Geriatric Considerations in NursingIntroduction Geriatric
nursing is a nursing subfield which involves caring for older
adults. Older adults have special needs which can become very
complex, making employment prospects in the field of geriatric
nursing very good. As people live longer with the assistance of
modern medical developments, many older people require extended
special care from members of the health profession who specialize
in geriatric health issues. To become a geriatric nurse, someone
must generally qualify as a nurse and take additional courses in
geriatric nursing to learn to meet the specific needs of older
patients. You may also hear this nursing field referred to as
gerontological nursing, depending on regional preferences. Numerous
professional organizations for geriatric nursing can be found
around the world, offering additional training, certification, and
support for people who work in this field. Geriatric nurses can
also take advantage of trade journals, research programs,
conferences, and other things which are designed to promote
knowledge and cooperation in the field. Caring for the elderly can
be very complex. In addition to providing basic nursing services, a
geriatric nurse must also offer emotional support to patients,
watching out for their mental health and keeping a close eye out
for medical conditions which can emerge quickly in the elderly.
Geriatric nurses must also be able to coordinate with the families
of their patients, and sometimes they work side by side with family
caregivers, offering training to help them care for their family
members while taking care of complex nursing tasks.
GeriatricsGeriatrics is a sub-specialty of internal medicine and
family medicine that focuses on health care of elderly people. Aims
It aims to promote health by preventing and treating diseases and
disabilities in older adults. Geriatrics, the care of aged people,
differs from gerontology, which is the study of the aging process
itself. The term geriatrics comes from the Greek geron meaning "old
man" and iatros meaning "healer". However, geriatrics is sometimes
called medical gerontology. The geriatric population is defined as
population aged 60 years and above1
According to the 1991 census, the geriatric population
constituted 6.3% of the total Indian population. As a proportion of
the total population, the geriatric population has been steadily
increasing over the decades. This rapid growth of the population of
the elderly is a challenge to the medical profession, the
administration and society. The elderly people suffer from a
variety of problems which are increasingly drawing the attention of
the Government and the public. On retirement, the income is
suddenly reduced. Economic hardship, with continued low standard of
living, affects the body and the mind. Retirement, change in
housing, illness or death of spouse greatly affect the physical
wellbeing of the aged person. The socioeconomic problems of the
elderly are aggravated by the lack of social security, inadequate
facilities for health care, rehabilitation and recreation. In most
of the developing countries, pension and social security is
restricted to those who have worked in the public sector or the
organized sector of industry The mental changes include impairment
of memory, rigidity of outlook and dislike of changing trends
(especially sociocultural norms). The social problems have been
caused by the break-up of the joint family system, the
nuclearization of families, housing shortages in urban areas and
the increasing participation of women in the workforce. Women
continue to be the health care providers for the elderly at the
household level. Human ageing is characterized by progressive
decline (referred to as homoeostenosis) in the homoeostatic reserve
of every organ system. This phenomenon is usually evident by the
third decade although, the rate and extent of the decline may vary.
The decline of each organ system appears to occur independently of
the changes in the other organ systems and is influenced by diet,
environment, personal habits and genetic factors. The elderly
suffer from health problems due to the ageing process[ like -
senile cataract, glaucoma, nerve deafness, musculo-skeletal changes
affecting locomotion, failure of special senses and poor reflexes
(resulting in accident proneness) and enlargement of prostate in
males. Elderly people in modern society Becoming elderly used to be
considered a sign of reverence and distinction. People would seek
out the elderly for their wisdom and experience. Too many times in
today's society growing old means being considered a family
nuisance. Like a pet that has outlived its usefulness, the elderly
are moved to places to be out of sight and out of mind. If they
have
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money, some family members may harness their own greed and use
it to cuddle up to the elderly in hopes of receiving a lump of
income when they pass on. Over 11,500 people per day pass the 65
year milestone in the United States alone. Each year, approximately
100,000 people go past the century mark. The vast majority of
surplus cash sits in the hands of today's elderly. Marketers know
this. More and more products and advertisements are targeting
people beyond their retirement years. Pain medications, denture
adhesives, Medicare supplemental insurance, and a host of other
products specifically target this market. It seems that everyone
but those who should love them tend to be aware of the value of the
elderly today. Nursing homes are multiplying. Doctors have learned
how to milk the cow of Medicare and medigap policies with
multiplied testing and monthly or quarterly office visits. Walkers,
canes, and wheelchairs have become more user friendly with wheels
on walkers and multiple legs on canes and motors on wheelchairs.
Everywhere we look, our society is working to catch the dollars of
the aging population. Elderly Care and Needs Needs of the elderly
can be of various types such as financial needs, health needs,
nursing requirements, etc. We will have a look at all of them one
by one. 1. Financial Needs of the Elderly If elderly individuals
happen to be living on their own, i.e. without anyone else's
support, it is but natural that they will have a certain amount of
financial needs. They will need to fend for themselves for
everything such as food, groceries, medicines, etc. Pensioners
would have the benefit of a steady source of monthly income
(whatever be the amount trickling in). However, those senior
citizens who do not have any pension facilities or any other
sources of income, would have to live entirely on the basis of
their savings or through special senior citizen government finance
schemes. 2. Health Care Requirements Senior health is the most
important requirement when it comes to needs of the elderly. With
advancing age, the body tends to slow down and becomes less
efficient. Elderly3
people are prone to a few age-related health issues. This is a
normal aspect of life and one cannot help it. However, through
proper care and nursing facilities, one can definitely help in
keeping most of these health issues in check and preventing them
from causing any serious harm. Regular medical checkups is
necessary. They can help in anticipating potential future
health-related issues. At the same time, they may help in
identifying serious health problems at an early enough stage during
which treatment is possible. 3. Dietary Requirements As people age,
their digestive system gradually starts weakening. Aged and elderly
people especially, face this problem wherein they start finding
certain foods indigestible or difficult to digest. What one must
realize is that their diet can no longer be the same as it was say,
twenty years ago. Their diet should now be modified accordingly
such that it remains a nutritious, balanced diet and yet, contains
foodstuffs that their system is able to accept, without causing
them any discomfort or problems. Often, the diets of elderly people
need to be altered depending on their medicinal prescriptions. 4.
Nursing Requirements If you have an elderly family member whose
mobility has become limited due to aging, he or she would require a
certain amount of assistance in his or her daily routine. If it is
not possible for someone in the family to be around the aged person
the whole day long, you could consider having a full-time nurse to
assist the elderly person. This could be beneficial, especially if
the elderly person requires assistance in basic activities like
walking, eating, bathing, dressing, etc. 5. Social and other Needs
of the Elderly One thing that you should keep in mind is, to shower
all your love and care on your elderly relative or family member.
Just because they have become old and slow, does not mean that you
should ignore them or let them be confined to themselves. Remember,
a few years down the line, you yourself will be in their position.
Spend time with them, chat with them and make them feel wanted,
cared for and loved. Pay special attention to their room. You could
consider installing a few senior citizen friendly appliances which
they would be comfortable using. Also, you should
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consider installing certain medical alarms that are specially
made keeping in mind elderly citizens. Health Insurance for Senior
Citizens in India Any individual aged 60 years or above is called
as senior citizen. These citizens have worked hard all their lives
and contributed to the development of the nation and the community.
Though generally ignored and sometimes shunned by the younger
community but there is much to learn from them. Some continue to be
productive and work in various capacities. Most organisations and
universities entertain these skilled manpower up to the age of 65
to 70 years.
The senior citizens need to be cared for and the society and
nation owes them a decent life in their old age. Keeping these
sentiments, the Indian Government of India, has introduced several
benefits through its various schemes in for senior citizens. One
amongst such schemes includes health insurance policy.
The schemes and policies are meant to promote the health,
well-being and independence of senior citizens across the country.
With numerous tax benefits, travel and healthcare facilities
exclusively designed and provisioned for them, Indian Government
has created sufficient reasons for Senior Citizens to feel
satisfied and elated. The central government of India came out with
the National Policy for Older Persons (or Elderly Individuals) in
1999. These guidelines aim to encourage individuals to facilitate
provisions for self as well as their spouses old age. It also
strives to encourage families to take special care of their elderly
family members who are often dependant on the bread-winners in the
family. This policy has been designed to enable and support
voluntary and non-governmental organizations (NGOs) to supplement
the care rendered by the family and provide care and protection to
these vulnerable lot. Healthcare, creation of awareness, training
facilities to geriatric caregivers/service providers and healthcare
research have also been looked into and implemented under this
policy. The main purpose of this policy is to make elderly people
fully independent citizens.
National Policy for Older Persons has resulted in the launch of
new schemes listed below:-
Strengthening of primary healthcare system in order to fulfill
the requirements pertaining to5
healthcare needs of elderly.
Provision for separate queues and reservation of beds for
elderly patients in hospitals and nursing homes.
Imparting necessary training and orientation programs designed
for medical and paramedical personnel in Geriatric care. Assistance
to societies for production and distribution of materials related
to geriatric care.
Promotion of the concept of healthy ageing process, preventive
healthcare aspects and well-being of Senior Citizens.
Extended coverage under the Antyodaya Scheme with special
emphasis on provision of food at subsidized rates for the Senior
Citizens especially the destitute and marginalized sections of
Indian Society.
"The Integrated Programme for Older Persons" is a scheme that
provides financial assistance up to 90 per cent of the project
costs to non-governmental organizations or NGOs involved in their
care. This money is used to establish and maintain old age homes,
day-care centres, and mobile medicare units as well as to provide
non-institutional services to elderly individuals. The scheme also
incorporates other requirements of elderly citizens such as
reinforcing and strengthening the family bonds, generation of
awareness on family related issues and facilitating productive
ageing.
Another important program introduced by the Government of India
is the Scheme of Assistance to Panchayati Raj Institutions,
voluntary organizations and Self-Help Groups for the construction
of Old-Age Homes and Multi-Service Centres for Senior Citizens.
This scheme provides a one-time construction grant.
Central Government Health Scheme (CGHS) provides pensioners or
retired employees of central government various healthcare
facilities for availing treatment and obtaining medicines for
chronic (or long-standing) ailments up to three months at a
stretch. The6
National Mental Health Program focuses on the needs of elderly
individuals who are affected with Alzheimers Disease Dementia,
Parkinsons disease, Depression, Psychosomatic disorder and
Psycho-Geriatric ailments.
The journey towards financial security does not end here. The
Central Government of India is constantly in the process of
evolving and rolling-out of newer plans and schemes to benefit
senior citizens across the country. In the 2007-08 Budget, the
Finance Minister had proposed to provide monthly income to seniors
and develop new healthcare insurance schemes.
For the benefits of senior citizens various schemes have been
introduced that includes:
The National Housing Bank - has introduced a 'reverse mortgage'
scheme under which a senior citizen owning a house in India can
avail of a steady monthly stream of income against mortgage of the
house. The senior citizen remains the legal owner and occupies the
house throughout his or her lifetime, without repayment of the
loan. Regulations are to be initiated for creation of mortgage
guarantee companies.
Exclusive health insurance schemes for senior citizens offered
by select Insurance Companies.
The Maintenance of Parents and Senior Citizens Bill of 2007 -
This bill facilitates care for the maintenance of aged parents,
establishment of old homes, provision of medical care and
protection of life and property of senior citizens.
These new developments concerning senior citizens are meant to
get such individuals on the path to a better, peaceful, stable,
financially sound and secured life.
The role of the nurse
Older peoples continuing care needs are met in a variety of
settings, including their own home, supported housing, residential
care, a nursing home or hospital. At some stage many older people
are likely to require registered nursing care.
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Older people in hospital or who live in care homes are likely to
be vulnerable. Indeed the RCN would argue that if older people are
vulnerable enough to require placement in a care home, then it is
likely that some level of nursing intervention will be needed. The
role of the nurse as an enabler of health in older people is
crucial in continuing care settings (RCN, 2004a). In a care home,
registered nurses have multiple roles that reflect the diverse
nature of nursing. Different functions that contribute to the
optimum health and overall wellbeing of older people
include:Supportive -
including psychosocial and emotional support, assisting with
easing transition,
enhancing lifestyles and relationships, enabling life review,
facilitating self-expression and ensuring cultural
sensitivity.Restorative -
aimed at maximising independence and functional ability,
preventing fur there
deterioration and/or disability, and enhancing quality of life.
This is undertaken through a focus on rehabilitation that maximises
the older persons potential for independence, including assessment
skills and undertaking essential care elements, for example,
washing and dressingEducative -
the registered nurse teaches self-care activities - for example,
self-medication
health promotion, continence promotion and health screening.
With other staff, the registered nurse engages in a variety of
teaching activities that are aimed at maximising confidence in
competence and continuously improving the quality of care and
service delivery Life-enhancing - activities that are aimed at
enhancing the daily living experience of older people, including
relieving pain and ensuring adequate nutrition Managerial - the
registered nurse undertakes a range of administrative and
supervisory responsibilities that call for the exercise of
managerial skills. Such responsibilities include the supervision of
care delivered by other staff and the overall management of the
home environment
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