Because so many of the elderly don't have their drivers license, and many don't need to have one, and also need care to the extent that they are unable to attend to the toiletry task on their own. This is something that is alienating and regressive and plays a part in the cognitive and emotional deterioration of the elderly
: they see themselves through the eyes of others, and fulfill the assumption (Golander, 1995, Whitborne, Culgin & Cassidy, 1995)
The Role of the Healthcare Worker:
It is fortunate that in view of the many losses "that accompany the retraction of the personal social network of the elderly tend to be minimized by our culture, by health and mental care worker and by the elderly themselves. To make explicit and to legitimize the impact of the subject's diminished sources of identity, history, and both emotional and intellectual validation has a profound therapeutic value." (Sluzki, 2000)
According to a report in Geriatric Times:
"Palliative care focuses primarily on the relief of suffering. Multidisciplinary teams of doctors, nurses and social workers also strive to help patients achieve the best quality of life possible and help families cope with the psychological, emotional and spiritual issues that these illnesses involve." (Kanapaux, 2004)
The problem, this report reveals is the lack of training provided to medical students in this area of treatment. The care that is provided through palliative care extends beyond that normally provided as palliative care is all encompassing and is termed to be a "highly skilled, medically driven process."
In an article entitled Delirium doulas ... Sarah H. Kagan, Critical Care Nurse states that Delirium, or that of elderly cognitive functional shift is one that places great demands upon the personal, social, cultural, financial and medical environment of the individual as well as leaving a ripple upon the environment itself.
The disease derived it's name from the word Adoula (doo'la) which is defined as: a non-professional or layperson who is the provider of physical, emotional, and informational support to women in labor and the women's partners. (Kagan) Other medical fields have doulas such as the intensive care unit with an innovative model with the purpose of defining optimum care for critically ill adults. So doulas is the term used for purposes of this writing as well. Delirium is defined as "disturbance of consciousness, attention, cognition, and perception" that reveals itself over a period of time, fluctuating by hours or days and is thought to "complicate the hospital course of 2.3 million patients" on an annual basis costing to the tune of $4 billion a year.
The Graying of the Boomers
The Baby-Boomer generation that was born in the middle of the 20th century is beginning to gray. The reason this is worth mentioning is due to the mega-load of individuals that comprise the boomers crowd. Another factor that is attributed to the overwhelming population count of the boomers is that the life span of an individual is much longer than was previously known and that has effected the population increase of elderly as well. According to the Administration on Aging the adults that were 6 years old or older equaled a whopping 25.6 million, accounting for 12.3% of the United States population. The Agency for Healthcare Research and Quality states that the hospitals discharged 12, 36, 530 adults 65 years of age and older in 2002 which accounts for 35% of the total amount of hospital discharges reported in the United States that year. Another factor incredibly is that the age group of adults that are 85 years old or older is the fastest growing group in any of the age groups.
Goals in Patient Care Involving Delirium:
Optimal care of those with the complications of delirium is inclusive of first giving consideration to the duration and initial prevention of possibilities of iatrogenic injury, offering emotional support to patient and their family, maintenance of pre-hospital functional status, and providing enhancement to the quality of life after hospital discharge. The elderly population when hospitalized is a double-risk for death and at a triple-risk requiring for nursing home requirement upon developing delirium. Kagan's project on doulas where she proposed these for the Intensive Care Unit gives a view of one of the major needs in medical care for elderly-focused doulas as well as daily life doulas in the lives of many elderly.
The Elderly: More Diverse and more Educated:
The older generation is more diverse and more educated and that is on the increase with the reported number of 65 plus adults supposed to increase by 2030 by having doubled in numbers.
(Administration on Aging Report 2004) These facts mean that the older individuals will more than likely retain cognitive functional capacity for longer than generations before due to better education and therefore more real knowledge concerning overall aspects of health and disease prevention. However, with the new element of environmentally produced disease, one wonders if the overly large population of elderly will manage to avoid death by disease.
Summary & Conclusion:
The fact that there is a shortage in the supply of the workers needed as nursing staff professionals at this time documented. It could be that the scientific process in healthcare has come full circle so to speak and felt the need for balance in the provision of care. Or perhaps it is just the fact that science is propelled and medical care propelled by need of knowing for reasons of cure and care. The years to follow will be a challenge as well as journey of discovery in meeting the challenges that are predicted to be facing both the elderly in their lives as well as providers of their care.
Provision and must be made for and included must be innovation in the positioning of the requirements of the elderly population.
Medical care providers must address this in order to provide ethical healthcare to the increasing elderly generation and the added challenges that is presented by disease. Therefore, this must be logically applied through organization of the micro and macro environment of the healthcare provider institution. Applying specific shifts and integration between organization and provision is ideal in a balance that both internally and externally optimizes patient care, specific to the elderly individual is needed to meet the challenges facing the provider of elderly care and societal consideration of the years to come.
It appears that Kagan who states that:
"Critical care providers may need to work from novel perspectives and use new models to meet the care needs for delirium . . . In critically older adults and explore the potential for improving the care of this frail, vulnerable population of patients. [Kagan 2004].
is right on target because the challenges ahead in provision of healthcare for the elderly will require innovation and collaboration on many levels.
Agency for Healthcare Research and Quality. HCUPnet [Online] available at: http://hcup.ahrq.gove/hcupnet.asp.
A Profile of Older American's (2003) Administration on Aging 2004 [Online] available at: http://research.AAARP.org/general/profiles.html. Kanapaux, William (2004) Palliative Care Seeks Structure for Growth. Geriatric Times: A Interdisciplinary Approach to Healthy Aging Sep/Oct 2004 Vol.V Issue.5 [Online] avialable at: http://www.geriatrictimes.com/g041003.html
Kagan, Sara H. (2004) Delirium doulas: An Innovative Approach to Enhance Care for Critically Ill Older Adults (Clinical Article) Critical Care Nurse 2004 Aug 1 [Online] available at: http://www.highbeam.com/library/doc3 .asp?ctrl Info=Rou nd9a%3APro d%3ADOC%3APrint& DOCID=1G1:120773318& print=yes
Vladeck, Bruce C. (2000) Health Care Financing Review; 6/22/2000; [Online] available at:…