Care of the Elderly

Ageing is a natural process that occurs in the course of an individual’s life. As we age, our bodies change in many ways that affect function and efficiency. These changes occur little by little and progress inevitably over time. The rate of this progression can be very different from person to person (Perring 2007). Aging is an important part of all human societies reflecting the biological changes that occur, but also psychological and social implications (Marr ; Kershaw 1998). Death of a partner or child, loss or change of a job, financial crises and major illness are changes that many individuals will experience.

Mrs. Adam being 84 years of age has certainly experienced and encountered many of these changes. This essay will follow up on some different factors that have contributed to certain changes in her life. This case study presents Mrs. Adam, who was recently admitted to the assessment ward of the Department of Medicine for Older People. From the information provided, one can see that Mrs. Adam is a candidate for falls rehabilitation, due to her history of numerous accidents over the last few months.

Falls are defined as ‘events that cause subjects to fall to the ground against their will’ and are serious problems among the elderly (Marr ; Kershaw 1998). Major injuries can be sustained after a fall, which may lead to hospital admission. How ever minor injuries, like bruising, endured by older people may force them to bed rest which can have serious consequences. These recent falls that Mrs. Adam has had have resulted in bruising, particularly over the hips and consequently led to her referral to the hospital. As mentioned before, our bodies change as we age in many ways that affect the function of both individual cells and organ systems.

Musculoskeletal changes lead to decline in bone density, muscle cells and size, quality and strength, leading to impairment of motor function. This can lead to greater risk of falling (McDonald 2004). Conditions like stroke, dementia, osteoporosis and low blood pressure, which are common in older people, can cause weak muscles, dizziness and confusion that increase the risk of falling (NHS 2007). In addition some medicines can cause dizziness, balance problems, confusion or sleepiness, which also increase the risk of a fall.

Interactions between medicines can also cause these symptoms as research shows that those on four or more medicines are at greater risk of having a fall. It is quite common for elderly people to be on four or more medications (NHS 2007). From the case study we are told that Mrs. Adam, up until the recent admittance to hospital, had been living alone, independently in an upstairs flat. We are not told for how long she has been on her own, as there is no mention of previous husband or partner, so there is an uncertainty of background details and circumstances.

The only family member that is acknowledged is that of a daughter, who lives on the same street as Mrs. Adam. The fact that she lives so close, we can assume that all the help Mrs. Adam needed previously was on her doorstep, which would have been of real comfort to her. We are informed that she has visited her mother every day since being admitted to hospital. Mrs. Adam appears to have been a very independent woman, and up until her recent fall was a very active woman. Her interest in socializing and meeting people is evident from the outline of the case study.

She is an active member of the church. From this information, one can presume that before admittance to hospital, she attended church on a regular basis. This not only gives her a sense of pride, carrying out her religious duty, but it allows her to interact with others in the community. The need to communicate and interact with others is an essential human drive for all individuals (Marr and Kershaw 1998). She is also a keen member of the Scottish Women’s Rural Institute, (SWRI). These are groups of women who meet together in centres throughout Scotland.

The meetings give the opportunity to meet other members, organize events or simply enjoy the friendship of fellow members at the monthly meeting (S. W. R. I. 2007). These meetings give Mrs. Adam something to look forward to. Very often, as people get older their social circle diminishes, through death, decrease in social events and most of all, restriction in activity. It states in Marr & Kershaw (1998), that elderly people living in situations in which they are confined to their own homes and deprived of social contact, can induce loss of self esteem, loneliness leading to lack of motivation and interest in life.

These social gatherings in her timetable seem to bring a little light into her daily routine, give her something to look forward. The move to hospital seems to have greatly affected Mrs. Adam. While living alone in her flat, she was used to being independent and following her own personal devised routine. Being in hospital has forced her into following someone else’s routine, complying with new rules and regulations.

She is told when to eat, given a particular time for washing and she may only have visitors between certain hours According to Marr and Kershaw (1998) relocation of an elderly person to unfamiliar surroundings can have adverse effects, delaying recovery of the patient, while in severe cases, may lead to severe depression and hasten death. The new surroundings and routine, along side the new course of medication can lead to state of confusion, lack of interest and motivation in personal self care and life in general. One must also consider her fear of never returning back home.

This fear may have some negative psychological effects on her. The current concern is the safety of Mrs. Adam, due to her history of falls over the past couple of months. Falling among elderly people is recognised as a serious problem for the health services as well as for the elderly people’s welfare (Simpson et al 1998). There are no details of the previous falls however one can assume that her accident of late, has raised much concern as to her health status as she has now been admitted to hospital. She does live alone so there is a high possibility that she may have been lying on her own for some time before she was found.

This ordeal can be a very fearful experience for any one, especially the elderly. Clinical experience and previous research shows that older people who are at risk of falling, can become anxious at the thought of being incapacitated on the floor (Simpson et al 1998). Many live in the fear of falling again, and this can lead to loss of confidence. Individuals who have experienced a fall, tend to reduce movements which can lead to a decline in their activities, for fear that a re-occurrence might leave them in a worse situation (Marr & Kershaw 1998). It appears that Mrs.

Adam has become isolated since her onset of falls, and is now less active. With the sudden decline in her health over the last few months, the issue will arise as to where Mrs. Adam shall live, keeping her welfare in mind. Considering the multiple falls and her current state of health, a decision will inevitably be made as to whether she should be moved permanently from her flat to a care home or be issued with a care package at home. Control over one’s activities in the home, assists older people to retain control over their lives and to remain independent.

Losing one’s independence is a state with which it can be extremely difficult to come to terms with (Marr & Kershaw 1998). Mrs. Adam could well be faced with this problem in the very near future. Hopes for her returning home and living as she once did do not seem possible. Her health has declined a considerable amount in a very short space of time. Only 3 months ago she was living independently. Her general mobility is decreasing rapidly. The history of falls is a problem that has to be dealt with and addressed immediately.

The extent of those numerous falls is unknown to us, but the fact that it has happened in a short space of time gives rise to a lot of concern. The fact that she is having difficulty with mobility in the hospital raises serious doubts as to her capability to look after herself at home. Mrs. Adam has numerous problems that have led her to her hospital referral. This move has been a terrifying experience for her. Rehabilitation is paramount for her recovery. Collaboration and co-ordination of both the patient and the professional teams will be a key factor in achieving a successful recovery.