INTRODUCTION
TO
GERONTOLOGICAL
NURSING
WHAT IS GERONTOLOGICAL
NURSING?
• Nursing sub-specialty for older patients
• Used to be called GERIATRIC NURSING
GERONTOLOGICAL NURSING VS
GERIATRIC NURSING
• Gerontological Nursing
– study of aging or the aged (old people)
• Geriatric Nursing
– medical care of the aged
GERONTOLOGICAL NURSING
• The history and development of Gerontological Nursing is rich in diversity and
experiences
• Focus is on increasing life expectancy
• Increasing numbers of acute & chronic health conditions
• Nurses provide disease prevention & health promotion
• Promote positive aging
HISTORY
• Specialty formed in the early 1960’s by ANA
• Standards for Geriatric Practice;Veterans Administration funded GRECC’s at VA
medical centers (1970’s)
• Establishment of NGNA & Scope and Standards of Gerontological Nursing
Practice (1980’s)
• Established Hartford Foundation Institute of Geriatric Nursing at NYU Division of
Nursing (1990’s)
PIONEERS IN GERONTOLOGICAL
NURSING
• Florence Nightingale
- first geriatric nurse
- Care of Sick Gentlewomen in Distressed Circumstances
PIONEERS IN GERONTOLOGICAL
NURSING
• Doreen Norton
- focused career on care of the aged
- described advantages of learning geriatric care in basic education
- Learning patience, tolerance, understanding and basic nursing skills
- Witnessing the terminal stages of disease and importance of skilled
nursing care
- Preparing for the future
- Recognizing the importance of rehabilitation
- Being aware of the need to undertake research
DEFINITIONS
• Gerontology
• Geriatrics
• Ageism
• Gerontological nursing
• Old
• Cultural terms: elder, senior, older adult, elderly
DEFINITION OF “OLD”
• Chronological age
– young-old: 65 - 74
– middle-old: 75 - 84
– old-old (frail elderly): 85+
• Biological age
PREVIOUS STEREOTYPES OF THE OLD
• Television
• Media
• Newspapers
• Film industry
• Commercials in magazines and on TV
• Greeting card/birthday cards
ROLES OF THE GERONTOLOGICAL
NURSE
• Provider of Care
• Teacher
• Manager
• Advocate
• Research Consumer
SCOPE AND STANDARDS OF
GERONTOLOGICAL NURSING PRACTICE
• SCOPE
–
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–
–
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Assessment
Diagnosis
Outcome Identification
Planning
Implementation
Evaluation
• STANDARDS
–
–
–
–
–
–
–
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Quality of Care
Performance Appraisals
Education
Collegiality
Ethics
Collaboration
Research
Research Utilization
PRACTICE SETTINGS
• Acute Care Hospital
• Rehabilitation
• Long-Term Care
• Community
– Assisted Living
– Intermediate Care
– Subacute or Transitional Care
– Skilled Care
– Alzheimer’s Care
– Hospice
–
–
–
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Home Health Care
Foster Care or Group Homes
Independent Living
Adult Day Care
CONTINUUM OF CARE
• Acute Care Hospitals
– Often the point of entry into the healthcare system
– Nurses care for older adults
– Admits older people except in L&D, post-partum & pediatrics
• Acute Rehabilitation
– Found in several settings including acute care hospitals, subacute care (transitional
care), & LTCF’s
– Goals are to maximize independence, promote maximal function, prevent
complications, & promote quality of life within a person’s strengths & limitations
CONTINUUM OF CARE
• Home Health Care
– For home-bound due to severity of illness or immobility
– Usually done by a visiting nurse
• Long Term Care Facility
– Referred to as nursing homes
– Provides support to persons of any age who lost some or all capacity for self-care
– Nurses provide planning & oversee residents
– Maintain the functional & nutritional status of residents while preventing
complications of impaired mobility
CONTINUUM OF CARE
• Hospice
– To care for the dying and their families
– Centered on holistic, interdisciplinary care to help the dying “live until they
die”
– Provide quality care until the last months, weeks, days or hours of their life
• Respite Care
– Provides care to give caregivers a break
– Can be done in a daycare center, at home, or ALF’s
CONTINUUM OF CARE
• Continuing Care Retirement Community (CCRC)
– Provides continuum of care from independent living to skilled care all
within a single campus, with levels of care adjusted to individual needs
– Patients can move seamlessly among independent living, assisted living,
skilled care, or long term care as their condition warrants
CONTINUUM OF CARE
• Assisted Living Facilities
– Alternative for those who don’t feel safe being alone
– For those who needs help with ADL’s
– May be connected to a LTCF
– Provides healthy meals, planned activities, places to walk & exercise, and
pleasant surroundings
CONTINUUM OF CARE
• Foster Care or Group Homes
– For those who can do ADL’s but with issues safety that requires
supervision
– Offers more personalized supervision in a smaller, more family-like
environment
• Green House Concept
– Primary purpose is to serve as a place where elders can receive assistance
and support with ADL’s & clinical care without the assistance becoming the
focus of existence
– Older people retain control of ADL’s
CONTINUUM OF CARE
• Adult Daycare
– For older adults who are unable to remain at home unsupervised
– Used by family members who care for the older person in their homes
– Community based program designed to meet the needs of functionally
and/or cognitively impaired adults through individual plan of care in
protective setting
– Programs may be sponsored to provide socialization, meals, & therapeutic
activities
DEMOGRAPHICS
OF AGING IN THE
PHILIPPINES
PHILIPPINE DEMOGRAPHICS
• 2018: 8,013,059 Filipinos over 60 years old
(8.2%)
–5,082,049 will be 65 years old and older
PHILIPPINE DEMOGRAPHICS
• PROJECTIONS
• Philippines will enjoy the benefits of a young population until 2030
• Growth: 4.9% (2020)
5.6% (2025)
6.3% (2030)
PHILIPPINE DEMOGRAPHICS
• Increased life expectancy
Average age: 68.5 (2017) to 74 (2018)
• Fertility
MORTALITY AND MORBIDITY IN
OLDER ADULTS
• Cardiovascular diseases, all forms
18.56%
• Pneumonia
6.21%
• Malignant neoplasms, all forms
5.11%
• COPD
3.42%
• Tuberculosis, all forms
3.04%
• Diabetes mellitus
2.74%
• GI ulcers & other GI diseases
1.42%
• Nephritis, nephrotic syndrome, nephrosis
1.19%
• Accidents and injuries
0.98%
• Chronic liver diseases & cirrhosis
0.55%
THEORIES OF
AGING
SOCIOLOGICAL THEORIES
• Changing roles, relationships, status and
generational cohort impact the older adult’s
ability to adapt.
SOCIOLOGICAL THEORIES
• Activity Theory
– Havighurst and Albrecht (1953)
– Conceptualized activity engagement & positive adaptation to
aging
– Remaining occupied and involved is a necessary ingredient to
satisfying late life
– Associates activity as a means to prolong middle age & delay the
negative effects of old-age
SOCIOLOGICAL THEORIES
• Disengagement Theory
– Cumming & Henry (1961)
– Contrast to activity theory
– Conceptualized that aging is characterized by gradual disengagement
from society and relationship
– Withdrawal from society & relationship serves to maintain social
equilibrium & promote internal reflection
– Outcome is a new equilibrium ideally satisfying to both individual and
society
SOCIOLOGICAL THEORIES
• Subculture Theory
– Rose (1965)
– Views older adults as a unique subculture within society formed as a
defensive response to society’s negative attitudes & the loss of status that
accompanies aging
– Conceptualized that the elderly prefer to segregate from society in an
aging subculture sharing loss of status and societal negativity regarding the
aged.
– Health and mobility are key determinants of social status
SOCIOLOGICAL THEORIES
• Continuity Theory
– Havighurst, Neugarten & Tobin (1968)
– Suggests that personality is well-developed by the time one
reaches old-age & tends to remain consistent across life span
– Past coping patterns occur as older adults adjust to physical,
financial, & social decline and contemplate death
SOCIOLOGICAL THEORIES
• Age Stratification Theory
– Riley and associates (1972)
– Society is stratified by age groups that are the basis for acquiring
resources, roles, status, & deference from others.
– Age cohorts are influenced by their historical contexts& share
similar experiences, beliefs, attitudes, & expectations of life
course transitions
SOCIOLOGICAL THEORIES
• Person-Environment Fit Theory
– Lawton (1982)
– Introduced functional competence in relationship to the environment
– Conceptualized that function is affected by ego strength, mobility, health,
cognition, sensory perception & the environment
– Competency changes one’s ability to adapt to environmental needs
SOCIOLOGICAL THEORIES
• Gerotranscendence Theory
– Tornstam (1994)
– Proposed that aging individuals undergo a cognitive transformation from a
materialistic, rational perspective toward oneness with the universe
– Successful transformations include a more outward or external focus,
accepting impending death without fear, an emphasis of substantive
relatiionships, intergenerational connectedness & spiritual unity with the
universe
– Activity & participation must be the result of one’s own choices which
differs from one person to another, & control over one’s life in all situation
is essential for the person’s adaptation to aging
PSYCHOLOGICAL THEORIES
• Explain aging in terms of mental processes,
emotions, attitudes, motivation and personality
development that is characterized by life stage
transitions
PSYCHOLOGICAL THEORIES
• Human Needs Theory
– Maslow (1954)
– Five basic needs motivate human behavior in a life-long process
toward need fulfilment
– The needs are prioritized such that more basic needs take
precedence before the complex need
PSYCHOLOGICAL THEORIES
• Theory of Individualism
– Jung (1960)
– Personality consists of an ego and personal and collective
unconsciousness that views life from a personal or external
perspective. Older adults search for life meaning & adapt to
functional & social losses
PSYCHOLOGICAL THEORIES
• Stages of Personality Development
– Erikson (1963)
– Personality develops in 8 sequential stages with corresponding
life tasks. The 8th phase, Integrity vs. Despair, is characterized by
evaluating life accomplishments; struggles including letting go,
accepting care, detachment, & physical & mental decline
– Peck (1968) refined the 8th phase into three challenges
• Ego differentiation vs. work role reoccupation
• Body transcendence vs. body preoccupation
• Ego transcendence vs. ego preoccupation
PSYCHOLOGICAL THEORIES
• Life Course (Life Span) Paradigm
– Bühler (1933)
– Blend key elements in psychological theories (life stages, tasks, &
personality development) with sociological concepts (role
behavior & interrelationship between individual & society)
– Life course is unique to each individual
– Divided into stages with predictable patterns
– Structured based on one’s role, relationships, internal values, &
goals
– Goal achievement is associated with life satisfaction
PSYCHOLOGICAL THEORIES
• Selective Optimization with Compensation
Theory
–Baltes (1987)
–Individual copes with the functional losses of aging
through activity/role selection, optimization, &
compensation
–Critical life points are morbidity, mortality, & quality of
life
–Facilitates successful aging
BIOLOGICAL THEORIES
• Stochastic Theories
– Based on random events that cause cellular damage that
accumulates as organism ages
• Nonstochastic Theories
– Based on genetically programmed events caused by cellular
damage that accelerates aging of the organism
BIOLOGICAL THEORIES (S)
• Free Radical Theory
– Membranes, nucleic acids, and proteins are damaged by free
radicals which causes cellular injury and aging
• Orgel/Error Theory
– Errors in DNA and RNA synthesis occur with aging
BIOLOGICAL THEORIES (S)
• Wear & Tear Theory
– Cells wear out and cannot function with aging
• Connective Tissue/Cross-Link Theory
– With aging proteins impede metabolic processes and cause
trouble with getting nutrients to cells and removing cellular
waste products
BIOLOGICAL THEORIES (NS)
• Programmed Theory
– Cells divide until they are no longer able to; this triggers
apoptosis or cell death
• Gene/Biological Clock Theory
– Cells have a genetic programmed aging code
BIOLOGICAL THEORIES (NS)
• Neuroendocrine Theory
– Problems with the Hypothalamus-Pituitary-Endocrine Gland
Feedback System causes disease; increased insulin growth factor
increase aging
• Immunological Theory
– Aging is due to faulty immunological function which is linked to
general well being
NURSING THEORIES OF AGING
• Functional Consequences Theory
– Environmental and biopsychosocial consequences impact
functioning. Nursing’s role is to minimize age-associated
disability in order to enhance safety and quality of living
• Theory of Thriving
– Failure to thrive results from a discord between the individual
and his or her environment or relationships. Nurses identify and
modify factors that contribute to disharmony among these
elements