Geriatric Nurses

More and more Ontario EDs are employing geriatric nurses. They go by different acronyms, but their mandates are all the same - see geriatric patients at risk of coming back to the ED soon, or, even worse, being admitted. Geriatric patients who end up admitted to hospital deteriorate. There's no way around it. The hospital environment doesn't stimulate them enough to keep their minds sharp. They end up staying in bed all day and sleeping more than they should so their muscles atrophy. Even a stay of less than 4 days can have lasting negative effects. The geriatric nurses work like heck with the CCAC workers to keep elderly patients at home.

They do fantastic assessments that can take hours (time that ED docs don't have). These assessments can discover things such as medication concerns that may have led to admission, poor walking shoes, poor nutrition, mood concerns etc. With a bit of polish and increased support in the community, the patients are often able to avoid admission and the dangers that lurk within.

In one community I was working in, an 84 year old man was brought into the ED by ambulance following a fall. The geriatric nurse was ecstatic. This was a farming community where most elderly folks are strong and independent and didn't need the extra attention that a geriatric nurse can give.

She went in to check on the man and asked "how did you fall?".

He said, "Well, I was pulling my 2 seated glider back into the hangar and slipped on a bit of water on the floor".

Crestfallen, the geriatric nurse went back to trolling for patients in the ED. Not every patient in their 80s fits the geriatric profile.

What is the geriatric profile?

It changes between hospitals. In general though, it's a patient who is at risk of not coping alone in the community. This can be because they have many illnesses (comorbities), too many prescriptions (polypharmacy), a history of falling, dementia, poor social supports.

I've met patients in their 90s who I wouldn't have really considered geriatric. They live independently in the community, often helping their neighbours (much younger neighbours) with groceries and chores. They have active social lives and manage their few medications well on their own. When the idea of a retirement home comes up, they laugh and tell you that they are for old people. One woman told me she wouldn't be old until she was 96. Don't know why she picked that age, but it made me giggle.