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Elder affairs: Improve geriatric care

Ambulatory Safety Monitor, August 19, 2005

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Advances in healthcare allow most people longer lives, and that longevity is starting to catch up with healthcare providers.

The geriatric population-composed of those ages 65 and older-continues to grow as do their needs. The number of geriatric people is expected to double from 35 million to 70 million by 2030 and will make up 20% of the population, according to The John A. Hartford Foundation Institute for Geriatric Nursing.

A March 2005 Academic Medicine report notes that in 2001, 53% of ambulatory visits by geriatric patients were to nonprimary care specialists, a trend that has grown since 1991.

In 2002 and 2003, the Association of Directors of Geriatric Academic Programs' team at the University of Cincinnati School of Medicine's Institute for Health Policy and Health Services Research reviewed 91 nonpediatric specialties to determine whether they required geriatrics medicine training. Seventy percent did not mention geriatrics' training. Of those that did, the requirements were modest, it said. (Click here for an abstract of the study).

Challenges in your systems

Staying on time regarding patient scheduling is vital in a surgery center to ensure smooth patient flow, which leads to shorter stays, more visits, and a better bottom line. But consider the challenges faced by different patient populations when trying to maintain good patient flow, says Sandy Maloof, RN, staff nurse at Virginia Mason Medical Center in Seattle.

For example, consider a 35-year-old patient who comes in for an elective procedure, she says. When called in the waiting room, this patient can probably stand up relatively easily, walk across the room, get on the scale, table, etc., without much struggle or assistance. This patient may move from waiting room to exam room in the anticipated time frame. Now, consider a 75-year-old patient with heart failure coming in for the same procedure. This person may move slower or may have hearing or sight problems that an average adult patient might not have. Chances are the surgery center has not built time into scheduling for this older patient's needs.

Staff can use easy-to-implement solutions to ensure that their geriatric patients' needs are met, including these, Maloof says:

• Identify on the schedule who might need assistance before patients arrive that day.

• Make specific nurses available to tend to special-needs patients.

• Encourage nurses to observe geriatric patients. Do they struggle to hear you? If so, use eye contact and speak at a slower pace. Do they have visual impairments? If so, take your lead from them. Do they need physical contact for cueing, such as guiding by touch? Or should you cue them with your voice? For example, "Mr. Smith, I'm on your left. Now we are going to turn right."

• Use your resources. For example, if you have a patient in a wheelchair, put this person in a room with a movable table to avoid falls or injuries to the patient or staff.

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