Patient education graduates to a different group as boomers age

Detailed assessment key to tailoring teaching to elderly patients

The old adage is true now more than ever: We ain’t getting any younger. According to the Census Bureau, the percentage of Americans age 65 and older has more than tripled since 1900. What’s more, this segment of the overall population is getting older itself. In 1997, the 85-and-older age group was 31 times larger than this same age group in 1900, and the 75-84 age group was 16 times larger. Between the years 2010 and 2030, these population groups will burgeon further when the baby boomer generation reaches age 65.

Patient education must meet the learning needs of the growing population of elders. To do so, patient education managers will have to create programs specifically for the elderly, train staff to overcome barriers to education that worsen with age, and find new ways to provide access to information and services for this growing population.

In 1995, older people accounted for 40% of all hospital stays and 49% of all days of care in hospitals, according to the U.S. Department of Health and Human Services’ Administration of Aging (AoA), in Washington DC. Most older Americans have at least one chronic condition and many have multiple conditions, according to the AoA. In 1994, the most frequently occurring conditions among the elderly were arthritis, hypertension, heart disease, and hearing impairments.

"The elderly need to know the same information as anyone else. The problem with teaching them is that they have more barriers. For example, they may have hearing or sight problems so they may need some material presented to them a different way," says Berdelle Ingeman, patient education coordinator at Rice Memorial Hospital in Willmar, MN.

Learning assessment vital

Completing a good learning assessment is vital to effectively teach the elderly, says Ingeman. For older patients, a learning assessment not only reveals what needs to be taught, but how they will best understand the information. The assessment should uncover physical or sensory changes that take place as we age, such as impaired mobility, hearing loss, or poor eyesight.

Personal losses also can affect learning, says Ingeman. These not only include the death of a spouse or other loved ones, but such lifestyle changes as retirement, moving from a house to an apartment, or not being able to drive anymore.

Finances, too, should be a part of the assessment because they often impact compliance, says Ingeman. "We need to assess their financial resources to determine if they have enough money for medications, food, shelter, and heat."

"The best thing that health care providers can do for elders is to get a very good assessment — including medical background, cultural background, and systems background. We need to know where these people live and what their support systems are like," says Angela Stoops, RN, vice president of education and work force development for AGE Institute, a nonprofit educational organization in Chambersburg, PA.

Although it is possible to list many general signs of aging, you should never generalize about a patient group, says Stoops. Each person is unique, and the assessment will make it possible to individualize the teaching, making it more effective.

The assessment doesn’t need to be complicated, it just needs to be complete, agrees Jennifer Browning, MS, RN, CNS, CNP, gerontological clinical nurse specialist and adult nurse practitioner at The Ohio State University Medical Center in Columbus. Ask simple, straightforward questions, she advises. These might include:

• Do you have any problems with your memory?

• Do you have any vision or hearing problems?

• What losses have you had in the last six months?

While undergoing a complete assessment before teaching might take a little longer, it will save time, says Ingeman. "It is important for staff to realize that by knowing the person’s special needs and completing the assessment, they will ultimately save time in the long run because they don’t have to go back and re-teach the person later," she explains.

Overcoming barriers

Learning effective teaching techniques for the elderly is important for all health care providers who work with these patients. Because many seniors experience hearing loss, those who teach elderly patients should face them when talking and make sure there are no distractions in the room or background noises, says Ingeman. Large-print materials should be available to reinforce teaching.

It’s sometimes difficult for the elderly to adjust to new restrictions and limitations brought on by aging, such as the fact that they are not as mobile as they use to be. "It’s important to start right where they are and help them make the necessary adjustments in their life," says Ingeman. (To learn about a community outreach class to help seniors adjust their lifestyle to the limitations of aging, see story, p. 3.)

The special requirements of the elderly always must be taken into account when designing classes and other educational programs for them, says Browning. Make sure the class is held in a barrier-free environment, she advises. Classes should be held in rooms the elderly can get to easily, that accommodate wheel chairs, and have parking close by. Night vision often is a problem so hold sessions in the daytime, and avoid rush-hour traffic. Incontinence can be an issue too, so make sure that the restroom is located near the classroom and hold short sessions.

If possible, distribute a screening questionnaire before holding a session to determine what special concerns seniors have. Also, ask what they hope to get out of the class. Adults in general, and especially older adults, want to know that they are going to come away with new insight or knowledge.

It’s best to be proactive in education, says Stoops. Help elders see aging as part of the natural life cycle instead of a negative, she says. That means providing access to information that helps people age well, including Web sites, books, articles and other publications.

"It is important for us as health care providers to provide access to services and systems," says Stoops.

(For Web site addresses and other resources, see source box at right. Also, see the following article about educational sessions to help seniors age well, p. 4.)

Sources

For more information on educating the elderly, contact:

Jennifer Browning, MS, RN, CNS, CNP, Gerontological Clinical Nurse Specialist and Adult Nurse Practitioner at The Ohio State University Medical Center, 480 West 9th Ave., Columbus, OH 43210. Telephone: (614) 293-4842. Fax: (614) 293-5612. E- mail: browning.3@osu.edu.

Berdelle Ingeman, Patient Education Coordinator, Rice Memorial Hospital, 301 Becker Ave. SW, Willmar, MN 56209. Telephone: (320) 231-8935. Fax: (320) 231-8924. E-mail: bing@rice.willmar. mn.us.

Angela Stoops, RN, Vice President of Education and Work Force Development, AGE Institute, 25 Penncraft Ave., Chambersburg, PA 17201. Telephone:(717) 263-7766. Fax: (717) 263-7602. E-mail: age@internet.net.