Comparative analysis of older adult outcomes in states with and without nurse practitioner full practice authority states: a national secondary data analysis

BACKGROUND: Older adults represent a rapidly growing segment of the U.S. population and often experience limited access to timely, high-quality care. Nurse practitioners (NPs), particularly in states granting Full Practice Authority (FPA)-which allows NPs to practice without mandated physician oversight-may play a critical role in addressing these gaps. Evidence remains limited on whether FPA improves outcomes specifically for older adults. The purpose of this secondary data analysis was to evaluate the impact of NP FPA on access, functional status, medication use, and cancer detection among adults aged 65-84 years. METHOD: We analyzed restricted Medical Expenditure Panel Survey (MEPS) data from 2010 to 2019. A difference-in-differences design compared states that implemented FPA to states without FPA during the study period. Outcomes included emergency department utilization, instrumental activities of daily living (IADLs), medication patterns, and detection of six cancer types. Models estimated adjusted incidence rate ratios and regression coefficients, accounting for rurality and clustering at the county-state level. RESULTS: Implementation of FPA was associated with fewer diagnostic ED visits and a greater share of emergency-related visits, indicating improved appropriateness of ED use. Older adults in FPA states reported better IADL functioning post-policy, with particularly strong improvements in rural areas. Medication-related findings were mixed, and several cancer types showed modest increases in detection following FPA adoption. CONCLUSIONS: NP FPA may improve access and care quality for older adults, particularly in functional outcomes and patterns of ED utilization. Continued evaluation is needed to determine long-term clinical implications.