Category: Gerontology

“We all admire the wisdom of people who come to us for advice”

“The best way to gain wisdom is by spending time with people that are older than you”

The older generation or the older adults are the most important part of the society. They are the diamonds of the society. They have wisdom. They admire us. They are the source of positive energy for us. They are helper for us.

Old age means no more young. This start at the beginning of the 60. This is the stage later to a normal life. It is the part of the aging. “Aging is the process in which a person lost all of its normal cellular, hormonal, metabolic gain with the passage of time and have weak cellular hormonal and metabolic function”. In aging a person is growing older and older in a specific life span but it can make a person old early and fastly due some reasons and behavioural changes like inactivity, smoking, obesity etc.

Geriatrics is define as the “taking care of the older one or aged people”. Gerontology – is the study of the older adults, the changes that occur in their lifestyle, behavior patterns,and also the physical changes. There are several branches of gerontology or geriatrics, some of which are: clinical gerontology; social gerontology; experimental gerontology; preventive gerontology.

When a person become old and reaches to the later stages of aging there are many changes take place in his/her body as well as behavior patterns even in their total life style. These changes can be: anatomical changes, physiological changes, psychological changes.

Anatomical Changes

With aging there are many anatomical changes occur. These changes may be muscular or be bones and joints related. Musculoskeletal related changes: muscle strength, power, endurance, flexibility all these are the components of the physical fitness. These components changes with aging or when you get older. The loss of these components (muscle mass, strength and function) due to aging is called as sarcopenia. In general as we aged we experience atrophy of the muscle fibers as well as decreasing the number of muscle fibers present. In short overall muscle mass and strength are decreased. Over adults there may development of muscle tremors associating with the generation of extra pyramidal system. In addition to all tendons of the body tendons to shrink and harden. The purpose of the tendon is to attach a muscle to a bone. In older age there is chances of tendon fibrosis.

As we aged both bone density and bone mass decreases. This happen specially in women that after menopause they reduce bone mass. If this bone loss is not prevented on time can lead to osteoporosis. Osteoporosis can cause the thinning of the vertebral disk and shortening of the vertebrae. This can also leads to the kyphosis of the neck as well as flexion on hip and knees. In addition to all of this, older adults commonly experience the deterioration of the joints which may lead to limitation of the activity. All of these factors together placing the older adults at risk for fractures.

Physiological Changes

With the aging there is changes occur in cell, respiratory, cardiovascular and other system of the body as well. As we aged the total number of cell in our body decrease, muscle and body mass decrease and this leads to decrease also in lead body mass. With the decrease in lean body mass will come an increased proportional amount of fat in our bodies with the decrease in lean body mass there is also decrease in the total body water. This in turn will make older adults much more susceptible to dehydration.

Many aging changes occur to respiratory system. Changes to the connective tissues of the nose leads to tipping of the nose downward. Older adults are also more likely to breathe through the mouth which may contribute to snoring and possibly obstructive sleep apnea. The mucus in the nose of older adults become more dry leading to the feeling of continual nasal stuffiness.

In terms of the chest itself the ribs and tissues within the lungs become more rigid making it difficult to expand and contract for older adults.

The cilia become less effective in removing mucus and bacteria from lungs. Older adults also experience the total number of alveoli within the lungs themselves and overall lungs become smaller less firm, lighter and more rigid. All this increased the residual volume and decreased lung capacity. All these make an older to develop respiratory infection such as pneumonia.

There is changes in the anatomy and physiology of the heart as well as the blood vessels of the heart through out the body.

In 1954, the possibility of a nuclear war was on the horizon. The public recognized that increased exposure to radiation was threatening to longevity and that antioxidants could be used to neutralize its effects. Sources of longevity were of importance around this time, as America pushed to increase its average life expectancy (Harman, 2009, p. 774). Along with many others, Denham Harman was interested in what he describes as “the long-expressed desire of ‘man’ to ‘live long but not be old’” (Harman, 2009, p. 774). His work endeavors attempted to reveal that free radicals were the explanation hidden behind aging. He proposed that the mortal effects of radiation exposure mirrored that of free radical oxidation within the body. His theory was discarded by scholars around the world for years to come. Despite criticism, Harman continued to pursue funding to research his theory through the eighties (Harman, 2009, p. 777-781). For the last sixty years, free radicals and oxidative stress have been a topic of discussion among scientists all over the world. Although it is much better understood now than it was in the 1950s, debate still remains about whether the free radical theory of aging is valid. However, a great deal of research shows its potential to understand the causes of aging and provides a promising outlook on increasing life expectancy, making it a focal point of the biological theory of aging.

Chemical bonds are formed between elements that constitute a compound by the sharing or transferring of electrons. Compounds typically follow the octet rule, in which each of its respective elements has eight valence electrons. It is important for atoms and compounds to follow the octet rule, because when they do not, they become unstable (Loudon & Parise, 2016, p. 3-9). Free radicals are unstable species that aggressively try to fill their valence shell and consequently damage biomolecules in the human body. Antioxidants counter the damage that free radicals cause in the body, by providing free radicals with a source from which they can take an electron. However, the balance between free radicals and antioxidants is delicate, and when thrown off causes oxidative stress, which is related to aging (Afanas’ev, 2010, p. 84). In summary, Harman theorized that free radicals accumulate as we age and cause oxidative damage, which lead to disease.

This theory was later expanded to differentiate free radicals, noting that not all of them were necessarily life-threatening. Despite the advancements, one free radical in particular remained the main source of concern: reactive oxygen species, or ROS. ROS is vital to humans in that it plays an important role in cell signaling. However, in excess, it leads to oxidative stress. This is important for gerontology because there is a positive correlation between age and ROS production and a negative correlation between age and balancing free radicals and antioxidants (Afanas’ev, 2010, p. 75-76).

Today, a major source of debate within the theory is whether the source of ROS is really mitochondria, as assumed by Harman, or if it is NOX. A respiratory burst occurs when cells use oxygen by activating NOX. NOX are enzymes used throughout the body that generate ROS. Proponents of NOX being the primary source of ROS claim that its science is broadly unexplored, and therefor undervalued. In the near future, this debate may be a source of weakness for the free radical theory of aging if proponents can confirm that in fact NOX is missing from the free radical oxidation equation (Krause, 2007, p. 256-261).

There are a couple theories that oppose the free radical theory of aging altogether. TOR theory suggests that another aging pathway promotes aging faster than ROS, making that the primary source of aging. This TOR pathway governs cell growth and function, and when overworked, aging emanates. However, it is important to note that the science behind this theory is not concrete, and that the TOR pathway is most likely regulated by ROS (Afanas’ev, 2010, p. 84).

Harman’s free radical theory had implications beyond gerontology. His work also helped disclose basic knowledge on free radicals that was once unknown to biologists and chemists alike. Today, this theory continues to develop, and influences preventative practices taken to increase longevity. The ramifications that this theory has offered to science and the human life make it particularly noteworthy.

The term aged refers to; ‘Old,’ ‘Elderly,’ ‘Ancient,’ or ‘Antiquated.’ The Chamber’s Twentieth Century Dictionary (1964) defined aged as ‘advanced in age.’ Crandall (1980) states that the term aged is harder to define. Ten years old is likely to think of someone as aged after the age thirty. On the other hand, a 65 years old may think as aged those individuals of 75 years of age. It is, thus difficult to decide when an individual is aged. Generally the term aged refers to: those individuals who are 65+ years of age The term ‘aged,’‘ older’ and ‘elderly’ are often used synonymously. Different countries adopt different age-specific definitions, often, those go with retirement age. “In Korea, for instance, the age of retirement in some services in 45+. In Japan and Australia, it is between 60 and 65. In India the age of retirement for government employees is 58 years and in semi-governmental institutions, it is 60 years. Therefore, in India, the term ‘aged’ could refer to those individuals who are 60+ years of age. After superannuation re-employment for a period of 5 years is given only to a chosen few. Old age is the product of the interaction of multiple influences of all earlier stages. i.e. the experience of old age will be different for the 20 million persons now over 65 years than it was for people of similar age a few years ago.

Old age is also called “later adulthood” and according to some psychologists begins at the age of fifty-one. The maximum age prescribed for treating a person as fixed old varieties. In India, the attainment of 55 years has been mostly accepted for the purpose of classifying aged persons. The census of India has accepted 55 years as the age for treating a person as ‘aged’ whereas in USA and U.K. and other western countries, in ranges from 60 to 65 years.

At the outset, it needs to be clarified that aging as it concerns an individual and a population are two distinct concepts. An individual invariably ages he/she passes through the various stages of life -such as childhood, adolescence, adulthood, and old age. On the other hand the aging of a population occurs when there is an increase in the proportion of persons defined ‘old’ in the population. It is also possible for a population to grow younger; this occurs when the proportion of young persons in the population increases. It has been suggested that a population may be arbitrarily defined as“young” if the percentage of persons above the age of 64 in the population in less than, as ‘mature’ when this percentage is between 4 and 7, and as ‘aged’ when it exceeds 7 percent. From the above discussion, it appears that old age can be identified through different approaches. Authors and experts have, however, presented various aspects of old age which may be presented in the following sub-points.

Physiological Consequence of Old Age

The process of life consists of physical and mental changes characteristic by growth and subsequent decline. Elderly years of life, growth predominates and later years declination predominates, though both these processes (also known as the evolution and atrophy) accompany each other from the embryonic life and continue till death. Aging generally comprises of those changes that take place during the later part of life, when physical and mental decline becomes more apparent to concerned individuals and to the society.

During the early years of old age, declination in both the physical and mental capacities is generally slow and the individual compensates the loss by part knowledge and reserves. This period of old age is known as “senescence.” When more or less, complete physical breakdown takes place and mental disorganization is seen, this period is known as “senility.” At this stage, the individual is no longer able to do anything from his reserves to meet his present need and thus exposes himself to social and psychological limitations affecting his personal and social adjustment.

Psychological Consequences of Old Age

Psychological aging consists of general decline in the mental abilities that accompany old age. The psychological changes in the aspect of individual’s concept of the self, his idea about his worth as an individual and as member of social groups, his feelings about the attitude and behavior of others towards him, and his general view of life and the world, including his own place there in, plays significant part in the process of ‘psychological aging.’ An unfavorable and negative attitude towards the changed physical and social condition proves not only a hurdle in better adjustment during old age but brings psychological aging even more rapidly.

Social Consequence of Old Age

Social age refers to the person’s roles and habits expected by the society for particular ages. A woman who became grandmother at 40 was older in terms of social age than a woman who bore her first child at 40 as the later was younger in terms of social status. Similarly, a 35-year-old man who assumed the role of head in an extended family would have a greater social role in comparison to an older man aged 55 years who is not the head of the family.

Functional Consequences of Old Age

Functional age refers to a person’s ability work and discharge duties in the society and probably biological, psychological and social age. An 85 years old man who lives alone, drives a car, and attends nightclubs is much younger in terms of functional age than the average 85 years old. He is probably healthier, sharper, and more involved than most of his peers. This much about the different aspects of old age. The problems of such people are discussed below.

Problems of Elderly People

Old age presents its special and unique problems but these have been aggravated due to the unprecedented speed of socioeconomic transformation in the country to a number of changes in different aspects of life and living of people. According to Nag (1987) “ due to socioeconomic changes in the wake of urbanization and increase in the proportion of the aged in the population, the problem of the aged has become formidable. With the impact of industrialization in society, the traditional means of earning a livelihood and mutual aid institutions are rapidly lying out. The ultimate responsibility for supporting the aged is gradually shifting from family to the state.” Government of India (1992) has also accepted:“ India is passing through an unprecedented phase of socioeconomic transformation. According to Chowdhry (1992), the following are the factors affecting the problem of the aged:

1. Bodily changes and depletion of physical and mental strength.
2. Modern education and working young couples.
3. Urban influence and industrialization.
4. Materialistic and individualistic outlook.
5. Breaking of the joint family system, generation gap.
6. High cost of living and lack of social security measures.
7. Paucity of accommodation in urban areas and un-congenial environments.
8. Migration of younger generation.
9. Employment of women.
10. Additional economic responsibility of the elderly educating sons, marrying daughters, etc. in later life.
11. Sense of loss of job, status, assets, physical strength, and social responsibility.

However, Gerontology, the scientific study of aging, is primarily concerned with time between maturity and death, divides the problem of gerontology into four major categories:

1. The social and economic problems caused by an increasing number of elderly people in the population.
2. The psychological aspects of aging along with their reaction to one another.
3. The physiological bases of aging along with pathological deviations and disease processes.
4. The general aspects of aging in all animal species.

The needs of the elderly in India are many and complex. They range from problems of practical and financial nature to problems of housing, health, isolation and loneliness and lack of services. The far-reaching and rapid changes of the modern society have profoundly affected the position of the old people and their ability to deal with their own problems. Today the extended family is no longer greater in numbers. The problems of the elderly vary from urban to rural settings. The life of the aged in rural area is a tranquil and simple one. They continue to the extent of their ability to undertake light work and their recreational demands are small. They have different sorts of relationships with their families and are better adjusted to the community.

Aging is not a new phenomenon. But the problem that occurs with aging appears to be a product of the modern age. In the context of the dynamic changes taking place in Indian society, the problems of the aged have assumed grave importance. In fact the order of prevalence in India has been mother-father, teacher, and God. Since time immemorial most of the traditional families in India strongly believe that since it is the duty of the parents to look after their children, it is equally important for the children to look after their dependent parents. One repay’s one’s duty to the parents and also pay one’s way to salvation. Apart from the above-mentioned ingrained belief in the mutual obligation, the joint family system, the caste institutions, the charitable organizations, and kind-hearted philanthropists have all been coming to the help of aged. Due to improved health facilities, there is an increase in the longevity of people from 30-40 years some decades ago to; 50-60 years now. It is Worthwhile here to note the opinion of the world Assembly on the Aging held at Vienna in July 1982.

This House has been in the world on the regrettable teachings of the aged Expressed widespread concern. With the steady decline in the incidence of mortality and mobility in most of the developed countries and the strives made by the family planning drive, in both the developed and developing countries, compounded by an increase in the population of the elderly in both the developed and developing societies. With higher expectancy of life, there has been a steady rise in the number of the aged.

The increasing number of the aged in the society is likely to be accompanied by various problems connected with the welfare of the dependent group of population.

The impact of the retirement is tremendous as it result in loss of role, status, Power, opportunities for interaction and as Miller (1965) states“ loss of an occupational identity,” with the result the individual withdraws from society and has little social interaction. Therefore, retirement, the point demarcating middle age from old age, can lead to low morale, decreased levels of satisfaction, depression, feelings of loneliness and hopelessness.

Social and Economic Problems of Elderly People

The problem of aged is also socioeconomic one. According to modern gerontology a problem is considered social when difficulties met by a group of people, result from:

1. The functioning, organization or structure of society.
2. May endanger the organization or structure of society.
3. Can and should be solved through social policies and political initiative (Philibert, 1968).

Advances in medical sciences, improvement in living conditions,functionless and public health facilities have prevented epidemics and brought up the life expectancy of people all over the world. In addition to the rise in the percentage of the old people, the more important factor is that the roles and status of the old people are declining in the present society. It deprives them of the satisfaction of their physical and socio-psychological needs. The drives or needs of the old people listed by some gerontologists (Kaplan, 1960; Arthur, 1954; Bortgs, 1963) may be summed up as:

1. Financial and physical security.
2. Recognition as a useful and significant person in their own world.
3. Associations and relation with others.
4. Social and creative activities.
5. Passing the leisure time in satisfying ways etc.

In the pre-industrial society, the old people used to get enough opportunities to satisfy their various needs. In the societies dominated by agricultural and handicraft economy they participated in productive activities as specialties (Simmons, 1960), directly or indirectly, depending on their physical health, and remained financially independent.

But the present society does not provide opportunities to its aged members to lead a comfortable, respectful and socially useful life. With the modernization and industrialization of society the roles and status of the old people decreases (Kooy, 1963). The younger generation replaces the aged people in their powerful positions, leaving them in a weakened and functionless situation (Simmons, 1959). Owing to the changing Indian social structure, the old people have been dislodged from the leadership positions in the family, caste, group and community (D, Souza, 1971; Bhatia, 1964; Singh, 1969). With the growth of new economic, political and value systems, the integrity and compactness of the joint family and caste group have been weakened and for the leadership in the community, properties like wealth or education have become more important than the ascribed properties like age and seniority in modern society. This is confirmed by the fact that whenever older persons are in the position of leadership, it is mainly due to their education and wealth rather than age (Jagjit Singh, 1962). Thus, aging is not only biological in nature but also in cultural process. Physical, social, and emotional changes at this age require readjustment in interpersonal relations in different situations with the members of the family and society (Chowdhary, 1981).

Psychological Problems of Elderly People

The Psychological aspects of aging involve a wide variety of problems. The effect of aging on certain needs and motives, the effect of prior experience in the aging process, the psycho-dynamic of the emotional life of the elderly, the effect of age upon learning, the effect of age on psychomotor performance, and the role and importance of sensory changes in aging are particularly important. Psychopathology and aging and problems of the adjustment set by the culture are important psychological aspects of aging. Changing adjustment may in turn be a causal condition determined by a variety of personality and other changes with age and also encompasses the psychological aspect of aging process. The emotional needs of the elderly have been studied intensively by variety of experts in different discipline, but physiological and medical researches are integral part of these studies.

Lemkar (1995) has clarified that old age brings a reduction in memory and subjects the aged to varied kinds of mental illness. Cavan (1946) has made it clear that old age comes with worry over finances, anxiety over health, feeling of being unwanted, isolated and lonely, feeling of suspicion, loss of mental rigidity, irritation, inability to adjust to changed conditions, and decreased social contracts and participation.

Chowdhary (1992) has pointed out that “an old person being to feel even his children does not look upon him with that degree of respect he used to get some years earlier. The old person feels neglected and humiliated. This may led to the development of psychology of shunning the company of others. Loneliness in turn may give rise to depression and may eventually lead to worsening of sickness.”

In brief, people during old age have to encounter a number of problems particularly when become redundant and un-useful.

After discussing the two terms i. e. ‘Adjustment pattern’ and ‘Old Age’ separately, between the two has to be examined. It is presented as below:

Adjustment Problems of Elderly People

To make an adjustment for older people to their family members May be required, which can increase their status. Older people may have to be devoid of more activity than life. This problem is more crucial for the persons who are required to retire from their active life. Old people may be required to face the problems of adjustment to the loss of spouse or loss of friend. They have a lot of free time and do not know what to do with it hence utilization of leisure time may be a problem.

In gerontological sense, it refers to the internal and external equilibrium of human organism (Rosow, 1963). It has been used mostly to refer to the state of harmony not only within itself but also with its environment (Kuhlen, 1959). The concept of adjustment has been used in the context of the practical purpose of gerontology. The practical purpose of gerontology is to help people in leading a better life in later years.

The first major study of adjustment in old age was those of Folsom and Morgan in 1937, and Landis in 1942. Folosom and Morgan (1937) have used the present life happiness as the index of adjustment and reported that factors like good health, freedom from liabilities, pleasant social and emotional relations with friends and family members, hobbies work like activities and independent living in own homes are positively associated with good adjustment of the recipient of old age assistance in New York. Landis (1942) by emphasizing the factors from the past life and using the activities and attitude of the aging individuals for the measurement of adjustment found that economic independence, high education, marriage at right time, small family, low death rate of children, infrequent resistance, good health, employment, hobby, visits to friend and church and preference for living with children are the variables corresponding positively with the adjustment.

The Consensus Model for APRN Regulation (2008) states the scope of practice is not setting specific but rather based on the needs of the patient. Advanced nursing programs are designed to prepare individuals specifically for their declared practice. Seeking practice outside of one’s specialty must require formal preparation and certification. APRNs are educated in one of the four roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related, or psych/mental health (Consensus Model for APRN Regulation, 2008, p. 6). Primary and family nurse practitioners (FNP) generally manage chronic health problems and long-term illnesses in the outpatient/ambulatory setting. Acute care nurse practitioners are trained to manage short-term critical problems that often require hospitalization. Even though settings and skills overlap, the full skill set is different, and experience in that setting as anything other than an ACNP can be very helpful but does not confer the full set of competencies needed to practice in that setting as an NP (Gardenier, Knestrick, & Edwards-Tuttle, 2017). Since the FNP’s scope of practice doesn’t include care for patients with acute or chronic illnesses in deteriorating or life-threatening conditions, the AG-ACNP is the go-to credential for NPs looking to serve adult patients in areas like emergency rooms, trauma units, and intensive care units (Nurse Journal, 2019). Studies have shown that ICU teams that include properly trained and supervised advanced practice providers can provide care that is of equivalent quality to that provided by resident staffed teams (Lily & Katz, 2016).

History

The AG-ACNP had not been a formal certification until 2008 when the APRN Consensus Model explicitly changed the competency requirements to address the multidimensional needs of the older adult population (Joel, 2018). Notably, the adult and gerontology foci were merged, and both the adult-gerontology and pediatric foci are distinguished as being primary care or acute care (NONPF, 2016, p. 3). These organizations recognized a demand for adult-gerontology specialists in acute care/critical care settings and began to break down requirements for educational programs. The change in competency requirements forced educational programs across the country to modify their curriculum and integrate specific competencies for the adult-gerontology patient populations. The designation was made to focus the NP’s role on the aging patient populations and their growing needs, however, questions emerged about the nature of acute care and primary care practice (NONPF, 2011). The National Organization of Nurse Practitioner Faculties (NONPF) issued a statement in 2011 addressing questions and clarifying the difference between the two roles in adult-gerontology practice. These declarations are used today to distinguish the scope of practice between ACNP and PCNP.

Program Design

The preparation of an ACNP differs from that of a primary care nurse practitioner (PCNP). The education of competent ACNP intensivists requires a specialized curriculum that provides both robust didactic content and clinical experiences (Squiers et al., 2012). Competencies for the ACNP include independently managing complex acute, critical, and chronically ill adult and older adult patients at risk for urgent and emergent conditions, using both physiologically and technologically derived data, to manage physiologic instability and risk for potentially life-threatening conditions. However, PCNP competencies focus on plans for long-term management of chronic health issues with the ability to provide interventions to prevent multi-system health problems. In addition, AG-ACNP programs provide formal education on therapeutic devices or treatments such as non-invasive and invasive respiratory support, hemodynamic monitoring, line and tube insertion, and lumbar puncture. Primary care NPs in acute care settings are forced to complete on-the-job training for line insertion or circulatory management without formal knowledge from their educational program. The separation of acute care and primary care set forth by the National Organization of Nurse Practitioner Faculties was to provide precision and focused training to each patient care area.

NPS who wish to practice in critical care requires substantial didactic and experiential education to attain confidence and competence as a provider (Donaworth, 2017). To further this case, studies have shown new APRN graduates do not feel confident or prepared for their roles in acute care even if they hold certification in acute care practice. One study issued a 44-item questionnaire to ACNP graduates evaluating the respondents’ perceptions of educational preparation for the ACNP role. Of this study, only 19% reported that they were very well prepared for practice (Donaworth, 2017). Thus, making it impossible for PCNPs to be well prepared for a role in critical or acute care.

Practice Outside of Legal Certification

Since a primary care NP’s scope of practice doesn’t include care for patients with acute or chronic illnesses in deteriorating or life-threatening conditions, the AG-ACNP is the go-to credential for NPs looking to serve adult patients in areas like emergency rooms, trauma units, and intensive care units (Nurse Journal, 2019). Licensure and accreditation are granted according to the patient population that is served. If the provider is professionally educated in primary care, he/she will sit for the AG-PCNP exam. If the PCNP then chooses to work in an acute care setting, he/she is not practicing under their formal preparation. This creates an increased liability for the new APRN graduate because they lack the expertise in high-acuity patients and complex life-threatening conditions. According to the Statement on Acute Care and Primary Care Nurse Practitioner Practice declared in 2011, NPs practicing beyond their scope of practice (e.g. PCNPs in acute care) present legal, ethical, and safety issues of which the NP – and generally not the employer – is responsible. State Boards of Nursing grant licensure to providers assuming they will practice in a moral and ethical manner. Licensure can be revoked at any time if the APRN is found liable for alleged acts of negligence including patient negligence as well as professional negligence.

Hiring Personnel and Complexity of NP Certification

Many hiring personnel do not understand the difference between NP certification. Registered nurses are trained to practice in all settings and, because not everyone who hires NPs understands that our training and certification model is different, it comes down to the NP to be sure that skills and credentials match the practice setting (Gardenier, Knestrick, & Edwards-Tuttle, 2017). There are many APRN students obtaining a primary care degree but have experience in acute or critical care as a registered nurses. Because of the previous specialized experience, administrators may be lead to believe that the APRN was formally prepared by their program to provide concentrated acute care. For example, a registered nurse who practiced in critical care and then completes a primary care NP formal educational program is not prepared to practice as an acute care NP (NONPF, 2011).

Since employers may not be aware of different educational preparations or practice settings this creates longer orientation and higher cost to train primary care NPs. ACNP’s curriculum includes training for patients with rapidly deteriorating conditions, line/tube insertion, and short-term treatment. PCNP programs do not require acute care hours or the completion of a critical care rotation. Clinical rotation sites and nursing practice mentors are essential components to clinical preparedness. The PCNP will lack formal education in these skillsets due to their limited curriculum and consequently require more on-the-job training at their health care facility.

Patient Risk

The acute care nurse practitioner works with patients with a higher level of acuity than those encountered in a primary care setting, requiring a skill set that blends the best of advanced practice and acute care nursing (Yeager, 2010). This level of acuity provides a foundation for defining the scope of practice and training requirements that should be used to grant credentials to advanced practice providers who practice in ICUs and raises the question of how the longitudinal educational and professional needs of ICU advanced practice providers should be supported (Lilly & Katz, 2016). Effective use of NPs in critical care becomes compromised when NPs are ill-prepared. Working outside the scope of practice places patients at increased risk for complications where health care scenarios become more complex every day. The National Organization for Nurse Practitioner Faculties (2011) remarked the PCNP does not have the educational preparation to care for the complex acute or critical patients but does have preparation to manage the simple acute patient. Likewise, the ACNP does not have the educational preparation to provide comprehensive, continuous care but does have the preparation to provide preventive services within the context of restorative care (NONPF, 2011). If patients were privy to this information, would it change the amount of confidence they have in their health care provider knowing the APRN has not been graduately-prepared according to their job description?

Conclusion

Concerns arise when providers practice outside of their designated specialty. The role of the NP has evolved over the years, requiring nursing organizations to modernize guidelines and specify settings for which APRNs may practice. The program curriculum for AG-ACNP is targeted at caring for patients with rapidly changing conditions who are often mechanically dependent. Generally speaking, the main focus for PCNPs is continuous care and the main focus for ACNPs is restorative care. Things can be further complicated because employers may not understand the intricacy of different APRN certifications. A continual challenge to the clarity of scope of practice for the ACNP and PCNP is the willingness of some employers to credential NPs to practice beyond their educational preparation and certification (NONPF, 2011). APRNs have a moral obligation to adhere to the guidelines set by State Boards of Nursing to ensure safe practice and problem prevention. Both certifications can agree the main priority is to provide care to the best of one’s ability. Ultimately, the certified ACNP has a stronger educational background and firmer understanding of inpatient specialties, better serving the acute care patient population.

Abstract

This research paper will be on older drivers and the social support or against older drivers. I will brief on four online articles that deal with the rules, regulations, and stigma that are associated with driving as an elder. After reading the class textbook (Hooyman, N. R., & Kiyak, H. A. (2011) Social Gerontology. A Multidisciplinary Perspective 9th ed.) I realized that among the many things that the elderly must relinquish because of diminishing cognitive skills is driving a motor vehicle which is something many will not stop until they are forced to regardless of their driving abilities. Driving is the single most independent and self-fulfilling form of means of transportation for a person even though there are plenty of other ways to get from place to place. Refraining from driving can feel like a big sacrifice to someone or become a life-changing event to anyone who has done it on a daily basis.

Society moves so fast that people are always in a rush to get around and drive too fast that they see older drivers as a nuisance but it’s the elder drivers who typically try to drive more cautious and obey the traffic laws. Society sees older drivers as a burden that it seems that they get in the way of others but their need to drive is just as important as any other. On the other hand, there are some examples and facts that show that elders can no longer process what’s around them fast enough that it increases the chances of car accidents or motor vehicle fatalities.

Many cities have public transportation systems to assist with this issue, but a lot of elderly people do not like the concept of waiting on strangers to take them places or knowing that they have to rely on someone else for their personal needs. The public transit system can also be complicated to the point that they will avoid its services because they don’t understand the process for its services, for example, learning how to buy metro tickets for the subway.

This paper will briefly review the problems associated with older drivers and at what age they should stop driving, the reasons on why older drivers should stop and what alternatives are available and how family support groups feel about older drivers, and what the solutions to the problems are. We will also look at some solutions to the conflict between older drivers not wanting to be regulated and what the government or society does to deal with it.

Cessation and social integration

Mezuk and Rebok (2008) discuss the impact of driving cessation on social integration and perceived support from relatives and friends among older adults. Data collected came from the population-based Baltimore Epidemiologic Catchment Area Study where participants aged 60 and older who had a frequency of interaction and social support from relatives or friends versus those who did not. Former drivers were older, more likely to be female and non-White, had lower education, had lower self-rated health, and had lower cognitive exam scores relative to continuing younger drivers. Over the follow-up period, driving cessation was associated with reduced network of friends and also showed that cessation had little to no impact on friends’ or relatives’ social lives. Social integration was negatively affected by elderly people refraining from driving even among elders who feel competent in using alternative forms of transportation.

Studies show that older drivers who stop driving are gender-based and is related to the widowed female. Most females after a certain age lose their independence and become less eager to keep the independent status and they start to develop the Informal support groups like family or friends which give emotional support. Or they start to form the reciprocal exchange (Keyes, 2002; Krause & Shaw,2000; Morrow-Howell et al., 2001; Kawachi & Berkman 2001; Temkin-Greener et al., 2006: Uchino 2004).

The article on surface transportation policy project. Linda Bailey; “Aging Americans: Stranded without options” (2004) explains on how the demographics will change dramatically in a couple of years as more baby boomers reach their 60s, and 70s and will have a greater need for assisted care of living. The U.S. Census Bureau projects that the number of Americans age 65 or older will increase from 35 million today to more than 62 million by 2025 which is estimated at an 80 percent increase. As people grow older, they often become less able to drive, making it necessary to depend on alternative methods of transportation or on their support system. Fragility

is the most single cause of this increased mortality among older drivers (Li, Braver, and Chen, 2003). Society is currently not prepared to provide adequate transportation choices for the rapidly aging population. Although public transportation is available, it doesn’t take into account the fact that the elderly still need assistance getting to the provided services (Foley, Heimovitz, Guralnik, and Brock, 2002). Alternatives to driving can also be minimal due to the locations, regions in where they live, and limited small town community services. As the number of older people increases, so too will their mobility needs. More than one in five Americans aged 65 and older don’t drive (21%) because of declining health, physical or mental, no access to a car, or just a personal preference. Addressing this issue will have significant social and economic ramifications due to the need for money and the restructuring of many locations.

This issue can increase the awareness in the need for funding in public transportation systems and the need to expand and improve services to meet the needs of older Americans. Increasing funding for existing specialized transportation programs that provide mobility for older persons, such as FTA’s Section 5310 program is one way of improving the situation. Fulfilling the needs of elders by planning transportation projects, services, and improved human service agencies can benefit everyone in the long run.

Social Learning Theory

The awareness of the dangers and safety issues with older drivers has resulted in the development of interventions that provide older drivers with ways to increase driver safety while still allowing them to maintain independence so they can continue to perform activities necessary for daily living. Crash involving older adults has been directly linked to visual processing impairments and decreased reaction time while driving (Johnson & Keltner, 1983; Owsley et al., 1998; Owsley & McGwin, 1999). Many older drivers meet the legal requirements for acquiring a driver’s license in many states despite having some disabilities that increase the chances of motor vehicle accidents. Those who do experience impaired visual capabilities may compromise their driver safety and those around them. The purpose of this article is to describe the process of developing, implementing, and evaluating the efficacy of a theory-based intervention for high-risk older drivers. The goal of this intervention is to promote the practice of self-regulation as a means to reduce crash risk and enhance public safety without restricting the older population the ability to drive. Early intervention is something that needs to be done by agencies and families. One way that can help is renewing their licenses more frequently and require more visual tests from the department of motor vehicles. Families can also intervene to ease the issue with their loved ones before problems develop by speaking with the older drivers when they’re in their late 50s or 60s or when they realize that the family member is no longer safe driving.

This type of proactive approach can benefit everyone. Telling people to stop driving is not enough. We must inform older drivers of the benefits of alternative transportation methods. Paratransit services are designed for people with disabilities who cannot take regular public transportation, these services have vans or mini-buses that pick you up and drop you off at your home. Local communities may offer discounted fares for older adults if they researched they can also find some taxis that are wheelchair-accessible. Private nonprofit organizations operate vans or buses to take people around. Some services are for people with physical or mental disabilities.

About 90 percent of drivers age 65 and older continue to drive. This age group will keep wanting to drive up to their 80s and 90s (Hooyman & Kiyak). Most accidents related to older drivers occur at low speeds but are more likely to be injured more sever because of the declined organ system, brittle bones, and longer duration of healing time. Regardless of the injuries, older adults, especially the ones 70 years and older have longer hospital stays and more health complications. However, they are more likely to avoid driving in bad weather conditions, at night time or during rush hour traffic. Driving routes become established which reduces the chances of vehicle accidents. Almost 4 percent of male drivers age 75 or older have dementia (Foley et al., 2000; Kennard, 2006). Improved road design can alleviate the confusion in older drivers. Road signs that are made to be larger and better lit can also help.

An electronic device can be added to a driver’s ear like a hearing aide which will make a loud noise or something to that effect to keep the driver awake at the wheel. Many car manufacturers are implementing changes to accommodate older drivers with wider rearview mirrors, less complicated instrument panels on cars, and booster cushions for those shorter drivers. Every possible means to keep a person save can be tried but the most effective way is to intervene and talk to the elder driver about not driving at all. Hooyman, N. R., & Kiyak, H. A. (2011). Social Gerontology. A Multidisciplinary Perspective (9th ed.) Boston, MA: Karen Hanson.

Identifying the Solutions

Langford and Koppel (Transportation Research Part F: Psychology and Behaviour; 2006) explain how the problem with older drivers and relation to the involvement in crashes has led to a widespread concern about older driver safety and future road casualty levels. Some people want to regulate the maintenance and tightening of age based mandatory assessment procedures which are seen as an effective control method to the increased statistics of older driver car accidents. The case against age-based assessment is that it has no demonstrable road safety benefits but it does prompt older people to use alternative transportation modes that are less risky than personal vehicles. It was concluded that unsafe drivers can best be identified not through mandatory age-based assessment but through a more strategic approach, relying upon referral.

This article can be argued both ways; it sums it up as the older driver should be forced to stop driving. We have to look at the flexibility of public transportation. Some transportation services require reservations ahead of time, so you must plan ahead and not many elders can do that. Some pick you up and drop you off at a time you choose at an increased price and others have a fixed schedule that cannot be changed or altered. Safety is also a concern; they may feel safer if another person accompanies them on a trip and would have to rely on social support if they had one. Some services cost more than others and most services do not provide senior citizen discounts. If safety and mobility is a concern for some or just can’t go out to get something, they have the option of having it delivered to their home. Many stores will deliver straight to their house. The public can now receive almost any prescribed medication by mail and online use can be a relief for some but they would also need to learn how to use it properly.

Conclusion

Several states are seeking to toughen licensing requirements for older drivers but have been stopped by senior-citizen lobbying groups like the AARP who say age-based measures are discriminatory. They claim that a person’s chronological age is not an accurate predictor of driving ability or disability. The lobbyists argue that if seniors are forced to take extra mandatory road tests without a history of an incident, other age groups should be required to take them as well. (http://www.smartmotorist.com/traffic-and-safety-guideline/older-drivers-elderly-driving-seniors-at-the-wheel.html). Screening could be given to all drivers for whom the age-related decline is suspected and whose performance is viewed as a safety concern for themselves and others.

We want to support their continued independence but we worry about their driving abilities and it’s unfortunate that driving is something that is taken for granted, we don’t have the luxury of being able to drive a car throughout our entire lifetime. Physical disabilities, mental illness, medications, or loss of vision can end anyone’s driving privileges permanently. We rely on cars to get to work, go shopping, or just for leisure. When the elderly lose their driving privileges, the get the feeling of being trapped or perhaps losing the will to choice how they live their lives. To be a safe driver, paying attention to road conditions at all times and being aware of our surroundings and our own bodies is essential.

References

1. Mezuk and Rebok (2008). The Journals of Gerontology Series B: Psychological Sciences and Social Sciences; Social Integration and Social Support Among Older Adults Following Driving Cessation. Retrieved from http://psychsocgerontology.oxfordjournals.org/content/63/5/S298
2. Linda Bailey, Michelle Ernst, Kevin McCarty, and Trinh Nguyen (2004). Surface Transportation Policy Project. Aging Americans: Stranded without options. Retrieved from http://www.transact.org/library/reports_html/seniors/aging.pdf
3. Langford and Koppel; Transportation Research Part F: Psychology and Behaviour; (2006) The Case For and Against Mandatory Age-based Assessment of Older Drivers. Retrieved from http://trid.trb.org/view.aspx?id=793711
4. The Development and Efficacy of a Theory-Based Educational Curriculum to Promote Self-Regulation Among High-Risk Older Drivers. (Beth T. Stalvey, MPH, PhD, CHES; Cynthia Owsley, MSPH, PhD. http://sophe.org/ui/olderDrivers.pdf
5. Hooyman, N. R., & Kiyak, H. A. (2011). Social Gerontology. A Multidisciplinary Perspective (9th ed.) Boston, MA: Karen Hanson.

The World Health Organization (WHO) states that people who enter the course of later life which refers to age 60 and over, will experience the changes in physiological, psychological, and sociological perspectives (World Health Organization, 2011). In a sociological perspective, changing of social networks has been discussed in many of the studies and it’s always an eye-catching topic due to the concerns over the social implications of transitions like retirement, health decline, and bereavement. The term social network refers to the web of social relationships that surround individuals, such as family, friends, organizations, etc (Kelly, et al., 2017). Many research studies suggest that social networks become smaller and denser when people getting older, it also leads to lower rates of social contact, greater loneliness, and even high risk of social withdrawal. However, some of the elderly are also more involved in social networks, such as community activities, volunteering works (Ajrouch, Blandon, & Antonucci, 2005).

Many theories explained what happens to the social networks in an individual’s later life. Some studies explained that due to life-course experiences such as health decline, and bereavement, social network connectedness has to be hampered and the tendencies of maintaining certain types of networks are declining. This explanation also echoes the theory of social disengagement (Cornwell, 2009). Moreover, Socioemotional selectivity theory emphasizes that older adults tend to shift to emotionally rewarding ties (Charles, & Carstensen, 2010). And there are also pieces of evidence that show that aging individuals always partners restrict their social networks to shared contacts through a process of dyadic withdrawal, which leads to smaller social networks (Kalmijn, 2003). However, some of the studies have different views. Studies show that many elderlies want to stay independently, so they establish social connections. For example, retirement causes lesser social connections, but on the other hand, it allows the elderly to have more free time to join social activities, such as voluntary work, thus retirement enhances their social network connectedness (Broese van Groenou & van Tilburg, 2010).

Social network gives rise to various roles in individuals’ later life: social support, companionship, and social control. This article focuses on these 3 roles of social networks in people’s later life.

Social networks provide social support in later life which can be categorized into 4 types;

1. Emotional support refers to provide love, trust, caring, and empathy.
2. Instrument support which involves sustained physical care and services provided to the elderly with declined health conditions or disability.
3. Informational support is referring to giving suggestions, information, and advice when the elderly in need.
4. Appraisal support is providing constructive feedback for the elderly to have correct self-evaluation (Heaney, 1995).

Studies show that social support which provided by the social network is affecting people’s health in their later life (Fratiglioni, Paillard-Borg, & Winblad, 2004). The study showed that people who have been isolated socially compared to those with strong social ties have a two-fold increase in mortality (Fratiglioni, Paillard-Borg, & Winblad, 2004). There are also shreds of evidence that week social tie affects people’s mental health. Those with limited social support have an increased risk of self-harm (Dennis, Wakefield, Molloy, Andrews, & Friedman, 2005), depression (Fiori, Antonucci, & Cortina, 2006), and even cognitive decline (Bennett, Schneider, Tang, Arnold, & Wilson, 2006). In other words, strong social support promotes health and wellbeing. Social support from social networks has been found to be crucial in providing less mortality and improved psychosocial health (Kafetsios & Sideridis, 2006). Due to the increased aging population, more and more people are suffering from chronic disease, and many of the elderly with declined health conditions need consistent physical care from caregivers and the community. Bereavement also comes with aging, many of them require emotional support from social networks. Due to retirement and role transitions, many elderly are facing challenges. thus, social support is playing an important role in their later life. The broad social network is vital in providing social support in promoting the health and wellbeing of the elderly.

Besides social support, the social network also plays a role of companionship in individuals’ later life. Companionship is a type of social involvement in shared activities, and to achieve the intrinsic goal of enjoyment or satisfaction (Rook, & Ituarte, 1999). Moreover, the aim of companionship is different as social support, it’s not about providing aids and problem-solving. Companionship is focused on experiencing pleasure. Studies have shown that companionship promotes psychological well-being, self-expression, social satisfaction, and happiness (Kafetsios, & Sideridis, 2006). With a broad social network, the elderly has been reported to have enhanced the feeling of self-worth, and decreased stress level. Moreover, social networks and companionship provide a meaningful human connection which improves their quality of life. The study has shown that companionship helps senior to combat with loneliness, it also has a significant impact in longer lifespan, promotes faster recovery, and provides peace mind. However, due to the increased aging population and decreased fertility rate, more elderly are stays alone or within a small family structure. Social network from family is limited as their children are busy with work, childcare, or other things. Moreover, due to limited mobility, cognitive decline or other age-related problems, the elderly is tending to be isolated. Therefore, the social network is restricted, and companionship is limited as well. In Singapore, the government had established plenty of the program which is able to reach the elderly who stays at home, such as befriender services. These programs allow the elderly to enter social networks again and have the benefit of companionship.

Social control is another role of social networks in later life. Social control theory emphasizes that social relationships serve as a regulatory function. Individuals who are socially integrated have lesser risk in engaging in deviant and risky behaviors (Ewart, 1991). In managing health behaviors, the elderly who involved in social activities and more social networks should practice more healthy behaviors. It leads to a better health conditions. Generally, social control always operates in two ways: direct social control which involves reminders, requests, threats, punishment ore rewards from social networks (Umberson, 1992); indirect social control refers to feelings of responsibility or obligation to others that prompt people to engage in healthy behaviors. On the other hand, the social network also encourages unhealthy lifestyles (Hawkins, Catalano, & Miller, 1992). Social control in health behaviors helps older adults in preventing or delaying the onset of disease. It also assists them in changing unhealthy lifestyles. However, people in their later life always have smaller, less proximal social networks which will result in a few encouragements of healthy behaviors. (Ajrouch, Antonucci, & Janevic, 2001).

Compared to positive effects of the social networks in later life, negative effects not occur frequently. The study showed that failed support from a social network may cause more distress, poor coping strategies, and even reduced self-esteem. Moreover, misdirected control from social networks will cause the adoption of unhealthy behaviors (Rook, 2015).

However, the characteristics and types of social networks are changing, due to the advancement of the technologies. More and more elderly start uses advanced technologies in their daily life. Social media plays a crucial role in social networks nowadays. It allows friends making more easier, they can make friends from multiple social medial Apps. Older adults are able to connect to the world without going out from home. Even they have limited mobility, mobile phones allow them to talk to others and the use of visual reality helps the elderly to have a new way to experience the world. Social media helps in fostering empathy. Many older adults are not comfortable to share their stories and feelings with people around them, they choose to share it via social media with people who care. What more, social media makes communications faster. Messages or post can be spread to another place or person within seconds, this will promote interaction between individuals. and social media makes the world smaller as well. Compared with a few decades ago, people are easy to connect to people in other places. Rather than that, social media helps in building relationships. People who lost contact may reconnect with each other through social media, such as Facebook, Twitter. It’s also a common platform that people always start their new relationships. However, social media networking also brings negative effects to older people. Due to the wide usage of advanced technology, seniors have been forced to use it. The studies have shown that using social media puts the elderly at a higher risk of depression which results from jealous feelings and lower self-esteem when they tend to compare themselves with others. It may also lead to isolation as seniors will spend less time in in-person interactions (Pantic, 2014).

With the rapid development of technologies, the types and characteristics of social networks are changing as well. However, maintaining a stable and supportive social network still an important element of aging well. Thus, the elderly has to choose a correct and appropriate way of social networking for themselves and benefit from it maximally.

References

1. Ajrouch, K. J., Antonucci, T. C., & Janevic, M. R. (2001). Social Networks Among Blacks and Whites: The Interaction Between Race and Age. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56(2), S112–S118. https://doi.org/10.1093/geronb/56.2.s112
2. Ajrouch, K. J., Blandon, A. Y., & Antonucci, T. C. (2005). Social Networks Among Men and Women: The Effects of Age and Socioeconomic Status. The Journals of Gerontology: Series B, 60(6). DOI: 10.1093/geronb/60.6.s311
3. Bennett, D. A., Schneider, J. A., Tang, Y., Arnold, S. E., & Wilson, R. S. (2006). The effect of social networks on the relation between Alzheimer’s disease pathology and level of cognitive function in old people: a longitudinal cohort study. The Lancet Neurology, 5(5), 406–412. https://doi.org/10.1016/s1474-4422(06)70417-3
4. Broese van Groenou, M., & van Tilburg, T. (2010). Six-year Follow-up on Volunteering in Later Life: A Cohort Comparison in the Netherlands. European Sociological Review, 28(1), 1–11. https://doi.org/10.1093/esr/jcq043
5. Charles, S. T., & Carstensen, L. L. (2010). Social and emotional aging. Annual Review of Psychology, 61, 383–409.
6. Cornwell, B. (2009). Good health and the bridging of structural holes. Social Networks, 31(1), 92–103. DOI: 10.1016/j.socnet.2008.10.005
7. Dennis, M., Wakefield, P., Molloy, C., Andrews, H., & Friedman, T. (2005). Self-harm in older people with depression. British Journal of Psychiatry, 186(6), 538–539. https://doi.org/10.1192/bjp.186.6.538
8. Ewart, C. K. (1991). Social action theory for a public health psychology. American Psychologist, 46(9), 931–946. https://doi.org/10.1037/0003-066x.46.9.931
9. Fiori, K. L., Antonucci, T. C., & Cortina, K. S. (2006). Social Network Typologies and Mental Health Among Older Adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(1), P25–P32. https://doi.org/10.1093/geronb/61.1.p25
10. Fratiglioni, L., Paillard-Borg, S., & Winblad, B. (2004). An active and socially integrated lifestyle in late life might protect against dementia. The Lancet Neurology, 3(6), 343–353. https://doi.org/10.1016/s1474-4422(04)00767-7
11. Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112(1), 64–105. https://doi.org/10.1037//0033-2909.112.1.64
12. Heaney, C. A. (1995). Support networks of older people: A guide for practitioners. Social Science & Medicine, 41(4), 600–601. https://doi.org/10.1016/0277-9536(95)90155-8
13. Kafetsios, K., & Sideridis, G. D. (2006). Attachment, Social Support and Well-being in Young and Older Adults. Journal of Health Psychology, 11(6), 863–875. https://doi.org/10.1177/1359105306069084
14. Kalmijn, M. (2003). Shared friendship networks and the life course: an analysis of survey data on married and cohabiting couples. Social Networks, 25(3), 231–249. https://doi.org/10.1016/s0378-8733(03)00010-8
15. Kelly, M. E., Duff, H., Kelly, S., Power, J. E. M., Brennan, S., Lawlor, B. A., & Loughrey, D. G. (2017). The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Systematic Reviews, 6(1). doi: 10.1186/s13643-017-0632-2
16. Pantic, I. (2014). Online Social Networking and Mental Health. Cyberpsychology, Behavior, and Social Networking, 17(10), 652–657. https://doi.org/10.1089/cyber.2014.0070
17. Rook, K. S., & Ituarte, P. H. G. (1999). Social control, social support, and companionship in older adults’ family relationships and friendships. Personal Relationships, 6(2), 199–211. https://doi.org/10.1111/j.1475-6811.1999.tb00187.x
18. Rook, K. S. (2015). Social Networks in Later Life. Current Directions in Psychological Science, 24(1), 45–51. https://doi.org/10.1177/0963721414551364
19. Umberson, D. (1992). Gender, marital status, and the social control of health behavior. Social Science & Medicine, 34(8), 907–917. https://doi.org/10.1016/0277-9536(92)90259-s
20. World Health Organization. (2011). Global Health and Aging, 2011 (No. 11-7737). Retrieved from https://www.who.int/ageing/publications/global_health.pdf

1. Describe your past work in your proposed specialty, including educational and non-course educational experiences, laboratory research, teaching or other relevant employment, publications, theses, research in progress, or other scholarly activities.

From practicing in the intensive care unit to practicing in a level two trauma emergency department, I have always gravitated towards working with patients requiring acute care resources. As I have worked in this fast-paced environment with this patient population, I have developed a passion to further my knowledge and become a clinical provider trained in utilizing evidence-based research in order to provide high-quality care. Educational and leadership experiences have provided me with insight into the doctorate in the nursing scope of practice and have prepared me to be successful in undertaking graduate study as an Adult-Gerontology Acute Care Nurse Practitioner (AGNP-AC) at the University of Colorado.

My desire to work as an Adult-Gerontology Acute Care Nurse Practitioner (AGNP-AC) was first inspired by non-course educational experiences working in the emergency room. These experiences demonstrated how research-based care decisions coupled with extensive teamwork are the foundation for improved patient outcomes. I have developed an appreciation for doctorate-trained nurse practitioners because I have observed these individuals being boundless in their energy and dedication towards improving clinical outcomes and the quality of healthcare the patient receives.

Not long after obtaining my Trauma Nursing Core Course (TNCC) certification and beginning to work as a trauma nurse, I cared for a patient who was found unconscious with self-inflicted bilateral neck lacerations. As blood sprayed from his arterial neck bleed, the patient’s blood pressure began dropping and emotions ran high in the trauma room. Amidst the chaos, I was impressed by the actions of the Acute Care Nurse Practitioner working on the team. She reflected the American Association of Colleges of Nursing (AACN) element of facilitating collaboration between interprofessional members by calmly ensuring clear communication between various specialties while our team administered blood products, sedated the patient, and prepared the patient for emergency surgery.

This experience was influential in my decision to pursue a clinical doctorate in acute care nursing practice because I observed how having a Doctorate in Nursing Practice trained individual on our trauma team was pivotal in the patient’s survival. Her clinical doctorate training clearly reflected a foundation in evidence-based research as she made clinical decisions while simultaneously facilitating constructive communication between interprofessional team members. With the increasing age of our nation’s population, I have observed a growing need for adult-gerontology trained healthcare providers ready to provide holistic care while addressing the challenge of managing these patients’ complex care. I am passionate about developing, implementing, and managing high-quality individualized care for my patients, which is why I am determined and ready to embrace the challenge of pursuing my vocation as an Adult-Gerontology Acute Care Nurse Practitioner.

Doctorate in advanced nursing practice trained individuals are also influential in developing health policy because clinical doctorate-trained nurse practitioners are prepared to apply new research to their practice and assess the results. While volunteering at a Muscular Dystrophy Camp over the summer, I had the opportunity to assist in implementing new policies regarding infection control at the camp when an outbreak of flu-like symptoms and fever spread. Implementing these policy changes regarding cleaning and sanitation procedures in the cabin was pivotal in preventing additional individuals from becoming ill. As a future adult-gerontology acute care nurse practitioner, I am passionate about developing my leadership skills in order to influence health policy because, through my clinical and volunteer experiences, I have observed how nursing practice policy development can positively influence patient and healthcare outcomes.

Doctorate-trained nurse practitioners are crucial for the improvement of healthcare. As I undertake graduate study, I will develop critical knowledge which will prepare me to provide high-quality individualized care for the adult-gerontology population while I simultaneously work towards influencing health policy. My passion for serving the adult gerontology patient population in an acute care setting coupled with my understanding of the doctorate in nursing scope of practice will make me successful in the Adult-Gerontology Acute Care Nurse Practitioner (AGNP-AC) track at the University of Colorado.

2. Describe your plans for graduate study and a professional career and how this program will contribute to them.

I am pursuing the Adult-Gerontology Acute Care Nurse Practitioner (AGNP-AC) track within the Doctor of Nursing Practice (DNP) degree program. The AGNP-AC track meets my personal and professional goals by providing me with the opportunity to first work as an intensivist in a hospital setting, then pursue specialty training as a trauma provider. The complexity of care involved in stabilizing these patient populations is mentally stimulating and presents a challenge that requires extensive teamwork and research to address.

As a future clinical provider, I understand the value of attending a doctorate program that reflects American Association of Colleges of Nursing (AACN) outcomes such as preparing individuals to critically evaluate how practice is delivered. After being exposed to the increased complexity of patient presentations through my clinical work as a nurse, I have realized that graduate-level nursing education meets my personal goals by providing thorough training in how to improve care delivery both as a clinician and a leader in the healthcare field. Doctorate-level training meets my professional career goals because the additional year of classwork and clinical hours coupled with additional exposure to evidence-based practice allows for time to practice applying evidence-based practice to my clinical work and allows for time to evaluate the outcomes.

The University of Colorado trained individuals I have worked with are conscientious and intentional when caring for patients and developing patient care plans. These individuals are clearly prepared to be leaders in improving care models based on professional standards. While working towards developing care models for patients presenting with chest pain or sepsis, I have noted that this University of Colorado-trained individuals have a firm foundation of knowledge regarding leadership and social justice which they have been trained to incorporate into their practice through their education at the University of Colorado.

The University of Colorado is the right fit for as I pursue my clinical doctorate in advanced nursing practice because of the university’s mission statement and transparent commitment to improving healthcare quality and accessibility with a focus on evaluating research and incorporating research into practice. As an individual compelled to advance community health and wholeness, I am confident that the University of Colorado fits my personal and professional goals.

Introduction

As time goes on, it becomes increasingly clear that there is a strongly defined discursive sounding to just about every gerontological concept/model. That is, the way in which social scientists go about defining the significance of one or another aspect of aging reflects the measure of these people’s affiliation with the currently dominant (hegemonic) socio-cultural discourse. Nowadays, this discourse happened to be associated with the political ideology of Liberalism, which glorifies the values of individualism, self-autonomy, and hedonistic egoism.

These values, however, are inconsistent with the fact that it is namely the systemic subtleties of the society’s functioning (as a whole) that define its overall quality, and not merely the sum of the society members’ individual qualities. In its turn, this explains why, even though many articles concerned with the issues of gerontology do offer a number of valuable insights into the discussed phenomena, they are rather sporadic and somewhat incidental. In my paper, I will explore the validity of this suggestion at length, with respect to four chosen articles from weeks 2-5, while arguing that just about each of them confirms the validity of the systemic (societal) outlook on the process of aging – even despite some of the authors’ initial intention.

Review

The main idea promoted throughout Lamb’s (2014) article is that, for elderly people to be able to lead a socially-productive and enjoyable lifestyle, they need to be encouraged to practice the model of ‘successful aging’, which according to the author reflects the earlier mentioned values. Hence, the model’s foremost principles, “Fight for your independence, maintain physical independence, maintain financial independence, know what you can do to avoid dependency” (p. 45).

According to Lamb, senior citizens must be discouraged from giving too much thought to the socially constructed implications of one’s advanced age. The reason for this is that the author believes this would help older people to strengthen the integrity of their sense of self-identity. As she noted, “Successful aging discourse may be termed ‘permanent personhood’—a vision of the ideal person as not really aging at all in late life, but rather maintaining the self of one’s earlier years” (Lamb, 2014, p. 45).

In its turn, this should help the model’s practitioners to remain the society’s productive members well into senility. Nevertheless, a closer analysis of the concerned suggestion will reveal that it is misleading to an extent. This simply could not otherwise – an older person’s ability to enjoy autonomy/impendence does not necessarily equal to his or her ability to contribute to the society’s well-being, in the factual sense of this word.

Yet, as practice indicates, it is specifically the senior citizens’ sensation of remaining practically ‘useful’ to the society, which makes them happy and content with life more than anything else does. And, the main precondition for old people to be considered socially ‘useful’ is their endowment with wisdom, which they can share with others. Consequently, this presupposes that ‘successful aging’ is about leading a socially-integrated/collectivist rather than highly individualistic/autonomous lifestyle.

In their article, Martinson and Minkler (2006) promote essentially the same idea, while pointing out to the fact that there are both: socio-economic and discursive aspects to the process of aging, which in turn explains the aspiration to remain socially active, on the part of many senior citizens. According to the authors, the manner in which elderly individuals go about trying to fill their lives with meaning reflects the overall quality of socio-economic dynamics within society. As they noted, “The political economy… considers how political and economic contexts and factors such as race, class, and gender interact to help shape and determine the experience of aging and growing old” (Martinson & Minkler, 2006, p. 320).

What it means is that, as time goes on, the potential strategies for elderly people to remain civically engaged are bound to undergo a continual transformation. The reason for this is apparent – these strategies may never cease being circumstantially appropriate. Therefore, the authors aptly conclude that it is utterly wrong to assume that social volunteerism, on the part of senior citizens, has the value of a ‘thing in itself’. Hence, the article’s main idea, “The growing movement to institutionalize volunteering and civic engagement among older Americans must be approached with thoughtfulness and a critical eye” (Martinson & Minkler, 2006, p. 322).

This, in turn, implies the inappropriateness of the practice of turning old people’s civic engagement into a fetish – something commonly done in the West. The authors need to be given credit for having voiced this suggestion, although rather implicitly.

With respect to how it discusses the significance of aging, the article by Twigg (2007) is somewhat similar to the above-mentioned one. According to the author, even though there are no fashions meant to appeal exclusively to old people, there are nevertheless a number of clearly identifiable trends in how senior citizens go about shopping for clothes. For example, the author noted that “Older people’s clothes… (are) longer and to some degree more shapeless than those of young adults” (Twigg, 2007, p. 293).

Older individuals also prefer non-catchy/subtle colors. Twigg refers to this as yet another indication of the fact that, despite their advanced age, senior citizens perceive the surrounding reality and their place in it from the strongly defined societal perspective. After all, it is specifically the society that prescribes these individuals to dress age-appropriately – once they cease to be sexually reproductive, there is no need for them to try to appeal to the representatives of the opposite gender by wearing colorful/body-revealing clothes. If they still do, however, society ends up ostracizing them.

This is indeed a rather insightful observation, on the author’s part, which helps us to gain a better understanding of an old person’s socially engaged behavior. The article’s main drawback is that it contains a few unsupported assumptions, such as the one concerned with the idea that, as time goes on; older people will be coerced to conform to the ways of the society to an even lesser degree.

The validity of the initial thesis can be also illustrated, in regard to Borovoy and Hine’s (2008) article, in which both authors aimed to tackle the phenomenon of elderly Russian Jewish émigrés being the most difficult/non-compliant patients in the nursing-care settings. As the authors noted, “Russian émigré patients have gained the reputation of being especially difficult, ‘noncompliant’ patients, particularly in the area of diabetes management” (p. 5).

Borovoy and Hine refer to the issue as being of the essentially socio-economic nature. According to the authors, having been born in the USSR, these individuals used to be discouraged from practicing self-discipline, which is individualistic (Western) virtue. Even though this point of view is thoroughly legitimate, it nevertheless does not take into account the possibility that the issue at stake is much deeper. Because of the specifics of their cultural affiliation, which implies that they have been brought up in the highly collectivist environment, Russian émigré patients are naturally predisposed to think that the purpose of medical therapies is to heal rather than to simply eliminate/suppress unpleasant symptoms in a person.

There is, however, nothing irrational about the mentioned tendency, on these people’s part – the fact that they are considered ‘difficult patients’ suggests that the very biomedical (Western) paradigm of healthcare is not quite as methodologically appropriate, as its proponents would like everybody to believe. In turn, this can be explained by the fact that the biomedical model of healthcare continues to be based on the assumption that the patient’s behavior is primarily defined by the individualist/egoist anxieties in him or her. Yet, as the example of Russian émigré patients indicates, this is not always the case.

Conclusion

I believe that the provided review/criticism of all four articles does correlate perfectly well with the initial thesis that the process of aging is best discussed in societal/collectivist rather than in strictly individualistic/libertarian terms. It is understood, of course, that neither of the reviewed articles promotes such an idea explicitly. Nevertheless, the reading of these articles will leave only a few doubts about the fact that the process in question cannot be discussed outside of the strongly defined social context. Therefore, when it comes to designing social policies, with respect to elderly people, social scientists/politicians must be willing to treat the former as a thoroughly tangible social asset.

References

Borovoy, A. & Hine, J. (2008). Managing the unmanageable: elderly Russian Jewish émigrés and the biomedical culture of diabetes care. Medical Anthropology Quarterly, 22(1): 1-26. Web.

Lamb, S. (2014). Permanent personhood or meaningful decline? Toward a critical anthropology of successful aging. Journal of Aging Studies, 29, 41-52. Web.

Martinson, M. & Minkler, M. (2006). Civic engagement and older adults: A critical perspective. The Gerontologist, 46(3), 318-24. Web.

Twigg, J. (2007). Clothing, age and the body: A critical review. Aging and Society, 27, 285-305. Web.

Role

The person interviewed for the paper is employed at a local nursing facility and works as a Clinic Nurse Manager. For confidentiality purposes, the interviewee is referred to as Alison. Alison has a Registered Nurse qualification and the corresponding level of competency. In the identified facility, Alison coordinates administrative activities. Particularly, she supervises the work of the employees, including FPNs and ANPs. Alison views the role of an Advanced Practice Nurse (APRN) as that one of a nurse and an educator. In other words, raising awareness among the target audience about essential health concerns is an important part of an APRN’s duties (Quill and Abernethy 1174).

Scope

The interviewee seems to have a rather good concept of the differences in the competencies and roles of an APRN, an FPN, and an ACNP. For instance, Alison makes it quite clear that an APRN should be considered primarily with addressing the availability of information to the patients, whereas the FPN should research family history and help family members build stronger ties, and an ACNP must address the emerging issues threatening the patients in the ICU (Goldman and Schafer 651).

Experience

The experience that Alison has is truly priceless, as it sheds light on not only the clinical concerns but also the communication dilemmas that nurses often have to address, along with managerial issues. For instance, the interviewee brought up the subject of successful communication between the nurses as the platform for creating a framework for continuous improvement in quality.

Indeed, there is evidence that the lack of appropriate tools for information acquisition and transfer triggers numerous misunderstandings and misconceptions including the threat of misinterpreting or omitting an essential part of the patient’s health record or personal information. Therefore, it is imperative to introduce the tools that will help store the patient’s information, retrieve and, and transfer it successfully (Cowen and Moorehead 290).

Additionally, the significance of emotional intelligence (EI) has risen among the nurses operating in the ICU environment. Seeing that the conditions of an emergency room (ER) require a quick and efficient response, an ACNP must be able to identify the problems that the patient faces in a manner as timely and efficient as possible. At this point, EI becomes a primary tool in locating the sources for concern and addressing them correspondingly (Bloomer et al. 758).

Procedures

The credentialing model employed at the facility follows the standard requirements. The education records together with the certificate and a license are viewed as a necessity. Additionally, the employment history and the clinical references of the candidate are considered very closely. The evidence for liability insurance is also required, as well as the proof of being a member of professional nursing organizations.

Furthermore, the analysis of the evidence of the candidate’s practice is also considered a part and parcel of the certification process. Although skill performance and the related records are not viewed as a crucial part of the model and are not necessarily reviewed in the course of the cementation, the provision thereof is a welcome addition to the pieces of evidence proving the person’s competency levels (Dahlin and Ferrel 60).

Number of APRNs

Since the facility is rather small, the number of staff members working in it is quite humble. At present, there are 47 APRNs employed. The facility also has a rather high employee turnover rate, which is partially due to the intense workload.

Number of FNPs

At present, the facility employs 27 FNP. However, according to the interviewee, the number of nurses employed in the facility changes regularly due to the high workplace burnout and employee turnover rates. Therefore, there are clear indications that the identified nursing environment requires better management, as Alison explains.

Reporting

The process of reporting used at the organization is rather simple. The reports summarize the essential outcomes of the therapies and interventions provided to the patients. After the essential information has been arranged in the required manner, it is submitted electronically to the Service Director following the company’s policies. Thus, the data is processed adequately, and the implications for further actions are identified.

Hospital Practices vs. the Board of Nursing Statements

The current framework of managing the work of APRNs, FNPs, and ACNPs aligns with the National Council of State Boards of Nursing (NCSBN). For instance, the significance of focusing on the individual needs of each patient and promoting successful communication between nurses are considered crucial elements of the NCSBN policies (National Council of State Boards of Nursing par. 4).

Implications for Improvements

Although the facility members have created an up-to-date environment, in which patients feel comfortable, there are certain issues to be addressed. For instance, the workload of the nursing staff needs reconsideration. Unless proper measures are introduced, an increase in workplace burnouts is expected. Therefore, a sustainable strategy must be incorporated into the company’s financial strategy so that the number of staff members could be increased.

Works Cited

Bloomer, Melissa J, Ruth Endacott, Margaret O’Connor and Wendy Cross. “The ‘Dis-Ease’ of Dying: Challenges in Nursing Care of the Dying in the Acute Hospital Setting.” A qualitative observational study. Palliative Medicine 27.8 (2013), 757-764. Print.

Cowen, Patrick S., and Sue Moorehead. Current Issues in Nursing. Elsevier Health Sciences, 2014. Print.

Dahlin, Constance, and Betty P. Ferrel, Advanced Practice Palliative Nursing. Oxford: OUP, 2016. Print.

Goldman, Lee, and Andrew I. Schafer. Goldman-Cecil Medicine. New York, NY: Elsevier Health Sciences, 2015. Print.

National Council of State Boards of Nursing. Standards development. 2016.

Quill, Timothy E., and Amy p. Abernethy. “Generalist Plus Specialist Palliative Care – Creating a More Sustainable Model.” The New England Journal of Medicine 368.13 (2013): 1173-1175. Print.

Introduction

The Gerontological Society of America (GSA) is an organization, which aims to research and ensure the health and wellness of aging among American older adults. It is an outstanding institution that can serve as a benchmark for integrating multiple fields of science alongside nursing and medical procedures. The GSA’s mission statement is to strive to be a linking point of research, education, and practice of gerontology by acting as a platform for connecting the relevant professionals in the common goal.

Knowledge promotion

The Gerontological Society of America was built to become a catalyzer of innovations and advancements in aging. It was founded in 1945, and the given institution includes members from more than 50 countries around the world (The Gerontology Society of America, 2019). By operating both domestically and internationally, the GSA expands its reach for scientific minds and top educators globally. Its main purpose is to promote aging education, training, and multidisciplinary research by disseminating the current knowledge to scientists, nurses, and practitioners (Phillips et al., 2015). Therefore, the Gerontological Society of America is a driving force behind aging-related progress in various fields.

Multidisciplinary approach

Furthermore, the GSA promotes gerontology studies among every scholarly and scientific discipline. They include not only physicians, biologists, nurses, and behavioral scientists, but also policymakers, social workers, and humanities professionals. By combining and introducing the interdisciplinary approach, the GSA makes sure that all contributions are utilized in increasing the level of health wellness in the aging process. It is important to note that the Gerontological Society of America is one of the largest and oldest institutions (Carter, Solberg, & Solberg, 2017). It aims to push the progress forward in aging by not only advancing extensive research but also by educating about the findings and integrating them into practice. All of these features of the GSA make it an excellent professional and career center for many gerontology enthusiasts and specialists.

Dissemination

The Gerontological Society of America organizes and conducts Annual Scientific Meeting by inviting 4000 experts from all over the globe. In addition, the given event can be attended by additional 5500 members of the organization, which ensures that the discoveries and scientific knowledge can be accessed and discussed (The Gerontology Society of America, 2019). The GSA also acts as a publication platform in order to disseminate the current data and information on gerontological advancements to professionals, who are not members of the given institution. It serves as a transitional promoter from publications to practice and policy, which ensures that the innovation and scientific discoveries are put to good use in both nursing and legislation (The Gerontology Society of America, 2019). The transfer of knowledge is done by the extensive education process, which involves various training and lectures. By creating a platform for educators to teach other experts about the current state of gerontology, the GSA directly spreads the results of numerous publications in a highly effective manner.

In conclusion, the Gerontological Society of America is one of the biggest organizations that acts as a unifying platform for education, practice, and research with the purpose of increasing wellness and health in the aging process. It operates both globally and locally, which expands the reach of professionals from all over the world. The GSA also applies a multidisciplinary approach, because it allows providing a smooth transfer of knowledge from publications to policies and practical implications. The Gerontological Society of America conducts an annual meeting in order to gather international experts to present the newest innovations in gerontology and discuss its future integrative use.

References

Carter, C. S., Solberg, L. B., & Solberg, L. M. (2017). Applying theories of adult learning in developing online programs in gerontology. Journal of Adult and Continuing Education, 23(2), 197–205.

The Gerontology Society of America. (2019). Purposes and Mission. Web.

Phillips, L. R., Salem, B. E., Jeffers, K. S., Kim, H., Ruiz, M. E., Salem, N., & Woods, D. L. (2015). Developing and proposing the ethno-cultural gerontological nursing model. Journal of Transcultural Nursing, 26(2), 118-128.