Nursing Jobs and Therapy Jobs

Depression, dementia and delirium fall under an umbrella of disorders that strike many older adults. Their special needs call for nurses with expertise in aging issues.

Demand for geriatric nurses is accelerating along with the nation's changing demographics. With baby boomers approaching their retirement years, the number of Americans age 55 and older will soar from 60 million (21 percent of the population) to more than 107 million (31 percent) by 2030, according to the National Council on Aging in Washington, D.C.

"Nurses work with older adults every day in all health care settings," said M. Kay Cresci, Ph.D., RN, CNS, BC, an assistant professor at Wayne State University's College of Nursing and Institute of Gerontology in Detroit. "They not only have to be an expert in their nursing specialty - critical care, oncology, primary care, home care, hospice, palliative care and so on - but also in the health needs of older adults. Even pediatric or neonatal nurses may be working with grandparents caring for grandchildren."

A strong movement is afoot to educate more nurses and nursing students about normal age-related physical and mental changes. Specialized knowledge and skills help them apply a holistic approach and coordinate care across the continuum.

While assisting people in living independently as long as possible, the goal is to improve - or at least maintain - functional status with bathing, dressing and other routine tasks. Unfortunately, "we tend to do everything for them, rather than letting them do it for themselves," said Cresci, a fellow of the National Gerontological Nursing Association. Encouraging older adults to perform these tasks - no matter how slowly - requires patience on the part of the nurse and family members.

"The need for community services will expand, and more of us will want to age in place - in our own homes or assisted-living facilities," added Glassman, who is a baby boomer. "The challenge for nurses will be to meet the growing demand for ambulatory, community-based and home care - to better support frail older adults."

Nurses can play a pivotal role in health promotion and risk reduction. Every 35 minutes, an older adult dies due to falling, according to the National Council on Aging. Also, "one in five older adults is caught in the grips of depression, anxiety, or substance abuse." As older adults become homebound, social isolation poses complications. Reports of elder abuse - intentional or neglectful acts by a caregiver or other trusted individual - are on the rise, although many cases remain untold.

But new models of care have emerged. Geriatric nurse practitioners are sought out as case managers in extended care facilities, focusing on early detection of illnesses, said Margaret J. Bull, Ph.D., RN, FAAN, professor and director of the Ph.D. program at Marquette University's College of Nursing in Milwaukee. "This approach has been effective in reducing hospital admissions."

The need for advanced practice nurses will surge in other settings as well - from clinics to rehabilitation centers. "Primary care is the center point for the new health care legislation, and we are needing geriatric nurse practitioners because there are fewer and fewer geriatricians," said Claudia Beverly, Ph.D., RN, FAAN, professor and director of the Hartford Center of Geriatric Nursing Excellence at the University of Arkansas for Medical Sciences in Little Rock.

Three-quarters of older people have at least one chronic illness. Their symptoms differ from those in younger people, said Bull, who specializes in health care transitions for elders and family caregivers. For instance, acute confusion - also known as delirium - is often a sign that an ongoing  condition such as heart failure has worsened. While harboring a urinary tract infection, an elderly patient also may exhibit confusion instead of manifesting a fever.

Other health concerns that nurses should pay attention to in older adults include drug interactions and declining appetite. "Having a primary care provider is very important for older adults," Glassman said, "as their often complex clinical problems can be compounded by too many medications."