longevity & nursing

In our unit on geriatrics last semester, we were told that aging resembles disease processes in many ways. While I understand the rationale behind that statement, I think it may present a skewed picture of nursing. It is a heterodox position, but I don't think care of the elderly is fundamental nursing practice. I use the distinction between necessary and sufficient conditions to make the point: learning how to navigate changes in mobility and mental status of the elderly is necessary nursing knowledge, but it is not sufficient nursing knowledge. That is, the skills unique to elder care can and are learned by a wide variety people including allied health workers and non-professionals. This point is highlighted by the fact that, while nursing students learn basic physiology and pathophysiology related to disease processes, geronotology is not covered in our studies as a branch of pathophysiology (which is what you would expect if aging resembles disease processes).

So, what does this tell us about the wide-spread use of nursing staff to manage elder care? Geriatrics is fundamentally a branch of public health, of government. Although nurses may work for the state or for private entities, in caring for the elderly, they are performing duties for the corporate social body. They are not providing care for the sick but performing an economic function in managing the aggregation of labor that is on the other side of the hump on the lifetime productivity bell curve. I think (I hope) this explains my visceral dislike of geriatrics--from the predominant social perspective, the elderly are like the walking dead.

Anyhow, what does this have to do with longevity, and what is longevity? On this blog, by "longevity," I mean an (as yet) imprecise term that is differentiated from geriatrics. Rather than the management of decline, it is the promotion of thriving. One could say I am just playing with semantics and that because of the inevitability of death, longevity is just a less morbid conception of dealing with geriatric patients. I would agree if medicine and technology were static, but in fact I believe there are great changes that are going to occur in the next decade or two that will make qualitative changes in the lives of chronologically advanced people.

My perspective is not new, but the people who are currently addressing these changes are research scientists and philosophers. In medicine, you occasionally hear news stories about new treatments, and about the health care system, if you hear anything, it is about the economic problems posed by increased life-span. But what about nursing, in terms of patient care, the labor market, and the professional concept? Will nurses have a new role de facto? Should they push for new roles in managing health? Should nursing shrink and allow the establishment of a new health profession in between nursing and medicine that would manage older people with fragile robustness? Is this the natural role of advanced practice nursing? Will there be a de-institutionalization of nursing homes, and the transformation of nursing home care into a distributed model like home health?

I don't have the answers to these questions, but they should be addressed.