OLDER ADULTS IN COMMUNITY SETTINGS BANKSTOWN SYDNEY Essay Example

  • Category:
    Nursing
  • Document type:
    Assignment
  • Level:
    Undergraduate
  • Page:
    5
  • Words:
    3017

Older Adults Community in Bankstown

Supervisor:

Introduction

A community is a group of people who have common values which act as identifiers of group. A community normally forms a social unit which share common risks, beliefs and preferences that are uniquely related to the social unit (Anderson 2010, p.350). The elderly people of Bankstown in Sydney are a form of special community. Bankstown consists of ethically diverse communities (ABS 2012, p.18). A survey carried out in the Sydney South West found that there are a high number of older adults in the area. In Bankstown, there were over 24000 people aged over 65 years old. The data from hospital showed that older adult in South West Sydney account for 45% of the acute hospital bed days (SSWAHS 2009, p. 104). The ailments for these people differ but are mainly related to chronic preventable diseases. In Australia in general it is predicted that the number of the elderly will increase by 45% by 2020 which will represent lead to a 13% population of the elderly (SSWAHS 2009, p. 108). Due to this increasing trend there are community systems that have been put in place to address the needs of the older adults in Australia.

The subsystems in the community

to reduce the mortality and morbidity rates among the older adults, the government of Australia has partnered with the Commonwealth (HACC) program in order to provide essential healthcare services to the older adults. The health services provided by the program include the nursing care, social support, personal care, podiatry, physiotherapy and speech pathology (AIHW, 2011). These services target the people who have retired from active economic activities and are aged over 65 years. An evaluative research conducted by SSWAHS (2009, p.103) found that the programs are helping to improve the health wellbeing of the elderly in Bankstown and there have been significant reduction in both morbidity and mortality rates. The trends in mortality and morbidity are important signals to the health status of a given population. Wannamethee, Sharper and Walker (2009, p.1359) noted that mortality and morbidly rates are best providers for the baseline indicators for the health system effectiveness. In order

Community perceptions

The main cause of the ill health among the older adults of Bankstown has been associated with myriad of factors which include the unhealthy diets, overweight and obesity, physical inactiveness and sedentary life (Hector, Espinel & King 2012, and p.7). Despite of the decrease in mortality, there has been great concern by community on the rising cases of heart related diseases.

Priorities for action

The older adults are inflicted by many health conditions which greatly reduces their quality of life. According to Anderson (2010, p. 349) 91% of the older adults have at least one chronic disease. An earlier survey carried out by Ades, Waldman and Gillespic (2009, p.13) found that 80% of the disease burden among the older adults suffer from chronic diseases. Most of the chronic diseases inflicting the older adults are preventable. In order to ensure that the quality of life this community is improved the priority healthy initiatives should focus on the diseases with high preference. In the community, the common chronic diseases include cardiovascular, cancer, diabetes, respiratory diseases, physical injuries and the mental health problems

The chronic diseases affecting the old adults in Bankstown have major implication on cost maintenance of the health systems in the area. In addition these conditions and diseases such as diabetes normally reduce the quality of life of the community and reduce the number of working days for the older adults who are still in active economic activities (Miller & Dustan 2009, p.54). The interventions through the provision of the health for the elderly by commonwealth HACCP programs have had significant improvements of the disease conditions for the older adults in the different fronts. However, there is still major concern on the increasing prevalence of the cardiovascular related diseases and diabetes in the community. The prominent health problems among this community have remained to be the terminal illnesses and the diseases attributed to the overweight and dietary practices. The hospital records collected and analysed, up to 65% of the older adults inpatients in the selected hospitals were found to be due to heart diseases and diabetes (SSWAHS 2009, pp 107). Other common diseases were musculoskeletal injuries, mental illnesses, respiratory diseases and cancer.

The older community is faced with many challenges which are supposed to be addressed holistically if tangible health results are to be realised in Bankstown in Australia. In Bankstown and the rest of Australia there have been marked downward trends in the mortality rates of the population (SSWAHS 2009, pp 107). Even though this is a big step for Australia, it does not signify improved quality of life for the population especially the older adults who continue to account for high bed occupancy in most of the hospitals. Therefore to ensure that the reduced mortality rates correlates with improved quality of life, there is need for measures that will ensure the common preventable chronic diseases among the elderly are addressed through informed health initiatives (Hector, Espinel & King 2012, p.8). Most of the diseases relate to lifestyle practices. The following is the order of priority for addressing the health issues affecting the older adult community in Bankstown in Sydney.

  • Cardiovascular diseases

  • Diabetes

  • Injuries

  • Mental illnesses

In Australia, the life expectancy has been continually increasing; this has been associated with high income levels of the citizens and the good health care system (SSWAHS 2009, pp 108). As the income increases, many people are in a position to afford sedentary lifestyles which sadly reduces their level of physical activity hence increasing prevalence of the diseases related to the sedentary lifestyle such as cardiovascular diseases (Briffa, Majorana & Allan, p. 2012). The lifestyle trend of physical inactivity cuts across the age groups and it become severe in older people who are retiring from active jobs and most of the times remain confined at their homes without much of physical activity (Eakin & Glasgow, 2010, p. 161). Therefore to address the issues of the diseases physical activity becomes a priority which will help in improving the quality of life for the community members with cardiovascular diseases.

The prioritisation of the health issues is based on the hospital statistics for the most reported illnesses among the old adults in Bankstown. The prioritisation is also based on the perception of the community on the major health concern. For instance, there is concern that there are no health amenities in Bankstown that support the older adults’ exercise (SSWAHS 2009, p.104). The issue of the diabetes was second because it also related to less physical exercise and was secondly ranking from the hospital records. The cases of musculoskeletal injuries were found to be caused by either falling or as the members of the community engaged in unsupervised exercise. The mental illness issues were ranked fourth as there are already services in the Bankstown providing health related services. Despite of the prevalence of the mental illnesses being relatively high, there has been significant reduction in the cases. Cancer is a common disease among the older adults in Australia. However, the management of cancer requires concerted effort between the patients and the health professionals with the major responsibility falling on the older adults going for regular screening services (Anderson 2010, p. 361). There are health support programs that have been creating awareness in Bankstown and most of the community members are already knowledgeable about the cancer and measures to take to prevent the different types of cancer, therefore this is not a major concern in the community.

Public health care programme

The changes in life stages especially in older adults affect their health directly or indirectly due to the underlying behaviour that may be responsible for the disease (Anderson 2010, p. 371). For instance, obesity and reduced exercise in the older adults is a major cause of cardiovascular diseases which increases the morbidity of the cardiovascular diseases and mortality resulting from the ailment (Hector, Espinel and King 2012, 7). The majority of the older adults are retirees which results to behaviour of sedentary lifestyle that consequently affects their diet and activity. A study carried by Todd (2011, p.24) on the socio economic activities of the older adults found that their major jobs are taking care of the grandchildren which confine them to homes with very minimal physical exercise.

In order to address the issue of cardiovascular diseases in Bankstown, the health promotion plan will entail a participatory approach that will be applied in the design and implementation of the initiative. Participatory approaches to community interventions bring stakeholders together who help in the championing of the benefits of the initiatives, promoting outreach and in mobilisation of demand and acceptance of the initiative (Anderson 2010, p.375). The initiative will include awareness creation on the importance of exercise and start exercise centres where the old adult can exercise under supervision of professionals. According to a research carried out by Eakin and Glasgow (2010, p. 164) to determine the role of exercise in improving the quality of life found that daily exercise significantly reduced recurrence of diseases among the older adult. The initiative will also entail collaboration with the healthcare authorities to identify centres where the older people can be encouraged to attend exercise sessions which will be supervised by health and fitness instructor.

Physical exercise is an inclusive strategy that addresses many factors. According to Maiorana, Driscoll and Dembo (2010, p.2001) physical activities lowers blood pressure and play a crucial role in lowering cholesterol levels which are major predisposing factors to cardiovascular diseases. By having the physical exercise in given centres, the older adults will meet and socialise which will also improve their social health. Exercise will also help in improving the quality of life for the community and address other issues such as diabetes and musculoskeletal injuries which mainly occur due to unsupervised physical activities and overweight (Maiorana, Driscoll and Dembo 2010, p.2004).

Implementing the program

The activities to be taken in the implementation will include creation of awareness on the importance of exercise, mapping centres favourable for the exercise and recruiting of the health professionals to be involved in the helping the older adults in exercise. According to Evashwick and Ory (2010, p.181) a sustainable community program should have clearly articulated objectives and strategies to help in working towards accomplishing the objectives. The initiative’s main objective will be behavioural change that will be geared at encouraging exercise to be part of the daily activities which will help in the addressing the chronic diseases through physical exercises that have been found to improve health wellbeing (Bauman 2010, p. 16). The initiative will be an inclusive undertaking that will involve stakeholders drawn from the community and the community itself. The initiative will be managed by the public health authorities in the Bankstown. This will ensure that it conforms to standards required for health promotion initiatives. The people to be involved in the initiative will be the older adults, the social workers, the selected public health officials, nurses and doctors. To incorporate these people a participatory and inclusive approach will be used which will form a committee of the people to be involved in the initiative. Participatory approaches have been found to increase integration, promote service delivery and increases acceptance in community (Evashwick & Ory 2010, p. 183).

In order to ensure success, the initiative will require finances to be used in creation of the awareness, and to provide allowances for the people involved in the initiative. There will also be requirement for land resource which will act as the exercise centres. Other resources will be first aid kits that will be used in case of emergency. In the creation of the awareness, the initiative will partner with the local media to help in creation of the awareness and prioritisation of the interventions (Anderson, 2010, p. 364). The hospitals will also be used in identification of the older adults and referral for older adults to exercise centres. The initiative is aimed at ensuring behaviour change; according to Sharma, Singh and Geromette (2012, p.122) behaviour change is a complex process that is dictated by many factors. Therefore repeated exposure is required in order to change the behaviour of individuals. This means that the time frame for the exercise will be a duration in which positive change can be realised. This initiative is aimed at running for six months which is the minimal time if behavioural change is to be achieved.

Evaluation of health outcomes

Evaluation plays a important role in determining the overall effectiveness of health promotion programs. According to Jones et al (2012, p.229) evaluation of the outcomes is normally through indicators that are used to measure the different variables in the health process. According to Anderson (2010, p.367) a health promotion intervention should be evaluated against set indicators in order to determine if it lived to its desired goals. The evaluation can be continuous or carried after the completion of the intervention. In my case, for the initiative to be gauged successful, the following indicators will need to be realised.

  • Increase in number of older adults attending the exercises.

  • Reduced hospital admissions due to heart related diseases

  • Reduced cases of musculoskeletal injuries.

Challenges

In the cause of the undertaking the initiative, there are unexpected happening which may arise and become a challenge on hoe to address them as they had not been planned for (Evashwick & Ory 2010, p.184), potential challenges could be inadequate resources required to build the capacity for the older adults. Furthermore, there is likely to be low turn up as the community may not be enthusiastic about exercise as they are used to resting. In addition, the older adults are not a homogenous population, their age and capabilities vary (Evashwick & Ory 2010, p.179), hence the initiative will need to be comprehensive in order to cover the diverse needs.

Addressing the challenges

To address the challenges of low turn out, the initiative will employ participatory approach and use the social workers to sensitise the community on the needs of the exercise and boost their confidence by encouraging them to register for the exercises. According to Evashwick and Ory (2010, p.181) the stakeholders in the interventions are very crucial in building capacity, promoting acceptance and sourcing for funding.

Reflection

Community assessment is an inclusive undertaking which has enabled me to work with other healthcare professionals to assist in the collection of the required data and subsequent planning of the strategy to address the challenges. This has been a great exposure to the real community needs and health issues affecting the older adults in the Bankstown. The community assessment has been an informative undertaking and a learning process. The process though time consuming has boosted my skills in the research and planning. Having successfully carried out the exercise, I believe it will be easier to undertake the initiative in real practice. However, I anticipate difficulties in bringing all the stakeholders together and the financial challenges in building of the initiative capacity. To solve this challenges inclusion of the key stakeholders in the society will be integral. The completion of this task has enhanced my understanding of the real work practice I will encounter in my professional community nursing.

References

Ades, P, Waldmann M, and Gillespie C. 2009. A controlled trial of exercise training in older coronary patients. Journals of Gerontology Series A: Biological Sciences and Medicine Sciences, 1 (1), pp. 12-25.

Anderson, G. 2010. Chronic Care: Making the Case for Ongoing Care. Princeton, NJ: Robert Wood Johnson Foundation, pp.349-371

Australian Bureau of Statistics (ABS). 2012. The Population of Older Adults in Australia. Australia Bureau of Statistics, p. 16-21.

Australian Institute of Health and Welfare (AIHW) (2011). Heart, stroke and vascular diseases. Cardiovascular Disease Series 14 (1)., 2-39.

Bauman A. E. 2010. Updating the evidence that physical activity is good for health: an epidemiological review. Journal of Science and Medicine in Sport, 7(1), pp. 6–19.

Briffa, T. Majorana, A., Allan, R. 2012. National Heart Foundation of Australia Physical activity recommendations for the old adults with cardiovascular diseases. Sydney: National Heart Foundation of Australia, pp. 7-36.

Eakin, E. G. and Glasgow, R. E., 2010. Review of primary care-based physical activity intervention studies: effectiveness and implications for practice and future research. Journal of Family Practice, 49(2), pp.158–168.

Estabrooks, P. A., Glasgow, R. E, Dzewaltowski, D. 2012. Physical activity promotion through primary care. Journal of the American Medical Association, 289 (22), pp.2913–2916.

Evashwick, C., and Ory, M. 2010. Organizational characteristics of successful innovative health care programs sustained over time. Family Community Health, 26(3), 177-193.

. Sydney: Physical Activity Nutrition & Obesity Research Group, pp.1- 18.Reducing the risk of chronic disease in older adults: A summary report to support obesity prevention planning in NSWHector, D., Espinel, P., and King, L. 2012.

Jones, R.A., Morris, B.R., Morrow, G.D., Ries, J.B, and Wekstein, D.R. 2012. Self perceived information needs and concerns of elderly persons. Perceptual and Motor Skills, 74, pp. 227-238.

Miller, Y. D. and Dunstan, D. W. 2009. The effectiveness of physical activity interventions for the treatment of overweight and obesity and type 2 diabetes. Journal of Science and Medicine in Sport.7 (1), pp. 52–59.

Maiorana A., O’Driscoll G and Dembo, L. 2010. Effect of aerobic and resistance exercise training on vascular function in heart failure. American Journal of Physiology. Heart and Circulatory Physiology, 279(4), pp.1999–2005.

Sharma, R. N., Singh, S., and Geromette, J. (2012). Positive behavior support strategies for young children with severe disruptive behavior. Journal of the International Association of behaviour change, 9 (1), pp.117–123.

Sydney South West Area Health service (SSWAHS). 2009. A Health Profile Of Sydney South West: A Status Report Describing the population their health and services provided for Sydney South West Area health service. Health Service Planning Report, 1 (1), pp. 102-109.

Todd, H. (1984). The information needs of newly retired people. Health Libraries Review, 1 (1), 29-35.

Wannamethee, S. G., Shaper, A. G. and Walker, M. 2009. Physical activity and mortality in older men with diagnosed coronary heart disease. Circulation 102 (1), pp.1358–1363.