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Module One Overview – Nursing Care of the Older Adult
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1. History and Evolution
a. Older adults are one of the largest group of patients in acute care,
long term care facilities, and rehabilitation facilities.
b. As Baby Boomers age and the number of people living longer
increases, the need for those with an aging expertise grows.
c. The field of gerontological nursing has evolved over the past
decades and its specialty is in greater demand more now than
ever before.
d. The history and evolution of gerontological nursing encompasses
major milestones from the day of primary care or private duty
nursing to acute care and now a shift to community based care.
e. The Nursing Competence in Aging initiative advocated for all
nurses to have greater knowledge, skills, and broader attitudes
toward the older adult primarily due to the prevalence and incidence
of chronic health and functional issues in older adult clientele.
f. The provision of quality healthcare and the complexities of the
older adult are ever growing challenges for the healthcare system.
g. Present day gerontological nursing
1. The present day of geriatrics as a specialized science,
has never presented a more opportune time to embrace
gerontological nursing as the healthcare system has
considerably shifted due to increased life expectancies, the
aging of the baby boomer population, increased complexities
and rise of chronic disease in older adult client care.
2. Nurses can expect to care for a large number geriatric
patients in every clinical setting over the next decades.
3. Nurses are in prime positions to manage the
complexities of older adult client care and to promote health,
wellness and disease prevention Efforts should be directed
toward health prevention, health screening, and health
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1. History and Evolution a. Older adults are one of the largest group of patients in acute care, long term care facilities, and rehabilitation facilities. b. As Baby Boomers age and the number of people living longer increases, the need for those with an aging expertise grows. c. The field of gerontological nursing has evolved over the past decades and its specialty is in greater demand more now than ever before. d. The history and evolution of gerontological nursing encompasses major milestones from the day of primary care or private duty nursing to acute care and now a shift to community based care. e. The Nursing Competence in Aging initiative advocated for all nurses to have greater knowledge, skills, and broader attitudes toward the older adult primarily due to the prevalence and incidence of chronic health and functional issues in older adult clientele. f. The provision of quality healthcare and the complexities of the older adult are ever growing challenges for the healthcare system. g. Present day gerontological nursing 1. The present day of geriatrics as a specialized science, has never presented a more opportune time to embrace gerontological nursing as the healthcare system has considerably shifted due to increased life expectancies, the aging of the baby boomer population, increased complexities and rise of chronic disease in older adult client care. 2. Nurses can expect to care for a large number geriatric patients in every clinical setting over the next decades. 3. Nurses are in prime positions to manage the complexities of older adult client care and to promote health, wellness and disease prevention Efforts should be directed toward health prevention, health screening, and health

maintenance and health promotion.

2. Older Adult Terminology a. The terms Gerontology, Geriatrics and Gerontological nursing are often used interchangeably, but there are distinct differences between the three. b. Gerontology - study of social, cultural, psychological, cognitive, economic and biological aspects of aging. c. Geriatrics - Specialty that focuses on healthcare of elderly people specific to disease and illness. d. Gerontological Nursing - Specialty that involves assessment, planning, implementing and evaluating care in older adult. 3. History of Gerontological Standards a. Rise in certifications and specialties of older adult care. b. Creation of Scope of Practice and Standards of Gerontological Nursing practice. 1. Although nurses published articles about the care of older adults as early as 1904, the specialty of gerontological nursing really began to emerge beginning in the 1950s.

Specialist –became available in 1989 by the American Nurses Association d. Current American Nurses Credentialing Options:

  1. Gerontological Nurse (Registered Nurse Board Certified)
  2. Adult Gerontology Acute Care Nurse Practitioner
  3. Adult-Gerontology Primary Care Nurse Practitioner
  4. Adult Gerontology Clinical Nurse Specialist 6. Gerontological Nursing Evolution a. Approximately 85 percent of older adults have at least one chronic health condition.
  5. Arthritis and hypertension been claimed to be the most common.
  1. Most deaths in the older adult population stem from heart disease, lung cancer, COPD, accidents, strokes, Alzheimer’s disease, diabetes, influenza/pneumonia, kidney disease and suicide. b. Approximately 60 percent have at least two chronic conditions
  2. Coping with multiple chronic conditions is a real challenge. Learning to manage a variety of treatments while maintaining quality of life can be problematic.
  3. Clinicians play an important role in educating patients and families about chronic health conditions.
  4. Connect clients with appropriate community resources and services. c. Nurses in a wide variety of settings and roles will be challenged to provide care to an increasingly diverse and complex group of older adults. 7. Older Adult Trends a. Older adults are the fastest growing segment of the population and living longer. b. There has been a steady increase in the aging population as people are living longer and the baby boomer generation most significantly is aging and at the point of retirement.
  5. Baby boomers are those individuals born between 1946 and 1964 and are the population most concerning within the healthcare arena.
  6. Expected rises in average individual Medicare spending is relevant to the baby boomers using healthcare
  7. By 2029, when all of the baby boomers will be 65 years and over, more than 20 percent of the total U.S. population will be over the age of
  8. Although the number of baby boomers will decline through mortality, this shift toward an increasingly older population is expected to endure.
  9. By 2056, the population 65 years and over is projected to become larger than the population under 18 years. 8. Demographic Trends a. Gerontological concerns extend and influence provision of

g. Although the majority of older adults are more financially secure than they were in previous generations, poverty affects a significant section of the older population. More than 4.2 million older adults were living below the poverty level with race and gender having significant influence as of 2014.

9. Older Adults in the Community a. Older adults prefer to live in their own homes and communities. b. Older adults are less likely to change residencies compared to other age groups. c. Many older adults live alone or with family members or perhaps with a caregiver. d. Older adults who live alone may require additional homecare and many live in assisted living communities, group homes, or long term care. 10.Negative Attitudes Toward Older Adults a. Ageism 1. A common term used associated with negative attitudes toward older adults. 2. The stereotyping and discrimination against individuals or groups on the basis of their age 11.Nursing Considerations a. To promote health and wellness of the older adult, Gerontological nurses must have effective teaching skills in order to educate the older adult, their family and/or caregivers about safe and effective health techniques, lifestyle changes, functional health, life transitions and as well as disease processes, community and service resources. b. Psychological, social, environmental and economic needs of the older adult client must be given equal consideration to presenting physical needs as well c. Gerontological nurses must strengthen their delegation skills as unlicensed Assistive Personnel (UAP) are used in select settings to assist with the high demands associated with older adult care. d. The ideal environment for living is the older adults own home. Recent economic, governmental and technological advancements have enabled more acutely ill clients to be discharged sooner and monitored at home.

e. Fundamental knowledge and skills related to nursing older patients: the ageing process, understanding the impact of life transitions, recognizing to an older person’s perspective on their health care needs, nursing assessment and care planning, communication with patients some of whom may have cognitive impairment and/or deficits in sight or hearing, encouraging participation and involvement of older people. Enabling patients to maintain their normal activities of daily living, identifying and meeting nutritional needs, management of incontinence and constipation, rehabilitation and mobilization, medication management, including self-medication relative to polypharmacy. f. The major risk of polypharmacy for the older adult is being treated by more than one physician