Challenges and Opportunities for Improving Nursing Care in the Geriatric Population

The geriatric patient population is not only increasing in numbers and longevity, but also in the complexity of their health care issues and needs. On the raise as well are the barriers and prejudices with caring for the aging population amongst healthcare providers. It is these barriers and prejudices that hinder healthcare providers to want to take the initiative to improve care for the aging. Preservation of our elder patient population’s dignity should be of the upmost importance. In order to preserve and maintain this dignity, as healthcare providers we need to understand what barriers and subconscious prejudices we may have and work to diminish.

Challenges and Opportunities for Improving Geriatric Nursing Care In September 2010, the American Association of Colleges for Nursing’s wrote, “Older adults constitute a majority – and growing – proportion of people who receive nursing care in the United States” (p. 7). Potential complications related to the increased longevity and duration of chronic illnesses are also on the raise with the elder population. In order to prevent these potential complications, healthcare providers need to remove the barriers and prejudices they may have in order to provide the aging client with the most optimal care.

This following questions need to be addressed by the healthcare provider: 1. What are the healthcare provider barriers? 2. Ageism, is it a healthcare provider prejudice? 3. How do we as healthcare providers diminish these barriers and prejudices?

Answering these questions will assist the healthcare provider in gaining a better understanding of the aging population. In addition, by understanding what our barriers, prejudices, and in other words limitations we may have, we may begin to understand where they have originated and begin to diminish their effects on how we treat and respect our elders.

Healthcare Provider Barriers According to Fox (2013), “Between 2000 and 2050, the number of people aged 65 and older will increase by 135%” (p. 52). With such a significant raise of this segment of our population, the need for specialists in the area of geriatrics will become more in demand. Geriatric specialists trained in helping alleviate some of the issues related to the aging population and the treatment of their chronic illnesses. The elder patient is not just an older adult and should not be treated as such. According to the Center for Disease, “About 80% of older adults have one chronic condition, and 50% have at least two.” Their metabolism or the way their bodies work is so different compare to the 20, 30, 40 year old adult.

There are numerous barriers that the aging population may have, but according to Bennett and Flaherty (2003), the four main barriers for the elder population to overcome in order to achieve optimal care from their providers, “providing resources to individuals to help manage chronic medical conditions, assuring a sufficient number of primary health care providers educated in geriatrics and gerontology, removing financial barriers to accessing health care and medications, and changing the cultural value system that emphasizes disease treatment over providing emotional, educational, and support resources.”

According to the CDC, “About 80% of older adults have one chronic condition, and 50% have at least two.” A chronic illness is “a condition that last a year or more and require ongoing medical attention and/or limit activities of daily living” (Warshaw, 2006, p. 5). Chronic illnesses or conditions and limited knowledge in their treatment can lead to disability, increased hospitalization, a decrease in activities in daily living, increased length of stay at rehabilitation centers, and in all increased financial drain on the client and the healthcare industry. Having healthcare members that are more proficient in the treatment and care of the elder population will improve their quality and potentially quantity of life.

Fox wrote (2013), “meager wages, lack of recognition…deter the novice professional nurse from pursuing careers in LTC” (p. 52). It not only deters the nurse, but also the other healthcare professions. Medicare, Medicaid, and insurance companies cap what is spent in the treatment of acute and chronic illnesses. Also, capped as well are the lengths of stays in a rehabilitation centers, hospitals and services through a VNA. Very few providers can afford to specialize and treat just the elder population.

The nurses that are trained and educated in geriatrics are reversely disproportionate to the raising elder population. These nurses are aging and will be entering that elder population. Few nurses and advanced degree nurses are entering into geriatric programs. Fewer nursing and medical schools are offering advanced degrees in geriatrics or classes in geriatric care. All this combined lead to the insufficient numbers of providers trained in geriatrics.

It has been said that health and health care affects, “our opportunity to pursue life goals, reduces our pain and suffering, prevents premature loss of life, and provides information needed to plan our lives” (Benjamin, 2009). Not all have equal opportunity or the financial opportunities to obtain and/or maintain health care. With the recession, the raising cost of medications, treatments, oil, willingness to ask for help, these factors play into whether or not the elder can afford to maintain their health.

Bennett and Flaherty-Robb (2003) stated, “the average annual drug expenditure for diabetes is $1379, for heart disease, $1187, and for hypertension, $1021.” In the ER, we see a lot of noncompliance with medications. The medications are either not picked up at the pharmacy or the medication is not taken correctly (i.e., halved, skipped doses). Medications not properly taken as ordered by the doctor can lead to a multitude of potential complications. Drug programs such as those at Wal-Mart and Target have $4 prescription.

As nurses, we go through both lists to make sure that the medication the doctor orders is on the list if we think the noncompliance is secondary to financial. If the medication prescribed is not on the list, we approach the doctor to ask for a substitute or another medication to be prescribed for the patient. Also an issue is the ability to get to the doctor’s office or the hospital. Most of the time the patient doesn’t want to feel as if they are a burden to their family members and won’t ask family members for a ride to the doctor’s office or the hospital.

Lastly, another potential complication related to financial is hypothermia. Having to choose between heating the home, food, and medication is difficult. Complicating the issue are the chronic conditions that put the elder at increased risk for hypothermia. Making healthcare more affordable for those that have supported us as we grew should be a priority for all.

Ageism The biggest prejudice healthcare has is ageism. “Elder cancer patients are even more affected by ageist attitudes and beliefs, and as a result experience poorer health outcomes” (Simkins, p. 24). Healthcare providers fear aging, and fear of aging leads to ageism. A doctor once said, you can place a percentage on whether or not an elder will be admitted to the hospital. He said you took 100 and subtract the elder’s age and that would be their percentage of discharge.

So, say the patient was 90- using his formula there would be only a 10% chance of discharging that patient. What I noticed after was the amount or rather the lack of the amount of elder patients he saw and instead the other doctors had to take a heavier elder patient load. Ageism leads to the patient receiving less care than they deserve. It puts the patient at risk for financial and physical abuse and neglect. What needs to happen is more education and training to the healthcare professionals in geriatrics. Repeated and early exposure to healthy aging will hopefully diminish ageism.

Diminishing Knowledge is power. Knowing what barriers and prejudices exist will diminish their harmful affects on the aging population. Education is power. More nursing and medical programs need to instill a geriatric course. Geriatrics is a specialty. Understanding, educating, and training of healthcare providers can only lead to the overall improvement in the elder’s quality of life and advance their activities of daily living. Harvath et al. (2006) wrote, “The enduring relationships between clinical agencies and academic centers has been instrumental in helping to develop an educational infrastructure that integrates clinical geriatric nursing principles” (p. 212).

Advocating for our most at risk patients is power. Nurses advocate for our elder patients and all patients. Taking our concerns to the healthcare team, such as the inability to pay for medication or treatments, and finding alternatives should be a primary responsibility of all healthcare providers. Also, educating the family and the patient on the importance of their treatments and medications will improve patient outcomes. Finding resources for the patient or going through case management and social service can be most beneficial for the patient.

Elevating the pay of the nurses that work in long term care facilities will not only ensure a greater pool of candidates for each position, but will also elevate their status. According to Grossman and Valiga (2009), “The more barriers there are to the change, the more effort will be needed to deal with those barriers” (p. 40). If we improve the education of healthcare providers in gerontology, we will break the walls, barriers, and prejudices in dealing with the elderly. Improved patient outcomes will be the reward for doing so, and will be worth the effort.

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