Foundations of Gerontological Nursing Practice: Aging Theories, Demographics, Ethics, and Law
What the exam tests here
Foundations items reward knowing why older adults differ, not memorizing a single theory. Biological theories - free-radical/oxidative stress, mitochondrial decline, the Hayflick limit and telomere shortening, cross-linking, immunosenescence, neuroendocrine and programmed-aging models - are complementary, so an item asking for 'the' cause of aging is a distractor. Psychosocial theories: disengagement (Cumming & Henry) is descriptive, not a prescription for withdrawing care; activity and continuity theory (Atchley) better match how most people age; Erikson's final task is ego integrity versus despair; selective optimization with compensation (Baltes) explains how an older adult narrows goals, practices what matters, and compensates with devices or help.
Demographics: the 85-plus group is the fastest-growing segment; women predominate at advanced ages and are more likely to live alone; minority elders face higher rates of poverty and chronic illness. Expect items on compression of morbidity and on the young-old versus old-old distinction.
Ethics: autonomy, beneficence, nonmaleficence, justice, veracity, fidelity. Autonomy is not forfeited with age - it hinges on decisional capacity: understanding information, appreciating consequences, reasoning, and communicating a choice. Capacity is decision-specific and may be intact for one choice and not another. Guardianship is a court action and a last resort; advance directives and a health care proxy are preferred.
Law and regulation: OBRA 1987 nursing home reform (resident rights, MDS, restraint limits), the Elder Justice Act, state mandatory abuse-reporting laws, HIPAA, and the state nurse practice act defining your scope.
Trap: ageism in item stems - attributing delirium, incontinence, or depression to 'normal aging,' or treating a capable older adult's refusal as incompetence. Rule of thumb: assess capacity, educate, explore the reason for refusal, document, and honor the decision of a capable adult.