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 IN THE ELDERLY
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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

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Population (1999)
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PLACES of CARE for the ELDERLYin EUROPE

• 94 in the COMMUNITY
• 6 in geriatric care facilities

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

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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

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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 !

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

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Medical vs. Psychiatric vs. Social CRISIS

• Need to avoid
• INAPROPRIATE HOSPITAL ADMISSIONS !!!

? INAPROPRIATE HOSPITAL STAY
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QUALITY of CARE

• STRUCTURES
• PROCESSES
• OUTCOMES (? or ?)

Accessibility to the needed care
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The GERIATRIC PROCESS

• Assessment
• J GRIMLEY EVANS Brit Med J 1997 315 1075-7

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GERIATRICCARE MODELS

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

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DIAGNOSIS and DAILY FUNCTIONING
COMPREHENSIVEGERIATRIC ASSESSMENT (CGA)

• Importance
• of
• USING
•  VALID 
• CRITERIA

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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
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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
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Nb of Geriatric Problems
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QUALITY of CARE

• STRUCTURES
• PROCESSES
• OUTCOMES (? or ?)

Important roleof an interdisciplinary
geriatric team in the emergency room
The good patient in the good bed
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The GERIATRIC PROCESS

• Assessment
• Agree objectives of care
• J GRIMLEY EVANS Brit Med J 1997 315 1075-7

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Agreed Objectives of Care

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

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The GERIATRIC PROCESS

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

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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

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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

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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
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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.

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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

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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

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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

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Dependency
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ADL IADL

• IADL
• Cooking
• House cleaning
• Laundry
• Ironing
• Telephone use
• Banking
• Transportation

• ADL
• Hygiene
• Nutrition
• Elimination
• Bathing
• Moving
• Medications
• Treatment of ulcers and wounds

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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

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Support from Nursing

• INFORMATION
• PROFESSIONAL EDUCATION
• EMOTIONAL SUPPORT

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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

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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.

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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.

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Scientific collaboration
Coordination
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THE FUTURE

SYNERGY
Informa / principal caregivers (national
level)

Informa / principal caregivers ( EU Countries)
EU RESEARCH FUNDS