Introduction to Gerontological Nursing – Flashcards
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Gerontology
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Scientific study of the process of aging (biological, physical, psychological, and socioeconomic) and problems of aged persons
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Geriatrics
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Diagnosis and treatment of diseases common in aging; this definition is disease focused
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Gerontological nursing
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-A specialized area of nursing focusing on providing comprehensive care to older adults -Emphasizes the promotion of the highest possible quality of life and wellness
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Older Adulthood
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>Life Course Continuum -Beginning of the END? WE LIVE LONG, so enjoy your life dammit -Individual Variation--Make sure they can live without harming themselves
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Old people
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Depend on religion more than younger! *Pay attention how many people will come visit the patient---you will realize not many come to visit so you need to realize that if you're the only person they saw today you made their day
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Pre-elderly
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ages 55-64 years
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The "young-old"
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ages 65-74
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The "middle-old"
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ages 75-84
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The "old-old"
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ages 85+ LOTS OF CHANGES
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Centenarian
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100 +
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Aging
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-Universal process beginning at birth (only 2 things are guaranteed in life, death and taxes... ok maybe 2 more.... wrinkles and flab )--->rare to see a morbidly obese old person, they lose body fat -Described according to experiences and personal meaning- this differs for everyone -Indicated by physiologic health (what body is going through), psychological well-being (anxious, depressed, sense of doom), socioeconomic factors (money---NO $ for money, food), and the ability to function and socialize (age just isn't a number, as the person's entire life changes as they age so all components must be considered)
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Attitude
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Feeling or emotion toward older persons and the aging process---People have false stereotypes about old people.
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Myth
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Ill-founded belief (+/-) about older persons---Not always sick! Not everyone has these chronic problems.
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Stereotype
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Commonly held standardized mental picture or oversimplified beliefs & attitudes about older persons & the aging process
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Ageism
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Defined as the" prejudices and stereotypes that are applied to older people sheerly on the basis of age" (Butler, 1969)
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ageism persists in the U.S. in spite of legislation prohibiting it- you CANNOT discriminate against individuals because of their age!
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At the present time...
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attitudes should change and ageism should diminish
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As more people live longer, are healthy, and are aging successfully...
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Impact of Ageism
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>Fosters myths & stereotypes >Decreases self esteem of older adults (they realize what they cannot do) >Gerontophobia >Fosters social isolation or dependence >Decreases opportunity for employment
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Impact of Ageism continued...
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>The impact of fewer Milestones to achieve (breakfast, lunch, and dinner, grand kids) >Common Myths: Box 1-1 ---If I am old I am sick ---Old people are set in their ways & cannot learn new things->can learn if they chose to, will probably listen to you more than other patients ---Health promotion is a waste for older people ---Older adults depend on others too much ---Older adults are lonely & isolated ---Older adults have no interest in sex
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65+ Fastest growing segment of our population!
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By 2030, 19% of Americans (1/5) will be...
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85+ years old Largest users of health care
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2010 - 5.8 million 2030 - 8.7 million 2050 - 19 million
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Graying of America
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Increased life expectancy Activist - Knowledgeable - Healthier
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Women
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Single 4.5% Married 44.5% Widowed 39.9% Divorced 11.1%
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Men
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Single 4.1% Married 74.5% Widowed 12.7% Divorced 8.7%
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Other Characteristics
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>Income/Employment >Multigenerational Families >Transcultural Perspectives of Aging ---Subgroups are lumped together ---Care must be culturally appropriate >Health ---Chronic Conditions ---Improved health and functioning
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Health Characteristics
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>Age 65 does not automatically make a person "old!" >Old age is not synonymous with disease! >Fewer acute illnesses >Older adults are not all the same! ---The combined effects of GENETICS, lifelong health habits, medical problems, lifestyle, and environment make elderly persons quite different from one another.
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Health Characteristics continued...
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>Older people today are physically and mentally active MUCH longer than was formerly thought possible >By engaging in healthy habits (i.e., exercise, proper nutrition), older adults can live happy, fulfilling lives >Functional Status ---Ability to carry out basic self-care activities that insure overall health and well being (i.e., ADLs, IADLs)
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Activities of Daily Living (ADLS)
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Bathing Dressing Eating Transferring Toileting Instrumental ADLS - home management Shopping Cooking Laundry Finances
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Demographics and Aging
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>Over the next 20 years 74 million baby boomers will retire. Medicare and Social Security will add 10,000 new retirees per day. >*The old-old are the fastest growing segment of the population*, growing at twice the rate of those 65 and over and 4 times faster than the total U.S. population. This group will triple by 2050. MEDICARE IS #1 health ins. for old people---over 65+ CAN also get MEDICAID if disabled
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Longevity and the Sex Differential
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>Women now comprise the majority of the older population (bless you men you are outnumbered) >In the United States the ratio of men to women over the age of 65 is 49 men to every 100 women >Older women face different socio-economic circumstances >The differences between countries have narrowed over time
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Life After 65
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>Health care has improved so people are living longer than ever before >Increased in the use of preventive services (mammograms, prostate exams, colonoscopies) >People are choosing healthier lifestyles >Medicare has expanded coverage of preventive services >The older adult should be urged to assume more responsibility for healthy aging
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Living Longer or Living Better
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>Quality over Quantity >80% of seniors will have at least 1 chronic health condition >The most common chronic conditions that limit older people include: ---HTN ---Heart Dx ---DM ---Respiratory disorders (pneumonia, flu) KNOW THESE
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Most Common Causes of Disability in the United States
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-DJD -Chronic back pain -Atherosclerosis -Lung or respiratory problems -Deafness or hearing problems -Mental or emotional problems -DM -Blindness or vision problems -Stroke
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How Can YOU Help Improve older persons QOL? Box 1-5
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1. Promote Healthy Lifestyles 2. Encourage Early Detection of Diseases through routine screenings: mammogram, prostate exam 3. Encourage Immunizations: FLU/PNA/Shingles 4. Teach Injury Prevention Methods: do not use RUGS! ON NCLEX, NO RUGS 5. Promote Self-Management Techniques: exercise, pain management
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Healthy People 2020
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>"Healthy People 2020" is the prevention agenda for the United States: ---Establish quality measures; identifying levels of training for people who care for older adults. ---Goal is to: Achieve health equity, eliminate disparities, and improve the health of all groups
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What is a theory?
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>A theory is a broad generalization that explains a body of facts or phenomena. >The analysis of a set of facts in their relation to one another. >The general or abstract principles of a body of fact, a science, or an art.
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Why Study Theories of Aging?
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Theories give order and a perspective from which to view facts They provide a springboard for discussion and research They have Historical Significance They help nurses develop approaches to assessing situations, planning care, and solving problems They attempt to explain various dimensions of aging
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Theories of Aging
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>The study of aging continues to grow and evolve as we learn more >Each body system is affected by aging (some changes start as early as 20-30 years of age) >Some changes associated with aging are benign such as wrinkles and graying of the hair, whereas the buildup of plaque can be harmful KNOW WHAT IS HARMFUL VS. HARMLESS >Modifiable changes can be slowed by healthy lifestyle
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Normal "Aging" Includes Changes in the Following Body Systems:
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Heart: Muscle thickens with age and pumping rate slows Arteries: Stiffen with age Lungs: *Decrease in capacity (up to 40%)* Brain: Looses axons and neurons Kidneys: Become less efficient Bladder: Capacity declines... gotta go, gotta go, gotta go right now....SMALL AMOUNTS/FREQUENT Body Fat: INCREASES throughout life, then slowly decreases as does weight and muscle
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Normal "Aging" Includes Changes in the Following Body Systems:
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>Muscles: Without exercise muscle mass declines >Bones: Have increased mineral loss (the loss outplaces the replacement for WOMEN at age 35 and is accelerated at menopause, so they need CALCIUM to slow bone loss) NEED VITAMIN D to absorb Ca! >Sight: Focus starts to change at age 40 (reading glasses) after age 50 glare sensitivity occurs, and may have trouble adapting to low light levels, at age 70 fine details begin to diminish >Hearing: Difficult to hear higher frequencies (declines more quickly in men than in women) >Personality: Typically DOES NOT CHANGE... whew... 1 good thing to look forward to
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3 Major Theories of Aging
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Biological Psychological Sociological
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Psychological Aging Theories
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Jung's and Erikson's
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Jung's Theory of Individualism
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As a person ages, the shift of focus goes from extroversion to introversion.
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Erikson's Developmental Theory
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Eight stages of life - the older adult, integrity versus despair.
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Theory of Gerotranscendence
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>A shift in perspective, from a materialistic and rational view of the world to a more cosmic and transcendent (religious) one, normally accompanied by an increase in life satisfaction >Regarded as the final stage in a natural progression towards maturation and wisdom >Shift occurs from egoism to altruism
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Spirituality
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>Religious practice and beliefs are a source of psychological help and health benefits to many individuals >Human beings seek to explain and validate their existence in the world >It is important for the nurse to acknowledge the spiritual dimension of a person and support spiritual expression and growth >Nurses need to address spirituality as an important component of care
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PROFESSIONAL ORIGINS
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1966 - Division of Geriatric Nursing Practice established 1969 - Standards of Practice for Geriatric Nursing completed by ANA 1981 - ANA formally defined gerontological nursing 1987 - Standards and Scope of Gerontological Nursing Practice published Professional Journals
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EDUCATION/ROLES
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>Generalist ---Basic Entry Level (BSN) ---Certification Exam >Advanced Practice ---Gerontological Nurse Practitioner -----MSN -----Clinical Supervision of physician -----Prescriptive Authority >Gerontological Clinical Nurse Specialist (CNS) ---MSN ---Advanced knowledge; Clinical Expertise >Clinician, Educator, Consultant, Administrator, Researcher ---MSN, DNS, PhD
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What is QSEN?
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>QSEN (Quality & Safety Education for Nurses) >Goal of QSEN is to prepare nurses so that they have the knowledge, skills, and attitudes necessary to improve the quality and safety of the healthcare system in which they work >Nursing care should be based upon current research evidence (evidence-based practice) >*Individual (and realistic) goals should be developed for each patient!!!!* Improvement of patient safety is a prime area of concern!
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Nursing DX and the Elderly: What's different?
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>The actual wording of the Nursing Diagnosis does not change because the person is older.... The way in which you select the *priority* diagnosis however may.... >For example: An elderly patient has Type II DM and has a H/O good BG control. Now he is testing his BG levels less frequently and is not administering insulin properly. Risk for Unstable Blood Glucose Level is an appropriate nursing diagnosis, however Ineffective Health Maintenance also applies....
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Nursing DX and the Elderly: What's different?
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>When selecting appropriate Nursing DX, you MUST Focus on the problems with HIGHEST priority: >Ask yourself... ---What can Immediately have a (-) impact on this patient ---What is of MOST concern to the patient or their family ---What may (-) affect function and QOL ---Use the above questions to help guide your selection
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Care Plans and the Elderly": What's different?
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>You MUST select REALISTIC & ATTAINABLE Goals (don't set them up for failure) >>Asking an elderly patient who just had a hip replacement to ambulate 2000 ft in the hallway TID is NOT realistic Overzealous yes, realistic NO >>The overall goals of nursing care in older adults includes: ---Influencing thier health outcomes ---Improving or maintaining health status ---Providing comfort care at the end of life
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Care Plan WORDS to AVOID
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>Only use *MEASURABLE* verbs when establishing your patient's goals >For example: ---States ---Performs ---Identifies ---Increases/Decreases ---Specifies ---Administers ---Avoid Accepts, Knows, Appreciates, and Understands b/cuz you cannot measure these....
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Selecting Appropriate Interventions
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>ALWAYS collaborate with the patient & their family when selecting interventions (they know what they can and cannot do, and most older adults are NOT lazy so they will do what you ask them to... Talk to your patient ) What do you want to improve on? What are you able to do? >Select appropriate interventions based upon: Needs Desires Resources
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Selecting Appropriate Interventions
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>Appropriate Interventions for the Older Adult Include: -Assisting them to a higher level of function or *self-care: THEY NEVER WANT TO LOSE INDEPENDENCE* -Identifying health promotion activities -Identifying disease prevention and screening activities -Providing necessary counseling -Seeking appropriate consultations -Implementing palliative care in the seriously ill patient
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Common Healthcare Settings for Older Adults
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>Know the difference between the following: ---Skilled Nursing Care: may be in a hospital or in a nursing home setting, care is delivered by licensed nurses, covered by insurance ---Retirement Communities: include independent living apartments, assisted living apartments, and nursing homes (typically private pay) ---Adult Day Care: for those who require daytime supervision (paid for privately) ---Rehabilitation Hospitals: special facilities that provide care to patients with complex needs, covered by insurance
