My mother, Ann Mason, died in March. She was 79. For much of her last three decades, her ever-present complaints challenged her health care providers-back pain, bladder problems, headaches, skin irritations, as well as depression that surely must have exacerbated some of her other ailments. About a year before she died my mother was diagnosed with mild dementia; as it progressed she had fewer complaints and became more pleasant, which forced me to question my long-standing belief that dementia is always horrific.
Our society is ashamed of such conditions and of aging itself. President Reagan's family has been criticized for hiding his Alzheimer disease from public view and refusing to discuss its progression, but this is commonplace. It's true that older adults may be living longer but they aren't necessarily living healthfully, according to the State of Aging and Health in America, a report from the Gerontological Society of America (GSA). "Since 1990," it says, "healthy life expectancy (the number of healthy years after age 65) has remained at about 12 years-below the Healthy People 2000 target of 14 years for 2000." The report concludes that further improvements depend upon exercise, diet, quitting smoking, preventing falls, and other preventive services.
The young aren't the only ones dreading aging. A study by Sarkisian and colleagues in the November 2002 issue of the Journal of the American Geriatrics Society found that the majority of more than 400 randomly selected older adults associated aging with depression, incontinence, and dependency, among other things, even though those conditions often can be prevented or managed. Those who held the lowest expectations of aging didn't think it was important to seek care for these conditions.
Nursing may be the most trusted profession, but nurses' knowledge and skill in geriatrics are not what they need to be. For example, studies by nurse researchers Lois Evans, Mary Naylor, and others show that older adults cared for by nurses with expertise in geriatrics are less likely to be restrained and readmitted to the hospital. And yet fewer than 1% of nurses are certified in geriatrics, even though most nurses have frequent clinical contact with older adults.
Older adults account for almost half of all days of hospitalization, 69% of home care, and 83% of skilled nursing facility care. Competency in geriatrics is therefore a priority for nurses nationwide. AJN has partnered with the GSA, with support from the John A. Hartford Foundation Institute for Geriatric Nursing, in a three-year project, funded by Atlantic Philanthropies, featuring a bimonthly series of continuing education articles called A New Look at the Old. It launches in this issue. We'll also feature the work of the GSA (see page 28), and we've asked column coordinators to increase their focus on older adults.
Our project's advisory committee struggled with the decision on how to illustrate the series. The committee wants to depict the vibrancy of aging-and this month's cover does so beautifully-so that nurses will want to learn about geriatrics. But we can't distort the true picture of old age when disease strikes and debilitation results. Whether nurses develop knowledge, skill, and compassion in their work can't depend upon the vitality of their patients.
When you're old, you won't want to be kept in diapers because a facility's staffing is inadequate and the available clinicians don't know how to establish a toileting program. Are you caring for your older patients in the way you will want to be cared for? Are you a model for the younger nurses who will be caring for us?
By the time I'm 65, in 10 years, will I be deemed a throw-away-demeaned, disparaged, and dismissed-because I'm "elderly"? In many cultures, a community's elders are respected for their wisdom and cared for with love. I want to grow old in a culture in which aging is an honor, regardless of whether one is vibrant or sick. Maybe it's up to nurses to restore dignity to the care of the aged-in sickness and in health.