CARE OF THE OLDER ADULT (WEEK 1)  The most rapid and dramatic growth for the older adult

 The most rapid and dramatic growth for the older adult segment of the total U.S.
population will occur between the year 2010 and 2030, when “ baby boom”
Demographics of Aging generations reaches 65 years of age.
 Life expentancy - the average number of years that a person can be expected to live
 Average life expentancy - 47 years (2004) Why They Increase?
 Figure had increased to 77.8 years  Improved sanitation
 What’s the IMPLICATION of this increasing life expectancy?  Advances in medical care
 Implementation of preventive health services
The Graying of America  In 1900s, deaths were due to infectious diseases and acute illnesses
Percent of Total U.S. Population over 65 in 2030  Older population now faced with new challenge
 Chronic disease
 Health care funding
 The ave. 75y/o has 3 chronic dses. & uses 5 rx meds.
 95% of health care expenditures for older Americans are for chronic diseases
 Changes in fertility rates
- Baby boom after WWII (1946 – 1964)
- 3.5 children per household
- Older population will explode between 2010 to 2030 when baby boomers reach age 65

Based on 1997 data, 4x as many widows as widower live in the United States.

About 5 % of persons over 65 reside in nursing facilities, but % increases dramatically with
advancing age.
Estimates indicates that more than 80% of persons over 65 years of age have one or more
chronic health conditions.
 In 2005, 13% of the U.S. pop. was over age 60
- 18.3 million aged 65–74
3 Leading Causes of Death for older persons, in order,
- 12.9 million aged 75–84
heart conditions, malignant neoplasms, & CVD’s
- 4.7% aged 85 or older
Feminization of Later Life
 This number is estimated to increase:
 Women comprise 55% of the older population
- To 20 million in 2010 (6.8% of total),
 Women have a longer life expectancy
- To 33 million in 2030 (9.2%), and
- The average life expectancy of women in the United States is 81 years
- To almost 50 million in 2050 (11.6%)
- The average life expectancy of men in the United States is 75.2 years
(National Center for Health Statistics [NCHS], 2006).
 Male exposure to risk factors may account for the differences
 Increases in female exposures to risk factors will reduce difference in life expectancy
 By mid-21st century, old people will outnumber young for the first time in history
 “Age 65 and older” is widely accepted & used for reporting
 demographic statistics about older persons;
 however turning 65 does not automatically means a person is “old”.
 Persons 65 years of age and older currently represent about 13% of the total
population.
Majority of older adults enjoy good health
But national surveys reveal that:
Challenge to all nurses
 A 20% of adults 65y/o & above report a chronic disability.  To promote positive lifelong health behaviours among all populations
 Chronic disease - major cause of disability - major cause of disability; - because the impact of unhealthy behaviours and choices = CHRONIC DISEASE.
 Heart disease, causes of
 Cancer, and The 3 leading death in people 65y/o & above in Geriatrics
 Stroke the U.S.  From Greek Geras, meaning “old age,”
 Alzheimer’s disease - 5th  branch of medicine & deals with the diseases & problems
 DM - 6th
(NCHS, 2006) Gerontology
 from the Greek Geron, meaning “old man,”
Majority of older adults enjoy good health national surveys reveal that:  is the scientific study of the process of aging and the problems of aged persons
 it includes biologic , sociologic , psychologic , and economic aspects.
Health Status of the Older Adult
 Majority of deaths (US) occur in people 65y/o & older  “Gero” – old age
- 50% of deaths--caused by heart disease & cancer  “Ology”- study of
- In the past 50 years --- a noted decline in overall deaths
- Due to the improvements in the prevention & early detection & treatment of diseases Older Age Group:
 Heart disease & cancer are two top causes of death, regardless of age, race, gender or  Young old – ages 65-74
ethnicity  Middle Old – ages 75-84
 Old Old – 85 and up.
70% of Physical Decline Related to Modifiable Risk Factors Age Discrimination – emotional prejudice among the older adult.
 Smoking Ageism – dislike of the aging and the older adult.
 Poor nutrition
 Physical inactivity Ageism
 Failure to use preventative and screening services  is prejudice against the old just because they are old.

Reason for the decline in limitations to activity of Older Adult: Senescence

 Recent trends in health promotion & disease prevention activities, such as:  Defined as a change in the behavior of an organism with age, leading to a decreased
- Improved nutrition, power of survival and adjustment, occur as well.
- Decreased smoking,
- Increased exercise, and Gerontology Nursing
- Early detection & treatment of risk factors such as hypertension & elevated serum  this specialty of nursing involves assessing the health & functional status of older
cholesterol levels. adults, planning and implementing health care & services to meet the identified needs,
and evaluating effectiveness of such care.
Aging Well
 72% of seniors report having good to excellent health Development of Gerontologic Nursing
 Numbers living in nursing homes has declined  1961 - Formation of a specialty group for geriatric nurses is recommended by the ANA
 1 out of every 5,578 people was 100 y/o or older  1962 - First national meeting of ANA Conference on Geriatric Nursing Practice held in
 Older adults are active and healthy Detroit, Mich.
 1966- First gerontologic clinical specialist nursing program is developed at Duke Nursing Care of Older Adults
University by Virginia Stone.  Gerontological nursing is provided in acute care, skilled and assisted living, the
 1968- Laurie Gunter Is the first nurse to present a paper at International Congress of community, & home settings.
Gerontology in Washington, D.C - First gerontologic nursing  Goals of care include:
 Barbara Davis is the first nurse to speak before the American Geriatric Society. First - promoting & maintaining functional status, and
article on nursing curriculum regarding gerontologic nursing is published. - helping older adults identify & use their strengths to achieve optimal independence.

Gerontologic Nurse Roles of the Gerontological Nurse

The nurse must meet all of the following requirements:  Provider of care
Should be educated about disease processes & syndromes commonly seen in the older
 Currently hold an active registered nurse license in US or its territories. population
 Hold a baccalaureate or higher degree in nursing.
 Have practiced 2000 hours within past 3 years  Teacher/Educator
 Have had 30 contact hours of continuing education applicable to Should focus their teaching on modifiable risk factors & health promotion through
gerontology/gerontologic nursing within the past 3 years. LIFESTYLE MODIFICATIONS

Gerontologic Nurse Practitioner  Manager

The nurse must meet the following requirements: They balance concerns of the patient, family, nursing & the rest of the interdisciplinary
team
 Currently hold an active RN license in the US or its  Must be skilled in:
territories - Leadership,
 Hold a master’s or higher degree in nursing. - Time management,
 Have been prepared as a nurse practitioner in either of the following: - Building relationships,
> A GNP master’s degree in Program - Communication &
 A formal postgraduate GNP track or program within a school of nursing granting - Managing change
graduate-level academic credit  They may also supervise other nursing personnel

Clinical Specialist in Gerontologic Nursing  Advocate

The nurse must meet all the following requirements: Acts on behalf of the older adults to:
 Currently hold an active RN license in the United States or its territories - Promote their best interests &
a.Hold a master’s or higher degree in gerontologic nursing - Strengthen their autonomy & decision making
b. Hold a master’s or higher degree in nursing with a specialization in gerontologic nursing. - It does not mean making decisions for older adults, but empowering them to remain
 Have practiced a minimum of 12 months after completion of the master’s degree independent and retain their dignity, even in difficult situations
 Meet the following requirements in current practice:
a. If a clinical specialist must have provided a minimum of 800 hours (post-master’s) of  Research Consumer
direct client care or clinical management in Gerontologic Nursing within the past 24 Must remain abreast of current research literature, reading & putting into practice the
months. results of reliable & valid studies
b. If a consultant, researcher, educator, or administrator, must have provided a minimum - The use of EVIDENCE-BASED PRACTICE RESEARCH can improve the quality of patient care
of 400 hours in all settings:
- Best method for delivery of care
- Based on clinical guidelines derived from research
- Coding system indicates the strength of the research
 All nurses should:
- Read professional journals specific to their specialty Affective:
- Continue their education by attending seminars & workshops 1. Provide the components of healthy promotion for elderly.
- Participate in professional organizations 2. Promote quality of life for elderly.
- Pursue additional formal education or degrees
- Obtain certification Psychomotor:
1. Determine appropriate safety precaution for elderly.
HISTORY OF GERONTOLOGIC NURSING 2. Participate actively during class discussions and group activities
 Demographics and Aging
 Longevity and Sex difference  American Nurses Association (ANA)
 Published a Statement on the Scope of Gerontological Nursing Practice in 1970
THEORIES OF AGING  Defines nature and scope of gerontological nursing
A. Biological Theories  Purpose
1. Programmed Theories - Health promotion
 Programmed Longevity - Healthy maintenance
 Endocrine Theory - Disease prevention
 Immunological Theory - Self-care

2. Error Theories Scope of Practice of Gerontological Nurse

 Wear and Tear Theory Specialize in:
 Cross-link Theory  nursing care
 Free Radical Theory  Health needs
 Somatic DNA Damage Theory  Plan
 Manage
B. Psychological Aging Theories  Implement
 Jung’s Theory of Individualism  Evaluate
 Erickson’s Development Theory
Roles of Gerontological Nurse
C. Sociological Aging Theories 1. Provider of Care
 Disengagement Theory 2. Teacher/Educator
 Activity Theory 3. Manager
 Continuity Theory 4. Advocate
5. Research Consumer
SCOPE AND STANDARD OF PRACTICE (WEEK 2)
Standards of Clinical Gerontological Nursing Care
At the end of the course unit (CU), learners will be able to: STANDARD I. Assessment
Cognitive: STANDARD II. Diagnosis
1. Discuss the scope and standards of gerontological nursing practice. STANDARD III. Outcome Identification
2. Examine core competencies in gerontological nursing practice. STANDARD IV. Planning
3. Discuss the unique roles of the gerontological nurses. STANDARD V. Implementation
4. Identify core competencies and core knowledge of gerontological nursing. STANDARD VI. Evaluation
5. Enumerate competencies and guidelines for geriatric nursing care.
 Core Competencies COMPONENTS OF HEALTH PROMOTION FOR THE ELDERLY
Critical Thinking
Communication
Assessment
Technical skills
 Role Development
- Provider of care
- Designer/manager/coordinator of care
- Member of a profession
 Core Knowledge
Health promotion, risk reduction, & disease prevention
Illness and disease management
Information & health care technologies
Ethics
Human diversity
LEVELS OF DISEASE PREVENTION
Global health care
Health care system & policy
1.Primary Prevention – designed to completely prevent a disease from occurring.
2.Secondary Prevention – early detection and management of disease.
Competencies and Curricular Guidelines for Geriatric Nursing Care
3.Tertiary Prevention – manage clinical disease in order to prevent them from progressing
 Recognize one’s own attitudes, values, & expectations about aging & their impact on
or to avoid complications of the disease.
care of older adults & their families.
 Communicate effectively, respectfully & compassionately with older adults & their
QUALITY OF LIFE MODEL
families.
 Physical Well being and Symptoms
 Recognize and assess sensation & perception ,functional, physical, cognitive,
 Psychological Well Being
psychological, & social changes common to old age.
 Social Well being
 Analyze and assess ,adapt knowledge, the effectiveness of community resources in
 Spiritual Well Being
assisting older adults & their families to retain personal goals, maximize function,
maintain independence, & live in the least restrictive environment.
WHO’s DETERMINANTS OF HEALTH
 Individualize care & prevent morbidity & mortality associated with the use of physical
1. Behavioral Determinants
& chemical restraints in older adults.
 Physical Activity
 Prevent or reduce common risk factors that contribute to functional decline, impaired
 Nutrition
quality of life & excess disability in older adults.
 Smoking
 Establish & follow standards of care to recognize & report elder mistreatment.
 Alcohol Abuse and Alcoholism
 Apply evidence-based standards to screen, immunize & promote healthy activities in
 Medication Adherence
older adults.
2. Personal Determinants:
 Recognize & manage geriatric syndromes common to older adults.
3. Psychological Determinants:
 Recognize the complex interaction of acute & chronic co-morbid conditions common
4. Physical Determinants
to older adults.
5. Social Determinants
 Use technology to enhance older adults’ function, independence & safety.
6. Economic Determinants
7. Social Services Determinants
HEALTHY AGING WITH NUTRITION (WEEK 3)

Unit Expected Outcomes

At the end of the course unit (CU), learners will be able to:
Cognitive: Common Nutritional Concerns in the Older Persons:
1. Understand normal age - related changes affecting nutrition.  Constipation
2. Identify common nutritional concern in older adult.  Increased risk of uncompensated dehydration can be a
3. Describe the components of a comprehensive nutritional assessment. result of;
4. Analyze age –related factors that affect dietary requirements in late life.  Fluid restriction
Affective:
1. To comply with the nutritional status of the elderly. NUTRITIONAL ASSESSMENT AND PARAMATERS:
2. Cooperate and listen attentively in class discussions A. Anthropometric
3. Respect comments and opinion of other and accepts criticism  Height
Psychomotor:  Weight
1. Evaluate nutritional status of elderly using mini nutritional assessment.  BMI
2. Participate in interactive discussion concerning dose-response relationship of drugs.  Body fat measurement
 Muscle mass
NORMAL AGE-RELATED PHYSICAL CHANGES AFFECTING ELDER ADULT’S NUTRITION B. Laboratory
1.Changes in Body Composition
 Sarcopenia (excessive loss of lean muscle mass) is a result of : The Nutrition Checklist is based on the warning signs: “DETERMINE”
 Loss of muscle can lead to D-isease
 At age 65, TBW is about 60% of total body mass (a decline from 72%) E-ating Poorly
 Bone Mineral Density T-ooth Loss/Mouth pain
2. Cognitive or physical limitations E-conomic Hardship
3. Sensory Changes R-educed Social contact
4.Medication side effects M-ultiple Medicines
5. Altered Nutritional Adequacy I-nvoluntary Weight Loss/Gain
6. Oral and Gastrointestinal changes affecting Nutrition N-eeds Assistance in Self Care
E-lder Years Above Age 80

ASSESSING ADULTS WITH NUTRITIONAL PROBLEMS

 Skin Assessment
 Hair Assessment
 Abdominal Assessment
 Pain Assessment
 Eating or Drinking Assessment

Mini Nutritional Assessment Guide are located at your Module.