Free Essay. the Role of Aprns in an Aging Population

In the 1870s, Florence Nightingale wrote in her diary that it would take up to 150 years to achieve the kind of nursing that she envisioned (INCA, 2017). 2020 marks 150 years since she wrote these words. While it may be difficult to exactly tell what she envisioned, she indicated that within that period educated and experienced nurses would transform the healthcare system (INCA, 2017). Looking at it from this light, her vision has gradually been achieved over the years. Moreover, various other dramatic changes have taken place in the profession. The rise in the popularity of advanced practice registered nurses (APRNs) is one of the most notable events in this evolution. APRNs have been providing primary, specialty, as well as acute healthcare to patients of all demographics for more than five decades. According to the American Association of Nurse Practitioners (AANP), there are more than 270,000 licensed nurse practitioners in the United States today (AANP, 2019). The rise in popularity of the role of APRN was informed by various factors such as the inability of physicians to meet the health demands of society. Resultantly, nurses began taking up some of the roles that were traditionally reserved for physicians. With time, APRNs were given more autonomy and today, they can independently practice in some states. While the increasing independence of APRNs has been opposed in some quarters, some changes taking place in the modern world are bound to change this stand (Lugo, 2016). The country's population is aging at an unprecedented rate. This, in turn, will place more pressure on the healthcare system. This shift coupled with the shortage of physicians currently being witnessed will increase the roles of APRNs (Kirch & Petelle, 2017). This paper seeks to discuss the role of APRNs in an aging population.

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Contextual Analysis of the Aging Population

Improvement in life expectancy around the world has been arguably the greatest achievement of the 21st century (Haseltine, 2018). For instance, while life expectancy in the United States was slightly below 70 years in 1968, it grew to almost 79 years in 2016 (Meola, 2019). According to the World Health Organization (WHO), the number of people aged more than 65 years is bound to hit 1.5 billion by 2050 (Garza, 2016). This population is also expected to outnumber that of children below the age of 5 years (Garza, 2016). However, to adequately care for the aging and aged population, a sustained and improved healthcare system must be provided. Moreover, improved quality of life, as well as the provision of sufficient economic and social resources must accompany the shift. As such, the trend calls for the formulation of various social and political regulations to ensure that society keeps pace with the changes. For instance, the increased longevity calls for an extension of the working life to reduce pressure on health, pension, as well as social insurance systems. However, to make such policies, policymakers must take into consideration the physical and mental capabilities of older people. Moreover, the decision on whether to dedicate more resources towards disease prevention or treatment of diseases must be made. All these factors make health policy decisions regarding the aging population increasingly complex. Various social factors are also expected to complicate the situation further. For instance, lack of family caregivers will mean that most of the old patients live alone, a factor that exposes them to risks, such as falls. Resultantly, this dynamic will increase the pressure on care homes (Fougere, et al., 2018).

This notwithstanding, the shift has also placed a bigger burden on the healthcare systems around the world. The leading cause of death has shifted from infections to chronic non-communicable diseases such as high cholesterol, hypertension, diabetes, arthritis, dementia, heart diseases, among others. Older patients also experience multi-morbidity and make up the majority of hospital admissions. In the US, the first batch of baby boomers, those born between 1946 and 1964, hit 65 in 2011 (Garza, 2016). Moreover, it is estimated that over 65% of this generation will be managing at least one chronic illness by 2030 (Garza, 2016). Management of these conditions alongside the disabilities that arise from them will lead to higher financial demands on the country's healthcare system. As such, more resources will be needed to address the challenges associated with the aging population. The diversity of patients will also change, hence calling for an increase in the diversity of caregivers. Most importantly, the shortage of healthcare professionals, especially physicians, is expected to rise. Resultantly, APRNs will be called upon to play a bigger role in addressing the health challenges mentioned above. Owing to the increasing incidence of chronic illnesses, the healthcare system will also need to focus on more complex healthcare needs instead of just one illness. The system must also be reformed to focus more on preventive care instead of reactive care. In this light, APRNs will be needed more in the primary healthcare system to help the community address these needs (Garza, 2016).

Analysis of the Role of APRNs in an Aging Population

As mentioned in the discussion above, the increase in the number of aging citizens is placing a bigger burden on the country's healthcare system. Unfortunately, the demand for healthcare services is higher than the supply, especially in the light of a shortage of physicians. Moreover, it has been revealed that non-communicable diseases have become a bigger health issue, calling for a shift from reactive care to preventive care. As such, the role of APRNs is bound to become more prominent in the future. A 2018 study found out that different countries around the world are expanding the roles and scope of practice of APRNs in an attempt to address the health concerns of the aging population (Fougere, et al., 2018). The move has largely been informed by the recognition of the fact that early detection, as well as treatment of geriatric conditions, helps avert or delay the development of disability, which places more strain on the healthcare system (Fougere, et al., 2018). Despite the importance of APRNs in this population, it has been established that there exists a deficit in the number of APRNs specialized in geriatrics (Fougere, et al., 2018). Moreover, the evidence of the role of APRNs in older people remains scattered, hence making it difficult to understand the different practice models as well as their components.

However, other studies have shown the importance of APRNs in the management of geriatric conditions. In light of this, different models of APRN service delivery for old patients, such as transitional care and case management, have been developed in various health contexts. The models are targeted at addressing specific geriatric syndromes, improving their quality of life, reducing hospital admissions, as well as addressing various behavioral symptoms associated with some of the diseases of old age such as dementia (Fougere, et al., 2018). Results from various studies have shown that the involvement of APRNs leads to an improvement in health status, behavior, as well as patient satisfaction in this population (Fougere, et al., 2018).

As mentioned earlier in this paper, the prevalence of non-communicable diseases has risen as the population ages. Therefore, there is a need to put more emphasis on the prevention of these conditions. Unfortunately, the existing healthcare system is inadequate to deal with the rising burden of non-communicable diseases. APRN involvement is critical in the achievement of this goal. Just like all the other primary care providers, APRNs, play a significant role in the prevention of geriatric conditions. This goal is achieved through risk assessment and screening of the focus population. Regular prevention and screening are consistent with the training of APRNs and hence their involvement is necessary. Most of the mentioned non-communicable diseases, such as obesity and cardiovascular diseases, are caused by various lifestyle factors including tobacco use, and physical inactivity, among others (Fougere, et al., 2018). Though lifestyle change in old age may be seen as impossible or unimportant, studies have shown that older citizens who lead healthier lifestyles live more independently and incur less health-related costs (Fougere, et al., 2018). To this end, APRNs play a critical role in assessing nutritional habits as well as the physical activity of this population. By establishing long-term relationships with the patients and family caregivers, the APRNs can evaluate the effectiveness of the recommended changes to the health of the patients (Fougere, et al., 2018). This way, the APRNs are in a position to help reduce the prevalence of non-communicable diseases and hence lower the pressure on the healthcare system.

The above study focused solely on the need for APRNs specializing in APRNs. However, the same study acknowledged that the literature and evidence on the role of APRNs on older patients are scanty. Therefore, there is a need for more nurse scientists to conduct research to inform evidence-based interventions to promote health as well as manage illnesses in this population (Grady, 2011). Nursing science is expected to grow further in the coming years as nurse scientists take up more prominent roles in interprofessional and interdisciplinary teams charged with understanding the complex issues facing in providing quality care among the elderly. More nurse scientists should also be trained in the field of aging (Grady, 2011). The collaborations are also important in developing nursing models to address the challenges that will emerge as the population ages.

Recommendations

In light of the inevitable trend discussed in this paper, there is a need for the government to prepare the healthcare system better for the changes that will arise as a result of the shift. The system should be more prepared for increased demand, especially in the area of management of non-communicable diseases. More efforts should be directed towards ensuring that more people are insured to afford these services. The policies made to address these challenges must also put into consideration the various social changes being witnessed. For instance, due to the possibility of a lack of family caregivers in the future, the government should invest more in care homes.

The discussion has also revealed that the demand for health services will outweigh the supply, especially due to the shortage of physicians in the country. Therefore, APRNs should be given more independence to take up some of the roles traditionally performed by physicians. In turn, this will help bridge the gap. Registered nurses should also be encouraged to specialize in geriatrics to prepare the workforce for the changing demographics. Moreover, to offer evidence-based care to this population, more nurse scientists should be trained. A combination of these factors will lead to the improvement of the quality of care given to the old citizens.

Conclusion

The American population is aging at an unprecedented rate. The immediate effect of this shift is increased pressure on the country's healthcare system. A shortage of physicians in the country has made the situation worse. In light of this, the role of APRNs has become more prominent. APRNs are involved in both the promotion of health as well as the management of illnesses. Moreover, they are involved in research to develop better ways of caring for the elderly. However, to adequately cope with the needs of the future, the government needs to invest more in the healthcare system as well as care homes.