Foundation of Nursing

Practice
Gerontological
Nursing

Topics

Introduction to Gerontology
Demographics of Aging
Perceptions of Aging
Theories of Aging
Communication
Ethico-legal Issues
End-of-life Issues

Advantages of Learning Geriatric Nursing

Learning patience, tolerance,

understanding and basic nursing
skills
Witnessing the terminal stages of
disease and the importance of
skilled nursing

Advantages of Learning Geriatric Nursing

Preparing for the future

Recognizing the importance of
rehabilitation
Being aware of the need to
undertake research.

Introduction to Gerontology

What is Gerontology?
- study process of

aging, and the

particular problems
of old people.

Geriatrics
Social Gerontology
Financial Gerontology
Branches of Gerontology

Classifications of Geriatrics
Young Old
Ages 65 - 74
Middle Old
Ages 75 - 84

Old Old (Very old,

frail Elderly)
Ages 85 and up

Branches of Gerontology
Gerontological
Rehabilitation Nursing
Combines expertise in
gerontological nursing
with rehabilitation
concepts and practice

Branches of Gerontology
Gerontological Nursing
Falls on the scope of
nursing practice
Scope of practice
includes all older adults
from the time of old
age until death.

Roles of the Gerontological Nurse

Provider of Care
Teacher
Manager
Advocate
Research Consumer

Continuum of Care
Inpatient subacute
unit

Inpatient rehabilitation
unit
PT
OT
Speech therapy
Social services
Nursing care

Long-term transitional
General
Chronic
Transitional

Ancillary services

OP Therapies
Adult day care
Home health care
Vocational rehab
Hospice

Home

ACUTE CARE
HOSPITAL

Group homes
Hospice
Assisted living
Residential
Long-term care facility
(Nursing home)

Demographics of Aging

Projected Acceleration of Population

Aging

Why the Population is Aging?

Factors that drive increase in life
expectancy:
Age Dynamics
Declining Fertility rates
Longevity increase

Life Expectancy at an All Time High

Its substantial and pleasing rise
results from infectious disease
control, public health initiatives,
and new surgical and
rehabilitation techniques.

A Skewed Sex Ratio

Its a Womans world
women characteristically
comprise the majority of the
older population in the majority
of countries throughout the
world.

A Skewed Sex Ratio

The sex ratio changes
65-74 age group:
100 females : 86 males
75-84 age group
100 females : 72 males
85 and older
100 females : 49 males

Perceptions of Aging

Aging Defies Definition

THE AGING PROCESS BEGINS WITH BIRTH
AND ENDS WITH DEATH. Thus, human aging
is:

universaleveryone ages
inevitablewe cannot stop the
process
irreversiblewe will never be
younger than we are today

Theories of Aging

Theories of Aging:
Characteristics of a good gerontological
theory:
Integrates knowledge
Tells how and why phenomena are related
Leads to prediction
Provides process and understanding
Holistic
Takes into account all that impacts on a
person throughout a lifetime of aging

Theories of Aging: Psychosocial Theories of Aging

Sociological Theories:
Activity Theory
Disengagement Theory
Subculture Theory
Continuity Theory
Age Satisfaction Theory
Person-Environment-Fit Theory
Gerotranscendence Theory

Theories of Aging

Biological Theories of Aging

Theories of Aging
Nursing Theories of Aging
Functional
Consequences Theory
Theory of Thriving

Psychosocial Theories of Aging

Psychological Theories
Personality
ego development
Challenges

Sociological Theories
challenging roles
relationships
status

Activity Theory
Postulated by Havighurst and
Albrecht in 1953
Conceived as an actual theory in
1963
Remaining occupied and
involved is necessary to a
satisfying late-life

Disengagement Theory
By sociologists
Cumming and Henry
(1961)
Aging is characterized
by gradual
disengagement from
society and
relationships

 Subculture Theory
Postulated by Arnold Rose in 1965
Views adults as a unique subculture
within a society
Older adults prefer to interact among
themselves
critical key determinants of social
status = Health and mobility
occupation, education or income

Individual differences
produce varied response
to aging
Personality influences
roles and life satisfaction
and remains consistent
throughout life.

CONTINUITY THEORY

4 Personality Types:
Integrated
Armored-defended
Passive-Dependent
Unintegrated

 AGE STRATIFICATION THEORY:

Age cohorts are influenced by:
Historical context
Shared similar experiences
Beliefs
Attitudes
Expectations of life course transitions

 PERSON-ENVIRONMENT-FIT
THEORY
Function is affected by:
Ego
Strength
Mobility
Health
Cognition
Sensory perception
Environment

 GEROTRANSCENDENCE THEORY
By Tornstams in 1994
oneness with the universe
Successful transformation includes:
Outward focus
Accepting impending death
Substantive relationships
Intergenerational connectedness
Spiritual unity with the universe

Psychological Theories of
Aging
A.medical
B.Processes emotions
C. Attitude
D.Motivation
E. Personality development

 Human Needs Theory

Postulated by Abraham Maslow in 1954
Five basic needs motivate human behavior
in a lifelong process toward need fulfillment

THEORY OF INDIVIDUALISM:
Jung (1960)
(extroversion) (introversion)
true self
It proposes that successful
aging includes:
Ability to accept the past
Adjust to losses as individuals
experience functional decline

 STAGES OF PERSONALITY DEVELOPMENT

THEORY (Erikson (1963)
- Ego Integrity vs.
Despair
1. Final phase of
development
2. Evaluating lifes
accomplishments
and meaning

 LIFE COURSE (LIFE SPAN

DEVELOPMENT) PARADIGM

Buhler, 1933
Life stages are predictable and
structured by roles, relationships,
values and goals

 SELECTIVE OPTIMIZATION WITH

COMPENSATION THEORY
Baltes (1987)
Selection
Optimization
Compensation
Critical life points:
Morbidity
Mortality
Quality of life

BIOLOGICAL THEORIES OF AGING

physiologic process
On the molecular level in the cells,
tissues, and body systems
How does the body-mind
interaction affect aging
What biological processes impact
aging
How to ones chromosomes impact
the overall aging process

CATEGORIES OF THE BIOLOGICAL THEORY

A. Stochastic Theory
random cell damage

B. Non-stochastic Theory
timed framework

Stochastic Theories

Free Radical Theory

Aging is due to
oxidative
metabolism and
the effects of free
radicals.

FREE
RADICALS
Appears as single
unpaired
electrons

causes:
A. Extensive damage to DNA ->
malignancy and accelerated
aging
B. Lipid oxygenation -> damage
to cell membrane -> affect
membrane permeability
C. DNA strand breaks and base
modifications -> gene
modulation

 ORGEL/ERROR THEORY
Environmental changes and randomly
induced events hastens aging (ex.
Radiation)
aging will not occur if destructive
factors such as radiation did not exist
and cause errors such as mutations
and regulatory disorders

Wear and Tear Theory

Excessive wear and
tear due
to
Aging
happens
due
Inability
of
strenuous
activities
to
the
cumulative
Cells inability
accelerate
aging
byin
some
cells
to
changes
occurring
to repair
causing
increased
cells
age
and
regenerate
damaged DNA
free radical
damage
cellular
production
metabolism

Connective Tissue Theory:

Also referred to as
Cross-link theory
biochemical processes
create connections
between structures not
normally connected
Occurs rapidly between
30-50 years of age

Non-stochastic Theories
Programmed Theory
(Cells die after a number of cell
divisions (40-60 times))

Defense mechanism of
cells to protect itself from
replication errors that can
cause mutations in DNA
When it is too short, the
cell undergoes apoptosis

Gene/Biological Clock
Theory

Compromising genetic
influences that predict
physical condition,
occurrence of disease, cause
and age of death, and other
factors that contribute to
longevity

Neuroendocrine Theory
Describes a change in hormone
secretion
Major hormones involved in aging:

Testosterone
Estrogen
Growth hormone
Melatonin

IMMUNOLOGIC/
AUTOIMMUNE THEORY

Aging is due to faulty

immunological function,
which is linked to
general well-being

Nursing Theories of Aging

FUNCTIONAL
CONSEQUENCES THEORY

Environmental
and biopsychosocial
consequences
impact functioning.

Nursing Theories of Aging

FUNCTIONAL CONSEQUENCES THEORY

Nursings role is risk

reduction to minimize ageassociated disability in
order to enhance
safety and quality of living.

Considers the
impact of
environment as
people age

THEORY OF THRIVING

Results from a discord between

the individual and his/her
environment or relationships.

THEORY OF THRIVING

THEORY OF THRIVING
Thriving is achieved when there is
harmony among a person and his/her
physical environment and personal
relationships.

Nurses identify
and modify
factors that
contribute to
disharmony
among these
elements
THEORY OF THRIVING

COMMUNICATION

Communication
negotiate adversity, and
convey or feelings.
express our needs and
wishes of others

Sensory Modalities Involved in

Communication

Vision
Hearing
Touch
Olfaction
Gustation
Movement
Speech
Disability

Verbal and Nonverbal

Communication

Effective Communication
Interprets the
messages and
responds in an
appropriate
manner

CUTE
AKO..

Effective Communication
Necessitates listening and taking into
account the meaning of an idea, event,
or experience described by the other
person

Effective Communication

We can learn together and build a

common bond through our respect and
understanding for others

Assistive Technology
Any item, piece or equipment, or
product system, whether acquired
commercially off the shelf,
modified, or customized, that is
used to increase, maintain, or
improve functional capabilities of
individuals with disabilities.

 Physiological changes assoc

with aging
Nursing facility residence
Cognitive decline
History of chronic otitis media
Exposure to excessive noise
Use of ototoxic medications
(antibiotics)

RISK FACTORS ASSOC.

WITH HEARING
IMPAIRMENT IN THE
OLDER ADULTS

FACTORS TO CONSIDER IN
USING ASSISTIVE DEVICES
A tool in
communication, not a
solution
Type of impairment
Degree of
impairment
Illness severity

ASSISTIVE TECHNOLOGY
Augmentative and Alternative
Communication (AAC)
An integrated group of
components, including
symbols, aids, strategies, and
techniques used by
individuals to enhance
communication

ASSISTIVE TECHNOLOGY
Augmentative and
Alternative Communication
(AAC)
Speech Language
Pathologist and
Occupational Therapist
determines what type of
communication device will
be prescribed

FOR HEARING

Transmits sound
waves to a microphone
worn by the individual
to improve listening
experience

For Hearing
May be used with or without a
hearing aid
Four major types
Personal frequency
modulation systems
Infrared systems
Induction loop systems
One-to-one communicators

COMMUNICATION
ESSENCE OF NURSING
TWO-WAY PROCESS

HEARING AIDS

CIC

ITC

ITE

BTE

GUIDELINES FOR
VERBAL
COMMUNICATION:
-Do not yell or
speak too loudly to
patients.
-Try to be at eye
level with the
patient.

GUIDELINES FOR VERBAL

COMMUNICATION
- Try to minimize background noise as it can make
it difficult for the pt to hear.
- Monitor the patients reaction.
- Touch the patient if appropriate and acceptable.

 Supplement verbal
instructions with written
instructions as needed.
Do not give long-winded
speeches or complicated
instructions to persons with
cognitive impairment,
anxiety or pain.
Ask how the patient would
like to be addressed.

GUIDELINES FOR VERBAL

COMMUNICATION

 Instrumental or Taskedfocused Communication

gathering information that will help
in the diagnosis of the client (formal)

Affective Communication
Focuses on how the health care
provider is caring about the person
(feelings or emotions)
More difficult

TYPES OF COMMUNICATION

5 Principles for Making Contact &

Communicating with Others
Invite
Arrange environment
Maximize
communication
Maximize understanding
Follow-through

1.Inviting
Use open-ended
questions to invite people
to engage
Extend your greeting and
make arrangements to
minimize distractions
during the admissions
interview

2. ARRANGING THE
ENVIRONMENT

Be face-to-face with
the client
Remember to respect
personal space and
territory
Ask for permission
before sitting down or
handling any assistive
devices
Arrange the room to
facilitate
independence and
provide safety

3. MAXIMIZING
COMMUNICATION
Maximize the patients
ability to understand the
message
Health Literacy

FOLLOW THESE TIPS WHEN COMMUNICATING

WITH PATIENTS:

Create a safe
environment for
patients
Sit down and face the
individual while
speaking, and talk
slowly
Organize information
Use simple language
Encourage questions

Limit amount of
information per visit
Use pictures/visual
aids
Ask patients to repeat
to you what you said
Ask patients what
they will do when
they return home

4. MAXIMIZING UNDERSTANDING
Most important skill:
LEARN TO LISTEN
Must be open-minded
and allow individuals
to share thoughts
Focus your time on the
person

5. FOLLOW THROUGH
Final principle
Back up your words
with actions to gain
trust
Trust and concern for
the welfare of others is
critical to optimal
health outcomes

Challenges in Communicating with

Older Adults
Communicating with individuals with:

Aphasia
Dysarthria
Visual Impairments
Hearing Impairments
Deafness

Ethical/Legal Principles and Issues

Ethics
principles that facilitate
decision making and
guide our personal
behavior
Evolved from our beliefs
and values
Driven by moral
reasoning

eTHICS OF cARE FOR THE oLD

cLIENTS
Compassion
Equity
Fairness
Dignity
Confidentiality
Autonomy

Ethical/Moral Principles
Advocacy
Autonomy
Beneficence/
Nonmal-eficence
Confidentiality
Fidelity

Fiduciary
responsibility
Justice
Quality of life
Reciprocity
Sanctity of life
veracity

P A T I E N T RIGHTS
Advanced Directives or
Living Wills
Durable Power of Attorney
Competence
Assisted Suicide

ETHICS IN PRACTICE
Mistakes
Conflict of Interest

END-OF-LIFE CARE

DEATH AND DYING

Nurses must take the lead in
integrating palliative care and
end-of-life care into their daily
practice, making it a core
competency in caring for people
with actual or potentially lifelimiting illness

 THE FOCUS OF CARE SHOULD

CENTER ON:
- Living with
terminal illness rather
than prolonging
suffering or the dying
process
- Addressing their
physical, emotional,
psychosocial, and
spiritual needs

COMMUNICATION ABOUT END-OF-LIFE

Talking about death and dying

ASK them

COMMUNICATING BAD NEWS

Six step approach:

Get started
Find out what the patient
knows
Find out how much the
patient knows
Share information
Respond to feelings
Plan/Follow up

Advanced Directives:

Durable power of attorney

Living will of declaration
Appointment of health care
representative
Do not resuscitate (DNR)
Life-prolonging procedures
declaration
(Five wishes)
Allow natural death (AND)

Options for End-of-Life Care

Curative/Acute
Care
Hospice Care
Palliative Care

End-of-Life Hospice Care

Conducted by a team:
Doctor of Medicine or Osteopathy
Registered Nurse
Social Worker
Pastoral or other counselor
Volunteers
Clergy/spiritual support
Additional counseling
Complementary therapies

 HOSPICE SHOULD INCLUDE, BUT

NOT LIMITED TO:
Nursing services and coordination of care
PT, OT, and speech-language pathology services
Medical social services
Home health aides and homemaker services
Physician services/Medical director
Counseling services (dietary, pastoral, & others)
Short-term inpatient care
Medical appliances and supplies
Medications and biologicals

Focus on Symptoms

Physical, Nonpain Symptoms

Physical, Pain Symptoms
Loss and Grief
Psychosocial Issues
Emotional Issues
Spiritual/Cultural Issues

Components of Peaceful
Dying
Instilling good
memories
Uniting with family
and medical staff
Avoiding suffering
with relief of pain &
symptoms
Saying good-bye

Maintaining
alertness, control,
privacy, dignity and
support
Becoming spiritually
ready
Dying quietly

POSTMORTEM CARE
Pronouncing Death
Identify the patient and note:
General appearance of the body
Lack of reaction to verbal or tactile stimulation
Lack of pupillary light reflex (fixed and dilated)
Absent breathing and lung sounds
Absent carotid and apical responses

Physical care of the Body

Conclusion

Aging continues to be explained from multiple

theoretical perspectives
Using the knowledge learned, nurses can:
Help people to use their genetic makeup to prevent
comorbidities
Facilitate best practices for managing chronic
illnesses
Maximize individuals strengths relative to
maintaining independence
Facilitate creative ways to overcome individuals
challenges
Assist in cultivating and maintaining older adults
cognitive status and mental health