Articles appearing in professional journals can be assumed to reflect the concerns and interests of the groups the journal serves. The preponderance of journal articles about the aged pertains to the nursing care of institutionalized, chronically ill older persons. No one would deny that there is a great need to share information about chronically ill older persons in longterm care facilities, but perhaps we should think of priorities and of balance. Little attention is given to two very important aspects of gerontological nursing: the needs of healthy older persons living at home and the unique needs of acutely ill older persons. In support of that position, I offer the following thoughts.
In the early 1970s, the ANA's Congress for Nursing Practice instructed the various divisions to formulate standards by which the competence of their members and the quality of their services could be judged. The first set of standards to be completed was the Standards for Geriatric Nursing (1973) for the ANA's newest division. Three years later this fledgling division developed a revised set of standards called Standards for Gerontological Nursing Practice. They reflected nurses' role in health maintenance and promotion, since the great majority of older persons were relatively healthy and needed assistance in staying that way
Let us take stock of the situation ten years later. First, the majority of older persons are still healthy. An oftenquoted statistic states that 4% to 5% of those over 65 are institutionalized. Although some of the 95% who are not institutionalized are ill at home, most are not. In spite of the fact that services designed to help healthy older persons maintain and enhance their health status could be expected to add to the quality and length of their lives, if nursing literature is an accurate gauge the time and effort we devote to these services is meager. Nursing has the field of health maintenance and promotion essentially to itself (no other professional group purports to provide care for healthy persons), but if we do not devote the measure of attention needed by this field, another group will take it over.
Second, the healthcare system is generally described as an acute care system. Clearly, acute care accounts for the greatest monetary expenditure and employs the most health professionals, including nurses. Older persons account for far more than their share of acute care patient hospital days. Nursing literature is replete with articles on acute care nursing, yet in spite of all the unique nursing needs of acutely ill older persons, one is hard pressed to find any articles dealing with those unique needs. Older persons' reserve capacity is reduced, resulting in problems where none would be expected. Their symptoms of illness are different. They respond differently to illness, diagnostic procedures, and practically all treatment modalities. Although there is inadequate knowledge available about the healthy elderly, we know that many norms are different for older persons. Unless nurses have knowledge of the elderly's unique nursing needs, acutely ill older persons will not get the care they need, and the result could make the difference between continued life and death. The situation will not change unless knowledge regarding these needs is made available to nurses who provide care for acutely ill older persons.
Let us not allow knowledge about these two important aspects of gerontological nursing to remain buried in libraries or stored in the minds of the relatively few nurses who have such knowledge. Let us see that journal articles more adequately reflect all aspects of gerontological nursing practice.