Foundations of healthy aging

• 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

• 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)

• 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)

• less than 1% RN are certified in gerontolgy
• only 3% of APRN's are certified gerontology
• you have to be skilled in this

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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)

• 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)

• 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 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

• 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)

• 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)

• 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

• 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

• 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

• 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

• 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

• 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

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

• 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

• 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

• 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

• 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

• Sleep pattern
• Eating
• Incontenience
• confusion
• evidence of falls
• skin

• 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

• 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