Focus on Practice - Care of the Older Adult Essay.
Case study response: Focus on practice - Care of the older adult
- From the case study notes, choose one legal, social, political, ethical, cultural, or healthcare issue and discuss why this is an issue and the relation of this issue to the wider context of the older adult population in New Zealand.Focus on Practice - Care of the Older Adult Essay.
- The ageing population” is about the ethical, social, political, cultural, and legal issues that are associated with the elderly population. As a healthcare professional, these areas impact on how you practice and the care services/delivery that older adults’ access and receive. Therefore, having an understanding of these factors from an international and national perspective is important.
- There will be a "Focus on practice - Care of the older adult" activity. A case study format will be presented about Mrs Berry that relates back to the module that is being covered. The purpose of this activity is for you to read the "Mrs Berry Case study notes" you have been given about Mrs Berry and to answer the associated questions using evidence-based literature.Focus on Practice - Care of the Older Adult Essay.
Angela Berry, a 84-year-old woman, lives independently in her own home. She goes for a morning walk every day. Her husband died 6 months ago and they had been married for 48 years. Mrs Berry has two children, a son who lives in Australia and a daughter who lives in England. Mrs Berry’s son last came to visit at Christmas time but has not seen her daughter for a long time. Mrs Berry is fiercely independent. Mrs Berry was a school teacher and her husband was an accountant. They both loved to travel and have been to many countries.
Focus on Practice - Care of the Older Adult Essay.
Over the last few months Mrs Berry has noticed a change in her mobility. She is struggling to get from bed to the toilet and finds she has to have a rest on the way to the toilet. She no longer is able to go for her morning walks. She is feeling tired most days and doesn’t have the energy to make any meals. Her son, Peter, calls her every few days and is becoming concerned about his mother because she doesn’t always answer the phone at the arranged time. When she does answer the phone, she doesn’t sound her usual self and sounds a bit confused. Peter suggests it may be time for Mrs Berry to have some form of arranged care to which she replies “I’m doing well thanks, this is my home and I am quite capable of looking after myself”. Peter remains worried but doesn’t want to upset his mother so leaves the discussion. He considers moving back to New Zealand with his family to be nearer Mrs Berry. Mrs Berry has also mentioned a lovely young man has being coming around and keeping her company. She occasionally buys his raffle tickets that he sells.Focus on Practice - Care of the Older Adult Essay.
A few days later Mrs Berry has a fall on her way to her letterbox. Her neighbour Mrs Dempsey sees her fall and quickly arranges an ambulance. When Mrs Dempsey goes into Mrs Berry’s home to collect some clothes to take to the hospital, Mrs Dempsey notices the house is not as orderly as Mrs Berry usually keeps it (Mrs Berry is known to be house proud).
On arrival to the hospital, Mrs Berry presents:
- confused
- is guarding her right hip with external rotation, and shorter than the left leg. She is also not moving her left arm.
- She has been incontinent of urine and faeces.
On observation:
- the stool appears blackened and has an offensive odour.
- Mrs Berry also has a wound on her left leg that appears infected (it has erythema, hot to touch, appears painful, and is purulent) and she can’t recall how it happened.
- Her peripheries are cool and clammy and she is pale.
- Her feet are slightly oedematous.
Mrs Berry does not appear to have an enduring power of attorney nor an advanced directive. Mrs Dempsey arrives to the ED and explains that Mrs Berry’s children live abroad. However, she is very eager to help where she can and explains to the staff that her son knows her and he will not mind if they discuss Mrs Berry’s situation with her.Focus on Practice - Care of the Older Adult Essay.
Introduction
According to Chan, Peart & Chin (2014), advance Care planning refers to a process in which discussions and shared plans for health in the future are made by patients. It is also referred to as an advance health directive or living will. Advance care planning includes an individual, his/her healthcare providers and family members. The entire process may lead to a patient writing an advance directive, an advance plan of care or alternatively assigning an enduring power of attorney. An advance directive is considered to be a legally binding document that an individual expresses his/her wishes for treatment in future/during the end of life. For the purpose of this assignment, the use of advance directives and enduring power of attorney in the clinical settings will be discussed. From a legal perspective, advance directives/enduring power of attorney informs clinical decision making at the end of life or when an individual becomes mentally incompetent to make decisions regarding care.Focus on Practice - Care of the Older Adult Essay.
Discussion
There are crisis situations that present in the clinical setting which are similar to that of Mrs. Berry whereby, she is currently not competent to consent to treatment and is not sectioned under the Mental Health Act. Neither does Mrs. Berry have an enduring power of attorney nor an advance directive. Such situations present healthcare providers with numerous challenges when providing care, circumstances that can equally be prevented through advanced care planning.
New Zealand’s older adult population (65 years and older) has the highest growth rate. By the year 2051, it is estimated that 1.18 million people will be 65 years and older: a 165% rise since the year 1999 (Street et al., 2015). The majority of this population has however failed to plan for end of life care in advance, partly due to lack of knowledge/information and partly due to not knowing when and what to talk about (Bradley et al., 2014). This discussion is an issue since it easily leads to disagreements amongst patients, families and their loved ones when making decisions about health in the end of life, when to stop or continue using medical procedures that sustain life (Peicius, Blazeviciene & Kaminskas, 2017).Focus on Practice - Care of the Older Adult Essay.
In New Zealand, patients have the right to use advance directives which should either be in oral or written form according to the Code of Health and Disability Services Consumers Rights (Luckett et al., 2015). In this context, consumers make written or oral choices about healthcare procedures which are only intended to be used when incompetent. Besides, one can nominate a person through the Protection of Personal Property Rights Act of 1988 to be his/her enduring power of attorney with regards to personal care (Luckett et al., 2015).Therefore, when incompetent, the appointed person will make decisions on behalf of an individual.Focus on Practice - Care of the Older Adult Essay.
According to New Zealand laws, in this case, the attending physician ought to continue with the administration of standard medical treatments that are intended to save Mrs. Berry’s life or to prevent the occurrence of serious harm to her health (Carter et al., 2016). However, any other decisions regarding Mrs. Berry’s treatment should preferably be made by the attending clinician/physician by considering her best interests, if she were competent enough to make them (Carter et al., 2016)Focus on Practice - Care of the Older Adult Essay.
Conclusion
Advance directives ensure that an individual’s interests and wishes are respected during a crisis. However, a crisis plan and an enduring power of attorney are even more effective in safeguarding an individual’s interests and wishes. The attending clinician in Mrs. Berry’s case should preferably be the one to make decisions regarding her health at now. He / She should start by administering standard medical treatments that are intended to save her life or to prevent the occurrence of serious harm to her health. Other decisions should be made with the patient’s best interests if she was competent to make them.Focus on Practice - Care of the Older Adult Essay.
Case study response: Focus on practice - Care of the older adult
- From the case study notes, choose one legal, social, political, ethical, cultural, or healthcare issue and discuss why this is an issue and the relation of this issue to the wider context of the older adult population in New Zealand.
- The ageing population” is about the ethical, social, political, cultural, and legal issues that are associated with the elderly population. As a healthcare professional, these areas impact on how you practice and the care services/delivery that older adults’ access and receive. Therefore, having an understanding of these factors from an international and national perspective is important.Focus on Practice - Care of the Older Adult Essay.
- There will be a "Focus on practice - Care of the older adult" activity. A case study format will be presented about Mrs Berry that relates back to the module that is being covered. The purpose of this activity is for you to read the "Mrs Berry Case study notes" you have been given about Mrs Berry and to answer the associated questions using evidence-based literature.
Angela Berry, a 84-year-old woman, lives independently in her own home. She goes for a morning walk every day. Her husband died 6 months ago and they had been married for 48 years. Mrs Berry has two children, a son who lives in Australia and a daughter who lives in England. Mrs Berry’s son last came to visit at Christmas time but has not seen her daughter for a long time. Mrs Berry is fiercely independent. Mrs Berry was a school teacher and her husband was an accountant. They both loved to travel and have been to many countries.Focus on Practice - Care of the Older Adult Essay.
Over the last few months Mrs Berry has noticed a change in her mobility. She is struggling to get from bed to the toilet and finds she has to have a rest on the way to the toilet. She no longer is able to go for her morning walks. She is feeling tired most days and doesn’t have the energy to make any meals. Her son, Peter, calls her every few days and is becoming concerned about his mother because she doesn’t always answer the phone at the arranged time. When she does answer the phone, she doesn’t sound her usual self and sounds a bit confused. Peter suggests it may be time for Mrs Berry to have some form of arranged care to which she replies “I’m doing well thanks, this is my home and I am quite capable of looking after myself”. Peter remains worried but doesn’t want to upset his mother so leaves the discussion. He considers moving back to New Zealand with his family to be nearer Mrs Berry. Mrs Berry has also mentioned a lovely young man has being coming around and keeping her company. She occasionally buys his raffle tickets that he sells.Focus on Practice - Care of the Older Adult Essay.
A few days later Mrs Berry has a fall on her way to her letterbox. Her neighbour Mrs Dempsey sees her fall and quickly arranges an ambulance. When Mrs Dempsey goes into Mrs Berry’s home to collect some clothes to take to the hospital, Mrs Dempsey notices the house is not as orderly as Mrs Berry usually keeps it (Mrs Berry is known to be house proud). Focus on Practice - Care of the Older Adult Essay.
On arrival to the hospital, Mrs Berry presents:
- confused
- is guarding her right hip with external rotation, and shorter than the left leg. She is also not moving her left arm.
- She has been incontinent of urine and faeces.
On observation:
- the stool appears blackened and has an offensive odour.
- Mrs Berry also has a wound on her left leg that appears infected (it has erythema, hot to touch, appears painful, and is purulent) and she can’t recall how it happened.
- Her peripheries are cool and clammy and she is pale.
- Her feet are slightly oedematous.
Mrs Berry does not appear to have an enduring power of attorney nor an advanced directive. Mrs Dempsey arrives to the ED and explains that Mrs Berry’s children live abroad. However, she is very eager to help where she can and explains to the staff that her son knows her and he will not mind if they discuss Mrs Berry’s situation with her.Focus on Practice - Care of the Older Adult Essay.