Community & Population Issue
Selected topic: Disabled elderly at risk of falls
In contemporary Western democratic societies disabled elders are viewed in a negative light. Advertising often depicts disabled elders being linked to continence problems or memory loss. Popular television programmes such as soap operas frequently associate old age with a decline in physical and mental ability. Nursing students have gained experience in geriatric wards or nursing homes which have focused mainly on dependency and finding solutions to the problems of physical and mental decline. These skills, gained mainly under the supervision of experienced skilled professionals, are invaluable to the nursing of older people; the experiences reported by students are variable in terms of care delivered. However, all experiences were taking place within an institutional setting thus perpetuating the view that older people are unable to totally self-manage (Alderman, 2003, P: 14-17).
In this paper we are intended to discuss several issues and factors that create prominent impact on the elder people health and how different factors are vulnerable to their existence and health issues. Although on community level there has been so much accomplished but it is not very much enough to completely eradicate this problem from our society. In order to solve this problems nursing has also played some remarkable role in the recreation of the elder population but they are also restricted in front of the state health policies and other legal issues that they have to follow before taking any steps towards the community and healthcare improvement.
In this paper we are intended to discuss a case of vulnerable adult who is in continued problem of fall due to which he might face several injuries and sickness. We have to counter several challenges that a social work can face while treating the patients. Vulnerable adults can face numerous diseases including falls, frailty, heart diseases and other diseases.
Health Problems in Vulnerable Adults
The vulnerable adults’ process is influenced by genetics and lifestyle factors such as diet, exercise, smoking and exposure to the sun. Hence two people of the same chronological age may age differently, The physiology of ageing affects all the body systems, although with individual variations; ageing can give rise to a range of common health problems, some of which may be considered minor, while others can affect the person's quality of life For example:
• Lung function declines with age, and cardiovascular changes include raised blood pressure as the arteries stiffen, and a decline in the heart muscle's ability to respond to effort
• Sight may deteriorate (with visual problems such as cataracts, glaucoma or macular degeneration)
• Poor hearing may cause difficulties with communication, and vestibular changes in the ear may lead to dizziness and falls (Beaumont, 2000).
• Changes to taste and smell may lead to a poor appetite and hence poor nutrition, and constipation is more common in older people as the bowel becomes less efficient
• Degeneration of the nervous system may affect cognitive function, leading to short-term memory loss, reduced reaction times and depression
• Endocrine changes may affect metabolism, thermoregulation, digestion, muscle and nerve activity, and bone density, particularly in women after the menopause
• muscle mass and strength decrease with advancing age( n7) and arthritic pain is more common, as are problems with feet and leg ulcers, which may contribute to mobility problems
• Pancreatic secretion of insulin and insulin sensitivity may be affected, leading to an increase in the incidence of type 2 diabetes
• Symptoms of different types of cancer may be reported, such as skin and bowel cancer
• older skin may look pale and offer less efficient thermoregulation, and there may be a loss of sensory nerve endings and of subcutaneous fat, dryness and laxity, wrinkles, and sun damage
• Autoimmune disorders, such as polymyalgia rheumatic, increase and antibody responses are lower, leading to increased susceptibility to infection (Biggs, 1993).
For women, a reduction in circulating oestrogen after the menopause results not only in a loss of bone density, but also in reduced vasomotor control (hence 'hot flushes'), changes to memory and mood and a decrease in circulating HDL cholesterol that increases the risk of cardiovascular disease; there may also be lowered libido and ultimately atrophy of the breasts and genitals. Men may develop hypertrophy of the prostate gland with consequent difficulty urinating, erectile dysfunction, and increased body fat.
Men and women may start to experience problems with urinary and bowel continence. Causes may include medication, mental confusion, infection, neurological problems and diabetes. This may lead to embarrassment, loss of self-esteem and feelings of helplessness.
Older people may not present for treatment early because they may accept their symptoms as an inevitable consequence of ageing or may feel too embarrassed to report continence problems, for example. Mental health issues may be under-diagnosed in older people, and therefore may not be managed effectively. The multiple pathologies that are a feature of health in older people can hide the symptoms of depression, and a person experiencing cognitive decline may have difficulty communicating their symptoms and low mood to a health professional.
A critical review of the literature
In this significant review, present information as well as exercise on elder abuse credit by healthcare workers is discovered with an importance on its association to household aggression. Present debates over showing tools looking at the standard of “advantage versus damage” always leads to an examination of the lot of fences to screening. Definitions of elder abuse and showing and hypothetical frameworks that support work on elder abuse are talked about, and how these narrate to the screening discussion and the significance of interdisciplinary employment is travel around. In addition, the association between elder abuse and sexual category and issues connected to the ability building of CHN workers are presented.
The aims of this discussion paper are:
• To increase consciousness concerning the subjects and debates around showing older patients for elder abuse;
• To recognize what study and training are required in order to go forward knowledge among CHN workers about elder mistreatment;
• To make advices to researchers, practitioners and policy-makers for the discovery, organization and avoidance of elder abuse towards policy growth.
Search strategy: inclusion and exclusion criteria
Given the broad insinuations of elder abuse and household aggression, the dissimilar fields of learngi and stakeholders involved, some searches were carried out as issues come out from the literature. The first investigation was performed in the electronic databases Medline, CINAHL, AgeLine, PsycINFO and PubMed. Supplementary hand searches of certain journals, books and web sites of law-making, intergovernmental, educational and civil civilization organisations were carried out. Ultimately, numerous references were recognized from side to side reference lists from beforehand certain publications, individual recommendations by colleagues or teachers and universal internet searches through Google.
The key words used were: “elder abuse”, “senior maltreatment”, “abuse of the old”, “aggression against the old”, “domestic aggression screening”, “violence next to women”, “ageing women”, “home aggression and older women”, “screening tools”, “elder abuse discovery tools” and “rights of older persons”. Also, the following mixture of key words was used: “elder abuse + screening”, “elder exploitation + screening”. The investigation was limited to the years 1995–2005. On the other hand, due to the rareness of primary research on elder abuse, a number of noteworthy publications before 1995 were also incorporated.
Consultation Issues in Vulnerable Adults
Older people who live alone may feel isolated and disempowered. It is important that the practice nurse has a warm and friendly approach to ensure the person feels comfortable, valued and respected as an individual. Communicating and consulting with older people requires developed communication skills, including active listening and a careful choice of words (Johnson, 2002, P: 739-750).
Communicating and consulting with older people can be challenging. The senses diminish with age and the practice nurse is likely to consult with people with impaired vision, conductive hearing loss and a loss of cognitive function. Assessment needs to be undertaken holistically, taking into account clinical, psychological and social factors. There may be symptoms that the person is uncomfortable about discussing, and it is important to ensure that issues such as erectile dysfunction and continence are discussed without causing offence or embarrassment. Privacy and dignity should always be maintained.
Consultations with older people may require more time, in part because of their increased health needs, but also because they may need more time to progress through the different aspects of the consultation. Information should be provided that is appropriate for the individual, and it is good practice to offer written guidance that may help a person with short-term memory loss, for example (Low H, 2002).
Health in over-50s
People aged over 50 are entitled to a free annual health and medication check each year if they have not been seen in the surgery for another reason in that time. This appointment will often be with a practice nurse. It is important that the appointment is long enough to allow time to listen to the concerns that the individual may wish to discuss, undertake the health assessment, review medication and offer health promotion advice. A structured template may be used to guide the appointment, but should also be flexible enough to accommodate the patient's concerns. As a minimum, the appointment should include:
• Measurement of height and weight
• Estimation of blood pressure
• Lipid screen
• Urine test
• Enquiry about physical activity
• Enquiry about diet and nutrition
• Vaccination status.
CHN Interventions in Elderly Healthcare
Service and prevention interventions in the ground of family aggression have urbanized divide approaches for children, spouses, and the elderly. Elder mistreatment is the mainly just “discovered” form of relations aggression, and its nature and magnitude are not well known. In some belongings, elder abuse stands for spousal abuse that has just stayed constant over an extensive era of time, and the aggression may be exposed only when a grievance is obvious. In other state of affairs, elder abuse may be the consequence of an adult child who has enthused back home with a weak father, perhaps as a caregiver, and who uses the monetary or other resources of the parent who may be capable to proffer only incomplete confrontation.
As noted in a new account (Reiss and Roth, 1993), elderly victims are excessively over age 75. They are more susceptible to persecution for the reason that of sickness or injury and they frequently live with the doer of abuse. Women outnumber men as victims, but the studies have not yet taken into explanation women's better risk experience for the reason that of their longer life expectation. However, sickness or injury of the injured party may not be the main risk factor for elder abuse. Study in this field, though not well urbanized, suggests that there may be dissimilar forms of elder abuse, only one of which may be conquered by risk factors suggesting injured party frailty or susceptibility.
Intrusion programs from CHN determined on elder abuse are very incomplete, and simply a few ground-breaking efforts have been urbanized. These programs highlight the significance of recognizing the multifaceted dimensions of elder abuse and considerate the requirement to equilibrium competing principles in this ground, such as the security of older people as well as their independence in making choices about their individual living situations.
Intervention at Primary level
CHN provided utmost possibilities to provide all the available basic healthcare facilities to the elder adults in their healthcare. CHN offered free of cost basic medical services and timely check-up plans just to ensure proper healthcare and their prevention from periodic diseases. This method was really effective at primary level because it guided the society towards the healthy patterns and it also ensures proper health of elder members of the society at very desirable prices and rates.
Secondary health care refers to those services chiefly provided by hospitals and the stipulation of main care inside CHN programs that are especially designed for the elder vulnerable adults. It is an imperative bridge in accessing and utilising secondary care services.
Tertiary Health Care refers to those specialist services mostly provided by the private medical profession. In case of CHN services it has settled several programs and options for the elderly vulnerable people in specialist hospitals just to ensure proper health facility and healthcare provisions. These programs are really effective and productive in providing desirable health services to the elder members of the society and it also offer periodic check up to nip in the bud all the expected problems and diseases.