April 21, 2016 by
Photography by Bill Sitzmann

Some people just don’t get it when it comes to the health of older adults. Many believe that elderly people are always tired. But that’s a myth.

“It’s also not true that an older person doesn’t have a brain that works as well,” says Sara Wolfson, geriatric nurse practitioner for the University of Nebraska Medical Center (UNMC) Home Instead Center for Successful Aging.

Myths such as these lead to ageism that can affect how older adults are treated (or under-treated) for illnesses.

A geriatric nurse can sort it out. This registered nurse specialist has the skills to recognize what’s normal for older adults versus what’s abnormal.

Beth Culross

Beth Culross

“We are really focused on looking at the process of aging and how we can help older adults maintain their  health and prevent health problems as they age. What is normal at age 80 might not be normal for 40 or 50,” says Dr. Beth Culross, an R.N. with a Ph.D. in gerontology. She teaches undergraduate gerontology at the UNMC College of Nursing in Omaha.

Geriatric nurses often function as case managers who help patients live with chronic illnesses, giving them a greater chance of staying independent and active.

“With case management, there are a lot of phone calls, checking on them, answering questions about medication, seeing how a visit to the ER went,” Wolfson explains.

She says it’s important to keep older adults out of hospitals. “Being in the hospital weakens people. It takes longer to recover. Some get confused. Older people have less reserve when they get sick.”

Geriatric nurses can be found working in hospitals, clinics, physicians’ offices, long-term care facilities—and in patients’ homes.

Senior Assist, a home-visit program for patients ages 65 and older whose primary care physician is with Nebraska Medicine, is available at no cost through the Home Instead Center for Successful Aging. Home visits give the nurse a look at the person’s living environment, and consequently gives them a clue to what is going on with their physical and mental health. 

“One nurse went to the home of a patient who was constantly coming here because of congestion and found she wasn’t using her nebulizer,” says Wolfson. “Home visits give a heads-up if someone is having a problem.”

UNMC’s Home Instead Center for Successful Aging offers seniors a wellness center, outpatient clinic, assessment, and education in topics as diverse as fall prevention,  nutrition, arthritis, and tai chi. Nurses provide education as mandated by Medicare—information about medications, like blood thinners, or about general health and nutrition, like cutting back on sodium.

“We’re a center for people who are aging well and people who have a lot of chronic illnesses that need to be managed,” Wolfson says. “We take walk-in patients. They might have a cold, feel dizzy or tired.”

The center also provides dementia evaluation and diagnosis.

“We wouldn’t diagnose dementia on the fact that their memory is bad. It’s based on function. Are they still independent?  Taking medications?  Or are they not bathing? Are their clothes tattered?” says Wolfson, who points out that there are other geriatric clinics available in the area.

As people live longer and the number of people over age 65 increases, more nurses specializing in geriatrics are needed.

By 2030, one in five adults—88 million people—will be 65 or older, according to the U.S. Census. About 10,000 adults turn 65 every day.

Sara Wolfson

Sara Wolfson

“Most of the hospitals in the Omaha area have started recognizing this,” Culross says. “These hospitals have special designations around the need for care for older adults.”

There is a shortage of nurses in general and—because the number of aging adults is increasing—there is especially a need for certified geriatric nurses.

Almost half of all patients admitted to hospitals are over 65, but only 1 percent of registered nurses and 3 percent of advanced practice registered nurses are certified in geriatrics, reports the American Geriatric Society.

Adults over 65 account for nearly 26 percent of all physician visits, 47 percent of all hospital stays, 34 percent of all prescriptions, 34 percent of all physical therapy patients, and 90 percent of all nursing home stays, according to the Eldercare Workforce Alliance.

By 2030, 7.7 million people will have Alzheimer’s disease, up from 4.9 million in 2007.

“The fastest growing segment of the population in the United States are people 85 and over,” Culross says.

Recognizing what’s normal and what’s not for an aging adult is important for a geriatric nurse. So is listening. Allowing patients to talk about their experiences and life stories tells where they are now and how she can help, says Culross.

“I learn as much from my patients as they do from me. My husband tells me I’m really good at it because I like to talk.”

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