Geriatrics Test 1 Flashcards
Gerontology Definition
Is the broad term used to define the study of aging
Geriatrics Definition
Is often used as a generic term relating to older adults, but it specifically refers to the medical care of older adults
Entry Level Gerontology Certification
- Having practiced the equivalent of 2 years full time as a registered nurse
- Having a minimum of 2,000 hours of clinical practice in the specialty area of gerontological nursing within the last 3 years
- Having completed 30 hours of continuing education in gerontological nursing within the last 3 years
Advanced Practice Certification (Geriatrics)
- Advanced practice registered nurse (APRN)
- Gerontological nurse practitioner (GNP)
- Clinical nurse specialist (CNS)
Scope of Nursing Practice
- Defined by state regulation
- Influenced by the complex and multifaceted needs of the population being served
- Depends on the setting in which the nurse practices
Standards of Nursing Practice
- Developed by the nursing profession
- Divided into clinical care and the role of the professional nurse
1. Assessment
2. Diagnosis
3. Outcome identification
4. Planning
5. Implementation
6. Evaluation
Standards of Professional Gerontological Nursing Performance
- Quality of care
- Performance appraisal
- Education
- Collegiality
- Ethics
- Collaboration
- Research
- Resource utilization
- Transitions of care
Elder Demographics
- The global share of older people (65 or older) increased from 6% in 1990 to 9% in 2019.
- The percentage of individuals at least 65 years old varies by country because of higher birth rates and shorter life spans in the least developed countries
Centenarians are more likely to be…
The population of centenarians is overwhelmingly female (84%), lower educated, more impoverished, more likely to be widowed, and more disabled as compared with other older cohorts
* The fastest growing segment of the population of U.S. comprises centenarians
Genomics Definition
Is the identification of gene sequences in the DNA
Genetics Definition
Is the study of heredity and the transmission of certain genes through generations
Gender and Older Age
- The older population is predominantly female
- By 2050, women will comprise 54% of the global population aged 65 or older
Health Disparities: African Americans
- In 2018, the medium income of older African American households was estimated to be $47,149, compared with $67,904 among older non-Hispanic white households
- African Americans experience higher rates of diabetes, HTN, and CKD than other Americans
Health Disparities: Hispanic
- The poverty rate in 2017 for Hispanic elders in the United States was nearly twice that of the total older population: 17% compared with 9.2%
- The top five leading causes of death for Hispanic Americans are heart disease, cancer, stroke, diabetes, and chronic lower respiratory diseases
Health Disparities: Asians and Pacific Islanders
- This ethnic group comprises 40 different ethnic groups with varying economic, educational, and health profiles
- Members of this ethnic minority are less likely than U.S. whites to live in nursing homes, and they have a higher life expectancy
- The top five causes of death are heart disease, cancer, stroke, Alzheimer’s disease, and diabetes
Health Disparities: Native Americans and Alaska Natives
- The census group Native American and Alaska Natives comprises 574 nations, tribes, bands, and native villages
- The top five leading causes of death are heart disease, cancer, chronic lower respiratory diseases, diabetes, and stroke
- This population has higher rates of diabetes, HTN, back pain, and vision loss
Health Disparities: Older Foreign-Born Population
- The newly immigrated are those people who are living in the United States who were not U.S. citizens at birth
- Approximately 13.17% of the total U.S. population is foreign-born
- From 2000 to 2017, the number of newly arrived immigrants who are aged 65 and older has roughly tripled, from 2% to 6%
Health Disparities: Living Arrangements
- Globally, 40% of older persons aged 60 years or older live independently, and it is far more common in developed countries
- Older people who live alone are more likely than their married counterparts to live in poverty
- Only 4.5% of older adults live in nursing homes, and 2% live in assisted living facilities
Health Disparities: U.S. Veterans
- In 2015, one out of every two men over 65 years old were veterans
- There are currently three cohorts of older veterans: those who served in WW2, Korean War, and Vietnam
- Some experience PTSD with age
- Changes in military healthcare systems have occurred
Health Disparities: Disabled
- Advances in healthcare have increased the life span of persons with disabilities, including individuals with acquired or congenital disabilities
- According to the U.S. Census, about 85,000 adults over 60 have IDD (intellectual and developmental disabilities), with 1.4 million projected to have IDD by 2030.
Health Disparities: Prisoners
- As of 2016, 38,000 inmates over the age of 65 were in federal and state prisons
- Because of the stressors related to incarceration, as well as increased likelihood of an unhealthy lifestyle preceding incarceration, prisoners 50-55 experience physical and mental changes normally associated with free-world citizens at least 10 years older (“they age faster”)
Leading Cause of Death for Older Adults in the United States
Heart disease
Changes in Medicare over the last decade:
- An initial wellness examination that includes prevention counseling
- Annual wellness visits
- Smoking cessation (no longer limited to those who have an illness caused by or complicated by tobacco use
- Comprehensive health programs that include complementary and alternative practices, developed for cardiac rehabilitation
- Screening and intensive behavioral therapy for obesity
- Depression screening in a primary care setting that can provide follow-up and referral
- Alcohol misuse counseling sessions, up to four per year, in a primary care setting with a qualified provider
- Elimination of all deductibles and copayments for prevention services to enhance access
Physical Health: Nutrition
- Older adults are vulnerable to both obesity and malnutrition
- Social isolation, dental problems, medical disease, and medication contribute to malnourishment
- Blue zones show a correlation in lifestyle habits and diet among the most concentrated areas of centenarians (Mediterranean diet)
Physical Health: Dietary Implications for Older Adults
- Low fat, low cholesterol, and low sodium diets are suggested
- Highly restricted diets can lead to deficient dietary intake and malnutrition
Emotional Health
- Physical and mental health are connected
- Depression (experiencing loss)
- Dependency
- Quality of life and wellness
Intellectual Health
- The ability to think, learn, process, and utilize memory clearly
- Alzheimer’s disease
- Dementia
Vocational Health
- More older adults cannot financially support themselves with retirement savings, making the role of employment increasingly significant
- Older adults may choose re-engagement over retirement through voluntary opportunities, cohousing, participation in senior centers, or intergenerational programming
Baby Boomers
- Baby boomers began turning 65 in 2011
- This cohort of older adults is the:
1. Longest lived
2. Best educated
3. Healthiest
4. Most engaged
5. Largest cohort of retirees
Spiritual Health
Life Review: an autobiographical effort preserved in print, by tape recording, or on videotape
Health Behavior Change
- The processes underlying the learning of new health behaviors
- Popular theories
- Cognitive theory
- Stages of change - Education paired with empowerment theory
- Health promotion interventions must be individualized
Green House
- Revolution in long term care
- First constructed in Tupelo, MS
- Looks life surrounding homes in the neighborhood
- 10 residents have private room and bath with shared areas for cooking and socializing, and a garden
- Promotes autonomy
Primary Prevention
Designed to prevent disease from occurring
Secondary Prevention
Early detection and management of disease
Tertiary Prevention
Management of clinical diseases to prevent them from progressing and to avoid complications
U.S. Preventative Services Task Force (USPSTF)
USPSTF endorsement:
- Level A: highly recommended
- Level B: recommended
- Level C: recommended for some
- Level D: not recommended
- Level I: insufficient data for recommendation
The Focus of Health Promotion Efforts
Recommended by Health People 2030 and USPSTF:
1. Physical activity
2. Nutrition
3. Tobacco use
4. Health screening
5. Injury prevention
6. Preventative medications and immunizations
7. Caregiver support
Physical Activity
- Functional decline is partly attributable to physical inactivity
- Moderate activity
- 30 minutes of brisk walking 5 or more days per week - Barriers to physical activity
- Lack of access to safe areas to exercise, pain, fatigue, and impairment in sensory function and mobility - Nursing plays a part in promoting physical activity
- Goal setting
- Planning
- Follow up
Signs of Poor Nutrition in Older Adults
- BMI under 21
- Weight gain or loss
- Albumin < 3.4 g/dL
- Cholesterol < 160 mg/dL
- Hgb < 12 g/dL
- Serum transferrin < 180
Safety and Older Adults
- Falls are the leading cause of unintentional injury death in older adults in the U.S.
- Nurses should provide a full multifactorial fall risk assessment if the adult:
- Has experienced more than one fall
- Has had an injury requiring medical care
- Has difficulty with walking and/or balance
Polypharmacy and Medication Errors
- Older adults are 12% of the U.S. population but use about 1/3 of all prescription and OTC drugs
- Increased numbers of medications carry increased risks
- Beer’s Criteria for Potentially Inappropriate Medications in Older Adults
- Screening Tool of Older Persons’ Prescriptions (STOPP)
- Screening Tool to Alert to Right Treatment (START)
Immunizations
- Flu (annual for age 65+)
- Pneumococcal pneumonia (one time for 65+)
- Tetanus and diphtheria (booster every 10 years for all older adults)
- Herpes zoster (one time for age 60+)
- COVID-19
Important Screenings for Older Adults
- Mental health
- Alcohol abuse
- Drug use
- Elder abuse and neglect
- Heart and vascular disease
- Stroke
- Thyroid disease
- Osteoporosis
- Vision and hearing
- Prostate cancer
- Breast cancer
- Colorectal cancer
Aging Process
- Aging processes that occur in one physiological system can directly or indirectly influence other physiological systems
- Physiological aging is an extremely individual process, and how the body ages is greatly affected by a person’s genetic makeup, health behaviors, and availability of resources