As population age, the body or physical appearance changes, mental, emotional and social aspects of person’s life are also altered. It is inevitable since nobody can live young for a long time. This also mean that an individual is vulnerable to any diseases. Most of the time the elderly people experience a lot of illnesses due to the fact that they cannot perform certain activities like the way they do when they were still young, imbalance or change of hormones especially to women, and loss of appetite or nutritional deficiencies. Some of the geriatric diseases are curable and treatable but there are also palliative cases or end stage.
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Moreover, the most common health problem among older ones is dementia, specifically Alzheimer’s disease. It causes progressive decline of person’s ability to function. Based on the Alzheimer’s organisation website, this illness is the 6th leading cause of death in the United States, and there are more than 5 million people living with this problem. Whilst according to the Alzheimer’s New Zealand, there are 48, 182 New Zealanders suffer from dementia in the latest statistics (2011). It is 1.1% of the total population of the country excluding those individuals who are not aware, diagnosed and documented. There are more cases of Alzheimer’s and other types of dementia recorded among females compared to males. In fact in the US, two thirds of the affected persons are women, and in NZ, 60% or majority of them are females.
Healthcare providers play a vital role in supporting demented individuals. Everyone is expected to give his/her best effort and perform the task whole-heartedly including the government. Family’s support is the most important one since blood is thicker than water. No matter how hard the medical team try to treat the patients, it becomes useless if the family is not there and are not willing to take actions. The emotional support is necessary especially to those elderly who are in their early stage of dementia.
As a Geriatric Healthcare Specialist at Kindly Residential Care Rest home, I will discuss about the emotional support such as individuals in early stage dementia involved in decision-making. Patient’s suffering from early stage dementia or mild- Alzheimer’s disease can most likely still be able to perform their daily activities and most probably need little assistance with the family, relatives, and support worker. These people including the care recipient will experience certain changes due to the health disease as days go by. It is important that the carer is knowledgeable enough to do the tasks and other related circumstances that goes with the situation effectively, and this includes decision-making.
Several barriers have been identified in making decision on behalf of the incapacitated person and these are; having difficulties in deciding what to do and the family member experiencing distress in making a decision, others have lack of information about the situation. Some instance in proxy decision making is lack of emotional support for people with early dementia who still have capacity hinders the discussion of future care options, including placement in residential institutions with 24-hour care. Decision making is always based on the person’s knowledge or education, training, previous experience as well as social and cultural background. Others ask for professional help and information but there are also whom do not.
There are many support organisations for geriatric health conditions. I will just give five different associations that are working with the same objective, which is assisting and providing help for the seniors, and to those who need their services. One of the organisations is the Alzheimer’s New Zealand Incorporated, it is a not-for-profit company providing support, additional information, helpful educational programmes and other services that are applicable to the local community. They are working with 21 Alzheimers member organisations located all over the country. In May 2010, they launched the National Dementia strategy at a special function that was attended by the Minister of health Tony Ryall and other important people who are part of the business.
There are eight strategic goals;
- Acknowledge/recognise dementia as a national health priority
- Boost the awareness of the society about dementia
- Deliver easy access to affordable and proper medical treatment
- Better management and diagnosis of dementia
- Give suitable services to all dementia patient’s
- Provide support to family/whanau/carers of people with dementia
- Create a workforce to provide quality care for demented people
- Expand the research and the evaluation of dementia practices.
This organisation is open for donation since helping to sick individuals cost money, they cannot function without the support of the community. Alzheimers New Zealand conducts a lot of programmes like “Please remember those who can’t” Countdown 2014 Alzheimers Appeal happening on 30 June to July 2014, and “Dementia: The future is now” biennial conference at Rotorua Convention centre on 14-15 November 2014.
Moreover, heart disease is a serious problem encountered by New Zealanders. There are cases in which patient is required to undergo surgery, some instances could lead to death, and others are under long-term medical treatment. That is why The Stroke Foundation is here to help those affected individuals. It is a non-profit association in New Zealand, and is the only organisation which aims and devoted to reduce the number of stroke, better treatment results, and supports those who are already suffering from heart disease. It is managed by board of directors and the main office is located in Wellington. There are three other regional offices in Auckland (Northern Region), Tauranga (Midland), and Christchurch (Southern Region). The Stroke Foundation of New Zealand has three missions; firstly, is to save more lives. They do this by promoting to the public about the health effects of stroke and other symptoms. An example of the programme is the “Blood Pressure awareness campaign” which is done yearly in May and happens all over the country with the cooperation of St. John, Foodstuffs supermarkets, and Rotary. F.A.S.T Campaign and Pacific stroke prevention programme are the other projects of Stroke foundation. Secondly, is to improve outcomes. The organisation wants to concentrate on the delivery of health services in order to provide better rehabilitation and acute hospital and treatment outcomes to the patients. They are in the process of making the stroke services in to the international best-practice standard. The organisation does National stroke Guidelines, Audit and report acute and post-acute DHB stroke services, and assists in Clinical networks. Lastly, they want to enhance life after stroke. The Stroke Foundation supports the families of the patients by visiting them to their home or in hospitals, giving advice and help in accessing the carer-relief services and funding. This association also have “Stroke Clubs” in which people involved have the chance to meet others regularly and all over New Zealand. They also conducts certain activities and stroke survivors are encourage to participate.
Furthermore, another non-for-profit and at the same time non-government organisation is the Diabetes New Zealand. This association has been established since 1962, and has a triple C vision, Controlled, Cured, and Contained. Their mission is to give the diabetic citizens of New Zealand all the support they need so that they can still enjoy the rest of their lives. It has 20 branches in other areas in the country and the main office is in Wellington. All of the branches are working together and giving the necessities of all diabetics. In order for them to achieve their envision and mission, they increase the public awareness regarding the disease, provide additional information and support to help individuals live well, to specifically give hand to those who are prone to type 2 diabetes and eventually delay the complications of diabetes, to promote improve and better services, and to do more researches about diabetes. Diabetes New Zealand is mainly funded by members’ donations, bequests, grants and fees. It is also a member of the International Diabetes Federation, an organisation for all diabetes consumer groups all over the world.
Also, changes in vision is common to elderly people. Some have poor eyesight, others may have more serious problems that could result to blindness, and glaucoma is one those. It is a condition of a group related diseases in which the optic nerve is affected. The nerve fibres continue to die which causes blockage to the peripheral or even side vision. This the leading cause of preventable blindness in New Zealand as well as in other developed countries. Early detection and proper treatment will prevent the community from blindness due to glaucoma. That is why Glaucoma New Zealand was established, and is a registered charitable trust in 2002. They have four aims; to enhance awareness of the public about glaucoma, assist and give knowledge to individuals regarding glaucoma, provide education to the eye health workers to ensure that a high quality of service is given to the clients, and to advocate research into glaucoma.
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Then, the Cancer Society of New Zealand is a not-for-profit association and is dedicated to reduce the incidence of cancer as well as to give the most care to all New Zealanders. The main office is in Wellington, there are 6 regional offices and 16 cancer centres, and each is providing their own funds and other support services. The organisation’s values are integrity, respect and excellence. Their core services are Health promotion, Support, Information and Resources, and Research. The team encourages the society to have a healthy lifestyle by educating them, providing policy, advocacy, and through communicating with the public. Some of the programmes or topics are Tobacco Control, Skin Cancer Prevention, Nutrition and Physical Activity, Screening and Early detection, and Men’s Health. They also accept volunteers which are devoted to the vision and mission of the association. They mainly rely on the donations, fund-raising activities like Relay for Life and Daffodil day, bequests, and personal support.
There are a lot of service provisions in New Zealand, and I will just discuss six among all the types. Hospice New Zealand is one of those service provisions. It is established to make sure that citizens of New Zealand have an access to quality palliative care. They intent to obtain government funding, establish standards and monitor the facilities at a national level, licensing, yearly inspection of hospices, and giving education and resources. This organisation has five goals; initially is the community engagement, which increases the awareness and understanding of care. Next is leadership, they want to guide the whole country into the right direction and support with the help of other members and sectors. Advocacy is the third goal, to ensure equitable funding and delivery of hospice care. The fourth goal is to develop workforce, they want to have a high palliative care and performing hospice manpower. The fifth and final goal is the quality and standards. This will enable them to improve the quality and standards palliative care for the families, clients and whanau. The vision of Hospice New Zealand is based on the World Health Organisation, which “intends neither to hasten nor postpone death”. The core values are being Professional, Respectful, Caring, Collaborative, and Honour diversity.
Similarly, Public hospitals is another service rendered for New Zealanders. These are manage and owned, or funded by District Health Boards (DHBs). It is made up to provide quality acute care, and guarantee that a lot of individuals are able to access the elective or non-acute services. There are varieties of publicly funded health and disability services right now such as surgical, maternity, medical, emergency, and diagnostic services. Hospital services are provided on a day case and outpatient basis, inpatient, and depends on the type of care needed by the clients. Inpatients are admitted in the hospital for only one day or overnight, day case clients are admitted and are being discharge on the same day, while outpatients go to specialist’s clinic services and are not admitted to hospital.
In addition, Residential care in New Zealand is provided by private companies and non- profit organisations. In most cases the cost of care to the individuals is subsidised by government funding known as the Residential Care Subsidy. It includes long-term care, and has four levels of care: rest home care, continuing care (hospital), dementia care, and specialised hospital care (psychogeriatric care). Short-term respite care and convalescent may also provide but do not involve income and asset testing. To be eligible for a government-subsidised residential care must be assessed as “needing care”. DHBs are responsible for funding residential care services for elderly persons. They also have contracts to other rest homes and hospitals owners, if the client is eligible for government funding through the residential care subsidy, DHBs will decide based on the assessment of a resident. Whether “high” or “very high” needs, and it is necessary to send the client to one of the service provisions, and the family or relative cannot be safely cared.
Moreover, GP or General Practitioners are one of the healthcare providers who help the residents in dealing with their diseases or situation. GP diagnose and treat the health concerns of the people within the community. Pay depends on the location, hours, and the number of patients they rendered their service. General Practitioners job description are the following: examine and diagnose client’s health problems, perform minor surgery, refer residents/patients to other health services if necessary, prescribe and administer medications, keep medical records and maintain the confidentiality of patients, advise on health care and prevention of illness, and also train and supervise doctors working towards their GP exams. It is essential for them to be great in communicating with the patients, they are knowledgeable about the anatomy and how human body works, and have the knowledge of different diseases, illnesses and injuries. They must update themselves by new research, treatments, and practices. The knowledge of medical ethics and law is very important, and the diagnostic skills. GP’s job is very important since the diagnosis of the patient depends on their assessment.
Counsellors are also important in the community. They help individuals in dealing with their personal problems, it could be emotional or financial. They also aid in deciding on what actions they can take to solve problems and create changes in their lives. The professional fees vary and depend on the offer of employer, as well qualifications and experience. It is a vital characteristic for the counsellor to be a good listener, respond, and reflect with clients. Counsellors must also convince their clients to talk and express their feelings about the happening in their life. It is also part of their job to help the patients in understanding themselves, their necessities as well as how to meet their goals. The skills and knowledge that a counsellor must have are: the knowledge of social, cultural issues, and self-care strategies. To be able to understand the human development and relationships, skills in analysing and evaluating human behaviour. This profession is very helpful for the elderly since they experience a lot of changes not only in their physical looks but also emotionally. They need an expert in decision making and an advice from their personal problems.
Finally, Dieticians play a vital role in health services when it comes to the seniors. Balance diet and healthy lifestyle is one of the common geriatric problems, that is why dietician is needed to ensure that they are eating nutritional food, preventing and eliminating vices such as smoking and drinking alcoholic beverages. A registered dieticians often seen working in the community like in, hospitals, catering companies, food industry, companies, sports commission, and other non-traditional work settings. This profession is essential in the treatment and prevention of disease in the hospital and other health care facilities. The elderly must eat properly since they are prone to other diseases like skin infection, allergies, skin tears and other related illnesses. Once they are healthy, they can prevent those diseases and can still enjoy the rest of their lives.
In conclusion, there are so many geriatric problems like emotional, physical, mental etc. The government and other non-profit associations are working hand and hand in order to eliminate and eventually prolong the lives of the seniors. Emotional support from the family especially in the early stage of having a disease is important for both parties so that they can cope with the problems together. By doing this, the sick individual is not feeling ignored or left behind. Heaps of support services are available nationwide such as Alzheimers New Zealand, Stroke Foundation, Diabetes New Zealand, Glaucoma New Zealand, and Cancer Society of New Zealand. All of these provide an outstanding health services towards residents who badly need help and support from the community. Aside from that, service provisions are necessary to complete the cycle of the health care plan. Examples are hospices, hospitals, residential cares, General practitioners (GP), Counsellors, and Dieticians. All of those have their own responsibilities and are experts in caring and giving their best efforts for the betterment of the elderly.
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