Research has shown that a significant and growing percentage of the Australian population is older than 65 years of age. The Australian Bureau of Statistics (ABS) predicts that by 2064 around 23% of the Australian population will be aged 65 or over (Australian Bureau of Statistics, 2013). Despite many older Australians enjoying a relatively good health condition, there is also a growing number of older people struggling with complex chronic diseases (Australian Institute of Health and Welfare, 2014a). Providing an appropriate level of care to promote independence and well-being for such persons continues to be one of the greatest challenges for the Australian health care sector (Australian Institute of Health and Welfare, 2014b). This essay will discuss the case of Mrs Doe, (whose name has been changed for protection of privacy), a 78-year-old retired factory worker with an Eastern European background. She currently lives at home alone, but receives support from her daughter. Her husband passed away 20 years ago. Mrs Doe was diagnosed with Osteoarthritis (OA) on her knees 5 years ago. As a result, she has decreased mobility and uses a 4-wheel walking frame. Mrs Doe is struggling to maintain her independence due to her current health status and her limited English, but refuses to move to residential support accommodation. Furthermore, most of Mrs Doe’s close friends are already deceased or live in distant suburbs. Combined with the fact that Mrs Do does not drive, this means that her social life has diminished significantly. Two theories of ageing will be described and related to Mrs Doe’s health condition. This will be followed by a description of appropriate models of care for Mrs Doe, including evidence based interventions aimed at supporting her well-being and maximising her quality of life. Moreover, potential legal and ethical concerns will be analysed as part of the holistic care for this person.
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Ageing is an inevitable process that starts from birth. It is a complex process that affects every cell in the human body. As a result of ageing, there is a significant decline in the preservation of homeostatic processes which normally occur in the human body. This then leads to complex comorbidities and mortality (Barzilai, Huffman, Muzumdar, & Bartke, 2012). Ageing is not the single indicator for deteriorating processes in the human body; many intrinsic and extrinsic factors affect the cells resulting in the variable rates of diminished capacity. A range of theories exist which aim to clarify the human ageing process. These theories provide different viewpoints about the ageing process, however, they share many common components. None of those theories can provide a complete and satisfactory explanation on their own (Meiner, 2015). Theories of ageing are beneficial for nurses looking after elderly people as they help nurses establish links between the pathophysiology of diseases that are commonly experienced by the elderly and the ageing process itself. This can then result in better understanding of the importance of certain interventions and health promotions and can also lead to more relevant care planning (Stuart-Hamilton, 2012).
Two of the modern biological theories on ageing will be focused on in the following paragraph. These will be divided further into two categories: programmed and error theories. Error theories describe that ageing happens as a result of the repetitive use of cells and tissues along the life span which eventually result in damage to the organs. This damage occurs as a result of different factors affecting the body. The healing abilities of cells and tissues diminish over time and are eventually lost(Touhy & Jett, 2016). Researchers believe that OA is closely related to so-called wear and tear theory which is a sub-category of error theories. According to the wear and tear theory, overuse of the joints over many years results in damage to the joint cartilage (Lei, Yongping, Jingming, & Xiaochun, 2013). On the other hand, programmed theories of ageing argue that each cell in the human body has its own predetermined lifespan that is different between individuals and no outside factors can affect this (Goldsmith, 2013). Ageing is therefore closely related to genetics, as well as hormonal and metabolic activity. One part of this theory states that, once the cells in the body begin to decline in results in a significant deterioration of the immune system. This then leads to increased susceptibility to morbidity and mortality (Tabloski, 2010).
The pathophysiology of OA will now be discussed. OA is a progressive, degenerative joint disorder. It is one of the most common disorders in people aged 65 or over. Furthermore, OA is more common among females than males. Over the years, there were many different theories espoused about whether ageing is the main reason behind the disease. Recent research has found that age is only one of the factors that contributes to the development of the disease (Saxon, 2014). OA occurs because of the gradual loss of articular cartilage present around the ends of bones, on the joints. This happens as part of the normal ageing process, but can be exacerbated by various extrinsic factors such as: occupation, physical activity, injury, diet and obesity (Meiner, 2015). The healthy cartilage is firm and rubbery, serving as an insulation between the bone ends and joints. Cartilage involved in the OA process loses its elasticity and resistance, due to repetitive stress, resulting in the bones rubbing against each other. Over time, further degeneration of the cartilage and hypertrophy of bone cells can also lead to formation of bony spurs that frequently alter the shape of the joint (Tabloski, 2010). Although the body attempts to repair the damage over time, this process is irreversible. This leads to pain, morning stiffness and reduced movement with a secondary effect being reduced balance. As a consequence, falls become quite common among persons with OA (Brown, Edwards, Seaton, & Buckley, 2015). In the case of Mrs Doe, several factors affect her current OA diagnosis: age, past work history as factory worker and obesity.
The following will now focus on the appropriate model of care for the case study. Older individuals like Mrs Doe who are struggling with OA and the complications from its disease processes require a certain level of assistance in order to promote their well-being and maintain their independence for as long as possible (Miller, 2012). In Australia, there are various services available to older persons in need of a support. Care can be delivered in both residential and community settings. This is determined by the current health status of the individual, the level of care they require and personal preferences. People are encouraged to stay in the community for as long as possible in order to promote and maintain their independence (Steering Committee for the Review of Government Service Provision, 2013). Mrs Doe can benefit from two models of care: Consumer Directed Care (CDC) or Person Centred Care (PCC). Both models are focused on the client and their preferences, but they are delivered in different settings. CDC is implemented in a community setting (Australian Government, 2016), while PCC is mainly used in acute settings and residential facilities (Australian Commission of Safety and Quality in Health Care, 2017). Mrs Doe is reluctant to move to residential care and prefers to stay in her own home. Considering that Mrs Doe does not have any other co-morbidities apart from OA and that she has an actively supportive family member, she is likely to benefit from a Home Care Package (HCP) delivered under the CDC model. Clients involved in CDC have access to different care packages according to their specific needs. Individuals that use CDC are included in decision making processes by participating in their individual care plan’s creation and also by helping to establish the time and place for delivery of their required services. Clients are also fully informed about financial resources they are entitled to and how these resources can be spent (Australian Government, 2016). This can be beneficial for Mrs Doe as it will enhance her independence and provide her with a sense of empowerment (Sarrami-Foroushani, Travaglia, Debono, & Braithwaite, 2014). To maintain the desired level of assistance, regular reassessment is established. It is important to remember that OA is a degenerative disease, meaning the level of care will increase over the lifespan (LeMone & Burke, 2011). Once the HCP is not able to provide a sufficient level of care, clients are normally then referred to Residential Support Facilities (Australian Commission of Safety and Quality in Health Care, 2017). This will help to provide a smooth transition from independent living to residential support for clients such as Mrs Doe. At the same time, HCP under CDC will help Mrs Doe avoid potential frustration, anxiety and depression from premature loss of independence (Sarrami-Foroushani et al., 2014; Stijnen, Jansen, Duimel-Peeters, & Vrijhoef, 2014).
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Relevant interventions and management strategies for Mrs Doe will now be discussed. This should be put in place in order to assist Mrs Doe living independently at home despite her OA. A multidisciplinary team needs to be involved in the care of the person with OA (Tabloski, 2010). To decrease the risk of falls and improve her strength and balance, regular a moderate exercise programme can be implemented. The physiotherapist can create suitable exercise programmes in line with the needs of the individual. Considering Mrs Doe’s obesity and the correlation of obesity with OA, she requires a healthy dietary regime prepared by a dietitian (Haber, 2013). Another member of the multidisciplinary team is the Occupational Therapist (OT) who will review the house environment and suggest modifications that will enhance Mrs Doe’s independence (Crisp & Potter, 2013). Moreover, the OT should regularly review the suitability of the walking aids that Mrs Doe is using (Ferraro, 2013). Pain related to OA can be managed with prescribed pharmacological therapy and non-pharmacological interventions such as warm showers, hot and cold packs and regular rest between activities (Touhy & Jett, 2016b). It is imperative that the client is educated about the disease processes as well as the importance of following the recommended management strategies. Moreover, the client should be educated to report any changes in general health status or increased pain levels not being managed by the current pharmacological and non-pharmacological measures (Meiner, 2015). Finally, Mrs Doe will benefit from culturally appropriate care. Engaging her in a community with an Eastern European background can improve her social life and her overall well-being (Australian Multicultural Community Services, 2017).
The following paragraph will discuss the legal and ethical complication that can arise while providing care for Mrs Doe. Consent is imperative to proceed with all the interventions outlined. For a consent to be valid it needs to be voluntarily given from an individual that is fully informed about the matters they are consenting to (Meiner, 2015). In the case of Mrs Do considering that she has limited English knowledge, it is imperative to arrange interpreter while obtaining the consent (Rorie, 2015). All the information obtained need to be confidential and not shared with any individual not participating in the care (Mazqai, 2015). Another important aspect is enabling autonomy for Mrs Do and respecting her preferences for the recommended model of care. Considering that Mrs Do is cognitively intact, it is up to her to determine will she include her family members in planning her care model and to which extent they can interfere in the process (Australian Government, 2016). Mrs Do can be advised about the likely benefits of an Advance Care Directive that can provide guidance for the carers and the family members in an event where Mrs Do is no longer able to express her wishes (Tabloski, 2010).
In conclusion, when looking after older adults with chronic health conditions, it is imperative to implement all the relevant skills and knowledge to enable maintaining the well-being and independence of the individual as long as possible. Possessing knowledge about different theories of ageing combined with the pathophysiology of the individual’s disease will provide better insight of normal ageing changes versus deterioration in the individual’s health. This will further assist in creating care plans and nursing interventions according to suitable model of care for the client’s individual needs. Involving the client in the creations of these care plans will provide asense of empowerment and promote the well-being of the individual. Finally, all the assistance given should always be legally and ethically valid and culturally appropriate.
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