Ageing Population Stats

8/11/2019 Ageing Population Stats

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http://www.medscape.com/viewarticle/767243_3 - with references.

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Language and Obesity: Putting the Person Before the Disease

Journal for Nurse Practitioners

Population Aging Implications for Nurse Practitioners

Karen A. Van Leuven, PhD, FNPDisclosures Journal for Nurse Practitioners. 2012;8(7):554-559.

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Abstract and Introduction
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5/11

Background Practice Implications Education Implications Research Implications Implications for Policy Recommendations References

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Practice ImplicationsThe emerging "silver tsunami" will increase the demand for health servicesfocused on chronic disease, comorbid status, and the unique health promotionneeds of older adults. The most common conditions affecting older adultsworldwide are CVD, cancer, diabetes, osteoarthritis, pulmonary disease,dementia, and depression .[10]

Community-based primary care is crucial for management of older adults withchronic health needs, especially those experiencing problems from frailty anddebilitation. Innovative evidence-based disease management programs withan interdisciplinary team approach have been shown to be highly successfulfor controlling chronic disease and encouraging patient self-management .[11,12] Care coordination to address co-existing conditions isessential as treatment of 1 problem can easily trigger an exacerbation ofanother. However, the current US health system is reactive, rather thanproactive. Patients and providers often need a roadmap to navigate thecomplex rules, and care frequently comes well after disease is established.

The Chronic Care Model (CCM) is a potential solution to this dilemma. Thismodel subverts the current model of physician as gatekeeper and places thepatient at the center of all activities. Patients are educated and empowered touse the health system to achieve their best health status by accessing an
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interdisciplinary team .[11] Self-management support is the cornerstone of thismodel .[13] Self-management implies that patients and family are activeparticipants in care: identifying areas of concern, setting goals, and havingaccess to providers to achieve desired outcomes.

Five pillars support patient self-management: organizations that value patientempowerment and recognize the importance of chronic conditionmanagement; clinical information systems that permit individual patient andpopulation data retrieval, thereby supporting clinicians and program plannersto optimally gauge care and services; delivery systems that challenge thestatus quo by supporting novel care strategies, such as group visits and ateam approach; decision support that streamlines provider access toevidence-based guidelines, research, and specialists; and community

resources to provide support to patients and clinicians through education andcoordination of community-based services .[13]

A number of demonstration projects have illustrated the success of this modelwith frail elders living at home [14] and in patients with chronic disease such asdiabetes ,[15,16] bipolar disorder ,[17] cancer comorbid with depression ,[18] andheart failure .[19] The CCM addresses a number of concerns about the currentsystem. By building care around patient needs, opportunities are opened upfor NPs, as research has consistently demonstrated NP expertise in providing

coordinated care for complex patients while simultaneously achieving patientsatisfaction and cost-effectiveness .[20]

The CCM is based on an interdisciplinary approach that does not prescribephysician leadership but rather acknowledges that patients have evolving careneeds based on their condition. In recent testimony before the SenateFinance Committee, Hackbarth [21] testified that our current health systemfavors specialty care over primary care, rewards more care regardless ofquality or outcome, and has created practice silos that lack coordination. The

CCM addresses these concerns by fostering collaborative interdisciplinarycare focused on achieving the highest level of patient health status. Self-management support is the cornerstone of the CCM, therefore healthpromotion activities are embraced.


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Older adult health promotion includes immunizations; counseling related toexercise, nutrition, and lifestyle factors; advanced care planning; andmedication management to prevent polypharmacy and optimize health. Theseactivities focus on disease prevention and early detection, thereby improving

quality and quantity of life .[22,23] Health promotion efforts have the potential todecrease the cost of care for older adults by shortening the amount of timespent in frail or dependent status . [24] NPs are ideally suited to delivercoordinated care and effect positive change for older adults by becominginvolved in CCM programs.

Full-scale implementation of the CCM requires substantial investment ininformation technology and platforms that facilitate communication amongprofessionals. Often, decision making about investments of this magnitude

occurs at the executive leadership level. Current financial constraints may limitimplementation. Nevertheless, organizational shifts that favor aninterdisciplinary model and self-management support can begin throughdialogue at the practice level.

The practice arena will also be affected by the aging nursing workforce. Overthe past 2 decades the number of persons selecting nursing as a professionhas diminished. Although men have entered nursing in increasing numbers,women make up the bulk of nurses globally. This decline in young entrants to

the field has created an aging nursing workforce . [25] Simultaneously, the needfor nursing care has risen from advances in health care, coupled with agingpopulations, and obesity-driven health problems. As a result of overalldeclining numbers of children and younger adults available to providesupportive care, the need for long-term care, home health services, andinnovative aging services has increased. A relative shortage of nurses existsin most countries. The shortage in developing countries is related toexportation of labor to more developed areas.

At the same time, the average age of employed nurses exceeds 40 in mostdeveloped countries, and a weighted average age of all practicing NPs in theUS is 48.2. Over the next 2 decades, the shortage will intensify by retirementof the existing work pool .[26] This shortage will affect traditional nursing jobsand the number of nurses entering advanced practice as most enter throughthe RN path. The US has filled many nursing positions with imported labor,


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but aging of the workforce is a global phenomenon; therefore, this strategy willhave limited efficacy.

Strategies to retain experienced nurses and NPs include flexible scheduling,

ability to reduce work hours and workload, rewards for expertise, incorporationof ergonomic measures to reduce risk of injury and diminish lifting, andprovision of educational opportunities tailored to experienced nurses .[26] Theuse of experienced nurses as mentors for entrants into the profession will beincreasingly important. The entering workforce, as well as the aging currentworkforce, will need to be educated on the health needs of a population that isolder, has more chronic diseases, and is more likely to be overweight orobese. Meanwhile, global efforts to enhance the image and rewards ofnursing must be undertaken to reverse the trend of younger cohorts shunning

the role.

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Journal for Nurse Practitioners. 2012;8(7):554-559. 2012 Elsevier Science, Inc.
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