Ask a group of first semester nursing students if they intend to care for older adults and the number of hands raised will be small. Unfortunately, too many students manifest "older patient avoidance syndrome". This is marked by ageist attitudes, a fear of old persons and a stated preference to work in pediatrics, labor, delivery, ICU or ED.
This syndrome is not unique to nurses as many health professions students, including medical students, manifest it too. It does show a gap between our societal culture and the reality of our health care practice environments.
How did attitudes and expectations become so disconnected from the reality of nursing practice? What underlies this bizarre syndrome? Over one third of all hospitalized patients are older adults. If you adjust hospitalization rates to remove maternal and child hospitalization, the number of older adults in hospitals climbs dramatically. The research on health care utilization over the last few years, suggest that persons over the age of 65:
- Use one half of all hospital days.
- Use approximately one quarter of all ambulatory visits.
- Account for 70% of home care visits.
- Represent some 85% of patients institutionalize in skilled and LTC facilities (wwww.Consultgerirn.org).
As the population of older adults expands, the need for more geriatric savvy nurses and health care professionals will increase as well. The diversity of older adults will present new challenges as well calling for ethno-geriatric savvy nurses. There are few settings in health care where the impact of the aging imperative will not be felt.
Nursing programs in the US and many other countries are hard at work trying to prepare nursing students by providing geriatric education. AACN geriatric competencies offer direction for educators. Generous support of foundations such as the Hartford Foundation has infused education, research and practice. Resources such as the “try this series” offer open access or free high quality evidence based resources for nurses.
Despite the heavy focus on integrating geriatric competencies in nursing, the results offer a mixed picture. The gains in practice in practice are slow to materialize. Research studies on attitudinal changes show mixed results. Students feel unprepared for the complexity of older patients, many who present with multiple co-morbid conditions. First experiences with patients with dementia and delirium imprint students with fearful and negative attitudes about geriatric nursing. A second concern is the common statement by nursing students that they “fail to see knowledge and skills learned routinely use in practice”.
Faced with an avalanche of aging patients and at risk for an epidemic of “geriatric avoidance syndrome”, there is a need for prevention. Basic primary prevention comes in the form of highly competent nurses, providing sensitive, respectful and quality of care for older adults. This is perhaps one of the most significant forces in the prevention and treatment of this nursing syndrome. As nursing students and novice nurses confront the complexity of older adults:
- Share with them the excitement and interesting aspects of care.
- Share with them the value of learning the stories of each patient.
- Help students and novice nurses learn how to balance the workload and manage their stress - remind them that it gets easier over time as they gain in skill.
- Embrace the knowledge and skills that students and novice nurses may bring with them. These may prove helpful to improve your care and the outcomes for patients.
The reality of caring for older adults does not have to result in an exacerbation in the “older patient avoidance syndrome”. Positive and supportive nursing staff provides a powerful inoculation. And remember, someday one of the students or novice nurses may be the provider of care for you or your family. Quality geriatric nursing is more than a curricular change but needs to be supported and sustained one nurse at time and nurse to nurse.
AACN. Geriatric Nursing Competencies retrievable at: AACN geriatric competencies or http://www.aacn.nche.edu/education-resources/competencies-older-adults
The Harford Institute for Nursing provides a clearinghouse for resources
- Check out the free “Try This” with protocols and assessment tools on more than 25 different geriatric nursing topics at www.consultgerirn.com
- Check out the resources and hospital nursing competencies
- Check out the most recent additions for Critical Care nurses and other specialty groups on the consultgerirn site
Do a reality check on your attitudes using tools adapted from Palamore or other tools such as this at “facts on aging tool retrieved from the University of Missouri at Kansas City: http://cas.umkc.edu/AgingStudies/AgingFactsQuiz.asp
Or Woolf at http://www.webster.edu/~woolflm/myth.html
About the author: Dr. Wolf is associate professor at Samuel Merritt University in Oakland California. She has practiced as a community health nurse and adult nurse practitioner; and has served as a nurse educator for more than 25 years. Formerly Associate Director of the Program in Nursing at the MGH Institute in Boston, Dr. Wolf also served as nurse practitioner and director of health & wellness for the Cambridge Health Alliance Senior Health Center. She has lectured and published widely on professional issues and nursing history, aging and health policy.