Aging - Process involves physical, psychological and social changes

-often influenced by attitudes, experience, culture and values

Gerontology - Study of older persons

Geriatrics - Medical care of older persons

Gerontological Nursing - Specialty practice that focuses on unique needs of older adults
and their families
-nurses advocating for health of older adults at all levels of prevention

6 Standards of Nursing - Assessment, diagnosis, outcome identification, planning,

implementing, and evaluation

Core Competencies - Provide a foundation of added knowledge and skill needed for
nurse to implement in daily practice

Young Old - 65-74

Middle Old - 75-84

Old-Old - 85 and up

Nonagenarians - 90's

Centenarians - 100 and up

Baby Boomers - 1946-1964

Ageism - stereotyping and discriminating against persons because they're older

Blue Zones - "Hot spots" in the world where the highest percentage of pop live
astoundingly longer, richer lives
-Sardinia, Italy
-Okinawa, Japan
-Nicoya, Costa Rica
-Ikaria, Greece
-Loma Linda, California
purpose, attitude, nutrition, lifestyle, environment

Stochastic (error) Theories - Aging results from an accumulation of errors in the

synthesis of cellular DNA and RNA

Wear-and-Tear
1980's - Wearing out, damage to cells over time
Cross-Linkage/Connective Tissue
1940's - Stiffening of proteins in the body (cant move)- arthritis or hardening of coranary
arteries (atherosclerosis)
~dec activity, change how we use carbs, nutrients, etc.

Free Radicals
1950's - Random damage from free radicals; single unpaired electrons (want to reduce)
-more=faster aging- exposure to carcinogens
~antioxidants help prevent free radicals

Telomeres and Aging - Caps continue to get shorter as division occurs

-cell death=death
(stress shortens telomeres faster)

Nonstochastic Theories - Process that is programmed and predetermined

Programmed Aging Theory - Genetically determined life span and life process; cells
divide until they cant
-body knows (g-parents lived till 90's, so will I)

Gene/"Biological Clock" Theory - Biologists are attempting to locate genes that govern
cellular mortality
-find what genes that will tell you how long you're gonna live & cells continue to
reproduce

Immunity Theory
1970's - Senescence(don't work) if the immune cells from damage from free radicals-
faulty immune system
-death will be b/c body cant fight disease/infection off (immune system declines as you
age)

Emerging Biological Theories -

Neuroendocrine Control - Systems change over time with hormone secretion- cortisol
(inc)-> inc stress, dec estrogen, dec melatonin

Caloric Restriction - Reduction of cals has inc life span, slow metabolism, and reduce
age related disease (how often and what)
-Genetic Research- disease process

Psychological Theories -

Erikson's Developmental Stages - Development/ stages and tasks of personality

throughout life, unfolding set of challenges to be mastered
8 stages: 7 "care": (40-65) Generativity vs Stagnation
8 "wisdom": (65+) Ego integrity vs Despair
Maslow's - Human Needs structure bio-psycho-social needs (1950's)

Jung's Individualism - Ego portion of personality; search for life meaning and adapt to
loss
~Personality development throughout lifespan

Sociological Theories -

Role Theory - Indiv. evolve (change) through various stages in life and roles evolve (dtr,
mom, grandma)

Age Norms - Socially and culturally constructed expectation of behavior (shuffle board,
bingo, etc.)

Activity Theory
1950's - Need to maintain a productive life for it to be happy/age well; volunteer, stay
involved in community

Disengagement Theory
1960's - Withdrawl of elders from society, their roles and activities to promote internal
reflection (met life goals) ex. retire
-socially isolate self, cant participate, give up, dementia

Continuity Theory - Develop and maintain a consistent pattern of behavior throughout

life, task to identify with ones age group

Age-Stratification Theory - Elders exist in cohorts, experience similar things/events over

time

Modernization Theory - Value of elders are lost when their labors are no longer
considered useful (dont have purpose, dont work anymore); once value is lost=life
limiting

Gerotranscendence - Older adults transform cognitively from materialistic perspective

toward oneness with universe
-accept age
-intergenerational connectedness
-borrows some concept from disengagement theory
~once reached this=end of life; not about house/$, more about others>self
(grandchildren)
~Views & behaviors relate to a higher power

Functional Assessment - Musculoskeletal:

-Morse Fall Scale
-POMA (performance-oriented mobility assessment)
-TUG (timed-up and go)

Activities of Daily Living (ADL's) - Bathing, dressing, eating, etc.

Instrumental Activities of Daily Living(IADL's) - Cook, wash, housekeeping, driving, etc.

Advanced Activities of Daily Living (AADL's) - Hobbies, gardening, etc.

-knowing how to so things around the house, making financial decisions

Cognitive Assessment - Attention, Memory, language, visuospatial capacity (letters to

numbers), executive capacity (understand risks, determine what to do with finances,
etc.)
-MMSE; mini mental state exam
-MOCA; montreal cognitive assessment

Psychological Function - -GDS- geriatric depression scale (short form)

-CAM- confusion assessment method (not participative; you assess)
*#1 is informed consent*
-Brief Evaluation of Executive Function (cog flex, concept form, self-monitor. pt. capacity
to executive health care decisions w/ discharge plan say)

STOPP - Screening Tool of Older Peoples Potentially Inappropriate Prescriptions

DETERMINE- Nutrition - disease, eating poorly, tooth loss, economics, reduced social
contact, multiple meds, invol.wt. loss/gain, needs assistance with self care, elder age
(over 80)

Mini Nutritional Assessment (MNA) - Common and done quickly

-checklist; 0-2=low risk, 3-5=mod risk, 6+= high nutritional risk

SPICES - -effective and efficient instrument for obtaining info necessary to prevent
health alterations in older adult pt.
Sleep, Probs with eating/feeding, Incontinence, Confusion, Evidence of Falls, Skin
breakdown

Keratinocytes - Epithelial cells that produce keratin (fibrous protein)

Melanocytes - Melanin produced (pigment that browns skin)

Dendritic (Langerhans) cells produced- prevent skin cancer development

Dermis - 3 forms of protein- collagen, reticular fibers, elastic fibers (wrinkles)

2 layers: papillary- connective tissue and blood vessels; gives nutrients to epidermis
Reticular layer- hair follicles, oils

Hyposmia (60y.o.) - Loss of smell; loss of cells in olfactory bulb; dec in number of cells
in nasal lining
Gustation (lose 50% of taste buds by age 50) - dec salivary amylase (enzyme bkdwn of
comple carbs)
-Xerostoma: dry mouth

Somatesthesia - Tactile sensitivity decreases

-slows nerve conduction thru PNS and degeneration of nerve fibers

Presbyopia - Decreased near vision (90%+ of elderly wear glasses or readers)

Ptosis - Eyelids lose elasticity

Floaters - Cornea becomes flatter, thicker and less smooth

-common; black specks that float in vision, then go away (not always)

Keratoconjunctivitis Sicca - "dry eyes"

Glaucoma - Chronic progressive disease, involving inc intraocular pressure, usually

bilat, can lead to permanent damage to optic nerve
-open angle 90%: painful
-closed angle 5-10%: emergency (not common)
~test: puff of air
~tx: eyedrops to dec pressure
*dec in peripheral vision*

Cataracts - -cloudy in the lens, "hazy"

caused by protein build-up on the lens of eye
~Most common age-related eye disorder

Macular Degeneration - Leading cause of vision loss and blindness in 65+; breakdown
of macula- cant do anything about it; PREVENTION!
-visual acuity drastically decreased/progressive central vision loss
-pigment alterations
-trouble discerning colors
-distorted vision
-blurred vision
~Dry 90% nonexudative, wet= exudative

Diabetic Retinopathy - Microaneurysms in caps of retina, hemorrhage occurs, block light

from reaching visual receptors

Presbycusis - Gradual and progressive loss; men>women

-higher frequency sound loss more often 1st
-more sensorineural than conductive loss (permanent; not getting back)
~Conductive- outer ear canal or middle ear
~Sensorineural- inner ear or auditory nerve function
Immune System - Slows and dec in process of distinguishing harmful substances from
healthy tissue (immunosenescence)
-thymus begins to atrophy (less immune cells; T and B lymphocytes produced)
-tumorigensis- >development of tumors
-autoimmune diseases- (RA, Lupus, MS)

Endocrine System - Regulates body's metabolism, produces and secretes hormones,

responsible for energy, balance, growth, reproduction, and response to stress
-decrease in adrenal secretions- maintains higher cortisol level (>wt=>stress)
-dec sensitivity to insulin
~central adiposity- waist circumference: risk for metabolic syndrome

Respiratory - Nose: elongates downward=restrict airflow

Trachea & Larynx: stiff cartilage (from calcifaction)
Chest wall: calcification or rigid of costal cart.
elastic recoil is lost (reduces efficiency of air expulsion)
Lungs: alveoli progressively enlarge (similar to emphysema), loss of elastin

Cardiovascular System - Inc adipose (fat build up around heart), inc L vent. hypertrophy
& fibrosis, loss of conduction cells (a. fib w/ SA node), diminished concentrations
catecholamines and enzymes= dec force and speed of contractions
-heart gets bigger and thicker

Presbycardia - Dec cardiac output= decreased EF (ejection fraction) =50-70%

-longer recovery time
-dec efficiency of heart muscle

Atherosclerosis - Fatty plaques in artery walls (build up and stiffen artery)

GI System - -dec movement of food thru esophagus

-change in pH, dec absorption of B12
-liver harder time bkdwn chol

CNS - Brain wt. and size dec., cellular changes-plaques and tangles
-slowness of function (stim. of feeling)
-proprioception- knowing where your body is in space

Sarcopenia - Age-related changes in muscle

Onycholysis - Common; assoc. w/ fungal infections