1. Donnelly, Gloria Ferraro PhD, RN, FAAN

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Newly accepted to a university nursing program and eager to get a head start learning the art of caring, I landed a summer job as a nurse's aide in a neighborhood nursing home. I lasted 1 day!!


With no orientation, I was assigned to give complete care to 10 patients. The "nurse" in charge kept rushing me, "Get moving girl!!" she shouted. "No time for talk and hand holding-the trays are coming and we have to feed these folks." I quickly learned that my speed increased if I avoided eye contact with patients but they desperately wanted to talk. I completed six baths by the time the trays arrived. I never finished the remaining four. Breakfast was just as rushed; however, seven of the patients were able to feed themselves albeit slowly. Then it was "toileting" time-either bedpan or a wheelchair trip to the group bathroom. My feeble attempts at gentleness and thoroughness took too much time. Two patients had "accidents" in the bed before I could get the bedpan positioned. By morning's end, I could barely function. The remainder of my first day in geriatric care is a blur except for my sense of frustration and failure.


Before leaving for the day, I checked my patients, most of whom were napping, except for Mary Jones, a 92-year-old resident. As I neared her bed she grasped my hand. "You had a very hard day dear, didn't you?" she said with great empathy. I could not stop the flood of tears. I could not muster one word. This was not the way it was supposed to be. The patient should not be watching me, understanding me, comforting me!! I leaned over to hug Mary Jones, left the nursing home, and never returned. Care of older adults, especially frail older adults, brings us face-to-face with our own vulnerabilities and inevitable mortality. Nurses have never rushed into geriatric care in great numbers. However, we have reached a critical point in planning and delivering care to older individuals.


The demographic engine is barreling toward a society in which 20% of the population will be older than 65 by 2030. Between 2010 and 2030 the older adult population will grow to twice the 1998 level. This phenomenon will increase the demand for nursing services for older adults especially because in 1995 a high percentage of individuals older than 65 reported at least one chronic condition and many reported multiple conditions such as arthritis, hypertension, heart disease, hearing impairments, orthopedic impairments, cataracts, sinusitis, and diabetes. Considering the growth of the aging population, demand is projected to outreach available services. Much of the care is falling to family members and this trend will continue to rise.


The authors of this issue offer exemplars of practice and programs that improve the care and health of older adults and their caregivers. They promote a holistic perspective on care of older adults through a focus on transgenerational and family caregiver issues as well as the special to health problems of older adults. In the near future most nurses in most arenas of practice will be delivering care to the growing percentage of older adults and their families. This issue identifies the challenges and opportunities inherent in caring for an aging population.




1. Fowles DG, Duncher A, Greenberg S. A Profile of Older Americans: 1999, AARP and the Administration on Aging. US Department of Health and Human Services. (