Hospital Discharge Plan for an Older Patient2009In 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.