By Nelah Di'Addezio
How Nurses can Best Care for the “Booming” Generation of Geriatric Patients
A close relative of mine has had her share of struggles living alone the past 8 years since the passing of her husband at the age of 67. Losing a spouse is extremely difficult emotionally. For her it has also been a challenge physically.
A few years after the passing of her husband, she tore her meniscus and needed surgery. This injury was believed to be a result of performing tasks within the home that she once relied on her husband to perform. This was followed with a fall one Christmas Eve on uneven pavement leading to surgical repair of a hip fracture and time spent in the hospital and rehabilitation center for the remainder of the holidays and beyond. Since this event, it has been hard for her to go up and down stairs, walk long distances on flat surfaces, and maintain balance on uneven terrain. A little less than a year after her hip repair, she needed another surgery for removal of a spur on her heel bone that was attached to her Achilles tendon.
Of these three surgeries, the third one stood out to me the most because of the lack of continuity of care. The surgery was performed in an outpatient setting and required detachment of the tendon, removal of the bone spur, and reattachment of the tendon to the heel bone. A week prior to surgery, she was told by a nurse that she would go home in a cast and use crutches to ambulate. Crutches were not a viable option for her. How could the nurse not see that? Was a baseline assessment of her activity level not performed? My relative asked how she would go up the few steps she had to enter her home. The nurse replied that she should hop up the steps on her good foot. She came home discouraged and left to figure out a way to make this work before she had her surgery. After a few calls she began to formulate a plan. A neighbor had a movable ramp that fit on her steps leading to her house. Her church had a wheelchair she could borrow for transportation from the car to the doctor’s office for follow-up visits. She asked a nurse if there were options other than crutches and found out a knee scooter could be used to remain non-weight bearing on her affected leg during recovery. She made arrangements for her kids to stay with her for the first few days and transport her to and from her surgery and follow-up appointments.
When day of surgery arrived and she was discharged to home, she thought she had made all the necessary arrangements for recovery. However, she soon realized that performing activities of daily living (ADLs) with a knee scooter was a big challenge. A call was made to the surgeon’s office to request homecare. Apologies were made by the staff for not arranging this beforehand, and homecare was set up. Unfortunately, she needed to wait a couple days for the initial homecare evaluation. Homecare educated her on how to perform ADLs with a knee scooter and provided physical therapy to prevent decline in her activity level. Thanks to homecare, she was able to adjust to the knee scooter in the first week after surgery.
My relative’s story is a picture of the complexity of caring for the older adult patient. Her challenges included living alone and her functional status due to past surgical history. There is not a “one size fits all” care plan for the geriatric patient; attention needs to be given to the unique issues each patient faces.
Caring for a geriatric patient requires awareness of the diverse needs of this population and competency in assisting the transition to home. This is a vulnerable population due to their various health needs. Older Americans are living longer but are not living healthier with poor diets and sedentary lifestyles. They often have more than 1 chronic illness. In addition, this patient group may be moved from unit to unit 3 to 6 times during their hospital stay and 21% are discharged to long-term care or another facility. These patients will see an average of 10 different physicians during the course of the hospital stay and possible transfer to another facility. These transitions affect continuity of care and put the older adult patient at risk for medication errors, falls, and missed or delayed treatments. Even a simple hospitalization is overwhelming for a geriatric patient and can lead to new complications.
As the baby boomer generation moves into the older adult patient group (the U.S. Census Bureau classifies baby boomers as those born between 1946 and 1964 with the oldest of this generation turning 65 in 2011), there are things to consider when caring for this new generation of geriatric patients. Baby boomers have more education compared to the preceding generation and will want to be more involved in the decision-making of their care. They are more knowledgeable and desiring of palliative care for their chronic illnesses. Many do not live close to their children who would be considered their primary caregivers.
All this supports the fact that we need nurses well-trained in geriatric care. Nurses often know the patients and families the most because they spend the most time at their bedside. Geriatric nurses are trained to anticipate issues that may arise in the transition to another unit, facility or home. They help facilitate smooth transitions by being cognizant of the patient’s goals, preferences, and clinical status. They ensure home arrangements are made, patient and family are educated, and coordination happens among the healthcare team prior to transfer. Because of their knowledgeable of the older adults complex issues, the patient is less likely to have readmissions to the hospital and to be transferred to a nursing home from the hospital.
Unfortunately, statistics show that there is a deficit in geriatric trained nurses. Less than 1% of registered nurses (RNs) are certified in geriatrics and the nursing curriculum in many nursing programs doesn’t provide a course focused on geriatrics. The National Gerontological Nursing Association (NGNA) published a position paper stating the need for gerontological nursing education in both the registered nursing programs and continuing education programs in order to develop competent geriatric nurses. America’s geriatric population receives greater than 50% of the healthcare administered in the hospital, other health facilities, and the outpatient settings; however, according to American Association of Colleges of Nursing’s (AACN) 2010 report, only one-third of graduates with a bachelor’s degree in nursing are knowledgeable in best practices for the geriatric patient due to the lack of educational curriculum.
The demand for geriatric nurses continues to grow as the oldest of the baby boomer generation moves into the older adult patient group. Not only are the baby boomers becoming older, some are also retiring from the nursing profession leaving a gap in the staffing. The opportunities for geriatric nurses span across hospitals, ambulatory care, and nursing homes. We need more geriatric nurses to bridge the gap and provide the support older adult patients, like my relative, need to live safe, healthy and active lives.
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By Nelah Di'Addezio