Care of the Older Person

I believe a human life is like a river, meandering

through its course, rushing through rapids,
flowing placidly over the plains , twisting and
turning through countless bends until it
spends itself. It is the same river; yet it looks
different from one place to another. So it is
with our lives; circumstances vary from one
time to another in the course of life, but I
think each stage has its own value.
~Georgia, a 35-year old
• is the broad term used to define the study of
aging and/or the aged and includes the
biopsychosocial aspects of aging.
• Under the umbrella of gerontology are several
subfields including
– geriatrics
– social gerontology
– geropsychology
– geropharmaceutics
– financial gerontology
– gerontological nursing
– gerontological rehabilitation nursing
• used as a generic term relating to the
aged, but specifically refers to medical
care of the aged.
• concerned mainly with the social aspects
of aging versus the biological or
psychological.
Social gerontologists
• also seek to understand how the biological
processes of aging influence the social
aspects of aging
• specialists in psychiatry whose knowledge,
expertise, and practice are with the older
population.
• also called geropharmacology,
• is a unique branch in which pharmacists
obtain special training in geriatrics.
• An emerging subfield that combines
knowledge of financial planning and
services with a special expertise in the
needs of older adults.
• the intellectual intersection of two fields,
gerontology and finance, each of which
has practitioner and academic
components (Cutler, 2004)
• combines expertise in gerontological nursing
with rehabilitation concepts and practice.
• Nurses working in gerontological
rehabilitation often care for the elderly with
chronic illnesses and long-term functional
limitations.
• to assist older adults with such health
deviations to regain and maintain the highest
level of function and independence possible
while preventing complications and
enhancing quality of life.
• the aspect of gerontology that falls within
the discipline of nursing and the scope of
nursing practice.
• It involves nurses advocating for the health
of older persons at all levels of prevention.
• Gerontological nurses work with healthy
elderly persons in their communities, the
acutely ill elderly requiring hospitalization
and treatment, and the chronically ill or
disabled elderly in long-term care facilities,
skilled care, home care, and hospice.
• The specialty of gerontological nursing was
first formally recognized in the early 1970s,
• when the Standards for Geriatric Practice
(1970)
• and the Journal of Gerontological Nursing
(1975) were first published.
• Provider of Care
• Teacher
• Manager
• Advocate
• Research Consumer
• Interestingly, although “old” is often defined
as over 65 years of age, this is a rather
arbitrary number set by the Social Security
Administration.
• the older age group is often divided into:
– young old (ages 65–74),
– the middle old (ages 75–84)
– the old old, very old, or frail elderly (ages 85 and
up)
Jean Louise Calment died in France at age 122.
At that time she was believed to be the
longest-lived person in the world. She outlived
her husband, her daughter, her only grandson
and her lawyer. Her husband died in 1942,
just four years before their 50th anniversary.
Her daughter died in 1936 and her grandson
in 1963. She was four when the Eiffel tower
was built and reportedly once sold art
supplies to Vincent Van Gogh.
Not only did she live a long life, but did
so with vigor. Madame Calment took
up fencing at 85 and was still riding a
bike at 107. She smoked until she was
117 and ate a lifelong diet rich in olive
oil. Her longevity remains a mystery to
experts and researchers.

Dollemore D: Aging under the microscope:

A biological quest. Bethesda, MD, 2006,
National Institute of Aging, National
• 2000, the population was 96 males for
every 100 females.
• This ratio declines steadily with age.
• For persons 65–74 it was 82:100;
• For those 85 and older, it was 41:100 (or
more than two women for every man)
• In 2003, over 75% of men ages 65–74
were married, compared to 56% of women
in the same age group.
• Only 36% of women ages 75–84 were
married; this dropped to 14% in the 85 and
older age group.
• For men 85 and older, 59% were married.
• 72% of older men and 71% of older women
had graduated from high school,
• while 23% of older men and 13% of older
women had graduated from college.
• 2003, older men were more likely to be
living with a spouse than were older
women (73% compared to 50%)
• Older women were twice as likely as older
men to be living alone (40% compared to
19%)
The leading cause of death for older adults
• diseases of the heart,
• malignant neoplasms,
• cerebrovascular diseases,
• chronic lower respiratory diseases,
• influenza and pneumonia,
• diabetes.
THEORIES OF AGING
• attempt to explain aging in terms of behavior,
personality, and attitude change.
• Psychological theories are concerned with
personality or ego development and the
accompanying challenges associated with
various life stages.
• Sociological theorists consider how changing
roles, relationships, and status within a
culture or society impact the older adult’s
ability to adapt.
• A high degree of life satisfaction
• Midlife patterns and ideals are no longer prime
motivators
• Complex and active coping patterns
• A greater need for solitary philosophizing,
meditation and solitude
• Social activities are not essential to well-being
• Satisfaction with self-selected social activities
• Less concern with body image and material
possessions
• Decreased fear of death
• Affinity with past and future generations
• Decreased self-centeredness and
increased altruism
• Ego differentiation vs. role preoccupation

• Body transcendence vs. body

preoccupation

• Ego transcendence vs. ego preoccupation

• aging manifested on the molecular level in
the cell, tissues, and body systems;
• how does the body-mind interaction affect
aging?
• what biochemical processes impact aging;
and how do one’s chromosomes impact
the overall aging process?
• Some aging theorists divide the biologic
theories into two categories:
1. A stochastic or statistical perspective, which
identifies episodic events that happen
throughout one’s life that cause random cell
damage and accumulate over time, thus
causing aging
2. The nonstochastic theories that view aging
as a series of predetermined events
happening to all organisms in a timed
framework.
• Oxidative free radical theory postulates that aging is
due to oxidative metabolism and the effects of free
radicals, which are the end products of oxidative
metabolism.
• Free radicals are produced when the body uses oxygen,
such as with exercise.
• This theory emphasizes the significanceof how cells
use oxygen (Hayflick, 1985).
• Also known as superoxides, free radicals are thought to
react with proteins, lipids, deoxyribonucleic acid (DNA),
and ribonucleic acid (RNA), causing cellular damage.
• This damage accumulates over time and is thought to
accelerate aging.
Free radicals cause:
• Extensive cellular damage to DNA, which can
cause malignancy and accelerated aging, due
to oxidative modification of proteins that
impact cell metabolism
• Lipid oxidation that damages phospholipids in
cell membranes, thus affecting membrane
permeability
• DNA strand breaks and base modifications
that cause gene modulation.
• This theory suggests that, over time, cells
accumulate errors in their DNA and RNA
protein synthesis that cause the cells to
die.
• Environmental agents
• randomly induced events can cause error,
with ultimate cellular changes.
• Over time, cumulative changes occurring
in cells age and damage cellular
metabolism.
• An example includes the cell’s inability to
repair damaged DNA, as in the aging cell.
It is known that cells in heart muscle,
neurons, striated muscle, and the brain
cannot replace themselves after they are
destroyed by wear and tear.
• This theory is also referred to as cross-link
theory, and it proposes that, over time,
biochemical processes create connections
between structures not normally
connected.
• As people age, more of their cells start to decide to
commit suicide or stop dividing.
• The Hayflick phenomenon, or human fibroblast
replicative senescence model, suggests that cells
divide until they can no longer divide, whereupon
the cell’s infrastructure recognizes this inability to
further divide and triggers the apoptosis sequence
or death of the cell (Sozou & Kirkwood, 2001).
• Therefore, it is thought that cells have a finite
doubling potential and become unable to replicate
after they have done so a number of times.
• This theory explains that each cell, or
perhaps the entire organism, has a
genetically programmed aging code that is
stored in the organism’s DNA.
• This theory describes a change in hormone
secretion, such as with the releasing
hormones of the hypothalamus and the
stimulating hormones of the pituitary
gland, which manage the thyroid,
parathyroid, and adrenal glands, and how
they influence the aging process.
The following major hormones are involved with
aging:
• Estrogen decreases thinning of bones, and
when women age less estrogen is produced
by the ovaries. As women grow older and
experience menopause, adipose tissue
becomes the major source of estrogen.
• Growth hormone is part of the process that
increases bone and muscle strength. Growth
hormone stimulates the release of insulin-like
growth factor produced by the liver.
• Melatonin is produced by the pineal gland
and is thought to be responsible for
coordinating seasonal adaptations in the
body.
• This theory was proposed 40 years ago and says
that the normal aging process of humans and
animals is related to faulty immunological function
(Effros, 2004).
• There is a decreased immune function in the
elderly.
• The thymus gland shrinks in size and ability to
function. hormone levels are decreased at the age
of 30 and are undetectable by the age of 60
(Williams, 1995).
• Involution of the thymus gland generally occurs at
about 50 years.
 “Will you still need
me,
Will you still feed me…
When I’m sixty-four?”

~ Paul McCartney