GERONTOLOGY:The study of Aging
birth to adulthood.
OBJECTIVES
 Define Gerontology
 Define Aging and Senescence
 List and describe theories of aging
 Identify patterns of health and disease
among older adults
GERONTOLOGY
 Is the study of the processes of aging
and challenges of older people.
 Is considered a young science.
 Is an applied science
 Seeks to understand the processes and
effects of normal aging.
GERIATRICS
 is the study and practice of the medical
problems and care of older people with
disease
GERONTOLOGICAL NURSING
 is the practice and study of adapting
and applying generic nursing methods
to the older adult patient, using
specialized knowledge about aging,
including information derived from
gerontology and geriatrics.
AGING AND THE LIFE SPAN
LIFE SPAN
 as the average maximum length of time
an organism can be expected to survive
or last .
 in human beings, the life span is
thought to be about 110 to 115 years.
LIFE EXPECTANCY
 as the average observed years of life
from birth or any stated age, and
depends on both biological and
environmental influences.
 the present life expectancy is 74.7 in
men and 79.9 in women.
THE HUMAN LIFE SPAN
 The Embryonic development – occurs
from conception to birth.
 Growth and Maturity – occurs from
 Senescence – occurs at the last stages
of adulthood through death.
AGING AND SENESCENCE
 are frequently used interchangeably,
and both are considered fundamental
and intrinsic properties of most living
organisms.
AGING
 the sum of all the changes that normally
occur in an organism with the passage
of time.
 is a complex and variable phenomenon.
 is a highly individualized process that
affects each person in unique ways.
 is the result of the interaction among
genetic endowment, environmental
influences, lifestyles, and the effects of
disease processes.
SENESCENCE – is the progressive
deterioration of the body and its processes.
CHARACTERISTICS OF AGING PROCESS
 Increased mortality rate with age after
maturation.
 Changes in biochemical composition in
tissue with age.
 Progressive decrease in physiological
capacity with age.
 Reduced ability to respond adaptively
to environmental stimuli with age.
 Increased susceptibility and
vulnerability to disease.
THEORIES OF AGING
I. EVOLUTIONARY THEORIES
Also known as developmental theory,
explores the human life span as affected by
the forces of natural selection. Natural
selection encourages reproduction of the
species; as a result, genes that encourages
healthy life until successful reproduction
are selected and the population is
increased. This selection in turn affects
aging either directly or through mechanism
that are helpful early in life, yet affect the
aging process later.
A. MUTATION ACCUMULATION THEORY
- suggest that genes that have negative
effect in later life gradually increase in the
population, because they are not weeded out
by natural selection.
B. DISPOSABLE SOMA
- proposes that once the organism has
produced, it is disposable. As a result, humans
are not programmed to continue maintenance
and repair of the body after reproduction, and
become more susceptible to disease with age.
C. ANTAGONISTIC PLEIOTROPY THEORY
- genes may be selected
because they positively influence early life
through reproduction, but just happen to have
negative affects on health in later life.
- Genes beneficial at younger
age become deleterious at older age.
II. CELLULAR THEORIES
Explores factors that affect cell division and
cumulative damage to cells that results in cell
senescence. All of the cells can divide initially
but with age many stop dividing, although they
continue to function well.
Explores mechanisms that result in cell damage.
When this damage reaches a certain level cell
death can result.
A. CELLULAR SENESCENCE – TELOMERE
THEORY
- Phenotype of aging are caused by an
increase in frequency of senescent cells.
Senescence may result from telomere loss or
cell stress.
B. WEAR AND TEAR THEORY
- aging is a physiological process
determined by the amount of stress and
damage to which one has been exposed.
- cells wear out from normal use,
ultimately resulting in cell death.
III. SYSTEM THEORY
 Explores the impact of the body’s
regulatory system on aging, including
the neurological-endocrine systems and
immune system.
 These system help the body respond
and adapt to internal and external
stimuli by their impact on other body
system.
A. NEUROENDOCRINE
– alteration in neuroendocrine control
of homeostasis result in aging –related
physiological changes.
B. IMMUNOLOGICAL
– decline of immune function with
aging results in decreased resistance to
infectious diseases and increased
incidence of autoimmunity.
C. RATE OF LIVING
– assumes a fixed rate of metabolic
potential for every living organism.
HIGH PREVALENCE OF CHRONIC DISEASE
1. Hypertension – 50%
2. Heart Disease – 32%
3. Arthritic Symptoms – 30%
4. Cancer – 21%
5. Diabetes – 16%
6. Stroke – 10%
7. Asthma – 9%
8. Chronic Bronchitis – 7%
9. Emphysema – 6%
( percentage of people age 65 and over who
reported having selected chronic condition)
GERONTOLOGICAL NURSING: ISSUES AND
TRENDS IN PRACTICE
Objectives:
 Define gerontological nursing and place
in the context of practice.
 Trace the history of gerontological
nursing and its influence on health care
of the older adult.
 Examine the roles and competencies for
gerontological nurses.
GERONTOLOGICAL NURSING
(Gunter and Estes 1079)
  A health service that incorporates
generic nursing methods and
specialized knowledge about the aged
to establish conditions within the
(patient) and within the environment
that will do the following:
1. Increase health-promoting behaviors in the
aged.
2. Minimize and compensate for health
related losses and impairments related to aging.
3. Provide comfort and sustenance through
the distressing and debilitating events of aging,
including dying and death.
4. Facilitate the diagnosis, palliation, and
treatment of disease in the aged.
FACTORS AFFECTING THE PRACTICE OF
GERONTOLOGICAL NURSING:
 Characteristics of the recipients of
gerontological nursing.
 The environment in which health care is
delivered.
 Essential knowledge and competencies
of gerontological nurses.
 Roles and standard for care.
 Application of the nursing process to
care of the older adult: Assessment,
nursing diagnosis , nursing
interventions , and nursing sensitive
outcomes.
GERONTOLOGICAL NURSING
TIME LINE:
1904 - American journal of nursing publishes an
article on care of the aged.
1920s – Many older individuals live on “poor
farms”.
1940s – Older adults are cared for in hospitals;
no focused plans are made for discharging older
adult home.
1950s – First geriatric nursing text by Newton is
published.
1961 – ANA recommends the formation of a
special interest group for geriatrics.
1966 – ANA Conference Group on Geriatrics
Nursing Practice is recognized.
1970 – ANA developed standards of geriatric
nursing practice; First publication of standards
for geriatric nursing practice.
1973 – NANDA publishes the first list of nursing
diagnoses; ANA certification in geriatric practice
is offered.
1975 - The JOURNAL OF GERONTOLOGICAL
NURSING becomes the first professional
nursing journal for gerontological nurses.
1981 – ANA publishes a statement on the
scope of gerontological nursing practice;
National Conference of Gerontological
Practitioners founded.
1984 – The Council of Gerontological Nursing is
formed; The NGNA is formed.
1989 – ANA certification is established for
gerontological nurse specialist.
1993 – Approximately 12000 nurses are
certified in gerontological nurse specialties.
2001- ANA publishes an updated Scope and
Standards of Gerontological Nursing
2004 – Terry Fulmer becomes the 1st nursing
president of the Gerontological Society of
America.
PIONEERS IN GERONTOLOGICAL NURSING
 VIRGINIA STONE (1912-1993) – helped
lead the ANA to develop standards of
practice in gerontological nursing , as
well as specialty certification. A key
focus of her career was identifying and
meeting the educational needs of
nurses on care of the older adult.
 MARY OPAL WOLANIN (1920-1997) –
examined the benefits of rehabilitation,
which later formed the subjects of her
writings. She became an expert on long
term care nursing and administration.
 DORIS SCHWARTZ (1917-1999) –
started one of the 1st geriatric nurse
practitioner programs at Cornell
Medical College and published some of
the 1st gerontological nursing research.
First nurse to receive funding from the
National Institutes of Health.
 IRENE BURNSIDE (1924-2003) –
pioneered therapeutic group work
 recognizing the value of reminiscence
and life review for older adult.
THE PRACTICE OF GERONTOLOGICAL NURSING
POTENTIAL ROLES FOR GERONTOLOGICAL
NUIRSE
1. Direct care provider
2. Independent practitioner
3. Health educator
4. Researcher
5. Nursing faculty
6. Consultant to community agencies
7. Provider of direct care and
interventions
8. Clinical research coordinator
9. Continuing education provider
10. Care manager/ case manager
11. Health planner
12. Administrator
13. Counselor
14. Leader
ESSENTIAL FOUNDATION FOR THE PRACTICE
OF GERONTOLOGICAL NURSING
 ASSUMPTIONS
 KNOWLEDGE
 SKILLS AND COMPETENCIES
 ATTITUDES
ASSUMPTIONS TO GUIDE GERONTOLOGICAL
NURSING PRACTICE
 Older individuals and their families can
be viewed as open system, capable of
change, growth, and mutual
interaction.
 Older individuals are affected in unique
ways by the combined effects of the
aging process, disease processes,
lifestyle, and environment.
 Older people are capable of making
independent decisions, unless some
well-documented pathological process
interferes with this ability.
 Older adult are interested in learning
more about health and aging, with
primary motivation of maintaining their
independence.
 Older people have the potential to
benefit from a wide variety of health
services, if appropriately targeted.
Nurses are not and should not be the
sole providers of care but should
function within an interdisciplinary
team context.
KNOWLEDGE BASE FOR GERONTOLOGICAL
NURSING
 Physical, psychological, and social
aspect of aging throughout the life
span; the resulting impact on the
individual and family.
 Pathophsiology, epidemiology,
treatment of chronic diseases, and the
impact of disease processes and
therapeutic regimens.
 Sign and symptoms of atypical
manifestation of disease in older
individuals, as well as common geriatric
syndromes.
 Altered pharmacology of drugs in the
older adult
 Approaches to health promotion,
disease prevention, and risk reduction
in later life.
 Current theory, research, and evidence
for nursing intervention, and standards
of care for the older adult.
SKILLS AND COMPETENCIES FOR
GERONTOLOGICAL NURSING
 Interact effectively with individuals who
have sensory and cognitive loss.
 Perform comprehensive assessment of
the older person using standardized
tools and individualized approaches
based on level of nursing practice.
 Serve as a collaborative partner in
interdisciplinary teamwork.
  Implement rehabilitative and
restorative nursing techniques.
 Help patient integrate past needs and
meet developmental needs
 Develop caring, collaborative
relationships with the older person and
family members in developing goals for
nursing care, even if the individual has
significant communication or cognitive
impairment.
 Modify the environment to maximize
the older person’s ability to function
independently.
 Provide excellent palliative, supportive,
and spiritual care for those who are
dying.
 Counsel the grieving.
 Participate in professional quality
improvements activities designed to
improve health care for older adults.
 Teach professional care givers, and
older adults about the aging process,
disease management, and health
promotion.
 Provide leadership by modeling
appropriate care for older patient.
 Engage in life long learning activities to
maintain up to date knowledge.
POTENTIAL CONSEQUENCES OF NEGATIVE
ATTITUDES TOWARD AND STEREOTYPES OF
AGING
 The needs of older adults are invisible
 Older people are presumed to be the
opposite of lively and fun.
 People involved in facilitating elderly
individuals are regarded as being at the
low end of the career pecking order.
 There is relatively little interest in
understanding the strengths and
advantages of later years.
APPLICATION OF NURSING THEORY
Objectives:
 Define theory and discuss its relevance
to gerontological nursing practice.
 Provide an overview of conceptual
models and grand theories of nursing.
 Discuss middle-range theories relevant
to gerontological nursing.
TERMS USED IN NURSING THEORY
 Theory – Describes more specific
relationships among concepts that can
guide and predict actions. Has been
describe as “the knowledge that
explains things”, and can be tested
through research.
 Conceptual Model- “A broad frame of
reference” or perspective for
considering a phenomenon such as the
discipline of nursing.
 Grand Theory- Many nursing theorists
have developed what have been called
grand theories. They are broad in scope
and “define general parameters on
which nursing function is based.
 Middle range theory- Theory that is
narrow in scope, addressing a specific
problem or situation.,describe based on
how specific they are.
GOALS OF NURSING THEORY
 Identify the domain and goals of
nursing.
 Provide knowledge to improve nursing
practice, education, research, and
administration.
 Identify areas to be studied.
 Establish criteria for measuring quality
nursing care, education, and research.
 Guide development of nursing care
delivery systems.
 Provide systematic structure and
rationale for nursing activities.
NURSING THEORISTS
Title
DOROTHEA OREM: Self-Care Deficit Theory of
Nursing
 Is a broad model describing nursing
practice.
 key concept is SELF-CARE.
 Self-Care – “the practice of activities
that maturing and mature persons
initiate and perform, within time
frames, on their own behalf in the
interests of maintaining life and
healthful functioning and continuing
personal development.
 Self-Care deficit- occurs when the
individual is unable to meet his or her
self-care needs, and this deficit gives
rise to the need for nursing.
SISTER CALLISTA ROY: Adaptation Model
 The process of adaptation is the major
concept in this theory, defined as an
ONGOING LIFE PROCESS.
 4 modes in Adaptation:
1. Physiological
2. Self-Concept(psychological/spiritual)
3. Role Functioning(social)
4. Interdependence
 In gerontological nursing, adaptation
may be more difficult or slower because
of the loss of reserves to deal with
illness or injury so that, for ex: (recovery
may be slower than for the younger
patient)
DOROTHY JOHNSON: Behavioral System Model
 Describe individuals as whole
behavioral systems with
interdependent parts, a different
perspective than the medical approach
of looking at the biological system.
 Has been helpful in developing and
testing behavioral nursing
interventions.
 E.g. The model was used with an older
woman who had suffered a stoke,
showing application of the model to
nursing practice with older adults.
MARTHA ROGERS: Unitary Human Being
 Describes human being as unitary
energy fields that are irreducible,
promoting a holistic approach to the
individual. Individual are open systems
with interaction between individuals
and the environment, which are
integral to one another.
 This theory provides a way to consider
how nursing interventions such as
music, humor, touch, and meditation
can positively influence health, and
encourages avoidance of a reductionist
approach to the care of individuals.
 The nurse use a holistic approach to
patients that encompasses MIND,
BODY, SPIRIT, and the ENVIRONMENT.
MYRA LEVINE: Conservation Model
 3 concepts in conservation model:
1. Wholeness
2. Adaptation
3. Conservation
• Conservation describes the way
complex organism or systems continue
to function even when challenged.
• 4 principle:
1. Conservation of energy
2. Conservation of structural integrity
3. Conservation of personal integrity
4. Conservation of social integrity.
E.g. The older adult with COPD may be taught
methods to conserve energy while completing
activities of daily living, which often leave them
exhausted.