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Concepts in Gerontological Nursing > Concepts in Gerontology > Flashcards

Concepts in Gerontology Flashcards

1
Q

What is gerontological nursing?

A
  • Gerontological nursing is a specialty requiring complex skill set to provide high quality care for patients with high acuity and long-term conditions.
  • Care of older adults is the fastest-growing employment segment in the health care sector and industry.
  • Older adults are the core consumers of health care, having higher rates of outpatient visits, hospitalizations, as well as home, retirement and long-term care (LTC) service use than any other age group.
  • Despite this high demand, the number of health care workers who are interested in and prepared to care for older adults remains low.
  • Less than 1% of registered nurses (RNs) are certified in gerontology.
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2
Q

What are the 11 Concepts in Gerontology

A

Perfusion
Gas Exchange
Mobility
Digestion
Elimination
Cognition
Metabolism and Glucose Regulation
Immunity
Tissue Integrity
Infection
Mood

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3
Q

Health Challenges:
Perfusion

A

- Vascular disorders
- CAD
- Heart failure (right and left)
- Stroke
- MI

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4
Q

Health Challenges:
Gas Exchange

A
  • COPD
  • pneumonia
  • emphysema
  • Pulmonary hypertension
  • asthma
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5
Q

Health Challenges:
Mobility

A
  • Arthritis
  • fractures due to falls
  • frailty
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6
Q

Health Challenges:
Digestion

A
  • Constipation (result from mobility)
  • acid reflux
  • ulcers (result from medications ex: NSAIDs)
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7
Q

Health Challenges:
Elimination

A
  • Poor kidney functions (result from reduced glomerular filtration rate, incontinence, UTIs)
  • general confusion
  • delirium
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8
Q

Health Challenges:
Cognition

A
  • Dementia
  • Parkinson’s
  • neurodegenerative diseases
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9
Q

Health Challenges:
Metabolism and Glucose Regulation

A
  • Diabetes (types 2)
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10
Q

Health Challenges:
Immunity

A
  • Increased risk for influenza, pneumonia, Flu shot
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11
Q

Health Challenges:
Mood

A
  • Sundowning
  • social isolation
  • depression
  • suicide (higher amongst older men)
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12
Q

Who is Old?

A

Considered 65 and older.

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13
Q

Burden on society or story of Success?
Older People and Ageing

A

Success
- being able to age due to medical health and being able to survive 1-5 years old
- People live longer because they survived infancy

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14
Q

Aging Pyramid 1891

A

Past:
- there were lots of children and as the population gets older there are less people.
- Due to dying younger
- People having more children In developing countries

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15
Q

Life Expectancy

A

83.8 years
- Higher for women than men
- Indigenous/ Black Canadians:
- On average 10 years shorter
- Due to social determinants of health: Residential schools lead to malnutrition, mental health, suicide rates, poor health access

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16
Q

Why are “ bed blockers” & “frequent flyers” considered to be a Burden to health care system and society?

A

Bed Blocker
- Putting the blame on individuals for blocking/using beds for someone who might still need a hospital bed

Frequent Flyer
- Many readmissions
- Negative image and portrayal of older people through language and visuals increases the risk of ageism, discrimination and poor quality, undignified care.
- Caring for older people requires highly skilled health care professionals due to the complexity of health challenges both in community and acute hospital settings.

17
Q

Infant Mortality Rate

A

The infant mortality rate in Canada, for children under the age of one year old, was 187 deaths per thousand births in 1900.
- For all babies born in 1865, almost one fifth did not survive past their first birthday.
- This has dropped significantly.
- The current infant mortality rate for Canada in 2022 is 4.055 deaths per 1000 live births
- Advances in medical science, welfare and care provision
- But consider health inequity and racism leading to disparate outcomes for Indigenous, Black and other ethnic minorities in Canada.

18
Q

Health Care Costs

A

The average per-person spending on health care for Canadians aged 64 and below is $2,700. The average per-person spending on Canadians aged 65 and over is more than four times higher at $12,000.
- Increase in LTC patients (almost double)
- Increase in people ageing at home and requiring home care (by 1/3)
- Projections that we will spend nearly $60 billion per year for older people’s services in 2031.
- Quality of care not just quantity

19
Q

Frailty and falls
Is it a typical old age problem?

A
  • Frailty is theoretically defined as a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised.
  • In the absence of a gold standard, frailty has been operationally defined by Fried et al. as meeting three out of five phenotypic criteria indicating compromised energetics:
    • Low grip strength: Muscle strength, proxy for overall muscle strength
    • Low energy
    • Slowed walking speed: Slower then expected
    • Low physical activity: Not physically active
    • Unintentional weight loss: To Have a baseline
20
Q

Who is at highest risk for frailty?

A
  • 85+ age group highest risk
  • Less likely to be physically active, risks for other comorbidities
  • Health care system - treatments are different for older vs younger

Women
- Losses muscle mass after menopause
- Higher risk for osteoporosis after menopause

More prevalent amongst Black older people than White older people
- Social determinates of health
- Don’t have enough information on this

21
Q

Who is at risk for Falls?

A

Similar to frailty risk:
- Oldest old – 85 years and older - have highest prevalence (nearly 10% reported a fall related injury – almost double to 65–69 year-olds)
- More likely to be female
- More likely to be living alone

Falls are the No. 1 reason for injury-related death, hospitalization and emergency department visits for older adults in Canada. Falls among older adults cost $5.6 billion in 2018 – nearly 20 per cent of the total cost of injury in Canada. 1 in 3 people aged 65 and older are likely to fall at least once.

22
Q

Falls Assessment

A

Assessment:
- Is the person at risk?
- Fall risk assessment tool

Prevention:
- Education
- Safe environment
- Exercise and maintaining activity
- Work on their balance, decreasing risk of falls

Best Practice Guidelines
- Fall prevention interventions: listen to patients/ clients

23
Q

Falls Nursing Care

A

Best Practice Guidelines
- Patient and family-centered care
- Consider cause and outcomes of fall:
- Environment / Rugs - tripping hazard
- Adequate lighting
- Foot wear
- Low traffic area
- Mobility aids nearby
- Stick rug to ground
- Dehydration - Drink fluids to prevent low BP and dizziness

24
Q

Fear of Falling

A
  • A person has lasting fear of falling and may avoid activities they would otherwise be capable of performing
  • As much of a concern to older people as crime, financial crisis or other adverse health events
  • More often affects older women, those with previous falls and certain co-morbidities (chronic illness, frailty)
  • Activity restriction in the long-term adversely affects mental and physical health and actually increases the risk of future falls.
  • Rehabilitation focuses on reducing fear of falling through building strength, balance and confidence
    Working with PT and OT to stay physically active
25
Q

Successful Ageing
What does that look like and for whom?

A

“Successful ageing has become an important concept to describe the quality of ageing. It is a multidimensional concept, and the main focus is how to expand functional years in a later life span.”
- Ageing in the absence of disease?
- Active Ageing?
- Productive Ageing?
- Ageing in place?
- Could be aging at home and not LTC

26
Q

Who decides what “successful” ageing is?

A

Policy makers/ politicians?
- Concerned about Money
- Health Care Organizations?
- Health Care Professionals?
- Communities?
- Individuals?

Consider population level or individual perspective and determinants of health
Public health focus: Population level stays health VS no determinants of health (not everyone has the chance to age healthy)

27
Q

Diversity, patient centered care and dignity in older age and opportunities for nursing

A
  • Each age cohort is different, and each older person is different
  • Be cautious in attributing specific characteristics simply to “old age”
  • Consider cultural differences and determinants of health
  • Gerontological nursing is an opportunity to make a significant difference in the lives of older adults.
  • Nurses have a responsibility to contribute to accessible health care and the reduction of health disparities.
  • How would you like to age and have health care provided to you in older age.
28
Q

Three factors that influence the aging experience

A
  1. Health
  2. History
  3. Gender
29
Q

Wellness

A
  • State of being and feeling that one strives to achieve through effective health practices.
  • In working toward wellness, an individual may reach plateaus in his or her ascension to higher-level wellness.
  • The person may also regress because of an illness or acute event or crisis, but these events can be a potential stimulus for growth and a return to moving along the wellness continuum
30
Q

Health

A
  • Definitions of health vary greatly and are influenced by both culture and where one is on the life span.
  • In later life is often thought of in terms of functional ability (i.e., the ability to do what is important to a given person) rather than the absence of disease.
  • Well-being for those older than 60 years of age is strongly related to functional status but is affected also by socioeconomic factors, degree of social interaction, marital status, and aspects of one’s living situation and environment.
31
Q

What are the potential risks/ health outcomes/ impacts of frailty?

A

The course of frailty is characterized by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalization, malnutrition, infection, physical and mental health co-morbidities, and mortality.

Concepts in Gerontological Nursing (6 decks)

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