Change, Advancing Health, makes our directive clear and powerful. The IOM was founded on the following premise: “Knowing is not enough; we must apply. Willing is not enough, we must do” (von Goethe). Now, more than ever, nurses are called upon to lead efforts to embed evidence-based practice in daily operations. As the IOM report states, “nurses have key roles to play as team members and leaders for a reformed and better-integrated, patient-centered health care system” (p. xii). The process of implementing sweeping change in health care will likely take years; however, nurses must start pragmatically and focus on these critically important protocols that have demonstrated improved outcomes for older adults. Simply stated, “Pick this book up and use it.” Susan L. Carlson, MSN, APRN, ACNS-BC, GNP-BC, FNGNA President National Gerontological Nursing Association References Centers for Medicare & Medicaid Services. (2011). Special open door forum: Hospital inpatient valuebased purchasing program. Fiscal year 2013. Proposed rule overview. Baltimore, MD. Health Care Advisory Board. (2010). Health care’s accountability moment: 15 imperatives for success under risk-based reimbursement. Washington, DC: The Advisory Board Company. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press. Landro, L. (2011, March 28). The time to innovate is now. The Wall Street Journal, R1. Toedtman, J. (2011, March 3). It’s tomorrow already. AARP Bulletin.2.Centers for Medicare & Medicaid Services (CMS). Special Open Door Forum: Hospital Value-Based Purchasing Proposed Rule Overview for Facilities, Providers, and Suppliers. Baltimore, MD; 2011. Welton, J. M. (2010). Value-based nursing care. Journal of Nursing Administration, 40(10), 399–401. xiii Acknowledgments We would like to thank the following for their involvement, support, and leadership during the production of this book: n All of the expert contributors for this fourth edition n Those nursing experts who participated in the Nurse Competence in Aging project and contributed protocols to www.HartfordIGN.org, many of which were the impetus for new topics added to this edition n The institutions that supported faculty and geriatric clinicians participating as contributors of the evidence-based protocols n Those who provided a valuable contribution in the first and second editions and their ongoing geriatric research n Faculty and clinicians involved in the project of the American Association of Colleges of Nursing to develop geriatric content for upper-division baccalaureate nursing programs n Springer Publishing Company for its ongoing support of quality geriatric nursing publications n Nurses Improving Care for HealthSystem Elders (NICHE) hospitals that bring many of these protocols to the bedside and are leaders in ensuring geriatric nursing best practices xv Introduction Older adults are overwhelmingly the majority of hospitalized patients and are, by far, the most complicated patients to care for in the acute care setting. They suffer from multiple complex medical problems, take multiple medications, are the most vulnerable to iatrogenic events, experience prolonged hospital stays, and are the more likely to die in the hospital (versus community or other setting). Acute care nurses have an enormous responsibility when providing care to older adults in this rapidly changing healthcare environment with increasing regulatory requirements and short staffing. Even though older persons are our fastest growing segment in the United States, most nursing programs, like medical programs, are just now incorporating geriatrics into the curriculum. Many unfamiliar with geriatrics might ask: What’s so different about older people? Don’t they have the same diagnoses as younger adults, like diabetes, hypertension, and heart disease? The answer to that is yes, they do have the same diseases; however, physiological changes that occur with aging, multiple coexisting medical problems, and multiple medications place older adults at significantly higher risk for complications, including death, while hospitalized. The nurse armed with information on the unique