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Nurse-led Programs Demonstrate Improved Health Outcomes for Older Adults

September 2012

Improving geriatric nursing care is more critical than ever, as older adults are now the largest population of patients in the hospital setting as a result of the baby boomer generation. Nurses in particular can influence the care of older patients and can help create change in healthcare facilities.

“Patients over the age of 65 comprise about 60 percent of the hospital population, which is why it’s imperative for nurses to understand how to care for older adults and take the lead on implementing programs that will benefit the aging population,” said Tara A. Cortes, Ph.D., RN, FAAN, Executive Director of the Hartford Institute for Geriatric Nursing and professor of Geriatric Nursing at New York University College of Nursing.

One example of how healthcare professionals are identifying the best ways to care for the aging population is the Medicare Innovations Collaborative, which is currently working with six health systems to test innovative programs that aim to improve care for Medicare patients with multiple chronic conditions. One of those programs is Nurses Improving Care to Healthsystem Elders (NICHE), a patient-centered model that aims to improve hospital care processes for older adults, with oversight by a nursing team.

A recent study led by Johns Hopkins University School of Medicine, which examined the early results of the Medicare Innovations Collaborative, found that the NICHE program might be a successful model for improving hospital quality and safety for older adults.

“At this time, approximately only 35 percent of baccalaureate nursing programs have unique courses for teaching geriatric care, which is why it is so important for hospitals to implement care models. The NICHE program is one model that can help educate nurses on how to provide specialized care for older adults,” said Cortes.

Founded in 1992 by the Hartford Institute for Geriatric Nursing at New York University College of Nursing, the goal of NICHE is to provide principles and tools to encourage and support change in the culture of healthcare facilities to achieve patient-centered care. The program aims to add geriatric-specific equipment, supplies and other resources to the nurses' practice. It also implements protocols and techniques that promote interdisciplinary collaboration by training nurse leaders to share the information they’ve learned from the program with other nurses on their teams.

In 2010, NICHE reached a milestone of 300 hospitals in its North American network, sustaining and building on its position as a leader in delivering evidence-based practices and tools for improving care of older adults. Hospitals that implement the NICHE program appoint a Geriatric Resource Nurse (GRN) who becomes a leader for other nurses on the unit. GRNs receive specialized education about care of older adults, as well as ongoing mentorship and clinical support from advance practice nurses and an interdisciplinary team. GRNs also become the point person when other nurse colleagues encounter patients with geriatric problems.

“NICHE is a solid method for an acute care setting because it helps nurses identify, interpret and apply evidence-based practice to optimize care outcomes, as well as the patient and family experience,” said Cortes. “The program covers a variety of best practices, including prevention and management of pain, pressure ulcers, disorientation, urinary incontinence, urinary tract infections and prevention of falls. These are important outcomes for the elderly.”

The Johns Hopkins study also found that health systems seeking to improve elderly care can simultaneously implement multiple geriatric health care delivery models, and then appropriately integrate and tailor them to improve their adoptability within the hospital or healthcare system.

“Implementing geriatric health care models can positively affect patient health outcomes and overall quality of care. The more you are able to tailor your care around the unique needs of individual patients and their families, the better quality of care you’re going to give as a nurse,” explained Cortes.

For more information about the NICHE program, visit

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