Chapter 1: GERONTOLOGIC NURSING AND AN AGING SOCIETY Tend to write things off w/ older ppl o BUT pain is body

y saying something is wrong Not always JUST aging Need to be able to differentiate between normal aging and something wrong

U.S. Population - 38.6 million people over age 65 o By 2050, 1 in 5 Americans will be over 65

Life Expectancy in U.S. o o o 1930 59.7 yearsJust over 6 million ppl over 65 1965 70.2 yearsOver 20 million ppl over 65 Currently 78.7 years38.6 million ppl over 65

Study of Aging o In past, healthy older men and women were an anomaly o Led to picture of older adult as frail and dependent

Religious and Secular Movements Puritans aging a sacred pilgrimage to God Victorian Age youth the symbol of growth and expansion Later elders seem cumbersome and a hindrance to progress

Reverse Ageism Largely attributable to gerontology professionals of baby boom confronting their own aging

Gerontology o o The scientific study of the effects of time on human development, specifically the study of older persons Biomedicalization of Aging Geriatrics coined by Ignatz Nacher (American physician) around 1900 Realized older ppl needed special care, much like pediatrics

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Aging seen as biomedical problem that must be reversed, eradicated, or held at bay as long as possible

Aging and disease are separate entities Individual ages chronologically, biologically, psychologically, sociologically, and spiritually Old category is arbitrary and varies w/ time, place, and perception Young-old = 65-74 Middle-old = 75-84 Old-old = 85-100 Elite-old = 100+

Parents of baby boomers called notch generation Exposed to most every disease b/c of lack of immunizations Adolescent and young adult lifestyles contributed to their current problems Ex: Cigarette abuse (didnt know effects), Lack of exercise (physical exertion only associated with hard labor jobs)

Nonagenarian Older than 90 years Survived dangers and diseases of childhood Experienced more hardship and lifestyle disruptions than any generation

Centenarians 100+ - the elite-old 1 in 26 Americans expected to live to 100 by 2025 Almost 50% life in nursing homes 30% without dementia 85% are females HOWEVER, men less likely to have significant mental/physical disabilities at this age

Racial crossover effect

Persons of color over age 85 are hardier than their white counterpart

Asked for their wisdomkey to longevity Myths abound o Ex: daily alcoholic drink, church, continuation of sexual activity

Significant lifestyle factors include: o Diets, maintaining proper weight, exercise, no smoking, social connections, stress management

Future Old = Baby boomers Born between 1946 and 1964 High-tech orientation Most have children, but low birth rate means fewer biologic children to assist them in old age Their income tends to be higher than other groups Their leisure time is scarcer than other adults; they are more likely to feel stressed They exercise more frequently than other adults Healthier old age attainable for baby-boomers Informed and educated They are the best-educated generation ever Toughest challenge for healthcare b/c look everything up on the internet and come in knowing their condition Have to help them sort out what is right for them

Predictions for baby-boomers They will have a highly active role in their health care Their ability to access information will keep them informed They will not be satisfied with the conditions of todays nursing homes o Current nursing homes will not work for this generation

Their blended families may need special assistance with caregiving demands o Coordinating care with family members will pose problem as family is typically spread throughout country

Common Myths About Aging o Families forget their older relatives o In some cultures, taking care of old is respected tradition

Most people become senile in old age Senile just means they are growing old Senile DEMENTIA is confusion and loss of memory

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Social Security provides every elderly person with a decent retirement income The majority of the elderly reside in nursing homes Less than 5% of older ppl in assisted living

Medicare covers all health care-related costs for older people

Gerontological Nursing o o A specific area or nursing practice since the 1950s Gerontology Nurse Pioneers and Leaders Origins of gerontological nursing rooted in England Began with Florence Nightingale, continued by Agnes Jones In U.S. almshouses were destination for poor older ppl Deplorable conditions and neglect 1935 Social Security Act said SS funds could not be used to pay for care in almshouses o o Current Initiative Hartford Institute for Geriatric Nursing Nurse-led organization seeking to increase quality of care of nations health care for older Americans Led to commercial nursing homes

Nurse Competence in Aging (NCA)

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Provides grants and technical assistance to geriatric nursing organizations

Nursing works on getting ppl back to level of wellness or to help them deal with decreased level of function Gerontological Nursing Education Schools of nursing now include gerontological nursing content in curricula Continued need to increase numbers of faculty with preparation in gerontological nursing Less than 30% BSN programs have a faculty certified in Gero nursing GNEC (Geriatric Nursing Education Consortium): purpose is to increase geriatric content in nursing programs

Every older person should expect care provided by nurses with competence in gerontological nursing CORE KNOWLEDGE for nursing profession

Gerontological Nursing Roles Functions in variety of settingshospital, home, subacute and long-term care facilities, community Advanced practice gerontological nurses Critical need for nurses w/ masters and doctoral degrees in gero Have improved health outcomes and cost-effectiveness

Mission is to preserve function, enhance health, and enhance quality of life and dying

Issues in Aging Today o o Demographics of Aging Aging in the United States Gender issues More women than men HOWEVER, more heart issues w/ women now that they are working more (e.g. stress)

Diversity

Rise in older adults in other ethnicities (non-white) Make up about 19% of older Americans Health care problems prevalent in these communities o Hypertension, diabetes

Nursing focus on providing care for this growing population o o Need to meet needs of community Need to provide clinic hours to meet needs (e.g. Many are poor and need to continue to work so must have weekend hours, nightly hours) Operationalize care so can reach all ppl Ex: Newark had prevalence of poor outcome after strokes UMDNJ put banner on sides of buses going through Newark Banner had signs of stroke w/ tagline: Time is Brain HAVE 3 HRS TO ADMINISTER CLOT BUSTING DRUG

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Marital Status Majority over 80 live independently in community Older men more likely to be married than older women 42% of older women are widowed

Living Arrangements Florida has highest proportion of ppl 65+ (17.6%)

Education Education of older ppl increasing Baby-boomers more educated than current old-old o Future generations will continue this trend

Income and Employment Median income of 65+ is $44,188

9.7% living below poverty level o o Gender, racial, and cultural disparities exist At risk for poverty include: o Women, African Americans, Hispanics,

Factors influencing poverty and women include: Pay inequity, occupational segregation, caregiving responsibilities, longer life expectancy, rising health care costs, and womens work patterns All factors reduce pension earning, public assistance benefits, and personal savings

Global aging Western Europe and Japan have more older people than young people Will be joined by rest of Asia in 2040 and U.S. shortly thereafter

Japan, Hong Kong, Iceland, and Switzerland have longest life expectancy Influence by infant mortality rate (they have lowest rate globally)

Caring for an Aging Society Eldercare workforce understaffed and unprepared Eldercare Workforce Alliance A group of 28 national organizations representing older adults and the eldercare workforce Includes: family caregivers, health care professionals, and direct care workers Immediate goals are: o o o o Strengthen direct care workforce Address clinician and faculty shortages Ensure a competent workforce Redesign healthcare delivery

Diversity of the Aged Population o o Percentage of total population 65+ *Including this info b/c it was one of the PP slides* Non-hispanic white o Black: o Asian: o 2003: 3% 2030: 5% 2050: 8% 2003: 8 % 2030: 10% 2050: 12% 2003: 83% 2030: 72% 2050: 61%

Hispanic 2003: 6% 2030: 11% 2050: 18%

Baby Boom Generation o o o o o o o Born between 1946 and 1964 High-tech orientation Most have children, but low birth rate means fewer biologic children to assist them in old age They are the best-educated generation ever Their income tends to be higher than other groups Their leisure time is scarcer than other adults; they are more likely to feel stressed They exercise more frequently than other adults

Nursing Research

Dementia Reality orientation telling pt the truth Has catastrophic event dealing with the truth Instead we lie to avoid this event

Reducing falls Older adults think a fall means the end: Fall = hip fx = death Bring beds lower Research of falls in community and reasons why ppl fall

Use of restraints No restraintsthey cause injury

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Pain management Delirium NOT DEMENTIA Treatable and typically caused by medications

Humane end-of-life care

Politics of Aging o White House Conferences on Aging o Make recommendations to President and Congress to help guide national aging policies

Older Americans Act Delivers community-based services through state Area Agencies on Aging (AAAs)

The Elderly in New Jersey o o Population age 65 or older 1,113,136 ranked 9 th in the US Percent of population age 65 or older 13.2% - ranked 18 th in the US

Healthcare Resource Utilization o Higher rates of hospitalization, surgery, and physician visits exist Care is more likely to be paid by federal dollars than private insurers or the elderly themselves

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Less than 5% of the older population is institutionalized at any given time Utilizing health care on their own: BP cuffs at pharmacy rather than going to hospital/doc each time BP and glucose home test that can be uploaded to hospital/doc Fit Bit bracelet that monitors your health

Chapter 2: HEALTH AND WELLNESS Health o o Healthy = absence of disease Health Continuum o o Medical interpretation of health continuum: if individual is in good health or is well, disease or impairment is absent

Older ppl dont fit into this category Healthy aging Individual engaged in health Individual engaged in social life

Healthy People 2020 Looks at where we want to be w/ healthcare in next 5 years

Older Adults & Healthy People 2020 o o Use of Welcome to Medicare benefit Older adults up to date on clinical preventive services o Ex: PSA test for males

Older adults confidence in managing their chronic conditions Fully educate older ppl on disease process

Receipt of Diabetes Self-Management Benefits by older adults Encourage ppl to take advantage of benefits

Functional limitations in older adults Decrease number of functional limitations Encourage ppl to know signs of a stroke and come in if they think they have had one only have 3 hour window!!

Pressure ulcer-related hospitalizations among older adults Reduce pressure ulcers Prevention is key

Need for long-term services and support

Caregiver support services Elderly spouse needs support as caregiver

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Health care workforce with geriatric certification Emergency department visits due to falls among older adults Information on elder abuse, neglect, and exploitation

Wellness o o Involves ones whole being: physical, emotional, mental, social, spiritual, and environmental Wellness approach sees possibility of everyone (regardless of level on wellness continuum p. 22) achieving well-being by being at an optimal level of functioning for their level When one uses wellness or holistic approach, which has been suggested as a more appropriate model for older people, one regards health and wellness continuum from more positive direction and role of individual is more active

Strategies for Improving Health of Older People o o o o o Healthy lifestyle behaviors Injury prevention Delivery of culturally appropriate clinical preventive services Immunization and preventive screenings Self-management techniques for chronic illnesses CHF Educate pt on what to look for (e.g. getting fatigued faster) Pt needs to take initiative and let doc know when having problems

Healthy Aging o Healthy aging is process of slowing down, physically and cognitively, while resiliently adapting and compensating in order to optimally function and participate in all areas of ones life (textbook definition) Older adults describe healthy aging as having functional independence, self-care management of illness, positive outlook on life, and personal growth and social contribution

Healthy aging must start from birth and continue throughout life

Health Status of Older People o Self-reported health o In 2008, 39% of older persons rated their health as excellent or very good

Disability and Chronic Illness Current generation of older adults is healthier than previous generations Rates of disability and chronic illness higher among racially diverse older adults Incidence of chronic illness increases with age More than 80% of 70+ have at least one chronic condition

Causes of Death Heart disease, stroke, and cancer are leading causes Preventable risk factors: Smoking High BP Elevated blood glucose Obesity

Disease Prevention and Health Promotion for Older Adults o Older adults taking responsibility for their health o Implies control and places ones wellness in ones own hands Strong effect on ones health behavior People are learning how to be in touch with their body signals and to take and seek action accordingly

Steps for Health Behavior Change Precontmeplation Extended time period Negative aspects of undesirable behavior stay in periphery of mind

Contemplation Has ideas of change Examines behavior problem Considers balance between cost and benefit May take long time

Preparation Intention to change unite w/ plan of action Concrete steps to be taken within 1 month

Action Actual steps taken to modify behavior Person feels empowered and in control of life Frequently relies on support from others Takes 1 day at a time

Maintenance Begins 6 months after action Prevention of relapse Lasts a lifetime

Medicare Coverage for Preventive Services One-time Welcome to Medicare physical examination Cardiovascular screening (cholesterol, lipid, triglyceride levels) Breast cancer screening mammograms (once every 12 months) Cervical and vaginal cancer screening (Pap test and pelvic examination once every 24 months unless high risk) Colorectal cancer screening (fecal occult blood every 12 months, flexible sigmoidoscopy every 48 months, screening colonoscopy once every 24 months if high risk), barium enema (instead of colonoscopy or sigmoidoscopy) every 24 months for high risk or every 48 months if not high risk) Prostate cancer screening (digital rectal examination every 12 months, PSA test once every 12 months)

Influenza, pneumococcal, hepatitis B immunizations Bone mass measurements (once every 24 months for people at risk for osteoporosis or more often if medically indicated) Diabetes screening, supplies, and self-management training (fasting plasma glucose test, glucose monitors, test strips, lancets, diabetes self-management training) Glaucoma tests (once every 12 months for people at high risk for glaucoma)

Adopting healthier lifestyles and habits Nutritional Awareness Nation obese and undernourished because of imbalanced diet Weight problems among older adults o o Increase risk of disabilities related to cardiovascular disease, diabetes, arthritis Associated with increased functional limitations and decreased physical performance

Physical Fitness Inactivity poses serious health hazards to young and old alike Many older people believe that they are too old to begin or participate in active fitness program, but even with chronic conditions, a fitness program is possible Reduce proportion of adults who engage in no leisure time physical activity Increase proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day Increase proportion of adults who engage in vigorous physical activity that promotes development and maintenance of cardiorespiratory fitness 3+ days per week for 20+ minutes per occasion Increase proportion of adults who perform physical activities that enhance and maintain muscular strength and endurance

Increase proportion of adults who perform physical activities that enhance and maintain flexibility

Tai Chi Training Purpose o Explores extent and time course over which tai chi (TC) impacts measures of physical performance and cardiovascular function in older adults who are becoming frail

Sample/Setting o 311 participants ages 70 to 97 (M 80.9) living in 20 independent congregate living facilities

Method o 8-week randomized trial provided to 291 women and 20 men who were transitionally frail (+70 years and had fallen at least once in past year) Participants randomized to either TC exercise or wellness education (control) interventions Physical performance (gait speed, reach, chairrises, 360-degree turn, picking up an object from floor, and single-limb support) and hemodynamic outcomes (heart rate and blood pressure) were obtained at baseline and after 4, 8, and 12 months

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Results o o Positive impact on body mass index, systolic blood pressure, and heart rate, as well as on chair rises Fall occurrences reduced. Positive outcomes apparent after 4 or 8 months of training and persisted through completion

Implications o Positive benefits for frail older adults, including improved cardiovascular performance, decreased falls, and increased functional ability

Stress Management Meditation Form of relaxation and coping with stress

Involves working toward psychological state termed transcendental awareness that restricts focus of attention to object of meditation, physiological process, or internal sensation

Biofeedback Feedback from bodys internal processes By observing monitoring devices, person can learn to influence heart rate, circulation, and muscle tension Learned skill in stress control Explores body-mind connection

Autogenic Training Total body biofeedback or self-regulation without machinery Combination of yoga and autosuggestion Effective in treatment of gastrointestinal, circulatory, and endocrine disorders as well as anxiety, irritability, and fatigue

Progressive Relaxation Achieved through tension-relaxation techniques of specific muscles or muscle groups or, without tension, through countdown method, imagery, or recall of pleasant events or experiences

Arranging Ones Environment to Reduce Stress Design quiet environment Proximity of familiar belongings and environment

Developing Selfishness Clearly understand older persons goals Ensure that goals are expressive of self and not someone elses goals

o Racially diverse populations less likely to have recommended preventive services

Higher incidence of poverty which tends to mean lower health care and self-care behaviors

Goals include: Reducing premature mortality and morbidity Maintaining functional independence Extending life expectancy

Primary and Secondary Disease Prevention Primary prevention: prevention of disease before it occurs Healthy lifestyle behaviors such as regular exercise, smoking cessation, moderate alcohol use, low-fat diets, stress management, active social engagement, and cognitive stimulation

Secondary prevention: detection of disease at an early stage

HEALTH PROMOTION pneumonic:

Hypertension screen Environmental screen for safety issues Apnea during sleep screen Loss of weight Tetanus vaccination Hear in a noisy environment Pain screen and treatment Resistance and other exercises Osteoporosis screen Mood screen (depression) Occult blood in stool Testosterone deficiency (andropause) Influenza and pneumococcal vaccinations Oral screen for caries and abscesses Nicotine education Sugar screen (diabetes mellitus)
Not enough evidence to ID factors which may increase or decrease risk of developing Alzheimers or other cognitive declines Nurses need to educate effective strategies to enhance cognition Suggested strategies include: Prevention and management of chronic conditions Maintaining a healthy weight Avoiding excess caloric intake

Cognitive Health

Limiting sodium and fat intake Increasing antioxidant defense by consuming fruits/veggies Physical activity Participation in mentally stimulating activity Social engagement

Environmental Sensitivity Physical components Air; Water; Land mass

Social components Government; Economics; Culture

Avenues through which individuals health and wellness can be enhanced or limited Encourage independence and let pts do for themselves what they can Dont just do it for them because its easier and faster