By Megan Malugani
January 27, 2000
Photo: Corbis

Most nursing schools aren’t making the grade when it comes to preparing students to care for older Americans. The typical patient today is 65 or older, and the elderly make up the fastest-growing segment of the population. Those over 65 represent only 12.8 percent of the American population but account for more than 60 percent of ambulatory adult primary visits, 80 percent of home care visits, 48 percent of hospital patients, and 85 percent of nursing home residents, according to the John A. Hartford Foundation Institute for Geriatric Nursing at New York University.

Despite this, only one in three baccalaureate nursing programs have faculty prepared to teach gerontological curriculum, and only one in four schools require a stand-alone course in gerontology, according to a survey published in the Journal of Professional Nursing last year.

Unique needs

Nursing schools cite overloaded curricula as the top reason they don’t require courses in gerontology, and they maintain that gerontological content is included in other courses. But researchers say schools aren’t giving a high enough priority to the unique healthcare needs of the elderly.

"There is a general sense that everyone takes care of the elderly and that there is no specialized body of content that applies to the elderly—that’s not true," said Mathy Mezey, EdD, RN, FAAN, director of the Hartford Institute, which funded the study and recently developed a series of videotapes, slides, and other materials intended to make it easier for BSN programs to incorporate gerontologic content into their curricula. "The information is out there. It’s a matter of nursing schools committing to more education on the elderly."

For example, students should be educated on age-specific topics such as functional and mental status assessment of the elderly and prevention and assessment of falls, Mezey said. They should also learn about the use of physical restraints, the management of urinary tract incontinence, and the treatment of pressure ulcers.

In addition, nursing students should be learning to care for the elderly in settings throughout the healthcare continuum, not just hospitals, said Dolores Alford, PhD, RN, FAAN, a gerontic nursing consultant in Dallas. "One of the tragedies with the current nursing curriculum is that it’s still in the traditional acute care medical model. We need to change the focus to wellness and health promotion and helping people deal with chronic illnesses as they age," Alford said. "Hospitals aren’t the main setting where nurses will work with the elderly."

Too few with expertise

Gerontology is still a relatively small nursing specialty, which may be another reason nursing schools haven’t emphasized elder care more. Less than one half of 1 percent of the total RN population have credentials as gerontological nurses or are prepared in gerontology at the master’s or doctoral level, according to last year’s survey.

"There aren’t enough people to teach it or role model it as a good career," said Neville Strumpf, PhD, RN, FAAN, professor and director of the gerontologic nurse practitioner program at the University of Pennsylvania School of Nursing in Philadelphia. "We have to make sure that more people are trained in gerontology at all levels," Strumpf said. "A good teacher will make gerontology fun and exciting for students."

Given the chance, nursing students will recognize that working with the elderly can be rewarding and challenging. "The elderly have so much to teach us," Alford said.

A requirement of the job

Making gerontology a required course—like pediatrics or community health—is logical because the class would expose students to the population they are most likely to care for over the course of their careers, experts say. Besides lobbying for more gerontologic education in nursing schools, Mezey and other gerontologic nursing advocates are encouraging organizations that accredit nursing schools to revise accreditation standards to reflect the importance of gerontologic content. They’re also recommending that more questions on the NCLEX-RN center on care of the elderly.

Gerontological nursing has advanced considerably in recent decades, Alford said. "In spite of the problems getting gerontological content into nursing curricula, we’re doing a better job of it than other professions. There is even less [elder care content] in schools of medicine, physical therapy, and social work."