Theories of Ageing

1. THEORIES OF AGEING
AND ASSESSMENT OF
ELDERLY

2. DEFINITION
AGEING
• Ageing the normal process of time related change begins with birth
and continues throught life.
• Ageing in living organism usually refers to a series of time dependent
anatomical and physiological changes that reduce physiological reserve
and functional capacity, although occasionally the term refers to the
positive, process of maturation or acquiring a desirable quality.
GERIATRICS
• The branch of medicine dealing with the physiological, psychological
aspects of ageing and with diagnosis and treatment of diseases affecting
older adult

3. THEORIES OF AGING:
•attempt to explain the phenomenon of aging as it occurs over
the lifespan
•aging is viewed as a total process that begins at conception
•senescence: a change in the behavior of an organism with age
leading to a decreased power of survival and adjustment
•Theories of Aging:Types
•o Biologic
•o Sociologic
•o Psychologic
•o Moral/Spiritual

4. BIOLOGICTHEORIES:
• o Concerned with answering basic questions regarding the physiological
processes that occur in all living organisms as they chronologically age
• Foci of BiologicTheories
• o Explanations of:
• 1) deleterious effects leading to decreasing function of the organism
• 2) gradually occurring age-related changes that are progressive over time
• 3) intrinsic changes that can affect all member of a species because of
chronologic age
• 4)all organs in any one organism do not age at the same rate
• 5) any single organ does not necessarily age at the same rate in difference
individuals of the same species

5. BIOLOGICTHEORIES: DIVISIONS
•Stochastic: Explain aging as events that occur randomly and
accumulate over time
•Nonstochastic:View aging as certain predetermined, timed
phenomena
•STOCHASTICTHEORIES
•ErrorTheory
•Free RadicalTheory
•Cross-LinkageTheory
•Wear &TearTheory

6. ERRORTHEORY
•Originally proposed in 1963
•Basis:
•1)errors can occur in the transcription in any step of the
protein synthesis of DNA
•2) error causes the reproduction of an enzyme or protein that
is not an exact copy
•More recently the theory has not been supported by
research,not all aged cells contain altered or misspecified
proteins nor is aging automatically or necessarily accelerated
if misspecified proteins or enzymes are introduced into a cell

7. FREE RADICALTHEORY
•o Free radicals are byproducts of metabolism--can increase as a
result of environmental pollutants
•o When they accumulate, they damage cell membrane,
decreasing its efficiency
•o The body produces antioxidants that scavenge the free
radicals
•o In animal studies, administration of antioxidants postpones
the appearance of diseases such as cardiovascular disease and CA
•o Free radicals are also implicated in the development of plaques
associated with Alzheimer’s

8. CROSS-LINKAGETHEORY
•Some proteins in the body become cross-linked,
thereby not allowing for normal metabolic activities
•o Waste products accumulate
•o Result: tissues do not function at optimal
efficiency
•o Some research supports a combination of exercise
and dietary restrictions in helping to inhibit the cross-
linkage process

9. WEAR &TEARTHEORY
•o Proposed first in 1882
•o Cells simply wear out over time because of
continued use--rather like a machine
•o Would seem to be refuted by the fact that
exercise in OA’s actually makes them MORE
functional, not less

10. NONSTOCHASTICTHEORIES
o ProgrammedTheory
• ImmunityTheory
PROGRAMMED (HAYFLICK LIMIT)THEORY
• Based on lab experiments on fetal fibroblastic cells and their reproductive
capabilities in 1961
• o Cells can only reproduce themselves a limited number of times.
• o Life expectancies are seen as preprogrammed within a species-
specific range

11. IMMUNITYTHEORY
• o Immunosenescence: Age-related functional diminution of the immune
system
• o Lower rate ofT-lymphocyte (“killer cells”) proliferation in response to a
stimulus& therefore a decrease in the body’s defense against foreign
pathogens
• o Change include a decrease in humoral immune response, often
predisposing older adults to:
• 1)decreased resistance to a tumor cell challenge and the development of
cancer
• 2) decreased ability to initiate the immune process and mobilize defenses in
aggressively attaching pathogens
• 3) increased susceptibility to auto-immune diseases

12. EMERGINGTHEORIES OF AGING
•o Neuroendocrine Control (Pacemaker)Theory
•o MetabolicTheory/Caloric Restriction
•o DNA-Related Research

13. NEUROENDOCRINE CONTROL
• Examines the interrelated role of the neurologic and endocrine systems over
the life-span of an individual”.
• there is a decline, or even cessation, in many of the components of the
neuroendocrine system over the lifespan
• Research has shown
• 1) the female reproductive system is controlled by the hypothalamus. What
are the mechanisms that trigger changes?
• 2) adrenal glands’ DHEA hormone
• 3) melatonin (from pineal gland)--a regulator of biologic rhythms and a
powerful antioxidant. Declines sharply from just after puberty

14. METOBOLICTHEORY OF AGING (CALORIC
RESTRICTION
•proposes that all organisms have a finite amount of metabolic
lifetime and that organisms with a higher metabolic rate have a
shorter lifespan”.
•Rodent-based research has demonstrated that caloric restriction
increases the lifespan and delays the onset of age-dependent
diseases

15. DNA-RELATED RESEARCH
•Major Developments:
•o Mapping the human genome (“…there may be as many as 200
genes responsible for contolling aging in humans”)
•o Discovery of telomeres

16. SOCIOLOGICTHEORIES OF AGING
•o DisengagementTheory
•o Activity/DevelopmentalTaskTheory
•o ContinuityTheory
•o Age StratificationTheory
•o Person-Environment FitTheory

17. DISENGAGEMENTTHEORY
•o Cumming & Henry--1961
•o Aging seen as a developmental task in and of itself,
with its own norms & appropriate patterns of behavior
•o “appropriate” behavior patterns involved a mutual
agreement between OA’s and society on a reciprocal
withdrawal.
•o No longer supported

18. ACTIVITYTHEORY (DEVELOPMENTALTASK
THEORY)
•o Havighurst, Neugarten,Tobin ~1963
•o “Activity is viewed by this theory as necessary to maintain a
person’s life satisfaction and a positive self-concept”.
•o Theory based on assumptions:
•1) it’s better to be active than inactive
•2) it is better to be happy than unhappy
•3) an older individual is the best judge of his or her own success in
achieving the first two assumptions

19. CONTINUITYTHEORY
• o How a person has been throughout life is how that person will continue through
the remainder of life
• o Old age is not a separate phase of life, but rather a continuation and thus an
integral component
• AGE STRATIFICATION THEORY
• o Riley--1985
• o Society consists of groups of cohorts that age collectively
• o The people & Roles in these cohorts change & influence each other, as
does society at large
• o Thus, there is a high degree of interdependence between older adults
& society

20. PERSON-ENVIRONMENT FITTHEORY
• o Lawton, 1982
• o Individuals have personal competencies that assist in dealing with the
environment:
• o ego strength
• o level of motor skills
• o individual biologic health
• o cognitive & sensory-perceptual capacities
• o As a person ages, there may be changes in competencies & these changes alter
the ability to interrelate with the environment
• o Significant implications in a society that is characterized by constantly changing
technology

21. PSYCHOLOGICTHEORIES OF AGING
• o Maslow’s Hierarchy of Human Needs
•o Jung’sTheory of Individualism
•o Erikson’s Eight Stages of Life

22. MASLOW’S HIERARCHY OF HUMAN NEEDS
• o Maslow--1954
• o each individual has an innate internal hierarchy of needs that
motivates all human behaviors”.
• o depicted as a pyramid; the ideal is to achieve self-actualization,
having met all the “lower” level needs successful
• o Maslow’s fully developed, self-actualized person displays high levels of
all of the following characteristics: perception of reality; acceptance of self,
others, and nature; spontaneity; problem-solving ability; self-direction;
detachment and the desire for primacy; freshness of peak experiences;
identification with other human beings satisfying and changing
relationships with other people; a democratic character structure;
creativity; and a sense of values.
• o Only about 1% of us are truly ideal self-actualized persons

23. JUNG’STHEORY OF INDIVIDUALISM
•o Carl Jung--1960
•o origins are Freudian
•o Self-realization is the goal of personality
development
•o as individual ages, each is capable of
transforming into a more spiritual being

24. ERIKSON’S EIGHT STAGES OF LIFE
• o 1993
• o Stages throughout the life course. Each represents a crisis to be
resolved.
• o For OA’s:
• o 40 to 65 (middle adulthood): generativity versus self-absorption or
stagnation
• o 65 to death (older adulthood): ego integrity versus despair
• o Self-absorbed adults will be preoccupied with their personal well-being
and material gains. Preoccupation with self leads to stagnation of life”
• o “Unsuccessful resolution of the last crisis may result in a sense of despair
in which individuals view life as a series of misfortunes, disappointments, and
failures”.

25. HISTORY COLLECTION AND PHYSICAL
ASSESSMENT
•THE HISTORY
•Demographic data
•• Full name
•• Age, sex and birth date
•• Marital status
•• Source of history

26. CHIEF COMPLAINTS
• • Primary reason for visit, ideally in patient on words
• • Duration of presenting symptoms
PRESENT ILLNESS
• • Chronological narrative of patient visit
• • Persistence, change, severity, character and disabling effect of initial
symptoms
• • Presence of new symptoms and associated symptoms
• • History of similar symptoms in the past
• • Aggravating and mitigating factors

27. PAST HISTORY
•• Previous medical history
•• General state of health
•• Childhood disease and immunization
•• History of adult medical diseases, injuries and operations
•• History of hospitalization
•• Medication including dosage, duration and indication
•• Allergies
•• Dietary habits

28. SOCIAL HISTORY
• • Birth place and residence
• • Level of education
• • Ethnicity and race
MARITAL STATUS
• • Quality of significant relationship and health of partner
• Vocation included type of industry, past and present industrial exposure, duration of employment and retirement
• Avocations, including hobbies and interests
• Habits including quality of sleep, exercise and recreation, consumtion of alcohol and other drugs
• Significant life experiences
• FAMILY HISTORY
• Presence of disease with recognized familial importance in first degree relatives – type II diabetes, tuberculosis,
cancer, hypertension, allergy, heart disease, neurological and psychiatric disease and arthritis
• Similar presenting symptoms in family members.

29. PHYSICAL EXAMINATION
• General Observation andVital Signs
• Check:
• a. Signs of ADL deficits, poor hygiene, dishevelled appearance.
• b. Rectal temperature if patient is seriously ill because of blunted immune
response .
• c. Orthostatic changes in blood pressure (BP) and pulse.
• d. Osler's maneuver if systolic BP is greater than 160 to screen for "pseudo
hypertension"-positive if radial artery is palpable with cuff inflated above
systolic BP level.
• e.Weight (at each visit to identify losses early and to establish a pattern).
• f. Signs of malnutrition or trauma (elder abuse and neglect or falls).

30. • SKIN
• • Assess the skin for Neoplasm (especially in sun exposed areas), nipple retraction,
peau d'orange.
• • Observe skin for signs of excessive dryness or impairment. Note presence, location,
and amount of exudates.
• • Observe hair for excessive loss, dryness or oiliness.
• • Observe nails for excessive length, sharp edges and brittleness.
• SPECIAL SENSES ..EYE
• • Inspect the fundus for colloid bodies causing alteration in pigmentation called druses.
• • Assess for visual acuity.
• HEARING
• • Test hearing by occluding one ear and using the technique for whispered voice or an
audioscope
• • Be sure to inspect the ear canals for cerumen because of removal can quickly improve
hearing.

31. • SMELL ANDTASTE
• •Check these sensation with different type of substances
• NECK
• a. Dix-Hallpike positional test maneuver for benign positional vertigo (see Dizziness).
• b. Jugular venous pulse is better observed on the right side since compression of the left
innominate vein by an elongated aortic arch may cause false distension on the left.
• CARDIOVASCULAR
• •Assess for signs of pallor, rubor or cyanosis
• •Assess apical and peripheral pulses. Compare both extremities while assessing the
characteristics of peripheral pulses.
• •Assess capillary filling time
• •Assess for presence of vertigo or syncope
• •Assess blood pressure in lying, sitting and standing position.
• •Assess for edema, note the location and severity

32. • LUNGS-
• -Age-related changes in pulmonary physiology and age-associated
pulmonary pathology often result in rales that may not indicate pneumonia
or pulmonary edema. For this reason, it is important to document a baseline
exam at a time when the patient is not ill. Localized wheezes may indicate an
obstructing bronchial lesion (carcinoma).
• • Assess depth, rhythm and rate of respiration at rest and with activity
• • Assess the amount of activity the individual is able to tolerate.
• • Note the activities that result in excess respiratory effort
• • Assess the presence of cough. Note whether productive or non
productive.
• BREAST EXAM--Tumors may be easier to palpate because of atrophy and
less fibrocystic disease. Remember, men may have gynecomastia or
malignancy

33. • ORAL CAVITY AND GASTRO INTESTINAL SYSTEM
• • Examine the oral cavity for odour, appearance of the gingival mucosa,
any caries, mobility of the teeth, quality of saliva.
• • Inspect closely for lesions on any of the mucosal surface.
• • Ask the patient to remove dentures so you can check the gum for
denture sores.
• • Assess for complaints of pyrosis ( heart burn) and intestinal cramping
• • Assess dietary intake, especially of high fiber food, fat and sodium
• • Note the amount of food and fluid intake. Monitor weight
• • Assess for signs of abdominal distension
• • Assess frequency, amount and consistency of bowel elimination
• • Assess bowel elimination routines and use of laxatives

34. • EXTREMITIES:
• Arthritis (rheumatoid, degenerative and crystalline), deformities,
contractures, injuries, podiatric care, poor hygiene all increase the risk of
pain, infection and gait disturbances
GENITOR URINARY SYSTEM
• Assess frequency, amount, odor, colour and consistency of urine
• Assess individual’s ability to control urination
RECTAL--Assess for diseases of the prostate, fecal impaction,
integrity of sacral reflexes in persons with impotence, spinal
stenosis or posterior column findings, hemoccult.
Pelvic examination--Assess for pelvic prolapse, uterine, adnexal or
vaginal neoplasm, infections, estrogen deficit.

35. • FEMALE GENITALIA
• • Inspect the vulva for changes related to menopause such as thinning of the skin, loss
of pubic hair and decreased ability to introitus.
• • Identify any labial masses. Note the bluish swelling that may be varicosities.
• • Bulging of the anterior vaginal wall below the urethra may indicate urethrocele or
urethra diverticulum
• • Look for valvular erythma.
• Note the enlargement of clitoris
MALE GENITALIA AND PROSTATE
• Examine the penis, retracting the foreskin if present. Examine the scrotum, testes and
epididymis.
• Proceed with rectal examination, paying special attention to any rectal masses and any
nodularity or masses of the prostate.

36. •NEUROLOGICAL
•• Mental status examination should be performed in all
patients to establish a baseline in the event of future
dysfunction).This need not occur in the first session.
•• Asses alertness level
•• Assess appropriateness of behaviour and responses
•• Assess change in memory
•• Assess sleep patterns. Note onset, duration and quality
of sleep as well as of any day time napping