Problems of the Older Population - Essay Example

? Problems of the older population Problems of the older population Problems of the older population The older population was increasing at a fast pace. The number of the population above 65 was being elevated so that this group with a large number of problems was becoming the cynosure of interest of health professionals. The diverse illnesses and problems of aging were being raised simultaneously. This writer will be highlighting two problems in this discussion: falls in acute care facility and elder abuse and neglect. The factors that contributed to problems like falls were dementia, cognitive deficits, lack of familiarity, altered mobility behaviours, environmental factors, worsening eyesight, diminishing confidence and unnoticed hazards (Clemson et al, 2003). Falls were common with the elder group in acute facilities or aged care ones (Hill et al, 2007). The incidence was higher in the inpatient settings of the various institutions (Hill et al, 2007). In Australia, 38% of adverse events were made up of falls and international figures were similar (Hill et al, 2007). A CDC statistics had reported that falls were a leading cause of death among older adults in the US (2004). Fall prevention was of utmost necessity in a world where the older people were increasing dramatically, living into the 80s and 90s. The critical health care issue of elder abuse and neglect was one filled with dilemmas and problems for nurses. Nurses had to be aware of the causes for abuse, questions for screening and the symptoms as they were the best persons to help reduce the distressing effects. Ideally suited to detect and manage elder abuse and neglect, nurses who were regularly contacting them could identify the marks of abuse on the body of the elder or deduct the underlying problem of abuse from the attitude of the person (Muehlbauer and Crane, 2006). The nurses were qualified to make physical and psychological assessments. Collaborative efforts with physicians and support services could be helpful in tackling the elder abuse. Authorisation of home health care or advice on hospital admission further elevated their role in handling the abused. Falls in acute care facility Impacts Head injury, soft tissue injury and fractures were the usual consequences of 30-40% of elderly falls (Hill et al, 2007). Psychological trauma in the form of negative effects could occur. The fear of falling again and anxiety troubled the elders (Hill et al, 2007). Prolonged hospitalization or moving into an acute care centre associated with increased costs became necessary (Oliver et al, 2004). The provider was worried over the drop in quality of care and a decreased functioning (Hill, 2007). The family and staff were distressed. Health resource expenditures were increased due to prolonged stay and additional diagnostic procedures and medicines (Hill et al, 2007)). Total cost of falls in the Australian Health Care System was found to be 2.1 million Australian dollars. A hospital in the US reported that hospital stay was 12 more days for fallers than the other patients controlled for age, gender and length of stay up to the fall (Hill et al, 2007) Implications of practice Prevention programmes had included core care plans (Healey et al, 2004) and multidisciplinary teamwork (Haines et al, 2004). An economic evaluation could help decision-makers and administrations in hospitals to provide ample resources for fall prevention moves. Hill had pointed out that costs did not only exist for hospital stay, they continued after discharge for more therapy and support services from the community (2007). The anxiety produced to the patient and care-giver could also be considered as costs. Risk factors were cognitive deficits, Parkinsonism, history of hip fractures and respiratory infections. McCarter-Bayer had indicated acute delirium states, problems of bowel and bladder control, dependence in daily living and disabilities (2005). Environmental, systemic factors, comorbidities, costing data for full research period also needed to be addressed. Identification of the patients at risk of falling, warning the patients, families and care staff of the risks of fall and interventions to make a safe environment were the components of fall prevention (McCarter-Bayer, 2005). The SAFE programme Staff Against Falls Everywhere was a programme instituted to prevent falls in the acute care centres (McCarter-Bayer, 2005). However the staff used the program incorrectly or inconsistently so that fall rate did not show a decrease. Then nurse managers were made responsible for education the staff of physicians and nurses, patients and visitors (McCarter-Bayer, 2005). Nursing assistants checked on patients every hour, helping in toileting, providing fluids and repositioning as required. Fall risk was impressed upon the staff and visitors through the display of safety signs in the patient’s room (McCarter-Bayer, 2005). Patients who had a greater risk were provided an orange armband for distinction. A Fall Investigative Report was instituted to obtain information on the environmental factors which contributed to the fall. A weekly fall report was also used by the nurses (McCarter-Bayer, 2005). The Fall prevention programme in Arizona, An interdisciplinary team (The Interdisciplinary Falls Team or IFT) of nurses, patient care technicians, supervisory nurse, geriatric clinic nurse specialist, a process analyst and a physical therapist implemented the program for fall prevention. They defined a fall, selected a tool to note patients at risk and communicated the risk to patients, families and staff. They also had interventions to prevent falls. Staff was educated. The Falls Advisory team was to monitor the programme on an ongoing basis. The hospital quality assurance was maintained by examining the change process (McCarter-Bayer, 2005). A risk tool was selected to collect relevant medical information to predict and prevent the risk of fall. It was made a part of the nursing assessment record and was reviewed every 12 hours. The increased risk was conveyed by door signs, patient’s room and in a yellow colour to identify fall risk. Fall interventions included non-skid shoes and socks, frequent patient contact for toileting help and water, restraints and bedside rails (McCarter-Bayer, 2005). Prevention strategies needed to use “sitters, bed and chair alarms and closer position to the nursing station” (Hill et al, 2007). Hip protectors could be used for prevention of injury to hip due to fall. Nursing care for elders suffering from abuse and neglect Definition “Elder abuse is any act occurring within a relationship where there is an implication of trust, which results in harm to an older person. Abuse can include physical, sexual, financial, psychological and social abuse and/or neglect” (Sadler, 2006). Identification of abuse Physical abuse could be recognized by bluish bruises or grip marks on the arms or neck (Muehlbauer and Crane, 2006).Examination of the wrists could indicate rope marks or welts. The patient could have several unexplained injuries in different parts. Refusal to attend the same emergency department for injuries in different episodes could be one indicator for diagnosis. The patient could be dismissive when explanation for the injuries was called for (Muehlbauer and Crane, 2006). Emotional or psychological abuse was identified by the refusal of the patient to communicate or respond to enquiries (Muehlbauer and Crane, 2006). They could be too scared or fearful of being ill-treated or adopted a suspicious behavior of others. Refraining from socialisation or being evasive constituted other suspicious behaviors. Chronic physical illness or psychiatric problems were also seen (Muehlbauer and Crane, 2006). Sexual abuse was identified by vaginal or anal bleeding without cause. Torn or bloody underwear or bruised breasts or venereal diseases pointed to sexual abuse (Muehlbauer and Crane, 2006). Financial abuse could be recognized if the elder was living in dire circumstances even though wealthy (Muehlbauer and Crane, 2006). Frequent automated teller activity or withdrawal of money could arouse suspicion of abuse by a son or someone else in the family or otherwise. Forged signatures were a tell-tale feature. The elder presented with sunken eyes or looked emaciated without obvious illness if neglected. Extreme thirst, dehydration and bed sores could be other presentations (Muehlbauer and Crane, 2006). Legal implications of practice The nurse was bound by local and national laws for the practice among the elders who were abused or neglected (Meiner, 2005). Being aware of her legal limitations could help her even though she was only a reporter mostly. At all times, she had to respect the autonomy and individual rights of the elders. The elders were eligible to decide their own environment and the kind of management they were to undergo. Legal and professional standards controlled the involvement of the nurse (Meiner, 2005). However as the nurse was closest to the elders, she could speak to them and understand their wishes. She had an opportunity legally to talk on behalf of the elders when no one else could (Meiner, 2005). Ethical issues The diverse perspectives of the various issues had no clear answers or were absolute rights and wrongs. A problem like elder abuse was difficult to solve merely using laws. Community efforts and personal concepts could influence the action taken (Miller, 2008). All adults had the “freedom to fair treatment, freedom from intrusion and also freedom from restraint and the right to self-determination” (Miller, 2008). The first dilemma was that adults could not be forced to accept support. The second was that respect for individuals could occasionally be impossible due to protective situations which hindered personal rights without meaning to interfere. Dilemmas arose when the patient though abused did not want help. Public pressure could also cause dilemmas. Differing societal values could worsen the situation. Clarifying the issues of the abused persons, their families and the health care providers, could clear the way for a satisfactory resolution (Lundy and Janes, 2009). The experience of the nurse could help her save her patient and still be right by law. If the nurse was doing things in good faith, she was provided immunity against any suit (Killion and Dempski, 2006). Failing to report abuse could invite criminal charges and disciplinary action. Conclusion The problems of the older population were increasing. Much research had to be done before we obtained solutions or ways to improve their life to a better quality one. Our lives would be blissful if we could provide sufficient care and attention to his group of people who so badly needed it. Prevention of falls needed to have hard-working staff who could implement the fall prevention protocol. Staff education, frequent evaluations of data with staff, a feedback on the implementation in order to identify newer prevention interventions constituted an effective falls prevention programme. Nurses were the right persons to be involved in elder abuse. Their dialogue with the abused personality could draw him out for establishing connection. Their actions had to be very careful, abiding by the societal values and avoiding legal issues. Ethical issues were also part of the dilemmas of resolution and learning to handle them were part of the nursing experience. References: Centers for Disease Control and Prevention (CDC) (2004). A tool kit to prevent senior falls: The costs of fall injuries among older adults. Retrieved from www.cdc.gov/ncipc/factsheets/ fallcost.ht Clemson,L., Manor, D. and Fitzgerald, M.H.( 2003). Behavioral Factors Contributing to Older Adults Falling in Public Places. OTJR: Occupation, Participation and Health. Volume 23, Number 3. Haines, T.P., Bennel, K.L., Osborne, R.H., Hill, K.D. (2004) Effectiveness of targeted falls prevention programme in subacute hospital setting: randomized controlled trial. BMJ 2004 Vol. 328: 676 Healey, F., Monro, A., Cockram, A. et al. (2004). Using targeted risk factor reduction to prevent falls in older in-patients: randomized controlled trial. Age Ageing, 2004, Vol. 33: 390-395 Hill, K. D.,Vu, M., Walsh, W. (2007). Falls in the acute hospital setting - impact on resource utilization Australian Health Review; Aug 2007; 31, 3; ProQuest Nursing & Allied Health Source pg. 471 Killion, S.W. and Dempski, K. (2006). Quick look nursing, legal and ethical issues Jones and Bartlett Publishing Inc. Lundy, K.S. and Janes, S. (2009) Community Health Nursing: caring for the public health. Jones and Bartlett Publishing Inc. McCarter-Bayer, A., Bayer, F. and Hall, K. (2005). Preventing Falls In Acute Care: An Innovative Approach. Journal of Gerontological Nursing; Mar 2005; 31, 3: 25-33 ProQuest Nursing & Allied Health Source Meiner, S.E. (2005). Gerontologic Nursing, 3rd Ed. Elsevier Health Sciences. Miller, C. (2008). Nursing for wellness in older adults. 5th Ed. Lippincott, Williams and Wilkins. Muehlbauer, M. and Crane, P.A. (2006) Elder abuse and neglect. Journal of Psychosocial Nursing, Vol. 44, No. 11 Oliver, D., Daly, F., Martin, F.C., McMurdo, M.E. (2004) Risk factors and risk assessment tools for falls in hospital inpatients: a systematic review. Age Ageing. Vol. 33:122-130 Sadler, P. (2006) Elder Abuse: A Holistic Response. ACSA Background Paper,Aged and community services March 2006. Read More