Woman in a residential care home receiving a birthday cake.
Gerontological nursing is the specialty of nursing pertaining to older adults. Gerontological nurses 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.
Gerontological nursing is important to meet the health needs of an aging population. Due to longer life expectancy and declining fertility rates, the proportion of the population that is considered old is increasing. Between 2000 and 2050, the number of people in the world who are over age 60 is predicted increase from 605 million to 2 billion. The proportion of older adults is already high and continuing to increase in more developed countries. In 2010, seniors (aged 65 and older) made up 13% and 23% of the populations of the US and Japan, respectively. By 2050, these proportions will increase to 21% and 36%.
Geriatric nurses are expected to be skilled in patient care, treatment planning, education, mental health, and rehabilitation. They also take on many roles in the workplace. The main responsibility is as a caregiver. They can also be advocates, counselors, and educators for their patients.
Gerontological nursing draws on knowledge about complex factors that affect the health of older adults. Older adults are more likely than younger adults to have one or more chronic health conditions, such as diabetes, cardiovascular disease, cancer, arthritis, hearing impairment, or a form of dementia such as Alzheimer's disease. As well, drug metabolism changes with aging, adding to the complexity of health needs.
Gerontological nurses work in a variety of settings, including acute care hospitals, rehabilitation, nursing homes (also known as long term care homes and skilled nursing facilities), assisted living facilities, retirement homes, community health agencies, and the patient's home. The conditions of the geriatric patient's health determines what type of facility one should reside in. Assisted living facilities are also known as senior retirement homes, and they provide care services depending on health conditions. Skilled nursing, otherwise known as a nursing home, is a place where they can reside and get provided with 24/7 cares. Older adults have been referred to as "the core business of healthcare" by gerontological nursing experts. Population aging and the complexity of health care needs of some older adults means that older adults are more likely than younger people to use health care services. In many settings, the majority of patients are older adults. Thus, experts recommend that all nurses, not only those identified as gerontological nurses, need specialized knowledge about older adults. This position was endorsed by 55 US nursing specialty organizations.
Including, GAPNA (formerly NCGNP) which was founded in 1981, by a group of Gerontological Nurse Practitioners with the intention of offering the first continuing education conferences designed specifically to meet the needs of advanced practice nurses providing care for older adults. Currently, GAPNA represents the interests of all advanced practice nurses who work with older adults. These advance practice nurses are active in a variety of settings across the continuum including primary, acute, post-acute and long-term care. GAPNA an organization for advanced practice nurses seeking continuing education in gerontological care as well as networking and peer support from experienced clinicians.
What Attracts Nurses to Gerontological Care
The last few decades have brought in more interest in older people as their numbers in society grow. More people than ever before are surviving to their senior years which substantially makes the demand for more working nurses in gerontology. Viewing aging as a natural process also develops more positive attitudes towards working with older adults.
Gerontology vs Geriatrics
Gerontology is often used anonymously with geriatrics but there are differences between the two. Geriatrics is the specific medical branch of illnesses that affect the aging. Gerontology is the study of factors that affect aging and the effects of aging on a person. Gerontological Nurses need to know about both how to care for illnesses that affect the aging, what other factors affect aging, and how they impact people.
Although nurses published articles about care of older adults as early as 1904, the specialty of gerontological nursing emerged beginning in the 1950s, with the publication of the first gerontological nursing textbook. Pioneers in the field of gerontological nursing include Vera McIver, Doris Schwartz, Mary Opal Walanin.
A geriatric nursing specialty group was formed by the American Nurses Association in 1966, with the name changed to the Gerontological Nursing Division in 1976. In the US, the National Gerontological Nursing Association was founded in 1984 and in 1985 the Canadian Gerontological Nursing Association was founded. Standards of practice for gerontological nursing were published by the American Nurses Association in 1971. In the US, certification for geriatric nurse practitioners and clinical specialists were available in 1984.
The specialty has advanced significantly since the 1990s through large scale education and practice development initiatives funded by the John A. Hartford Foundation, including the Hartford Institute for Geriatric Nursing at New York University. Significant efforts to enhance nursing education have been made in the last decade. In 2010, the American Association of Colleges of Nursing and the Hartford Institute for Geriatric Nursing published the Recommended Baccalaureate Competences and Curricular Guidelines for the Nursing Care of Older Adults. Between 2007 and 2009 the Geriatric Nursing Education Consortium created teaching tools and trained educators in the US to improve gerontological content in nursing education.
Training and education
Gerontological nursing includes generalist and specialist practice. A generalist is a registered nurse or Licensed Practical Nurse. A gerontological nurse specialist is an advanced practice nurse or nurse practitioner who has graduate education in gerontological nursing.
Specific education in gerontological care is important for all nurses, even those who work outside of long-term care, because older adults make up a significant portion of patients across specialties. However, additional certification in Gerontological care is uncommon for registered nurses, with less than 1% being certified. Fewer than 3% of advance practice nurses in the United States have this certification.
Registered nurses have the option of becoming certified in gerontological nursing. National nursing organizations such as the American Nurses Credentialing Center and the Canadian Nurses Association offer certification in gerontological nursing. Requirements for maintaining certification vary. The American Nurses Credentialing Center lists requirements as including 2 years experience as an RN, 2,000 hours of clinical experience and 30 hours of continuing education, both within the specialty of gerontological nursing. Post graduate certificates in gerontological nursing are also available by completing continuing education courses through colleges and universities.
Most often times, gerontological nursing is often ignored within baccalaureate educational programs, with only 1/3rd of all schools requiring a specific course in geriatrics. This is due to educational programs focusing more attention on the sick rather than the well, who are more representative of the older population. 1/4th of all nursing programs in the United States do not have a gerontological staff member.
To better identify those who are most qualified and experienced in managing patient care, there is an APRN Specialty Certification in Gerontology. This APRN Gerontological Specialist Certification (GS-c) distinguishes APRNs who possess expert knowledge, experience, and skill in managing the complex health needs of older adults.
Issues in Gerontological Nursing
The nursing shortage continues to affect all aspects of nursing, and gerontological nursing is no exception. It is estimated that 50-150% more nurses will be needed in this speciality in the next decade. Often times nursing students do not express a desire to work in gerontological nursing as their specialty. This can be due to negative stereotypes, misconceptions, and attitudes toward the aging that are common among nursing students. Gerontological nursing can be unpopular because geriatric nurses are sometimes perceived to be somewhat inferior in capabilities, or not good enough for other specialties. Facilities have also discouraged competent nurses from working in these settings by paying low salaries.
Geriatric care facilities face a problem of staff retention of both professional workers (including registered nurses) and paraprofessionals (including nursing assistants). The American Healthcare Association found a turnover rate of 65% for registered nurses working in nursing homes.
Burnout among nurses in geriatric care is common. Physical stressors, such as frequent heavy lifting, and emotional stressors, such as regularly encountering death, all contribute.
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