Reflections on a 25th birthday

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• Priscilla Ebersole, PhD, RN, FAAN

In June 1980, Geriatric Nursing was born, and Cynthia Kelly brought it into the world. In reviewing her initial editorial, I am struck by the things that are the same and the things that have changed in the care and cultivation of older persons. “Cultivation” is rather a strange word to use, but it seemed right until I looked it up in my trusty thesaurus and saw farming, agriculture, horticulture, and husbandry. But cultivate is a wonderful word—and what I hope we are doing: edify, enrich, reclaim, enlighten, and humanize (thanks to Kirk Swearingen, my first Mosby editorial manager in 1991, I was taught to put words together in order of size unless there was a reason not to). And I called Cynthia at least weekly to learn what I should be doing with this journal. Commendations to the foresight of American Journal of Nursing (AJN) publishers who saw the need for the journal before geriatric nursing had become fashionable.

I offer my profound gratitude to one of our columnists, Peggy Yen, who has been with us the entire quarter century of GN's existence, keeping us current on considerations regarding geriatric nutritional health. In the premier issue, Virginia Barckley wrote of her experience trying to eat on $1.18 per day to make the plight of many of the aged at that time more real to her. Now one major concern is how to eat and purchase medications on $4 daily.

That first issue included numerous messages of support and congratulation. Mary Opal Wolanin's letter noted, “we do not use older persons as resources. We study them—as anthropologists study the last of the aborigines. And perhaps we are the new aborigines. But it is as strangers looking at some wonderful new thing that has just been discovered. We older folks have discovered also, the reality of aging.”

I was impressed by Ingeborg Mauksch's enthusiastic welcome to the new arrival. A champion of geriatric care, I first met her in 1976 and was impressed by the clarity of her thoughts. She recently died, and her obituary appeared in the October 1994 issue of AJN. Her article in the premier issue of GN, “A Look at the Elderly at Home and Abroad,” compared medical and social security benefits in the United States, Denmark, and Israel. We fell far short.

Now, 25 years later, what have we done? In Cynthia's editorial, she wrote of the scary world we entered—cutbacks in programs and services, tight economics for most people and especially for elders—these are the same now, maybe worse. I fear the world my 25-year-old grandson faces and the burgeoning number of single mothers struggling with little help to raise children. It has traditionally been thought that the young are our hope for the future. If that be true, we do precious little as a society to husband them, to cultivate their potential. And what of the old?

The situation in “health care” has gone from bad to worse. Now nearly 41 million people in the United States have none. Older persons are quickly discharged from acute care, most to their homes or those of relatives, where there may or may not be anyone with sufficient energy, incentive, or knowledge to care for them properly. In nursing homes, even though only about 5% of elders live in them at any one time, 45% are expected to spend some time in a nursing home before they die. The nursing home 5% figure has shifted somewhat with the growth of assisted living options. These are occasionally used and administered inappropriately.

But is this any way to celebrate a birthday? What have we done? We have learned that the aged give us far more than we give them. A great wave of interest in the stories, oral histories, memoirs and reminiscences of the aged has grown to tsunami dimensions. We have marvelous senior centers throughout the United States, providing nutritious meals, activities, and opportunities for travel and meaningful contributions to their communities. Applied research and humane considerations have almost ended the use of restraints in institutional settings, and a growing interest in end-of-life-care is allowing numerous elders to end their days in dignity.

The offshoots of the Hartford Institute for Geriatric Nursing, directed by Mathy Mezey, are reaching throughout the United States. By numerous creative methods, nurturing, recognition, consultation, and financial support, the Institute has brought geriatric nursing to the attention of the nation's nurses. Several endowed chairs of geriatric nursing exist in universities, the first being the Florence Cellar Gerontological Chair at Frances Payne Bolton School of Nursing, Case Western Reserve University, in Cleveland, Ohio. Florence, an obstetric nurse at University Hospital said, “When I saw the superb care and caring my parents were receiving in the nursing home, I knew that improving geriatric education was the proper place to invest my money” (Cellar, personal communication, 1988).

Irene Burnside wrote, “At this one [nursing home] there is a talkative cockatoo, a dog named Trudy, who fetches and carries tennis balls and seems to be adept at avoiding octogenarian legs.” And, “Remember that ‘he who laughs, lasts’” (Geriatr Nurs 1980;1:31). The geriatric nurse pioneers knew all these concepts decades ago and incorporated pets, gardens, children, and even happy hours into the homes. Eden Alternative—step aside.

I am now 76 years old, and Cynthia is 87. What have we discovered? Cynthia, the tenacity of the human spirit, and I that living the theories is an entirely unique and individual experience. Cynthia wrote, “Health at any time of life, but especially in our advanced years, is inseparable from decent housing and transportation, food, water and sunshine, relief from pain, solace in loss, affection, respect, and stimulation, independence of choice, and physical-emotional care when our reserves begin to flag.” There is nothing more I can add.