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Week 2:Question for DiscussionChapter 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. aging_week_2_lecture_chapter_3.ppt aging_week_2_lecture_chapter_4.ppt Unformatted Attachment Preview Chapter 3 Biological Theories of Aging and Age-Related Physical Changes Copyright © 2018, Elsevier Inc. All rights reserved. Biological Theories of Aging   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 Copyright © 2018, Elsevier Inc. All rights reserved. 2 Oxidative Stress Theories    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 Copyright © 2018, Elsevier Inc. All rights reserved. 3 Immunological Theory   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 Copyright © 2018, Elsevier Inc. All rights reserved. 4 Aging and DNA   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? ➢ Copyright © 2018, Elsevier Inc. All rights reserved. 5 Skin Changes of Aging   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 Copyright © 2018, Elsevier Inc. All rights reserved. 6 Skin Changes of Aging (Cont.)  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 Copyright © 2018, Elsevier Inc. All rights reserved. 7 Hair and Nail Changes  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 Copyright © 2018, Elsevier Inc. All rights reserved. 8 Musculoskeletal Changes    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 Copyright © 2018, Elsevier Inc. All rights reserved. 9 Copyright © 2018, Elsevier Inc. All rights reserved. 10 Cardiovascular Changes  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 Copyright © 2018, Elsevier Inc. All rights reserved. 11 Copyright © 2018, Elsevier Inc. All rights reserved. 12 Respiratory Changes   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 Copyright © 2018, Elsevier Inc. All rights reserved. 13 Copyright © 2018, Elsevier Inc. All rights reserved. 14 Renal Changes   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 Copyright © 2018, Elsevier Inc. All rights reserved. 15 Endocrine Changes   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 Copyright © 2018, Elsevier Inc. All rights reserved. 16 Reproductive Changes  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 Copyright © 2018, Elsevier Inc. All rights reserved. 17 Gastrointestinal Changes  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 Copyright © 2018, Elsevier Inc. All rights reserved. 18 Copyright © 2018, Elsevier Inc. All rights reserved. 19 Neurologic Changes  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 Copyright © 2018, Elsevier Inc. All rights reserved. 20 Copyright © 2018, Elsevier Inc. All rights reserved. 21 Eye and Vision Changes   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 Copyright © 2018, Elsevier Inc. All rights reserved. 22 Ear Changes   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 Copyright © 2018, Elsevier Inc. All rights reserved. 23 Immune Changes  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 Copyright © 2018, Elsevier Inc. All rights reserved. 24 Question 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.) A. B. C. D. E. Irregular heart rate Increased salivation Reduced muscle mass Decreased lower leg hair Diminished bowel sounds Copyright © 2018, Elsevier Inc. All rights reserved. 25 Answer C, D—An irregular heart beat, increased salivation, and diminished bowel sounds are not associated with normal aging Copyright © 2018, Elsevier Inc. All rights reserved. 26 Question A nurse performing a health history on an older adult patient determines that further follow-up is required for which non–age-related finding? A. B. C. D. Early feelings of satiety Occasional constipation Seeing halos around lights Difficulty hearing some conversations Copyright © 2018, Elsevier Inc. All rights reserved. 27 Answer C—Seeing halos around lights is not a normal age-related finding. It is a symptom of glaucoma, and follow-up is required. Copyright © 2018, Elsevier Inc. All rights reserved. 28 Chapter 4 Psychosocial, Spiritual, and Cognitive Aspects of Aging Copyright © 2018, Elsevier Inc. All rights reserved. Psychosocial Aging Theories     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 Copyright © 2018, Elsevier Inc. All rights reserved. 2 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 Copyright © 2018, Elsevier Inc. All rights reserved. 3 Second-Generation Theories        Disengagement Continuity Age stratification Social exchange Modernization Developmental Gerotranscendence Copyright © 2018, Elsevier Inc. All rights reserved. 4 Disengagement Theory     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 Copyright © 2018, Elsevier Inc. All rights reserved. 5 Continuity Theory    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 Copyright © 2018, Elsevier Inc. All rights reserved. 6 Age-Stratification Theory    Believes in age categories of older adults as young, middle aged, and old Historical content is the key to the agestratification theory Social and cultural expressions of age are examined Copyright © 2018, Elsevier Inc. All rights reserved. 7 Social Exchange Theory   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 Copyright © 2018, Elsevier Inc. All rights reserved. 8 Modernization Theory    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 Copyright © 2018, Elsevier Inc. All rights reserved. 9 Developmental Theories    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 Copyright © 2018, Elsevier Inc. All rights reserved. 10 Gerotranscendence    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 Copyright © 2018, Elsevier Inc. All rights reserved. 11 Question 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 A. B. C. D. premature disengagement. ego integrity versus despair. inability to provide continuity. overinvolvement in gerotranscendence. Copyright © 2018, Elsevier Inc. All rights reserved. 12 Answer  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. Copyright © 2018, Elsevier Inc. All rights reserved. 13 Third-Generation Theories   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 Copyright © 2018, Elsevier Inc. All rights reserved. 14 Implications for Gerontological Nursing and Healthy Aging    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 Copyright © 2018, Elsevier Inc. All rights reserved. 15 Question A nurse caring for an 80-year-old patient would like to use reminiscence as therapy. Which question best encourages reminiscence? A. B. C. D. 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? Copyright © 2018, Elsevier Inc. All rights reserved. 16 Answer  D—Asking to the patient to recall past events in an open-ended manner best encourages the older adult to relive life experiences. Copyright © 2018, Elsevier Inc. All rights reserved. 17 Spirituality and Aging     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 Copyright © 2018, Elsevier Inc. All rights reserved. 18 Spiritual Distress   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 Copyright © 2018, Elsevier Inc. All rights reserved. 19 Copyright © 2018, Elsevier Inc. All rights reserved. 20 Copyright © 2018, Elsevier Inc. All rights reserved. 21 Implications for Gerontological Nursing and Healthy Aging  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 Copyright © 2018, Elsevier Inc. All rights reserved. 22 Copyright © 2018, Elsevier Inc. All rights reserved. 23 Nurturing the Spirit of the Nurse  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 Copyright © 2018, Elsevier Inc. All rights reserved. 24 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 Copyright © 2018, Elsevier Inc. All rights reserved. 25 Fluid and Crystalized Intelligence    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. Copyright © 2018, Elsevier Inc. All rights reserved. 26 Memory  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 Copyright © 2018, Elsevier Inc. All rights reserved. 27 Implications for Gerontological Nursing and Healthy Aging (Cont.)   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 Copyright © 2018, Elsevier Inc. All rights reserved. 28 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 Copyright © 2018, Elsevier Inc. All rights reserved. 29 Implications for Gerontological Nursing and Healthy Aging (Cont.)   Share resources available for older adults who want to learn computer skills and adaptations that can be made to make computers as userfriendly as possible Teach patients how to evaluate the reliability and validity of health information on the Internet Copyright © 2018, Elsevier Inc. All rights reserved. 30 Copyright © 2018, Elsevier Inc. All rights reserved. 31 Copyright © 2018, Elsevier Inc. All rights reserved. 32 ... Purchase answer to see full attachment