Introduction
Australia’s aged population is increasing, and this phenomenon calls for more care services in residential facilities for the aged. The services also need to be improved in order to meet the challenging and complex care needs and health preferences of the aged people (Bruen, 2005, p. 131). Notably the residential aged care sector should meet these challenges in a way that ensures the wellbeing of Australia’s aged people, in a cost effective manner, for the benefit of the whole community.
In this regard, Bird and Parslow examine depression in older people and the potential of social programs to prevent depression in the aged living, in residential care (2002, p. 107). Depression is one of the leading causes of common late-life disorders among the aged population. The authors identify different risk factors that predispose the aged population to recurrent depression viz. functional impairments, vascular diseases and metabolite abnormalities. From the results of this study, the authors recommend three nursing care approaches such as dietary supplements, exercise, and increased depression awareness among the aged at RACFC.
In contrast, Duque et al. assess the risks of older people living in care facilities to suffer fractures and osteoporosis. The study establishes that regular fracture checks can facilitate early implementation of fracture prevention measures (2010, p. 175). In particular, the routine determination of the levels of phosphate and calcium serum can indicate fractures or osteoporosis. The study recommends a multi-factorial approach involving the use of pharmacological and non-pharmacological methods to prevent this condition.
Another study by O’Halloran, Britt, and Valenti reviewed the general practitioner consultations provided at residential aged-care facilities (RACF). A workforce shortage in RACF is a serious problem facing specialized care delivery for the aged making the management of complex medical conditions problematic. The authors conclude that, advanced training of informal workers can address the problem of workforce shortages in RACF.
Review of the Articles
The care needs of older Australians are challenging because of the complex conditions that the aged suffer. In addition, the ability of the older Australians to access specialized care is limited by financial constraints and the availability of services. Specialized care at RACF is largely lacking; O’Halloran, Britt and Valenti attribute this to lack of specialized practitioners in RACF settings (2007, p. 89). The care given general practitioners (GP), who are paid by the Medicare Benefits Schedule, is different from all other GP encounters in the country. This implies that patients in high-level care may not access adequate and specialized care as required. The authors identified low referral rates to specialists at the RACF. Thus, older patients with challenging care needs and complex conditions do not access specialized services such as physiotherapy, which predisposes them to osteoporosis and associated fractures.
In this regard, Duque et al examines the care given to older patients suffering from osteoporosis in RACF settings, in Australia (2010, p.173). The authors attribute the failure to assess the patients for fracture risks to increased osteoporosis in patients living in RCF settings. While O’Halloran, Britt, and Valenti support increased specialized consultation services at RACF facilities to prevent chronic conditions, Duque et al. suggest a multi-factorial approach, which incorporates pharmacological and non-pharmacological interventions implemented early to protect patients in RACF from future fractures. In addition, O’Halloran, Britt, and Valenti study focuses on the competition for specialized practitioners in the acute care sector. Presently, there is a shortage of nurses and GPs working in aged facilities (Iyengar, & Lepper, 2000, p. 351). This has implications on the availability and quality of aged care services. In addition, lower remuneration of aged care workers compared to workforce in other care settings fails to attract specialized workforce at aged care facilities.
Duque et al recommend specialized interventions to lower the risk of the aged developing osteoporosis and fractures. This implies case management care for this group of patients. According to Quine, Morrell, and Kendig (2007, p. 324), case management for aged patients results to improved and consistent quality care, lowers the risk of physical and cognitive impairment and increases staff morale and family involvement in patient wellness. Therefore, the shortage of aged care workforce can be addressed through extending the scope of practice for enrolled nurses and registered nurses as proposed by O’Halloran, Britt and Valenti (2007, p. 97). This will primarily involve utilizing the skills and experience of care workers to suit the broad nature of aged care needs (Baxter, Glendinning, & Clarke, 2007, p. 201). The effectiveness of community care services for the aged is largely dependent on informal or general practice care providers (Borowski, Encel, & Ozanne, 2007, p. 221). This means that specialized training and financial support to community caregivers can reduce the demand for residential care, a practice that constrains the RACF facilities.
In this context, Bird and Parslow examine the potential of community/social programs to lower depression in aged people, in RACF settings. As the authors put it, “depression is one of the leading causes of psychiatric disorders among older peoples” (2002, p.107). Karmel, Lloyd, and Anderson (2008, p. 13) found out that, the level of depression in nursing homes is high, with Major Depressive Disorder being common. Furthermore, mild cognitive impairment among the older people increases the prevalence of depression and acts as an impediment to the early detection of depression by GPs (Bird, Kurowski, Dickman, & Kronborg, 2007, p. 554). As a result, most of these patients are not under antidepressant medications resulting to low-level care for these patients. While O’Halloran, Britt and Valenti suggest specialized training for informal care providers providing community care services for older people, Bird and Parslow recommend increased community awareness on care services for the aged to improve care delivery. Additionally, Bird and Parslow suggest interacting prevention methods including exercise and dietary supplements to reduce depression (2002, p. 110). In contrast, Duque et al recommend pharmacological and non-pharmacological methods such as hip protectors for prevention of osteoporosis in aged patients at RACF.
The Findings of the Articles
Care delivery for aged people in RACF faces broad ranging challenges. Chronic illnesses and the predisposition to acute conditions mean that quality and cost-effective aged care is essential. Osteoporosis is a serious problem that affects the aged people in Australia. Furthermore, less intervention measures are put in place to prevent this condition among the aged people at RACF. Duque et al. study involved an examination of the osteoporosis treatment strategies in RACF facilities, in Australia. The study found out that practitioners rarely identify or treat osteoporosis at RACF settings. The author recommends pharmacological interventions that include calcium and vitamin D supplements and biphosphates, and non-pharmacological measures such as hip protectors to prevent fractures in this at-risk patient group.
Bird and Parslow, on the other hand, found out that awareness on late-life depression among in the general population is low. In particular, the elderly people and aged caregivers are largely unaware of late-life depression often due to mild cognitive impairment common at this age. Consequently, the researchers recommend expansion of community-based exercise alongside nutritional supplements to prevent and increase awareness on late-life depression. In contrast, O’Halloran, Britt, and Valenti study addresses the issue of shortage of aged care workforce (2007, p. 91). They compare the clinical activity performed by GPs during visits to RACFs with the general GP practice in Australia. The researchers found out that, the GP characteristics, and care for RACF patients, differ from general care delivery with respect to treatments provides and case management. The authors recommend training of informal caregivers at RACF to assist in mitigating the problem of specialized workforce shortages.
As a nurse, I think the challenging and complex care needs of the elderly people at RACF can be addressed in multiple perspectives. Patient-cantered approach, where the patient care choices are considered, will have the potential of influencing the scope and nature of aged care services. In this regard, I think chronic conditions such as osteoporosis will be detected early for prevention. In addition, I think improving aged care education and training will serve to extend the nurses scope of practice and help overcome the inflexibilities and inefficiencies of the workforce with regard to aged care delivery.
Conclusion
The care needs for the elderly people at RACF are complex and challenging. In addition, a shortage of workforce in this sector and inadequate diagnostic coupled with therapeutic measures, specific to elderly care, hampers quality care delivery for the aged. Duque et al established that elderly caregivers rarely identify or treat osteoporosis, a common condition among the elderly people at RACF. This implies that the diagnostic procedures for aged care are inadequate. In contrast, Bird and Parslow establish that practitioners and the general population are largely unaware of late-age depression; a phenomenon that is indicative of inadequate aged care training. On the other hand, O’Halloran, Britt and Valenti found out that GPs consultations during visits to RACFs differs from the general practice in many respects affecting care delivery.
Reference List
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