Learning objectives

1. Describe the roles of the gerontological nurse.

2. Discuss the scope of practice in gerontological nursing.
3. Discuss aging across different cultures.
4. Critically evaluate successful aging.
Introduction to Gerontological Nursing
As a nursing student, you may have preconceived ideas about caring for older
adults. Such ideas are influenced by your observations of family members, friends,
neighbors, the media, and your own experience with the elderly. Perhaps you have a
close relationship with your grandparents or you have noticed the aging of your own
parents. For some of you, the aging process may have become noticeable when you
look at yourself in the mirror. But for all of us, this universal phenomenon we call aging
has some type of meaning, whether or not we have taken the time to consciously think
about it.

Gerontology is the study of the social, cultural, psychological, cognitive,

and biological aspects of ageing. The word was coined by Ilya Ilyich Mechnikov in
1903, from the Greek γέρων, geron, "old man" and -λογία, -logia, "study of".[The
field is distinguished from geriatrics, which is the branch of medicine that
specializes in the treatment of existing disease in older adults. Gerontologists
include researchers and practitioners in the fields of biology, nursing, medicine,
criminology, dentistry, social work, physical and occupational therapy,
psychology, psychiatry, sociology, economics, political science, architecture,
geography, pharmacy, public health, housing, and anthropology.
Gerontology is defined as the study of the maturing and development through middle age and
later life. It isn't just about studying old people. It's a broad study area, including:

 Physical changes, like those in the muscles, skeleton and hormone systems
 Mental changes, including how thoughts and memories change
 Social changes, such as how one interacts with others and how society interacts with you

The field of gerontology is actually quite broad, containing many professionals who focus on
various aspects of aging and development. While it could be considered one large field, it
actually consists of many smaller fields all working together with a united focus on middle-aged
and older adults.

 Care-taking
 Research
 Policy and program

Roles of the Gerontological Nurse

1. Provider of Care - In the role of caregiver or provider of care, the gerontological nurse
gives direct, hands-on care to older adults in a variety of settings.
2. Teacher -An essential part of all nursing is teaching. Gerontological nurses focus their
teaching on modifiable risk factors
3. Manager- Gerontological nurses act as managers during everyday care as they balance
the concerns of the patient, family, nursing, and the rest of the interdisciplinary team.
4. Advocate - As an advocate, the gerontological nurse acts on behalf of older adults to
promote their best interests and strengthen their autonomy and decision making.
5. Research Consumer - The appropriate level of involvement for nurses at the
baccalaureate level is that of research consumer. This involves gerontological nurses
being aware of current research literature, continuing to read and put into practice the
results of reliable and valid studies.

Concepts, Principles and Theories in the Care of Older Adults

Demography of Aging and Implications for Health and Nursing Care

1. Global Aging
2. Aging in the Philippines

Impact of Aging Members in the Family

 A Global Perspective on Aging

Aging as a Social Construction

While aging itself is a biological

process, what it means to be
“young” or “old” is socially
constructed. This means that there
is no inherent cultural meaning to
the biological process of aging.
Rather, cultures imbue youth and
age with meanings. Aging is
perceived differently around the
world, demonstrating its social
construction.

Frequently, the average life

expectancy in a given region bears
on what age counts as “old.” For
example, in the United States,
where the average life expectancy is
over 78 years, people are not
considered “old” until they are in
their sixties or seventies. However,
in Chad the average life expectancy
is less than 49 years. People in their
thirties or forties are therefore already middle-aged or “old.” These variations in people’s
perceptions of who should or should not be considered elderly indicates that notions of
youth and age are culturally constructed. There is thus no such thing as a universal age
for being considered old.

Cultural Treatment of Aging

Is this Incongruous?: Given the socially constructed nature of age, there are certain behaviors that people
typically associate with certain age groups as being “appropriate” or “acceptable. ” Is this old woman
challenging any conventional perceptions about how women of a certain age should behave?

Cultures treat their elderly differently and place different values on old age. Many
Eastern societies associate old age with wisdom, so they value old age much more than
their Western counterparts. In Japan, adult children are expected to care for their aging
parents in ways different than in the United States. Sixty five percent of Japanese elders
live with their children and very few live in nursing homes. Japanese cultural norms
suggest that caring for one’s parents by putting them in an assisted living home is
tantamount to neglect. When unable to care for themselves, parents should ideally
move in with their children. The Japanese celebration of old age is further illustrated by
the existence of Respect for the Aged Day, which is a national holiday to celebrate
elderly citizens.

With an aging population that continues to grow, our health care system will be changed
forever. Are we ready for it?

According to the Global Health and Aging report presented by the World Health
Organization (WHO), “The number of people aged 65 or older is projected to grow from
an estimated 524 million in 2010 to nearly 1.5 billion in 2050, with most of the increase
in developing countries.” In addition, by 2050, the number of people 65 years or older is
expected to significantly outnumber children younger than 5 years of age (Figure 1 1).

WHO attributes the elderly population’s rapid size increase to a change in the leading
cause of death—from infections to chronic noncommunicable diseases—which
increased life expectancy.1 These chronic conditions may include hypertension, high
cholesterol, arthritis, diabetes, heart disease, cancer, dementia, and congestive heart
failure. Heart disease, stroke, and cancer have been the leading chronic conditions that
have had the greatest impact on the aging population, especially in high-income
countries.1 In addition, the incidences of obesity and falls are increasing. 1-3

This leads to the question: what are the implications of the aging population on health
care? We have all heard the term “baby boomer.” According to the Office of Disease
Prevention and Health Promotion, the first Baby Boomers (those born between 1946
and 1964) turned 65 in 2011. 2 By 2030, it is projected that more than 60% of this
generation will be managing more than 1 chronic condition. Managing these chronic
conditions, along with a patient’s level of disability, will increase the financial demands
on our health care system. 3 The cost increases with the number of chronic conditions
being treated, taking into account the expected twice as many hospital admissions and
physician visits for Baby Boomers by 2030 3 (Figure 23).

According to the WHO report, some believe that as life expectancy increases, the
prevalence of disability will decrease because the progress we make in medicine will
slow disease progression from chronic disease to disability. As a result, there will be a
decrease in severe disability, but there will be increases in milder chronic
diseases.1 Other researchers, however, believe that as life expectancy increases, the
prevalence of disability will increase.

There are certain health conditions that are expected to be a challenge to our health
care system with the increasing aging population. These conditions include cancer,
dementia, increase in the number of falls, obesity, and diabetes.

Cancer
Due to the increasing aging population, the number of cancer cases is expected to
increase to 17 million by 2020 and 27 million by 2030. 1

Dementia
The burden of dementia is expected to increase with the increasing aging population, as
well. Alzheimer’s Disease International projects there will be 115 million individuals
living with Alzheimer’s disease/dementia in the world by 2050. The organization also
projects a significant proportion of the 115 million will be in less developed countries. 1

Increase in Falls
With falls being one of the most common causes of injury in the older population, this is
expected to be a challenge to our health care system. This is attributed to the fact that
Baby Boomers are living longer, remaining active, and possibly on medications that
could lead to falls.3

According to a report released by the American Hospital Association (AHA), “More than
 one-third of adults 65 or older fall each year. Of those who fall, 20% to 30% suffer
moderate to severe injuries (such as hip fractures) that decrease mobility and
independence. Almost 350,000 hip fractures occurred in 2000, a figure that is expected
to double by the year 2050.”3

Obesity
The number of people who are considered obese will continue to increase and have a
negative impact on our health care system. Not only is obesity a risk factor for many
health conditions, but it is very costly: patients who are obese cost the Medicare
program approximately 34% more compared with patients of normal weight. 3

Diabetes
According to another report released by the AHA, the number of “Americans with
diabetes is expected to rise from 30 million today to 46 million by 2030, when 1 of every
4 Boomers, 14 million, will be living with this chronic disease.” 3

Challenges
Expected challenges to the health care system include the following:
 Resource needs will continue to increase across all health care settings
 The incidence of obesity will continue to increase
 A shortage of health care professionals is expected
 The diversity of caregivers lags behind the growing diversity of patients
 Care has been focused on a single disease versus addressing comorbidity
 The sustainability and structure of federal programs in relation to the increasing
aging population are a concern
 Changes in family structure may lead to fewer family caregivers
 Adapting and adjusting to the Affordable Care Act pose challenges
To address the increasing aging population, the health care system must take on the
challenges listed above. Our health care system also needs to prepare for new
technology (especially because of the higher cost) by increasing training of health care
workers and examining how technology will impact hospital infrastructure. 3

The health care system will need to prepare for the increasing incidences of chronic
conditions within the aging population, as well as develop strategies to prevent falls. An
important challenge is implementation of new approaches in health care delivery to
address the changing health status of this aging population. With chronic conditions on
the rise in this population, their health care becomes more complex. Focusing on a
single disease rather than comorbidity can result in insufficient focus on other present
medical conditions.4

Instead, the health care system must prepare for implementing a multidisciplinary
approach to ensure patients are receiving better case management. There also needs
to be a focus on providing preventive care versus reactive care. Strategies may include
a more comprehensive care plan before discharge, a system to help identify patients
who require follow-up, and implementation of a program to help monitor patients.

Recent demographic shifts will have major implications for the U.S. healthcare
system, both in terms of the delivery of patient care and the practice of
nursing. According to experts at Kansas State University, improved public
health and clinical care have led to an increase in the average life span,
meaning that by the year 2020 more than 20 percent of the population will be
age 65 or older. In fact, individuals over the age of 85 make up the fastest-
growing group. This will lead to extended treatment of long-term chronic
conditions, challenging the healthcare system’s ability to provide efficient care.
In addition, the diversity of the general population is a relevant topic on the
minds of many nurses. Because multiculturalism affects the nature of illness
and disease as well as morbidity and mortality, nurses must learn to adapt
their practice to various cultural values and beliefs. Relevant factors include
national origin, religious affiliation, language, gender, sexual orientation, age,
disability, socioeconomic status and more. Understanding cultural diversity is
becoming a daily responsibility for many nurses.

Such changes in the population are significant for nurses. Nursing practice,
education and perspectives must adapt and respond to changing
demographics because nurses play an increasingly important role in
healthcare delivery.

Aging in the Philippines

Understanding the Aging Population
As the baby boomer generation ages, the number of older adults in the United States is
expected to increase exponentially. Combine this with a longer average life span, and
the healthcare system needs to adapt — quickly. To meet the needs of a large aging
population, nurses in particular must “identify strategies to allow older adults to live
independently for as long as possible; provide health care and education for older adults
who are self-managing multiple chronic illnesses; ensure that older adults in long-term
care settings receive high-quality care,” says Patricia A. Grady, Ph.D., RN, of the
National Institute of Nursing Research.
The National Institutes of Health estimates that about 80 percent of people over the age
of 65 have at least one chronic illness, such as heart disease, diabetes or arthritis. In
addition, the number of older adults with multiple chronic illnesses is substantial.
Chronic illnesses are one of the most central issues facing nurses in terms of the aging
population because they impact quality of life for patients and garner considerable
expenses. Seventy-five percent of healthcare costs in the United States are the result of
chronic illness, according to the Centers for Disease Control and Prevention.

The number of older people is growing

In the Philippines, the number of older people is increasing rapidly, faster
than growth in the total population. In 2000, there were 4.6 million senior
citizens (60 years or older), representing about 6% of the total population.
In two decades, this has grown to 9.4 million older people or about 8.6% of
the total population. The World Population Prospects 2019 projects that by
2050, older people will make up around 16.5% of the total population.

Older people need care and support

An ageing population increases the demand for health services. Older people
suffer from both degenerative and communicable diseases due to the ageing
of the body’s immune system. The leading causes of morbidity are
infections, while visual impairment, difficulty in walking, chewing , hearing,
osteoporosis, arthritis and incontinence are other common health-related
problems.

Older people struggle with poverty

According to the Department of Social Welfare and Development (DSWD), a

nearly a third (31.4%) of older people were living in poverty in 2000.
Currently, this number is estimated to be 1.3 million older people.

More than half of all older people (57.1%) were employed in 2000. More
males were employed (63.6%) than women (37.4%). The majority of those
employed (41%) were involved in primary economic activities such as
farming, forestry work and fishing. According to the latest World Social
Protection Report 2017-19, just 39.8% of people older than the statutory
pensionable age in the Philippines receive an old-age pension (contributory,
noncontributory or both).

Key facts
Below are the key statistics on the Philippine’s population of older people:

2019 2050

Population aged 60 and above (total) 9,433,000 23,863,000

Population aged 60 and above (% of total population) 8.6 16.5

Older women aged 60+ (% of total population) 4.83 9.40

Life expectancy (males) 67.08 71.88

Life expectancy (females) 75.31 79.5

Old-Age Dependency Ratio (Age 65+ / Age 15-64) 8.6 17.7

Rural older people (% of total population) 6.48

Urban older people (% of total population) 6.54

Older persons living alone aged 60 and above (% of total 5.4

population aged 60+)

The Impact on Health When Caring for an Aging Family Member

The majority of people who look after elderly and disabled adults throughout the United
States are family members. It might be a spouse or adult child. It could even be a sibling
or close friend. When someone people care about is struggling or faces a medical
emergency, they want to do whatever they can to help, and that can lead them to give
up many aspects of their life, as well as deal with increased stress.
With increased stress comes health issues of their own. Far too often, though, stress
begins so subtly as to barely be recognized. It slips in through a sleepless night, an
extra hour spent running errands for this aging senior, or by running late for work in the
morning. Then it begins to build and the physical effects of stress can become
significant.
This generally leads some families to turn to other long-term care options. Home care
agencies and the caregivers who devote themselves to providing the best support to
men and women at home should be aware of the general motivations behind seeking
these alternative solutions.
According to AAP News & Journals Gateway, in a blog titled, Many families
shouldering responsibilities for home health care, written by Zachary M.
Rossfeld, M.D.:
“After trying home health care, my husband is now secure and well-cared for in a
nursing home. He and I were determined to provide quality care at home. The
search for quality was confusing, essxhausting and depressing. He has little local
family to help. We depended on neighbors and the Chicago Fire Department to
help after his many falls, some quite dangerous. We didn’t understand the
avalanche of changing medical needs and care-taking needs that quickly put him
at risk.”
Because health and even relationships can be impacted by caring for someone in need,
home care agencies can offer a more cost-effective solution that allows these seniors to
remain home while providing relief to the family caregiving support network. Believing
that there are no other viable options can be difficult to counter, but when many of these
family caregivers realize that home care support is available, and that it’s a cost-
effective option that will supplement what they’re doing for their aging loved one, it
allows these aging men and women the chance to remain home, where they’re most
comfortable.
The busier family caregivers are in their normal routines in life, the more likely stress will
become a potent force and agencies are ideally positioned to offer them the support
they need. Sometimes it simply takes more advertising and the Internet is a powerful
force in spreading information.
ATTITUDES TOWARDS AGING
The way we care for aged individuals is influenced by our experiences with family,
friends, neighborhood, school and even work. Aging is a normal process, and it is
common to see older people around in our community. However, derogatory attitudes
toward older adults often exist because of negative past experiences. Some of us may
not have solid beliefs about older adults, but separating myth from reality is a good way
of appreciating older adults and caring for them in the correct manner.

DEMOGRAPHICS OF AGING
In the latest census by the US Census Bureau, a whopping 39.6 million older adults
reside in America, which makes up 12.9% of the population of the country. By 2035, it is
expected that 1 out of 5 individuals will be 65 years or older. These seniors will be
different from those of past decades. They will enjoy better health, longer lives, and
more active lifestyles because of technology and new advancements in medical care.

However, the increased life expectancy has also caused the creation of three elderly
sub-populations, namely the young old (people aged 65 to 74), the old (people aged 74
to 84) and the oldest-old (people aged 85+). The new retirees will require medical and
Social Security assistance to meet their needs. They will also need long-term care to
maintain their health and well-being throughout the remainder of their lives.

Despite the slow progress that has been made nursing of the older
adults is now recognized as a legitimate specialty. The important
groundwork that that has been laid now serves as the basis from which
the specialty will forge into the future. Gerontologic nurses of all level of
educational preparation and in all settings of care must now venture
into that future with creativity, pride, and determination as they meet
their professional responsibility in providing quality care to older person
everywhere,

Assignment
1. Care of the older person today is considerably different than it was 50 years ago.
Cite examples of how and why the care of older is different today than it was the
past,
2. As a student, you are often assigned to care for older person. As what point in your
education do you feel care of the older person should be included, early in, later in or
throughout your nursing program? Support your position

Personal Reflections

1. How do you feel about aging? Do you dread getting older, or look forward to it?
Do you see advanced age as a challenge or something to fear?
2. Have you ever cared for an elderly person before? If so, what was that
experience like? How do you feel about caring for older adults in your nursing
practice?
3. What do you think about nurses who work in nursing homes? Have you ever
considered a career in gerontology? What are the positives you can see about
developing expertise in this field of nursing?
4. Have you ever seen ageism in practice? If so, think about that situation and how
it could have been turned into a positive scenario. If not, how have the situations
you have been in avoided discrimination against the elderly?
5. Which of the settings for gerontological nursing practice appeal to you most at
this time in your professional career? Is there any one setting that you can see
yourself working in more than another? Do you think this will change as you
progress in your career?