Barton and Mulley (2003) define gerontology as the study of the biological, social, psychological and spiritual aspects of the aging process. It is the science of aging and the effects of time on human development, specifically aging, and gerontology is the
preferred term for the study of normal agmg. The authors noted that although gerontological nursing has taken several centuries to become acknowledged as a separate nursing specialty, generally its rise should be understood within the context of the emergence and development of the nursing profession. Geriatrics is the branch of medicine that focuses on health promotion, and the prevention and treatment of disease and disability in later life. According to Barton and Mulley (2003), the term originated from the Greek word geron which describes an old man and iatros which describes a healer; the term was proposed in 1909 by Dr. Ignatz Leo Nascher. It describes the area of study related to diseases of the elderly (Barton and Mulley).
The history of gerontological nursmg m South Africa was lacking in the literature.
However, according to Barton and Mulley (2003), sick people were cared for in monasteries in medieval times, and some religious orders built hospital wings where the elderly and infirm patients received better food and received special care. Later, convents adopted a nursing role. In the United Kingdom, Barton and Mulley (2003) noted that the Mother of Geriatrics is Dr. Marjorie Warren, who emphasized that rehabilitation was essential to the care of older people. Using her experience as a physician in a London Workhouse infirmary, she advocated that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care and support. She found that some of the patients who had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment. The practice of geriatrics in the UK is also one with a rich history of multidisciplinary working, valuing all the professions and not just medicine, for their contribution in optimizing the well-being and
Another hero of British Geriatrics is Bernard Isaacs, who described incontinence, immobility, impaired intellect and physical instability as "giants" of geriatrics (Cannon, Choi & Zuniga, 2006). Isaacs asserted that all common problems with older people relate back to one of these giants.
Gerontology as a field of study was notable in Europe prior to North America. According to Steffle (1984), it began as an inquiry into the characteristics of long-lived people. In North America, gerontological nursing began its rise with the acknowledgment of this new nursing specialty by the American Nurses Association in 1962 and the formation of the National Gerontological Nursing Association in 1984. In Canada, the Canadian Nurses Association recognized the Canadian Gerontological Nursing Association as a specialty in 1985. Other nursing specialty organizations developed in Australia and Great Britain. In contrast to the continued use of the term geriatric, the term gerontological nursing came into use in the early 1980s to reflect the provision of care and the treatment of the whole person, as opposed to care of disease in a medical setting only. The assessment of the health needs of older adults, the planning and implementing of health care to meet those needs, and the evaluation of the effectiveness of such care are critical activities in assisting older adults to optimize their functional abilities. Such assessment helps maximize independence and promote well-being among the elderly, prime directive for gerontological nurses. A more recent term, gerontic nursing, refmes the sphere of responsibility of gerontological nurses who care for the elderly by encompassing the art and intuition of caring and maintaining the well elderly, as well as emphasizing illness and scientific principles of care (Steffle, 1984).
Cannon, Choi and Zunig (2006) cautioned that gerontological nurses must have the knowledge and skill to manage care focused on normal and abnormal age-related physical changes, such as musculoskeletal, sensory and neurological alterations. Age- related psychosocial and spiritual changes, which include developmental, intellectual capacity, learning and memory losses also feature. Gerontological nurses must be educated concerning care strategies about wide-ranging basic and complex physiological and behavioral issues such as pain, pressure ulcers, cognitive impairment, lowered self- esteem, bereavement, fluid and electrolyte imbalance and caregiver stress, among other issues. Gerontological nurses must also have expertise in navigating the health care system to act as advocates for their clients (Cannon, Choi & Zuniga, 2006).
2.11 The Older Person's Act of South Africa
Like the rest of the world, the population of South Africa is ageing. Along with the ageing of population, there are changes taking place that are leaving many families less able to care for their frail relatives at home. In the face of these changes, ideally many of the elderly could be residents of nursing homes where health workers provide care.
Sustaining a growing older population is institutions are the responsibility of the government, as well as the private sector, families and the individuals themselves. The Older Persons Act (Act No. l3 of 2006) is a framework that set a new standard for the care of the elderly in communities as well as institutions. This new legislation was developed in 2006 by the Department of Social Development to repeal The Aged Persons
1998) and The Older Person's Bill (August 13, 2003). These pieces of legislation, however, fail to meet the Constitutional demands that all South Africans, including older persons, shall realize human rights and its fundamental freedoms to the fullest extent possible (South African Council of Churches, 2003). Thus, the Older Persons Act was developed to fill in the gap.
The goal of the new Older Persons Act (Act No. 13 of 2006) is to deal effectively with the plight of the elderly by establishing a framework aimed at the empowerment and protection of older persons and at the promotion and maintenance of their status, rights, well-being, safety and security; and to provide for related matters. The Act is an expression of the government's effort to redress the effects of inequity in social and human development planned by successive apartheid regimes. It is an indication of the government's further commitment to redress these inequities and to uphold the Constitutional values of respect, dignity and well being of all, especially of the vulnerable, marginalized and older persons. Chapter One of the Act outlines its objectives its implementation, application as well as its general principles. The chapter also recognizes the skills and wisdom of older persons in the community, as well as in institutions and shifts the emphasis from institutional care to community-based care. The acknowledgements ensure that the older person stays in hislher home in the community for as long as possible and feasible.
Chapter two speaks about creating an enabling and supportive environment for older persons. The focus is on the development of norms and standard for quality service delivery and the enforcement of punitive measures for deviation for the norm. It
emphasizes that the services to the elderly should be provided in an environment that recognizes the cultural, social and economic contributions of older persons; promotes communication networking between nongovernmental organizations (NGOs) and other structures in the community; and ensures access to information through educating and training of the elderly as well as preventing them from exploitation.
Chapter three speaks about the possibility of providing community-based care and support services for the elderly who wish to remain in the community for as long as possible, and the legislation that ensures the community based care and support services are provided. The community-based programs for the elderly should fall into two broad categories:
1). Prevention and promotion programs that ensure independent living for the elderly in the community; the programs should be aimed at ensuring that the elderly are economically and socially empowered. It further ensures that older persons have access to information, education and counseling especially in HIV / AIDS.
2). Horne-based care that ensures the frail older person receives maximum care within the community through a comprehensive range of integrated services. These services should include horne based care information; education on how to take care of the older person;
and counseling for family members; care givers and the community regarding ageing and associated conditions. The chapter further emphasizes the importance of registration of
community based care services and training of caregivers as well as the registration of professionals with relevant statutory bodies to ensure protection of older persons.
The focus of chapter four is on residential or institutional facilities. It emphasizes that the homes have to be registered, and should meet certain requirements as stipulated by the norms and standards. In addition, it stipulates that older persons in residential facilities enjoy the rights in the Older Persons Bill. The Bill also stipulates that the elderly have the rights to appoint representatives to act on their behalf; have reasonable access to assistance and visitation; keep and use personal possessions, be informed about the financial status of the residential facility; and changes in management and be given at least 30 days notice of a proposed transfer or discharge. It emphasizes the need for a 24- hour care and support services to frail older persons and those who need special attention.
All residential facilities have to have residents committees especially if more than 10 older persons reside in such a facility.
The legislation made provision on the admission clause to protect older persons. The following clause is critical to prevent forceful admission and minimizing the dumping of older persons in residential facilities. On the other hand however, no older person should be refused admission to the residential facility. If so, the manager of that facility has to do it in writing giving the reasons for non admission. It also made provision for monitoring of registered residential facilities by the State Social Worker or any person designated by the Director-General. The legislation, however, promotes the multi-disciplinary approach in monitoring of residential facilities. It further emphasizes that the operator of a registered residential facility (nursing home) must within 60 days after the end of the
financial year of that facility submit to the Minister a report covering that financial year in respect of prescribed service standards. The communication should also include details on measures to prevent and combat abuse of older persons and the provision of the prescribed service level agreements concluded during that financial year.
The focus of chapter five is on protection of older persons in both the community and the residential facilities. It firstly describes an older person in need of care. It further stresses that all people have a duty to report elder abuse including community members. The procedure for bringing complaints of abuse against an older person in the community before the magistrate are discussed at length in the legislation also the enquiry into abuse of older person. It further requires the Department of Social Development to keep a register of persons convicted of abuse or any crime pertaining to older persons. A person whose name appears in the register is prohibited to operate a residential facility or be employed at any residential facility or provide any community -based care and support service to an older person. Chapter Six provides for the delegation of powers. The Minister has the right to delegate powers to any officer of the Department.
The Department is hereby commended for developing such legislation that seeks to assign the process of care and protection of the older person within the community and institutions. However, there seems to be areas that the Act does not address. For example, in terms of a national norm and standards of practice as stipulated in Chapter One, there appears to be no national norm available at the moment. In Chapter Four the Act is quiet about the type and standard of services that should be provided for the elderly in nursing
homes, and it does not specify what the homes should be monitored for, just to mention a few. Thus, the Act needs to be strengthened through research in order to be effective.