CHN
The CH nurse works as a member of the health team
COMMUNITY - a collection of people who interact with
one another and share common interests and
characteristics
2 types:
Geopolitical Community- barangays, cities, provinces,
regions, nations
Phenomenological Community- interactive
groups/shared group based on culture, values,
perspective, interests, history and goals
CHN - According to American Nurses Association
(ANA), community health nursing is defined as "the
synthesis of nursing practice and public health practice
applied to promoting and preserving the health of
populations
PUBLIC HEALTH NURSING - According to ANA &
American Public Health Association defined public
health nursing as "the practice of promoting and
protecting the health of populations using knowledge
from nursing, social, and public health sciences
GOAL: Major goal is to preserve the health of the
community and surrounding populations by focusing in
health promotion and health maintenance of individuals,
families, and groups within the community
PHILOSOPHY AND PRINCIPLES
Philo
-Philosophy of individual's right of being healthy
-Philosophy of working together under a competent
leader for the common good. The philosophy is that the
people in the community have the potential for continual
development and are capable of dealing with their own
problems if educated and helped.
-Philosophy of socialism
Principles
1. CHN is based on the recognized needs of
communities, families, groups, and individuals.
2. The CH nurse must fully understand the objectives
and policies of the agencies she represents.
3. In CHN, the family is the unit of service.
4. CHN must be available to all.
5. Health teaching is the PRIMARY responsibility of the
CH nurse
6.
7. There must be provision for periodic evaluation of
CHN services
8. Opportunities for continuing staff education programs
for nurses must be provided by the agency.
9. The CH nurse makes use of available community
health resources
10. The CH nurse utilizes the already existing active
organization in the community
11. There should be accurate recording and reporting in
CHN
FEATURES
Population-based
-involves specific approach: community assessment,
community diagnosis, planning, intervention, and
evaluation
-involves epidemiology and information about the
community
-data collection for assessment and management
decisions within a community is ongoing, not episodic
Delivers care for different levels of clientele
individual family group/aggregate community as a whole
Collaborates with a variety of other professions,
organizations, entities, and the community itself
identify implement evaluate meet the health needs
Prioritizes on health promotion and disease prevention
Actively reaches out to all who might benefit of the
service
Optimal usage of resources and selected strategies are
made to ensure best services for the population
HEALTH BELIEF MODEL
-It was initially proposed in 1958 by group of social
psychologists -- Irwin M. Rosenstock, Godfrey M.
Hochbaum, Stephen Kegeles, and Howard Leventhal at
the U.S. Public Health.
-This was developed by the group of psychologists to
explain why the public failed to participate in the
screening for tuberculosis. (Hochbaum,1958)
-It provides the basis for the practice of HEALTH
EDUCATION and HEALTH PROMOTION
-It is the one of the most widely used conceptual
framework in health behavior to be able to explain
behavior change and maintenance of behavior change
and to guide health promotion interventions.
-It includes different key concepts - perceived
susceptibility, perceived severity, perceived benefits,
perceived barriers, cues to action, self-efficacy.
-The group of psychologists the same questions that
perplex many health professionals today.
>why do people who may have a disease reject health
screening?
>why do individuals participate in screening if it may
lead to the diagnosis of the disease
Key Concepts:
Perceived susceptibility - One's belief regarding the
chance of getting a disease
Perceived severity - One's belief regarding the
seriousness of given condition
Perceived benefits - One's belief in the ability of an
advised action to reduce the health risk or seriousness
of a given condition
Perceived barriers - One's belief regarding the tangible
and psychological costs of an advised action
Cues to action - Strategies or conditions in one's
environment that activate readiness to take action
Self-efficacy - One's confidence in one's ability to take
action to reduce health risks.
-Kurt Lewin's work lent itself to the model's core
dimensions. He proposed that behavior is based on
current dynamics confronting an individual rather than
prior experiences
-The Health Belief Model is based on the assumption
that the major dominant of preventive health behavior is
disease avoidance.
Disease avoidance includes:
- perceived susceptibility to disease "X"
- perceived seriousness of disease "X"
- modifying factors - cues to action
- perceived benefits minus perceived barriers to
preventive health action
- perceived threat of disease "X"
- likelihood of taking a recommended health action
How is HBM used by Nurses?
-It assists clients in making necessary behavior
modifications by making them conscious of the need for
such modifications
-It is used by the nurse to determine client's
misperceptions that serve as barriers to appropriate
health action
Limitations of HBM
-It places the burden or pressure to action
exclusively on the client
-It focuses on giving interventions designed to
modify the client's perceptions
-It DOES NOT acknowledge the health's
professional's responsibility to alter or reduce health
care barriers
MILIO’S FRAMEWORK FOR PREVENTION
-This was proposed by Nancy Milio, a Public Health
Nurse, and leader in public health policy and education.
-A framework for prevention that includes concepts of
community-oriented, population-focused care.
-Inclusion of economic, political and environmental
health determinants.
-This provides a mechanism for directing attention
upstream and examining opportunities for nursing
intervention at the population level.
-Made of six propositions that relate an individual's
ability to improve healthful behavior to a society's ability
to provide accessible and socially affirming options for
healthy choices.
-She challenged the common notion that a main
determinant for unhealthy behavioral choice is lack of
knowledge.
-According to Milio, the range of available health
choices is critical in shaping a society's overall health
status & that policy decisions in governmental and
private organizations shape the range of choices
available to individuals.
-MOST HUMAN BEINGS, PROFESSIONAL OR
NON-PROFESSIONAL, PROVIDER OR CONSUMER,
MAKE THE EASIEST CHOICES AVAILABLE TO THEM
MOST OF THE TIME.
-Health-promoting choices must be done readily
available and less costly than health-damaging options
for individuals to gain health and for society to improve
health status.
-Milio believed that national level policy-making was the
best to favorably impact the health of most people rather
than concentrating efforts on imparting information in an
effort to change individual patterns of behavior.
-Individual's health and lifestyle choices are influenced
by resources, availability, cost, and convenience more
than knowledge obtained in education.
6 PROPOSITIONS
1 Population health deficits result from deprivation
and/or excess of critical health sustaining resources.
2 Behaviors of populations result from selection from
limited choices that arise from actual and perceived
options available as well as beliefs and expectations
developed from socialization, education and experience.
3 Organizational decisions and policies (both
governmental and nongovernmental) sets the range of
options available to individuals and populations and
influence choices.
4 Individual choices related to health promotion or
health damaging behaviors are influenced by efforts to
maximize valued resources.
5 Alteration in patterns of behavior resulting from
decision making or a significant number of people in a
population can result in social change.
6 Without concurrent availability of alternative health
promoting options for investment of personal resources,
health education will be largely ineffective in changing
behavior patterns.
PENDER’S HEALTH PROMOTION MODEL
-Nola J. Pender
Living Legend of the American Academy of Nursing.
A nursing theorist who developed the Health Promotion
Model.
An author and a professor emeritus of nursing at the
University of Michigan.
Started studying health-promoting behavior in the
mid-1970s and first published the Health Promotion
Model in 1982
HPM
-Originally published in 1982 and later improved in 1996
and 2002.
-It explores many biopsychosocial factors that influence
individuals to pursue health promotion activities.
-Does not include threat as a motivator, as threat may
not be a motivating factor for clients in all age groups.
-Was designed to be a “complementary counterpart to
models of health protection. ”
Purpose: To help nurses know and understand the
major determinants of health behaviors as a foundation
for behavioral counseling to promote well-being and
healthy lifestyles
-Defines health as “a positive dynamic state not merely
the absence of disease” . It describes the
multi-dimensional nature of persons as they interact
within the environment to pursue health.
Health Promotion - an approach to wellness
Health Protection - focuses on illness prevention
Health promotion model focuses on the following areas:
1 Individual characteristics and experiences
a. PRIOR RELATED BEHAVIOR - rior
behaviors influence subsequent behavior
through perceived self-efficacy, benefits,
barriers, and affects related to that activity.
Strong indicator: Habit
b. Personal Factors - Biological Factors: Age,
body mass index, strength, and agility.
Psychological Factors: Self-esteem, self-
motivation, and perceived health status.
Sociocultural Factors: Race, ethnicity,
acculturation, education, and socioeconomic
status
2 Behavior-specific cognitions and affect
 a. Perceived benefits of action - Strong
motivators of the behavior. These motivate
behavior through intrinsic and extrinsic
benefits
b. Perceived barriers to action - Perceived
unavailability, inconvenience, expense,
difficulty, or time regarding health behaviors.
c. Perceived self-efficacy - One’s belief that he
or she is capable of carrying out a health
behavior
3 Behavioral Outcome
a. Commitment to a plan of action - Initiates a
behavioral event. This commitment will
compel one into the behavior until
completed, unless a competing demand or
preference intervenes.
b. Immediate competing demands and
preferences - Alternate behaviors that one
considers as possible optional behaviors
immediately prior to engaging in the
intended, planned behavior.
c. Health-promoting behavior - This is the goal
of the Health Promotion Model. To attain
positive health outcomes.
PRECEDE-PROCEED MODEL
-Lawrence W. Green
- provides a model for community assessment,
health education, health planning and evaluation
Behind PRECEDE-PROCEED lie some
assumptions about the prevention of illness and
promotion of health, and by extension, about
community as well. These include:
- PRECEDE-PROCEED model should be a
participatory process.
- Health is, by its very nature, a community issue.
- Health is an integral part of a larger context,
probably most clearly defined as the quality of life,
and it' s within that context that must be considered.
- Health is more than physical well-being, or the
absence of disease, illness, or injury.
PRECEEDE
PREDISPOSING REINFORCING ENABLING
CONSTRUCTS IN EDUCATIONAL DIAGNOSIS
AND EVALUATION
Phases:
1 Social Assessment - Determine the social
problems and needs of a given population and
identify desired results
2 Epidemiological Assessment - Identify the health
determinants of the identified problems and set
priorities and goals
3 Ecological Assessment - Analyze behavioral and
environmental determinants that predispose,
reinforce, and enable the behaviors and lifestyles to
be identified.
4 Implementation
PROCEED
POLICY REGULATORY AND ORGANIZATIONAL
CONSTRUCTS IN EDUCATIONAL AND
ENVIRONMENTAL DEVELOPMENT
Phases:
5 Implementation - Design intervention, assess
availability of resources, and implement program
6 Process Evaluation - - Determine if program is
reaching the targeted population and achieving
desired goals
7 Impact evaluation - - Evaluate the change in
behavior
8 Outcome - - Identify if there is a decrease in the
incidence or prevalence of the identified negative
behavior or an increase in identified positive
behavior

ROLES AND ACTIVITIES OF CHN

CLINICIAN Ensures health care services Holism,

health promotion, and skill expansion
EDUCATOR Assess the people and provides health
education
ADVOCATE preserving human dignity, promoting
patient equality, and providing freedom from
suffering.
Managerial administrative direction towards the
accomplishment of specified goals
Collaborator - Coordinates with patients and groups
for health related services. Coordinates nursing
program with other health programs
Researcher Systematic investigation, collection, and
analysis of data to solve problems and enhance
community health nursing practice
Leader - Acting as the strategic lead for patient care
initiatives (Change agent) Influencing others through
effective communication and interpersonal skills

GERON
CONCEPTS, PRINCIPLES AND THEORIES IN
THE CARE OF OLDER ADULTS

Perspective on Aging
-A man's life is normally divided into five main
stages namely infancy, childhood, adolescence,
adulthood and old age. In each of these stages an
individual has to find himself in different situations
and face different problems. The old age is not
without problems. In old age physical strength
deteriorates, mental stability diminishes; money
power becomes bleak coupled with negligence from
the younger generation
-Elderly is an individual over 65 years old who have
a functional impairments Elderly care, or simply
eldercare, is the fulfillment of the special needs and
requirements that are unique to senior citizens. This
broad term encompasses such services as assisted
living, adult day care, long term care, nursing homes
(often referred to as residential care), hospice care,
and home care
The normal aging process
-Aging is not merely the passage of time. It is the
manifestation of biological events that occur over a
span of time.
-It is important to recognize that people age
differently. The aging body does change. Some
systems slow down, while others lose their "fine
tuning. "
-As a general rule, slight, gradual changes are
common, and most of these are not problems to the
person who experiences them. Sudden and
dramatic changes might indicate serious health
problems
4 aspect of Aging
1 Biological
-Individuals are unique in their psychological and
physical aging process. As the individual ages, there
is a quantitative loss of cells and changes in many of
enzymatic activities within cells .
-Age related a change occurs at different rate in
different people
2 Psychological
-Aging is a multidimensional and multidirectional
process. From a lifespan perspective successful
development and aging in late adulthood and old
age requires the accomplishment of different typical
developmental tasks or the solution of the final
psychosocial crisis postulated in Erikson's stage
theory (ego-integrity versus despair).
-Negative images of aging and old age in the society
may negatively influence the self-concept of elderly
people and the way their needs are met by
professionals and institutions
3 Sociocultural
-Old age brings many important socially induced
changes, some of those changes have the potential
for negative effect on both the physical and mental
well being of older persons.
-In developing countries and Asian countries the
aged are awarded a position of honor, that place
emphasize on family cohesiveness. In industrialized
countries many negative stereotyped perspectives
on aging still persisting, aged are always tires or
sick, slow and forgetful, isolated and lonely,
unproductive etc. Emplacement is one of the area
where the aged faces discrimination. Although
compulsory retirements has been eliminated,
discrimination still persist in hiring and promoting the
aged employees. The status of elderly may improve
with time as the number of elder person increases
world wide
4 Sexual
Male
-Testosterone plays an important role in a man's
sexual experience. Testosterone levels vary greatly
among men. In general, however, older men tend to
have lower testosterone levels than do younger
men.
-As a man ages, the penis may take longer to
become erect, and erections may not be as firm. It
may take longer to achieve full arousal and to have
orgasmic and ejaculatory experiences. Erectile
dysfunction also becomes more common.
Female
-As women approach menopause, their estrogen
levels decrease, which may lead to vaginal dryness
and slower sexual arousal. Emotional changes can
increase feelings of stress, which also can change
your interest in sex.
-While some women may enjoy sex more without
worrying about pregnancy, naturally occurring
changes in body shape and size may cause others
to feel less sexually desirable.
Demography of Aging and Implications for Health
and Nursing Care
GLOBAL AGING
AGING AND THE HEALTH SYSTEM
-According to the Global Health and Aging report
presented by the World Health Organization (WHO),
“The number of people aged 65 or older is projected
to grow from an estimated 524 million in 2010 to
nearly 1.5 billion in 2050, with most of the increase
in developing countries.” In addition, by 2050, the
number of people 65 years or older is expected to
significantly outnumber children younger than 5
years of age.
-According to the Office of Disease Prevention and
Health Promotion, the first Baby Boomers (those
born between 1946 and 1964) turned 65 in 2011. By
2030, it is projected that more than 60% of this
generation will be managing more than 1 chronic
condition. Managing these chronic conditions, along
with a patient’s level of disability, will increase the
financial demands on our health care system. The
cost increases with the number of chronic conditions
being treated, taking into account the expected twice
as many hospital admissions and physician visits for
Baby Boomers by 2030.
DIRECT CHALLENGES FOR THE HEALTH
SYSTEM
1. CHANGING HEALTH PROFILES - A key
challenge for the health system will be how to best
meet the health needs of an ageing population and,
in particular, how to manage the increasing impact
of chronic disease. These chronic conditions may
include hypertension, high cholesterol, arthritis,
diabetes, heart disease, cancer, dementia, and
congestive heart failure. Heart disease, stroke, and
cancer have been the leading chronic conditions
that have had the greatest impact on the aging
population, especially in high-income countries. In
addition, the incidences of obesity and falls are
increasing.
2. DISABILITY AND DISABILITY-FREE LIFE
EXPECTANCY - Population ageing is expected to
result in an increase in the absolute number of
people with disability, simply because there are
more people in the older age groups and disability
becomes more common with age. According to the
WHO report, some believe that as life expectancy
increases, the prevalence of disability will decrease
because the progress we make in medicine will slow
disease progression from chronic disease to
disability. As a result, there will be a decrease in
severe disability, but there will be increases in milder
chronic diseases. Other researchers, however,
believe that as life expectancy increases, the
prevalence of disability will increase
3. INCREASED DEMAND FOR HEALTH SERVICE
USE - The higher use of health services by older
people also has implications for the health
workforce. An aging population will require an
adequate health workforce —in terms of numbers,
distribution, and skill set—to meet changing needs
and increased demand. Future shortages of
appropriately skilled workers are also expected to be
a particular challenge in the aged care sector.
4. RISING HEALTH COSTS - With older people
being high users of the health system, and health
costs being higher in older age groups, population
aging has led some to express concerns about
unsustainable pressure on expenditure within the
health system. Funding for health goods and
services comes from a range of sources. This
includes local governments and non-government
sources such as private health insurers and injury
compensation insurers, and out-of-pocket payments
by individuals.
WHAT ARE THE RESPONSES FOR HEALTHY
AGING?
1 Enabling healthy aging
2 Supporting socioeconomic participation
3 Enhancing productivity in health-care delivery
AGING IN THE PH
DEMOGRAPHY
- In 2000, there were 4.6 million senior citizens
(60 years or older), representing about 6% of
the total population.
- For over two decades, The Philippines’
population increased by over 35% with the
older adult population (60 years and older)
expected to overtake those aged 0–14 years
old by 2065.
- The current population of the Philippines is
111.2 million as of September 2021, based
on Worldometer elaboration of the latest
United Nations data.
QUALITY OF LIFE
-An aging population increases the demand for
health services. Filipinos tend to live longer now
than in previous decades, with life expectancy at
birth increasing from 62.2 years in 1980 to 71.66
years in 2021. This is attributed mainly to the
improving living conditions in the country. However,
older people still suffer from both degenerative and
communicable diseases due to the aging of the
body’s immune system. The leading causes of
morbidity are infections, while visual impairment,
difficulty in walking, chewing, hearing, osteoporosis,
arthritis, and incontinence are other common
health-related problems
-In terms of research on quality of life of older
Filipinos, many elders generally report positive
health, community participation, and financial
security.
-Older Filipinos can attain greater stability in later
life, and they may develop methods to cope with
distressing events through previous challenges they
experienced and overcame.
-Older Filipinos residing in rural areas lacked access
to services than older adults living in more urban
settings.
-Older Filipinos can view late adulthood as a period
of life where new relationships can be created and
as an opportunity to become more engaged in their
communities.
-Overall, older Filipinos report adequate life
satisfaction and well-being; however, social and
financial inequalities may act as a hindrance
-Barriers to access community and health support
services should be reduced for older adults who
may need assistance
SENIOR CARE IN THE PHILIPPINES
-The dedication to family caregiving is evident in
Filipino culture, and it is a part of the very fabric of
Philippine society.
-Caregiving in Filipino households is so
commonplace that failure to provide care or
resources to family members in need is seen as
shameful, or “hiya” in Tagalog.
-Filipino caregivers utilize mainly family resources in
care provision, so they are often less reliant on
formal services for assistance
-In Filipino culture it is perceived as a stigma to
accept services from the community, so many
families either forgo them or use them in secret.
-Families would opt to provide care themselves
rather than resort to any health or social services for
assistance in providing care.
-Filipino caregivers who do not utilize external
services fear that society will deem them unable to
adequately care for a family member if they utilize
support services.
-Families believe that the care provided by relatives
is sufficient for the needs of the care recipient
IMPACT OF AGING MEMBERS IN THE FAMILY
-How does caring for aging parents affect family life?
-Whether you and your parents live together or
thousands of miles apart, you might find yourself
increasingly responsible for their day-to-day care.
EMOTIONAL EFFECTS
Caring for your aging parents prompts a range of
impulses and emotions. This may include:
-Guilt for not being able to do more for parents
-Anger for having to set aside your own needs or
shift your priorities
-Fear and anxiety
-Anticipatory grief and fear of financial strain.
Positive Emotional Effects
1 Enrichment that comes with relationships between
grandparents and grandchildren.
2 Increased opportunity to pass on stories and
knowledge to younger generations.
3 Younger generations having a sense of being able
to give back to parents and grandparents
Financial Effects
-Caring for aging parents often means extra costs
related to home health care, medical expenses not
covered by insurance and extra insurance premiums
for services such as longterm care.
Structural Effects
-When you live with your aging parents or assume a
high amount of daily care for them, you experience a
change in your family roles.
-This shift can cause guilt and stress, as family
members work to find a place in the new family
dynamic, but it can also result in more open
communication among family members.
Physical Effects
-Prioritizing parents' care can ease their pain and
worry, but might impact your health
-Caregiving and time pressure contribute to the
physical effects of aging members in the family
Positive Effects
-Some families have the opposite experience by
creating what she describes as a positive "wiring" in
their brains to produce more potentially positive
outcomes
-They consider what moments in their days make
them smile
THEORIES OF AGING AND ITS NURSING
IMPLICATIONS
BIOLOGICAL THEORIES
Cross-linkage Theory
-proposes that cellular division is threatened as a
result of radiation or a chemical reaction in which a
crosslinking agent attaches itself to a DNA strand
and prevents normal parting of thestrands during
mitosis.
- As these cross-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.linking
agents accumulate, they form dense aggregates
that impede intracellular transport; ultimately, the
body’s organs and systems fail
Mitochondrial Free Radical Theory
-- suggests that aging is due to oxidative metabolism
and the effects of free radicals (Hayflick, 1985).
- Free radicals are highly unstable, reactive
molecules containing an extra electrical charge that
are generated from oxygen metabolism. They can
result from normal metabolism, reactions with other
free radicals, or oxidation of ozone, pesticides, and
other pollutants. These molecules can damage
proteins, enzymes, and DNA by replacing molecules
that contain useful biological information with faulty
molecules that create genetic disorder
- There has been considerable interest in the role of
lipofuscin “age pigments, ” a lipoprotein by-product
of oxidation that can be seen only under a
fluorescent microscope, in the aging process.
- Because lipofuscin is associated with the oxidation
of unsaturated lipids, it is believed to have a role
similar to that of free radicals in the aging process.
As lipofuscin accumulates, it interferes with the
diffusion and transport of essential metabolites and
information-bearing molecules in the cells. A positive
relationship exists between an individual’s age and
the amount of lipofuscin in the body.
- Investigators have discovered the presence of
lipofuscin in other species in amounts proportionate
to the life span of the species (e.g., an animal with
one tenth the life span of a human being
accumulates lipofuscin at a rate approximately 10
times greater than human beings).
Hayflick Limit Theory
- One of the first proposed biologic theories is based
on a study completed in 1961 by Hayflick and
Moorehead. This study included an experiment on
fetal fibroblastic cells and their reproductive
capabilities. The results of this landmark study
changed the way scientists viewed the biologic
aging process. Hayflick and Moorehead’s study
showed that functional changes do occur within cells
and are responsible for the aging of the cells and the
organism.
- The study further supported the hypothesis that a
cumulative effect of improper functioning of cells and
eventual loss of cells in organs and tissues are
therefore responsible for the aging phenomenon
- This 1961 study found that unlimited cell division
did not occur; the immortality of individual cells was
found to be more an abnormal occurrence than a
normal one. Therefore this study seemed to support
the Hayflick Limit Theory. Life expectancy was
generally seen as preprogrammed within a
species-specific range; this biologic clock for
humans was estimated at 110 to 120 years (Gerhard
& Cristofalo, 1992; Hayflick, 1996). Based on the
conclusions of this experiment, the Hayflick Limit
Theory is sometimes called the “Biologic Clock
Theory, ” “Cellular Aging Theory, ” or “Genetic
Theory.”
- The study further supported the hypothesis that a
cumulative effect of improper functioning of cells and
eventual loss of cells in organs and tissues are
therefore responsible for the aging phenomenon.
This study contradicted earlier studies by Carrel and
Ebeling, in which chick embryo cells were kept alive
indefinitely in a laboratory; the conclusion from this
1912 experiment was that cells do not wear out but
continue to function normally forever. An interesting
aspect of the 1961 study was that freezing was
found to halt the biologic cellular clock (Hayflick &
Moorehead, 1961)
Immunologic Theory
- It has been found that as a person ages, the
immune system functions less effectively. The term
immunosenescence has been given to this
age-related decrease in function.
- Essential components of the immune system are T
lymphocytes, which are responsible for
cell-mediated immunity, and B lymphocytes, the
antibodies responsible for humoral immunity. Both T
and B lymphocytes may respond to an invasion of
an organism, although one may provide more
protection than the other in certain situations
- The changes that occur with aging are most
apparent in T lymphocytes, although changes also
occur in the functioning capabilities of B
lymphocytes. Accompanying these changes is a
decrease in the body’s defense against foreign
pathogens; this manifests as an increased incidence
of infectious diseases and an increase in the
production of autoantibodies, which lead to a
propensity to develop autoimmune-related diseases
Nursing Implications
- Based on these concepts, gerontologic nurses can
promote the health of older adult patients in many
ways. Helping with smoking cessation would be one
example of health promotion.
- Nurses can develop a health promotional activity
for education regarding sun exposure.
- Nurses can also advise patients to ingest a varied,
nutritious diet using the food pyramid as a guide and
suggest supplementation with antioxidants such as
vitamins C and E (Goldstein, 1993).
_ Encouraging older adults to participate in activities
may prove a challenge to nurses interacting with
these patients (Carter, 2003).
- Encouraging older adults to participate in daily
walking, even on a limited basis, facilitates
peripheral circulation and promotes the development
of collateral circulation.
PSYCHOSOCIAL THEORY
Activity Theory
- Havighurst first proposed the idea that aging
successfully is related to staying active.
- This theory sees activity as necessary to maintain
a person’s life satisfaction and positive self-concept.
- This theory is based on three assumptions:
(1) It is better to be active than inactive;
(2) it is better to be happy than unhappy;
and (3) an older individual is the best judge of his or
her own success in achieving the first two
assumptions (Havighurst, 1972).
Continuity Theory
- proposes that how a person has been throughout
life is ho that person will continue to be through the
remainder of life (Havighurst et al., 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.
- Simply stated, the theory proposes that, as people
age, they try to maintain or continue previous habits,
preferences, commitments, values, beliefs, and the
factors that have contributed to their personalities
(Havighurst et al., 1963).
Age Stratification Theory
- only one example of a theory addressing societal
values. The key societal issue addressed in this
theory is the concept of interdependence between
the aging person and society at large (Riley,
Johnson, & Foner, 1972).
- This theory views the aging person as an individual
element of society and also as a member, with
peers, interacting in a social process. The theory
attempts to explain the interdependence between
older adults and society, and how they constantly
influence each other in a variety of ways.
- Riley (1985) identifies the five major concepts of
this theory: (1) Each individual progresses through
society in groups of cohorts that are collectively
aging socially, biologically, and psychologically; (2)
new cohorts are continually born, and each of them
experiences their own unique sense of history; (3)
society itself can be divided into various strata,
according to the parameters of age and roles; (4)
not only are people and roles within every stratum
continuously changing but so is society at large; and
(5) the interaction between individual aging people
and the entire society is not stagnant but remains
dynamic.
Person-Environment Fit Theory
- This theory, proposed by Lawton (1982), examines
the concept of interrelationships among the
competencies of a group of persons, older adults,
and their society or environment.
- The theory further proposes that, as a person
ages, the environment becomes more threatening,
and he or she may feel incompetent dealing with it.
In a society constantly making rapid technologic
advances, this theory helps explain why an older
person might feel inadequate and may retreat from
society
- This theory, proposed by Lawton (1982), examines
the concept of interrelationships among the
competencies of a group of persons, older adults,
and their society or environment.
- The theory further proposes that, as a person
ages, the environment becomes more threatening,
and he or she may feel incompetent dealing with it.
In a society constantly making rapid technologic
advances, this theory helps explain why an older
person might feel inadequate and may retreat from
society.
Nursing Implications
- Nurses need to be aware that whatever similarities
exist among the individuals of a cohort group, they
are still individuals. Older adults are not a
homogeneous sociologic group, and care needs to
be taken not to treat them as if they were.
- However, it is within the nurse’s scope of practice
to identify maladaptive responses and intervene to
protect the integrity of the person.
- Using assessment skills and specific tools, nurses
can further investigate and plan appropriate
interventions to help resolve a potentially adverse
situation.
- By examining the past and being aware of
significant events or even beliefs about health and
illness, the health care provider can develop a
deeper understanding of why these older adults act
the way they do or believe in certain things.
- The health care provider can also gain insight into
how a group of older adults responds to illness and
views healthy aging. This knowledge and insight can
certainly assist in planning not only activities but
also meaningful patient teaching
PHYSIOLOGIC CHANGES IN AGING AFFECTING
VARIOUS SYSTEMS
Integumentary
Being the largest organ in the human body, the skin
is the most obvious place to observe signs of ageing
and its key functions are increasingly impaired as
well.
Two Main Parts of the Skin
1 Epidermis
Outside layer and protects underlying layers from
the environment.
Hosts cells that produce keratin, a substance that
makes the skin waterproof and stronger, and cells
that contain melanin, a photo protective pigment that
gives skin its color.
No blood supply, however, there are cells that afford
the body immunity against bacteria and other
invading organisms
2 Dermis
Thickest layer
Contains cells that give skin its strength, support,
flexibility
Sensory receptors present in the dermis allow the
body to experience pressure, pain, and temperature
while small blood vessels provide the skin with
nutrients and remove its waste products.
Present all over the skin except on the palms of the
hands and the soles of the feet are the sebaceous
glands that produce oil to keep the skin hydrated,
softens hair, and helps kill bacteria in the pores. Also
hosts the sweat glands and hair follicles.
Below these two layers is an innermost layer of
subcutaneous tissue, the hypodermis which anchors
the skin to the fascia (the underlying connective
tissues that wrap around skeletal muscles). It
consists mainly of fat cells that insulate the body and
helps conserve heat
Functions of the Skin
-Thermoregulation
-Storage and synthesis
-Sensation
-Protection
Intrinsic Skin Aging
Aging caused by internal factors related to
degeneration of physiologic processes.
As skin ages, it becomes thinner and more easily
damaged. Intensifying this effect is the decreasing
ability of skin to heal itself.
Decrease in volume and elasticity, and the increased
incidence of wrinkles can also be noted. Cortisol
(associated with stress) causes degradation of
collagen, accelerating the aging process.
Extrinsic Skin Aging
Caused by environmental factors such as:
- SMOKING
- DIET
- EXPOSURE TO CHEMICALS
- TRAUMA
- EXPOSURE TO UV RADIATION
Often referred to as photoaging, defined as skin
changes caused by chronic exposure to UV light. It
causes two major concerns: an increased risk for
skin cancer and is associated with emergence of
neoplastic (cancer) lesions.
Characterized by coarse and deep wrinkling, rough
texture, telangiectasia (spider veins), irregular or
mottled pigmentation, a sallow or yellow complexion
and a loss of elasticity
- Coarse and deep wrinkling
- Telangiectasia (spider veins)
- Irregular/mottled pigmentation
Features of Aged Skin
Wrinkles and Sagging
- Factors such as gravitational force, loss of
subcutaneous fat, and repeated traction exerted by
facial muscles over expression lines, which results
in deep creases over the forehead, contribute to the
formation of wrinkles.
Changes in Hair and Nails
-Chest, axillary and pubic hair all decrease in
density with age, but men may experience increased
hair growth in other body sites like the eyebrows,
ears and nostrils. Hair also becomes drier.
-Hair greying, which is genetically controlled,
appears to be a consequence of a depletion of hair
melanocytes, which can no longer provide colour to
the developing hair in the follicle.
-Nail growth starts to slow down. Nails become more
brittle and develop beaded ridges due to a reduction
in lipophilic sterols and fatty acids
Skin Lesions
-The number of melanocytes decreases with age
and those remaining increase in size; this explains
why blotchy pigmented ‘liver spots’ may appear on
the back of the hands.
-Due to the cumulative effects of chronic sun
exposure, the risk of skin cancers also increases
with age
Senile Purpura
-Senile purpura is a common, benign and
self-resolving condition affecting more than 10% of
people aged over 50 years.
-Caused by the thinning of dermal tissues and
increase in the fragility of blood vessels. As a result,
superficial vessels tear and rupture, even with
negligible trauma.
-Characterised by the recurrent formation of
irregularly shaped, dark purple ecchymoses, about
1-4cm in diameter, often appearing on the forearms
after a minor trauma.
-Does not undergo the colour changes of a normal
bruise and take up to three weeks to resolve. Risk
factors include chronic sunlight exposure and the
use of oral or topical corticosteroids and
anticoagulants.
WAYS TO TAKE CARE OF OUR SKIN
Use a good quality sunscreen when outdoors.
Wear protective clothing and a hat when needed.
Good nutrition and adequate fluids are helpful.
Keep skin moist with lotions and other moisturizers.
MUSCULOSKELETAL
Cartilage and connective tissues becomes thinner
which makes joint resilient and more susceptible to
damage as people age.
Joints do not slide as it used to and has become
stiffer
Motion of joints become limited
Types of muscle fibers are affected by aging as well
MUSCLE STRENGTH
Strong predictor of severe mobility limitation, slow
gait speed, increased fall risk, risk of hospitalization,
and high mortality rate.
Aging = Reduced muscle strength
Ability to activate motor units contribute to muscle
strength and power reduction
In the case of mobility-impaired patients, the loss of
muscle power is due to a combination of deficits in
muscle strength and contraction velocity
MUSCLE SIZE
Skeletal muscle comprises approximately 40% of
the human body weight and contains between 50%
and 70% of all proteins in the human body
Sacropenia – loss of skeletal muscle mass and
function
TENDONS
They they transmit the force developed by muscle
cells to bones, making movement possible
Respond to mechanical loading and unloading and
are at risk of injury during activities
Tendon tissue injuries is more frequent with aging
(including tendons of rotator cuff, patellar tendon,
and Achilles tendon)
Most important effect of aging to tendons:
-reduction in cell density
-decline in matrix turn-over
-increase in advanced glycation end products
-mild reduction in fibril diameter
-reduction in the elastic modulus
Short-term immobilization of human elderly tendon
reduces collagen protein synthesis
Aging impairs proliferation of stem cells and reduces
its ability to regenerate

LIGAMENTS
provide important joint support and stability
changes are almost similar to tendons
-decreases in collagen synthesis and concentration
-elastic modulus
-ultimate force

BONE
Reduction in bone mineral content and density.
Osteoporosis contribute to risk for fractures
Changes in both muscle and bone tissues can result
in significant impairment and disability

MOST COMMON MUSCULOSKELETAL

DISORDERS
1 Fractures
2 Osteoporosis
3 Osteoarthritis
4 Microcrystal disorders

HOW TO TAKE CARE

MOVE MORE
EAT A BALANCED DIET
GO OUTSIDE
STAY HYDRATED
LESSEN ALCOHOL INTAKE
GET ADEQUATE REST
QUIT SMOKING