By 2030, roughly 1 in 5 U.S. adults will be 65 years or older. Though healthier, more active, and living longer than previous generations, these adults still are likely to experience increasingly complex care needs as they age.

At the center of this care are nurses, more specifically, adult-gerontology primary care nurse practitioners (AGPCNPs), whose foundational training makes them well-suited to provide comprehensive care to older patients. As care demands outpace supply of qualified clinicians, opportunities for NPs abound.

Why enter adult-gerontology nursing?

“The very definition of what nurses do is tending to human responses to illness and treatment. Every day our world view looks at how our patients or communities we serve are stepping up and adapting to changes in their well-being,” said Nancy P. Blumenthal, DNP, ACNP-BC, associate director of the Doctor of Nursing Program, director of the Post-Master’s/Systems Leadership Major, and associate director (CO-I) of the Johnson & Johnson Nurse Innovation Fellowship at the University of Pennsylvania School of Nursing in Philadelphia.

“The treatment plan may be medicine, but it’s really about lifestyle modifications, preventive care, patient education, using resources within the patient’s own realm to meet their needs, and understanding what the diagnosis means to that patient,” said Blumenthal.

Improving Outcomes in Older Patients

Casey Brown, DNP, AGPCNP-BC, RN, practices at the Duke Cancer Institute and is assistant clinical professor and director of the Adult-Gerontology Primary Care NP program at Duke University School of Nursing in Durham, North Carolina.

In her role, Brown cares for adults as they move through the aging spectrum and said she incorporates her primary care expertise into complex medical management of patients.

“As adult-gerontology primary care NPs, we are trained to provide comprehensive, patient-centered care that addresses both acute and chronic conditions,” said Brown.

“A patient may be coming in for a particular diagnosis, but we consider the entire physical, cognitive, and social picture so we can ultimately promote positive outcomes.”

Brown said that not only do adult-gerontology primary care nurse practitioners excel in symptom management, but also care coordination across multidisciplinary teams, mainly using an evidence-based framework — 4Ms — as a guide.

“We’re well-prepared to engage in difficult conversations with older adults — for example, discussing driving safety, functional decline, and end-of-life preferences,” she said, emphasizing the importance of how clinical knowledge is delivered, i.e., with empathy and respect for patient autonomy. Hence the 4Ms, core considerations that apply regardless of number/type of functional problems, or cultural, racial, ethnic, or religious identity or background:

Collaborative Care

Across the board, the experts Medscape Medical News spoke with expressed the joy associated with working with older adults.

“People who work with older adults tend to be happier and stay in their jobs longer; we love what we do,” said Maria Vejar, NP, RN, assistant professor of medicine-geriatrics at the University of Colorado-Anschutz and a geriatric NP at UCHealth Seniors Clinic - Anschutz Outpatient Pavilion in Aurora, Colorado.

Vejar attributed that joy, in part, to the ability to slow down, an attribute rarely associated with medicine today.

“The pull is that if you are doing it right, you’re not rushing — you’re listening, you’re pausing, you are learning as much from them as they are learning from you,” said Vejar. “This can be hard to do sometimes in medicine and in nursing because there’s so many commitments and priorities and tight schedules.”

Vejar said that some NPs might be hesitant to enter geriatric nursing due to a sense of fear around the complexity of the care.

“One of the things I tell them is none of us know it all. We utilize the expertise, support, and wisdom around us from our colleagues, we frequently have huddles where we discuss complicated patients, what’s working or not, and obtain their insight,” she said.

The Beacham Center for Geriatric Medicine at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, exemplifies this teamwork.

“Our clinic is unique in that we are very team-oriented and we fill in the gaps to where our patients don’t have to go to the emergency room if their doctor is not available that day,” said Regina Greco, CRNP, DNP, CPAFH, a geriatric NP and associate director at Beacham. “For example, if I have a patient with a specific need or urgent issue, we have team members that will cover in case I am out, and vice versa,” Greco said.

Blumenthal concurred, noting that regardless of the practice model, caring for older patients is a team sport.

“What I’ve always enjoyed about being an NP is the autonomy, and frankly, the efficiency of being able to be both a nurse RN and a diagnostician and treatment provider,” said Blumenthal.

“Even when you provide care independently, you’re still looking at an interdisciplinary team for a solution where you’re calling on dietitians and physical therapists and physicians and social workers, community resources. So it’s the nurse alongside the patient at the hub of planning for care,” she said.

Blumenthal, Brown, Vejar, and Greco reported no financial disclosures of interest.

Liz Scherer is an independent health/medical journalist and frequently reports for Medscape.

Home

Adult-Gerontology Nursing the Future of Elder Care