Chapter 1 Introduction to Gerontological Nursing Bonnie M

Chapter 1: Introduction to Gerontological Nursing Bonnie M. Wivell, MS, RN, CNS

Gerontological Nursing Defined An encompassing view of the care of older adults (Mauk, pg. 5) Providing both physical and emotional support in addition to respectful care

Trailblazers Florence Nightingale The first true geriatric nurse Nurse superintendent comparable to our current nursing homes Doreen 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 practice 1984 – NGNA established 1988 – First Ph. D program 1992 – NICHE established at NYU 1996 – John A. Harford Foundation Institute of Geriatric Nursing established at NYU 1998 – ANA certification available for APNs

Old Defined Young old: 65 – 74 Middle old: 75 – 84 Old old: 85 and up Only a guide as there is a vast difference in biological and chronological aging

Roles of the Gero Nurse Provider of care Teacher Manager Advocate Research 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 practice Core 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 Care Continuing Care Retirement Community Independent living to skilled care Assisted Living Foster Care or Group Homes Green House Concept – alternative to LTC Adult Daycare

Chapter 2: The Aging Population Bonnie M. Wivell, MS, RN, CNS

The Numbers Steady increase in older population Projected 40 million age 65 or over in 2010 Old old is projected to increase to 6. 1 million in 2010 By mid-21 st 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 1900 s, 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 5 th leading cause of death among black men 4 th leading cause among Hispanic men 4 th leading cause of death for Hispanic and black women 65 or older 6 th among white men and men of Asian or Pacific Islander origin 7 th leading cause of death for white women 65 or older

Chronic Disease Increases with age 4 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