Summer 2021 Newsletter
By Danette Scherer, MSN, RN, CCRN
Nurse Educator, Quality Management Coordinator
University of Arkansas for Medical Sciences
Prepare yourself for some mind bending, belief shattering insights. These truths I share with you are a part of my personal growth journey that began in February 2021 when I was hired as a nurse educator with the Arkansas Geriatric Education Collaborative (AGEC). When I went through nursing school, almost 30 years ago, the curriculum did not include specific geriatric education. There were specific classes that focused on mental health, maternity and pediatrics. But we were not provided specific education focused on gerontology.
Growing up I had minimal exposure to older people. My parents were older when I was born, and they were also born to parents that were older. “Late in life baby” is a term commonly used for parents older than 35. My extended family had already passed on by the time I came around. The only “old folks” I knew were my own parents. As a daughter of a military pilot, I grew up in many underdeveloped countries where the life expectancy was short, nutrition was poor, and access to medical care was scarce or nonexistent. Therefore, learning about and from older adults was not part of my initial nursing education or my early life.
So I imagine what you must be thinking. How does somebody, especially a nurse, get through to middle age with limited exposure to old people? Well, my knowledge of “older adults,” as I’ve learned to call them was quite limited. I was in my twenties and a brand-new nurse, a volatile combination I might add, and my only knowledge of geriatric patients was from caring for them in the ICU. Even being an ICU nurse for 28 years, the only thing that I truly knew about geriatrics was that old people got sick, they came to the ICU, and they died. They all seemed to be delirious, demented, and/or combative. Their families were also very difficult, uninformed, and not accepting of the fact that death is a natural process and that we are all designed to die. I believe this was because of fear and lack of information.
I seldom recall any family of an older adult that did not want all life prolonging treatments to be provided to their loved one. Their experience of having a parent in the ICU was the very first time they realized that at some point, their parents would succumb to bodily failure and death. We participated in activities of care that for many of these patients, seemed far beyond heroic; however, they were the “norm”, they may have also been a substitute to the real conversation everyone was ignoring, death. Advanced care planning, as we know it today, did not exist in most situations. Most healthcare providers and families ignored and even fought the inevitability of death. In hindsight, contemplating what I’ve seen and what the families may have observed, I can’t help but wonder why we did “that” to patients at the end of their life. Very few or any of us would agree to spend their last moments having all of that done to their body. I think this is especially true for older adults. Over time my scrubs transitioned from a work uniform, to battle fatigues. And oh my, I was fatigued by this battle. My heart broke and bled nearly every shift, and fear rushed over me when I thought this was to be my fate as well. To be a frail old person and to endure the trauma of life prolonging interventions.
So here’s what I’ve learned and where the mind bending, belief shattering insights come into play. Since joining the AGEC at UAMS and working with the Thomas and Lyon Longevity Clinic, I have ultimately been enrolled in what I’m calling an intensive learning residency in gerontology. I have learned there is such a thing called “healthy aging.” There is hope and people can actually age well. When I started in the Institute on Aging, the very first day there were all of these older adults exercising in the halls and moving about like humming birds. I simply didn’t know what to make of this. I’d never seen such things before in my life! I was bombarded with the visual images of older adults moving about and just living and loving life! This was a shock to my known experiences. I wondered, do such strange sights pose a threat to my way of thinking? Well, it sure did challenge my paradigm and my belief system about aging in a good way. Seeing these active older people was inspirational and gave me hope for myself and for all older adults!
Reflecting back on my 28 years of ICU experience, I realize that when I was taking care of older adults in the ICU, I was giving excellent ICU care. However, I also now realize that I was not giving excellent geriatric care. From now on when I am trusted with the care of an older adult, I will be giving excellent care that focuses on the specific needs of that person and where they are in life, paying extra special attention to what matters most to that individual. I will actually ask them “What Matters Most?” to you. I will work with the interdisciplinary team to ensure that Age-Friendly medications are prescribed. I will make every effort to identify signs and symptoms of dementia and treat and prevent delirium and depression, and not just assume all older adults will be depressed or get dementia at some point. I will promote mobility and movement to prevent the accelerated deconditioning that the older adult experiences. I will practice Age-Friendly Healthcare and employ all of the 4Ms: What Matters, Medication, Mentation, and Mobility. For all of these epiphanies, I am grateful. I know my intensive learning experience in Gerontology will follow me in every facet of my nursing practice and life and I am excited to share what I have learned with others.