Dr A.

I Aiyegbusi

PST 513: HOME CARE VS

INSTITUTIONAL CARE
 INTRODUCTION
 The elderly age is an integral part of human life.
 It is the evening of life, It is unavoidable, undesirable,
unwelcome and problem- ridden phase of life
 Old age is a phase of life, which will arrive and stay till
death takes its toll.
 The way a person adapts and copes, reflects his aging
process on a psycho-social level
 Often elderly people faces bad life events in their life
such as the loss of spouse and old friends, faced with
multi-dimensional problems like financial constraint and
have no source of income, completely depending on their
spouse or children.
 Just a few decades back, in the majority of cases, the
institution of the family was enough to take care of
their aged.
 Urbanization, industrialization, and modernization
have,however, brought about exogenous as well as
endogenous changes in the family system.

 Because of the ever-growing economic difficulties, the

newer concepts of small-sized nuclearfamilies have
emerged and the idea of 'joint families' living under one
roof is breaking down
 In recent past, the family was looked upon as the only
institution to take care of the elderly and provide both
emotional and financial support to them.
 But changes in the living arrangements and family
structure, migration of children for jobs outside

 Prominently, radical changes in the nature of people

from accommodative to an independent,self-centered,
and individualistic outlook with callous concern for
even very near relations,have compelled many old
people to live alone

 The extended families which once allowed elderly

people to live out their lives among kin have been
weakened by greater sociomobility and a shift to the
nuclear family as the basic kinship unit.
 CHALLENGES FACED BY THE ELDERLY
 A feeling of loneliness adversely affects elderly people
mental health which shows through some physical
problems.
 Older adults may be experiencing a change in roles such
as an empty nest, retirement and obsolete work skills in
addition to declining health
 The main reasons for institutionalizing the elderly are
related to demographic, social, family and health
factors.
 Care overload, illness, decreased functional capacity
and the lack of a responsible person to provide home
care were the main factors associated with
institutionalization
 LOCATION OF CARE (LOC)
 Location of care (LOC) for the elderly has become an
increasingly important societal issue
 With a demographic shift towards an aging population
with complex healthcare needs, healthcare systems
face challenges in providing long-term care for elders
 One such challenge is matching the elders’ health and
wellbeing needs to the environment.
 The ecological theory of aging suggests that the
environment influences elders’ functional status.
 Promoting optimal outcomes requires a goodness of fit
between the elders and the environment
 CARE OPTIONS FOR THE ELDERLY
Common long-term LOC options include home care
and institutional care
1. Long-term care (LTC) Institutions
 These institutions for the elderly enables long-term
care for this population.

 Although it is an outdated way of caring for the

elderly, it is not the first option for a large percentage
of the elderly and their family members, considering
the stereotypes of the LTC, which often link them to
family distance and abandonment
 Study shows that institutionalization was related
to decreased family bond.

 However, it can also mean alternative support and

protection, especially for those who have no
family and those who live in a condition of family
conflict

 Institutional LOCs typically refer to nursing home

care or skilled nursing care facilities.
 Elders and caregivers have identified deciding
about moving from home to an alternative
LOC as one of the most difficult decisions they
face

 This decision is complicated by the evolving

factors relating to the care situation such as
elder health status, characteristics of the
caregivers and physical environment
2. Charitable religious organizations
 These have been managing homes for the elderly for
centuries. These services have now been expanded
considerably in the voluntary sector.

There are three types of Old Age Homes

 State-run homes

 Homes run by a voluntary organization with financial

help from the government,

 Paid Old Age Homes which do not receive any financial

assistance from the government and charge from the
elderly
 Home Care for the Elderly
 Many elderly people prefer and choose to age at home.
 Healthcare organizations and policy makers are thus
increasingly challenged to better support a shift from
institutionalized long-term care to support elders to
remain in their community
 In recent times, people are opting for home care
services from professionals

 However, some important guidelines must be taken

into consideration when sourcing for the services of
Home Care professionals
 These guidelines include
 Patience: During the home care services for an
elderly or elder patient, the Home care
professional needs to have patience, since elders
need time to understand things

 Experience: One of the most important parts of

home care support is the experience. The more
experienced the Carer, the more comfortably
they can handle and help the elderly. From
bathing, grooming and medical activities
without any problems
 Compassion: While taking care of the elderly,
there is a need to understand the mind-set of elder
people anddevelop a nature around it.

 Empathy: There is need for empathy in order to

have a cordial relation with older people.

 Friendliness: Always carry a friendly nature

towards elders, never misbehave with them and
practicing good conduct should be of topmost
priority
DR A.I AIYEGBUSI
MULTIDISCIPLINARY APPROACH
TO GERONTOLOGY
 INTRODUCTION
 The practice of Geriatric Medicine requires an acceptance of
the strong interrelationships between physical, mental and
social factors.
 Therefore, to assess a patient completely and instigate
therapy, several specialist viewpoints are required.

 Geriatric Medicine, therefore requires a multidisciplinary

team approach
 To achieve a successful outcome not only does the team
have to know each patient but each team member must have
an appreciation of his/her co-worker's role, capabilities and
limitations.
 To be successful there must be good communication
and mutual respect. There is no place for professional
rivalry and the inflexible protection of professional
boundaries.

 Sound leadership is obviously required, though many

question the doctor's assumption that he or she is
automatically the leader.

 However, It has to be remembered that the team

ultimately has to make a decision and someone has to
be accountable for that decision.
 It would therefore seem reasonable to expect that the
person with ultimate responsibility makes the ultimate
decision

 The Nurse and Doctor are usually the people who

decide which other professionals are required. For
instance, a doctor would not prescribe a drug without
having some knowledge of its effect, both beneficial
and adverse

 Likewise, referral to other health professionals should

not be contemplated without thought for indications
and expectations.
SPECIALIST INVOLVED IN CARE OF
THE ELDERLY
 THE DOCTOR

 The doctor is responsible for assessing the overall

condition of the patient. He does this by taking a full
history, performing a full examination and by
interviewing relatives or carers whenever possible

 The doctor is then in a position to enumerate the

problems and outline a management plan.

 The doctor will refer the case to other health care

professionals when appropriate.
 THE NURSE
 The nurse is probably the foundation on which a good
geriatric service is built. Without specialist trained,
motivated nurses, no department of Geriatric Medicine will
survive.

 The specialist nurse has a role both in hospital and in the

community. The nurse is responsible for assessing the total
needs of the patient, making a nursing diagnosis and
formulating a management plan for nursing care.

 Good communication with medical staff is essential to

ensure that both are working towards similar goals.
 The nurse institutes preventive measures, she is
vital for the promotion of continence.
Rehabilitation would be impossible without a
suitably trained nurse.

 Specially trained nurses can assess the elderly at

home, promote physical independence and
emphasize the importance of secondary and
tertiary prevention.
 NURSE LIAISON STAFF

 Hospital and community services each have their own

problems.
 A liaison nurse working between the two environments
facilitates communication and professional
understanding.

 Therapy initiated in either situation can be explained

fully.

 Advice given to relatives and patient in one environment

can be reinforced when a patient moves into the other
situation.
 PHYSIOTHERAPIST

 The physiotherapist has two roles, one is directly

related to patients, the second is concerned with
education, advising relatives and staff about the
correct way of dealing with physical problems.

 Physiotherapy is vital if patients are to be

encouraged to retain their mobility during an
acute illness or improve their mobility following
an insult to their locomotor system.
 The physiotherapist requires information from
other members of the team with regards to
exercise tolerance, home situation, family and
patient expectations and clinical prognosis.

 The advice given by a therapist should be

communicated to the nursing staff (or to the carers
if the patient is in the community) as they have 24
hours contact with the patient

 This is important so they can continue the

therapeutic regime in the absence of the therapist.
 OCCUPATIONAL THERAPIST
 Within a Department of Geriatric Medicine the role of the
occupational therapist revolves around the assessment and
treatment of activities of daily living.

 These are the activities that are normally taken for granted
but which cause concern and consternation when lost, eg.
ability to dress and undress, ability to eat unaided, to get
on and off a chair, bed or toilet.

 The occupational therapist is an expert at assessing

perceptual disorders, a field unfamiliar to many medical
practitioners but knowledge of which, is vitally important
to all members of the team.
 The occupational therapist may assess the patient
in the hospital environment but may also undertake
a home visit to assess the patients capabilities
within their own environment.

 As a result of this, the occupational therapist may

recommend that adjustments or additions be made
at home ie. rails in toilet or shower, chair or bed to
be at correct height.
 The occupational therapist also has an advisory role
and may wish to discuss domestic arrangements with
both the family and the patient.
 In a long term care environment both physiotherapist
and occupational therapist may still be of great
benefit.

 Both therapists will endeavour to ensure that each

individual patient maintains his maximum level of
independence.
 They may do this by encouraging group therapy with
enjoyment, social interaction and a tangible end
product.
 THE SOCIAL WORKER
 Unfortunately, referrals to social workers are often only
considered when financial difficulties are encountered,
while their counselling skills likely to be ignored.
 A family under stress can receive a great deal of support by
prompt referral to a trained social worker. Group therapy or
family therapy may be considered.
 The social worker has knowledge of available services and
resources.
 The preceding team members constitute the core team,
required for the majority of patients. Other staff members
are important but may not participate in the
multidisciplinary team on such a regular basis.
 THE SPEECH THERAPIST
 Communication is of utmost importance.

 The speech therapist will assess the speech problem

and undertake therapy but he/she will also advise the
patient, the relatives and the multidisciplinary team on
the most effective form of communicating with
individual patients whilst specialist therapy is
continuing.

 He/she may see patients individually or may instigate

group therapy.
 THE DIETICIAN

 Undernutrition in clinical or subclinical form is

being increasingly recognised in elderly patients.

 Income correlates inversely with the degree of

nutrient deficit found in elderly people.

 Socio-economic status is inversely associated with

risk of age -associated falls in dietary calcium,
vitamin A, vitamin C and protein.
 Many social factors other than income influence
the dietary intake of old people including
education, culturally based food habits, eating
alone and bereavement.

 In general there is a poor prognosis in

undernutrition in old people. The dietician is
ideally placed to assess nutritional intake and
advise regarding necessary supplementation.
 PHARMACIST
 The elderly are far more at risk of adverse drug reactions
than the younger members of the population. They are
prescribed more drugs and seem to have an increased
susceptibility to adverse reactions.
 Physiological changes make drug handling more
unpredictable as Pharmacokinetics and pharmacodynamics
are altered in the aged individual.
 The expert advice of a pharmacist can be invaluable in the
daily management of an elderly patient.
 The weekly attendance of a ward pharmacist increases
awareness of possible drug interactions and is a positive
step towards safer prescribing.
 CHIROPODIST
 A fully trained registered chiropodist is required on any
multidisciplinary team as Foot problems may precipitate
hospital admissions and should not be ignored.
 Foot care assistants may be adequate for routine toe nail
cutting, which the elderly find difficult, but the care of the
diabetic foot, the ischaemic foot and the deformed foot
needs the help and advice of a qualified chiropodist.
 Trained specialists have knowledge of adaptive footwear
and can help in the management of intractable neuropathic
ulcerations.
 Painful foot problems lead to loss of mobility and
independence. Adequate chiropody services can prevent
this.
 THE PSYCHOLOGIST
This specialist studies human behaviour. He is of
immense help in assessing situational determinants of
individual behaviour.
 The psychologist may assess an individual patient or
may be involved with the whole family.

 The psychologist is adept at measuring cognitive

decline and has many tests at his disposal to identify
differences in levels of cognitive functioning between
diagnostic sub -groups of elderly mentally ill patients.
 He is well aware of the importance of continued
learning in old age.

 The psychologist would encourage the team to

provide environmental and educational
stimulation to each elderly patient undergoing
rehabilitation as this would be of vital importance
for the psychological wellbeing of the individual
 CONCLUSION
 The key members of an active multidisciplinary team
have been outlined. However, two groups have been
omitted.
 The patient and the carers are also important members
of the team and unless both are involved in discussion,
difficulties will arise.
 The patients expectations have to be considered, the
carer's capabilities have to be assessed.
 The professionals cannot work in isolation, they need
the co-operation of the patient and his family.
 A successful multidisciplinary team will involve patient,
carer and professionals all working together towards
common aims.