Gerontologic Nursing
Gerontologic Nursing
Gerontologic Nursing
Demographics of Aging
Life expectancy- the average number of
years that a person can be expected to live Average life expectancy - 47 years (2004)
Figure had increased to 77.8 years
Older Adult
Young Old - 60-74 Middle Old - 75-84 Old Old - 85 & older
Presently: 12.8% of
Source of data: U.S. Census Bureau, State Interim Projections by Age and Sex: 2004-2030, 2005.
Source of data: U.S. Census Bureau, State Interim Projections by Age and Sex: 2004-2030, 2005.
Demographics of Aging
By mid-21st century, old people will outnumber young for the first time in history
Figure 1-1 Population over the age of 60, worldwide and developing regions.
The greatest increases will be in developing countries Asian countries have less time to prepare for aging because aging is occurring more rapidly than economic growth.
Adequate healthcare services for the elderly may simply be beyond the reach of many Asian countries They may not be able to afford a large dependent elderly population. They might not have the necessary institutions & financial systems in place (e.g., efficient and well-managed pension and healthcare programs)
(The Future of Population in Asia: Asia's Aging Population; Sidney B. Westley and Andrew Mason;
January 2005)
Projected Changes
Racial Background of U.S. Elderly (2050)
Hispanic*
Asian
Black
White
*Note: Persons of Hispanic origin may be of any race. Source of data: U.S. Census Bureau, U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin, 2004.
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
Baby boom after WWII (1946 1964) 3.5 children per household
Source of charts: U.S. Census Bureau, 65+ in the United States: 2005, December 2005.
the United States is 81 years The average life expectancy of men in the United States is 75.2 years
Female 50.9%
Male 49.1%
Female 58.8%
Male 41.2%
Female 71.1%
Male 28.9%
Source of data: U.S. Census Bureau, State Interim Population Projections by Age and Sex: 2004-2030, 2005.
With spouse
Other
WOMEN
65-74 years
75+ years
MEN
Source of data: U.S. Census Bureau, America's Families and Living Arrangements: 2003, Current Population Reports, P20-553, November 2004.
Some Facts
Higher education equates to more money, higher standards of living, and aboveaverage health Older people who live alone are more likely to live in poverty Significant increase in proportion of minorities
White
Black
Hispanic
Source of data: U.S. Census Bureau, Current Population Survey: Annual Social and Economic Supplement, 2006.
Majority of older adults enjoy good health But national surveys reveal that: 20% of adults 65y/o & above report a chronic disability. Chronic disease - major cause of disability; Heart disease, The 3 leading causes of Cancer, and death in people 65y/o Stroke & above in the U.S. Alzheimers disease - 5th DM - 6th (NCHS,2006)
Table 1-1 Top Causes of Death for People Age 65 and Over
Females
54.4% 43.1%
Source of data: U.S. Census Bureau, Older Americans 2008: Key Indicators of Well-Being, 2008.
condition
Two of the three leading causes
36.9%
Source of data: U.S. Census Bureau, Americans with Disabilities: 2002, Current Population Reports,
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.
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 y/o or older Older adults are active and healthy
Many chronic conditions commonly found among older people can be managed, limited, and even prevented.
Older people are more likely to maintain good health and functional independence
If encouraged to do so and If appropriate community-based support services
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
physical/psychosocial challenges
and helping older adults identify & use their strengths to achieve optimal independence.
Provider of care
Should be educated about disease processes &
Teacher/Educator
Should focus their teaching on modifiable risk
Manager
They balance concerns of the patient, family,
nursing & the rest of the interdisciplinary team Must be skilled in:
Leadership, Time management, Building relationships, Communication & Managing change
Advocate Acts on behalf of the older adults to: Promote their best interests & Strengthen their autonomy & decision making It does not mean making decisions for older adults, but empowering them to remain independent and retain their dignity, even in difficult situations
Research Consumer Must remain abreast of current research literature, reading & putting into practice the results of reliable & valid studies The use of EVIDENCE-BASED PRACTICE RESEARCH can improve the quality of patient care in all settings: Best method for delivery of care Based on clinical guidelines derived from research Coding system indicates the strength of the research
Read professional journals specific to their specialty Continue their education by attending seminars & workshops Participate in professional organizations Pursue additional formal education or degrees Obtain certification
Certification
Nurse certification - a formal process by which a certifying agency validates a nurses knowledge, skills, & competencies through a written exam in a specialty area of practice
It provides reassurance to patients & their families that the nurses caring for them are:
Highly skilled and Posses expert knowledge in providing excellence in
Certification
Why certify?
Professional
accomplishment/Leadership Commitment to profession Provide higher quality of care Evidence-Based Practice & resource to others
*Generalist Certification
yrs.)
*Advanced Certification
doctorate or higher degree Demonstrates advanced knowledge & clinical expertise in the care of older adults Function independently & in collaboration with other health care providers in a variety of setting
*Advanced Certification
ANCC offers two separate advanced
practice (APRNs) certification exam: Gerontological Nurse Practitioner (Gnp) Clinical Nurse Specialist In Gerontological Nursing (GCNS)
patient care
Patient/family care
Developing nurses
Impacting organizations and systems Through the development & implementation of EVIDENCE-BASED PRACTICE RESEARCH
Practices in diverse settings & is actively engaged in: Education (e.g., patient staff, students and colleagues) Case management Expert clinical practice Consultation Research Administration
CLINICAL NURSE SPECIALIST IN GERONTOLOGICAL NURSING (GCNS) Focuses more on the EDUCATOR and CONSULTATIVE ROLE GERONTOLOGICAL NURSE PRACTITIONER (GNP) Focuses more on the DIRECT PROVISION and EVALUATION OF CARE
care for older adults in all settings Division name changed to Division on Gerontological Nursing Practice in 1976
nursing Purpose
Health promotion Healthy maintenance Disease prevention Self-care
To identify & use the strengths of older adults and To assists them in maximizing their independence
They must actively involve older adults & family members, in decision making process (w/c has a great impact on the everyday quality of life of the pt.)
IV. Planning
V. Implementation
VI. Evaluation
CORE COMPETENCIES
Provide a foundation of added knowledge and skills necessary for the nurse to implement in daily practice This was developed by the AACN and the John A Hartford Foundation Institute for Geriatric Nursing OLDER ADULTS: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
This serves as guides to nursing professors to prepare
Core Competencies
Core Knowledge
Health promotion, risk
Role Development
Provider of care Designer/manager/coordinator
reduction, & disease prevention Illness and disease management Information & health care technologies Ethics Human diversity Global health care Health care system & policy
Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
Recognize ones own & others attitudes, values, & expectations about aging & their impact on care of older adults & their families. Adopt the concept of individualized care as the standard of practice with older adults. Communicate effectively, respectfully & compassionately with older adults & their families. Recognize that sensation & perception in older adults are mediated by functional, physical, cognitive, psychological, & social changes common to old age.
Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
Incorporate into daily practice valid and reliable tool to assess the functional, physical, cognitive, psychological, social & spiritual status of older adults. Assess older adults living environment with special awareness of the functional, physical, cognitive, psychological, & social changes common to old age. Analyze the effectiveness of community resources in assisting older adults & their families to retain personal goals, maximize function, maintain independence, & live in the least restrictive environment. Assess families knowledge of skills necessary to deliver care to older adults.
Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
Adapt technical skills to meet the functional, physical, cognitive, psychological, social and endurance capacities of older adults. Individualize care & prevent morbidity & mortality associated with the use of physical & chemical restraints in older adults. Prevent or reduce common risk factors that contribute to functional decline, impaired quality of life & excess disability in older adults. Establish & follow standards of care to recognize & report elder mistreatment.
Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
Apply evidence-based standards to screen, immunize & promote healthy activities in older adults. Recognize & manage geriatric syndromes common to older adults. Recognize the complex interaction of acute & chronic co-morbid conditions common to older adults. Use technology to enhance older adults function, independence & safety.
Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
transition across & between home, hospital, & nursing home, with a particular focus on the use of technology. Assists older adults, families & caregivers to understand & balance everyday autonomy & safety decisions. Apply ethical & legal principles to the complex issues that arise in care of older adults.
Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
Appreciate the influence of attitudes, roles, language, culture, race, religion, gender, & lifestyle on how families & assistive personnel provide long-term care to older adults. Evaluate differing international models of geriatric care. Analyze the impact of an aging society on the health care system. Evaluate the influence of payer system on access, availability & affordability of health care for older adults.
Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
Contrasts the opportunities & constraints of a supportive living arrangement on the function & independence of older adults & on their families. Recognize the benefits of interdisciplinary team participation in the care of older adults. Evaluate the utility of the complimentary & integrative health care practices on health promotion & symptom management for older adults.
Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
Facilitate older adults active participation in all aspects of their own health care. Involve, educate & when appropriate, supervise family, friends & assistive personnel in implementing best practices for older adults. Ensure quality of care commensurate with older adults vulnerability and frequency & intensity of care needs. Promote the desirability of quality end-of-life care for older adults, including pain & symptom management, as essential, desirable & integral components of nursing practice.
Continuum of Care
Multitude of settings for those > 65
receiving care
Often the POINT of ENTRY in the health care system Nurses are likely to care for older adults even if they do not specialize in geriatrics
50% of all pts. In this setting are 65y/o & above
Acute Rehabilitation
Rehabilitation may be found in several settings: Acute care hospital Subacute care or transitional care Long-term care facilities (LTCFs) Regardless of the setting, it is accomplished through the work of interdisciplinary team that includes: Nurses Therapists Other professional staff
Goal:
To maximize independence Promote maximal function Prevent complications, and Promote quality of life w/in each persons strengths & limitations
Rehab in acute care hospital pt must b able to tolerate @least 3 hours of therapy/day
Beneficial to help pts. recovering from/adapting to conditions
such as Stroke, Head trauma, Neurological diseases, Amputation, Orthopaedic surgery and SCI
services must be ordered by the physician and the client must be considered homebound
People desired to be cared for in a familiar surroundings by their familiesfuelled the need for more agencies Majority of home health care patients are elderly with a variety of nursing needs such as:
Wound care
IV therapy Management of newly diagnosed Diabetes, and Tube feedings
Challenge for nurses: To maintain the functional & nutritional status of residents, while preventing the complications of impaired mobility (e.g., pressure ulcers and falls) Dementia care is also a substantial part of the of the nursing care provided in LTCF Managing health conditions Medication regimen
Alzheimers Care
A growing trend in LTCFs, which offer a dedicated unit for the care of persons with Alzheimers disease and other dementing illnesses
Due to growing need and high rate of Alzheimers with
advanced age
Goal: To preserve the functional status of the demented person via supportive care that fosters selfworth and socialization even w/in the context of diminishing cognitive capacity
Challenge for nurses: To manifest expertise in the provision of care and management of this challenging disease To help family members understand disease progression and to assure them that their loved one is being well cared for even at the end of this ultimately fatal disease
Typical patients seen in this setting are those that need assistance as a result of: Non-healing wounds, Chronic ventilator dependence, Renal problems, IV therapy, and Coma management As well as those with complex medical &/or rehabilitative needs (e.g., pediatric, orthopedic & neurological)
Skilled nurse must have: Good assessment & communication skills in caring for this complex patients Should also have knowledge in the ff: Transfer techniques, Prevention & assessment of swallowing problems, Bowel & bladder management, and Nutrition Must also be expert in preventing hazards of immobility Pressure ulcers and contractures
Hospice
Concept o Hospice:
Centered on holistic interdisciplinary care that helps
Hospice requires a gerontological nurse to have a great deal of patience, expertise, understanding, interdisciplinary communication and compassion
Respite Care
Provides time off for family members who care for someone who is ill, injured, frail, or demented
Because caregiving for a dependent older adult can be a
Can be provided in an adult daycare center, in the home of the person being care for or in an assisted living facility or LTCFs Objective: provide caregivers with temporary, intermittent, substitute care, allowing for relief from the daily responsibilities of caregiving
Nurses play a role in the care of CCRC residents as they progress from independent living to requiring skilled nursing care
GN may also function in the are a of health promotion
It may be connected with a LTCFs, care network or maybe free-standing. The typical resident in an ALFs has a private room or apartment, some type of kitchen/kitchenette and a private bathroom with shower
Some older adults sell their homes to enter ALF
Planned activities,
Places to walk and exercise, & Pleasant surroundings where adults socialize with
game rooms
Indicated for those older adults who can most of their ADLs, but may have safety issues and require supervision with some activities such as dressing or taking medications It generally offers more personalized supervision in a smaller, more family-like environment than a traditional nursing home
There is no requirement that a nurses service be
Endorsed by the Centers for Medicare & Medicaid Services The Green House Model was conceived by Dr. William Thomas (2004) He teamed up with Robert Wood Johnson Foundation They replaced more than 100 nursing homes nationwide with clusters of small, cozy houses, each housing 8-10 residents in private rooms, with private bathrooms & an open kitchen
assistance & support ADLs and Clinical care without that assistance becoming the focus of their existence Caregivers are empowered to provide individualized care to older adults who retain control over daily activities, creating an environment that is a HOME
Adult Daycare
Provides another avenue for older adults who are unable to remain at home during the day w/out supervision
Especially for older adults being cared for at home
by their own family, who has to work during the day and wish that their relative be safely cared for during their absence
Adult Daycare
Services are offered only during the day 6a.m.6p.m. (normal office hours) Planned activities are included emphasis is on recreation and some health promotion activities May offer transportation Typically fees are paid privately Meal services normally included Additional health service availability varies
Theories of Aging
Defines our practice In gerontological nursing they must be comprehensive yet consider individual differences
Integrates knowledge, Tells how and why phenomena are related, Leads to prediction, and Provides process and understanding In addition, it must be holistic & 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
Various coping or adaptive strategies must occur for a person to age successfully Triggers for coping/adaptive responses
Physical changes of aging Issues of retirement Dealing with the death of spouse or friend Declining health
Development does not stop when one ages It does not only includes behaviour but also devt aspects r/t lives of the older adults Psychological: How mental processes, emotions, attitudes, motivation, and personality influence adaptation to physical and social demands?
Maslow Continued
Human motivation is viewed as a hierarchy of
human needs that are critical to the Growth & devt. of all people
Although Maslow doesnt specifically address old age, it is clear that physical, economic, social, and environmental constraints can impede need fulfillment of older adults. Individuals are viewed as active participants in life, striving for self actualization
Maslow Continued
SELF-ACTUALIZED PERSON
Displays high levels of all of the ff. characteristics:
Perception of reality; Acceptance of self, others and nature; Spontaneity; Problem-solving ability; Self-direction; Detachment and the desire for privacy; Freshness of peak experiences; Identification with other human beings; Satisfying and changing relationships with other people; Democratic character structure; Creativity; and A sense of value
It hypothesizes as one ages the shift of focus is away from the EXTERNAL WORLD (extroversion) toward the inner experience (introversion) The older person search for answers to many of lifes riddles and try to find the essence of true self To age successfully: accept past accomplishment or failures
Sociological: How changing roles, relationships, and status within a culture or society impact the older adults 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
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
A guiding framework that would address older adults with physical impairment and disability Nursings 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 wellbeing 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