Are Nurses Well Prepared to Care for Geriatric Patients?

Many Geriatric Patients But Few Specialized Nurses

To address the complex clinical needs of the older adult patient, Karen Devereaux Melillo argues in a recent editorial that it's imperative to prepare nurses as gerontological specialists.^[1] Despite the ever-increasing population of older adults in this country, the number of nurses holding nationally recognized certification in gerontological nursing is low. Of 2.9 million nurses, the American Nurses Credentialing Center reports that only 7891 have gerontological certification.

Educators must incorporate geriatric education and geriatric psychiatry into the basic education of all nursing students. Given the limited number of geriatric specialists within nursing, Melillo stresses the need to look toward professional organizations, research, and leaders in the field to assist with gaining the additional knowledge and skills required to care for the burgeoning elderly population.

Furthermore, Melillo believes that it is critical for nurses to be prepared in mental health issues specific to the geriatric patient, and gerontological nurses are essential to this goal. Opportunities to help gerontological nurses to fully implement geropsychiatric and mental health nursing in their nursing practice might include postgraduate courses, certifications, specialty work-related hours, and a national examination.

Viewpoint

The gerontological nurse practitioner practices in a variety of settings that include long-term and transitional care facilities, acute care for the elderly units in hospitals, clinics for older adults, home-based primary care programs, and inpatient and outpatient palliative care, with both interdisciplinary teams and in primary group practice. As a gerontological nurse practitioner (GNP), my graduate school education addressed the biological/psychological and social needs of older adults and their families. This specialized training has given me the tools to provide care for the frail, critically ill, and well older adult.

The Advanced Practice Registered Nurse Consensus Work Group and the National Council of State Boards of Nursing Advanced Practice Registered Nurses Advisory Committee eliminated the GNP track and its certification exam in 2015 and replaced it with the adult gerontological nurse practitioner (AGNP) program. The consensus model supported the training of generalist nurse practitioners to care for a wider variety of age groups from young adult to geriatric, and geriatric content was added to all adult nurse practitioner programs.^[1,2]

The depth and breadth of knowledge to care for the unique needs of older adults is now being addressed in the AGNP program with the integration of the programs. However, concerns have been expressed about possible dilution of the specialized training necessary to care for the older population.^[3] With the elimination of the GNP, there will be fewer geriatric-specific providers just at the time when the population is growing and becoming more in need of care.^[4]

By 2030, 1 in 5 Americans will be over the age of 65 years. There will be 61 million "younger-old" adults, aged 65-84 years, and 9 million people in the "older-old" age group, age 85 years and older.^[5] While the expansion of the adult nurse practitioner (ANP) to AGNP is a way to address the healthcare needs of a rapidly growing aged population, there are concerns that this curriculum is not sufficient to address the complex needs of these older adults, who often present with subtle symptoms or a lack of symptoms.^[4]

The American Geriatric Society echoes this sentiment that specialized education is necessary for the care of geriatric patients and lists GNPs as active members in the Society.^[6] They support specific specialization in order to reduce the frequency of undertreatment or overtreatment and increase effective communication in caring for the older adult.^[7]

As we move forward, those of us with specific geriatric expertise need to stay active in teaching, writing, research, and participating in geriatric professional organizations. The American Association of Colleges of Nursing plans to address this issue by developing a post-master's degree for advanced practice nurses to address the unique needs of the elderly.^[2]

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