By Kim McCarten, contributor
August 26, 2010 - If it seems like you’ve been caring for more and more elderly patients, you’re not imagining it. According to a new report, the average age of patients has increased in recent years – and these older patients are taking up more appointment time than anyone else.
And as the population continues to age, nurses will be spending more and more time working with, and caring for, elderly patients. In fact, according to Medicare’s projections, the number of adults age 65 and older will nearly double to 70 million Americans by 2030.
This translates into some obvious, and some not-so-obvious, changes in the daily structure of doctor's offices and medical practices. A new report, Population Aging and the Use of Office-based Physician Services, released in August 2010 by the Centers for Disease Control and Prevention (CDC), fills in some details.
More time to treat
One of the biggest changes expected to accompany the aging of the patient population is the greater complexity and time needed for patient visits.
The new CDC report documents that in 2008 patients 65 and older spent more total time with physicians than any other patients (59 percent in total, up from 50 percent in 1998). Appointment time lengthened to 28 minutes (from 24 minutes), and patients required more medications and imaging (CT scans, MRIs, X-rays and ultrasound).
This trend has a clear impact on scheduling as well as coordination with other facilities.
Also, the report found that elderly patients are making more trips to medical and surgical specialty facilities, a trend that is on the rise.
More Medicare issues
Most doctors now accept new Medicare patients, with ophthalmologists, general surgeons, orthopedic surgeons, and cardiac specialists offering the highest rate of acceptance.
Staff who are new to handling the details of Medicare paperwork, as well as Medicare “veterans,” will need to continue to improve and streamline this process, utilizing software and other digital resources to improve efficiency and decrease errors in diagnosing, billing and processing.
Nurses who are new to Medicare need to know that they can be called on to help determine a patient's eligibility for PACE (Program of All-Inclusive Care for the Elderly), a Medicare program that provides home, day, and/or inpatient facility care. PACE is available in 31 states.
Hospital nurses need to be cognizant of the “do-not-pay list,” which are health care-acquired conditions or incidents (including patient falls, mediastinitis, pressure ulcers, UTIs and vascular catheter infections) that Medicare will not reimburse.
Age-specific concerns
A 2008 Institute of Medicine report called Retooling for an Aging America: Building the Health Care Workforce stated that "The healthcare workforce in general receives very little geriatric training, and is not prepared to deliver the best care to older patients.” But there are professionals proactively addressing this accelerating shift in demographics with specific geriatric training.
Susan Harder, RN, BSN, MEd, remembered that when she first started the gerontological phase of her career as a CNA "she had no training," although now, CNAs have 75-80 required hours, and other gerontologically-specific positions have developed that require even more training, such as medication aides, geriatric CNA specialists and the like.
Harder is director of nursing for Good Samaritan/St Luke's in Kearney, Neb., and president of the Heartland Chapter of the National Gerontological Nursing Association.
Attitude is very important in this area. "You have to have a great love and great respect for who you're caring for," said Harder.
In fact, researchers in a Journal of Advanced Nursing study found a direct link between the attitude of nurses toward their senior patients and the quality of care provided.
Nurses need to guard against stereotypes and assumptions about this age group, and also need to be aware of overt, as well as potential underlying, problems that can face the elderly. A 1994 study published in Psychology & Health noted that nurses can miss critical components of elderly patients' overall health by not factoring in sometimes covert symptoms and behaviors.
"Taking care of someone in their 80s is not the same as taking care of someone in their 40s," said Harder. "An 80-year-old is not just an older, or more crippled, 40-year-old." There are additional considerations for this age group, and there's an explosion of science tracking some of the specifics, such as drug efficacy, brain neuroplasticity, rehabilitation capacity, etc.. "It can be hard to keep up," Harder said.
As for overt health concerns, the latest CDC report found that the diagnoses with the largest increase for seniors are hypertension (a 62 percent increase from 1998), cardiac dysrhythmias (a 139 percent increase) and diabetes (a 45 percent increase).
And patients may present with more than one of these concerns; in fact, 20 percent of the Medicare population has at least five chronic conditions.
In addition to chronic conditions, elderly patients can face depression, sensory changes, and dementia (more than 33 percent of senior women, and 20 percent of senior men as documented by the Journal of the AMA). Healthcare providers can also help address quality-of-life problems such as disrupted sleep patterns, sexual issues, and mealtime/digestive difficulties.
Of course, many seniors are living longer, healthier lives and might need advice about nutrition, exercise and physical training.
One of the most important things for nurses to remember, according to Harder, is the importance of giving the patient as much control as possible.
"It's important for elders, anyone really, to be able to make as many decisions for themselves as possible," she said, including treatment options to long-term care. She added that nurses can provide leadership as well as mentor co-workers about how to keep health care centered on a patient and his or her wishes.
In addition, nurses should encourage elderly patients to talk over any concerns, unhealthy habits or mental health difficulties, review prescription and over-the-counter medications, and ask about appropriate screenings.
RNs play a critical role in promoting patient autonomy, and can provide guidance for patients and their families about long-term and end-of-life care.
Embracing a trend
There are challenges and opportunities that come with this aging population trend.
The American College of Nurse Practitioners is currently lobbying to expand the role of nurse practitioners (NPs) in treating Medicare patients, including ensuring that NPs are allowed to order home health services.
There will undoubtedly be additional adjustments needed regarding responsibilities and authority as more patients join this category.
As nursing schools, medical facilities and home care agencies are already making adjustments to include a greater emphasis on elder care, nurses are embracing the challenge of caring for more and more seniors. Many realize that they are instrumental in helping aging patients raise their awareness about health maintenance, troubleshoot potential health problems and gain better treatment options; they are in a unique position to make a difference.
© 2010. AMN Healthcare, Inc. All Rights Reserved.