More and more, it is becoming apparent that patients older than 65 are hospitals' "core business." Older patients constitute 48% of hospital discharges nationwide. Perhaps more importantly, we are slowly coming to appreciate that older patients are the predominant population in specialty areas of nursing practice; they make up 46% of patients in critical care, 63% of patients with cancer, and 60% of patient visits to cardiologists. The risk for poor outcomes for older patients who have medical comorbidities and for the subset of older patients with dementia is substantially higher than for younger adults.

Data are clear that when nurses are knowledgeable about best practices in the care of older patients, patients have improved outcomes in the hospital and have fewer complications and readmissions after discharge. Unfortunately, most nurses, and especially nurses working in specialty areas of practice, lack the necessary knowledge and competency in geriatric best practices.

For the past 5 years, the John A. Hartford Foundation Institute for Geriatric Nursing has focused their mission on assuring that every nurse has the requisite knowledge and competency to provide quality care to the older individuals who come under their care. In recognition of the contribution of nurses who belong to specialty nursing associations, the Hartford Institute developed programs to serve the approximately 400,000 nurses who represent more than 50 specialties that predominantly serve older patients. The programs and materials available to specialty nurses can be found on the Hartford Institute Web site (http://hartfordign.org). As of September 2002, The Atlantic Philanthropies has provided a 5-year grant to the American Nurses Foundation to create a strategic alliance between the American Nurses Association, the American Nurses Credentialing Center, and the Hartford Institute to markedly increase the dissemination of geriatric content to specialty nurses and specialty nursing associations. Activities currently in progress under this grant include competitive funding for specialty associations to move forward with initiating geriatric nursing activities, the creation of a Web site to foster information dissemination, and a certification campaign to recognize specialty nursing preparation in the care of older patients.

Thus, it is important to recognize the ground-breaking efforts of the Infusion Nurses Society on behalf of their older patients. The majority of the 5200 members of INS interact daily with older patients in ambulatory, inpatient, and homecare settings. Because many of these patients are extremely frail, administration of nutritional support is critical to their recovery and to their survival. With INS' one-day educational workshop on Elder Care offered this year and the special focus on older patients in this issue of the Journal, INS has taken a critical step as a nursing specialty association. Recognizing the unique needs of older patients who come under their care places INS at the forefront of nursing organizations addressing the overall needs of older patients. The focus on early nutritional screening and pain management of older adults in this issue of the Journal addresses areas of critical importance to the care of older patients. Unfortunately, as nurses, we know of instances where optimum nutrition and pain management has been denied to older patients due to ignorance and ageism on the part of healthcare providers.

We are confident that these important initial steps will stimulate INS to further their efforts to assure that their members are fully prepared to address the hydration and nutritional needs of their elderly patients. The Hartford Institute is committed to helping to further these efforts in any way it can.