Social Determinants of Health Assessment of Freds Care Needs - Essay Example

?Case Study 3 Fred General Overview of Case Fred is a 75 year old male who lives in a small house in a rural town. Fred and his wife were once farmerbut they retired ten years ago and are living on a pension. Freed enjoys walking his dog and chopping wood, which gives him exercise on a daily basis. Fred’s wife has rheumatoid arthritis and Fred takes care of her. Fred has gained weight (from 180 cm to 120kg) but Fred sees this as that he has ‘put on a bit of weight lately”. Fred is the one who cooks for he and his wife and finds it easier to heat up frozen food than it is to cook nutritional food. Also, Fred has a “few beers” every night, depending on his fortnightly budget. Fred also does all of the housework because his wife cannot do it, and he does all the shopping; he occasionally goes to social outings to get out of the house. Fred continues to smoke 20 cigarettes a day which amounts to about one pack, depending on the type of cigarettes he smokes and the number of cigarettes in the pack. He is also experiencing shortness of breath, and he his not as mobile as he used to be, having gained the weight. Medications and Current Conditions Fred had bypass surgery nine years ago and has hypertension. He currently takes anti-hypertensive drugs, metoprolol, and aspirin (has taken them for two years) for his hypertension. He also has problems with his eyes, having had surgery on his left eye to eliminate a cataract in it. He still does not see well out of that eye. Fred also fell recently while walking his dog, and lacerated his right shin, which requires a visit from the District Nurse each day to change his dressings. Fred stays away from his GP unless he needs his prescriptions filled, but he is beginning to feel that he cannot continue doing all of the work on his own. He has asked to go into full-time care. Social Determinants of Health Assessment of Fred’s Care Needs Income and Social Status The South Australian Council of Social Service (SACSS) (2008) states that there is a direct correlation between economic status and a person’s health. Fred may be having problems paying for his care because he is only on a pension. Because he is living on a pension, he may not have the resources to go to a doctor on a regular basis. He states that he only goes to the GP when he needs a prescription refilled, but he must be going because of his bypass surgery. He worries about having enough money to pay for his care, as he has noted in his possible upcoming surgeries. Fred and his wife are both in need of healthcare but it is not certain as to whether his wife is also getting her needs met in healthcare. The case study states that Fred uses his car for social outings but it does not go into whether he has friends or not. The SACSS (2008) states that when people live in poverty, may not have social outlets or a connection to a community. Also, their three children live three ours away, so they may not visit very often to see their parents or take them out to social events. This could have a negative effect on the parent’s attitudes and feelings of well-being. Social Participation and Social Support Networks The second health determinant is the social participation and social support networks. The SACSS (2008) provides information that financial exclusion and income levels can prevent people from having access to social supports. As the SACSS (2008) explains this, There are four areas where people do not have access if they have a low income: 1. Consumption – they are not able to purchase the goods and services that they need on a regular basis. 2. Production – they will not be able to participate in social or economic activities that in which they have an interest. 3. Political engagement – they do not have interaction with governmental processes that are on the local, state, or federal level. This means that they cannot participate in decision making. 4. Social interaction – they may not be connected to family, friends or to the community in a substantial way. Fred has some access to his family but they are three hours away. While he has a car and is able to drive, he says that he does get out for social things, but there is no indication of how often he is able to get out. Whether he has political engagement or production, it is not said. He is able to buy the groceries that he needs on a regular basis. Education and Health Literacy Education is another area that is important but there is no mention of education for Fred. At 75 years old, he may not have education beyond high school. This would help to determine whether or not he is able to understand what he needs to do for his health. The SACSS (2008) also states that there is a link between education and a person’s health literacy. An individual must have the “cognitive and social skills” (p. 10) to be able to understand and use health information. At this point, Fred may not have the cognitive skills to understand what he needs to do for his health. He is at least motivated to go to the doctor to receive his medications, but he does not seem to care about his health. Perhaps it is not a matter of caring, but just of not totally understanding what he needs to do to stay healthy; this may be a reason that he is asking for full-time care. Health Living Conditions Fred seems to live in a healthy living situation. He is able to keep the house clean and he chops wood for the combustion heaters. The only area where he is not healthy is in the food that he cooks. He cooks frozen pies instead of good, nutritional, and fresh food. Early Life Factors and Genetics The study does not say whether there is a history in Fred’s family of heart disease or other illnesses. He does take hypertension medicine which could mean that this was a condition that has lasted for a very long time. Jelinek, Kolbe, Wang and Oxbrow (2008) state that hypertension is one of the major contributors to a person’s loss of health in Australia. This means it is a common disease and accounts for 18% of deaths. A screening for Fred may be necessary to see whether this is a genetic situation. This would be an area that would need to be questioned. Individual behaviours and lifestyle factors One of the greatest challenges for Fred is his smoking. Since he smokes about a pack a day and has done so for many years, he can have more problems health wise. He may be experiencing emphysema at this stage with his shortness of breath. If he is only living on his pension, he may be in a place where his health is being compromised because of the excess smoking. Also, he already has problems with his heart and hypertension, so he is more likely to have his health deteriorate more quickly over time. The Australian Bureau of Statistics (2010) states that one in five people are active smokers in Australia. Although smoking has gone down, it is generally believed that smoking is “single most preventable cause of ill health and death in Australia” (para. 4). With this being said, it would be a good thing for Fred to stop smoking so that his health could improve. Access to health care Currently, Fred has continued access to healthcare. He sees the District nurse when he needs his prescriptions, and he knows how to gain access to healthcare when he needs it for his wife or for him. He seems to be able to get healthcare when he needs it by driving to the hospital or to the doctor’s office. Primary Healthcare Model and Early Intervention Strategies The health model that will be discussed in this section is the health model for rural towns. Since Fred and his wife life in a rural time, this is a fitting explanation of what could have happened for him if he had understood more about his healthcare needs. The information from the Australian Government, Department of Health and Ageing (2009) is very important to understanding how Fred could have been helped to date. One of the first things that could have helped to prevent Fred’s health problems would have been health checks at regular intervals. Because he is 75 years old, he has a different need for health checks than he would have if he were 20 or 40. If the health checks had begun when he was in his 40s he would have had them regularly and this would have helped him stay with them as he became older. Many times the healthcare in rural areas is difficult because there are no doctors practicing in those areas, and patients must go to the larger cities to receive care (Australian Government, Department of Health and Ageing, 2009). Conger and Plager (2008) state that that one of the ways to rectify this situation is to create student programs in these areas. In a study done by Conger and Plager (2008) a large majority of graduates (87%) were already working in rural areas. This would be a solution to older people in need of healthcare check-ups. Cerasa (2011) states that nurses in rural areas are also important to “reduce disparity in healthcare” (p. 16) and to provide an opportunity for those who would otherwise have no access to health care to have it. Cerasa (2011) states that since nurses already work in a variety of settings, having them in the community would also be very beneficial for understanding the need for care in these rural areas. By the time of this study, Fred has had bypass surgery nine years ago for hypertension. Fred is walking his dog, but a preventative measure for this condition may have been to do more exercise beyond walking his dog. That is, walking more regularly for longer distances. A study by Zheng, Ehrlich, and Amin (2010) found that walking at a normal pace for 30 minutes, during three to four days, was enough to stop heart disease. The authors found that this would be a cost saving to medicine and it would improve the health of most Australians. This idea would be a good one for Fred. Another way that he could do this is to join a walking club if there is one in his area. This would allow him a change to meet new friends and find other things to do besides siting at home. Smoking cessation has been important in Australia as in other countries. In Fred’s case, his smoking may be creating problems with his breathing. He smokes 20 cigarettes a day and he has he has shortness of breath. A study by White, Hill, Siapush and Bobevski (2003)showed that many people have stopped smoking in Australia and regained their health. Fred may need other things to do in order to take his mind off the need to smoke. Obesity is a challenge to people in Australia and Fred says that he has definitely gained weight. He considers himself overweight, but there may be more problems with obesity than can be seen now. There are several preventative measures that could have happened here. One is that a nutritionist may have been able to talk with Fred and help him learn to cook nutritious meals, or find frozen foods that were more nutritious than pies. Rangan, Schindeler, Hector, Gill, and Webb (2009) studied the effects of what they called, extra foods, on obesity. They found that these extra foods did not have any nutritional value and they added to the energy, fat, and sugar intakes of people who eat them. This study showed that meat pies were one of the foods that were considered unhealthy. A nutritionist and a nurse who could provide in home care may be a solution to the problem now. Ferguson et al. (2010) suggest that there is a need for early intervention of patients who may be prone to malnutrition. This type of screening would have been beneficial to Fred to teach him about nutrition and why it was important to eat well instead of eating frozen foods all the time. Better nutrition could also possibly help his wife. Hypertension is something that Fred is troubled by and this may be because of his smoking and obesity. As stated previously, Jelinek, Kolbe, Wang and Oxbrow (2008) show that this is a major health problem in Australia. The study by Jelinek et al. (2008) also showed that people in rural areas were more apt to suffer from hypertension than those in other areas. Booth and Nowson (2010) studied the incidences of healthcare providers helping their patients who were obese with information about losing weight. They found that this was an area that was not talked about which could explain why so many people are obese. This is definitely a conversation that Fred must have with his District Nurse or with a doctor so that he can begin to lose the weight that is needed. Obesity can add to other problems that can include Type 2 Diabetes as well as the hypertension he already has, and this would make his health problems worse than they are now. Conclusion In many situations, Fred’s age may have prevented him from gaining the healthcare that he needs. He is living in a situation with his wife who is also sickly and there seems to be no real opportunity for his wife to help him. Fred seems discouraged in some ways, but he also seems to have his life under control as far as it goes. Fred is talking walks, but it seems that he needs more exercise in order to keep the health that he has currently. Fred is a smoker and this is one of the ways that his health is deteriorating. He will need to have several interventions in order for his health to improve. Some of those interventions include more exercise, having conversations with a nutritionist who can help him learn how to cook nutritious food instead of frozen pies, and how to access lifestyle changes to decrease his obesity. Chances are that Fred’s health may become worse if he continues to smoke and there may come a time when he and his wife will have to move into full-time care. His children do not seem to care much about what his happening, so there may need to be intervention from the government in his behalf. References Australian Bureau of Statistics. (2010). Risk factors – Health risk factors. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4364.0Main%20Features42007-2008%20%28Reissue%29?opendocument&tabname=Summary&prodno=4364.0&issue=2007-2008%20%28Reissue%29&num=&view= Australian Government (2009). Taking preventative action – A response to Australia: The healthiest country by 2020 –the report of the national preventative health taskforce. Department of Health and Ageing Retrieved from http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/taking-preventative-action Australian Government. (2010). Australia’s health 2010. Australian Institute of Health and Welfare. Retrieved from http://www.aihw.gov.au/publication-detail/?id=6442468376 Booth, A. O., & Nowson, C. A. (2010). Patient recall of receiving lifestyle advice foroverweight and hypertension from their General Practitioner. BMC Family Practice, 118-14. doi:10.1186/1471-2296-11-8 Cerasa, D. (2011). Australian Health care: Closing the service gap. Nursing Management - UK, 18(8), 16-19. Conger, M., & Plager, K. (2008). Advanced nursing practice in rural areas: connectedness versus disconnectedness. Online Journal Of Rural Nursing & Health Care, 8(1), 24-38. Ferguson, M., Banks, M., Bauer, J., Isenring, E., Vivanti, A., and Capra, S. (2010). Nutrition screening practices in Australian healthcare facilities: A decade later. Nutrition & Dietetics, 67(4), 213-218. Jelinek, H., Kolbe, C., Wang, L., & Oxbrow, D. (2008). Identification of hypertension and efficacy of treatment in a rural Australian population. Clinical & Experimental Hypertension, 30(5), 359-366. doi:10.1080/10641960802275064 Rangan, A. M., Schindeler, S. S., Hector, D. J., Gill, T. P., & Webb, K. L. (2009). Consumption of ‘extra’ foods by Australian adults: types, quantities and contribution to energy and nutrient intakes. European Journal Of Clinical Nutrition, 63(7), 865-871. doi:10.1038/ejcn.2008.51 South Australian Council of Social Service. (2008). The social determinants of health sacoss information paper. Retrieved from http://www.sacoss.org.au White, V. V., Hill, D. D., Siahpush, M. M., & Bobevski, I. I. (2003). How has the prevalence of cigarette smoking changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tobacco Control, 12ii67-ii74. Zheng, H., Ehrlich, F., & Amin, J. (2010). Economic evaluation of the direct healthcare cost savings resulting from the use of walking interventions to prevent coronary heart disease in Australia. International Journal Of Health Care Finance And Economics, 10(2), 187-201. doi:http://dx.doi.org/10.1007/s10754-009-9074-2 Read More