Case Study: Nursing Care For Older People

Introduction

Most nurses’ practitioners are likely to encounter an aged person in the course of their duty. Studies conducted indicate that more than two-thirds of the in-patients in most hospitals are over sixty five years of age (Jones, Endacott and Crouch, 2002). The studies further indicate dissatisfaction by older patients in the services that they receive from people taking care of them when they are ill. Recent literature has criticised the current care given to the aged by arguing that they fall below the required standards. It is evident that older patients suffer from various needs which are complex in nature (Farell, 1990). This means that an older person may have multiple diagnoses characterised by chronic and acute illness requiring urgent attention. They may further experience other disabilities such as sensory impairments that hinder the aged patients from communicating effectively. These are among many reasons that make nursing care of the aged people taxing (Dunning, 2005). The practise of nursing care therefore requires a professional who has the skills and the right resources to deliver quality services. Through a case study, this paper will discuss the concept of nursing care of the older people, the relationship with the carers and the holistic approach towards the concept.

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Case Study

Fred, an active 75 years old man resides in a rural town with his wife who suffers from agoraphobia, an anxiety disorder. He therefore takes it upon himself to take care of his wife. His daughter lives next door with her husband and their two teenage daughters. He engages in various activities such as walking his dog and chopping fire wood in a bid to keeping him occupied. He has also engaged himself in the business of selling eggs in the neighbourhood, courtesy of the chickens that he rears. The small house that he occupies has two slow combustion heaters. However, Fred has been running out of breath over the past few days and has a florid complexion. In addition he recently had some incontinence, a condition that affects one’s bowels.

He also requires daily dressing as a result of a fall he had hence lacerating his right shin. Being an old man with a big physique, his ability to move around freely has greatly decreased. It should be noted that Fred had a bypass surgery nine years ago. He has been on anti-hypertensive drugs for the past two years and he has been taking aspirins and lipex as well. He recently had another minor operation in his left eye to remove a cataract. However, he argues that the operation was a waste of time as he can no longer see anything using the left eye that was operated on. His active nature drives him to do most of the housework though the couple gets assistance from community service. He still drives around in his car when he requires going out on a social outing or shopping. Fred is concerned about his current health and the possibility of undergoing another surgery, a process that he argues will require a lot of his time and money. He says that he is tired of his normal routine and is considering of going into long-term care.

Understanding The Concept Of Nursing Care Of Older Person

The case study presents an older person who requires nursing care. What then does nursing care of such an older person entail? Older people have been known to experience functional decline that render them susceptible to multiple illness (Tolson, Booth and Schofield, 2011). The functional decline among the older generation has been attributed to numerous complications as regards malnutrition, decreased mobility, loose bowels, falls and delirium development. The concept of nursing care is therefore designed in the context of social, economic and political status into which it has been provided (Nay and Garratt, 2009). The social context include factors such as social inequality in rising incomes leading to poverty levels among the elderly and age discrimination that is triggered by lower standards of care given to older people. The recent survey conducted in Australia estimated that the average life span was increasing over the decades (Fox 2010). Old age currently define people over 75 years as opposed to the days when it defined the population of people who had attained 65 years of age. The current generation of old people is over 85 years of age.

This brings to fore the debate by most scholars whether the issue of longevity in the heterogeneous population of aged people is an indication of an increased healthy life or morbidity (Borowski, Encel and Ozanne, 1997). It has been established that most of the elderly people are still in good health and therefore not right to stereotype all of them as being frail and infirm. On the other hand, health indicators show a correlation between old age, functional disability and application of nursing care. Age has been associated with diseases such as hypertension, bone and ischaemic heart diseases and even stroke. Other diseases such as dementia and Alzheimer are more common in older persons with its rate doubling with the age increase. Most scholars argue that the current generation of older people seem to enjoy greater power and health stability than those in previous generation (Hindle and Coates, 2011). This has been attributed to social changes such as access to basic knowledge. However, despite the current status of the aged in the modern society, nursing care becomes an important aspect. Fred indicates his will to go into long term nursing care even though he still has the strength to carry on his activities with less help. It is for this reason that the term ‘older person’ also denotes referral to close relatives and carers. This explains the reasons why despite the older people’s desire to take care of themselves, it becomes necessary to involve someone else to take care of them.

The concept of nursing care for older people is therefore a specialism that calls for highly skilled nurses. The nurses should possess adequate skills required to handle the complex needs presented by older people. With the increase in the old age population, a clear understanding of these needs should be taken into consideration to ensure the well-being and quality of life of the older generation. The nurses should have the ability to address issues that deal with frailty associated with old age. Nursing care for older people entails getting familiar with an individual with a view of understanding their needs. This is achieved through an assessment that shows the degree of care that the aged should be given whilst at the same time maintaining their dignity and respect (Nazarko, 2002).

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The Impact Of The Aging Upon Health Care Needs

The current generation as earlier discussed seems to be aging gracefully. Fred who is 75 years of age prefers to spend the rest of his remaining life in long-term care. Several opinions have been forwarded on the impact of aging in the health care system. Some predict that major structural changes will take place in health systems as a result while others do not view the problem of aging as having any impact at all (Robinson, 2007). However, it can be argued that aging is likely to have an impact upon health care needs. To analyse the impacts, the projection of current drift into the future should be taken into account.

The current demographic trends of the aging population are changing. It has been predicted that if the trend continues at the current rate, the aging population is likely to find itself living in the rural areas. In addition, they are likely to become more diversified as regards their racial and ethnic backgrounds and experience unstable economic security. The growth of aging population is estimated to grow by 45% by the year 2030 with more people surpassing the age bracket of 65. The increased population is likely to have an impact on the general health status of the aged. Though it is hard to predict the kind of diseases that will still be popular among the aged people 19 years from now, it is evident that medical technology has played a big role in modern life expectancy. With an increase in new drugs and medical devises, the health status among the aged continue to improve with each generation. This has actually led to a decrease in mortality rates especially in the young generation while it has slightly increased in persons over 75 years in the past 8 years. If the trend is characterised by postponing morbidity, then the life span of a patient suffering from a chronic disease before succumbing to his death will increase. Such changes will therefore have significant impact on the general health care and the community at large. The leading causes of death in the older people are cancer, respiratory diseases, stroke and heart attacks or diseases. Diabetes and pneumonia are also common diseases that seem to increase the mortality rate. However, the health care sector has advanced in its clinical procedures to curb the high mortality rate among the old people.

Partners In Caring: Users, Carers And Society

Nursing care for older people is a process that involves the user of the service, the carers and the society in general. The relationships between the three are interlinked to achieve quality health care. The case study presents Fred, an aged person who is surrounded by his family, friends and the community at large. However, the concept of involving user and carer seems to be a challenging task (Redfern and Ross, 1991). Professionals either lack adequate knowledge or skills to effectively implement the particular concept. In most instances, old people lack the assertiveness to bring to fore their needs. Frequently, the carers themselves are also old hence experiencing the same challenge as the users in making their needs known. Fred himself is in old age and suffering from various diagnoses. However, he has taken upon himself to care for his wife who is also in old age. Both partners have specific needs but are not able to make their needs known to each other.

Health professionals often tend to ignore the needs of carers. However, basic guidelines about understanding carers’ needs should be put in place to enable the professionals work effectively with the carers. The relationship between the users and carers should be promoted to achieve the required results. Both of their needs should be negotiated and addressed at a societal level. The professional staff involved need to initiate a culture that involve the old persons and their relatives to engage themselves in care planning. The staff will therefore be in a position to work hand in hand with the carers to ensure that their needs are taken into consideration through assessment and review. An adjustment period needs to be provided to the carers in form of training and adequate preparations especially to those carers facing a new set of difficulties through the disability of the user. For example, Fred is a carer who is faced with a challenge of looking after his wife who suffers from agoraphobia. The society has also been linked with health care of old people. This is why community service is made available to Fred and his wife to lessen their burden. The local people offer the voluntary service. The use of trained community volunteers as carers appears to enhance the quality of health care among the old people in the society, giving them a sense of belonging (Phillips and Penhale, 1998).

A Critical And Reflective Approach Towards Nursing Care Practice Of The Old Older People

From the case study and the discussion presented above, it is evident that a high population of patients in acute conditions is the older generation. They present complex health care needs and are faced by certain factors such as poverty and lack of adequate enough support. A recent study concluded that most old people are not satisfied with the care they receive from nursing care practice when they are ill frail (Maliik, Hall and Howard, 2009). It further stated that the nursing care given fails to meet the most basic needs of old people such as foods containing all the nutrients, body fluids, adequate rest and lots of exercise. The current concept of nursing care fails to meet fundamental skills required to take care of the aging persons. Lack of proper communication has been attributed as the main reason that has lead nursing care become deficient in enhancing quality care among the old people. The rapid growth in the aging generation requires a need for well trained specialists in this particular field.

Though the field of gerontological nurse specialists is being expanded to provide professional nursing care to the aged, adequate training and education should be provided to all nurses in order to inculcate in them the necessary skills. The current training impounded on nurses has not managed to keep up with the pace of rapid changing needs of the aging population (Potter and Perry, 2007). Finally, the physical environment of nursing the aged people plays a very important role in the value of quality service care that is delivered. It also acts as an impediment to providing quality nursing care to the older generation. Nursing care has been neglected in general and lack of adequate resources have been blamed for the situation. A nursing care health plan needs to be put in place as part of reforms to rectify the nursing care sector. Though the current conditions of nursing care are far from perfect, the reforms will play a big role to improve the care of the older generation.

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A Holistic Multidisciplinary Approach As Described In The Case Study

The case study presents a scenario that upholds the importance of living a healthy life. Older people require special attention to their needs due to their numerous complex diseases (Tirrito and Nathanson, 1996). Making an accurate diagnosis in an older patient therefore becomes difficult and the patient may take a longer time to respond to the treatment. Take for instance Fred who has received several operations but is still experiencing some complications. He cannot see using his left eye that was operated on. To understand the concept of care described in the case study, a holistic multidisciplinary approach is essential. Specialists need to be regularly involved to understand the correct diagnosis and treatment to be administered to the older persons (Wade, 2004).The specialist for old people provides a framework towards a holistic global care that aids in the general care of the old hence the ability to monitor its progress. The process of holistic care planning should take into consideration the current needs and lifestyles of the old people as described in the case study.

Conclusion

The desire by Fred to go into long-term care is characterised by the importance to understand his needs. The administration of nursing care to older people plays a very big role in the society as a move to increase the livelihood. There is a need to engage in various activities as part of their lifestyle and to eat nutritional foods. Professionals need to be trained to gain the necessary skills required to deliver quality care to old people. Major reforms needs to be put in place and a policy implemented to promote the level of nursing care.

Reference List

Borowski, A., Encel, S., and Ozanne, E. (1997). Ageing and social policy in Australia. Melbourne: Cambridge University Press.

Dunning, T. (2005). Nursing care of older people with diabetes. Victoria: Blackwell Publishers.

Farell, J. (1990). Nursing care of the older person. Michigan: Lippincott Publishers.

Fox, J.A. (2010). Towards Healthier Ageing: The Development, Implementation and Evaluation Of a Proactive Health Promotion Intervention for older adults. Victoria: Universal-Publishers.

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Hindle, A. and Coates, A. (2011). Nursing Care of Older People. New York: Oxford University Press.

Jones, G., Endacott, R., and Crouch, R. (2002). Emergency Nursing Care: Principles and Practice. New York: Cambridge University Press.

Maliik, M., Hall, C., and Howard, D. (2009). Nursing knowledge and practice foundations for decision making. Australia: Elsevier.

Nay, R., and Garratt, S. (2009). Older people: Issues and Innovations in care. Australia: Elsevier.

Nazarko, L. (2002). Nursing in care homes. Victoria: Blackwell Publishing Company.

Phillips, J. and Penhale, B. (1998). Reviewing care management for older people. London: Jessica Kingsley Publishers.

Potter, P. and Perry, A. (2007). Basic nursing: essentials for practice. Australia: Mosby Elsevier.

Redfern, S. and Ross, F. (1991). Nursing Older People. Australia: Elsevier.

Robinson, M. (2007). Global health and global aging. San Francisco: Josey-Bass Publishers.

Tirrito, T. and Nathanson, I. (1996). Elder Practice: a multidisciplinary approach to working with older adults in the community. Columbia: University of South Carolina Press.

Tolson, D., Booth, J., and Schofield, I. (2011). Evidence Informed Nursing with Older People. Victoria: Blackwell Publishers.

Wade, S. (2004). Intermediate care of older people. London: Whurr Publishers.

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