Recognize the many facets of gerontological nursing

Abstract

Article:Fact: Older adults influence hospital environments. This patient population is now the predominant recipient of services in all healthcare settings-50% of hospital patients, 70% of home care patients, and 90% of ambulatory patients.1 Patients over age 65 account for 48% of critical care unit admissions and more than 50% of critical care days.2 Hospitalized older patients use more resources and have higher charges and longer stays, accounting for up to 70% of cost outliers. 3,4 Nurse leaders of hospital units with high percentages of patients over 65 years of age face numerous challenges, including personnel, organizational structure, and regulatory requirements. There's little information, however, on management issues in hospital units that aren't designated specifically for older adults. Unique nursing needsHospital units that consider children their -core business‖ often support, and sometimes require, national certification for registered nurses in pediatric specialties; ensure adherence to national scopes and standards for pediatric nursing care; and meet Magnet or Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements for staff competence in the care of pediatric patients. Yet when older adults are the -core business‖ of a hospital unit, there's usually no requirement for gerontological/geriatric certification for nursing staff, no adherence to national scopes and standards for care of older adults, and no consideration of Magnet or JCAHO requirements for staff competence in the care of older adults (-age-specific competencies‖). 5 Nevertheless, hospitalized older adult patients have unique nursing needs. Admission to an acute care hospital doesn't necessarily improve older patients' health status; often the goal of treatment for geriatric patients is to maintain function or slow the decline of functional consequences of chronic health problems, rather than restore older patients to previous levels of health or better. This difference is significant in the philosophy of care for nursing staff who are accustomed to -making somebody well.‖ Older patients also frequently present with ambiguous illness symptoms. For example, an older person with pneumonia or urinary tract infection may not have the elevated temperature or changes in laboratory values that would be seen in younger adult patients. Because of age-related changes in the immune system, the only symptom of infection may be a change in mental status.In addition to acute problems that prompt hospitalization, older patients are often dealing with chronic health problems such as arthritis, diabetes, hearing and vision problems, hypertension, and cardiovascular disease. Comorbid conditions can complicate treatment and recovery, increasing length of stay and leading to hospital charges that fall outside the established payment scale. Further, because of age-related physiological changes, older patients have fewer energy reserves and unpredictable responses to medical and nursing interventions. They're at greater risk fo...

Considering Elderly Competence When Consenting to Treatment

“…2(p67) As life expectancy lengthens, numerous concerns such as autonomy, cognitive function, quality of life, competence, and the complexity of medical care with comorbidities challenge the health care system. [1][2][3] Health care providers as well as educators will continue to address these concerns.…”