Exam 1 geri study guide.

NURSING

Exam 1: Gerontologic Nursing

Aging Demographics

o “Older Adult” is defined as anyone 65+ years
o Women: Men = 3:2
o Life Expectancy: 77.8 years
o Racially & Ethnically: Diverse, becoming more racially and ethnically diverse
o Older adults represent 13.6 percent of US population; by 2050 there will be 89 million adults in the US
(more than double older adults than now)
o On any given day, 50% of hospital patient population is older adults

o Why the increase of older adult population?
1) Improved Medical Care
2) Aging Baby Boomers

o By 2047, for the first time, older persons are projected to exceed the number of children.

o The United Nations’ World Population Aging 2013 report projects that by the year 2050, the older
population will:
 More than double
 Surpass the population of children
 Live in less developed regions

o Expectations is there will be 2 billion older adults around the world by 2050

o Emerging Trends in Global Aging:
 Life Expectancy Increasing
 The Oldest Old: People 85 years and older, are the fastest growing portion of many populations
 Chronic Diseases: Chronic non – communicable diseases are the major cause of death among
older people
 Shrinkage of Total Populations: While world population is aging rapidly, the total population is
declining in some nations related to low birth rates. In less developed countries, the decline is
primarily due to communicable disease epidemics (HIV, Ebola).
 Changing Family Structures: As people live longer and have fewer children, family structures
are changing. This change results in fewer care options for older adults
 Changing Patterns: More years are spent in retirement. The ratio of workers to retirees
continues to decrease, straining existing health and pension systems.
 Insurance: Healthcare costs and social insurance spending continue to rise. Re-evaluation of
existing systems will be necessary.
 Finances: New financial approaches are required to deal with the effects on social entitlement
programs, labor supply, trade, and savings worldwide.

o Geographic Distribution in the US
 9 states have more than one million elderly persons: California, New York, Pennsylvania, Texas,
Illinois, Ohio, Michigan, New Jersey
 Florida has the highest proportion of the elderly

,  People age 85+ are clustered in the farm states: Iowa, South Dakota, Nebraska, North Dakota,
and Kansas

o Increasing Diversity
 Greater racial or ethnic minorities
 25% of older adults by 2030
 African American, Hispanic, Asian or Pacific Islander, American Indian & Native Alaskan
 While the older white population is expected to increase by an estimated 81 percent during the
next two decades, the older minority population is projected to increase by 217 percent.

o Health & Ethnicity
 Lower health status among minorities
 Chronic conditions (high blood pressure, diabetes, cancer) are more prevalent in the minority
population
 Greatest effect on African American & Hispanics—research indicates these 2 groups receive a
lower quality of health care and have decreased access to care
 Black females and black males have significantly shorter life spans than their white
counterparts. This is an example of the health disparities between African American and white
older adults that currently exist in the U.S.

o Family Structure & Caregiving Changes
 Multiple generations in need of care
 Parents give care to older patients
 Older adults care for spouses
 Chronic diseases create burden for caregivers
 As life expectancy increases, the occurrence of older adults with living parents increases
 Parents of young children may be caregivers for aging parents. These individuals caring for two
generations are often called the “sandwich generation.”

o Heavy Healthcare Users
 Increased need for nurse providers (By 2030 70% of new nursing graduates will be caring for an
older adult in every type of healthcare setting
 3 – 5 times more costly than for those under 65 years old
 50% of hospital spending
 57% of visits to generalist doctors
 90% of nursing home care

o Hospital’s Core Consumer
 Adults 65 years and older:
 Account for 50% of hospital market
 Have high rates of readmission
 Are likely to suffer complications/adverse events
 Have longer stays (Average 7.8 days for a single stay)

o Attitudes & Stereotypes
 Ageism: Discrimination that often accompanies old age and is based solely on age. The idea
that people cease to the be the same or become inferior based on age
 Effects:

,  Reduced health care from providers of care
 Less health education and teaching
 May be regarded as not eligible for certain therapies or programs ex: rehab, certain types
of surgeries, treatment for cancers
 Treated socially and medically based on myths and stereotypes

Payment for Services

o Medicare: health insurance program
 Part A: hospital and other services
 Part B: medical visit services and other services
 Part C: Medicare Advantage Plans
 Part D: drug plan

o Affordable Care Act:
 Make affordable health insurance available to more people. The law provides consumers with
subsidies (“premium tax credits”) that lower costs for households with incomes between 100%
and 400% of the federal poverty level.
 Expand the Medicaid program to cover all adults with income below 138% of the federal
poverty level. (Not all states have expanded their Medicaid programs.)
 Support innovative medical care delivery methods designed to lower the costs of health care
generally.

o Medicare is the insurance associated with social security.
 Currently when one reaches 65 years of age, they are eligible for Medicare part A & B.
 There is a cost for part B and that cost is based on the earnings of the individual 2 years before
they request it (you do not need to request part B at 65).
 Individuals who continue to work after 65 may defer entering part B is, they have another form
of insurance that provides that provides the same coverage.
 When they retire and collect social security the cost for part B is deducted from the social
security allotment received each month.
 The drug plan must be purchased separately, and many individuals purchase this plan with
supplementary insurance that provides coverage for the Medicare deductibles and those items
are not covered by Medicare.

o Medicaid
 Health care for the poor of all ages
 Federal law, 1965
 Income-based
 State and federally funded
 Primary and hospital care
 Nursing home: usually after “spend down”
 Individuals who have savings or homes must “spend down” – that is pay for these
services until they have no disposable funds left.
 For individuals who own their homes Medicaid can demand to receive some or all of the
proceeds of the sale of that home when heirs or the individual sell the property – it is
viewed as savings that were not available in cash at the time of receiving the Medicaid
benefits.

, Theories of Aging

o Biology, psychology and sociology all have theories about aging.
o It is unclear if or how these theories are related.
o Biological theories consider functional capacities and life limitations of organ systems. Psychological
theories examine the behavioral capacity of an individual to respond to a changing environment.
o Social theories consider roles and relationships and the person’s response to their society.

1) Biological Theories

a. Stochastic: Explain aging as events that occur randomly and accumulate over time.
 Cross-linking theory
 Free radicals and lipofuscin theories
 Wear and tear theories
 Evolutionary theories
 Mutation accumulation theory
 Antagonistic pleiotropy theory
 Disposable soma theory
 Bio-gerontology

b. Non-stochastic: View aging as a predetermined and timed phenomenon.
 Apoptosis
 Genetic theories
 Autoimmune reactions
 Changes in immune function with aging
 Neuroendocrine and neurochemical theories
 Radiation theories
 Nutrition theories
 Environmental theories

o None of these theories provide a complete explanation of the failure or resilience of certain biological
functions or that of the body as a whole.
o Certainly, some theories have sound underpinnings and the health care team can use these theories as
a basis for recommending certain self-care guidelines.

2) Sociological Theories

A. Early Theories That Focus on the Status of Older People in Society
a. Activity Theory: Older people remain socially and psychologically fit if they remain actively engaged in
life.
b. Disengagement Theory: Social and psychological withdrawal by the individual is a universal and
inevitable part of the aging process.
c. Subculture Theory: Because older people as a group have their own norms, expectations, beliefs, and
habits, they form a unique subculture.
d. Age-stratification Theory: Each age cohort develops a unique history as it interacts with society and
social influences.