In the United States, life expectancy continues to rise. The average American can now expect to live approximately 79 years (the average for men is 76 years, while the average for women is 81 years). Thus, Americans are living more than 10 years longer than in the 1950s. Concurrent with the increase in life expectancy in the United States is a significant rise in the prevalence of chronic diseases. Chronic diseases account for 75% of healthcare costs in this country and are also the leading cause of death and disability. In addition, multicomorbidity (the presence of two or more chronic diseases in one person) continues to escalate; the percentage of Americans suffering from two or more chronic diseases has increased from 21.8% in 2001 to 26% in 2010 (Ward & Schiller, 2013).
Older adults-those aged 65 years and older-are the fastest-growing population in the United States, and they also have the highest prevalence of multicomorbidity (Freid, Berstein, & Bush, 2012). Chronic neurological conditions are among the most common in older adults. Stroke, epilepsy, multiple sclerosis, Parkinson's Disease, Alzheimer's Disease, and vascular dementia are pervasive in this population. In addition, 21% of older adults have both heart disease and diabetes, the chronic conditions that are most associated with stroke, the leading cause of neurological deficits (Katz & Gilbert, 2008).
Now more than ever, nurses must be prepared to care for older adults who have, in addition to other chronic conditions, a variety of neurological diseases. Nurses can expect to see an increase in older adults suffering exacerbations of neurological conditions in the acute care environment, as well as self-managing such conditions in the community. Further, nurses who do not specialize in the care of patients with neurological conditions will continue to find themselves caring for older adults with coexisting neurological conditions.
An aging population increasingly experiencing chronic neurological conditions in addition to other chronic diseases has important implications for nursing practice. First, nurses who specialize in the care of patients with neurological conditions must consider how advanced age affects the presentation and treatment of common neurological disorders. Persons of advanced age have changes in metabolism and cognitive function, and their symptoms of neurological conditions may appear different from those of younger people. For instance, older adults with epilepsy most often have complex partial seizures that may be mistaken as age-related memory loss, syncope, or dementia (Miller, Buelow, & Bakas, 2014). There is thus a need for education of both inpatient and outpatient nurses regarding the needs of the aging population with neurological conditions.
Second, nurses who do not specialize in the care of patients with neurological conditions will increasingly be caring for older patients who, in addition to the conditions that have brought them to seek treatment, are affected by coexisting neurological conditions. Education of these nurses regarding the most optimal care of older adults with neurological conditions is thus needed.
Third, nurses caring for older adults in both inpatient and outpatient settings must be vigilant in assessing for the signs and symptoms of new-onset neurological conditions in this population. Older adults can experience delays in appropriate diagnosis of neurological conditions due to their atypical presentation of symptoms and/or attribution of symptoms to other, existing conditions (Miller et al., 2014). Such delays put older adults at risk for inappropriate treatment, or no treatment at all. Nurses, then, are put in a position to advocate for the initiation of proper diagnostic paths in older patients that they suspect may be suffering from a neurological condition.
Finally, nursing faculty members must deliberately infuse their curricula with neurological content. Older adults are the most common population requiring care from nurses. Thus, newly-graduated nurses will be caring for older adults at an ever-increasing rate, and many of those patients will be inflicted with chronic neurological conditions.
Americans are not getting any younger-advances in medical treatment have resulted in an ever-growing population of older adults in this country. Further, growth in the oldest population in the United States is not expected to slow. Members of this population are at especially high risk for chronic neurological conditions, particularly given the high prevalence of cardiovascular disease in those aged 65 years and older. Currently-practicing and future nurses, in order to provide the best patient-centered care for older adults, must ensure that they have adequate expertise to care for older adults with neurological diseases, and to recognize the symptoms of such conditions in this population so that they may advocate for the proper testing and treatment of neurological conditions in aging adults. Nursing faculty have a responsibility to ensure that newly-graduated nurses are prepared to care for older adults-likely the most frequent patients they will encounter upon entering practice-and especially those with chronic neurological conditions.
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