Tag Archives: Healthcare

North America

Expectations and Reality: A Review of Long-Term Care

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Tendercare Nursing Home. Photo by Jeffrey Smith.
Photo Credit: Jeffrey Smith.

Unfortunately, it is impossible to create a standardized time frame regarding end-of-life or long-term care since it varies case by case. While there are signs and symptoms that allow people to predict the direction that someone’s health is going, many individuals begin long term care after a sudden life change that leaves them unable to care for themselves at home. One day, they could be healthy and the next, there could be a stroke or fall. In the best-case scenario for a situation like a stroke or fall, patients return home after successful rehabilitation, but more often than not, patients are unable to fully recover. When this happens, depending upon the severity of the person’s impairment, they are either taken care of by family members or moved into an institutional setting.

About 80 percent of seniors receiving long-term care remain within a private home (either their own or a family member’s), and the remaining 20% are moved into facilities. Each situation has pros and cons and what is best for one individual may not be the right choice for another. Those who remain within their homes are often eligible for home-health services to aid family members in their responsibilities. According to the AARP Public Policy Institute, the elderly population in nursing homes has declined over the past ten years with more people receiving care at home, living in assisted living, or being taken care of in group homes. Nursing homes are generally preferred if a person needs 24-hour supervision.

Long-term care, a general term, refers to the type of assistance provided for people with cognitive or physical limitations. Caregivers provide patients with the care needed to complete daily activities. If patients are unable to remain at home, facilities continue rehabilitation to try and strengthen patients and improve their quality of life. Not only does a more functional patient ease the burden of the caregiver, but the more a resident can do by him or herself (eating, using the bathroom, bathing, and changing), the happier they generally are. As age and illness advance, it is important to not have unrealistic expectations since people start to naturally decline.

Typically, long term care is not paid for by insurance companies so cost is definitely a factor when deciding what is best for your loved one. Even with 80 percent of elders receiving care through informal caretakers such as family members, there is still monetary value attributed to this “donated” care. The time spent caring for a loved one could be spent employed elsewhere with wages. There are also transportation costs to think about since an informal caregiver performs duties otherwise performed by paid healthcare aides. It is therefore important to reach out to a social worker as there are benefits that caregivers may not be aware of in their home state. Some states provide a stipend to informal caregivers while other states grant special benefits. Planning ahead and purchasing long-term care insurance can be a good option for many families. Even without this type of insurance, many facilities, especially hospices, charge on a sliding scale. In some states, there is no fee at all beyond Medicaid coverage. See here for eligibility guidelines and a list of Medicaid rules in your home state.

From long-term care, people unavoidably move toward end-of-life or palliative care, and when a loved one makes the transition, it is not about giving up or hastening death. Rather, it is about making death as comfortable and painless as possible. Many people mistakenly believe that admission to a hospice facility is determined by a life expectancy of six months or less, but this is false. Palliative services exist to relieve emotional or physical pain and to manage symptoms.

Before getting to this stage in life, it is crucial to have a written and notarized document, declaring how your loved one would like the end of their life managed in case they become unable to make decisions for themselves. Without preference information available in one’s medical records, it becomes harder on families in a time when things are already hard enough. Thankfully, people live in a time when long-term care and end-of-life care have made one’s later years more comfortable.

Max Gottlieb is the content editor for the Arizona Long Term Care System (ALTCS) and Senior Planning in Phoenix, Arizona, USA. Senior planning is a free service that has helped many Arizona seniors and their families navigate the process of long term care planning. ALTCS and Senior Planning find and arrange care services as well as help people apply for state and federal benefits.

 

 

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Asia

How Robot Technology is Caring for the Elderly

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Communication
Japan faces a rapidly aging population. As more and more of the population greys, fewer and fewer young people are available to care for the elderly. There is a particular shortage of health care workers who work with the elderly therefore the demand for elderly health care is not being met. Among health care workers, there is a high turnover rate which was close to 17% in 2013. Japan’s answer to this shortage is research in robot technology to assist in elderly health care.

A prototype robot, Robear, has been developed. Designed by Riken, a Japanese research institute, this robot is a polar bear cub look-alike that aids health care workers. The Robear is the successor of two previous heavier robots, RIBA and RIBA-II. Robear helps in lifting patients from beds and supporting them in walking. Apart from research in the robot’s abilities, research into understanding the needs of the elderly has also been done, especially in the appearance of the robot. Researcher Mukai says, “The polar cub-like look is aimed at radiating an atmosphere of strength, geniality and cleanliness at the same time.”

Another robot being developed in the country is the ChihiraAico, a 32-year-old Japanese woman look-alike that is supposed to ease communication between humans and non-humans. The creators at Toshiba are aiming to use ChihiraAico with patients with dementia to help them connect with counselors and medical staff with ease. On the other side of the Pacific, the USA is developing PARO, a robotic pet. There is evidence to show that pets can effectively combat loneliness among the elderly and PARO currently shows promising results. A pilot test in a home suggested that elderly residents feel calmer and less anxious after interacting with these robotic pets.

Robotic technology in Japan is not limited to health care, and has expanded to a range of end-of-life services. As more and more elderly people take charge of their funerals, Japan’s end-of-life industry has come up with ‘skyscraper graveyards’. Traditionally, the Japanese cremate the dead and store the ashes in the family crypts in cemeteries. Due to the space constraints, ‘skyscraper graveyards’ have become increasingly popular. Relatives are given identity cards and robotic arms assist them in retrieving the urns stored in vaults deep underground.

Using robots for elderly health care has advantages and disadvantages. On the one hand, robots can effectively aid in the under-staffed health care system in Japan by assisting in hospitals and elder care units. It can also be placed in individual homes and provide remote monitoring of the individual. Moreover, it can help combat loneliness. On the other hand, the use of such expensive technology raises questions on the lack of human relationships and its impact on family dynamics.

Is robot technology the future of elderly health care? What is the scope for robots outside of high income countries like Japan and USA? What, if any, impact will the high dependability on robots have on human-to-human interaction? Only time can answer these questions. Japan’s experiments with robots are promising, and if this technology proves to decrease the burden of aging on Japan’s health care, there will only be more demand and a greater space for robotic technology.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health. 

Global

Ebola and the Elderly: Focusing on a Vulnerable Population

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Certain diseases like pertussis and dementia are associated with distinct populations. Pertussis is generally linked to children and dementia is generally linked to older adults. While both diseases can affect atypical populations, health professionals cannot have the same mindset when rare diseases like Ebola are concerned.

Miguel-Pajares
The Ebola outbreak continues to make headlines around the world and the focus has been on adults and children. If one studies the media and research papers, older adults are nearly absent. The aging population remains sidelined from the Ebola epidemic although the disease has affected the elderly around the world. Some may argue that Ebola mainly affects adults and children but few reports have shown that the elderly are also casualties. The rate of casualties regarding the elderly may not be accurate since there is little focus on this population. How long will older adults continue to be sidelined from issues that also affect them? Ebola attacks the elderly in unique ways compared to adults and children. For instance, older adults are prone to disease and disability because of their age. Specific risk factors that affect older adults also include:

  • Injury and poverty
  • Development of non-communicable diseases
  • Social isolation and exclusion, mental health disorders
  • Elder maltreatment.

These medical conditions in addition to contracting the Ebola virus disease (EVD) make matters worse for the elderly.

Cases regarding the elderly and EVD are not widespread in the media hence this piece will highlight just a few of these instances. The first case is an elderly woman who tested positive of the Ebola Virus Disease in Port Harcourt, Rivers State, Nigeria. The elderly woman had been quarantined in the Ebola Isolation Centre because she shared the same ward with the late Dr. Ike Enemuo, a Port Harcourt-based medical practitioner who treated an ECOWAS diplomat with the Ebola virus. Dr. Enemuo was ill and receiving treatment at the Good Heart hospital in Port Harcourt. He died of Ebola on August 22, 2014. The second case is an 87-year-old woman from Madrid, Spain, who was isolated in the senior center where she lives. The elderly woman was driven in the same ambulance as Nurse Teresa Romero, the first person to become infected in Europe. A key point about this case is that the elderly woman had suffered a fall which made matters worse. Another case in Spain is 75-year-old Miguel Pajares, an elderly priest who was working in Liberia. He was carrying out missionary work when he tested positive for Ebola.

The goal is not to ignore populations that are affected by certain diseases. Health professionals need to have a holistic view for disease outbreaks, knowing that outbreaks still affect populations that are marginalized. As Ebola remains in the news, let us remember the elderly, people with disabilities, and more because each population faces unique challenges during disease outbreaks. Treatment is not just for certain groups, it’s for all groups affected. Health and media professionals can think outside the box when it comes to reporting events. If not, public health interventions may continue to ignore elderly issues around the world.

Sophie Okolo is the Founder of Global Health Aging.

Europe

Italy: How Location Affects Mental Health

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Sardinia_slide
Depression among the elderly is very common and can cause suicidal thoughts. People think that having depression is part of growing old and a disease that needs to be lived with. However, depression can be treated. There are many factors that can cause depression such as losing a lifelong partner and seeing their own children grow up. These life situations can result in many elderly people feeling useless and asking themselves: What else is there to live for? Is death the only thing to wait for?

In Italy, researchers have found out that a certain factor contributes to depression among the elderly more than gender, marital status, age, or lifestyle choices. This factor is that the elderly who live on the island of Sardinia are less depressed than Italian elderly from anywhere else in the country. Does it really make a difference where you live? Yes, it does. In the field of Public Health, we know that availability and infrastructure of health care services as well as social and recreational services are important for the peoples’ well-being. Elderly from Sardinia have health care services nearby to get treatment and preventive services they need. In addition, they are more physically active and more socially and culturally engaged, which increases their self-esteem and mental health.

What can Italy and other countries worldwide take away from this study? I believe that offering cultural, social, and recreational events for the elderly can improve their mental health. In addition, improving health care services in cities as well as in rural areas can not only prevent many mental and physical illnesses, but also give the elderly the treatments needed to live a longer independent life.

Martina Lesperance is a Health Educator and Screening Technician in El Paso, Texas.

Africa

Old and Forgotten: The Crisis of Africa’s Elderly

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viellissement-670x446
Africa is currently the most youthful continent in the world. At least 35 per cent of its more than one billion population is between the ages of 15 and 35. While investing in the youth is a priority for the continent’s transformation, the elderly should not be forgotten. As Africa’s population grows, the number of older people also increases therefore it is important to highlight the issues that affect this population.

Traditionally, extended families have taken care of elderly members but since that is changing, aging Africans are now facing new problems. The United Nations Population Fund estimates that around 50 million people above the age of 60 account for around five percent of Sub-Saharan Africa’s population. In the past, most of them turned to families for help but the practice is becoming less widespread. It is difficult to convince people that the elderly in Africa are in need of help. Issues affecting this population are not popular because either everyone is just focusing on children, which is important, or they are under the notion that the elderly live happily with their extended families. It becomes more difficult when even development policy debates marginalize issues related to the elderly. For example, the Millennium Development Goals (MDGs) focuses only on women and children.

Despite these issues, society should not give up on the elderly because they need our assistance. There are many ways to help the elderly in Africa such as organizations can partner with local hospitals to train volunteer healthcare assistants who will visit the elderly in their homes and ensure that they receiving the care they need. Other complex issues can be tackled efficiently. For instance, there are at present senior citizens who cannot afford sufficient medical care in South Africa. The situation is more problematic because advocates for the elderly state that the services for senior citizens have dramatically decreased in the last two decades.

According to Anita Powell, Southern Africa reporter for Voice of America, few among South Africa’s rapidly growing elderly population are faring well, health wise, due to economic insecurity which is linked with worse health outcomes. Elderly advocates insist that Nelson Mandela, South Africa’s most famous senior citizen, is not the standard by which South Africa’s treatment of its weakest members should be judged. Unlike other aging South Africans, Mandela spent nearly two weeks in a Pretoria hospital for a lung infection, and received the best possible medical care. The nation’s growing elderly population is increasingly marginalized by a government that has focused its health care on young people and women. While child health is very important, the health care needs of the elderly should not be overlooked especially in a nation with only eight registered geriatric doctors. Despite these issues, it is good to know that South Africa’s pension system was the second most distributed of the African countries in the Global AgeWatch Index, the first-ever overview of the well-being of older people around the world. Without a formal pension system, the prevalence of poverty among older persons will likely increase. Currently, there are no formal systems in most other African countries.

It is critical to provide proper assistance and support to combat poverty and economic security for today and tomorrow’s seniors. Africa’s elderly still contribute to development, civic life, and the economy in many ways including caring for grandchildren when the middle generation has died or become very sick from HIV/AIDS. Ultimately, they need to be rewarded. This video portrays the work of the Ikaheng Daycare Centre for the Aged in the South African Township of Ikaheng.

Sophie Okolo is the Founder of Global Health Aging.

Africa, South America

Quality of Life for Elders: Lessons from South Africa and Bolivia

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Photo Credit: Pixabay
                                                                                               Photo Credit: Pixabay

Last year, the Global AgeWatch Index published a report on the quality of life for elders in 91 nations. The report included several factors such as income security, health and well-being, employment and education. African nations did not fare well. South Africa was the highest ranked African nation at number 65 while Ghana, Morocco, Nigeria, Malawi, Rwanda and Tanzania came in at numbers 69, 81, 85, 86, 87 and 90 respectively. Other African nations were not included in the report because there was not sufficient data. With South Africa leading the pack in elderly well-being, it helps to decipher the various ways South Africa deals with its senior citizens.

South Africa has the second largest and most developed economy in Africa with the old age pension reaching 72% of the older population. The pension system is the second most distributed of the African countries that are in the Index. Namibia is the first at a whopping 167.3% although there was not enough data in other areas to include the nation in the report. While South Africa performed moderately well in income security, the nation ranked low in elderly health status. There are only eight registered geriatric doctors to serve an older population of 4 million in South Africa. Since 1994, dramatic changes have taken place in the structure of health services. The government prioritized maternal and child healthcare because of the HIV/AIDS pandemic in the 90’s.

Although South Africa was ranked at number 65, Bolivia, one of the poorest countries on the list was ranked at number 46. This shows that higher-income does not always correlate with better quality of life. In fact, some lower-income countries that invested in aging saw positive impacts. Bolivia, for instance, implemented a national plan on aging and free health care for older people, which vastly improved quality of life.

The rankings illustrate that limited resources need not be a barrier to countries providing for their older citizens, that a history of progressive social welfare policies makes a difference, and that it is never too soon to prepare for population aging. This is important for African nations because the elderly are a significant boon. African nations can do better by learning from each other as well as non-African nations. The outcomes may vary but the collective goal is to improve the elders’ quality of life for present and future generations.

Sophie Okolo is the Founder of Global Health Aging.