Nurses skilled in geriatric care make a difference every day in the health and lives of older adults—in hospitals, clinics, long-term care facilities, and patients’ homes. They administer therapies and medications, monitor and assess symptoms, educate patients and their families, ensure safety, and provide comfort and support—all directed toward the needs of older adults. Illness, whether acute or chronic, may be experienced quite differently in older age than earlier in life (see profiles of Dr. Hilaire Thompson and Dr. Corrine Jurgens).
To describe this expertise in action, consider Alice, an older adult whose story represents common clinical issues and mistakes in the health care system. Alice’s situation is not unusual. She was confused and disoriented when her daughter brought her to the local hospital clinic. The student nurse who first evaluated the 81-year-old observed that she believed it was 1955, and she was demanding to see her husband. Alice’s daughter explained that her father died six months ago. The nurse reported to her supervisor that Alice appeared to be suffering from dementia. After learning from Alice’s daughter that the mental confusion had come on suddenly, the supervisor—a geriatric nurse practitioner—conducted a more thorough assessment.
The nurse practitioner’s evaluation revealed that Alice suffered from several chronic illnesses, including diabetes, arthritis, and osteoporosis. More than 80 percent of adults over age 65 have at least one chronic health problem.1,2 Alice was also taking several medications, which can sometimes be a source of acute health problems, especially if the drugs are taken improperly. Even when taken as directed, medication use in older adults must be closely monitored since older adults metabolize drugs differently than younger people. They may need a smaller dose, should take them for a shorter period of time, or avoid certain drugs altogether. Some common pain killers and sleep medications can cause delirium and confusion in older people.
The nurse also reviewed psychological issues. A possible explanation for Alice’s confusion may have been mourning over the loss of her husband. But the geriatrically prepared nurse practitioner suspected that the cause of Alice’s symptoms might be a urinary tract infection. A simple test confirmed her suspicion. The major symptom of a urinary tract infection in a young adult is often pain. An older adult, however, may experience little or no pain. Instead, there may be an abrupt change in mental status.
Older adults are not simply older versions of young adults. This nurse had the specialized geriatric education needed to properly assess Alice and to pinpoint the treatable cause of her problem. Without this, Alice would have received substandard care. She may have been subjected to unnecessary tests, possibly hospitalized, or even admitted unnecessarily to a long-term care facility. This nurse also took the opportunity to discuss Alice’s chronic health conditions to make sure they were adequately managed and that she and her daughter understood her medications and how to take them.
Older adults have unique and often complex needs related to the physiological, psychological, cultural, and social factors involved in aging. In addition to having a higher prevalence of chronic illnesses, older adults are more vulnerable to injury (e.g., falls) and acute illnesses (e.g., influenza or pneumonia). They also tend to have more physical limitations (see profile of Dr. Sarah Szanton). In 2007 (the most recent year for which data are available), 42 percent of people age 65 and over reported a functional limitation.3 Fourteen percent had difficulty performing one or more instrumental daily activities, such as using the telephone, housework, meal preparation, shopping, or managing money. Approximately 25 percent had difficulty with at least one activity of daily living, such as bathing, dressing, eating, getting in and out of chairs, walking, or using the toilet.“Gerontological nurses apply a body of specialized knowledge and skills to provide nursing care that meets the unique needs of the diverse population of older adults and promotes healthy aging,” says Patricia Archbold, DNSc, RN, Director, Building Academic Geriatric Nursing Capacity (BAGNC) Initiative. “Skilled gerontological nurses are able to detect problems early and initiate care that often prevents more serious conditions or minimizes their effects,” she adds. They have the skills to work with older adults to reduce a variety of risks that can be detrimental to health and well-being.
The benefits of highly skilled geriatric nursing have been documented. Evidence shows that older adults cared for by geriatric nurse practitioners and clinical nurse specialists are less likely to experience delirium as a by-product of hospitalization, be in pain, or be readmitted to the hospital from home or from a nursing home. The presence of a nurse practitioner in nursing homes has been shown to reduce the number of hospital admissions and to result in residents having fewer pressure ulcers and a lower incidence of incontinence.4,5,6
Older adults can present complex challenges in every health care setting. Nurses are the health care professionals with the most frequent direct contact with patients. Their ability to be effective in caring for older adults depends on obtaining a high-quality education in geriatrics, having knowledge of the most up-to-date nursing practices, and having the support of the health care system and society to make quality care of older adults a priority.
1. MedPAC (Medicare Payment Advisory Commission). Report to the Congress: Increasing the Value of Medicare. Washington, DC: MedPAC. 2006.
2. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine. 2002. Vo. 162, Number 20, pp. 2269-2276.
3. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010: Key Indicators of Well-Being. Washington, DC: U.S. Government Printing Office. July 2010.
4. Kane RL, Garrard JG, Skay CL, et al. Effects of a geriatric nurse practitioner on process and outcome of nursing home care. Am J Public Health. 1989. Vo. 79, Number 9, pp. 1271-1277.
5. Ryden MB, Snyder M, Gross CR, et al. Value-added outcomes: the use of advanced practice nurses in long-term care facilities. Gerontologist. 2000. Vo. 40, Number 6, pp. 654-662.
6. Krichbaum K, Pearson V, Savik K, Mueller C. Improving resident outcomes with GAPN organization level interventions. Western Journal of Nursing Research. 2005. Vo. 27, Number 3, pp. 322-337.