Exam 1 - Gerontology

Aging Population

Historical Perspectives

  • 1935: Federal Old Age Insurance Law provided financial security.

  • 1960s: Administration on Aging formed; Medicaid (financial) & Medicare (age) introduced (1965).

  • 1972: Supplemental Security Income (SSI) enacted.

  • 1991: Omnibus Budget Reconciliation Act passed.

    • Regulating nursing homes.

Categories of Older Adults

  • Young Old (65-74)

  • Middle Old (75-84)

  • Oldest Old (85+)

  • Centenarians (100+ years)

  • Chronological Age: Based off of your birth. Can not change it.

  • Functional Age: Based off of if you are able to function. Is there limitation or impairments? What level are they able to function at?

  • Perceived Age: Based on how others see you. Some people may look/feel older or younger than they seem.

Population Trends

  • Increasing due to aging baby boomers (65+).

  • Life expectancy: 79.05 years.

    • 76-77 for males and 81 in females.

  • We want to live longer, but want these extra years to be quality.

Income, Employment, and Health Insurance

Income & Employment

  • Many older adults work longer for financial stability.

  • Social Security is often a primary income source, though originally supplemental.

  • Medicare - insurance for older adults

    • Age: 65, unless underlying disability.

    • Used to become eligible when you got your Social Security benefits, but that age has increased.

  • Medicaid - used as a supplement to Medicare; eligibility depends on income, not age.

Medicare Overview

  • Part A: Hospital stays, limited home health/nursing care.

    • inpatient, acute care setting

  • Part B: Comprehensive services (labs, outpatient care, vaccines).

    • covers outpatient care, monthly payments

  • Part C: Private insurance options.

    • Traditional insurance, BCBS.

  • Part D: Prescription drugs.

    • Only medications

Long-Term Care Insurance

  • Covers home care, assisted living, nursing homes.

Implications of Aging Population

  • Increased demand for medical services.

  • Higher service costs.

  • Potentially fewer caregivers available.

  • Changing lifestyle preferences (fitness, stress management).

Theories of Aging

Biological Theories

  • Stochastic Theories: Random aging events (e.g., cellular damage).

  • Nonstochastic Theories: Aging as a pre-programmed process.

Sociologic Theories

  • Focus on societal roles and aging.

Psychological Theories

  • Erikson: Integrity vs. Despair.

  • Peck: Ego/body transcendence vs. preoccupation.

Nursing Theories

  • Functional Consequences Theory: Promote wellness by addressing age-related changes.

  • Theory of Thriving: Harmony between individual and environment.

  • Theory of Successful Aging: Emphasizes physical, mental, spiritual, and self-perception.

Diversity in Aging

  • Older adults are increasingly ethnically and racially diverse.

  • Nurses must deliver culturally appropriate care.

  • Nurses should avoid prejudice and address patient bias professionally.

Life Transitions

Common Transitions

  • Role changes: Parenting, grandparenting, loss of spouse.

  • Retirement phases: Loss of work identity, reduced income.

  • Appearance/abilities: Wrinkles, gray hair, reduced memory and endurance.

Coping Mechanisms

  • Life Review: Reflecting on and sharing experiences.

  • Self-Reflection: Journaling, art, and communication.

  • Inner Resources: Promote independence, boost self-esteem, empower patients.

Historical Context of Gero Nursing

  • 1935: Social Security Act passed—enabled aging individuals to afford care.

  • Early Care: Nursing homes evolved from home-based care provided by women calling themselves nurses.

  • Perception of Gero Nursing:

    • Historically unpopular due to low wages and lack of emphasis in nursing curricula.

    • Seen as inferior to other specialties.

  • Advocacy for Change:

    • 1960s: ANA began advocating for geriatric nursing.

    • 1966: Division of Geriatric Nursing established; recognized as a specialty.

    • 1970: First standards for geriatric nursing practice published.

    • 1975: Gero nurses achieved certification; Journal of Gerontological Nursing launched.

    • 1990s: Hartford Institute for Geriatric Nursing established.

Core Elements of Gerontological Nursing Practice

  1. Evidence-Based Practice (EBP):

    • Includes meta-analysis, cost-analysis, and benchmarking.

  2. Standards:

    • ANA Scope and Standards for Gerontological Nursing Practice.

  3. Competencies:

    • Assess normal vs. abnormal findings.

    • Engage, empower, and advocate for older adults.

  4. Principles:

    • Refer to Box 6-2, Page 82.

  5. Roles in Gero Nursing:

    • Healer: Align care with the body’s natural healing processes.

    • Caregiver: Provide direct care.

    • Educator: Address barriers to learning in older patients.

    • Advocate: Essential for ensuring proper care.

    • Innovator: Develop new methods to enhance care.

  6. Advanced Practice Roles:

    • Nurse practitioners, clinical specialists, nurse clinicians.

    • Improve quality of care and reduce costs.

Future of Gerontological Nursing

  • Focus areas: EBP, research, integrative care, caregiver education, and new role development.

Self-Care for Nurse Healers

  1. Characteristics:

    • Presence, availability, and meaningful connections.

  2. Holistic Care:

    • Definition: Whole-person care addressing physical, emotional, and social needs.

    • Includes health promotion and addressing health challenges.

  3. Health Promotion Needs:

    • Gratification, connection, physiological balance.

  4. Health Challenges:

    • Education, counseling, coordination, therapies, and advocacy.

  5. Requisites for Meeting Needs:

    • Cognitive, physical, and financial abilities, as well as motivation.

Gero Nursing Processes

  • Assessment:

    • Evaluate the ability to meet health promotion/challenge needs.

    • Develop interventions if independence is limited.

  • Case Example: Refer to Mrs. D, Pages 99-105.

Key Takeaways

  1. Gero nursing has evolved significantly and is now recognized as a critical specialty.

  2. Nurses must apply holistic, evidence-based practices and address the unique needs of older adults.

  3. Advocacy, education, and innovation are central to gero nursing success.

  4. Focus on self-care to maintain personal well-being and provide high-quality care.

Laws Governing Practice

  1. Sources of Laws: Public and private, state and local levels.

  2. Scope and Standards: Governed by Scope and Standards of Gerontological Nursing.

Legal Risks in Gerontological Nursing

  1. Malpractice: Ensure proper documentation and adherence to standards of care.

  2. Confidentiality: Protect patient information (HIPAA compliance).

  3. Patient Consent: Always obtain informed consent for treatments.

  4. Patient Competency:

    • Guardianship/Conservatorship: Court-appointed, controls decision-making.

    • Power of Attorney (POA): Legally designated individual to make decisions.

  5. Staff Supervision: Properly monitor and manage subordinates to avoid liability.

Risks in Gero Nursing

  1. Medications:

    • Monitor closely for polypharmacy issues.

  2. Restraints:

    • Use alternatives whenever possible.

    • Never use for staff convenience.

  3. Telephone Orders:

    • Provide all relevant information.

    • Obtain verbal orders, verify by read-back, and ensure physician’s signature within 24 hours.

  4. Do Not Resuscitate (DNR) Orders:

    • Must be a medical order signed by a physician.

    • Requires patient or family consent.

  5. Advance Directives:

    • Developed while the patient is competent.

    • Include:

      • Durable Power of Attorney

      • Living Will

      • Patient Self-Determination Act

  6. Elder Abuse:

    • Forms include physical, emotional, sexual, exploitation, neglect, and abandonment.

Legal Safeguards

  1. Follow state laws, facility policies, and nursing standards.

  2. Monitor employees under your supervision.

  3. Refuse unsafe assignments that risk patient harm.

  4. Use common sense and proper documentation.

Ethical Aspects of Gerontological Nursing

  1. Ethical Standards:

    • Beneficence: Do good for patients.

    • Nonmaleficence: Avoid harm.

    • Justice: Ensure fairness.

    • Fidelity/Veracity: Be truthful and keep promises.

    • Autonomy: Respect patient choices and rights.

    • Confidentiality: Protect patient privacy.

  2. Ethical Dilemmas in Gero Nursing:

    • Expanded roles of nurses.

    • Advances in medical technology.

    • Fiscal constraints in care.

    • Assisted suicide.

    • Managing the growing older adult population.

  3. Making Ethical Decisions:

    • Understand your values and beliefs.

    • Discuss patient wishes with them and their family if appropriate.

    • Collaborate with the healthcare team.

    • Use ethics committees for guidance.

Key Takeaways

  1. Understand legal and ethical guidelines to protect patients and yourself.

  2. Always prioritize informed consent, confidentiality, and patient autonomy.

  3. Stay informed on current laws, ethical standards, and facility policies.

  4. Use a collaborative approach when faced with ethical dilemmas.