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Labors of Love
pEvery day for the next twenty years, more than 10,000 people in the United States will turn 65. With life expectancies increasing as well, many of these Americans will eventually require round-the-clock attention—and we have only begun to prepare for the challenge of caring for them. In Labors of Love, Jason Rodriquez examines the world of the fast-growing elder care industry, providing a nuanced and balanced portrait of the day-to-day lives of the people and organizations that devote their time to supporting America’s aging population. Through extensive ethnographic research, interviews with staff and management, and analysis of internal documents, Rodriquez explores the inner workings of two different nursing homes—one for-profit and one non-profit—to understand the connections among the administrative regulations, the professional requirements, and the type of care provided in both types of facilities. He reveals a variety of challenges that nursing home care workers face day to day: battles over the budget; the administrative hurdles of Medicaid and Medicare; the employees’ struggle to balance financial stability and compassionate care for residents. Yet, Rodriquez argues, nursing home workers give meaning and dignity to their work by building emotional attachments to residents and their care. An unprecedented study, Labors of Love brings new insight into the underlying structures of a crucial and expanding sector of the American health care system./p
eBook
High prevalence of geriatric syndromes in older adults
The geriatric syndromes of frailty, sarcopenia, weight loss, and dementia are highly prevalent in elderly individuals across all care continuums. Despite their deleterious impact on quality of life, disability, and mortality in older adults, they are frequently under-recognized. At Saint Louis University, the Rapid Geriatric Assessment (RGA) was developed as a brief screening tool to identify these four geriatric syndromes.
From 2015-2019, the RGA, comprised of the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS) tools and a question on Advance Directives, was administered to 11,344 individuals ≥ 65 years of age across Missouri in community, office-based, hospital, Programs of All-Inclusive Care for the Elderly (PACE), and nursing home care settings. Standard statistical methods were used to calculate the prevalence of frailty, sarcopenia, weight loss, and dementia across the sample.
Among the 11,344 individuals screened by the RGA, 41.0% and 30.4% met the screening criteria for pre-frailty and frailty respectively, 42.9% met the screening criteria for sarcopenia, 29.3% were anorectic and at risk for weight loss, and 28.1% screened positive for dementia. The prevalence of frailty, risk for weight loss, sarcopenia, and dementia increased with age and decreased when hospitalized patients and those in the PACE program or nursing home were excluded.
Using the RGA as a valid screening tool, the prevalence of one or more of the geriatric syndromes of frailty, sarcopenia, weight loss, and dementia in older adults across all care continuums is quite high. Management approaches exist for each of these syndromes that can improve outcomes. It is suggested that the brief RGA screening tool be administered to persons 65 and older yearly as part of the Medicare Annual Wellness Visit.
Journal Article
From the Past to Present to Create a Workforce for the Future: The Teaching Nursing Home Collaborative
The Teaching Nursing Home (TNH) initiative exposes future nurses to career opportunities and ignites excitement around working with older adults living in nursing homes (NHs). The NH environment remains an important setting for teaching students about the complex needs of older adults. Fostering strong partnerships between nursing programs and NHs enhances the educational experience for not only students and faculty, but NH staff. As part of the revitalized TNH collaborative, evidence-based frameworks, including experiential learning, person-centered care, the American Association of Colleges of Nursing Essentials, and Age-Friendly Care, are used to enhance nursing education and improve care in NHs. The TNH initiative has proven to be a transformative approach to nursing education and plays a vital role in addressing the growing needs of the aging population to ensure a more competent nursing workforce. [Journal of Gerontological Nursing, 50(12), 47–49.]
Journal Article
Clinical Course Development on Age-Friendly Health Systems 4Ms Care in Nursing Homes
Background:
As the United States population ages, there is an urgent need to prepare nurses specialized in geriatric care, particularly in long-term care. Clinical curricula in nursing homes (NH) are needed to enhance geriatric training for prelicensure students.
Method:
An 8-week (5 hours per week), 1-credit elective clinical course based on the Age-Friendly Health Systems (AFHS) 4Ms framework was developed and implemented through an academic-practice partnership with an NH. Undergraduate nursing students engaged in weekly learning activities and developed a case study applying the 4Ms. Evaluation included pre- and postcourse surveys of student and faculty competency ratings.
Results:
Postcourse data showed positive trends in student competency, especially in clinical assessment skills and person-centered care. Qualitative feedback highlighted improved understanding of geriatric care and nurse-resident relationships.
Conclusion:
The AFHS 4Ms-based course demonstrates NH can be effective clinical learning environments. Structured and competency-based curricula can enhance student preparedness for geriatric nursing.
Journal Article
The Impact of Emergency Department Geriatric Nurse Practitioners on Patient Length of Stay
Limited research exists that examines the impact of geriatric-focused nurse practitioners practicing within United States emergency departments on the reduction of inpatient admission length of stay for older patients. This represents a significant gap in the provision of care. Our study aimed to assess the efficacy of geriatric-focused nurse practitioners’ integration into an emergency department setting and the subsequent effect on the length of stay of inpatient hospital admissions.
We conducted a retrospective analysis of medical records for patients aged ≥65 years from a large, private, not-for-profit, urban hospital emergency department. Data on ED encounters were collected from the year 2023 and aggregated based on patients’ age, inpatient hospital admission, and whether they were assigned to a geriatric-focused nurse practitioner while in the emergency department. To investigate the differences in inpatient admission length of stay between geriatric patients assessed and treated by geriatric-focused nurse practitioners and those who were not, we needed to establish confounders that could contribute to the patient’s length of stay. We conducted a causal effect identification model and identified 4 confounding variables, which were adjusted for during our analysis.
Findings indicated that patients receiving consultations by geriatric-focused nurse practitioners in the emergency department had a statistically significant reduction in their inpatient length of stay. The unadjusted mean admission length of stay reduced to 5.86 days from 7.28 days, with an unadjusted median reduced to 4.63 days from 4.95 days. We used a multivariable linear regression model using log-transformed length of stay adjusted for confusion assessment method score, mobility score, polypharmacy status, and triage acuity. Data showed that geriatric-focused nurse practitioners’ consultations with older patients within the emergency department resulted in a 10.3% reduction in admission length of stay (95% CI, 1.95-17.93).
Geriatric-focused nurse practitioners in the emergency department led to a substantial decrease in inpatient lengths of stay.
Journal Article
Getting Connected: Experiential Dementia Skills Training
Purpose
Getting Connected: Experiential Dementia Skills Training, based on the Positive Approach to Care® model, was implemented to bridge the gap between knowledge and skills to determine whether nursing students feel more comfortable and prepared to care for persons living with dementia (PLWD).
Method
The study examined the impact of experiential dementia skills training on nursing students' knowledge, comfort, and confidence when interacting with PLWD. The training was conducted at a 4-year pre-licensure, Bachelor of Science Nursing program in rural Southeast United States, where 62 sophomore students completed a 6-hour dementia skills training. Participation in the study was voluntary. Students were given pre-and posttests, with the dementia skills training serving as the intervention. Thirty-two students completed pre- and posttests, measuring knowledge, comfort, and confidence.
Results
Findings showed the training enhanced students' knowledge of dementia and communication approaches; however, they did not feel more confident or comfortable interacting with PLWD immediately following the training.
Conclusion
The Getting Connected: Experiential Dementia Skills Training using the Positive Approach to Care® model can be a useful approach for teaching nursing students about the lived experience of dementia and beneficial in helping them acquire knowledge and communication strategies for caring for PLWD. [Journal of Gerontological Nursing, xx(x), xx–xx.]
Journal Article
Applying the Age-Friendly Health Systems Framework to Promote Adoption and Sustainability of Interventions for Older Adults in the Intensive Care Unit
Older adults hospitalized in an intensive care unit (ICU) frequently experience adverse outcomes, including delirium, functional decline, medication-related harm, and goal-discordant care. Despite the availability of evidence-based interventions to address these risks, adoption and sustained implementation remain limited. The Age-Friendly Health Systems 4Ms Framework offers a policy-aligned structure for advancing adoption and sustainability of gerontological nursing interventions in the ICU. The Centers for Medicare & Medicaid Services announcement of the 2025 Age-Friendly Hospital Measure marks a turning point: hospitals will be incentivized to deliver care integrated with the 4Ms (What Matters, Medication, Mentation, and Mobility) to older adults. The introduction of this new measure presents a timely opportunity to align innovative gerontological nursing interventions with institutional quality goals. Grounding interventions in the 4Ms will facilitate engagement with key stakeholders, including frontline health care providers and hospital leadership, who are essential to the adoption and sustainability of age-friendly critical care for older adult patients in the ICU.
Journal Article
Impact of Transitional Experiences on the Preparedness of Internationally Educated Nurses to Provide Care for Older Adults in U.S. Long-Term Care Settings: A Qualitative Study
Purpose
To explore the transitional experiences of internationally educated nurses (IENs) in U.S. long-term care (LTC) settings, focusing on their preparedness to provide care for older adults and the perceived quality of professional development opportunities.
Method
A qualitative descriptive methodology was used with 22 IENs from eight countries participating in semi-structured interviews. Braun and Clarke's thematic analysis framework integrated inductive and deductive approaches.
Results
Two key themes emerged from the analysis—Preparation for Care of Older Adults and Navigating Professional Growth. IENs with prior gerontological care experience felt more prepared for LTC roles. Professional development opportunities varied significantly, with many participants citing inadequate ongoing training. Findings suggest that a comprehensive clinical orientation program and ongoing professional development opportunities are essential for IENs to succeed in LTC facilities.
Conclusion
Findings underscore the importance of comprehensive orientation and structured, continuous professional development tailored to IENs' needs. Enhanced support systems could improve IEN integration, care quality, and workforce retention in U.S. LTC settings.
Journal Article
Using Goal Achievement as an Outcome Measure Following a Gero-Oncology Educational Program for Oncology Nurses: The GrOW Curriculum
This article describes the qualitative analysis of goal achievement by oncology nurses who attended a gero-oncology course.
Four annual programs were completed and included 140 teams of oncology nurses from cancer settings across the United States.
Self-determination theory and achievement goal theory provided the conceptual framework for understanding what motivates people to achieve goals and how goals can measure outcomes. SMART goals were used to measure outcomes and barriers.
Goal achievement at 18 months showed that 70% of developed goals were in process or completed. The top three goal categories were professional education, structure/team building, and resource development. Top barriers included time constraints and staffing shortages.
Encouraging oncology nurses to set specific goals while attending an educational program supports successful integration of new knowledge in their practice setting.
Journal Article