13 Gerontological and Long-Term Care

Assess the person and establish a baseline

Older adults are not a uniform group. Assess each person's usual abilities, health conditions, preferences, culture, and support system instead of making assumptions based on age. A new or sudden change in function or mental status should be reported and assessed rather than dismissed as normal aging.

Establish a baseline and compare current findings with it. Assess physical status, including pain, vital signs, breathing, mobility, skin, nutrition, hydration, elimination, sleep, and sensory needs. Also assess cognition and mood, including orientation, memory, communication, behavior, and signs of depression or distress.

Assess ability to perform Activities of daily living (ADLs), such as bathing, dressing, eating, toileting, and transferring. Also consider Instrumental activities, such as shopping, cooking, and managing medicines. Assess safety and support by asking about fall history, hazards in the home or room, medication use, caregiver capacity, access to food and transportation, and social connection.

Speak directly to the older adult, allow time for responses, use glasses or hearing aids as needed, and explain care in clear language. Involve family or caregivers with the person's permission, and respect the person's right to make decisions. Written instructions and Teach-back—asking the person to explain the plan in their own words—can show when more teaching is needed.

Manage chronic illness and medication safety

Chronic conditions may affect energy, mobility, mood, independence, and ability to follow a treatment plan. Coordinate care with the interdisciplinary team and help the person set realistic, meaningful goals. Reinforce prescribed self-management, follow-up appointments, nutrition and activity guidance, and when to report worsening symptoms. Tailor the plan to the person's routine and resources.

Older adults may use several prescriptions, over-the-counter medicines, and supplements. Perform Medication reconciliation at transitions of care by reviewing the complete medication list, and report discrepancies, suspected adverse effects, or difficulty taking medicines. Observe for changes such as dizziness, sedation, confusion, or weakness that may raise safety concerns. Do not start, stop, or change a medication without an authorized order.

For example, a resident who becomes unusually drowsy and unsteady after a medication change needs prompt assessment and notification of the nurse or prescriber—not simply a reminder to walk more carefully.

Support rehabilitation and safe mobility

Rehabilitation aims to restore, maintain, or improve abilities needed for daily life. Goals should be specific to the person, such as transferring from bed to chair with less assistance or dressing independently. Physical therapists address strength, balance, mobility, and fitness; occupational therapists work on daily activities and adaptive strategies; speech-language therapists may address communication or swallowing.

Nurses support the plan by encouraging participation, using prescribed mobility aids, following transfer instructions, allowing time for the person to do what they can, and reporting pain, fatigue, or changes in ability.

Promote safety without unnecessarily restricting activity. Reduce fall risks by keeping pathways clear, ensuring appropriate footwear and lighting, placing needed items within reach, and using prescribed assistive devices. Follow the individual care plan for transfers and supervision. Report falls and assess for injury according to facility policy, even when injury is not obvious.

Coordinate long-term care and transitions

Long-term care may be provided at home, in assisted living, or in a nursing facility, depending on the person's needs and available support. Maintain privacy, choice, routines, and independence wherever possible.

Prevent complications of limited mobility through appropriate repositioning, skin observation, movement, hydration, and nutrition according to the care plan. During handoffs and transitions, clearly communicate current function, medications, allergies, risks, and follow-up needs.

Provide palliative and end-of-life support

Palliative care focuses on comfort, symptom relief, and quality of life for people with serious illness; it may be provided alongside treatment intended to control or cure disease. Hospice is a form of palliative care for people approaching the end of life.

Care should reflect the person's goals and documented wishes. Advance directives may describe preferences and name a health care proxy for times when the person cannot communicate. Follow applicable orders and facility procedures, and refer questions about interpretation or changes to the appropriate clinician.

At the end of life, assess and report pain, breathing difficulty, agitation, nausea, skin discomfort, and other signs of distress. Provide ordered comfort measures, gentle personal care, mouth and skin care, privacy, and a calm presence. Support emotional, cultural, and spiritual preferences. Explain changes compassionately, preserve dignity, and include family or chosen support people as the patient wishes. Notify the care team when symptoms are not controlled or needs change.

Support caregivers

Caregivers may experience fatigue, stress, isolation, and financial or physical strain. Ask how they are managing, listen without judgment, and identify what support they need. With consent, include caregivers in teaching and care planning, and confirm that they understand safe techniques and whom to contact with concerns.

Encourage shared responsibilities, community resources, support groups, and Respite care. Caregivers also need to attend to their own health and seek help when overwhelmed.

Respond to changes with sound clinical judgment

When a change occurs, compare it with the person's baseline, assess immediate safety and relevant symptoms, and follow the care plan and scope of practice. Report urgent or unexpected changes promptly. Document objective findings, actions, and the person's response.

New confusion, sudden weakness, difficulty breathing, or an injury after a fall calls for prompt assessment and escalation—not an assumption that the change is simply due to age. Effective gerontological care is individualized and team-based: support self-management and medication safety, promote rehabilitation and safe mobility, honor end-of-life wishes, and include caregivers while recognizing their need for support.