1. Gerontological Nursing: Past, Present, and Future Copyright © 2016 by Elsevier, Inc. All rights reserved.

2. It is essential that nurses have the knowledge and skills to help people of all ages, races, and cultures to achieve health aging To enhance health in aging requires attention throughout life, along with the expert care of nurses Estimates are by 2020 up to 75% of nurses’ time will be spent with older adults 2 Copyright © 2016 by Elsevier, Inc. All rights reserved.

3. In the United States, eldercare is projected to be the fastest growing employment sector in health care Less than 1% of registered nurses and fewer than 3% of advanced practice nurses are certified in geriatrics The Patient Protection and Affordable Care Act (2010) provides many initiatives that will have a direct impact on gerontological nursing with regard to workforce, education, and practice 3 Copyright © 2016 by Elsevier, Inc. All rights reserved.

4. Gerontological nurses have made significant contributions to the body of knowledge guiding best practices for older adults It has emerged as a specialty area of practice only within the past six decades The specialty was defined and shaped by nursing pioneers who saw that older individuals had special needs and required subtle, holistic, and complex nursing care See what the pioneers have to say (Box 2-2) 4 Copyright © 2016 by Elsevier, Inc. All rights reserved.

5. Gerontic Nurse Pioneers and Leaders Origins of gerontological nursing rooted in England Began with Florence Nightingale Expanded in United States with passage of Social Security Act AJN article (Gelbach, 1943) recommended that nurses have specific geriatric education 1950—First textbook on nursing care of elderly 1952—First published nursing research on chronic disease and the elderly 5 Copyright © 2016 by Elsevier, Inc. All rights reserved.

6. Current Initiatives Hartford Institute of Geriatric Nursing, established in 1996 by the John Hartford Foundation Nurse Competent in Aging (NCA) Project; check out ConsultGeriRN.org as one resource Resourcefully Enhancing Aging in Specialty Nursing (REASN) Sigma Theta Tau’s Center for Nursing Excellence in Long-Term Care 6 Copyright © 2016 by Elsevier, Inc. All rights reserved.

7. Gerontological Nursing Education ANA Gerontological Nursing: Scope and Standards of Practice addresses knowledge and skills for nurses Older adult competencies have been developed by the American Association of Colleges of Nursing (AACN) and are reflected in The Essentials of Baccalaureate Education for Professional Nursing Practice In 2010, The Hartford Institute published the Recommended Competencies and Curricular Guidelines for Nursing Care of Older Adults 7 Copyright © 2016 by Elsevier, Inc. All rights reserved.

8. Organizations Devoted to Gerontology Research and Practice Gerontological Society of America (GSA) American Society on Aging (ASA) Association for Gerontology in Higher Education (AGHE) National Council on Aging (NCOA) National Gerontological Nursing Association (NGNA) Gerontogical Advanced Practice Nurses Association (GAPNA) National Association Directors of Nursing in Long Term Care (NADONA/LTC) Canadian Gerontological Nursing Association (CGNA) 8 Copyright © 2016 by Elsevier, Inc. All rights reserved.

9. Early studies focused on older people who were ill and failed to adequately address aging issues The current impetus for research has focused around the impact of disease and morbidity, impending death on quality of life, and experience of aging A need to shift from the “biomedical” model of aging The National Aging Institute, the National Institute of Nursing Research, the National Institute of Mental Health, and the Agency for Healthcare Research and Quality have contributed to our understanding of older persons and provide federal funding 9 Copyright © 2016 by Elsevier, Inc. All rights reserved.

10. Has evolved to the point of producing best practice standards The National Institute of Nursing Research provides considerable funding for research with older adults Nurse researchers publish in many journals related to gerontology Nursing research has significantly impacted the quality of life of older people Future directions of nursing research (Box 2-3) 10 Copyright © 2016 by Elsevier, Inc. All rights reserved.

11. Gerontological nursing offers a wide variety of settings and circumstances with limitless opportunities Can function in generalist or specialist roles Functions in variety of settings: primary care, acute care, home care, subacute and long-term care (LTC) facilities, and the community National certification is a way to demonstrate knowledge in care of older adults 11 Copyright © 2016 by Elsevier, Inc. All rights reserved.

12. Specialist Roles APRN may specialize, but are not licensed solely in a specialty APRNs with certification and interest in geriatrics is low Adult nurse practitioner and gerontological nurse practitioner specialty education is now combined and will hopefully lead to more expertise in care of the older adult Adult-gerontological nurse practitioners may be trained in acute or primary care Geriatric nurse practitioners and clinical nurse specialists have made a big difference in LTC over the last 40 years. 12 Copyright © 2016 by Elsevier, Inc. All rights reserved.

13. Acute Care In the acute care setting, 60% of medical-surgical patients and 46% of critical care patients are older adults Only a small number of the 6,000 hospitals in the country have practice guidelines, educational resources, and administrative practices to support older adult care Because of the aging demographics more nurses will realize that they are subspecialist or generalist in geriatric care 13 Copyright © 2016 by Elsevier, Inc. All rights reserved.

14. Nurses Improving Care of Health System Elders (NICHE) Started in 1992 and designed to improve outcomes for hospitalized older adults The role of a geriatric resource nurse is pivotal in influencing outcomes and coordination of care Supports geriatric nursing competencies Focuses especially on iatrogenic complications, which occur at a rate of 29-38% More than 500 hospitals in more than 40 states and part of Canada are involved in the NICHE program 14 Copyright © 2016 by Elsevier, Inc. All rights reserved.

15. Community and Home-Based Care Much of the care of older adults will occur in the community because of escalating health care costs and aging in place Nurses in the home setting provide comprehensive assessments Care management and working with interprofessional teams are integral components of home care New roles such as care coordinator, nurse/family cooperative facilitator, remote monitoring, and primary care will become emerging roles 15 Copyright © 2016 by Elsevier, Inc. All rights reserved.

16. Certified Nursing Facilities (Nursing Home) Custodial care is no longer a valid description of the nursing home 37% of all acute hospitalizations require post-acute care and older adults are entering nursing homes with increasingly acute care health problems Professional nursing roles include nursing administrator, manager, supervisor, educator, infection control, Minimum Data Set coordinator, case manager, quality improvement, and direct care Care in this setting requires independent decision making 16 Copyright © 2016 by Elsevier, Inc. All rights reserved.

17. Older people have complex problems and often require care across multiple settings This makes them more vulnerable to poor outcomes during transition Because each setting is considered an independent entity, one setting may not be aware of what the other does This is slowly changing with the development of accountable care organizations, health home, and bundled care payments 17 Copyright © 2016 by Elsevier, Inc. All rights reserved.

18. Readmissions: The Revolving Door One in five older adults is readmitted to the hospital within 30 days of leaving 90% of these are unplanned and cost upward of $17 billion 1 out of 4 Medicare patients admitted to a skilled nursing facility will be readmitted within 30 days The Centers for Medicare and Medicaid Services has identified avoidable readmissions as one of the top leading problems facing the U.S. health care system 18 Copyright © 2016 by Elsevier, Inc. All rights reserved.

19. Factors Contributing to Poor Transitional Care Outcomes Can be related to the patient, provider, and system Most are related to a fragmented system of care Patient factors relate to language, literacy, and cultural and socioeconomic factors Medication discrepancies are the most prevalent adverse event following discharge from the hospital See Box 2-10 for Resources for Best Practice See Box 2-11 for Tips for Best Practice 19 Copyright © 2016 by Elsevier, Inc. All rights reserved.

20. Gerontological nurses will play a significant role in research, innovations in care, and provision of services to the growing population of older adults in global society Specialized knowledge will contribute to initiatives that directly impact the health and quality of life of our older population Continued recruitment and education of nurses to meet the needs of this growing population 20 Copyright © 2016 by Elsevier, Inc. All rights reserved.

21. What is the most prevalent adverse event following discharge from the hospital ? a. Medication discrepancies b. Falls c. Pneumonia d. Dehydration 21 Copyright © 2016 by Elsevier, Inc. All rights reserved.

22. By the year 2020 the average amount of time nurses will spend caring for older adults is: a. 25% b. 50% c. 75% d. 100% 22 Copyright © 2016 by Elsevier, Inc. All rights reserved.