CARE OF THE OLDER ADULT

Prepared by Briiliant Muhayra N. Dumay,

RN
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TOPICS FOR ORIENTATION

• GRADING SYSTEM
• ONLINE CLASSROOM RULES
• SUBJECT ORIENTATION
• EXAMINATION SCHEDULE
• WHAT ARE YOUR EXPECTATIONS?

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GRADING SYSTEM
QUIZZES 40
EXAMINATION 40
REQUIREMENTS / 10
PARTICIPATION
ATTENDANCE 10
100%
PRELIM 20
PRE MIDTERM 20
MIDTERM 20
PRE FINAL 20
FINAL 20
100%

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ONLINE
CLASSROO
M RULES
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SUBJECT ORIENTATION

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Course Title CARE OF THE OLDER ADULT

Course NCM 114
Number
Course This course deals with concepts,
Description
principles, theories and techniques in
the care of older adults. The
learners are expected to perform
holistic nursing care of the older
persons in wellness and chronic
illness utilizing the nursing process.

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Course Credit Theory 2 units (36 hours)

RLE : Clinical (Hospital/Community)
1 unit
(51 hours)
Placement Third Year; First Semester

Prerequisites NCM 103

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Introduction
• As a nursing student, you may
have preconceived ideas about
caring for older adults.
• For all of us, this universal
phenomenon we call aging has
some type of meaning, whether
we have taken the time to
consciously think about it.

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Let’s answer these
questions:

If you pictured yourself at the

age of 85, what would you look
like?
What sights and sounds would
be around you?
Where would you be living?
What activities would you be
engaged in?
The picture of yourself as an older
person may be positive or
negative. The way that you view
aging, and the elderly is often a
product of your own environment
and the experiences to which you
have been exposed. Negative
attitudes towards aging or the
elderly (ageism) often arise in the
same way—from negative past
experiences.
Majority of you in your careers as nurses will be
caring for older adults at some point. Population
statistics make that an irrefutable fact. Because
the elderly have unique life situations and deal
with physical changes as they age, it is
essential that nurses be prepared to provide
quality of care to this group of individuals.
Perhaps you already have a positive
attitude towards caring for the
elderly. Build on that and consider
devoting your time and efforts to the
field of gerontological nursing.
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GERONTOLOGY

is the broad term used to define the

study of aging and/or the aged. This
includes the biopsychosocial aspects of
aging.

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What is old and who defines old

age? Interestingly, although “old” is
often defined as over 65 years of
age, today, the older age group is
often divided into the young old
(ages 65–74), the middle old (ages
75–84), and the old old, very old, or
frail elderly (ages 85 and up).
However, it is obvious that these
numbers provide merely a guideline
and do not actually or clearly define
a true picture of the various strata of
the aging population. Sample Footer Text
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GERIATRICS
Geriatrics is often used as a generic term relating
to the aged, but specifically refers to medical care
of the aged.

This is why many nursing journals and texts have

chosen to use the term gerontological nursing
versus geriatric nursing.

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GERONTOLOGICAL NURSING
Gerontological nursing, then, is the aspect of gerontology that falls
within the discipline of nursing and the scope of nursing practice
guided by standards of practice. It involves nurses advocating for
the health of older persons at all levels of prevention.
Gerontological nurses work with healthy elderly persons in their
communities, the acutely ill elderly requiring hospitalization and
treatment, and the chronically ill or disabled elderly in long-term
care facilities, skilled care, home care, and hospice. The scope of
practice for gerontological nursing includes all older adults from
the time of “old age” until death.

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Early 1970s
⬩ The specialty of gerontological nursing
was first formally recognized when the
Standards for Geriatric Practice (1970) and
the Journal of Gerontological Nursing (1975)
were first published (Eliopoulos, 2005).

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ROLES OF GERONTOLOGICAL NURSE

A. Provider of Care
Older adults often present with atypical
symptoms that complicate diagnosis and
treatment. Thus, the nurse as a care provider
should be educated about the common
disease processes seen in the older
population. This includes knowledge of the
backgrounds and statistics, risk factors, signs
and symptoms, usual medical treatment,
nursing care through evidence-based practice,
and rehabilitation if applicable.

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ROLES OF GERONTOLOGICAL NURSE

B. Teacher
An essential part of all nursing is
teaching. Gerontological nurses
focus their teaching on modifiable
risk factors. Many diseases of
aging can be prevented through
lifestyle modifications such as a
healthy diet, smoking cessation,
appropriate weight maintenance,
increased physical activity, and
stress management. Sample Footer Text
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ROLES OF GERONTOLOGICAL NURSE

C. Manager
Gerontological nurses act as managers during everyday care
as they balance the concerns of the patient, family, nursing,
and the rest of the interdisciplinary team. Nurse managers
need to develop skills in staff coordination, time management,
assertiveness, communication, and organization. Nurse
managers may supervise other nursing personnel including
licensed practical nurses (LPNs), certified nursing assistants
(CNAs), nurse technicians, nursing students, and other
unlicensed assistive personnel (UAP).

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ROLES OF GERONTOLOGICAL NURSE

D. Advocate
As an advocate, the gerontological nurse acts
on behalf of older adults to promote their best
interests and strengthen their autonomy and
decision making. Advocacy may take many
forms, including active involvement at helping to
explain medical or nursing procedures to family
members on a unit level. Whatever the
situation, gerontological nurses remember that
being an advocate does not mean making
decisions for older adults, but empowering
them, helping them remain independent and NCM 114
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ROLES OF GERONTOLOGICAL NURSE

E. Research
Consumer
This involves gerontological
nurses being aware of current
research literature, continuing to
read and put into practice the
results of reliable and valid
studies. Using evidence-based
practice, gerontological nurses
can improve the quality of patient
care in all settings.
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Settings of Care

Because of the nature of

the aging process, it is
likely that older adults will
enter and exit the health
care system at many
different points throughout
old age.

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Settings of Care
Acute Care Hospital

The acute care hospital is often the point of entry to the health
care system for older adults. Nurses working in hospitals are
likely to care for older adults even if they do not specialize in
geriatrics, because about half of all patients in this setting are
older. The purpose of care will be to assist with survival and
prevent complications

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Settings of Care
Long-Term Care

There are many different levels of care that fall under the long-
term care umbrella. These may include assisted living,
intermediate care, skilled care, and Alzheimer’s units. Facilities
that offer these services are generally called by one of several
names: nursing homes, long-term care facilities (LTCFs), skilled
nursing facilities (SNFs), retirement homes, assisted living
facilities, or rehabilitation and health care village.

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LONG TERM CARE

Assisted Living
As older persons continue to age, it is likely that
common disorders associated with the aging process
may interfere with their ability to care for themselves.
Assisted living facilities may be free-standing or may be
part of a larger facility that provides multiple levels of
care.

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LONG TERM CARE

Intermediate Care
This level of care provides 24-hour per day direct nursing contact
and may be considered to be the entry level into nursing home
care. Older persons are unable to live on their own because of a
number of factors, including numerous medications to manage,
mobility problems, or the presence of chronic diseases that
require an amount of nursing supervision beyond what a person
could manage independently.

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LONG TERM CARE

Subacute care
Subacute care is generally for patients who require more
intensive nursing care than the traditional nursing home can
provide, but less than the acute care hospital. These units are
designed to promote optimum outcomes in the least expensive
cost setting. Gerontological nurses working in this setting would
benefit from having a critical care background and rehabilitation
experience as well.

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LONG TERM CARE

Skilled Care
Skilled care units or skilled nursing facilities (SNFs) are for those older
adults requiring more intensive nursing care. Some units are found within
nursing homes, others within hospitals. The care required is at a higher
level. Persons in skilled care may include those with severe stroke,
dementia, head injury, coma, or advanced degenerative and/or
neurological disorders. The skilled care nurse should have knowledge of
transfer techniques, prevention and assessment of swallowing problems,
bowel and bladder management, and nutrition.

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LONG TERM CARE

Alzheimer’s Care
Because of the higher incidence of Alzheimer’s disease with advanced
age, there is a growing need for units that provide nursing care for elders in
the various stages of dementia that occur with Alzheimer’s. Alzheimer’s
units can be a great benefit to the community by having gerontological
nursing staff that has expertise in the management of this difficult disease.
Nurses can help family members understand disease progression and
assure them that their loved one is being well cared for even to the end of
the disease, which results in death.

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LONG TERM CARE

Hospice
Gerontological nurses may also choose to work in hospice,
caring for dying persons and their families. Although many
patients in hospice are not elderly, the majority of the dying are
older. The concept of hospice is centered around holistic,
interdisciplinary care that helps the dying person “live until they
die.”

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Settings of Care

Rehabilitation
Rehabilitation may be found in various degrees in several
settings, including the acute care hospital, subacute or
transitional care, and LTCFs. The level of intensity of acute
rehabilitation is greater than for subacute or long-term care. The
goals of rehabilitation are to maximize independence, promote
maximal function, prevent complications, and promote quality of
life within each person’s strengths and limitations. The level of
intensity of acute rehabilitation is greater than for subacute or
long-term care.

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Settings of Care

Community
Most older adults live in the community. . However, remember
that many encounters with older adults will be as they enter the
health care system for illness, whether chronic or acute, so fewer
job possibilities exist at present in primary and wellness-oriented
settings.

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Community
Home Health Care
• Older adults requiring a longer period of observation or care from nurses
may be candidates for home health care services Home care is designed
for those who are homebound due to severity of illness or immobility.
• Visiting nurse associations (VNAs) have long been known for their positive
reputation in providing home care.
• People’s desire to be cared for in familiar surroundings by their families,
versus an institution
• The majority of home care patients are elderly and experience a variety of
problems needing nursing, such as chronic wounds, intravenous therapy,
long-term indwelling urinary catheters, and tube feedings

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Community
Foster Care or Group Homes

• Foster care and/or group homes are for those older adults who can do
most of their ADLs but may have safety issues and require supervision with
some activities such as dressing or taking medications.
• Foster or group homes generally offer more personalized supervision in a
smaller, more family-like environment than a traditional nursing home and
should be licensed to provide such services.
• Some persons offering this service have a small number of elders inside
their existing own home residence, whereas others have purchased a
larger dwelling for this purpose.
• Social workers can usually provide good information about local foster or
group homes

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Community
Foster Care or Group Homes

• Foster care and/or group homes are for those older adults who can do
most of their ADLs, but may have safety issues and require supervision
with some activities such as dressing or taking medications.
• Foster or group homes generally offer more personalized supervision in a
smaller, more family-like environment than a traditional nursing home and
should be licensed to provide such services.
• Some persons offering this service have a small number of elders inside
their existing own home residence, whereas others have purchased a
larger dwelling for this purpose.
• Social workers can usually provide good information about local foster or
group homes

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Community
Independent Living
• Independent living for older adults is often in the community, but as
previously stated, may be available in many LTCFs.
• The accommodations will be as homelike as possible with kitchens,
bathrooms, living areas, and the like, similar to assisted living.
• Nurses working in this setting may focus on primary prevention, that is,
health promotion/disease prevention activities such as educational
programs.
• In the community setting, independent living arrangements often take the
form of senior housing, such as with apartment complexes that are
exclusively devoted to the elderly.

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Community
Adult Day Care
• Usually, these services are used by family members who are
caring for older parents or loved ones in their own home, but
who may work during the day and wish to have their relative
safely cared for in their absence. This is an excellent
alternative to institutionalization.
• Services are offered only during the day, often from 6 a.m.–6
p.m. (or normal business hours) with an emphasis on
recreation and some health promotion. Some programs offer
weekend hours. Costs vary depending on the sponsoring
agency.
• Adult day care programs may be sponsored by a variety of
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different organizations including churches, hospitals, health
 Competencies Necessary for Nurses to Provide 40

High Quality Care to Older Adults and Their

Families

1. Recognize one’s own and others’ attitudes, values, and expectations about aging
and their impact on care of older adults and their families.
2. Adopt the concept of individualized care as the standard of practice with older adults.
3. Communicate effectively, respectfully, and compassionately with older adults and
their families.
4. Recognize that sensation and perception in older adults are mediated by functional,
physical, cognitive, psychological, and social changes common in old age.
5. Incorporate into daily practice valid and reliable tools to assess the functional,
physical, cognitive, psychological, social, and spiritual status of older adults.

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High Quality Care to Older Adults and Their

Families
6. Assess older adults’ living environment with special awareness of the functional,
physical, cognitive, psychological, and social changes common in old age.
7. Analyze the effectiveness of community resources in assisting older adults and their
families to retain personal goals, maximize function, maintain independence, and live
in the least restrictive environment.
8. Assess family knowledge of skills necessary to deliver care to older adults.
9. Adapt technical skills to meet the functional, physical, cognitive, psychological,
social, and endurance capacities of older adults.
10. Individualize care and prevent morbidity and mortality associated with the use of
physical and chemical restraints in older adults.

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High Quality Care to Older Adults and Their

Families
11. Prevent or reduce common risk factors that contribute to functional decline,
impaired quality of life, and excess disability in older adults.
12. Establish and follow standards of care to recognize and report elder mistreatment.
13. Apply evidence-based standards to screen, immunize, and promote healthy
activities in older adults.
14. Recognize and manage geriatric syndromes common to older adults.
15. Recognize the complex interaction of acute and chronic co-morbid conditions
common to older adults.
16. Use technology to enhance older adults’ function, independence, and safety.

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High Quality Care to Older Adults and Their

Families
17. Facilitate communication as older adults transition across and between home,
hospital, and nursing home, with a particular focus on the use of technology.
18. Assist older adults, families, and caregivers to understand and balance “everyday”
autonomy and safety decisions.
19. Apply ethical and legal principles to the complex issues that arise in care of older
adults.
20. Appreciate the influence of attitudes, roles, language, culture, race, religion, gender,
and lifestyle on how families and assistive personnel provide long-term care to older
adults.
21. Evaluate differing international models of geriatric care.

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High Quality Care to Older Adults and Their

Families
22. Analyze the impact of an aging society on the health care system.
23. Evaluate the influence of payer systems on access, availability, and affordability of
health care for older adults.
24. Contrast the opportunities and constraints of a supportive living arrangement on the
function and independence of older adults and on their families.
25. Recognize the benefits of interdisciplinary team participation in care of older adults.
26. Evaluate the utility of complementary and integrative health care practices on health
promotion and symptom management for older adults.
27. Facilitate older adults’ active participation in all aspects of their own health care.

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 Competencies Necessary for Nurses to Provide
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High Quality Care to Older Adults and Their

Families
28.Involve, educate, and when appropriate, supervise family, friends, and
assistive personnel in implementing best practices for older adults.

29.Ensure quality of care commensurate with older adults’ vulnerability

and frequency and intensity of care needs.

30.Promote the desirability of quality end-of-life care for older adults,

including pain and symptom management, as essential, desirable, and
integral components of nursing practice.
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High Quality Care to Older Adults and Their

Families
28.Involve, educate, and when appropriate, supervise family, friends, and
assistive personnel in implementing best practices for older adults.

29.Ensure quality of care commensurate with older adults’ vulnerability

and frequency and intensity of care needs.

30.Promote the desirability of quality end-of-life care for older adults,

including pain and symptom management, as essential, desirable, and
integral components of nursing practice.
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