ABSTRACT
I. CLINICAL RELEVANCE A. Need for Acute Care Geriatric Nursing The demographic trends that have swept the United States have had a profound effect on acute and critical care nursing of the elderly. In the 1970s, no journals were specifically focused on geriatric nursing, and within the existing journals, most geriatric nursing articles dealt with long-term care issues. Intensive care of the elderly was considered a nonissue. New treatments and equipment-ventilators, defibrillators, and bypass machines-were changing the nature of hospital nursing practice, but elderly patients were not routinely treated with these therapies. Lack of experience with how an older person might fare under such care may have contributed to the situation, but such scarcely available, extreme measures were also saved for younger more ‘‘viable’’ patients. Medical or societal taboos with regard to triaging out older patients were minimal, and policies for
intensive care unit (ICU) admission, so named for the increased ratio of nurses to patients, openly reflected age biases. For example, as recently as 1970, age was used as an exclusion criterion for open-heart surgery (1). At present, such biases might exist, but they are certainly not stated overtly, and indeed might be the cause of litigation if they were. The reality today is that more than 65% of ICU beds are occupied by patients aged 65 years and older. More than one third of older adults in the United States are admitted and discharged from an acute care hospital each year, and between 6% and 45% of those people are likely to experience at least one untoward event while hospitalized (2). Despite the fact that so many critical care patients are elderly, nurses, including acute care and critical care nurses, have received little, if any, formal preparation in geriatrics. This chapter will discuss the importance of geriatric nursing knowledge in acute and critical care nursing. Information regarding nurses’ current preparation to care for elderly patients in the critical care setting will be presented. Models of nursing care for geriatric patients in the acute and critical care setting that have been developed to meet the needs of elders in the hospital will be described. To support these models, institutional assessment strategies and care protocols will also be presented.
