Chapter 1 - Attitudes Toward Aging and Demographics on Aging, Gero History, & Nursing Roles

Frail-old

75+ years old needing services or 85+ years old

Middle-old

75-84 years old

Oldest-old

85+ years old

Elite-old

95+ years old

ANA Standards of Gerontological Nursing Practice

1. Assessment 2. Diagnosis 3. Outcomes Identification 4. Planning 5. Implementation: coordination of care health teaching & promotion consultation; prescriptive authority & treatment 6. Evaluation 7. Quality of Care 8. Performance Appraisal 9. Education 10. Collegiality 11. Ethics 12. Collaboration 13. Research 14. Resource Utilization 15. Leadership 16. Advocacy

Centenarians

100+ years old

50

121,000 inmates age ______ and over were in state or federal prisons (more than twice as many as a decade earlier) according to the U.S. Justice Department.

20.1%

1990-2010: Approximately 12.8% of population is 65 years or older. o Age of 65 came about via Social Security, which was established in 1935. o By 2030, the number is expected to increase to ______%.

Pre-elderly

55-64 years old

Young-old

65-74 years old

About half (52.4%)

About _____% of America's elders 65+ lived in the nine most populous states in 2010: o Florida o New York o Texas o Pennsylvania o Ohio o Illinois o Michigan o North Carolina

long-term care facilities.

Aging by different cultural groups is defined very differently. Asian, African, Hispanic, and many minority cultures usually do not put their families into ______________.

1. Children 2. Adolescents 3. Adults

Aging is defined differently by different age groups._________ and ______ view it more positively whereas _______ tend to view aging negatively.

Hispanic

Among all ethnic and racial groups, the Hispanic older population is projected to grow the fastest, from about 2 million in 2000 to more than 13 million by 2050.

Reduced death rates for children and young adults, new drugs, medical technology, and better disease prevention.

An American's average life expectancy at birth has trended upward as a result of:

1. chronologically 2. biologically 3. psychologically 4. sociologically 5. spiritually as a unitary being

An individual ages ___________, ___________, ___________, ___________, and s___________.

65

By 2050 one in five Americans will be over the age of ______

non-Hispanic white

By 2050, the percentage of the older population that is _________ is expected to decline from 84% to 64%

1. hypertension 2. arthritis 3. heart disease

Compression of Morbidity: o Gender: The number of men per 100 women by age decreases. Women live longer than men. o Over half of men and women reported _________ with _________ and _________ as the next most common conditions.

1. high school 2. bachelor's degree or higher. 3. White 4. Asians and Pacific Islanders 5. African Americans 6. Hispanics 7. Educational Attainmen

Education: • The educational level of the older population is increasing. • Between 1970 and 2008, the percentage of older persons who had completed _______ rose from 28% to 77.4%. • In 2008, about 20.5% had ________ • Completion of high school varies considerably by race and ethnic origin: 82.3% of the _______ population, 73.9% of A_______ , 59.7% of _______ , and 45.9% of _______ . • Older persons will continue to increase in their levels of education. • _________ - shows the growing increase in the number of persons over 65 who are high school graduates - about 78 percent in 2008. The percent of college graduates is also increasing although it is much lower.

1. functional age 2. the ability to perform activities of daily living (ADLs)

From the gerontological nursing perspective, ________, or _________, is more essential measure of age than chronological age.

5

In 1900, majority of population was under the age of ____.

10-14

In 1970, majority of population was between ______ years of age

30-39

In 1995, majority of population was between _____ years of age

alone

In the United States, 39% of women and 19% of men over the age of 65 live ________.

65

In the United States, the age of _______ is the standard by which one is awarded the status of senior citizen, whether it is desired or not.

1. Hispanic 2. African American 3. African American 4. 10% 5. 15,000 6. 24,999

Income and Employment: • Gender, racial, and cultural disparities exist • The highest poverty rates were experienced by older ______ women (43%) and older ________ women (34.7%). • The U.S. has one of the highest poverty rates for older women among industrialized countries. • Factors influencing the poverty status of older women include pay inequity, occupational segregation, caregiving responsibilities, longer life expectancy, rising health care costs, and women's work patterns, all of which reduce pension earnings, public assistance benefits and personal savings. • An increasing number of people over the age of 65 are remaining or returning to the workforce. • Approximately ______% of older adults live at poverty level. • Majority report incomes of _______ - ________. It's not a lot of money and it's is mostly paying for healthcare, medication, etc

2030

It is estimated by ______ that the US population while be spread relatively evenly across all ages. Aging population, not growing.

65

Life expectancy at age ______ increased by only 2.5 years between 1900 and 1960 but has increased by 4.2 years from 1960 to 2007.

1. houses, apartments, or public housing. 2. 5% 3. 85% 4. 80% 5. 5%

Living Arrangement of Older Persons (65+): • 90% live in __________ • Only ______% live in nursing homes. But they make up 85% of nursing home residents • Make up _____% of hospitalized patients • ______% of homecare visits • 5% - nursing homes • _____% - congregate housing, continuing care retirement communities, personal care homes, boarding homes, hotels, etc.

1. Men 2. Women

Living Arrangements - Of persons 65 years of age or older more _______ are married with a spouse than _______ .

female

Most centenarians are ________ (85%) and come from families in which longevity is common.

Immigration and higher fertility rates.

Most of the growth in racially and culturally diverse Americans is a result of patterns of ________.

1. metropolitan

Most persons 65 years of age and older live in metropolitan areas (80.6%)

health, finances, job security, sending children to college, caring for parents.

The major concerns of baby boomers are:

1. men 2. women 3. widowed

Older ______ are more likely to be married than older ______ , and 42% of all older women are ______

independently in the community

The majority of people over the age of 80 live independently in the community.

1. Social Security

Sources of Income for persons over 65: Social Security constitutes over 90% of income reported by 35% of Social Security beneficiaries. Although the income is not a lot, many people rely on Social Security

1. 12.6% 2. older men 3. older women 4. 20.1% 5. 85 years and older 6. 100 7. women

Statistics about U.S. Elderly Population: o In 2010, US total population = 308,745,538. o Of these, almost 38 million = 65+ yrs. (______%) o 42% - older men o 57.8% - older women o By 2030, almost 1 in 5 Americans (72 million) will be 65+ (______% of pop.) o The age group __________ is now the fastest growing segment of the U.S. population. o At present, about 3.1% of the population are at least ______ years old, compared with 0.1% in 1901. The total number is expected to increase by more than 400% by 2030. The majority of these centenarians will be ______.

Geriatrics

Sub-specialty of internal medicine and family medicine that focuses on health care of elderly people.[2] It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician or geriatric physician, a physician who specializes in the care of elderly people. Rather, this decision is determined by the individual patient's needs, and the availability of a specialist.

1. 12.8% 2. 48%

The 65+ population represent only 12.8% of the American population but accounts for 48% of all hospitalized patients.

Compression of Morbidity

The delay or postponement of illness and disability caused by chronic illness due to improvements in lifestyle and medical technology. It is compressed to a brief period at the end of the life span.

baby boomers

The first wave of _______ will turn 65 in 2011, and between 2008 and 2030 this group will swell the ranks of older adults.

1. African-American 2. Asian-American 3. Hispanic American 4. Native Americans and Alaska Native

The number of _______ elders will increase by 128%; the population of Asian-American elders will increase by 301%; Hispanic-American elders will grow 322%; and Native Americans and Alaska Native elders will increase by about 193%.

1. divorced 2. separated

The number of older people who are ________ or ________ is increasing and can be expected to rise as the baby boomers age.

90

The old-old and the elite-old (those ______ years and older) are the fastest growing segment of the aging population, as technologic advances have facilitated their survival.

Gerontology

The scientific study of the effects of time on human development, specifically the study of older persons.

nonagenarians

There is an expanding group of the very old, those now older than 90 years (_________), who remain mobile and active.

o Their diversity o The uncertain political and economic future o Potential major shifts in lifestyle expectations o Changing health care delivery and reimbursement systems o Progress in technology and medical management o Shifts in values and ethics that will profoundly affect daily life

To plan well for their (the baby boomers) retirement years, we must consider the following: 1._______ 2._______ 3._______ 4._______ 5._______ 6._______

1. Reduced death rates for children and young adults, new drugs, medical technology, and better disease prevention. 2. Access to better health care. 3. Taking better care of their health. 4. Vaccinations, immunizations, and medications.

What are the main reasons for the increase in life expectancy? 1._________ 2._________ 3._________ 4._________

These are people over the age of 110.

Who are supercentenarians?

1. the biology of aging 2. life expectancy 3. Diseases of affluence 4. increased 5. Negative

Why the interest or study of aging? • Increasing interest in __________ - Why do we get old? Can we retard the process? • Phenomenal shift in __________ - Growing population of the older adults. • ___________ are abundant in old age - Looking at more long-term illnesses, i.e., cardiovascular disease, cancer, stroke. • Cost of health care has _________. • ________ attitudes toward elders persist.

85+ years old

___ Age = the fastest growing segment of the US population

85%

_____% of nursing home residents are 65 yrs. and older.

5%

_____% of older adults reside in nursing homes

Florida

______ has the highest proportion of people over the age of 65 (17.6%) followed by West Virginia (15.7%), Pennsylvania (15.3%), Maine (15.1%), and Iowa (14.8%).

Older adults (65+)

______ represent 80% of home care visits. Hartford Institute. (2000).

Racially and culturally diverse

________ older people make up about 19% of all older Americans. This is projected to increase to approximately 40% by 2050.

1. Geriatrics 2. gerontology

________, the care of aged people, differs from _________, which is the study of the aging process itself.

Chronology

_________ is becoming a less significant factor to consider in aging

Centenarians

_________, the "elite old," are approached with some awe as our society seeks routes to longevity. These are people older than 100. They are the fastest growing segment of our population. 50% live in nursing homes

the parents of the baby boomers, the children of the Great Depression

___________, make up the majority of the present older generation.

Specialist gero nurse

advanced preparation at the master's level; clinical expertise (Educator & Advanced Practice Nurse Roles)

Generalist gero nurse

completed a basic-entry level educational program

Aging

is a universal experience that begins at the moment of birth. Affects every cell in every organ in the body.

U.S. Population by Age & Gender: The "Rectangularization of Aging"

o After WWII, the baby boomers were born (1946-1964). o According to the graphs, the percentage of the population was almost in a pyramidal shape. As the baby boomers generation grew older, their bracket set continued to move up until the graph resembled the shape of a rectangle. o This indicates the need for more nurses and improved health care.

Impact of Ageism

o Fosters myths and stereotypes. o Decreases self-esteem on part of elder - They think the stereotypes are the way that people really feel about them. o May result in a self-fulfilling prophecy - Becomes a self-fulfilling prophecy for the elderly, i.e., dressing the elderly for them; they might start to think that they are actually slow. o Gerontophobia. o Fosters social isolation or dependence - They know these myths so they won't take time to be around people. Need to include them in patient teachings and communication. o Decreases opportunities for elder employment - People think they can't work as well as younger people. o Rehabilitation and health education not a priority - Lacking a good "quality of life." o Lack of empathy and patience, disrespect common. o Decreased compensation and respect for nurses, etc. working in long-term care settings.

Mortality Crossover Effect

o Minorities tend to not live as long as the white population. This is usually due to access to health care, economics, and socioeconomic status. o However, after age 75, minorities tend to have lower death rates than the white population and this is due to the fact that they tend to have hardy personalities and they have access to better health care. o Healthy People 2010 - mentions the health disparities

Gerontological Nurse Entrepreneurs

o Nurse Entrepreneurs combine their nursing background with business and utilize their individual creativity and resourcefulness to start their own companies.

Gerontological Clinical Nurse Specialist

o Provide direct & indirect care to patients and their families. o Serve as nurse consultants to staff on complex issues of patient care. o Care for older adults in a variety of settings. o Prepared at the graduate level (master's degree).

Gerontological Nurse Practitioners:

o Provide primary care for older adults in an independent practice or a collaborative practice with a physician. o Care for older adults in a variety of settings. o Have considerable autonomy in treating common illnesses. o Prescriptive authority

Nurse Educators

o Teach & practice as faculty in colleges and universities, or as staff development educators in health care facilities. o Design, implement, evaluate and revise academic and continuing education programs. o May serve as nurse consultants. o Prepared at the graduate level (masters or doctoral degrees).

Ageism

stereotyping based on aging

Gerontophobia

the fear of aging.

Supercentenarians

those older than 110

History of Gerontological Nursing

• 1906 - 1st article published in AJN on care of the elderly • 1950 - Geriatrics becomes a specialization in nursing • 1966 - Division of Geriatric Nursing created by ANA • 1970 -Standards of practice for Geriatric Nursing published by ANA 1974 - 1st Certification in Gero nursing offered by ANA • 1975 - 1st issue of Journal of Gero Nursing published • 1976 - Standards for Gerontological Nursing Practice (ANA) • 1980 - 1st issue of Geriatric Nursing published by AACN & Hartford Foundation • 1984 - National Gero Nursing Association established • 1990 - Division of Long-Term-Care established by ANA • 1996 - Hartford Foundation launches gerontological initiatives/funding • 2000 - Baccalaureate competencies & curricular guidelines for Geriatric Nursing care published • 2010 - Gero Nursing: Scope & Standards of Practice published by ANA; Recommended Baccalaureate Competencies & Curricular Guidelines for Nursing care of older adults published by AACN & Hartford

1. centenarians 2. "hardier"

• Although there are fewer male _______, they are less likely than women to have significant mental or physical disabilities at that age. • Persons of color who live to age 85 are ________ than their white counterparts. • Lifestyle factors that do seem significant include diet, maintaining proper weight, exercise, avoidance of smoking, social connections, and how well a person handles stress.

Employment for Gerontological Nurses

• Hospitals • Long Term Care/Nursing Homes • Home Health Care • Ambulatory Care Clinics • Continuing Care Retirement Comm. • Health Departments • Adult Day Care Centers • Prison Systems

Certification

• How to receive the Gerontologic Nurse (BSN) Certification? o Show evidence of a BSN, a professional RN license, & practice equivalent to 2 yrs. full time as an RN o Have a minimum of 2000 hrs. of clinical practice in specialty area within last 3 yrs. o Have completed 30 hrs. of continuing education in Gero within last 3 yrs. o Pass the specialty certification exam • Renewing certification- (Certification lasts for 5 yrs.) o Must meet professional development requirements. o Must show evidence of practice (1,000 hrs.) or retest.

1. women 2. men 3. Ignatz Nascher 4. aging 5. disease

• Many more ______ than _____ grow old. • In the past, people who lived to old age were curiosities, stimulating reverence, speculation, and myth. • The term geriatrics was coined by an American physician, __________, around 1900 because he recognized that the medical care of older people involved in special considerations, much like the field of pediatrics. • ______ and _______ are separate entities although frequent companions

Certification: Going the extra mile

• The formal process by which clinical competence is validated in a specialty area of practice. (ANA, 2002) • ANCC is the credentialing arm for ANA. (ANCC= American Nurses Credentialing Center) • Only a small # of certified Gero nurses or geriatric advanced practice RN's.