1 G E R O N T O L O GY

NURSING
CONCEPTS

G L O R I A P. D E L E O N , R N , R M , M A N
LEARNING OBJECTIVES:
At the end of this chapter the students will be able to:
1. Overview of Aging
2. Define Aging and its classification.
3. Discuss Demography of Aging
4. Describe the unique roles of gerontological nurse.
5. Mention the Impact of Aging and its Nursing Implications.
AGING OVERVIEW

We all know the obvious signs of aging: wrinkles, gray hair, a

slightly stooped posture, perhaps some "senior moments" of
forgetfulness.
But why do those things happen? What is aging?
• Aging is a gradual, continuous process of natural change that
begins in early adulthood.
• During early middle age, many bodily functions begin to
gradually decline.
• People do not become old or elderly at any specific age.
• Traditionally, age 65 has been designated as the beginning of
old age.
• But the reason was based in history, not biology.
• Many years ago, age 65 was chosen as the age for retirement
in Germany, the first nation to establish a retirement program.

• In 1965 in the United States, age 65 was designated as the

eligibility age for Medicare insurance.
• This age is close to the actual retirement age of most people in
economically advanced societies.
Each of us is made up of cells—13 trillion of them.

Our tissues and organs are each a bunch of cells, held together
with various natural materials that the cells have made.
From the moment of conception, each of our cells—and, hence,
our tissues and organs—begins a process of aging.

 Early in life, of course, we still are growing, and expanding the

number of cells that we have.
• The cells are aging, but so slightly that we can't see it: we just
see the body growing and developing.
At some point in life, often in the 30's, the tell-tale signs of
aging begin to be apparent.

They can be seen in everything from our vital signs (like blood
pressure) to our skin, to our bone and joints, to our
cardiovascular, digestive, and nervous systems, and beyond.
Some aging changes begin early in life.

 For example, your metabolism starts to gradually decline

beginning at about age 20.

Changes in your hearing, on the other hand, do not usually

begin until age 50 or later.
We do not yet fully understand the complex interplay of factors
that cause us to age as we do.

We know that many different things affect aging: genetics,

diet, exercise, illness, and a host of other factors, all of which
contribute to the aging process.
We know that many different things affect aging:
genetics,
 diet,
 exercise,
 illness, and a host of other factors, all of which
contribute to the aging process.
Aging is a continuous, progressive process
that continues until the end of life.
 CONCEPTS AND THEORIES
OF AGING
DEFINITION
• AGING- can be defined as the time-related deterioration of the
physiological functions necessary for survival and fertility.
• AGING PROCESS- is the process of growing old or developing
the appearance and characteristics of old age.
Classification of aging

 Objectively, ageing is a universal process that begins at birth

and is specified by the chronological age criterion .

.
 Subjectively, aging is marked by changes in behavior and self-
perception and reaction to biologic changes.

 Functionally, aging refers to the capabilities of the individual

to function in society.
AGING:

1. Aging is a normal process of time related change, begins

with birth and continuous throughout life.
2. It is a multidimensional process of physical, psychological,
and social change.
3. Illness is frequently misdiagnosed as “normal” aging.

4. Because of “decline” due to “normal” aging, symptoms

are neglected by family and medical personnel.

5. Older persons under report symptoms of illness because they

interpret symptoms as “growing older.”
6. Most older persons have more than one chronic disease.

7. Chronological age is simply the number of years a person has

lived.
8. Functional age refers to the person’s ability to function
effectively within society.
A. Gerontology:

• Scientific study of the process of aging;

• examining the changes that occur as a person ages;
• study of the needs of the older adult.
Gerontology

* is the study of the social, cultural, psychological, cognitive,

and biological aspects of ageing.
“Ang herontolohiya ay ang pag-aaral ukol sa mga nagaganap
sa katawan at isipan ng mga taong tumatanda o matanda na.

Kasama sa pag-aaral na ito ang mga sakit na dumarapo sa

mga taong ito.

Tinatawag na isang herontologo, herontologa, o

herontolohista ang mga taong may kaalaman sa
herontolohiya”
 Gerontological nursing:
Use of the nursing process in caring for the
physiological, psychological, and sociological needs of
the aging person.
• LIFE SPAN- maximum potential for survival of a species.
LIFE EXPECTANCY- amount of time lived from birth to death.

FRAIL OLD- person 75 years of age or older with some

impairment in ability to provide functional self-care.
GERIATRICS- is often used as a generic term relating to the aged
but specifically refers to medical care of the aged.
• SOCIAL GERONTOLOGY – is concerned mainly with the social
aspects of aging versus the biological or psychological.
GEROPSYCHOLOGY- is a branch of psychology concerned with
helping older persons and their families maintain well being,
overcome problems, and achieve maximum potential during
later life.
• GEROPHARMACOLOGY- is the study of pharmacology as it
relates to older adults. The credential for a pharmacist certified
in geropharmacology is CGP (Certified Geriatric Pharmacist).
FINANCIAL GERONTOLOGY- is another emerging subfield that
combines knowledge of financial planning and services with a
special expertise in the needs of older adults.
Culter (2004) defines financial gerontology as “ the intellectual
intersection of two fields, gerontology and finance, each of which
has a practitioner and academic components.
GERONTOLOGICAL REHABILITATION NURSING- combines
expertise in gerontological nursing with rehabilitation concepts
and practice.
• Care for older adults with chronic illnesses and long term
functional limitations.
• Eg. Stroke, head injury
• Purpose : to assist regain and maintain highest level of function
and independence possible while preventing complications and
enhancing quality life.
GERONTOLOGICAL NURSING- falls within the discipline of nursing
and the scope of nursing practice.
It involves nurses advocating for the health of older persons at
all levels of prevention.
CLASSIFICATION OF AGING

Middle Age 40-61 years of age

Young Old 65-74 years of age

Middle Old 75-84 years of age

Very Old 85 UP years of age

 ROLES OF THE
GERONTOLOGICAL NURSE
1. PROVIDER OF CARE- GN gives direct, hands-on care to older
adults in a variety of settings.
- Educate about disease processes and syndromes commonly
seen in the older population
2. TEACHER- an essential part of all nursing is teaching.
- GN focus their teaching on modifiable risk factors and health
promotion.
3. MANAGER- GN act as managers during everyday practice as
they balance the concerns of the patient, family, nursing and the
rest of the interdisciplinary team.
Nurse mangers must be:
• skilled in leadership,
• time management,
• building relationship,
• communication and managing change.
* May supervise other nursing personnel including:
- practical nurse (LPN’s)
- certified nursing assistants (CNA’s).
- Technicians,
- nursing students
- and other unlicensed assistive personnel (UAP)
Geriatric care managers:

> Discuss difficult topics and complex issues

> Make home visits and suggest needed services
> Address emotional concerns
> Make short- and long-term plans
• Evaluate in-home care needs
• Select care personnel
• Coordinate medical services
• Evaluate other living arrangements
• Provide caregiver stress relief
4. ADVOCATE- GN acts as on behalf of older adults to promote
their best interests and strengthen their autonomy and
decision making.
In forms of:
• Active involvement at the political level or helping to explain
medical or nursing procedures to the family members on a unit
level.
• Helping family members choose the best nursing home for
their love one or listening to family members vent their
frustrations about health problems encountered.
* Being an advocate does not mean making decisions for older
adults, but empowering them to remain independent and retain
dignity, even in difficult situation.
Demographics

• The population of Asia is growing both larger and older.

• Demographically the most important continent in the
world, Asia’s population, currently estimated to be 4.2
billion, is expected to increase to about 5.9 billion by
2050.
• Rapid declines in fertility, together with rising life expectancy,
are altering the age structure of the population in 2050,

• for the first time in history, there will be roughly as many

people in Asia over the age of 65 as under the age of 15.
- To address these matters, this publication shall explore four
large areas of aging in Asia:

- (1) new and emerging initiatives (including strengthening

infrastructure for science and policy);
(2)economic growth, labor markets, and consumption (including
population aging, intergenerational transfers, and economic
growth; facilitating working lives; retirement processes.
- (3) family roles and responsibilities (including household
dynamics and living arrangements; social networks, family,
and caregiving; effects of social activities on cognitive
functions), and;

- (4) health and well-being (including health care and insurance;

aging, health, and chronic conditions; life satisfaction).
• Aging in the Philippines According to a 2018 study by the
Philippine Institute for Development Studies (PIDS), the
Philippines is on its way to becoming an “ageing society” in
2032.

• This means that in 13 years, Filipinos aged 65 years old and

older will make up 7% of our country’s total population.
• In 2069, this figure will go up to 14%, making the Philippines
an “aged society.” research fellow Michael Abrigo says that
“Population ageing is not a bad thing.

• It represents a story of our collective success as Filipinos. It

means that we are able to conquer the challenges such as
those related to income, health, and education.”
- Filipinos are found to have a generally positive view of ageing.

- A 2013 study found that receiving social support from relatives

gives seniors more encouragement and allows them to have a
more positive outlook on life.
- Given our values system, the culture of caregiving remains
strong in our country.
• A study published by the Gerontological Society of America
claims that Filial Piety-(the ideological basis for traditional
[Chinese] society“) and family caregiving in general is “part of
the of the very fabric of Philippine society”, often utilizing the
family’s resources to support the elderly relative as opposed to
formal services.

• Family members who have taken on the role of caregiving feel

fulfilled and find meaning in doing this task.
• While an ageing population is a sign of increased productivity,
it also entails the availability of more services and facilities that
will support their needs.

• Seniors in the Philippines benefit from the 2010 Expanded

Senior Citizen’s Act which provides discounts on medicine
and health services, utilities, transportation, and even
recreational activities.
• However, there are still gaps in the provision of products and
services for the elderly that both the private and public sectors
can fill in

As our society ages, Filipinos – both the elderly and their

caregivers – need to be more aware of what they can do to care
for themselves.
• IMPLICATIONS FOR HEALTH AND NURSING CARE

• According to the US government's census and population

board, by 2030 the Baby Boomer generation will be over the
age of 65 and as such, the shift in demographics will cause
many changes to the USA's way of life and tending to the aged.
* One such area where these changes will see direct effects is in
the palliative care and nursing home care for aging and senior
citizens.
Available Beds in Nursing Homes
As the American population sees the shift toward having more
senior citizens there is going to be pressure on the available
nursing homes in the country to expand and provide more beds
and spaces to accommodate the change.

This is no small task.

• The two sides of the coin to this have positive and negative
effects on the aging population (and indeed, to those under
age 65).

• The positive side of the coin shows projections illustrating

increases in the amount of jobs available in the country,
especially in the construction, design and nursing fields.
• As the American population ages construction of new facilities
and assisted living homes becomes critical.
• As the construction and expansion takes place there will be a
need for qualified laborers and construction specialists such as
architects and designers.

• Economists say this will help push the country's economy

forward and will help to keep the unemployment rate down.
• The flip side of this coin is while the age demographics shift,
there is going to be a demand for laborers and constructions
workers, but there will be a dip in available hands to actually
do the work.

• This is going to create a demand for higher wages and benefits

which will push the already spiked costs for nursing care and
elderly services even higher leaving many in tough situations .
• Nurses, Doctors and Trained Medical Professionals

• With the growing aged population, there is going to be a huge

need for more qualified Nurses, doctors and medical
professionals who understand and work with the elderly.
• When this shift occurs, there will be a strain on available
medical services and professionals already in the country.

• The hope is younger generations will go into the needed fields

of medicine and technician professionals.
• Everything from radiology techs to physician assistants are
going to be in high demand.

• But with the younger generations not growing as fast as the

aging, there are valid concerns about available new medical
health practitioners and where to find them.
• With the continued strain on Nurses and other medical
professionals, there is going to be long waits for basic
appointments and services as well as increases in the already
high costs of American medical services
• For many in the aging population, the fear that even with a
pension and health insurance, meeting the basic monthly
expenses for needed prescription drugs and doctor's
appointments may be out of reach for many.

• This means the aging population will be at risk as they will not
be able to afford their needed medical services and drugs.
• Some economists argue that as the demand for such services and
professionals increase, there will be a huge opportunity for the
younger generations to study, train and enter the medical field.
• Hopefully this will meet the services needed by the aging population
as well as increase the economy and push positive growth forward.

• This is projected to mean better conditions and services available to

the growing and aging population of the USA.
• The solutions for the aging population are not easy, but
hopefully the country will rise to the challenge to take care of
it's elderly.

• They have already given so much to the country and it is

important the country rise to meet their needs as they grow
old.
• MORBIDITY AND MORTALITY
 THE IMPACT OF AGING
MEMBERS IN THE FAMILY
Key areas to consider include:

1. Accommodation – how long can you remain independent in your own

home or in a seniors’ residence? If you are still living at home, what
would trigger a need for additional support or home care services? When
do you feel is the right time to move to a seniors’ residence or long term
care?
2. Responsibility for maintenance around the house – is your family able
to help you out or should you hire someone to cut the grass and shovel
the walk?
3. Finances – how much do you have in savings? Are family
members willing, and able, to contribute to home-care, a
retirement residence, or, if necessary, long-term care? Do you
have insurance? Are you up-to-date on what is/isn’t covered?
4. Health and wellness – In the event of life-saving measures,
what medical interventions does you want in place? Do you want
specific time-lines attached to them? Is a Do Not Resuscitate
(DNR) in place? A DNR Form is a request not to have any CPR
administered to restore cardiac or respiratory functions.
5. To which extent are life support measures to be in place?
Discontinued? Who has been designated as the Power of
Attorney (POA) in the event you are unable direct your care or
have life support measures discontinued? A Power of Attorney kit
can help you to identify your wishes for your personal care and
your care of property.
A POA provides a person, designated by you, with the capacity
to make health care decisions, on your behalf, should you
become mentally incapable of doing so, yourself.
6. Would hospice be an option? It is important to share this
information with a primary health care provider.

7. End of life – And, inevitably, what are end of life wishes?

Funeral? Service? How will the costs be covered? Consider using
“My Own Voice” to record your end of life wishes and share
these with family members and your healthcare team
The leading causes of death among older persons ages
65years and older are:

• Heart disease
• Cancer
• Stroke
• Chronic lower respiratory diseases such as emphysema and
chronic bronchitis
• Influenza and pneumonia
• Alzheimer’s disease
• Diabetes
• Nephritis, nephrotic syn-drome, and nephrosis, which are
kidney diseases
• Accidents (unintentional injuries)
• Septicemia (blood poisoning)
Significant trends in mortality among older persons include:

• Dramatic declines in death rates from heart disease and

stroke
• Declines in death rates from cancer—since 1990 for men and
since 2000 for women
• Increases in Alzheimer’s disease death rates
Chronic diseases are the leading causes of death:

* Heart disease and cancer have been the two leading causes of
death for persons 65 years of age and older for the past two
decades, accounting for nearly a million deaths in 2002.
*Nearly one-third of all deaths among older persons were due to
heart disease, including heart attacks and chronic ischemic
heart disease.

* Cancer accounted for about one-fifth of all deaths in that age

group.
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 regent logic nurse is to identify the factor that
causes negative functional consequences and to initiate
interventions that will result in positive ones.
- Normal age related changes and factors may negatively
interfere with patients activity and quality of life.
- The nurse must differentiate between normal age related
changes that can be reversed
Importance to Nurses

1. Each theory provides framework and insight into the

differences among elderly patients.
2. Nurses play a significant role in helping aging person
experience health fulfillment and sense of well being.
3. Nurses attitude towards aging can have an enormous impact
on patients.

4 It makes the nurse aware whether the changes are related to

aging or disease condition.
5.It helps to provide specific care keeping in mind about the
various changes in their biological and psychological aspect.

6. It helps to differentiate normal aging from the abnormal one.

7.It can be tested, changed or used to guide research or to
provide base for evaluation.

8. It guides the nurses in helping the old people adapt to various

changes.

9. It helps the older people on re-balancing the relationship.

Some myths and facts related to aging are given below:

Myths:
1. Ageing is the time of tranquility and that ageing is
synonymous with senility.
2 Old age is time of reduced activity.
3. Older person are thought to be resistant to change.

4. Ageing is a uniform process that progresses at the same rate

and with the same results for all.
Facts:
1. Many older people retain their mental faculties well beyond
the ninth decade of life.

2. Societal factors may limit opportunities for older adults to

demonstrate their productivity but many older adults remain
productive throughout life.
3.Resistant to changes tends to be lifelong characteristics, not
one developed with advancing age.

4. Ageing affects each individual differently and the outcomes of

ageing may be different from one individual to another.
Nursing care of older adults is challenging and they should be
cared for according to their level of understanding because all
older adults are not the same.

For example, some may be physically active, intelligent and

productive members of the community whereas others may not
be aware of these differences.
CONCEPTS OF AGING

• CHRONOLOGIC AGING
• BIOLOGIC AGING
• PSYCHOLOGIC AGING
• SOCIAL AGING
• COGNITIVE AGING
 1. CHRONOLOGIC AGING
CHRONOLOGIC AGING

• Chronological age refers to the actual amount of time a

person has been alive.

• In other words, the number of days, months or years a person

has been alive
 2. BIOLOGIC AGING

BIOLOGIC AGING
• Senescence or biological ageing is the gradual deterioration of
function characteristic .

• Biological aging refers to the physical changes that “slow us

down” as human get into middle and older years.
• For example:
>> arteries might clog up, or problems with lungs
might make it more difficult for us to breathe.

• This aging is also known as physiologic aging.

 3.PSYCHOLOGIC AGING

PSYCHOLOGIC AGING
• Psychological aging refers to the psychological changes,
including those involving mental functioning and personality,
that occur as human age.

• Chronological age is not always the same thing as biological

or psychological age. •
• Some people who are 65, can look and act much younger than
some who are 50.
• Psychological ageing may be seen as a continuous struggle for
identity, i.e. for a sense of coherence and meaning in thoughts,
feelings and actions.

• Success depends on a lucky synchronization of changes

through life in different parts of the personal self.
 4. SOCIAL AGING

SOCIAL AGING

• Social aging refers to changes in a person’s roles and

relationships, both within their networks of relatives and friends
and in formal organizations such as the workplace and houses of
worship
• Social aging differ from one individual to another.
• It is also profoundly influenced by the perception of aging that
is part of a society’s culture.

• If a society views aging positively, the social aging

experienced by individuals in that society will be more positive
and enjoyable than in a society that views aging negatively.
 5. COGNITIVE AGING

COGNITIVE AGING
• Cognitive ageing is the decline in cognitive processing that
occurs as people get older.

Age-related impairments in reasoning, memory and processing

speed can arise during adulthood and progress into the elder
years.
• Cognitive aging is concerned with the basic processes of
learning and memory as well as with the complex higher- order
processes of language and intellectual competence or executive
functioning.

• The concept of cognitive aging, a term that describes a

process of gradual, longitudinal changes in cognitive functions
that accompany the aging process.
THEORIES OF AGING
THEORIES OF AGING

* Each theory of aging attempts to provide a framework in

which to understand aging from different perspectives.

* Each theory is useful to the clinician because a framework and

insight into differences among elderly patients are provided.
The theories of aging are classified into
Biologic theories
Psychosocial theories
Developmental theories
A. BIOLOGIC THEORIES

• Biologic theories of aging attempt to explain why the

physical changes of aging occur or
* Concerned with answering questions regarding the
physiological processes that occur in all living organisms as they
chronologically age
The Explanations of:
1. Deleterious effects leading to decreasing functions of
organisms.
2. Gradually occurring age- related changes that are progressive
over time
3. Intrinsic changes that can affect all member of a species
because of chronologic age
4. All organs in any one organism do not age at same rate
5. Any single organ does not necessarily age at the same rate in
difference individuals of the same species.
BIOLOGIC THEORIES
• The programmed theory/ Biological clock theory
• The run out of program theory
• Gene theory
• Molecular theory
• Cellular theories
1. THE PROGRAMMED THEORY/ BIOLOGICAL CLOCK
THEORY
• The programmed theory proposes that every person has a
“Biologic clock” that starts ticking at the time of conception.

• In this theory each individual has a genetic program

specifying an unknown but predetermined number of cell
divisions.
• As the program plays out, the person experiences predictable
changes such as atrophy of the thymus, menopause, skin
changes and graying of the hair

• Aging has a biological timetable or internal biological clock

B. THE RUN OUT OF PROGRAM THEORY
• Every person has a limited amount of genetic material that will run out
over time.

• All events are specifically programmed into genome and are sequentially
activated.

• After maturation genes have been activated there are no more programs
to be played and as cells age there may be chance of inactivation of genes
that cannot be turned on.
C. GENE THEORY

• The gene theory proposes the existence of one or more

harmful genes that activate overtime, resulting in the typical
changes seen with aging and limiting the life span of the
individual. •
.• Organism failure occurs in later life because of the presence
of imperfect genes activated over lengthy periods of time.

• Two gene types, one supports growth and vigor, and the other
supports senescence and deterioration
4. MOLECULAR THEORIES
The aging is controlled by genetic materials that are encoded to
predetermine both growth and decline.
• The error theory
• The somatic mutation theory
a. THE ERROR THEORY
• The error theory proposes that errors in ribonucleic acid
protein synthesis cause errors to occur in cells in the body,
resulting in a progressive decline in biologic function.
• Error theory Aging is a result of internal or external assaults
that damage cells or organs so they can no longer function
properly
b. THE SOMATIC MUTATION THEORY
• The somatic mutation theory proposes that aging result from
deoxyribonucleic acid (DNA) damage caused by exposure to
chemicals or radiation and this damage causes chromosomal
abnormalities that lead to disease or loss of function later in life.

• Exposure to x-ray radiation and or chemicals induces

chromosomal abnormalities.
D. CELLULAR THEORIES
• The cellular theories propose that aging is a process that occurs because of
cell damage.
• When enough cells are damaged, overall functioning of the body is
decreased.
• The free radical theory
• The crosslink or connective tissue theory
• Clinker theory
• The wear and tear theory
A.THE FREE RADICAL THEORY
• Denham Harman 1956.

• The term free radical describes any molecule that has a free
electron, and this property makes it react with healthy molecules
in a destructive way.

• Free radical molecule creates an extra negative charge.

• This unbalanced energy makes the free radical bind itself to
another balanced molecule as it tries to steal electrons.
• Balanced molecule becomes unbalanced and thus a free
radical itself.
• Diet, lifestyle, drugs (e.g. tobacco and alcohol) and radiation
 B.THE CROSSLINK OR CONNECTIVE TISSUE THEORY/
GLYCOSYLATION THEORY OF AGING
• Cell molecules from DNA and connective tissue interact with
free radicals to cause bonds that decrease the ability of tissue to
replace itself.
• The results in the skin changes typically attributed to aging
such as dryness, wrinkles, and loss of elasticity.
• Fibrous tendons, loosening teeth, diminished elasticity of
arterial walls and decreased efficiency of lungs and GI tract.
• It is the binding of glucose (simple sugars) to protein, (a
process that occurs under the presence of oxygen) that causes
various problems.
• Senile cataract and the appearance of tough, leathery and
yellow skin
C. THE CLINKER THEORY

• The clinker theory combines the somatic mutation, free radical

and cross link theories to suggest that chemicals produced by
metabolism accumulate in normal cells and cause damage to
body organs such as the muscles, heart, nerves and brain.
D. THE WEAR AND TEAR THEORY
• Body is similar to a machine, which loses function when its
parts wear out.
• As people age, their cells, tissues and organs are damaged by
internal or external stressors.
• Good health maintenance practices will reduce the rate of
wear and tear, resulting in longer and better body function.
 THE NEUROENDOCRINE THEORY
• Prof Vladimir Dilman and Ward Dean

• this theory elaborates on wear and tear by focusing on the

neuroendocrine system.

This system is a complicated network of biochemicals that

govern the release of hormones which are altered by
hypothalamus.
• The hypothalamus controls various chain-reactions to instruct
other organs and glands to release their hormones etc.
* The hypothalamus also responds to the body hormone levels
as a guide to the overall hormonal activity.
* Accordingly, as ages the secretion of many hormones
declines and their effectiveness is also reduced due to the
receptors down- grading.
. IMMUNOLOGIC THEORY

• The immunologic theory proposes that aging is a function of

changes in the immune system. • The immune system weakens
over time, making an aging person more susceptible to disease,
increase in autoimmune disease and allergies
• Over time, cells involved in immune function are less self-
regulatory, resulting in cells being misidentified as foreign
material and being attacked by the immune system’s own
defenses. Eg: rheumatoid arthritis (RA) and lupus
THE MITOCHONDRIAL DECLINE THEORY
• The power producing organelles.

• Their primary job is to create Adenosine Triphosphate (ATP) and

they do so in the various energy cycles that involve nutrients such as
Acetyl-L-Carnitine, CoQ10 (Idebenone), NADH and some B vitamins
etc.
• Enhancement and protection of the mitochondria is an
essential part of preventing and slowing aging.
THE MEMBRANE THEORY OF AGING
• Professor Imre Zs.

• It is the age-related changes of the cells ability to transfer

chemicals, heat and electrical processes that impair it.
.
•As older the cell membrane becomes less lipid (less watery and
more solid).

* This impedes its efficiency to conduct normal function and in

particular there is a toxic accumulation.
.CONCEPTS IN THE GENETIC THEORY OF AGING
• Telomeres
• Longevity genes
• Cell senescence
• Stem cells
• Epigenetics
 PSYCHOSOCIAL THEORIES

• Psychosocial theories of aging attempt to explain changes in

behaviour, roles and relationship that occur as individual age.
• This attempt to predict and explain the social interactions and
roles that contribute to successful adjustment to old age in older
adults.
The disengagement theory
The activity theory
The continuity theory
The subculture theory
 1. DISENGAGEMENT THEORY
• Cummings and Henry(1961) states that aging people
withdraw from customary roles and engage in more
introspective, self-focused activities.

• The disengagement theory was developed to explain why

aging process separate from the mainstream of society.
• This theory proposes that older people are systematically
separated, excluded, or disengaged from society because they
are not perceived to be of benefit to the society as a whole.

• This theory further proposes that older adults desire to

withdraw from society as they age, so the disengagement is
mutually beneficial
2. THE ACTIVITY THEORY

• This theory proposes that activity is necessary for successful

aging.

• Active participation in physical and mental activities helps

maintain functioning well into old age.
Purposeful activities and interactions that promote self-esteem
improve overall satisfaction with life, even at the older age.

• The continuation of activities performed during middle age is

necessary for successful aging (Lemon, Bengston and Peterson,
1972).
3. THE CONTINUITY THEORY

• The continuity theory (Neugarten, 1964) state that personality

remains the same and the behaviors become more predictable
as people ages.
• Personality and behaviour pattern developed during a life time
determine the degree of engagement and activity in older
adulthood.

• Personality is a critical factor in determining the relationship

between role activity and life satisfaction
4. THE SUBCULTURE THEORY
• Rose (1965) theorized that older adults from a unique
subculture within society to defend against society’s negative
attitude toward aging and the accompanying loss of status.
. • Older adults are a subculture with their own norms and
beliefs.

The subculture occurs as a response to loss of status.

• In the subculture, individual status is based on health and

mobility, instead of on education, occupation and economic
achievement.
4. CONCEPT OF PSYCHOSOCIAL THEORIES

• Disengagement theory views aging as a process of mutual

withdrawal in which older adults voluntarily slow down by
retiring, as expected by society.

Proponents of disengagement theory hold that mutual social

withdrawal benefits both individuals and society.
• Activity theory, on the other hand, sees a positive correlation
between keeping active and aging well.

Proponents of activity theory hold that mutual social withdrawal

runs counter to traditional American ideals of activity, energy,
and industry
3. DEVELOPMENTAL THEORIES

■ Developmental theories or life-course theories

■ These theories trace personality and personal adjustment
throughout a person’s life.
■ Many of these theories are specific in identifying life- oriented
tasks for the aging person.
 Erikson’s
 Havighurst’s
 Newman’s
 Peck’s
 Jung’s theory
ERIKSON’S THEORY
 Erickson’s(1963) theory identifies eight stages of
developmental tasks that an individual must comfort throughout
the life span:
Trust versus mistrust
Autonomy versus shame and doubt
Initiative versus guilt
Industry versus inferiority
Identity versus identity confusion
Intimacy versus isolation
Generativity versus stagnation
Integrity versus despair
The last of these stages is the domain of late adulthood, but
failure to achieve success in tasks earlier in life can cause
problems later in life.

• The stage pertaining to older adults is

: Ego integrity versus Despair.
• .The task of this stage is acceptance of one’s life as
meaningful and that death is part of life, versus despair, which
is failure to accept the meaningfulness of one’s life, along with
fear of death
PECK’S THEORY
• Peck expanded Erikson’s theory and focused more on later
developmental stages.

• Body transcendence versus body preoccupation is a phase

concerned with enjoyment of life in the face of physical
discomforts associated with aging.
.adapting to social roles in a flexible
establishing satisfactory living arrangements.
• Later maturity is Havighurst’s term for older adults.
• The task for later maturity is disengagement.
Disengagement from tasks of middle age allows involvement in
new roles such as grandparent, citizen, friend
HAVIGHURST THEORY
• Havighurst’s(1968) theory details the process of aging and
defines specific task for late life, including
adjusting to decreased physical strength and health,
adjusting to retirement and decreased income,
adjusting to the loss of a spouse,
establishing a relationship with one’s age group,
adapting to social roles in a flexible way, and
establishing satisfactory living arrangements.
• Later maturity is Havighurst’s term for older adults.
• The task for later maturity is disengagement.
Disengagement from tasks of middle age allows involvement in
new roles such as grandparent, citizen, friend
NEWMAN’S THEORY
• Newman’s theory identifies the task of aging as

Coping with the physical changes of aging

Redirecting energy to new activities and roles including
retirement, grand parenting and widowhood
Accepting one’s own life; and
Developing a point of view about death.
JUNG’S THEORY
• Jung’s theory proposes that the development continues
throughout life by a process of searching, questioning and
setting goals that are consistent with the individual’s personality.
• As individuals age, they go through a reevaluation stage at
midlife, at which point they realize there are many things they
have not done.
• At this age they begin to question whether the decision and
choices they have made were the right choices for them.
This is so called “midlife crisis”, which can lead to radical career
or lifestyle changes or acceptance of the self as is.

• As aging continues, Jung proposes that the individual is likely

to shift from an outward focus (wit concerns about success and
social position) to a more inward focus.

.
• Successful aging includes acceptance and valuing of the self
without regard to the view of others.
CONCEPTS OF DEVELOPMENTAL THEORY

• The concepts based on the identification of traits and

characteristics that may be developed early in life or may
change emphasis at different stages of development.
•Those who succeed at the final task also develop wisdom,
which includes accepting without major regrets the life that one
has lived, as well as the inescapability of death.

• However, even older adults who achieve a high degree of

integrity may feel some despair at this stage as they
contemplate their past.
APPLICATION IN NURSING FIELD

• Physical theories of aging indicate that, although biology places

some limitations on life and life expectancy, other factors are
subject to behaviour and life choices.

Nursing can help individuals achieve the longest, healthiest lives

possible by promoting good health maintenance practices and a
healthy environment.
• Psychosocial theories help to explain the variety of behaviors
seen in the aging population.

* Understanding all of these theories can help nurses recognize

problems and provide nursing interventions that will helping
aging individuals successfully meeting the development tasks of
aging.
* Cultural, spiritual, regional, socioeconomic, educational and
environmental factors as well as health status impact older
adult’s perceptions and choices about their health care needs.

• Theories can predict patient outcomes hold the greatest

promise for guiding nursing practice in ways that help each
individual patient age successfully
LEGAL AND ETHICAL ISSUES
Three issues warrant special attention:
1. Most states, whether reporting is mandatory or voluntary,
offer immunity and anonymity for reporters.
Health care professionals should report even suspicions of abuse
or neglect to the appropriate adult protective services.
2.Elder abuse raises ethical issues of competency, privacy, and
the right to refuse intervention.

All older persons are deemed competent unless adjudicated

otherwise through a formal competency hearing; thus, they
reserve the right to refuse intervention regardless of perceived
dangers.
3.If victims refuse to participate in assessment or deny that
abuse exists, despite extensive evidence to the contrary,
investigators may have no legal right to intervene or overrule
such decisions
 ASSIGNMENT
CRITICAL THINKING AND THE NURSING PROCESS

1. Imagine your self at age 80. what will be you like? What will you like
best about being older? What are your fears regarding your own
aging?

2. Examine your lifestyle. Are you engaging in behaviors that will

support and encourage healthy aging? Are you engaging in risky
behaviors that might promote the development of chronic illnesses?
3. Think of older people you know who have aged successfully.
What are some characteristics they possess that might have
contributed to a healthy older age?

PLS. SUBMIT YOUR ASSIGNMENT THRU ONLINE. This is

included in your 20% Theory Grade.
THANK YOU.