Public Health Series: The Aging Population

Hey guys!

Can I just say..what a whirlwind these past two weeks were? Essentially, I just finished my 2nd block in my ABSN program and without a break (well, ok, a 1 hour lunch break), we went right into the 3rd and last block of our first semester. Crazy right?

This isn’t a nursing blog post, but a public health series post that I have been thinking a lot about and been very burdened by. It’s been hard thinking about the reality of aging because I find that there are a lot of issues that I am learning about as a nursing student but have been keenly aware of as a public health professional.

Currently, US Census Bureau, in March 2016’s “An Aging World: 2015 International Population Reports” report (URL: https://www.census.gov/content/dam/Census/library/publications/2016/demo/p95-16-1.pdf),  562 million people were 65 years and older (worldwide) as of 2012, when the world’s population hit 7 billion. In 2015, that number rose an extra 55 million. That is a lot of people who are hitting an age that hasn’t been seen in a long time.

And then you also here that the US that chronic disease and many other various illnesses are creating a morbidity and mortality rate where Americans are dying younger.

So…are we getting older? Are we dying younger as Americans? What’s the deal?

The deal is, many are still growing older. In fact, the CDC reports that in America, we’ve had more centarians now than ever. In 2014, there was over 72K people in the US who have lived past 100. Crazy right? I would think so. To live past a century and recall the things that have happened? Now that’s an interesting life.

Or is it?  The thing is, many Americans have chronic diseases ranging from diabetes to cardiovascular disease to cancer to Alzheimers. Many of these lead to so pretty serious complications. Many require care that is not available in one’s personal home, unless of course that person can afford in home private nursing services. This leads to the need for more assisted living facilities, skilled nursing facilities, adult day care, and even hospitalization. Gerontology has become a hot nursing career for many, especially as our population worldwide has been aging.

The idea that we have an aging population is also scary as well. Why? Because we are not ready to serve the vast amounts of people who are aging. One highlight that I had this past week is learning about some of the symptoms that older adults may have that younger healthier adults don’t present with. For instance, have you heard of a silent myocardial infarction (i.e. silent heart attack)? Did you know that an older adult can have one of these and what we may think is a normal heart attack (as if that’s not serious…it is!!) won’t be presented in an older adult? Someone who suffers from a silent MI, would actually present many times with shortness of breath than chest pain. Is that scary? YES! This is why we even have advanced practice nurses who specialize specifically in the aging older adult, because what they present with is so different than what a normal adult may present with.

Now, I’m no professional. I am a public health professional, yes. In this sense, I look at statistics, I read the latest research, I observe, and I talk to those who have a lot more experience than me about how to ensure that the public’s health is improved. As a nursing student, I am still learning. However, thinking about my own personal experience of what it is like to see someone take care of an older adult, it angers me when I know that we having an increasing amount of people who are 65 and older, and we have providers who simply say certain things like “Incontinence is part of aging.” when it is not. It angers me when I see how skilled nursing facilities are not providing the care that is similar to what is in the hospital, especially those who are serve Medicaid/Medicare populations. Even those who the upper echelon of society, which I’ve seen because I’ve worked in a facility that caters to those who are wealthy, you see that the care given is not the same as that in the hospital. How do I know this? I’m in clinicals right now, and what I do there and what I recall as a CNA many moons ago and even with my own grandmother, I must say, there aren’t enough resources going to facilities and the care of our older population that can help them thrive rather than die as an older adult.

I am not saying that caring for an older adult is easy. There are some pretty complicated cases and issues that an older adult faces that honestly requires a lot of services, specialists, and time. However, I think that our aging population is a public health concern. The question is, how can we care for those who are aging, who have chronic diseases and illnessess, and may require facilities that right now aren’t ready for to serve the many who are growing older? One startling statistic that I found recently, in an academic journal (which I’ll site of course!!! I’m a student and a believer of those who do academic research!) is that “The proportion of US deaths occurring in nursing homes (NH) has been increasing in the past 2 decades and is expected to reach 40% by 2020” (Temkin-Greener PhD et al., 2013). We are in 2017, and in 3 years, while I’m excited for the Tokyo Summer Olympic games, is a very scary statistic. In 2020, 40% of those in the nursing home will die in the nursing home. Some of this isn’t from natural causes, many are from complications. Many of them are from neglect or poor care. Heck, some will die because the reality is, many are under staffed or are employed by healthcare professionals who aren’t qualified to care for those who have incredibly complicated issues. Some don’t have time to do head to toe assessments on their patients when the facility has maybe 45 patients to take care of. This is the reality folks…and I hope that someone who is public health midned…who is health oriented will read this, because I’m not sure if people are talking about this outside of the academic world as well as conference halls of professional associations.

We have many issues going on in our world today. The aging population may not even be a priority given so many issues happening. However, this will hit us all in the face one day because we are all growing older, each year. That’s a fact. The number of people beyond 65 is growing world wide. In the US, this is a trend that we cannot simply push aside and wait. As mentioned before, the site of death among nursing home residents is growing. That is a very scary statistics, that I hope that as public health professionals, medical professionals, and many others can come together and discuss how we can improve morbidity and mortality of those who are going into these facilities. The older adult population needs a voice, and to see some of the things that I am learning about, experienced, seen, and heard, I think more needs to be done for our growing adult population.

Citation for “Site of Death Among Nursing Home Residents in the United States: Changing Patterns, 2003-2007”

Temkin-Greener, H., Zheng, N. T., Xing, J., & Mukamel, D. B. (2013). Site of death among nursing home residents in the united states: Changing patterns, 2003–2007. Journal of the American Medical Directors Association, 14(10), 741-748. doi:10.1016/j.jamda.2013.03.009

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