Gerontological nursing has a rich history of more than 100 years, with the first article on gerontological nursing reportedly published in the American Journal of Nursing in 1904 and written by Bishop, who was a physician. The first specialty textbook appeared in 1950 (Newton, 1950) and the first nursing research article about older adults appeared in the inaugural issue of the journal Nursing Research (Mack, 1952). From these beginnings, interest in older adults and their special nursing needs grew, leading to a significant body of gerontological nursing research, multiple journals dedicated to the topic, and a cadre of nursing scientists prepared to improve the health of older adults (Burggraf & Barry, 1998; Grady, 2011).
In the Midwest, gerontological nursing research has had a strong presence, due in part to the Midwest Nursing Research Society (MNRS; Hershberger et al., 2017). The organization was formed and had its first meeting in 1977. The MNRS initiated research interest groups (RIGs) for various nursing specialities in 1981, with group meetings at annual conferences, including one focused on aging. The current authors, as members of the MNRS and the Gerontological Nursing RIG, were curious about the progress and changes in nursing science in the specialty area of gerontology. One author (P.G.) had explored progress in gerontological nursing research in the 1990s and presented this research to the RIG members. The other author (H.W.L.) presented a brief update in April 2017 on progress in this area, as the MNRS celebrated its 40th anniversary conference in Minneapolis, Minnesota. However, a systematic review of changes in gerontological nursing research over the decades had not been conducted. Through examination of abstracts of the MNRS presentations, the current article presents a formal analysis of gerontological nursing research in the Midwest over the past 40 years.
The current project was conducted using content analysis of abstracts of presentations at the MNRS annual conferences at 10-year increments from 1977 to 2017. Abstracts from 1977, 1987, 1997, 2007, and 2017 were retrieved from the MNRS archives at the Midwest Nursing History Research Center at the University of Illinois, Chicago, as they are not published as proceedings. Authors also had online access to abstracts from the most recent meeting. Abstracts were reviewed to identify presentations related to gerontological nursing. Only abstracts specifying gerontological nursing, populations age ≥65, or nursing home residents were included. Data were extracted from the abstracts, including the purpose, design, sample, topic, theory, and focus (issue or disease), into a matrix by year. Two members of the research team reviewed each abstract and the data extracted for validity, and came to a consensus on details if there were discrepancies. The following findings address the contents of abstracts for 1977, 1987, 1997, 2007, and 2017.
Researchers did not find any abstracts related to gerontological nursing from the first MNRS conference in 1977, which had just 10 abstracts. In 1987, 25 (10%) of 246 abstracts related to gerontological nursing or older adults. In 1997, 72 (14%) abstracts were about gerontological nursing; in 2007, there were 57 (9%) relevant abstracts; and in 2017, there were 56 (10%) relevant abstracts. The abstracts represented all presentation types, including symposia, oral presentations, posters, and poster discussions. Authors were junior and senior researchers and students. Studies covered many topics, included a diversity of designs, and represented all levels of evidence. The current article provides a summary of various characteristics of the studies reported in these abstracts and trends identified from analysis.
The gerontological nursing research abstracts for the MNRS conference addressed studies on an extensive range of health and illness topics (Table 1). Common chronic diseases such as heart disease and cancer, as well as geriatric conditions (e.g., dementia, delirium, incontinence, falls) had strong representation among abstracts across all years. However, in later years, abstracts increasingly focused on older populations with specific conditions. These conditions were most often chronic, such as Parkinson's disease or arthritis. Along with studies that focused on chronic conditions, studies that addressed symptoms (e.g., pain, fatigue) and treatments, including medications, were more prevalent in later years. End-of-life issues, such as advance directives, also were an increasing interest.
Topics and Settings of Gerontological Nursing Abstracts
Health, health promotion, and quality of life among older adults were topics strongly represented in abstracts throughout the years. Abstracts addressed studies on nutrition, screening behavior, and prevention in older adults. Numerous abstracts described their outcomes as related to general well-being or quality of life. Trends indicated a growing focus on exercise and physical activity, including exercise interventions such as tai chi.
Psychosocial issues ranged from family issues to retirement, volunteering, and widowhood. As a subset, caregiver research was strongly represented in abstracts, especially in the latter decades, comprising 12% of gerontological nursing relevant abstracts. Caregiving was often related to dementia, but caregiving for individuals with conditions such as stroke and heart failure was also studied. Mental health–related issues also were addressed regularly, especially depression, but also anxiety, substance abuse, and spirituality. Recent abstracts were more likely to address a variety of populations, including minority, marginalized, or vulnerable populations. These topics mirror the increasing interest of researchers in population health, health disparities, and social determinants of health.
Some other topics are worth noting, although they were found in only a few abstracts. Only two studies on genetics or biomarkers were noted, one in each of the past 2 decades. Similarly, only a few studies used animal models or physiological variables. Technology was increasingly used in intervention studies (e.g., fitness trackers) or for collecting study data (e.g., monitoring systems).
The gerontological nursing research abstracts spanned all settings where older adults live and receive care, including acute care, the community, home health, and nursing homes. The largest percentage, representing approximately one fourth of all studies (23%), was studies conducted in long-term care settings, with 19 abstracts in 1997. These settings included assisted living facilities, which were increasingly studied in later years, reflecting the growing population of older adults. The number of studies on transitions in care also increased, as did the number of abstracts focused on rural older adults.
A few abstracts were from studies focused on gerontological nursing and gerontology rather than older adults themselves. Several studies included perceptions or education of nurses and other health care professionals related to care of older adults, although only two studies addressed undergraduate education. Nurses' perceptions, education, and practices were studied. Institutional approaches to improve care of older adults, such as evaluation of the use of patient care protocols/policies/systems and training approaches, were noted in several abstracts.
Research designs of abstracts were categorized as descriptive, experimental, qualitative, quality improvement, and other (Table 2). Percentages of the design categories were calculated based on the total number of studies that included the design in the abstract. In 1987, 18 (72%) of 25 studies used a descriptive design. The percentage of descriptive studies was lower in the next 3 decades (47%, 56%, 38%, respectively), as other designs became more common.
Theory and Research Designs of Gerontological Nursing Abstracts
The number of abstracts reporting studies that used quasi-experimental or experimental designs was relatively consistent over the 4 decades, ranging from a high of 20% in 1987 to a low of 14% in 2017. Within the category of studies using quasi-experimental or experimental designs, a total of 14 abstracts were from randomized controlled trials (RCTs), with only one abstract in 1987 from a RCT and two in 1997. The number of abstracts reporting on RCTs was highest in 2007, with fewer quasi-experimental designs in 2017.
Although there was only one abstract in 1987 about a qualitative study, there were many in other years. Numbers of abstracts with a qualitative design were similar for 1997 (15%), 2007 (19%), and 2017 (18%). A variety of specific qualitative methods were used over the years, including focus groups, grounded theory, and phenomenology, although a specific method was not always noted in the abstract. One qualitative approach, content or thematic analysis, was the most frequently cited in the abstracts, and especially common in 2017 (60% of qualitative studies).
Some differences in the distribution of other types of designs over the years were noted. As the percentage of abstracts from studies using descriptive designs decreased, other designs increased and some new types of studies were reported. As noted above, qualitative content/thematic analysis increased to 11% of studies in 2017, compared to ≤4% for other years. A few mixed methods studies were noted in the last three sets of abstracts, as well as measurement studies. Studies in four abstracts used a quality improvement design in 2017, representing 7% of that year's studies, with the first abstract reporting a quality improvement design noted in 2007. Synthesis projects such as integrative reviews were also first noted in 2007, and there were six abstracts with this design in 2017, although only one abstract reported a meta-analysis study in 1997 related to older adults.
Theories and/or frameworks of abstracts were reviewed (Table 2). First, it is important to note that in each year reviewed, many abstracts did not specify a theory or framework. Nine (36%) of 25 studies in 1987 did not have a theory or framework. The number of abstracts without a theory or framework climbed to 54% (39 of 72 studies) in 1997, 65% (37 of 57 studies) in 2007, and 41% (23 of 56 studies) in 2017.
Nursing grand theories were noted in abstracts all years, but decreased as a percentage from 16% (four of 25 studies) in 1987 to ≤6% for the following years. Use of middle-range theories increased, although the focus varied over the years. Two recurrent theory categories were noted in several abstracts: stress and coping and health behavior theory. The use of stress/coping theories guiding studies was greater in 1987 and 1997 compared with 2007 and 2017. The highest percentage of abstracts of studies that used health behavior theories was 16% in both 1987 and 2017. In 2017, 38% of studies used a middle-range theory other than a stress/coping or health behavior theory. This percent was highest compared to the other years examined (32% in 1987, 18% in 1997, and 14% in 2007).
Gerontological nursing research is alive and well in the Midwest. The sample of abstracts reviewed represents interest among nurse researchers in improving the health and quality of life of older adults over time. Approximately 10% of all abstracts presented at the MNRS annual conference from 1987 to 2017 were related to older adults. The field of gerontological nursing research is strong, which may be due to a number of passionate nurses, support from national organizations, increased educational initiatives, and funding opportunities (Touhy, 2018). The trends among the reviewed abstracts indicated topics, theories, and designs that reflect trends in geriatrics, gerontological nursing, and nursing research across time. The conceptual and methodological advances in nursing science are reflected in the current sample.
Nursing research has progressed in sophistication and breadth. As the abstracts reviewed represent all levels of researchers—from students to senior scientists—a wide range of study types and designs were expected. Researchers found increasing diversity in the types of studies reported in these abstracts, as well as in the topics, theories, and populations. Most studies addressed clinical problems. All types of research are needed to support evidence-based practice (Melnyk & Finout-Overholt, 2015) and improve care of older adults. Research and practice build on descriptive and qualitative studies that improve understanding of older adults' experiences. Experimental studies build evidence for innovative interventions (Polit & Beck, 2015) to address the many challenging problems older adults may experience.
There was increasing diversity of topics, approaches, and theories used, suggesting that gerontological nurse researchers were informed by the growth in nursing research, training opportunities, and interprofessional collaborations. The use of theory moved from grand theories or frameworks in nursing to the use of more specific middle-range theories. This change is not surprising, as this is a general trend in nursing theory (Im & Chang, 2012). Although specific theory was not addressed in a significant number of abstracts, suggesting a lack of conceptual depth (Polit & Beck, 2015), most abstracts included some rationale for the study.
An example of change is evidenced in the growth in abstracts on implementation science or quality improvement projects across time. The MNRS began including presentations from Doctor of Nursing Practice students as these programs developed, and accepted abstracts on quality improvement projects from members. In addition, literature reviews or synthesis projects were increasingly presented, and one study represented a meta-analysis. Another example of change is technology, which increasingly affects all parts of individuals' lives and has become more common in research, as evidenced by more abstracts noting aspects of technology.
Issues in long-term care settings related to long-term care residents and their quality of care have long been an interest of gerontological nurses, hence the strong representation in the reviewed years, representing 23.3% of abstracts. However, some studies were conducted in every type of setting in which one might find older adults. Researchers saw changes that pointed to health care trends, such as a focus on transitions in care and assisted living settings.
Researchers were surprised that there were not abstracts related to nursing education in 2017, although there were some training projects, and two abstracts related to nursing education in 2007. Numerous sessions at the 2017 conference focused on nursing education but were not related to gerontological nursing. Some trends in research topics noted at other gerontological conferences or in the literature, such as precision health; pragmatic trials; lesbian, gay, bisexual, and transgender populations; older adults with intellectual disabilities; and interprofessional education, were not the focus of the reviewed abstracts, but may have been presented in other years or with other age groups.
Two key factors may be in part responsible for the strong gerontological nursing research in the Midwest and increasing sophistication of programs of research. First is the very existence of the MNRS, which has fostered leadership, mentoring, and collaboration of nurse researchers in the Midwest, as well as provided grant funding to help nurse researchers get started. The Gerontological Nursing Science RIG meetings at each annual conference promote connections and networking. In addition, the John A. Hartford Foundation supported growth of gerontological nursing research through training opportunities for scholars, as well as pre- and post-doctoral funding. In 1999, the Hartford Institute for Geriatric Nursing Summer Scholars program focused on researchers from the Midwest, promoting further connections in the region. Centers of Geriatric Nursing Excellence at the University of Iowa and University of Minnesota further increased opportunities for training in gerontological nursing and research (Edelstein, Cheung, Voss, & Kaas, 2011; Maas, Conn, Buckwalter, Herr, & Tripp-Reimer, 2009). The current authors benefited from some of these opportunities.
The current analysis is limited, as abstracts from the MNRS meetings were sampled for only 1 year per decade, and no gerontology abstracts were found in the first year. Researchers also may have overlooked gerontological nursing topics or abstracts from these years, as they had access only to the information provided in the abstracts, and details might have been missing, such as age of the sample. In addition, guidelines for writing abstracts have changed over the years, such as recent direction to include either a theory or framework or rationale for the study. However, overall, researchers found many trends that were similar to changes in gerontological nursing and research in general during this time frame. Researchers present just a glimpse of how this change was represented by nursing research presented at the MNRS conference. This process could be replicated by researchers in other regional societies or who are interested in other research topics.
Throughout the authors' careers, there has been a call for nurses with gerontological interest and training and more research on this area (Fulmer & Mezey, 2002; Gueldner et al., 1995). The authors have firsthand clinical experiences of older adults' challenges that affect their health. In addition, the authors have heard the continued reminder of the coming aging tsunami of older adults who will likely need evidence-based nursing care (Gueldner et al., 1995). The authors are happy to see continued research related to gerontological nursing through the current analysis. Gerontological nursing research has impacted practice, policy, and regulations, as noted by Ebersole and Touhy (2006) and Fulmer and Mezey (2002), with even more examples evident in the reviewed abstracts. However, the authors recognize the existence of many problems, including shortages of faculty and paucity of funding and interest in gerontological nursing research. Despite the challenges, the authors are hopeful for future work to improve care for this growing population of older adults.
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Topics and Settings of Gerontological Nursing Abstracts
|1987 (N = 25)||1997 (N = 72)||2007 (N = 57)||2017 (N = 56)|
| Dementia/delirium/cognition||3 (12)||7 (10)||11 (19)||15 (27)|
| Heart/lung||1 (4)||7 (10)||9 (16)||3 (5)|
| Urinary incontinence||2 (8)||4 (6)||2 (4)||1 (2)|
| Pressure ulcers (injuries)||1 (4)||3 (4)||0 (0)||1 (2)|
| Other chronic disease||2 (8)||5 (7)||6 (11)||11 (20)|
| Symptoms||2 (8)||7 (10)||9 (16)||10 (18)|
| Medications||0 (0)||1 (1)||0 (0)||3 (5)|
| End of life/advance directives||1 (4)||2 (3)||2 (4)||5 (9)|
| Frailty/falls/functional decline||1 (4)||5 (7)||2 (4)||5 (9)|
| Health promoting behaviors (e.g., nutrition, screening)||5 (20)||10 (14)||4 (7)||3 (5)|
| Exercise/physical activity||1 (4)||3 (4)||6 (11)||8 (14)|
| Quality of life/well-being||1 (4)||5 (7)||6 (11)||8 (14)|
| Vulnerable/minority/immigrant populations||1 (4)||3 (4)||3 (5)||6 (11)|
| Uses of technology||0 (0)||0 (0)||4 (7)||4 (7)|
| Genetics/biomarkers||0 (0)||0 (0)||1 (2)||1 (2)|
| Nurses/health professionals/institutional issues||3 (12)||8 (11)||4 (7)||4 (7)|
| Nursing education||1 (4)||1 (1)||2 (4)||0 (0)|
| Family/social/network||5 (20)||5 (7)||8 (14)||3 (5)|
| Roles (e.g., retired, widow, volunteer)||3 (12)||2 (3)||1 (2)||0 (0)|
| Caregiving||4 (16)||8 (11)||7 (12)||7 (13)|
| Mental health||3 (12)||7 (10)||5 (9)||7 (13)|
| Depression||1 (4)||4 (6)||3 (5)||5 (9)|
| Long-term care/assisted living||8 (32)||19 (26)||9 (16)||13 (23)|
| Home/community-dwelling||2 (8)||8 (11)||11 (19)||7 (13)|
| Transitions in care settings||1 (4)||0 (0)||6 (11)||3 (5)|
| Acute care||4 (16)||3 (4)||3 (5)||5 (9)|
| Rural||0 (0)||2 (3)||1 (2)||2 (4)|
Theory and Research Designs of Gerontological Nursing Abstracts
|1987 (N = 25)||1997 (N = 72)||2007 (N = 57)||2017 (N = 56)|
| Not addressed||9 (36)||39 (54)||37 (65)||23 (41)|
| Nursing grand theories (e.g., theories by Orem, Levine, Roy, Newman, Leininger, Kolcaba, Peplau)||4 (16)||4 (6)||1 (2)||3 (5)|
| Stress/coping theories (e.g., theories by Lazarus, Folkman, Perlin; Family Management Theory; Resiliency Model of Family Stress)||4 (16)||5 (7)||6 (11)||1 (2)|
| Health Behavior Theory (e.g., Health Belief Model, Transtheoretical Model)||4 (16)||7 (10)||4 (7)||9 (16)|
| Other middle-range theories (e.g., theory by Strauss and Corbin; Need Driven Dementia-Compromised Behavior Model)||8 (32)||13 (18)||8 (14)||21 (38)|
| General/miscellaneous theories (e.g., theories on quality of life, quality of care)||1 (4)||3 (4)||2 (4)||2 (4)|
| Descriptive||18 (72)||34 (47)||32 (56)||21 (38)|
| Survey||0 (0)||3 (9)||0 (0)||3 (14)|
| Longitudinal||0 (0)||3 (9)||4 (13)||2 (10)|
| Secondary analysis||0 (0)||4 (12)||2 (6)||5 (24)|
| Case-control study||0 (0)||1 (3)||0 (0)||0 (0)|
| Experimental||5 (20)||11 (15)||10 (18)||8 (14)|
| Quasi-experimental||4 (80)||9 (82)||7 (70)||4 (50)|
| Randomized controlled trial||1 (20)||2 (18)||7 (70)||4 (50)|
| Quality improvement||0 (0)||0 (0)||1 (2)||4 (7)|
| Qualitative (any)b||2 (8)||11 (15)||11 (19)||10 (18)|
| Grounded theory||1 (50)||0 (0)||1 (9)||1 (10)|
| Interpretive/phenomenology||0 (0)||3 (27)||1 (9)||2 (20)|
| Content analysis/thematic analysis||0 (0)||3 (27)||1 (9)||6 (60)|
| Focus groups||0 (0)||2 (18)||1 (9)||0 (0)|
| Multiple qualitative methods/ethnography||0 (0)||2 (18)||1 (9)||0 (0)|
| Measurement||0 (0)||4 (6)||4 (7)||2 (4)|
| Mixed methods||0 (0)||2 (3)||1 (2)||2 (4)|
| Animal study||0 (0)||1 (1)||1 (2)||0 (0)|
| Physiological variable||3 (12)||3 (4)||1 (2)||1 (2)|
| Pilot study||1 (4)||6 (8)||4 (7)||5 (9)|
| Meta-analysis||0 (0)||1 (1)||0 (0)||0 (0)|
| Narrative review/synthesis||0 (0)||0 (0)||1 (2)||6 (11)|