Improving Geriatric Nursing Care
Improving Geriatric Nursing Care
The U.S. population is aging with the proportion of adults aged 65 or older steadily increasing. Older adults have unique health care needs relating to the treatment and prevention of comorbid illnesses, disability, and cognitive decline. The health care system must be ready to meet these needs in order to provide the best care and increase the quality of life of seniors. Innovations are therefore much needed and nurses are in the position to lead efforts by obtaining further training and education, engaging in research, and advocating.
Innovations Needed in the Senior Care Industry
Accountable care. There must be accountable care organizations (ACOs) providing safe, high-quality, and cost-effective geriatric services. The ACO model addresses many of the weaknesses of conventional care delivery systems. Partnerships between different organizations permit an ACO to provide integrated care with seamless transitions between different levels of care for older adult patients (Bennett, 2012). The entire network is also quality conscious as their ACO designation and incentives relies on meeting performance criteria for senior care (DeVore & Champion, 2011). Further, an ACO can commit to caring for a defined senior population, thus an assurance of service availability in the community. Finally, the pillar of an ACO is an academic hospital with a strong research component that includes focus on improving geriatric care (Bennett, 2012).
Aging in place. For otherwise healthy older adults, aging in place must be an option. Aging in place is continuing to live independently in one’s home while sustaining meaningful social ties with the community (Bacsu et al., 2012). Community-based programs make this possible. Through awareness building, such programs dispel misconceptions about aging and mobilize the resources and support necessary to assist older adults as they age. The active involvement of different groups in the community is crucial to success.
Support services should include transportation. Mobility allows seniors to keep physician appointments, meet their shopping needs, and participate in activities (Bacsu et al., 2012). Home safety services must be another component. Falls in the home that result in injuries such as wounds and fractures are common occurrences among older adults. As a preventive measure, homes need to be inspected to determine safety risks that can then be reduced through minor repairs (Lichtman & Lichtman, 2011). Such include installing good lighting, anti-skid devices on stairs, and grab bars in the bathroom as well as anchoring rugs.
Aging in place further needs to encourage programs that promote health (Wang, Shepley & Rodiek, 2012). Physical activity can be increased by encouraging seniors to join walk clubs and clubs that teach mild forms of martial arts such as qigong, tai chi, and tae bo. Among the many health benefits, these exercises improve strength and balance, and reduce the risk of disability with advancing age as well. To sustain the social connectedness of seniors and prevent the depression that comes with social isolation, aging in place programs should bridge older adults to one another through common interest clubs (Bacsu et al., 2012). Activities such as teaching and mentoring further link them to younger persons in the community and generate a sense of productivity even after retirement.
Telehealth. Older adults commonly have comorbid conditions requiring long-term pharmacologic treatment and periodic follow-ups. Telehealth provide links to nursing and medical services minus the cost of travel that may be inconvenient for the elderly especially with great distances and limitations in mobility (Janiak, 2010). Telehealth also supplements treatment and management by allowing seniors to access qualified health care professionals who can answer questions or give appropriate advice about medication side effects, management of multiple medications, complementary therapies, diet, and laboratory results among others (Shah et al., 2013). Encounters serve to reinforce positive health behaviors while checking against detrimental ones.
Telehealth can further be utilized to follow the patient over time for treatment compliance and health outcomes. Providers and nurses can call the patient to ascertain medication adherence. Software installed in an older adult’s home computer can transmit biometric measurements such as blood pressure, temperature, heart rate, blood sugar, peak airflow, weight, body mass index, and oxygen saturation for remote monitoring (Hanson, Takahashi & Pecina, 2013). Monitoring can alert health care professionals of early manifestations of impending acute exacerbation that should prompt an assessment of the patient so that decisions about further treatment and management can be made.
Options for relocation. While aging in place is not an option that is ideal or even possible for all older adults, there must be a variety of residential options to suit individual needs. Retirement homes and assisted living centers must live up to and even exceed consumer expectations (Lichtman & Lichtman, 2011). There must be laws in place to regulate operations and ensure adherence to standards. Mechanisms to raise the quality of services need to be established to ensure value for money. For instance, older adults in these environments need to feel that the facility is a home and a community rather than an institution. Consumer satisfaction is largely anchored on this aspect.
Further, services must conform to theoretical frameworks of aging that foster autonomy and activity for as long as possible. As such, the physical layout, programs, policies, and services of these homes must foster health promotion among residents (Rosenberg et al., 2012). The rationale is to make residential care consistent with public health goals for the older adult segment of the population. There must also be clear guidelines regarding resident transfer to another type of residential facility more apt to changing physical and mental conditions.
For nurses to lead innovations in geriatric care, the workforce needs to be sufficiently educated. Auerhahn et al. (2010) pointed out that at the practitioner level nurses caring for older adults have varying educational preparations. Nurse practitioners may qualify for gerontological, adult primary care, and adult acute care designations with differences in competencies although providing services to populations of older adults. To standardize the competencies and ensure similar roles and responsibilities, the merging of these roles into the adult gerontology nurse practitioner (AGNP) designation was proposed and developed. The corresponding curriculum was based on a national consensus with the aim of having a nursing role with the capacity to meet the unique health care needs of the elderly (Auerhahn et al., 2010). The Institute of Medicine (IOM) is calling for lifelong learning and by considering the AGNP role this nurse gives a timely response to the call. Adequate preparation permits the provision of quality nursing services for seniors.
Engaging in nursing research is another area this nurse can contribute to. Nursing research contributes to the advancement of nursing care by generating evidence in support of traditional interventions and improvements therein (Polit & Beck, 2012). It is also a strategy to develop innovative ways of delivering care in the current health reform environment. In addition, this nurse can help promote safe and high quality geriatric care through advocacy at various levels including the health care facility, community, and state levels (Greco & Vincent, 2011). Policies and regulations favorable to improving geriatric nursing capabilities and the quality of care must be supported for legislation or implementation. Advocacy is an exercise of leadership that is expected from registered nurses.
Conclusion
Improving geriatric care deserves priority attention because of the increasing demand for related services. Nurses can best provide geriatric nursing care by receiving nurse practitioner training. This provides the knowledge and skills necessary to tailor health care to the unique needs of older adults. There are many innovations developed in recent years to make the care of older adults better, more efficient, cost-efficient, and satisfactory. Accountable care organizations, telehealth, aging in place, and a wider range of choices for relocation are some of the developments. However, much need to be done to establish the evidence of effectiveness through sound nursing research. Moreover, innovations require an investment of resources and the involvement of different sectors of society. Nurses can make an impact through supporting or initiating advocacy work to advance the care of older adults in the community and clinical settings as well as in the legislative arena.
References
Auerhahn, C., Mezey, M., Stanley, J., & Wilson, L.D. (2010). Ensuring a nurse practitioner workforce prepared to care for older adults: Findings from a national survey of adult and geriatric nurse practitioner programs. Journal of the American Academy of Nurse Practitioners, 24(4), 193-199. doi: 10.1111/j.1745-7599.2011.00685.x.
Bacsu, J.R., Jeffery, B., Johnson, S., Martz, D., Novik, N., & Abonyi, S. (2012). Healthy aging in place: Supporting rural seniors’ health needs. Online Journal of Rural Nursing and Health Care, 12(2), 77-87. Retrieved from https://www.rnojournal.binghamton.edu/index.php/RNO/article/download/52/217
Bennett, A.R. (2012). Accountable care organizations: Principles and implications for hospital administrators. Journal of Healthcare Management, 57(4), 233-254. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22905603
DeVore, S., & Champion, R.W. (2011). Driving population health through accountable care organizations. Health Affairs, 30(1), 41-50. doi: 10.1377/hlthaff.2010.0935.
Greco, S.M., & Vincent, C. (2011). Disability and aging: An evolutionary concept analysis. Journal of Gerontological Nursing, 37(8), 18-27. doi: 10.3928/00989134-20110329- 04.
Hanson, G.J., Takahashi, P.Y., & Pecina, J.L. (2013). Emerging technologies to support independent living of older adults at risk. Case Management Journals, 14(1), 58-64. Retrieved from http://dx.doi.org/10.1891/1521-0987.14.1.58.
Janiak, B. (2010). Telemedicine consultations with emergency department physicians reduce unnecessary transfers of nursing home residents in rural areas. Retrieved from http://www.innovations.ahrq.gov/content.aspx?id=3189
Lichtman, J.L., & Lichtman, S.M. (2011). The older cancer survivor. Community Oncology, 8(1), 32-36. Retrieved from http://www.oncologypractice.com/co/journal/articles/0801032.pdf
Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Rosenberg, D.E., Kerr, J., Sallis, J.F., Norman, G.J., Calfas, K., & Patrick, K. (2012). Promoting walking among older adults living in retirement communities. Journal of Aging and Physical Activity, 20(3), 379-394.
Shah, M.N. (2013). High-intensity telemedicine-enhanced acute care for older adults: An innovative healthcare delivery model. Journal of the American Geriatrics Society, 61(11), 2000-2007. doi: 10.111/jgs.12523.
Wang, Z., Shepley, M.M., & Rodiek, S.D. (2012). Aging in place at home through environmental support of physical activity: An interdisciplinary conceptual framework and analysis. Journal of Housing for the Elderly, 26(4), 338-354. doi: 10.1080/02763893.2011.625289.
