Forward

With 12% of the current US population now > 65 years of age, and with this number expected to reach 20% by 2030, older adults clearly constitute the "core business" of health care. People reaching 65 years of age can expect to live, on average, an additional 26 years. Currently there are 70,000 centenarians, with this number expected to reach 700,000 by 2050.

Whether they are prepared as family or adult nurse practitioners, advanced practice nurses today and even more so in the future, can expect older adults to make up the majority of their patients. Already, older adults make up 57% of all visits to generalist physicians, 60% of all visits to cardiologist and 63% of all visits to oncologists. In hospitals, older adults account for 60% of medical-surgical patients, 46% of CCU visits, 50% of ICU days, and 50% of hospital expenditures overall. Older adults also consume the vast majority (80%) of home care visits, and 90% of nursing home care.

Thus it is imperative that programs preparing adult and family nurse practitioners teach geriatric content. Students need to be exposed to exemplars in care of older adults and to gain an appreciation as to the differences in the way: 1) illness often presents in older adults; 2) treatments affect older adults; 3) co-morbidities and geriatric syndromes (e.g. falls, urinary incontinence) impact assessment and treatment; and 4) older adults judge whether outcomes of care are consistent with their quality of life.

Luckily, there are many excellent geriatric textbooks available to help faculty infuse geriatric content into adult and family nurse practitioner curriculum. Of special note is the American Geriatrics Society Geriatric Nursing Review Syllabus (2007). However, faculty have identified the need for appropriate case studies that they can easily slot into existing lectures that illustrate key aspects of geriatric care. This series of web-based, interactive case studies is an attempt to address this need.

Case studies are a standard teaching tool in academic programs preparing advanced practice nurses. They are used to help students gain analytic skills as to patient assessment, differential diagnosis, and management. They are also useful for faculty to determine whether students are demonstrating the expected level of proficiency in meeting clinical course objectives.

Similarly, these geriatric case studies have been constructed to mirror case studies typically used in nurse practitioner education, and thus to help faculty easily introduce geriatric concepts into the curriculum. The case studies address content, e.g. unexplained weight loss and pain management, typically taught to students preparing to be adult and family nurse practitioners. Because they are web-based and interactive, the case studies can be assigned for students to complete at home. They can also be used in the classroom to stimulate classroom discussion.

The geriatric case studies were developed by expert geriatric faculty with the support and guidance of the American Association of Colleges of Nursing (AACN) and the New York University College of Nursing John A. Hartford Foundation Institute for Geriatric Nursing (www.hartfordign.org). The rigorous process used to develop the case studies involved advanced practice nurses and faculty from around the country. Each case study clearly shows how content addresses the geriatric competencies in the AACN document Nurse Practitioner and Clinical Nurse Specialist Competences for Older Adult Care (2004; see www.aacn.nche.edu).

The Case Studies are not intended to "turn" adult and family nurse practitioners into geriatric nurse practitioners. Rather their purpose is to help faculty integrate key geriatric concepts into content that they are already teaching to adult and family nurse practitioner students. Exposure to the case studies should make students more knowledgeable about and more sensitive to the needs of their older patients.

Mathy Mezey, EdD, RN, FAAN
Professor and Director
The John A. Hartford Foundation Institute for Geriatric Nursing
New York University College of Nursing