[3] Geriatric Nursing (Theories of Aging, Physiologic Changes due to Aging, and Psychosocial Issues related to Aging)

From Sir Rocky Aguirre's lecture last July 20, 2025

1. Biological Theories

2. Psychological Theories

What are the major classifications of theories of aging

Decreased cell division → Decreased growth → Aging

What is the general mechanism of the Biological Theories of aging?

1. Gene Theory

2. Immunologic Theory

3. Endocrine Theory

4. Wear-and-tear Theory

5. Free radical Theory

6. Cross-linkage Theory

Theories of Aging: What are the theories under biological theories of aging?

“Why?”

Theories of Aging: What question is being answered by the Biological Theories?

60 years or over

What age is considered as elderly in the Philippines

“How?”

Theories of Aging: What question is being answered by the Psychological Theories?

DACE

1. Disengagement Theory

2. Activity Theory

3. Continuity Theory

4. Erikson’s Psychosocial Theory

Theories of Aging: What theories are under the Psychological Theories of Aging?

Gene Theory

• Biological Theory

Theories of Aging: Biological Timeline

• What type of theory is this?

a. Infancy

Most rapid growth and development

a. Infancy
b. Adolescence
c. Adulthood
d. Older Adulthood

Immunologic Theory

• Biological Theory

Theories of Aging: Decrease in immune function leading to risk in disease

• What type of theory is this?

Cell Damage

What is the endpoint of the Immunologic Theory of Aging?

Endocrine Theory

• Biological Theory

Theories of Aging: Also known as the neuroendocrine theory

• What type of theory is this?

a. Decrease in brain function

• → Decrease in hypothalamic function → Decrease stimulation of the pituitary gland → Decreased hormonal production → Decreased T3 and T4 → Decreased Metabolism → Decreased cell division → Decreased growth → Aging

Endocrine Theory

a. Decrease in brain function
b. Decrease in hormones

*Explain the mechanism

Wear-and-tear Theory

• Biological Theory

Theories of Aging: The more you use your body, the quicker you die

• What type of theory is this?

Free-radical theory

• Biological Theory

Theories of Aging: Unstable molecules causing cell damage

• What type of theory is this?

Cross-linkage theory

• Biological Theory

Theories of Aging: Tight bonding of proteins

• What type of theory is this?

Decreased elasticity

Theories of aging: What is the endpoint of cross-linkage theory?

Disengagement Theory

• Psychological Theory

Theories of Aging: Isolate from society → Ageism

• What type of theory is this?

Activity Theory

• Psychological Theory

Theories of Aging: Increased productivity

• What type of theory is this?

Continuity Theory

• Psychological Theory

Theories of Aging: Maintain values, habits, behaviors. “Kung masama ang ugali mo ngayon, ganon pa rin pagtanda.”

• What type of theory is this?

Continuity Theory

• If you were outgoing when you were younger, you will remain outgoing when you age

Theories of Aging: What debunks the disengagement theory? Why?

Ego integrity vs. Despair

• Psychological Theory

Theories of Aging: What is the stage of the elderly based on Erikson’s Psychosocial Theory?

• What type of theory is this?

1. Despair

2. Ego integrity

Theories of Aging: Identify what is being describe in the following based on Erikson’s Psychosocial Theory

1. Death is not yet OK (-); Regrets

2. Death is okay (+); Satisfaction

Decreased physiologic function and Increased risk for disease

What is the general rule in the physiologic changes due to aging?

1. Long-term memory (Decreased long-term memory is an early sign of dementia)

2. Insulin

3. Heart Rate

4. Respiratory Rate

5. Sexual Desire

6. Penis Size

7. Prostate Size (Increases in size → high risk for BPH)

Physiologic Changes due to aging: Give what functions remain normal or does not decrease (yung mga naka-heart).

1. ↓ Epidermis → Thin, fragile → Soft clothes

   1. ↓ Melanin → Pale skin, gray hair, increased risk for skin cancer →

      1. Avoid 10 AM — 4 PM

      2. Sunscreen SPF >/= 15

      3. Protective clothes

2. ↓ Dermis

   1. ↓ Sweat Glands → Dry skin → Moisturizer

   2. ↓ Blood Supply → Increased risk for ulcer → Turn q2H or use of barrier cream

3. ↓ Hypodermis → Decreased fat (insulator) → Hypothermia → Warm blankets

4. ↓ Nail Growth → Thick and brittle

Physiologic Changes due to Aging (Integumentary System): Describe what happens (mechanism) under the following changes, together with the nursing interventions appropriate for each:

1. ↓ Epidermis

   1. ↓ Melanin

2. ↓ Dermis

   1. ↓ Sweat Glands

   2. ↓ Blood Supply

3. ↓ Hypodermis

4. ↓ Nail Growth

30 minutes before going out

• Reapply every 2 hours

Physiologic Changes due to Aging (Integumentary System): When should you apply and reapply sunscreen?

Xerosis

Physiologic Changes due to Aging (Integumentary System): What is the other term for dry skin?

Lentigo Senilis

Physiologic Changes due to Aging (Integumentary System): Brown spots in sun exposed areas (increase in melanocyte size due to decreased production)

Senile Purpura

Physiologic Changes due to Aging (Integumentary System): Bruising, bleeding under the skin due to bursting blood vessels

Seborrheic Dermatitis

Physiologic Changes due to Aging (Integumentary System): Effect of xerosis (extreme dryness)

3-4 weeks

Physiologic Changes due to Aging (Integumentary System): How long does it take before nails grow again?

1. ↓ Muscles → Sarcopenia → Strength, mobility, balance → Falls → Fall precautions

2. Cartilage → Dry → Increased risk for osteoarthritis

3. Bones → Osteoporosis

Physiologic Changes due to Aging (Musculoskeletal System): Describe what happens (mechanism) under the following changes, together with the nursing intervention appropriate for each:

1. ↓ Muscles

2. Cartilage

3. Bones

a. Cartilage

Osteoarthritis

a. Cartilage
b. Bone

b. Osteoporosis

Bone resorption > Bone formation

a. Osteoarthritis
b. Osteoporosis

Kyphosis or Dowager’s Hump

Physiologic Changes due to Aging (Musculoskeletal System): What is the hallmark sign of osteoporosis?

1. Remove hazards

   1. Avoid wet surface

   2. Safety bars (CR and Kitchen)

   3. Throw the rugs

2. Adequate Lighting

3. High Seat Toilet

4. Non-slip/skid Footwear

5. Side rails up

Physiologic Changes due to Aging (Musculoskeletal System): What are under the fall precautions?

Gait becomes wide → Parang penguin

Physiologic Changes due to Aging (Musculoskeletal System): What happens to the gait of patients with osteoporosis?

DEXA (Dual-Energy X-ray Absorptiometry)

Physiologic Changes due to Aging (Musculoskeletal System): What is the confirmatory test for osteoporosis?

1. ↓ Short-term memory

2. Long-term memory → remains (decrease is an early sign of dementia)

   1. Reminiscing is healthy for this age group

3. ↓ Neurons → Decrease in complex learning → Simple, short instructions

4. ↓ Melatonin → Sleep disturbance →

   1. Warm milk

   2. Avoiding stimulants

   3. Short day naps

5. ↓ Conduction speed of nerve fibers → Slowed Reflex

6. ↓ Cerebral blood flow → Decreased brain function → Decreased hormonal production

Physiologic Changes due to Aging (Neurological): Describe what happens (mechanism) under the following changes, together with the nursing intervention appropriate for each:

1. ↓ Short-term memory

2. Long-term memory

3. ↓ Neurons

4. ↓ Melatonin

5. ↓ Conduction speed of nerve fibers

6. ↓ Cerebral blood flow

TRUE

TRUE or FALSE: The induction of sleep is not a problem but the maintenance is.

• Milk → It contains tryptophan which helps produce melatonin

• Warm → It is soothing, calming the nervous system

Why is warm milk recommended for sleep disturbances

4 PM

Physiologic Changes due to Aging (Neurological): To help with sleep disturbances, when should be the patient’s last intake of stimulants?

Less than 20 minutes

Physiologic Changes due to Aging (Neurological): To help with sleep disturbances, how long should day naps be?

1. ↓ Thyroid → ↓ BMR → High Temperature

   1. ↓ Appetite → Anorexia → SFF (Small Frequent Feedings)

2. Insulin → Increased resistance → Increased blood glucose

3. ↓ Sex hormones

Physiologic Changes due to Aging (Endocrine): Describe what happens (mechanism) under the following changes, together with the nursing intervention appropriate for each:

1. ↓ Thyroid

2. Insulin

3. ↓ Sex hormones

1. Senile Cataract

2. Presbyopia

3. Senile Miosis

Physiologic Changes due to Aging (Special Senses): Identify what is being described in the following:

1. Increased lens opacity

2. Decreased lens elasticity

3. Decreased pupil size

Presbyopia

Physiologic Changes due to Aging (Special Senses): Far sightedness; Means “Aging” and “Vision” together

Mydriasis (dilation)

Physiologic Changes due to Aging (Special Senses): What is the opposite of Miosis?

Protective Adaptive Mechanisms

Physiologic Changes due to Aging (Special Senses): What intervention should be incorporated for the vision of older adults?

1. Heart rate → Normal (60-100 bpm)

2. ↓ Myocardium → ↓ Contractility → ↓ CO → Activity Intolerance → Mild to moderate exercises

3. Heart Valves, Arteries, Veins → Decreased Elasticity

4. ↓ Baroreceptor → Slowed response → Orthostatic Hypotension → Increased risk for falls → Reposition Gradually

Physiologic Changes due to Aging (Cardiovascular): Describe what happens (mechanism) under the following changes, together with the nursing intervention appropriate for each:

1. Heart rate

2. ↓ Myocardium

3. Heart Valves

4. Arteries

5. Veins

6. ↓ Baroreceptor

b. Weight-bearing

• Walking, gardening, dancing

Physiologic Changes due to Aging (Cardiovascular): Mild to moderate exercises

a. Weightlifting
b. Weight-bearing

1. Physiologic murmur (Extra heart sound due to incomplete closure)

2. Slightly increased BP (e.g. 128/86 mmHg)

3. Peripheral edema

Physiologic Changes due to Aging (Cardiovascular): What are the effects of the decreased elasticity of the following?

1. Heart valves

2. Arteries

3. Veins

Modified Trendelenburg

• OR elevate legs above the level of the heart

Physiologic Changes due to Aging (Cardiovascular): What should be the position for peripheral edema?

Baroreceptors

Physiologic Changes due to Aging (Cardiovascular): Receptors that are responsible for blood pressure in relation to position changes

1. Respiratory rate = Normal (12-20 cpm)

2. ↓ Thoracic muscles

   1. ↓ Cough

   2. ↓ Depth

3. ↓ Alveoli Size and function → Slightly decreased → Hypoxemia & Hypercarbia

   1. Fowler’s

   2. Deep breathing exercises (to increase O2)

   3. Pursed lip breathing

Physiologic Changes due to Aging (Respiratory): Describe what happens (mechanism) under the following changes, together with the nursing intervention appropriate for each:

1. Respiratory rate

2. ↓ Thoracic muscles

3. ↓ Alveoli

1. ↓ Mouth →

   1. ↓ Teeth → Soft diet (Pureed), dentures (refer to dentist)

   2. ↓ Salivary Gland → Dry →

      1. Increase OFI

      2. Ice chips

      3. Hard, sugarless candy

2. ↓ Stomach → ↓ Acid and Enzymes (which breakdown food) → Less effective → Indigestion → SFF

3. ↓ Intestines → ↓ Peristalsis →

   1. Increased fiber diet

   2. Increased OFI

   3. Ambulation

Physiologic Changes due to Aging (Gastrointestinal): Describe what happens (mechanism) under the following changes, together with the nursing intervention appropriate for each:

1. ↓ Mouth

   1. ↓ Teeth

   2. ↓ Salivary Gland

2. ↓ Stomach

3. ↓ Intestines

Xerostomia

Dry skin: Xerosis

Dry Salivary Glands: ____________

1. ↓ Kidney Size

   1. ↓ Tubules → Decreased concentration → Diluted urine

   2. ↓ Nephrons → Decreased GFR → Increased waste, drug metabolites + Polypharmacy → Increased risk for drug toxicity → Medication Review

2. ↓ Bladder tone → Increased residual urine → UTI

Physiologic Changes due to Aging (Renal): Describe what happens (mechanism) under the following changes, together with the nursing intervention appropriate for each:

1. ↓ Kidney Size

   1. ↓ Tubules

   2. ↓ Nephrons

2. ↓ Bladder

ALOC

Physiologic Changes due to Aging (Renal): What is the earliest indicator of drug toxicity?

ALOC

Physiologic Changes due to Aging (Renal): What is the earliest indicator of UTI?

Concentration

Nephrons: Filtration

Tubules: ________

1. Sexual desire → Normal

2. Male

   1. ↓ Testes Size → ↓ Testosterone → Andropause

   2. Penis Size → Normal but ↓ Blood supply → Erectile dysfunction

   3. Prostate Size → Increases in size → Increased risk for Benign Prostatic Hypertrophy

3. Female

   1. ↓ Estrogen → Menopause

      1. → Breast atrophy

      2. → Decreased secretions → Dry → Water-based lubricant

Physiologic Changes due to Aging (Reproductive): Describe what happens (mechanism) under the following changes, together with the nursing intervention appropriate for each:

1. Sexual desire

2. Male

   1. ↓ Testes

   2. Penis Size

   3. Prostate Size

3. Female

   1. ↓ Estrogen

Andropause

Female: Menopause

Male: ___________

Oil-based lubricants harbor microorganisms because they cannot be absorbed by the skin/mucosa easily → Increased risk for infection

Why is water-based lubricants better than oil-based ones?

1. Isolation

2. Depression

3. Suicide

4. Delirium

5. Dementia

Psychosocial Issues Related to Aging: Enumerate issues regarding mental health

Safety

• Close supervision (“near the nurses’ station”)

Psychosocial Issues Related to Aging: What is the priority for delirium and dementia? What should the intervention be?

a. Delirium

Temporary impairment of neurons

a. Delirium
b. Dementia

a. Delirium

Reversible, rapid

a. Delirium
b. Dementia

a. Delirium

ALOC

a. Delirium
b. Dementia

a. Delirium

Reversible memory loss

a. Delirium
b. Dementia

a. Delirium

Hospitalization, surgery, shock

a. Delirium
b. Dementia

b. Dementia

Total death of neurons

a. Delirium
b. Dementia

b. Dementia

Irreversible, gradual

a. Delirium
b. Dementia

b. Dementia

Normal LOC

a. Delirium
b. Dementia

b. Dementia

Irreversible memory loss

a. Delirium
b. Dementia

b. Dementia

Alzheimer’s

a. Delirium
b. Dementia

Alzheimer’s

• 40 years old

In the Philippines, what is the most common cause of dementia? It starts as early at what age?

TRUE

TRUE or FALSE: Neurons do not regenerate

Dependency

• Immobility

• Mental conditions (e.g., those with autism has poor judgment)

What is the primary risk factor of abuse?

a. Domestic Mistreatment

Abuse: Home

a. Domestic Mistreatment
b. Institutional Mistreatment

b. Institutional Mistreatment

Abuse: Hospital, long-term care facilities

a. Domestic Mistreatment
b. Institutional Mistreatment

FALSE

• Self-neglect is abuse as well

TRUE or FALSE: Self-neglect is not a type of abuse as the neglect should be done by other parties

TRUE

TRUE or FALSE: Abuse is related to physical, emotional, and mental concerns

Assess and treat

Abuse: What is the priority?

FALSE

• NEVER leave the victim alone

Abuse: You should leave the victim alone to provide space and privacy

• Respect: Use Therapeutic Communication “Tell me more” (Allows verbalization of feelings)

• Safety: Keep the victim away from the abuser

Abuse: To provide respect and safety, what should the RN do?

Bruises with multiple stages of healing

• Isolate the patient from the abuser then REPORT. It is not our job to talk with the abuser.

Abuse: What is the tell-tale sign of abuse? What should you do?

Document

Abuse: Given that abuse is an ethico-legal case, what should the RN do?