Gray Matters

America is a graying society. According to the 2000 U.S. Census, 35 million people in this country are age 65 and older, and there are 9.2 million Americans age 80 or older. These numbers are expected to rise dramatically over the next 20 years as the country’s 80 million baby boomers hit retirement. In fact, the 65-and-older population is expected to increase nearly 80% by 2025.

When this tidal wave of elderly Americans hits, will our health care facilities be ready to care for them? As the severe national nursing shortage drags on, many experts are concerned that the answer will be “no.” For example, a study recently published in Nursing Economic$ raised the alarm that the nation’s supply of cancer nurses is likely to fall far short of the number needed to meet the demands of the baby boomers as they age.

The rapid growth of the “senior boomer” population is creating an urgent need for nurses in a variety of specialties, from cancer to Alzheimer’s—and RNs with specialized skills and training in geriatric health will be in particularly high demand.

“Gerontology is the field that is going to have the greatest need for nurses in the future,” predicts Mireya Guzman, RN, MSN, MHSA, who works at the Health Foundation of South Florida. “People are living longer, many resources that weren’t always available to the elderly are becoming more available now and more invasive procedures are being performed on elderly patients. This specialty will continue to grow.”

Because the U.S. population is not only getting older but also becoming more ethnically and culturally diverse, she adds, there will be a critical demand for more minority gerontology nurses who can help meet elderly patients’ need for culturally competent care.

“I don’t think belonging to the same ethnic group as the patient necessarily means you will provide better care,” says Guzman, who is of Cuban descent. “Some nurses who work with a minority population are able to develop a sensitivity to that group’s cultural needs, regardless of their own ethnic background. But I do think it’s nice to have, for example, some Hispanic nurses in the field, because other nurses can learn from them and increase their awareness of cultural issues that affect Hispanic patients’ health needs.

“Research has demonstrated that when we get ill, we regress to our roots,” she continues. “Sometimes people become more dependent when they get sick, and they may feel a stronger need to rely on their familiar cultural traditions.”

For example, Guzman explains, while North American culture emphasizes independence, Hispanic culture is more family-oriented. “When a Hispanic person has to make a decision, what their family thinks is very important,” she notes. “When you get older, that tradition not only stays with you, but can become stronger. Now that they are physically weaker, they will place tremendous value in what their children say. The children are really expected to be there for the older relative and provide that support.”

Aging Parents, Changing Needs

This approach to caring for elderly family members holds true in other minority cultures as well, according to Carmen Galang, RN, PNSc, a Filipino American nurse who is a lecturer at California State University, Long Beach, and the team leader for an undergraduate course on gerontological nursing. In her own case, Galang took a leave of absence from her educational pursuits, and later from a teaching position, to take care of her ailing parents.

Throughout her education, Galang has done aging-related research; she also has extensive clinical experience in the care of elderly patients in community, home health and hospital settings. After her father became ill, she decided to look at how other cultures deal with this situation, focusing first on Mexican Americans. Many people from this culture, Galang learned, prefer to care for their elders at home rather than placing them in a nursing home or other facility. “Sometimes additional relatives come over [from Mexico] to help out,” she adds.

But Victoria Berbano, RN, BSN, MHA, vice president of case management for VitalCare America in Orange County, Calif., which manages long-term care for patients who are in acute care facilities, believes this pattern is beginning to change as more minority baby boomers struggle with their “sandwich generation” responsibilities of caring for both their own children and their aging parents.

“I never used to see Koreans or Filipinos being admitted to long-term care, because Asians usually take care of their elderly parents at home,” reports Berbano, who is Filipino. “But now there are a lot of Asian Americans who, like myself, are baby boomers who work full time and are not able to take care of their older moms and dads. I am definitely seeing more Asians in long-term care than I used to see 12 years ago.”

Many African-American communities are also underserved in the area of elder care, says Tonya Boyd, RN, MS, CS, a nurse at the Hebrew Rehabilitation Center for the Aged in Boston. She feels that a stronger representation of minorities in geriatric nursing might encourage older people of color to seek care more quickly.

“African Americans are usually reluctant to seek care until a disease process has progressed to a point where the treatment might be difficult,” she explains. “The African- American patients we do get here seem to respond better to me than to my [white] counterparts. They tend to be more open with me.”

Gwen Huddleston, RN, BSN, an African-American nurse who works at Hurley Medical Center in Flint, Mich., echoes that assessment, adding that it’s important for elderly black patients to feel comfortable with their nurses because these patients often lack knowledge about medications and other care options available to them. “People say we are all alike but our cultures are very different,” she maintains. “If you grew up in a [minority] community, you can sometimes see it better. There is a close bond and you can’t take that bond away. Black patients, especially the very old, sometimes listen better to people who are like them. They didn’t grow up in a community that was white–they came up in a black community.”

Special Skills for a Special Population

While many of the nurses interviewed for this article feel there is good representation of minorities in gerontological nursing, this was not always the case. Sarah Myers, RN, PhD, nursing clinical coordinator for Geriatrics and Extended Care at the Atlanta Veterans Administration Nursing Home Care Unit, part of the VA Medical Center, remembers having few role models when she was growing up. As a youngster in Georgetown, S.C., Myers used to watch TV shows like “Dr. Kildare” and “Marcus Welby, MD.”

“One factor that influenced me to become a nurse was the noticeable absence of African-American health professionals on television, in the local health department and in the doctors’ offices in my hometown,” she recalls. Helping her mother care for her great-grandmother, who lived to be 115, and her grandmother, who died at 98, also shaped her decision and led to her interest in geriatric nursing.

Older people, says Myers, represent a population of untapped wisdom. “This is a population that has suffered significant losses,” she points out. These can include the death of a spouse, loss of a body part or function, loss of income and the loss of significant others, be it children, siblings or friends. “I can’t think of any population–other than veterans–that has suffered so many losses, sometimes all or most of them occurring at the same time,” she continues.

In addition, the elderly population presents nurses with significant and complex health care challenges. “They require a health professional with specialized skills,” Myers notes. “Gerontology is a specialty and there is a knowledge base that nurses must have to work with these patients.”

For starters, nurses need to know normal aging. “You need to know what happens to someone as they get older, so that when you see something that deviates from that, you will know it is not normal,” Myers says. “These specialized skills relate to issues such as pain management, wound management, prevention and management of bed sores, and nutrition.” Research shows that a significant number of patients suffer weight loss in long-term care settings as well as hospitals, she adds.

Career paths for gerontological nurses are not just limited to working in hospitals and nursing homes. Community health, home health care, public health, senior centers, clinics and hospices all offer opportunities for nurses who specialize in this field. All of these settings, experts agree, will have high demand for nurses over the next 20 years.

With today’s health care economics dictating shorter and shorter hospital stays, Galang adds, more elderly patients are receiving nursing care at home and in outpatient settings. “There will be a lot of

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    in home health, nursing homes, extended care facilities and boarding care. Nurses in this field have lots of opportunities.”

    Gerontology Goes to School

    Although gerontological nurses of color are not a rarity in the clinical setting, their presence is severely lacking when it comes to teaching this specialty. “In academia there are very few of us,” says Galang. “I think we need more gerontology faculty who are minorities. They could share their own experiences and culture with students, to help them learn to be more culturally sensitive.”

    Stronger gerontology curricula at the nation’s nursing schools would be helpful as well, Myers believes. “The care of older people is changing so much, even in areas like pain management, nutrition, weight loss and elder abuse,” she emphasizes. “If you look at current curricula, some of these things need to be added.”

    Myers is currently working as a consultant for Tuskegee University on a program to enhance students’ knowledge within this field. The university recently earned a major grant from the John A. Hartford Foundation, which has helped the school incorporate more gerontology into its nursing curriculum.

    Another historically black nursing school, the Department of Nursing at Winston-Salem State University School of Health Sciences, has been nationally recognized by the American Association of Colleges of Nursing (AACN) for its innovative baccalaureate curriculum in gerontological nursing. The program has included courses held in low-income community housing projects where the students had the opportunity to work directly with elderly residents.

    Other schools whose gerontology programs have been cited as exceptional by AACN include Pennsylvania State University School of Nursing, University of Nebraska Medical Center College of Nursing and Sacred Heart University Nursing Programs and Physical Therapy Program in Connecticut.

    A Booming Need for Researchers

    Gerontological research is still another area where minority nurses can find rewarding careers and make a difference in improving health care for the elderly. There are several organizations that fund such projects nationwide, including The National Institute on Aging, one of the National Institutes of Health.

    “There are many subjects [in gerontology] that need to be explored, including behavioral research,” Galang stresses. “Right now there is lot of money available for doing research on the elderly. I think it is in anticipation of the aging baby boomers.”

    Saun-Joo Yoon, RN, PhD, an assistant professor at the University of Florida, Gainesville, College of Nursing, was one of approximately a dozen gerontology nurses from the Southern region who spent time this past summer participating in New York University’s John A. Hartford Institute for Geriatric Nursing program.

    “We met renowned gerontology scholars and researchers who became our mentors,” she says. The institute’s goals include fostering successful gerontological research programs with significant implications for practice, assisting in the refinement of a program of significant research, honing nurses’ research skills and helping them gain a competitive edge in obtaining funding for their projects.

    Yoon is a published researcher who has presented her findings at a number of conferences. In 2001, she published a paper on the use of oral dietary supplements among older women. She is currently doing a similar research project, but has narrowed her topic down to focus on older African-American women. She is also working on another project involving use of the supplements glucosamine and condroitin for older people with osteoarthritis.

    A native of South Korea, Yoon says her interest in gerontology research is a result of several factors. “In America, the minority population is steadily increasing, and they are aging as well, along with the white Americans,” she explains. “The new Census shows that the elderly Hispanic, African American and Asian populations are increasing both in number and age. We definitely need to have a better understanding of these populations’ health needs as they grow older.”

    Historically, Yoon says, the older generation of minorities has been reluctant to participate in research studies because of their memories of negative experiences in the past, such as the infamous Tuskegee syphilis study, which from 1932 to 1972 allowed African-American men with the disease go untreated. Today, she still finds it difficult to recruit minority participants for certain studies, because of lingering mistrust and misconceptions about the research process.

    “I try to utilize the best possible ways to include minorities in research,” Yoon comments. “Their participation will provide valuable information, which will, in turn, provide better health care.”

    Giving and Getting Back

    Whether your passion is scientific investigation, caring for patients or educating the next generation of nurses, these roads converge in gerontological care. “If you like seniors and you like to teach, this field is as wonderful as it is rewarding,” Huddleston concludes. “I love working with these people. I am hoping to retire in the next few years and this is a perfect closure to my nursing career. It has been a great opportunity for me.”

    “You get the chance to meet new people, as well as their families and loved ones,” adds Carmen Stephens, RN, a Mexican-American elder care nurse at La Mesa Care Center, a long-term care and rehab center in Yuma, Ariz. “To work in this field, you need passion and compassion for the elderly, and what you get back is the chance to know you made a difference in someone’s life. The greatest reward is when you put a smile on an elderly person’s face.”

    Next Steps

    Want to learn more about careers in gerontological nursing, research opportunities and health issues affecting the elderly? Here are a few good places to start:

    National Gerontological Nursing Association
    7794 Grow Drive
    Pensacola, FL 32514
    (800) 723-0560
    www.ngna.org

    Administration on Aging
    U.S. Department of Health and Human Services
    330 Independence Avenue, SW
    Washington, DC 20201
    (202) 619-7501
    www.aoa.gov

    The National Institute on Aging
    Building 31, Room 5C27
    31 Center Drive, MSC 2292
    Bethesda, MD 20892
    (301) 496-1752
    www.nia.nih.gov

    John A. Hartford Foundation Institute for Geriatric Nursing
    New York University
    Division of Nursing
    246 Greene Street
    New York, NY 10003
    (212) 998-9018
    www.hartfordign.org