Aging Issues - An Introduction to Elder Care
- What is Elder Care?
- Giants of Geriatric Medicine
- Falls and the Elderly
- Depression and Older Adults
- Medical Conditions Affecting the Elderly
- Aging in Place
- Services Available
- Getting Financial Help
- Caregiver Support and Respite Care
What is Elder Care?
Elder Care is an umbrella term that encompasses care and services associated with the frail elderly. In some parts of the world it may be referred to as “Aged Care” and includes a wide range of services.
While the segment of the population who is over the age of 65 equates to only 5 percent of the population, people within this demographic utilize the largest amount of health care resources such as hospital inpatient admissions, residential care facilities, adult day care, hospices, home care, long-term care and nursing homes.
The elder population in the United States and elsewhere is set to increase dramatically over the coming decades as those in the post-war baby boom generation approach retirement. The over-65s are the fastest-growing population in the early 21st century. This means that elder care is going to become a major social, economic and political issue.
Giants of Geriatric Medicine
Geriatric giants are major sources of affliction in the frail elderly population. These include loss of mobility, impairment in memory or intellect, inability to concentrate, impaired hearing or vision, incontinence and instability. Any one or all of these may result in social isolation, depression and loss of independence.
Falls and the Elderly
Falls in the elderly are one of the giants of geriatric medicine and a major source of morbidity and mortality. The consequences of a fall can be devastating. There are often multiple causes and the prevention of falls requires a multifaceted approach to both treating injuries sustained during a fall and to prevent future incidents.
In an article published in 1988 in the New England Journal of Medicine, Tinetti et al. defined a fall as an event that causes an individual to unintentionally come to rest on the ground (or lower level) as a result of something other than an overwhelming hazard or major extrinsic event.
The causes of falls in the elderly may be broken down into intrinsic factors and extrinsic factors. Intrinsic factors include things like stroke, Parkinson’s disease, arthritis, disturbances of the inner ear, neuromuscular disease and neuropathy. Medications, impaired vision, cognitive problems and urinary infections may also contribute to the overall risk of falling.
Extrinsic factors comprise poor lighting, footwear/clothing, rugs, stairs and lack of special aids and equipment. Extrinsic factors are the easiest to eliminate by simply installing guardrails in the bath and on both sides of the stairs; removing or securing rugs; walking aids; adding extra lighting; and, in extreme cases, providing a wheelchair. Other aids include walk-in bathtubs, Velcro fasteners and devices to dial telephones and control appliances.
Bone fracture is one of the most serious potential consequences of a fall. Apart from the immediate medical problem of stabilizing the fracture, fractures can lead to social isolation and depression. Fractures also take longer to heal in people over the age of 65.
Depression in Older Adults
Physical and mental declines with age are major sources of depression in the aging population. It affects both the quality of life and the ability of individuals to look after themselves properly. The proportion of depression among institutionalized persons is significantly higher at 70 percent than is the proportion of those living independently (18 percent) or in the general population (8 percent). These figures reflect the importance of aging in place, the ability of seniors to live independently for as long as feasible. Resources should therefore be channeled in this direction.
Medical Conditions Affecting the Elderly
Some medical conditions are either specific to the elderly population or they are more prevalent in this age group. Most common are the dementia (Alzheimer’s, Lewy Body Disease, vascular dementia), strokes, cardiovascular disease, Parkinson’s, diabetes, impaired vision, chronic respiratory conditions, osteoporosis and arthritis.
Geriatric social workers and physicians indicate that there are several warning signs that may indicate an elderly person is in need of extra help or a major change in circumstances has occurred:
- Burns or injuries - An uncharacteristically large number of burns, cuts, bruises, etc., may indicate that the person is becoming forgetful, weakening or maybe even abusing alcohol.
- An increase in automobile accidents - May indicate deteriorating vision, slowed reflexes, reduced attention, increasing weakness or a general reduction in the ability to operate and maintain a motor vehicle.
- Sudden weight loss - May be an indication that the person is unable or unwilling to prepare meals or to eat properly.
- An increase in forgetfulness - This may take the form of missing appointments, not paying bills, failing to remember their name, address or telephone number or forgetting meal times could indicate a problem in this area.
- Extreme suspiciousness - This could express itself as a fear that neighbors, family members, healthcare professionals and/or friends are conspiring against them. A persistent or repeatedly expressed fear that something dreadful is about to happen may indicate the presence of a thought disorder.
- Failure to take medication as prescribed or over-dosing - Potential signals of confusion, forgetfulness or a lack of understanding of medical instructions.
- A series of small fires - May indicate drowsiness, forgetfulness or carelessness with matches and could indicate dizzy spells of blackouts.
- Deterioration of personal habits - Lack of hygiene such as infrequent bathing and hair washing, or not using dentures c ould signal mental or physical problems.
- Any type of bizarre behavior - This could be wearing heavy clothing in warm weather or flimsy clothing in winter time, wandering off without warning or any other unusual speech or actions.
- Consistent deterioration - This may express itself as not knowing who or where they are, who friends and family are or talking to people who are not there.
Aging in Place
Aging in place is the concept of living independently in one’s own home safely and comfortably irrespective of age, income or level of ability. Residential neighborhoods that foster aging in place include naturally occurring retirement communities (NORCs), condominiums, apartment buildings or other types of cooperative not designed specifically as retirement associations but where more than half of the residents are over the age of 62.
The types of services that fall under the general description of elder care include the following:
- Meals - either in the home or in a group setting
- Social activities - Many cities have some form of senior social program to promote independence, provide advice and financial assistance, serve meals and offer opportunities to learn new skills or simply socialize
- Help with light housekeeping
- Personal care - dressing, grooming, bathing, toileting
- Medical alert systems
- Residential care - nursing facilities, retirement homes/communities, board and care home
- Telephone contact - often just to provide reassurance
- Friendly visiting
- Transportation - Nearly all public transportation services make special provision for the elderly and those with a disability and may offer reduced fares, improved accessibility or specially-equipped vehicles
- Respite care
- Support for caregivers
- Emergency response systems
Getting Financial Help
Americans can get help with many of the expenses associated with being over the age of 65. One form of such help is Medicare, a federal health insurance program consisting of two types: hospital insurance and medical insurance. Hospital insurance helps pay for the cost of inpatient medical care. While it does not cover nursing home care or custodial services, it does cover residential care for convalescence. Medical insurance covers the cost of outpatient care, including doctors and some other medical services.
Caregiver Support and Respite Care
The main caregiver for a frail elderly person is often a member of the family, either a spouse, adult offspring or grown-up grandchild. The term respite care revers to the provision of trained personnel to provide surrogate care to allow the primary caregiver an opportunity to take a break.
This may be a matter of a few hours to allow the caregiver to do some shopping, get their hair done, etc. It may also be a matter of days to enable the family member to take a vacation from the often burdensome responsibilities of looking after an elderly relative. Respite care is an essential part of aging in place.
Elder care is an all-encompassing term that refers to the entire spectrum of support services for the frail elderly. Giants of geriatric medicine are the main medical factors that impede the ability of the elderly population to fully enjoy their retirement years.
Two of the main giants are the risk of falls and depression in the elderly. With the proportion of citizens over the age of 65 set to increase substantially owing to the aging of the baby Boomer generation, elder care will occupy an increasingly substantial portion of social and medical care budgets.