HEALTH CARE NEEDS IN THE ELDERLY

Background
Population aging Increase of care needs Societal and family structure changes The family as the main informal support

system Uncertain future of elderly care A challenge for: State/Public Social and Health care system as well as for family dynamics

Population (1999)
WORLD 0-14 years 15-64 years > 65 years TOTAL 31% 62% 7% 5918,6 Millions EU 17% 67% 16% 374,6 Millions

PLACES of CARE for the ELDERLY in EUROPE

94% in the COMMUNITY

6% in geriatric care facilities

Aged adult

INFORMAL NETWORK
Family members Friends and neighbours

FORMAL NETWORK
Community care Emergency room, Hospital

Common geriatric acute events

Surgical emergency ()

Medical vs. Psychiatric vs. Social CRISIS

Acute pain of unknown origin Dehydration, fall, pulmonary tract infections () Drug side effects !! Delirium, spacio-temporal disorientation () Psycho-social crisis Depressed mood, family conflict ()

GERIATRIC PATIENTS in the emergency ward

Medical vs. Psychiatric vs. Social CRISIS

OWN EMOTIONAL FEELINGS LIFE COURSE CO-MORBIDITIES & DAILY FUNCTIONING LIFE PROJECTS QUALITY of LIFE...

Affective surroundings

FAMILY MEMBERS
EMOTIONAL FEELINGS
Anxiety, fear, culpability, anger, Indifference, acceptation or denial...

PROBLEMS of UNDERSTANDING
Acute disease vs. multiple co-morbidity

PARTICIPATION in CARE
Burden of care

QUALITY of LIFE, PROJECT of LIFE ... FINANCIAL CONCERNS !

DISJUNCTION /GAP between HUMAN BEING and SURROUNDINGS !

Medical vs. Psychiatric vs. Social CRISIS

Need to avoid

INAPROPRIATE HOSPITAL ADMISSIONS !!! INAPROPRIATE HOSPITAL STAY

QUALITY of CARE

STRUCTURES PROCESSES OUTCOMES ( or )

Accessibility to the needed care

The GERIATRIC PROCESS

Assessment

J GRIMLEY EVANS Brit Med J 1997; 315: 1075-7

GERIATRIC CARE MODELS

BIOMEDICAL +++ FUNCTIONAL ABILITY HUMAN / TECHNICAL SURROUNDINGS QUALITY of CARE ETHICAL issues of care QUALITY of LIFE +

DIAGNOSIS DAILY FUNCTIONING

and

Importance of USING VALID CRITERIA

COMPREHENSIVE COMPREHENSIVE GERIATRIC GERIATRIC ASSESSMENT ASSESSMENT (CGA) (CGA)

CGA in the emergency room DETECTION of unrecognized geriatric problems

7 6 5 4 3 2 1 0

1.8 1.5

The screening procedure allowed the detection of an average of

1.7 1.3
4.5
A fte r C G A

2.8
B e fo r e C G A

additional problems (Paired t-test, P < 0.001)

N u m b e r o f d ia g n oSsta s d a r d d e v ia ti o n en

Number of geriatric problems before and after CGA

300

PAIN 200 INCONTINENCE 100 DEPRESSION0 ADL -100 impairments

-200

Nb of patients

After CGA Before The screening procedure allowed the detection of an average of 1.7 1.3 additional problems
(Paired t-test, P < 0.001)

COGNITIVE -300 Disturbances

-400 SENSORY troubles

9 10 11

Nb of Geriatric Problems

QUALITY of CARE

STRUCTURES
Important role Important role of an of an interdisciplinary interdisciplinary geriatric team geriatric team in the emergency in the emergency room room

PROCESSES

OUTCOMES ( or )

The good patient in the good bed

The GERIATRIC PROCESS

Assessment Agree objectives of care

Ag ree d Objectives of Care

What does the patient want ? What is feasible ?

GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84

The GERIATRIC PROCESS

Assessment Agree on care objectives Specify the management plan

J GRIMLEY EVANS Brit Med J 1997; 315: 1075-7

MANAGEMENT PLAN
Need of a precise diagnosis to provide the best possible treatment To close the ecological gap between patient abilities and environmental possibilities
GRIMLEY EVANS J J Royal Coll Phys 1997 ; 37 : 674-84

The GERIATRIC PROCESS

Assessment Agreement on care objectives Specify the management plan Assure an adequate follow-up
J GRIMLEY EVANS Brit Med J 1997; 315: 1075-7

Patients quality of life and cost of care

Patients QoL Relieving sufferingthe

IF accessibility to the emergency room is easy - the emergency ward is equipped with high tech Medicalisation of old age - an interdisciplinary geriatric team is not to the emergency is included to be repudited staff geriatric care networks but - should be encouraged ! (community and hospital) S are EBRAHIM Brit Med J 2002; 324: 861-3 () working harmoniously
Cost of care

Adapted from GOODWIN JS New Engl J Med 1999; 340: 1283-5

General objective
To evaluate the health care needs and effectiveness of care provided to people over 65 years of age. The final objective is to identify new nursing interventions and innovations that will improve health care of people over 65 by the implementation of holistic care.

Purposes of the Informal Caregivers group

Identification of the characteristics of the IC

and their dependent care receipient

Analysis of the type of care provided by the

IC and their support system available activities on the IC themselves

Analysis of the consequences of the care Describe the healthcare policies for IC Design new health support intervention for

IC

Informal caregivers

Women: 83.95% Mean age: 56 year old House keeper: 60% Working outside their homes: 22%

Men: 17% Mean age: 65 year old Retired: 45% Working outside their homes: 42%

Full time: 83%

Full time: 57%

Role: Daughter-son / daughter-son in low: 62%

Spouse: 26% Paid caretaker: 5-9 %

Activities done by the informal caregiver

Over 50% dedicate more than 5 hour per

day (>150 hours / month) IADL (80%) ADL (60%) Women do more AVD y AIVD Men do mainly IADL

Dependency
TIME HIGH MODERATE LOW > 3 h / Day 1-2 h / Day 1 h / Week ADL / IADL 3 or more hrs ADL 1-2 hrs ADL or >5 hrs IADL Some IADL (< 5 hrs)

ADL & IADL

ADL

IADL

Hygiene Nutrition Elimination Bathing Moving Medications Treatment of ulcers and wounds

Cooking House cleaning Laundry Ironing Telephone use Banking Transportation

Support resources

Economic help (Decrease in taxes, time off from work and flexible working time) Primary care Home care Day care Telehealthcare

Nursing homes Relieve centers Home assistance Support groups Other interventions

Voluntary help Associations Community help

Support from Nursing

INFORMATION PROFESSIONAL

EDUCATION EMOTIONAL SUPPORT

Consequences of care on caregivers

NEGATIVE Depression Anxiety Burnout Stress Fatigue Aches and pains Social isolation

POSITIVE

Personal development Meaning of life Autonomy Sense of control Positive relations with others Self-acceptance Positive feelings

Conclusions
The informal care is the most important

support of the elderly dependent. To improve the care of the elderly, it is essential to provide with adequate resources to the informal caregiver. It is necessary to do more research to generate innovative interventions to support the caregiver activities and their quality of life.

Conclusions
1. 2. 3. 4. 5.

ICs have the need to express their feelings and experiencies. There is a lack of social and political understanding and acknowledgement of the IC rol. It is difficult for the IC to identify the resources that she / he needs. It is difficult for the IC to apply for resources (Channels of application and paper work). The health care system is effective for the treatment of acute health problems, but it to slow to solve chronic health problems related to dependency.

Scientific collaboration
Informal / Principal Caregivers Ethical & Legal problems

Home, primary & continuity of health care

CARE FOR PROYECTO THE ELDERLY PEOPLE NACIONAL

Coordination

Nursing interventions

Outcomes evaluation

THE FUTURE
SYNERGY

Informa / principal caregivers (national level) & Informa / principal caregivers ( EU Countries)

EU RESEARCH FUNDS