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Chapter 1

Overview of Gerontologic 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.

Foundations of the Specialty of Gerontologic Nursing (1 of 2)

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

Foundations of the Specialty of Gerontologic Nursing (2 of 2)

1969

ANA Division of Geriatric Nursing Practice completed the first Standards of Practice for Geriatric Nursing.

1976

Standards revised; name changed to Standards of Gerontological Nursing Practice

1981

ANA published A Statement on the Scope of Gerontological Nursing Practice; revised in 2010

Incorporates concepts of health promotion, health maintenance, disease prevention, and self-care

Standards of Practice

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

Nursing Roles

Geriatrics

Gerontology

Gerontologic nursing

Gerontic nursing

Terminology

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 (1 of 2)

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.

Demographics of the Older Population (2 of 2)

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

Profile Highlights

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.

Gender Differences

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.

Marital Status

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.

Race and Ethnicity

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.

Living Arrangements

Education level is steadily increasing.

1970 and 2016: Increase of adults that had completed high school, from 28% to 85%

2016: 28% had gone to college for at least 4 years.

Low levels of education can impair the ability:

To live a healthy lifestyle

To access service and benefit programs

To recognize health problems and seek appropriate care

To follow recommendations for care

Education

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.

Income

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).

Employment

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.

Health Status of Older Adults

The degree of functional ability is of greater concern than the incidence and prevalence of chronic disease.

Functional ability is the capacity to carry out the basic self-care activities that ensure overall health and well-being.

Improving the health and functional status of older adults may delay the onset of physical frailty and cognitive impairment.

Decrease the likelihood of institutionalization

Functional Status (1 of 2)

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

Functional Status (2 of 2)

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

Health Care Expenditure and Use

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.

Affordable Care Act (ACA) of 2010

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

Implications for Health Care Delivery

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 (1 of 3)

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 (2 of 3)

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

Impact of an Aging Population on Gerontologic Nursing (3 of 3)