CONCEPTS, PRINCIPLES AND THEORIES IN THE CARE OF OLDER ADULTS

Aging --- deterioration of the physiological functions necessary for survival and fertility.

 Aging process - the process of growing old ---------- lead to senescence

 Senescence - a change of behavior leading to a decreased power of survival and adjustment

PEOPLE ARE LIVING LONGER ---------- 60 years +20 years

WHAT MAKES US AGE DIFFERENTLY? (5) ------- Our access to health care

 Genetic inheritance --- Who we are ----- Where we live ------ Our health behaviour

World Health Organization (WHO)

 65 or older grow 524 million in 2010 to nearly 1.5 billion in 2050

 2030, 60% of this generation will be managing more than 1 chronic condition. --- baby boomers

 As life expectancy increases, the prevalence of disability will decrease / increase

HEALTH CONDITIONS THAT ARE CHALLENGE TO HEALTHCARE SYSTEM (5)

1. Cancer - expected to increase to 17 million by 2020 and 27 million by 2030.

2. Dementia - 115 million of Alzheimer's disease by 2050

3. Increase in the number of falls -American Hospital Association (AHA)

 one-third, fall each year ----- 20% to 30%, 350,000 hip fractures

4. Obesity - medicare program of 34% ----------------- Diabetes

TO ADDRESS THE INCREASING AGING POPULATION, THE HEALTH CARE SYSTEM MUST

a) Prepare for new technology

b) Prepare for increasing incidences of chronic conditions
c) Prepare for implementing a multidisciplinary approach
d) Focus on providing preventive care versus reactive care
e) Strategies include a more comprehensive care plan

THEORIES OF AGING ------ This explain the phenomenon of aging as it occurs over the lifespan.

TYPES THEORIES OF AGING (4)

1. BIOLOGIC ---- aging occurring from a molecular, cellular

 This answers the questions regarding the physiological processes

a) FOCI OF BIOLOGIC THEORIES

 Deleterious effects leading to decreasing function of the organisms.

BIOLOGIC THEORIES: DIVISIONS (2)

a) Stochastic Theories - aging as randomly and accumulate over time (4)

 1) Error theory / Error Catastrophe Theory ----- 1963, Orgel

 Occur in the synthesis of DNA that do not function at the optimal level.

2) Cross-linkage theory -- Some proteins in the body become cross-linked

3) Wear & tear theory --1882 by Welsman ------------ Result of tissues being worn out

4) Free radical theory --------- byproducts of metabolism.

b) Nonstochastic Theories - aging as predetermined and timed phenomena

1) Programmed (HAYFLICK LIMIT) Theory --- 1961 by Hayflick and Moorehead

 "Biological clock," "cellular aging." or "genetic theory."

 Based on lab experiments and their reproductive capabilities

2) Immunity Theory
 Immunosenescence - diminution of the immune system
 T cells - responsible for cell-mediated immunity
B cells - responsible for humoral immunity.
 t-lymphocyte ("killer cells") - response to a stimulus

EMERGING THEORIES OF AGING (3)

a) Neuroendocrine control (pacemaker) theory

 Examines the role of the neurologic and endocrine systems over the life- span

b) Metabolic theory/caloric restriction ------ all organisms have metabolic lifetime

c) DNA-related research ---- 200 genes ---- enzyme telomerase

2. SOCIOLOGIC ---- 1960s ---- sociologists focused on the losses of old age (5)

a) Disengagement theory - Cummings and Henry (1961)

 Aging process separate from the mainstream of society.

b) Activity/developmental task theory – Robert Havighurst in 1960

 Proposed that people needed to stay active if they age successfully.

 it's better to be active than inactive ------- it is better to be happy than unhappy

c) Continuity theory --- Neugarten, 1964

 Personality remains the same and the behaviors becomes more predictable

 Personality – a critical factor in determining the relationship between role activity and life
satisfaction.

d) Age stratification theory --- Riley-1985

 The key societal issue being addressed in this theory is the concept of interdependence

e) Person-environment fit theory ---- Lawton 1982

 Examines the concept of interrelationship among group of persons

 Personal Competencies (4)

 Ego strength --------- motor skills

  biologic health -------- Cognitive and sensory capacities

3. PSYCHOLOGIC (5)

a) Maslow's hierarchy of human needs

 Physiological, Safety, Love/Belonging, Esteem and Self-actualization (characteristics)

 Perception of reality ---- Problem solving ability --- Acceptance of self

b) Jung's theory of individualism --- Swiss psychologist Carl Jung (1960)

 "Midlife crisis" - begin to question whether the decision they have made were the right choices

 Self- realization - the goal of personality development

c) Erikson's eight stages of life

 Crisis - impacts the development of the person's ego.

 40 to 65 (middle adulthood) -- generativity versus self-absorption or stagnation

 65 to death (older adulthood) -- ego integrity versus despair

d) Peck's expansion of Erikson's theory

 Ego differentiation versus work role preoccupation

 Body transcendence versus body preoccupation

 Ego transcendence versus ego preoccupation

e) Selective optimization with compensation

3 INTERACTING ELEMENTS

1) Selection -- increasing restriction

2) Optimization -- people engage in behaviors to enrich their lives

3) Compensation -- results from restrictions due to aging

4. MORAL/SPIRITUAL --- Kolberg --- Illness a life crises

HEALTH PROMOTION AND ILLNESS/DISABILITY PREVENTION

Care in the acute care settings -- resolving immediate health problems

Care in the community -- focuses on self- care.

THE PURPOSE OF HEALTH PROMOTION AND DISEASE PREVENTION

 To reduce the potential years of life lost

 Primary prevention - prevention of disease before it occurs

 Secondary prevention - detection of disease at an early stage.

  Vaccinations – Mammography – Pelvic examination – Screenings – Osteoporosis – Counseling

FACTORS THAT INFLUENCE HEALTH BEHAVIORS IN OLDER ADULTS (9)

 Cognitive impairment -------- Function -------- Access to care

 Resources -------- Social supports ------- Sensory changes
 Environment -------- Unpleasant sensations --------- Competing priorities

Health promotion -- activities to help individuals change their lifestyle to move toward a state of optimal
health

Optimal health -- a balance of physical, emotional, social, spiritual, and intellectual health

Disease prevention -- activities designed to protect patients or other members of the public from actual or
potential health threats and their harmful consequences.

Primary prevention -- measures provided to individuals to prevent the onset of a targeted condition

Secondary prevention -- activities that identify and treat asymptomatic persons who have already
developed risk factors or preclinical disease but in whom the condition is not clinically apparent

Tertiary prevention -- activities that involve the care of established disease; attempts are made to restore
the person to highest function, minimize the negative effects of disease, and prevent disease-related
complications.

Quaternary prevention -- limiting disability caused by chronic symptoms while encouraging efforts to
maintain functional ability or reduce any loss of function through adaptation

AREAS OF HEALTH PROMOTION MOST RELEVANT TO PHYSICAL FITNESS OF OLDER ADULTS

 Increasing physical activity --------- Smoking control

 Medication safety/drug safety ---------- Spiritual health
 Cardiac health: heart healthy diet, exercise, and preventive medication use
 Nutrition --------- Medical self-care
 Environmental health -------- Social health
 Weight maintenance ---------- Driving safety

MODELS OF HEALTH PROMOTION

a) ONPRIME Model
b) Health Belief Model
c) PRECEDE/PROCEED Model
d) Health Promotion Model