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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
Certification
Nurse 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 Competencies
Scope 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 Continued
Although 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 Theory
A 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