Patient Group And Health Service Available To The Group
During one of my clinical rotations in Ipswich, Queensland, Australia, I worked in geriatrics department to look after elderly people. With the advancement in health care and technology, life expectancy of people has increased. Hence, I have witnessed large in flow of elderly patients with range of disability and health concerns. In Australia, male have an average life expectancy of 80 years and females have life 84.3 years (Australia's Demographic Challenges, 2017). This has lead to rise in ageing population and increase in presentation of elderly people at hospitals. The number of Australians above 65 years is constantly rising with about 3.4 million people in this age group in 2014 and it is expected to reach to about 6.2 million in 2042 (About ageing in Australia (AIHW), 2017). As my clinical placement was in a hospital in Quensland, the older population above 65 years in this area was found to be 14% in 2014 and it is expected to reach upto 24.2% in 2061. Queensland is home to 17.4% very elderly people behind New South Wales and Victoria and many migrated from other states to Queensland. The average at which Queenslander die has also increased with 76.9 years in male and 83.6 years in female in 2013 (Queensland Seniors, 2013–14, 2017).
With more number of people at age above 65 years, more illness, dependency and disability is seen in elderly people. The common health care problems that I have found in ageing population of Australia includes cognitive disorder, arthritis, cardiovascular illness, diabetes, hypertension disease and hearing loss. Dementia has also been found to be a major challenge in the life of elderly population. Due to this reason, chronic disease is the major cause of deaths in Australia compared to injuries and accidents. Cardiovascular disease is the leading cause of death followed by dementia and Alzheimer’s disease (About ageing in Australia (AIHW), 2017). This will increase the burden of health care as well as the social cost.
Elderly or ageing population are more vulnerable to ill health and health concerns because of advancing age. The risk of fall increases with age leading to long-term functional disability and costly interventions for elderly. Furthermore, ageing is a lifelong process and poor nutrition, physical inactivity and substance abuse contribute to development of chronic disease in elderly people. In addition, the risk of poverty and social exclusion increases at old age making them incapable to equally access health care. All these affect their mental health and quality of living (Prince et al., 2015). Ageing is not just a biological process, it is a social construction that varies culturally and demographically. The increase in life expectancy is the reason why elderly people carry greater burden of disease such as mobility issues, declining vision, heart problems, cognitive impairment and arthritis. Demographic and social factors also contribute to health inequality in older people because effect of old age is not seen in all elderly equally, it varies according to socioeconomic status, gender and ethnicity (Matthews, 2014).
During my clinical placement in a hospital at Ipswich, Queensland, 24 hour geriatric care service was available to elderly people. Aged care assessment and health ageing program was also available at the hospital. In addition to this, other range of health care services available to elderly people in Australia included emergency geriatric care services, geriatric ambulatory services, geriatric rehabilitation service, evaluation and management service, cognitive impairment service and many others. Permanent care in residential aged care homes and respite care service for temporary basis was also available (Aged care (AIHW), 2017).
Literature Review (Health Care Disparities In The Group)
Advancing and range of illness exposed older adults to ranges of health care disparities and challenges. The research by Miller et al., (2014) gives insight into disparities in access to health in elder people with disabilities. Minority and lower socioeconomic group individuals are disproportionately affected by disabilities and they fail to receive preventive and treatment services due to disability. Health care cost also act as a barrier for them in access to care. Even when service is available to them, health care staff fails to realize the needs of people with disabilities and increase their sufferings. Lakhani, (2012) also reports about challenges to health for an ageing population due to dementia and repeated hospitalization due to frailty and multiple health risk. The presentation of symptoms of cognitive impairment and losing memory negatively affects the quality of life of older people with dementia. Socio-demographic and clinical variables also affect the way an older patient is affected by dementia. The diagnosis of dementia affects the comprehension and communication skill of a person. In such situation, they are more vulnerable to personality changes, depression and agitation which will risk their health and quality of life outcomes (Moyle et al. 2012). Jing, Willis, & Feng, (2016) gives insight regarding the demographic, social, psychological, regional and social factors affect quality of elderly people with dementia. Enforcement of dignity and autonomy in patient has a positive on quality of living (QoL) in such people. There is a need to pay attention to QoL by stages of dementia to reduce health disparities in affected people.
Williams, (2007) presented important evidence regarding health challenges to older people due to biasness and unfavorable attitude towards elderly people in communities. People regard physical frailty and illness in older adults as burden to family and society. Hence, prejudices, stereotyping and discrimination against older people increases and it exposed them to greater health risk and mental illness. Social isolation and maltreatment in old age increases the likelihood of chronic depression in elderly. Ignorance and social isolation at old age is associated with increased risk of mortality as such individuals are at greater risk of developing cardiovascular disease, illness, cognitive deterioration and injuries or fractures. To provide good quality of life at old age, it is necessary to make efforts to reduce isolation and loneliness and neglect in older adults (Steptoe et al., 2013).
Experience of Patients on Placement
The literature review gave evidence to the fact that health staff in clinical setting are insensitive to the needs of elderly people in care (Miller et al., 2014). During my experience of caring for an older patient with dementia, I also witnessed similar issues. This happened when I encountered an elderly dementia patient who was difficult to manage at home as she developed hallucination and often tend to run away from home and interact with stranger people. She also had instable memory and mild cognitive impairment. This significantly affected communication with the patient and this created a burdensome cycle of conflict. The issues was witnessed not only for dementia patient, this was common for almost all patients above 70 years as hearing loss, failing memory and cognitive disability affected their ability to communicate rationally. Many nurses failed to understand the feelings of such person and tend to be rude to them.
One positive factor in my clinical placement was that senior staffs paid attention to clinical difficulties faced by new health care staffs in caring for older people. This was a commendable step as they were aware about the health complexity at old age and challenges faced by health staffs in looking after such individual. My clinical placement had arrangement for regular feedback and training sessions for new staffs to address their issues and develop their skills in geriatric care. Communication problem mainly arose because of reduced hearing capacity, failing eyesight, neurological changes and effects of medications in old age. Our clinical facility emphasized on two-way process of communication by developing verbal and non-verbal communication skills of staff. This training was found to be effective in identifying the source of communication issues and modifying care strategies according to mitigate those source of problem. However, there is one thing that still requires improvement and this includes competitive strategies for fall management of older patient. Fall management is extremely critical for elderly people, but staffs are incompetent in this area (Williams, Ilten, & Bower, 2016).
From my clinical placement in geriatric care, I became aware of range of health issues and disparities experienced by elderly people. At the first instance, the risk to health increased for older people because of the biological mechanism of ageing and gradual physical deterioration of health. Secondly, I also realized that multiple illnesses further aggravated their health condition and made them suffer in clinical setting. People at old age normally experience cognitive and mobility problems and this was further compounded by diseases like dementia, hypertension, diabetes and cardiovascular disease. Another important learning for me was that I realized that care in hospital setting did not improved health of older people, their health and well-being was highly affected by social contact and closeness with family members. I can say this because many patients were found to gloomy and had slow pace of recovery due to loneliness and social isolation issues in their life.
This experience has been exceptional transformation for me a care staff because it made me aware of the pathos and sufferings of people at old age. Normally clinicians or staff fail to realize the feelings or suffering older people and disrespect and dishonor them in delivering care. However, after this placement, I would change my way of looking at this people. I would make maximum effort to engage in effective communication with elderly people and given them the autonomy to make their own decision. This will make them more responsive in care and help me to build appropriate therapeutic relationship with patient. With my commitment to work in geriatric department, I expect to find more barriers that increase health disparity in this group of patient and use my clinical values and skills to overcome them to reduce the burden of the health care system as well as the ageing person.
Conclusion and Recommendation
From the analysis of the health care and health service vulnerabilities experienced by older people, I got to know about the common ailments and disease burden in elderly people. Apart from biological factors of illness, socioeconomic factors of loneliness, inappropriate attitude of staffs, discrimination, stereotypes and insensitivity increased the sufferings for elder people. In view of the barrier or challenges to health in older people, the following will be major priority in clinical intervention:
- It will be ensured that all staffs gave respect to older adults and empowered them to take their own decisions in care.
- In case of communication issues with older patients, it will be ensured that patient’s right is not violated in excuse of communication disability of patient.
- To provide holistic care to patient, all staffs should make it a priority to minimize risk and stereotypes related to old age in community.
Considering the presence of various personal and societal risk factors contributing to health issues in older adults, it is necessary to educate the inter-professional team about optimal patient-centered care. This would help to think from the perspective of old age people and meet their health and social needs in the best possible ways. To maintain dignity and quality of life of older adults, embracing leadership responsibility will also be influential. Secondly, as dementia is the leading cause of mortality in Australian people, it is proposed to improve cultural competence of staff to address communication barrier in care and validate older adults feelings (Williams, 2013). This will facilitate interpersonal communication and improve quality of life of older adults in long-term care setting.
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Australia’s Demographic Challenges —Australia's Demographic Challenges. (2017). Demographics.treasury.gov.au. Retrieved 1 July 2017, from https://demographics.treasury.gov.au/content/_download/australias_demographic_challenges/html/adc-04.asp
Jing, W., Willis, R., & Feng, Z. (2016). Factors influencing quality of life of elderly people with dementia and care implications: A systematic review. Archives of Gerontology and Geriatrics, 66, 23-41. doi:10.1016/j.archger.2016.04.009
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Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences, 110(15), 5797-5801.
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Williams, K. N., Ilten, T. B., & Bower, H. (2016). Meeting communication needs: topics of talk in the nursing home. Journal of psychosocial nursing and mental health services, 43(7), 38-45.
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