NUR4090 Geriatric Individual Term Paper
Quality of Life
Wenyang Cai
Professor Michelle Gellar
Summer 2016
On the first day of class professor asked us to identify 10 things that associated with the aging population. As the most common things that comes up first in people’s mind, we think of aging is associated with increase vulnerability and immobility, disability, being lonely, ineffective coping, easily to fall, unable to perform activities that used to do when one was young, nutrition deficit, different types of disease or disorders linked with geriatric population such as diabetes, cardiovascular disease, hearing and vision problems, dementia etc., and unable to enjoy life like they used to. In other words, people usually linked aging with negative aspects. It could not be denied that these negative aspects are some facts that associated with aging. However, we could still see many elderly population has get rid of the negative tags mentioned above and live a fruitful happy life. For example, I have seen some energetic elderly always show big smiles on their faces, actively participating different activities and enjoying their lives in the Stein Senior Center in my last semester Community Health Nursing clinical, and I learned from my experience by talking and participating different kinds of activities with them that aging does not prevent one’s happiness of life, but the quality of life of the elderly-which usually includes physical health, psychological health, social relationships and environment, that really plays an important part. Gerontological nurses are usually the key to help geriatric population to improve their quality of life and make them enjoy a healthier and happier life.
The reason why quality of life has a great impact on geriatric’s life is because learning from many geriatric’s true life experiences and from many researchers telling us that living with low quality of life can not only bring about physical illness and pain that troubles one’s life but also can lead to despair instead of getting ego integrity in Erikson’s psychosocial stages, which makes elderly live in unhappiness for the rest of their lives. According to Eliopoulos (2013), aging is about changes in appearance and body function that affect one’s body image and self-concept; the manner in which individuals perceive themselves and their functional abilities can determine the roles they play. For example, some elderly views their body image as being distorted as wrinkles appears on skin and colorful hair turn gray by the aging process may have sense of inferiority that preventing them from going out on the street and taking part in social activities with friends like they used to do when they were young, which would interfere them from joining social activities and thus they would become lonelier at home as they have no friends to talk to. Another example is that some elderlies becomes mentally ill and having conditions such as dementia, delirium or depression, which scientifically affects their daily actively and psychosocial activities that lowers their quality of life and thus preventing them and their families from enjoying a happy life. Some other elderlies may be living with chronic disease such as diabetes, chronic kidney failure that require daily dialysis, cardiovascular disease that preventing them from doing exercises they used to do, arthritis that make them suffering from pain every day, and bladder and bowel incontinence that disturbs their daily lives, all these conditions affect their physical health and preventing them from living comfortable lives and this low quality of life make them lose the interest to enjoy daily life. In contrary, elderlies who live with youthful minds and lead an optimistic spirit towards lives are always happy hanging out and enjoying different social activities in their lives; Those who has a healthy physical body or those who coping with disease effectively by following the correct medical regimen are always happy with their lives and taking part in many exercise and activities as well. As a result, gerotological nurses are responsible for providing comprehensive care to help elderly live a healthy physical and spiritual life, hence the elderly can enjoy their lives and find their life fruitful and meaningful.
According to Lenardt, et al. (2014), the increased longevity of geriatric population make people think more deeply about aging process and its effects on quality of life. As a result, a study was designed by the researchers aimed at assessing the perception of quality of life of the population of aged 65 years or more. Researchers found that the majority considered ‘being healthy’ and ‘not having disabilities’ are definitions of high quality of life. They also found that elderly like answers such as ‘having energy’, ‘being happy’ and ‘proper functioning of the senses’. In addition, researchers pointed out that although quality of life can be defined in different ways, it is a multidimensional concept that encompassed psychological, social, environmental and spiritual dimensions. From this study we can see the importance of how elderly people value their quality of life and what aspects are associated their quality of life; and from it we can learn that how improving elderly’s quality of life can make a big difference on making them feel happy towards their lives.
In order to make people understand more about the importance of quality of life for geriatric population, here I want to give another example to indicate how quality of life is relevant to many dimensions in how elderly can live a better life, which is a study about the importance of older patients’ experiences with care delivery for their quality of life after hospitalization. This research is studied by Hartgerink, Cramm, Bakker, Mackenbach & Nieboer (2015). Given the background that vulnerable geriatric patients have complicated on-going needs, having chronic disease and conditions, and experience difficulties on daily living activities, as a result, the provision of healthcare, social services and related services at the right time and place to such geriatric clients are of great importance in promoting their health and quality of life. Based on this background, a longitudinal research was designed based on a pilot study of older adults who recently had been admitted to a hospital, aims to identify the relationship between elderly client’s experiences with hospital care, perceived quality of integrated care and quality of life after hospitalization. Result showed that elderly clients who are more satisfied about the received hospital care and experience higher levels of integrated care delivery are those with a higher quality of life three months after hospitalization, and “perceived quality of integrated care delivery, and quality of life within 48 hour of hospital admission are significantly correlated with quality of life three months after hospital admission”. This study underlined the importance of how providing geriatric client with good experiences with hospital care could enhance their perception of quality of life and thus making their lives better.
Factors that determine the quality of life for geriatric population are vary in different situation. One standard to measure quality of life may not suitable for other geriatric population or for the same geriatric population under different circumstance. For example, in the study of Halvorsrud & Kalfoss’s (2016), a randomized, stratified, cross-sectional study was designed to measure how intimacy loneliness, physical and psychological health, and attitudes towards aging affect the quality of life between non-depressed and depressed older adults. Result shows that in the non-depressed group, physical health accounted for the greatest variance in quality of life while in the depressed group psychological health, losses, and feeling of intimacy made significant contributions. Hence the study drew out the conclusion that health professionals should always assess the aspect of what are the things their clients value and what their client’s goals are before planning interventions. This evidence-based study can be generalized to a broader domain-not only for elderly with depressions, but also for all kinds of geriatric populations. When gerontological nurses try to help their geriatric clients to improve their quality of life, it is very important to do a comprehensive assessment to gain insight into the client’s self-concept towards what are the things that they value toward their health and life, so that they can achieve satisfaction and happiness of their lives.
In addition, in terms of how to measure geriatric’s quality of life, Kalfoss’s study (2016) has pointed out that the clinicians seldom routinely applying tools for measuring QoL for measure geriatric client’s quality of life, and he also has pointed out the strong relationships of how community health nurses can help to promote geriatric client’s quality of life. Kalfoss then has generated several validated instruments that could assist nurses in achieving a number of important objectives related to holistic and community assessment, identifying clients at risk, promoting health service evaluation and making the nurses become more familiar using the QoL instruments available to inform best practice thus can provide geriatric client with better care. Gerontological nurses could benefit from learning how to use QoL tools effectively for geriatric clients from this study and hence providing clients with better care.
In considering what are the factors that affecting geriatric’s quality of life, one example is shown by Rasheed & Woods (2014). Given the background that older adults are the age group that very prone to be malnutrition, and malnutrition usually predisposes people to risk of morbidity and mortality that affecting geriatric’s quality of life (QoL). As a result, a study designed evaluate the relationship between malnutrition and QoL was conducted by Rasheed & Woods (2014). Result showed that there were significant associations between QoL scores and the Mini Nutritional. The findings of the study reinforce the importance of nutrition as a priority that leading geriatric to achieving improvements in quality of life. From this study we learned that one significant aspect of geriatric’s quality of life is geriatric’s nutrition status, being in malnutrition could negatively affect one’s quality of life. As nurses we should pay more attention to care for geriatric population’ s nutrition status and make them live a better quality of life.
People might think it too complicated for factors affecting of quality of life, but as a matter of fact, quality of life for geriatric population could be just a simple thing, such as improving geriatric’s living environmental safety. To be more specific, here is a research study giving the example of effects on fear of falling on quality of life in geriatric population. According to Joshi & Joshi (2015), 28% to 35% of individuals aged 65 or above will fall within a year of time, exposing them to serious injury and can result in serious problems. It has been reported that 50 % of elderly have a fear of falling after experiencing just one fall. In this study, the correlation of fear of falling with quality of life in geriatric population was being investigated by the researchers. Result showed that the correlation is extremely significant. Therefore, from this study we can learn that fear of falling has great impact on affecting geriatric population’s quality of life, gerontological nurses could make actions on promoting safe home and community environment to help prevent elderly from falling and enhance their quality of life.
Another study also showed that modifications in homes of geriatric populations has the effect on improving quality of life of geriatric population. As is stated in to Kurtkoti (2014), “older adults are often not aware about healthcare and lack scientific knowledge about the home modifications, rehabilitation and the place of living”, in order to make their home a safe comfortable place and enhancing their quality of life, action is required to assess the homes of geriatrics for home environmental barriers and to make necessary modifications for keener places at home and thus prevent falls and improving their quality of life. Results found that maximum geriatric have done modifications in bathroom, living room, stairs, kitchen and bedroom, they have willingness to do home modifications with the bathroom found to be the most concerned area of home and where maximum modifications have been done. This study has clinical significance on suggesting health care professionals, such as gerontological nurses to check home hazards for the elderly and make appropriate modification suggestions for them, so that they could have a higher level of safety health and higher level of quality of life.
What else could nurse do for geriatric population to improve quality of life? Here is another example. Markle-Reid, Browne, & Gafni (2013) stated that “The identification of effective and efficient interventions to promote the health-related quality of life (HRQOL) of older adults is a public health priority because of the unprecedented aging of the population. Frail elderlies are most likely to benefit from this intervention because they are in particularly high risk for adverse health outcomes. Frailty cause by increased age is not an inevitable outcome of aging. Falls, unhealthy diet, social isolation, physical inactivity and depression are negative effects of frailty that can be reversed and changed and thus bring about improvements oh health”. 3 nurse-led health promotion and disease prevention (HPDP) interventions were targeting known risk factors for functional decline and frailty. Result found that this 3 nurse-led HPDP interventions can provide greater improvement in HRQOL compared with usual home care, and such approaches are highly acceptable to the geriatric population and should consist of multiple home visits, multidimensional screening and assessment, intensive case management, inter-professional collaboration, geriatric training and experience and referral to coordination of community service. As a result, gerontological nurses or other nurses such as community health nurses that can help with elderly should use the nurse-led HPDP interventions in home care to HRQOL and promote elderly with a good quality of life.
The above eight evidence-based studies have discussed different dimensions of geriatric’s quality of life, including how geriatric population view their quality of life, how quality of life is relevant to the happiness of their lives, factors that determine the quality of life for geriatric population, different examples that describing geriatric’s quality of life, and different ways nurses and health care professions could do to help promote geriatric’s quality of life. No matter which dimension these researchers were addressing, these eight studies have one thing in common-they all acknowledged the importance of how geriatric’s quality of life significantly impacts their perception of happiness how it directs the way they live.
Taking the above eight evidence-based studies as references, I begin to learn from the concept and ideas of these studies and plan to take actions to help improve the geriatric population’s quality of life. From Lenardt’s study (2014), it mentioned about the majority geriatric population considered ‘being healthy’ and ‘not having disabilities’ are definitions of high quality of life. They also found that elderly like answers such as ‘having energy’, ‘being happy’ and ‘proper functioning of the senses’. Hence, I will make their goal ‘being healthy’, ‘having energy’, and ‘being happy’ as my goal and I will plan actions to help the geriatric clients achieve these goals. Although for some individual ‘not having disabilities and having proper functioning of senses might not able for them to achieve, I will still work hard to help them preserve their maximum functioning abilities and help them achieve small goals little by little so that they will have sense of accomplishment, since I knew that not only the physical health, but also the spiritual health is an essential component of geriatric’s quality of life. In addition, in Halvorsrud & Kalfoss’s (2016) study, I learned that factors determine the quality of life for geriatric population are vary in different situation, therefore it’s also essential to carefully assess our geriatric client’s goal towards their quality of life before we plan out any interventions.
Geriatric population has a high in-patient hospital rate. Hartgerink, Cramm & Bakker, etc (2015) gave out the study underline the importance of how providing geriatric client with good experiences of hospital care could enhance their perception of quality of life and thus making their lives better. Therefore, nurses in the hospital that caring for the elderly client are of great importance in making their best effort to care the elderly patient physically and mentally so as to enhance their perception of quality of life, and thus their body would heal better. On the other hand, Joshi & Joshi (2015) and Kurtkoti (2014) presented the similar idea that home safety is a key element affecting geriatric’s quality of life, therefore I will send gerontological nurses, community health nurse, and visiting nurses to every elderly family’s house and to assess client’s home safety issues and help them to make a plan and do modification if necessary. Also, all modification should be on-going assessed by nurses until the modification has been done. Follow-up visits to assess their safety issues will also be done by these team members.
One of the most important aspect that needed to be addressed to improve geriatric’s quality of life is their nutrition status. Rasheed & Woods (2014) indicated in their study that older adults are the age group that very prone to be malnutrition, and malnutrition usually predisposes people to risk of morbidity and mortality that affecting geriatric’s quality of life (QoL). As a result, I will send out gerontological nurses or visiting nurses to do home visits for elderly families to assess their nutrition status, if anyone is in malnutrition status, visiting nurses should do detail nutrition knowledge teaching to the elderlies together with their family members, help them to eat a healthy diet. If situation is severe, nurses will refer clients to get treatment from doctors and have a consultation with local dietician near them. Follow up visits will also be made by nurses to trace their improvement.
What I also will do is to use several QoL validated instruments that generated by Kalfoss (2016), which could assist nurses in achieving a number of important objectives related to holistic and community assessment, identifying clients at risk, promoting health service evaluation to inform best practice, thus can provide geriatric client with better care. In addition, I will incorporate the nurse-led HPDP intervention that mentioned by Markle-Reid, Browne, & Gafni (2013), which consist of multiple home visits, multidimensional screening and assessment, intensive case management, inter-professional collaboration, geriatric training and experience and referral to coordination of community service, so that to provide geriatric clients with comprehensive health cares. I believe that by using the nurse-led HPDP together with other gerontological nurses or other community health nurses can promote elderly with a good quality of life.
‘Being healthy’ is usually the basic of living a high quality of life. In addition to gerontological nurses, I believe community health nurses and visiting nurses will be perfect resources closely bonded with geriatric population’s health, as certain conditions may prevent elderlies from going out and seeking health care regularly, and sometimes they lack the knowledge about when and where they should seek for health care, or they may not even realize the need to seek for health care. Therefore, their health condition is closely depending on we as nurse to approach them actively so that we can do health assessment and educations for them. In order to approach them and give them help, I believe gerontological nurses, together with community health nurses, visiting nurses and social workers would be a perfect team to provide them with help. Places that elderlies would usually go to such as senior centers should provide abundant activities for elderlies with different interest to choose from, as helping them engaging in social activities can not only get them exercises more and thus benefit them wtih physical health, but also can get them talk to other friends and thus preventing them from being lonely and so that could fulfill their spiritual psychosocial world. In addition, health seminar or health trivia should be held often in senior centers in order to expose elderlies with more knowledge about their self-health management. Together with these resources and ideas I believe they would live happier and healthier and thus live a higher quality of live
References
Eliopoulos, C (2013). Gerontological Nursing (8th ed.). Lippincott Williams & Wilkins
Halvorsrud, L., & Kalfoss, M. (2016). Exploring the quality of life of depressed and nondepressed, home-dwelling, Norwegian adults. British Journal Of Community Nursing, 21(4), 170-177. doi:10.12968/bjcn.2016.21.4.170
Hartgerink, J. M., Cramm, J. M., Bakker, T. J., Mackenbach, J. P., & Nieboer, A. P. (2015). The importance of older patients’ experiences with care delivery for their quality of life after hospitalization. BMC Health Services Research, 15(1), 1-7. doi:10.1186/s12913-015- 0982-1
Joshi, S., & Joshi, S. R. (2015). Effect of Fear of Falling on Quality of Life in Geriatric Population. Indian Journal of Physiotherapy & Occupational Therapy, 9(4), 173-176. doi:10.5958/0973-5674.2015.00167.7
Kalfoss, M. (2016). Use of instruments to measure quality of life among healthy and ill adults in community settings. British Journal Of Community Nursing, 21(5), 232-239.
Kurtkoti, A. (2014). Modifications in Homes of the Geriatric Population to Improve Quality of Life. Indian Journal Of Physiotherapy & Occupational Therapy, 8(4), 1-5. doi:10.5958/0973-5674.2014.00001.X
Lenardt, M. H., Hammerschmidt Kolb Carneiro, N., Albino, J., & Hautsch Willig, M. (2014). Quality of life of frail elderly users of the primary care. Acta Paulista De Enfermagem, 27(5), 399-404. doi:10.1590/1982-0194201400067
Markle-Reid, M., Browne, G., & Gafni, A. (2013). Nurse-led health promotion interventions improve quality of life in frail older home care clients: lessons learned from three randomized trials in Ontario, Canada. Journal Of Evaluation In Clinical Practice, 19(1), 118-131. doi:10.1111/j.1365-2753.2011.01782.x
Rasheed, S., & Woods, R. T. (2014). An investigation into the association between nutritional status and quality of life in older people admitted to hospital. Journal Of Human Nutrition & Dietetics, 27(2), 142-151. doi:10.1111/jhn.12072
