Chapter 1

 Overview of Gerontologic Nursing

 Foundations of the Specialty ofGerontologic Nursing
 History and evolution
 The earliest reference to the need for a specialty in older adult care was in a 1925 anonymous
column in AJN entitled “Care of the Aged.”
 After 1960, there was a steady increase in literature with a focus on the older adult.
 Professional origins
 1966
 ANA established the Division of Geriatric Nursing Practice and Geriatric nursing was
defined as “concerned with the assessment of nursing needs of older people; planning and
implementing nursing care to meet those needs; and evaluating the effectiveness of such
care.”
 In 1976
 The name The Division of Geriatric Nursing Practice was changed to The Division of
Gerontologic Nursing Practice.
 1989
 Established certification for gerontologic clinical nurse specialist

 Standards of Practice
 Nursing Roles
 Generalist nurse
 RN who practices in wide variety of settings
 Consults with the advanced practice nurse and other interdisciplinary health care professionals
 Gerontologic clinical nurse specialist
 Master’s prepared RN who functions as clinician, educator, consultant, administrator, or researcher
 Adult gerontologic acute care nurse practitioner
 Practice in various settings and function as a provider of primary care and a case manager

 Demographics of the Older Population

 The graying of America
 Increase in the number of adults over the age of 65
 Social Security (1935) 65 would be a reasonable age for allocating benefits and services.
 Now with many older persons living productive, highly functional lives well beyond age 65, this age
is does not determine a person is old.
 Nurses must use each patient as their own standard, comparing the patient’s previous pattern of health
and function with current status.

 Demographics of the Older Population

 Increase in the older adult population is related to:
 Result of falling fertility rates, reduced infant and child mortality, improved sanitation, advances
in vaccination, and increasing survival at older ages
 Life expectancy
 In developed countries is 78 years, in developing countries is 68 years.
 By 2050, in developed countries people are expected to live an average of 83 years, those in
developing countries are expected to live an average of 74 years.
 The Relationship Between Aging and Wellness
 Definitions of aging
 Aging: universal process beginning at birth
 Subjective age: person’s perception of age
 Perceived age: other people’s estimation of someone’s age
 Chronologic age: length of time that has passed since birth
  Functional age: physiologic health, psychological well-being, socioeconomic factors, ability to
function and participate in activities

 Profile Highlights
 Population aged 85 or older is expected to be 6.3 million by 2015 and 14.6 million by 2040.
 Americans aged 65 and older numbered 47.8 million,14.9% of the total population of the United
States
 Which is a 30% increase since 2005
 1 in 7 persons is an older American
 Accounts for 14% of the U.S. population

 Gender Differences
 Women live longer than men.
 Women have reduced accident rates and men have increased chronic illness.
 After age 65 women have an average life expectancy of an additional 20.6 years.
 After age 65 men have an average life expectancy of an additional 18 years.

 Marital Status
 Older men are much more likely to be married than older women: 70% of men versus 45% of women
 Marital status is an important determinant of health and well-being because it influences income,
mobility, housing, intimacy, and social interaction.
 Majority of older women are likely to be poor, live alone, and have a greater degree of functional
impairment and chronic disease.

 Race and Ethnicity

 By 2044, more than half of all Americans are projected to belong to a minority group.
 Hispanics will continue to be one of the fastest growing segments.
 Numbers of African Americans, Native Americans, Native Alaskans, Asians, and Pacific Islanders will
also increase.

 Living Arrangements
 Differ according to the needs and preferences of each person
 Person’s overall degree of health and well-being greatly influences the selection of housing.
 Housing should promote functional independence with consideration for safety and social interaction.
 Options include: their own home, with family, retirement communities, assisted living, and long term
care.

 Income
 Median income in 2015 was:
 15% reported less than $10,000
 46% reported $25,000 or more
 The major source of income for older individuals and couples in 2014 was Social Security.
 Nonwhites continued to have substantially lower incomes than their white counterparts.
 Older women had a poverty rate higher than older men in 2017.

 Employment
 18.9% of older adults classified as labor force participants.
 23.4%, men
 15.3%, women
 Since 2008, many older men and women have continued to work past the expected retirement age of
66 (born before 1960) and 67(born after 1960).

 Health Status of Older Adults

 Old age is not synonymous with disease
  Even older persons with disease, disability, or both may be considered healthy and well to some degree
on the health-illness continuum.
 Most older adults have one or more chronic conditions.
 75% of all deaths are caused by heart disease, lung cancer, COPD, accidents, stroke, Alzheimer’s
disease, diabetes, kidney disease, influenza/pneumonia, and suicide.

 Functional Status
 You will be entering the nursing profession as the majority of Baby Boomers are aging.
 Discuss the demographics of this generation of patients and how it may impact the health care they
receive.
 Women and aging
 Race and ethnicity
 Living arrangement
 Income and employment
 Health status

 Health Care Expenditure and Use

 The federal government funds most health care in the United States for persons aged 65 or older
through the Medicare insurance program:
 Part A—hospital insurance
 Part B—medical insurance
 Part C—Medicare advantage plans like HMOs or PPOs
 Part D—Medicare prescription drug coverage

 Affordable Care Act (ACA) of 2010

 Improved the cost of prescription drugs
 10.7 million Medicare beneficiaries saved more than $20.8 billion since it was enacted.
 ACA facilitated these savings by bridging the Medicare Part D “donut hole” (Box 1.2).
 By 2020, the “donut hole” or coverage gap that existed prior to the ACA will be closed.
 Recipients will pay only 25% of the costs of medications until the yearly out-of-pocket spending
limit is reached.

 Implications for Health Care Delivery

 Acute care setting—used for acute conditions and do not do well in preventing functional decline or
prompting independence
 Subacute care units—aimed at high-risk, hospitalized older adults – bridge between hospital and home
 Nursing facilities—used for those over 85 years of age with decreased functional ability
 Home care—older home care patients have multiple, complex problems

 Impact of an Aging Population on Gerontologic Nursing

 Ageism
 Nursing education
 Gerontologic nursing content needs to be an intricate component throughout the nursing curricula
in all nursing educational programs.
 The NGNA Core Curriculum for Gerontological Nursing has set the tone for the essentials in
education.
 Educational programs at all levels should add geriatric nursing content with clinical experiences to
enhance nurses’ responsibilities, knowledge, and skills to the practice of nursing.
 Impact of an Aging Population on Gerontologic Nursing
 Nursing practice
 Skills required by nurses
 Ability to teach about safe and effective caregiving and the services and resources available
 Comprehensive knowledge of functional assessment
 Knowledge intervention and management strategies from a rehabilitative perspective
  Lifestyle counseling skills
 Ability to provide anticipatory guidance for psychological reactions to life experience

 Impact of an Aging Population on Gerontologic Nursing

 Nursing research
 Knowledge built through research is imperative for developing a safe and sound knowledge base
that guides clinical practice and for the promotion of the specialty.
 Evidence-based practice
 Result of putting the findings of the research into operational use
 Has the potential to improve care for the older adult

Chapter 2
Theories Related to Care of the Older Adult
 Introduction
 No one definition or theory exists that explains all aspects of aging.
  Several theories may be combined to explain various aspects of the complex phenomena we call aging.
 Biologic, sociologic, and psychologic theories of aging attempt to explain and explore the various
dimensions of aging.
 No single gerontologic nursing theory has been accepted by this specialty.

 Theory of Successful Aging

 Successful aging is “an individual’s perception of a favorable outcome in adapting to the cumulative
physiologic and functional alterations associated with the passage of time, while experiencing spiritual
connectedness, and a sense of meaning and purpose in life.”
 Guides the gerontologic nurse in the provision of mental, physical, and spiritual nursing interventions
aimed at promoting positive coping and successful aging.

 Health Promotion Model

 Comfort Theory
 Comfort is “the immediate experience of being strengthened through having the needs for relief, ease,
and transcendence met in four contexts of experience (physical, psychospiritual, social, and
environmental).”
 The theory recognizes the importance of patient involvement in identifying their needs.
 Comfort is the holistic outcome of nursing interventions.
 Moral Spiritual Development
 Important for the nurse to acknowledge the spiritual dimension of a person and support spiritual
expression and growth
 Spirituality no longer merely denotes religious affiliation; it synthesizes a person’s contemplative
experience.
 Illness, a life crisis, or even the recognition that one’s days on earth are limited may cause a person to
contemplate spirituality.