Introduction To

Nursing Gerontology
and Global Aging
Week1

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By the end of this session, the
students will be able to:
1. Define the basic concepts of gerontology nursing.
2. Understand the recent trends in population aging and how this is
reflected on health services capacity in Jordan and worldwide.
3. Explain factors that affect aging process and its common changes.
4. Explain the role of gerontology nurse

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 Definitions
• Gerontology: is the broad term used to define the study of aging and/or the aged.
• This includes the biopsychosocial aspects of aging. [Bio – Psycho – Social]
• Under the umbrella of gerontology are several subfields, including, but not limited to
1. Geriatrics,
2. Social gerontology,
3. Geropsychology
4. Geropharmacology,
5. Gerontological nursing,
6. Geropalliative care,
7. Gerontological rehabilitation nursing.
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 Cont. Definitions
• What age is an older adult and who decides?
• Although an older adult is often defined as older than 65, this is an arbitrary
number set by the Social Security Administration.
• Today, the older age group is often divided into:
1. Young old (ages 65–74),
2. Middle old (ages 75–84), and
3. Oldest or frail older adults (ages 85 and up).

However, these numbers merely provide a guideline and do not actually define
the various strata of the aging population.
Among individuals, vast differences exist between biological and chronological
aging and between the physical, emotional, and social aspects of aging.
How and at what rate a person ages depends upon a host of factors that are 4
discussed later throughout this textbook.
 How and at what rate a person
ages depends upon a host of
1.
factors that are:
Biological Theories: a) Aging is affected by molecular and cellular processes, including the genetic
programming within cells, b) the role of free radicals in cellular damage, and c) how different body systems age
at varying rates.
2. Environmental Factors: External factors such as exposure to toxins, pollutants, lifestyle choices (diet, exercise),
and stress play a significant role in aging. The accumulation of environmental damage over time accelerates
the aging process.
3. Psychosocial Theories: Social and psychological factors also influence aging. An individual’s ability to adapt to
changing roles, relationships, and social expectations as they age affects their mental and emotional health,
which in turn influences physical well-being.
4. Cultural and Socioeconomic Conditions: Social determinants like access to healthcare, education, housing, and
nutrition have a direct impact on how a person ages. Those with greater resources generally experience
healthier aging.
5. Health Promotion and Lifestyle Choices: Healthy aging can be promoted through regular physical activity,
balanced nutrition, mental stimulation, and avoiding harmful behaviors like smoking. Engaging in activities that
support physical and mental well-being throughout life can delay or mitigate the effects of aging.
6. Genetics and Genomics: Genetic predisposition to certain conditions, resilience to stress, and other hereditary
factors also play a significant role in how individuals age. Studies into genomics explore how genes impact
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longevity and the development of age-related diseases .
 Cont. Definitions
1. Geriatrics: refers to medical care of older adults, while gerontological
nursing is the preferred term for this nursing specialty. Why????
2. Social gerontology: is concerned with the social aspects of aging versus the
biological or psychological aspects.
3. Geropsychology: is a branch of psychology concerned with helping older
persons and their families 1) maintain well-being, 2) overcome problems,
and 3) achieve maximum potential during later life.
4. Geropharmacology is the study of pharmacology as it relates to older adults.
5. Financial gerontology: specialty combines 1) knowledge of financial
planning and services with 2) a special expertise in the needs of older
adults.
6. Elder law specialty which focuses on legal and ethical issues associated with
aging.
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 Cont. Definitions
7. Gerontological nursing falls within the discipline and scope of nursing practice, that involves nurses
advocating for the holistic care of older adults.
• The health status of older adults is diverse and complex.
• A key focus of in gerontological nursing is to minimize the loss of independence associated with
1) Health promotion and a) functional decline and
2) Disease prevention b) illness.

• Gerontological nurses work with older adults across the continuum of care. This includes:
1) Communities,
2) Acute care,
3) Long-term care,
4) Skilled rehabilitation,
5) Home care, and
6) Palliative and hospice care.
• The scope of practice for gerontological nursing includes all older adults from 65 years of age until 7death.
 Cont. Definitions
8. Geropalliative care nursing encompasses concepts from both disciplines to provide
person-centered care that aligns with an older person’s values and preferences,
especially in situations where the burdens of care may outweigh the benefits.
• When older adults have limited life expectancy and anticipate living another year or
two, the focus should be on
1) Quality of life and
2) Well-being.
• Geropalliative care suggests a more thoughtful approach that involves
1) Older persons
in shared healthcare decision-making
2) Their families
.
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 Cont. Definitions
9. Gerontological rehabilitation nursing combines
a. Expertise in gerontological nursing with
b. Rehabilitation concepts and practice.
• Nurses working in gerontological rehabilitation often care for older adults with:
1. Chronic illnesses
2. Long-term functional limitations [such as stroke, head injury, multiple sclerosis, Parkinson’s
disease, spinal cord injury, arthritis, joint replacements, and amputations].
• The goal of gerontological rehabilitation nursing is to:
assist older adults to 1) regain and 2) maintain the highest level of
a) Function while preventing complications and enhancing quality of life.

b) Independence possible
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2. Understand recent trends in population aging and how this is
reflected on health services capacity in Jordan and worldwide.

a. Identify trends in aging across the globe.

b. Describe social and economic issues related to aging.
c. Discuss aging across cultures and countries.
d. Consider challenges for aging in the 21st century.

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 Trends in Aging Across the
Globe
• Globally, people are living longer, contributing to a growing proportion of older adults in
society.
• By 2050, it's projected that 1 in 6 people worldwide will be over the age of 65, compared to
1 in 11 in 2019.
• This demographic shift is largely due to improvements in:
a. Healthcare
b. Sanitation which have led to increased life expectancy
c. Nutrition,

• For example, in Jordan life expectancy has increased from an average of around 55 years in
1900 to around 74.8 years by 2020​.
• This longevity presents both opportunities and challenges for individuals and societies.
While it is a positive indicator of global health improvements, it also places pressure on
various sectors, including a) healthcare, b) social services, and c) economies. 11
 Cont. Trends in Aging Across the Globe
•As people around the world live longer, the increasing number of older adults aged 65 and over is having a profound impact on:
1. Social policies,
2. Economic resources,
3. Businesses,
4. Communities, and
5. Healthcare systems.
•This demographic shift requires:
1. Reassessment of how society views aging, with the goal of
expanding productive years, not just extending retirement.
•Health is a key determinant of the quality of life in older age, influencing the ability to enjoy these additional years of life.

•These figures highlight that Jordan, like

many other countries, is experiencing the
dual challenge of increasing life
expectancy and an aging population. As
more individuals live longer, this places
additional strain on healthcare and social
support systems, which will need to adapt
to provide adequate care for the elderly. 12
 Cont. Trends in Aging Across the Globe
• As populations age, many countries, particularly in the West, are experiencing declining birth rates alongside
increased longevity.
• This shift affects the "dependency ratio," meaning there are fewer younger people available to support an
increasing number of older adults.
• Developing countries, which tend to have higher birth rates, are experiencing this trend to a lesser degree.
However, as these nations continue to develop, they too will face challenges associated with aging populations​.
•In Jordan, where the birth rate has decreased from around 8 children per woman in 1970s to approximately 3
children per woman today (World Bank, 2020).
•This decline in birth rates, coupled with longer life expectancy, is creating a demographic shift where the
percentage of older adults is growing.

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 Aging Across Cultures and
Countries
• Aging is experienced differently across cultures and countries, influenced by factors such as:
1. Healthcare infrastructure,
2. Social norms, and
3. Government policies.

In more developed countries, people generally live longer due to better access to healthcare and
preventative measures. For instance, European and North American nations have comprehensive health
services that contribute to higher life expectancies.
In contrast, many developing countries are still grappling with infectious diseases and malnutrition,
which can limit life expectancy despite improvements in medical care​.

Cultural factors also shape attitudes toward aging. In many Arabs and Asian cultures, elders are highly
respected and cared for by their families, a tradition that reduces reliance on institutional care.
However, as younger generations increasingly migrate to urban areas for work, traditional caregiving
structures are being challenged, leading to a greater need for formal eldercare services​.
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 Challenges for Aging in the 21st
Century
• the 21st century presents several challenges for aging populations, particularly as the proportion of older adults
increases rapidly.
1. Healthcare challenges
• As people live longer, the prevalence of age-related diseases, such as dementia and Alzheimer's disease, is rising.
• Healthcare systems need to adapt to manage these chronic conditions, includes
shifting from acute care models to long-term care and chronic disease management​.
2. Economic challenges
• Sustainability of pension systems.
• Governments are exploring various strategies, such as:
a. Raising the retirement age,
b. Encouraging private pension schemes
c. Promoting longer working lives to maintain economic stability​.

3. Ensuring that older adults remain socially engaged and active in their communities.
• Social isolation is a growing concern, particularly in urbanized societies where family members often live far from
one another.
• Promoting age-friendly environments, such as accessible public spaces and transportation, can help mitigate 15
some of these challenges by enabling older adults to stay active and connected​.
Challenges for Aging in the 21st
Century
1. Centenarians
2. Genetics and Genomics
3. Gender and Older Age
4. Marital Status
5. Race, Ethnicity, and Older Adults
6. Health Disparities
7. Education
8. Living Arrangements
9. The Older Population with Disabilities
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 1. Centenarians
• The fastest-growing segment of older populations globally is those aged
85 and over, and centenarians (individuals aged 100 or more) represent a
small but rapidly growing group.
• Although data on centenarians in Jordan is limited, improvements in
healthcare and living conditions suggest that this demographic may
follow global trends.
• Centenarians are overwhelmingly female and more likely to experience
poverty, disability, and widowhood than younger elderly cohorts.
• These individuals often require specialized healthcare and social services
due to their advanced age and frailty (United Nations, 2018).

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 2. Genetics and Genomics
•Genomics is the identification of gene sequences in the DNA.
•Genetics is the study of a) heredity and the b) transmission of certain genes
through generations.
• Genetics and genomics play a key role in understanding longevity and the
aging process.
• Research in this area is helping to identify genes that contribute to aging-
related diseases like Alzheimer's and cancer.
• Genomic studies could lead to personalized medicine approaches for older
adults,
Helping to:
1. Improve their quality of life and
2. Reduce the impact of age-related conditions
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 3. Gender and Older Age
• In Jordan, as in most countries, women make up a larger portion of the older population.
Women generally live longer than men, which results in a higher proportion of elderly
females, particularly in the 85+ age group. Globally, by 2050, women will comprise 54% of
the population aged 65 and older (United Nations, 2018).

Source: https://www.populationof.net/jordan/ 19
 4. Marital Status
• In Jordan, as in many countries, older men are more likely to be married than older women.
• Widowhood is more common among women, who tend to live longer than men.
• This disparity in marital status has significant implications for social support systems, as older women are
a) more likely to live alone and b) may have fewer financial resources than their male counterparts (Jordanian
Department of Statistics, 2020).

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5. Race and Ethnicity and Older Adults
•Jordan's population is more ethnically homogeneous than many other
countries, but as with global trends, the country is experiencing
increasing diversity due to migration.
•While race and ethnicity do not play as significant a role in Jordan as
they do in countries like the United States, it is important to consider the
unique cultural and ethnic backgrounds of elderly individuals,
especially among immigrant or minority groups who may have different
health needs (United Nations, 2019).

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 6. Health Disparities
•Health disparities have been defined as “preventable differences in the burden of:
1) disease, to achieve optimal health, experienced by socially disadvantaged
2) injury, a) racial,
3) violence, or in b) ethnic, and
4) opportunities c) other population groups and communities” (CDC, 2013, p. 1).

•Health disparities are influenced by:

1. Socioeconomic factors,
2. Access to healthcare, and
3. Geographic location. 22
7. Education
•Education plays a crucial role in the health and economic security of
older adults.
•Worldwide, older adults with higher levels of education tend to have: 1.
Better health outcomes
2. Higher incomes
3. Greater access to healthcare

Educational attainment has increased over the decades, but many older
adults may still have lower levels of formal education, which can limit
their access to resources and affect their quality of life.
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 8. Living Arrangements
•The living arrangements of older adults in Jordan are influenced by 1) cultural
and 2) economic factors.
•Traditionally, extended families often care for elderly relatives, but this is
changing as more people move to urban areas and family structures evolve, in
which smaller proportion lived alone or in institutional care settings.
•Older adults living alone are at higher risk of:
1. Social isolation
2. Poverty
3. Health complications.
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9. The Older Population with Disabilities
•Advances in healthcare have increased the life expectancy of individuals
with disabilities, including those with congenital or acquired conditions.

•As in developed countries, the number of older adults in Jordan with

disabilities is growing, and this population requires specialized healthcare
and support services, which placing additional strain on the healthcare
system.

•This trend mirrors global patterns, where people with disabilities are living
longer due to medical advancements.
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 Morbidity and Mortality
•Changes in life expectancy throughout the 20th century were related to:
1. Improved sanitation,
2. Advances in medical care, and
3. Implementation of preventive health services.
In the early 1900s, infectious diseases and acute illnesses were the cause of most
deaths.
Today, most deaths occur from chronic disease such as cardiovascular disease.
• More individuals are surviving acute events such as myocardial infarction (heart attack) and
stroke,
• Modern medicine has made replacement of organs through transplant possible.
These medical advances have contributed to the increased longevity.
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 Cont. Morbidity and Mortality
•In Jordan, life expectancy has improved significantly over the past decades, with the current average at approximately 74.8
years as of 2020, according to the World Bank (World Bank, 2020).
•Like many countries, Jordan has experienced a shift from deaths caused by infectious diseases to deaths primarily related to
chronic conditions such as cardiovascular disease, diabetes, and cancer.

•Globally, healthcare costs, including medication costs, have become a primary issue for many senior adults, The healthcare
system in Jordan is facing challenges related to the rising elderly population and the increasing burden of chronic diseases.
•National healthcare expenditures are expected to rise as a result of aging, with a large portion of healthcare costs
attributed to chronic disease management (Jordanian Ministry of Health, 2020).

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 Causes of Death
•In Jordan, the leading causes of death among older adults include
heart disease, cancer, and stroke, with ischemic heart disease and
stroke ranking as the top two killers (WHO, 2018).
•Diabetes, chronic respiratory diseases, and renal failure also
contribute significantly to mortality rates. Research shows that many
of these deaths could be delayed or prevented through lifestyle
interventions, such as reducing smoking and improving dietary
habits (Jordanian Ministry of Health, 2020).
•Age-adjusted death rates reveal that men in Jordan are more likely
to die from heart disease and cancers, while women experience
more deaths due to complications from diabetes and hypertension
(CDC, 2020).
•The high prevalence of smoking, particularly among men,
exacerbates the health risks and increases mortality from chronic
conditions.

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 Chronic Diseases
•Chronic diseases in Jordan reflect global patterns, with noncommunicable diseases (NCDs)
replacing infectious diseases as the primary cause of morbidity and mortality.
•According to the World Health Organization (WHO), NCDs account for 78% of all deaths in
Jordan (WHO, 2018).
•Cardiovascular diseases, stroke, diabetes, and cancer are among the top causes of death. Women
tend to report higher incidences of hypertension and arthritis, while men have higher rates of heart
disease and cancer (WHO, 2018).

•Obesity is an increasingly prevalent issue in Jordan, the age-standardized prevalence of obesity

was 60.4% among men and 75.6% among women, while approximately three-quarters of men
and women were overweight or obese as defined by BMI. Obesity was significantly associated
with increased odds of diabetes mellitus, hypertension, elevated triglycerides, and low high-density
lipoprotein cholesterol. (Ajlouni et al. 2020)
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 Cont. Chronic Diseases
1. Sensory impairments
become more frequent with
2. Oral health problems
aging

•Early detection can prevent or postpone:

1. Physical,
2. Social, effects that these changes have on a senior’s life
3. Emotional

•Common eye conditions resulting in vision loss include: glaucoma, macular degeneration, and cataracts.

•These changes in sensory function can lead to:

1. Decreased function
2. Independence
3. Social isolation
•Having missing teeth or wearing dentures can affect nutrition because people without teeth or with dentures often prefer soft, easily chewed foods instead of
foods such as fresh fruits and vegetables.
•Glasses, hearing aids, and dentures can be difficult to obtain for financial reasons.
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• Decline in memory, particularly short-term memory, is another chronic problem that can affect older individuals. However, sudden memory loss
 Healthy Aging
•Despite the growing burden of chronic diseases,
many older adults in Jordan report good health.
•Public health campaigns increasingly focus on
promoting healthy aging by:
1. Encouraging exercise
2. Healthier diets
3. Reducing smoking.
•The Jordanian healthcare system is gradually
emphasizing preventive care and early detection to
address the rising rates of chronic diseases (WHO,
2018).

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Cont. Healthy Aging
•Lifestyle choices, such as: avoiding smoking, maintaining a healthy diet, and staying
physically active, are critical factors for healthy aging.

•Health programs in Jordan are being developed to promote early screening and preventive
care, aiming to improve the quality of life for older adults (Jordanian Ministry of Health,
2020).

•In conclusion, while Jordan faces challenges with it’s a) aging population and the b)
rise of chronic diseases, efforts to:
are key to improving the long-term well-being of
1) Promote healthy aging and older adults in the country.
2) Manage healthcare resources
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 Factors affect the aging process
1. Heredity Factors: Genetics and genomics play a significant role in health
outcomes and longevity.
2. Health History and Diseases: Age-related health changes, such as cardiovascular
and respiratory function, are influenced by lifestyle and health history, which are
key considerations for aging .
3. Lifelong Patterns: Exercise, diet, and other habits are important factors in
maintaining health into older age. Regular physical activity, such as yoga and tai
chi, is recommended to improve flexibility and balance, crucial in preventing
frailty .
4. Stress: Psychological and social stressors, including mental health challenges like
depression, are known contributors to aging, especially in later life. Resilience,
which can mitigate the effects of stress, is also influenced by genetic and
environmental factors
Cont. Factors affect the aging
process
5. Environmental Factors: These include physical, social, and attitudinal
environments (how society views older adults or people with disabilities), which directly affect
functional ability and overall well-being .
6. Culture and Standards of Living: Cultural factors, including beliefs,
practices, and social support, significantly affect health outcomes in
older adults .
7. Economic Conditions: Socioeconomic status, education, and financial
stability are linked to health disparities and quality of life in older adults,
influencing their ability to maintain health and access care.
8. Presence of congenital diseases and disabilities
 Roles of gerontological NURSES
1. Direct Caregiver:
a. Provide direct, hands-on care to older adults.
b. Responsible for understanding the unique symptoms, risk factors, and care
needs of older adults,
often in settings where diseases and health conditions may present atypically​.
2. Advocate:
• They act as advocates for older adults, ensuring their autonomy and dignity are
respected.
This role includes helping patients:
a. Make informed decisions and
b. Representing their best interests
in both healthcare settings and political arenas​.
Cont. Roles of gerontological
NURSES
3. Teacher: Nurses in this field educate older adults about:
a. Health promotion and
b. Disease prevention,
c. Focusing on modifiable risk factors such as: diet, exercise, and stress
management​.
 Cont. Roles of gerontological
NURSES
1. Leader: Gerontological nurses are expected to:
a. Lead by balancing the concerns of patients, families, and healthcare teams.
b. Supervise other nursing personnel,
c. Act as change agents, and
d. Ensure the provision of high-quality care​.
1. Evidence-Based Clinician: They must stay current with research and evidence-
based practices in order to implement the best care possible for older adults​.
2. Consultant and Coordinator: In more advanced roles, gerontological nurses
may serve as consultants, service coordinators, or administrators, ensuring the
efficient and effective delivery of geriatric care