NCM 114:

C A R E O F T H E O L D E R A D U LT

SHARON D. TALAHIBAN, RN
 UNIT 1: PERSPECTIVE ON AGING
OBJECTIVES:
1.Describe the subjective and objective ways that aging is defined.
2. Identify personal and societal attitudes toward aging.
3. Define ageism.
4. Discuss the myths that exist with regard to aging.
5. Identify recent demographic trends and their impact on society.
6. Describe the effects of recent legislation on the economic status of
older adults.
7. Identify the political interest groups that work as advocates for older
adults.
8. Identify the major economic concerns of older adults.
WHAT IS GERONTOLOGICAL NURSING?

• Nursing sub-specialty for older patients

• Used to be called GERIATRIC N U R S I N G

G E R I AT R I C

The term geriatric comes from the Greek words “geras,” meaning old age, and
“iatro,” meaning relating to medical treatment.

GERIATRICS is the medical specialty that deals with the physiology of aging and with the
diagnosis and treatment of diseases affecting older adults. Geriatrics, by definition,
focuses on abnormal conditions and the medical treatment of these conditions.
 G E R O N TO LO GY
• The term gerontology comes from the Greek words
“gero,” meaning related to old age, and “ology,” meaning the study of.

GERONTOLOGY is the study of all aspects of the aging process, including the clinical,
psychologic, economic, and sociologic problems of older adults and the consequences
of these problems for older adults and society. Gerontology affects nursing, health care,
and all areas of our society—including housing, education, business, and politics.
 GERONTICS OR
GERONTIC NURSING

• Term was coined by Gunter and Estes in 1979 to define the

nursing care and the service provided to older adults.
• Gerontonic nursing encompasses a holistic view of aging with the
goal of increasing health, providing comfort, and caring for older
adult needs.
• Geriatric Nursing care nursing care primarily for older persons
who are ill.
• The dictionary defines old as “having lived or existed for a long
time.” The meaning of old is highly subjective; to a great degree, it
depends on how old we ourselves are. Few people like to consider
themselves old.

• A recent study reveals that people younger than 30 years view

those older than 63 as “getting older.” People 65 years of age and
older do not think people are “getting older” until they are 75.
CHARACTERISTICS OF THE OLDER
A D U LT P O P U L AT I O N

• Aging is a pattern of life changes that occurs as one grows older. It is a

normal physiological phenomenon that is part of our growth and
development as human beings. It is physiologic, behavioral and social
changes that occur with increasing chronological age.
 TYPES OF AGING:
1. Chronological age – is measured by the number of years lived, the number
of years since birth, is a simple method of evaluating age.

Classification of the Older Population by Chronologic age:

Young-old : 65 to 74 years
Middle-old : 75 to 84 years
Old-old : 85+years

2.Biological age - is predicted by the person’s physical condition and how

well vital organ systems are functioning.
 Categorizing the Aging Population
Age (Years) Category
55 to 64 Older
65 to 74 Elderly
75 to 84 Aged
85 and older Extremely aged
Or
60 to 74 Young-old
75 to 84 Middle-old
85 older Old-old
 TYPES OF AGING
3.Psychological age – is expressed through a person’s ability and control of memory, learning
capacity, skills, emotions, and judgment. Maturity and capacity will direct the manner in which one is
able to adapt psychologically overtime to the requirements of the physical and social environment.
4.Social age - is measured by age-graded behaviors that conform to an expected status and role
within a particular culture or society.

• ***A person maybe chronologically 80 years of age but biologically 60 years of age because he or
she has remained fit with a healthy lifestyle. Or, a person with a chronic illness maybe biologically
80 years of age but psychologically is much younger because he or she has remained active and
involved in life.
Successful aging the changes due solely to the aging process,
uncomplicated by damage from environment, lifestyle or disease.

Usual aging changes due to the combined effects of the aging

process and of disease and adverse environmental and lifestyle factors.

Senescence the nonreversible, deteriorative changes in aged

organisms that predispose them to fatal disease and death.
Older adults preferred term used when speaking about aged
individuals who aged 65 years and older.

• Sexagenarian - a person who is from 60 to 69 years old.

• Septuagenarian - a person who is from 70 to 79 years old.
• Octogenarian -one who is between the age of 80 and 89.
• Nonagenarian - a person who is from 90 to 99 years old
• Centenarian - a person who is one hundred or more years old.
• Functional age is a term used by gerontologists to describe physical, psychological,
and social function; this is relevant in that how older adults feel and function may be
more indicative of their needs than their chronological age.
➢ Frail Elderly refers to those older than 75 years or those than 65 years who have
some type of functional impairment.
➢ Healthy Elderly usually means individuals without functional impairment who
maneuver well within the environment and need minimal assistance.
• Perceived age is another term that is used to describe how people
estimate a person’s age based on appearance.

• Lifespan can be defined as the potential maximum number of years a

person can live.
• Life Expectancy is the average number of years one can expect to live.
 FOUR BASIC CHARACTERISTICS OF
THE AGING PROCESS
1.The aging process is universal. All people age except when death occurs at a young
age.
2.The aging process is progressive, but all individuals do not necessarily show the signs
of aging at the same chronologic age.
3.The aging process is intrinsic in nature; it appears to originate from within the body.
4.Aging is affected by extrinsic factors, which originate outside the body and affect the
aging process. Extrinsic factors include the environment, standard of living and coping
mechanisms.
V I E W S O F O L D E R A D U LT S
THROUGH HISTORY
 V I E W S O F O L D E R A D U LT S T H R O U G H H I S TO R Y

Historically, societies have viewed their elder members in a variety of ways:

•Confucius’ time - there was a direct correlation between a person’s age and the degree
of respect to which he or she was entitled.
•Early Egyptians dreaded growing old and experimented with a variety of potions and
schemes to maintain their youth.
•Early Greeks, opinions were divided Plato promoted older adults as society’s best
leaders, whereas Aristotle denied older people any role in governmental matters.
•In the nations conquered by the Roman Empire, the sick and aged were customarily the
first to be killed.
•And, woven throughout the Bible is God’s concern for the well-being of the family and
desire for people to respect elders (Honor your father and your mother … Exodus 20:12).
V I E W S O F O L D E R A D U LT S T H R O U G H H I S TO R Y
•Yet, the honor bestowed on older adults was not sustained. Medieval times gave rise to strong feelings
regarding the superiority of youth; these feelings were expressed in uprisings of sons against fathers.
•Early 17th century during the Industrial Revolution, no labor laws protected persons of advanced age;
those unable to meet the demands of industrial work settings were placed at the mercy of their offspring
or forced to beg on the streets for sustenance.
•The passage of the Federal Old Age Insurance Law under the Social Security Act in 1935 improved the
lives of the older Americans by providing some financial security for older persons.
•Since that time, American society has demonstrated a profound awakening of interest in older persons
as their numbers have grown. A more humanistic attitude toward all members of society has benefited
older adults, and improvements in health care and general living conditions ensure that more people
have the opportunity to attain old age and live longer, more fruitful years in later adulthood than previous
generations.
•Today, older adults are viewed with positivism rather than prejudice, knowledge rather than myth, and
concern rather than neglect.
 GERONTOLOGICAL NURSING

• The history and development of Gerontological Nursing is rich in diversity and

experiences

• Focus is on increasing life expectancy

• Increasing numbers of acute &chronic health conditions

• Nurses provide disease prevention & health promotion

• Promote positiveaging
 HISTORY
• Specialty formed in the early 1960’s byA N A

• Standards for Geriatric Practice;VeteransAdministration funded GRECC’s at VA

medical centers (1970’s)

• Establishment of N G N A & Scope and Standards of Gerontological Nursing

Practice (1980’s)

• Established Hartford Foundation Institute of Geriatric Nursing at N Y U Division of

Nursing (1990’s)
 PIONEERS IN
GERONTOLOGICAL
NURSING
Florence Nightingale

▪ first geriatric nurse

▪ Care of Sick
Gentlewomen in
Distressed
Circumstances
 PIONEERS IN
GERONTOLOGICAL
NURSING
• Doreen Norton
• focused career on care of theaged
• described advantages of learning geriatric care in basic
education
• Learning patience,tolerance,understanding and
basic nursing skills
• Witnessing the terminal stages of disease
and importance of skilled nursing care
• Preparing for the future
• Recognizing the importance ofrehabilitation
• Being aware of the need to undertakeresearch
ROLES OF THE GERONTOLOGICAL NURSE

• Provider of Care

• Teacher

• Manager

• Advocate

• Research Consumer
SCOPE AND STANDARDS OF
GERONTOLOGICAL NURSING PRACTICE
• SCOPE • S TA N D A R D S
– Assessment – Quality of Care
– Diagnosis – PerformanceAppraisals
– Outcome Identification – Education
– Planning – Collegiality
– Implementation – Ethics
– Evaluation – Collaboration
– Research
– Research Utilization
 PRACTICE SETTINGS
• Acute Care Hospital
• Long-Term Care
– Assisted Living
– Intermediate Care
– Subacute or TransitionalCare
– Skilled Care
– Alzheimer’s Care
– Hospice
• Rehabilitation
• Community
– Home Health Care
– Foster Care or Group Homes
– Independent Living
– Adult Day Care
 CONTINUUM OF CARE

• Acute Care Hospitals

– Often the point of entry into the healthcare system
– Nurses care for older adults
– Admits older people except in L&D, post-partum & pediatrics
• Acute Rehabilitation
– Found in several settings including acute care hospitals, subacute care (transitional
care), & LTCF’s
– Goals are to maximize independence, promote maximal function, prevent
complications, & promote quality of life within a person’s strengths & limitations
 CONTINUUM OF CARE

• Home Health Care

– For home-bound due to severity of illness or immobility
– Usually done by a visiting nurse
• Long Term Care Facility
– Referred to as nursing homes
– Provides support to persons of any age who lost some or all capacity for self-care
– Nurses provide planning & oversee residents
– Maintain the functional & nutritional status of residents while preventing
complications of impaired mobility
 CONTINUUM OF CARE

• Hospice
– To care for the dying and their families
– Centered on holistic, interdisciplinary care to help the dying “live until they
die”
– Provide quality care until the last months, weeks, days or hours of their life
• Respite Care
– Provides care to give caregivers a break
– Can be done in a daycare center, at home, or ALF’s
CONTINUUM OF CARE

• Continuing Care Retirement Community (CCRC)

– Provides continuum of care from independent living to skilled care all
within a single campus, with levels of care adjusted to individual needs
– Patients can move seamlessly among independent living, assisted living,
skilled care, or long term care as their condition warrants
CONTINUUM OF CARE

• Assisted Living Facilities

– Alternative for those who don’t feel safe being alone
– For those who needs help with ADL’s
– May be connected to a LTCF
– Provides healthy meals, planned activities, places to walk & exercise, and
pleasant surroundings
 CONTINUUM OF CARE

• Foster Care or Group Homes

– For those who can do ADL’s but with issues safety that requires
supervision
– Offers more personalized supervision in a smaller, more family-like
environment
• Green House Concept
– Primary purpose is to serve as a place where elders can receive assistance
and support with ADL’s & clinical care without the assistance becoming the
focus of existence
– Older people retain control of ADL’s
CONTINUUM OF CARE

• Adult Daycare
– For older adults who are unable to remain at home unsupervised
– Used by family members who care for the older person in their homes
– Community based program designed to meet the needs of functionally
and/or cognitively impaired adults through individual plan of care in
protective setting
– Programs may be sponsored to provide socialization, meals, & therapeutic
activities
T H E A G I N G P O P U L AT I O N
AND GERONTOLOGICAL
NURSING
GLOBAL AGING
 1.2 DEMOGRAPHY OF AGING
• The world is on the brink of a
demographic milestone. Since the
beginning of recorded history, young
children have outnumbered the number
of people aged 65 or older will
outnumber children under age 5. Driven
by falling fertility rates and remarkable
increases in life expectancy, population
aging will continue, even accelerate
(Figure 1).
Source: United Nations. World Population Prospects: The 2010 Revision.
Available at: http://esa.un.org/unpd/wpp.
GLOBAL
AGING

Source: United Nations. World Population Prospects: The 2010 Revision.

Available at: http://esa.un.org/unpd/wpp.
THE NUMBERS
• Steady increase in older population
• By mid-21st century, old people will outnumber
young for the first time in history (FIGURE 1)
• 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
 WHY THE INCREASE?
• Improved sanitation
• Advances in medical care
• Implementation of preventive health services
• In 1900s, deaths were due to infectious diseases and acute illnesses
• Older population now faced with new challenge
• Chronic disease
• Health care funding
• The average 75 y.o. has 3 chronic diseases and uses 5 rx meds
• 95% of health care expenditures for older Americans are for chronic diseases
• Changes in fertility rates
• - Baby boom after WWII (1946 – 1964)
• - 3.5 children per household
• - Older population will explode between 2010 to 2030 when baby boomers
reach age 65
 SOME FACTS:

• Female to male ratio increases with age

• Higher education equates to more money, higher standards of living, and above-average health
• Older people who live alone are more likely to live in poverty
• Significant increase in proportion of minorities
o More racially and ethnically diverse
• African Americans
• Hispanics
• Asians and Pacific Islanders
• American Indians and Alaskan Natives
• Older foreign-born are more likely than native-born elders to
o Live in family households
o Have less education
o Higher poverty rate
o Less health coverage
• The number of U.S. Vets 85 or older is expected to increase to 1.4 million in 2012 due to Vietnam era
• Aging disabled population
o Traumatic injuries
o Developmentally disabled
o Elderly inmates
o Elderly begins at 50 due to stresses of prison life
AGING IN THE PHILIPPINES
 POPULATION AGEING IN THE PHILIPPINES

• DEMOGRAPHIC TRENDS AND PROSPECTS

▪ Is the Philippine population is aging?

▪ Are the older Filipinos living longer and healthier?
 W H E N CA N A P OP UL AT I ON B E CON S I D E R E D
AGING?

• Young Societies – Less than 10% of population age 60 and over

• Ageing societies – 10 to 19% of population age 60 and over
• High‐ageing societies – 20 to 29% of population age 60 and over
• Hyper‐ageing societies – 30% or more of population age 60 and over
Source: UNDESA Population Division, World Population Prospects: the 2015 revision
Examples by stage of aging:
Young: Philippines
Aging: China (11.72% are 65+ as of 2019)
Aged: Republic of Korea (15% are 65+ as of 2019)
Super Aged: Japan (27.9% are 65+ as of 2019)
•The size of the older population (aged 60 and over) of the Philippines has been rising
steadily for the past 50 years from about 1 million in 1950 to around 4 million 2000.
•It is projected to reach 11 million in 2025 and 25 million in 2050, by which time the total
Philippine population is projected to reach 128 million
•Philippines is not yet an aging population. It is projected to reach an aging population status
near 2025 when the percent share of 60 year old's and over of the total population is
projected to reach 10 percent. (Based on United Nations data)
•The country consists of approximately 103 million inhabitants, with less than 5% of the
population 65 years and older (Central Intelligence Agency, 2016).

AGING IN THE PHILLIPINES

 •Currently, the age structure of the Philippines resembles many other
developing countries because there are a greater proportion of younger
Filipinos in comparison to older Filipinos. Despite the larger number of
young Filipinos, the 60 years and older population of the Philippines is
expected to increase by 4.2%, whereas the 80 years and older population
is expected to increase by 0.4% from 2010 to 2030 (Help Age Global
Network, 2017b).
•The 60 years and older population of the United States will increase 5.4%
from 2010 to 2030 (Help Age, 2015).
•The Philippines’s population increased by over 35% over the last two
decades with the older adult population (60 years and older) expected to
overtake those aged 0–14 years old by 2065 (Help Age Global Network,
2017a).

AGING IN THE PHILLIPINES

 •The current life expectancy for Philippines in 2020 is 71.28 years, a
0.18% increase from 2019. The life expectancy for Philippines in
2019 was 71.16 years, a 0.18% increase from 2018.
(https://www.macrotrends.net/countries/PHL/philippines/life-
expectancy).
•Females are projected to expect an increase of 4.0 years in life
expectancy and males an increase of4.7 years in life expectancy by
2030 (Help Age Global Network, 2017b).
•The improvement in life expectancy can be attributed to advances
in public health in the Philippines, which have eradicated many of
the diseases that once caused earlier mortality in Filipinos
(Coscoluella & Faustino, 2014).

AGING IN THE PHILLIPINES

 Total Population: 109, 581, 085
Source: Asia Health and Wellbeing Initiative (AHWIN)
The Philippines is still considered a young population
• The Philippines is projected to transition to an aging population between
2025‐2030 based on population projections
 •Increasing life expectancy at age 60 which
suggests the improving longevity of older
Filipinos

Are older Filipinos – Female OP live longer but spend a

living longer and greater part of their remaining life in inactive
getting state relative to the males

healthier? •Functional health is improving over time (1996

PES and 2007 PSOA); 19% of older Filipinos
have at least 1 ADL difficulty (2010 Census)

•Younger cohorts of OP have better health

status.
 H E A LT H S TAT U S O F O L D E R A D U LT S

•The older population experiences fewer acute illnesses than younger age groups and
a lower death rate from these problems. However, older people who do develop
acute illnesses usually require longer periods of recovery and have more
complications from these conditions.
•Chronic illness is a major problem for the older population. Most of the older adults
have at least one chronic disease, and typically, they have multiple chronic conditions,
termed comorbidity.
•Chronic conditions result in some limitations in activities of daily living and
instrumental activities of daily living for many individuals. The older the person is, the
greater the likelihood of difficulty with self-care activities and independent living.
 TEN LEADING CHRONIC CONDITIONS
AFFECTING POPULATION AGED 65 YEARS AND
OLDER

1. Arthritis
2. High blood pressure
3. Hearing impairments
4. Heart conditions
5. Visual impairments (including cataracts)
6. Deformities or orthopedic impairments
7. Diabetes mellitus
8. Chronic sinusitis
9. Hay fever and allergic rhinitis (without asthma)
10. Varicose veins
Source: Centers for Disease Control and Prevention, Chronic Disease Prevention and Health Promotion. Retrieved
April 14, 2012 from http://www.cdc.gov/chronicdisease/index.html
 L E A DI N G CAUS E S OF DE ATH F OR
PERSONS 65 YEARS OF AGE AND OLDER
1. Disease of the heart
2. Malignant neoplasms
3. Chronic lower respiratory disease
4. Cerebrovascular disease
5. Alzheimer’s disease
6. Diabetes mellitus
7. Influenza and pneumonia
8. Accident (unintentional injuries)
9. Nephritis, Nephrotic syndrome, nephrosis
10. Septicemia
From National Center for Health Statistics. (2016). Table 1. Deaths, percentage of total deaths, and death rates for the 10 leading causes of death in selected age groups, by
race and sex: United States, 2013. National Vital Statistics Reports, Vol. 65, No. 2, February 16, 2016. Retrieved from
http://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_02.pdf
SOCIOECONOMIC ASPECTS OF
AGING
• Aging Society - the societal aspect of aging is marked by the rapidly growing number
and proportion of older people in the population.
A. Industrialization
• It is most difficult for the older worker who becomes unemployed to find a new job.
SOCIOECONOMIC ASPECTS OF
AGING
• B. Urbanization
• The small dwelling units’ characteristics of urban life and of shrinking two generation
family make it difficult or impossible for grandparents to live with their children and this
complicates the problem of older people in finding living arrangements that satisfy
their needs.
• There are few opportunities for older people to find the health services they need,
make new friends, learn and practice creative activities, retrain for new jobs, seek
recreation, and participate in educational and community experiences.
EFFECTS ON SOCIETY
▪ The effect of aging on the economy is fundamental.
▪ The growing number of older people can become financial dependents.
▪ Older people derive their incomes from gainful employment, work-connected
pensions, savings, help from relatives, and through government in the form of different
payments or services in kind
1. EMPLOYMENT

Importance of employment for older people:

• It satisfies the needs of many for financial security and the feeling of usefulness.
• It maintains their status as income producers rather than financial dependents.
• It takes advantage of their capacities as producers of goods and services
Older workers are not hired because of:
▪ slowing down
▪ deterioration
▪ resistance to new processes
▪ susceptibility to injury
• Retirement is a major adjustment of an aging individual. This transition brings the loss
of a work role and is often an individual’s first experience of the impact of aging. In
addition, retirement can require adjusting to a reduced income and consequent
changes in lifestyle.
• “Abrupt retirement is a death sentence to large numbers of old people, and a sick or
morale breakdown to many others.”
2. LIVING ARRANGEMENTS

• The well-being of the individual at any age depends upon his ability to satisfy his total
needs in socially acceptable ways. Basic needs do not change with age, although the
means of satisfying them may.
• Most of the older people seem to wish to live in their own homes to enjoy continued
status of independence, self-management and privacy, feeling of emotional security
derived from familiar surroundings.
• It is natural that they should like to be near long-time friends, near children if possible,
and near shopping centers and familiar institutions.
• For many older people, the home should be on one floor and should be as free as
possible from health hazards
IN THE PHILIPPINES:
ON ECONOMIC CONCERNS:
• Social Security System (SSS) and the Government Service Insurance System (GSIS)
were established only in the early ’60s and covered only formal sector employees in the
private and public sectors.
• Pensions are not enough to cover their basic economic needs after retirement. Cost of
health care which tends to rise in old age.
• Phil health covers only small proportion of the total health care costs.
• The Senior Citizens Act offers financial relief only to those who have the means to buy
medicines (20% discount)
• Social support system of family and kin networks—mainly children living arrangement.
• As old people grow increasingly older and less able to function independently, they will
need people to help them out whom they depend on is culturally prescribed: spouse,
children, siblings, other relatives, friends, private homes/institutions or the government.
THE PHILIPPINE GOVERNMENT’S
PROGRAM RESPONSES FOR THE
CARE OF OLDER PERSONS
• The Department of Social Welfare and Development (DSWD) The overall lead of the
National Inter‐Agency Coordinating and Monitoring Board of RA 9994 implementation.
• Has designed long‐term care (LTC) program strategies to respond to the need of the older
persons for care and support as provided in RA 9994. (Expanded Senior Citizens Act of
2010)
Home Care Support Services for Senior Citizens (HCSSC)
• ‐ a strategy to improve the capacities of family members, kinship carers and homecare
volunteers in caring for sick, frail, bedridden or disabled elderly family member. Deemed to
promote stronger family relationship and social responsibility in the community.
LEARNING ACTIVITY 1
A.TERMINOLOGY
Direction: Define each words found in the table below:
KEY TERMS DEFINITION

1.Baby boomers

2.Centenarian

3.Chronic Disease

4.Cohort

5. Mortality

6. Morbidity

7. Life Expectancy

8. Senescence

9. Demographic tidal wave

10. Native- born

LEARNING ACTIVITY 2

DIRECTION: Create a Pie Chart or Histogram related to the following:

A. Common Cause Of Disability
• Identify the Most Common Cause of Disability among Older Person in the Philippines
and in the U.S. Make a necessary comparison between the two countries.
B. Mortality And Mortality Rate
• Identify the Most Common Cause of Disability among Older Person in the Philippines
and in the U.S. Make a necessary comparison between the two countries.

• Note: Make a necessary interpretation and implications.

A S S I G N M E N T:

• Link will be send at Google Classroom

A. Watch this link
(https://www.youtube.com/watch?v= hjHnWz3EyHs) and answer the following
questions.
1. What kind of example of ageism have you seen? How do you feel about it?
2. What was your first impression when you did not see the performance yet?
3. What lesson we can get from the story?
B. Research the different Philippine Government policies related to older people?
Briefly discuss each policies?
THANK YOU!!