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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
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
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
Distribution of population size by age ranges for males and females KSA MoH 2014
Changing population size: a hundred year ‘snap shot’
KSA MoH 2014
Life expectancy increases during life course
KSA MoH 2014
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
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.
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
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
Health factors
• Physical status• Mental health• Emotional wellbeing• Social Isolation• Economics• Family support
networks
Chronological age vs biological age ???
Functional decline• Hearing/Vision + other
senses• Agility• Strength• Eating & Digestion• Mental acuity• Continence• Dependency
Common medical conditions in older age
• Cancers• Respiratory disease• Cardiovascular disease and stroke• Mental health, behavioural problems,
vascular dementia
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
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
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
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
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
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
Complexity in charting......
Common reported barriers in caring for older people
• Time consuming• Repetitive tasks• Uncertain outcomes• Expectations
achievable?• Influence of stereotype
assumptions?
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
Not all he may seem...
Considerations• Do older people need to be treated
any differently?• If so why?....in what manner?• Perceptions mismatch...them and us?
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
Growing older is a privilege denied to many
Thank you