INTRODUCTION TO GERIATRIC NURSING

        Ageing is a natural process, characterized by continued development and maturation. It is estimated that by 2013 the number of people aged 65 and over will exceed 15 million people and comprise 23% of the whole population. This population shift will have dramatic effects on healthcare provision and it is essential not only that the services are in place to meet this demand but also that the nurses have the skills to care for this age group. They are unique people because they have lived the longest and have participated in and adapted to complex social changes. Rapidly growing older adult population and continuing shortage of advanced practice nurses educated to care for older adults.

        Dr. Ignatz Leo Nascher, the father of modern geriatrics coined the term "geriatrics" in 1909. The term "geriatrics" comes from the Greek word "geron" meaning "old man", and "iatros" meaning "healer". The ancient Indian system of medicine Ayurveda has mentioned about the Jara Rasayana (geriatrics). The term "geria" is very close to the Sanskrit word "jara". "Rasayana" is defined as a branch of medicine that deals with the prevention of premature ageing, management of diseases and especially the management of diseases related to Old age.

        Geriatric 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%.

According to a report by UNFPA and Help Age International says "India will be the youngest country in the world by 2020 with a median age of 29 years. India has around 100 million elderly at present that divides into three categories: the young old (60-70) the middle-aged old (70-80) and the oldest old (80 plus). India's population is likely to increase by 60% between 2000 and 2050 but the number of elders, who have attained 60 years of age, will shoot up by 360%. Out of this, the oldest old segment, which is the most vulnerable on account of suffering from disabilities, diseases, terminal illness and dementia, is also the largest growing segment of the elderly population, at a rate of 500%." (UNFPA and Help Age International, 2013)

        The increasing population of the elderly is "a development concern that warrants priority attention for economic, health and social policies to become senior citizen-friendly," the report said. Therefore, the demands of the geriatric nursing and nurses will increase in India.

DEFINITIONS

• "Old age is an incurable disease." (Seneca)
• "You do not heal old age; you protect it; you extend it." (Sir James Sterling Ross)
• "Ageing is the progressive and generalized impairment of functions resulting in the loss of adaptive response to stress and in increasing the risk of age related diseases." (Dr. A.B. Dey)
• Geriatrics – Geriatrics is the branch of medicine dealing with the physiological and psychological aspects of ageing and with diagnosis and treatment of diseases affecting older adults.
• Gerontology – Gerontology is the study of all aspects of the ageing process and its consequences.
• Gerontological Nursing – It is concerned with assessment of the health and functional status of older adults; diagnosis, planning and implementing health care and services to meet the identified needs and evaluating the effectiveness of such care.
• Gerontic Nursing – Gerontic Nursing is a seldom-used term considers the nursing care of older adults to be the art and practice of nurturing, caring and comforting rather than merely the treatment of disease.
• Geriatric Nursing- "The adaptation of professional nursing knowledge, skills and attitude in recognizing and meeting the nursing, health & emotional needs of an aging population."

DEVELOPMENT OF GERIATRIC NURSING

• Gerontological nursing involves advocating for the health of older persons at all levels of prevention.
• In the 1960's gerontological nursing became a subspecialty of nursing.
• In the 1980's gerontological leaders stated that most practicing nurses did not have sufficient knowledge about gerontological nursing.
• As a result since 1990's schools of nursing provide classes or courses about nursing care of the elderly. Practicing gerontological nursing can obtain gerontological nursing certification through the American Nurses Association.
• Advanced practice in gerontological nursing requires a master's degree in nursing, of which here are two options: the gerontological clinical nurse specialist and the gerontological nurse practitioner.

IMPORTANT CONCEPTS IN THE PRACTICE OF GERIATRICS

The manifestation of disease and its course in old people is different from that in younger individuals. It is important to remember the following concepts of geriatric medicine.

• Older patients get symptomatic early but seek health care much later due to socioeconomic reasons.
• Some s/s, such as anemia confusion, and recent onset of incontinence warrant immediate attention, as they may be associated with several life-threatening conditions.
• Not all clinical abnormalities complained or detected can be given equal importance and need to be prioritized.
• A single diagnosis for many coexisting symptoms is not possible in old age. Many diseases coexist and needs a multiple management strategy.
• Multiple small deficits often produce major disability and multiple small interventions produce dramatic results.
• Older people often require rapid access to health care and may need specialized care.
• Apart from medicines and surgeries, physiotherapy and counselling play a major role in the care of older patients.
• Contrary to popular belief, all kinds of prevention are effective in old age. Nurses and health care workers; therefore provide preventive interventions in all situations.

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