Bonnie M. Wivell, MS, RN, CNS


An encompassing view of the care of older
adults (Mauk, pg. 5)
Providing both physical and emotional
support in addition to respectful care

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





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








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






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




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





Provider of care
Teacher
Manager
Advocate
Research Consumer


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


Scope and standards of practice
Core Competencies – review pg. 15

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


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
Bonnie M. Wivell, MS, RN, CNS




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-21st century, old people will
outnumber young for the first time in history





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



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




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





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


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
Heart disease and cancer are two top causes of
death, regardless of age, race, gender or ethnicity
 Diabetes

 5th leading cause of death among black men
 4th leading cause among Hispanic men
 4th leading cause of death for Hispanic and black women
65 or older
 6th among white men and men of Asian or Pacific Islander
origin
 7th leading cause of death for white women 65 or older


Increases with age
4 leading causes of death
 Heart disease
 Stroke
 Cancer
 DM

Sensory impairments and oral health
problems more frequent




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



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


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
Bonnie M. Wivell, MS, RN, CNS






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



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
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

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.
 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

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


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
Nursing’s role is to minimize age-associated
disability in order to enhance safety and
quality of living


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