In Chapter 2 of the course text book “Toward Healthy Aging”

In Chapter 2 of the course text book “Toward Healthy Aging” the topic of transition of care is a leading problem in the older adult population that leads to hospital readmissions. Read this section of the text on “transitions across the “continuum: the role of nursing.” Identify some of the major causes of readmission and the role of the gerontological nurse in improving and preventing readmissions. Read the following article on “The Prevention of Hospital Readmissions in Heart Failure.”

In this discussion (5 paragraphs) you will address will address the following:

1. Summarize the contents of the article: The Prevention of Hospital Readmissions in Heart Failure

2. What are some of interventions that can be used to prevent hospital readmissions. Use additional sources to support your work. Cite your sources in APA format.

3. What care setting interest in your future role as a nurse (pediatrics vs adults, outpatient vs inpatient vs community) and why?

4. Be sure to include in-text references and a reference summary.

Chapter 2

Gerontological Nursing:
Past, Present, and Future

Care of
Older
Adults

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

Who Will Care for Older Adults?

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

Less than 3% of medical students choose to take
geriatric electives

rights reserved.
3

Gerontological Nursing

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 2-1)

Gerontological Nursing
Perspectives

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

Gerontological Nursing
Perspectives

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

Gerontological
Nursing
Perspectives

• 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)

Research on Aging

• 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

Nursing Research

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 2-2)

Gerontological
Nursing Roles

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

Gerontological Nursing
Roles Perspectives

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.

Gerontological
Nursing Roles
Perspectives

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
6000 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

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

Gerontological
Nursing Roles
Perspectives

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

Gerontological Nursing Roles
Perspectives
Certified nursing facilities (Nursing home)

• Custodial care is no longer a valid description of the
nursing home

• One quarter of Medicare patients admitted to hospital
are discharged to PAC

• 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

Transitions
Across the
Continuum

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

Transitions Across the
Continuum Perspectives

Readmissions: The revolving door

• One in four 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

Transitions Across the Continuum
Perspectives

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 2-11 for Resources for Best Practice

• See Box 2-12 for Tips for Best Practice

Promoting
Healthy Aging:
Implications for
Gerontological
Nursing

• 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

Question 1

What is the most prevalent
adverse event following
discharge from the hospital?

a. Medication
discrepancies

b. Falls

c. Pneumonia

d. Dehydration

Question 2

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%.

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