Editorial: Ageing in place, older people and community nursing: gerontological nursing in place.

Abstract

Ageing in place. A maxim used in all sorts of definitions and directives for ageing societies around the world. As nurses, we often include this central gerontological principle in lectures to students and colleagues. We point up aspects of community-based nursing practice as examples of enacting the principle of ageing in place. But our discussion of best and evidence-based practice in this, the largest and most encompassing of our healthcare delivery ‘settings’, is often spare. The demands for evidence to guide our practice and shape the specialty of community gerontological nursing are vast. Gerontological nursing struggles with an implicit assumption about our scope and setting for practice. The assumption, drawn almost certainly from our historic beginnings in many societies within almshouses and convalescent facilities, is that we specialise in care of older people living in residential long-term care facilities. While vulnerable elders who live in nursing and care homes absolutely need our best care and strongest science, they represent a small but needful proportion of our overall older population. The great majority of older people, in societies around the world, live in their communities. That is to say they live in our communities. They are our family members, friends and neighbours in rural, suburban and urban communities. Often confronting the dire circumstances of profoundly limited resources and managing life with significant functional limitations, these elders commonly reveal similar or even greater health and social care needs than their counterparts who live in residential care settings. Elders who live among us in our villages, towns and cities are the largest population in need of gerontological nursing care, meriting similarly advanced care practices with strong evidence to support that care. In the 21st century, gerontological nurses must truly be community nurses just as community nurses – with few exceptions – must be at least competent to care for older people and most must be specialists in our field. The challenge we face in shifting the mythical assumption and reflecting the true nature of gerontological nursing practice today lies in the word ‘setting’. Globally, our healthcare systems remain largely centred on acute care. Hospitals remain the apex of our care networks. The prestige garnered by acute and critical care nursing practice is testament to the practice and reputational extent to which our health care is ‘acute-care centric’. We continue to focus on delivering nursing care in settings whether hospitals or extended care facilities. In an era of aged demographics, policies mandating ageing in place and limited resources for integrated care continua, much about nursing and health care still only sees hospitals and – for older people living with chronic conditions – nursing homes. In an era of ageing in place, we must create a sense of gerontological nursing in place. Gerontological nursing ‘in place’ connotes a spirit of nursing truly embodied in the nurse without the constraint of an institution defining the delivery of care. Nursing becomes wholly focused on the person. Providing care to an older person and family is freed from the boundaries of physical ‘settings’ where an older person becomes a patient or resident and enters a world controlled by clinicians or at least designed with them in mind. If, spiritually and philosophically, we endorse the value and wisdom of ageing in place, then it is time for casting off historically derived definitions of nursing that rely on exclusively on the setting of care. We must lead the way for gerontological nursing in place with increasingly sophisticated science exploring and improving daily life, health and function as we age in place.