Public Release: 

Hartford institute scholars decry shortfall in geriatric expertise of health care professionals

Cogent analysis in health affairs article

New York University

The September/October 2002 issue of the journal Health Affairs features an article outlining an impending crisis in health care for older adults and the great need for expanded education in geriatrics for all health care professionals. The authors, Christine Tassone Kovner, RN, PhD, FAAN, Mathy Mezey, RN, EdD, FAAN, and Charlene Harrington, PhD, RN, FAAN, of The John A. Hartford Foundation Institute for Geriatric Nursing at New York University, make the case that two demographic trends are converging to create conditions for inadequate care for older adults: the aging of the baby-boom generation and the shortage of health care workers --particularly nursing. The authors assert that geriatrics needs to join pediatrics as a required element of training the next generation of health care professionals.

Adults over age 65 use about three times as many hospital days as those persons ages 55 to 64, and, in 1999 they made an average of 10.5 ambulatory care visits, compared with 6.4 visits for those under 65. Older adults are also more likely to have chronic conditions such as arthritis, hypertension, heart disease, and urinary incontinence than younger people. There is much evidence that nurses trained in geriatric syndromes are able to provide a higher quality of care to this population. Yet fewer than one percent of the 2.2 million RNs in the United States are certified in geriatrics. The article emphasizes that, "all programs in nursing and medicine...have required pediatric rotations, but a similar commitment to geriatrics has yet to emerge."

The lack of nurses trained in geriatrics is a reflection of the nursing education system, according to the article. In 1999, only 4 percent of the nation's 670 nursing programs leading to the bachelor's degree met all criteria for exemplary geriatrics education, such as a course in geriatrics, two or more placement sites in geriatrics, or at least one full-time faculty member trained in geriatrics. Fewer than one-quarter of all nursing programs required a geriatrics course.

Shortfalls in geriatric expertise abound in other areas of the health care workforce as well: only small percentages of physicians, pharmacists, physical therapists, and social workers specialize in geriatrics.

Acknowledging that more research is needed to determine more precisely the future need for geriatric specialists, the authors state that, at minimum, every older adult requires a provider who has some education and training in geriatrics, and that students in health professionals education programs should all receive educational content and have experience in caring for older adults.

Furthermore, they recommend that all programs in nursing and medicine make a commitment to geriatrics similar to that made to pediatrics. States might follow the lead of the six states (Arkansas, California, Delaware, Florida, Indiana, and South Dakota) that mandate content and experience in geriatrics for all nursing education, or those that require a specified number of continuing education credits in geriatrics. In addition, health facilities could be required to show evidence of staff training in geriatrics as a condition of licensure.

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The John A. Hartford Foundation Institute for Geriatric Nursing seeks to shape the quality of the nation's health care for older Americans by promoting geriatric nursing excellence. It seeks to positively influence both individual nurse competence as well as the systems in which nurses learn and work so that older adults can age with optimal function, comfort, and dignity. It accomplishes this mission through activities in four areas: education, practice, research, and policy and consumer education. Within these areas, partnerships and champions are nurtured to augment, enrich, and disseminate the work of the Hartford Institute. Health care experts are available on request.

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