Sarah H. Kagan PhD, RN
We live in the age of aging. Unprecedented longevity juxtaposed against declining birth rates means the older population is expanding at rates we have never encountered before. Aging defined in positive terms – “healthy aging” anyone? – is increasingly popular. But discussing realities like health care is far different.
Understanding realities of health and care in later life is often subject to misperception and myths. I spend a lot of time debunking myths of aging, but I think the myths of health care for older people are equally important to consider. My specialty of gerontological nursing is limited by several such myths. I hear it all the time: “Oh, you mean you work in a nursing home?”
Myth #1: Gerontological nurses always practice in nursing homes.
TRUTH: When gerontological nursing began to take shape as a specialty in the middle of the 20th century, nursing homes were where many nurses intent on caring older people practiced. But this practice setting was a feature of health care at the time – no Medicare as yet – and demographics – the average life expectancy in 1950 was 66 years for men and 71 years for women.
We are living longer than ever. In the US, we’ve gained about 20 years in average life expectancy since the turn of the century. It’s about 79 today. Already 65? Expect about another two decades. About 13% are older than 65 but only 4% live in nursing homes. Older people are the majority of patients in most health care settings outside of nursing homes. As a result, most nurses who aren’t pediatric specialists are de facto geriatric nurses, whether they acknowledge that reality or not.
Myth #2: Gerontological nursing and geriatric nursing are synonymous
TRUTH: Gerontological and geriatric are mistakenly used as synonyms. Gerontology is the study of aging, health, and function – classically divided into the domains of the biology, psychology, and sociology of aging. Geriatrics is the medical specialty that focuses on aging and on disease and disability associated with old age. Geriatric nursing grew out of necessity. Nurses were writing about care for older people in the American Journal of Nursing, trying to improve care for poor elders living in chronic hospitals and nursing homes.
Geriatric nursing paralleled geriatric medicine as each developed during the mid-20th century. With the rise of professional nursing and our metaparadigm’s emphasis on health, gerontological seemed better suited to reflect emphasis on health and function in later life. More recently, the distinction has been blurred but many still prefer gerontological, conscious of perspective and history.
Myth #3: Gerontological nurses’ patients inevitably decline in function and then die
TRUTH: While aging has long drawn the attention of scholars, from Confucius and Aristotle forward, the science of aging is a 20th century invention. Before modern geriatric and gerontological care, being old was a product of fate and time. Elders with means were cosseted at home while the aged poor were relegated to alms houses, poor houses, and later public chronic hospitals and nursing homes.
Images of debility, dependency, and tragic demise linger to this day. Listen and you’ll hear ageist imaginings of old age everywhere. You might believe ageist images of old age, that is until you reach a certain age or otherwise gain interest in contemporary realities of aging. Today, we know that frailty and conditions associated with old age are almost certainly epigenetic. Study daily life in America and you’ll quickly see that being 65 is not really old. Many of know nonagenarians and centenarians personally. As a result, most nurses are caring for many people who are considered older and are living full, often demanding lives. Nonetheless, the imagined universal dependency of old age persists.
Myth #4: Gerontological nursing is hard work and no fun
TRUTH: We continue in nursing to teach a largely mid-20th century curriculum where care of children is required knowledge and care of older people is generally elective content. Present demographics and epidemiology argue for exactly the opposite but we maintain this approach and inadvertently codify myths of aging.
Cultivating the specialty of geriatric nursing has incurred disadvantage. Nursing failed to adapt education and practice to demographic shifts and emerging science which clearly mandate making care for older people mandatory knowledge and competent practice. As a result, we struggle to model and reflect the real joys of caring for older patients, sadly implying stereotypes instead. Is it any wonder most enter nursing with an aim of becoming something other than a gerontological nurse?
Myth #5: Gerontological nursing is becoming obsolete
TRUTH: Gerontological nursing exists in a paradoxical limbo. Devised to address necessary care when growing old was far more unusual than it is today, generalist nurses attended elders just as they did other vulnerable patients. Now, in a time when the very old are the most rapidly growing demographic group, gerontological nursing seems in some ways more specialized than ever. Competing forces including proliferation of subspecialties in acute and other care settings, the rise of palliative care, and persistently low pay and low status accorded long term care and home health nurses, almost certainly detract from more considered analysis of nursing needs in our aging society.
We gerontological nurses may unintentionally add to our dilemma, defending our specialty and doing comparatively little to advance the broader cause of compulsory competence in care of older people. Nevertheless, by 2050 when 1 out of 5 Americans will be older than 65, the option to choose competence in care of older people really won’t exist. Nurses will – with the exception of specialists in care of younger people – be generalists in care of older people by default or choice. Specialist gerontological nurses will then have to support those generalists, striving to distribute their expertise to care for an enormous population of elders in the best way possible. With our universal hope to age well, I think we would better dispute the myths and turn current trends around to insure we have sufficient numbers of nurses competent to care our aging society.
Sarah H. Kagan, PhD, RN, FAAN is a gerontological nurse. She holds the Lucy Walker Honorary Term Chair as Professor of Gerontological Nursing at the University of Pennsylvania and practices in the Living Well Geriatric Oncology Program at Pennsylvania Hospital. Follow Sarah on Twitter @SarahHKagan and look for her Myths of Aging column at http://www.mysuncoast.com/health/kagan/.