The Quality of Care in an Elderly Person's Life - Essay Example

The Quality of Care in an Elderly Person's Life In this essay I will discuss the implications of the changes in the quality of life toan elderly patient, the standards of care received, the significance of discrimination in the elderly, and the possibility of improving services. The statistics on leading causes of death and the health issues of the elderly will be provided. In the analysis, I will define the concept of health, understand the main reasons for health hazards in the elderly and will define health and wellness in terms of medical definitions and also holistic ones. The various aspects of change in the health of elderly will be defined considering physical changes and body image of the elderly. Other aspects that will be covered include spirituality, the role of religion and issues of loneliness and isolation, depression in old age and feelings of worthlessness. The issues that seem to be of concern in old age include lack of family support and concern, boredom in old age due to inactivity and retirement and depression due to illness or fear of death. Introduction: According to the World Health Organisation 'Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' (WHO, 1946). A National Service Framework (NSF) for Older People has been established to examine and solve the problems of older people so that they could be delivered better services. The NSF emphasises on plans to eliminate the age discrimination and helps support person-centered care with newly integrated services (DH, 2001). The Department of Health stresses that intermediate care should be developed at home or in care settings and appropriate hospital care should be delivered by the staff. The NHS has also been urged to take action on stroke prevention, an ailment common in the elderly; and aid in the promotion of health and active life and a reduction in the number of falls for older people (DH, 2001; Ahmed et al, 2005). The Health authorities have emphasised that older people should be given integrated mental health services. Nationally supported standards of healthcare for the elderly have been identified to provide local delivery through the NHS. According to the NHS, the needs of the older people may not be uniform as people have a wide range of needs. The three stages of old age include entering old age, transitional phase, and frail older people. These stages and the specific needs are given here. Entering old age - old age may signify the end of professional life and these may be people who have completed their career in paid employment and/or child rearing. Old age is a socially constructed definition and may include people from the age of 50 years to 60 or 65 years of age. These people who enter old age may remain active and independent till very old age. The goals of health and social care policy are to promote a healthy active life, and to compress morbidity or the period of life spent in frailty (DH, 2001). Transitional phase - This group of older people is the next stage when older people are in transition between healthy, active life just after retirement and frailty at a very old age. This transition occurs when people are in 70s or 80s.The goals of health and social care policy are to identify the emerging problems ahead of crisis in very old age, and ensure that effective responses will prevent crises and long-term dependency. Frail Older People - Frail older people are vulnerable as a result of health problems such as stroke, dementia, paralysis, social care needs or a combination of these factors. Frailty is often experienced only in late old age, so all healthcare services for older people should be implemented with their needs in mind. The goals of health and social care policy are to anticipate and respond to problems, recognising the complex interaction of physical, mental and social care factors that can adversely affect the independence and quality of life (National Service framework for older people, DH 2001). Healthcare in the elderly - An Analysis In this analysis I will present the results of an interview with an elderly person to understand the importance of standards in quality of care. According to statistical reports provided by the government, the proportion of older people with a long-term illness or disability (LLTI) that restricts their daily activities increases with age. Over a quarter of men and women aged 50-64 in Great Britain reported a disability compared with two thirds of men and three quarters of women aged 85 and over in 2001 (National statistics online, 2005). A chart is given below: Figure 1: Age standardised rates of long-term illness or disability which restricts daily activities: by gender and age, April 2001, GB. Source: National Statistics Online, 2005. Many people who are in the older age groups still consider themselves to be in good health, even if they may have a long-term illness which restricts their daily activities or may not have an active life. In 2001, of all men and women aged 65 and over reporting a limiting long-term illness, just over 10 per cent considered themselves in 'good health' over the following year and around 45 per cent reported being in 'fairly good health'(National Statistics Online, 2005). Thus long term illness or disability in old age definitely limits one's ability. The NHS and National Statistics Online show a rise in the proportions of older people who consulted GP in two weeks. For people 75 years of age or over, 20% consult GPs in a two week period. According to statistical reports presented, one in five older people (aged 50 and over) had attended an outpatient or casualty department in the three months prior to interview and one in ten had stayed in hospital as an inpatient in the previous 12 months (statistics online, 2005). A chart on the use of services from GPs is given here: Figure 2: NHS general practitioner consultations in previous 2 weeks: by age, 1972 to 2003, GB - Source: National Statistics Online, 2005. Use of health care services varies by age, with individuals in older age groups being more likely to seek medical attention. Ill health also rises with age. The majority of older people continue to live in the community well into later life; just less than three quarters of people aged 90 and over were living in private households in 2001. According to statistical reports presented, one in five older people (aged 50 and over) had attended an outpatient or casualty department in the three months prior to interview and one in ten had stayed in hospital as an in patient in the previous 12 months (statistics online, 2005). Use of health care services varies by age, but reports have indicated that individuals in older age groups being more likely to seek medical attention. Ill health has been found to be proportional to age although the majority of older people continue to live in the community well into later life; it was found that just less than three quarters of people aged 90 and over were living in private households in 2001 (National Statistics Online, 2005). The health hazards of the elderly have been related to falls and fractures and deaths due to injury. Other problems include delayed discharge of the elderly which the health department claimed to have reduced. Stroke, heart disease and cancer are some of the biggest killer diseases for older people in the UK (NHS plan, DH 2000; Smith 2005). The NHS along with social care and health teams has recently provided 24-hour support to the elderly, faster access to community equipment, better home-care packages and support. A health report on older people claims that since 1998, there have been rapid developments in stroke services and in areas of emergency care, surgery, long-term conditions and mental health. The NHS has also focused on more person-centred services and practices. Older people's NSF standards include eight primary standards on rooting out age discrimination, person centered care, intermediate care, general hospital care, stroke, mental health in older people, falls, and promotion of health and active life in older age (DH, 2001). The first standard emphasises that NHS services will be provided to all, regardless of age, on the basis of clinical need alone. Older people cannot be discriminated against on the basis of their age; social care services will not use age in their eligibility criteria or policies, to restrict access to available services. Standard two of the NSF standards suggest that NHS and social care services should treat older people as individuals and enable them to make choices about their own care. The single assessment process, integrated commissioning arrangements and integrated provision of services, including community equipment and continence services are some of the services provided by the NHS (DH, 2001). The aim of standard three is to provide integrated services to promote faster recovery from illness, prevent unnecessary acute hospital admissions, support timely discharge and maximise independent living. Standard four on general hospital care is to ensure that older people receive the specialist help they need in hospital and that they receive the maximum benefits that they expect from being in hospital. The standard five on stroke has helped reduce the incidence of stroke in the population and ensure that those who have had a stroke have prompt access to integrated stroke care services. Falls and fractures have been considered as one of the main causes of death and injury for the elderly. The sixth standard has aimed to reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen. The aim of the seventh standard on mental health in older people is to promote good mental health in the elderly and to treat and support older people with dementia and depression. The promotion of health and active life in older age helps in extending the healthy life expectancy of older people. Case Study An interview is taken with an elderly person and the person was having heart ailments and was admitted to hospital due to coronary heart disease. The person had stroke, heart disease and also showed symptoms of paralysis. The patient is a widower and 70 years of age. The case study is given below along with the interview taken with the patient: The Interview is as follows: Social worker: Are you feeling better now than when you were in the hospital Patient: Yes, I do feel better. Social worker: Do you think that the services in the hospital were according to your expectations Patient: The services in the hospital were good but I think they need to improve even further. Social worker: Do you have any specific suggestions that you have for the healthcare services Patient: I specifically felt that the staff should attend to the elderly as promptly as they attend to other people. Social worker: So do you think that you have been discriminated against because of your age Patient: Yes, I felt so. I am old and 70 years is a long time. Social worker: Do you feel you have enough family support Patient: My wife died a few years back and my children live in another country and call me once a month, so I don't have much family support. Social worker: Do you feel lonely then Patient: Yes, I do feel lonely and very depressed at times. Social worker: Is there any particular issue you think about when you are depressed Patient: Yes, I think of death and the fact that I may die with no one beside me. Social worker: Do you feel physically better now than when you were in the hospital Patient: Yes, before going to the hospital, I was feeling a constant pain in my chest, now I feel some pain but possibly that is a muscular pain rather than heart problems. I have paralysis now and have severe movement problems which I did not have before I went to the hospital. Social worker: So is your paralysis very severe Patient: Yes, I am confined to the wheelchair and I cannot move or stand up without help. A nurse has been helping me. Social worker: Is there any issue that you would like to point out about the healthcare services Patient: Yes, I would suggest that they improve the services of the healthcare with regular visits by doctors, lower waiting times for nurses or doctors to attend to the patient, and more effective treatment. Social worker: Did you have to wait for too long for doctors or nurses to attend to you Patient: Not initially when I was admitted to the hospital, but later, after a few days in the hospital, I felt the waiting time was increasing and doctors and nurses took up to an hour to attend to my needs. Social worker: So did you not get all the benefits that you expected in the hospital Patient: I was not made aware of all the benefits available in the hospital in the first place, but I think I could have got more benefits. Social worker: Are you happy with the care you are receiving now at home Patient: Yes, the nurse helps me as I have mobility problems. Social worker: Are there any issues and concerns about healthcare that you would like to point to Patient: Yes, I feel there should be more psychological support given to people like us and the services should be more focused on elderly. Social worker: Do you feel any physical or personal concerns Patient: My body is also betraying me now and I no longer feel the same energy that I used to feel even five years back. Social worker: So how do you spend your time now that you are mostly confined at home Patient: I read, watch the news on TV, listen to music and I have become interested in spiritual matters that have given me solace in recent times and throughout my illness. Social worker: Ok, thank you for your cooperation and your responses. I wish you better health. Patient: Yes, thank you. The issues that have come up from the interview suggest that the patient has confronted some problems in the context of the standards of the NSF for older people. The first standard on discrimination as mentioned in older people's services point out that older people cannot be discriminated against on the basis of their age and the health authorities should attend to the elderly on the basis of their needs (DH, 2001). Certain NSF standards have also pointed out to the need to promote an active and healthy life in the elderly and in this case study, promoting an active life for the patient is only possible by providing services such as regular physiotherapy and psychological support (DH, 2001). Supporting timely discharge, preventing illness and maximising independent living are some of the issues that have been highlighted in the NSF standards for the elderly. Reducing waiting times after admission to hospital and while still in care has been one of the primary issues in healthcare. Considering patient responses, the issues in healthcare seem to be related to spirituality and religion, loneliness and depression and the need for psychological support and effective treatment and rehabilitation. I will argue for a more holistic approach to healthcare for the elderly to improve rehabilitation to improve the quality of life of such patients. The issues will be dealt with considering more reported case studies and research in healthcare. Choi- Kwon et al (2005) have discussed the implications of post-stroke fatigue which is a common problem in the elderly who suffer from stroke. The paper studied the characteristics associated with post-stroke fatigue and selected 220 outpatients at 15 months after onset of stroke. The study used standardised questionnaire to identify post-stroke depression (PSD) and post-stroke emotional incontinence. The presence of pre-stroke fatigue was also assessed and apart from a questionnaire a fatigue severity scale was used. The impact of PoSF was measured. From the 220 patients, 125 had PoSF (Post-stroke fatigue), 83 had PrSF (pre-stroke fatigue), and 53 had PSD (post-stroke depression). The study by Choi-Kwon concluded that fatigue is a fairly common after effect of stroke and exerts an impact on daily activities. Pre-stroke fatigue is related to post-stroke fatigue and this is often found along with post stroke depression. Depression and fatigue are thus common effects of stroke and this may even be exaggerated in the elderly as in older patients depression and fatigue are related to loneliness and fear of death (Antai-Otong, 2004). Several researchers have suggested that strategies to improve PoSF should be implemented and considered on the basis of causative factors. Ostir et al (2005) have highlighted the importance of quality of lie assessments to understand the benefits of rehabilitation intervention. The study shows an association between functional status and satisfaction with community participation for persons with stroke at 80-180 days after discharge from medical rehabilitation. The study was conducted on 1870 individuals who had stroke, aged 40 or older and had complete information at admission and follow-up. The results of the study showed a positive association between change in functional status and satisfaction with community participation suggesting that quality of life improves rapidly when the elderly who are in rehabilitation also participate in community activities. Conclusion: Considering this study by Ostir et al, it can be suggested that for the patient interviewed here, regular spiritual talks, community meetings and some amount of social recreation could be considered to improve his functional status. This could be done in the patient's home or in a place easily accessible to the disabled. Care homes and disabled recreation facilities could be made available. Issues such as body image concerns, fear of death and matters related to life and religion could be emphasised in the later years to improve quality of life, social participation and to foster a positive attitude (see Jonsson, et al. 2005). The use of movement therapy has been suggested by Dettmers et al (2005). Studies on post-stroke depression suggest that issues of depression and loneliness may have to be taken into consideration by the healthcare services and psychological support should be emphasised as the 'most important factor' in healthcare for the elderly. Bibliography: Andrawes WF, Bussy C, Belmin J. Prevention of cardiovascular events in elderly people. Drugs Aging. 2005;22(10):859-76. Ahmed S, Mayo NE, Corbiere M, Wood-Dauphinee S, Hanley J, Cohen R. Change in quality of life of people with stroke over time: true change or response shift Qual Life Res. 2005 Apr;14(3):611-27. Antai-Otong D. Poststroke depression: psychopharmacological considerations. Perspect Psychiatr Care. 2004 Oct-Dec;40(4):167-70. Chuang KY, Wu SC, Yeh MC, Chen YH, Wu CL. Exploring the associations between long-term care and mortality rates among stroke patients. J Nurs Res. 2005 Mar;13(1):66-74. Choi-Kwon S, Han SW, Kwon SU, Kim JS. Poststroke fatigue: characteristics and related factors. Cerebrovasc Dis. 2005;19(2):84-90. Epub 2004 Dec 17. Dettmers C, Teske U, Hamzei F, Uswatte G, Taub E, Weiller C. Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke. Arch Phys Med Rehabil. 2005 Feb;86(2):204-9. Jonsson AC, Lindgren I, Hallstrom B, Norrving B, Lindgren A. Determinants of quality of life in stroke survivors and their informal caregivers. Stroke. 2005 Apr;36(4):803-8. Epub 2005 Mar 10. National service framework for older people, 2001 Crown Copyright; Department of Health publication. Older people's NSF standards, 2001 Crown Copyright; Department of Health publication. The NHS Plan: a plan for investment, a plan for reform, 2000 Crown Copyright; Department of Health publication. Ostir GV, Smith PM, Smith D, Ottenbacher KJ. Functional status and satisfaction with community participation in persons with stroke following medical rehabilitation. Aging Clin Exp Res. 2005 Feb;17(1):35-41. Smith MA, Frytak JR, Liou JI, Finch MD. Rehospitalization and survival for stroke patients in managed care and traditional Medicare plans. Med Care. 2005 Sep;43(9):902-10. Also see the section on Older People from National Statistics Online www.statistics.gov.uk WHO definition of health, 1946 in http://www.who.int/about/definition/en/ Read More