Ageism, gerontological nursing and healthcare contexts

Professors Kathleen Hunter and Sherry Dahlke from the University of Alberta’s Faculty of Nursing explain why gerontological nursing education is key to addressing the unconscious negative stereotypes about ageing and improving care for older adults

Ageism is worldwide and is apparent in healthcare professions and health systems. ⁽¹⁾ This is partly due to healthcare systems, particularly hospitals, that are institutionally ageist because they are designed for younger people with one acute condition rather than the majority of users who are older adults with chronic and acute conditions. ⁽²⁾ Moreover, healthcare professionals, of which nurses are the largest group that interact with patients, may be unconscious about their negative biases towards older people. Nurses’ unconscious biases are often demonstrated by overaccommodating older patients due to an underlying belief that older people are less capable. ⁽³⁾ Nurses may feel pressured to engage in overaccommodation to save time because they are working in hospitals where they experience time constraints due to short staffing, lack of material resources, and hospital cultures that focus on medical acuity. ⁽⁴⁾

Furthermore, physicians and other healthcare professionals often interrupt nurses’ work with older patients to ask them questions, and/or the sudden change in medical status of one of their patients diverts their attention from what they perceive to be their more stable older patients. Unfortunately, these chaotic environments predispose nurses’ failure to recognize functional changes in older patients, such as cognitive or mobility decline, which can be a signal of an acute illness. Nurses’ lack of knowledge about ageing and older adults can translate into care practices leading to adverse outcomes, functional decline, increased length of hospital stay for older adults, further medical decline and possibly even death. ⁽⁵⁾ This further perpetuates overcrowded hospital units, where nursing staff try to survive their shifts through informal unit norms about how to manage older patients that do not address underlying issues. ⁽⁶⁾

Gerontological nursing education

To address these challenges, it is necessary to recognize unconscious bias and ensure that nurses have the necessary gerontological education to provide evidence-based assessment and care to older patients and working environments that allow them to practice as gerontological nurses. To address unconscious bias, nurses must receive adequate education about the heterogeneity of older people in order to balance previous education focused on the decline and medical conditions with age ⁽⁷⁾ and opportunities to reflect on negative stereotypes about ageing and older people they may hold. ⁽⁸⁾ Nursing programs that focus on providing education that addresses gerontological competencies will support nurses’ knowledge about how to address and manage the care of older people. However, the most critical is addressing the hospital context through elder-friendly systems and processes that support nurses in providing gerontological care.

Scholars have developed system-wide and individual hospital-level changes to improve the care of older people. Some examples include the Hospital Elder Life Program (HELP) model, ⁽⁹⁾ the EAT WALK ENGAGE model, ⁽¹⁰⁾ and the WALK-FOR program. ⁽¹¹⁾ Unfortunately, the sustainability of these types of older person-friendly initiatives is unknown. These initiatives require ongoing funding to support nurses and other healthcare professionals to adequately assess older people’s needs and implement best practices to minimize long-term functional changes. Putting the resources into addressing these issues will not only provide older people with appropriate care, but it will also decrease further decline, perhaps prevent the perpetual over capacity on hospital units and decrease length of hospital stay. It would also be important for support within the community to be enhanced to support older peoples’ recovery in their homes, which could decrease re-admissions as well. In summary, improving the care of older people requires individual nurses to address their unconscious negative stereotypes about ageing, nursing programs to adequately educate student nurses about older people and, most critically, healthcare contexts that support nurses in providing gerontological nursing care.

References

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