nursing and challenges for geriatric care in acute hospitals
TRANSCRIPT
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Role of nursing in geriatric care: barriers in practice
Grace Lindsay BSc, RN, RM, MN, PhD
Faculty of NursingUmm Al Qura University
Makkah
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Overview• Reflection on complexity of older
population health issues• Nature of the client population health
needs/goals and potential challenges• Considerations for nurses in provision
of care of older patient in acute care
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World Health Organization survey results….
…of those 13% are over 80 years old.
. 804 million people (approx.) over the age 60 living in the world WHO 2011
…by 2050 ..estimated thatthis number will be almost 2 billion and number of elderly exceed number of children
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Distribution of population size by age ranges for males and females KSA MoH 2014
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Changing population size: a hundred year ‘snap shot’
KSA MoH 2014
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Life expectancy increases during life course
KSA MoH 2014
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Demographics• Facing increasing numbers of people• aged 60 year+….on a large scale
– Pattern of exceeding predicted life expectancy as a person ages
– Currently large numbers of population in 20-30 year old age bracket
• In the ‘oldest old’ women and men have almost same mortality rates: but many more women
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Definitions of ‘health’• “a complete state of physical, mental and
social well-being, and not merely the absence of disease or infirmity.” WHO (1).
• “a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility” (2)
• “a condition of well being, free of disease or infirmity, and a basic and universal human right” (3)
1. WHO. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June 1946, and entered into force on 7 April 1948.
2.Bircher J. Towards a dynamic definition of health and disease. Med. Health Care Philos 2005;8:335-41.
3.Saracci R. The World Health Organization needs to reconsider its definition of Health. BMJ 1997;314:1409-10
Scores of definitions of ‘health’ are available on the Internet.
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Challenges in care of older people: Population perspectives
• Increased life expectancy• Increased numbers of older people potentially
needing healthcare• Evolving models of multi-sector provision• Government funding level not guaranteed• Supporting healthy quality-living survivorship
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Productive ageing
• Strategies to slow decline into frailty and dependence
• Greater importance given to wider social, emotional, psychological well-being
• Enhance self-management potential• Active ageing• Quality of life
Concepts
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Health factors
• Physical status• Mental health• Emotional wellbeing• Social Isolation• Economics• Family support
networks
Chronological age vs biological age ???
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Functional decline• Hearing/Vision + other
senses• Agility• Strength• Eating & Digestion• Mental acuity• Continence• Dependency
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Common medical conditions in older age
• Cancers• Respiratory disease• Cardiovascular disease and stroke• Mental health, behavioural problems,
vascular dementia
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Health Challenges....Co-morbidities more common
• Cancer• Ischaemic disease-
heart; brain +?• Diabetes• COPD• Osteo- arthritis• Parkinsonism• Mental health issues inc.
Depression• End-of-life care
• Life situation issues– Sedentary– Anxiety– Financial – Family roles– Reduced
autonomy; increased dependency
– Respect from others?
– Sense of lack of dignity
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Acute healthcare settings
Some of the challenges for nursing…..• Focus on disease/injury treatment• Medical model of health• Outwith specialist facilities for older care
infrastructure for multi-agency, multi-disciplinary involvement may be limited
• Complexity, dependency• Length of hospital stay
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All cause mortality by age and sex (UK, 2013)
45-54
55-64
65-74
75-84
>= 85
020000400006000080000
100000120000140000
MaleFemale
• Numbers of males and females in mid-life similar
• Cumulative earlier male deaths
• More older womensurvivors
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Nursing considerations
• Conditions/treatments• Health Goals /targets• Individual focussed care• Activities of daily living• Promoting independence• Quality of life• Chronic disease....self-
management focus
Framework for care delivery
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Applying the ‘Nursing process’
• Assessment– Multi-dimensional– Standardised tools– Risk of harm
potential• Diagnosis
– Individualised– Priority of needs– Multi-factorial
• Planning and implementation– Careplans– Multi-disciplinary input– Family/carers
engagement– Goal focussed
• Evaluation– Sensitive meaningful
outcome measures
Standards set…clinical quality indicators across practice
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Nursing care planning: Individual level• ADL support needs• Risk Assessment-
falls, nutrition, cognition
• Care/dependency levels
• Pharmacy (poly)• Discharge planning
(early in process)
• Medical investigations, diagnosis and management
• Vital signs• Monitoring
routine/specialist tests
Use of standardised and validated assessment tools
Based on overall health status and presenting condition
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Complexity in charting......
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Common reported barriers in caring for older people
• Time consuming• Repetitive tasks• Uncertain outcomes• Expectations
achievable?• Influence of stereotype
assumptions?
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Stereotyping ....
• Generalisation of characteristics of groups• Convey certain qualities that engender
presumptions• Positive and negative perspectives• Could be seen as a form of equality within
groupings• Groupings implies a ‘single entity’ not at an
individual level• Fosters judgemental attitudes
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Not all he may seem...
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Considerations• Do older people need to be treated
any differently?• If so why?....in what manner?• Perceptions mismatch...them and us?
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Conclusions• Growing sector of the population• Clarity on appropriate and achievable
health outcomes• Targeting multi-dimensions of health
improvement• Individualised approach has even
greater importance• Multi-discipline/sector/individual and
family involvement
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Growing older is a privilege denied to many
Thank you