Homebound Geriatric Patients - Term Paper Example

Homebound Geriatric Patients Homebound geriatric patients are elderly patients who, due to their limited mobility and many frailties, are consigned to the homes. The homebound elderly patients often suffer from loneliness. They also tend to be very dependent. Due to their physical disabilities (due to stroke, amputation, chronic lung disease, or arthritis), they keep to their homes, and consequently, are “cognitively or emotionally disabled (due to dementia or depression), afraid or ashamed to socialize (due to incontinence, falls, deafness or blindness), or unable to use public transportation” (Stillman, 2007). Homebound geriatric patients often live in senior apartment housing or sometimes, in individual housing. Their homes are sometimes in substandard conditions even if they try very hard to keep their homes clean and livable. Most geriatric patients live alone and depend on visits from family and/or medical professionals for their survival. Their physical limitations also make it difficult for them to go out and buy food for themselves, or if they do have food, they are hampered by their physical or cognitive disabilities to prepare the food. They are vulnerable because of their physical limitations which put them in further danger of injury. Their physical limitations and dependence consequently makes them frustrated and depressed. Their doctors sometimes do not see them for years because they cannot leave their homes and physicians are not anymore in the practice of making house calls. Oftentimes, when medical help is made available to them, their medical condition has already progressed to unmanageable stages. They are then again consigned to nursing homes or sent back home—back to the very conditions that brought about their worsening medical conditions. I chose this topic because like, the homebound elderly patients, this topic is not given enough attention by the medical community, by our government, and by our society. I chose this topic for its relevance. “World demographic changes show an increase in the elderly population worldwide” (Zini & Pietrokovsky, 2006). The increase in life span has also resulted to an increase in the number of elderly patients but still not enough medical attention and care given to them. This topic interests me because, unless attention is brought to it, this problem will worsen. The early 1990s alone presented alarming statistics for homebound elderly patients. “The growth in the number of elderly people in need of long-term care at home has been and is projected to be greater than the growth of the nursing home population” (Freed & Kirstein, 1995). The number of elderly patients is predicted to double by the year 2030, and as a result, the demand for home-based medical care and such other associated services will also increase. We have yet to come up with long-term solutions for this problem, and until we do, we shall remain swamped and overwhelmed by the sad plight of the homebound geriatric patients. Community Assessment Techniques for the Homebound Geriatric Patient Many practitioners and clinicians recommend regular home-visits from medical professionals to assess the health of geriatric patients. Many geriatric patients prefer to receive medical attention in their place of residence. Home-visits are now being used by many medical professionals in order to monitor the health of many homebound geriatric patients. “The best interests of the patient and society are served when the provider has first-hand knowledge of the physical, psychosocial, environmental and economic factors that affect the patients health care needs” (AGS Clinical Practice Committee, 2002). During these home-visits, assessment of the elderly patient is usually done by the medical professional. The assessment of the elderly usually relates to sensory and auditory perception, diet and exercise, immunization, sexuality, and accident-risk. Assessment for dementia is also prudent in the case of elderly patients. The goals of assessment techniques are to “encourage a systematic assessment of various areas of potential geriatric risk and to develop a database appropriate to the unique concerns of elderly patients” (Miller, et.al., 2000). During the home visits, the medical practitioner can also assess the environment in which the patient is living in. The practitioner can assess if the home is safe enough for the geriatric patient and is equipped to deal with the physical limitations and disabilities of the patient. There are various community assessment techniques now available for the practitioner assessing the elderly patient. “Health care providers are finding that home diagnostics, including radiology and electrocardiography, are available in most areas, and hand-held laboratory devices are becoming more common” (American Geriatric Society, et.al., 2006). Through home-visits, it may be established that environmental modifications to the patient’s home are needed. These may include bathtub modifications, hand-held showers, grab bars, and bedside commodes which can improve the quality of life of the patient. Common Disease and Health Risks Associated with Homebound Geriatric Patients Homebound geriatric patients usually suffer chronic conditions. They usually suffer disabilities related to “strokes, lung or heart disease, hearing or vision loss, cognitive or emotional problems like dementia or depression, or, most often, a combination of several of these” (Stillman, 2008). Patient’s physical disabilities are commonly attributed to strokes. Many of them are partially paralyzed from stroke and consequently have limited mobility. They cannot function independently and are unable to get from one to another without assistance. Some of them are also bed-bound and consequently suffer from bed sores. Because of their advancing age, many elderly patients suffer urinary incontinence. They are unable to control their urine and it often leaks out during very inopportune times. This problem “affects approximately 13 million persons in the United States, most of whom are older adults” (Fantl, et.al, 1996 as cited by Weiss, 1998). Urinary incontinence is related to different medical problems which include urinary tract infections, sepsis, renal failure, and increased mortality. On a social sense, it decreases their self-esteem, causes depression, and eventually limits their social and sexual activities. Urinary incontinence is usually the primary reason why geriatrics are placed in nursing homes. Another medical problem commonly faced by geriatric patients is depression. Their frustration with their condition and their physical limitations make them think hopeless, self-pitying, and depressive thoughts. Living alone, a reduced sense of purpose, health problems, recent bereavement, medications, and fears all contribute to their depression (Segal, 2007). The limited visits from family often add to their depression. As they are nearing the end of their lives, they often reflect on the things they have and have not done. Without any firm support system, they are often led to think discouraging thoughts about themselves. And this eventually leads to depression. Falls are very common in the elderly. Annually 30% of those who are over 65 suffer from falls. Many of these falls lead to hip fractures. These hip fractures mean limited mobility for the elderly. About 25% of those who suffer from hip fractures die within six months, and the rest become functionally dependent (Johnston, 2001). Their advanced age, muscle and bone degeneration contribute to their falls. Community Health Diagnosis or Problem Common in Homebound Geriatric Patients One of the most common and relevant health diagnoses for homebound geriatric patients is depression. A study covering 539 patients who were 65 years and above revealed that “major depression is twice as common in patients receiving home care as in those receiving primary care” (Bruce, et.al., 2002). The study also revealed that depression in the homebound elderly is often undiagnosed and untreated. Depression is often caused by difficulties in adjusting to events like retirement, loss of a loved one, isolation, or a life-threatening illness. Untreated depression sometimes has the very undesirable outcome—suicide. “One out of every four suicides is committed by a person 65 years of age or older, and depression underlies two thirds of these suicides (Blixen, et.al., 1996, as cited by McDougall, 1997). Therapy and other medical and drug interventions are often made available to these homebound geriatrics however, the cost of treatment is too high and sometimes not fully reimbursed by their Medicare coverage. Depression in the homebound elderly “often presents atypically manifesting as a lack of initiative or somatization” (Capezuti, et.al., 2007). Elderly patients often do not reveal their depressive and despairing thoughts. They often self-medicate or turn to alcohol to cope with their depression. Depression in the elderly patient usually presents in symptoms like memory lapses and loss, confusion, loss of appetite, insomnia, irritability, and delusions or hallucinations. They are often severely sad, but if asked if they are depressed, they mostly answer in the negative. “Depression without sadness is one of those seeming paradoxes that impedes its recognition” (Jeste, 2003). This makes depression in the elderly patient difficult to diagnose. But it is nevertheless a health problem that most geriatric patients face daily. Health Promotion and Public Health Interventions for the Homebound Geriatric Patients There are various health promotion interventions for homebound geriatric patients. The primary intervention that is being undertaken to prevent illnesses and health problems in the homebound elderly is prevention. Prevention is usually done through routine screening. Screening for health problems and health risks like sensory deficits, fall risks, drug intake problems (adverse drug reactions and drug interactions), depression and substance abuse, urinary incontinence, dementia, and elder abuse and neglect is available for elderly patients. Prevention is also undertaken by medical practitioners by encouraging geriatric patients to participate in healthy activities like exercise (such as walking, gardening, range of motion activities, and dancing), eating a balanced diet, annual dental examination, quitting smoking, developing and maintaining a support and socialization system. Secondary prevention is undertaken through more specific disease screening activities. Elderly patients have a higher risk for developing cancer, cardiovascular diseases, and diabetes. Therefore, it is prudent to involve them in routine and regular screening for these diseases. Screening for cardiovascular diseases, hypertension, diabetes, osteoporosis, and cancer (breast, colon, prostate, cervical, etc) are available for elderly patients. These screening programs help promote early detection and increase chances of beating these diseases. Home-based primary care (HPBC) programs are also now available to look into the needs of the homebound elderly patient. These programs have yet to gain widespread support from the medical community, but the experience of the Mount Sinai Visiting Doctors in East Harlem, New York has had promising results. “The program has met many of its initial goals, such as helping patients to live and die at home, decreasing caregiver burden, creating a home-based primary care training experience, and becoming a research leader” (Smith, et.al., 2006). Governmental Programs for the Homebound Elderly Patients Government programs have been made available for homebound elderly patients. The Agency for Healthcare Research and Quality (AHRQ) has sponsored a research on depression in elderly patients. Through their research the diagnosis and treatment of depression in the elderly was made possible. “As part of its emphasis on enhancing the science base for health decision-making, AHRQ released Treatment of Depression—Newer Pharmacotherapies: Summary in March 1999” (U.S. Department of Health and Human Services, 2000). This research was able to establish relevant facts about depression and possible interventions for the disease. The findings of this research now serve as the basis for other policies and programs under the U.S. Department of Health and Human Services in caring for the homebound elderly patient. A study conducted by the Federal Study of Adherence to Medications in the Elderly (FAME) revealed a new pharmacy care program to benefit the homebound elderly patient. In its initial research phase, the program was able to increase medication adherence to 96.9% and was able to present significant improvements in systolic blood pressure. Subjects underwent “standardized medication education, regular follow-up by pharmacists and all medications dispensed in time-specified blister packs” (Senior Journal, 2006). The results of the FAME study serve as a basis for medication monitoring in the elderly population. The Medicare also encourages doctors to make house calls to elderly patients. Medicare “will now reimburse a doctor and possibly a staff member—if test equipment is involved to visit homebound patients in their homes” (Utah Eldercare Planning Council, 2008). Through this program, the doctor will be able to see the living conditions of the patient and assess if they are safe for the patient. The elderly patient will also be elated by the visit and as a result they will be more compliant with their treatment and medication regimen. And, “in essence the doctor learns much more about a patient in her home and he can achieve a personal connection that would have been difficult to establish in the office” (Utah Eldercare Planning Council, 2008). This program is the most beneficial and cost-effective program for the elderly. It offers many advantages and benefits for the elderly. Home-visits or house calls are a dying medical practice, but with the help of the government (more specifically the Medicare program), it is slowly finding its way back into the medical profession. The homebound elderly population is the most neglected and ignored member of our population. They are vulnerable because they are prone to various illnesses like urinary incontinence, depression, sensory problems, falls, chronic lung disease, and life-threatening illnesses. There are various health interventions and programs available for the homebound elderly population. Most of these health programs and interventions focus on prevention and screening of illnesses and diseases they are most at-risk for. Regular and routine screening for specific illnesses is available for many elderly patients. Medicare-supported programs like house-calls and home-visits prove to be the programs which are most advantageous for the elderly population. Through house-calls, they are made to feel like valued individuals. And being valued by society and by other people can make a world of difference to the self-esteem and self-worth of many geriatric patients. Works Cited About Geriatric Care (2008). Utah Eldercare Planning Council Retrieved 06 January 2009 from http://www.careutah.com/services/a15_about_geriatric_health_care.htm#home American Geriatrics Society, et.al. (2006) Geriatrics Review Syllabus. USA: American Geriatrics Society, USA AGS Clinical Practice Committee (2002) The Role of House Calls in Geriatric Practice. American Geriatrics Society. Retrieved 06 January 2009 from http://www.americangeriatrics.org/products/positionpapers/housecall.shtml Bruce, M., et.al., (August 2002) Major Depression in Elderly Home Health Care Patients. American Journal of Psychiatry. Retrieved 06 January 2009 from http://ajp.psychiatryonline.org/cgi/content/abstract/159/8/1367 Capezuti, L., et.al. (2007) The Encyclopedia of Elder Care: The Comprehensive Resource on Geriatric and Social Care. New York: Springer Publishing Company Freed, B. & Kirstein, M. (1995). Including Optometric Services for the Homebound Elderly Curriculum Optometric Education. Banjo Ben. Retrieved 06 January 2009 from http://www.banjoben.com/homebound_article.htm Guadagnino, C. (May 2008). A Return to Home Visits for the Homebound Elderly. Physician’s News Digest. Retrieved 06 January 2009 from http://www.physiciansnews.com/spotlight/508pa.html Improving Quality of Care for People With Depression January 2000. Agency for Healthcare Research and Quality. Retrieved 06 January 2009 from http://www.ahrq.gov/research/deprqoc.htm Jeste, D. (May 2003) Depression in Older Persons. National Alliance for Mental Illness. Retrieved 06 January 2009 from http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7515 Johnston, C. (May 2001). Falls in the Elderly. University of California Office of the President. Retrieved 06 January 2009 from http://www.ucop.edu/agrp/docs/sf_falls.ppt. Martin, C. (1997) Urinary Incontinence in the Elderly. American Society of Consultant Pharmacists. Retrieved 06 January 2009 from http://www.ascp.com/publications/tcp/1997/aug/elderly.html McDougall, G., et.al. (1997) The Process and Outcome of Life Review Psychotherapy With Depressed Homebound Older Adults. National Institute of Health. Retrieved 06 January 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2562588 Miller, K., et.al. (15 February 2000) The Geriatric Patient: A Systematic Approach to Maintaining Health. American Family Physician. Retrieved 06 January 2009 from http://www.aafp.org/afp/20000215/1089.html Pharmacy Care Program Helps Elderly Patients Take Their Medications Better (November 13, 2006) Senior Journal. Retrieved 06 January 2009 from http://seniorjournal.com/NEWS/Eldercare/6-11-13-PharmacyCareProgram.htm Segal, J. (October 2007) Depression in Older Adults and the Elderly. Help Guide. Retrieved 06 January 2009 from http://www.helpguide.org/mental/depression_elderly.htm Smith, K., et.al (30 June 2006) A Multidisciplinary Program for Delivering Primary Care to the Underserved Urban Homebound: Looking Back, Moving Forward. Interscience Wiley. Retrieved 06 January 2009 from http://www3.interscience.wiley.com/journal/118579405/abstract?CRETRY=1&SRETRY=0 Stillman, A. (December 2007). Healthcare for Homebound Geriatric Patients from the Frontline. Jefferson Digital Commons. Retrieved 06 January 2009 from http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1555&context=hpn __________(2008) Careers in Geriatrics. American Geriatrics Society. Retrieved 06 January 2009 from http://www.americangeriatrics.org/education/stillman_bio.shtml Struck, B. & Ross, K. (n.d) Health Promotion in Older Adults. Modern Medicine. Retrieved 06 January 2009 from http://geriatrics.modernmedicine.com/geriatrics/Urology/Health-promotion-in-older-adults-Prescribingexerci/ArticleStandard/Article/detail/327139 Weiss, B. (June 1998) Diagnostic Evaluation of Urinary Incontinence in Geriatric Patients. American Family Physician. 06 January 2009 from http://www.aafp.org/afp/980600ap/weiss.html Zini, A. & Pietrokovsky, J. (October 2006). Homebound Persons. Bio Info Bank. Retrieved 06 January 2009 from http://lib.bioinfo.pl/meid:206541 Read More