Nursing Theory of Aging

Nursing Theory of Aging 

• Miller (2004) has developed the functional consequences theory.
• Older adults experiences functional consequences because of age related changes and additional risk factors.
• Without interventions, many functional consequences are negative; with them, however functional consequences can be positive.
• The role of regent logic nurse is to identify the factor that causes negative functional consequences and to initiate  interventions that will result in positive ones.
• Normal age related changes and factors may negatively interfere with patients activity and quality of life.
• The nurse must differentiate between normal age related changes that can be reversed and risk factors that can be modified.

Importance to Nurses 
1. Each theory provides framework and insight into the differences among elderly patients.
2. Nurses play a significant role in helping aging person experience health fulfillment and sense of well being.
3. Nurses attitude towards aging can have an enormous impact on patients.
4  It makes the nurse aware whether the changes are related to aging or disease condition.
5. It helps to provide specific care keeping in mind about the various changes in their biological and psychological aspect.
6. It helps to differentiate normal aging from the abnormal one.
7. It can be tested, changed or used to guide research or to provide base for evaluation.
8. It guides the nurses in helping the old people adapt to various changes.
9. It helps the older people on re-balancing the relationship.

Natural changes during older adulthood 

Ageing is a natural process. It should be regarded as a normal inevitable biological changes which are incident to old age is gerontology. Care of aged is called geriatrics.

Old people have limited regenerative capabilities and are more prone to disease, syndromes, and sickness than other age groups. There is often a common physical decline, and people become less active. Old age can reason, along with other things:

• Hair loss
• Changes of hair color to gray or white 
• Wrinkles and liver spots on the skin.
• Agility and slower reaction times 
• Reduced ability to clear thinking 
• Lessened hearing 
• Diminished eyesight 
• Difficulty recalling memories 
• Lessening or termination of sex, sometimes because of physical symptoms such as erectile dysfunction in men, but often simply a decline in libido.
• Greater weakness to bone disease such as osteoarthritis 

Some myths and facts related to aging are given below:

Myths:
1. Ageing is the time of tranquility and that ageing is synonymous with senility.
2 Old age is time of reduced activity.
3. Older person are thought to be resistant to change.
4. Ageing is a uniform process that progresses at the same rate and with the same results for all.

Facts:
1. Many older people retain their mental faculties well beyond the ninth decade of life.
2. Societal factors may limit opportunities for older adults to demonstrate their productivity but many older adults remain productive throughout life.
3. resistant to changes tends to be lifelong characteristics, not one developed with advancing age.
4. Ageing affects each individual differently and the outcomes of ageing may be different from one individual to another.


Nursing care of older adults is challenging and they should be cared for according to their level of understanding because all older adults are not the same. For example, some may be physically active, intelligent and productive members of the community whereas others may not be aware of these differences.  

Theories

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Psychological theories

1. Disengagement theory: One of the earliest theories 

• Developed by Elaine cumming and Willaim Henry (cumming and Henry 1961)
• This theory viewed aging as a process through which society and the individual gradually withdraw or disengage from each other.
• Nobody grows old merely by living a number of years. We grow old by deserting our ideas . Years may wrinkle the skin but to give up enthusiasm wrinkles the soul. - Samuel Ullman.

2. Activity theory : Proposed by Havighrust (1963)

• Suggest that aged people should continue an active middle-aged lifestyle and should remain as active as possible.
• It suggests that obstacles are to be resisted and that problems involving declining health, loss of roles and responsibilities, reduction in income and diminishing circle of friends are to be overcome.
• It suggests many ways for older people to maintain an active life.
• For most elderly people when physical activity is much reduced, intellectual activities should be emphasized.
• when old friends and relatives are dying or otherwise lost, the establishment of new friendship would be encouraged.

3. Continuity theory: Negatron, 1964

• In spite of aging process, personality and basic patterns of behavior are considered to be constant in the individual.
• Patterns and activity levels develop over a life time will largely determine whether an individual remain engaged and active or disengaged and inactive as they age.
• This theory encourages young people to consider their own future aging process.

4. Social Exchange theory :

• Postulates that social interaction between individuals and groups continues as long as everyone profits from the interaction.
• When there is no longer profit from the social exchange, imbalance occurs in the interaction and one individual is perceived as having more power than the over.
• The decrease in the social interaction of the aged is the result of exchange relationship that gradually erodes the power of the aged.

Environmental Theories :

• The elements in the environments have been considered by the researchers to have an effect on aging phenomena.
• Biologists have considered the effects of the environment on the cellular structure of the human organism.

1. Radiation Theory: Excessive exposure to the suns radiation puts the skin at risk during the somatic mutation process.

2. Stress Theory: According to Perlman (1954), Human aging is a disease syndrome arising from a struggle between environmental stress and biological resistance and relative adaptation to the effects of stress or agents. These stress or agents might include air, pollutants, chemical and psychological and sociological events.

Developmental Theory : 

• Erikson (1963) theorized that person's life consists of eight stages.
• Each stage represents a crucial turning point in life stretching from birth to death, with its own developmental conflicts to be resolved.
• According to him, the major developmental task of old age is either to achieve ego integrity or to suffer despair.

Theories

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Biologic Theories

 
Biologic Theories

1. Cellular theory :  Cells have been subjects of  much scientific inquiry in exploring aging phenomena, Cell has three distinct components:
  a. cells that can reproduce
  b. cells that cannot reproduce
  c. inter cellular substance/materials

• Cells that can reproduce : Reproduction of cells occur. Some new cells become non-functioning or less effective than the others that are replaced. Three systems in human body are continuously replaced . With the progress in the aging process there is accumulation of these inefficient  and non-functioning cells. Organism functional ability becomes apparent. Visible changes occur in the aging process.
• Cells that cannot reproduce : Eg. CNS kidney. With age cells progressively wear and tear out and or destroyed. Develop an accumulation of non-functioning cells. Systems became less efficient and difficult to handle.
• Inter cellular substance/materials :  Gradual deterioration of inter cellular material with aging reduces the ability of the cells to provide necessary nutrients and oxygen for respective tissue and directly interfere the functioning abilities of each system.

2. Programmed aging theory : Aging and death, according to this theory, are not a result of wear and tear or exposure, but are a programmed, natural and necessary part of genetics. In short, we are programmed to age and die.

3. Error Theory : 

• Miss-transcription and miss-translation of certain genes products.
• Results in self amplifying error producing derangement
• Initial error will, most likely result in further errors of similar types
• The productions of faulty products of other genes which accumulate with aging. eg. Enzyme with decrease catalytic activity in the later life.

4. Somatic mutation theory (similar to error theory)

• Cells exposed to x-ray radiation or chemicals
• Cell by cell alteration in DNA occurs
• Increase the incidence of chromosomal abnormalities 
• Occurs more at youth and its deleterious effect are seen in later life

5. Wear and Tear Theory 

• Postulates that an organisms wears out with use
• Damage begins at the level of molecules in our cells
• DNA that makes up our genes sustains repeated damage from toxins 
• Bodies have the capacity to repair the damage but not all are accurately corrected 
• Damage cells progressively accumulates

6. Auto immune theory :  Postulates that with age, the immune system produces auto-anti-bodies that causes cell death or cell changes that fosters the aging process

7. Free radical theory

• Free radical is a molecule with an unpaired, highly reactive electron. One type of free radical generated in our body is oxygen free radical
• This free radical grabs the molecule from any other molecule and damage the other molecule
• Molecule that are damaged by free radicals are Fat , Proteins and DNA. (both of nucleus and mitochondria)
• Under normal condition natural defense mechanism prevent most of the oxidation damage
• This theory purpose that little by little small damage accumulates and contributes to deterioration of tissues and organs

 8. Cross linkage theory :  Also called as collagen theory.

• With age, our proteins, DNA and other inappropriate cross links to one another 
• This unnecessary links decreases the elasticity of proteins and other molecules
• Proteins that are damaged are no longer needed and are broken down by pro tease enzyme 
• Presence of cross linkage inhibits the activity of pro tease.
• Damaged and unneeded proteins stick around and can cause problem. Eg: wrinkling of skin at aging, age related cataract formation.

    

Older Adulthood

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Older Adulthood

It is difficult to define when middle age ceases and  old age starts .Usually a man feels older when they are unable to do things they used to do .Old Age and the aging  mechanism are of course a     biological  occurrence which has its  own  dynamism, largely beyond our command. 

It is strange no   one expects to grow old  but everyone expects to live long.

Aging is a Reality - prepare to accept  Gracefully                                                                                                                                            Facts and Figure

• The senior citizens Acts 2063, Nepal defines the senior citizen as "people who are 60 years and above ".
• The total population of Nepal in 2010 is estimated to be about 28 million of which nearly 8% are aged 60 and over.
• In a study done in old age home of Kathmandu  (2010) more than half of the residents were suffering from at least one chronic illness. Hypertension, gastritis and arthritis were the most common diseases.
• In a study done in Bhaktapur district (2009) the common problems felt by elderly people were pain and swelling of joints (65.7%), indigestion (63.7%), excessive tiredness (38.2%) and hypertension (35.8%).

Theories of aging 

1.Biologic theories 

• Cellular theory 
• Programmed aging theory 
• Somatic mutation theory
• Wear and tear theory 
• Auto immune theory
• Error theory
• Free-radical theory
• Cross linkage theory

2. Psychological theories 

• Disengagement theory 
• Activity theory
• Continuity theory
• Social exchange theory

3.  Environmental theories 

• Radiation theory
• Stress theory

4. Development theory

                                                                                                                                                  

Adult Nursing

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Middle Adulthood (40-50 years of age)

Introduction 

• Middle aged starts at the age of 40 and ends at 50 years.
• This is the period of physiological changes that are gradual and inevitable; although physical growth has stopped he/she continue to mature emotionally.
• In this period he or she has obtained personal achievements and socioeconomic stability.
• He or she enjoys the role in assisting other young people or children. That is the time of helping aging parents progress through the later years of life.
• The middle aged adults use his leisure time in creative work and get satisfaction from his/her own work.
• This is the time when a person prepares for retirement. 

Physiological Development 

• Major physiological changes occur between 45-65 years of age.
• The changes in physical appearance and functions vary from person to person.
• The most visible changes are grey hair, loss of hair, wrinkling, body metabolism which begins to slow down due to lack of excess fat deposition especially around waist and abdomen.
• Presbyopia ( blurred vision at close range ) is common in middle adulthood. 
• The impact of physiological changes has an effect on the person's self concept and body image.

Cognitive Development 

• Middle aged adults are able to learn new skills and information.
• Some adults prepare themselves for new education, career and vocational training.
• The cognitive function changes when they are seriously ill or have trauma.

Psychological Development 

1. The psychological changes in the middle aged are due to children moving away from home, divorce and death of spouse.

• The changes may cause stress and affect the health of an individual .

Sexuality 

• During this period sex hormone begins to decline such as estrogen and progesterone in the female. Therefore most of the women experience menopause between the age of 45-60 years of age.
• There is decreased level of androgen which may cause climacteric changes in both male and females, middle aged adult experience changes in the erection and decreased repeated orgasm. Therefore some may experience emotional distress and for this reason, both male and female clients need more information about menopause and climacteric changes.

Physiological Needs and Developmental tasks 

Physiological needs of Middle Aged are :

1. Adaptation to changing sexuality.
2. Promotion of adaptive health maintenance measures.
3. Monitoring for and treatment of chronic illness.
4. Early detection of loss of perception.

Seven Development tasks have been Described by "Havighurst" 

1. Achieving adult civic social responsibility.
2. Establishing and maintaining as standard of living.
3. Helping teenage children become responsible and happy adults.
4. Developing leisure activities.
5. Relating to one's spouse as a person.
6. Accepting and adjusting to physiological changes of middle age.
7. Adjusting to aging parents.

Central tasks of middle adulthood 

1. Express love through more than sexual contacts.
2. Maintain healthy life patterns.
3. Develop a sense of unity with mate.
4. Help growing and grown children to be responsible adults.
5. Relinquish central role in lives of grown children.
6. Accept children's mates and friends.
7. Create a comfortable home.
8. Be proud of accomplishments of self and mate/spouse.
9. Reverse roles with aging parents.
10. Achieve mature, civic and social responsibility.
11. Adjust to physical changes of middle age.
12. Use leisure time creativity.

Major Health Problems of Middle adulthood

Common health problems in middle adulthood include:

1. Diabetes
2. Accidents
3. Heart diseases
4. Stroke
5. Hypertension
6. Cancer
7. Alcoholism
8. Degenerative joint disease, Gout
9. Gallbladder disease 
10. Coronary artery disease 
11. Varicose veins
12. Gl disorders: peptic ulcer disease 
13. Obesity 
14. Dental problems 
15. Visual changes 
16. Reproductive/menopausal problems
17. Anxiety/stress
18. Accidents/injuries.

Many of these diseases are preventable wholly or in part through behavior changes . Middle aged adults can influence their own health as well as their children's through healthier life styles.

Nursing consideration in middle adulthood 

1. Encouraging regular medical check up 
2. Teaching self breast examination to females and self testicular examination to males.
3. Encouraging to have pap smear test done for females.

INTRODUCTION

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INTRODUCTION TO NURSING CARE OF ADULT

INTRODUCTION TO NURSING CARE OF ADULT

Developmental Needs and tasks
young adult
Middle aged adult
Older adults
Major Health Problems of Adult `
young adult
Middle aged adults eg gall stone, ulcer heart conditions
Older adults eg CVA
Young Adults (21-39 years )

Introduction
Young adulthood starts at the age of 21 year and ends at 39 years.
Young adults are usually physically healthy, chronic illness are less in this age group.
Young adulthood is a period of productive life. The young adult may attend college or may have a job and choose a life partner and marry. Some may remain single, but most of them are involved in rearing children and caring for parents.
The young adult changes gradually in his/her attitudes due to natural due to natural process of maturation and socialization. During this period young adults set goals and choose a carrier.
He or she gradually enters middle age and may be aware of some changes in his/her reproductive life and other physical changes. During this transitional period, the person may reassess his/her goals in life and add new goals.
Physiological Development
Physiological development is complete and he or she may experience changes in body structure or shape.
The young adult are usually active and may not have serious illness.
They ignore minor physical symptoms and often postpone seeking medical help.
Chronic illness does not appear in this age group.
The physical characteristics of young adults gradually change into middle age.

Cognitive Development
Young Adults develop a habit of rational thinking.
They gain experience through different areas such as formal and informal education.
General day to life experience and occupational/job opportunities greatly increase the individual's conceptual and problem solving skills as well as motor skills.
They are often found to be satisfied with their job or occupation.
Psycho-social Development
Emotional health of a young adult depends upon how he resolves his/her personal problems, social tasks and frequency of exposure ti similar problems.
During this period he refines his life goals and relationship. He wants success in his chosen carrier.
He may have more social contacts eg. work place, cub etc.
The young adults gives more attention to his carrier or occupation and wants to improve his socioeconomic status through his chosen carrier. Successful employment not only ensures economic security but also leads to friendship, social activities, support and respects from coworkers. In this regard a nurse also helps the individual in achieving of his her goals.
Development needs and tasks of Young adults
The physical needs of young adult are :
1. Establishment of lifelong health maintenance measures.
2. Early detection of disease process.
3. Assistance with reproduction.
According to Diekelmann (1976) there are five developmental tasks:
1. The young adults achieve Independence from parental control.
2. They begin to control strong friendships and intimate relationship outside the family.
3. They establish personal sets of values.
4. They prepare for life work and develop the capacity for intimacy.
Major health problems of Young Adults
1. Accidents related to the following activities:
    Driving
    Occupational
     Recreational
2. Social Problems:
     Drug abuse
     Tobacco use
      Alcohol and substance abuse
      Suicidal attitude (poison, burn, hanging)
      AIDS, STD

INTRODUCTION

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