Hospital Discharge Planning for an Older Patient - Essay Example

Hospital Discharge Plan for an Older Patient 2009 In this paper, I will discuss the community health issue of hospital discharge plan for elders. While discharging from the hospital, the care of the older patient is transferred to the family caregiver but the role of the community caregiver does not end. In particular, since the care giving for elders is substantially different from what is required for younger patients, community health workers need to keep a constant monitor on the well-being of the patient and train the family caregivers on the requirements of geriatric patients, which may often involve psychological as well as physical aspects. This is a crucial problem for community health professionals and social policy making because elder abuse and neglect has been found to be more common in the family setting than in institutional setting. The most comprehensive study on elder abuse was conducted by Ogg and Bennett (1992) who surveyed a sample of about 2,000 people in the United Kingdom. They found that about 5 percent of the elders above 60 years of age suffered verbal or psychological abuse while 2 percent suffered physical or financial abuse from family and relatives. It is perpetrated by family members, care staff, relatives, friends and the society at large. Abuse may also take many forms – physical abuse, sexual abuse, medical abuse, medical negligence, withdrawal or control of treatment, sedating patients or simply degrading the elderly by treating them in a dehumanized or infantile manner. Physical abuse consists of hitting, restraining, over or under medication. Sexual abuse consists of forcing a person into a sexual relationship without his or her consent. Psychological abuse consists of shouting, swearing or treating a person in a degrading manner. Financial abuse is involved when a person’s money, property or bank documents are illegally accessed. Neglect occurs when a person is deprived of heating, food, clothes or other items of daily care. However, it must also be noted that not many older people would like to report abuse from the family. A survey by the Community and District Nursing Association in the United Kingdom found in 2003 elder abuse was as prevalent as 88 percent and 12 percent of elders reported abuse at least once a month (House of Commons, 2004). Older people, particularly those suffering from dementia, are subject to abusive treatment at home as well as in hospitals and nursing homes. Administering anti-psychotic drugs and restraining of older people suffering of dementia and Alzheimer’s Disease from wandering by tying them with furniture is not unusual either in the family or the institutional setting. McCreadie (1996) found that a large number of older people, particularly women, live long term in communal settings like hospitals, nursing homes, local authority or private, voluntary residential homes. In such cases, the discharge plan after specific illnesses needs to be drawn out with care since it involves long term care giving. It is often the case that elder abuse is not detected since the case of neglect and deliberate control of medication for elders is often not very apparent. Often, over-prescription is used by the care staff to control elders, particularly those with dementia. There are ethical dimensions of this form of treatment as well as other issues of abuse, like neglect and treating elder patients as if they are kids. Besides, there are social factors that lead to such situations as well as the responsibilities of the caregivers, including doctors, nurses and others. Although the baby boomer generation looks at ageing in a considerably different manner than did earlier generations, with more people above 65 having gainfully employed lives and 30 percent of people above 75 helping out other elderly who are in need (Jeevans, 2004), there are frequent media reports of institutional abuse on the elderly, particularly on those who suffer from dementia or learning disabilities. According to the International Longevity Centre – UK (2006), 1 in 100 people in the UK suffer from dementia. The figure is 1 in 20 for the age group between 70 and 79 years, 1 in 5 for people between 80 and 85 and 1 in three for those above 90. Hence, the issue of abuse takes crucial importance for such elders who are not able to look after themselves. In many institutions, excessive medication, especially of the anti-psychotic type, are used for people with dementia to make it easier for the staff to control them. Such drugs calm and pacify patients. Between 1999 and 2002, British doctors wrote 6 percent more prescription of anti-psychotic drugs in the United Kingdom (House of Commons, 2004). Patients are either over-prescribed or under-prescribed such drugs since they do not have the capacity to verbally respond. Many of the care staff is not adequately trained to understand the requirements of anti-psychotic drugs. The Alzheimer’s Society told the House of Commons (2004) that “Over-prescription of neuroleptics is a common form of physical abuse – often used to sedate people with dementia in care of homes or hospitals”. Although anti-psychotic drugs are at timed required to calm patients with dementia, these are more often used to prevent patients from wandering away or unruly behaviour. Burstow (2002) found that among the 935 resident patients in 22 south London nursing homes, 24.5 percent were prescribed such drugs, of which 82 percent was not appropriate. Besides anti-psychotic drugs, many institutions also attempt to restrain elders by using furniture like bedrails or ‘Buxton’ chairs, physical confinement or electronic tagging, which are all the more terrible (House of Commons, 2004). Such restraint mechanisms, which may as well result in physical injury, are criminal and should never be indulged in by nursing homes. Elders are more vulnerable to morbidity as a result of inappropriate medication. Older people in nursing homes are prescribed more drugs than those at home and the number of hospital admissions as a result of medication is nearly four times that of others. The National Survey Federation (NSF) has advocated a special medication guideline for older people. Yet, only 44 percent of UK nursing homes meet the standards of medication guidelines. Many of the inappropriate medication can even end up being fatal (Howard and Avery, 2004). Elder abuse may also be in the form of neglect and unavailability of items of daily need like heating, food or even teeth. Forced isolation and lack of leisure activities are also forms of institutional abuse of elders (Penhale and Manthorpe, 2001). In the care management of the elderly, in particular, it has been found that the evolution of bio-medicine and the clinical definitions of decay have imposed a disciplinary condition on the geriatrics. Informal, residential and community care of the elderly have put them under surveillance of the care managers. In order to reduce the minimum number of service providers as well as costs of care management, surveillance techniques are increasingly being used to monitor the medical state of the elderly even before they are admitted to the institutions. Not only do social service departments monitor the health status of the elderly, the community and the various organizations entrusted with funding of social security are also engaged in the process of scrutiny. Societal attitude towards ageing has a natural implication for the provision of healthcare for the elderly. Besides, the cost of health services poses another impediment for the elders. The elders live on fixed income while the cost of living rises. Hence, the elders may not be able to afford health services in countries like the United States if they are not covered under health insurance. Besides, lack of transport services makes many elders dependent on family or community caregivers for transportation in order to access health care. This is particularly crucial for seniors living in rural areas, where almost one in four elders of the United States lives. Elders in rural areas often do not have access to adequate health services (Susan). Further, minority elders have even more acute problems in accessing health services. There are cultural differences among the minority elders and the community healthcare providers, who are mostly from the majority social groups. Cultural differences include attitude towards illnesses and treatment and language barriers. While discharging an elder patient from the hospital, all the issues that are applicable to the well being of the patient needs to be considered. It need not be assumed that the elder will be necessarily abused in the home setting but the family caregivers should be adequately trained to deal with the elder patient. Many community health organizations have day care facilities for the elders, which not only takes care of the medicinal aspects of healthcare but also gives some space to the family caregivers to get on with their lives. Many elders also live long term in the institutional setting, which increases the responsibility of the community health workers. Elder patients bear a sense of neglect and concern over the financial and material aspects of health services since they do not have increasing incomes. For such elders, in particular, community health workers need to be particularly sensitive. Restrictions from movement and excessive medication, including that of anti-depressants are typical ways of dealing with elder patients that are indulged in by health workers. But, such measures often enhance morbidity and treat the elder patients in a dehumanizing manner. Works Cited Ogg, J and Bennet G, Elder Abuse in Britain, British Medical Journal, Vol 305, 1992 McCreadie, Claudine, General practitioners' knowledge and experience of elder abuse funded by King's Fund, King's College London, 1996, retrieved from https://www.kcl.ac.uk/kis/schools/life_sciences/health/gerontology/pdf/elderabus/intro.doc Jeevans, Christine, Welcome to the Ageing Future, 29 November 29, 2004, BBC Online, http://news.bbc.co.uk/1/hi/uk/4012797.stm International Center for Longevity – UK, Building Our Futures, Planning for an Ageing Population North East HLIN 2006, Retrieved from www.ilcuk.org.uk House of Commons Health Committee, Elder Abuse, Second Report 2003-04, 2004, retrieved from https://www.kcl.ac.uk/kis/schools/life_sciences/health/gerontology/pdf/elderabus/intro.doc Susan, Comprehensive Community Health Nursing, Elsevier Health Services Read More