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Posted: 8/20/2009

Bette Davis once quipped, "Aging ain't for sissies." For many, its a time of change and challenges. Despite medical advances, and while living longer, many people aren't living better. Johns Hopkins University School of Nursing (JHUSON) researchers and educators have been at work to better equip the nation's aging population with tools and resources to lead healthier, engaged lives and to ensure comfort and dignity at the end of life.

Helping older adults keep on keeping on
It's thought that staying physically and mentally active helps older adults hold disability at bay by nourishing mind, body, and soul.  Physical and social engagement are at the heart of both late-life health promotion and the work of Assistant Professor, researcher, and gerontologist Elizabeth (Ibby) Tanner, PhD, MS, RN. Her research centers on engaging older adults in community-based activity as a health improvement strategy. Her current study population: older adults participating in the Baltimore Experience Corps, one of 21 programs nationwide in which older adult volunteers help students and teachers in inner-city schools. Not only do the older volunteers provide additional hands and minds in the classroom, but they also get a mental and physical workout that Tanner believes can help promote better health. With grant funding from the National Institutes of Health National Institute on Aging, Tanner is assessing what motivates older adults to volunteerism and is also examining if involvement yields increased wellbeing among its older adult program participants. Piggybacking on Tanner's study, Assistant Professor Sarah Szanton, PhD, CRNP hopes to learn if the participants monthly stipends help combat money worries. According to Tanner, "Older adults are a growing national resource with great knowledge to share. The Experience Corps enables them to give something back to their communities, and, we hope, to improve their own health at the same time." But Tanner's work doesn't end with research. As a nurse educator, shes building the knowledge base in geriatric nursing, including a role in the launch of a first-in-the-nation, online guided care course focusing on the best practices in geriatric nursing care.
 
Stress can make you sick and old before your time
What happens when a social cause lobbyist becomes a nurse researcher?   Dr. Sarah Szanton happens. A recent recipient of the Claire M. Fagin geriatric nursing fellowship from the prestigious John A. Hartford Foundation, Szanton has translated past concern about social change and justice into scientific inquiry with the public health and public good at heart. With a passion for community-based research and desire to reduce health disparities among low-income older adults, Szanton has focused her research on the damaging effects chronic stress has on late-life health. "I've seen the psychological stamp of a lifetime of accumulated stress and inequality on the lives and health of older, low-income older adults," she notes. "Over time, environmental stress, including economic worries, can take a massive toll on a persons health." Worry about finances is among the most significant of the stressors. Older women with high levels of worry about money are 60% more likely to die within 5 years than their less-stressed counterparts. Some may cut back or stop taking medicines; others may eat less frequently and less well. Still others may skip health care appointments or home repairs needed for better mobility or energy efficiency. All of these means of budget management can result in depression, isolation, debilitating chronic illness and disability, and, ultimately, untimely death. She says, "It's about time that we address the sources of financial strain for older adults, like the costs of medication and health care. For many, it's a matter of life and death."

 
When Jack and Jill are over 65: A fall can mean a fracture
Jack and Jill, London Bridge, and Humpty Dumpty all fall down; so do more than one-third of older adults every year. The human and economic cost of falls is not lost on Assistant Professor and gerontological nurse researcher Elizabeth (Beth) Hill, PhD, RN. While some factors implicated in falls have been well documented, like difficulty walking, loss of vision, and some medicines, Hill's work looks beyond the person to the environment for possible culprits. Her research suggests how a long-term care environment can be made far more supportive of its residents in both a figurative and literal sense. Does the long hall include a place to rest? Is it too narrow to avoid bumping into other residents or medical equipment? Are thresholds easy to negotiate; is the carpet lumpy? "The environment needs to be adapted as physical challenges increase with age," says Hill. "Where older adults live needs to be safe, not just attractive. Without attention to safety, the environment just becomes another part of the problem. And that's when falls happen." As important as the physical plant, so, too, is the interdisciplinary care team, particularly nurses. Because they spend the most time with patients, nurses can identify the environmental nuances in health care settings that could compromise the health of elders. According to Hill, lessons learned can reduce the number of falls and associated injury for older adults today and tomorrow. 
  
When living well becomes dying well
Associate Professor Marie T. Nolan, PhD, MPH, RN, likes to say that the goal of geriatric nursing is to help older adults stay as healthy as possible for as long as possible and, when that becomes impossible, to keep the older adult at home and comfortable as long as possible. Nolan says, "If Ibby Tanner's work is about promoting healthy aging, the work of my long-time interdisciplinary research team is about promoting peaceful, comfortable dying. Each is just as important, in its time, for an older adult and family." When older adults near the end of life, nurses are in the best possible position to help reduce the growing stresses and concerns of patients and families. They can suggest ways to reduce accelerating disability, pain, and fatigue; they can coordinate care and interpret options presented by the medical team for the family. Above all, they can help ensure that the end of a long, productive life is a supported, peaceful time for both patient and family, rather than a time too often disrupted by distress and anxiety. Nolan's past research has found that a majority of patients want family to weigh in on difficult end-of-life decisions. Yet, some family members are not be aware of the patients desires and others may find the matter so stressful that they shrink from involvement. In a new pilot study, Nolan and her team are testing whether a nurse-led discussion can both help patients make their wishes for family involvement known to their families and help reduce the emotional upheaval families may experience when facing treatment decisions about a dying loved one.
 
Aging America: Aging nurses
As the population ages, so too does its nursing workforce. According to the most recent data available, on average, a practicing nurse is 47 years old. The numbers of nurses in the workforce appears to be on the uptick, but not because growing numbers are graduating with nursing degrees. The force driving the surge is far more transient:  its the economy. And, Karen Haller, PhD, RN - who serves both as Vice President of Nursing and Patient Care Services at The Johns Hopkins Hospital and Associate Dean for Clinical Affairs at JHUSON - is concerned. "When the recession lifts, we can expect a 'silver tsunami'. In the same 20-year span that boomers are growing old, the number of nurses who will retire or reduce hours will leave a shortfall of as many as 500,000 practicing nurses. So, we need to start problem-solving now." With no mandatory retirement age, The Johns Hopkins Hospital is experimenting with ways to accommodate older nurses who want to stay on, such as providing options to 12-hour shifts. The goal is to preserve knowledge as well as numbers. Haller regularly looks forward to discern where future nursing needs will lie. "Because retiring boomers will likely want to stay at home as long as possible, the demand for home health nursing increases," she notes. "We need to be prepared with options and alternatives that can bridge the gap between service need and service availability while maintaining the hands-on, caring nursing touch."