home on anticoagulant therapy

- Develop large-print handouts that reflect the verbal information presented

Cognitive changes
- Reversible systemic disorders are often implicated as a cause of delirium.

Aging of the baby boomers

These conditions require long-term care
This generation is living longer, yet experiencing higher rates of obesity, diabetes, high cholesterol, and hypertension.
Costs for aging baby boomers are expected to be high.
Long term care high cost financing, good community-based delivery system and long-term care facilities

The real challenges of caring for the elderly in 2030 will involve:
(1) making sure society develops payment and insurance systems for long-term care that work better than existing ones,
(2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible,
(3) changing the way society organizes community services so that care is more accessible,and
(4) altering the cultural view of aging to make sure all ages are integrated into the fabric of community life
Sustainable Development and Older Persons in preparing for an ageing population (Gender Inequality)

Study Design
A series of analyses are used to consider the challenges related to caring for elders in
the year 2030:
(1) measures of macroeconomic burden are developed and analyzed,
(2) the literatures on trends in disability, payment approaches for long-term care, healthy
aging, and cultural views of aging are analyzed and synthesized, and
(3)simulations of future income and assets patterns of the Baby Boom generation are
developed.

Older persons are important actors in communities, making key contributions in the following interrelated areas:
1. Economic development: Older persons make substantial contributions to the economy through participation in the formal or
informal workforce (often beyond retirement age), taxes and consumption, and transfers of assets and resources to their
families and communities,
2. Unpaid care work: Older persons, particularly older women, play a vital role in providing unpaid care for spouses,
grandchildren and other relatives, including those with disabilities (UNFPA and HelpAge International 2012).
3. Political participation: With variation across contexts, older persons in some countries, notably in advanced democracies, can
carry significant weight which is mostly associated with the concentration of economic resources and a tradition of political
participation (UNDESA 2007).
4. Social capital: Many older persons tend to be actively involved in community and civic life through volunteering,
governance of public institutions, and participation in community-based institutions.

Future Old = Baby boomers•Born between 1946 and 1964

•High-tech orientation
•Most have children, but low birth rate means fewer biologic children to assist them in old age
•Their income tends to be higher than other groups
•Their leisure time is scarcer than other adults; they are more likely to feel stressed
•They exercise more frequently than other adults
•Healthier old age attainable for baby-boomers

A gerontologic nurse
Currently hold an active
Registered nurse license in US or its territories.
Hold a baccalaureate or higher degree in nursing.
Have practiced 2000 hours within past 3 years
Have had 30 contact hours of continuing education applicable to gerontology/Gerontologic nursing within the past 3 years.
In collaborative practice to meet the growing needs of older adults.
Expert in providing, directing, and influencing the care of older adults
Works in long-term care facilities

Life Care Planning - is a comprehensive document designed to help meet the long-term financial and health needs of a person
experienced catastrophic injury
Life Care Planning
The concept of life care planning was first developed in the 1980s, to meet a growing need for an informed document that presented
actual estimated costs of care for persons who had experienced a catastrophic injury or accident. Many settlements for those persons in
devastating accidents were made arbitrarily without actual calculation and consideration of the multitudes of factors influencing these
costs, such as doctors’ visits, equipment, medications, tests, cost of caregiving, and potential complications over a lifetime.LCP is a
comprehensive document designed to help meet the long-term financial and health needs of a person experienced catastrophic injury

Chartered Advisor for Senior Living (CASL)

-A person with CASL certification assists older persons with retirement savings, pension and social security planning, health and long-
term issues, estate planning and managing life course transitions, family relationship and living arrangement.

Registered Financial Gerontologist (RFG)

- The RFG certifications a similar designation to the CASL, but is offered through the American Institute of financial Gerontology and
supported by the American Society on Aging.

Certified Senior Advisor (CSA)

-The CSA is a designation offered by the society of Senior Advisors. The curriculum includes a large number of topics in aging, chronic
illness, end of life, and long-term care as well as Medicaid and financial planning. It is self-study program that takes 2-6 months to
complete.

Recent trends in health promotion & disease prevention activities, such as:
Improved nutrition,
Decreased smoking,
Increased exercise, and
Early detection & treatment of risk factors such as hypertension & elevated serum cholesterol levels.

TRENDS IN LONG-TERM CARE

Long-term care is the “broad range of medical, custodial, social, and other care services that assist people who have an
impaired ability to live independently for an extended period”. The National Council on aging estimates that 6.4 million people all over
the age of 65 and 50% of those over age 85 will need long-term care

LONG-TERM CARE INSURANCE

Long –term care insurance is designed to cover individuals needing health care outside of the hospital, including diagnostics
testing, rehabilitation, and custodial care. Reasons for purchasing long-term care insurance include worrying about being a burden to
their family, staying financially independent, having more choices for care if needed( such as remaining in the home), preserving their
assets, and providing peace of mind.

Long-term care insurance can be purchased at anytime, but premiums increase with age. In, 2005, the annual premiums for a low-option
policy for a person who was age 65 was about $1,800, and increased to about $5,500 at age 79. Long-term care insurance may cover any
one or all of the following types of care.
Nursing Home care
Assisted living
Hospice
Home health
Adult day care
Respite
Caregiver training
Home health care coordinators

CONTINUING CARE RETIREMENT COMMUNITIES (CCRCs)

 Growing trend for older adults, services by promoting aging in place through offering various levels of care on a continuum that might
include independent living, assisted living, skilled care, and home health services all on one campus

Green Houses- a movement to replace nursing homes with more home-like environments, started through the vision of a physician
named Bill Thomas, consist of 10-12 residents in a home setting who enjoy private rooms and share a common living space.

Geriatric Care management – Another emerging trend in gerontological nursing is the role of the geriatric care manager. The
professional geriatric care manager (PGCM) is a specialist who helps families care for older adults while encouraging as much
independence as possible.
PGCM perform the following:
 Conduct assessments
 Develop care plans that address pertinent problems
 Arrange, interview for, and monitor in-home caregivers or other services
 Act as a consultant for caregivers who live near or far
 Review financial, health-related, or legal issues
 Provide referrals to other geriatrics specialists
 Intervene in times of crisis
 Act as an advocate and/ or liaison between families and service providers
 Coordinate or oversee care
 Assist with transitions in living arrangements, including recommending the most appropriate settings and helping facilitate the move
 Provide education and links to resources
 Offer counseling and support
 Some PGCMs also offer guardianship, caregiving, and /or financial services.

geriatric care manager

Coordinate care
Review financial, health-related, or legal issues
Intervene in times of crisis
Act as an advocate

Clinical Specialist in Gerontologic Nursing

The nurse must meet all the following requirements:
Currently hold an active RN license in the United States or its territories
Hold a master’s or higher degree in gerontologic nursing
Hold a master’s or higher degree in nursing with a specialization in gerontologic nursing.
Have practiced a minimum of 12 months after completion of the master’s degree

Health advocacy in the medical profession

Advocacy services
Advocacy services support the rights of anyone receiving or seeking to receive aged care services, and empower older people to make
informed decisions about their care. An aged care advocate can assist things like:
• interacting with the aged care system
• transitioning between aged care services
• knowing and understanding their rights
• making decisions about the care they receive
• options for having their aged care needs better met
• resolving concerns or complaints with the aged care provider about the services they receive
• speaking with their service provider at their direction
• Increasing their skills and knowledge to advocate for them self.

Who can access advocacy services?

Anyone who is receiving or seeking to receive government-funded aged care services, including family and representatives, are entitled
to access advocacy services. This includes people who:
•live in an aged care home
•receive aged care services in their own home
•receive transition care
•Are helping someone who is receiving aged care services.

Healthy People 2020

Healthy People 2020 was the fourth iteration of the Healthy People initiative. Launched in December 2010, Healthy People 2020 set an
ambitious yet achievable 10-year agenda for improving the nation’s health.
The vision for Healthy People 2020 was “a society in which all people live long, healthy lives.”
Its mission was to:
•Identify nationwide health improvement priorities
•Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress
•Provide measurable objectives and goals that are applicable at the national, state, and local levels
•Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and
knowledge
•Identify critical research, evaluation, and data collection needs
Healthy People 2020 set overarching goals to:
•Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death
•Achieve health equity, eliminate disparities, and improve the health of all groups
•Create social and physical environments that promote good health for all
•Promote quality of life, healthy development, and healthy behaviors across all life stages

Review different resources produced by the Law and Health Policy project:
•Disability and Health
•Healthcare-Associated Infections
•Health Equity
•Healthy People 2030
•Leading Health Indicators
•Maternal, Infant, and Child Health
•Mental Health and Mental Disorders
•Nutrition and Weight Status
•Oral Health
•Policy Levers
•Substance Abuse

Six model health promotion programs that have been focused on older adults and have received national attention, received federal
funding and foundation support to evaluate their effectiveness and to encourage their replication.

1. Healthwise
The best-known older adult medical self-care program is Healthwise. It provides information and prevention tips on 190 common health
problems, with information periodically updated.
2. Chronic Disease Management
Kate Lorig, a nurse-researcher at the Standford University School of Medicine, and her medical colleagues have been evaluating
community-based, peer-led,chronic disease self-management programs for more than two decades, beginning with the Arthritis Self-
Management Program (Lorig et ai.,1986)
3. Project Enhance
Senior Services of Seattle/King County began the Senior Wellness Project (later renamed Project Enhance) in 1997 at the North Shore
Senior Center in Bothell, Washington. It was a research-based health promotion program that included a component of chronic care self-
management that was modeled after Kate Lorig’s program(Lorig et al.,1999) The program also included health and functional
assessments; individual and group counseling; exercise programs; a personal health action plan with the support of a nurse, social
worker, and volunteer health mentor; and support groups.
4. Ornish Program for Reversing Heart Disease
Dr. Dean Ornish, a physician at the University of California at San Francisco and founder of the Preventive Medicine Research Institute,
has developed a program for reversing heart disease that has been replicated at several sites around the country. Dr. Ornish (1992) has
recommended a vegetarian diet with fat intake of 10% or less of total calories, moderate aerobic exercise at least three times a week,
yoga and meditation an hour a day, group support sessions, and smoking cessation.
5. Benson’s Mind / Body Medical Institute
Dr. Herbert Benson is a physician affiliated with Harvard Medical School, and best known for his best-selling books on the relaxation
response and for popularizing the term mind/body medicine. For individuals feeling the negative effects of stress, Benson’s program
teaches them to elicit the relaxation response, a western version of meditation.
6. Strong for Life
The Strong for Life Program is a home-based exercise program for disabled and nondisabled older adults. It focuses on strength and
balance, and provides an exercise video, a trainer’s manual, and a user’s guide. The program was designed by physical therapists for
home use by older adults, and relies on elastic resistive bands for strengthening muscles.

Telehealth allows patients across the lifespan to receive care remotely in a manner that is often more accessible and convenient than in-
person care with Real time interpretation of healthcare status for healthcare management. A common misconception is that older adults
have either no interest in the use of technology or cannot use technology platforms. Current data indicate otherwise; in fact, most older
adults (7 in 10) have and utilize a computer, smart phone, or tablet with internet access at home. However, when it comes to the use of
telehealth, there is limited reach among older adults (e.g., only 11% feel comfortable using telehealth).

Beyond reimbursement limitations with health insurance, barriers to telehealth among older adults include provider misperceptions of
interest, lack of telehealth training/orientation in older adults, and telehealth platforms that do not account for the needs of older adults.
Here are some factors to consider and strategies to implement when providing telehealth to older adults.

A. Sensory and motor changes

Most older adults experience age-related changes in vision, hearing, touch, perception, mobility, and balance. Many of these declines
begin at age 40.
For older adults, there may be difficulties with light perception, sensitivity to glare, reduced acuity, and impaired focus on nearby
objects.
Discriminating between background noises becomes more difficult as we age, and low-level sounds are muffled. And for some, there is
increased risk of developing Tinnitus, which can make certain sounds difficult to discern.
There are also changes to muscle strength and tone that make muscles stiffer and less

B. Cognitive changes
Most older adults experience some cognitive changes as a part of the normal aging process, such as slowed speed of processing,
difficulty in multitasking, and small declines in episodic memory, which generally do not interfere with everyday functioning. However,
many cognitive abilities, including semantic memory, reasoning, problem solving, and executive functioning are preserved well into late
life. The relatively minor cognitive changes that occur with aging should not prevent use of telehealth by older adults.
Even adults who experience conditions such as mild cognitive impairment (MCI) can successfully learn new skills, especially if they
use compensatory strategies like making notes or using reminders. This could include making reminders about telehealth appointment
times in their calendar and using a series of written notes about how to start their computer or tablet and launch a telehealth application.
There are some older adults whose cognitive impairments may be too advanced to use telehealth successfully (for instance, in severe
dementia). However, some older adults with mild forms of dementia can use telehealth effectively with some modifications or
adjustments. For instance, they may need a family member’s assistance to set up the telehealth account or to get the telehealth session
started.

C. Strategies for providing technology support

Don’t assume older adults are uninterested in telehealth.
Just as you do with all patients, meet older adults where they are and talk about the pros and cons of telehealth. Provide a clear
explanation of what to expect and let them know that most people experience a few “bumps” adjusting to new technology but you’ve
been able to successfully work with people with this modality.
Providing technology support requires additional resources early in treatment but avoids delays on the day of the appointment, so plan
to provide additional instruction and individual tech support. Though telehealth platforms may not be intuitive to older adults, many can
successfully use them. Contact the older adult over the telephone prior to the appointment to provide verbal instructions, test the
telehealth platform, and ensure the older adult understands and is comfortable with the technology. Support staff may be able to do this
step. Additional benefits include increasing older adults’ access to care and promoting treatment continuity by overcoming barriers to in-
person sessions.
Prior to the appointment, provide older adults with written instructions for using telehealth (you may find this beneficial for all your
patients). Instructions that use concise language, a larger font size, and include screen shots of each step of the process may be
particularly helpful.
Older adults using telehealth technology will benefit from visual presentation modifications (e.g., raise display/screen illumination, use
matte surfaces instead of glossy surfaces).
Auditory enhancements may also help the user experience (e.g., adjust volume settings, offer closed captioning options with enhanced
text size, consider the use of headphone sets).
You can provide these suggestions in the initial written information or discuss during the setting up session.
When using a video platform, a neutral, not “busy” visual background for you will ensure the older adult with visual challenges is
better able to focus on you and not other stimuli in the background. Similarly, reducing noise on the provider’s end reduces auditory
interference for the patient. Be aware of noises such as HVAC, white noise generators, and other sounds and seek to minimize these with
the position of your equipment and the use of headphones.
To curb pain from muscle stiffness, ask your patient if they need movement accommodations for their sessions (e.g., allow time for
stretching, invite older adults to use items that may be of comfort like heating pads, comfortable chairs, etc.).
Providing an end-of-session summary of the goals, reading, and exercises to be completed between sessions can be advantageous for
all clients but especially valuable for older adults.

D. Strategies for establishing rapport

Directly acknowledge that telehealth sessions can feel awkward. Reassure older adults that most people feel increasingly comfortable
over time.
Attempt to look directly at the camera as much as possible to mimic eye contact.
Use clarifying and reflective techniques to avoid miscommunication and misinterpretation of the older adult’s emotions. Clarify
ambiguous body language verbally with the acknowledgement that telehealth can make communication more difficult (e.g., “I want to
make sure I understand how you are feeling. Meeting over video can make that more difficult since I can’t see you completely. You
seem to be frustrated—is that how you are feeling?”).
Implementing these strategies could increase the likelihood of older adults successfully engaging in and benefiting from telehealth.

How Telehealth Can Improve Access to Elderly Care

Telehealth gives patients the option to consult with their healthcare provider remotely using live video, audio and instant messaging on a
telemedicine app. This reduces the need for in-person visits and consultations, making it easier for at-home caregivers to meet the needs
of their loved ones.

Many of these at-home caregivers will have responsibilities of their own, from raising children to holding down a job. If they can consult
with their loved one’s doctor from the comfort of their own home, they won’t have to spend as much time shuttling their loved one to
and from the doctor’s office. At-home healthcare providers can quickly gain valuable insight and knowledge from these remote
consultations, improving their loved one’s quality of care.
Telehealth can help families and elderly patients in the following ways:
•Reduce the burden and cost of certain travel expenses
•Reduce the number of unnecessary hospital visits
•Reduce the stress put on at-home caregivers
•Improve overall patient satisfaction

Using Telehealth to Care for the Elderly

At-home caregivers can use telehealth to help better manage and treat a range of conditions and diseases that tend to affect older patients.
While in many of these cases, in-person visits will still be required, telehealth makes it easier for family caregivers to care for their loved
one by giving them direct access to healthcare professionals. If they have a question about caring for their loved one, they can always
consult with a licensed physician or specialist using telemedicine video conferencing software.

Nurse Entrepreneur
Nurse entrepreneurs use their professional nursing experience and education to start their own business in the healthcare
industry. Businesses established by nurse entrepreneurs may include developing and selling a home health product or medical device, or
offering independent nursing services, such as patient care, nursing education, home health and/or consulting services. A nursing career
path that offers independence and autonomy, becoming a nurse entrepreneur requires creativity, hard work and strong business skills.
As in other nursing careers, aspiring nurse entrepreneurs begin their careers by completing their Associate's Degree in Nursing or
Bachelor of Science in Nursing degree and pass the NCLEX-RN exam. In addition to the standard nursing education, nurse
entrepreneurs benefit significantly from learning important business skills such as marketing, accounting and managerial techniques.
Then an aspiring nurse entrepreneur often begins work as a professional nurse in order to learn the industry and discover business
opportunities within it.
While an advanced degree is not required for nurse entrepreneurs to start their own business, many nurses may consider a dual master's
degree program in nursing and business administration, in which students complete their Master's of Science in Nursing and Master of
Business Administration degrees simultaneously.

Nurse entrepreneurs work for themselves and therefore the skills required for this position vary depending on the nature of the individual
business venture, but in general the following skills and qualifications are beneficial for nurse entrepreneurs:
•ADN (Associate Degree in Nursing) or BSN degree and valid RN license
•Prior professional nursing experience within the relevant area of specialty
•Basic business skills and knowledge (e.g., accounting, marketing, ability to manage staff)
•Good communication skills for interacting with customers, patients and employees
•Ability to work independently and willingness to take on personal financial risk

In general, nurse entrepreneurs have completed a minimum of the ADN or BSN degree and have attained an RN license in the state in
which they live. A background in business is also highly valuable for nurses who wish to start their own businesses. This may include
informal training or mentoring in business skills, taking a few courses in business, or attaining a business degree. Many nursing schools
across the country offer dual programs which deliver MSN and MBA degrees simultaneously.

Certifications or Credentials Needed?

There are no specific certifications or credentials required for becoming a nurse entrepreneur. However, a nurse entrepreneur may find
certain certifications valuable based on the nature of their business. For instance, a nurse who runs a home health company and provides
patient care may wish to hold the Basic Life Support Certification (BLS) from the American Heart
Association or American Red Cross.

Nurse entrepreneurs may work in a variety of settings, including in offices running their own business, as an independent nurse
contractor in hospitals or clinics, in home healthcare visiting patients, or as a nurse educator. Nurse entrepreneurs have the freedom to set
their own hours and the flexibility to determine their own work environments based on the company they establish.

Nurse Entrepreneur Do
A nurse entrepreneur uses his or her background in professional nursing to start their own business within the healthcare industry.
Business ventures established by registered nurses run the gamut from medical devices and home health products to independent nursing
services such as patient care, nursing education, home health services and consulting work. The day-to-day responsibilities of a nurse
entrepreneur depends upon the specific venture, but usually includes activities related to running a business including accounting,
marketing or sales, and developing a customer base.

Roles and Duties of a Nurse Entrepreneur

•Use nursing education and experience to establish their own business venture within the healthcare field
•Promote the business, including advertising and sales efforts to attract and retain customers
•Hire and manage employees to assist in running the business as needed
•Tend to the financial side of running a business, including accounting, payroll and tax issues
•Provide healthcare products or nursing services which may include direct patient care, education or consulting services depending on
the nature of the business

Nurse Enterpreneural
An increasing number of nurses are enjoying the benefits of self-employment. While salary can vary widely based on the specifics of
their business ventures, many nurse entrepreneurs are also independent nurse contractors who set the terms of their own services and
negotiate their salary with a healthcare facility, such as a hospital or nursing home. While not as certain as traditional employment, a
career as a nurse entrepreneur can be more profitable than a standard RN position.