Healthcare professionals who work with older adults are sleuths who dig deep to understand their patients. They collaborate across disciplines to support individuals’ health and improve care systems. They are experts in anticipating and avoiding potential problems.
That’s what panelists at a recent Careers in Aging Week discussion told University of Wisconsin–Madison School of Nursing and other health sciences students. The panelists included a nurse, occupational therapist, pharmacist, and social worker who work with older adults, either in a hospital or long-term care setting.
“I had a very unique career journey,” says Geriatric Clinical Nurse Specialist Kari Hirvela.
Hirvela started as a nurse on a hospital pulmonary unit, then moved to pediatrics, then to the ICU. She taught at the UW–Madison School of Nursing for ten years. She then entered the School’s Doctor of Nursing Practice program, in the Adult-Gerontology Clinical Nurse Specialist track.
“During my clinical time, I was at Meriter [Hospital] a few semesters with the geriatric clinical nurse specialist there and absolutely loved it,” says Hirvela. “It was my jam. I could go consult on patients. My favorite thing is to make something out of a puzzle. I really like digging into the charts and looking at why patients are here, being able to tell the nurse what I found, and putting the picture together. Bedside nursing just doesn’t have the time to do that.”
Hirvela now leads the Age-Friendly Health Initiative at UW Hospital.
“It uses the four M’s framework, which is what matters most, mobility, mentation, and medications,” she explains. “That by default is interdisciplinary. You’re screening for high-risk medications. You’re making sure patients are walking. That involves nursing, pharmacy, medicine, PT, OT—the whole team. You need a team approach for every single patient.”
Gabriel Cranley is an occupational therapist and the Therapy Manager at Capitol Lakes continuing care retirement community.
“What really drew me to the geriatric population was they know what they want or don’t want,” says Cranley. “The younger population doesn’t quite have that understanding of what to work towards. Working with the geriatric population, you can find their interests and that’s how you shape their therapy.”
Cranley appreciates that her role as a therapist in long-term care is highly collaborative.
“I’ve seen a huge improvement in the collaboration in discharge planning,” says Cranley. “Patients might come from acute care to the nursing home to rehab with us for 30 or 40 days, or maybe just ten days. We see where their triggers are, what will keep them successful at home or things to watch out for. We meet weekly with the UW nurse discharge planner, who sees people in the community. Talking with the nurse who will follow up with patients, sharing areas of concern, is key to improving the process for successful aging.”
As a young adult, Magda Bertalan worked at a continuing care retirement community and enjoyed engaging the residents. As a college student, she decided to pursue a career in social work. Today, she’s a geriatric social worker at UW Hospital.
“I work on the Acute Care for Elders team,” says Bertalan. “That’s a consult team for people in the hospital age 60 and older. It includes nurses, physicians, pharmacists, therapists, and social workers. We look at anything from reviewing medications, to preventing falls, supporting caregivers, and trying to improve the transition out of the hospital.”
Bertalan’s role allows her to focus on each patient.
“I can spend extra time with patients and families, even connect with them after they leave the hospital to see how things are going,” says Bertalan. “If you think about why somebody comes to the hospital—let’s say it’s related to their diabetes or heart failure. Their legs are swelling. But it’s not just that. There are other things going on. Are they forgetting to take their meds? Do they not have the financial resources to get their meds? Is their caregiver struggling or stressed out? Are they weak and not able to move around their home like they used to? I really enjoy being able to fill in some of the gaps.”
Mara Kieser is a consultant pharmacist for Capitol Lakes and the Assistant Dean for Experiential Education at the UW–Madison School of Pharmacy.
During her residency at UW Hospital, “I was lucky enough to be with one of the preceptors who did home health care for older adults and also saw them in the clinics,” says Kieser. “I just thought wow, what an opportunity to make a difference with older adults and drugs and all the things that can go wrong.”
When patients move from one care setting to another, their medications may change or be miscommunicated.
“Part of my job as a consulting pharmacist is to look for drug therapy problems,” says Kieser. “If you can make sure every one of those drugs has a reason, you’re winning half of the battle. If there isn’t a good reason for a drug, or the reason’s changed, or they’re not getting benefit, it can help to start deprescribing or getting rid of medications.”
Kieser is helping to pilot a system to decrease medication errors during transitions of care.
“One of the biggest things that you wouldn’t think would make such a difference is just alphabetizing the drug list,” she laughs. “That makes it so much easier to process and compare multiple lists. It saves you a ton of time.”
Careers in aging are rewarding and will continue to evolve, the panelists noted. Even during the early days of the ongoing COVID pandemic, panelists valued working with older adults.
“That was where I found the biggest beauty,” says Cranley. While long-term care residents were afraid and isolating in their rooms, “They were still so incredibly grateful—for a hello, for the simplest things. They were so thankful that we were there. It’s a remarkable group of people.”