As our nation faces tough economic challenges, none looms so foreboding as the wave of older Americans, ready to flood our healthcare system. Simply "gearing up" existing systems to address the explosive demand will not be enough. New, bold ideas are essential. New, creative approaches to health promotion, disease prevention, and chronic disease management are the solutions our country needs.
Assembled in this issue are some of the creative approaches and bold ideas to consider and implement in our healthcare system to meet the needs and demands of older Americans. The lead article challenges nurses to advocate for meaningful change in the healthcare reform debate that will meet the current and future needs of older adults. The next 2 articles address the pivotal role of the director of nursing in nursing homes and a new approach to leadership development for nurses who work in long-term care settings. The fourth article is a research article revealing the effectiveness of nurse care managers who work with patients with multiple chronic diseases in primary care settings; this nurse partnership approach could be a solution to costly, complicated chronic disease management. The fifth article illustrates the application of relationship-based care as an elderly couple transitions from independently living at home to end-of-life care; this illustration is one that many would hope could be their story. Next, the evidence for fall management in a variety of healthcare settings is concisely presented for nursing administrators who are often perplexed by these costly adverse events. Then, the results of a pilot study about a creative, dance-based intervention to reduce fall risk in frail older people; this one could be of interest to many, both young and old. The next article is about a highly prevalent clinical problem among frail older people, pressure ulcers in nursing homes. This research article points to the need for long-term care leadership to develop systems of care to ensure the use of pressure ulcer prevention guidelines (amazingly, after many years with clinical guidelines to prevent pressure ulcers, they are not widely used in nursing homes). Assisted living is a rapidly expanding long-term care setting, but few RNs are present in this setting and delegation of medication administration is state-specific and complex; this article explains the complexity of nurse delegation in assisted living and provides recommendations for practice and esearch.
The final article is an exciting example of a new, creative approach to health promotion, chronic disease management, primary care services, long-term care services, new business opportunities, and senior housing. Bold ideas address the complex problems of inner-city hospital closures and economic decline; these ideas have resulted in new, positive community development and healthcare services. Such bold ideas shed rays of hope and life for the future as we embrace the aging wave.
Marilyn J. Rantz, PhD, RN, FAAN
Professor, Sinclair School of Nursing Associate Director MU Interdisciplinary Center on Aging University of Missouri, Columbia E-mail: [email protected]