➢ The cross-linkage theory of aging hypothesizes
that with age, some proteins become increasingly
Free Radicals cross-linked or enmeshed and may impede
metabolic processes by obstructing the passage of
Causes of free radical increased production:
nutrients and wastes between the intracellular and
➢ Ozone extracellular compartments. According to this
➢ Pesticides theory, normally separated molecular structures
➢ Radiation are bound together through chemical reactions.
➢ This primarily involves collagen, which is a
relatively inert long-chain macromolecule
produced by fibroblasts. As new fibers are
 created, they become enmeshed with old fibers
and form an actual chemical cross-link. The result
of this cross-linkage process is an increase in the
density of the collagen molecule but a decrease in
its capacity to both transport nutrients to the cells
and remove waste products from the cells.
➢ Cross-linkage theory proposes that as a person
ages and the immune system becomes less
efficient, the body’s defense mechanism cannot
remove the cross-linking agent before it becomes
securely established. Cross-linkage has been
proposed as a primary cause of arteriosclerosis,
decrease in the efficiency of the immune system,
and the loss of elasticity often seen in older adult
skin.
This 1961 study found that unlimited cell division did not
occur; the immortality of individual cells was found to be
more an abnormal occurrence than a normal one.
Hayflick Limit Theory
Based on the conclusions of this experiment, the Hayflick
➢ Hayflick and Moorehead’s study showed that Limit Theory is sometimes called the “Biologic Clock
functional changes do occur within cells and are Theory,” “Cellular Aging Theory,” or “Genetic Theory.
responsible for the aging of the cells and the
organism. The study further supported the
hypothesis that a cumulative effect of improper
IMPLICATIONS
functioning of cells and eventual loss of cells in
organs and tissues are therefore responsible for Among biologic theories of aging, two concepts have
the aging phenomenon. gained wide acceptance:
1. The limited replicative capacity of certain cells
causes overexpression of damaged genes and
oxidative damage to cells.
2. Free radicals may cause damage to cells over
time.
Based on these concepts, gerontologic nurses can
promote the health of older adult patients in many
ways.
➢ Cigarette smoking causes increased cell turnover
in the oral cavity, bronchial tree, and alveoli.
Smoking also introduces carcinogens into the
body, which may result in an increased rate of cell
damage that can lead to cancer.
➢ Excessive exposure to ultraviolet light is another
example of a substance causing rapid turnover of
cells, which may lead to mutations and ultimately
malignancies.
➢ To reduce free radical damage, nurses can also
advise patients to ingest a varied, nutritious diet
using the food pyramid as a guide and suggest
supplementation with antioxidants such as
vitamins C and E (Goldstein, 1993).
 ➢ Daily routines need to incorporate opportunities Social Aging
that capitalize on existing abilities, strengthen
• Social aging refers to changes in a person’s roles and
muscles, and prevent further atrophy of muscles
relationships, both within their networks of relatives and
from disuse.
friends and in formal organizations such as the workplace
➢ Performing activities of daily living (ADLs)
and houses of worship.
requires the functional use of extremities.
➢ Daily exercises that enhance upper arm strength • Social aging differ from one individual to another.
and hand dexterity contribute to older adults’
ability to successfully perform dressing and • If a society views aging positively, the social aging
grooming activities. experienced by individuals in that society will be more
➢ Even chair-based activities such as deep breathing positive and enjoyable than in a society that views aging
increase the oxygen flow to the brain, thereby negatively.
promoting clear mental cognition, minimizing • One of the easiest ways to view Sociological Theory is
dizziness, and increasing stamina with activity. to view them with the context of their social value in
➢ Encouraging older adults to participate in daily which where they were developed
walking, even on a limited basis, facilitates
peripheral circulation and promotes the
development of collateral circulation. Activity Theory
➢ Walking also helps with weight control, which
often becomes a problem in older adults. • This theory proposes that activity is necessary for
➢ Encouraging preventive measures such as annual successful aging.
influenza vaccination or a one-time inoculation • Active participation in physical and mental activities
with the pneumococcal vaccine is essential to helps maintain functioning well into old age.
providing a high-quality life experience for the
older population. • Purposeful activities and interactions that promote self-
➢ Teaching the basic techniques of relaxation, esteem improve overall satisfaction with life, even at the
guided imagery, visualization, distraction, and older age.
music therapy facilitate a sense of control over • The continuation of activities performed during middle
potential stress-producing situations. age is necessary for successful aging.
➢ Additional options, including heat or cold
application, therapeutic touch, and massage Explores the effect of physical and social Activity in the
therapy, could be explored. process of aging.
It is Also known as :

Sociologic Theories of Aging ➢ Implicit Theory

➢ Normal Theory
➢ Lay Theory
➢ Move to life Theory
Robert J. Havighurst. 1961
➢ American Gerontologist
➢ Developed Activity theory
Emphasizes:
The importance of maintaining Social Activities.
The theory suggests that “A person's self Identity is
heavily dependent on the role played by the person and
the social groups that the person interacts with, hence the
more social an individual is the better his or her sense of
self esteem and satisfaction of life.”.
Establishing new Roles and Group ➢ The theory distinguishes normal aging from
pathological aging, neglecting the older adults
Lost Groups and roles can be replaced however engaging
with chronic illness.
on activity for the sake of interaction is detrimental.
➢ The feminist theories criticise the continuity
One should doing things that can brings satisfaction and theory for defining normal aging around a male
enjoyment, for example: model
➢ Another weakness of the theory is that it fails to
➢ Senior citizens who misses being parents can join demonstrate how social institutions impact the
charity organizations that helps youth. individuals and the way they age
➢ Artistic adults can partake in Painting, Sketching
and Drawing.
➢ Senior Citizens who misses office works can
Age Stratification Theory
apply or volunteer on the Town Hall.
Age stratification is developed by Matilda White Riley
and her associates (most notably John Riley and Anne
Critiques of the Active theory of Aging Foner) since the early 1970s is arguably the most cited
and used approach in the aging literature.
➢ The primary critique of Havighurst’s theory is
that it overlooks inequality. Not every aging adult ➢ This theory views the aging person as an
has the same health status. individual element of society and also as a
➢ here may be economic factors which inhibit an member, with peers, interacting in a social
individual’s ability to pursue relationships or process.
engage in preferred activities. ➢ The theory attempts to explain the
➢ Some older adults may also derive satisfaction interdependence between older adults and society
from their ability to no longer pursue a new and how they are constantly influencing each
challenge. other in a variety of ways

ContinuityTheory Riley (1985) identifies the five major concepts of this

theory:
➢ The continuity theory of normal aging states that
older adults will usually maintain the same 1. Each individual progresses through society in
activities, behaviors, personality traits, and groups of cohorts that are collectively aging
relationships as they did in their earlier years of socially, biologically, and psychologically.
life. 2. New cohorts are continually being born, and each
➢ Continuity is a subject phenomenon and can be of them experiences their own unique sense of
internal or external history.
➢ Robert Atchley 3. Society itself can be divided into various strata
according to the parameters of age and roles.
Internal Structures: (of an individual) remain relatively 4. Not only are people and roles within every
constant throughout a person’s lifetime and includes stratum continuously changing, but so is society
elements such as personality traits, ideas, and beliefs. at large.
External Structures: (of an individual) consist of 5. The interaction between individual aging people
relationships and social roles, and support the and the entire society is not stagnant but remains
maintenance of a stable self-concept and lifestyle. dynamic.

Continuity emphasizes that personally plays a major role

in adjustment to aging and that adult development is a Person-Environment Fit Theory
continuous process
Person-environment fit theory Lawton (1982)
Criticisms and weaknesses
Individuals have personal competencies that assists in
dealing with the environment:
- Ego strength ➢ Abraham Harold Maslow
➢ April 1,1908- June 8, 1970
- Level of motor skills
➢ American psychologist & philosopher best known
- individual biologic health for his self-actualization theory

- cognitive and sensory- perceptual capacities Everyone has an innate internal hierarchy of needs
that motivate all human behaviors (Maslow, 1954).
As a person ages, there may be changes or even decreases
in some of these personal competencies ➢ human needs have different orders of priority.
➢ human needs are often depicted as a “pyramid”,
This theory proposes that, as a individual ages, the with the most elemental needs at the base.
environment becomes more threatening and one may be
incompetent dealing with it.
And this theory explain why an older person might feel
inhibited and may retreat from society.

Implications for Nursing

Nursing Implication
It is important that all adults cannot be grouped
collectively as just one segment of population.
Withdrawal of older adult may be manifestations of
deeper problems such as, Depression.
Older may refuse to engage in particular because of “Fear
of Failure” and the frustration of not able to perform
activity.
Examining the past and being aware of significant events
the health care provider can develop a deeper
understanding of “why” a particular adult act on a way.

Psychological Theories of Aging

Maslow’s Hierarchy of Human Needs
➢ Developed by psychologist Abraham Maslow
➢ Believed that our behavior is driven by needs
➢ Needs are pursued in hierarchical fashion
➢ Pursuit of higher level needs is contingent upon Maslow’s fully developed, self-actualized person
lower level needs being met. displays high levels of all the following characteristics:
(Maslow, 1968)
➢ perception of reality
➢ acceptance of self, others, and nature
➢ spontaneity
➢ problem solving ability
➢ self-direction
➢ detachment and the desire for privacy
➢ freshness of peak experiences
➢ ➢ identification with other human beings
 ➢ satisfying and changing relationships with other
people
➢ a democratic character structure
➢ creativity
➢ sense of values

Jung’s Theory of Individualism

➢ Carl Gustav Jung
➢ Born on July 26, 1875, at Kesswil, Switzerland
➢ Died on June 6, 1961, at the of (aged 85)
➢ at Switzerland
Jung proposed and developed the concepts of the: Jungian Archetypes

➢ Extroverted and the Introverted Personality ➢ Archetypes are universal, inborn models of
➢ Archetypes and the Collective unconscious people, behaviors, or personalities that play a role
➢ His work has been influential in psychiatry and in in influencing human behavior.
the study of religion, literature and related fields. ➢ They were introduced by the Swiss psychiatrist
Carl Jung, who suggested that these archetypes
were archaic forms of innate human knowledge
Extroverted vs. Introverted passed down from our ancestors

Anima and Animus

➢ The contrasexual aspect of a person's psyche. In a
woman's psyche, her inner personal masculine is
conceived both as a complex and an archetypal
image, comparably in a man's psyche, his inner
personal feminine is conceived both as a complex
and an archetypal image.
Shadow
➢ The repressed, therefore unknown, aspects of the
personality including those often considered to be
negative.

The Persona
➢ element of the personality that arises "for reasons
of adaptation or personal convenience" – the
"masks" one puts on in various situations.

The Self
➢ The central overarching concept governing the
individuation process, as symbolised by
Jungian Archetypes
mandalas, the union of male and female, totality,
 unity. Jung viewed it as the psyche's central The Personal Unconscious
archetype.
The analytic psychology of Carl Jung , the portion of each
individual's unconscious that contains the elements of his
or her own experience as opposed to the collective
Other Archetypes
unconscious, which contains the archetypes universal to
The following are just a few of the various archetypes that humankind.
Jung described:
The father: Authority figure; stern; powerful
The collective Unconscious
The mother: Nurturing; comforting
The collective unconscious is a concept originally
The child: Longing for innocence; rebirth; salvation defined by psychoanalyst Carl Jung. Sometimes referred
to as the "objective psyche," it refers to the idea that a
The wise old man: Guidance; knowledge; wisdom segment of the deepest unconscious mind is genetically
The hero: Champion; defender; rescuer inherited and is not shaped by personal experience.

The maiden: Innocence; desire; purity

The trickster: Deceiver; liar; trouble-maker

3 Levels of Consciousness
The three main ones were the ego, the personal
unconscious, and the collective unconscious.

Erikson’s Eight Stages of Life

Psychosocial development
Erik Erikson (1902–1996) was trained in psychoanalytic
theory but later developed his own theory of psychosocial
development
A theory that stresses the importance of culture and
The Ego
society in development of the personality (Erikson,
According to Jung, the ego represents the conscious mind 1993).
as it comprises the thoughts, memories, and emotions a
He describes eight developmental stages covering the
person is aware of. The ego is largely responsible for
entire life span.
feelings of identity and continuity.
➢ The way in which people relate to inner and outer
worlds is determined by their attitude type:
extraverted and introverted
 Stage 8: Integrity vs. Despair
Integrity refers to a person's ability to look back on their
life with a sense of accomplishment and fulfillment.
Benefits of Integrity
➢ Ego integrity
➢ Peace and fulfillment
➢ Wisdom

Despair refers to looking back on life with feelings of

regret, shame, or disappointment

Summary of Erikson’s Theory: Middle and Older Consequences of Despair

Adulthood ➢ Increased depressive symptoms
➢ Increased regret
➢ Decreased life satisfaction

Erikson had grouped all individuals together into “old

age” beginning at age 65, not anticipating that a person
could live another 30 to 40 years beyond this milestone.
Peck (1968) expanded the eighth stage, ego integrity
versus despair, into three stages:
(1) ego differentiation versus work role preoccupation,
(2) body transcendence versus body preoccupation, and
(3) Ego transcendence versus ego preoccupation
Stage 7: Generativity vs. Stagnation
Generativity refers to "making your mark" on the world
by caring for others as well as creating and accomplishing Strength and Weakness of Erikson's Theory
things that make the world a better place. One of the strengths of psychosocial theory is that it
Stagnation refers to the failure to find a way to contribute. provides a broad framework from which to view
These individuals may feel disconnected or uninvolved development throughout the entire lifespan.
with their community and with society as a whole. One major weakness of psychosocial theory is that the
Benefits of Generativity exact mechanisms for resolving conflicts and moving
from one stage to the next are not well described or
➢ Better health developed.
➢ More positive relationships
➢ Greater productivity
➢ Greater fulfillment
➢ Increased community involvement
Selective Optimization with Compensation
Consequences of Stagnation
Selective Optimization with Compensation (SOC) is a
➢ Worse health model developed by Baltes and Baltes (1990).
➢ Lower quality relationships
➢ Decreased life satisfaction It is a strategy for improving health and wellbeing in older
adults and a model for successful aging.
This theory’s central focus is that individuals develop ➢ The key is to have a self-exploration and inner
certain strategies to manage the losses of function that discovery that Jung called "individuation,"
occur over time. ➢ We can be open to conscious grieving and let go
of goals that we did not achieve earlier in life. We
This general process of adaptation consists of three
can refocus our energy on those things that we can
interacting elements;
still achieve during the second half of life.
(1) selection ➢ “Understanding ourselves better can help us to
better understand and relate to others.”
(2) optimization ➢ "A greater depth of self-understanding also will
(3) compensation help those of us who are aging to better tolerate
the ambiguity and paradoxes of aging, and affirm
Rubinstein stated that, as he grew older, he first reduced the value of life in the face of good and evil, pain
his repertoire and played a smaller number of pieces and joy, and the other oppositions that mark our
(selection); second, he practiced these more often existence."
(optimization); and third, he slowed down his playing
right before fast movements, producing a contrast that
enhanced the impression of speed in the fast movements Erikson’s eight stages of life
(compensation).
➢ The process of adjustment to these demands
produces a state of tension or crisis within the
Implications for Nursing individual that forces the person to utilize
developmental skills that have only recently been
Maslow's hierarchy of human needs mastered.
➢ As far as the physiological needs are concerned, ➢ Processes and skills of crisis resolution that are
the Nurse should give patients appropriate care to unique to each of the stages of the life cycle are
function the basic necessities of life. Walking and outlined.
eating opportunities should be given to patients. ➢ The concept of coping, the concept of active
➢ As far as the safety needs are concerned, the mastery, is related to the process of crisis
Nurse should provide the patients security, safe resolution.
and hygienic environment. ➢ Coping involves a new approach that will bring
➢ As far as social needs are concerned, the Nurse the person beyond the problem and into a new
should encourage teamwork and cooperation to relationship with the environment.
meet the needs of the patient.
➢ As far as esteem needs are concerned, the Nurse
can appreciate patients on accomplishing their Selective Optimizations with compensation
healing goal ➢ It is a strategy for improving health and wellbeing
➢ As far as self-actualization needs are concerned, in older adults and a model for successful aging.
the Nurse can give the patients challenging It is recommended that seniors select and
responsibilities(e.g. Taking care of themselves) optimize their best abilities and most intact
in which the patients skills and competencies are functions while compensating for declines and
fully utilized. Moreover, growth opportunities can losses.
be given to them so that they can reach the peak. ➢ Seniors take an active approach in their aging
process and set goals that are attainable and
meaningful.
Jung’s theory of individualism ➢ Older adults typically report higher well-being
➢ People in the second half of life can work toward compared to middle-aged adults, despite
the possibility of continuing creativity and possessing comparatively fewer cognitive,
fulfillment, and a deepening of spirituality. physical, and social resources (George, 2010). As
the percentage of middle-aged and older adults
rises, examining what behaviors contribute to—
and can help increase— well-being at different
ages is key