-
Aging Cohort
- Aging is determined by society and culture
- in 1985 w/establishment of social security old was set at 65
- in the 2000's was set closer to 70
- centenarian a person who has lived at least 100 yrs
- traditional categories:
- - young old- 65-74
- - middle old- 75-85
- - old old 85 or older
-
Aging depends on
- decade one was born in or his/her history
- gender: women tend to live longer
- ethnic group- certain ethnic live longer
- Definitions of health:
- - health is influence by culture and age
- - wellness is ones whole being; physical, emotional, mental, and spiritual
- - functional ability are the person's ability to live independently to enjoy family and life. (able to make own choices)
-
Global Aging
- 2050, the number of person 60 are older worldwide is likely to exceed those younger than 15 yrs (huge disparity between young and old)
- occurred in europe in 1995 estimated not occur in North America until 2015
- people older than 60 yrs of age will not surpass children until 2040 in Asia, latin american, and the caribbean
- in 2007, japan alread had the highest percentage of person 60 yrs of age and older at 27.9%
- only africa, major region, when population is relatively young (60 wont exceed)
-
Identified need for Certification in Gerontology
- less than 1% RN are certified in gerontolgy
- only 3% of APRN's are certified gerontology
- you have to be skilled in this
-
Healthy people 2020 part 1
- to attain high quality, longer live and free of preventable diseases, disability injury and premature death
- to achieve health equity, eliminate disparities, and improve the health of all groups
- to create social and physical environments that promote good health for all
- to promote quality of life, healthy development, and healthy behaviors across all life stages
-
Healthy people 2020 part 2
- emerging issues in the health of older adults- identifies needs
- coordinates care- collab with family and care team
- help older adults manage their own care
- establish quality measures
- identify minium levels of training for people who care for older adults- nurse/cna/people who bring the food tray
- research and analyze appropriate training to equip providers with tools they need to meet basic needs of the older adults
-
Interventions to promote wellness
- Preventive service: Screening screening services and preventing illness thru vaccinations (pneumococal and hep b), hearing balance exams, vision, smoking cessation, senses intact. encourage annual wellness exams
- Wellness and person-oriented intervention: largest barrier to pt's participanting related to lack of knowledge and resources to promote wellness related to coverage by insurance and co payment
-
select clinical preventive services by race and ethnicity
- American Indian/Alaskan native adults: 40% need influenza vaccination, 35% need pneumococcal
- Asian/pacific islander adult: 49% colorectal cancer screening; 47% dm screening
- black americans: 47% need pneumococcal vaccination 46% influenza
- hispanic: 51% pneu, 47% colorectal
- white: 34% need colorectal, 31% dm screening
-
examples of interventions to promote wellness
- Preventive services: influenza, pneu, mammogram, colorectal
- wellness and person-oriented intervention: community outreach- such as home visits, neighbor to neighbor campaign. develop effective reminder systems
- reminder systems, one to one education and counseling, transportation issues
- coverage depends of type of test used. develop effective reminder system, reduce structural barriers such as transportation
-
Maslow heirachary of human needs
- is an organized framework for understanding individuals and their concerns during a particular time or situation
- to reach the higher levels, lower levels must be met first
- the gerontological nurse ensure that the needs of older adults are met and that they can function at a high level of wellness
-
Level of needs
- Basic needs: air, food, water, sleep, homeostasis
- safe and secure: family, health, morality, employment
- needs to belong: family, friendship, sexual intimacy
- develop self-esteem and self efficacy: confidence, achievement, respect of others
- Self actualization: morality, creativity, acceptance, lack of prejudice
- (healthy lifestyle, quality life, stimulate interest/ engage them, no isolation convo
-
Orem's universal self-care requirements
(1, 2) similar to maslow- a nurse theorist 1990
- 1. maintaining sufficient intake of air, water, food
- a. taking in the quantity required for normal functioning
- b. preserving the intergrity of associated anatomic structures and physiologic processes
- 2. Maintaining satisfactory elimination
- a. same as b above
- b. providing hygenic care to the body or surfaces to prevent injury or/and infection
- c. maintaining adequate and sanitary disposal systems
-
Orem's universal self care requirements
3-4
- 3 maintaining a balance between activities and rest:
- a. selecting activities that stimulate, engage and keep in balance physical movement and rest adequate for health
- b. know when they need activity and when they need to rest
- c. know cultural norms
- 4. maintaining a balance between solitude and social interaction
- a. need personal automy and social interaction
- b. fostering bonds of affection, love and friendship
- c. participating in situations of social warmth and closeness
- d. pursuing opportunities for satisfying group interactions
- (helps in eliminating depression)
-
Role of Gerontological Nurse
- Assist the older person to achieve their highest level of functioning (adapt their level of functioning to meet their needs)
- fosters empowerment to enhance, and support the client for achievement of wellness (empower them)
- uses available resources (some don't know what is out there)
- collaborate with older adult to implement interventions (team care approach)
- care and comfort always, cure sometimes, prevent what can be prevented (can't heal everything but teach them how to live with it)
-
We are Aging
- by 2050 1 in 5 americans will be older than the age of 65
- the number of those living beyond 100 yrs old is increasing
- older people are healthier, better educated and expect a higher quality of life as they age than in the past
-
Eldercare
- eldercare is the fastest growing employment sector
- older adults are the core consumers of health care
- older adults have the highest rates of outpatients visits
- the interest of nurses to care for older adults is low
-
Patient protection and affordable care act
2010
- Provide quality affordable healthcare for all Americans
- identify the role of public programs
- improving the quality and efficacy of healthcare
- Prevention of chronic disease improving public health (biggest focus, need for healthcare will be less)
-
Current Initiatives
- Hartford institute for Geriatric nursing- most significant influence (only nurse led org) (great resource)
- To improve care provided to older adults by:
- - Promoting geriatric nursing education, nursing practice, nursing research and nursing policy
- - Providing nurses a web based gerontology resource center to obtain evidence-based information on topics related to the care of older adults
- - building nursing leadership skills through the geriatric nursing leadership academy (GNLA)
-
gerontolgy nursing education
- 2010, the american association of critical care nurses (AACN) addressed the geriatrics nursing educational content for the bachelor's of science in nursing (BSN) degree
- clinical practice sites are not limited to acute care or nursing home setting but also those elders in the community
- Identified need for educators: faculty members with geriatrics expertise are scarce
-
Roles in Gerontological nursing
- Gero nurses may be:
- - Generalist: work in hospitals, homes, or sub acute and long term facilities or in the community providing care to individuals and their families
- - Specialist: work in acute care settings, nursing homes, retirement homes, assisted living facilities, adult daycare centers, and senior citizen housing
-
Gerontological Nursing research
- research has investigated:
- 1. interventions for improving care of those with dementia
- 2. reducing falls
- 3. use of restraints: dont really use now use of alarms
- 4. pain management
- 5. delirium- differ from dementia
- 6. care transitions- is it safe for them to go home?
- 7/ end of life care
-
Other gerontological caregivers
- CNA and nurses aides provide the majority of care in the nursing home
- older adults in the nursing home will develop relationships with the CNAs, they are often described as family
- CNA's must have the respect that is developed in the culture of the care facility
- CNA's high job turnover as high as 100% a need to promote job satisfaction and quality care across the healthcare continuum
-
Early history of the Gerontological nurse
- 1906: Lavina Docl address the needs of older adults in almshouses
- 1912: The american nurses association (ANA) appointed a almshouse committee to oversee nursing for older adults
- 1935: passing of social security act- monies were set aside for insurance and assistance
- 1940: centers of geriatrics excellence were established
- 1950: the first text book of geri
- 1968: ANA published geriatrics standards of practice and a geriatrics certificate was offered
- 1984: the speciality of geriatrics nursing was form
- **2010: the first edition of scope and standards of gerontology nursing practice is published
- 2013:Gerontology acute and primary care certified nurse practioner
-
Community based homes care
- care of elders living in the community (people checking in on them)
- independent in home care
- senior housing
- adult day health
- high healthcare cost people are being d/c home earlier with home care team
- assessment, wound care, medication compliance, IV therapy, rehab, palliative care
-
Focus of Acute and long term care
Acute care orientation: illness, high technology, short term, episodic, one dimentional, professional, medical model, cure
Long term care orientation: function, high touch, extended, interdisciplinery model, ongoing, mulitdimentional, paraprofessional and family, care
-
Skilled nursing homes and facilities
- mixed patients some with skilled nursing, rehab units, dementia units
- 2 types:
- - skilled nursing care
- - sub acute: patients with complex needs length of stay usually 1 month (higher levels of professional staffing
-
Long term care or custodial care
- 24 hour personal care
- pts with strokes, dementia, hospice and more than 50% have some cognitive dysfunction
- american healthcare association (2010) identifies there is a need of 41% of RN's in long term facilities
-
Levels of Staffing
- only 1 RN is required for staffing in a nursing home for 8 hours day the rest can be LPN's and CNA's
- need for more direct care. RN's have shown benefits of decreasing hospitalizations, pressure ulcers, UTI (which cause confusion) and weight loss
-
goal of LTC
- provide safe & supportive environment for chronically ill and functionally dependent people
- restore and maintain highest level of functional ability
- preserve individual autonomy
- maximize quality of life, satisfaction w/care
- provide comfort and dignity at end of life for residents and families
- provide coordinated care to subacute ill residents who plan to return to homeless restrictive level of care
- stabilize and delay progression when possible of chronic medical conditions
- prevent acute medical/atrogenic illnesses. identify and treat rapidly
- create a homelike environment that respects dignity of each resident
-
SPICES
- Sleep pattern
- Eating
- Incontenience
- confusion
- evidence of falls
- skin
-
Gerontology Organizations
- demostrates the need for interdisciplinary collaboration in research and practice
- improve the understanding of direct care among disciplines
- provide nurses the opportunity to occupy positions as officers and committee chairs
- include national and international concerns
- are associations for nursing assistants
-
implication for gerontological nursing
- nursing is a vital aspect of health care for older people
- gerontogical nursing specialization provides experts in caring for older people
- Gero nursing have made an impact in research
- Gero nursing is the most needed specialty
|
|