No Older Adult Left Behind
Older adults are one of the fastest growing populations in the United States. According to the 2010 US census, there are approximately 40 million adults 65 years and older, an increase of over 5 million since 2000. This burgeoning growth in the US and worldwide necessitates that emerging entry-level nurse generalists be competent in caring for older adults. The American Association of Colleges of Nursing (AACN) has recommended that nursing curricula include a stand-alone gerontological nursing course with a didactic and clinical component.
However, many Historically Black Colleges and Universities (HBCUs) have been slow to adopt the AACN’s recommendation. As of 2005, only a third of US baccalaureate nursing programs required a geriatric nursing course, according to a study published in The Journal of Professional Nursing. After an online search of nursing curriculum plans at HBCUs (as posted on websites), I discovered that currently over 65% of traditional four-year BSN programs did not have a stand-alone gerontological nursing course. Accordingly, about 35% of HBCUs did. Comparing this observation to the 2005 national survey, this suggests that HBCUs are doing slightly better than the general US programs. But it must be remembered that there are considerably fewer HBCUs compared to the number of predominantly white institutions.
Afua Arhin, PhD, RN, department chair and professor at Fayetteville State University School of Nursing argues, “Because there is a 1 in 4 chance of encountering a patient who is 50 years or older, it is imperative that gerontology as a specialty is integrated into nursing education curriculum at all universities, especially HBCUs, to ensure that student nurses are competent in caring for this important cross-section of the population.”
Thus, current and future nurses will most likely care for an older adult at some point in their career. In fact, many of today’s medical-surgical patients are 65 years or older. Unfortunately, many medical-surgical nursing textbooks present minimal, if any, information on best practices for older adults, according to a recent study conducted by the National League for Nursing (NLN). It is clear that there is dire need for greater numbers of health care professionals prepared to care for older adults. The results of the 2013 America’s Health Rankings® Senior Report showed that many states’ older adult populations are very unhealthy. It is interesting to note that many of the HBCUs without a gerontological course are located in the lowest ranking states for senior health: Louisiana, Arkansas, Mississippi, Alabama, Georgia, Tennessee, and Oklahoma.
In order to improve care of older adults, all nursing programs must implement gerontological didactic courses and clinical practicums into their curricula. As far back as 1993, Verna Holtzen and colleagues reported that gerontological nursing education was no longer a “curricular luxury” but a necessity for a baccalaureate degree. Nursing students and nurses without adequate knowledge of the aging life-course will continue to provide care that doesn’t reflect best practices; consequently, the health of older adults will remain suboptimal.
Reasons for Lack of Course
Interestingly, in 1993, Terri H. Brower and Ruth E. Yurchuck examined the state of gerontological nursing education in Southern states. According to their study published in Nursing and Health Care, much variation was found in the amount of content, topic areas, and reasons for lack of gerontological content. Though it remains unclear why many schools today have yet to require a gerontological nursing course, several general reasons may explain this absence. For one, there persists a perceived lack of priority in implementing gerontological content, most likely due to insufficient knowledge of older adults’ unique needs.
Additionally, many nursing programs’ curricula are already overloaded with nursing courses, making it difficult to incorporate any additional courses. Insufficient financial resources and infrastructure further hinder the infusion of gerontological content, including a shortage of qualified faculty to develop and teach gerontological nursing courses. While no state board of nursing mandates the inclusion of gerontological content, minimal gerontological content on the NCLEX promotes the perception of older adult care as lower priority.
Current Recommendations and Alternatives
In 2008, the Institute of Medicine released its report, “Retooling for an Aging America: Building the Health Care Workforce,” emphasizing geriatric competency of the entire health care workforce and the need for improved delivery of care in older adults. Then in 2010, the AACN released Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults, which highly recommended that nursing programs implement a stand-alone gerontological nursing course.
Subsequently, the National Gerontological Nursing Association further recommended that all undergraduate RN programs establish a three-hour didactic gerontological stand-alone nursing course and a three-hour clinical practicum by 2013. Yet, as we see, these recommendations have not been implemented nationally. Several other organizations—including the NLN, National Hartford Centers of Gerontological Nursing Excellence, and The Reynolds Center for Geriatric Nursing Excellence—have committed to increasing and improving gerontological nursing education and research.
“Current statistics illustrate there will not be enough providers with specialization in geriatrics to meet the needs of the aging population—thus, one important response is to assure that all pre-licensure health professional students, including nurses, are prepared to address the health care needs of older people,” states Keela Herr, PhD, RN, FAAN, AGSF, co-director of the Hartford/Csomay Center for Geriatric Nursing Excellence at The University of Iowa.
If implementing a stand-alone course in geriatrics is not feasible, incorporating gerontological content into existing specialty courses—such as community health, medical-surgical, and psychiatric-mental health nursing courses—should be considered. Older patients are present in almost every health care setting, and nurses in these specialty areas must be equipped to care for older adults. Being that more and more grandparents are caring for young children, a life-span approach can be taken, in which gerontological content is integrated into pediatric and maternal health nursing courses as well.
Perhaps, HBCUs can partner with schools that offer a gerontological course and allow their students to enroll for course credit. Offering course credit to participate in a summer geriatric externship is an additional strategy. Other strategies include offering a gerontological nursing course as an elective, or allowing nursing students to take gerontology-related or aging-specific courses in other departments. This can at least provide some knowledge of older adult care before they transition into professional practice, and this approach fosters inter-professional learning.
The future of nursing education is driven by two powerful forces—the aging population and a transforming nursing education system. Although some programs have integrated some gerontological content in various courses, courses dedicated solely to nursing care of older adults are missing in many HBCUs. We must prepare our students to be able to care for older patients in their practice, as well as their grandparents, aging parents, and elderly family members and neighbors. Nursing education must attend to and reflect current nursing practice populations. Our generation’s and future generations’ success is based on the sacrifice of past generations. It is our responsibility to assure quality health care for seniors in all of America. We can’t afford to leave older adults behind!
Staja “Star” Booker, RN, MS, is a geriatric nurse and an alumna of Grambling State University. Currently a PhD student (Aging/Gerontological Nursing) at The University of Iowa, she is also a 2013-2015 National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar.