CONCEPTS, PRINCIPLES AND THEORIES IN THE CARE OF OLDER ADULTS
Aging --- deterioration of the physiological functions necessary for survival and fertility.
Aging process - the process of growing old ---------- lead to senescence
Senescence - a change of behavior leading to a decreased power of survival and adjustment
PEOPLE ARE LIVING LONGER ---------- 60 years +20 years
WHAT MAKES US AGE DIFFERENTLY? (5) ------- Our access to health care
Genetic inheritance --- Who we are ----- Where we live ------ Our health behaviour
World Health Organization (WHO)
65 or older grow 524 million in 2010 to nearly 1.5 billion in 2050
2030, 60% of this generation will be managing more than 1 chronic condition. --- baby boomers
As life expectancy increases, the prevalence of disability will decrease / increase
HEALTH CONDITIONS THAT ARE CHALLENGE TO HEALTHCARE SYSTEM (5)
1. Cancer - expected to increase to 17 million by 2020 and 27 million by 2030.
2. Dementia - 115 million of Alzheimer's disease by 2050
3. Increase in the number of falls -American Hospital Association (AHA)
one-third, fall each year ----- 20% to 30%, 350,000 hip fractures
4. Obesity - medicare program of 34% ----------------- Diabetes
TO ADDRESS THE INCREASING AGING POPULATION, THE HEALTH CARE SYSTEM MUST
a) Prepare for new technology
b) Prepare for increasing incidences of chronic conditions
c) Prepare for implementing a multidisciplinary approach
d) Focus on providing preventive care versus reactive care
e) Strategies include a more comprehensive care plan
THEORIES OF AGING ------ This explain the phenomenon of aging as it occurs over the lifespan.
TYPES THEORIES OF AGING (4)
1. BIOLOGIC ---- aging occurring from a molecular, cellular
This answers the questions regarding the physiological processes
a) FOCI OF BIOLOGIC THEORIES
Deleterious effects leading to decreasing function of the organisms.
BIOLOGIC THEORIES: DIVISIONS (2)
a) Stochastic Theories - aging as randomly and accumulate over time (4)
1) Error theory / Error Catastrophe Theory ----- 1963, Orgel
Occur in the synthesis of DNA that do not function at the optimal level.
2) Cross-linkage theory -- Some proteins in the body become cross-linked
3) Wear & tear theory --1882 by Welsman ------------ Result of tissues being worn out
4) Free radical theory --------- byproducts of metabolism.
b) Nonstochastic Theories - aging as predetermined and timed phenomena
1) Programmed (HAYFLICK LIMIT) Theory --- 1961 by Hayflick and Moorehead
"Biological clock," "cellular aging." or "genetic theory."
Based on lab experiments and their reproductive capabilities
2) Immunity Theory
Immunosenescence - diminution of the immune system
T cells - responsible for cell-mediated immunity
B cells - responsible for humoral immunity.
t-lymphocyte ("killer cells") - response to a stimulus
EMERGING THEORIES OF AGING (3)
a) Neuroendocrine control (pacemaker) theory
Examines the role of the neurologic and endocrine systems over the life- span
b) Metabolic theory/caloric restriction ------ all organisms have metabolic lifetime
c) DNA-related research ---- 200 genes ---- enzyme telomerase
2. SOCIOLOGIC ---- 1960s ---- sociologists focused on the losses of old age (5)
a) Disengagement theory - Cummings and Henry (1961)
Aging process separate from the mainstream of society.
b) Activity/developmental task theory – Robert Havighurst in 1960
Proposed that people needed to stay active if they age successfully.
it's better to be active than inactive ------- it is better to be happy than unhappy
c) Continuity theory --- Neugarten, 1964
Personality remains the same and the behaviors becomes more predictable
Personality – a critical factor in determining the relationship between role activity and life
satisfaction.
d) Age stratification theory --- Riley-1985
The key societal issue being addressed in this theory is the concept of interdependence
e) Person-environment fit theory ---- Lawton 1982
Examines the concept of interrelationship among group of persons
Personal Competencies (4)
Ego strength --------- motor skills
biologic health -------- Cognitive and sensory capacities
3. PSYCHOLOGIC (5)
a) Maslow's hierarchy of human needs
Physiological, Safety, Love/Belonging, Esteem and Self-actualization (characteristics)
Perception of reality ---- Problem solving ability --- Acceptance of self
b) Jung's theory of individualism --- Swiss psychologist Carl Jung (1960)
"Midlife crisis" - begin to question whether the decision they have made were the right choices
Self- realization - the goal of personality development
c) Erikson's eight stages of life
Crisis - impacts the development of the person's ego.
40 to 65 (middle adulthood) -- generativity versus self-absorption or stagnation
65 to death (older adulthood) -- ego integrity versus despair
d) Peck's expansion of Erikson's theory
Ego differentiation versus work role preoccupation
Body transcendence versus body preoccupation
Ego transcendence versus ego preoccupation
e) Selective optimization with compensation
3 INTERACTING ELEMENTS
1) Selection -- increasing restriction
2) Optimization -- people engage in behaviors to enrich their lives
3) Compensation -- results from restrictions due to aging
4. MORAL/SPIRITUAL --- Kolberg --- Illness a life crises
HEALTH PROMOTION AND ILLNESS/DISABILITY PREVENTION
Care in the acute care settings -- resolving immediate health problems
Care in the community -- focuses on self- care.
THE PURPOSE OF HEALTH PROMOTION AND DISEASE PREVENTION
To reduce the potential years of life lost
Primary prevention - prevention of disease before it occurs
Secondary prevention - detection of disease at an early stage.
Vaccinations – Mammography – Pelvic examination – Screenings – Osteoporosis – Counseling
FACTORS THAT INFLUENCE HEALTH BEHAVIORS IN OLDER ADULTS (9)
Cognitive impairment -------- Function -------- Access to care
Resources -------- Social supports ------- Sensory changes
Environment -------- Unpleasant sensations --------- Competing priorities
Health promotion -- activities to help individuals change their lifestyle to move toward a state of optimal
health
Optimal health -- a balance of physical, emotional, social, spiritual, and intellectual health
Disease prevention -- activities designed to protect patients or other members of the public from actual or
potential health threats and their harmful consequences.
Primary prevention -- measures provided to individuals to prevent the onset of a targeted condition
Secondary prevention -- activities that identify and treat asymptomatic persons who have already
developed risk factors or preclinical disease but in whom the condition is not clinically apparent
Tertiary prevention -- activities that involve the care of established disease; attempts are made to restore
the person to highest function, minimize the negative effects of disease, and prevent disease-related
complications.
Quaternary prevention -- limiting disability caused by chronic symptoms while encouraging efforts to
maintain functional ability or reduce any loss of function through adaptation
AREAS OF HEALTH PROMOTION MOST RELEVANT TO PHYSICAL FITNESS OF OLDER ADULTS
Increasing physical activity --------- Smoking control
Medication safety/drug safety ---------- Spiritual health
Cardiac health: heart healthy diet, exercise, and preventive medication use
Nutrition --------- Medical self-care
Environmental health -------- Social health
Weight maintenance ---------- Driving safety
MODELS OF HEALTH PROMOTION
a) ONPRIME Model
b) Health Belief Model
c) PRECEDE/PROCEED Model
d) Health Promotion Model
