Erin O’Hair
Degree: MS 2011
For Erin O’Hair, the most important thing about gerontology, the study of aging and caring for older people, is a holistic approach.
“You really need to take a step back and look at the whole picture and the person as a whole,” she says, reflecting on the older patients she’s served for over a decade of her nursing career. “You can’t treat just the disease.”
Gerontology, like the holistic approach O’Hair favors, is a multidisciplinary branch of care. Different from geriatrics, a more physically focused medical specialty, gerontology is also concerned with the social aspects of aging.
For a successful holistic approach, O’Hair believes in the importance of having conversations with patients and their families, ensuring that the care aligns with the patient’s own goals.
“As people age, and they get closer to the end of life, their goals may shift. So you need to have those continuing, ongoing discussions about ‘Okay, this is where we were when you decided these goals. This is where we are now. Are those goals still the same?’” she says.
Determined to ensure that healthcare enhances the quality of her patients’ life rather than diminishes it, O’Hair cares for her patients from the comfort of their own homes. After six years as a nurse in the Intensive Care Unit, including time in UCI Medical Center’s traumasurgical ICU, O’Hair no longer sees patients on the hospital floor. Now, she tries her best to keep her patients from unnecessary hospitalizations, focusing on preventative home-based care.
O’Hair saw many frail, older patients on ventilators while working in the UCI trauma-surgical ICU. Desiring to prevent such hospitalizations, she wanted to go into palliative care. Pivoting from the fast-paced life of an ICU nurse, O’Hair turned her focus to caring for older people. In 2011, she graduated as part of the inaugural class of nurse practitioners from the then-Program in Nursing Science, the precursor to the Sue & Bill Gross School of Nursing. She earned her degree as a Doctor of Nursing Practice 10 years later from California State University, Fresno.
“What I really, really like about my role and this type of work is I get to slow down,” she says, “So I’m going to someone’s home, I get to look around. I get to see, you know, who’s important to them. I get to look at family photos. I get to assess their environment and their living situation, and I have the time to do that, which is really nice.”
As people age, their goals may shift. You need continuing discussions about where they are now
Erin O’Hair
She wishes that more people knew how rewarding gerontology can be, that though gerontology patients are complex, and the work includes tough conversations about care until the end of life, gerontology care done well is a true service to the patient and their family.
O’Hair’s first experience caring for an older person came in 2003, when, as an undergraduate with an undeclared major at Chico State University, she didn’t yet know what she wanted to do. She got a position as a caregiver with an older man who had Parkinson’s disease, her first patient.
“He told me I had a knack for it, that I should go to nursing school,” O’Hair says. “I hadn’t really considered it before, but I did it, and I’m glad I did.”
Danielle Alfego
Degree: MS 2016
Danielle Alfego (née Godino), has known she wanted to be a nurse since the sixth grade.
“I’ve always had a calling to help people,” she says. “Ever since I was little, even when I was in school, I was always trying to make sure everyone felt included and valued. Anyone who was on the outskirts, I never wanted people to feel bullied or left out or anything like that.”
Now, Alfego continues to be a champion for inclusion as a family nurse practitioner who primarily sees older adult patients. In her primary care practice at the University of California, San Diego, she wants to make sure that her patients, who usually range from 60 to 100 years old, feel involved in their care through shared decision making.
“It’s challenging for aging folks to feel like they don’t have control anymore,” Alfego says. “Especially when it comes to memory, or even musculoskeletal issues, to give up that sense of independence or realize that they might not be able to do things as they did before. I feel helping them through that life change is important.”
Alfego finds creative ways to help her patients feel more in control, such as digital health monitoring for blood pressure management, at-home programs for physical or occupational therapy and post-ER follow-ups, and support resources for disease management, all to help preserve independence and prioritize good quality of life.
I’ve always had a calling to help people
Danielle Alfego
A key way to help older adults feel empowered, Alfego says, is giving them a say in their own care. She believes it’s important to talk to older patients about how to integrate beneficial changes in a manner that fits their individual lifestyles, rather than treating them all the same.
“I feel as though giving them a voice in their own care is imperative because a lot of times, the easy thing to do is to say, ‘These are the recommendations, and this is what we’re doing to meet standard guidelines,’ instead of sitting down with the patients and saying, ‘You know, I want you to be involved in your care, this is your life and what you need matters,’” Alfego says.
When caring for older adults, it is not unusual to also work with their family members, especially when it comes to joint decision making. Alfego compares working with the patients and their families to mediating —the most important part is coming to an agreement about what’s best for the patient. Alfego enjoys the constant education that comes with nursing.
Since graduating from UC Irvine, she has continued to be involved in the family nurse practitioner program as a preceptor.
“Medicine is constantly changing, so you always have to be up to date with evolving guidelines,” she says. “I want to ensure that the students are using best practices, that they feel comfortable in an environment to learn before they actually go out into the field, because it is hard.”
Alfego appreciates that throughout the FNP program she was taught to think outside the box. She’s still in touch with her mentors, Susan Tiso and Susanne Phillips.
“It was a pleasure to mentor a student with her level of compassion for patient care, her sense of humor and humility, and indeed her passion for learning, growing, and continuing her pursuit to be the amazing nurse practitioner she has become,” says Phillips, senior associate dean and professor at the Sue & Bill Gross School of Nursing.
Alfego’s passion for nursing and caring for others could not be made more clear than by her own philosophy.
“I treat every patient as if they were one of my own family members,” she says. “I give them all the time they deserve.”
