Aging A natural Process

Aging: A Natural Process

• Process of maturing or aging
• Comments associated with aging
• Aging is not a disease
• Aging brings the opportunity for usefulness, fulfillment, and joy
• Need for a realistic understanding of the aging process

Factors Influencing the Aging Process

• Heredity, nutrition, health status, life experiences, environment, activity, and stress • Aging is
individualized
• General characteristics evident among most people in a given age category

The following is a summary of significant landmarks in the development of gerontological

nursing as a specialty
■ 1902 American Journal of Nursing (AJN) International Congress of Gerontology
publishes first geriatric article by an MD
■ 1904 AJN publishes first geriatric article by an ■ 1970 ANA creates the Standards of Practice
R for Geriatric Nursing 1973 ANA offers the first
■ 1925 AJN considers geriatric nursing as a generalist certification in gerontological nursing
potential specialty Anonymous column entitled (74 nurses certified)
"Care of the Aged" appears in AIN ■ 1975 First nursing journal for the care of older
1950 First geriatric nursing textbook, Geriatric adults published: Journal of Gerontological
Nursing(Newton), published First master's thesis Nursing by Slack, Inc. First nursing conference
in geriatric nursing completed by Eleanor held at the International Congress of nursing
Pingrey Geriatrics becomes a specialization in Gerontology
nursing ■ 1976 ANA Geriatric Nursing Division changes
■ 1952 First geriatric nursing study published in name to Gerontological Nursing Division ANA
Nursing Research 1961 ANA recommends publishes Standards of Gerontological Nursing
specialty group for geriatric nurses 1962 ANA ■ 1977 Kellogg Foundation funds Geriatric
holds first National Nursing Meeting on Geriatric Nurse Practitioner certificate education First
Nursing Practice gerontological nursing track funded by the
■ 1966 ANA forms a geriatric nursing division Division of Nursing at the University of Kansas
First Gerontological Clinical Nurse Specialist ■ 1979 First national conference on
master's program begins at Duke University gerontological nursing sponsored by the Journal
■ 1968 First RN (Gunter) presents at the of Gerontological Nursing
International Congr

■ 1968 First RN (Gunter) presents at the

 The following is a summary of significant landmarks in the development of gerontological
nursing as a specialty

■ 1980 AJN publishes Geriatric Nursing journal Hartford Foundation Institute for Geriatric
Education for Gerontic Nurses by Gunter and Nursing established at NYU Division of Nursing
Estes suggests curricula for all levels of nursing ■ 1998 ANA certification available for geriatric
education ANA establishes Council of Long advanced practice nurses as geriatric nurse
Term Care Nurses practitioners or gerontological clinical nurse
■ 1980 First Robert Wood Johnson (RWJ) specialists
Foundation grants for healthimpaired elders ■ 2000 American Academy of Nursing, the John
given (eight in the United States) A. Hartford Founddation, and the NYU Division
■ 1981 First International Conference on of Nursing develop the Building Academic
Gerontological Nursing sponsored by the Geriatric Nursing Capacity (BAGNC) program
International Council of Nursing (Los Angeles, ■ 2002 American Nurses Foundation (ANF) and
California) ANA Division of Gerontological ANA fund the Nurse Competence in Aging (NCA)
Nursing publishes statement on scope of joint venture with the John A. Hartford
practice John A. Hartford Foundation's Hospital Foundation Institute for Geriatric Nursing
Outcomes Program for the Elderly (HOPE) using ■ 2003 The John A. Hartford Foundation
a geriatric resource nurse (GRN) model Institute for Geriatric Nursing, the American
developed at Yale University under the direction Academy of Nursing, and the American
of Terry Fulmer Association of Colleges of Nursing (AACN)
■ 1982 Development of RWJF Teaching-Nursing combine efforts to develop the Hartford
Home Program (five programs in the United Geriatric Nursing Initiative (HGNI) John A.
States) 1983 First endowed university chair in Hartford Foundation Institute for Geriatric
gerontological nursing (Florence Cellar Endowed Nursing at NYU awards Specialty Nursing
Gerontological Nursing Chair) established at Association Programs-in Geriatrics (SNAP-G)
Case Western Reserve University grants
■ 1984 National Gerontological Nursing ■ 2004 American Nurses Credentialing Center's
Association (NGNA) established ANA Division first computerized generalist certification exam
on Gerontological Nursing Practice becomes is for the gerontological nurse 2005 Journal of
Council on Gerontological Nursing Gerontological Nursing celebrates 30 years
■ 1986 National Association for Directors of ■ 2007 NICHE program at John A. Hartford
Nursing Administration in Long Term Care Foundation Institute for Geriatric Nursing at NYU
established ANA publishes Survey of receives additional funding from the Atlantic
Gerontological Nurses in Clinical Practice 1987 Philanthropies and U.S. Aging Program
ANA revises Standards and Scope of ■ 2008 Geriatric Nursing journal celebrates 30
Gerontological Nursing Practice years Journal of Gerontological Nursing
■ 1988 First PhD program in gerontological Research emerge
nursing established (Case Western Reserve
University 1989 ANA certification established for
Clinical Specialist in Gerontological Nursing
1990 ANA establishes Division of Long Term
Care within the Council of Gerontological
Nursing 1992 Nurses Improving Care for
Healthsystem Elders (NICHE) established at
New York University (NYU). Division of Nursing
based on the HOPE programs 1996 John A.
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AACN Essentials (1998

• Core Competencies
• Critical thinking
• Communication
• Assessment
• Technical skills
• Core Knowledge
• Health promotion,
• risk reduction, and disease prevention
• illness and disease management
Information and health care technologies
• Ethics Human diversity Global health care
Health care systems and policy
• Role Development Provider of care Designer/manager/coordinator of care Member of a
profession

Structure
The Research Agenda on Ageing consists of four sections: Major Priorities. Critical Research
Areas Key Methodological Issues and Implementations. The major priorities and the critical
research areas child in there are linked to the Priority Directors of the Masinisenaal P Action on
Ageing bee table, below)

MADRID RESEARCH AGENDA ON AGING

International
Plan of Critical Research
Major Research Priorities Areas
Action on
Ageing

Priority 1. Relationships of 1 Social

population participation and
Priority Priority 2. Current practices and integration
direction 1:
options for maintaining material 2. Economic
Older
Persons and security in old age security
Development Priority 3. Changing family 3. Macro-societal
structures. change and
Intergenerational transfer systems development
and emergent family and 4. Poverty
institutional dynamics 5. Social security
system

Priority 4. Determinants of healthy 6. Healthy ageing

Priority ageling 7. Biomedical
direction II: Priority 5. Basic biological 8. Physical and
Advancing mental
mechanisms and age associated
Health and functioning
well-being diseases 9. Quality of life
into old age Priority 6. Quality of life and ageing 10. Care systems
in diverse cultural, socio-economic 11. Changing
and enviromental situations family structures
Priority and functions
direction III: Priority 3. Changing family
Ensuring
structures. and emergent family and
enabling and
supportive institutional dynamics
environments Priority 6. Quality of life and ageing
in diverse cultural socio-economic
and environmental situations

Implementati 12. Policy design,

on and implementation,
follow-up monitoring and
evaluation
2.3. Macro-societal change and development Research is needed focusing on relationships
between major forces of societal change and population and individual ageing. It should
document, monitor and project the effects of these forces on older people as a societal group,
which may have fewer resources to enable adjustment to change and especially recovery from
adverse effects of such change. Specific topics include:
2.3.1 Social development in ageing societies.
2.3.2 Globalization and ageing.
2.3.3 Interaction between population ageing and societal development.
2.3.4 Implications of, and adjustment to, a changing age structure.
2.3.5 Inclusion of population and individual ageing in international and national developmental
policies and programmes.
2.3.6 Dynamics of wealth re/distribution across the life span and of younger people and older
people in rural and urban environments.
2.3.7 Impact of policies and programmes promoting development on the economic and health
status of older persons.
2.3.8 Needs of older persons arising from technological change and economic advancement

Readmission Rates Decrease with

Comprehensive Discharge Planning + Post-discharge Support

Competencies Necessary for Nurses to provide HighQuality Care to Older Adults and Their
Families
• 1. Recognize one's own and others' attitudes, values, and expectations about aging and their
impact on care of older adults and their families
• 2. Adopt the concept of individualized care as the standard of practice
with older adults.
• 3. Communicate effectively, respectfully, and compassionately with older
adults and their families,
• 4. Recognize that sensation and perception in older adults are mediated by
functional, physical, cognitive, psychological, and social changes common
in old age.
• 5. Incorporate into daily practice valid and reliable tools to assess the
functional, physical, cognitive, psychological, social, and spiritual status of older adults.
• 6. Assess alder adults' living environment with special awareness of the functional physical,
cognitive, psychological, and social changes common in old age.
• 7. Analyze the effectiveness of community resources in assisting older adults and their
families to retain personal goals, maximize function, maintain independence, and live in
the least restrictive environment.
• 8. Assess family knowledge of skills necessary to deliver care to older adults.
• 9. Adapt technical skills to meet the functional, physical, cognitive, psychological, social,
and endurance capacities of older adults.
• 10. Individualize care and prevent morbidity and mortality associated with the use of
physical and chemical restraints in older adults.
• 11. Prevent or reduce common risk factors that contribute to functional decline,
impaired quality of life, and excess disability in older adults.
• 12. Establish and follow standards of care to recognize and report elder mistreatment
• 13. Apply evidence-based standards to screen, immunize, and promote healthy activities in
older adults.
• 14. Recognize and manage geriatric syndromes common to older adults.
• 15. Recognize the complex interaction of acute and chronic co-morbid conditions common to
older adults.
• 16. Use technology to enhance older adults' function, independence, and safety.
• 17. Facilitate communication as older adults transition across and between home, hospital,
and nursing home, with a particular focus on the use of technology.
• 18. Assist older adults, families, and caregivers to understand and balance "everyday"
autonomy and safety decisions.
• 19. Apply ethical and legal principles to the complex issues that arise in care of older adults.
• 20. Appreciate the influence of attitudes, roles, language, culture, race, religion, gender, and
lifestyle on how families and assistive personnel provide long-term care to older adults.
• 21. Evaluate differing international models of geriatric care.
22. Analyze the impact of an aging society on the health care system
23. Evaluate the influence of payer systems an access, availability, and affordability of health
care for older adults
24 Contrast the opportunities and constraints of a supportive living arrangement on the function
and independence of older adults and on their families
25. Recognize the benefits of interdisciplinary team participation in care of older adults.
26. Evaluate the utility of complementary and integrative health care practices on health
promotion and symptom management for older adults.
27. Facilitate older adults' active participation in all aspects of their own health care
28. Involve, educate, and when appropriate, supervise family, friends, and assistive personnel in
implementing best practices for older adults.
29. Ensure quality of care commensurate with older adults vulnerability and frequency and
intensity of care needs.
30. Promote the desirability of quality end-of-life care for older adults, including pain and
symptom management, as essential, desirable, and integral components of nursing practice

Research Agenda on Ageing for the 21st Century

• Introduction
• The Research Agenda on Adeling for the Twenty-First Century is designed to
support the implementation of the Madrid international Plan for Action on Acein adopted by the
Second World Assembly on Ageing 18-12 An 2002 Madrid, Spain).
• The Research Agenda identities priorities for policy related research and data collection.
Simultaneously, it encourages researchers to pursue studies in policy related areas of ageing
where the findines may have practical and realistic applications
• The Rasearch Agenda on Ageing is addressed to legislatures, governments and academia, as
well as non-governmental organizations and aid agencies dealing with issues of population and
individual ageine it is based on recognition of the diversity in societies at different levels of
demographic, social and economic development

Section 2: Critical Research Areas

This section identifies specific areas for research exploration and lists specific topics for
studies of ageing.

2.1. Social participation and integration

Older people are at risk of exclusion from community and social life. This theme:f ocusses on
the extent of participation and integration of older people in the spheres of life and the factors
that facilitate their integration in society.

Specific topics include

2.1.1 Intergenerational relationships
2.1.2 Ageism in different societies.
2.1.3 Images of ageing. Is there a convergence between older persons’ and younger
persons’ views of ageing and older people?
2.1.4 Effects of demographic factors, e.g., rapid urbanization and migration, on social
participation and integration.
2.1.5 Gender, ethic, racial and other difference
2.1.6 Phychosocial determinants of social participation and integration
2.1.7 Strategies to prom,ote social integration and participation of older persons in
society. Socio-economics, structural and attitudinal factors that influence participation
and integration in different societies.
2.1.8 Active ageing: concept, determinants, repercussions at different levels (individual,
family, etc.), measurement.
2.1.9 Social, economics and other contribution of older people.
2.1.10 Political participation of older people
2.1.11 Isolation of older person in rural area, and measures to promote their
participation in social, political and economic activities.
2.1.12 Age discrimination
2.1.13 Elder abuse, neglect, violence and exploltation
2.1.14 Displacement of and support for older persons in emergency situations , such as
man-made and natural disasters.

Research Agenda on Ageing for the 21st Century

2007 update
A joint project of the United Nations Programme on Ageing and the International Association of
the International Association of Gerontology and Geriatrics
• 2.2. Economic security
• Economic security is directly linked to the health and well-being of people of all ages.
• Research is needed on behaioyr, self-provision and programmes to maximize economics
security across the life span and in old age. Specific topics include:
• 2.2.1 Labour force participation of older persons and family members: its psychosocial, health
and policy determinants.
• 2.2.2 Patterns of resource availability to older persons; use and exchange of resources by
older persons
• 2.2.3 Measurement of wealth, including savings, income and consumption, over the life
course.
• 2.2.4 Patterns and complexities of intergenerational transfers.
• 2.2.5 Formal programmes for providinng economics security in old age, e.g., social and
occupational pensions.
• 2.2.6 Informal economy based income security in old age.
• 2.2.7 Continuing education and re-training in old age.
• 2.2.8 Preparation for retirement at individual, family, community and societal level.
• 2.2.9 Economic and social impact of the removal of mandatory retirement age and age
discrimination in the workplace