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7/31/2019 Healthcare Management of Elderly People
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HEALTH CARE NEEDSHEALTH CARE NEEDSIN THE ELDERLYIN THE ELDERLY
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BackgroundBackground
Population agingPopulation aging
Increase of care needsIncrease of care needs
Societal and family structure changesSocietal and family structure changes The family as the main informal supportThe family as the main informal support
systemsystem
Uncertain future of elderly careUncertain future of elderly careA challenge for: State/Public Social andA challenge for: State/Public Social and
Health care system as well as for familyHealth care system as well as for family
dynamicsdynamics
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Population (1999)Population (1999)
WORLDWORLD EUEU
0-14 years0-14 years 31%31% 17%17%
15-64 years15-64 years 62%62% 67%67%
> 65 years> 65 years
7%7%
16%16%
TOTALTOTAL 5918,6 Millions5918,6 Millions 374,6 Millions374,6 Millions
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94%94%in thein theCOMMUNITYCOMMUNITY
6% in geriatric care facilities6% in geriatric care facilities
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Aged
adult
INFORMAL NETWORK FORMAL NETWORKFamily members Community care
Friends and neighbours Emergency room, Hospital
XX
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Common geriatric acute eventsCommon geriatric acute eventsSurgical emergency ()Surgical emergency ()
Acute pain of unknown originAcute pain of unknown origin
Dehydration, fall, pulmonary tract infections ()Dehydration, fall, pulmonary tract infections ()
Drug side effects !!Drug side effects !!
Delirium, spacio-temporal disorientation ()Delirium, spacio-temporal disorientation ()
Psycho-social crisisPsycho-social crisis
Depressed mood, family conflict ()Depressed mood, family conflict ()
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OWN EMOTIONAL FEELINGSOWN EMOTIONAL FEELINGS
LIFE COURSELIFE COURSE
CO-MORBIDITIES & DAILY FUNCTIONINGCO-MORBIDITIES & DAILY FUNCTIONING
LIFE PROJECTSLIFE PROJECTS
QUALITY of LIFE...QUALITY of LIFE...
Affective surroundingsAffective surroundings
Medical vs. Psychiatric vs. SocialCRISIS
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EMOTIONAL FEELINGSEMOTIONAL FEELINGSAnxiety, fear, culpability, anger, Anxiety, fear, culpability, anger,
Indifference, acceptation or denial...Indifference, acceptation or denial...
PROBLEMS of UNDERSTANDINGPROBLEMS of UNDERSTANDINGAcute disease vs. multiple co-morbidityAcute disease vs. multiple co-morbidity
PARTICIPATION in CAREPARTICIPATION in CARE
Burden of careBurden of care
QUALITY of LIFE, PROJECT of LIFE ...QUALITY of LIFE, PROJECT of LIFE ...
FINANCIAL CONCERNS !FINANCIAL CONCERNS !
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DISJUNCTION /GAPDISJUNCTION /GAP
betweenbetween
HUMAN BEINGHUMAN BEING
andand
SURROUNDINGS !SURROUNDINGS !
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Need to avoidNeed to avoid
INAPROPRIATEINAPROPRIATEHOSPITAL ADMISSIONS !!!HOSPITAL ADMISSIONS !!!
INAPROPRIATE
HOSPITAL STAY
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STRUCTURESSTRUCTURES
PROCESSESPROCESSES
OUTCOMES (OUTCOMES ( oror ))
Accessibility to the needed care
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The GERIATRIC PROCESSThe GERIATRIC PROCESS
AssessmentAssessment
J GRIMLEY EVANSJ GRIMLEY EVANS Brit Med J 1997; 315: 1075-7Brit Med J 1997; 315: 1075-7
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GERIATRICGERIATRIC
CARE MODELSCARE MODELS
BIOMEDICAL +++BIOMEDICAL +++
FUNCTIONAL ABILITYFUNCTIONAL ABILITYHUMAN / TECHNICAL SURROUNDINGSHUMAN / TECHNICAL SURROUNDINGS
QUALITY of CAREQUALITY of CARE
ETHICAL issues of careETHICAL issues of care
QUALITY of LIFE +QUALITY of LIFE +
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ImportanceImportance
ofof
USINGUSING VALID VALID
CRITERIACRITERIA
COMPREHENSIVEGERIATRIC
ASSESSMENT(CGA)
COMPREHENSIVEGERIATRIC
ASSESSMENT(CGA)
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CGA in the emergency roomCGA in the emergency room
DETECTIONDETECTION
of unrecognized geriatric problemsof unrecognized geriatric problems
0
1
2
3
4
56
7
B e f o r e C G A A f te r C G A
N u m b e r o f d i a g n o s e sS t a n d a r d d e v i
2.8 4.5
1.5
1.8
The screening procedure
allowed the detection of
an average of
1.7 1.3
additional problems(Paired t-test, P < 0.001)
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-400
-300
-200
-100
0
100
200
300
0 1 2 3 4 5 6 7 8 9 10 11
After CGAAfter CGA
Before
Nb
ofpatients
Nb of Geriatric Problems
The screening procedure
allowed the detection of
an average of
1.7 1.3
additional problems(Paired t-test, P < 0.001)
PAIN
INCONTINENCE
DEPRESSION
ADL
impairments
COGNITIVE
Disturbances
SENSORY
troubles
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STRUCTURESSTRUCTURES
PROCESSESPROCESSES
OUTCOMES (OUTCOMES ( oror ))
The good patient in the good bed
Important role
of aninterdisciplinary
geriatric team
in the emergency
room
Important role
of aninterdisciplinary
geriatric team
in the emergency
room
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The GERIATRIC PROCESSThe GERIATRIC PROCESS
AssessmentAssessment
Agree objectives of careAgree objectives of care
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What does the patient want ?What does the patient want ?
What is feasible ?What is feasible ?
GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84
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The GERIATRIC PROCESSThe GERIATRIC PROCESS
AssessmentAssessment
Agree on care objectivesAgree on care objectives
Specify the management planSpecify the management plan
J GRIMLEY EVANSJ GRIMLEY EVANS Brit Med J 1997; 315: 1075-7Brit Med J 1997; 315: 1075-7
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To closeTo close
the ecological gapthe ecological gapbetweenbetween
patient abilitiespatient abilities
andandenvironmental possibilitiesenvironmental possibilities
GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84
Need of a precise diagnosisto provide the best possible treatment
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The GERIATRIC PROCESSThe GERIATRIC PROCESS
AssessmentAssessment
Agreement on care objectivesAgreement on care objectives Specify the management planSpecify the management plan
Assure an adequate follow-upAssure an adequate follow-up
J GRIMLEY EVANSJ GRIMLEY EVANS Brit Med J 1997; 315: 1075-7Brit Med J 1997; 315: 1075-7
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Patients quality of lifePatients quality of life
and cost of careand cost of carePatients QoLPatients QoL
Relieving sufferingRelieving suffering
Cost of care
Adapted from GOODWIN JS New Engl J Med 1999; 340: 1283-5
Medicalisation of old ageis not to be repudited
but should be encouraged !
S EBRAHIM Brit Med J 2002; 324: 861-3
IF- the accessibility to the emergency room
is easy- the emergency ward is equipped
with high tech- an interdisciplinary geriatric teamis included to the emergency staff
- geriatric care networks(community and hospital)
are working harmoniously ()
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General objectiveGeneral objective
To evaluate the health care needs andTo evaluate the health care needs and
effectiveness of care provided toeffectiveness of care provided to
people over 65 years of age.people over 65 years of age.
The final objective is to identify newThe final objective is to identify newnursing interventions andnursing interventions and
innovations that will improve healthinnovations that will improve health
care of people over 65 by thecare of people over 65 by the
im lementation of holistic care.implementation of holistic care.
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Purposes of the InformalPurposes of the Informal
Caregivers groupCaregivers group
Identification of the characteristics of the ICIdentification of the characteristics of the ICand their dependent care receipientand their dependent care receipient
Analysis of the type of care provided by theAnalysis of the type of care provided by theIC and their support system availableIC and their support system available
Analysis of the consequences of the careAnalysis of the consequences of the careactivities on the IC themselvesactivities on the IC themselves
Describe the healthcare policies for ICDescribe the healthcare policies for ICDesign new health support intervention forDesign new health support intervention for
ICIC
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Informal caregiversInformal caregivers
Women: 83.95%Women: 83.95%
Mean age: 56 yearMean age: 56 year
oldold
House keeper:House keeper:
60%60% Working outsideWorking outside
their homes: 22%their homes: 22%
Full time: 57%Full time: 57%
Men: 17%Men: 17%
Mean age: 65 yearMean age: 65 year
oldold
Retired: 45%Retired: 45%
Working outsideWorking outside
their homes: 42%their homes: 42% Full time: 83%Full time: 83%
Role:Role: Daughter-son / daughter-son in lowDaughter-son / daughter-son in low: 62%: 62% SpouseSpouse: 26%: 26% Paid caretaker: 5-9 %Paid caretaker: 5-9 %
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Activities done by the informalActivities done by the informal
caregivercaregiver Over 50% dedicate more than 5 hour perOver 50% dedicate more than 5 hour per
day (>150 hours / month)day (>150 hours / month)
IADL (80%)IADL (80%)
ADL (60%)ADL (60%)
Women do more AVD y AIVDWomen do more AVD y AIVD
Men do mainly IADLMen do mainly IADL
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DependencyDependency
TIMETIME ADL / IADLADL / IADL
HIGHHIGH > 3 h / Day> 3 h / Day 3 or more hrs3 or more hrsADLADL
MODERATEMODERATE 1-2 h / Day1-2 h / Day 1-2 hrs ADL or1-2 hrs ADL or
>5 hrs IADL>5 hrs IADLLOWLOW 1 h / Week1 h / Week Some IADLSome IADL
(< 5 hrs)(< 5 hrs)
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ADL & IADLADL & IADL
ADLADL HygieneHygiene NutritionNutrition EliminationElimination BathingBathing MovingMoving MedicationsMedications Treatment of ulcersTreatment of ulcers
and woundsand wounds
IADLIADL CookingCooking
House cleaningHouse cleaning
LaundryLaundry IroningIroning
Telephone useTelephone use
BankingBanking
TransportationTransportation
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Support resourcesSupport resources
Economic helpEconomic help(Decrease in taxes,(Decrease in taxes,time off from worktime off from workand flexible workingand flexible workingtime)time)
Primary carePrimary care Home careHome care
Day careDay care TelehealthcareTelehealthcare
Nursing homesNursing homes
Relieve centersRelieve centers
Home assistanceHome assistance
Support groupsSupport groups
Other interventionsOther interventions Voluntary helpVoluntary help
AssociationsAssociations Community helpCommunity help
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Support from NursingSupport from Nursing
INFORMATIONINFORMATION
PROFESSIONALPROFESSIONAL
EDUCATIONEDUCATION
EMOTIONALEMOTIONAL
SUPPORTSUPPORT
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Consequences of care on caregiversConsequences of care on caregivers
NEGATIVENEGATIVEDepressionDepression
AnxietyAnxiety BurnoutBurnout StressStress FatigueFatigue
Aches and painsAches and pains Social isolationSocial isolation
POSITIVEPOSITIVE Personal developmentPersonal development
Meaning of lifeMeaning of life AutonomyAutonomy Sense of controlSense of control Positive relations withPositive relations with
othersothers Self-acceptanceSelf-acceptance Positive feelingsPositive feelings
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ConclusionsConclusions
The informal care is the most importantThe informal care is the most importantsupport of the elderly dependent.support of the elderly dependent.
To improve the care of the elderly, it isTo improve the care of the elderly, it isessential to provide with adequateessential to provide with adequateresources to the informal caregiver.resources to the informal caregiver.
It is necessary to do more research toIt is necessary to do more research togenerate innovative interventions togenerate innovative interventions tosupport the caregiver activities and theirsupport the caregiver activities and theirquality of life.quality of life.
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ConclusionsConclusions
1.1. ICs have the need to express their feelings andICs have the need to express their feelings andexperiencies.experiencies.
2.2. There is a lack of social and political understanding andThere is a lack of social and political understanding and
acknowledgement of the IC rol.acknowledgement of the IC rol.
3.3. It is difficult for the IC to identify the resources that she /It is difficult for the IC to identify the resources that she /
he needs.he needs.
4.4. It is difficult for the IC to apply for resources (ChannelsIt is difficult for the IC to apply for resources (Channels
of application and paper work).of application and paper work).5.5. The health care system is effective for the treatment ofThe health care system is effective for the treatment of
acute health problems, but it to slow to solve chronicacute health problems, but it to slow to solve chronic
health problems related to dependency.health problems related to dependency.
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Scientific collaborationScientific collaboration
PROYECTONACIONAL
Informal /Informal /PrincipalPrincipalCaregiversCaregivers
Ethical &Ethical &
LegalLegalproblemsproblems
CoordinationCoordinationHome, primary &Home, primary &
continuity ofcontinuity ofhealth carehealth care
NursingNursinginterventionsinterventions
OutcomesOutcomesevaluationevaluation
CARE FOR THEELDERLY PEOPLE
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THE FUTURETHE FUTURE
EU RESEARCH FUNDSEU RESEARCH FUNDS
SYNERGY
Informa / principal caregivers (national level)Informa / principal caregivers (national level)
Informa / principal caregivers ( EU Countries)Informa / principal caregivers ( EU Countries)
&