CARE OF THE OLDER ADULT
society for certain activities, such as driving,
INTRODUCTION
 Aging is not merely the passage of time
 It is important to recognize that people age
differently
 As a general rule, slight, gradual changes are
common and most of these are not problems
to the person who experiences them.
GERONTOLOGY VS GERIATRIC
 Scientific and medical disciplines, respectively
concerned with all aspects' of health and
diseases in the elderly and with the normal
aging process.
GERONTOLOGY
 Is concern primally with the changes that
occur bet? Maturity and death & w/ the
factors that influence these changes. It
addresses the social and economic effects of
an aging population & the physiological and
psychological aspects of aging to learn about
the aging process and possibly minimize
disabilities.
GERIATRIC
 Hence both deal with aging, but Geriatric
focuses on the care of aging people, while
gerontology is that the actual study of the
aging process. A geriatrician or geriatric
Physician and gerontology nurse works to
promote health in the older adults while
preventing & treating diseases prone to them.
DEFINITION
 a normal developmental process
 occurring throughout the human life span
 causes a mild progressive decline in body
system functioning
DEMOGRAPHIC AGING
WHAT IS AGING?
It is the process of growing old or developing of
appearance and characteristic of old age, and is
classified as,
1. OBJECTIVELY
2. SUBJECTIVELY
3. FUNCTIONALY
1. Chronological Aging
 Refers to the number of years the person has
lived.
 Most commonly used objective method.
 Chronological age serves as a criterion in
employment and the collection of retirement
benefits. Three categories:
o Young old- (ages 60-74)
o Middle-old (ages 75-84)
o Old-old(ages 85-100)
o Elite old (over 100)
2. Biological or Physiological Aging
 refers to the determination of age by body
function
3. Functional Age
 refers to a person's ability to contribute to
society and benefit others and himself
THEORIES OF AGING
1. SOCIOLOGICAL THEORIES OF AGING
Changing roles, relationships, status, impact the older
adult's ability to adapt.
A) ACTIVITY THEORY
 Remaining occupied and involved is necessary
to a satisfying late-life.
B) DISENGAGEMENT THEORY
 Gradual withdrawal from society and
relationships serves to maintain social
equilibrium and promote internal reflection.
C) SUBCULTURE THEORY
 The elderly prefer to segregate from society in
an aging subculture sharing loss of status and
societal negativity regarding the aged.
D) CONTINUITY THEORY
 Personality -influences roles and life
satisfaction and remains consistent
throughout life.
 Past coping patterns recur as older adults
adjust to physical, financial, and social decline
and contemplate death.
E) AGE STRATIFICATION
 Individuals in different generations have
different experiences that may cause them to
age in different ways.

2. PSYCHOLOGICAL THEORIES
 Explain aging in terms of mental processes,
emotions attitudes, motivation, and
 personality development that is characterized
by life stage transitions.
A) HUMAN NEEDS
 Five basic needs motivate human behavior in
a lifelong process toward need fulfillment.
Maslow surmised that a hierarchy of five
needs motivates human behavior: physiologic,
safety and security, love and belonging, self-
esteem, and self-actualization.
B) INDIVIDUALISM
 Personality consist of an ego and a personal
and collective unconsciousness that views life
from a personal or external perspective. Older
adults search for life meaning and adapt to
functional and social losses.
C) STAGES OF PERSONALITY DEVELOPMENT
 Personality develops in eight sequential
stages with corresponding life tasks. The
eighth phase, integrity versus despair, is
characterized by evaluating life
accomplishments; struggles include letting go,
accepting care, detachment, and physical and
mental decline.
D) LIFE-COURSE/Life Span Development
 Life stages are predictable and structured by
roles, relationships, values, and goals. Persons
adapt to changing roles and relationships. Age
group norms and characteristics are an
important part of the life course.
E) SELECTIVE OPTIMIZATION WITH COMPENSATION
 Individuals cope with aging losses through
activity/role selection, optimization and
compensation. Critical life points are
morbidity, mortality, and quality of life.
Selective optimization with compensation
facilitates successful aging.
3. Environmental Theories
A. Radiation Theory
 Excessive exposure to the suns radiation puts
the skin at risk
B. Stress Theory
 Human aging is a disease syndrome arising
from a struggle between environmental stress
and biological resistance and relative adaption
to the effects of stressor agents. (air
pollutants, chemicals, psychological and
sociological events)
4. Moral/Spiritual Theories
 This transcends the need to inhabit a body,
and the person approaches the end of life.
 aging process results in greater satisfaction
 Become increasingly more comfortable being
alone.
QUOTES
“POSITIVE aging means to LOVE, to WORK, to LEARN
something we did not know YESTERDAY, and to ENJOY
the Remaining PRECIOUS moments with LOVED
ONES" (George E. Valiant MD- Aging Well 2002)
SOCIOECONOMIC ASPECTS OF AGING
1. AGE COHORTS
 Persons who share the experience of a
particular event or time in history are grouped
together in what is called a cohort.
2. POVERTY
 Inadequate income may affect the quality of
life for older adults.
 Delay seeking medical help. May not follow
through with the prescribed treatment or
medications.
3. EDUCATION
 Has been shown to have a strong relationship
to health risk factors. The level of education
influences earning ability, information
absorption, problem-solving ability, value
systems, and lifestyle behaviors
4. HEALTH STATUS
 The health status of older adults influences
their socioeconomic status. Persons over 65
have an average of 2 chronic conditions.
5. INSURANCE COVERAGE
 Health insurance is a necessity for older adults
because of medical problems- therefore
medical expenses- increase with age.
 As person's age, they visit doctor more often
6. SUPPORT SYSTEMS
 Throughout life, people make new
acquaintances, develop friendships, and form
family circles. People identify with schools,
churches or synagogues, clubs,
neighborhoods, and towns. These are the
places and people they turn to when they
need advice or help, want to celebrate, or are
grieving.
THE AGING FAMILY beliefs, Lifestyle, Wide range of experiences,
etc....
FAMILY
CHRONIC ILLNESSES IN OLDER PERSON AND ITS
 A basic social unit consisting of parents and BEHAVIORAL MANAGEMENT & HEALTH EDUCATION
their children, considered as a group, whether
dwelling together or not: the traditional COMMON CHRONIC ILNESSES
family.
 HYPERTENSION
 A social unit consisting of one or more adults
 ARTHRITIS
together with the children they care for: a
single-parent family.  CHRONIC OBSTRUCTIVE PULMONARY DISEASE
 Any group of persons closely related by blood,  Chronic Bronchitis-
as parents, children, uncles, aunts, and  Emphysema
cousins: to marry into a socially prominent  Asthma
family.  DIABETES
 Family members plays an important role to  DEMENTIA
their elderly, their support system when an  CANCERS
elderly becomes dependent on them and to  STROKE
maintain a satisfaction in later life. PATTERNS OF HEALTH & DISEASE IN THE OLDER
ROLES AND RELATIONSHIPS ADULT

 Roles of members CHANGE A. Diseases that occur to varying degrees in older

 Grandparents may assume parental roles to adults
their grandchildren 1. cataracts
 Adult children may provide limited or 2. arteriosclerosis
extensive caring to their own parents 3. benign prostatic hypertrophy [males]
 This caregiving may be TEMPORARY or LONG-
TERM. B. Diseases with increased incidence with advancing
age
The family of the elderly is the support system that
renders care\ and gives LOVE, STRENGTH, and HOPE 1. neoplastic disease
in the life of an individual chronically ill patient. This 2. diabetes mellitus
family could be the spouse, brothers, sisters and sons/ 3. dementia disorders
daughters.
C. Diseases that have more serious consequences in
CHANGES IN THE OLDER PERSON AND THEIR the elderly
IMPLICATION TO CARE
1. pneumonia
 AGING CHANGES IN CARDIOVASCULAR 2. influenza
STRUCTURE 3. trauma
 AGING OF THE RESPIRATORY SYSTEM D. Very common chronic diseases
 AGING OF THE GASTROINTESTINAL SYSTEM
 URINARY STRUCTURAL CHANGES WITH AGE 1. arthritis
 REPRODUCTIVE SYSTEM 2. hypertension
 NERVOUS SYSTEM 3. heart disease
 THE MUSCLE
E. Functional disability
 THE SKELETAL SYSTEM
 THE SENSORY SYSTEM 1. 32% of persons over 65 years have some
 THE INTEGUMENTARY SYSTEM limitation of functions
 THE IMMUNE SYSTEM 2. 25% of persons over 65 years require help
with at least one ADL or IADL
Cultural Factors/ Perception of health for elders with
regards to diversity
DIVERSITY OF ELDERS
 Ethnicity/race, Nationality, Age, Gender,
Sexual orientation, Socio economic status,
Physical ability, Religious beliefs, Political
CHANGES IN THE OLDER PERSON
Aging changes in Cardiovascular Structure
Cardiac Aging
 Enlargement of heart chambers and coronary
cells occurs with age, as does increased
thickening of the heart walls especially in the
left ventricle. Ventricles in the heart also
begin to thicken and stiffen in correlation with
continued steady production of collagen.
Vascular Aging
 Aged arteries become extended and twisted.
With age, large arteries begin to dilate and
stiffen, leading to hypertension.
Aging of the Respiratory System
Alveoli
 The volume of blood distributed to pulmonary
circulation declines with age due to a
decreasing number of capillaries per alveolus
-impairs efficient passage of oxygen from the
alveoli to the blood.
Lung Elasticity
 With age, there is a decrease in the lungs’
elasticity, which in turn causes a change in the
elastic recoil properties of the lungs. Loss of
elastic recoil causes the lung s to close
prematurely, trapping air inside and
preventing the lungs from emptying
completely.
The Chest Wall
 The Chest Wall becomes stiffer with advancing
age, decreasing the ease with which the
thoracic cavity can expand. The stiffness of
the chest reduces its ability to expand during
inhalation and contract during exhalation.
Aging of the Gastrointestinal System
Pharynx and esophagus
 Overall, the gastrointestinal system appears to
be relatively preserved in aging with only
minor changes. The two gastrointestinal areas
most affected by age are the upper tract
(pharynx and esophagus) and the colon.
Stiffening of the esophageal wall affect the
older patient’s ability to swallow. Dysphagia,
reflux, heartburn and chest pain are common
complaints.
The Large Intestine
 The rectum, a colonic structure that is located
before the anus, shows age-related increase in
fibrous tissue. This increase reduces the
rectum’s ability to stretch as feces pass
through.
Urinary Structure changes with age
Kidneys
 With age, the kidneys shrink in length and
width. Changes in renal blood flow and
glomerular filtration rate (GFR) account for a
majority of functional disability in the kidneys
with age.
Bladder
 With age, the bladder decreases in size and
develops fibrous matter in the bladder wall,
changing its overall stretching capacity ad
contractibility (Diogiovanna, 2000).
Urination
 The amount of urine expelled from the body
decreases with age.
Changes in the Reproductive System
 Ovaries
 With age, the ovaries atrophy to such a small
size that they can become impalpable during
an exam. (Smith, 1998).
Uterus
 Age-related decreases in uterine endometrial
thickening during menstrual cycles occur as
the result of decreased estrogen and
progesterone levels.--decline in menstrual
flow.
Vagina
 With age, the vagina becomes shorter and
narrower and the vaginal walls tend to thin
and weaken. As a result, the vagina can
become very dry, causing intercourse to be
very painful.
Menopause
 The menopause transition is defined by
declines in estradiol along with the onset of
variable menstrual cycles. Periods of
amenorrhea trigger the move into the late
stages.
For male
Testes
 In aging, the testes decrease in both size and
weight, but with high variability among men.
Although a decline in sperm production occurs
in aging males, the production never ceases,
as a result, the older male remains fertile.
Glands
 The biggest concern in older males is changes
in the prostate gland. The lining and muscle
layer of the prostate gland become thinner
with age, probably dueto the reduced blood
flow to the area. Benign Prostatic
Hypertrophy (BPH)-- remains very common
among aging males.
Penis
  The penis begins to show fibrous changes in
erectile tissue around the urethra starting in
the 30’s and 40’s. This fibrosis in erectile
tissue -- increase in the amount of time it
takes to achieve an erection I older males.
Andropause
a decline in testosterone levels and eventually
deficiency significant enough to cause clinical
symptoms (American Society for Reproductive
Medicine). Unlike menopause, andropause occurs
gradually over time and does not occur in all aging
males. Symptoms include: low libido; decreased
energy, strength and stamina; increased irritability;
and cognitive changes.
Changes in the Nervous System
The Aging Brain
 Memory changes can be observed by the fifth
decade, but changes remain variable among
individuals. The brain decreases in size and
weight as men and women age.
The Aging Spinal Cord
 Nerve Conduction
 According to Abrams and colleagues(1995),
the aging spine may narrow due to pressure
on the spinal cord resulting from bone
overgrowth. Due to this narrowing, changes
in sensation can occur.
Changes in the Muscle and Skeletal system
 A reduction in muscle mass occurs to at least
some degree in all elderly persons as
compared to young healthy, physically active
young adults ---sarcopenia.
 Sarcopenia --associated with tremendous
increases in functional disability and frailty.
Estrogen deficiency
 key contributor to bone loss and bone loss
accelerates in women after menopause due to
a decline in estrogen levels.
Estrogen deficiency
 plays a role in bone loss among men--due to a
decline in levels of estrogen, not testosterone.
Osteoporosis
 results from reductions in bone quantity and
strength that are greater than the usual age-
related reduction. Bones of those with
osteoporosis are very porous--containing
numerous holes or empty pockets--prone to
fracture.
Changes in the Sensory System
Touch
 The ability to touch and distinguish texture
and sensation tends to decline with age due
to a decrease in the number and alteration in
the structural integrity of touch receptors or
Meissener’s corpuscles and pressure
receptors or Pacinian corpuscles . Receptors
that are elated to the sense of touch are also
known as mechanoreceptors.
Smell
 A decrease in the number of olfactory neurons
and weakening of olfactory neural pathways
to the brain lead to a reduction in the ability
to identify and distinguish aromas . A
decrease in the sense of smell is referred to as
hyposmia
TASTE
 Aging causes a decrease in taste, also known
as hypogeusia, usually more noticeable
around the age of 60 with more severe
declines occurring after the age of 70.
VISION
 most common visual concerns in aging --
presbyopia or the inability to focus on nearby
objects, such as newsprint. This is also called
farsightedness.
HEARING
 Age-related hearing loss occurs as a result of
changes in the inner ear . Aging changes that
cause hearing loss include the alteration and
decline in the ability to hear high frequency
sounds, and the ability to discern .
 Age-related hearing loss, also known as
prebycusis--most common sensory deficit in
the older population.
Changes in the Integumentary System
The greatest changes in aging skin - dermis. There is a
general thinning of the dermal layer, with loss of
thickness averaging 20% in older persons . This
thinning of the dermis is due in large part to a general
loss of collagen- approximately 1% loss per year in
adulthood.
Changes in the Immune System
Immunosenescence
 refers to the aging of the immune system.
 associated with increased incidence of
infectious disease such as bronchitis and
influenza.
 It is also implicated in the increased incidence
of tumors and cancer that occurs with age.