Sample paper : HLTH7003: Geriatric Care
Introduction
The positive life experience of older adult in New Zealand is influenced through holistic approaches, psychological and psychosocial factors. The quality of life under holistic approaches and wellbeing is influenced by factors such as income, health, transport, and housing for positive ageing in an elderly adult’s life. Firstly, the essay critically examines the four holistic approaches that predict positive life experiences for an older adult, while evaluating its impact on older adults in New Zealand and highlights on some recommendations for improvement in positive ageing outcomes. Lastly, the essay evaluates physiological changes and psychosocial factors that influence and impact on the quality of life of an older adult.
Holistic Factors
In attempting to examine holistic factors that predict positive life experience for an older adult, the positive ageing indicators are explained such as income, health, transport, and housing in New Zealand positive ageing experience.
Income
Firstly, incomeis key to the wellbeing of New Zealand’s elderly adult so that food, clothing, and housing as basic need could be bought. Adequate income reflects wellbeing of older adult so that they not only enjoy a decent living standard but also enjoy prosperity (NZCCSS, 2020). As elderly adults rely on pensions, income for the New Zealand Superannuation is low and therefore older adults find hardship as rising housing, food, energy, and fuel costs impact their lifestyle.
Health
Secondly, New Zealand considers good health of older people as a national priority (Ministry of Health , 2002). The normal ageing process involves phasing out function over a period. Illnesses such as high blood pressure also emerge as age increases. Older people are fully less able to enjoy their lives without good health, their opportunities are limited, and their general level of contentment and satisfaction is likely to decrease (Age Concern New Zealand , 2002). Healthy ageing reflects on comprehensive physiological changes in older adults. For example, an older person with chronic and degenerative conditions may neglect moderate or vigorous physical activity, so large amounts of time spent waiting of elderly people with serious disability are significant risk factors for negative health effects.
Housing
Thirdly, good quality, accessible and sustainable housing is a significant factor in preserving independence and ageing in a positive way for older people. Housing that is suitable for the level of independence of the older person and encourages the protection of their health and wellbeing is likely to help avoid premature admission into hospital and residential care and minimize health and social costs. For example, safety bars, ventilation, proper heating system and handrails would reduce accidents and health issues (Howden-Chapman, Signal, & Crane, 1999).
Transport
Transport is an important factor in enabling healthy, socially, and active lifestyle in communities for elderly adults. The lack of accessible and appropriate transport services leads to social isolation, which could be a barrier to older adults independence (Age Concern New Zealand , 2002). While on the other hand, promoting mobility would involve physical activities such as walking to bus stop or driving a mobility scooter to shopping.
Evaluation
Income
The four factors have a huge impact on life experience for older adults. Such as low income would lead to poor health, as elderly adults will not be able to meet the medical costs. There is a cost of social involvement that could be denied to low-income elderly adults living with social networks being constrained because they do not have the means to participate. As report shows, the proportions of older New Zealanders experiencing extreme hardship are fairly small (2.4 %) (Stephens, Alpass, & Towers , 2020). While as a positive attribute, New Zealand government on the other hand has a range of programmes to secure financial stability such as NZ Mega, Kiwi Saver, and Super Gold Card, free primary care and rebates in rates to reduce elderly adults poverty (Super Seniors , 2019).
Housing
Furthermore, getting adequate housingwill improve the capacity of people to adapt to disability and disease, and make it more likely that they will be able to continue living independently. A study conducted by Howden (1999) shows that older people usually want to live as long as possible in their own homes, whether owned or rented. Having handrails, in bathrooms, toilet and other areas would reduce falls that would be a positive impact of housing for older adults hence appropriate; affordable housing would protect older adults from hazards and encourage good health and wellness.
Health
In addition, the health of older adults is affected by the fact that how long people live and the quality of their lives depends on good health, which is why older adults want to be free of pain, disability and suffering. Older people with poor health restrictions are more likely to have a reduced standard of living. An shift to positive behaviors for example physical activities and healthy eating leads to good health and wellbeing of older adults while on the other hand, The rise prevalence of other chronic illnesses and decreased incidence of dementia can raise health and disability demand, as the population is aging (Age Concern New Zealand , 2002).
Moreover, transport impacts negatively on older adults as with reduced physical mobility could be having difficulty using public transportation for example using public transport increases barriers that includes distance from bus routes, bus access, timetable, fares, and facilities at bus stops and interchanges. Additionally, ageing decreases clear vision and hearing ability which could be a negative impact on driving their private cars having declined chance of renewal of driving license for elderly drivers and could have increased chances of accidents. Older people should be assessed regularly for their driving fitness and prepared early for the possibility that they may not be able to drive in the future at some point. This should happen not only at the time of renewal of the driver’s license, but whenever health conditions or medicines change that may affect the driver’s license for older adults.
Recommendation
Income
In recommendation, the New Zealand Superannuation should take proper account of the particular circumstances of older people and adjust by giving discounts and subsidies in the cost of public services, such as electricity, heating, telecommunications, housing (rent or rates), and expenses associated with maintaining social participation, including transportation to prevent hardship (Super Seniors , 2019).
Transport
Secondly, walking to a long distance from the residential care or personal homes to get public transport decreases willingness to travel. It is recommended that bus stops should be established close to residential cares. Secondly, elderly adults driving license renewal should be decreased to six monthly, so that proper health is considered to approve license. Thirdly, having a separate footpath for driving mobility scoters for elderly people would prevent accidents and increase confidence of driving to increase social involvement.
Housing
New Zealand has a higher seasonal mortality rate among older people compared with other more severe countries (Age Concern New Zealand , 2002). Therefore, redesign of elderly homes for proper ventilation to reduce dampness and moulds is highly recommended with a minimum cost while promoting full independence in decision making would enhance psychosocial wellbeing of elderly adult. Secondly, a care coordinator is recommended to be allocated in residential care units and rest homes to ensure the changing needs of older adults are provided such as mobility scoters and wheelchairs.
Health
The increase in life expectancy of 65 years and plus of New Zealand population has increased challenges to health providers (Ministry of Health, 2018). It is recommended that government health care benefits such as subsidies must be adequate to ensure that older people can afford to see their GP, be referred for specialist examination, and be able to access prescription, laboratory and radiology services as they face hardships in terms of low income (Age Concern New Zealand , 2002). Secondly, more district nurse and mobile health should be allocated by Ministry of Health to reach out rural elderly adults for medical care visits
Physiological Changes
Physiological changes arise over age in the whole system of human organs. Progressive physical deterioration and the physiological progressive decline with an elderly age include a reduction of productivity and a lack in viability. Older persons become exposed to illness and are prone to it such as cardiovascular system, respiratory system, and nervous system.
Cardiovascular system
There are changes in cardiovascular system with ageing resulting in alterations in cardiovascular physiology (Cheitlin, 2003). The aged heart undergoes a number of functional changes and compensatory responses which diminish its ability to react to increased workload and reduce its reserve power in older adult hence reducing ability in performing daily activity (Strait & Lakatta, 2012). Ageing process affects cardiovascular system such as the heart is less able to pump efficiently, and due to this, there is lowered blood oxygen level as a result elderly adult get tired quickly.
In addition, social integration and loneliness affects quality of life in older adults. Such changes reduce physical mobility and confidence in older adults in doing daily tasks and too extreme case cause anxiety and heart attack. Consequently, with different physical and emotional symptoms, such as fatigue, edema and sleeping difficulties, limiting their physical and social activity, leading to poor quality of life in older adults hence resulting in hospitalization.
Respiratory System
A number of parameters of lung function gets affected as ageing such as ventilation, gas exchange as well as mechanisms for pulmonary defense (Sharma & Goodwin, 2006). The respiratory system begins to lose its elasticity as it ages. Older people living with advance respiratory disease and sever chronic breathlessness have a poor quality of life experience as it is a disabling symptom to experience. Fatigue and cough are two major cardinal signs of severe respiratory disease and have very negative effects on quality of life that limits socialization of older adults (Booth & Johnson , 2019). Isolation, lack of self-care, loss of social confidence, loss of physical activity and depression are examples of influence on quality of life in older adults.
Consequently, often people with progressive respiratory illness (and those closest to them) experience poor quality of life, impaired by persistent breathlessness, exhaustion, and other symptoms. They are socially isolated from long-term disease risks and are often financially impoverished.
Musculoskeletal System
Ageing affects all bones, muscles and joints as they are affected by changes in connective tissues and cartilage and becomes more brittle (Forte, 2019). The bones become more weaken and are prone to fracture while muscles lose its strength. The cartilage within a joint is thinner and the cartilage materials are altered which will make the joint less resilient and more vulnerable to injury (Roberts , et al., 2016). The decrease in muscle mass is correlated with a decrease in muscle strength, which leads to frailty, fracture risk, reduced quality of life and loss of independence in older adult. This increases social isolation and pain in joints hence increasing other health problems such as old age obesity, due to less physical activity.
In addition, health problems associated with musculoskeletal system such as arthritis, osteoarthritis, and osteoporosis. Though these ageing changes may not be life threatening, it reduces confidence, independence and mobility that affects quality of life in an older age.
Psychosocial Factors
Loneliness
Older adult’s loneliness and isolation can increase because of decreased personal relationships, with such social isolation leading to or exacerbating geriatric depression (Han et al, 2015). Loneliness leads to depression in older adults and negatively effect on healthy ageing. Good mental health can reduce depression and a sense of alienation and loneliness by increasing self-esteem by enhancing their participation in social activities. Loneliness is determined by external and internal factors relatively, such as absence of social network, absence of family interaction relationships and disagreements or dissatisfaction of family and social relationships (Han et al, 2015). Loneliness and social isolation in older adults are linked to mood and wellbeing which decreases quality of life and reduces ability to do daily work.
Loneliness not only leads to depression but also sometimes could lead to serious health related issues such as suicide. As people get older, they are more likely to suffer age-related losses. Such losses for example death of a spouse may impede the maintenance or acquisition of preferred relationships, resulting in a greater loneliness incidence (Willis, Goodwin, & Lee, 1997). Many people feel isolation either because of living alone, lack of near family relations, reduced links with their culture of origin or an inability to participate actively in local community.
Relocation
Relocation is common in older adults and may occur several times during older age for example, retirement homes with desirable amenities, smaller quarters to reduce the burden of care, siblings’ or adult children’s homes, or residential care facilities. Physical and mental health is significant predictor of relocation transition, as is adequate and careful planning (Scheibl et al, 2019). A minority of the elderly adults voluntarily moves closer to their families for support and in anticipation of the need for assistance well ahead of a health or social care crisis while they have power over their decision to relocate.
Relocation sometimes also leads to loneliness, anxiety, isolation and depression as it reduces the independence of the older age while on the other hand, a positive attribute to relocation is that it has more care and support, impaired wellbeing and safety of older adults.
Bereavement
Social interaction and companionship decrease while changing social status in bereavements in an elderly person’s life. Older people find difficulty coming out of grief by death of a spouse as research by Tohit et al (2013) shows that ages between 75-84 years have higher risk of developing complicated grief’s and leading to illness such as depression, sleep disturbance and anxiety which could be resolved in a short time. Feeling of guilt, hallucination, and thoughts of unrelated deaths to survivorship are some typical symptoms that could also result to self-harm and neglecting to social interaction in elderly adult.
However, bereaved patients should be monitored carefully as a decline in health is possible or may lead to suicide hence use of short-term anxiolytic drugs could help with anxiety relief (Cavalli, Lalive, & Guillet, 2009).
Conclusion
In conclusion, positive ageing indicators such as income, housing, health, and transport are some of the determinants that impact the quality of life for elderly adults. Families, health providers and residential cares in New Zealand play a vital role in taking good care of an elderly adult by maintain their confidence and independence of life. The aging process will affect the old age people physically, psychologically, socially, and spiritually. As ageing progress, physically aged people become less active. Based on wear and tear theory of aging, degenerative changes takes place almost in all the systems such as brain, cardiovascular system, respiratory system musculoskeletal system exposing the elderly people to a greater degree of physical illnesses (Cavalli, Lalive, & Guillet, 2009). The changes such as relocation, bereavement and loneliness lead to depression and anxiety as a psychosocial factor that impact quality of lifer for and older adult.
Reference
Age Concern New Zealand. (2002). Retrieved May 16, 2020, from Towards a Positive Future – Policies and Aims of Age Concern New Zealand builds on and updates Age Concern’s 2002 policy document Challenging the Future.:
https://www.ageconcern.org.nz/files/TowardsPositiveFuture.pdf
Bpac NZ. (2010). Retrieved May 24, 2020, from Driving rules and assessment for older people: https://bpac.org.nz/BPJ/2010/March/driving.aspx
Cavalli, S., Lalive, C. J., & Guillet, L. (2009). Bereavement in Very Old Age: Impact on Health and Relationships of the Loss of a Spouse, a Child, a Sibling, or a Close Friend. Omega (Westport , 60 (4), 301.
Cheitlin, M. D. (2003). Cardiovascular Physiology- Changes With Aging. The American Journal of Geriatric Cardiology , 12 (1).
Dezube, R. (2019, June). Effects of Aging on the Respiratory System. Retrieved May 21, 2020, from MSD: https://www.msdmanuals.com/en-nz/home/lung-and-airway-disorders/biology-of-the-lungs-and-airways/effects-of-aging-on-the-respiratory-system
Forte, A. V. (2019, December). Effects of Aging on the Musculoskeletal System. Retrieved May 21, 2020, from MSD: https://www.msdmanuals.com/home/bone,-joint,-and-muscle-disorders/biology-of-the-musculoskeletal-system/effects-of-aging-on-the-musculoskeletal-system
Han , K., Lee, Y., Gu, J., Oh, H., & Kim, K. (2015). Psychosocial factors for influencing healthy aging in adults in Korea. BioMed Central , 13 (31), 2.
Hasim, S. M., Eng, C. T., Tohit, N., & Wahab, S. (2013). Bereavement in the elderly: the role of primary care. Mental Health in Family Medicine , 10, 159.
Howden-Chapman, P., Signal, L., & Crane, J. (1999). Housing and health in older people: Ageing in place. Social Policy Journal of New Zealand , 13 (13).
Ministry of Health. (2002). Retrieved May 17, 2020, from The Strategy in Summary ; Health of Older People Strategy: https://www.health.govt.nz/system/files/documents/publications/olderplebb.pdf
Ministry of Health. (2018, June 18). Retrieved May 19, 2020, from Older people’s health data and stats: https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/older-peoples-health-data-and-stats
NZCCSS. (2020). Retrieved May 16, 2020, from Poverty and older people: https://nzccss.org.nz/work/older-people/poverty-and-older-people/
Roberts , S., Colombier, P., Sowman, A., Mennan, C., Rolfing, J. H., Guicheux, J., et al. (2016). Ageing in the musculoskeletal system. Acta Orthop , 87 (363), 18.
Scheibl, F., Farquhar, M., Buck, J., Barclay, S., Brayne, C., & Fleming, J. (2019). When Frail Older People Relocate in Very Old Age, Who Makes the Decision? Innovation in Aging , 3 (4).
Sharma, G., & Goodwin, J. (2006). Effect of aging on respiratory system physiology and immunology. Clin Interv Aging , 1 (3), 254
Stephens, C., Alpass, F., & Towers , A. (2020). Economic Hardship Among Older People in New Zealand: The Effects of Low Living Standards on Social Support, Loneliness, and Mental Health. New Zealand Journal of Psychology , 39 (2), 50.
Strait , J. B., & Lakatta, E. G. (2012). Aging-associated cardiovascular changes and their relationship to heart failure. Heart Fail Clin , 8 (1), 144.
Strait, J., & Fleg, J. L. (2012). Age-associated changes in cardiovascular structure and function: a fertile milieu for future disease. Heart Fail Rev , 17, 547.
Super Seniors. (2019). Retrieved May 16, 2020, from Better Later Life: http://www.superseniors.msd.govt.nz
Willis, L., Goodwin, J., & Lee, K.-o. (1997). Impact of Psychosocial Factors on Health Outcomes in the Elderly: A Prospective Study. Sage Journals , 10 (1).
.