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Gerontology Education Something for Everyone

Wednesday September 1, 2004
Prudence Twigg, APRN-BC (left), adult/gerontology nurse practitioner at Danville Regional Rehabilitation Center, Danville, Ind., says nursing programs should put more emphasis on treating geriatric patients. Photo by Andrew Campbell.
Prudence Twigg, APRN-BC (left), adult/gerontology nurse practitioner at Danville Regional Rehabilitation Center, Danville, Ind., says nursing programs should put more emphasis on treating geriatric patients. Photo by Andrew Campbell.
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America is getting grayer - and yet elder care doesn't rate much attention
in nursing school curricula. That may be changing, though, thanks
to new scholastic initiatives backed by a number of nursing groups.

Imagine a labor and delivery nurse who hasn't studied
childbirth, or a pediatrics nurse with no education about child development and diseases.
Even though only a small percentage of graduates will ever work in these specialties, they're still a significant part of the
nursing curriculum, commonly requiring both semesterlong
classes and clinical practicums.
Yet, the patients who will account for the majority of nurses' practice rarely rate a separate course.
Older adults and elders not only constitute an increasingly greater percentage of the population, but also consume the majority of its health care.
"In 2002, one in eight Americans were 65 and older. By 2030, it will be one in five," says Patricia Franklin, RN, MSN, CPNP, project manager for Building Academic Geriatric Nursing Capacity, Washington, D.C. "Older adults are the [fastest] growing population in the world, and in the U.S., they're the largest patient populations in hospital, long-term care, and home care settings," she says, adding that at least 50% of patients are older than age 65 and account for at least 60% of ambulatory care visits. Increasingly, they represent the majority of patients in nurses' care, and they're the core of nursing practice. "Even in pediatrics practice," Franklin says, "nurses deal with more older adults who are caring for grandchildren."
Different Needs
For decades, nursing schools have recognized that children are not simply little adults and addressed their needs accordingly. But it's taken far longer to recognize that the elderly are not the same, developmentally and particularly physically, as they were when younger. Although more nursing programs discuss the life spectrum, few offer a specialized curriculum to address the needs of older adults.
"The average 65-year-old today is different from 65-year-olds 40 years ago," Franklin says. "Thanks to improvements in health maintenance, disease treatment, and decreased accidents, life expectancy is increasing, and people may have a higher level of wellness. But they aren't the same as they were at 30. Their bodies function differently - there are changes in their organs and metabolic rate and function. And there are more mediating factors, such as diabetes, high blood pressure, and high cholesterol."
With longer life expectancy, the ceiling for procedures, including transplants and other operations, has been raised, bringing flocks of older patients to specialty areas once limited to younger adults. And older patients are more likely to experience comorbidities that complicate care and recovery.
Time for Change
Several groups have mobilized to focus attention on the clinical and developmental issues related to aging, provide the research needed for proven practices, disseminate information to practicing nurses, and increase the number of graduate-level faculty equipped to teach the next generations of students. Among them are the John A. Hartford Foundation Geriatric Nursing Program and the American Academy of Nursing.
Together, the two organizations sponsor initiatives including the Building Academic Geriatric Nursing Capacity Programs. This initiative provides $1.3 million each in funding to five centers of geriatric nursing excellence over five years; scholarships; leadership development; and the seven schools of the Nursing School Geriatric Investment Program. Each NSGIP school is awarded $75,000 a year for three years. Each year, the two organizations also provide 10 predoctoral and 10 postdoctoral scholarships of $50,000 a year for two years. The goal is to advance the care of older adults by increasing the number and capacity of expert geriatric nurses, faculty, and researchers.
The New York-based Hartford foundation is also awarding almost $4 million between 2001 and 2005 to the American Association of Colleges of Nursing to enhance curriculum expansion in some 20 baccalaureate and 10 advanced practice programs. It also supports the Institute for Geriatric Nursing at New York University.
For some nurses, geriatrics is the biggest remaining research frontier. For others, it's a complex clinical challenge. And for still others, it's an unparalleled opportunity for developing personal relationships with patients. "It's a nationwide movement," Franklin says. "Scholars have a nationwide network of colleagues who are there for them, people they can tap, utilize, and leverage to fuel their careers. They're disseminating their research and overlapping with other areas, including social work and medicine. It's essential to address aging in every spectrum of nursing."