Family Nurse Practitioners Caring for Older Adults

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Problems that seem insignificant in younger people can signal underlying health problems in older adults.

With about 10,000 people in the United States turning 65 every day, older adults are expected to outnumber children and young adults by 2035. The so-called graying of America means the need has never been greater for healthcare professionals who can assist the older generation as they struggle with the chronic illnesses and functional disabilities that come with aging.

Experts recommend older adults visit their healthcare providers at least once a year, but many older patients visit far more often. Problems that seemed insignificant as younger adults, such as memory loss, constipation, fatigue or weight loss, can be harbingers of underlying health problems in older adults. Standing ready to help older patients with their primary care needs are family nurse practitioners (FNPs) who are educated to treat patients from birth through old age.

“Nurse practitioners have successfully closed gaps in care related to provider shortages and have expanded access to care for vulnerable populations — including geriatric patients with complex chronic conditions,” researchers said in the International Journal of Nursing Studies. “Additionally, NPs in certain settings function in collaborative roles wherein they bring an advanced practice nursing perspective as part of an interprofessional approach to care emphasizing case management, care coordination, disease prevention and health promotion improving the quality of care.”

In the coming decade, the need for FNPs is expected to grow as policymakers continue to extend the nurse practitioner scope of practice, which includes assisting geriatric patients. At the same time, experts have been calling on registered nurses (RNs) to take on more responsibilities in MSN careers to alleviate the healthcare crisis and help the aging population.

FNPs as Primary Care Providers for Older Patients

As people age, they face different health problems than they did when they were younger. Healthcare experts quantify aging in distinct categories: The young-old are in their 60s and early 70s and generally active and healthy; the old are in their 70s and 80s with chronic health conditions and are typically slowing down; and the old-old (sometimes called oldest-old) are in their 80s and 90s and have disabilities.

For all of the older adult health groups, experts agree the needs are generally the same: well-coordinated healthcare that avoids harm and takes place in their communities, rather than an institution (such as a nursing home). As primary-care providers, FNPs are prepared to provide care to the older population in various settings:

Home health

One of the most significant advantages to working as an FNP is the ability to practice from virtually anywhere, including private homes. Medicare data shows that nurse practitioners made more than 2.2 million home visits in the United States in 2012 and 2013 (the most recent years for data). In comparison, physicians made about 1 million home visits in both years.

NPs said the advantage of working in home health is that it allows patients to be comfortable and relaxed and gives providers the chance to see how the patient lives.

“Having this 360-degree view allows me to more effectively collaborate with patients on their treatment goals and help address any obstacles,” an NP said in Today’s Geriatric Medicine.

Walk-in clinics

Healthcare clinics, including those in retail locations such as Target and CVS, have long been considered a less expensive alternative to doctor’s offices or emergency rooms for patients suffering from less-serious illnesses. Researchers have also found walk-in clinics are more convenient because they are more accessible than primary-care physicians. A growing number of these clinics are focused on geriatric care, and many of them are run by NPs.

Private practice or outpatient clinics

FNPs practice with and without physician oversight, depending on state law. The increase in autonomy has led many such FNPs to open private offices. In private practice, FNPs provide many of the same services as primary-care physicians, including diagnosis, testing, annual exams, health screenings, chronic disease management and treatment of acute injuries, illnesses and infections.

FNPs Assisting with Age-Related Conditions

In addition to treating older patients in specific settings, FNPs treat age-related diseases and chronic conditions and assist with aging-related difficulties. Some of the more common conditions in older people include diabetes, heart disease, cancer, stroke, arthritis and chronic bronchitis/emphysema. FNPs help patients as they move through the stages of aging and other common difficulties, including:

Dementia care

As primary care providers, FNPs provide vital services to patients with impaired thinking and memory, including diagnosis and long-term care. During routine office visits, FNPs measure brain health by using common assessments, such as asking the date or the patient’s birthday.

NPs often refer patients to dementia specialists who can order diagnostic procedures for a clearer picture of the patient’s condition. NPs also help patients’ family members to better care for the dementia patient.

Unsafe driving

Because driver safety is considered a public and personal safety issue, NPs working in primary care with older patients often assess and intervene in unsafe driving. Within the nurse practitioner scope of practice, FNPs treating geriatric patients perform physical assessments as they relate to driving abilities, including hearing, vision and cognitive status. In one study, NPs used several assessments to determine driving ability:

  • Identifying physical frailty
  • Assessing diminished short-term memory, forgetfulness or dementia
  • Assessing sensory impairment
  • Obtaining information from family members
  • Assessing for confusion

NPs also work cooperatively with family members to help older patients transition out of driving. While working with family members, experts recommend that NPs use non-threatening communication and express concern for the driver’s safety.

Fall prevention

Older people are at a higher risk of falls as a result of problems that include imbalance, chronic medical conditions, poor muscle tone and fragility. The resulting injuries can be traumatic.

FNPs who care for older patients can help prevent falls by determining whether a pattern exists and implementing necessary changes. Among the many types of testing FNPs can order for older patients who fall are metabolic studies, cardiovascular assessments, vision and hearing testing, cognitive evaluations and bowel and bladder assessments.

In addition, FNPs help older people by prescribing medications and delivering ongoing patient education. As the population ages, RNs who take on MSN careers, including as FNPs, will be in even higher demand.

At Duquesne University, online master’s in nursing students have an opportunity to specialize in FNP practice or earn a post-master’s FNP certificate to help members of the aging population as they move through life changes.

About Duquesne University’s Master of Science in Nursing

Duquesne University’s online master’s in nursing programs prepare graduates for careers as FNPs working alongside physicians and in private practice. The university’s FNP programs — the Family (Individual Across the Lifespan) Nurse Practitioner MSN and Post-Master’s Certificate — are designed to meet the needs of all RNs. The coursework is presented entirely online, so RNs can maintain their careers and personal lives while pursuing their education goals.

Duquesne University’s online MSN FNP program prepares graduates for the American Academy of Nurse Practitioners Certification Board (AANPCP) and American Nurses Credentialing Center (ANCC) Family Nurse Practitioner certification examinations. For more information, contact Duquesne University today.




Older People Projected to Outnumber Children for First Time in U.S. History: U.S. Census Bureau

Mayo Clinic Q and A: Do healthy older adults need regular health care visits?: Mayo Clinic

International practice settings, interventions and outcomes of nurse practitioners in geriatric care: A scoping review: International Journal of Nursing Studies

Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population: Frontiers in Public Health

Nurse practitioners could help meet need for elderly home care: Medical Xpress

Clinical News: Nurse Practitioners Bring Back the House Call: Today’s Geriatric Medicine

The NPs Role of Assessing and Intervening with Older Adult Drivers: Nursing Research and Practice

Brain Health: The Role of Nurse Practitioners: Medscape

Fall prevention in older adults: The Nurse Practitioner