Quality of Care for Populations
Quality of Care for Populations
Part 1: The Vulnerable Population
The course of my practice exposed me to various clinical settings and different patient populations, an aspect that built my experience as a nurse. One particular vulnerable population that was of interest to me was the elderly group. Across the country, the older population is among the fastest growing populations, an aspect attributed to increased life expectancy over the recent years. The increase in elderly populations implies a rise in chronic morbidity as older people are susceptible to various chronic conditions that present functional, psychological, and social problems. Typically, the older population is characterized by individuals aged 65 years old and above. My experience provided insight into important epidemiological data along with some crucial health determinants to consider in care provision.
Through my interactions with the older population, I gained first-hand experience on how to form a suitable relationship focused on tending to their needs and guaranteeing that their quality of life is not compromised. An important aspect to consider is having the right body language and exercising patience when communicating with them. Additionally, I respected their cultural ideals and attempted to integrate these aspects in care provision. Part of attending to this population also involves recognizing potential sensory challenges such as hearing loss and visual impairment, and incorporating the necessary measures to guarantee that they feel comfortable and safe when seeking treatment. From my experience, I found that building a relationship with older populations requires honesty, sincerity in my actions, and finding common grounds that can help to build a rapport with them.
Focusing on the epidemiological data, the main health-related causes of death among the elderly include Alzheimer’s disease, cardiovascular diseases, cancer, heart disease, and stroke (Gill & Moore, 2013). Cumulatively, these account for approximately 69.5% of all deaths. Research also shows that in the United States, people over the age of 65 had a higher prevalence for various conditions including stroke, coronary heart disease and hypertension. Other chronic conditions commonly experienced by this population included type II diabetes, chronic joint problems, and arthritis. These conditions negatively impact the population’s health and their general quality of life, making them dependent on pharmaceutical and non-pharmaceutical care management strategies. Older adults are also at a higher risk of contracting diseases due to decreased immunity and as such, require additional measures to improve their health.
Disability and physical limitations are also common among the older population owing to their susceptibility to the previously mentioned conditions among other causes. Physical limitations inhibit activities of daily living which include grasping, reaching, and standing in addition to other self-care tasks (Bowling et al., 2019). I also noted that many seniors find it difficult to seek help in their vulnerable conditions as it may reflect negatively on them. They have a great desire for independence and seek to accomplish simple feats by themselves although this can be hard to achieve. Due to their need for independence and their physical limitations, many seniors are at a higher risk of falls and slips within and out of the clinical setting. Appeadu and Bordoni (2022) highlight that more than 30% of older adults experience at least one fall annually, a percentage that increases to 40% in patients over 85 years old. Among the elderly, falls are the most prevalent accidents resulting in hospitalization. Injuries from falls lead to increased healthcare costs (from ambulatory and hospital services) and increased mortality.
Factors Compounding Elderly Vulnerability
From my observations, elderly vulnerability can be attributed to a combination of factors revolving around their social and economic status. From a social standpoint, elderly people are occasionally overlooked or abandoned as their children grow older. I interacted with elderly people who were abandoned for various reasons including poor family relations, exhaustion by family members, financial inability, spatial distance, and the absence of relatives to provide care. Additionally, the older population is also economically vulnerable due to the high cost of care associated with treating their chronic illnesses. As a result, they experience challenges in affording the right course of care or seeking medical help. Low-income seniors are at a particular disadvantage as they have limited healthcare access and this can be detrimental when they develop health complications. Economic vulnerability among the elderly is attributed to an accumulation of various factors through their lifetime including structural issues, lack of a source of income, and dependence on their retirement funds or family members.
Healthwise, another aspect contributing to their vulnerability is a decline in problem-solving and information processing skills as a result of declining cognitive flexibility, reasoning skills, and memory capacity. Consequently, these aspects lead to poor judgment and decision-making particularly in this rapidly-evolving environment. Physical limitations also compromise their independence and functional capabilities, leaving them dependent on others or on the healthcare system. Due to this dependency, older adults are exposed to exploitation especially within the society. Ana et al. (2021) show that older adults of low socioeconomic status are at considerably higher risks of disaffection, social isolation, and experiencing crime, in addition to facing discrimination when accessing healthcare and social services.
Adverse childhood experiences bear significant impacts on an individuals mental and physical health through their lifetime. Regarding physical health, early trauma has been linked to obesity and increased fatigue in adulthood (Lamers-Winkelman, Willemen & Visser, 2012). Other studies have shown that for older adults, childhood emotional abuse contributed to poor sleep quality, heightened emotional distress, and difficulty forming social support. Adverse childhood experiences (ACEs) have also been proven to indirectly impact the prevalence of depression among geriatric patients.
Based on my interactions with patients, some of the ACEs that lead to elderly vulnerability include sexual abuse, living with a parent’s mental illness, being exposed to domestic violence, and emotional abuse. A study by Schickedanz, Jennings, and Schickedanz (2021) formed a positive connection between these experiences and the likelihood of developing dementia in older adults. These ACEs have also been associated with frailty among seniors, and there is a need for early screening to identify potential childhood maltreatment to determine at-risk patients. Studies also show that the early death of a guardian and domestic violence have a significant contribution to older adult poverty, an aspect that reflects economic vulnerability among this population (Schickedanz, Jennings, & Schickedanz, 2021). To add on, the lack of motherly affection or poor relationships with female guardians were associated with social isolation and depression. It is also important to note that depression in early childhood was also evident in older adults especially in instances where the condition was left untreated until adulthood. Seniors who experienced childhood trauma had a higher likelihood of isolating themselves or avoiding interpersonal communication population (Schickedanz, Jennings, & Schickedanz, 2021). As a result, they end up exposed to health and socioeconomic disparities that ultimately affect their ability to meet their healthcare needs.
Role of the Nurse
For the nurse emancipatory knowledge highlights the convergence, reproduction, and sustenance of a status quo that unfairly discriminates against a particular group. In this context, it requires my understanding of the inequities and social injustices experienced by the elderly, a critical analysis of the root source, and the development of solutions to rectify this problem. This concept also emphasizes my role as the patient’s advocate within the clinical setting and in the development of healthcare policies. One approach I would focus on towards reducing elderly inequality would be to increase healthcare accessibility. Many of my patients were bed-ridden or had difficulties getting to healthcare facilities and as a result, they failed to receive immediate treatment when they needed it. In my capacity, I would set up mobile clinics and mobilize other nurses to actively participate in visiting patients at their residence. Part of this program would also involve collaborating with other established organizations to guarantee that elderly patients I can reach elderly patients more efficiently and that they can seek medical help when in need.
In advocacy, the geriatric population has often been overlooked and the policies in place do not sufficiently accommodate their increasing healthcare needs. For example, while Medicaid and Medicare have provisions and exceptions for older adults, elderly patients in these programs are still unable to comprehensively cover their medical costs. I would use my role as an advanced practice nurse to advocate for policy changes geared towards alleviating the financial burden associated with healthcare costs. Another part of advocacy involves educating the patient on their rights and upholding these rights on my end. Since some elderly patients might have declining mental capabilities, my role would be to represent their best interests and guarantee that their beliefs are upheld during care provision. I also anticipate to work with my patients in developing treatment plans and formulating lifestyle changes that might help to improve their quality of life.
Based on my interactions, I noted that older adults have a strong desire for independence and I aspire to help them achieve this as a nurse. Educating patients on the self-management of chronic illnesses would go a long way as to empower them and equip them with the skills they would require to take care of themselves. I would also collaborate with other nurses to form group therapy sessions where patients can interact, share their experiences, and potentially feel less isolated or vulnerable as they receive care. Working with the administration, I would evaluate potential areas where the healthcare facility might be lacking in equipment or facilities that can help the elderly exercise more independence. I aspire to work with patients’ families and loved ones in formulating treatment plans and educating them on how to provide care without compromising the patient’s independence and self-respect. Additionally, I would emphasize cultural awareness and competence as cultural values are of great significance to older patients. It is important that healthcare personnel do not overlook a patient’s culture and their spiritual needs. Forming a multidisciplinary team inclusive of a spiritual leader, a mental health expert, and other integral healthcare professionals would guarantee the provision of holistic care focused on the patient’s mental, physical, social, and spiritual wellbeing, thereby guaranteeing better patient outcomes.
Ana, P., Gabriela, S., Victoria, F., & Vitalie, O. (2021). Vulnerability in the elderly. The Moldovan Medical Journal, 64(3), 62-67. https://doi.org/10.52418/moldovan-med-j.64-3.21.12
Appeadu, M., & Bordoni, B. (2021). Falls and Fall Prevention In The Elderly. In StatPearls [Internet]. StatPearls Publishing.
Bowling, C. B., Deng, L., Sakhuja, S., Morey, M. C., Jaeger, B. C., & Muntner, P. (2019). Prevalence of activity limitations and association with multimorbidity among US adults 50 to 64 years old. Journal of general internal medicine, 34(11), 2390-2396. https://doi.org/10.1007/s11606-019-05244-8
Gill, J., & Moore, M. J. (2013). The State of aging & health in America 2013. Retrieved from: https://www.cdc.gov/aging/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Faging%2Findex.htm”>https://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf
Lamers-Winkelman, F., Willemen, A. M., & Visser, M. (2012). Adverse childhood experiences of referred children exposed to intimate partner violence: Consequences for their wellbeing. Child abuse & neglect, 36(2), 166-179. https://doi.org/10.1016/j.chiabu.2011.07.006
Schickedanz, H. B., Jennings, L. A., & Schickedanz, A. (2021). The Association Between Adverse Childhood Experiences and Positive Dementia Screen in American Older Adults. Journal of general internal medicine, 1-7. https://doi.org/10.1001/jamanetworkopen.2019.20740