Description
The presentation highlights on management of GERIATRIC patients, processes, care models along with effectiveness and costing.
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 31% 62% EU 17% 67%
> 65 years
TOTAL
7%
5918,6 Millions
16%
374,6 Millions
PLACES of CARE for the ELDERLY in EUROPE
94% in the COMMUNITY
6% in geriatric care facilities
Aged adult
X
?
X
?
X
? ?
INFORMAL NETWORK
? Family members ? Friends and neighbours
FORMAL NETWORK
? Community care ? Emergency room, Hospital…
Medical vs. Psychiatric vs. Social CRISIS
Common geriatric acute events
Surgical emergency (…) 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 GERIATRIC ASSESSMENT (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
2.8
Before CGA
4.5
After CGA
additional problems (Paired t-test, P < 0.001)
Number of diagnoses Standard deviation
Number of geriatric problems before and after CGA
300
PAIN
200
INCONTINENCE 100 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)
DEPRESSION0 ADL -100 impairments
-200
COGNITIVE -300 Disturbances
-400 SENSORY troubles
Nb of patients
0
1
2
3
4
5
6
7
8
9 10 11
Nb of Geriatric Problems
QUALITY of CARE
STRUCTURES
Important role of an interdisciplinary geriatric team in the emergency room
PROCESSES
OUTCOMES (? or ?)
“The good patient in the good bed”
The GERIATRIC PROCESS
?
Assessment
?
Agree objectives of care
Agreed 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
Patient’s quality of life and cost of care
Patient’s QoL Relieving suffering
IF - the 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 repudited is included tobe emergency staff - geriatric care networks but should be encouraged ! (community and hospital) S EBRAHIM Brit are working Med J 2002; 324: 861-3(…) 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
? Analysis ? Analysis
of the characteristics of the IC and their dependent care receipient
of the type of care provided by the IC and their support system available of the consequences of the care activities on the IC themselves the healthcare policies for IC new health support intervention for
? Describe ? Design
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 > 3 h / Day 1-2 h / Day ADL / IADL 3 or more hrs ADL 1-2 hrs ADL or >5 hrs IADL Some IADL (< 5 hrs)
LOW
1 h / Week
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.
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).
2.
3.
4.
5.
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
doc_765689501.ppt
The presentation highlights on management of GERIATRIC patients, processes, care models along with effectiveness and costing.
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 31% 62% EU 17% 67%
> 65 years
TOTAL
7%
5918,6 Millions
16%
374,6 Millions
PLACES of CARE for the ELDERLY in EUROPE
94% in the COMMUNITY
6% in geriatric care facilities
Aged adult
X
?
X
?
X
? ?
INFORMAL NETWORK
? Family members ? Friends and neighbours
FORMAL NETWORK
? Community care ? Emergency room, Hospital…
Medical vs. Psychiatric vs. Social CRISIS
Common geriatric acute events
Surgical emergency (…) 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 GERIATRIC ASSESSMENT (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
2.8
Before CGA
4.5
After CGA
additional problems (Paired t-test, P < 0.001)
Number of diagnoses Standard deviation
Number of geriatric problems before and after CGA
300
PAIN
200
INCONTINENCE 100 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)
DEPRESSION0 ADL -100 impairments
-200
COGNITIVE -300 Disturbances
-400 SENSORY troubles
Nb of patients
0
1
2
3
4
5
6
7
8
9 10 11
Nb of Geriatric Problems
QUALITY of CARE
STRUCTURES
Important role of an interdisciplinary geriatric team in the emergency room
PROCESSES
OUTCOMES (? or ?)
“The good patient in the good bed”
The GERIATRIC PROCESS
?
Assessment
?
Agree objectives of care
Agreed 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
Patient’s quality of life and cost of care
Patient’s QoL Relieving suffering
IF - the 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 repudited is included tobe emergency staff - geriatric care networks but should be encouraged ! (community and hospital) S EBRAHIM Brit are working Med J 2002; 324: 861-3(…) 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
? Analysis ? Analysis
of the characteristics of the IC and their dependent care receipient
of the type of care provided by the IC and their support system available of the consequences of the care activities on the IC themselves the healthcare policies for IC new health support intervention for
? Describe ? Design
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 > 3 h / Day 1-2 h / Day ADL / IADL 3 or more hrs ADL 1-2 hrs ADL or >5 hrs IADL Some IADL (< 5 hrs)
LOW
1 h / Week
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.
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).
2.
3.
4.
5.
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
doc_765689501.ppt