By 2030, the United States Medicare eligible population is projected to grow to 69.7 million (Stanhope, & Lancaster, 2008, p. 50). This will ultimately increase health care costs and expose numerous vital health care issues. Susan Smith is an 81 year old female, who lives independently in ranch style home in a suburban area. In the scenario, she presents with many health problems that are beginning to effect everyday life. Susan feels she is capable of living independently, but her children feel otherwise. Throughout this paper, I will discuss the essential issues such as health, safety, socioeconomic, ethical, and legal concerns that must be addressed in the elderly population.
Health
How do you define health? Meanings of health differ greatly and are influenced by different backgrounds and stages throughout one’s life. The World Health Organization reflected a holistic perspective in its definition of health as a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity (Stanhope, & Lancaster, 2008). As a nurse, it is important to identify the client’s individual beliefs and feelings of what health means to them. In the scenario, Susan presents with many health problems and illnesses that are beginning to affect the most important need in Maslow’s Hierachy; biological integrity. She has CAD, diabetes, hearing and vision impairments, osteoarthritis, spinal stenosis, and history of breast cancer. Moreover, she had an incident with a fire that caused major burns on her face, chest, and upper extremities. The burns and increased smoke inhalation has significantly affected her breathing and skin integrity. Although Susan may feel like she is in good health because she is 80 years old and is still able to drive a car, care for her own home, work in the garden, attend appointments with the doctor, and go to the grocery store weekly, Susan’s family is concerned with their mother’s health and no longer feel she is capable of living independently.
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There are many different health practices that can help Susan treat and manage her multiple disease processes. Maintaining a healthy diet and establishing an appropriate exercise regimen is important to improving overall health. A good approach to the scenario would be acquiring about physical therapy and a dietician consult. A respiratory therapist consult would also help maintain an effective airway because her airway may be compromised from the burns and smoke inhalation. A wound care nurse consult would also be beneficial to appropriately change and assess the burns she endured from the fire. In a recent study, nanocrystalline silver dressings appear to induce major improvements in the healing of a variety of wounds and very positive results have been demonstrated with regard to antimicrobial effectiveness, ease of use and increased rate of re-epithelialization across partial-thickness burns (Marazzi, 2007). Susan’s dry macular degeneration cannot be cured but current recommendations express an increase in vitamins, specifically A, C, E, Zinc, and Copper, to decrease the incidence of progression (Donaldson, 2006). These recommendations are geared to improving Susan’s health and facilitating with the multidisciplinary team.
Safety
Home safety is an integral part of holistic care that tends to be misunderstood and forgotten with the older adult. Safety is categorized under the second level of Maslow’s Hierarchy of human needs. Older adults covet their independence as long as they can, even when their safety and independence are compromised by physical disabilities or chronic illnesses. Throughout the scenario, Susan continually puts her health at risk to stay independent and free from help. First, she continues to drive with vision and hearing impairments even though she has gotten into several car accidents. Not only is she putting herself at risk for further injuries, but she is also putting other drivers at risk. Secondly, Susan puts herself at risk by leaving food on the stove and forgetting about it. This led to the house catching on fire causing multiple first and second degree burns on her upper body. Third, Susan’s osteoarthritis and spinal stenosis puts her at an increased risk for falls when she is working in her yard and garden. Lastly, Susan puts herself at risk of managing her diabetes improperly. Because of her dry macular degeneration, accurately measuring her blood sugar and administering the correct amount of insulin is a daunting task. It is clear to see that Susan’s disease processes are beginning to interact with one another and significantly affect her safety.
There are numerous recommendations Susan requires because of her inability to live a safe life independently. Because she does not want to live in assisted living, a possible solution to the problem is having one of her children move back closer to home or have the older adult move in with one of the children. This would be an extremely difficult change for the family, as they would have to alter the way they were living. Another possible solution to the problem may be to apply Susan for the PACE program. The Program All-conclusive Care for the Elderly is optional under Medicaid or Medicare and offers all health care services needed at home while allowing the older adult to remain independent (Hirth, 2009). In relation to Susan’s driving, a current recommendation is to have the elder take a SAFE questionnaire to see if the elder is capable of driving. The SAFE questionnaire tests the elder’s cognition of general traffic laws, road signs, and effects of alcohol (Adler, 2006). If the elder is unable to drive, paratransit services are available to transport people. In regards to Susan’s cooking while maintaining a safe environment, a recommendation for hot meals would be receiving Meals on Wheels. In the article Wheeling and Mealing, Meals on Wheels brought the satisfaction of a hot meal and it provided structure and motivation in the older adult’s daily life (Elliott, 2006). To maintain strict control of her diabetes, recommendations gear to using insulin pens rather than using syringes to draw up insulin. A recent study shows insulin pens are more likely to ensure the correct dosage and result in fewer trips to the emergency department, resulting in substantial savings to diabetics and their insurers (Asche, 2010). All these recommendations are possibilities for Susan to maintain a safe environment.
Socioeconomic
Socioeconomic status influences overall human functioning and plays a role in determining the quality of life of an older adult. Older adult’s individual socioeconomic circumstances and the neighborhoods they live in have been found to be associated with the health and well-being in a variety of settings (Lang, 2009). Throughout her life, Susan has always been a homemaker with a limited education of the tenth grade. She has been a widow for ten years living on a fixed income. Susan has unintentionally overdrawn her checking account three times in the past six months. With an increase in dementia, Susan is demonstrating signs that she is unable to provide or manage her financial funds correctly without causing further problems.
A need of recommendations for Susan’s socioeconomic status is evident. First, to accommodate her increasing dementia, a support group would be beneficial. Adult day care centers are community-based long-term care options that provide alternatives to being institutionalized for the elderly who suffer from dementia (Abramson, 2009). These also provide older adults the opportunity to exercise and socialize with others whom have dementia. Due to Susan’s difficulties managing her finances, establishing a meeting with Susan and her children to discuss recent financial issues is recommended. During the meeting it is vital to discuss important financial documents such as deeds, stocks, and bonds. Next, it is recommended to consider any further costs Susan may accumulate when caring for her disease processes. Finally, acquiring about a financial adviser is recommended who can help manage financial accounts and determine eligibility of beneficial resources would be very helpful. These recommendations are another important step in the interdisciplinary care of Susan.
Ethical
Ethics relates to the moral characteristics of an individual’s behavior and personal character. There are many ethical dilemmas that may occur in relation to individual choices, responsibilities, rights, or obligations. Ultimately, it is important that the choices made are in the best interest of the client, community, and the family involved. Susan’s closest family member is nearly six hours away causing her to do everything on her own. In the scenario, the children of the Susan are very concerned with their mother’s progressive diseases. Not only are the diseases beginning to affect her own safety, but they are beginning to affect other people in the community. After numerous incidents, her children are insisting she move into an assisted living facility. Susan denies she is need of any help, and feels she is still capable of living independently.
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Recommending Susan to an assisted living facility would be going against her wishes, but ultimately would be the best, most safe care for herself, community, and family. Assisted living facilities provide a safe environment for elders and are also in place for individuals who are in need of assistance in basic functioning. Benefits of assisted living include assistance if needed, independence, social activities, minimal responsibilities, food and laundry services provided, and medical care readily available. “Living here (assisted living in Bluffton) has taken a lot of stress off my shoulders. It was becoming really hard on my body to do all the chores around the house each day by myself.” (Personal communication, October 13, 2010). Assisted living offers a safe environment for Susan while still maintaining independence and as needed assistance of basic functioning.
Legal
Legal preparation for older adults can be separated into two categories, health care planning and financial planning. With continuing refusal of Susan to deny any extra help, it is important for the family to ask Susan if she has filled out paper work of her advanced directive, power of attorney, and living will. It is vital that the older adult fills out a legal document called an advanced directive that conveys his or her wishes about end of life care. If an older adult becomes too sick or disabled and is unable to speak his or her own wishes, it is important that the older adult can give consent to someone, who would be known as the power of attorney, which will make health care decisions for them the way they would want them to be. In the scenario, the children are beginning to recognize that Susan is becoming more and more confused on the phone. She also forgot about her cooking pan on the stove that caught on fire. Not only is she refusing to go somewhere to get extra help, but she is also believes she is capable of taking care of herself and keep on doing some of the things, such as driving, that may cause harmful effects to herself and others.
As Susan’s diseases progress and her dementia increases, it is recommended that Susan has her appropriate legal documents filled out. Solutions to this issue may be to have a meeting with her children to discuss her preferences in the advanced directive and determine who will be the power of attorney. It is also recommended that the children discuss with Susan the problems they are noticing and the need for intervention. The most effective way of doing this is by providing her with different options that will assist in her care. It is evident that Susan is in need of assistance in caring in her ever day life.
Final solution
Susan’s comprehensive final plan is based on current best practice, what is acceptable to the client and family, and utilizes an interdisciplinary team approach. The final solution begins with a comprehensive head to toe assessment by Susan’s family doctor while recording current medications and a medical history. Secondly, Susan, her children, and family doctor need to set a date to discuss Susan’s current medical condition, what options are available, and her medical needs at this time. Next, her children and Susan need to discuss who is going to be the power of attorney and what her wishes are regarding the advanced directive and living will. I believe the best and most effective way to help with assisting and managing Susan’s medical conditions is using the PACE program. This program will not only give Susan her independence by living at home but will also give her the medical attention and the supervision she needs. With this program, she can see a respiratory therapist, a nurse, a dietician, a wound care specialist, or a physical therapist periodically throughout the week to help improve her overall health. The PACE program will reduce stress on the family by knowing that she is receiving care each and every day. To assist in hot meals, Meals on Wheels could provide her with a hot meal each day of the week to prevent Susan from cooking on the stove. This will help the family cope about further fires caused by her stove. To manage her financial needs and problems, I believe acquiring about a financial adviser would be the best approach to assist finding available resources and management of money. Finally, I believe the best solution to the vision impairment and driving difficulties would be to take the SAFE questionnaire test and have a vision screening examination. Prior to taking the questionnaire and vision screening, the children and Susan are to sign a contract saying if she cannot pass this questionnaire and a vision screening, then she is no longer able to drive. If she fails, then her transportation would be the paratransit services that would bring her where ever she needs to go. Not only are these decisions in the best interest of Susan, but it also provides a sense of security for the family, knowing that their mother is being taken care of.
Conclusion
When discussing what is best for older adults, there are multiple issues that need to be considered into the plan of care. A person’s physical, mental, and social well-being status are important factors in determining an elder’s health. Older adults sacrifice their safety to maintain their independence in which they covet. Socioeconomic issues affects the quality of life and also influences overall human functioning. Ethical issues arrive in determining what is in the best interest of older adult, community, and the family. Legal issues decide whether or not the older adult is cognitively able to make his or her own decisions. The comprehensive solution provides holistic care throughout, uses current best practice, is acceptable to the client and family, and utilizes an interdisciplinary team approach.
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