Individualize care and prevent morbidity and mortality associated with the use of physical and chemical restraints in older adults. 11. Prevent or reduce common risk factors that contribute to functional decline, impaired quality of life, and excess disability in older adults. 12. Establish and follow standards of care to recognize and report elder mistreatment. 13. Apply evidence-based standards to screen, immunize, and promote healthy activities in older adults. 14. Recognize and manage geriatric syndromes common to older adults. 15. Recognize the complex interaction of acute and chronic co-morbid conditions common to older adults. 16. Use technology to enhance older adults’ function, independence, and safety. 17. Facilitate communication as older adults transition across and between home, hospital, and nursing home, with a particular focus on the use of technology. 18. Assist older adults, families, and caregivers to understand and balance “everyday” autonomy and safety decisions. 19. Apply ethical and legal principles to the complex issues that arise in care of older adults. 20. Appreciate the influence of attitudes, roles, language, culture, race, religion, gender, and lifestyle on how families and assistive personnel provide long-term care to older adults. 21. Evaluate differing international models of geriatric care. 22. Analyze the impact of an aging society on the health care system. 23. Evaluate the influence of payer systems on access, availability, and affordability of health care for older adults. 24. Contrast the opportunities and constraints of a supportive living arrangement on the function and independence of older adults and on their families. 25. Recognize the benefits of interdisciplinary team participation in care of older adults. 26. Evaluate the utility of complementary and integrative health care practices on health promotion and symptom management for older adults. 27. Facilitate older adults’ active participation in all aspects of their own health care. Continuum of Care 15 (continues) 55805_CH01_0001_0025.qxd 2/19/09 1:01 PM Page 15 16 Chapter 1: Introduction to Gerontological Nursing seen in the hospital, 80% of home care patients, and 90% of those in nursing homes (Mezey, 2005). A few of these settings will be discussed here. Some additional unique areas of employment are suggested in Chapter 23. Because of the nature of the aging process, it is likely that older adults will enter and exit the health care system at many different points throughout old age. Figure 1-1 presents the web of health care that often occurs when older adults enter the system due to illness or accident. Settings of care can be described and titled in a variety of ways. Following is a brief description of some of the most common settings of care, employing commonly used nomenclature. Acute Care Hospital The acute care hospital is often the point of entry into the health care system for older adults. Nurses working in hospitals are likely to care for older adults even if they do not specialize in geriatrics, because about half of all patients in this setting are 65 years of age or older. In this setting, gerontological nurses focus on nursing care of acute problems, often involving exacerbations of cardiopulmonary conditions, cancer treatment, and orthopedic problems. All nursing units (with the exception of labor and delivery, postpartum, and pediatrics) in acute care hospitals admit older adults, so nurses may encounter elderly patients in critical care or rehabilitative services or anywhere in between. The goal of inpatient care will be to promote recovery and prevent complications. Acute Rehabilitation Rehabilitation may be found in various degrees in several settings, including the acute care hospital, TABLE 1-3 AACN Essentials (1998) Core Competencies Critical thinking Communication Assessment Technical skills Core Knowledge Health promotion, risk reduction, and disease prevention Illness and disease management Information and health care technologies Ethics Human diversity Global health care Health care systems and policy Role Development Provider of care Designer/manager/coordinator of care Member of a profession SOURCE: American Association of