Prof' Dr' Mirko Petrovic Department of Geriatrics Ghent University Hospital - PowerPoint PPT Presentation

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Prof' Dr' Mirko Petrovic Department of Geriatrics Ghent University Hospital

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Prof. Dr. Mirko Petrovic. Department of Geriatrics. Ghent University Hospital. HEALTH CARE NEEDS ... A challenge for: State/Public Social and Health care ... – PowerPoint PPT presentation

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Title: Prof' Dr' Mirko Petrovic Department of Geriatrics Ghent University Hospital


1
Prof. Dr. Mirko Petrovic
Department of Geriatrics Ghent
University Hospital
HEALTH CARE NEEDS IN THE ELDERLY
2
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

3
Population (1999)
4
PLACES of CARE for the ELDERLYin EUROPE
  • 94 in the COMMUNITY
  • 6 in geriatric care facilities

5
X
X
X
Aged adult
? ? ? ?
INFORMAL NETWORK FORMAL NETWORK ? Family members
? Community care? Friends and neighbours ?
Emergency room, Hospital
6
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 ()

7
GERIATRIC PATIENTSin 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

8
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 !

9
  • DISJUNCTION /GAP
  • between
  • HUMAN BEING
  • and
  • SURROUNDINGS !

10
Medical vs. Psychiatric vs. Social CRISIS
  • Need to avoid
  • INAPROPRIATE HOSPITAL ADMISSIONS !!!

? INAPROPRIATE HOSPITAL STAY
11
QUALITY of CARE
  • STRUCTURES
  • PROCESSES
  • OUTCOMES (? or ?)

Accessibility to the needed care
12
The GERIATRIC PROCESS
  • Assessment
  • J GRIMLEY EVANS Brit Med J 1997 315 1075-7

13
GERIATRICCARE MODELS
  • BIOMEDICAL
  • FUNCTIONAL ABILITY
  • HUMAN / TECHNICAL SURROUNDINGS QUALITY of CARE
    ETHICAL issues of care
  • QUALITY of LIFE

14
DIAGNOSIS and DAILY FUNCTIONING
COMPREHENSIVEGERIATRIC ASSESSMENT (CGA)
  • Importance
  • of
  • USING
  •  VALID 
  • CRITERIA

15
CGA in the emergency roomDETECTION of
unrecognized geriatric problems

The screening procedure allowed the detection
of an average of 1.7 1.3 additional problems
(Paired t-test, P lt 0.001)
? 1.8
? 1.5
4.5
2.8
16
Number of geriatric problems before and after CGA
PAIN INCONTINENCE DEPRESSION ADL
impairments COGNITIVE Disturbances SENSORYtrou
bles
300
200
100
After CGA
0
Before
Nb of patients
-100
The screening procedure allowed the detection of
an average of 1.7 1.3 additional problems
(Paired t-test, P lt 0.001)
-200
-300
-400
0
1
2
3
4
5
6
7
8
9
10
11
Nb of Geriatric Problems
17
QUALITY of CARE
  • STRUCTURES
  • PROCESSES
  • OUTCOMES (? or ?)

Important roleof an interdisciplinary
geriatric team in the emergency room
The good patient in the good bed
18
The GERIATRIC PROCESS
  • Assessment
  • Agree objectives of care
  • J GRIMLEY EVANS Brit Med J 1997 315 1075-7

19
Agreed Objectives of Care
  • What does the patient want ?
  •  
  • What is feasible ?
  •  
  • GRIMLEY EVANS J J Royal Coll Phys 1997  37 
    674-84

20
The GERIATRIC PROCESS
  • Assessment
  • Agree on care objectives
  • Specify the management plan
  • J GRIMLEY EVANS Brit Med J 1997 315 1075-7

21
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

22
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

23
Patients quality of life and cost of care
  • IF
  • the accessibility to the emergency room is easy
  • the emergency ward is equipped with high tech
  • an interdisciplinary geriatric team is included
    to the emergency staff
  • geriatric care networks (community and
    hospital) are working harmoniously ()
  • Patients QoL
  • Relieving suffering

Medicalisation of old age is not to be repudited
but should be encouraged ! S EBRAHIM Brit Med
J 2002 324 861-3
Cost of care
Adapted from GOODWIN JS New Engl J Med
1999 340 1283-5
24
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.

25
Purposes of the Informal Caregivers group
  • Identification of the characteristics of the IC
    and their dependent care receipient
  • Analysis of the type of care provided by the IC
    and their support system available
  • Analysis of the consequences of the care
    activities on the IC themselves
  • Describe the healthcare policies for IC
  • Design new health support intervention for IC

26
Informal caregivers
  • Women 83.95
  • Mean age 56 year old
  • House keeper 60
  • Working outside their homes 22
  • Full time 57
  • Men 17
  • Mean age 65 year old
  • Retired 45
  • Working outside their homes 42
  • Full time 83
  • Role Daughter-son / daughter-son in low 62
  • Spouse 26
  • Paid caretaker 5-9

27
Activities done by the informal caregiver
  • Over 50 dedicate more than 5 hour per day (gt150
    hours / month)
  • IADL (80)
  • ADL (60)
  • Women do more AVD y AIVD
  • Men do mainly IADL

28
Dependency
29
ADL IADL
  • IADL
  • Cooking
  • House cleaning
  • Laundry
  • Ironing
  • Telephone use
  • Banking
  • Transportation
  • ADL
  • Hygiene
  • Nutrition
  • Elimination
  • Bathing
  • Moving
  • Medications
  • Treatment of ulcers and wounds

30
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

31
Support from Nursing
  • INFORMATION
  • PROFESSIONAL EDUCATION
  • EMOTIONAL SUPPORT

32
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

33
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.

34
Conclusions
  • 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).
  • 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.

35
Scientific collaboration
Coordination
36
THE FUTURE

SYNERGY
Informa / principal caregivers (national
level)

Informa / principal caregivers ( EU Countries)
EU RESEARCH FUNDS
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