A system-level approach to improving the care of the older critical care patient.

As the population continues to age, the specialized needs of older adult patients warrant the close attention of the critical care nurse. The combination of critical illness, age-related changes, multiple comorbidities, and the hospital environment can make the diagnosis and management of the older adult's critical illness challenging. The NICHE (Nurses Improving Care for Healthsystem Elders) program provides a framework to create an aging-sensitive care environment in the critical care setting. The Geriatric Resource Nurse model is the foundation of the program. The goals of NICHE are to support nursing departments to (1) bring evidence-based geriatric practice to the bedside; (2) build patient- and family-centered environments; (3) cultivate healthy and productive practice environments aligned with meeting the specialized needs of older adults and their families ("geriatric nursing practice environments"); and (4) conduct comprehensive measurement of geriatric initiatives.