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Nursing Care of the Older Adult Week 1

by: Brittany Nicole

Nursing Care of the Older Adult Week 1 473

Marketplace > Adelphi University > Nursing and Health Sciences > 473 > Nursing Care of the Older Adult Week 1
Brittany Nicole
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week 1 topics
Nursing Care of the Older Adult
Class Notes
Nursing, older, adult, development, care, Management, quality, Erik Erikson, Healthy Lifestyles, developmental, Psychology




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This 8 page Class Notes was uploaded by Brittany Nicole on Wednesday September 7, 2016. The Class Notes belongs to 473 at Adelphi University taught by N.Joseph in Fall 2016. Since its upload, it has received 3 views. For similar materials see Nursing Care of the Older Adult in Nursing and Health Sciences at Adelphi University.

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Date Created: 09/07/16
Week 1 Notes Nursing Care of the Older Adult Chapter 1: Intro to Healthy Aging  There is an increasing number of elderly  Population of 65 years and older is growing and is expected to keep growing Three groups of “old”  Young old – 65-75 yrs  Middle old - 75-84 yrs  Old old – over 85 yrs  Supercentarians – over 110 years Healthy Aging  Wellness – involves whole individual. Includes physical, emotional, mental, and spiritual aspects of a person.  Maximizing the potential the person is capable of within the environment he or she is functioning in.  Wellness is achieved through hard work and effort. It is related to functional ability not just the absence of disease.  Health crisis can be seen as a potential for growth of a person.  Preventative services promote wellness (flu vaccine, breast cancer screening, wellness visits). Health Status of Older Adults  Old age is NOT synonymous with disease  A person may be considered healthy and well to some degree on a health-illness continuum with disease or disability.  Many persons over age of 65 years have at least one chronic condition, many have multiple conditions.  Because of technology and teaching, older people are healthier, better educated, and can expect a higher quality of life now as compared to aging in the past. Maslow’s Hierarchy of Needs  Basic, psychological, and self-fulfillment Health People 2020 Emerging Issues in the Health of Older Adults  To help older adults manage on their own  Establishment of quality measures  Identification of minimum training for those who are taking care of older adults  Research and training to further equip providers with tools to meet the needs of the older adult population The nurse can empower, enhance, and support a persons achievement of wellness through knowledge and affirmation. Chapter 2: Gerontological Nursing History, Education, and Roles Key Issues:  By 2050, it is expected that 1 in 5 Americans will be over 65 years old, with over 85 years as the greatest number.  We can expect to spend 40 years as an older adult  Individuals living to 100 will grow at more than 20 times the population by 2050  Eldercare is the fastest growing sector of the healthcare industry  Eldercare workforce in America is understaffed  Less than 1% of nurses and 3% of APRN’s are certified in gerontology  Geriatric medicine and other health care professions face similar challenges in this way History of Gerontological Nursing  Florence Nightingale – Institution for the Care of Sick Gentlewomen in Distressed Circumstances  Almshouses in America – destitute for older people. Insufferable places with bad conditions, neglect, poor care, suffering, and contagion.  Lavinia Dock – Addressed the needs of the elderly in almshouses in 1908.  1912 ANA appointed an Almshouse Committee to oversee nursing in Almshouses  1925 ANA proposed a specialty in nursing care of the elderly  1935 – Social Security Act passed – Provided insurance and public assistance for older adults in need  1940 - 2 nursing journals described centers of excellence for geriatric care – Cuyahoga County Home in Ohio and Hebrew Home for the Aged in NY  1943 – AJN article recommends nurses have specific geriatric education  1950 – 1 textbook on nursing care of the elderly  1966 – ANA formed Division of Geriatric Nursing  1968 – First set of Geriatric Standards published by ANA and soon after geriatric certification  1976 – ANA changed name to Gerontological Nursing Division  Mid 70’s – Certificate and Masters programs started for NPs with funding from Dept. of Health, Education, and Welfare.  1984 – Council of Gerontological Nursing formed and certification for Geriatric NPs and Geriatric Clinical Nurse Specialists established  1996 – Hartford Institute for Geriatric Nursing – College of Nursing at NYU to promote gerontological excellence to the nursing profession and community  Nurse Competence in Aging (NCA) Project ensures geriatric competencies among nurse specialty organizations  Geriatric Nurse Leadership Academy (GNLA) – grant awarded to STTI (Sigma Theta Tau International) to develop leadership skills of geriatric nurses in positions of influence in health care settings Nursing Education  Educational competencies and academic standards developed by AACN (American Association of College of Nursing) for basic and advanced education nursing.  Geriatric skills and experiences are needed by the student in clinical. Includes community care, home-care, long term care, and acute care.  Staff with geriatric expertise and certification are scarce  Resources:  GNEC – Geriatric Nursing Education Consortium initiative from AACN, enhance geriatric content  ACES – Advancing Care Excellence for Seniors  BAGNC – Building Geriatric Nursing Capacity and Fellows Award Program – scholarships and fellowships for research, faculty development. Increasing interest Gerontological Nursing Research Investigates:  Interventions for improving care of those with dementia  Fall reduction, use of restraints, pain management, delirium, care transitions, end-of-life care. Roles for Gerontological Nurse  Specialist Roles  Advanced Practice RNs  Adult Gerontology Acute Care Nurse Practitioner  Adult Gerontology Primary Care Nurse Practitioner  Have Prescriptive privileges, certified and licensed  Generalist Roles  Direct Care Provider  Care Managers  Discharge Planners  Traditional Care Coordinators  Administrators  Educators Nursing Roles: Generalist RN with certification in Gerontology  Recognizes excellence and in voluntary  An additional credential granted to a practicing RN  Requires 2000 hours of practice in gerontologic nursing within 3 years  30 contact hours of continuing education applicable to gerontology/gerontologic nursing within 3 years Gerontologic Nurse Practitioner (GNP)  Masters, postmasters, or doctorate degree from a gerontologic nurse practitioner program with 500 supervised clinical hours  Nursing process to detect and manage acute and chronic health conditions  Collaborates health care team in ambulatory, acute, sub-acute, and long term care settings  Can provide ambulatory care in private practice or group practice  Acute care NPs manage patients in a hospital  Prescriptive authority in many states, can bill for services in many states Types of Health Care Settings  Acute care, skilled nursing facilities, long term care, rehab, community, home care. Gerontology Organizations  Multi-disciplinary and General  Gerontology Society of America – interdisciplinary collaboration in research  American Society of Aging – multidisciplinary collaboration  Association for Gerontology in Higher Education  National Council on Aging  Nursing  National Gerontological Nursing Association  Gerontological Advanced Practice Nurse Association  National Association of Directors of Long-term Care Health Facilities  American Association for Long-term Care Nurses  National Association of Geriatric Nurse Assistants Theories of Aging  Changes are intrinsic, extrinsic, and some can be beneficial.  Triggers or aging influenced by genetics, injury, or abuse of the body. Human Aging – begins at conception, varies upon individuals. Senescence – change with aging, lead to decreased survival and adjustment. Error (Stochastic) Theories  Aging as the result of an accumulation of errors in the synthesis of cellular DNA and RNA. More errors occur until the cell is no longer able to function.  Were & Tear Theory - Cell errors as the result of “wearing out”  Cross-Link Theory – error by cross linking or stiffening of proteins in the cell. Mostly seen with collagen  Oxidative Stress Theory (Free Radical Theory) – Free radicals are natural by-products of cellular activity and always present. They are molecules in the cells that cause damage. Pollutants are known to increase the production of free radicals. Naturally occurring vitamins, hormones, enzymes, and antioxidants neutralize free radicals as needed. Chronic exposure to racial discrimination increases oxidative stress. Programmed Aging (Nonstochastic Theories)  Aging as a process that is predetermined or “programmed” at the cellular level. “biological clock”. As mor signs of aging appear, the person ultimately dies. Neuroendocrine – Immunological Theory  Programmed death of of the immune cells from damage caused by the increased number of free radicals produced by the aging process  Ties into programmed theory and free radical theories  Healthy cells are mistaken for foreign substances and are attacked. T lymphocytes show more signs of aging than B.  The changes in an individual leave them with reduced immunity and vulnerability to illness. Sociological Theories of Aging  Predict and explain changes in the roles and relationships of older adults with an emphasis on adjustment  Role change, relationships, status and generation impact the older adult’s ability to adapt Disengagement Theory  Theory states that it is normal or natural for one to withdraw from society and community. Natural and accepted Activity Theory  Remaining as active as possible. Is possible when one is living in a stable society, has access to positive influences, and opportunities to participate in society. Continuity Theory  Focuses on personality. In the normal progression of aging, personality remains stable. Personality influences role activity, level of interest, and life satisfaction. Says that a person will respond to aging the same way they have responded to previous life events. Age-Stratification Theory  Theory believes in age categories ranging from young, middle aged, and old adults. Includes historical content, grouping elders into cohorts. Members of same “unit” or those have lived in similar historical periods, being exposed to similar events, political circumstances, and conditions. Social and cultural aspects also examined, life experiences from different cultures and areas of the world. Social Exchange Theory  Talks about withdrawal or social isolation as the result of an imbalance between elderly and young members of society. Balance creates satisfaction or dissatisfaction/social support. “Pay-back” for providing care to others in previous years. Ex: watching grandkids while adult children work – being provided with a home, money, food in return. Elders typically have less material things and more non-material resources such as love, respect, wisdom, giving back to society. Cultural differences and how they affect views of elders by younger people. Modernization Theory  Social changes resulting in the devaluing of elders and their contributions. Value of elders is lost when their labors are no longer useful to society. These changes are results of advancing technology, mass education, urbanization. Symbolic Interaction Theories  Interaction of the older adult and his/her environment. Confrontation with change, older adult tries to master the new situation while using a positive self concept. Examples of this are relocating, learning to use technology, needing to use assistive devices such as a cane or walker, retirement. Psychological Theories of Aging  Say that aging is a developmental process experienced between birth and death. Does not address influences of culture, gender, and ethnicity.  Jung’s Theory of Personality  Developmental Theories  Theory of Gerotranscendence Jung’s Theory of Individualism  Extroverted vs. introverted personalities.  Suggests that aging results in the movement of one from extroversion to introversion  Mid-life crisis – searches for answers about achieving goals, dreams, values, and priorities.  Movement from extroverted to introverted personality addresses spiritual issues as one is aging … - self actualization, finding answers within oneself, self acceptance. Developmental Theories  Eric Erikson – developmental stages and tasks of life.  Last stage of life is looking back/reflection (Ego Integrity (sense of completeness)or Despair), middle-age task is generativity.  Robert Peck – expanded on Erikson’s theories, Identified specific tasks needed to be addressed to establish ego integrity.  Ego Differentiation vs. work role preoccupation – individual not defined by his or her work  Body Transcendence vs body preoccupation - Body is taken care of but does not consume the interest/attention of the person.  Ego Transcendence vs ego preoccupation – self is less central, one becomes/feels a part of mass humanity. Able to share their destiny and struggles.  Havighurst – also proposed specific tasks to be accomplished in middle-aged/older adults. Havighurst’s Developmental Tasks for Later Maturity  Adjustment to decreasing physical strength/activity, retirement/reduced income, death of a spouse.  Establishment of an affiliation with ones age group and satisfactory living arrangements.  Adoption of social roles in a flexible way Theory of Gerotranscendence  Shift in perspective, from material world to the cosmic and concurrent with increased life satisfaction. Thought to be gradual and ongoing, though can be brought on by serious disruptions. Wisdom and spiritual growth. Less concerned with image and material items. Lessened fear of death. Social activities are not essential to well-being. Nursing Implications  Integration of aging theories into practice is important as the population continues to age. Provides understanding for the nurse to be able to better educate and counsel patients. Provides focus for research, education, understanding of the aging process from biological, sociological, and psychological perspectives. Trends in Aging  Older adults are the fastest growing age groups. First “baby-boomers” (adults born between 1946 and 1964) turn 65 in 2011. More than 60% of this group will manage more than 1 chronic condition by 2030.  Healthy People 2020 – designed to promote healthy outcomes for a population.  Many factors that affect health, function, and quality of life for older adults - Participation in physical activity, self management of chronic disease, preventative health service use, balanced nutrition/healthy living, injury prevention, dental hygiene.  Enhancing Quality of Life for Older Adults - A strong and consistent predictor of illness and death is socioeconomic status  Housing, transport, community resources, caregivers and support for caregivers, staying at home, long term care standards.  Chronic illnesses and Related Disabilities: - Chronic Conditions with a high risk of development  Diabetes, Arthritis, CHF, Dementia. Chronic conditions are the leading cause of death amongst older adults. Health Status  Average of 2 chronic health conditions for persons 65 years and older - Most common problems in 2002  Arthritis (50%), Hypertension (36%), Heart Disease (32%), Hearing Impairments (29%), Cataracts (17%), Orthopedic impairments (16%), Sinusitis (15%), Diabetes (10%). (US Census Bureau, 2004-2005)  Long Term Services and Supports - Need for long-term service/support, support services for caregivers, workforce with geriatric certification, emergency department visits due to falls in older adult population, information on elder abuse, neglect, exploitation.  Emerging Issues in Improving the Health of Older Adults - Coordination of care, helping older adults manage their own care, establishment of quality measures, identification of a minimum training for those caring for older adults, research/analyze appropriate training to equip providers to better meet the needs of the older adults.


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