1.Present a synopsis of the family developmental tasks specific to the chosen developmental stage.
Many individuals consider the later years as the best years as they are filled with meaningful memories and experiences. Old age has been viewed by some in our society as a period in an individual’s life that is marked by loneliness, aches and pains and loss. Older adults are not only faced with the challenge of having a positive outlook on life but also with the dealing with chronic illnesses.
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Developmental tasks may emerge from different factors. Firstly, an individual may be physically maturing and accomplish developmental tasks like learning to talk. Another factor is that the laws and socio-cultural expectations of the environment may influence the age at which an individual masters a task; for instance, marriage or birth of a child. The third factor which has an influence on development task is an individual’s personal values and aspirations; for instance, the career an adult decides to pursue (Choolayi, 2019). There are developmental tasks that have been documented for the aging family; these include:
(1). The Aging Family must adjust to failing health and old age:
An aging individual is faced with the reality that they are getting physically weak and may not be able to do things as they used to. The aged person must structure his/her life to engage in activities that is centered on mental and physical activities that are ideal for their health status and age.
(2). The Aging Family must adjust to retirement and the possibility of receiving a reduced income:
Individuals in the aging family will be faced with retirement planning. They hope and pray that their pensions will be able to cover up their expenses but in recent years pensions have been shrinking and property values have been falling, so older people are left with no other options but to postpone their retirement and stay in the work force (Rathus, 2014).
(3). Meeting social and civil obligations:
In most communities the elderly is an individual who has had a lot of experiences in life and is full of wisdom. This individual may be tasked with the responsibility of sharing their wisdom and experiences with the younger members of the society. This can be accomplished through social interactions with not just members of the same age group, but also with younger members of the community (Choolayi, 2019).
(4). Adjusting to the death or loss of a spouse:
Losing one’s spouse may be one of the most devastating events in a person’s life. The elderly person who has lost a spouse must engage in taking care of their personal hygiene, assume responsibilities which was handled by their spouse and stay connected to their community, family or religious organization (Rathus, 2014).
(5). Affiliation with members of one’s age group and younger members of the community:
Aging is marked with feelings of loneliness. Most elderly people have lost their spouse and may be living alone. The elderly must seek to establish healthy friendship relationships with people of their age in the community. In some cases, older people have been found to have meaningful relationships with people of younger ages and people of different sexual orientation. In recent times gay men and lesbians have been forming relationships with straight people. These relationships are not sexual but rather strong friendships; and most of these couples see themselves as families (Rathus, 2014).
(6). Developing a point of view about death:
Death is inevitable; and elderly people must face this fact of life. Elderly people must develop a positive attitude when it comes to preparing for death and dying. Religious beliefs and cultural values can help the elderly in coping with death.
2.Identify a specific family health threat specific to this developmental stage (20 points)
(1). Include current statistics related to the incidence and prevalence of this threat
Chronic diseases are the leading cause of death in older adults. According to the Centers for Disease Control and Prevention (CDC), chronic illnesses have been and is still the leading cause of death in older people in the United States. Heart Disease and Cancer are the leading chronic illnesses followed by stroke, chronic lower respiratory disease, alzheimer, diabetes, influenza and pneumonia. These illnesses pose the greatest risk to their health and wellbeing. The risk of developing a chronic disease increase significantly with age (CDC, 2013).
1). Diminished Quality of Life and Loss of Independence:
Elderly people living with chronic illnesses are not only burdened with the fear of dying; but they go through the heartache of experiencing a diminished life, disability and in some instances severe pain. They are also faced with coping with the inability to perform activities of daily living and may need help with managing money, grooming, shopping, preparing meals and medication management. The loss of control due to chronic illnesses in the elderly may sometimes put the elderly in the nursing home or assisted living facility. Loss control may also lead to depression in the elderly.
There has been a rise of obesity among older adults in the United States. Obesity is a serious health concern. Obesity has been linked to mental health disorders, diabetes, heart disease, stroke and cancer. According to statistics presented by the Centers of Disease Control and Prevention, the prevalence of obesity among United States residents over 20 years old have increased from 26.4% in 2006 to 31.7% in 2018 (CDC, 2019).
3). Inability to obtain healthcare coverage
With the high cost of healthcare; most people cannot afford healthcare coverage. Elderly people most sustain themselves on the little that they get from social security and therefore cannot afford extra costs for healthcare. The percentage of the population in the United States who failed to obtained needed healthcare due to cost at sometime during the past 12 months was 4.8% ; 95% to confidence interval = 4.58%-5.05% in 2018 (CDC, 2019).
3). Chronic Illnesses effect on Health Care Cost:
The United States of America Health Care cost is the highest among other developed counties in the world. This cost is expected to rise even higher with the increase in chronic illnesses among older people. Currently more than two thirds of all health care costs are spent on treating chronic illnesses. 95% of health care cost in the older American has been spent on chronic diseases. The cost of for rendering healthcare to an individual 65 years or older is three to five times higher than the cost of an individual younger than 65 years of age. By 2030 it is projected that healthcare spending will increase by 25% as the current population are expected to live longer and will be getting older. Medicare spending is also projected to increase from 555 billion in 2011 to 903 billion in 2020 (CDC, 2013).
(2). Name specific risks that contribute to this threat
there are several factors for the occurrence of chronic illness in the elderly. These risk factors include:
1). Decrease in physical activity
Regular activity is important for healthy aging. Physical activity reduces the risk of chronic illnesses and premature death. A study conducted by the CDC found that out of 31 million adults aged 50 and older, 28% were found to be physically inactive. Inactivity is defined by the CDC as not getting any physical activity beyond basic movement from daily life activities. The same study mentioned found that physical inactivity is higher in women, Hispanics and non-Hispanics blacks, and older adults with one or more chronic diseases (CDC, 2016).
2). Poor nutrition
Poor nutrition in older adults makes them susceptible to chronic diseases. According to a study conducted by the Baltimore Longitudinal Study of Aging there is a substantial decline in food intake with advancing age. Energy intakes between ages 25 and 70 years can decline by as much as 1000 to 1200 kcal/day for men and 600 to 800 kcal/day for women. By age 80, 1 in 10 men consumed less than 890 kcal/day whereas 1 in 10 women consumed less than 750 kcal/day. Reduced energy intakes can lead to inadequate intakes of protein, vitamins, and minerals. NHANES III data show potentially important decreases with age in median protein and zinc intakes (down by about one third in men) as well as intakes of calcium, vitamin E, and other nutrients. Risk for inadequate nutrient intakes is especially acute for older men. As many as 10% of older men obtained only one fifth to one third of the recommendations for protein, zinc, calcium, vitamin E, thiamin, riboflavin, vitamin B6, and vitamin B12. In contrast to the general decline in micronutrient intakes, estimated intakes of carotene, vitamin A, and vitamin C tended to increase with age, especially for women (Drewnowski & Evans, 2001).
3). Infectious agents
Older people have defective have duff immune system. This compromise their ability to ward off infections. Inadequate immune systems and decline in in T- lymphocytes production and proliferation, thinning skin, enlarged prostrate, diminished cough reflex, and other anatomic and physiologic make the elderly more vulnerable to infectious diseases and chronic illnesses. nursing home residents exhibit virtually all the risk factors for infections associated with the geriatric population. Infections happen more commonly in nursing homes. Health care-associated infections also occurs at a higher rate in the nursing home setting. Three types of endemic infections occur in nursing homes: urinary tract infections, lower respiratory tract infections--principally pneumonia, and various skin and soft tissue infections (CDC, 2003).
4). Underuse of Health Care Services
The Patient Protection and Affordable Care Act of 2010 has provisions which included preventive services like cancer screening and immunizations to Medicare. These services can prevent diseases or help to detect diseases at its early stages. It has been documented that older adults underuse these services; thus, exposing them to chronic illnesses. Those underusing these services have been found to be from Minority and African American groups (Office of Disease Prevention and Health Promotion [ODPHP], 2019).
3.Identify 2 potential health protection family interventions that the primary care nurse practitioner could implement to address this issue. (20 points)
•Tie these interventions into national health agendas such as Healthy People 2020
•Identify community resources that should be incorporated into the plan
During the past century, the health issue shift from infectious diseases and acute illness to chronic disease and degenerative illness. According to Healthy People 2020, two out of every three older Americans have multiple chronic conditions, and 66% of the country’s health care budget used for this group of population (CDC, 2018c). Now, the concern is what health protection family interventions could effectively address this issue, and significantly improve the quality of life for an aging family with chronic illness.
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As Healthy People 2020 maintained, “person-centered care planning that includes caregivers” is one of the issues in the health of older adults. The caregivers play a very impotent role for seniors, and patient engagement care is expanding to include caregivers’ engagement care. As the healthcare providers, we should encourage our patient and his or her caregivers to take an active role in discovering how to manage chronic problems, to help caregivers’ access information, get help with decision support, and discuss values to help them become more involved in decision making with the seniors they take care. Align care decisions among patients, family/caregivers, and clinicians would minimizing the conflicting of recommendations, and provide the person-centered care which focused on what matters most to patients (Boyd et al., 2019). Effectively involve caregivers in the care of aging family with chronic illness would help achieve the goal of “Reduce the proportion of noninstitutionalized older adults with disabilities who have an unmet need for long-term services and supports” (Centers for Medicare and Medicaid Services [CMS], 2016).
According to Healthy People 2020, “Quality measures of care and monitoring of health conditions” is another issue in the health of older adults. In 2014, only 41.2 percent (Males, 65+ years) and 42.6 percent (Females, 65+ years) who received clinical preventive services (CMS, 2016). Especially those from certain racial/ethnic groups and LGBTQ groups. For example, lesbians experience a higher risk of breast cancer, and gay men have a higher incidence of anal cancer, but the cancer screening rates in this group decreased (Margolies, & Brown, 2018). “Increase the proportion of older adults who are up to date on a core set of clinical preventive services” the goal of Healthy People 2020 and understand the preventive health services for older adults is very important to help to detect disease early, help access prompt treatment when necessary, help monitoring of health condition, also help reduce overall medical expenses. As health care providers, we should encourage aging adults to attend periodical gender-specific medical exams such as hypertension, age-specific cancer screen for colon and breast. Immunization also is essential for older adults against infectious diseases such as the annual influenza vaccine, pneumococcal vaccine, and herpes zoster (Nicholas, & Hall, 2011).
As healthcare providers, we also have to introduce useful community resources to the aging family with chronic illness. Such as chronic disease self-management education program. This program is a workshop in community settings helps people with different chronic health problems. Provide information such as appropriate exercise for maintaining and improving strength, proper use of medications, manage daily nutrition, and how to evaluate a new treatment. This program gives the aging family with chronic illness skills to maintain their health, help them keep active in their lives (CDC, 2018a). The community-based supports and services also are designed to help older adults. Provides educational program and counseling services for older adults and their caregivers to remain older adults safely in their homes and delay or prevent institutionalization (Eugenia, Sonam, Michael, Laureano, & Carrington, 2015).
4. Identify current research on health threat. (20 points)
(1). Are there any existing health policies/programs that are focusing on this issue?
1). Medicare’s Annual Wellness Visit (AWV) for Preventive Care
Preventive services have been proved to slow the progress of chronic diseases and maintain elderly health and wellbeing (Jiang, Hughes, & Wang, 2018). Medicare is the largest public health insurance program for the elderly, which plays an imperative role in promoting healthy aging and managing chronic conditions (National Prevention Council [NPC], 2016). Some provisions in the Affordable Care Act (ACA) that add several preventive services into Medicare, such as cancer screenings and immunizations. To better coordinate chronic and preventive care, Medicare starts providing a free AWV to beneficiaries beyond their first 12 months of Part B coverage (Jiang et al., 2018). This AMV evaluates patients' health risk factors, reviews medical and family history, and generates personalized prevention plans (Jiang et al., 2018). AWV represents an assuring opportunity to promote the delivery of preventive care for the elderly and to improve knowledge about strategies for healthy aging (Koh, Blakey, & Roper, 2014). AWV matches the target goal of Healthy People 2020 that expands the proportion of elders who acquire a core set of clinical preventive services (U.S. Department of Health and Human Services [HHS], 2014).
2). Older Americans Act (OAA) programs
Congress enacted the OAA in 1965 in response to concern by policymakers about the lack of community-based services for older persons, such as nutrition programs, transportation, elder abuse prevention, caregivers support, case management, senior center services, legal services, employment, elder abuse prevention services, long-term care and in-home services (Administration for Community Living [ACL], 2017). The OAA programs maintain elders' health and independence in their own homes and communities to avoid hospitalization and nursing home care (Menne, 2018). These programs focus on offering assistance to seniors with low-income, limited English proficiency, or residing in rural areas by providing essential home and community-based services and support (ACL, 2017). The benefits of OAA programs are not only for older but also support family caregivers by offering services and jobs in the health and long-term care sectors in local communities around the country (ACL, 2017).
3). Chronic Disease Self-Management Education (CDSME) Programs
Chronic diseases can be prevented and controlled through healthy lifestyles and self-management education (Lock & Belza, 2017). Evidence-based CDSME programs are community-based education programs for older adults with chronic disease specifically focus on building multiple health behaviors and generalizable skills such as goal setting, decision making, problem-solving, and self-monitoring. There are two widely accepted CDSME programs, the Chronic Disease Self-Management Program (CDSMP) and Diabetes Self-Management Program (DSMP), give participants knowledge and skill to take in charge of their health (Bobitt, Aguayo, Payne, Jansen, & Schwingel, 2019). These programs are supported by the National Council on Aging (Siantz & Aranda, 2014). CDSME Programs were developed at Stanford University and are available in approximately 17 languages (Smith et al., 2017).
The CDSMP has been extended to particularly address arthritis, diabetes, lung, and heart disease (Smith & Ory, 2015). The topics of CDSMP covers the techniques of dealing with chronic problems, appropriate exercise, use of medications, family communication, social relationship, nutrition, and new treatments evaluation by utilizing problem-solving, action planning, and goal setting (CDC, 2018a). People who took CDSMP illustrated significant enhancements in exercise, ability to do social and household activities, less depression, fear and frustration, reducing in symptoms like pain, and increasing confidence in their capacity to handle their condition (CDC, 2018a).
The DSMP is a computer-based, internet-based, peer-led, and theory-based 6-week group program for people with type 2 diabetes (Palmas et al., 2015). It is delivered by two trained leaders, one or both of whom have diabetes, and meet participants 2.5 hours a week in the interactive workshop at different community locations (CDC, 2018b). The program helps individuals better manage diabetes symptoms, tiredness, pain, emotional issues, and medications compliance by teaching healthy lifestyles and self-coping skills (Singh et al., 2018; Turner, Ma, Lorig, Greenberg, & DeVries, 2018). DSMP have positive impacts on the promotion of body mass index, body fat percentage, and activity levels in participants (Sherifali et al., 2014).
(2). Do you have specific recommendations regarding this health threat?
1). Minimum levels of geriatric training for health professionals.
The number of geriatric patients with chronic disease increasingly outpaces the number of physicians with sufficient skills to manage them (Gabbard & McNabney, 2018). Therefore, there is a need for health professionals with training and skills in geriatric care for delivering high-quality care (Gabbard & McNabney, 2018). However, very few health care providers undergo training in this area (Knecht-Sabres et al., 2018). It is vital to educate physicians to manage our aging population better and emphasizing patient-directed care..
2). Enhance Health Access on Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) population of older adults.
Fredriksen-Goldsen (2014) remarked the diversity within the older adult population and estimated that by 2030, there would be more than 5 million LGBT adults aged 50 and older. Some LGBTQ aging people felt they had been denied health care or received inferior care due to being LGBTQ (Dunkle, 2017). The legislation had been introduced to improve and expanse the OAA to be LGBTQ inclusive (Porter & Cahill, 2015). The public policy should take efforts to engage vulnerable sexual minority older adults as full members of society in the future policy direction. As primary health care providers, we should understand their needs and ensuring appropriate services are in place for them.
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