As baby boomers age, shortage of geriatric care looms - East Valley Tribune: Business

As baby boomers age, shortage of geriatric care looms

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Posted: Saturday, March 19, 2011 10:00 am

Retired corporate executive George Gabel, 72, regularly sits at his computer and chats via videoconferencing about how exercise has helped ease his type 2 diabetes symptoms.

In a research center at the University of California-Davis Health Science Center, Sheridan Miyamoto coaches and encourages him.

In a small way, the two are pioneering the geriatric care of the future.

As a registered nurse, Miyamoto has worked in a family practice clinic and a child abuse clinic. But as a doctoral student at UC Davis' Betty Irene Moore School of Nursing, she's learning that gerontology is a core discipline of health care.

"So much of what we look at in class is this rapidly aging population we have and the burden of chronic disease," said Miyamoto, 38. "There are demands for all of us to know about the geriatric population and change health care so it can be really accessible."

With 75 million baby boomers edging into their years of greatest health care usage -- and with the number of geriatrics physicians steadily declining -- registered nurses are stepping up to fill the need.

Doing so requires not only a significant statistical shift in the nursing work force but also a cultural shift in the way patients and medical staff view delivery of health care.

"The majority of people in the hospital or in care homes or in ambulatory care settings are over 65," said Heather Young, the nursing school's founding dean and associate vice chancellor.

"It's required in nursing courses that you have pediatrics training and know about pregnant women. Why is gerontology not required? That's what's got to change, that narrow view of what's fundamental."

A nationally known expert in gerontological nursing, Young insists on maintaining a strong focus on aging in her school's curriculum.

And she stresses the need for new health care strategies -- telehealth clinics for routine blood pressure checks, for example, and regular health coaching for people just out of the hospital -- in which nurses can help meet the needs of a new and more demanding generation of older health consumers.

Gabel's videoconference sessions with Miyamoto are part of a nursing school research project monitoring diabetes patients in rural areas. The program could easily be adapted for cardiac care and other chronic diseases.

"In a clinical environment, every patient doesn't need to see a doctor every time," said Cheryl Phillips, a Sacramento geriatric physician and chief medical officer for On Lok, an elder care consortium in the San Francisco area.

"Successful geriatrics is best delivered as a team sport. The expertise that nurses bring in collaboration with physicians creates a much better process. Wellness, disease management and patient and caregiver education can be done in many ways better by a nurse."

Will there be enough nurses to do the work? After all, they're growing older, too.

More than 25 percent of registered nurses are already in their 50s, according to the federal Division of Nursing, and 55 percent of boomer generation nurses plan to retire by the end of this decade.

The recession has temporarily eased the nursing shortage, simply because a decline in pensions and investments has kept older nurses in the work force longer than many expected.

Some experts project more than 260,000 unfilled nursing jobs across the country within the next 15 years, on top of the estimated 8.5 percent of nursing positions that the U.S. Department of Health and Human Services says are already unfilled.

Yet nursing schools regularly reject qualified applicants in large part because the widespread graying and retirement of faculty members leave potential classes without instructors.

To address that need, the Moore School's inaugural class consists only of graduate-level nursing students, the nursing school faculty of the future. Pre-licensure students won't be admitted for another four years.

But doesn't the new emphasis on the role of nurses raise the possibility of turf wars with physicians? Not necessarily, say Phillips and Young.

"Nurses are not wannabe doctors," said Phillips. "There's plenty of work for all of us. In the world of the aging population, there's not enough of us to go around."

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