Geriatric Patient Care: An Overview

Geriatrics, the field of medicine that deals with aging concerns, has been in existence since the 19th century. Described as “the last real frontier in medicine,” by Dr. Mike Wasserman, the field of geriatrics emphasizes the patient or resident in a way that other medical practices do not. Unfortunately, a lack of funding and poor representation of the nature of work are turning medical students away from geriatrics. Wasserman joined Peter Murphy Lewis on the LTC Heroes podcast to discuss the challenges facing geriatrics and where it needs to go to fulfill the needs of a rising senior population.

In this article, we will share a brief overview of the history of geriatrics, discuss geriatric patient care, and provide a list of potential careers in the field. Special attention will be given to geriatric nursing, its significance to long term care facilities, and the means by which one can enter this profession. We will then discuss the great need for more medical students entering the field of geriatrics and what has to change for that to happen. 

The History of Geriatrics

Although intellectuals have been studying old age since ancient times, the term “geriatrics” was not invented until the 20th century. Furthermore, geriatrics has only been a recognized medical field in the U.S. for about forty years. Here are some of the most significant events from the history of geriatrics in the U.S.

• 1942: the American Geriatrics Society is founded
• 1966: Dr. Les Libow establishes the first fellowship in geriatric medicine
• 1976: The first Geriatric Research, Education and Clinical Centers (GRECCs) are founded by the Veterans Administration. 
• 1977: Cornell University establishes the first geriatrics professorship
• 1982: Mount Sinai Medical School creates the first department of geriatrics
• 1988: The first certification exam for geriatric medicine is administered

Geriatrics Today

Since the introduction of geriatrics to the United States, the field has “really has struggled to gain a lot of traction,” said Wasserman. He explained that there are only about 7,000 board-certified geriatricians in the U.S. today, a number that has fallen from a peak of 14,000 in the 1990s. Wasserman highlights three reasons for this drastic decline of geriatric professionals:

1. Low Reimbursement: Geriatricians are paid lower than other doctors, with 6.6% less lifetime earnings than primary care physicians. In his conversation with Lewis, Wasserman recalled a fellow geriatrician’s anecdote about applying for a job: “When she told them, ‘I’m also boarded in geriatrics in addition to internal medicine,’ they reduced their offer by $10,000.”
2. Negative Experiences in Medical School: Wasserman explained that many students choose their future specialty based on mentors and role models, but these individuals are scarce in geriatric medical programs. Having no one to look up to, students lack the inspiration to enter the field. Additionally, “a lot of medical students and residents deal with the sickest, most frail people,” Wasserman remarked, giving them only a partial perception of practicing geriatrics. In reality, working with older individuals and getting to know them and their stories can be a fulfilling experience, but medical programs fail to provide students with this insight, leading them to stray away from geriatrics. In fact, only 0.57% of medical students ultimately decide on pursuing geriatrics.

3. Lack of Government Funding for Geriatric Education: One reason for the negative medical education experiences is a lack of funding for geriatric programs. Each year, the government spends $10 billion to support medical education, but almost none of that amount goes toward geriatric training, Wasserman told Lewis. To make matters worse, the source of the funding is the Medicare Trust Fund. “We’re using taxpayer dollars that were supposed to be spent on Medicare to teach doctors how not to take care of older adults,” stated Wasserman.

Caring For Geriatric Patients

The type of care given by geriatrics is known as “person centered care.” This entails recognizing the uniqueness of each patient and their needs as well as ensuring they are treated with dignity. The person centered approach is paramount to the field of geriatrics because it highlights an understanding that those being cared for have been through a lot in their lifetime and deserve to be treated with respect.

Geriatric professionals assess the effects of a treatment plan on all aspects of a patient’s life, not just whether the treatment is helping with a medical condition. “Those of us in the field of geriatrics focus on function and quality of life,” Wasserman said. That means including patients or residents in the process of making medical decisions to give elders a sense of empowerment and autonomy over their health care. Rather than simply instructing a patient or resident to adhere to a care plan, a geriatrician will comprehensively go over the plan with the elder, ensuring that all aspects of the plan align with his or her lifestyle and cultural preferences. If not, the patient, resident, or family would be free to detail any concerns or make suggestions that could help the doctor create a more suitable plan.

Geriatric Careers in LTC Facilities

As the number of senior citizens in America rises, so does the need for long term and acute care for the elderly. As Wasserman puts it, “We as a society need more people in the field of geriatrics.” Moreover, working as a geriatric professional can be a highly rewarding career. Not only can you help elders in a medical capacity, but you can also brighten their lives by providing them friendship during an otherwise lonely or distressing time. If you are interested in helping improve the lives of older adults, the field of geriatrics offers several opportunities for working in long term care facilities, including being a: 

Geriatrician – A doctor who specializes in assessing and treating the health of older adults. Geriatricians are different from other medical specialists because they often treat individuals who can have over 10 health conditions. Moreover, because geriatrics uses a person centered approach to care, the methods of treatment employed can vary based on the individual patient or resident. This is why, as Wasserman puts it, geriatricians are like “chess grandmasters,” having to recognize patterns and make multiple considerations before coming to a decision. Geriatricians can be found in hospitals, research centers, or long term care facilities.

Geriatric Pharmacist – A pharmacist with specialized knowledge of medication and care plans for the elderly. Compared to regular pharmacists, who may only have general knowledge regarding the effects of medication on the older population, geriatric pharmacists go through additional training and certification and are specially trained to prescribe medications to older adults and assess the impact on their health. Like geriatricians, geriatric pharmacists often work with seniors who have several medical conditions and must take multiple medications a day. Geriatric pharmacists can work in assisted living facilities or skilled nursing facilities. 

Geriatric Nurse – This is a registered nurse who has received extra training to care for elders on a daily basis. Geriatric nurses are well versed about illnesses more prevalent in older adults, such as diabetes and dementia, and can work with elders to deal with concerns regarding aging. Their responsibilities range from providing assistance with everyday tasks, such as eating, to curating and managing care plans for residents. Thus, the geriatric nurse is a vital part of the geriatric field, providing person centered long term care to the elderly in facilities across America. 

Gerontological Nursing

We will now further examine gerontological nursing or geriatric nursing, a critical component of long term care facilities. Geriatric nurses work alongside doctors, therapists, and other nurses in caring for residents with chronic conditions or disabilities resulting from old age. The geriatric nurse’s responsibilities include assessing the resident’s condition and ensuring that resident needs are met. Daily tasks include taking vitals and assisting residents with eating, dressing, toileting, and bathing. Additionally, geriatric nurses are expected to record resident information daily into an EHR system.

How to become a geriatric nurse

With fewer than 1% of registered nurses being geriatrics certified, the demand for geriatric nurses is high. By 2026, it is expected that another 400,000 gerontological nurses will be needed to fulfill the demand. And with life expectancy on the rise across the world, the need for geriatric nurses is only going to get higher. If you are interested in taking advantage of this great demand and caring for the growing population of older adults, follow these steps to become a geriatric nurse:

• Become a registered nurse (RN) by completing a nursing program and passing the NCLEX-RN.
• Obtain certification from the American Nurses Credentialing Center (ANCC), which requires the following:
  • Two years of experience as an RN
  • Over three years and 2,000 hours in gerontological nursing training
  • Completing a three-year gerontological nursing educational program

Aside from practical and academic experience, geriatric nursing requires patience, empathy, and tenacity. Nursing in long term care facilities often involves long hours caring for residents who might be unable to fully communicate their needs. It is a difficult occupation, but many who have worked in the field have reported that it is a fulfilling experience to form bonds with the elderly and make a positive impact on their lives.

The Future of Geriatrics

As previously discussed, geriatrics in the United States has seen slow growth, and even a decline, in the last several decades. Unfortunately, if nothing changes, this will remain the case going into the future. According to an article in The Journal of Nutrition, Health & Aging, the geriatrician to elder adult ratio is expected to decrease to 1:4254 in 2030, down from 1:2546 in 1985. If we want to ensure that future generations of older adults are well cared for, this deficit must be addressed.

To meet demand, it is expected that 36,000 geriatricians will be needed in 2030. This means that the United States must see about a 500% growth in geriatricians over the next 9 years. While this might be too lofty of a goal, even a small increase will be beneficial, so it is still imperative that changes are made to encourage today’s medical students to become geriatricians. We can motivate medical students to enter the field of geriatrics by: 

• Increasing pay of geriatricians
• Increasing government funding of geriatric education programs
• Reforming geriatric education to highlight the positive and fulfilling aspects of this career path

Innovation 

With the constant advent of new technologies and increased automation, the practice of geriatrics in nursing homes may radically change in the future. During his discussion with Lewis, Wasserman offered some of his own ideas of possible advancements that we could see. In the same way that Amazon Go Grocery Stores have sensors detecting the movement of customers, Wasserman predicts that nursing homes in the future will be equipped with devices that automatically document all aspects of care that a resident receives, making it possible for a doctor or nurse to focus their attention solely on the resident and not worry about writing down information.

This technology – already being used by Amazon – could be used in LTC today if there was more of an emphasis on providing care, opined Wasserman. He said that many present EHR technologies are “solely based on billing and maximizing revenue, and not focused on delivering care.” Thus, in order for technology to provide maximum benefit to residents, there needs to be a disconnect between financials and resident care. “When we uncouple billing from the technology, and we focus technology on actually improving care, I think we could make great strides,” Wasserman said. Fortunately, progress is already being made at Experience Care. Our key performance indicator (KPI) dashboard lets you view tens of items like census, vitals, care delivery, documentation, and diagnoses at a glance so that you can better manage resident care. 

Summary

Geriatrics is a fairly new medical field that addresses concerns related to aging using a person centered approach. Today, there is a shortage in geriatric professionals that is projected to only get worse in the next decade. Due to a growing number of elders, the demand for geriatric careers is high. There are several opportunities available in the field, many of which are in long term care, where geriatric nurses are required for residents to receive daily assistance and care. The path to becoming a geriatric nurse involves participation in academic programs, training, and certification from the ANCC. Working in geriatrics may appear challenging, but if you have a real passion for caring for seniors, it can be a truly gratifying experience.

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