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

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

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.  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.  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.  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-21 st 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.  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  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

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.  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.  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.  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

30.  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.  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.  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.  Need to take human aging into consideration  Need to develop a more situation-specific theory of aging to guide practice

34.  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.  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