CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter shows the literature, studies and researches identified to have relation with

the present study. These related readings have provided the researchers with strong

foundation of the present research study.

Related Literature

According to Mauk (2014; 8-9), Gerontology is used to distinguish the study of

aging. This incorporates the biopsychosocial perspectives of aging. Beneath the umbrella

of gerontology are several subfields including geriatrics, social gerontology,

geropsychology, geropharmaceutics, financial gerontology, gerontological nursing, and

Gerontological rehabilitation nursing. In spite of the fact that “old” is frequently defined

as over 65 years of age, this can be a self-assertive number set by the Social Security

Organization. Nowadays, the older age gather is regularly separated into the young old

(ages 65–74), the middle old (ages 75–84), and the old old, very old, or frail elderly (ages

85 and up). Furthermore, in the Philippines, based on RA 9994 “Expanded Senior

Citizens Act of 2010,” Section 3, a Senior citizen or elderly refers to any resident citizen

of the Philippines at least sixty (60) years old.

According to Tabloski (2006; 227-228), as one ages, there are physical changes

that could occur. These changes may be at the chemical, structural, and functional levels

and may result in a disorganization of sleep and disturbance of circadian rhythms. The

neuromechanisms for sleep are aggravated in the brain stem, basal forebrain, and

subcortical and cortical regions. Neurotransmitters such as serotonin and norepinephrine

22
keep some parts of the brain on alert during sleep. The sum of time spent in deeper levels

of sleep decreases with aging. There's an increase in awakenings during sleep and an

increase in the total time spent in bed trying to sleep as rest gets to be less efficient.

Irregular sleep behaviors are category of events that can happen at any time all through

the life cycle but become more common with advancing age. Older people exhibiting

these sleep issues will encounter daytime sleepiness as a result of poor quality and

inadequately quality of rest. Abnormal sleep behaviors require assessment from

neurologists or rest specialists and is usually treated with medications such as antianxiety

agents, benzodiazepines and dopamine agonists.

According to Touhy and Jett (2014; 3). The definitions

of health change significantly and are influenced by culture and where one is on the life

span. The strong development of the holistic health movement has resulted in even

broader definitions of wellness and changes in Medicare to support preventive care have

promoted more beneficial aging. Wellness includes one's entire being – physical,

emotional, mental, and spiritual – all of which are crucial components. In a classic work,

Dunn characterize all–encompassing approach to wellbeing as integrated strategy of

working which is situated toward maximizing the potential of which

the person is capable inside the environment he or she is working. Wellness involves

accomplishing a balance between one’s inner and outer environment and one’s

emotional, spiritual, social, cultural and physical forms.

According to Alineghad, Matlabi and Zeinalhajlou, (2015; 53) they stated that

healthy aging in broader point of view involves the multidimensional forms of lifelong

learning and individual improvement aimed at fulfilling independence and autonomy for

23
elderly individuals. Based on the premises of such components, potential changes in

public approach aimed at improving the mobility of older adults as well as empowering

positive behavioral changes in the lifestyles of older people were proposed to progress

the plan of solid maturing.

Healthy lifestyle may be a way of life that gives, sustain, promotes the wellbeing

and quality of life. Life style incorporates components including appropriate

nourishment, regular and adequate physical movement and avoiding smoking, liquor

consumption and other addictive persuading substances and drugs, doing regular

checkups, applying relaxation strategies and elderly cooperation in social exercises and

being with family part and support systems. Lifestyle adjustments may increment the

freedom of the elderly individuals and anticipate numerous constant challenges and

decrease social and financial burden in societies. In spite of the fact that applying healthy

lifestyle ought to be started through all age groups particularly in teenagers, it is never

late to change the way of life and take after the good habits leading to wellbeing and joy.

According to Melillo and Houde (2011; 103), advancement in health sciences and

medicine has progressed wellbeing which lead to extend in life expectancy and the

development of the elderly population. Aging is one of the wonders included in

worldwide health. Reports appear that Asian developing countries are maturing quicker

than other nations. With respect to the developing status of elderly population and

declining physical and mental capacities and higher frequency of chronic illnesses within

the elderly individuals, paying consideration to the issues and needs of this age is

essential. Developing urbanization and industrialized way of life as well as change within

24
the population age pyramid and the maturing of today's youthful population will

increment the prevalence of persistent illnesses within the near future.

Changes or misfortune in wellbeing, family, society, and finances can cultivate

mental disequilibrium and promote stress in older grown-ups. They pointed out that

generally, adults with restricted emotional and financial resources who view their lives as

having dynamic and startling issues frequently encounter their circumstance as unstable

and unpredictable and are more slanted to get to be discouraged.

According to Mauk (2014; 196), Specialist General’s Report on Physical Action

and Health was an exceptional survey that inquire about on the impacts of physical

activity on people’s wellbeing that was conducted on 1996. Frequent exercise and

physical movement enhance wellbeing in variety of ways, such as decrease in heart

disease, diabetes, high blood pressure, excess weight, falling, depression, anxiety, bone

thinning, muscle wasting, and joint pain. 60% of grown-ups did not accomplish the

suggested amount of physical activity, and 25% of grown-ups were not physically

dynamic at all. By age 75, around one in three men and one in two women engaged in no

physical movement. Inactivity was moreover more common among ladies and

individuals with lower earnings and less education.

Mauk (2014; 199) stated that older adults are at the highest chance of being

malnourished (Brews & Berkow, 2000). Social separation, dental issues, and medical

illness are among the risk components for malnourishment in older grown-ups. Older

grown-ups are more dedicated about nutrition than other age.

According to Fenner (2002; 7-8), healthy life styles in elderly are depicted as a

lifelong process optimizing opportunities for progressing and protecting wellbeing and

25
physical, social, and mental wellness; freedom; quality of life; and upgrading effective

life-course moves. Recent studies have given new results that a sound way of life in

elderly individuals that combines principles of healthy sustenance, rest, hygiene,

customary physical action, non-smoking, standard periodic examination, having mental

health examination and cooperation in social activities, in addition to being a family.

According to Mauk (2014; 233-234), in older adults, falls are the leading cause of

unintentional injury death. Twenty to thirty percent of these falls result in crucial injuries,

traumatic brain injuries, and lacerations. Some of the suggestions for older grown-ups

are similar to those younger individuals which is needed for safety are: wearing belts in

vehicles, avoid driving while drunk, and using of assistive devices when needed. Falls, in

any case, are hazard that's generally prone to the elderly. Elderly grown-ups are

vulnerable to falls as a result of postural instability, diminished muscle strength, gait

disturbances and visual and/or cognitive disability, and polypharmacy.

Elderly grown-ups are vulnerable to falls as a result of postural instability,

diminished muscle strength and diminished proprioception, visual and/or cognitive

impairment. Natural conditions that contribute to falls are slippery surfaces, stairs, poor

lighting, incorrect footwear, and impediments within the pathway. Ways are pointed out

on minimizing the hazard of falls encompasses a home security assessment, cessation of

high-risk medications, management of postural hypotension, vitamin D supplementation,

evaluation and treatment of foot problems. There are concrete information to assist the

efficacy of strengthening exercises for fall reduction.

According to Mauk (2014; 245-246), lack of suitable screening instruments and

underreporting of abuse and neglect by healthcare experts is the cause of difficulty of

26
estimating the prevalence of elder abuse. It is required to report elder abuse to the

protective services agency. Studies directed toward identifying of both abuse victims and

culprits are required. Senior abuse may incorporate physical, sexual, mental, and

monetary abuse; neglect; and infringement of rights. Physical abuse incorporates shaking,

controlling, hitting, or threatening with objects. Sexual abuse incorporates undesirable

contact with the genitals. Clients who are mentally mishandled encounter threats, insults,

or receivers of cruel commands.

Money related abuse happens within the family individuals who attempt to abuse

a client’s cash or belonging. Neglect may be intentional or inadvertent and happens when

required nourishment, medication, or individual care isn't given. Clients who are denied

the right to create their own choices, in spite of the fact that they are competent to do so,

are enduring from an infringement of their inalienable rights. Elder women tend to be the

most helpless to abuse. Caregiver burnout and stress, budgetary stresses and

psychopathology within the abuser are the common reasons for abuse. Ways in elder

abuse treatment are:  (1) report abuse and disregard to adult protective services; (2)

guarantee that there's a security plan and evaluate safety; (3) evaluate the client’s

cognitive, emotional, and health status; and (4) evaluate the recurrence, severity, and

intent of mishandle.

Good, La Grow and Alpass (2011; 96-97) stated that numerous physiological

changes happen during the ordinary process of healthy aging for the better or for worse.

With old age brings the developing risk of persistent illnesses and impedance of bodily

functions. Sensory decline, such as the reducing ability to see objects closely and listen

also go with individuals within the aging process and can adversely influence older

27
adults’ functional capacities in daily life. Though physiological changes of aging vary by

individuals due to heredity, it is fraudulent to simply neglect the importance of lifestyle

choices, which can influence the typical aging process. In this manner, it becomes

apparent that appropriate nourishment is one figure that will offer assistance to advance

life span and suffice the wellbeing related perspective of typical sound maturing, as

numerous illnesses that more seasoned individuals endure from are due to dietary factors.

Since the quality of life is straightforwardly related to the utilitarian status of more

seasoned grown-ups and their feeling of control over their environment, it is fundamental

to advance work out, which may diminish the hazard of muscle, bone, (osteoporosis and

joint pain), cardiovascular, and metabolic diseases.

The vital components to be considered for healthy aging inside the psychological

point of view incorporate life fulfillment, positive well-being, and cognitive working.

When concerning the mental wellbeing of older adults, the foremost predominant issues

are the prevention, treatment, and quality of life interventions. Moderate charitable giving

has also been seen to have a critical impact on older people’s psychological well-being

and has been found to have positive physical, functional, and mental wellbeing results for

elderly volunteers.

According to Dionigi (2015; 1-2), aging is a highly individualized and complex

prepare. It continues proceeds to be stereotyped, particularly in Western societies.

Stereotypes about a certain group play an effective part in forming how we think about

and interact with other individuals, and how individuals within the stereotyped group see

themselves. Stereotypes of aging incorporate assumptions and generalizations about how

individuals should act, and what they are likely to encounter. Any stereotype of aging

28
(including those that equate aging with frailty and decline, or later life with wellbeing and

affluence) has the potential to strengthen ageism. The purpose of this study is to report

findings on the impacts of stereotypes of aging on health outcomes related to older

grown-ups, such as physical and mental functioning and overall well-being and quality of

life. The study highlights that both positive and negative stereotypes of aging can

simultaneously have enabling and constraining impacts on the activities, performance,

decisions, attitudes, and, subsequently, holistic wellbeing of an elderly.

According to Magnavita, Sakowski and Ricciardi (2018; 753-754), aging will

result in a rise in the number of older people suffering from a variety of health problems

that are typical of an older age group, e.g., cancer, fractured hips, stroke, and dementia.

On account of the unprecedented number of elderly adults who extend their working life

beyond the traditional retirement age, a growing number of workers are affected by

chronic diseases that impact on the quality of life. A new approach to the economic

security and overall quality of life of older adults should take into account the

overlapping aspects of aging, work, and health.

According to Alhawassi, Alatawi and Alwhaibi (2019;1-2), comparing one–

person performance with anticipated population standards is a way of screening or

evaluating for body systems. Glasser first coined the term ‘norm-referenced test’. These

are tests   show when people are not functioning within anticipated population ranges for

healthy body systems. Members whose execution failed to meet anticipated population

standards were hypothesized to show signs of early decrease of function. PIMs utilization

can lead to negative wellbeing consequences and can affect patients’ quality of life. PIMs

increases the hazard of hospitalization, drug-related issues and other unfavorable health

29
 outcomes. Drug-related issues secondary to the improper use of sedative among elders

found related it is more at risk of falls, delirium, and hallucination. Factors related with

improper medications use are variable. The factors that are related with PIMs use are

older age, females, polypharmacy, having different prescribers’ doctors, and poor

wellbeing status.

According to Alidoust, Holden and Bosman (2014; 173) The level of noise of the

environment affects the elderly’s feeling of security and the accessibility of the

environment are also found imperative in their social life. The impacts of the urban

environment are not restricted to its physical and policy measurements. The impacts of

the urban environment are not restricted to its physical and policy measurements.

According to Noghabi, Alhani, and Peyrovi (2012) that physical examination is

needed for determining the health and wellbeing of elderly people and their health-related

needs.

According to Rondón & Navarrro (2018), general approach to the state of health

from the quality of life and the importance of distinguishing health from life satisfaction,

which involves with the life of the present and past experiences. In this sense, many

gerontologists claim that older adults who successfully age are those who feel satisfied

with their past and present and enjoy positivity including social relationships and

contacts. It also refers to a subjective dimension of welfare, to an adequate capacity to

accept and recognize the surroundings, in order to have a better perception of health.

 
Ferreira, Filgueiras Meireles & Caputo Ferreira (2018; 617) stated that due to the

increase in the number of recurrent diseases among the elderly, there may be changes in

the health and quality of life among older people, making it important to understand the

30
 risk and protective factors that influence these components. They stated that World

Health Organization defines quality of life as a comprehensive concept that involves not

only physical health of person but also psychological state, level of independence, social

relationships, personal beliefs and other characteristics involved in the environment of the

individual, including a system of values involving goals, expectations, and standards.

According Warmoth, Abraham and Tarrant (2015; 2), the perception of people

about ageing are often negative and it is because of declining health and functioning.

Health, functional limitations, and mobility difficulties are commonly attributed to old

age. Many older adults expect to become more dependent, have more pains, and have less

energy There is evidence that older adults use these beliefs to make sense of, and place

into context, their own experiences of health, disability, and ageing.

According Forte, Boreham, De Vito and Pesce (2015), increased understanding of

how to ensure health and quality of life in older adulthood urges older adults with life

expectancy in which there is a huge rise in the proportion of the population. Health-

related quality of life is a considered as a multi-dimensional construct reflecting the

perception of the individuals’ state of health and ability to function in relation to the

environment they live.

According to Núñez, Salmorán, Cortés, Maldonado and Ramos (2018)  that

healthy aging, which considers self-care and self-promotion are achieved by establishing

the adoption and maintenance of healthy lifestyles. It provides older people with the basic

knowledge of gerontology for self-care, and self-promotion, related to preventing and

controlling chronic diseases that have high prevalence among aged communities.

31
 According to Şahin, Özer and Yanardağ (2019), 28.6% of the total variance in

the satisfaction with life perceived social support and the quality of life. The quality of

life is the most influential variable on the satisfaction with life. The findings of their

study suggest that making improvements to the elderly people social support and quality

of life will increase their satisfaction with life.

Borglin, Hallberg and Edberg (2004) indicated that older people's view of quality

of life is more complex than today's most commonly used quality of life assessment tools

that needs to measure beyond pure health indices. For nursing care the use of life review

in their everyday care, and an open way towards existential topics as well as a family-

oriented care along with preventive work may help them enhance their experience of

quality of life.

According to Condello, Capranica, Stager, and Pesce (2016), in order to maintain

health and quality of life, healthy diet and physical activity is needed for older people.

Changes in health and quality of life perception are necessary. The lifestyle factors that

can counteract the decline of quality of life with advancing age, physical activity, and diet

have been claimed to play a pivotal role. The fact that it positively impacts not just

physical health and function, but it lowers the incidence of non-communicable diseases,

emotional and cognitive components of mental health influence of physical activity on

health-related quality of life perception.

According to Benyamini and Burns (2019) that age and health perceptions had

similar independent effects which include controlling for demographics and chronic

conditions. Health perceptions did not mediate the association between health perceptions

and mortality. Age perception measures differed in their associations with various

32
outcomes, indicating that they assess different subjective age constructs. The findings

correspond with proposed explanations for the predictive effect of age and health

perceptions and support the significant though weaker independent effects of age

perceptions compared with health perceptions.

People’s perceptions about

Several studies which have bearing with this present study have helped the

researchers gain deeper insight into the topic at hand. These are reviewed and discussed

below.

Health Perceptions and Health Behaviours in the Elderly Age 65 years and Older

The discussion section of this research study interprets the findings of a study

which examined a sample of Midwestern, community-dwelling senior citizens, age 65

years and older, to determine if a relationship exists between perception of health and

33
health promotion behaviours. The Health Promotion Model (Pender, 1996) is utilized

here as the theoretical framework exploring the relationship of health perception to health

behaviour in this study sample. Pender’s model facilitates a discussion detailing the

movement of subjects through a cognitive-perceptual process from perception of benefits,

barriers, and self-efficacy of health choices to the adoption of health promotion

behaviours. Also presented for discussion are limitations and alternative explanations of

the study, as well as implications to Nurse Practitioner (NP) practice and

recommendations for future research.

The interpretation of this study posed the question: Is there a relationship between

perception of health and health promotion behaviours in the elderly age 65 years and

older. The data suggests that a relationship appears to exist between health perception and

health promotion behaviours, yet does not meet a level of statistical significance. The

presence of relationship of low to moderate strength is supported by the correlation

coefficient. Though this finding does not support a robust relationship between health

perceptions and health promotion behaviours, Polit and Hungler (1999) indicate that

findings of .10 to .40 are common to studies of a psychosocial nature. Also, the results of

the study would support Kaufman’s work (1996), which links one’s perception of health

promotion behaviour.

It also gave some implications to nursing. As the members of elderly are projected

to reach seven million by the year 2020, the NP will play a strategic role in the provision

of quality, holistic healthcare that is comprehensive as well as cost effective, and which

provides for the educational needs of the patient. Thus, the findings of this study have

relevance to NP practice in a number of ways. First, this study examined factors that

34
influence health promotion behaviours of the elderly. Second, the findings may provide

insight in identifying patterns or trends consistent with those individuals most likely to

participate in programs that target the elderly as candidates for health promotions.

Thirdly, the findings may provide insight into the design and implementation of future

health care services or programs that focus on the elderly. Such knowledge may support

the current focus on health promotion and disease prevention, which is both health

enhancing as well as cost effective. Fourth, the findings of this study may provide a

means of evaluation programs for effectiveness in changing health choices and behaviour

patterns of the elderly over time. (Fenner, 2002;19)

Another study which is based on population studies, it is shown that self-

perceived health is a powerful predictor of health outcomes. The extent to which self-

perceived health is associated with personality characteristics is largely unknown. It was

found out that personality factors were significantly associated with perception of poor

health in elderlies. Among those without self-reported medical problems (N = 834),

openness to experience, extraversion and conscientiousness were associated with

perception of good health, while neuroticism was associated with the perception of poor

health. In subjects with self-reported medical problems (N = 2772), high scores on

agreeableness, openness to experience, extraversion and conscientiousness, and low

neuroticism scores were associated with perception of good health. These associations

remained significant after adjustments for age, gender, race, marital status and education.

The result was self-perceived health in elderlies is strongly associated with

personality characteristics, both in subjects with and without self-reported medical

problems. It is suggested that personality characteristics could contribute to the

35
previously reported associations between self-perceived health and health outcomes.

(Goodwin & Engstrom, 2019)

Another descriptive correlational study has a purpose of examining the

relationships among health‐promoting behaviors, perceived social support, and self‐

reported health having 113 persons age 55 years and over. It came from three hypotheses

were formulated: first is health‐promoting behaviors are positively related to perceived

social support; second, health‐promoting behaviors are positively related to self‐reported

health, and lastly, perceived social support is positively related to self‐reported health.

But only the first two were supported by these findings. Based on data analysis, it

revealed that positive correlations between the average health‐promoting lifestyle profile

(HPLP) score and education, and frequency of attending the nutrition site screening

clinics for high blood pressure and diabetes. Better‐educated subjects scored higher on

selected subscales of the HPLP (self‐actualization and health responsibility). It was found

out that age was negatively correlated with the HPLP subscales of health responsibility

and exercise. Focus increased attention on the older participants and those who are less

well‐educated by nurses and support personnel at nutrition sites. Expanding the variety

and frequency of health services available to nutrition site participants merits attention.

(Riffle, Yoho & Sams, 2019)

36