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Module One Overview – Nursing Care of the Older Adult

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.

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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.

The 1960s and 1970s marked a notable recognition for the need of standards of practice in geriatric nursing, with the creation of the first Standards of Practice for Geriatric Nursing documents in 1969, an effort led by the American Nurses Association.
In the 1970s Medicare and Medicaid programs marked a significant growth within the healthcare industry for the older adult segment. 4. Gerontological Nurse Roles a. Direct hands-on care to older adults in various settings. b. Knowledge of disease processes, medical treatments, rehabilitation and end of life care. c. The 21st century has provided a resurgence in interest in gerontological care. There are several types of nurses that work in this field. d. Older adults often present with atypical symptoms that complicate diagnosis and their plan of care and treatments.
Older adults are high risk for falls. The nurse must assess if they have altered mobility, confusion, malnutrition, polypharmacy.
Skin breakdown - is associated with diagnoses of dementia, osteoporosis, osteomyelitis 5. Gerontological Nurse Credentialing a. Current American Nurses Credentialing Options:
Gerontological Nurse(Registered Nurse Board Certified(RN-BC)
Adult Gerontology Acute Care Nurse Practitioner (AGACNP-BC)
Adult-Gerontology Primary Care Nurse Practitioner (AGAPCNP- BC)
Adult Gerontology Clinical Nurse Specialist b. The certified gerontological nurse holds an active registered nurse license with at least 2 years of full time practice, and has completed clinical practice at least 2000 hours in gerontologic nursing within the last 3 years … 30 contact hours of continuing education applicable to gerontological nursing within the past 3 years is an additional requirement. c. In the US, certification for Gerontological Clinical Nurse Specialist –became available in 1989 by the American Nurses Association d. Current American Nurses Credentialing Options:
Gerontological Nurse (Registered Nurse Board Certified)
Adult Gerontology Acute Care Nurse Practitioner
Adult-Gerontology Primary Care Nurse Practitioner
Adult Gerontology Clinical Nurse Specialist 6. Gerontological Nursing Evolution a. Approximately 85 percent of older adults have at least one chronic health condition.
Arthritis and hypertension been claimed to be the most common.

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

12. Nursing Skills a. The functional abilities of older adults classified as activities of daily living (ADLs) includes bathing, dressing, eating, transferring and toileting along with home management activities such as shopping, cooking, housekeeping, laundry and handling finances. b. These should be assessed by the nurse under systematic assessment measurement tools… these tools are useful to indicate the older adults functional ability and overall degree of health. c. Assessment of the effect of chronic disease and age related declines in functional abilities allow nurses to establish a plan of care more appropriately. It is critical as one is hospitalized to optimize functional ability and independence as much as possible. d. Nurses must have effective assessment skills to recognize subtle cues. Nurses must have excellent communication skills when interacting with older adults especially with sensory deficits.

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