INTRODUCTION TO GERONTOLOGICAL NURSING

INTRODUCTION TO
GERONTOLOGICAL
NURSING
BY: ROMMEL LUIS C. ISRAEL III
1

WHAT IS GERONTOLOGICAL NURSING?
Nursing sub-
specialty for
older patients
Used to be
called
GERIATRIC
NURSING
2

GERONTOLOGICAL NURSING VS GERIATRIC
NURSING
• study of aging or the aged (old
people)
Gerontological Nursing
• medical care of the aged
Geriatric Nursing
3

GERONTOLOGICAL
NURSING
The history and development of
Gerontological Nursing is rich in
diversity and experiences
Focus is on increasing life
expectancy
Increasing numbers of acute &
chronic health conditions
Nurses provide disease prevention &
health promotion
Promote positive aging
4

HISTORY
early 1960’s
Specialty formed in
the early 1960’s by
ANA Standards for
Geriatric Practice;
1970’s
Veterans
Administration funded
GRECC’s at VA medical
centers
1980’s
Establishment of NGNA
& Scope and Standards
of Gerontological
Nursing Practice
1990’s
Established Hartford
Foundation Institute of
Geriatric Nursing at
NYU Division of
Nursing
5

PIONEERS IN GERONTOLOGICAL NURSING
• Florence
Nightingale
- first geriatric nurse
- Care of Sick Gentlewomen in Distressed Circumstances
6

PIONEERS IN GERONTOLOGICAL NURSING
• Doreen Norton
• focused career on care of the aged
• described advantages of learning geriatric care in basic education
• Learning patience,tolerance,understanding and basic nursing skills
• Witnessing the terminal stages of disease and importance of skilled
nursing care
• Preparing for the future
• Recognizing the importance of rehabilitation
• Being aware of the need to undertake research
7

DEFINITIONS
• Gerontology
• Geriatrics
• Ageism
• Gerontological nursing
• Old
• Cultural terms:elder,senior,older
adult,elderly
8

DEFINITION OF “OLD”
• Chronological
age
–young-old: 65 - 74
–middle-old: 75 - 84
–old-old (frail elderly): 85+
• Biological age
9

PREVIOUS
STEREOTYPES
OF THE OLD
•Television
•Media
•Newspapers
•Film industry
•Commercials in magazines
and on TV
•Greeting card/birthday
cards
10

ROLES OF THE
GERONTOLOGICAL
NURSE
Provider of Care
Teacher
Manager
Advocate
Research Consumer
11

SCOPE AND STANDARDS OF
GERONTOLOGICAL NURSING PRACTICE
• STANDARDS
– Quality of Care
– Performance Appraisals
– Education
– Collegiality
– Ethics
– Collaboration
– Research
– Research Utilization
•SCOPE
–Assessment
–Diagnosis
–Outcome Identification
–Planning
–Implementation
–Evaluation
12

PRACTICE SETTINGS
• Acute Care Hospital
• Long-Term Care
–Assisted Living
–Intermediate Care
–Subacute or
Transitional Care
–Skilled Care
–Alzheimer’s Care
–Hospice
• Rehabilitation
• Community
– Home Health Care
– Foster Care or Group
Homes
– Independent Living
– Adult Day Care
13

CONTINUUM
OF CARE
Acute Care Hospitals
• Often the point of entry into the
healthcare system
• Nurses care for older adults
• Admits older people except in L&D, post-
partum & pediatrics
Acute Rehabilitation
• Found in several settings including acute
care hospitals, subacute care (transitional
• care), & LTCF’s
• Goals are to maximize independence,
promote maximal function, prevent
• complications, & promote quality of life
within a person’s strengths & limitations
14

CONTINUUM
OF CARE
Home Health Care
• For home-bound due to severity of illness
or immobility
• Usually done by a visiting nurse
Long Term Care Facility
• Referred to as nursing homes
• Provides support to persons of any age
who lost some or all capacity for self-care
• Nurses provide planning & oversee
residents
• – Maintain the functional & nutritional
status of residents while preventing
complications of impaired mobility
15

• Hospice
• T
o care for the dying and their families
• Centered on holistic,interdisciplinary care
to help the dying“live until they
• die”
• Provide quality care until the last months,
weeks,days or hours of their life
• Respite Care
• Provides care to give caregivers a break
• Can be done in a daycare center,at home,
orALF’s
CONTINUUM OF CARE
16

CONTINUUM OF CARE
• Continuing Care Retirement Community (CCRC)
• Provides continuum of care from independent
living to skilled care all within a single campus,
with levels of care adjusted to individual needs
• Patients can move seamlessly among independent
living, assisted living, skilled care, or long term
care as their condition warrants
17

CONTINUUM OF CARE
• Assisted Living Facilities
• Alternative for those who don’t feel safe being
alone
• For those who needs help with ADL’s
• May be connected to a LTCF
• Provides healthy meals, planned activities,
places to walk & exercise, and pleasant
surroundings
18

CONTINUUM
OF CARE
Foster Care or Group Homes
• For those who can do ADL’s but with
issues safety that requires
• supervision
• Offers more personalized supervision in
a smaller, more family-like environment
Green House Concept
• Primary purpose is to serve as a place
where elders can receive assistance and
support with ADL’s & clinical care
without the assistance becoming the
focus of existence
• Older people retain control of ADL’s
19

CONTINUUM OF CARE
• Adult Daycare
• For older adults who are unable to remain at home
unsupervised
• Used by family members who care for the older person in
their homes
• Community based program designed to meet the needs of
functionally and/or cognitively impaired adults through
individual plan of care in protective setting
• Programs may be sponsored to provide socialization, meals, &
therapeutic activities
20

DEMOGRAPHICS
OF A G I N G I N T H E
P H I L I P P I N E S
21

22

PHILIPPINE DEMOGRAPHICS
•2018:8,013,059 Filipinos
over 60 years old (8.2%)
– 5,082,049 will be 65 years old
and older
23

PHILIPPINE
DEMOGRAPHICS
PROJECTIONS
•Philippines will enjoy
the benefits of a young
population until 2030
•Growth: 4.9% (2020)
•5.6% (2025)
•6.3% (2030)
24

PHILIPPINE
DEMOGRAPHICS
Increased life
expectancy
•Average age: 68.5
(2017) to 74 (2018)
Fertility
25

MORTALITY AND MORBIDITY IN OLDER
ADULTS
18.56%
6.21%
5.11%
3.42%
3.04%
2.74%
1.42%
1.19%
0.98%
0.55%
Cardiovascular diseases, all forms
Pneumonia
Malignant neoplasms, all forms
COPD
Tuberculosis, all forms
Diabetes mellitus
GI ulcers & other GI diseases
Nephritis, nephrotic syndrome, nephrosis
Accidents and injuries
Chronic liver diseases & cirrhosis
26

T H E O R I E S O F A G I N G
27

SOCIOLOGICAL
THEORIES
•Changing roles,
relationships,
status and
•generational
cohort impact the
older adult’s
•ability to adapt.
28

SOCIOLOGICAL
THEORIES
• ActivityTheory
• Havighurst andAlbrecht
(1953)
• Conceptualized activity
engagement & positive
adaptation to aging
• Remaining occupied and
involved is a necessary
ingredient to satisfying
late life
• Associates activity as a
means to prolong middle age
& delay the negative effects
of old-age
29

SOCIOLOGICAL THEORIES
• DisengagementTheory
• Cumming & Henry (1961)
• Contrast to activity theory
• Conceptualized that aging is
characterized by gradual disengagement
from society and relationship
• Withdrawal from society &
relationship serves to maintain social
equilibrium & promote internal
reflection
• Outcome is a new equilibrium ideally
satisfying to both individual and society
30

• SubcultureTheory
• – Rose (1965)
• Views older adults as a unique subculture within
society formed as a
• defensive response to society’s negative attitudes &
the loss of status that
• accompanies aging
• Conceptualized that the elderly prefer to segregate
from society in an aging subculture sharing loss of
status and societal negativity regarding the aged.
• Health and mobility are key determinants of social
status
31

SOCIOLOGICAL
THEORIES
• ContinuityTheory
• Havighurst, Neugarten &Tobin
(1968)
• Suggests that personality is well-
developed by the time one
reaches old-age & tends to
remain consistent across life span
• Past coping patterns occur as
older adults adjust to physical,
financial, & social decline and
contemplate death
32

• Age StratificationTheory
• Riley and associates (1972)
• Society is stratified by age groups
that are the basis for acquiring
resources, roles, status, & deference
from others.
• Age cohorts are influenced by
their historical contexts& share
similar experiences, beliefs,
attitudes, & expectations of life
course transitions
33

• Person-Environment FitTheory
• Lawton (1982)
• Introduced functional
competence in relationship to
the environment
• Conceptualized that function is
affected by ego strength,
mobility, health, cognition,
sensory perception & the
environment
• Competency changes one’s
ability to adapt to
environmental needs
SOCIOLOGICAL
THEORIES
34

• Gerotranscendence Theory
• Tornstam (1994)
• Proposed that aging individuals undergo a
cognitive transformation from a
materialistic, rational perspective toward
oneness with the universe
• Successful transformations include a more
outward or external focus, accepting
impending death without fear,an
emphasis of substantive relatiionships,
intergenerational connectedness &
spiritual unity with the universe
• Activity & participation must be the result of
one’s own choices which
• differs from one person to another, & control
over one’s life in all situation is essential for
the person’s adaptation to aging
SOCIOLOGICAL
THEORIES
35

PSYCHOLOGICAL THEORIES
•Explain aging in terms of mental processes,
emotions, attitudes, motivation and
personality development that is
characterized by life stage transitions
36

• Human NeedsTheory
• Maslow (1954)
• Five basic needs motivate
human behavior in a life-long
process toward need
fulfilment
• The needs are prioritized
such that more basic
needs take precedence
before the complex need
PSYCHOLOGICAL
THEORIES
37

PSYCHOLOGICAL
THEORIES
• Theory of Individualism
• –Jung (1960)
• –Personality consists of
an ego and personal
and collective
unconsciousness that
views life from a
personal or external
perspective. Older
adults search for life
meaning & adapt to
functional & social
losses
38

PSYCHOLOGICAL
THEORIES
• Stages of Personality Development
• Erikson (1963)
• Personality develops in 8 sequential stages
with corresponding life tasks. The 8th phase,
Integrity vs.Despair,is characterized by
evaluating life accomplishments;struggles
including letting go, accepting care,
detachment,& physical & mental decline
• Peck (1968) refined the 8th phase into three
challenges
• Ego differentiation vs.work role
reoccupation
• Body transcendence vs.body
preoccupation
• Ego transcendence vs.ego
preoccupation
39

• Life Course (Life Span) Paradigm
• Bühler (1933)
• Blend key elements in psychological theories (life
stages, tasks, & personality development) with
sociological concepts (role behavior &
interrelationship between individual & society)
• Life course is unique to each individual
• Divided into stages with predictable patterns
• Structured based on one’s role, relationships,
internal values, &
• goals
• Goal achievement is associated with life
satisfaction
40

• Selective Optimization with
Compensation Theory
• –Baltes (1987)
• –Individual copes with the
functional losses of aging through
activity/role selection,
optimization, & compensation
• –Critical life points are morbidity,
mortality, & quality of life
• –Facilitates successful aging
41

BIOLOGICAL THEORIES
• StochasticTheories
• Based on random eventsthat cause
cellular damage that accumulates as
organism ages
• NonstochasticTheories
• Based on genetically programmed
events caused by cellular damage that
accelerates aging of the organism
42

BIOLOGICAL THEORIES (S)
• Free RadicalTheory
• Membranes, nucleic acids, and
proteins are damaged by free radicals
which causes cellular injury and aging
• Orgel/ErrorTheory
• Errors in DNA and RNA synthesis occur
with aging
43

BIOLOGICAL THEORIES (S)
• Wear &T
earTheory
• Cells wear out and cannot function
with aging
• ConnectiveTissue/Cross-LinkTheory
• With aging proteins impede
metabolic processes and cause
trouble with getting nutrients to
cells and
removing cellular waste products
44

• ProgrammedTheory
• Cells divide until they are no
longer able to; this triggers
apoptosis or cell death
• Gene/Biological ClockTheory
• Cells have a genetic
programmed aging code
BIOLOGICAL
THEORIES (NS)
45

• NeuroendocrineTheory
– Problems with the
Hypothalamus-Pituitary-
Endocrine Gland Feedback
System causes disease;
increased insulin growth factor
increase aging
• ImmunologicalTheory
– Aging is due to faulty
immunological function which
is linked to general well being
BIOLOGICAL THEORIES
(NS)
46

NURSING
THEORIES OF
AGING
Functional Consequences Theory
• Environmental and biopsychosocial
consequences impact functioning.
Nursing’s role is to minimize age-
associated disability in order to enhance
safety and quality of living
Theory of Thriving
• Failure to thrive results from a discord
between the individual and his or her
environment or relationships. Nurses
identify and modify factors that
contribute to disharmony among these
elements
47

INTRODUCTION TO GERONTOLOGICAL NURSING

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