This paper will detail the origins of geriatric nursing from early in the twentieth century until the 1980’s. The first calls for care of the chronically ill elderly came before World War I in connection with conditions in almshouses. The 1920’s through the 1940’s saw scant progress in nursing’s concern for treatment of the aged. With the publication of the first textbook devoted to geriatric nursing in 1950, the pace began to quicken. A decade later the nation seemed to have awakened to the plight of the elderly as the growing civil rights movement contributed to a concern for all Americans to be treated fairly. The federal government and the health community at large led the way to advances in nursing care. Increased activism in the 1970’s augmented the previous gains, culminating with important structural developments in educational opportunities for specialized nursing training during the mid 1980’s Generally home to the poorest, the nineteenth century asylum, forerunner to the twentieth century hospital and nursing home, housed various categories of society’s unwanted. The insane, prostitutes, syphilitics, tubercular patients, orphans and the chronically ill elderly were all grouped together. The early part of the century saw development of separate facilities, such as sanitaria, orphanages and the insane asylum, for most of these categories. Gradually the percentage of elderly increased, from 50% early in the century to 2/3 by 1920 (Schell, 1993). While substantial numbers of the elderly lived out their years in private charitable old-age homes, “these institutions provided custodial rather than medical care” (Schell, p.205) for the largely well elderly, mostly providing for their social and psychological needs. According to Irene Burnside the earliest call for geriatrics as a nursing specialty was an article entitled “Care of the Aged” (1925) in the American Journal of Nursing [AJN].It was not definitively answered for almost 40 years (Burnside, 1988, p.52). Prominent among the voices for change in nursing care for the aged was Lavinia Dock, a nurse and a contributing editor of AJN, a leading feminist and socialist. Along with leading women’s organizations Dock wanted to institute nursing training in the almshouse. As one leading women’s figure stated, “ the great variety of chronic cases- the cases in which the hospital training school is most deficient –will constitute a post-graduate opportunity of great value” (Crane, 1907, p.880). But ultimately political and social factors negated their cries for improvement. Most almshouses were run by local or state authorities who had a vested financial interest in keeping costs (and ultimately care) at a minimum. Women in general and nursing within the broader medical community lacked the political power to effect change (Schell, 1993). The exuberance of the 1920’s showed little concern for the chronically ill elderly and beginning in 1929 the nation was preoccupied with surviving the Depression. The steady criticism and exposure of the almshouse’s shortcomings in the 1920’s and 1930’s gradually led, not to reform, but to closure. Between the early 1930’s and 1950’s its numbers declined by almost 50% from a high of 135,000 to 72,000. (Schell, 1993) State and local authorities could not shoulder the financial cost of reform during the Depression and World War II. Additionally, the Social Security Act of 1935, in an effort to encourage more community-based solutions, forbade residents of public institutions from receiving benefits .While meaning to foster independence and a return to home and families, the government’s policy failed to take into account the needs and care offered by an institution (Schell). Many elderly moved to the rapidly increasing number of nursing homes while others were transferred to different types of facilities such as the mentally ill and senile to mental hospitals. By the end of the Second World War several factors led to the dramatic expansion in...
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