Introduction to Gerontological Nursing Health status of the older adult

Although many older adults enjoy good health, most

Aging have at least one chronic illness, and many have
- is a normal process of time related change, begins multiple health conditions. The degree of functionality
with birth and continuous throughout life. is of greater concern to older and nurses than the
- It is a multidimensional process of physical incidence and prevalence of chronic disease.
psychological, and social change
Gerontologic Nursing HISTORY OF GERONTOLOGIC NURSING
- Is the field of nursing that specializes in the care of the
1900 - the need for gerontological nursing specialty
older adults
was identified
- goal of care includes promoting and maintaining,
1966 - specialty was formally recognized, as other
functional status as well as helping older adults identify
specialties in nursing were being formed.
and use their strengths to achieve optimal
1904 - The first article on the nursing of the aged was
independence
published
Demographic profile of Aging 1930 - board and care homes were formed that led to
the development of today’s nursing homes.
Demography 1962 - American Nurses Association (ANA) convened
– is the science dealing with the distribution, density, the first meeting of the Conference Group on Geriatric
and vital statistics of human population. Nursing Practice.
-the statistical study of the size and distribution of 1966 - Division of Geriatric Nursing Practice was
population, is extremely significant in gerontology established, giving nursing of the aged specialty status
Older adults represent an increasingly diverse along with maternal-child health, medical-surgical
population in the United States. The greatest nursing, psychiatric nursing, and community health
growth in the older adult population is for those aged nursing
85 years and older; this population is projected to more 1968 - Laurie Gunter is the first nurse to present a paper
than double from 6 million in 2013 to grow to 14.6 at the International Congress of gerontology in
million in 2040 (Administration on Aging [AoA], Washington, DC
2014). 1969 - First article on nursing curriculum regarding
gerontologic nursing is published (Delora)
-Women have been living longer than men because of 1970 - Standards of geriatric Nursing Practice is first
reduce maternal mortality, decrease death rate from published. First gerontologic clinical nurse specialist
infectious diseases. graduate from Duke University
1976 - The name Geriatric nursing was changed to
-Majority of older women are likely to be poor, live gerontologic nursing practice to reflect the nursing roles
alone, and have a greater degree of functional of providing care to healthy, ill and frail older persons.
impairment and chronic disease. An important issue for 1984 - The division came to be called The Council of
gerontologic nurse. Gerontologic Nursing to encompass issues beyond
clinical practice
Implications of Older increasing older adult 1989 - Certification for Gerontologic Clinical nurse
population specialist was established by ANA
1. The need for more resources for older adults to live
2013 - Difference in acute and primary care were
happy and healthy lives
identified and separate certification examination were
2. More facilities to take of older adults
established by the ANA
3. The need for competent gerontologic nurse
- Generalist in Gerontologic Nursing
- Gerontologic Nurse Practioner (GPN)
- Gerontologic Clinical Nurse Specialist
- Adult-Gerontologic Nurse Specialist
TERMINOLOGIES Gerontophobia
- refers to the fear and the refusal to accept older
Gerontology people into the mainstream of society
- from the Greek geron, meaning “old man”
Ageism
- scientific study of the process of aging and the
- the negative stereotyping of aging and older persons
problems of aged persons
- a belief that aging makes people unattractive,
- includes biologic, sociologic, psychologic, and
unintelligent, and unproductive; it’s an emotional
economic aspects
prejudice
Geriatrics
Age Discrimination
- from the Greek geras, meaning “old age”
- the practice of treating people differently simply
- the branch of medicine that deals with the diseases
because of their age
and problems of old age
- viewed by many nurses as having limited application Chronological Age
to nursing due to its medical and disease orientation - refers to the number of years a person has lived
Geriatric Nursing Physiologic Age
-the nursing care of older people with health problems, - refers to the determination of age by function
or those requiring tertiary care Functional Age
Gerontological Nursing - refers to a person’s ability to contribute to society and
benefit others and himself
- this specialty of nursing involves assessing the health
and functional status of older adults
- the term most often used by nurses specializing in this CHRONOLOGICLA CATEGORIES OF AGE
field
- planning and implementing health care and services to
meet the identified needs and evaluating the
effectiveness of such care
Financial Gerontology
- another emerging subfield that combines knowledge
of financial planning and services with a special
expertise in the needs of older adults
- “the intellectual intersection of two fields, gerontology
and finance, each of which has practitioner and ROLES OF THE GERONTOLOGICAL NURSE
academic components” (Cutler 2004)
1. Provider of care
Social Gerontology
Gives direct, hands-on care to older adults in a variety
-is concerned mainly with the social aspects of aging
of settings
versus the biological and the psychological
- also seeks to understand how the biological processes 2. Teacher
of aging influence the social aspect
Gerontological nurses focus their teaching in modifiable
Gerontological Rehabilitation Nursing risk factors and health promotion
- combines expertise in gerontological nursing with
3. Manager
rehabilitation concepts and practice
- care of older adults with chronic illnesses and long- Gerontological nurses act as managers during everyday
term functional limitation such as stroke, physical practice as they balance the concerns of the patient,
disability, arthritis, amputations family, nursing, and the rest of the interdisciplinary
team
4. Advocate When residents require additional assistance and no
longer able to live independently. This level of care
The gerontological nurse acts on behalf of older adults
provides 24-hour nursing oversight to protect the client
to promote their best interests and strengthen their
from injury and increase the client’s quality of life (Pratt,
autonomy and decision making
2010).
5. Research Consumer
2.c Skilled care units or skilled nursing facilities (SNFs)
Gerontological nurses must remain abreast of current
are designed to provide for the needs of clients whose
research literature, reading and putting into practice
acuity levels require a higher level of nursing care.
results of reliable and valid studies
Gerontological nurses working in SNFs often care for
SETTINGS FOR CARE clients who require tube feedings, intravenous therapy

1. Acute Care 2.d Alzheimer’s disease (AD).

- Older adults are the majority of clients cared for in Units dedicated to the major phases of Alzheimer’s
acute care disease (AD).

- focuses on management of acute problems such as 3. Hospice

trauma, orthopedic injuries and serious circulatory or
Gerontological nurses may also work in care for dying
respiratory problems
clients and their families. The goal of hospice care is to
- Nurses in an acute care setting focus on protecting the provide the client with pain management and with
health of the older adult, with the goal of the older psychosocial and spiritual care through the dying
adult returning to his or her prior level of process
independence.
4. Rehabilitation
2. Long-Term Care Facilities
Nurses working in gerontological rehabilitation often
- is the provision of health care and personal care care for older adults with chronic illnesses and long-
assistance to clients who have a chronic disease or term functional limitations (e.g., orthopedic surgery,
disability (Li & Jensen,2011) stroke, or amputation).
This rehabilitative care may be found in several settings:
- also known as nursing facilities - a new term that acute care hospitals, subacute or transitional care
includes providers of care who are certified by Medicare centers, and long-term care facilities. The role of the
and institutions previously referred to as intermediate nurse is often as a health care coordinator, manager,
care and counselor for older adults and their families
- the individual is referred to as a resident 5. Community settings

Long-Term Care Facilities different levels of care: - Nurses often assess the older client’s needs and then
try to match the need with a community resource
may include assisted living, intermediate care, skilled
care, and Alzheimer’s units 5.a Home health care.

2.a Assisted living Home care is designed for those who are homebound
due to the severity of illness or disability. Services are
Older adults who do not feel safe living alone or provided by a primary care provider and require skilled
require additional help with activities of daily living the or rehabilitation nursing. Research has shown that
assisted living facility provides meals, weekly activities, providing home health services to older adults prevents
and a pleasant environment to socialize with other hospital readmissions
residents
.5.b Nurse-run clinics.
2.b Intermediate care
- These clinics focus on managing chronic illness.
Nurses follow up with either telephone contacts or
home visits within a week after discharge from a
hospital.

5.c Adult day care.

- The older adult may receive adult day care where the
focus is on social activities and health care. Family
caregivers who may need to work during the day or
need some respite from the continual care often use
these services.

Levels of Care and its Goal

1. Aggressive Care Goal: Extension of life

•Interventions : aggressive chemotherapy, invasive

testing, radical surgery

2. Modified Care-Goal: Extension of life with

consideration of the burden of treatment

•Interventions : management of illness with

medications, minimally invasive surgery, noninvasive
testing.

3. Palliative Care

Goal: patient comfort with life extension as secondary

goal

• Interventions : Pain management, symptom control,

gentle rehabilitation, holistic care

4. Hospice Care- Goal: Comfortable death

• Interventions: Pain management, symptom control,

holistic care.
Gerontology Non Stochastic Theories
Goals and levels of care
Programmed theory of Aging
1. Aggressive – extend life of client, chemo
- animals and humans are born with a genetic
therapy, invasive testing, radical surgery
2. Modified – Extension of life with consideration
program or biological clock
of the burden of treatment ex. Management of -
illness with medications Immunity theory
3. Palliative care – Pt’s comfort with life extension - as we age immune system function less effectively
as secondary goal. Pain mgt,, symptom control, -changes in T lymphocytes hence decrease in
gentle rehabilitation . body’s defense against pathogens.
4. Hospice care goal is comfortable death: Pain
mgt, symptom control.
Theories of aging Sociological theories
-To explain aging
Disengagement theory
-To view perspective of aging
- Society and the individual gradually withdraw
-Provide a springboard research
Biological theories
from each other to the mutual satisfaction &
1. Stochastic Theories – cause random cell benefits of both
damage and accumulate overtime - Individual – freed from societal roles& focus on
2. Non-Stochastic Theories – aging series of themselves
predetermined events happening to all - Society –orderly means of transferring of power
organisms in a timed framework to young
Activity Theory
Stochastic Theories - People need to be active if they are to age
Free radical theory successfully
-aging is due to effects of free radicals - remaining active
-damages protein, enzymes and DNA that cells Continuity Theory
cannot regenerate themselves. - Person will continue to be through the
Lipofuscin - a lipoprotein that interferes with remainder of life.
the transport of essential metabolites. - as people age they try to maintain or
Error Theory
continue previous habits, preferences, values and
- AS cells ages various changes occurs naturally
belief
in its DNA and RNA
- Proposes that error can occur in transcription
of synthesis of DNA
-May lead to aging
Wear and tear Theory
-Attribute aging to the repeated use of the body
overtime
-Cells wear out through exposure to internal
and external stressors like trauma, chemicals and
natural wastes

Connective Tissue Theory

- Aka Cross- linking theory
- Protein become increasingly cross linked and may
impede metabolic process
- Involves collagen loss of elasticity, stiffness
- Responsible for failure of tissues and organs Psychological Theories of aging
 HIGH RISK ADOLESCENT
Erik Eriksons theory
Head Injury
- Older adult accept that their life is
Types:
meaningful
- Ego integrity
1.Concussion – severe blow to the head jostles
- Acceptance of ones life as meaningful.
brain, causing it to strike the skull and results in
Peck’s theory
temporary neural dysfunction
-expanded Erik’s theory and focused on
S/S: headache, transient loss of consciousness,
developmental stages
nausea, vomiting, dizziness, irritability
-Body transcendence - Enjoyment of life in
the face of physical discomfort
2. Contusion – results from more severe blow that
-EGO transcendence – older adult focus on
bruises the brain and disrupts neural function
sharing or contributing to next generation.
S/S: neurologic deficits depend on site and
Havighurst Theory
extent of damage
- Task in every stages in life
dec LOC,sensory deficits,hemiplegia
- Disengagement from task of middle age allows
involvement in new roles such as grandparent,
3. Hemorrhage
citizen, friend
a. epidural – blood between dura matter and skull
Newmans theory
laceration of middle meningeal artery during skull
- Coping with the physical changes of aging
fracture blood accumulates rapidly
- Redirecting new activities &roles including
S/S: brief loss of conc, severe headache, vomiting,
retirement, grand[arenting and widowhood
possible seizures
- accepting ones own life.
-Developing a point of view about death.
b. Subdural – blood in the dura and arachnoid
Jungs Theory
venous bleeding that form slowly
-As individuals age they go through a reevaluation
acute, sub acute or chronic
stage at midlife at which point they realize there
S/S: alteration in LOC,headache,
are many things they have not done.
- They question whether decision or choices they
c. Subarachnoid – bleeding in subarachnoid space
have made are right for them.
Human needs Theory
d. Intracerebral – accumulation of blood in the
-Hierarchy of 5 needs motivate human
cerebrum
behavior: physiologic, safety & security, love and
S/S: headache, dec LOC, pupillary dilatation
belongingness, self esteem, an self-actualization.
- Needs are prioritized like physiological
functioning or safety take precedence over
personal growth.

Nursing theories of aging

Functional consequences theory – Environmental;
and biophysical consequences impacts functioning
Theory of thriving – failure to thrive makes them
feel they are not productive for the environment or
for their selves
4. Fractures
ACCIDENTS AND INJURY linear, depressed, comminuted, compound
S/S: leakage of CSF from nose or ear brain swelling
8. Insert FBC as ordered
Diagnostics
1.Skull x ray
Post operative
2.CT scan
1.Maintain a patent airway
Nursing Interventions 2.Check VS and NVS
1.Maintain a patent airway and adequate 3.Monitor fluid and electrolytes
ventilation 4.Assess dressing frequently and report for any
2.Monitor VS and NVS abnormalities
3.Observe for CSF leakage 5. Administer medications as ordered
4.Prevent complications of immobility 6. Apply ice to swollen eyelids, lubricate lids with
5.Prepare client for surgery if indicated petroleum jelly
6.Provide psychologic support to client and family 7.Refer for rehabilitation
7.Client teachings: rehabilitation
Fractures Spinal Cord Injury
Immobilize Common in males
splint Ages – 15 to 25
Causes: motor vehicle, diving in shallow water, falls
Intracranial surgery industrial accidents,sports injuries
Non traumatic – tumors, spina bifida, aneurysms

Types: Classification
1.Craniotomy – surgical opening of skull to gain 1. Extent of injury
access to intracranial structures removal of may affect vertebral column: fracture, dislocation
tumor, evacuate blood clots, control anterior/posterior ligaments – compression of
hemorrhage relieve increased ICP spinal cord spinal cord and its roots
S/S:
2. Craniectomy – excision of a portion of a skull - Complete cord transection – loss of all voluntary
use for decompression movements and sensation below the level of injury
- Incomplete – will depend on damaged
3. Cranioplasty – repair of a cranial defect with a neurological tracts
metal or plastic plate

Nursing Intervention
Pre operative
1.Routine pre op care
2.Provide emotional support
3.Shampoo the scalp and check for signs of
infection
4.Shave hair
5.Evaluate and record baseline vital signs and
neuro checks
2. Level of injury
6. Avoid enema
a. cervical – C1 –C8 ( quadriplegia)
7. Give pre op steroids as ordered – to decrease
- paralysis of all four extremities
 - respiratory paralysis – C6 2. Maintain optimum cardiovascular function
3. Maintain fluid and electrolyte balance and
b. thoracic –lumbar – T1 – L4 nutrition
- paraplegia 4. Maintain immobilization and spinal alignment
- paralysis of the lower half of the body always
involving both legs 5. Prevent complication of immobility
6. Maintain urinary and bowel elimination
3. Mechanisms of injury 7. Monitor temp control
- hyperflexion 8. Observe for and prevent infection
- hyperextension 9. Observe for and prevent stress ulcers
- axial loading – diving accidents
- penetrating wounds
Spinal shock – occurs immediately
- insult to the CNS
- several days to 3 months
-absence of reflexes below the level of the
lesion

Management :
- immobilization and maintenance of normal
spinal alignment to promote fracture healing

1.Horizontal turning frames

1.Stryker frame
2. Skeletal traction
a. cervical tongs
b. halo traction
3. Surgery
a. decompression
b. laminectomy
c. spinal fusion

Nursing intervention – emergency care

1. Assess ABC
2. Quick head to toe assessment
3. Immobilize client

Acute care
1. Maintain optimum respiratory function