Chapter 1: Introduction to Gerontological Nursing

Bonnie M. Wivell, MS, RN, CNS

An encompassing view of the care of older adults (Mauk, pg. 5)

Providing both physical and emotional support in addition to respectful care

Gerontological Nursing Defined

Trailblazers

Florence Nightingale The first true geriatric nurse Nurse superintendent comparable to our

current nursing homesDoreen Norton

1956 speech at the annual conference of the SNA in London

Advantages of Learning Geriatric Care Learning patience, tolerance,

understanding, and basic nursing skills Witnessing the terminal stages of

disease and the need for skilled nursing care

Preparing for the future because the aged will always be a part of the care you provide

Recognizing the importance of rehab A need for research

Landmarks 1950 – First geriatric textbook published 1952 – First geriatric nursing study published 1961 – ANA recommends specialty group for

geriatric nurses 1966 – Duke opens first Master’s CNS program 1970 – ANA Standards or Practice 1973 – First certification exam 1975 – Journal of Gero Nursing by Slack, Inc. 1979 – First national gero nursing conference

Landmarks Cont’d.

1981 – ANA scope of practice1984 – NGNA established1988 – First PhD program1992 – NICHE established at NYU1996 – John A. Harford Foundation

Institute of Geriatric Nursing established at NYU

1998 – ANA certification available for APNs

Old Defined

Young old: 65 – 74Middle old: 75 – 84Old old: 85 and upOnly a guide as there is a vast

difference in biological and chronological aging

Roles of the Gero Nurse

Provider of careTeacherManagerAdvocateResearch Consumer

CertificationNurse certification is a formal

process by which a certifying agency validates a nurse’s knowledge, skills, and competencies through a written exam in a specialty area of practice

Why certify? Professional accomplishment/Leadership Commitment to profession Provide higher quality of care EBP and resource to others

SOP & Core CompetenciesScope and standards of practiceCore Competencies – review pg. 15

Continuum of Care Multitude of settings for those > 65

48% in hospital requiring care 80% receiving home care 90% in nursing homes receiving care

Acute Care Hospital Acute Rehab Home Health Care LTC vs. SNF Alzheimer’s Care – preserve functional

status Hospice

Continuum of Care Cont’d.Respite CareContinuing Care Retirement

Community Independent living to skilled care

Assisted LivingFoster Care or Group HomesGreen House Concept – alternative

to LTCAdult Daycare

Chapter 2: The Aging Population

Bonnie M. Wivell, MS, RN, CNS

The Numbers

Steady increase in older populationProjected 40 million age 65 or over

in 2010Old old is projected to increase to

6.1 million in 2010By mid-21st century, old people will

outnumber young for the first time in history

Why The Increase? Improved sanitation Advances in medical care Implementation of preventive health

services In 1900s, deaths were due to

infectious diseases and acute illnesses Older population now faced with new

challenge Chronic disease Health care funding

Why The Increase?

The average 75 yo has 3 chronic diseases and uses 5 rx meds

95% of health care expenditures for older Americans are for chronic diseases

Changes in fertility rates Baby boom after WWII (1946 – 1964) 3.5 children per household Older population will explode between 2010

to 2030 when baby boomers reach age 65

Some Facts

Female to male ratio increases with age Higher education equates to more

money, higher standards of living, and above-average health

Older people who live alone are more likely to live in poverty

Significant increase in proportion of minorities More racially and ethnically diverse

Facts Continued

African Americans Hispanics Asians and Pacific Islanders American Indians and Alaskan Natives Older foreign-born are more likely than

native-born elders to Live in family households Have less education Higher poverty rate Less health coverage

Facts Continued

The number of U.S. Vets 85 or older is expected to increase to 1.4 million in 2012 due to Vietnam era

Aging disabled population Traumatic injuries Developmentally disabled Elderly inmates▪ Elderly begins at 50 due to stresses of prison

life

Mortality and Morbidity Heart disease and cancer are two top

causes of death, regardless of age, race, gender or ethnicity

Diabetes 5th leading cause of death among black men 4th leading cause among Hispanic men 4th leading cause of death for Hispanic and

black women 65 or older 6th among white men and men of Asian or

Pacific Islander origin 7th leading cause of death for white women 65

or older

Chronic Disease

Increases with age4 leading causes of death

Heart disease Stroke Cancer DM

Sensory impairments and oral health problems more frequent

Aging Well

72% of seniors report having good to excellent health

Numbers living in nursing homes has declined

1 out of every 5,578 people was 100 yo or older

Older adults are active and healthy

History of Aging

1861 – Military pensions were initiated by Teddy Roosevelt

1935 – Franklin Roosevelt signed social security act that provided income assistance to elderly

1965 – Medicare and Medicaid law signed by President Johnson

Successful Aging Achievement of sense of autonomy,

dignity, and absence of suffering New England Centenarians study

Avoided chronic/acute diseases Successfully navigated through obstacles

and the physical/psychosocial challenges Healthy People 2010 – to increase the

quality and quantity of a healthy life A positive view of aging as a normal

process is needed

Chapter 3: Theories of Aging

Bonnie M. Wivell, MS, RN, CNS

Purpose Of Nursing Theory

Defines our practice In gerontological nursing they must be

comprehensive yet consider individual differences

Tells how and why phenomena are related

Leads to prediction Provides process and understanding Must be holistic and take into account all

that impacts on a person throughout a lifetime of aging

Aging Theories Cultural, spiritual, regional,

socioeconomic, educational, environmental factors, and health status impact the older adults perceptions and choices about their health care needs

Limited work has been done to identify nursing-specific aging theories

Aging is a distinct discipline that requires aging theories that have an interdisciplinary perspective

Types of Theories

Psychosocial: Attempt to explain aging in terms of behavior, personality, and attitude change

Encompass psychological and sociological theories Psychological: How mental

processes, emotions, attitudes, motivation, and personality influence adaptation to physical and social demands

Maslow’s Hierarchy of Human Needs Theory

Maslow ContinuedAlthough Maslow doesn’t

specifically address old age, it is clear that physical, economic, social, and environmental constraints can impede need fulfillment of older adults.

Types of Theories Cont’d.

Sociological: How changing roles, relationships, and status within a culture or society impact the older adult’s ability to adapt▪ Activity theory – central theme that

remaining active in old age is desirable▪ Disengagement theory – characterized

by gradual withdrawal from society and relationships

Types of Theories Cont’d.Biological: Explain the physiologic

processes that change with aging Free Radical Theory – aging caused by

effects of free radicals Wear and Tear Theory – cumulative

changes occurring in cells age and damage cellular metabolism

Nursing Theories

Need to take human aging into consideration

Need to develop a more situation-specific theory of aging to guide practice

Functional Consequences TheoryA guiding framework that would

address older adults with physical impairment and disability

Nursing’s role is to minimize age-associated disability in order to enhance safety and quality of living

Theory of Thriving

Based on the concept of failure to thrive and application of thriving to the experience of well-being among frail elders living in nursing homes

Nurses identify and modify factors that contribute to disharmony among a person and his or her physical environment and personal relationships