GERIATRICS NURSING - Prelims
GERIATRIC, GERONTOLOGY, GERONTICS
AGING DEMOGRAPHICS (GLOBAL)
• Geriatric - Greek word “geras” = old age, + “iatro,” =
relating to medical treatment
- the medical specialty that deals with the physiology of aging
(abnormal conditions) and with the diagnosis and treatment
of diseases affecting older adults
• Gerontology - Greek word “gero” = related to old age +
“ology,”= the study of - 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 AGING DEMOGRAPHICS (LOCAL)
• Gerontics - aka Gerontic Nursing
- the nursing care and the service provided to older adults
- holistic view of aging
AGING
complex process, chronologically, physiologically, and
functionally
- 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
Chronological Age - No. of years the person lived - easiest to
identify and measure but not the most meaningful
measurement of aging WHAT IS THE SCOPE OF THE AGING POPULATION IN YOUR
AREA?
CATEGORIZING THE AGING POPULATION • Gender and Ethnic Disparity
• Marital Status
• Education Status
• Economic Status
THEORIES OF AGING
• Theories of Aging:
• attempt to explain the phenomenon of aging as it occurs
over the lifespan
• aging is viewed as a total process that begins at conception
• senescence: a change in the behavior of an organism with
age leading to a decreased power of survival and adjustment
NURSES ATTITUDE TOWARDS AGING THEORIES OF AGING: TYPES
• Biologic
•Realistic expectations • Sociologic
• Self-evaluation • Psychologic
• Willingness to learn • Moral/Spiritual
• Prior experience
BIOLOGIC THEORIES:
MYTHS AND STEREOTYPES Concerned with answering basic questions regarding the
physiological processes that occur in all living organisms as
• Physical Attraction they chronologically age
• Physical Illness
• Financial need
• Sexual disinterest
• Inability to learn
• Socially disconnected
FOCI OF BIOLOGIC THEORIES C-L THEORY, CONT’D
Explanations of: • Some research supports a combination of exercise and
1) deleterious effects leading to decreasing function of the dietary restrictions in helping to inhibit the cross-linkage
organism process
2) gradually occurring age-related changes that are
progressive over time WEAR & TEAR THEORY
3) intrinsic changes that can affect all member of a species • Proposed first in 1882
because of chronologic age • Cells simply wear out over time because of continued use--
ALSO: • all organs in any one organism do not age at the rather like a machine
same rate • Would seem to be refuted by the fact that exercise in OA’s
• any single organ does not necessarily age at the same rate actually makes them MORE functional, not less
in difference individuals of the same species
Nonstochastic Theories:
BIOLOGIC THEORIES: DIVISIONS • Programmed Theory
Stochastic: Explain aging as events that occur randomly and • Immunity Theory
accumulate over time
Nonstochastic:View aging as certain predetermined, timed PROGRAMMED (HAYFLICK LIMIT) THEORY
phenomena • Based on lab experiments on fetal fibroblastic cells and
their reproductive capabilities in 1961
Stochastic Theories • Cells can only reproduce themselves a limited number of
• Error Theory times.
• Cross-Linkage Theory • Life expectancies are seen as preprogrammed within a
• Wear & Tear Theory species-specific range
• Free Radical Theory
IMMUNITY THEORY
ERROR THEORY • Immunosenescence: Age-related functional diminution of
• Originally proposed in 1963 the immune system
Basis: • Lower rate of T-lymphocyte (“killer cells”) proliferation in
1)errors can occur in the transcription in any step of the response to a stimulus
protein synthesis of DNA • & therefore a decrease in the body’s defense against
2) error causes the reproduction of an enzyme or protein that foreign pathogens
is not an exact copy
3) As transcription errors to occur, the end product would IMMUNITY, CONT’D
not even resemble the original cell, thereby compromising its • Change include a decrease in humoral immune response,
functional ability often predisposing older adults to:
1) decreased resistance to a tumor cell challenge and the
ERROR, CONT’D development of cancer
• More recently the theory has not been supported by 2) decreased ability to initiate the immune process and
research mobilize defenses in aggressively attaching pathogens
• not all aged cells contain altered or misspecified proteins 3) increased susceptibility to auto-immune diseases
• nor is aging automatically or necessarily accelerated if
misspecified proteins or enzymes are introduced into a cell EMERGING THEORIES OF AGING
• Neuroendocrine Control (Pacemaker) Theory
FREE RADICAL THEORY • Metabolic Theory/Caloric Restriction
Free radicals are byproducts of metabolism- • DNA-Related Research
-can increase as a result of environmental pollutants
• When they accumulate, they damage cell membrane, NEUROENDOCRINE CONTROL
decreasing its efficiency • “examines the interrelated role of the neurologic and
• The body produces antioxidants that scavenge the free endocrine systems over the life-span of an individual”.
radicals • there is a decline, or even cessation, in many of the
components of the neuroendocrine system over the lifespan
FREE RADS, CONT’D
• In animal studies, administration of antioxidants postpones NEURO, CONT’D
the appearance of diseases such as cardiovascular disease • Research has shown
and CA 1) the female reproductive system is controlled by the
• Free radicals are also implicated in the development of hypothalamus. What are the mechanisms that trigger
plaques associated with Alzheimer’s changes?
2) adrenal glands’ DHEA hormone
CROSS-LINKAGE THEORY 3) melatonin (from pineal gland)--a regulator of biologic
• Some proteins in the body become cross-linked, thereby rhythms and a powerful antioxidant. Declines sharply from
not allowing for normal metabolic activities just after puberty
• Waste products accumulate
• Result: tissues do not function at optimal efficiency
METOBOLIC THEORY OF AGING (CALORIC RESTRICTION) • Thus, there is a high degree of interdependence between
older adults & society
• “proposes that all organisms have a finite amount of
metabolic lifetime and that organisms with a higher PERSON-ENVIRONMENT FIT THEORY
metabolic rate have a shorter lifespan”. • Lawton, 1982
• Rodent-based research has demonstrated that caloric • Individuals have personal competencies that assist in
restriction increases the lifespan and delays the onset of age- dealing with the environment:
dependent diseases • ego strength
• level of motor skills
DNA-RELATED RESEARCH • individual biologic health
• Major Developments: • cognitive & sensory-perceptual capacities
• Mapping the human genome (“there may be as many as
200 genes responsible for contolling aging in humans”) E FIT, CONT’D
• Discovery of telomeres • As a person ages, there may be changes in competencies &
these changes alter the ability to interrelate with the
SOCIOLOGIC THEORIES OF AGING environment
• Disengagement Theory • Significant implications in a society that is characterized by
• Activity/Developmental Task Theory constantly changing technology
• Continuity Theory
• Age Stratification Theory PSYCHOLOGIC THEORIES OF AGING
• Person-Environment Fit Theory • Maslow’s Hierarchy of Human Needs
• Jung’s Theory of Individualism
Changing FOCUS of Sociological considerations of aging: • Erikson’s Eight Stages of Life
• 60’s focus on losses and adaptation to them • Peck’s Expansion of Erikson’s Theory
• 70’s broader global, societal, and structural factors • Selective Optimization with Compensation
influencing lives of OA’s
• 80’s-90’s exploration of interrelationships between OA’s MASLOW’S HIERARCHY OF HUMAN NEEDS
and their physical, political, environmental & socioeconomic Maslow--1954
mileau • “…each individual has an innate internal hierarchy of needs
that motivates all human behaviors”.
DISENGAGEMENT THEORY • depicted as a pyramid; the ideal is to achieve
• Cumming & Henry--1961 selfactualization, having met all the “lower” level needs
• Aging seen as a developmental task in and of itself, with its successful
own norms & appropriate patterns of behavior
• “appropriate” behavior patterns involved a mutual • “Maslow’s fully developed, self-actualized person displays
agreement between OA’s and society on a reciprocal high levels of all of the following characteristics: perception
withdrawal. of reality; acceptance of self, others, and nature; spontaneity;
• No longer supported problem-solving ability; self-direction; detachment and the
desire for primacy; freshness of peak experiences;
ACTIVITY THEORY (DEVELOPMENTAL TASK THEORY) identification with other human beings;
• Havighurst, Neugarten, Tobin ~1963 • satisfying and changing relationships with other people; a
• “Activity is viewed by this theory as necessary to maintain a democratic character structure; creativity; and a sense of
person’s life satisfaction and a positive self-concept”. values.
• Only about 1% of us are truly ideal self-actualized persons
ACTIVITY, CONT’D
• Theory based on assumptions: JUNG’S THEORY OF INDIVIDUALISM
1) it’s better to be active than inactive • Carl Jung--1960
2) it is better to be happy than unhappy • origins are Freudian
3) an older individual is the best judge of his or her own • Self-realization is the goal of personality development
success in achieving the first two assumptions • as individual ages, each is capable of transforming into a
more spiritual being
CONTINUITY THEORY
• How a person has been throughout life is how that person ERIKSON’S EIGHT STAGES OF LIFE
will continue through the remainder of life • 1993
• Old age is not a separate phase of life, but rather a • Stages throughout the life course. Each represents a crisis
continuation and thus an integral component to be resolved.
• For OA’s:
AGE STRATIFICATION THEORY • 40 to 65 (middle adulthood): generativity versus self-
• Riley--1985 absorption or stagnation
• Society consists of groups of cohorts that age collectively • 65 to death (older adulthood): ego integrity versus despair
• The people & Roles in these cohorts change & influence
each other, as does society at large
ERIKSON, CONT’D
• “Self-absorbed adults will be preoccupied with their
personal well-being and material gains. Preoccupation with
self leads to stagnation of life”
• “Unsuccessful resolution of the last crisis may result in a
sense of despair in which individuals view life as a series of
misfortunes, disappointments, and failures”.
PECK’S EXPANSION OF ERIKSON’S THEORY
• Erikson’s last two stages are expanded to 7
• The final three of the developmental tasks for old age:
• ego differentiation versus work role preoccupation
• body transcendence versus body preoccupation
• ego transcendence versus ego preoccupation
SELECTIVE OPTIMIZATION WITH COMPENSATION
• Baltes--1987
• Individuals develop strategies to manage losses of function
that occur over time
SELECTIVE OPTIMIZATION, CONT’D
3 Interacting Elements:
• selection: increasing restriction of one’s life to fewer
domains of functioning
• optimization: people engage in behaviors to enrich their
lives
• compensation:developing suitable, alternative adaptations
