The Aging Population

Demographics of Aging
Life expectancy- the average number of

years that a person can be expected to live Average life expectancy - 47 years (2004)
Figure had increased to 77.8 years

Whats the IMPLICATION of this

increasing life expectancy?

Older Adult
Young Old - 60-74 Middle Old - 75-84 Old Old - 85 & older
Presently: 12.8% of

population 2030: will increase to 20% of population

The Graying of America

Percent of Total U.S. Population over 65 in 2000

Source of data: U.S. Census Bureau, State Interim Projections by Age and Sex: 2004-2030, 2005.

The Graying of America

Percent of Total U.S. Population over 65 in 2030

Source of data: U.S. Census Bureau, State Interim Projections by Age and Sex: 2004-2030, 2005.

Demographics of Aging

In 2005, 13% of the U.S. pop. was over age 60

18.3 million aged 6574 12.9 million aged 7584 4.7% aged 85 or older

This number is estimated to increase:

To 20 million in 2010 (6.8% of total), To 33 million in 2030 (9.2%), and To almost 50 million in 2050 (11.6%)
(National Center for Health Statistics [NCHS], 2006).

By mid-21st century, old people will outnumber young for the first time in history

Figure 1-1 Population over the age of 60, worldwide and developing regions.

All Nations Have an Aging Population

The greatest increases will be in developing countries Asian countries have less time to prepare for aging because aging is occurring more rapidly than economic growth.
Adequate healthcare services for the elderly may simply be beyond the reach of many Asian countries They may not be able to afford a large dependent elderly population. They might not have the necessary institutions & financial systems in place (e.g., efficient and well-managed pension and healthcare programs)
(The Future of Population in Asia: Asia's Aging Population; Sidney B. Westley and Andrew Mason;
January 2005)

Projected Changes
Racial Background of U.S. Elderly (2050)
Hispanic*

Asian

Black

80+ 65-79 65+

White

All races 0 20 40 60 Numbers in millions 80 100

*Note: Persons of Hispanic origin may be of any race. Source of data: U.S. Census Bureau, U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin, 2004.

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

Why The Increase?

The ave. 75y/o has 3 chronic dses. & 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

U.S. Population Pyramids

2000 2020 2040

Source of charts: U.S. Census Bureau, 65+ in the United States: 2005, December 2005.

Feminization of Later Life

Women comprise 55% of the older

population Women have a longer life expectancy

The average life expectancy of women in

the United States is 81 years The average life expectancy of men in the United States is 75.2 years

Figure 1-3 Number of males per 100 females by age, 2002.

Women Live Longer

U.S. Population by Gender and Age (2000)
All Ages Age 65+ Age 85+

Female 50.9%

Male 49.1%

Female 58.8%

Male 41.2%

Female 71.1%

Male 28.9%

Source of data: U.S. Census Bureau, State Interim Population Projections by Age and Sex: 2004-2030, 2005.

Older Women More Likely to Live Alone

Living Arrangements of Older Adults in U.S. (2003)
Alone
75+ years

With spouse

Other

WOMEN

65-74 years

75+ years

MEN

65-74 years 0% 20% 40% 60% 80% 100%

Source of data: U.S. Census Bureau, America's Families and Living Arrangements: 2003, Current Population Reports, P20-553, November 2004.

Feminization of Later Life

Male exposure to risk factors

may account for the differences

Increases in female exposures

to risk factors will reduce difference in life expectancy

Some Facts
Higher education equates to more money, higher standards of living, and aboveaverage health Older people who live alone are more likely to live in poverty Significant increase in proportion of minorities

More racially and ethnically diverse

At Risk from Poverty

Percent of 65+ in Poverty in the U.S. (2005)
Males Females
25.3% 20.1% 22.0% 17.0% 10.9% 5.9%

All 65+ persons 10.1%

White

Black

Hispanic

Source of data: U.S. Census Bureau, Current Population Survey: Annual Social and Economic Supplement, 2006.

Majority of older adults enjoy good health But national surveys reveal that: 20% of adults 65y/o & above report a chronic disability. Chronic disease - major cause of disability; Heart disease, The 3 leading causes of Cancer, and death in people 65y/o Stroke & above in the U.S. Alzheimers disease - 5th DM - 6th (NCHS,2006)

Table 1-1 Top Causes of Death for People Age 65 and Over

Chronic Health Problems

Percent of 65+ with selected conditions, 2005-2006
Males
60 50 40 30 20 10 0
Heart Disease Hypertension Stroke Cancer Diabetes Arthritis 10.4% 36.8% 26.4% 23.6% 19.3% 19.1% 17.3% 8.4% 52% 54.3%

Females
54.4% 43.1%

Source of data: U.S. Census Bureau, Older Americans 2008: Key Indicators of Well-Being, 2008.

Chronic Conditions in Seniors

80% have at least one chronic

condition
Two of the three leading causes

of death declined by one third

Heart disease and stroke

Older Adults More Likely to Have Disabilities

Percent of Americans with Disabilities (2002)
60
52.3%

50 40 30 20 10 0 % with any disability

P70-107, May 2006.

36.9%

65+ 15-64 0-14

15.1% 8.4% 9.6% 3.4%

% with severe disability

Source of data: U.S. Census Bureau, Americans with Disabilities: 2002, Current Population Reports,

Health Status of the Older Adult

Majority of deaths (US) occur in people 65y/o & older 50% of deaths--caused by heart disease & cancer In the past 50 years --- a noted decline in overall deaths Due to the improvements in the prevention & early detection & treatment of diseases Heart disease & cancer are two top causes of death, regardless of age, race, gender or ethnicity

Health Status of the Older Adult

Positive health reports declined with advancing age

African American and Hispanic or Latinos - less likely to report good health than their Caucasian or Asian counterparts. Majority of people 75y/o & over remain functionally independent, and the proportion of older Americans with limitations in activities is declining (CDC, 2007a).

70% of Physical Decline Related to Modifiable Risk Factors

Smoking Poor nutrition Physical inactivity

Failure to use preventative

and screening services

Reason for the decline in limitations to activity of Older Adult :

Recent trends in health promotion & disease prevention activities, such as: Improved nutrition, Decreased smoking, Increased exercise, and Early detection & treatment of risk factors such as hypertension & elevated serum cholesterol levels.

Aging Well
72% of seniors report having good to

excellent health Numbers living in nursing homes has declined 1 out of every 5,578 people was 100 y/o or older Older adults are active and healthy

Chronic Conditions and Older Adult

Many chronic conditions commonly found among older people can be managed, limited, and even prevented.

Older people are more likely to maintain good health and functional independence
If encouraged to do so and If appropriate community-based support services

are available (King, 2006; Miller, 2009).

History of Aging
1861 Military pensions were initiated

by Teddy Roosevelt 1935 Franklin Roosevelt signed social security act that provided income assistance to elderly 1965 Medicare and Medicaid law signed by President Johnson

Successful Aging
Achievement of sense of autonomy, dignity, and absence of suffering New England Centenarians study

Avoided chronic/acute diseases Successfully navigated through obstacles and the

physical/psychosocial challenges

A positive view of aging as a normal process is needed

Healthy People 2010 to increase the quality and

quantity of a healthy life

Challenge to all nurses

To promote positive lifelong

health behaviours among all populations

because the impact of unhealthy

behaviours and choices = CHRONIC DISEASE.

Nursing Care of Older Adults

Gerontological nursing is provided in acute care, skilled and assisted living, the community, & home settings. Goals of care include:

promoting & maintaining functional status,

and helping older adults identify & use their strengths to achieve optimal independence.

Roles of the Gerontological Nurse

Provider of care
Should be educated about disease processes &

syndromes commonly seen in the older population

Teacher/Educator
Should focus their teaching on modifiable risk

factors & health promotion through LIFESTYLE MODIFICATIONS

Roles of the Gerontological Nurse

Manager
They balance concerns of the patient, family,

nursing & the rest of the interdisciplinary team Must be skilled in:
Leadership, Time management, Building relationships, Communication & Managing change

They may also supervise other nursing personnel

Roles of the Gerontological Nurse

Advocate Acts on behalf of the older adults to: Promote their best interests & Strengthen their autonomy & decision making It does not mean making decisions for older adults, but empowering them to remain independent and retain their dignity, even in difficult situations

Roles of the Gerontological Nurse

Research Consumer Must remain abreast of current research literature, reading & putting into practice the results of reliable & valid studies The use of EVIDENCE-BASED PRACTICE RESEARCH can improve the quality of patient care in all settings: Best method for delivery of care Based on clinical guidelines derived from research Coding system indicates the strength of the research

Roles of the Gerontological Nurse

Research Consumer (cont.)

All nurses should:

Read professional journals specific to their specialty Continue their education by attending seminars & workshops Participate in professional organizations Pursue additional formal education or degrees Obtain certification

Certification

Nurse certification - a formal process by which a certifying agency validates a nurses knowledge, skills, & competencies through a written exam in a specialty area of practice

It provides reassurance to patients & their families that the nurses caring for them are:
Highly skilled and Posses expert knowledge in providing excellence in

gerontological nursing care

(Hartford Institute for Geriatric Nursing, 2008)

Certification
Why certify?

Professional

accomplishment/Leadership Commitment to profession Provide higher quality of care Evidence-Based Practice & resource to others

*Generalist Certification

Must have completed the basic entry-level program in nursing:

Associate, Diploma, or Baccalaureate degree in Nrsg.

Must be a licensed RN for at least 2 years

Practiced a minimum of 2,000 hrs. (w/in the last 3

yrs.)

Must pass the computerized exam in gerontological nrsg.

CERTIFIED GERONTOLOGICAL NURSE

Assess, manage & deliver health care that meets the needs of older adults Evaluate the effectiveness of their care Identify the strengths & limitations of their pts. Maximize patient independence Involve patient & family members

American Nurses Credentialing Center (ANCC, 2008)

*Advanced Certification

ADVANCED PRACTICE REGISTERED NURSES (APRNs)

An RN who holds a masters degree,

doctorate or higher degree Demonstrates advanced knowledge & clinical expertise in the care of older adults Function independently & in collaboration with other health care providers in a variety of setting

*Advanced Certification
ANCC offers two separate advanced

practice (APRNs) certification exam: Gerontological Nurse Practitioner (Gnp) Clinical Nurse Specialist In Gerontological Nursing (GCNS)

CLINICAL NURSE SPECIALIST IN GERONTOLOGICAL NURSING (GCNS)

RN with preparation in graduate level gerontological clinical nurse specialist program Provides advanced care for older adults, their families & significant others Has an expert understanding of the dynamics, pathophysiology, & psychosocial aspects of aging.

Serve as consultants to staff on complex issues of

patient care

CLINICAL NURSE SPECIALIST IN GERONTOLOGICAL NURSING (GCNS)

Focuses on 3 spheres of influence:

Patient/family care
Developing nurses

Impacting organizations and systems Through the development & implementation of EVIDENCE-BASED PRACTICE RESEARCH

CLINICAL NURSE SPECIALIST IN GERONTOLOGICAL NURSING (GCNS)

Practices in diverse settings & is actively engaged in: Education (e.g., patient staff, students and colleagues) Case management Expert clinical practice Consultation Research Administration

GERONTOLOGICAL NURSE PRACTITIONER (GNP)

RN with preparation in graduate level gerontological nurse practitioner program Delivers primary care to older patients They have a considerable autonomy addressing health care problems, often with prescriptive authority Includes independent & interdependent decision making Directly accountable for clinical judgements

Brief comparison of GCNS and GNP

CLINICAL NURSE SPECIALIST IN GERONTOLOGICAL NURSING (GCNS) Focuses more on the EDUCATOR and CONSULTATIVE ROLE GERONTOLOGICAL NURSE PRACTITIONER (GNP) Focuses more on the DIRECT PROVISION and EVALUATION OF CARE

American Nurses Association (ANA)

Responsible for defining scope & standards of nursing practice Established the Division of Geriatric Nursing Practice in 1966

Mission to create standards for quality nursing

care for older adults in all settings Division name changed to Division on Gerontological Nursing Practice in 1976

American Nurses Association (ANA)

Published a Statement on the Scope of Gerontological Nursing Practice in 1970

Defines nature and scope of gerontological

nursing Purpose
Health promotion Healthy maintenance Disease prevention Self-care

SCOPE OF PRACTICE OF GERONTOLOGICAL NURSE (AACN)

They specialize in the nursing care and health needs of older adults They plan, manage and implement health care to meet those needs & evaluate the effectiveness of such care The primary challenge

To identify & use the strengths of older adults and To assists them in maximizing their independence

They must actively involve older adults & family members, in decision making process (w/c has a great impact on the everyday quality of life of the pt.)

American Nurses Association (ANA)

Standards of Clinical Gerontological Nursing Care

I. Assessment II. Diagnosis III. Outcome Identification

IV. Planning
V. Implementation

VI. Evaluation

CORE COMPETENCIES

Provide a foundation of added knowledge and skills necessary for the nurse to implement in daily practice This was developed by the AACN and the John A Hartford Foundation Institute for Geriatric Nursing OLDER ADULTS: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
This serves as guides to nursing professors to prepare

students to be competent to provide excellent care to Older adults

AACNs Essentials of Baccalaureate Education for Professional Nursing Practice (1998)

Core Competencies

Core Knowledge
Health promotion, risk

Critical Thinking Communication Assessment Technical skills

Role Development
Provider of care Designer/manager/coordinator

of care Member of a profession

reduction, & disease prevention Illness and disease management Information & health care technologies Ethics Human diversity Global health care Health care system & policy

Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care

Recognize ones own & others attitudes, values, & expectations about aging & their impact on care of older adults & their families. Adopt the concept of individualized care as the standard of practice with older adults. Communicate effectively, respectfully & compassionately with older adults & their families. Recognize that sensation & perception in older adults are mediated by functional, physical, cognitive, psychological, & social changes common to old age.

Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care

Incorporate into daily practice valid and reliable tool to assess the functional, physical, cognitive, psychological, social & spiritual status of older adults. Assess older adults living environment with special awareness of the functional, physical, cognitive, psychological, & social changes common to old age. Analyze the effectiveness of community resources in assisting older adults & their families to retain personal goals, maximize function, maintain independence, & live in the least restrictive environment. Assess families knowledge of skills necessary to deliver care to older adults.

Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care

Adapt technical skills to meet the functional, physical, cognitive, psychological, social and endurance capacities of older adults. Individualize care & prevent morbidity & mortality associated with the use of physical & chemical restraints in older adults. Prevent or reduce common risk factors that contribute to functional decline, impaired quality of life & excess disability in older adults. Establish & follow standards of care to recognize & report elder mistreatment.

Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care

Apply evidence-based standards to screen, immunize & promote healthy activities in older adults. Recognize & manage geriatric syndromes common to older adults. Recognize the complex interaction of acute & chronic co-morbid conditions common to older adults. Use technology to enhance older adults function, independence & safety.

Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care

Facilitate communication as older adults

transition across & between home, hospital, & nursing home, with a particular focus on the use of technology. Assists older adults, families & caregivers to understand & balance everyday autonomy & safety decisions. Apply ethical & legal principles to the complex issues that arise in care of older adults.

Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care

Appreciate the influence of attitudes, roles, language, culture, race, religion, gender, & lifestyle on how families & assistive personnel provide long-term care to older adults. Evaluate differing international models of geriatric care. Analyze the impact of an aging society on the health care system. Evaluate the influence of payer system on access, availability & affordability of health care for older adults.

Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care

Contrasts the opportunities & constraints of a supportive living arrangement on the function & independence of older adults & on their families. Recognize the benefits of interdisciplinary team participation in the care of older adults. Evaluate the utility of the complimentary & integrative health care practices on health promotion & symptom management for older adults.

Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care

Facilitate older adults active participation in all aspects of their own health care. Involve, educate & when appropriate, supervise family, friends & assistive personnel in implementing best practices for older adults. Ensure quality of care commensurate with older adults vulnerability and frequency & intensity of care needs. Promote the desirability of quality end-of-life care for older adults, including pain & symptom management, as essential, desirable & integral components of nursing practice.

Continuum of Care
Multitude of settings for those > 65

48% in hospital requiring care 80% receiving home care

90% in nursing homes

receiving care

Acute Care Hospital

Often the POINT of ENTRY in the health care system Nurses are likely to care for older adults even if they do not specialize in geriatrics
50% of all pts. In this setting are 65y/o & above

GN focus - nursing care of acute problems, such as:

Exacerbation of CP conditions Cancer treatment and Orthopedic problems

Goal: promote recovery & prevent complications

Acute Rehabilitation
Rehabilitation may be found in several settings: Acute care hospital Subacute care or transitional care Long-term care facilities (LTCFs) Regardless of the setting, it is accomplished through the work of interdisciplinary team that includes: Nurses Therapists Other professional staff

Acute Rehabilitation (cont)

Goal:

To maximize independence Promote maximal function Prevent complications, and Promote quality of life w/in each persons strengths & limitations

Rehab in acute care hospital pt must b able to tolerate @least 3 hours of therapy/day
Beneficial to help pts. recovering from/adapting to conditions

such as Stroke, Head trauma, Neurological diseases, Amputation, Orthopaedic surgery and SCI

Home Health Care

Designed for those who are home bound due to severity of illness or immobility Indicated for independent-living older adults requiring a longer period of observation or care from nurses Visiting Nurses Association (VNAs) has a great contribution and reputation in the provision of home health care services

For reimbursement of allowable expenses Home health care

services must be ordered by the physician and the client must be considered homebound

Home Health Care (cont)

People desired to be cared for in a familiar surroundings by their familiesfuelled the need for more agencies Majority of home health care patients are elderly with a variety of nursing needs such as:
Wound care
IV therapy Management of newly diagnosed Diabetes, and Tube feedings

Long-Term Care Facility (LTCF)

Traditionally referred to as Nursing Homes Provide support to persons of any age who lost some or all of their capacity for self-care due to illness, disability or dementia Though not acutely ill, they require 24-hr. nrsg. Care (SeniorNursingCare, 2008) RNs provide care planning and oversight of numerous residents, often directing and coordinating the care via LPNs & CANs or other UAPs

Long-Term Care Facility (cont)

Challenge for nurses: To maintain the functional & nutritional status of residents, while preventing the complications of impaired mobility (e.g., pressure ulcers and falls) Dementia care is also a substantial part of the of the nursing care provided in LTCF Managing health conditions Medication regimen

Alzheimers Care

A growing trend in LTCFs, which offer a dedicated unit for the care of persons with Alzheimers disease and other dementing illnesses
Due to growing need and high rate of Alzheimers with

advanced age

Goal: To preserve the functional status of the demented person via supportive care that fosters selfworth and socialization even w/in the context of diminishing cognitive capacity

Alzheimers Care (cont)

Challenge for nurses: To manifest expertise in the provision of care and management of this challenging disease To help family members understand disease progression and to assure them that their loved one is being well cared for even at the end of this ultimately fatal disease

Skilled Nursing Facilities (SNF)

Sometimes called Subacute or transitional care Indicated for those patients requiring more intensive nursing care than provided in LTCF It is usually found as specially designated units within long-term care facilities or in some hospitals This units are designed to promote optimum outcomes in the least expensive cost setting

(Easton, 1999)

Skilled Nursing Facilities (cont)

Typical patients seen in this setting are those that need assistance as a result of: Non-healing wounds, Chronic ventilator dependence, Renal problems, IV therapy, and Coma management As well as those with complex medical &/or rehabilitative needs (e.g., pediatric, orthopedic & neurological)

Skilled Nursing Facilities (cont)

Skilled nurse must have: Good assessment & communication skills in caring for this complex patients Should also have knowledge in the ff: Transfer techniques, Prevention & assessment of swallowing problems, Bowel & bladder management, and Nutrition Must also be expert in preventing hazards of immobility Pressure ulcers and contractures

Hospice

Caring for the dying person and their families

Majority of dying patients are elderly

Concept o Hospice:
Centered on holistic interdisciplinary care that helps

the dying person live until they die

Hospice requires a gerontological nurse to have a great deal of patience, expertise, understanding, interdisciplinary communication and compassion

Respite Care

Provides time off for family members who care for someone who is ill, injured, frail, or demented
Because caregiving for a dependent older adult can be a

demanding task and may lead to stress and burnout

Can be provided in an adult daycare center, in the home of the person being care for or in an assisted living facility or LTCFs Objective: provide caregivers with temporary, intermittent, substitute care, allowing for relief from the daily responsibilities of caregiving

Continuing Care Retirement Community (CCRC)

Also referred to as a Life care Community

It provides a continuum of care from independent

living to skilled care, levels of care are adjusted to individual needs

Nurses play a role in the care of CCRC residents as they progress from independent living to requiring skilled nursing care
GN may also function in the are a of health promotion

to help older adults maintain independence for a long as possible

Assisted Living Facilities (ALFs)

An alternative option for those older adults;

Who do not feel safe living alone,

Who wish to live in a community setting, or

Who needs some additional help with ADLs

It may be connected with a LTCFs, care network or maybe free-standing. The typical resident in an ALFs has a private room or apartment, some type of kitchen/kitchenette and a private bathroom with shower
Some older adults sell their homes to enter ALF

Assisted Living Facilities (ALFs) (cont)

Provides the ff:

Healthy meals,

Planned activities,
Places to walk and exercise, & Pleasant surroundings where adults socialize with

others in a safe and protected environment

Other facilities in ALFs:

Walking paths, aviaries, workout rooms, chapels and

game rooms

Foster Care or Group Homes

Indicated for those older adults who can most of their ADLs, but may have safety issues and require supervision with some activities such as dressing or taking medications It generally offers more personalized supervision in a smaller, more family-like environment than a traditional nursing home
There is no requirement that a nurses service be

available or someone has a healthcare background to operate one

Green House Concept

Endorsed by the Centers for Medicare & Medicaid Services The Green House Model was conceived by Dr. William Thomas (2004) He teamed up with Robert Wood Johnson Foundation They replaced more than 100 nursing homes nationwide with clusters of small, cozy houses, each housing 8-10 residents in private rooms, with private bathrooms & an open kitchen

Green House Concept (cont)

Primary purpose:

To serve as a place where elders can receive

assistance & support ADLs and Clinical care without that assistance becoming the focus of their existence Caregivers are empowered to provide individualized care to older adults who retain control over daily activities, creating an environment that is a HOME

Adult Daycare

Provides another avenue for older adults who are unable to remain at home during the day w/out supervision
Especially for older adults being cared for at home

by their own family, who has to work during the day and wish that their relative be safely cared for during their absence

An excellent alternative to institutionalization

Adult Daycare
Services are offered only during the day 6a.m.6p.m. (normal office hours) Planned activities are included emphasis is on recreation and some health promotion activities May offer transportation Typically fees are paid privately Meal services normally included Additional health service availability varies

Theories of Aging

Purpose Of Nursing Theory

Defines our practice In gerontological nursing they must be comprehensive yet consider individual differences

A good GERONTOLOGICAL THEORY:

Integrates knowledge, Tells how and why phenomena are related, Leads to prediction, and Provides process and understanding In addition, it must be holistic & take into account all that impacts on a person throughout a lifetime of aging

Aging Theories
Cultural, spiritual, regional, socioeconomic, educational, environmental factors, and health status impact the older adults perceptions and choices about their health care needs Limited work has been done to identify nursing-specific aging theories Aging is a distinct discipline that requires aging theories that have an interdisciplinary perspective

Types of Theories
Psychosocial: Attempt to explain

aging in terms of behavior, personality, and attitude change Encompass psychological and sociological theories

PSYCHOLOGICAL Theories of AGING

Various coping or adaptive strategies must occur for a person to age successfully Triggers for coping/adaptive responses
Physical changes of aging Issues of retirement Dealing with the death of spouse or friend Declining health

PSYCHOLOGICAL Theories of AGING

Development does not stop when one ages It does not only includes behaviour but also devt aspects r/t lives of the older adults Psychological: How mental processes, emotions, attitudes, motivation, and personality influence adaptation to physical and social demands?

Maslows Hierarchy of Human Needs Theory

Maslow Continued
Human motivation is viewed as a hierarchy of

human needs that are critical to the Growth & devt. of all people

Although Maslow doesnt specifically address old age, it is clear that physical, economic, social, and environmental constraints can impede need fulfillment of older adults. Individuals are viewed as active participants in life, striving for self actualization

Maslow Continued

SELF-ACTUALIZED PERSON
Displays high levels of all of the ff. characteristics:
Perception of reality; Acceptance of self, others and nature; Spontaneity; Problem-solving ability; Self-direction; Detachment and the desire for privacy; Freshness of peak experiences; Identification with other human beings; Satisfying and changing relationships with other people; Democratic character structure; Creativity; and A sense of value

Jungs theory of Individualism

It hypothesizes as one ages the shift of focus is away from the EXTERNAL WORLD (extroversion) toward the inner experience (introversion) The older person search for answers to many of lifes riddles and try to find the essence of true self To age successfully: accept past accomplishment or failures

Types of Theories Contd.

Sociological: How changing roles, relationships, and status within a culture or society impact the older adults ability to adapt
Activity theory central theme that remaining

active in old age is desirable Disengagement theory characterized by gradual withdrawal from society and relationships

Types of Theories Contd.

Biological: Explain the physiologic processes that change with aging

Free Radical Theory aging caused by effects of free

radicals Wear and Tear Theory cumulative changes occurring in cells age and damage cellular metabolism

Nursing Theories

Need to take human aging into consideration Need to develop a more situation-specific theory of aging to guide practice

Functional Consequences Theory

A guiding framework that would address older adults with physical impairment and disability Nursings role is to minimize age-associated disability in order to enhance safety and quality of living

Theory of Thriving

Based on the concept of failure to thrive and application of thriving to the experience of wellbeing among frail elders living in nursing homes Nurses identify and modify factors that contribute to disharmony among a person and his or her physical environment and personal relationships