Problem of Ageing Populations - Essay Example

 Older People Abstract The essay aims to address a two-fold objective, to wit: (1) to select two topics between falls in acute care facility, elder abuse and neglect, and relocation into aged care facility; and (2) to discuss with a focus on practice implications and definitions. Falls in Acute Care Facility Introduction Sense of independence is a very important goal for the older people. But loss of physical function and falls affect the older people’s independence and well-being. Both of these can either be the causes or consequences of each other (Nay, 2009, p.189). A significant feature of population ageing in Australia is the tremendous increase in the aged population itself. Morbidity and disability including falls, are positively associated with old age thus, increased in the incidence of morbidity and disability are expected both in acute care facility and aged care facility (Borowski, 2007, p. 20). Functional decline, also, has a relationship to independence and falls. Functional decline is defined as the reduced ability to perform tasks of everyday living (walking, dressing) due to a decrease in physical or cognitive functioning. Falls occur when a person unintentionally rest on the ground or floor or other lower level (Nay, 2009, p. 189). Causative factors related to falls are multifactorial and if falls are not prevented, it will lead to fractures, anxiety, loss of mobility and ability to perform activities of daily living (ADLs), and loss of confidence and autonomy. Factors Risk factors related to falls can be categorized as intrinsic, extrinsic, or behavioral. Intrinsic factors are age-related changes which include poor vision and hearing, less toe and foot lift while stepping, impaired balance, slower reaction time and continence issues, loss of muscle strength and flexibility, and cognitive impairment. Extrinsic risk factors comprise environmental hazards such as wet floor, waxed floors, clutter, poor lighting, loose coverings, and uneven flooring. Medications that cause drowsiness and impair balance are also included. Behavioral factors include activities of older adult that lead to falls such as not using assistive devices for stability and standing on a chair to change the light bulb. Specific factors identified are fast history of a fall, age, female gender, lower extremity weakness, balance problems, low levels of physical activity, cognitive impairment, psychotropic drug use and polypharmacy, chronic medical problems (stroke, arthritis, Parkinson’s Disease), sensory loss, orthostatic hypotension, acute health problems (pneumonia, urinary tract infections), dizziness, diabetes, depression, and incontinence (Nay, 2009, p. 192). Incidence The incidence of falls increases with age and varies according to residential location. Falls are more common in residential aged care facilities where 30-60% cases of falls were reported in 12 months than in hospitals with 17 falls out of 1000 bed days (Nay, 2009, p. 190). In Australia, for the year 2005-2006, the estimated number of hospitalized injury cases due to falls in people aged 65 years and over was 66, 800 – a rise of 10% since 2003-2004. Half of all fall injury cases for people aged 65 years and older occur from home (Byrne, 2010, p. 141). Falls are a major cause of morbidity and mortality among older people. In community-dwelling older people, 5-10% of falls result in major injuries such as fractures, head trauma, and major lacerations. In residential aged care facilities, major injuries range from 10-30%. Falls have also been identified as a contributory risk factor in 40% of residential aged care admissions (Nay, 2009, p. 192). Implications for Practice The increase in the incidence of falls among acute care facilities and residential aged care facilities seems to be alarming. High incidence of falls among older people implies that an enormous amount of effort must be put in prevention interventions and programs for falls. A review to assess the effectiveness of current prevention interventions is needed, most especially in the residential aged care facilities. In the acute care setting, an integrated multidisciplinary team (consisting of the physician, nurse, health care provider, risk manager, physical therapist, and other designated staff) must be established. The multidisciplinary team plans care for the older adult and other individuals at risk for falls based on individualized assessment. If incidence of falls still continues to occur despite review of assessment tools and facilities, a reexamination of the elderly must be conducted. Elder Abuse and Neglect Introduction Older people are prone to abuse and neglect because of biological and physiological effects of ageing. Abuse and neglect are society’s problems for decades and awareness and unacceptability has grown in recent decades. Abuse and neglect is a very pertinent issue involving the home care setting and residential aged care facilities. Every individual is mandated to report suspected or recognized abusive situation but must be acted and handled in a sensitive and professional manner. Elder Abuse is defined as any pattern of behavior that causes physical, psychological, financial, and social harm to an older person. Elder neglect, on the other hand, is a subcategory of Elder Abuse. Neglect is failure to meet the needs of a dependent person, either active or passive. Neglect relates to hydration, nutrition, cleanliness, clothing, shelter, medical care, dental care, and access to other health services. Neglect is the most common form of elder abuse (Byrne, 2010, p. 143). Often times, cases of abuse and neglect remain undetected. The undetected cases can be attributed to the older people’s cognitive impairment, communication difficulties, fear from the perpetrator, fear of losing support and going to residential aged care facilities, and feelings of shame and embarrassment. Incidence Incidences of elder abuse are often undetected and unreported. However, a recent national prevalence study of elder abuse was conducted in private households in England, Scotland, Wales, and Northern Ireland (Biggs, 2009, p. 1). Of the 2111 respondents, 2.6% reported abuse by family members, close friends, or health care workers. Most of the reported type of abuse was neglect with 1.1%, followed by financial abuse with 0.6%, psychological abuse with 0.4%, 0.4% also with physical abuse, and 0.2% sexual abuse (Biggs, 2009, p. 1). Assessment The older person requires a thorough and careful assessment. During the assessment process, the older person has the right to refuse to answer questions and be examined. When interviewing the abused elderly, keep them in private. Older persons may feel ashamed of admitting the abuse in front of other people or they may feel fear from the perpetrator. Highly experienced professionals should conduct the interview as this may involve trust development and use of tact and sensitivity. Documentation should be accurate and detailed because it is essential for evaluating the information received and involvement in decision making. Cognitive, functional, and psychosocial assessments are also important for providing baseline interventions and future planning. In Australia, elder abuse is a recognized issue and there are specialized advocacy services available to assist in dealing with abuse matters (Byrne, 2010, p. 144). Caring for an Abused Elderly Caring for an abused elderly individual depends on the identified needs. Care may be in the form of crisis care, home nursing, respite care, or counseling. Counseling involves the abuser and the victim in a one-on-one basis, group therapy, family therapy or attendance to support groups. Home nursing assists the abused individual in elimination, home-delivered meals, housekeeping and maintenance, and assistance in transportation. Respite care gives care in a home, day center, or residential facilities. But if the older person requires immediate removal from an abusive situation, crisis care must be applied. In crisis care, abused persons are brought to the residential aged care facilities for permanent or alternative accommodation. Proper and updated screening tools, assessment instruments, protocols, and guidelines, would aid in early detection of abuse. Ethical and Legal Implications Decisions in providing care in an abused elderly are often based on the principles of autonomy and beneficence – what the client wants and what will promote good care. Based upon autonomy, abused clients have the right to respect, informed consent, and self-determination. If a competent abused client decides not to do anything about the situation, client’s decision must be upheld. On the other hand, health care professionals are put into a dilemma where beneficence, in an abusive situation, is needed. Health care professionals’ follows the principle of doing good and preventing evil harm thus, weighing between the ethical principles of autonomy and beneficence puts care interventions into a dilemma. Legal interventions and criminal charges also apply to an abusive situation. The Charter of Residents Rights and Responsibilities under the Aged Care Act of 1997 explicitly states that “people living in aged care homes in Australia have the right to be treated with dignity and respect, and to live without exploitation, abuse or neglect”. Physical, sexual, and financial abuse are very obvious and that abuse can be reported promptly while psychological abuse and neglect are less easily determined. Verifications from a multidisciplinary team or a health professional are needed to prove psychological abuse or neglect. Legal interventions could involve revoking power of attorney arrangements, taking out a domestic violence order, or having the perpetrator evicted from the older person’s premises. However, if older person is mentally incapacitated, affairs must be handled by a guardianship office. References: Aged Care Australia. (24 September 2007). Preventing Falls. Retrieved from www.agedcareaustralia.gov.au Anthony, E.K., Lehning, A.J., Austin, M.J. & Peck, M.D. (2009). Assessing Elder Mistreatment: Instrument Development & Implications for Adult Protective Services. Journal of Gerontological Social Network, 52, 815-836. Biggs, S., Manthorpe, J., Tinker, A., Doyle, M. & Erens, B. (2009). Mistreatment of Older People in the United Kingdom: Findings from the First National Prevalence Study. Journal of Elder Abuse and Neglect, 21, 1-14. Borowski, A., Encel, S. & Ozanne E. (2007). The Dimensions and Implications of Australian Population Ageing. Longevity and Social Change in Australia (p. 15-39). Australia: University of South Wales Press Ltd. Byrne, G. & Neville, C. (2010). Risk Assessment. Community Mental Health for Older People (p. 141-148). Australia: Churchill Livingstone Elsevier. Chelly, J.E., Convoy, L., Miller, G.A., Elliot, M.N., Horne, J.L. & Hudson, M.E. (2008). Risk Factors & Injury Associated with the Falls in Elderly Hospitalized Patients in a Community Hospital. Journal of Patient Safety, 4, 178-183. Dowling, A.M. & Finch, C.F.(2009 October). Baseline Indicators for Measuring Progress in Preventing Falls & Injury in Older People. Australian & New Zealand Journal of Public Health, 33, 413-417. Gill, T., Taylor, A.W. & Pengelly, Ann. (2005). A Population-based Survey of Factors Relating to the Prevalence of Falls in Older People. Gerontology, 51, 340-345. Helmes E. & Cuevas M. (2007 September). Perceptions of Elder Abuse among Australian Older Adults and General Practitioners. Australasian Journal on Ageing, 26, 120-124. McDermott, S., Linahan, K. & Squires, B.J. (2009). Older People Living in Squalor: Ethical and Practical Dilemmas. Australian Social Network, 62, 245-257. Nay, R. & Garratt, S. (2009). Supporting Independent Function and Preventing Falls. Older People Issues and Innovations in Care (p. 189-215). (3rd. ed). Australia: Churchill Livingstone Elsevier. Stern, C. & Jayasekara, R. (15 December 2009). Interventions to Reduce the Incidence of False in Older Adult Patients in Acute Care Hospitals: A Systematic Review. International Journal of Evidence-based Health Care, 7, 243-249. Read More