UNIT:1

GERONTOLOGICAL NURSING

BY
Dr. Bader Albaqami RN. Ph.D. (N)
Dr. Aziza Ibrahim RN, RM, Ph.D. (N)
Dr. Amani Sobhy RN, RM, Ph.D. (N)
Dr. Abdulelah Alanazi RN. Ph.D. (N)
Dr. X.S.Blessing NimaSajai, RN, RM, Ph.D. (N)
GENERAL AND SPECIFIC OBJECTIVES

General objective:
At the end of the teaching students will gain adequate knowledge regarding gerontological
nursing.

Specific objectives:

Students will be able to:-

• Define gerontological nursing
• Explain history of gerontological nursing
• Explain significant events in the growth of gerontological nursing as a specialization
• Explain the concept and scope of gerontological nursing
• Explain the branches of gerontology
• Enumerate the principles of gerontological nursing
• Discuss the attitude towards aging and older adults
• Explain perspectives of ageing
• Explain global challenges in gerontological nursing
 INTRODUCTION
• Aging, the normal process of time-related change, begins with birth and
continues throughout life. Gerontological nursing is the specialty of nursing
pertaining to older adults.
• Gerontological nurses or geriatric nurses who work in collaboration with
older adults, their families, and communities to support healthy aging,
maximum functioning, and quality of life.
• The term gerontological nursing, which replaced the term geriatric nursing
in the 1970s, is seen as being more consistent with the specialty's broader
focus on health and wellness, in addition to illness.
• The new specialty of gerontology, the study of old age, the process of ageing
and of older people’s special needs, has emerged and become a recognized
sphere of specialist knowledge and practice, which is increasingly research-
based.
• Gerontology is considered to be both an art and a science.
DEFINITION
Gerontology :
Gerontology is the study of the social, cultural, psychological, cognitive, and biological aspects of ageing.

Geriatrics :
Geriatrics or geriatric medicine, is a specialty that focuses on health care of elderly people.

Geriatric Nursing:
The branch of nursing concerned with the care of the older population, including promotion of healthy aging as
well as prevention, assessment, and management of physiological, pathological, psychological, economic, and
sociological problems.

Gerontological nursing :
Gerontological nursing is an evidence-based nursing specialty practice that addresses the unique physiological,
psychosocial, developmental, economic, cultural, and spiritual needs related to the process of aging and care of older
adults.

Gerontological nurses:
Gerontological nurses are the registered nursing professionals who collaborate with older adults and their significant
others to promote autonomy, wellness, optimal functioning, comfort, and quality of life from healthy aging to end of
life. Gerontological nurses lead interprofessional teams in a holistic, person-centered approach in the specialized care
of older adults.
DEFINITION
Social gerontology:
Social Gerontology is a subfield of gerontology that focuses on the social aspect of growing old. Professionals in
this field strive to improve the interactions between older adults and the rest of the world, including family members,
peers, and healthcare professionals.

Geropsychology:
Geropsychology is a branch of psychology concerned with helping older persons and their families maintain
wellbeing, overcome problems, and achieve maximum potential during later life.

Geropharmacology:
Geropharmacology is the study of pharmacology related to older adults. The credential for a pharmacist certified in
geropharmacology is CGP (certified geriatric pharmacist).

Financial gerontology:
Financial gerontology is defined as the intellectual intersection of two fields, gerontology and finance, each of which
has practitioner and academic components.

Gerontological rehabilitation:
Gerontological rehabilitation is defined as the process of using somatic therapies (e.g., occupational therapy,
physical therapy) to restore to the fullest extent possible the functional abilities of older adults following an illness or
injury that resulted in lost or diminished independence.
 HISTORY OF GERONTOLOGICAL NURSING

➢ Lowering the cost of caring and maintaining sick older adults had its beginnings with Florence
Nightingale and Agnes Jones during the 1800s in England. Consider that in the early 1900. During
this time, care was provided by family members.

➢ From 1800 to the 1930s, almshouses were a norm of care for various groups of poor people. It was
during this time that Lavinia Dock, a nurse, and Carolyn Crane, a social activist, found themselves
attending to the chronically ill who were elderly.

➢ In1912, the American Nurses Association Board of Directors created a committee to supervise
nursing services in almshouses.

➢ TheWorld War I era of 1910 to 1920 included efforts at improving nursing services at almshouses.
In 1925, American Journal of Nursing ran an article that “called for nurses to consider a specialty in
nursing care of the aged” (Ebersole and Touhy, 2006)

➢ During the 1930s, almshouses became nursing homes .There was emphasis on rehabilitation of the
elderly.
 HISTORY OF GERONTOLOGICAL NURSING
➢ In
1950, the first book on nursing care of older adults was written by Newton and Anderson
was published.
➢ In
1952, the first research article was published on chronic disease and the elderly in the
generic issue of Nursing Research.
➢ Numerous policy changes occurred during the 1960s and 1970s, in part as a result of
increased government involvement, research, and the growing numbers of older adults.
➢ AtDuke University School of Nursing, Virginia Stone (1966) developed the first master’s
degree program in gerontological nursing specific to the role of clinical nurse specialists.
➢ In1970s brought about the expansion of programs in nursing schools for gerontological
nurse practitioners (NPs) and gerontological clinical nurse specialists (CNSs) that focused on
care of the elderly.
➢ Latein the 1980s, nursing research showed that improved care of the older adult can be
achieved and should be an appropriate expectation within the nursing profession.
➢ Infusionof evidence-based practice in the clinical care of older adults is a vital component in
nursing education and in all healthcare facilities.
➢ The continuing need for more registered nurses and advanced practice nurses who have
included or attained certification in gerontological nursing remains a reality as we move into
the second decade of the 21st century.
 SIGNIFICANT EVENTS IN THE GROWTH OF GERONTOLOGICAL NURSING
AS SPECIALIZATION
The following is a summary of significant landmarks in the development of gerontological nursing as a
specialty:
➢ 1902 American Journal of Nursing (AJN) publishes first geriatric article.
➢ 1904 American Journal of Nursing (AJN) publishes first geriatric article by an RN.
➢ 1925 American Journal of Nursing (AJN) considers geriatric nursing as a potential specialty Anonymous
column entitled ―Care of the Agedǁ appears in AJN.
➢ 1950 First geriatric nursing textbook, Geriatric Nursing (Newton), published First master‘s thesis in
geriatric nursing completed by Eleanor Pingrey Geriatrics becomes a specialization in nursing.
➢ 1952 First geriatric nursing study published in Nursing Research.
➢ 1961 ANA recommends specialty group for geriatric nurses
➢ 1962 ANA holds first National Nursing Meeting on Geriatric Nursing Practice.
➢ 1966 ANA forms a geriatric nursing division First Gerontological Clinical Nurse Specialist master‘s
program begins at Duke University
➢ 1968 First RN (Gunter) presents at the International Congress of Gerontology
➢ 1970 ANA creates the Standards of Practice for Geriatric Nursing.
➢ 1973 ANA offers the first generalist certification in gerontological nursing (74 nurses certified).
➢ 1975 First nursing journal for the care of older adults published: Journal of Gerontological Nursing by
Slack, Inc. First nursing conference held at the International Congress of Gerontology.
➢ 1976 ANA Geriatric Nursing Division changes name to Gerontological Nursing Division ANA publishes a
Standards of Gerontological Nursing.
➢ 1977 Kellogg Foundation funds Geriatric Nurse Practitioner certificate education First gerontological
nursing track funded by the Division of Nursing at the University of Kansas.
 SIGNIFICANT EVENTS IN THE GROWTH OF GERONTOLOGICAL NURSING
AS SPECIALIZATION

➢ 1979 First national conference on gerontological nursing sponsored by the Journal of Gerontological
Nursing.
➢ 1980 AJN publishes Geriatric Nursing journal Education for Gerontic Nurses by Gunter and Estes
suggests curricula for all levels of nursing education ANA establishes Council of Long Term Care
Nurses.
➢ 1980 First Robert Wood Johnson (RWJ) Foundation grants for health-impaired elders given (eight in
the United States).
➢ 1981 First International Conference on Gerontological Nursing sponsored by the International
Council of Nursing (Los Angeles, California)
➢ 1982 Development of RWJF Teaching-Nursing Home Program (five programs in the United States).
➢ 1983 First endowed university chair in gerontological nursing (Florence Cellar Endowed
Gerontological Nursing Chair) established at Case Western Reserve University.
➢ 1984 National Gerontological Nursing Association (NGNA) established ANA Division on
Gerontological Nursing Practice becomes Council on Gerontological Nursing.
➢ 1986 National Association for Directors of Nursing Administration in Long Term Care established
ANA publishes Survey of Gerontological Nurses in Clinical Practice.
➢ 1987 ANA revises Standards and Scope of Gerontological Nursing Practice.
➢ 1988 First PhD program in gerontological 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.
 SIGNIFICANT EVENTS IN THE GROWTH OF GERONTOLOGICAL NURSING
AS SPECIALIZATION
➢ 1992 Nurses Improving Care for Health system Elders (NICHE) established at New York University
(NYU) Division of Nursing based on the HOPE programs.
➢ 1996 John A. Hartford Foundation Institute for Geriatric Nursing established at NYU Division of
Nursing NICHE administered through the John A. Hartford Foundation Institute for Geriatric Nursing
➢ 1998 ANA certification available for geriatric advanced practice nurses as geriatric nurse practitioners
or gerontological clinical nurse specialists.
➢ 2000 American Academy of Nursing, the John A. Hartford Foundation, and the NYU Division of
Nursing develop the Building Academic Geriatric Nursing Capacity (BAGNC) program.
➢ 2002 American Nurses Foundation (ANF) and ANA fund the Nurse Competence in Aging (NCA)
joint venture with the John A. Hartford Foundation Institute for Geriatric Nursing.
➢ 2003 The John A. Hartford Foundation Institute for Geriatric Nursing formed.
➢ 2004 American Nurses Credentialing Centre‘s first computerized generalist certification exam is for
the gerontological nurse.
➢ 2005 Journal of Gerontological Nursing celebrates 30 years.
➢ 2007 NICHE program at John A. Hartford Foundation Institute for Geriatric Nursing at NYU receives
additional funding from the Atlantic Philanthropies and U.S. Aging Program.
➢ 2008 Geriatric Nursing journal celebrates 30 years Journal of Gerontological Nursing Research
emerges.
➢ 2010 Gerontological nursing: scope & standard of practice are updated by ANA
➢ 2015 Gerontological nursing is an integral part of adult-gerontology advanced practice nursing
education and certification examinations.
 CONCEPTS AND SCOPE OF GERONTOLOGICAL NURSING

➢ Gerontological nursing draws on knowledge about the

complex factors that affect the health of older adults.
Today’s healthcare environment—with its increasing focus
on aging issues, quality of care, quality of life, access to
affordable health care, ethics, and detailed advance
directives is constantly changing.
➢ Gerontological nurses work in a variety of settings,
including acute care hospitals, rehabilitation, nursing
homes etc.
➢ The goal of gerontological nursing is to provide the
highest quality of care to the older adults within a
healthcare system.
 CONCEPTS AND SCOPE OF GERONTOLOGICAL NURSING
There are five main scope are in gerontological nursing and they are..
I. Studying the physical, mental and social changes in people (adults) as they
age.
II. Investigating the ageing process itself (biogerontology).
III.Investigating the interface of normal ageing and age related diseases
(geroscience).
IV.Investigating the effects of our ageing population on our society; including
the fiscal effects of pensions, entitlements, life and health insurance and
retirement planning.
V. Applying knowledge to policies and programmes; including a macroscopic
perspective i.e. (running a nursing home).
•These five scopes of gerontology can simply be referred to as multidisciplinary
because there are a number of sub-fields in it including psychology and sociology.
The field of gerontology is relatively a late developed or recent field of study.
However, the huge increase in the elderly population in the post industrial western
nations made gerontology to become most rapidly growing field of study. Currently,
gerontology is a well paid field for many all over the world.
 BRANCHES OF GERONTOLOGY
•Biogerontology: This is a sub-field of gerontology that studies the biological
process of ageing.
•Biomedical gerontology: This is also known as experimental gerontology or life
extension. Life extension is a sub discipline of biogerontology that endeavours to
slow, prevent and even reverse ageing in both humans by curing age-related
diseases.
•Medical gerontology: This branch of gerontology studies the biological causes and
effects of ageing.
•Social gerontology: This is a multidisciplinary sub-field of gerontology that
specializes on studying and working with older adults. Social gerontologists are
responsible for educating, researching and advancing the broader causes of ageing in
older adults by giving informative presentations, publishing books and articles that
concerns the ageing population, producing relevant films and television programmes
and producing new graduates in colleges and universities.
 PRINCIPLES OF GERONTOLOGICAL NURSING
The basic principles of gerontological nursing are:-
Principles Descriptions
1. Aging is not a disease • Aging occurs at different rates between
individuals, within individuals in different organ
systems.
• Aging alone does not generally cause symptoms.
• Aging increases susceptibility to many diseases
and conditions ("homeostenosis").
• Aging people are heterogeneous - some are very
healthy, some are very ill.
•
2. Medical conditions in geriatric Older individuals commonly suffer multiple
acute & chronic conditions, making managing
patients are commonly chronic,
complex and challenging.
multiple, and multifactorial • Multiple factors are generally involved in the
pathogenesis of geriatric conditions.

3. Reversible and •
treatable Systematic screening for common geriatric
conditions can help avoid undiagnosed, treatable
conditions are often under- conditions.
• Geriatric "syndromes" are commonly undiagnosed
diagnosed and undertreated in
and therefore not managed optimally, such as:
geriatric patients delirium, gait, instability and falls, urinary
incontinence, pain, and malnutrition.
 PRINCIPLES OF GERONTOLOGICAL NURSING
The basic principles of gerontological nursing are:-

Principles Descriptions
•
4. Functional ability and quality of life are Functional capacity, in combination with social
supports, is critical in determining living
critical outcomes in the geriatric population situation and overall quality of life.
• Small changes in functional capability can make
a critical difference for quality of life of older
patients and their caregivers.
•
5. Social history, social support, and patient Understanding the patient's life history and
preferences for care like place of birth,
preferences are essential aspects of managing education, occupation, family relationships,
geriatric patients spirituality, resources, a willingness to take care,
etc).
• Living circumstances are critical to managing
older patients.
6. Geriatric care is multidisciplinary • Various disciplines play an important role in
geriatric care, e.g. nursing, rehabilitation
therapists, dieticians, pharmacists, social
workers, etc.
 PRINCIPLES OF GERONTOLOGICAL NURSING
The basic principles of gerontological nursing are:-
Principles Descriptions
•
7. Cognitive and affective disorders are prevalent Aging is associated with changes in cognitive function.
• Common causes of cognitive impairment include delirium,
and commonly undiagnosed at early stages
Alzheimer's Disease, and multi infarct dementia.
• Geriatric depression is often undiagnosed.
• Screening tools for delirium, dementia, and depression should
be used routinely.

8. Iatrogenic illnesses are common and many •are Polypharmacy, adverse drug reactions, drug-disease
interactions, drug-drug interactions, inappropriate
preventable
medications all common.
• Complications of hospitalization, such as falls, immobility, and
reconditioning can be serious and life-threatening

9. Geriatric care is provided in a variety • of Transitions between care settings must be coordinated in
order to avoid unnecessary duplication, medical errors, and
settings ranging from the home to long-term care
patient injuries.
institutions • Integrated, multi-level systems provide the most coordinated
care for complex geriatric patients.

•
10. Ethical issues and end-of life care are critical Ethical issues arise almost every day in geriatric care.
• Advance directives are critical for preventing some ethical
aspects of the practice of geriatrics
dilemmas.
• Principles of palliative care and end-of-life care are essential
for high quality geriatric care.
 ATTITUDE TOWARDS AGING AND OLDER ADULTS
• The way you view aging and older adults is often a product of your
environment and the experiences to which you have been exposed.
• Attitudes to ageing become more negative in the presence of
psychological difficulties among older people. However, attitudes to
ageing are affected more by perceptions, idiosyncratic appraisals and
emotions, rather than the severity of physical symptoms of age-related
conditions.
• Healthcare professionals who express high levels of confidence in
working therapeutically with older clients and who have more frequent
social contacts with healthy older people report more positive attitudes to
ageing.
• Tackling ageing anxiety in student populations can be improved through
increasing knowledge of ageing and facilitating positive interactions
between younger and older people.
• Improving attitudes towards ageing has been seen within policy
documents as one means of improving the participation and contribution
of older people within society (e.g. World Health Organization, 2002).
 ATTITUDE TOWARDS AGING AND OLDER ADULTS

➢ In order to improve attitudes to ageing in older people, we need to consider

optimizing opportunities not only for physical health but also mental health, so as
to enhance the quality of life as people age.
➢ In order to improve attitudes to ageing among healthcare professionals, we
need to increase training opportunities with older people in order to increase
confidence and to challenge negative stereotypes.
➢ In order to improve attitudes to ageing in younger populations, we need to
give education regarding process of aging, old age care, etc. to younger
population.
➢ Nurses need to develop research to understand attitudes towards older people
with individuals other than healthcare professionals.
➢ Researchers need to engage in a dialogue with both social and traditional media
to challenge unwittingly negative portrayals of older people. Media campaigns
can provide realistic and positive images of ageing, as well as educational
information on active ageing, which may be beneficial for both young and old
audiences
 PERSPECTIVES OF AGEING
• The ageing process can be viewed from three major perspectives;
namely, biological ageing, sociological ageing and psychological
ageing.
i. Biological Ageing: This is usually associated with decline in the
regulation and proper functioning of the vital organs of the body.
ii. Sociological Ageing: This is usually how a person relates with others
in the society. In sociological ageing, personal or attitude and
interaction within the community are used to assess a person’s
maturation and ageing.
iii. Psychological Ageing: Jegede (2003) stated that the indices of
psychological ageing include feelings, motivation, memory, emotions,
experience and self-identify.
 PERSPECTIVES OF AGEING
• Psychological ageing is heterogeneous and continuous as an individual
passes through life. Cavanaught (1993) .Osunde and Obiunu (2005)
divided ageing into three viz, the primary ageing, the secondary ageing
and the tertiary ageing.
i. The Primary Ageing: Primary ageing is considered as the normal
process which has nothing to do with illness. It simply involves changes
in the biological, social and psychological domains. These occur due to
tear and wear of vital organs of the body.
ii. The Secondary Ageing: This process is associated with different kinds
of terminal illness which prevent normal functioning of the individual.
iii. The Tertiary Ageing: This occurs when there are loses brought about
by death or disasters like war(s) on a family member or close friends
that could lead to a gradual decline in the proper functioning of the
individual.
 GLOBAL CHALLENGES IN GERONTOLOGICAL NURSING

• The growing geriatric population's economic and social needs must be

anticipated globally and include worldwide collaboration between
governments and organizations in order to deliver new and innovative
strategies addressing the unique needs of the aging population.
• Policies and services need to be specifically tailored to the older
population including housing, employment, healthcare, infrastructure, and
protection.
• Systems must manage health promotion, gender equality, employment,
reduce inequity across countries, and collaborate to include global
societies.
• There are many global challenges to gerontological nursing including, the
rapid increase in the older population, the need for different ways of
working, transnational migration, changing core competencies,
international collaboration, facilitating choice, and the global nurse
shortages.