nursing and challenges for geriatric care in acute hospitals

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