"While every specialty of medicine requires us to have maturity and spiritual awareness, geriatric care in particular calls on us to bring a real sense of comfort, concern and compassion," said Steven Johnson, PA-C, president of the Society of Physician Assistants Caring for the Elderly.
Johnson's path to geriatrics took shape via a drive for community service. After graduating from the Stanford University Primary Care Associate Program, at that time a joint education option for both PAs and NPs, he worked with an internist providing community-based care to older adults. "I had been a paramedic, but I wanted to do something more long term that was quieter and less intense than an emergency room," Johnson said. "I've been in internal medicine with a geriatric focus for 31 years."
Johnson now practices at the Palo Alto Medical Foundation. Previously, he influenced the education of future NPs and PAs through a teaching position at Stanford University, where he helped formulate a geriatrics-specific curriculum.
"Geriatrics is changing dramatically in that primary care is now responsible for the vast majority of older patients," he said. "There are simply not enough geriatricians available to provide care to such a rapidly growing patient population." Johnson said that board-certified geriatricians are increasingly seeking consultative practice with primary care physicians. They perform assessments and create care plans, providing an opportunity for NPs and PAs to practice in a field that is, unfortunately, not often sought.
"Despite a focus on geriatric care in most education programs for PAs and NPs, I don't see a growth in the field, particularly for PAs," Johnson said. "NPs have done a great job of integrating into geriatric care."
A Shift in Care
"Nursing homes are no longer the dumping grounds they were when I began my career as a PA," Johnson said. "Facilities are now managing more subacute patients with a demand to keep people from going back to the hospital."
Soon, older adults will comprise a majority of patients in this country. "Across gender and ethnic groups, we are going to see an increased number of older adults who need skilled medical care, as well as culturally appropriate care." But whether you practice directly with older patients or not, he said, "The geriatric imperative will impact you."
Johnson said that NPs and PAs may see older adults in such areas as pediatrics, where they may be caring for grandchildren; cardiothoracic surgery, where they may be struggling with heart problems; and orthopedics, to treat fractures.
As the population ages, Johnson said, there will be an impact on every part of healthcare and society as a whole. "It's critical that we appreciate older adults' physiology and needs in the same way we would for growing adolescents," he said. "As NPs and PAs, we need to help people prepare to grow older and train them to be successful older adults by staying in shape and maintaining flexibility, balance, strength and a sense of community and spiritual life. We are in an excellent position to address these particular issues."
When providing such care, Johnson believes the key is patience. "Caring for older adults takes time," he said. "Cultural differences in this population are significant, and it is important to have sensitivity to patient needs while also maintaining medical status." Patients may become discouraged with a loss of ability and lose motivation for self-care. "Function is the hallmark of geriatric care," Johnson said. "Patients might have a great blood pressure and normal lab values, but may not be able to walk because of osteoarthritis, for example, which is making them miserable and in turn, creating barriers to care."
Johnson said it's important for NPs and PAs to remember that older patients have likely lost many of the things they value most. "We are in a position where we are comforting people who have had to struggle with some of the most trying times in a human's life," he said. "It demands a certain maturity and philosophy. For that reason, elder care can be a struggle. But above all, it is satisfying and rewarding."
Geriatric Resources for NPs & PAs
The Society of Physician Assistants Caring for the Elderly offers information and resources for PAs practicing in geriatric medicine: http://www.geri-pa.org
The Gerontological Advanced Practice Nurses Association represents NPs working with older adults in a variety of practice settings: https://www.gapna.org
Kelly Wolfgang is the assistant editor. Contact: firstname.lastname@example.org