Empowering Nurse Practitioner Education: Immersive Virtual Reality Cases for Holistic Geriatric Care in Underserved Communities in South Carolina

Sponsor/Type: The Duke Endowment 
Project Period: 01/01/2025-12/31/2027

Abstract:

Across the United States, older adults experience significant gaps in health care and this is only expected to worsen with adults aged 65. Due to longer life expectancies, and the 78 million Americans born in the baby boomer generation (1945-1965), there is expected to be a rise in the number of adults aged 65 and older that will require primary geriatric healthcare from 12% in 2005 to almost 20% in 2030. In South Carolina, older adults account for 19.1% of the population of the 5.3 million residents aged 65 and older. Further exacerbating the issue of age-friendly care is that South Carolina is a largely rural state, with almost 36.8% of the approximately 390,080 residents 65 and older living in rural communities. All 46 counties are federally designated as being total or partial Medically Underserved Areas (MUA)/Populations and 43/46 counties as Health Provide Shortage Areas (HPSA).

Older adults often present with complex medical needs, including multiple co-morbidities, cognitive impairment or dementia, and polypharmacy; further impacted by their social determinants of health (SDOH), necessitating focused provider education1 which requires additional focused education and clinical experiences. Discomfort discussing cognitive impairment and palliative care (PC) adds to the challenge. With SC being a largely rural state, this underscores the necessity for tailored training that considers SDOH and incorporation of palliative care and early cognitive evaluation for those with serious illness. However, primary care geriatric services are scarce with only 70 board-certified geriatricians in the entire state of SC and according to the SC Board of Nursing in 2024, primary care adult gerontologic nurse practitioners (AGNP) only account for 3.4% (422/12,412) of the nurse practitioners throughout the state. This equates to approximately 1 primary care AGNP for every 2,386 people aged 65 or older in the state.

Based on the current estimates of geriatricians and AGNPs, the expanding geriatric population along with the retirement of many primary care providers born in this same generation, the deficit in geriatric primary care providers will continue to grow. The education of primary care providers specializing in geriatrics is paramount. Furthermore, evidence shows that programs that emphasize curriculum and clinical training in rural and underserved areas had higher rates of working in these areas upon graduation. There is an urgent need to increase the number of nurse practitioners who are competent in age-friendly care in SC.

The MUSC College of Nursing (CON) supports culturally congruent care and is dedicated to improving SC’s geriatric primary care NP workforce to improve patient health outcomes in rural and MUAs. The goal of this program is to improve primary care for older adults in rural and medically underserved areas in South Carolina through expanded education and clinical opportunities for AGNP and FNP students. This will include integrating innovative virtual reality (VR) geriatric training into the curriculum that includes content on SDOH, primary palliative care, and early cognitive evaluation, additionally Increase geriatric, palliative care, and rural/medically underserved clinical opportunities for AGNP’s and FNP’s in South Carolina.

For more information contact
Whitney A. Smith
DNP, APRN, AGPCNP-BC
smithwhit@musc.edu