Global Health and Healthcare Issues: Older Adults
The field of nursing has numerous challenges that practitioners should address globally. However, with the permanent growth of the percentage of aging population across the world, the number of issues that practitioners need to handle multiplies in the arithmetic progression. For instance, Prince et al. (2015) specify that at least 23% of the worldwide burden of disease is attributable to the elderly, whose health problems are both complex and complicated. Apart from biological aging of the body and continuous loss of the scope of functional independence, these individuals are likely to have multiple chronic conditions, comorbidities or disability. Therefore, the target population needs intensive medical care. Due to the fact that the percentage of older adults, especially those above 80, is likely to grow further, the challenges persist and are going to become even more topical and acute (Palmer & Paterson, 2010). The complexity of the problem requires thorough and holistic solutions; however, it is arguable whether older adults across different countries have these strategies in place. Therefore, the paper considers care for older individuals in the sphere of nursing in a brief but apt manner. The report outlines the most critical elements of the issue, such as its implication in the context of education, populations’ health, social relations, policies and economies as well as draws conclusions from the discussion.
History of the Topic in Nursing Curriculum
Scholars confirm that care for older population has been an integral part of nursing from a historical perspective, but the needs for current update in the nursing curriculum should not be underestimated. For decades, nurses have been following narrow-specific guidelines for gerontological care while targeting particular diseases rather than the concept of aging as a whole (Palmer & Paterson, 2010). Since the late 1980s-1990s, an evolutionary change of such positioning of healthcare needs of the target population in research and practice areas has been introduced. However, the process is rather slow and controversial in the educational context, especially based on the long-term stereotypes about the target population as a burden for the society (Hindle & Coates, 2011). Hence, the curriculum still has to be adjusted to the multidimensional needs of this growing part of population.
In this respect, Hindle and Coates (2011) assert that contemporary training and education of nurses with a specialization in geriatric care vary across the institutions. To illustrate, some educational facilities still focus on preparing specialists with narrow-focus skills and knowledge of particular, most common diseases and other branches of the field. In contrast, other institutions emphasize that “teaching and learning about older people’s health needs, including assessment and care planning, whilst maintaining dignity, will be fundamental for all nursing courses” (Hindle & Coates, 2011, p. 4). Additionally, Palmer and Paterson (2010) recognize that nurses should learn from practice and exchange the feasible care strategies with their colleagues across the borders. Hence, the necessity for a change is evident so as to comprehensively meet the multiple needs of this population. Furthermore, evidence exist that incorporation of technology in nursing preparation is valuable not only in terms of advanced care and accurate diagnostics, but it also assist these individuals, allowing them to “age in place” and expand “life in years” instead of “years in life” (Holtz, 2016, p. 508). Nonetheless, the fact that no standardized curriculum exists throughout healthcare institutions undermines the likelihood of holistic care and assistance to older adults, especially in countries with poorly developed healthcare infrastructure.
Documented Healthcare Disparities/Inequalities
Tracing and monitoring the statistical as well as qualitative data regarding the existing healthcare inequalities and/ or disparities among older adults worldwide and within countries’ borders is very important. This information is valuable for decision-makers and practitioners in terms of developing policies, regulations and strategies to address the most prevalent issues in the sector, fill in the gaps, relocate and allocate resources efficiently and according to the needs of the specified population segment, to name but a few. For instance, Holtz (2016) stresses that approximately 59% of the global older adult population live in developing countries and thus are likely to have either limited or no access to efficient health care services. Moreover, older people from developing nations have a higher likelihood of having multimorbidities because of poorer quality of life, low income and social status as well as a “higher risk of care dependency” as compared to the same population group in industrialized countries (Picco et al., 2016, p. 2). Although these are just a few examples, the conclusion seems more than evident: the reported healthcare disparities and inequalities are crucial for informed decision-making and proper support and care to older adults globally.
The specificity of the regulatory basis for this target population is that it is mostly of narrowed nature and majorly targets particular diseases rather than thoroughly analyzes mental and physical health of the discussed population group. Apart from that, country-specific regulation guidelines are developed by healthcare agencies, such as the American Diabetes Foundation or the Commission for Certification in Geriatric Pharmacy among others. At the same time, one should mention that Healthy People 2020 aims at an update in the regulatory background for care for older adults. The goal is framed as “improve the health, function, and quality of life of older adults” and is considered as one of the fundamental regulations in the field from an international perspective (US Department of Health and Human Services, 2016). On the other hand, this general goal is also narrowed down to fragments that target the most common diseases in this population instead of holistic promotion of a healthy lifestyle. Thus, the gaps have also been identified in this aspect of the field.
Moral Issues in Global Healthcare for Older Adults
The factor of morality is another significant component of the discussed topic. On the one hand, a nurse practitioner should be concerned with the value of dignity of any patient because this virtue is at the core of the professional ethics (Hindle & Coates, 2011). However, the actual state of affairs reveals that older adults are often forced to experience the implications of ageism in the changing attitude to their age and decreasing functionality as physical, psychological and sociological individuals (Hindle & Coates, 2011). For example, while some scholars emphasize that age-based discrimination is not frequent in industrialized countries, these stereotypes are deeply rooted in the minds of practitioners and common people at large (Hindle & Coates, 2011). Therefore, apart from the general health vulnerability, these people face prejudices, stereotypes and even abuse from caregivers, family members and healthcare providers among others.
“Burden of Chronic Care”
“The burden of chronic care” is one of the most distinct traits of this population segment. For example, studies report that from 60% to 80% of older adults are likely to have at least 1 chronic disease, ranging from heart failure and diabetes to dementia (Pines, Mullins, Cooper, Feng & Roth, 2013). The latter becomes one of the most unpredictable chronic conditions as its frequency increases. In addition, the evidence exists that low-income and middle-income regions encounter a greater economic burden of care about older adults, which is manifested through numerous infections, heart disease, respiratory and sensory disorders (Prince et al., 2015). Similarly, with age, these individuals become more prone to acquiring morbidities due to having little resources, if any, to address these concerns.
Healthcare Productivity and Economic Costs
The situation has a detrimental impact on the productivity of healthcare and the incurred costs. The trend can be evidenced with the use of a single study. In particular, according to the data of 2001-2009 US national study, the number of older adults’ visits to healthcare institutions increased by 23.5%, especially for emergency departments (Pines et al., 2013). The phenomenon also entailed additional expenditures on diagnostic testing procedures, with the rise of computer tomography use alone by 167% (Pines et al., 2013; Ward & Schiller, 2013). Moreover, readmission of these patients increased from 2% to more than 4% (Pines et al., 2013). However, these several facts illustrated the case in the industrial country while it is more than reasonable to assume that the circumstances and consequences for people in developing states are far more acute.
In accordance with the analysis’ findings, it is evident that older adults represent an extremely vulnerable population segment due to the current living conditions. Since the number of these individuals as compared to the general population increases, the role of nurses in addressing this acute challenge should be considered. Primarily, nurses have long been a part of the general care delivery to the target population. Nonetheless, their preparation to working performance seems to be of a rather fragmented nature. In particular, the lack of a unified conception of this type of care is one of the issues that undermine older people’s quality of life and care accordingly. At the same time, the target population encounters numerous chronic conditions, which places an additional burden on healthcare, including financial and economic implications among many others. Thus, the need for a comprehensive strategy in the sphere is more than evident.
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