ANGELES UNIVERSITY FOUNDATION

COLLEGE OF NURSING
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NCM 0114 - CARE OF THE OLDER PERSON

MODULE 1
Concepts, Principles and Theories in the
Care of the Older Persons
Module Overview
In today’s world, we are witness to the continuous increase in population and to life’s
expectancy especially to the developed and developing nations. With these, the growing
generation of older adults brings more challenges in health care delivery and to society
in general. Touhy and Jett (2018) pose the following questions in Chapter 1:
introduction to health aging, of their book: How is aging defined? How will these
definitions, meaning, and perception of aging change, as the health and wellness of
individuals, communities, and nations improve? And how will the roles and
responsibilities of nurses change in caring for today’s older persons? Try to answer
these questions as you go over the module and discover new perspectives of the older
persons and the challenges they bring to nursing practice as we try to meet their
changing health needs.

NCM 0114 - Care of the Older Person Module 1

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In this module, you will learn the following major topics: (1) the Perspectives on Aging,
(2) Demography of Aging and Implications for Health and Nursing Care, (3) the Impact
of Aging Members in the Family, (4) the Theories of Aging and its Nursing Implications,
and (5) the Physiologic Changes in Aging Affecting Various Systems. You will spend six
(6) learning hours on this module.

Module Learning Outcomes

At the end of the module, you should be able to:

LO1: Integrate principles and concepts of physical, social, natural and health
sciences and humanities in the care of the older adult.

LO2: Apply appropriate concepts of normal physiologic changes in aging in the

care of the older person holistically and comprehensively.

Definition of Terms

Ageing - can be defined as the life-long process of progressive change in biological,

psychological and social structures of a person. It is commonly referred to specific age
groups, those aged 60 years and above. 1

Ageism - is the stereotyping, prejudice, and discrimination against people on the basis
of their age.2

Age identity - describes how people feel or perceive their own age.

Chronological age - the years a person has lived since birth.

Functional age - is a term used by gerontologists to describe physical, psychological,

and social function;

1
"AGEING: A GLOBAL PERSPECTIVE - NCBI." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705998/.
Accessed 5 Aug. 2020.
2
"Ageism - WHO." https://www.who.int/ageing/ageism/en/. Accessed 5 Aug. 2020.
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Geriatrics - from the greek word “geras” meaning “old age”. It is the branch of medicine
that deals with the diseases and problems of old age.

Life Expectancy - the length of time that a person can be predicted to live.

Life Span - the maximum years that a person has the potential to live, currently, it is 122
years for humans.

Perceived age - used to describe how people estimate a person’s age based on their
appearance.

Senescence - the process of becoming old, or the state of being old.3

Perspectives on Aging
Today, for the first time in history, most people can expect to live into their sixties and
beyond. A longer life represents an important opportunity, not only for older people and
their families, but also for societies as a whole. Additional years provide the chance to
pursue new activities such as further education or a long neglected passion, while
continuing to make valuable contributions to family and community. Yet the extent of
these opportunities depends heavily on one factor: health.4

Ageing presents both challenges and opportunities. To have a healthy, productive older
population, will increase demand for primary health care and long-term care, require a
larger and better trained workforce and intensify the need for environments to be made
more age-friendly.5 Hence, as nurses, it is important to know more about the older
population to effectively deliver care and health education.

3
"Definition of Senescence - MedicineNet." https://www.medicinenet.com/script/main/art.asp?articlekey=13402.
Accessed 5 Aug. 2020.
4
"Ageing and health - World Health Organization." 5 Feb. 2018,
https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 5 Aug. 2020.
5
(n.d.). WHO | Ageing and Life Course - World Health Organization. Retrieved August 5, 2020, from
https://www.who.int/ageing/en/
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How old is old age?

Society’s view of “old age” has not always kept up with the reality of being old. Many
current beliefs about aging were based on information that is no longer valid given
recent scientific advances.6 Contrary to common beliefs, many older adults are in good
health, enjoying life and contributing to society.

Chronological Aging

● In most developed and developing countries, the chronological late life is

recognized as between the ages 50 and 65, in the United States, “old” or
retirement age was set at 65, also known as senior citizens who’s qualified to
receive pension or benefits and services from the government. While in the
Philippines, it is 60 years old.

“Older Person” Terminology

● A range of terms is used to refer to those considered old, including elderly, senior
citizens, elders, granny and older adults. The term elderly is often used to
describe frail individuals. A European survey asking older individuals their
preferred term indicated a preference for older or senior and strongly rejected
terms aged, old, and most strongly elderly. In 1995, the United Nations
Committee on Economic Social and Cultural Rights of Older Persons rejected the
term elderly and opted for the term “older persons” who are 60 and above. 7

● Because people are living longer, the segment of the population known as the
“oldest old” (85+ years) is the fastest growing segment of the population, where
more people are now living into the 80s, 90s or beyond. In the US and developed
countries like Japan and the UK, the people over 100 years old, the
“Centenarians”, are the fastest growing segment of the population (Mauk, 2018).

6
"Older Adults' Health and Age-Related Changes." https://www.apa.org/pi/aging/resources/guides/older.
Accessed 5 Aug. 2020.
7
"Use of the Term “Elderly” : Journal of Geriatric Physical Therapy."
https://journals.lww.com/jgpt/fulltext/2011/10000/Use_of_the_Term__Elderly_.1.aspx. Accessed 5 Aug. 2020.
 4

● Experts generally agree that frailty in older persons refers to a state of

vulnerability to adverse health outcomes. It is considered different from aging per
se, since some individuals live to an old age without becoming frail. Furthermore,
individuals of the same age can be quite different in terms of how frail they are.
Frailty would be the opposite of what many consider successful aging.8

Thoughts to ponder: “Aling Mila is a seventy-nine-year-old widow with

four adult children. Her medical history includes mild osteoarthritis
and hypertension, for which she takes acetaminophen as required.
She lives with her unmarried daughter, keeps herself busy socially
connected through FB and messenger, and walks two streets away
from home to attend morning masses everyday with her daughter.
She walks without aids but seems to have slowed down lately. Her
cognition is normal, and she is completely independent for basic activities of daily living
(ADLs).” - Is she frail? What is your basis for saying she is or she is not? What is frailty?

● Although some associate ‘ageing’ with mental decline and physical impairment,
this is a misconception, as the majority of older people enjoy good health and
lead active lives. While the functional capacity of biological systems (e.g.,
muscular strength, cardiovascular performance, etc.) declines after peaking in
early adulthood, health and activity in older age are largely determined by the
exposures and actions of an individual during the whole life span. Thus,
individuals are able to influence how they age by adapting to ageing-associated
changes and by adopting healthier lifestyles.9

8
"Frailty in the eye of the beholder - McMaster Optimal Aging ...." 20 Sep. 2014,
https://www.mcmasteroptimalaging.org/blog/detail/blog/2014/09/20/frailty-in-the-eye-of-the-beholder.
Accessed 5 Aug. 2020.
9
"AGEING: A GLOBAL PERSPECTIVE - NCBI." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705998/.
Accessed 5 Aug. 2020.
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The BABY BOOMERS: Implications for the Aging Population

❖ The youngest of the “older generation” are referred to as “baby boomers” or

“boomers”. They were born sometime between 1946 and 1964 depending on
how they are defined by any one country. In the US the first to become baby
boomers turned 64 in 2010; and the last will do so 21 yrs from now, by 2031
(Touhy and Jett, 2018).

❖ In anticipation of the needs and services for the incoming older adult generations,
nurses must consider the realities of the baby boomers who will be the next wave
of senior citizens. Their impact on the growth of the older population is such that
it has been referred to as a demographic tidal wave (Eliopoulus, 2018).

❖ Characteristics of the Baby Boomers, that set them apart from other groups
(Eliopoulus, 2018):

➢ Most have children, but this generation’s low birth rate means that they will
have fewer biological children available to assist them in old age.

➢ They are better educated than preceding generations with slightly more
than half having attended or graduated from college.

➢ Their household incomes tend to be higher than other groups, partly due
to two incomes (3 out of 4 baby boomer women are in the labour force),
and most own their own homes.

➢ They are enamoured with “high-tech” products, are likely to own a

computer, and spend several hours online daily.

➢ Their leisure time is scarcer than older adults, they are more likely to
report feeling stressed at the end of the day.

➢ As inventors of the fitness movement, they exercise more frequently than

do other adults.

➢ They are informed consumers of healthcare and desire a highly active role
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in their care.

➢ Their ability to access information often enables them to have as much

knowledge as their healthcare providers on some health issues.

10 FACTS OF AGEING Accdg. To WHO (2017)10

Fact 1: The world’s population is rapidly ageing

The number of people aged 60 years or older will rise from 900 million to 2 billion
between 2015 and 2050 (moving from 12% to 22% of the total global population).
Population ageing is happening more quickly than in the past.

Fact 2: There is little evidence that older people today are in better health than
their parents

The proportion of older people in high-income countries needing help from another
person to carry out basic activities such as eating and washing may have declined
slightly over the past 30 years. However, there has been little change in the prevalence
of less severe limitations in functioning.

Fact 3: The most common health conditions in older age are noncommunicable
diseases

Older people in low- and middle-income countries carry a greater disease burden than
those in the rich world. Regardless of where they live, the biggest killers of older people
are heart disease, stroke and chronic lung disease. The greatest causes of disability are
sensory impairments (particularly in low- and lower-middle-income countries), back and
neck pain, chronic obstructive pulmonary disease (particularly in low- and
lower-middle-income countries), depressive disorders, falls, diabetes, dementia and
osteoarthritis.

Fact 4: When it comes to health, there is no 'typical' older person

10
"10 facts on ageing and health - WHO." https://www.who.int/features/factfiles/ageing/en/. Accessed 5
Aug. 2020.
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Biological ageing is only loosely associated with person age in years. Some 80
year-olds have physical and mental capacities similar to many 20 year-olds. Other
people experience declines in physical and mental capacities at much younger ages.

Fact 5: Health in older age is not random

Although some of the variations in older people's health reflect their genetic inheritance,
most is due to their physical and social environments, and the influence of these
environments on their opportunities and health behaviour. Importantly, these factors
start to influence ageing from childhood. This means that an older person from a
disadvantaged background is both more likely to experience poor health and less likely
to have access to the services and the care that they may need.

Fact 6: Ageism may now be more pervasive than sexism or racism

Ageism – discrimination against a person on the basis of their age – has serious
consequences for older people and societies at large. Ageism can take many forms,
including prejudicial attitudes, discriminatory practices, or policies that perpetuate ageist
beliefs. It can obstruct sound policy development, and it can significantly undermine the
quality of health and social care that older people receive.

Fact 7: Comprehensive public health action will require fundamental shifts in how
we think about ageing and health

Health in older age shouldn’t be defined by the absence of disease. Healthy Ageing is
achievable by every older person. It is a process that enables older people to continue
to do the things that are important to them. While health and social care expenditures
for older people are often viewed as costs to society they should be understood as
investments in realising opportunities and enabling older people to continue to make
their many positive contributions.

Fact 8: Health systems need to be realigned to the needs of older populations

Most health systems around the world are ill-prepared to address the needs of older
people, who often have multiple chronic conditions or geriatric syndromes. Systems
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must be capable of providing older person-centred and integrated care, and focus on
maintaining capacities as people age.

Fact 9: In the 21st century, all countries need an integrated system of long-term
care

In some countries, this means building a system from almost nothing. In others, it
means rethinking long-term care: from a basic safety net for the most vulnerable,
towards a broader system that maximizes older people’s functional ability and upholds
their autonomy and dignity. The number of older people who need support for activities
of daily living in developing countries is forecast to quadruple by 2050.

Fact 10: Healthy Ageing involves all levels and sectors of government

Examples of intersectoral action include establishing policies and programmes that

expand housing options; making buildings and transport accessible; promoting
age-diversity in working environments; and protecting older people from poverty through
social protection schemes. Making progress on Healthy Ageing will also require a far
better understanding of age-related issues and trends.

Demography of Aging and Implications for Health and

Nursing Care
People worldwide are living longer. By 2050, the world’s population aged 60 years and
older is expected to total 2 billion, up from 900 million in 2015. Today, 125 million
people are aged 80 years or older.11 According to data from World Population Prospects:
the 2019 Revision, by 2050, one in six people in the world will be over age 65 (16%), up
from one in 11 in 2019 (9%). By 2050, one in four persons living in Europe and Northern
America could be aged 65 or over. In 2018, for the first time in history, persons aged 65
or above outnumbered children under five years of age globally.12
11
"Ageing and health - World Health Organization." 5 Feb. 2018,
https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 6 Aug. 2020.
12
"Ageing | United Nations - the United Nations." https://www.un.org/en/sections/issues-depth/ageing/.
Accessed 6 Aug. 2020.
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While this shift in distribution of a country's population towards older ages – known as
population ageing - started in high-income countries (for example in Japan 30% of the

population are already over 60 years old), it is now low- and middle-income countries
that are experiencing the greatest change. By the middle of the century many countries,
e.g. Chile, China, the Islamic Republic of Iran and the Russian Federation will have a
similar proportion of older people to Japan.13

14
Older People of Asia

In the Asia Pacific, with over 4.6 billion people in 2019, is home to 60% of the world’s
population. It is a diverse region, with seven of the world’s ten most populous countries,
and also some of the world’s smallest island nations in the Pacific.

The region is at the forefront of population ageing with the number of older people
expected to triple by 2050 to 1290 million. At this point, one in every four people will be

13
"Ageing and health - World Health Organization." 5 Feb. 2018,
https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 6 Aug. 2020.
14
"Ageing - UNFPA Asia-Pacific." https://asiapacific.unfpa.org/en/node/15208. Accessed 6 Aug. 2020.
 10

over the age of 60. Leading the way will be China, with an estimated 485 million older
people. Other countries that will have large populations of older people include
Indonesia (74 million) and Japan (45 million). In Japan, more than 30% of the
population are already over 60. This is expected to grow to 44% by 2050.

Japan is not alone – other countries where older people are expected to make up over
35% of the population include South Korea and Singapore. This phenomenon is not
limited to advanced economies; by 2050 older people will also make up significant
proportions of the population in developing countries such as Thailand, where at
present, people over 60 make up 19% of the total population but in 2050 will make up
36% of the population. The main reasons for this demographic change are rapidly
declining birth rates and longer life spans.

The Philippines

In the Philippines, the number of older people is increasing rapidly, faster than growth in
the total population. In 2000, there were 4.6 million senior citizens (60 years or older),
representing about 6% of the total population. In two decades, this has grown to 9.4
million older people or about 8.6% of the total population. The World Population
Prospects 2019 projects that by 2050, older people will make up around 16.5% of the
total population.15

Because of its young population structure, the Philippines is not yet considered an
ageing society. As of the last census, in 2015, a third of the country’s population was
below 15 years old, with merely 8% aged 60 years and over. As we anticipate further
improvements in longevity and a sustained fertility decline, the demographic landscape
is projected to slowly transition to an ageing population. From 2025 to 2030, older
Filipinos aged 60 years and over are projected to account for at least 10 % of the total
population, making the Philippines an ageing society based on the United Nations (UN)
definition.

15
"Ageing population in the Philippines | Help Age Asia." 30 Oct. 2019,
https://ageingasia.org/ageing-population-philippines/. Accessed 6 Aug. 2020.
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Demographic drivers of population ageing 16

The size and age composition of a population are determined jointly by three
demographic processes: fertility, mortality and migration.

All regions have experienced substantial increases in life expectancy since 1950. As the
life expectancy at birth increases, improvements in survival at older ages account for a
growing proportion of the overall improvement in longevity.

While declining fertility and increasing longevity are the key drivers of population ageing
globally, international migration has also contributed to changing population age
structures in some countries and regions. In countries that are experiencing large
immigration flows, international migration can slow the ageing process, at least
temporarily, since migrants tend to be in the young working ages. However, migrants
who remain in the country eventually will age into the older population.

Older people’s needs 17

Three main challenges facing older people in Asia are income security in old age,
access to health services and community recognition and participation.

Income security in old age

● The proportion of older people living in poverty tends to be higher than the
proportion of poor in the general population. Only about 30% of the older
population in the region receives some form of pension. However, evidence
shows that social (non-contributory) pensions available to older people not only
reduce their poverty but reduce intergenerational poverty. For example, pension
income is spent on children in the household, leading to significant improvements
in their education and health.

Access to appropriate health services

16
"Ageing | United Nations - the United Nations." https://www.un.org/en/sections/issues-depth/ageing/.
Accessed 6 Aug. 2020.
17
"Ageing - UNFPA Asia-Pacific." https://asiapacific.unfpa.org/en/node/15208. Accessed 6 Aug. 2020.
 12

● Maintaining good health and access to health care is a concern for older people
throughout the region. Ageing brings an increased risk of developing chronic
disease and disability. Large numbers of older people suffer from
non-communicable diseases (NCDs) such as cancer, diabetes, cardiovascular
disease and dementia. NCDs are already the single largest cause of both
mortality and morbidity in most developing countries. Worldwide, NCDs account
for nearly 90% of the disease burden for the over 60s.

● The quality and cost of healthcare is important. In other developed countries,

national healthcare alleviates these expenses for elders. But in developing
countries, healthcare services and medicines for chronic diseases simply may
not exist. And if it does, most health systems are currently set up to address
communicable diseases, rather than chronic conditions. Health systems and the
training of health professionals should be adapted to meet the requirements of
older people.

Community recognition and participation

● Older people contribute to all their family and community in many ways, both
financially and in-kind. They can be found acting as mediators, educators,
workers, volunteers, homemakers and caregivers. They are valuable sources of
knowledge, history and guardians of culture.

● Older persons in rural areas often have expert knowledge of traditional farming
practices, including ways of coping with environmental shocks and food
shortages, which may be crucial for the survival of rural communities in times of
crisis.

● In spite of the growing recognition of the role of older persons in society, there is
still a long way to go. Changing support structures combined with migration are
gradually weakening traditional informal support provided by family and
community. In many areas, older men and women are still seen as dependents
and a burden to society.
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Healthy Aging
In actuality, the vast majority of old persons report adequate health. 75% of older
persons younger than 64 years old report having 3 or fewer chronic conditions such as
high blood pressure or high cholesterol. This is compared with 71% of individuals aged
65 - 74 years old. Older people aged 75 and above report more chronic illness with 45%
and more than 50% of the oldest old or aged 85 and above with more than 4 chronic
conditions. The secret to good health in old age is good health during the individual’s
younger years. Lifestyle is a major contributor to how people age. Avoiding smoking and
obesity and engaging in regular exercise can make a substantial difference to health in
old age (Mauk, 2018).

Impact of Ageing Members in the Family

Improvements in life expectancy have
changed the structure of multigenerational
families; and across generations has
resulted in extended periods of support
exchanges (including caregiving) and
affective connections over the life span. At
the same time, relationships in aging
families have become more fluid and less
predictable, as reduced fertility and
increased rates of divorce, remarriage, and
stepfamily formation have altered the microcontext in which intergenerational, spousal,
and sibling relationships function. The implications of increased diversity in kinship
structures for such practical outcomes as support and caregiving to older family
members have yet to be parsed but remain important concerns in light of declining filial
commitment and the aging of support providers and recipients.18 Below are some of
the findings on researches done on family relationships and impact of aging member to
the family:

★ The combined effects of delayed childbearing and longer life expectancy mean
18
"Aging and Family Life: A Decade Review - NCBI."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427733/. Accessed 6 Aug. 2020.
 14

more adults in later-middle age may be “sandwiched” (sandwich generation)

between the competing demands of their children and those of their aging
parents and parents-in-law. Women—who have traditionally served as parent
care providers—are more likely to be employed than in previous generations,
limiting their availability, and increasing their time constraints.

★ One in 10 women in the 45 to 64 age group provides significant parental care

and either financial assistance or housing (within their homes for one year or
more) to both an adult child (age 25 or older) and a parent during the period.
Supporting multiple generations “may affect well-being in retirement if women
decrease labor supply to care for parents or if money transfers to children are
made at the expense of retirement savings.” 19

★ As many adult children remain in their parents’ home longer or return to their
parents’ home, a “club sandwich” generation of caregivers is being seen who
care for aging parents, children, and grandchildren or grandparents, parents, and
children. Growing numbers of people employed full time also carry family
caregiving responsibilities.

★ Most studies examining intergenerational resource transfers have found

evidence for motivations based on altruism and reciprocity. An altruism
perspective posits that each generation provides to the other on the basis of
need: Parents provide money to adult children with the fewest economic
resources, and adult children provide social support and care to parents who are
in the worst health.

★ Family caregiving to impaired older people has become increasingly common, as

life expectancy has nearly doubled over the past century and one of the most
consistent findings in the elder-care literature is that women provide more family
care than men.20

★ Changes in the family structure and activities present new challenges to today’s
grandparents. Most mothers are employed outside of the home, or like in the
Philippines, one or both parents are working abroad. As a result, grandparents

19
"Family Caregiving for Older People – Population Reference ...." 24 Feb. 2016,
https://www.prb.org/todays-research-aging-caregiving/. Accessed 6 Aug. 2020.
20
"Aging and Family Life: A Decade Review - NCBI."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427733/. Accessed 6 Aug. 2020.
 15

may assume childcare responsibilities to a greater extent than previous

generations did. In fact there is a rise to this type of arrangement, known as
skipped generation households (Eliopoulus, 2018).

★ Parents increasingly do not depend on their children for their needs, and the
belief that children are the best insurance for old age is fading.

Marital Status and Living Arrangements

● More than half of the women older than 65 years are widowed, and most of the
male contemporaries are married.

● Married people have a lower mortality rate than do unmarried people at all ages,
with men having a larger advantage.

● Most older adults live in a household with a spouse or other family member,
although more than twice the number of women than men live alone in later life.
The likelihood of living alone increases with age for both sexes.

● Most older people have contact with their families and are not forgotten or
neglected.

Answer the Learning Activity Sheet 1 - Perspectives and

Demographics on Aging for Activity 1 and 2
by clicking on the link: https://forms.gle/ARYpdQRA3NGpQT5P7

You are ONLY given one try to answer the Learning Activity Sheet.
Be sure you have read the topics on perspectives, demographics on
aging and the impact of ageing members in the family. Also, you need
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For Activity 3 - Discussion Forum, see the discussion page.

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Theories of Ageing and Its Nursing Implications

Today’s aging theories have evolved from the ground breaking work of earlier scientists.
Advancements in technology now allow us to see changes within one of the most basic
structures in cells, the mitochondria. Aging changes appear to have negative effects on
the functioning and longevity of the organism, be it a yeast cell or a human being. They
may result from unchecked damage from atoms or clusters of atoms called “free
radicals”, or from genetic mutations, or even from long term environmental stressors
such as pollution and/or those associated with the stress of poverty.

Biological Theories of Aging

Explains the physiologic process that changes with aging; such as the manifestation of
aging in the molecular level in the cells, tissues, and body system; how the body-mind
interaction affects aging; and other biological processes impact aging; however, no one
predominant theory has evolved. Both genetics and environment influence the
multifaceted phenomenon of aging.
 17

To explain biological aging, theorists have explored many factors, both internal and
external to the human body, and have divided them into two categories: Stochastic
theories view the effects of aging as resulting from random cell assaults or damages
from both the internal and external environment and accumulate overtime, thus causing
aging. Nonstochastic theories view aging as a series of predetermined events
happening to all organisms in a timed framework.

Stochastic Theories

1. Free Radical Theory

● This theory suggests that aging is due to oxidative metabolism and the
effects of free radicals. These free radicals are highly unstable, reactive
molecules containing an extra electrical charge that are generated from
oxygen metabolism. This theory emphasizes the significance of how cells
use oxygen.

● Free radicals are chemical species that arise from atoms as single,
unpaired electrons. Because a free radical molecule is unpaired, it is able
to enter reactions with other molecules, especially along membranes and
with nucleic acids.

● Also known as superoxides, free radicals are thought to react with

proteins, lipids, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA),
causing cellular damage. This damage accumulates over time and is
thought to accelerate aging.

Lipofuscin Theory

● Free radicals can generate cellular debris rich in lipids and proteins called
lipofuscin, which older adults have more of when compared to younger
adults.
 18

● It is thought that lipofuscin, or age pigment, is a non-degradable material

that decreases lysosomal function, which in turn impacts already disabled
mitochondria.

● It is also considered a threat to multiple cellular systems which leads to

cellular death.

2. Orgel/Error Theory

● This theory suggests that, over time, cells accumulate errors in their DNA
and RNA protein synthesis that cause the cells to die.

● Environmental agents and randomly induced events can cause error, with
ultimate cellular changes. It is well known that large amounts of X-ray
radiation cause chromosomal abnormalities.

● Thus, this theory proposes that aging would not occur if destructive
factors such as radiation did not exist and cause “errors” such as
mutations and regulatory disorders.

3. Wear and Tear Theory

● One of the building blocks of contemporary theories of aging, proposes

that overtime, cumulative changes occurring in cells age and damage
cellular metabolism.
● This theory attributes aging to the repeated use and injury of the body over
time as it performs its highly specialized functions. Like any complicated
machine, the body will function less efficiently with prolonged use and
numerous insults (e.g. smoking, poor diet, and substance abuse).

4. Connective Tissue Theory / Cross-linking Theory

● It proposes that overtime, biochemical processes create connections
between structures not normally connected. Several cross-linkages occur
rapidly between 30 and 50 years of age. However, no research has
identified anything that could stop these cross-links from occurring.
 19

● Over time, as these cross-linking agents accumulate, they form dense

aggregates that impede intracellular transport; ultimately the body’s
organs and systems fail.

● An effect of cross-linking on collagen (an important connective tissue in

the lungs, heart, blood vessels, and muscle) is the reduction in tissue
elasticity associated with many age-related changes.

Nonstochastic Theories

1. Programmed Theories

● It proposes that as people age, more of their cells start to decide to

commit suicide or stop dividing.

● Hayflick phenomenon or human fibroblast replicative senescence model,

suggests that cells divide until they can no longer divide, whereupon the
cell’s infrastructure recognizes this inability to further divide and triggers
the APOPTOSIS sequence or death of the cell.

● It is thought that human cells age each time they replicate because of the
shortening of the TELOMERES, the most distal appendages of the
chromosomes arms. It becomes reduced in length with every cell division
and eventually becomes too short to allow further division, the gene notes
this and causes cells to die or apoptosis. Thus, it is thought that cells have
a finite doubling potential and become unable to replicate after they have
done so a number of times.

Gene / Biological Clock Theory

 20

● In 1981, Hayflick and Moorhead coined the term “biological clock”. They
purported that each cell had a preprogrammed life span; that is the
number of replications was limited and not dependent on other factors.

● This theory explains that each cell, or perhaps the entire organism, has a
genetically programmed aging code that is stored in the organism’s DNA.
It comprises genetic influences that predict physical condition, occurrence
of disease, cause and age of death, and other factors that contribute to
longevity.

2. Neuroendocrine and Neurochemical Theories

● These theories suggest that aging is the result of changes in the brain and
endocrine glands. Theorists claim that specific anterior pituitary
hormones promote aging. Others believe that an imbalance of chemicals
in the brain impairs healthy cell division throughout the body.

3. Immunologic / Autoimmune Theory

● This theory was proposed almost 50 years ago and describes the normal
aging process of humans and animals as being related to faulty
immunological functions.

● There is a decreased immune function in the elderly due to the thymus

gland shrinking to 15% of its capacity, altered lymphocyte function, and the
decreased cell mediated and humoral immunity response. The elderly are
more susceptible to infections as well as cancers.

● There is a loss of T-cell differentiation, so the body incorrectly perceives

old, irregular cells as foreign bodies and attacks them, hence increased
autoimmune disorders are diagnosed in old age.

Psychosocial Theories of Aging

 21

These theories focus on changes in behavior, personality, and attitude as we age. The
authors propose that aging is a lifelong process characterized by transitions.

Sociological Theories of Aging

1. Activity Theory

Havinghurst and Albrecht (1963) proposed that staying occupied and involved is
necessary to having a satisfying late-life, and clearly believed that activity was
associated with psychological health. They concluded that society expects
retirees to remain active in their communities. Harlow and Cantor (1996) agreed
that sharing tasks was an important predictor of life satisfaction particularly
among retirees.

2. Disengagement Theory

Cumming and Henry (1961), asserted that aging is characterized by gradual

disengagement from society and relationships. The authors contended that this
separation is desired by society and older adults, that it serves to maintain social
equilibrium.

By disengaging, older adults are freed from social responsibilities and gain time
for internal reflection, while the transition from old to young maintains a
continuously functioning society unaffected by lost members.

3. Subculture Theory

Rose (1965) theorized older adults as a group with distinct norms, beliefs,
expectations, habits, and issues that separate them from the rest of society.
Their formation of a subculture is a response to the negative attitudes and
treatment by society.

It was believed that older persons are accepted by and more comfortable among
their own age group. A component of this theory is the argument for social
reform and greater empowerment of the older populations so that their rights
 22

and needs can be respected, although less relevant today than it was in the
1960s when it was first offered.

4. Continuity Theory

In the 1960s, Havighurst and colleagues created this theory, which hypothesizes
that personality influences the roles we choose and how we enact them, which in
turn influences satisfaction with living. This theory suggests that personality is
well developed by the time we reach old age and tends to remain consistent
throughout our lives. For example, activists at 20 years of age will most likely be
activists at 70 years of age.

5. Age Stratification Theory

Riley and colleagues (1972) suggest that society is stratified by age groups,
persons within similar age groups generally have similar age groups generally
have similar experiences, beliefs, attitudes and life transitions that offer them a
unique shared history.

New age groups are continually being formed with the birth of new individuals;
thus, the interaction between society and the aging population is dynamic. As
each group ages, they have their own unique experience with and influence on
society; and there is an interdependence between society and the groups.

Thoughts to ponder:

How would you expect the aging experience of Generation X and

Generation Y to differ from that of the baby boomers and their
parents?

6. Person Environment Fit Theory

Lawton (1982) proposed the capacity to function in one’s environment is an

important aspect of successful aging, and that function is affected by ego
 23

strength, motor skills, biologic health, cognitive capacity, and sensori-perceptual

capacity, as well as external conditions imposed by the environment.

Functional capacity influences an older adult’s ability to adapt to his or her

environment. Those individuals functioning at lower levels can tolerate fewer
environmental demands.

7. Gerotranscendence Theory

This theory of Tornstam (1994) proposes that aging individuals undergo a

cognitive transformation from materialistic, rational perspective toward
“oneness” with the universe.

Characteristics of successful transformation include a more outward or external

focus, accepting impending death without fear, an emphasis on substantive
relationships, a sense of connectedness with preceding and future generations
and spiritual unity with the universe.

Gerotranscendence borrows from disengagement theory but does not accept its
idea that social disengagement is a necessary and natural development. Rather,
Tornstam asserted that activity and participation must be the result of one’s own
choices and that control over one’s life in all situations is essential for successful
adaptation to aging.

Psychological Theories of Aging

1. Human Needs Theory

Maslow surmised that a hierarchy of needs motivates human behavior:

physiologic, safety and security, love and belonging, self-esteem, and self
actualization. These needs are prioritized such that more basic needs like
physiological functioning or safety take precedence over personal growth needs
(love and belonging, self-esteem, and self-actualization).
 24

Self-actualization requires the freedom to express and pursue personal goals and
be creative in an environment that is stimulating and challenging. Maslow
asserted that failure to grow leads to feelings of failure, depression, and the
perception that life is meaningless.

2. Theory of Individualism

Jung’s Theory of Individualism (1960) proposed that our personality develops

over a lifetime and is composed of an ego or self-identity that has personal and
collective unconsciousness. Jung’s theory says that people tend to view life
through either their own “lens” (introverts) or the lens of others (extroverts).

As individuals age, they begin to reflect on their beliefs and life

accomplishments. Accdg. To Jung, one ages successfully when he or she
accepts the past, adapts to physical decline, and copes with the loss of
significant others. Subsequent theorists also describe introspection as
promoting positive inner growth and describe it as a part of healthy aging.

3. Stages of Personality Development Theory

Erikson’s Theory (1963) proposes personality development in eight (8) sequential

stages. Each stage has a life task of which we may succeed at or fail. During the
final stage, “ego integrity vs despair” individuals search for the meaning of their
lives and evaluate their accomplishments. Satisfaction leads to integrity, while
dissatisfaction creates a sense of despair.

Erickson and colleagues also suggested that older adults face additional
challenges or life tasks including physical and mental decline, accepting the care
of others and detaching from life, thus, expanded his definition of “integrity vs
despair” to include three (3) other challenges: 1) creating a meaningful life after
retirement, 2) dealing with an “empty nest” as children move away, and 3)
contemplating the inevitability of death.

4. Life-Course (Life Span Development) Theory

 25

Is concerned with understanding age group norms and their characteristics. The
central theme of life course is that life occurs in stages that are structured
according to one’s roles, relationships, internal values, and goals.

Goal achievement is linked to life satisfaction but people’s goals are limited by
external factors. Successful adaptation to life changes (eg. roles and
relationships, finishing college, or retiring) may require revising one’s beliefs to be
consistent with society’s expectations.

5. Selective Optimization with Compensation Theory

In Baltes’s (1987) theory of successful aging, he asserted that individuals learn to

cope with the functional losses of aging through the processes of selection,
optimization, and compensation.

Aging individuals adjust activities and roles as limitations present themselves; at

the same time, they choose those activities and roles that are most satisfying
(optimization). Ideally, selective optimization with compensation is a positive
coping process that facilitates successful aging.

Nursing Theories of Aging

1. Functional Consequences Theory

Miller (1990) asserted that aging adults experience environmental and

biopsychosocial consequences that impact their functioning. The nurse’s role is
to assess age-related changes and accompanying risk factors, and to design
interventions that minimize age-associated disability. The goal is to maximize
functioning in ways that improve patient safety and quality of life.

2. Theory of Thriving
 26

Haight et al. (2002) developed this theory to explain that thriving is possible when
harmony exists between individuals and their physical and human environments.
The process of thriving is continuous and enables aging individuals to find
meaning in life and adapt to changes.

3. Theory of Successful Aging

Flood (2005) attempts to develop a nursing theory to guide the care of the older
adults. In this theory, it not only considers successful aging in terms of the older
adult’s physical, mental, and spiritual well-being but also includes the individual’s
self-appraisal.

Flood hypothesizes that people with high levels of personal control and a positive
affect will experience higher levels of wellness in aging due to their ability to
participate in health-promoting activities.

Thought to ponder:
Which among the discussed theories do you believe in and
can apply to your aging family member?
 27

Physiologic Changes in Aging Affecting Various

Systems
1. INTEGUMENTARY SYSTEM

PHYSIOLOGIC CHANGES RESULTS

Decreased amount of melanin due to ➔ (Increased, Decreased) hair

progressive loss of pigment cells coloring (graying)

Decreased sebaceous gland and sweat ➔ Increased dry skin; reduced ability
gland function and number to produce Vitamin D when skin is
exposed to sunlight
➔ Slightly decreased perspiration

Decreased subcutaneous fat, from 6th ➔ Increased wrinkling, lines and

decade of life sagging becomes more evident
➔ more sensitive to cold
temperatures

Decreased thickness and vascularity of
epidermis and dermis;
Decreased rate of epidermal proliferation
and skin immune response declines
Collagen fibers become coarser and more
random
Decreased melanocytes but Increased
localized pigmentation or melanocytes
cluster
Increased capillary fragility
Decreased density of hair growth; atrophy
and fibrosis of hair bulb
Decreased rate of nail growth
Decreased peripheral circulation
Increased androgen/ estrogen ratio
28
➔ Increased susceptibility to trauma
or injury
➔ Delayed wound healing;
➔ increased susceptibility to infection
➔ Reducing skin elasticity;
➔ Becomes more dry and fragile
➔ Skin breaks down more easily
➔ Tanning more slowly and less
deeply
➔ Increase risk for solar damage
such as skin cancers
➔ Increased incidence of brown spots
(senile lentigo or age spots /
Lentigines)
➔ Increased purple patches (senile
purpura)
➔ Decreased amount and thickness
of hair on head and body
➔ Increased brittleness of nails
➔ Increased risk for fungal infections
➔ Increased longitudinal ridges of
nails;
➔ increased thickening and yellowing
of nail
➔ Increased facial hair in women
➔ Increased growth of eyebrow, ear,
and nostril hair occurs in men.
 29

2. MUSCULOSKELETAL SYSTEM

PHYSIOLOGIC CHANGES RESULTS

Decreased bone calcium/bone mineral ➔ Increased osteoporosis;

density ➔ Brittleness of the bones- fracture
risk or trauma

Decreased fluid in intervertebral discs, ➔ Decreased height

ligaments, tendons, and joints ➔ Reduced flexibility
➔ increased curvature of the spine
(kyphosis)

Decreased blood supply to muscles ➔ Decreased muscle strength

Decreased tissue elasticity ➔ Decreased mobility and flexibility

of ligaments and tendons

Decreased muscle mass (Sarcopenia), ➔ Decreased strength;

muscle fibers atrophy, and with fibrous ➔ decreased movement also
tissue gradually replacing muscle tissue. resulting in flabby and weak
muscles.
➔ increased risk for falls

Tendons shrink and harden ➔ Decrease tendon jerk reflex

➔ Impaired flexion and extension
movements - slight wrist and knee
flexion

Reduced body water ➔ Increased risk of dehydration

 30

3. RESPIRATORY SYSTEM

PHYSIOLOGIC CHANGE RESULTS

Decrease body fluids ➔ Decreased ability to humidify air

resulting in drier mucous
membranes

Decreased number of cilia and their ➔ Decreased ability to trap debris;

activity stasis of secretions – susceptible to
infection

Decreased number of macrophages ➔ Increased risk for respiratory

infection

Decreased tissue elasticity and increased ➔ Decreased gas exchange;

rigidity in the alveoli and lower lung lobes ➔ increased pooling of secretions;
➔ increase risk for lower tract
Alveoli fewer in number and larger in size infection

Decreased muscle strength (expiratory ➔ Decreased ability to breathe deeply

muscles) and endurance; thoracic (forced expiratory volume reduced);
muscles more rigid ➔ diminished strength of cough

Decreased number of capillaries ➔ Decreased gas exchange

Increased calcification of cartilage ➔ Increased rigidity of rib cage;

decreased lung capacity

Oxygen depth in the muscles ➔ dyspnea on exertion, sleep apnea

due to decreased oxygen in the
brain.
 31

Decrease chest wall compliance ➔ decrease expiratory excursion,

affecting inspiratory and expiratory
volumes.

4. CARDIOVASCULAR SYSTEM

PHYSIOLOGIC CHANGE RESULTS

Decreased cardiac muscle tone ➔ Decreased tissue oxygenation

related to decreased cardiac output
and reserve

Increased heart size, left ventricular ➔ Compensation for decreased

enlargement muscle tone

Decreased cardiac output ➔ Increased chance of heart failure;

decreased peripheral circulation

Decreased elasticity of heart muscle and ➔ Decreased venous return;

blood vessels ➔ increased dependent edema;
➔ increased incidence of orthostatic
hypotension;
➔ increased varicosities and
hemorrhoids
➔ Increased risk for hypertension
➔ Reduced blood flow to some
organs, eg. kidney

Decreased pacemaker cells ➔ Heart rate 40-100 beats/min;

➔ increased incidence of ectopic or
premature beats;
➔ increased risk for conduction
abnormalities

Decreased baroreceptor sensitivity ➔ Decreased adaptation to changes

in blood pressure
 32

Increased incidence of valvular sclerosis ➔ Increased blood pressure, weaker

peripheral pulse
Incomplete valve closure ➔ Systolic and diastolic murmurs

5. HEMATOPOIETIC AND LYMPHATIC SYSTEM

PHYSIOLOGIC CHANGE RESULTS

Increased plasma viscosity ➔ Increased risk for vascular

occlusion

Decreased red blood cell production ➔ Increased incidence of anemia

Decreased mobilization of neutrophils ➔ Less effective phagocytosis

Increased immature T cells response ➔ Decreased immune response

6. GASTROINTESTINAL SYSTEM

PHYSIOLOGIC CHANGES RESULTS

Mouth: wear and tear of teeth; ➔ Decreased ability to chew

Increased dental caries and tooth loss normally, decreased nutritional
status

Gums recede ➔ Increased risk for oral and cardiac

disease
 33

Tongue atrophies, loss of papillae ➔ Decreased taste sensation

Decreased thirst perception ➔ Increased risk for dehydration and

constipation

Decreased gag reflex ➔ Increased incidence of choking

Decreased esophageal motility and more and aspiration
dilated esophagus ➔ Slow esophageal emptying

Decreased muscle tone and sphincters ➔ Increased incidence of heartburn

(esophageal reflux)

Decreased saliva and gastric secretions ➔ Decreased digestion and

absorption of nutrients

Decrease gastric motility and slow ➔ Early sensation of fullness

intestinal peristalsis ➔ Reduced ability to adequately
absorb nutrients
➔ Increased flatulence, constipation,
and bowel impaction

Decrease liver size and enzyme production; ➔ Decrease ability to metabolize

reduced blood flow drugs leading to increased risk for
toxicity

7. ENDOCRINE SYSTEM

PHYSIOLOGIC CHANGE RESULTS

Decreased pituitary secretions (growth ➔ Decreased muscle mass

hormone)
 34

Decreased production of ➔ Decreased metabolic rate

thyroid-stimulating hormone

Decreased insulin production or increased ➔ Increased risk for type 2 diabetes

insulin resistance mellitus

Decreased production of parathyroid ➔ Increased blood calcium levels

hormone (seen with osteoporosis)

Decreased gonadal secretions ➔ Gradual decrease in testosterone,

estrogen and progesterone

8. URINARY SYSTEM

PHYSIOLOGIC CHANGE RESULTS

Atherosclerosis of renal vessels ➔ Decreased renal function

➔ Decreased glomerular filtration
Atrophy of kidney rate

Tubular function decrease ➔ Less efficient tubular exchange of

substances, water and minerals.
➔ Decreased reabsorption of glucose
which may cause +1 proteinuria
and glycosuria not to be of major
diagnostic significance

Reduction in number of functioning ➔ Decreased in urine concentration

nephrons

Bladder muscles weaken and bladder ➔ More difficult emptying of the

capacity decreases; micturition reflex bladder
delayed; ➔ Retention of large volumes of urine

9. REPRODUCTIVE SYSTEM
 35

PHYSIOLOGIC CHANGE RESULTS

Women: ➔ Menopause - on average from 51

Decreased estrogen and progesterone years old
production ➔ Loss of vulvar subcutaneous fat
and hair

Breast, vulva, uterus, fallopian tubes, ➔ Cancer risk - increased with age
ovaries, cervix atrophy

Weakening of the pelvic floor muscles ➔ Involuntary release of urine (stress

incontinence)

Decreased vaginal secretions, less elastic ➔ Reduced lubricants;

➔ More alkaline vaginal
➔ Sexual activity declines (does not
lose the ability to engage in and
enjoy intercourse)

Men :
● increased fibrosis of seminiferous ➔ Decreased sperm count
tubules;
● Decreased Testes size
● Prostate enlargement in most men ➔ Problems with urinary frequency
● Venous and arterial sclerosis of ➔ Orgasm and ejaculation tend to be
penis less intense (still achieve erection)

10. SENSES

EFFECTS OF AGING ON EYES AND VISION

PHYSIOLOGIC CHANGE RESULTS

Eyelids lose elasticity ➔ Drooping (senile ptosis) results

➔ In extreme cases the lids sag far
enough to block vision

Decrease number of eyelashes
Reduced efficiency of goblet cells
Cornea: flatter, thicker, less flexible
Lens and intraocular: potential thickening
and yellowing, reduced flexibility
Changes in vision due to reduced elasticity
of the lens
Opacity of the lens
EFFECTS OF AGING ON AUDITORY SYSTEM
PHYSIOLOGIC CHANGE
EXTERNAL CANAL –the skin becomes
thinner; hair becomes longer and denser
MIDDLE EAR- loses elasticity and ossicles
tend to shrink
36
➔ Increased risk for eye injury
➔ Uncomfortable drying of eye
➔ Increased far-sightedness
(hyperopia)
➔ Reduced accommodation and the
need for greater levels of lighting
are the result of reduced
responsiveness of the pupils and
changes in the lens.
➔ Decreased depth and color
perception (judging ht and curbs of
steps)
➔ Inability to focus or accommodate
properly result to decrease in near
vision (Presbyopia)
➔ May lead to the development of
Cataract
RESULTS
➔ More susceptible to tears and
infection
➔ Does not cause loss of sound
waves
➔ Many elders become intolerant of
loud noises and incapable of
distinguishing among some of the
sibilant consonants such as z, s,
sh, f, p, k, t and g
 37

INNER EAR- loss of elasticity in the basilar ➔ Problem in balance or equilibrium

membrane as well as degeneration of the
➔ Progressive hearing loss
organ of Corti and vestibular structures and
(Presbycusis)
atrophy of cochlea

Degeneration of the small blood vessels,

decline in hair cells, spiral ganglion cells,
reduced flexibility of basilar membrane and
reduced production of endolymph.

11. NERVOUS SYSTEM

PHYSIOLOGIC CHANGE RESULTS

Central Nervous System: reduced number ➔ Increased risk for trauma

of dendrites, atrophy of brain itself
(primarily the frontal brain)

Slight changes in physiology and chemistry ➔ Slowed central processing; or less

of brain (neurodegeneration and efficient in processing, storage, or
neurochemistry) encoding of information
➔ Mild memory impairments
increased risk for slight balance
difficulties

Peripheral nervous system: ➔ Altered kinesthetic sense or

Significantly reduces vibratory sense in proprioception (awareness of
lower extremities one’s position in space) and has
Decreased sensory functions at the less tactile awareness - thus put
periphery the person at risk for falling and
Decreased proprioception injury.
 38

Personality ➔ Drastic changes normally do not

occur as one ages.

Intelligence ➔ Basic intelligence is maintained

(eg. verbal comprehension and
arithmetic operations) and
correlate with educational level
➔ Maintained through the adult years
Crystallized Intelligence - the knowledge
accumulated over a lifetime and arises
from the dominant hemisphere of the brain.
It enables the individual to use past learning
and experiences for problem solving.

Fluid Intelligence - involves new ➔ Believed to decline in later life

information emanating from the
nondominant hemisphere, controls
emotions, retention of nonintellectual
information, creative capacities, spatial
perceptions and aesthetic appreciation.

You are ONLY given one try to answer the Learning Activity Sheet 2. Be sure you have
read the topics on theories of ageing and physiologic changes in ageing. Also, you
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Answer the Learning Activity Sheet 2:

Activity 1. Physiologic Changes in Ageing
by clicking the link: https://forms.gle/jTaVJkftJJZWCbYj6

Activity 2. Theories of Ageing by clicking the link:

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 39

References:

● Eliopoulos, C. (2018). Gerontological nursing (9th ed.). Wolters Kluwer.

● Hirst, S. P., Lane, A.M., Miller, C.A. (2015). Miller’s nursing for wellness in older adults.
(Canadian ed.). Wolters Kluwer.

● Mauk, K. (2018). Gerontological nursing competencies for care (4th ed.). Jones &
Bartlett Learning.

● Meiner, S.E. (2015). Gerontologic nursing (5th ed.). Missouri, Elsevier Mosby.

● Touhy, T and Jett, K. (2018). Ebersole and Hess’ Gerontological nursing & healthy
aging (5th ed.). Elsevier.

Prepared by:

Debbie Q. Ramirez, RN, PhD Mary Angelica P. Bagaoisan, RN, MAN

NCM 0114 Instructor NCM 0114 Instructor

Contributor for Academic Year 2021-2022

Rolando L. Lopez Jr., RN, MN

NCM 0114 Instructor

Peer Reviewed by:

Jasleen S. Yumang RN, MN

NCM 0114 Instructor

Reviewed and Evaluated by:

Anna Lyn M. Paano, MAN Sherwin M. Quizon RN, MN

Level 3 Academic Coordinator Level 3 RLE Coordinator

Approved by:

Zenaida S. Fernandez, RN, Ph.D

Dean, College of Nursing