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NCM 114: CARE OF THE OLDER ADULT

Prepared by: Edna R. Javier

Module Description: This module summarizes the

theories in the Care of Older Adult. It will discuss several
nursing implications for each of the major biologic,
sociologic and psychologic theories of aging.

Learning Outcome
At the end of the lesson, the students should be able to: Apply
appropriate nursing concepts and actions holistically and
comprehensively.

HOW TO USE The Care of the Older adult MODULE

This module contains the theories that explains biologic, sociologic or
psychologic aging process and its nursing implications. As you read through each part,
the following icons will serve as your guidance.
Introduction/Module description. This icon describes the scope of the
module and gives a summary of the topics.
Learning outcome.  This icon tells what a learner is expected to do and know at
the end of the module.

PRETEST. This icon instructs a student to take a test prior to

starting the course to determine prior knowledge to the course.
TOPICS. This icon contains the discussions/lecture in the module.

KEY POINTS. This icon emphasized the essential/important parts of the

module.

ACTIVITY ICON. This icon gives direction on the task or activity that a
student should accomplish.

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POST TEST. This icon instructs a student to take to test knowledge gained on the
topic.

R EFLECTION. This icon tells students to write their thoughts about their
learnings from the module, difficulties encountered and comments on the
context of the module.

R EFERENCES. This icon contains all the references cited throughout the
module.

Topic 2: THEORIES OF AGING AND ITS

NURSING IMPLICATIONS

Key Points
'" There is no one theory that explains the biologic,
sociologic, or psychologic aging processes”.

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An eclectic approach incorporating concepts from biology, sociology, and

psychology was used in developing aging theories.
Biologic theories must address what factors actually trigger the aging process in
organisms.
Humans are thought to have a maximum lifespan of 110 to 120 years.
A change in the efficiency of immune processes may predispose individuals to
disease with advancing age.
Biologic theories alone do not provide a comprehensive explanation of the aging
process.
Reminiscence is supported by sociologic theories and assists older adults in
appreciating past memories.
Each individual is unique, no matter what age. Older adults are not a homogenous
population.
The activity theory remains popular because it reflects current societal beliefs about
aging.
As a person ages, various adaptive changes occur which may assist the person in
coping with or accepting some of the biologic changes.
Human development is a process that occurs over the lifespan.

THEORIES OF AGING
1. BIOLOGIC
 Concerned with answering basic questions regarding
physiologic processes that occur in all living organisms
(Hayflick, 1996)
2. SOCIOLOGIC
 Focused on the roles and relationships within which
individuals engage in later life (Hogstel, 1995)
3. PSYCHOLOGIC
 Influenced by both biology and sociology and address
how a person responds to the task of their age
4. MORAL/SPIRITUAL
 Examine how an individual seeks to explain and validate their
existence (Edelman,Mandle, 1988)

BIOLOGIC THEORIES OF AGING

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 Answers basic questions regarding the physiologic processes that occur in all
living organisms as they chronologically age
 View aging as occurring from a molecular, cellular, or even a systems point of
view
 The foci of biologic theories include explanations of the following:
(1) deleterious effects leading to decreasing function of the organism
(2) gradually occurring age-related changes that are progressive over time
(3) intrinsic changes that can affect all members of a species because of
chronologic age

BIOLOGIC THEORIES CAN BE SUBDIVIDED INTO

TWO MAIN DIVISIONS:
1. Stochastic – explain aging as events that occur randomly and accumulate
over time
2. Non-stochastic – view aging as certain predetermined and timed phenomena

NON-STOCHASTIC THEORIES

1 Error Theory is based on the idea that errors can occur in the transcription of the synthesis of
DNA. These errors are perpetuated and eventually lead to systems that do not function at the
optimal level. The organism's aging and death are attributable to these events (Sonneborn, J 979).

2 CROSS LINKAGE Theory - it has been theorized that some proteins in the body become cross-
linked This does not allow for normal metabolic activities and waste products accumulate in the cells.
The end result is that tissues do not function at optimal efficiency. (Hayflick, 1196)

3 FREE RADICAL THEORY

- Free radicals are byproducts of metabolism. When these byproducts accumulate, they damage the
cell membrane, which decreases its efficiency. The body produces antioxidants that scavenge the free
radicals (Hayflick, 1996).

4 WEAR AND TEAR Theory

- Equates man with machine. It hypothesizes that aging is the result of use.

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STOCHASTIC THEORIES
1 -
program Theory- implies that aging follows a biological timetable
regulated by changes in gene expression that affect the systems responsible for maintenance,
repair and defense responses
- consider aging to ultimately be the result of a biological mechanism or program that purposely
causes or allows deterioration and death in order to obtain a direct evolutionary benefit achieved
by limiting lifespan beyond a species-specific optimum lifespan

2 IMMUNITY Theory

- states that the immune system is programmed to decline over time, leading to an increased vulnerability to
infectious disease and thus ageing and death

IMPLICATIONS OF BIOLOGIC
- Changes occur in the immune system, most specifically with the T-lymphocytes as a result of aging. These
changes leave the individual more vulnerable to disease

THEORIES TO NURSING
- relate the key concepts of biologic theories to the care being provided to the older population,
they certainly can provide an explanation for some of the changes seen in the aging individual
- gerontologic nurses can promote the health of older adult clients in a number of ways:
1. Provide assistance with smoking cessation
2. Advise clients to ingest a varied, nutritious diet using the food pyramid as a guide, and
suggest supplementation with antioxidants such as vitamin C and E (Goldstein, 1993).
3. Encourage older adults to participate in activities that capitalize on existing abilities,
strengthen muscles, and prevent further atrophy of muscles related to disuse.

SOCIOLOGIC THEORIES OF AGING

Sociologic theories focus on changing roles and relationships,
In some respects, sociologic theories relate to various social adaptations in the lives of
older adults.
Consists of 5 theories: Disengagement theory, Activity theory, Continuity Theory, Age
Stratification Theory and Person Environment Fit Theory
Each of these attempts to explain how a person successfully ages into older life. When we
talk about a theory, it is worth noting that these are ideas based on observations and
predictions about future events.

Disengagement Theory

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- It is the process wherein individuals withdraw and isolate from prior social
interactions due to aging
- Older people’s work in the 1950s was often very hard on the body and the
medical care was not what we're used today. These life and medicine
issues led to shorter life-spans and less vigorous older people. Back then,
it was quite intuitive to say that as people grew older, they would
disengage from activities they were part of because they no longer had the
stamina or energy to stay involved.
- This theory has been largely abandoned or modified due to the increase in
the life-span of people as well as the increase in the general health level of
elderly people. Older folks don't sit at home in rocking chairs anymore.
While they may not be climbing Everest every day, they are staying
involved through volunteer work, continuing to work past retirement, and
engaging in more activities with retirement.
- It has been modified to indicate that older people may disengage from
activities but will likely engage themselves in an alternate activity, such as
spending time with their family or hobbies.

Activity/developmental task Theory

- The basis of the activity theory is that the need to remain
involved in activities continues into older life, but the
meaning and the focus changes.
- Based on the hypothesis that
1. Active older people are more satisfied and better
adjusted than those who are not active,
2. An older person’s self-concept is validated through
participation in roles characteristic of middle age, and older people
should therefore replace lost roles with new ones to maintain their
place in society

Continuity Theory
- This theory dispels the premises of both the disengagement
and activity theories
- Based on the hypothesis that central personality
characteristics become more pronounced with age or are
retained through life with little change; people age
successfully if they maintain their preferred roles and
adaptation techniques throughout life.
- According to this theory, being active, trying to maintain a
sense of being middIe-aged, or willingly withdrawing from
society does not necessarily bring happiness.

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- This theory proposes that how a person has been throughout life is how that person will continue
through the remainder of life (Havighurst, Neugarten, Tobin, 1963).
- According to this theory, the latter part of life is a continuation of the earlier part and therefore an
integral component of the entire life cycle.
- The theory can be seen as a developmental theory. Simply stated, the theory proposes that as
persons age, they try to maintain or continue previous habits, preferences, commitments, values,
beliefs, and all the factors that have contributed to their personalities {Havighurst, Neugarten,
Tobin, 1963}

Age Stratification Theory

- This theory views the aging person as an individual element of society and also as a
member, with peers, interacting in a social process.
- This theory is based on the belief
that societal age structure affects roles, self-
concept and life satisfaction.
- The theory attempts to explain the
interdependence between older adults and
society and how they are constantly influencing each other in a variety of ways.

Person-Environment Fit Theory

- This theory was proposed by Lawton (1982) and examines the concept of
interrelationships among the competencies of a group of persons, older adults, and
their society or environment.
- Lawton (1982) identified personal
competencies as ego strength;
level of motor skills, individual
biologic health, and cognitive and
sensory-perceptual capacities. All of
these help a person deal with the
environment in which one lives.
- As a person ages, there may be
changes or even decreases in some of these personal competencies. These changes
influence the individual's abilities to interrelate with the
environment.
- If a person develops one or more chronic diseases, such as rheumatoid arthritis or
cardiovascular disease, then competencies may be impaired and the level of
interrelatedness may be limited.
- The theory further proposes that, as a person ages, the environment becomes more
threatening and one may feel incompetent dealing with it.
- In a society constantly making rapid technologic advances, this theory helps explain

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why an older person might feel inhibited and may retreat from society.

Implications of Sociologic theories to Nursing

Older adults respond to current experiences based on their past life encounters, beliefs,
and expectations. If their "typical" reaction to stress, challenges, or fear is to disengage
from interactions, then current situations often produce the same responses.
1. Respect older adult responses.
2. Nurses identify maladaptive responses and intervene to protect the integrity of the
person.
3. Use assessment skills and specific tools to investigate and plan appropriate
interventions to resolve withdrawal and depression of older adults.
4. Plan successful realistic group activities that provides an opportunity for increasing
an older person's self-confidence
5. Be aware and examine significant events and beliefs about older adult’s health and
illness in order to conduct meaningful client teaching.
6. Assist older adults in adapting to various limitations and securing appropriate living
arrangements.

PSYCHOLOGIC THEORIES OF
AGING
 The basic assumption of the
psychologic theories of aging
is that development does not
end when a person reaches
adulthood, but remains a
dynamic process that occurs
over the lifespan.
 As a person passes from the
middle to the later life roles,
abilities, perspectives, and belief systems enter a stage of transition.
 The nurse, by providing holistic care, seeks to employ strategies to enhance
clients' quality of life (Hogstel, 1995).
 The psychologic theories of aging are much broader in scope than the
previous theories because they are influenced by both biology and sociology.
Therefore, psychologic aging cannot readily be separated from biologic and
sociologic influences.

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Implications of
Psychologic Theory
to Nursing
 Integrating the psychologic aging theories into nursing
practice becomes increasingly important as the population
continues to age. Present and future generations can learn
from the past.
 Nurses can do the following interventions when caring
for older adults:
1. Encourage to engage in “life review” (e.g. reminiscence,
oral histories, story-telling) to promote positive self-
esteem
2. Understand that each stage of life has specific
developmental tasks to achieve. The nurse should
facilitate their achievement.
e.g. If an older person is talking about retirement, worrying about physical living space,
or even planning funeral arrangements, these are all part of the developmental task
appropriate for this age group.

3. Keep in mind that intellectual functioning continues to remain intact in majority of

older adults. A younger person can gain much by observing older persons, listening to
how they have coped with life experiences, and discussing their plans for the future with
them.

4. Plan activities that older adult enjoys feeling needed, respected and considered a
contributing member of society.

Examples: activities like collecting an oral history, creating a mural, or quilting a

particular event or even an individual's lifetime could be included

5. Promote programs of interaction between older adults and younger children

Examples: - Caring for small children - represented a happy time in their lives

- Rocking, cuddling, and playing with children might bring back feeling of
being valued and needed.

 The touching aspects of this activity are important in relieving stress

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MORAl/SPIRITUAL
DEVELOPMENT
 Kolberg has postulated a
theory of moral development
that is based on interviews
with young persons. He found
distinct sequential stages of
moral thinking.
 Though he did not study older
adults, parallels could be
drawn between his highest
stage of moral development,
Universal Ethical Principles,
and Maslow's highest level of Self-Transcendent Needs. In each instance only a
small segment of the population reaches this highest level of development,
where their personal needs are sublimated for the greater good of society
(Edelman, Mandle, 1998; Levin, Chatters, 1998; Mehta, 1997)
 It is important for the nurse to acknowledge the spiritual dimension of a person
and support spiritual expression and growth (Hogstel, 1995).
 Spirituality no longer merely denotes religious affiliation; it synthesizes a person's
contemplative experience. Illness, a life crisis, or even the recognition that our
days on earth are limited may cause a person to contemplate spirituality.

Implications of Moral/Spiritual theory to Nursing

 The nurse can assist clients in finding meaning in 'their life crises.
 Nurses need to address spirituality as a component in holistic care (Phipps,
Sands, Marek, 1999).

Summary
When interacting with older adults, the nurse often
plays a key role as the coordinator of the health
care team.
Nurses have the background to incorporate
information from a variety of sources when

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planning care for older adults. By using an eclectic approach to aging theories,
the nurse will have a broad background from which to draw specific details to
provide clarity, explanations, or additional insight into a particular situation.
Biologic theories help the nurse understand how the physical body may change
with advancing years and what factors may increase older adults' vulnerability to
stress or disease. The nurse will also be able to develop health promotional
strategies on behalf of' older clients.
Understanding sociologic theories broadens the nurse's view of older adults and
their interactions with society.
Psychologic theories provide an understanding of the values and beliefs an older
person may possess. These theories enable a nurse to understand the phases of
the lifespan and the developmental tasks faced by the aged population.
Through the integration of the various components of these theories, quality
care can be planned' for older adults.
As the population continues to age, nurses with the capability to understand and
apply theories of aging from several disciplines will be the leaders of
gerontologic nursing in the future.
These nurses will contribute to increasingly holistic care and an improved quality
of life for older adults.

Post Test
Direction:  Read each question carefully and choose the ONE
best answer. Encircle the letter of your choice.

1. A theory of aging that states that the human body wears out because of the
passage of time and exposure to environmental stressors.
a. Feminist Theory
b. Wear and Tear Theory
c. Exchange Theory
d. Continuity Theory
2. The nurse is aware that the theory of aging is most likely to explain why the older
population is at risk for autoimmune disorder is:
a. Cross-linked Theory
b. Free Radical Theory
c. Error Theory
d. Autoimmune Theory

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3. The nurse implements activity theory of aging when instructing the older client
with osteoarthritis to:
a. Continue her daily walking routine
b. Curtail further increases in physical activity
c. Document preferred end of life interventions
d. Avoid exposing herself to crowds
4. The continuity theory asserts that
a. Aging adults will maintain only the internal structures they had in
their earlier years of life.
b. Aging adults will maintain the same internal and external structures
they had when they were young.
c. Aging adults will not maintain the same internal and external
structures they have in their earlier years of life.
d. Aging adults will maintain only the external structures they had in
their earlier life.
5. What are the three psychosocial theories of aging?
a. Activity theory, Disengagement theory, Age stratification theory
b. Activity theory, Continuity theory, Disengagement theory
c. Activity theory, Disengagement theory, Person Fit Environment
theory
d. Age Stratification theory, Person Fit theory, Continuity theory

Activity: CRITICAL THINKING

EXERCISES
1. A 62-year-old woman believes that heart disease and poor
circulation are inevitable consequences of growing older and is resistant to altering
her ADLs and dietary regimen. How would you respond?
2. A 74-year-old man repeatedly talks about how he wishes he were as strong and
energetic as he was when he was younger. His family consistently changes the topic
or criticizes him for being so grim. How would you intervene in this situation?
3. What health promotion strategies would you recommend to promote successful
aging?

REFLECTION:
 What did you learn from this module?

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 Imagine yourself at age 75. Describe your appearance, your health issue, and your
lifestyle.

REFERENCES:

Website: Lumen the Biology of Aging https://courses.lumenlearning.com/atd-

herkimer-biologyofaging/chapter/why-the-body-ages/

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Social Theories of Aging:

https://www.webpages.uidaho.edu/gbabcock/PDFs/hooyman_Ch8.pdf
Maddison, Holly Evans. Theories of Aging. 2000.
https://ogg.osu.edu/media/documents/sage/handouts/SAGE%20Theories%20of%20Aging
%20geron%20nurs.pdf

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