How Care Management Is Practised in Older Persons - Literature review Example

Case Management Practice Name Institutional Affiliation Case Management Practice Introduction Delivery of care attracts a social concern following the advancement in health, social, and economic challenges. According to Prince et al. (2015), approximately 23% of the total disease burden globally relates to the disorders stemming from old age. Significant in this percentage is the contribution of the developed countries to the cases of old-age disorder compared to the developed regions. However, Prince et al. (2015) mention that the per-head burden of individuals suffering the health challenges is higher in developing regions. Despite the differences, World Health Organization (2015) explains that the ageing population is increasing worldwide interpreting to more engagement in the form of improved health and health systems, workforce and budgets to cater for these populations. World Health Organization (2015) recommends a change in formulating health policies and the delivery of service. This essay critically analyses case management for the older persons. The discussion includes the topics how care management is practised in order persons, common case management models, issues faced by target population and the benefits and limitations of case management. How Care Management is Practised in Older Persons Based on World Health Organization (2015), healthy ageing not only covers the absence of a disease but also the maintenance of the functional abilities. The inclusion of functional abilities as the most important factor for older people entails the application of an integrated care systems focusing on the needs of the elderly. With the advancement in technology, people at present have an increased life expectancy with a majority of the population going past 60 years of age. World Health Organization (2015) attributes the increased expectancy to the reduced mortality at younger ages including during childbirth and the eradication of infectious diseases. Developed countries are a set ahead in managing mortality at the older ages by incorporating care management models for different groups. It is important to understand the concept of case management in effecting healthy ageing. According to Wagner (2000), care management centres on discharge planning and a reduction in the use of health services. Reilly et al. (2015) identify case management as a model for organising and coordinating care at an individual level. The imperative of case management is its abilities to focus on the specific needs of a patient similar to integrated care management system. Therefore, the discussion on defining case management establishes that the practice entails providing health and social services tailored to the needs of the elder person. An example is a study by Reilly et al. (2015) addressing dementia, a disorder common to individuals between the ages of 60- 65. Apart from the focus on the specific disease or challenge, Reilly et al. (2015) include place as a factor determining the practice of case management. Typical places catering for the aged include the hospitals, care home, and the residential homes where the family performs most of the care. The provision of case management services includes a fragmented organisation structure. Based on Reilly et al. (2015), the fragmentation stems from the multiple sources covering the service provider, the formality or the informality of the services, and including the dimension of services as either being health or social service oriented. Prince et al. (2015) contribute to the understanding of the process by including the age factor. Older individuals face age discrimination when it comes to diagnosis and obtaining treatment. Much as the argument explains on issues facing the target population, it contributes to case management by informing on the less evidence-based treatment provided to the older population (Prince et al. 2015). Case management varies internationally as discussed by (Goodwin, Dixon, Andersn and Wodchis, 2014). The particular study focuses on countries such as Australia, Canada, the Netherlands, US, UK, New Zealand, and Sweden. The choosing of these countries follows their large population of 65 and above people. According to Goodwin et al. (2015), the difference in case management in the selected regions include the professionals involved in providing the care, the ease of sharing information, and the level of engagement of the patient with a health professional. Moreover, there is the issue of funding and to what specific services channelling of funds caters. It is evident from these variations that there is no specific practice of case management. The absence of specificity develops the advantages and disadvantages of the health and social care program which is vital for the target population. Common Case Management Models Change in family structure realises the different forms of case management models available today. Samanta (2016) includes that primary caregiving is on a fast decline and currently there is no clear knowledge of who is or should be responsible for the older population. Studying case management, it is found to include various non-exclusive patterns. According to Ghosh, Greenberg and Seltzer (2012), examples of these models include Pearlin’s stress, life-course perspective, role, coping and convey models. Wodchis, Dixon, Anderson and Goodwin (2015) contribute to the discussion whereby some case methods focus on improving the recipient experience and independence, other focus on the coordination of the exercise by various professions while other models objective is to reduce utilisation of the hospitals and finances. Focusing on the Pearlin’s stress, Samanta (2016) discusses its relation to the coping model. Although developed primarily to examine the case of Alzheimer, the model functions by pointing the stressors affecting the well-being of the population. The application of the framework in health and social services involves the aim to reduce caregiver burden by providing interventions that alleviate the stressors. Samanta (2016) argues that the model faces criticism following its focus on care burden than caregiving which is the objective of case management. Concerning the life-course perspective, Samanta (2016) address the model as being focused on providing knowledge on the various facets available in caregiving. In particular, its role in case management revolves around health rather than social care. It differs from the aforementioned model whereby it emphasises that case management is a process occurring throughout life. Moreover, it helps the elderly understand the social path where they manage to integrate both the formal and informal roles in caregiving. Gender plays a significant role in understanding the application of case management models. An example is the role occupancy theory by Samanta (2016), where it considers the effects of performing multi-roles in the society by the female gender. In the research, the multiple responsibilities accorded to women generate more psychological stresses, especially in their elderly ages. It is evident that most communities expect women to provide care to their family members even when old and frail. In this case, the elderly women perform as caregivers while in fact there needs care themselves. Therefore, the model examines the well-being of the caregiver. Comparatively, Samanta (2016) discusses the convoy model where the focus is on the relationship between the caregiver and the recipient. In the context of the elderly, their network comprises of the family members dispersed in various geographies and economies limiting their availability to provide direct care. Following the factors limiting the relation and availability of care, the convoy model forms a protective surrounding on the recipient, where it identifies the most appropriate family member to care for their elderly. Social Solutions (2009), provides a different perspective of case management models involving the brokerage, clinical, and strength base clinical case management. In the brokerage system, it operates by assisting the client learns of available services according to their needs. In this case, it focuses on making the elderly independent rather than provide support to these people. Conversely, clinical case management goes beyond facilitating the access to these needed services by availing clinical care personnel to work directly with the target group (Social Solutions, 2009). More important is the strength- based clinical case model, where it contributes to the well-being of the recipient by integrating the actions of the care manager with the family. An advantage of the plan is the ability to promote the growth and skills of the client through an outreach setting where the formal and informal caregivers work simultaneously. Issues Faced by the Target Population As age progresses, there is a parallel increase in being at risk of contracting disorder and diseases associated with age decline. According to Wodchis et al. (2015), studies provide that the elderly are prone to chronic diseases and functional impairment. However, the management of these conditions is more advanced in the west and developed regions where care management facilities are extending to include more of the older population. Samanta (2016) provides typical examples of challenges in old age including depression, communicable diseases, chronic especially the cardiovascular, and accidents following reduced impairments. However, the study finds that the occurrence of these conditions to the elder is higher in low and middle-income countries. Contrastingly, World Health Organization (2015) addresses the reasons for the increased ageing populations and the challenges of ageing. In particular, the main issues include changes in epidemiological and demographical factors. Following these changes, examples of issues faced by the aged include sensory, movement, cognitive, and immune failure. Prince et al. (2015) provided further examples of cancer, visual impairment, pulmonary diseases, diabetes, dementia and musculoskeletal disorder. Nevertheless, it is important to note that the provided examples are not necessarily an outcome of old age but their possibilities increase with age appreciation. The discussion by Samanta (2016) describes economic and social factors such as lack of income and social alienation of the elderly as contributors to the suffering of these persons. Benefits and Limitation of Case Management Case management is a complex process limiting control of the exercise to a specific group (Ling, Brereton, Conklin, Newbound and Roland, 2012). Ling et al. (2012) also present the improper methods of information sharing following different information technology systems as a challenge to active case management. Moreover, the difference in values and objectives of the participating organisation such as the government acts as barriers to the proper work integration between the caregiver, recipient and the health and social functions (Ling et al. 2012; Cameron, Lart, Bostock and Coomber, 2014). Part of the limitation is the argument by Berenson and Horvath (2003) include the failure of the program to cover prescription drugs. Comparatively, the program realizes benefits such as overall improvement of quality of life (Lim, Lambert and Gray, 2003). According to Ling et al. (2012), the collective action of the model through integrating health and social services improves the outcome of the elderly. Similarly, Oeseburg, Wynia, Middel and Reijneveld (2009) addresses benefits such as cost saving, reduced dependency on service, reduced hospital admissions, readmissions, the length of stay and visits to emergency rooms. Moreover, Ross, Curry and Goodwin (2011) introduce three categories of benefits including health outcomes, service utilisation, and patient experience. A significant advantage includes the avoidance of inappropriate care admissions of the elder through the integrated case management system (Cameron et al. 2014). Conclusion In summary, case management is an active strategy for the older people who experience social, economic, and health challenges. In particular, case management functions to improve the independence of the recipient, and accessibility to care services that are vital for their survival. The imperative is the practice of the service whereby through the various model's management follows the type of suffering, the situation of the patient, the location, and the professionalism of the caregiver. Despite the difference in case management model, it is important to provide an integrated system focused on the individual needs of the elderly person. References Berenson, R. A., & Horvath, J. (2003). Confronting the barriers to chronic care management in Medicare. Health Affairs, W3. Cameron, A., Lart, R., Bostock, L., & Coomber, C. (2014). Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature. Health & social care in the community, 22(3), 225- 233. Ghosh, S., Greenberg, J. S., & Seltzer, M. M. (2012). Adaptation to a spouse’s disability by parents of adult children with mental illness or developmental disability. Psychiatric Services, 63(11), 1118–1124. Goodwin, N., Dixon, A., Andersn, G., & Wodchis, W. (2014). Providing integrated care for older people with complex needs: lessons from seven international case studies. London: The King’s Fund 201(4). Lim, W. K., Lambert, S. F., & Gray, L. C. (2003). Effectiveness of case management and post-acute services in older people after hospital discharge. Medical Journal of Australia, 178(6), 262-266. Ling, T., Brereton, L., Conklin, A., Newbound, J., & Roland, M. (2012). Barriers and facilitators to integrating care: experiences from the English Integrated Care Pilots. International journal of integrated care, 12(129), 1- 12. Oeseburg, B., Wynia, K., Middel, B., & Reijneveld, S. A. (2009). Effects of case management for frail older people or those with chronic illness: a systematic review. Nursing research, 58(3), 201-210. Prince, M. J., Wu, F., Guo, Y., Robledo, L. M.G., O’Donnell, M., Sullivan, R., & Yusuf, S. (2015). The burden of disease in older people and implication for health policy and practice. The Lancet 385(9967), 549-562. Reilly, S., Miranda-Castillo, C., Malouf, R., Hoe, J., Toot, S., Challis, D., & Orrell, M. (2015). Case management approaches to home support for people with dementia. The Cochrane Library. Ross, S., Curry, N., & Goodwin, N. (2011). Case Management. London: The King’s Fund. Samanta, T. (2016). Cross-Cultural and Cross-Disciplinary Perspectives in Social Gerontology. Berlin Heidelberg: Springer. Social Solutions. (2009). Three Unique Case Management Models. Retrieved from http://www.socialsolutions.com/blog/unique-case-management-models/ Wagner, E. H. (2000). The role of patient care teams in chronic disease management. BMJ: British medical journal, 320(7234), 569. Wodchis, W., Dixon, A., Anderson, G., & Goodwin, N. (2015). Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis. International Journal of Integrated care, 15(6). World Health Organization. (2015). World report on ageing and health. Geneva: World Health Organization. Read More