healthcare management of elderly people

7/31/2019 Healthcare Management of Elderly People

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HEALTH CARE NEEDSHEALTH CARE NEEDSIN THE ELDERLYIN THE ELDERLY


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BackgroundBackground

Population agingPopulation aging

Increase of care needsIncrease of care needs

Societal and family structure changesSocietal and family structure changes The family as the main informal supportThe family as the main informal support

systemsystem

Uncertain future of elderly careUncertain future of elderly careA challenge for: State/Public Social andA challenge for: State/Public Social and

Health care system as well as for familyHealth care system as well as for family

dynamicsdynamics


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Population (1999)Population (1999)

WORLDWORLD EUEU

0-14 years0-14 years 31%31% 17%17%

15-64 years15-64 years 62%62% 67%67%

> 65 years> 65 years

7%7%

16%16%

TOTALTOTAL 5918,6 Millions5918,6 Millions 374,6 Millions374,6 Millions


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94%94%in thein theCOMMUNITYCOMMUNITY

6% in geriatric care facilities6% in geriatric care facilities


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Aged

adult

INFORMAL NETWORK FORMAL NETWORKFamily members Community care

Friends and neighbours Emergency room, Hospital

XX


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Common geriatric acute eventsCommon geriatric acute eventsSurgical emergency ()Surgical emergency ()

Acute pain of unknown originAcute pain of unknown origin

Dehydration, fall, pulmonary tract infections ()Dehydration, fall, pulmonary tract infections ()

Drug side effects !!Drug side effects !!

Delirium, spacio-temporal disorientation ()Delirium, spacio-temporal disorientation ()

Psycho-social crisisPsycho-social crisis

Depressed mood, family conflict ()Depressed mood, family conflict ()


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OWN EMOTIONAL FEELINGSOWN EMOTIONAL FEELINGS

LIFE COURSELIFE COURSE

CO-MORBIDITIES & DAILY FUNCTIONINGCO-MORBIDITIES & DAILY FUNCTIONING

LIFE PROJECTSLIFE PROJECTS

QUALITY of LIFE...QUALITY of LIFE...

Affective surroundingsAffective surroundings

Medical vs. Psychiatric vs. SocialCRISIS


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EMOTIONAL FEELINGSEMOTIONAL FEELINGSAnxiety, fear, culpability, anger, Anxiety, fear, culpability, anger,

Indifference, acceptation or denial...Indifference, acceptation or denial...

PROBLEMS of UNDERSTANDINGPROBLEMS of UNDERSTANDINGAcute disease vs. multiple co-morbidityAcute disease vs. multiple co-morbidity

PARTICIPATION in CAREPARTICIPATION in CARE

Burden of careBurden of care

QUALITY of LIFE, PROJECT of LIFE ...QUALITY of LIFE, PROJECT of LIFE ...

FINANCIAL CONCERNS !FINANCIAL CONCERNS !


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DISJUNCTION /GAPDISJUNCTION /GAP

betweenbetween

HUMAN BEINGHUMAN BEING

andand

SURROUNDINGS !SURROUNDINGS !


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Need to avoidNeed to avoid

INAPROPRIATEINAPROPRIATEHOSPITAL ADMISSIONS !!!HOSPITAL ADMISSIONS !!!

INAPROPRIATE

HOSPITAL STAY


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STRUCTURESSTRUCTURES

PROCESSESPROCESSES

OUTCOMES (OUTCOMES ( oror ))

Accessibility to the needed care


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The GERIATRIC PROCESSThe GERIATRIC PROCESS

AssessmentAssessment

J GRIMLEY EVANSJ GRIMLEY EVANS Brit Med J 1997; 315: 1075-7Brit Med J 1997; 315: 1075-7


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GERIATRICGERIATRIC

CARE MODELSCARE MODELS

BIOMEDICAL +++BIOMEDICAL +++

FUNCTIONAL ABILITYFUNCTIONAL ABILITYHUMAN / TECHNICAL SURROUNDINGSHUMAN / TECHNICAL SURROUNDINGS

QUALITY of CAREQUALITY of CARE

ETHICAL issues of careETHICAL issues of care

QUALITY of LIFE +QUALITY of LIFE +


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ImportanceImportance

ofof

USINGUSING VALID VALID

CRITERIACRITERIA

COMPREHENSIVEGERIATRIC

ASSESSMENT(CGA)

COMPREHENSIVEGERIATRIC

ASSESSMENT(CGA)


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CGA in the emergency roomCGA in the emergency room

DETECTIONDETECTION

of unrecognized geriatric problemsof unrecognized geriatric problems

0

1

2

3

4

56

7

B e f o r e C G A A f te r C G A

N u m b e r o f d i a g n o s e sS t a n d a r d d e v i

2.8 4.5

1.5

1.8

The screening procedure

allowed the detection of

an average of

1.7 1.3

additional problems(Paired t-test, P < 0.001)


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-400

-300

-200

-100

0

100

200

300

0 1 2 3 4 5 6 7 8 9 10 11

After CGAAfter CGA

Before

Nb

ofpatients

Nb of Geriatric Problems

The screening procedure

allowed the detection of

an average of

1.7 1.3

additional problems(Paired t-test, P < 0.001)

PAIN

INCONTINENCE

DEPRESSION

ADL

impairments

COGNITIVE

Disturbances

SENSORY

troubles


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STRUCTURESSTRUCTURES

PROCESSESPROCESSES

OUTCOMES (OUTCOMES ( oror ))

The good patient in the good bed

Important role

of aninterdisciplinary

geriatric team

in the emergency

room

Important role

of aninterdisciplinary

geriatric team

in the emergency

room


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Agree objectives of careAgree objectives of care


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What does the patient want ?What does the patient want ?

What is feasible ?What is feasible ?

GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84


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Agree on care objectivesAgree on care objectives

Specify the management planSpecify the management plan



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To closeTo close

the ecological gapthe ecological gapbetweenbetween

patient abilitiespatient abilities

andandenvironmental possibilitiesenvironmental possibilities

GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84

Need of a precise diagnosisto provide the best possible treatment


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Agreement on care objectivesAgreement on care objectives Specify the management planSpecify the management plan

Assure an adequate follow-upAssure an adequate follow-up



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Patients quality of lifePatients quality of life

and cost of careand cost of carePatients QoLPatients QoL

Relieving sufferingRelieving suffering

Cost of care

Adapted from GOODWIN JS New Engl J Med 1999; 340: 1283-5

Medicalisation of old ageis not to be repudited

but should be encouraged !

S EBRAHIM Brit Med J 2002; 324: 861-3

IF- the accessibility to the emergency room

is easy- the emergency ward is equipped

with high tech- an interdisciplinary geriatric teamis included to the emergency staff

- geriatric care networks(community and hospital)

are working harmoniously ()


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General objectiveGeneral objective

To evaluate the health care needs andTo evaluate the health care needs and

effectiveness of care provided toeffectiveness of care provided to

people over 65 years of age.people over 65 years of age.

The final objective is to identify newThe final objective is to identify newnursing interventions andnursing interventions and

innovations that will improve healthinnovations that will improve health

care of people over 65 by thecare of people over 65 by the

im lementation of holistic care.implementation of holistic care.


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Purposes of the InformalPurposes of the Informal

Caregivers groupCaregivers group

Identification of the characteristics of the ICIdentification of the characteristics of the ICand their dependent care receipientand their dependent care receipient

Analysis of the type of care provided by theAnalysis of the type of care provided by theIC and their support system availableIC and their support system available

Analysis of the consequences of the careAnalysis of the consequences of the careactivities on the IC themselvesactivities on the IC themselves

Describe the healthcare policies for ICDescribe the healthcare policies for ICDesign new health support intervention forDesign new health support intervention for

ICIC


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Informal caregiversInformal caregivers

Women: 83.95%Women: 83.95%

Mean age: 56 yearMean age: 56 year

oldold

House keeper:House keeper:

60%60% Working outsideWorking outside

their homes: 22%their homes: 22%

Full time: 57%Full time: 57%

Men: 17%Men: 17%

Mean age: 65 yearMean age: 65 year

oldold

Retired: 45%Retired: 45%

Working outsideWorking outside

their homes: 42%their homes: 42% Full time: 83%Full time: 83%

Role:Role: Daughter-son / daughter-son in lowDaughter-son / daughter-son in low: 62%: 62% SpouseSpouse: 26%: 26% Paid caretaker: 5-9 %Paid caretaker: 5-9 %


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Activities done by the informalActivities done by the informal

caregivercaregiver Over 50% dedicate more than 5 hour perOver 50% dedicate more than 5 hour per

day (>150 hours / month)day (>150 hours / month)

IADL (80%)IADL (80%)

ADL (60%)ADL (60%)

Women do more AVD y AIVDWomen do more AVD y AIVD

Men do mainly IADLMen do mainly IADL


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DependencyDependency

TIMETIME ADL / IADLADL / IADL

HIGHHIGH > 3 h / Day> 3 h / Day 3 or more hrs3 or more hrsADLADL

MODERATEMODERATE 1-2 h / Day1-2 h / Day 1-2 hrs ADL or1-2 hrs ADL or

>5 hrs IADL>5 hrs IADLLOWLOW 1 h / Week1 h / Week Some IADLSome IADL

(< 5 hrs)(< 5 hrs)


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ADL & IADLADL & IADL

ADLADL HygieneHygiene NutritionNutrition EliminationElimination BathingBathing MovingMoving MedicationsMedications Treatment of ulcersTreatment of ulcers

and woundsand wounds

IADLIADL CookingCooking

House cleaningHouse cleaning

LaundryLaundry IroningIroning

Telephone useTelephone use

BankingBanking

TransportationTransportation


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Support resourcesSupport resources

Economic helpEconomic help(Decrease in taxes,(Decrease in taxes,time off from worktime off from workand flexible workingand flexible workingtime)time)

Primary carePrimary care Home careHome care

Day careDay care TelehealthcareTelehealthcare

Nursing homesNursing homes

Relieve centersRelieve centers

Home assistanceHome assistance

Support groupsSupport groups

Other interventionsOther interventions Voluntary helpVoluntary help

AssociationsAssociations Community helpCommunity help


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Support from NursingSupport from Nursing

INFORMATIONINFORMATION

PROFESSIONALPROFESSIONAL

EDUCATIONEDUCATION

EMOTIONALEMOTIONAL

SUPPORTSUPPORT


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Consequences of care on caregiversConsequences of care on caregivers

NEGATIVENEGATIVEDepressionDepression

AnxietyAnxiety BurnoutBurnout StressStress FatigueFatigue

Aches and painsAches and pains Social isolationSocial isolation

POSITIVEPOSITIVE Personal developmentPersonal development

Meaning of lifeMeaning of life AutonomyAutonomy Sense of controlSense of control Positive relations withPositive relations with

othersothers Self-acceptanceSelf-acceptance Positive feelingsPositive feelings


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ConclusionsConclusions

The informal care is the most importantThe informal care is the most importantsupport of the elderly dependent.support of the elderly dependent.

To improve the care of the elderly, it isTo improve the care of the elderly, it isessential to provide with adequateessential to provide with adequateresources to the informal caregiver.resources to the informal caregiver.

It is necessary to do more research toIt is necessary to do more research togenerate innovative interventions togenerate innovative interventions tosupport the caregiver activities and theirsupport the caregiver activities and theirquality of life.quality of life.


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ConclusionsConclusions

1.1. ICs have the need to express their feelings andICs have the need to express their feelings andexperiencies.experiencies.

2.2. There is a lack of social and political understanding andThere is a lack of social and political understanding and

acknowledgement of the IC rol.acknowledgement of the IC rol.

3.3. It is difficult for the IC to identify the resources that she /It is difficult for the IC to identify the resources that she /

he needs.he needs.

4.4. It is difficult for the IC to apply for resources (ChannelsIt is difficult for the IC to apply for resources (Channels

of application and paper work).of application and paper work).5.5. The health care system is effective for the treatment ofThe health care system is effective for the treatment of

acute health problems, but it to slow to solve chronicacute health problems, but it to slow to solve chronic

health problems related to dependency.health problems related to dependency.


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Scientific collaborationScientific collaboration

PROYECTONACIONAL

Informal /Informal /PrincipalPrincipalCaregiversCaregivers

Ethical &Ethical &

LegalLegalproblemsproblems

CoordinationCoordinationHome, primary &Home, primary &

continuity ofcontinuity ofhealth carehealth care

NursingNursinginterventionsinterventions

OutcomesOutcomesevaluationevaluation

CARE FOR THEELDERLY PEOPLE


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THE FUTURETHE FUTURE

EU RESEARCH FUNDSEU RESEARCH FUNDS

SYNERGY

Informa / principal caregivers (national level)Informa / principal caregivers (national level)

Informa / principal caregivers ( EU Countries)Informa / principal caregivers ( EU Countries)

&

healthcare management of elderly people

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