New perspectives on advanced practice nursing case management for aging patients.
Providing case management for older individuals is challenging in that this group rarely fits any DRG or managed-care mold. Because many people are living healthier and longer lives, intergenerational family dynamics such as that observed in Sophie and Leo's case may become more the norm than the exception. Well-intentioned family members, lacking the guidance of an experienced gerontologic APN case manager, may inadvertently place their aged loved ones at risk by attempting to arrive at health care, social, and housing solutions on their own. Even though 82-year-old Sophie stated subjectively that she "felt better than ever", an objective clinical assessment revealed that she still was in a convalescent period following major abdominal surgery at the same time that she was faced with providing in-home care for Leo, her 102-year old father. Sophie may have experienced response shift, or a reconceptualization of her own health state, in the aftermath of serious illness. The advanced practice knowledge and skills, systems acumen, talents, and creativity of two APN case managers in two different states contributed to successful health and social outcomes for two "master survivors," whose longevity and clinical presentations exceeded expectations. The value of APNs as case managers is clear: APNs possess the proficiency, tenacity, knowledge base, and nursing confidence needed to make a positive contribution toward individualizing care for members of the greatest generation.
Mick
Diane J
DJ
Center for Clinical Research on Aging and Center for Clinical Trials and Medical Device Evaluation, University of Rochester School of Nursing, 14642-8404, USA. Diane_Mick@urmc.rochester.edu
Ackerman
Michael H
MH
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D019090:Case Management; D005260:Female; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009720:Nurse Clinicians; D009722:Nurse Practitioners; D010351:Patient Discharge; D018570:Risk Assessment; D014481:United States