MODULE 1

CONCEPTS AND PRINCIPLES IN THE CARE OF OLDER ADULTS

 MODULE OUTCOMES:
• AT THE END OF THE MODULE, THE STUDENT SHOULD BE ABLE TO:
1. Trace back the history of gerontological nursing and its significance to the
philosophy of science
2. Discuss the concepts and principles underlying the care of older adult.

 MODULE CONTENT:
1. Perspective on Aging
2. Demography of Aging and Implications for Health and Nursing Care
3. Impact of Aging Members in the Family
4. Theories of Aging and its Nursing Implications
 CONCEPTS, PRINCIPLES AND THEORIES IN THE CARE OF
OLDER ADULTS

LESSON 1: Perspectives in Aging

Aging is a
treatable disease

Aging is a HOW DO YOU

normal stage
VIEW AGING?
These perspectives may influence
how we assess, treat, and, establish
research agendas, and advocate for
the older adults whom we serve.
A. Perspectives in Aging
Importance of
studying the aging
process:
POSITIVE Negative Ageism  To examine
myths and
- sexism, racism
realities
- losing a job; being
 Environment refused interest-free  To separate fact
credit, a new credit from fiction
 Past Experiences card, car insurance or
travel insurance;
 To gain
 Observation (Family appreciation of
receiving a lower
Members, Friends, what older
quality of service in a
Neighbors, Media) shop or restaurant--- all adults have to
because of old age offer
 Gerontology Geriatrics
STUDY OF AGING/ AND OR THE AGED: Deals with diseases, medical care and
 BIOPSYCHOSOCIAL AGING ASPECTS treatment of older adults (ill)
 Geriatricians, geriatric nurses
Geropsychology-
Geriatrics and
maintain well-being,
Gerontological Social Gerontology
achieve maximum Gerontological Nursing
Nursing
potential
Gerontological Rehabilitation-with  Scope of nursing practice which
chronic illness and functional
Geropharmacology limitations; goals: highest level of advocates holistic care of older
function, independence, prevent adults
complications, enhance quality of
life  Key focus: minimize loss of
independence associated with
Financial
Elder Law-legal and functional disease and illness
ethical issues
Gerontology
DEFINING “OLD” CHRONOLOGICAL AGE BIOLOGICAL AGE
  ”THERE IS NO GENERAL
AGREEMENT ON THE AGE  amount of time that has  Physiological or functional
passed from birth to the age
AT WHICH A PERSON
given date  gradual occurrence that
BECOMES OLD”  age in terms of years, accumulate cell and tissue
 ONE WITH months, days damage
 primary risk factor for  Genes, lifestyle, nutrition
CHRONOLOGICAL AGE OF
mortality and morbidity
65 YEARS AND OLDER
(SOCIAL SECURITY
ADMINISTRATION),
USUALLY IN WESTERN
COUNTRIES; EXCEPT IN
AFRICA (?)
 Definitions fell into three
main categories: (Glascock,
1980)

1) chronology;
2) change in social role
3) change in capabilities

Older Age Group:

1. Young Old (65-74)

2. Middle Old (75-84)
3. Old old or Frail Elders
(85 and up
 Aging is a Developmental Process

 AGING
- A RELENTLESS AND UNSTOPPABLE PROCESS THAT HAPPENS TO ALL HUMANS

 MEILAENDER: “AGING IS A NORMAL STAGE OF LIFE IN WHICH BODIES BEGIN TO

FUNCTION LESS EFFECTIVELY, MAKING ONE MORE VULNERABLE TO DISEASE”

(MEILAENDER, 2011)

 SENESCENCE
- THE PASSAGE OF BIOLOGICAL TIME ; DETERIORATION (WRINKLES; POOR EYESIGHT, HEARING)
- “THE TIME-DEPENDENT ACCUMULATION OF DAMAGE AT THE MOLECULAR LEVEL THAT BEGINS AT
FERTILIZATION AND IS EVENTUALLY EXPRESSED AS NONSPECIFIC VULNERABILITY, IMPAIRED FUNCTION,
DISEASE, AND ULTIMATELY DEATH

EVEN IF A PERSON AGES WELL, BECAUSE OF SENESCENCE THAT PERSON WILL STILL ULTIMATELY DIE OF SOME
CAUSE. (GEMS, 2011)
 Aging is a Developmental Process

 the purpose of senescence is preservation of the human species via natural

selection

 Biological aging occurs because nature has little reason to keep humans
alive beyond their reproductive years

 Primary purpose of a human's life is to procreate and to be a carrier of

DNA. Having passed that DNA on to the next generation, the human is then
dispensable. (Evolutionary perspective)

 Disposable Soma Theory by Tom Kirkwood

- the body optimally allocates metabolic resources to maintain the soma, or
body, in response to its ability to reproduce
- the human body does not invest in sustaining itself beyond
the productive task and, in turn, becomes more vulnerable to the
harmful effects of deleterious genes, a weakening immune
system, increasingly brittle bones, and deteriorating
sensory systems
 Aging is a Developmental Process

 Biological perspective- all humans grow, experience puberty, mature,

and age as the course of a normal, healthy life. 

 Humanistic perspective- aging is inextricably linked to death

 Scientists’ view- aging is biological condition that can be

manipulated, treated, and delayed. Therefore, it becomes the duty of
doctors to treat it and scientists to discover ways to delay it. They
believe that through science, it is possible that humans could live
longer (Kelland, 2001)
 LESSON 2: Demography of Aging and its
Implications for Health and Nursing Care

 1980- 382 million

 2017- 962 million (2/3 are from the developing regions)

 Projection in 2050- 2.1 billion

 In 2030, older persons are expected to outnumber children

under age 10 (1.41 billion versus 1.35 billion); in 2050,
projections indicate that there will be more older persons
aged 60 or over than adolescents and youth at ages 10-24
(2.1 billion versus 2.0 billion). (?)

 In 2050, it is expected that nearly 8 in 10 of the world’s older

persons will be living in the developing regions.

Gerontological Nursing is the place to

be!
 Life Expectancy: 72 years (74.2 years for females
and 69.8 years for males), WHO, 2016
- Lifestyle practices, incidence of chronic
diseases, high immunity of women to GLOBAL AGING
infectious diseases; stress management
techniques

 2010: Asia, Africa and in Latin America and the

Caribbean, more than 50% co-resided with a child. By
Life Expectancy: 83 years contrast, in Europe and in Northern America: only
around 20% co-resided with their children.

 Impact to Government: Implement policies to address

the needs and interests of older persons:
 Housing
 Employment
 Health care
 Social protection
 Other forms of intergenerational solidarity
GLOBAL AGING AND HEALTH

 Population aging is likely to influence patterns of

healthcare spending both in developed and developing
countries in the decades to come. In developed countries,
where acute care and institutional long term care services
are widely available, the use of medical services by adult
rises with age, and expenditures on health care are
relatively high among older age groups.

 Accordingly, the rising proportion of older people is

placing upward pressure on overall health care spending
in the developed world, although other factors such as
income growth and advances in the technological
capabilities of medicine generally play a much larger
role.
GLOBAL AGING AND HEALTH

WHO- DATA ON BLOOD PRESSURE AMONG

WOMEN IN SIX DEVELOPING COUNTRIES
FINDINGS: UPWARD TREND BY AGE IN THE
PERCENTAGE OF WOMEN WITH MODERATE
OR SEVERE HYPERTENSION. IF RISING
HYPERTENSION RATES IN THOSE
POPULATIONS ARE NOT ADEQUATELY
ADDRESSED, THE RESULTING HIGH RATES
OF CEREBROVASCULAR AND
CARDIOVASCULAR DISEASE ARE LIKELY TO
REQUIRE COSTLY MEDICAL TREATMENTS
THAT MIGHT HAVE BEEN AVOIDED WITH
ANTIHYPERTENSIVE THERAPIES COSTING
JUST A FEW CENTS PER DAY PER PATIENT.
• IMPLICATION ON HEALTHCARE: EARLY DETECTION AND EFFECTIVE
MANAGEMENT OF RISK FACTORS SUCH AS HYPERTENSION AND DIABETES IN
DEVELOPING COUNTRIES CAN BE INEXPENSIVE AND EFFECTIVE WAYS OF
CONTROLLING FUTURE HEALTH CARE COSTS. DATA ON THESE KINDS OF
RESEARCH WILL PROVIDE CRUCIAL EVIDENCE FOR POLICYMAKERS
DESIGNING HEALTH INTERVENTIONS.
IMPLICATIONS OF AGING TO HEALTH AND NURSING CARE

 The dramatic increase in average life expectancy during the 20th century
ranks as one of as one of society’s great achievements. Although not all
regions have shared in these improvements. (One notable exception is the
fall in life expectancy in many parts of Africa because of deaths caused
by the HIV/ AIDS epidemic.) The most dramatic and rapid gains have
occurred in East Asia, where life expectancy at birth increased from less
than 45 years in 1950 to more than 74 years today.

 The victories against infectious and parasitic diseases are a triumph

for public health projects of the 20th century, which immunized
millions of people against smallpox, polio, and major childhood killers
like measles. Even earlier, better living standards, especially more
nutritious diets and cleaner drinking water, began to reduce serious
infections and prevent deaths among children.
CENTENARIANS
At 116 years and 85 days old (as of March 28, 2019), Kane
Tanaka from Fukuoka, Japan has been officially
confirmed by Guinness World Records as the oldest
person living.
Kane was born prematurely on 2 January 1903, the same
year the Wright brothers became the first to achieve
powered flight.
The oldest person in the Philippines has just
turned 122 years old last September 11, 2019.
Francisca Susano from Barangay Oringao,
Kabankalan City, Negros Occidental; former
farmer, with 14 children and 300 grandchildren 
 • A VENEZUELAN MAN HAS BEEN
RECORDED BY THE 
GUINNESS WORLD RECORDS AS THE
WORLD'S OLDEST LIVING MAN. 
• AS OF 17 MAY 2022, JUAN VINCENTE MORA
IS A RECORD-BREAKING 113 YEARS OLD.
• MORA COMES FROM A LONG LINE OF
FARMERS WHO GREW SUGAR CANE AND
COFFEE.

The oldest person to have ever lived was Frenchwoman Jeanne

Louise Calment who lived for 122 years and 164 days.
Calment, who smoked until she was 117 and ate large amounts
of chocolate every week, was born 21 February 1875 and died 4
August 1997.
 CENTENARIANS
Japan
- person who has reached the age of 100 years. The government had in the past gifted
Because life expectancies worldwide are below
centenarians with silver cups in the prime
100 years, the term is invariably associated with
longevity. In 2012, the United Nations estimated
minister’s name, but since 2016 it was changed
that there were 316,600 living centenarians to silver plated cups to reduce costs
worldwide Philippines
- The United States has the most centenarians, - PHP100,000 cash benefit from the Philippine
with an estimated number of about
government
80,000. Japan follows, with an estimated 47,700,
and is also home to the “official” oldest living
person in the world in 2019.

- Born from 1940s- 1960s where

Baby boomers birth rate is at surge, then starts
to decline, together with fertility
rate; then death rate also goes
down dramatically leading to
rise in number of old age
Aging in the Philippines:
• THE PHILIPPINES IS A DIVERSE COUNTRY THAT WILL EXPERIENCE AN INCREASE IN ITS
AGING POPULATION IN THE NEAR FUTURE.
• POLICYMAKERS AND GOVERNMENT LEADERS MUST PLAN FOR THE EXPECTED
GROWTH IN THE NUMBERS OF OLDER ADULTS, WHICH IS LIKELY TO INCREASE THE
DEMAND FOR SERVICES AND SUPPORT FOR ELDERS AND THEIR CAREGIVING FAMILIES. 

Demography

 103 million inhabitants- less than 5% 65 years and older (Central Intelligence
Agency, 2016).
 Old age population (60 years above)- expected to increase by 4.2%
 80 years above population- expected to increase by 0.4% from 2010 to 2030 (Help
Age Global Network, 2017b)
 (WHO Data, 2018 )life expectancy: Male 66.2, Female 72.6 and total life expectancy is 69.3
 advances in public health, which have eradicated many of the diseases that once caused earlier mortality
in Filipinos

 Fertility rate- compared to developed countries with fertility rate of about 1.7 children per woman
(united nations, 2015), there is a high fertility rate of 3.1 children per woman in the Philippines
(Help Age Global Network, 2017).
 University of the Philippines Manila -only major institution with established research center
specifically for aging.
 FOCUS: perceptions of aging, quality of life of older Filipinos, and older adults in the workforce.

 In terms of research on quality of life of older Filipinos, many elders generally report positive
health, community participation, and financial security. However, Filipinos who reported higher
socioeconomic status and more educational attainment also tended to report better quality of life.
 Filipinos’ Perception in
Aging

 Living in multigenerational households and communities shape perceptions of aging as a

responsibility, due to the establishment of family roles, adult engagement in the workforce, and
family social ties (Valdez, Angeles, Pareja-Corpuz, & Hernandez, 2013). 

 Valdez and colleagues (2013) -aging is a period of increased productivity and promising

experiences. Perceptions of aging are derived from the unique life experiences and social units
that encompass their lives .

 Older adults who receive more social support from their relatives often feel encouraged and
have better perceptions about their own aging process.

 Although older Filipinos do acknowledge the physical and functional declines that might occur
with increasing age, they view aging in a more positive light due to the respect and dignity that
are attained with maturation.
Filipino Family Care-giving

BECAUSE OF FILIAL PIETY, FILIPINOS SHARE THE SAME OBLIGATION TO CARE

FOR FAMILY MEMBERS AS OTHER ASIAN CULTURES. THIS IS SO COMMONPLACE
THAT FAILURE TO PROVIDE CARE OR RESOURCES TO FAMILY MEMBERS IN
NEED IS SEEN AS SHAMEFUL, OR “HIYA” IN TAGALOG.
BOTH MALES AND FEMALES SHARE DECISION MAKING AND FINANCIAL TASKS.
OLDER FILIPINO MALE CAREGIVERS MAY ASK THEIR ADULT CHILDREN TO
ASSIST WITH THE MORE PHYSICALLY DEMANDING CAREGIVING TASKS, WHILE
THEY THEMSELVES TAKE ON MORE OF THE HOUSEHOLD TASKS (MCBRIDE,
2006).
CHRISTIANITY (CATHOLICISM: SELF-SACRIFICING IDEATION) MOVES FAMILY
MEMBERS TO CONTRIBUTE TO THE FAMILY THROUGH VARIOUS MEANS
(KIMURA & BROWNE, 2009).
RESEARCH SHOWS THAT EVEN AFTER FILIPINOS MIGRATE TO THE UNITED
STATES, THEY STILL MAINTAIN THE PROPENSITY TO PROVIDE CAREGIVING
 LESSON 3: Impact of Aging Members in the
Family
 It is a stigma (Filipino culture) to accept services from the community, so many families either
forgo them or use them in secret (McBride, 2006).
 The social support that Filipino caregivers have in the community and at home can moderate
the negative impact of care recipient problematic behavior on caregiver strain.
 (Varona, Saito, Takahashi, & Kai, 2007).
 Positive aspects of caregiving:
 personal growth and fulfillment
 finding life’s meaning in caring for a loved one
 able to manage the challenges of caregiving
 integrate the new role in their lives (Jones et al., 2002)
 Those who are of lower socioeconomic status may be financially strained in providing adequate
care to an ailing loved one.
 “Caregivers Welfare Act,” 2016: employment standards are set, mandatory number of hours
for rest and minimum salaries are ensured; adequate certification and training prior to
employment
 However, policies should also address the demands of Filipino informal caregivers by offering
paid family leave or even payment to family caregivers who are in need
 - caregiver is overwhelmed and is unable to
perform their role to the best of their
ability; accompanied by stress and anxiety

 Reasons:
o financial burden of taking care of a
loved one
o sudden increase in responsibility and
limitations of freedom
o drastic family dynamic shift

 When care recipient is experiencing

difficult symptoms, caregivers often feel the
effects of those challenges, too and vice
versa