Late Adulthood

(65 years and above)

Definition of terms:
Aging- characterizes changes which occur in the last part of the lifespan
-most noticeable in middle and late adulthood

Ageism- term to describe the deep profound prejudice in American Society

-the tendency to draw conclusion or formulate belief about a person on the basis of
chronological end.

Geriatric-define the study of aging and older adults

-associated with the medical care of the elderly

Gerontology- multidisciplinary and is specialized one within various disciplines

-study of aging and older adults

Geragogy- the process involved in helping and stimulating elderly person to learn

Maximum Lifespan- the genetic limit to length of life for a person free of external
factors
-maximum number of years that a person can be expected to live under the best
condition

View Points on Aging

Life expectancy-average number if years that a person can be expected to live
Life Span-maximum number of years that a person can be expected to live under the
best condition.

120 years is the longest verified time that anyone has lived.
115 years maximum lifespan
68- Filipinos live on average (1996)
Today’s life expectancy:
Women- 1985- 78.2 years; 2020-82 years
Men- 1985- 71.2 years; 2020- 74 years

People live longer because of:

High technology
Emergent of drugs that control diseases
Immunization

THEORIES OF AGING
1. Cellular Clock Theory ( Microbiological Theory)
-Leonard Hayflick’s view that cells can be divide a maximum of about 100 times and
that as we age; our cells become increasingly less capable of dividing

2. Free Radical Theory

-When oxygen molecules breakdown within the cell. The reaction strips away an
electron, creating radical.
-these molecules ricochet around the cells, damaging DNA and other cellular structures
-Their damage can lead to a range of disorders including cancer and arthritis

3. Hormonal Stress Theory

-states that aging in the body’s hormonal system can lower resilience to stress and
increase the likelihood of disease
-emphasizes that with aging, the hormones stimulated by stress that flow through HPA
(hypothalamic-pituitary-adrenal)

4. Wear and Tear Theory

-suggest that the body, much like any machine, gradually deteriorates and finally
wears out
-explains some diseases such as osteoarthritis
5. . Metabolic Theories
-focus on aspects of the body’s metabolism to explain why people age
-Two important processes in this approach are caloric intake and stress
-These is some evidence that people who limit the number of calories
-How readily one adapts to physical stress is also significant

6. Programmed Senescence Theory

-suggest that age related physical declines result from species-specific genes for aging
development
-holds that bodies are according to a normal timetable built into the genes
-longevity is a family trait
-people inherit one or two risk factors which influence the chances of dying

PHYSICAL DEVELOPMENT/CHANGES
1. INTEGUMENTARY SYSTEM
-Decrease sebaceous gland activity and inability of age skin to retain fluid
-Deterioration of nerve fibers and nerve endings
-Decrease vascularity of the dermis and tissue layers that produce hair follicles
-Decrease subcutaneous fats
-Decrease number of functioning melanocytes
-Low body temp. due to decrease metabolic rate and temp. of 37.5 represent marked
fever
-Shivering reflexes diminished
-Clustering of melanocytes resulting to brown “age spots” on exposed body parts

2. MUSCULOSKELETAL SYSTEM
-Decrease in height due to bone loss in the vertebrae
-From 30-50, men ½ inch loss in height, then ¾ from 50-70; height loss in women is 2
inches from 25-75
-Weight drops by 60 years of age due to loss of muscle
-Older adults move slower than young adults

3. NERVOUS SYSTEM
Decrease in:
-Number of brain cells
-Sensory perception
-Reflexes
-Balance and coordination and motor responses

4. SENSORY SYSTEM
VISION
-Decrease in peripheral vision, color perception, night vision, tear production
-Increased sensitivity to glow and glare
-Common vision problems: Cataract: opaque area in the lens, Glaucoma: hardening of
the eyeballs, Macular degeneration: degeneration of retina

HEARING
-Decrease ability to distinguish “high frequency sound”
-Thickening of ear drums
-75% of individuals from 75-79 yrs are experiencing some type of hearing problem
-15% of population over 65 is legally deaf due to degeneration of cochlea

TASTE AND SMELL

-Taste buds continue to degenerate
-Sensitivity to 4 basic taste reduction is usually due to tobacco use, dentures or
presence of dental problems
-Smell and taste losses often begin around age 60 and become marked after 70s.
-Decline in sense of smell

TOUCH
-Increased threshold for sensation of pain and touched
-With aging individuals could detect touch less in the lower extremities than in the
upper extremities
-Decreased sensitivity can help with injury but can be harmful with mask injury

5. RESPIRATORY SYSTEM
-Respiratory condition is affected by nutrition, smoking habits, and exercise patterns
-Lung capacity drops 40% between ages 20 and 80 even without disease
-Lung lose elasticity, the chest shrinks and the diaphragm weakens
-Can improve lung functioning with diaphragm strengthening exercises.

6. CIRCULATORY SYSTEM
-W hen heart disease is absent, the amount of blood pumped is the same regardless of
an adult’s age
-consistent BP at 160/90

7. GASTROINTESTINAL PATTERN
-Gradual decrease in digestive enzymes (ptyalin, pepsin/trypsin, lipase)
-Decrease in the number of absorbing cells in the intestines
-Decrease in the intestinal muscles—decrease peristalsis and elimination

8. URINARY SYSTEM
-Hypertrophy of the prostate
-Older women—incontinence
-Decrease bladder capacity
-Increased volume of residual urine

9. ENDOCRINE SYSTEM
-Decrease in pituitary secretions: production of thyroid stimulating hormone; basal
metabolic rate; and the production of parathyroid hormone

10. REPRODUCTIVE SYSTEM

FEMALE
-Decrease estrogen level, vaginal secretion, size of the uterus and ovary, and
increased in vaginal alkalinity
MALE
-Decrease testosterone level, rate and force of ejaculation, rate of gaining
erection, and no definite cessation of fertility associated with aging

PSYCHOSOCIAL DEVELOPMENT
ERIK ERIKSON THEORY
Ego Integrity vs. Despair- involves coming to terms with one’s life.
-Adults who arrive at a sense of integrity feel whole, complete and satisfied with their
achievements
-Realize that the paths they followed, abandoned and never selected were necessary
for fashioning a meaningful life course
-Despair occurs when elders feel they have many wrong decisions, yet time is too short
to find an alternate route to integrity.

COGNITIVE DEVELOPMENT
-Disorientation, loss of language skills, loss of ability to calculate and poor judgment
are not normal aging process
-Older adults take in information more slowly and find it harder to apply strategies and
retrieve relevant knowledge from long-term memory, the chances of memory failure
increase
-“failing memory”

4 stages of memory
a. Sensory Memory- momentary perception of stimuli by the senses
b. Short-term memory- is passive “holding tank” for small amount of recently
experienced information
c. Recent Memory- deals with activities or the recent past minutes to few hours
d. Long term Memory- long term or remote memory (the repository of
information stored for very long period) longer than 72 hours and usually weeks and
years.
3 common conditions affecting cognition
DELIRIUM- an acute confused state, potentially reversible, often due to physiologic
cause: infection, F/E imbalance, hypoglycemia, or sensory deprivation in unfamiliar
surroundings and emotional distress or pain.
DEMENTIA- generalized impairment of the intellectual functioning that interferes with
social and occupational functioning, characterized by gradual progressive and
irreversible cerebral dysfunction as in Alzheimer’s disease.
DEPRESSION- a feeling of gloom due to disappointment, loss or failure
-the most common emotional problem of older adults
-tend to rise from loss of self-esteem and may be related to life situation such
as loss of spouse or retirement

SPIRITUAL DEVELOPMENT
-Spirituality and faith may advance to a higher level
-Older adults are in the conjunctive stage of Fowler’s stages of faith dev’t.
-The few people who attain this stage form has an enlarged vision of an all-inclusive
human community.

HEALTH PROBLEMS
1. INJURIES
-Because vision is limited, reflexes are slowed and bones are brittle, caution is required
in climbing stairs, driving car and even walking.

2. CHRONIC DISABLING
-Ex. Arthritis, Osteoporosis, Heart disease, stroke, Obstructive lung disease, vision and
hearing alterations.

3. DRUG USE AND MISUSE

-Most elders living independently take their medications with no supervision

Common Medication errors made by Older adults

• Forgetting to take the drug
• Failing to understand instructions or the importance of the drug
• Taking the OTC drugs
• Taking out of date drugs
• Taking drugs prescribed for someone
• Refusing to take medication due to some undesirable side effects

Nursing interventions r/t use of medications

• Emphasize medicines that are essential
• Attempt to reduce medicine usage that is not essential
• Screen medicine usage
• Assess alcohol use
• Encourage the use of written or medication reminder system
• Monitor medication dosage strength and timing
• Encourage the use of one pharmacy
• Work with the physician and pharmacists to establish routine drug profile
• Advocate for low income prescription support services: dosage routine that are
simple and once daytime release form

4. Alcoholism
-Clients who are alcoholics should not be stereotyped or prejudged by the nurse.
-They should be accepted, listened to and offered help
-the role of the nurse is to act as a client advocate and facilitate the treatment of
drinking problem

5. DENTAL PROBLEMS
Common problems are: dental carries, gingivitis, broken or missing teeth and or ill-
fitting dentures

6. DEMENTIA
NURSING RESPONSIBILITY
-To provide supportive nursing care, accurate information and referral assistance, if
placement in a nursing care facility becomes necessary

7. ELDER MISTREATMENT
-Elder abuse or neglect may occur in privatehomes, senior citizen home, nursing
homes, hospitals and long term care facilities
-Nurses should be familiar with the laws of the particular state

Forms of Abuse
• PHYSICAL NEGLECT- not providing correct medication or proper physical care
• PSYCHOLOGICAL ABUSE- displaying threatening behavior or swearing at the
person
• PSYCHOLOGICAL NEGLECT- isolating elderly person
• VIOLATION OF INDIVIDUAL RIGHTS- lack of privacy
• EXPLOITATION- taking property without consent or through coercion

SPECIAL NEEDS OF THE ELDERLY

1. IMMUNIZATION AND HEALTH MAINTENANCE VISITS
• Hepa B for those at risk
• Yearly PE, visual examination, dental assessment, testicular/prostate examination
• Mammogram for women
• Blood test: sugar, lipid on regular basis

2. SAFETY-ACCIDENT PREVENTION
• Falls, burns, pedestrian accident, automobile accident

3. HYPOTHERMIA
• Due to lowered metabolism and loss of normal insulation from thinning subcutaneous
tissue.
• Cover warmly and protect head and hands when going outdoors in cold weather
• Use extra blankets at night to keep feet warm with woolen socks that are safer than
hot water bottles
• Eat a balanced diet including high energy food such as fats and carbohydrates

4. NUTRITION
• Their ability to meet their needs for good nutrition is influenced by life long eating
habits and situational factor
• Nutritional needs are affected by their levels of activity and clinical conditions
• Good nutrition means: appropriate caloric intake and limited intake of fats, salt,
refined sugar and alcohol

5. EXERCISE
• It’s primary benefits: maintaining and strengthening functional ability and promoting
a sense of enhanced well-being
• Walking is the preferred exercise
• Should have PE before beginning a formal exercise program

SAFETY HIGHLIGHTS
SAFETY CONSIDERATION DURING EXERCISE
• Wearing appropriate shoes and clothing
• Drink water before and after exercise
• Avoid outdoor exercise when weather is very warm or cold
• Exercise with partner
• Stop when chest pain occur, dizziness, lightheadedness or palpitation is experienced

PREVENTING FALL
• Adequate lighting in all rooms, hallway and stairways
• Get out of bed slowly
• Install grip bars in the bathroom/toilet
• Make sure that the rug and carpet are firmly attached to the floor and stairs
• Make electrical wiring or cord secured against the base board to prevent tripping
• Keep indoors and outdoors walkways and stair in good condition
• Install sturdy, slip resistant and hand railing along stairs

PREVENTING BURNS
• Check the temperature of bath water and heating pad
• Avoid smoking in bed or when sleeping
• Install a smoke alarm
• Place hand fire extinguisher in a convenient place
• Avoid wearing loose fitting clothing when cooking
• Don’t overload electrical circuits and keep appliances in good condition

PREVENTING PEDESTRIAN ACCIDENT

• Wear reflective or light colored clothing when out in the streets
• Cross street at intersection
• Be sure to look both ways

PREVENTING AUTOMOBILE ACCIDENT

• Have regular eye examination
• Wear good quality gray or green colored sunglasses at day time to reduce glare
• Keep car windows clean and wiper in good condition
• Place mirror on both sides of the car and always check rear view and side mirrors
when changing lane
• Always look behind the vehicle for people or obstacle before backing up
• Avoid smoking when driving
• Follow physicians restriction if any, about when or where to drive
• Learn the effect of prescribed medication in driving ability
• Do not drink and drive
• Stop periodically to stretch your muscles
• Leave car windows partially open and set radio low or off so that you can hear sirens
or horns
• Have the ability to drive checked periodically. Keep your automobile in good condition
and keep tail lights, headlights and turn signal clean

POSSIBLE NURSING DIAGNOSIS (PSYCHOSOCIAL NEEDS)

• Isolation r/t inadequate individual resources
• Impaired home maintenance r/t inadequate social support system

SPECIFIC NURSING RESPONSIBILITIES

1. IMPROVING COMMUNICATION
a. Reduce noise destruction
b. Talk in unhurried manner
c. Use clear, easy to understand sentences
d. Provide list and simple written instruction

2. PROMOTING INDEPENDENCE IN SELF-CARE ACTIVITIES

3. PROVIDING FOR SOCIALIZATION AND INTIMACY NEEDS

4. PROMOTING ADEAQUATE NUTRITION

• Offer one dish at a time
• Cut food into small pieces
• Serve warm not hot food