Chapter 5 Theories of Aging and Physical Changes

Chapter 5 Theories of Aging and Physical Changes

Objectives • Identify the physical changes that are associated with normal aging • Begin to differentiate normal age-related changes from those that are potentially pathological • Describe at least one age-related change for each body system • Develop a plan of care for the older adult that targets prevention and health promotion 2

Changes with Aging • Changes are: • Intrinsic, which comes from within • Extrinsic, which comes from environmental factors (e. g. , exposure to smoke or pollutants) • Triggers of aging are influenced by genetics or by injury or abuse to the body. 3

Biological Theories of Aging • Theories indicate that: • Cells in the body become disorganized or chaotic. • Cells no long replicate. • Cellular death occurs. 4

Error (Stochastic) Theories • Errors are accumulated in the synthesis of cellular DNA and RNA. • With the accumulation of replication errors, cells are no longer able to function. • Most common theories are: • Wear and tear • Cross link • Oxidation stress (free-radical) • https: //www. youtube. com/watch? v=7 CEq. UWl 7 s. BM 5

Programmed Aging (Nonstochastic) Theories • Attributes aging to be predetermined or “programmed” at the cellular level. • As more cells cease to replicate, signs of aging occur. 6

Neuroendocrine-Immunological Theory • Cells of the immune system become more diversified with age. • T-lymphocytes show more signs of aging than Blymphocytes. • This will be a good review for you: http: //www. wisconline. com/Objects/View. Object. aspx? ID=OTA 2505 7

Physical Changes of Aging: Skin • Changes occur as a result of genetic (intrinsic) and environmental (extrinsic) factors. • Dryness, thinning, and a decrease in elasticity occur. • As a result of a decrease in the epidermis, blood vessels and bruises are more visible. • Fewer melanocytes result in a lighter appearance of the skin. • Age spots or liver spots (lentigines) appear on the backs of hands and wrists and on the face. • Seborrheic keratoses and thick, brown, and raised lesions appear. • Thinning of the dermis causes a decrease in the stretching ability of the skin. 8 • Areas of the hypodermis atrophy, which causes the person to be more sensitive to cold.

Physical Changes of Aging: Hair and Nails • • Hair thins on the head. Hair increases in the ears, nose, and eyebrows. Pigmentation is lost (graying occurs). Older woman develop chin hair, and leg, axillary, and pubic hair decrease. • Nails are hard and thick. • Vertical ridges appear. • Nails are slower growing. 9

Physical Changes of Aging: Musculoskeletal • Aging affects the ligaments, tendons, and joints, which causes the older person to be more rigid and stiff in his or her movements. • Muscle mass decreases. • Posture changes as a result of the intervertebral disks that dehydrate. 10

Physical Changes of Aging: Cardiovascular • Myocardial and blood vessels become stiff. • The left ventricle wall thickens, and the size of the left atrium slightly increases. • Maximum coronary artery blood flow, stroke volume, and cardiac output decrease. • The heart takes longer to accelerate and then to return to normal. • Elasticity decreases, and blood vessels recoil. • Veins become stretched, and the valves become less efficient. 11

Physical Changes of Aging: Respiratory • • • Recoil is lost. The chest wall stiffens. Gas exchange is less efficient. Resistance to air flow increases. Effectiveness of cough response is reduced. 12

Physical Changes of Aging: Renal • Kidney blood flow decreases. • Size and function of the kidneys decrease. • Urine creatinine clearance decreases. 13

Physical Changes of Aging: Endocrine • Glands atrophy, and the rate of secretion decrease. • The rate of type II diabetes is high in older adults. • The rate of hypothyroidism increases as a result of changes in the structure and function of the thyroid in the older person. 14

Physical Changes of Aging: Reproductive • Women are unable to procreate after the cessation of ovulation. • Female breasts appear smaller, are more pendulous, and are less firm. • Ovaries, uterus, and cervix atrophy. • Estrogen levels decrease. • Vaginal wall loses its ability to lubricate. • Testes atrophy and soften. • Ejaculation is slower and less forceful. 15 • Testosterone level reduces. • Men may experience urinary retention.

Physical Changes of Aging: Gastrointestinal • Teeth lose enamel and dentin, making them vulnerable to decay. • Taste buds decline in number. • Salivary secretion lessens; consequently, a dry mouth exists. • Pleasure in eating decreases, and weight loss occurs. • Esophagus and stomach sluggishly empty. • Villi in the intestines are less functioning, which affects absorption. • Peristalsis slows. • Constipation is common. 16

Physical Changes of Aging: Accessory Organs • Liver function tests are unaltered. • Incidence of gallstones increase. • Serum cholesterol level increases. 17

Physical Changes of Aging: Neurological Cognition • • • Brain size and weight decrease. Sleep disturbances occur. Mild memory disturbances are evident. Balance difficulties develop. Injuries increase as a result of a decrease in tactile sensations in the fingers and palms. • Reaction time is delayed. • Risk for falls increases. • https: //www. youtube. com/watch? v=45 qlm 6 cf. Hgg 18

Physical Changes of Aging: Eyes and Ears • Senses of smell, sight, and touch decrease. • Near vision decreases, and the lenses thicken. • Eyelids lose elasticity and droops, and color perception decreases. • Lower eye lids turn out, and dry eye syndrome is common. • Ear lobes sag, elongate, and wrinkle; hearing loss occurs; and ear hair is more stiff and course. • Ear wax is more thick and dry. 19

Physical Changes of Aging: Immune • • Immunity is reduced at the cellular level. Oral temperature is lower. Decreased response to foreign antigens Immunoglobulins increase. 20

Maslow’s Hierarchy and Physical Changes • Physical changes affect all levels of Maslow’s hierarchy • Level 1 - Physiologic needs in every body system affected by aging • Upper level needs can be affected by inability to adequately meet physiologic needs. 21

Question Stan arrives at your clinic. His daughter reports a decrease in cognitive function. Which of the following could be causes for this event? A. B. C. D. Urinary tract infection Eye infection Change of residence Muscle atrophy 22

Chapter 6 Social, Psychological, Spiritual, and Cognitive Aspects of Aging

Objectives • Explain the major psychological and sociological theories of aging • Discuss the influence of culture and cohort on psychological and social adaptation • Discuss the importance of spirituality to healthy aging • Explain cognitive changes with age and strategies to enhance cognitive health • Discuss factors influencing learning in late life, including health literacy, and appropriate teaching and learning strategies 24

Life Span Development Approach • • Development is lifelong. Each person’s development is defined by time and place. Development involves growth and decline. Development is limited and varies 25

Types of Aging • Chronological aging is defined by years. • Biological aging is predicted by a person’s physical condition. • Psychological aging is expressed through ability, control of memory, learning capacity, skills, emotions, and judgment. 26

Sociological Theories of Aging • The following sociological theories explain and predict changes in the roles and relationships of older adults with an emphasis on adjustment: • • • Disengagement theory Activity theory Continuity theory Age-stratification theory Social exchange theory Modernization theory 27

Disengagement Theory • Aging is inevitable. • Aging results in a decrease in interaction between the aging person and others or society. • Withdrawal in natural and accepted. 28

Activity Theory • • The ideal of life is to remain as active as possible. Activity is possible when living in a stable society. The older person has: • Access to positive influences and significant others. • Opportunities to participate in the broader society if he or she chooses to. 29

Continuity Theory • Life satisfaction with engagement or disengagement depends on personality traits. • In normal aging, personality traits remain stable. • Personality influences role activity and the individual’s interest in a role. • Personality influences life satisfaction. 30

Age-Stratification Theory • Believes in age categories of older adults as young, middle-aged, and old. • Historical content is the key to the age-stratification theory. • Social and cultural expressions of age are examined. 31

Social Exchange Theory • Is based on the consideration of the cost-benefit model of social participation. • Withdrawal or isolation is the result of an imbalance between exchanges of an older person and a younger person. • Balance determines an older person’s satisfaction. 32

Modernization Theory • Value in older adults is lost when their skills are no longer considered useful. • Is due to technology, urbanization, and mass education. 33

Symbolic Interaction Theories • Focus on the interaction between the older adult and his or her environment. • When confronted with change, the older person tries to master the new situation while extracting a positive selfconcept from the environment. 34

Implications for Gerontological Nursing and Healthy Aging • Sociological theories • provide the gerontological nurse with useful information and a background for enhancing healthy aging and adaptation • Have been adapted and applied to contemporary approaches to aging in many ways 35

Psychological Theories of Aging • Psychological theories of aging presuppose that aging is a developmental process experienced between birth and death; they include: • Jung’s theory of personality • Developmental theories • Theory of gerotranscendance 36

Jung’s Theory of Personality • Defines the last half of life as having a purpose of its own allowing for inner growth, self-awareness, and reflection • Personality is directed either toward the external world (extrovert) or the internal world (introvert). • Midlife presents questions of one’s own dreams, values, and priorities. 37

Developmental Theories • Erikson’s hierarchy presents developmental stages and tasks. • Erikson’s last stage of life is to look back and reflect (ego integrity or despair). • Peck expanded on Erikson with identification of specific tasks of old age to establish “ego integrity”. • Havighurst also proposed specific tasks to be accomplished in middle age and later maturity 38

Theory of Gerotranscendance • Human aging brings a shift from the material world to the cosmic world with increased satisfaction. • This shift is ongoing and associated with wisdom and spiritual growth. 39

Spirituality and Aging • Spirituality is the quality of the person resulting from faith, a search for meaning, connection to others, and transcendence itself. • Physical health, loss of a loved one, and understanding that his or her life may be coming to an end causes a reflection of life. 40

Spirituality and Nursing • Spirituality is the deepest resource for healing. • Neuman, Parse, and Watson are nursing theorists who addressed this concept. • Evidence-based guidelines promote spiritual assessment and interventions. 41

Implications for Gerontological Nursing and Healthy Aging • Older adults want nurses to address spiritual needs, as well as their physical needs. • Religious needs are important and can enhance the healing process. • The framework of the spiritual assessment tool, FICA, is Faith, Importance or Influence, Community, and Address). • The Joint Commission requires spiritual assessments in hospitals, nursing homes, and any care setting for older adults. 42

Nurturing the Spirit of the Nurse • Nurses must consider • What gives their own life meaning and value • What assists them in offering spirtual support to patients • Taking care of nurses’ own spiritual needs help them to better meet the patient’s spiritual needs 43

Cognition and Aging • Cognition is the process of acquiring, storing, sharing, and using information. • Its components include language, thought process, memory, execution of function, judgment, attention, and perception. • Cognition can remain stable or decline with aging. 44

Scenario John’s wife of 57 years died 4 years ago. John has several children, but he still feels lonely since his wife’s death. He only goes to the grocery store when needed and rarely goes out for any occasion. He stays home reading and watches television in the evenings. 45

Question Regarding John’s daughters notice that he is having difficulty with conversation, as well as moving throughout his condominium. These difficulties could be the result of: A. B. C. D. Loneliness Lack of nutrition “Don’t use it, you lose it” theory Depression 46

Fluid and Crystalized Intelligence • Fluid intelligence or “native intelligence” consists of skills that are biologically determined and independent of experience or learning. • Examples include: • • Flexibility in thinking Inductive reasoning Abstract thinking Integration with people to draw conclusions 47

Crystalized Intelligence • Crystalized intelligence is the knowledge and abilities a person acquires through education and life and includes: • • Verbal reasoning Word association Social judgment Number skills 48

Memory • Is the ability to retain and store information and thus retrieve the information when needed: • Immediate memory • Short-term memory • Long-term memory • Familiarity, previous learning, and life experiences can compensate for memory loss. • Age-associated memory impairment (AAMI) is memory loss that is considered normal in light of person’s age and educational level 49

Implications for Gerontological Nursing and Healthy Aging • The following strategies maintain and enhance cognition and a vitality for life: • • Managing chronic conditions Maintaining a healthy weight Avoiding excess caloric intake Limiting sodium and fats Increasing antioxidants Participating in physical activities Participating in stimulating activities Being social 50

Learning Late in Life • Must be relevant information. • New learning must relate to what the older person already knows. • Literacy level and cultural variations play a role. • Many older adults have computers and make up the fastest growing age group who owns them. 51

Health Literacy • Is the ability to obtain, process, and understand basic health information and services to make appropriate decisions regarding health care. • Requires more than the ability to read and write. • Is the ability to interpret and understand prescriptions, appointment slips, medical education brochures, provider instructions, and consent forms, as well as interact with health professionals. 52

Implications for Gerontological Nursing and Healthy Aging • Nurses have gained knowledge about life and the aging “norms. ” • Nurses ensure that the “inner self” of their client has meaning and purpose as they care for the older adult. 53

References • Touhy, T. A. , & Jett, K. F. (2014). Ebersole and Hess' Gerontological Nursing & Healthy Aging (4 th ed. ). St. Louis, Elsevier. • Touhy & Jett Powerpoint • www. youtube. com • Healthy People 2020 54