Advances in health care for the elderly has led to an increased life expectancy and have resulted in a larger aging population. As this group continues to grow, more nurses will be needed to provide ongoing care. Many healthcare providers prefer to specialize in areas with younger or more physically able patients. This “older patient avoidance syndrome”, including ageist attitudes, a fear of old persons, and a preference to work with other age groups, may be disconnected from the reality of both current and future patient populations. Not only is there a shortage of healthcare providers who are interested in caring for the elderly, the overall healthcare workforce is inadequately trained to care for older adults.
According to theInstitute of Medicine 2008 report entitled “Retooling for an Aging America: Building the Health Care Workforce”,the number of older adults in the U. S. will almost double between the years of 2005 and 2030, when the 78 – million member baby boom generation will turn 65. This group will then comprise almost 20% of the U. S. population.
Currently, more than three-quarters of adults over the age of 65 suffer from at least one chronic medical condition that requires ongoing care and management. Older adults rely on health care services far more than any other group, accounting for: one-half of all hospital days, approximately one-quarter of all ambulatory visits, 70% of home care visits, and about 85% of all patients residing in skilled and long-term care facilities.
Implications for Nursing Practice
This increasing number of older adults has huge implications for acute and critical care settings. A 2000 study by the American Association of Critical Care Nurses (AACN) showed that 70% of nurses responding did not identify geriatrics as a part of their practice, equating care of the elderly with the non-acutely ill or with long-term care. Accordingly, the AACN has increased efforts to promote geriatric education, increase geriatric competencies, and encourage geriatric nursing research.
Yet, quality geriatric nursing care is much more than curriculum-based knowledge. Elderly patients are not just “old adults”; they have age-specific needs that require competent nurses providing sensitive, respectful quality care. Many present with multiple co-morbid conditions which may be exacerbated by the confusion and anxiety of hospitalization. This group will also be the most diverse population ever, having more education, increased longevity, widely dispersed families, and more racial and ethnic diversity than previous generations.
By focusing on the management of chronic medical conditions the nurse can help improve the patient’s quality of life. In learning to manage their own health, patients can retain more independence and possibly lessen the need for medical treatment. The nurse can also assist family members, friends, and others to receive the knowledge and skills they need to provide care to the patient, helping to alleviate their stress.
Care of Patients with Dementia
As life expectancy increases, greater numbers of older adults are experiencing the onset of Alzheimer’s disease and other dementias. The care of these patients can be challenging and difficult to manage without an understanding of the disease process. Dementia is defined as the decline of the cognitive function of the mind, and eventually results in the deterioration of both mental and physical status. It is vitally important to ensure a safe environment for these patients, while treating them with respect and helping them to maintain their dignity.
These patients should be allowed to complete tasks for themselves, such as activities of daily living (bathing, eating, toileting, brushing teeth and hair) as long as safely possible. As many patients tend to be fixed and repetitive in their thoughts and actions, a schedule of specific medication times, mealtimes, bath time, and bedtime are often more calming. A quiet environment with soothing colors and lighting may also help decrease the anxiety and confusion common to the hospitalized patient with dementia.
Hydration and nutrition are also important factors in the care of this patient. Dementia, especially when advanced, may cause the patient to forget when or even how to eat and drink, possibly leading to further health complications. The nurse should be especially sensitive to the patient’s nutritional status, and offer small servings of favorite snacks and drinks when possible.
It may be difficult to communicate with the patient who has dementia. They may have difficulty expressing thoughts and following instructions. Simple words and phrases should be used and the use of facial expressions and body signals may be helpful. If the patient becomes angry or confused, redirection to another topic in a calm, yet firm, manner may help to ensure their safety.
As the elderly population of the U. S. grows, it will face a healthcare system that is currently too small and unprepared to meet its needs. There is a critical need for more nurses who are competent in the care of the elderly to both provide care, and guide and educate other healthcare workers. Expanding nursing school curricula to include courses in geriatrics and gerontology, and providing specialized training to nurses currently in the workforce will help prepare them to provide optimal care to this growing patient population.