Future of Healthcare as it Relates to the Geriatric Population Description and Problem Statement

The geriatric population in the United States is growing and compared to the population of health care providers the geriatric population growth is advancing much more rapidly. This presents a problem in making provision of health care to the future geriatric population. While there is a growth in the demand for geriatric health care services, there is not a matching growth in the population of health care providers and in fact, a shortage presently exists.

The population of geriatric patients is experiencing rapid growth while the population of health care providers specifically trained in geriatric medicine is seriously lagging behind. In fact, of the approximately 650,000 medical doctors who are practicing, only a small percentage receives the training and education required to provide geriatric care. Exacerbating the problem is the fact that only three medical schools in the United States out of the total of 145 medical schools have a geriatrics department that is of a full scale and that makes it mandatory that students and residents participate in a mandatory rotation. Unfortunately, only a mere three percent of medical students take a course in geriatrics while attaining their education.

Research Objective

The objective of the research proposed is to examine the issue of the future of health care for the geriatric population and the relevance that this holds for health care leaders and administrators in the acute care hospital environment.

Part II: Background of the Problem

Background

The first of the Baby Boomers recently turned the age of 65. This population of individuals is such that the present base of health care providers is not sufficient to meet the demand of this population for health care services. It is critical that a competent workforce that is committed be at focus for development within the health care profession in order to meet the demand for the provision of care in the future for the geriatric population. Not only is there a shortage of providers to meet the health care needs of the population of Baby Boomers reaching age 65 and older, the acute hospital environment is unprepared for the future rising demand in acute health care service needs. The following figure labeled Figure 1 in this study shows the hospital emergency department visits by race and age in the United States for the years 1992 through 2000. Clearly, those who are 65 years of age and older are the group with the highest percentage of hospital emergency department visits for that eight-year timeframe.

Figure 1

Source: U.S. Department of Health and Human Services (2004)

This is particularly important for consideration in light of the knowledge that 35.6 per 100 deaths in a total of 2.4 million deaths occurring in 1999 in short-stay hospitals. Of these, it is reported that the transfers of the elderly from hospitals to nursing homes represents a great percentage of deaths. (U.S. Department of Health and Human Services, 2004, paraphrased) Nursing home residents discharged from hospitals between 1985 to 1999 are shown in the following chart labeled Figure 2. It is clear from the information revealed in the chart that a large majority of individuals when discharged are admitted into nursing home facilities upon being discharged.

Figure 2

Source: U.S. Department of Health and Human Services (2004)

Furthermore, as reported by the U.S. Department of Health and Human Services, those who are residents in nursing homes who are admitted to and discharged from hospitals are of advanced age with the majority of these individuals being in the age group 85 years of age or older, followed by those in the age group 74 to 84 years of age and then followed by the group age 65 years of age and older all of which is shown in the following chart labeled Figure 3 in this study.

Figure 3

Source: U.S. Department of Health and Human Services (2004)

Individuals admitted into acute care hospitals for diabetes are predominantly those in the age 75 years of age and older age group followed by those in the 65 years of age or older age group. In addition, individuals who were admitted into the acute care hospital for coronary artery bypass graft surgeries and for percutaneous transluminal coronary angioplasty surgeries between the years of 1990 and 2000 were predominantly those in the age 65 years of age or older age group. (U.S. Department of Health and Human Services, 2004, paraphrased) Individuals admitted into acute care hospitals for coronary artery stent insertion between 1990 and 2000 were also predominantly those...

Department of Health and Human Services (2004)
Individuals admitted into acute care hospitals between 1999 and 2000 for hip replacement were primarily those in the age group 74 years of age and older and those admitted in acute care hospitals between 1999 and 2000 for knee replacement were primarily those in the age group 65 years of age and older. (U.S. Department of Health and Human Services, 2004) Between 1990 and 2000, individuals admitted into acute care hospitals with diagnoses of adverse effects of medical treatment were predominantly those in the 75 years of age and older followed by those in the 65 years of age and older group. Between 1985 and 2000 individuals discharged to nursing home or long-term care institutions were those individuals in the 65 years of age and older age group as shown in the following chart labeled Figure 5 in this study. As well, between 1985 and 2000 individuals that were admitted to acute care hospitals who were nursing home residents were those in the 65 years of age or older age group.

Figure 5

Source: U.S. Department of Health and Human Services

Further complicating this problem in terms of future health care provision for older adults that as reported in the work of Graverholt, et al. (2011) because residents in nursing homes have a high percentage of acute illness they are going to represent and even larger base of demand for acute hospital services in the future. The reasons for this include their progression of aging, illnesses underlying their condition, and their lack of mobility. The acute hospital admissions while already high among nursing home residents will rise in the future above the present level of admissions into acute care hospitals which already represents 55% of the elderly population using acute care hospital services. There are also other considerations for the CEO and leadership of the acute care hospital in regards to provision of care to the aging in the future and which relate to economical, political, social, cultural and even acute care hospital design and layout factors.

Part III: Leadership Role

Critical Nature of Assessments of the Elderly

Leadership in the hospital must be aware of strategies that serve to bring about optimization to the outcome of the elderly patient. This begins with a geriatric assessment for identification of the baseline of the patient and the patient's current functional status. The expected functional status of the patient at the time that is anticipated for discharge from the hospital is stated and set as the goal functional outcome. Collaboration of the nurse and other health professionals is included along with instruments and scales include the basic ADL and IADL used to measure the ability of the patient to take medications independently, the handle their own finances, to perform tasks in their households, to do their own shopping and utilize public transportation as well as to take medications or to use a telephone. Also included in the measures is a test of mobility, a test of cognitive function, assessment for symptoms of depression, and a nutritional status assessment. (Palmer, nd)

Hospital Design: Exterior

Another consideration for hospital management and administration is highlighted in the work of Gabel (2012) who reports that acute care hospitals need to consider hospital designs that provide the most in the way of support to acute care patients who are aging. Gabel reports that proving to be the most in the way of stress and confusion for aging individuals in a hospital is the attempt to navigate their way around the facility. Elderly individuals have difficulty in locating entrances and locations for parking and navigation through the facility presents even more in the way of difficulty. It is reported that extraordinary landscaping that accidently blocks the view of sign that directs hospitals visitors and those to be admitted is attractive for viewing but otherwise simply not effective. The design should be such that emphasizes the entranceways that the elderly are most likely to utilize such as the walk-in emergency entrance, the primary entrance, and the entrance for outpatient services. The different entrances need to be able to be distinguished from one another.

Hospital Design: Interior

Hospital interiors need to be designed with the elderly in mind and should include customized handrails for the elderly complete with resting spots spaced appropriately and clearly marked directions along the way as well as landmarks that are distinct that makes use of color and art…