Week 2:Question for Discussion

Chapter 3 –  Biological Theories of Aging & Age Related Physical Changes. 
Chapter 4 –  Psychosocial, Spiritual, and Cognitive Aspects of Aging.

Question(s):
Discuss / explain the biological theories of aging.

Guidelines: The answer should be based on the knowledge obtained from reading the book, no just your opinion. All the theories (corresponding chapter in textbook) should be mentioned and explained (mention at least three). Your grade will be an average of all theories. 

Chapter 4
Psychosocial, Spiritual, and Cognitive Aspects of Aging
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Early theories were attempts to explain and predict the changes in middle and late life with an emphasis on adjustment
Adjustment was seen as an indication of success
Based primarily on “face validity”
Major first-generation theories
Role
Activity
Psychosocial Aging Theories
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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
Activity Theory
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Disengagement
Continuity
Age stratification
Social exchange
Modernization
Developmental
Gerotranscendence
Second-Generation Theories
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In the natural course of aging the person does, and should, slowly withdraw from society to allow the transfer of power to the younger generations
This is necessary for the maintenance of social equilibrium
Provided the basis of age discrimination
An elder’s withdrawal is no longer an indicator of successful aging

Disengagement Theory
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People develop and maintain a consistent pattern of behavior over a lifetime
Aging reflects a continuation of the patterns of roles, responsibilities, and activities
Successful aging is associated with one’s ability to maintain and continue previous behaviors and roles or to find suitable replacements
Continuity Theory
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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Historical content is the key to the age-stratification theory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
Age-Stratification Theory
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As one ages, one has fewer and fewer economic resources to contribute to the society, resulting in loss of social status, self-esteem, and political power
Only those who are able to maintain control of their financial resources have the potential to remain fully participating members of society and anticipate successful aging
Social Exchange Theory
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Value in older adults is lost when their skills are no longer considered useful
Is due to technology, urbanization, and mass education
Modernization has had a notable effect on cultures such as those in China and Japan
Modernization Theory
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Erikson’s hierarchy presents predetermined order of developmental stages and tasks
Erikson’s last stage of life is to look back and reflect (ego integrity or despair)
Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction
Developmental Theories
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Aging is an ever-evolving process that alters one’s view of reality, sense of spirituality, and meaning beyond the self
The person withdraws from society to give time for self-reflection and contemplation
Wisdom is achieved through personal transformation, and transcendence is a marker of successful aging
Gerotranscendence
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A 75-year-old patient has remained unmarried and childless. She shares with you that she feels her life has little meaning and no one cares if she lives or dies. She wishes she had made different choices so that she was now not alone. The issue the patient needs to resolve is
premature disengagement.
ego integrity versus despair.
inability to provide continuity.
overinvolvement in gerotranscendence.

Question
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C—During ego integrity versus despair, people reflect back on the lives they have lived and come away with either a sense of fulfillment from a life well lived or a sense of regret and despair over a life misspent.
Answer
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The life story
Reminiscing
Any recall of the past
Provides a pleasurable experience, increases socialization, provides cognitive stimulation, improves communication, facilitates personal growth, and can decrease depression scores
Life review
A formal therapy technique than reminiscence
Takes a person through his or her life in a structured and chronological order
Third-Generation Theories
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Provide the gerontological nurse with useful information and a background for enhancing healthy aging and adaptation
Nurses have a unique opportunity to use multiple approaches to understanding aging and coming to know the person in uniqueness
Nurses have a voice in testing, modifying, and discussing psychosocial theories and frameworks and how they apply to worldwide diversity

Implications for Gerontological Nursing and Healthy Aging
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A nurse caring for an 80-year-old patient would like to use reminiscence as therapy. Which question best encourages reminiscence?
What is your favorite food?
How many children do you have?
Does your religion provide you comfort?
What are some of your favorite childhood memories?
Question
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D—Asking to the patient to recall past events in an open-ended manner best encourages the older adult to relive life experiences.
Answer
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Spirituality is a broader concept than religion
It encompasses a person’s values or beliefs; search for meaning; and relationships with a higher power, with nature, and with other people
As people age and move closer to death, spirituality may become more important
Spiritual belief and practices play a central role in helping older adults cope with life challenges and are a strength in the lives of older adults
Spirituality and Aging
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An individual’s perception of hurt associated with the part of his or her person that seeks to transcend the realm of the material
May be manifested by anger, guilt, blame, hatred, expressions of alienation, turning away from family and friends, inability to derive pleasure, and inability to participate in religious activities
Spiritual Distress
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Using evidence-based guidelines for promoting spirituality provides a framework for spiritual assessment and interventions
Older adults want nurses to address spiritual needs
Spiritual assessments include FICA (Faith, Importance or Influence, Community, and Address) and the Brief Assessment of Spiritual Resources and Concerns
The Joint Commission requires spiritual assessments in hospitals, nursing homes, and any care setting for older adults
Implications for Gerontological Nursing and Healthy Aging
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Nurses must consider
What gives their own life meaning and value
What assists them in offering spiritual support to patients
Taking care of nurses’ own spiritual needs help them to better meet the patient’s spiritual needs
Nurturing the Spirit of the Nurse
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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
Cognition and Aging
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Fluid intelligence consists of skills that are biologically determined and independent of experience or learning
Crystallized intelligence is the knowledge and abilities acquired through education and life
Older people perform more poorly on performance scales (fluid intelligence), but scores on verbal scales (crystallized intelligence) remain stable.
Fluid and Crystalized Intelligence
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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
Memory
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Paying attention to cognitive health is just as important as attention to physical and emotional health
Nurses need to educate people about strategies to enhance cognitive health and brain plasticity
Following a healthy diet
Participating in physical activities
Participating in stimulating activities
Being social
Implications for Gerontological Nursing and Healthy Aging (Cont.)
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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
Learning Late in Life
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Share resources available for older adults who want to learn computer skills and adaptations that can be made to make computers as user-friendly as possible
Teach patients how to evaluate the reliability and validity of health information on the Internet
Implications for Gerontological Nursing and Healthy Aging (Cont.)
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Chapter 3
Biological Theories of Aging and Age-Related Physical Changes
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Are attempts to explain senescence or changes in the organism, leading ultimately to its death
Theories indicate that
Cells in the body become disorganized or chaotic
Cells no long replicate
Cellular death occurs
Biological Theories of Aging
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A rise in the level of reactive oxygen species (ROS) damages cells and ultimately results in the cell no longer being able to function
The number of ROS is increased by external factors such as pollution and cigarette smoke and by internal factors such as inflammation
Damage appears to be random and unpredictable, varying from one cell to another, from one person to another
Oxidative Stress Theories
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Suggests that aging is a result of an accumulation of damage to the immune system, or immunosenescence
A chronic state of inflammation, combined with increasing number of ROS in the cells, appears to be a key factor in the aging process and the development of many health problems common in later life
Immunological Theory
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Growing evidence suggesting that ROS and free radicals alone do not trigger the aging process but lead to DNA mutations that cause errors in reproduction
Area of great research interest
Do telomeres have their own “biological clock?”
Is there a relationship between oxidative stress and the development of disease?
Aging and DNA
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Occur as a result of genetic (intrinsic) and environmental (extrinsic) factors
Epidermis
Thins, making blood vessels and bruises 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
Skin Changes of Aging
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Dermis
Loses about 20% of its thickness
Dermal blood vessels are reduced, which accounts for resultant skin pallor and cooler skin temperature
Collagen synthesis decreases
Elastin fibers thicken and fragment, leading to loss of stretch and resilience and a “sagging” appearance
Hypodermis
Areas atrophy, causing increased sensitivity to cold
Sebaceous (oil) glands atrophy
Skin Changes of Aging (Cont.)
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Hair
Thins on the head
Increased hair in the ears, nose, and eyebrows
Loses pigmentation (graying occurs)
Women develop chin hair, and leg, axillary, and pubic hair decrease
Nails
Become harder, thicker, dull, and more brittle
Vertical ridges appear
Growth slows
Hair and Nail Changes
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Although not life-threatening, they can affect one’s ability to function and quality of life
Changes are influenced by many factors, such as age, sex, race, and environment
Changes
Ligaments, tendons, and joints become dry, hardened, and less flexible
Muscle mass decreases
Vertebral disks thin, causing a shortening of the trunk
Musculoskeletal Changes
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Cardiac
Left ventricle wall thickens
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
Vascular
Elasticity decreases, and blood vessels recoil
Veins become stretched, and the valves become less efficient
Cardiovascular Changes
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Respiratory problems are common but almost always the result of exposure to environmental toxins rather than the aging process
Changes include
Loss of recoil
The chest wall stiffens
Gas exchange is less efficient
Resistance to air flow increases
Effectiveness of cough response is reduced
Cilia are less effective
Respiratory Changes
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Changes are significant because of increased susceptibility to fluid and electrolyte imbalance and structural damage from medications and contrast media
Changes include
Kidney blood flow decreases
Size and function of the kidneys decrease
Urine creatinine clearance decreases
Renal Changes
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The impact of most changes is not clear
Changes include
Most glands shrink
Rate of secretion decreases
Increased insulin resistance
Rates of type II diabetes and hypothyroidism are higher in older adults
Endocrine Changes
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Women
Unable to procreate after the cessation of ovulation
Breasts appear smaller, more pendulous, and less firm
Ovaries, uterus, and cervix atrophy
Estrogen levels decrease
Vaginal wall loses its ability to lubricate
Male
Testes atrophy and soften
Ejaculation is slower and less forceful
Testosterone level reduces
May experience urinary retention
Reproductive Changes
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Mouth
Teeth lose enamel and dentin, making them vulnerable to decay
Taste buds decline in number
Salivary secretion lessens; consequently, a dry mouth exists
Stomach
Esophagus and stomach sluggishly empty
Decreased gastric motility and volume
Decreased ability to produce intrinsic factor
Intestines
Villi in the intestines are less functioning, which affects absorption
Peristalsis slows
Constipation is common
Gastrointestinal Changes
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Central nervous system
Brain size and weight decrease
Subtle changes in cognitive and motor functioning occur in the very old
Mild memory impairments and difficulties with balance may be seen
Performance of tasks may take longer
Peripheral nervous system
Decreased tactile, kinesthetic, and vibratory senses
Reaction time is delayed
Neurologic Changes
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Changes are both functional and structural
All of the changes affect visual acuity and accommodation
Near vision decreases, and the lenses thicken
Eyelids lose elasticity and droop
Color perception decreases
Lower eyelids turn out, and dry eye syndrome is common
Resorption of the intraocular fluid becomes less efficient
Decline in peripheral vision
Eye and Vision Changes
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Affect both the structure and the function of the ear
Appearance changes, especially in men
Ear lobes sag, elongate, and wrinkle
Wiry, stiff, course hairs grow
Ear wax is more thick and dry
Age-related hearing loss occurs
Primarily lose ability to hear high-frequency sounds
Ear Changes
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Changes result in an increased risk for infection in older adults
Immunity is reduced at the cellular level
Oral temperature is lower
Decreased response to foreign antigens
Immunoglobulins increase
Immune Changes
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In performing a physical assessment for an older adult, the nurse anticipates finding which of the following normal physiological changes of aging? (Select all that apply.)
Irregular heart rate
Increased salivation
Reduced muscle mass
Decreased lower leg hair
Diminished bowel sounds
Question
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C, D—An irregular heart beat, increased salivation, and diminished bowel sounds are not associated with normal aging
Answer
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A nurse performing a health history on an older adult patient determines that further follow-up is required for which non–age-related finding?
Early feelings of satiety
Occasional constipation
Seeing halos around lights
Difficulty hearing some conversations
Question
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C—Seeing halos around lights is not a normal age-related finding. It is a symptom of glaucoma, and follow-up is required.
Answer
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