Marilyn Lopez, RN, MA, GNP-BC, was our first geriatric nurse specialist. Fascinated by the longevity of her grandparents—especially her grandmother, who lived independently until her late 90s—she is passionate about helping older people remain fully functional for as long as possible. The New York Times recently featured Lopez in an article about America's aging population. Caring for the elderly, she told the Times, "is a profession of the heart." To read the article, click here.
Does the term "elderly" still mean what it used to?
The U.S. government defines an "elderly" person as someone over the age of 65. But with aging baby boomers remaining so active, both physically and mentally, the term is now used more sparingly. We're only as old as we feel, after all, and many seniors don't feel elderly. We wouldn't consider people like Warren Buffett, who is 80, elderly. Or Senator John Glenn, who was healthy enough to be an astronaut at 77.
Late life brings its share of health challenges. Does it bring healthcare challenges as well?
Medical advances have enabled Americans to live longer, but that means coping with multiple chronic illnesses, increased frailty, and prolonged periods of dementia. Seniors find themselves seeing multiple doctors for different problems. As the numbers of clinicians increase, patients are likely to find it challenging to understand and remember the instructions they receive. They're also more likely to suffer adverse effects from drug interactions.
Which conditions typically bring older people to NYU Langone?
We're seeing an increasing number of high-risk geriatric patients. In 2008, 44% of our hospital discharges were 65 or older, excluding newborns and psychiatric patients. These numbers have increased even over the past three years. Typically, we see patients with multiple overlapping conditions who are on complex medication regimens. They exhibit dizziness, fainting, unsteadiness, delirium, dementia, frailty, and incontinence. These "geriatric syndromes" present complex diagnostic, pharmacologic, and nursing challenges.
What about aftercare?
It's important that families receive timely, accurate information to effectively participate in decision-making. Before discharge, our team prepares patients and their families to cope with chronic illnesses. Two to three days after discharge, our Geriatric Service follows up by phone to monitor that medications are being taken correctly, to reinforce skills taught at the bedside—for example, use of insulin or feeding tubes, wound care—and to ensure that appropriate resources, as well as equipment, are in place.
What makes you most proud of NYU Langone's geriatric care?
Our Geriatric Program is recognized as a "Magnet Exemplar" nationally because of its innovative, senior-friendly care. We are continuing to move up nationally in U.S. News and World Report rankings. Our dual focus on medical education and application of best practices enhances safety and improves outcomes for our patients. A Geriatric Resource Nurse (GRN) model has been in place at the Medical Center for more than a decade to ensure that vulnerable seniors receive specialized high-quality bedside care. Since 1997, we have been involved with Nurses Improving Care for Health system Elders (NICHE), which is a national Geriatric program of the John Hartford Foundation Institute for Geriatric Nursing at New York University (to read about NICHE click here). Additionally, a multidisciplinary geriatric consult team—attending geriatrician, geriatric nurse practitioner (GNP), geriatric fellow, and pharmacist—conducts comprehensive assessments of reversible medical conditions, reviews medication and treatment options, and monitors high-risk patients.
As our aging population increases, what will this mean for the healthcare profession?
Most seniors will require some medical care—it's just a question of when and to what extent. But nationally, only 1% of registered nurses are certified in the area of geriatrics, and there's only one geriatrician for every 2,500 Americans 75 or older. Most American medical schools still concentrate on training for critical care, but the aging population is more likely to require treatment for chronic diseases. Healthcare professionals will also need to focus more on prevention and treatment of risk factors.
In a society that values youth over age, what are the rewards of working with seniors?
Older people have a wealth of lifetime experience, and the wisdom that goes with it. They like nothing more than to share those experiences with our nurses, who take the time to create laughter and conversation with people who may be lonely and frightened. We learn so much from them, and helping them is a reward in itself—a true gift that comes with the job. Not only are you providing a valuable service, but it's an opportunity to learn more about yourself, particularly your own mortality. For many of us, caring for seniors is more than a commitment. It's a genuine calling.