GHA 548 Week 1 The Field of Gerontology Example

Why a Hospital System Needs Gerontology, Not Only Geriatrics: The Field, Its Disciplines and the Demographic Case for a New Director of Senior Services

[Student Name]

University of Phoenix

GHA/548: Foundations of Gerontology for Health Administrators

Week 1 Assignment

[Instructor Name]

[Date]

The health system, its data and the director's role are composites written for a model paper; demographic projections and research come from the sources listed.

Three weeks after being hired as director of senior services at a composite regional health system with four hospitals, 22 clinics and a home health agency, the new director met the chief operating officer, who asked a fair question: the system already employs five geriatricians, so what does a gerontology perspective add? This paper answers that question by defining the field, describing its disciplines and history, presenting the demographic case and showing how gerontology becomes administrative practice.

Gerontology and Geriatrics

Geriatrics is the branch of medicine that cares for older people, especially those with multiple chronic conditions, frailty or cognitive impairment. Gerontology is broader: the study of aging itself, including the biological changes of the body, the psychological changes in thinking, emotion and personality and the social changes in roles, relationships, income and community. A geriatrician treats a patient's heart failure; a gerontologist asks why that patient lives alone, how retirement changed her income, whether she can climb the stairs to the clinic and what she wants from the rest of her life. A health system needs both, because most of what shapes older patients' health happens outside the examination room.

The Disciplines of Gerontology

Biologists study cellular and physiological aging and why people age at different rates. Psychologists study memory, learning, emotion and adaptation across the life span. Sociologists study roles, family, retirement, social networks and inequality. Economists and policy analysts study income, pensions, health insurance and long-term care financing. Environmental gerontologists study housing, transportation and the design of places. Health administrators draw on all of them when planning services.

A Short History of the Field

Gerontology developed as an organized field in the middle of the twentieth century. The Gerontological Society of America was founded in 1945, bringing together researchers from biology, medicine and the social sciences. In 1965, Congress passed both Medicare and the Older Americans Act, creating national health insurance for older people and a network of state and local aging agencies. The National Institute on Aging was created in 1974 to fund research. Theories of aging, which a later paper will examine, came from this period and continue to shape how services are designed.

The Size and Growth of the Older Population

The most recent federal profile put the population aged 65 and over at 57.8 million in 2022, or 17.3% of all residents, with roughly one American in five expected to be in that group by 2040 (Administration for Community Living, 2024). Census projections published in 2018 showed people 65 and over passing the number of children under 18 during the 2030s, a crossing the nation had never seen and the population aged 65 and older reaching about 95 million by 2060 (Vespa et al., 2018). The fastest growth is among people 85 and older, the age group whose members most often rely on others for bathing, dressing and getting around.

Diversity Within the Older Population

Older adults differ more from one another than any other age group. A 67-year-old marathon runner and a 92-year-old with dementia are both older adults. The older population is becoming more racially and ethnically diverse, and income, education, health and living arrangements vary widely. Averages hide these differences, so administrators need data broken down by age group, sex, race and ethnicity, income and place.

What the Numbers Mean for the Health System

In the system's service area, residents aged 65 and older are 19% of the population but account for about 45% of hospital days, a pattern common in hospitals. Older patients have longer stays, more complications such as delirium and falls, more readmissions and more complex discharges. They are also the system's most important Medicare and Medicare Advantage population. Planning services, staffing, facilities and finances without understanding aging is planning for the system's largest group of patients by guesswork.

From Field to Practice: Age-Friendly Care

A framework developed by a national quality organization and a foundation gives health systems a practical starting point. It asks systems to act reliably on four elements for every older patient: what matters to the patient, medication, mentation and mobility (Fulmer et al., 2018). What matters means asking about the person's goals and preferences. Medication means avoiding drugs that are risky for older adults. Mentation means screening for and managing dementia, depression and delirium. Mobility means helping patients move safely every day. The four elements are gerontology translated into questions a nurse can ask on the first day of admission.

How Gerontology Changes Administrative Decisions

A gerontology perspective changes ordinary decisions. Facilities: clinics with benches, handrails, large-print signs and drop-off areas close to entrances. Scheduling: appointments that avoid early mornings for people who rely on family for rides. Workforce: training for all staff on communication with people with hearing loss or dementia, not only for clinicians. Services: partnerships with community agencies for meals, transportation and caregiver support. Finance: understanding that preventing a fall or a readmission matters under value-based contracts.

Health and Function in Later Life

Aging and illness are not the same. Many people in their seventies and eighties live with chronic conditions such as high blood pressure, arthritis or diabetes yet manage their own lives without help. What predicts the need for services is function: whether a person can bathe, dress, walk, shop, manage medications and handle money. Function declines with age on average, but the decline varies enormously and can often be slowed through exercise, medication review, treatment of hearing and vision loss and support for social connection. For a health system, this means measuring function as carefully as diagnoses, since function drives readmissions, discharge needs and long-term costs.

The Workforce Question

The same demographic change affects the system's workforce. A growing share of its nurses and support staff are themselves in their fifties and sixties and will retire over the next decade, while demand from older patients rises. Few clinicians receive much training in the care of older adults, and the country has far fewer geriatricians than the older population would require if every older patient needed one. Gerontology helps administrators respond by training all staff in the basics of aging, redesigning work so older employees can stay longer and reserving specialists for the most complex patients.

Avoiding Ageism

Gerontology also asks organizations to examine their language and assumptions. Terms such as elderly and senile carry stereotypes. Assuming an older patient does not want aggressive treatment, or cannot use a patient portal, can lead to worse care. The next paper examines these myths.

Three Early Priorities

The director proposed three priorities for the first year: adopt the four-element framework in the two largest hospitals, starting with medication review and mobility; build a dashboard of outcomes for patients 65 and older, including delirium, falls, readmissions and patient-reported goals; and train frontline staff on communication with older adults.

Conclusion

Geriatrics treats older patients' illnesses; gerontology helps an organization understand aging as a whole and design around it. With nearly 58 million Americans aged 65 and older and growth concentrated among the oldest, health systems that serve older adults well will need the perspective of biology, psychology, sociology and policy. The four-element framework offers a practical start, and the director's priorities turn the field into a plan.

References

Administration for Community Living. (2024). 2023 profile of older Americans. U.S. Department of Health and Human Services. https://acl.gov/sites/default/files/Profile%20of%20OA/ACL_ProfileOlderAmericans2023_508.pdf

Fulmer, T., Mate, K. S., & Berman, A. (2018). The age-friendly health system imperative. Journal of the American Geriatrics Society, 66(1), 22-24. https://doi.org/10.1111/jgs.15076

Vespa, J., Armstrong, D. M., & Medina, L. (2018). Demographic turning points for the United States: Population projections for 2020 to 2060 (Current Population Reports P25-1144). U.S. Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf