The effect of the ageing population on the nursing profession in the 21st Century
As we plunge deeper into the 21st century, life expectancy is steadily increasing, which means that the population is also ageing – and fast. It is inevitable. The number of New Zealanders in the 65+ age group has been on the rise since 2009 – with a total population count of 552,600 to 587,100 in 2011. Although this is not a dramatic increase, during the year 2011 itself, there had been an estimated population growth of 37,400 – 0.9 percent (NZ Demographic Trends 2011). The U.S Census (2010) also showed that America has had increases in the 65+ age group, inferring that it is becoming a global trend. The census examined the growth since the early 2000’s in the 65+ age group and it had increased by 29.9%, going from 3.9 million to 5.1 million in a span of 10 years (U.S Census 2010). These changes are likely to have a major impact on the nursing profession and the delivery of nursing care.
Although the average lifespan seems to be increasing at a steady rate, life quality on the other hand, is not. This suggests that the HLY – healthy life years remaining with good health, without disability or physical/mental impairments, is rising at a slower rate. This puts a heavy demand on caregiving as it means that more people will be in hospital, requiring a wide spectrum of different treatments. Nurses are not an exception to this. Studies have shown that the average age of nurses in the U.S is 47 years, and nearly 45% of registered nurses are aged 50 years or older (Keller & Burns, 2010). In New Zealand, an estimate of 40% of nurses were aged over 50 years (Clendon & Walker, 2013). Also the Commonwealth Department of Health (2004) concluded that nurses – especially registered nurses, were substantially older than the typical female worker (Richardson and Martin 2004). This means that almost half the nursing population will be susceptible to chronic illness, as when the human life expectancy increases, the prevalence of chronic illness rises simultaneously. It is stated that 68% of older adults have at least two chronic diseases (“Impact of Aging Population on Nursing”, n.d). Additionally, as the nursing workforce continues to age along with the population, it is predicted that over 50% of the present workforce will retire by 2035 – putting pressure on the supply of future nurses to adapt to the consequences of the population changes (Nursing Council of New Zealand, 2013). The U.S Census (2010) stated that approximately 1.3 million people 65 years and older (3.1% of this population) are living in skilled nursing facilities. This means, if nurses were to be affected, it would likely cause a cascade of effects on the ageing population. This is due to the lack of the nurses who serve as the primary care provider in health. Hence, for countries where there is an insufficiency of protection against disease/illness, there would be increased vulnerability due to the shortage of nurses in times of rising demands for health care.
As the ageing population and in turn the chronic disease counts increase, the more people there will be in hospital. This makes it important to have well-educated nurses – a primary point of contact in health care, to cater for the wide scope of patients they are likely to encounter. However, the younger generations are not growing at equivalent rates to the ageing population, putting a strain on the availability of experienced nurse professionals who are able to cater for the widened patient population. A lack of well educated and experienced nurses can lead to longer waiting times for basic services, plus extra costs added to the already high medical expenses, and as such – create more problems for the ageing populations who may no longer be able to afford medical care (Magrath, P. 2018). More importantly, the current nursing profession does not reflect the changing ethnic composition of the New Zealand population (Nursing Council of New Zealand, 2013). According to the N.Z census (2013), New Zealand’s major ethnic groups are still on the rise with the Asian population increasing from 9.2% (354,552) to 11.8% (471,708), MELAA population increasing from 0.9% (34,743) to 1.2% (46,953) and the Pacific population increasing from 6.9% (265,974) to 7.4% (295,941). Thus, investment in nurse education on different cultures for younger generations will need to increase to compensate for the growing sick population. More sick people equalises to a widened ethnic composition of patients in hospital, meaning that nurses will need to be aware of cultural barriers that may oppose to treatment considered as the ‘standard’ in New Zealand. The World Health Organization stated that many Maori perceive hospitals as unfriendly environments and are reluctant to seek these institutions, hence the ‘Te Rangimaire clinic’ was built at a Marae – a sacred place, for Maori to feel at ease. This can interfere with the current healthcare systems already set in place, putting pressure on government fundings for more concepts and nurse practices such as ‘Kawa Whakaruruhau’ (“What is Cultural Safety”, n.d). This cultural safety concept is aimed at nurse’s behaviours and attitudes towards patients and their ability to create a trusting relationship (“What is Cultural Safety” n.d). This adds another dimension to the healthcare system, highlighting the major contribution that ‘difference’ and ‘individual identity’ plays in shaping health care interactions. This is a crucial concept that must be undertaken in the nursing profession, as nurses play key roles in the provision of health and as such, safer handling of patients should be encouraged in respect to the growing social issues in the 21st Century.
As the 65+ age group increases, more adults are likely to be affected by disease/illness. In 2016, the Ministry of Health stated that more than 1 in 5 adults (21%) were experiencing chronic pain. This encouraged the nursing profession to shift to a community based level, following the New Zealand Health Strategy (2016) as the prevalence of chronic illness in the older population increased. Community based care helped set up nurses to not only focus on the “physical aspects” of a person, but also the “mental and spiritual aspects” (Kristin Ocker, College of St Catherine, 2009). This differs greatly from the historical perspectives during the 20th Century, where nursing was seen to be associated with hospital settings only. However during the 21st Century, the inclusion of the ‘promotion of health in communities’ in Florence Nightingale's classic model was linked into the New Zealand Health Strategy (2016), which helped nurses to engage with the wider environment outside the hospital (MOH 2016). The implementation of community care in the nursing profession lowered issues related to accessing healthcare, as older people use more health services than younger people according to the Ministry Of Health (2016). Also community care can help strengthen New Zealand’s financial status, as home-based support services usually cost less than hospital based care and serves to be more effective by allowing the patient to maintain their social relationships in a familiar environment (OAG 2014). As the nursing profession evolves along with the changing population, the need for prioritising community based care over acute care has become necessary, meaning that the need for more qualified nurses, geriatricians and medical professionals who are able to provide optimal care for older patients suffering from ‘multimorbidity’ outside the hospital environment will increase (AAFC 2012). The Ministry Of Health (2011) estimated that by 2026, the number of patients aged 65 and over being admitted to an acute hospital will decline from 605,000 to 578,000 (decreasing by 7%). Hence, the nursing profession anticipating this change, are beginning to start prioritising community support services over acute care.
The ageing population will have – and continue to have many impacts on the nursing profession during the 21st century. This is due to the ‘Epidemiological Transition’ where there is a predominance of non-communicable diseases. Many different nursing implementations will be enforced in desperation to reduce the burden of disease, as well as the need to adapt to these constant changes. However, as the ageing population increases there will be a gradual shortage of nurses in the health sector; and because the growth of the younger generation does not compensate for this reduction, the need for increased funding to attract more health professionals in the nursing field will be stronger than ever to minimise the impacts of the ageing population. Despite this problem, the nursing profession has evolved to a community-based level to provide geriatric support. However, the number of people interested in this sector has also been decreasing. This puts a strong emphasis on the need for changing public perceptions on nursing completely, and bringing in more nurse roles that can attract more people into the health workforce. As dynamic as the 21st century is, the nursing profession must continue to develop along with the ageing population in order for patients to get the most out of their health entitlements.