Chapter 1: Introduction to Gerontological Nursing

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

2. 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

3. 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

4. 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

5. 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

6. Landmarks Cont’d. • 1981 – ANA scope of practice • 1984 – NGNA established • 1988 – First PhD program • 1992 – NICHE established at NYU • 1996 – John A. Harford Foundation Institute of Geriatric Nursing established at NYU • 1998 – ANA certification available for APNs

7. 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

8. Roles of the Gero Nurse • Provider of care • Teacher • Manager • Advocate • Research Consumer

9. 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

10. SOP & Core Competencies • Scope and standards of practice • Core Competencies – review pg. 15

11. 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

12. 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

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

14. 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-21st century, old people will outnumber young for the first time in history

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Chronic Disease • Increases with age • 4 leading causes of death • Heart disease • Stroke • Cancer • DM • Sensory impairments and oral health problems more frequent

22. 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

23. 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

24. 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

25. Chapter 3: Theories of Aging Bonnie M. Wivell, MS, RN, CNS

26. 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

27. 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

28. 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

29. Maslow’s Hierarchy of Human Needs Theory

30. 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.

31. 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

32. 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

33. Nursing Theories • Need to take human aging into consideration • Need to develop a more situation-specific theory of aging to guide practice

34. 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

35. 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