While community, or public, nursing has become widely prevalent in the health care field for decades now, there remains some confusion as to exactly what it is. The term is, at best, ambiguous and non-specific. However, community nursing is essentially that which is not reliant upon a hospital foundation, and which permits the nurse to interact more intimately with patients within their community settings. It is a sphere of nursing meant to enable nurses to address recent changes in society itself, and to educate as they tend to patients in a wide variety of settings, both clinical and otherwise: “Public health nursing, with its focus on preventing disease and promoting health in the community, offers an alternative to hospital care of the sick” (Raffel, Barsukiewicz, 2002, p. 86).

One substantial change in modern society is reflected in the senior population. As will be seen, the growing and very real health concerns of this segment of society serve to illustrate both the opportunities available to community nursing practice, as well as inherent challenges.

In the United States, as well as globally, individual communities are increasingly confronted with a reality occurring within them, and in the greater areas surrounding them: simply, the senior population is growing farther and faster beyond the rates of any previous, elderly population. People are living longer and, while this speaks well for health care and public health consciousness generally, it presents new and enormous difficulties. New generations of seniors are literally adding a new demographic to existing populations, and within society – and individual communities – not equipped for their presences.

An obvious problem is the fact that older people are more likely to become ill and/or suffer from infirmities which require professional care. The issue is one expanding exponentially, and the actual data on infirm senior citizens does not always keep pace with the ongoing rises in the population itself. Nonetheless, the ratios are documented and fairly consistent: “The elderly, who make up about 13% of the population, consume more than 30% of health care costs…” (Smeltzer, et al., 2009, p. 223). It is entirely probable that, as more seniors enter the population ranks, these numbers will only increase. Moreover, records of hospital costs do not reflect the unreported expenses and/or need of seniors who do not visit the hospitals.

Another issue concerns the degrees of senior infirmity and how they play into senior needs. The elderly are more prone to illness, but the forms these illnesses take often do not require hospitalization. Seniors frequently encounter difficulties related to health issues which go unreported and/or unaddressed. Those living with family have options in receiving care, yet many seniors live independently, apart from family or assisted living environments, and have no choice but to endure their health issues as best as they can.

This relates to the matter of access itself, as many seniors are limited in travel options, yet are as well disinclined to give up their independence: “Most seniors prefer to stay in their own homes and communities rather than enter long-term care or assisted living facilities” (Hunt, 2008, p. 339). Seniors wish to maintain independent lives, yet are also more vulnerable to illness and consequently more prone to require care. These factors, among others, point to a genuine need for community-based nursing, which provides patient care at an appropriate, non-physician level and occurs away from the frequently unnecessary hospital site.

In any environment, seniors present unique challenges to health care professionals. As noted, often their complaints are born primarily from the inevitable aches associated with aging, such as diminished capacities in hearing, vision, bladder control, and energy levels. Falls and mishaps resulting from diminished coordination occur, as well. While many seniors suffer from specific diseases or illnesses requiring a nurse’s care, a great many others are not extreme situations and more call for the occasional attentions of a trained nurse, and/or a nurse’s guidance in altering lifestyle choices to improve the senior’s general health.

A specific problem in dealing with seniors actually derives from the mentioned infirmities of age to begin with, and the fact that such conditions tend to co-exist. Varying days often translates to varying degrees of discomfort and/or impairment, and within an entire range of health problems. The reality is that many seniors are unaware of actual illness because they simply anticipate degrees of discomfort due to their age. For the community nurse, this presents the dilemma of information which may be inherently unreliable: “The presentation of signs and symptoms of illnesses in older adults may be atypical. They may under-report or over-report symptoms of illnesses or have multiple, nonspecific complaints…” (Lundy, Janes, 2009, p. 869). Seniors typically do not seek to “invent” or poorly describe ailments; it is rather a case of their being difficult to assess properly.

Then, the issue of mobility arises, which of itself can foster additional infirmity. The senior who has trouble walking, for example, is clearly lacking exercise as well, and this in turn will reflect dietary intake. Community nurses increasingly make home visits and provide varieties of therapies for such seniors, but these are ultimately conditions continually present in the patient’s life, and a more expansive kind of care is needed.