Portfolio II: Objective 1 Health Maintenance, Lifestyle Changes, and Environment An individual’s attitude, knowledge, resources, and support all play roles in one’s health maintenance. Erikson’s task of old age is achieving ego integrity versus despair. If older adults face the challenges of this life stage with acceptance and motivation to adapt, they can better achieve ego integrity and be welcoming of healthy behavioral changes (Potter & Perry, 2009). Physical decline associated with aging is partly due to poor lifestyle choices. With supportive resources and motivation, the aging population can practice healthy behaviors and maintain their health as much as possible. Healthy living in old age involves genetics, preventative measures, healthy habits, and luck (Potter & Perry, 2009). Eating a nutritious diet, staying physically active, and adequate sleeping habits are all important, basic health maintenance behaviors. Regular medical checkups can help prevent small health issues from progressing to large ones. Not smoking and drinking alcohol in moderation are vital to aging healthily. Medication use and management is also an important aspect of health maintenance. Staying involved in life, in touch with family and friends, and keeping a positive attitude are health maintenance behaviors highly associated with happiness in old age. As people age, the lifestyle changes that go along with the process can be difficult, and this connects again with Erikson’s developmental task. Decreased mobility, hearing loss, and other physical changes can be faced with an attitude of adaptation or with anger and despair. Some old aged people feel a need to contribute to society with the loss of work roles, and find ways to stay active and involved in their environment. Another lifestyle change is becoming more dependent on others, and balancing independence and autonomy with relying on help. Older adults need to find ways to maintain their quality of life, accept themselves as aging, adjust to lifestyle changes like a fixed income, decreasing health and physical strength, and death of loved ones (Potter & Perry, 2009). The home environment one lives in is another important aspect of older adult life. As people age, they tend to decide where they want to live out their lives. Do they want to stay in their long term home, move in with family, live in an assisted living facility, or a nursing home? The living environment needs to be safe and satisfactory. This includes floor safety and prevention of falls. There should be no slippery floors, unsecured rugs, unsafe stairs, or tripping hazards. The lighting in the home should be sufficient, and grab bars in the bathrooms and handrails can help with safety as well (Potter & Perry, 2009). Current Health Care Financing and Community Support Systems Health care financing for elderly in the United States is changing with the Affordable Care Act of 2010. This law gives free preventative services, free annual wellness visits, and a 50% discount to Medicare recipients in coverage gaps on prescription drugs for the elderly (www.healthcare.gov, 2012). The primary means of financing healthcare for most older Americans is through Medicare, which is the Federal government health insurance program available for those over age 65. In 2011, Medicare covered 40.4 million people over 65 (The Medicare Trustees Report, 2012). Medicare Part A covers hospital insurance, and Medicare Part B is for outpatient services. There is also the option of Medicare Part D, prescription drug coverage. Most people do not pay a premium for Part A if they worked and paid taxes into Medicare, the monthly premium for Part B is around $99.00 for most, and the premium for Part D coverage varies (http://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html, 2012). Medicare does not cover all health expenses for many, and some rely on additional coverage. Medicaid, a service for low income elders, provides health coverage to 4.6 million seniors as well, most of whom are also enrolled in Medicare (www.medicaid.gov, 2012). There are many community support systems in place for elders. The federal government’s Administration on Aging, which serves to administer grant programs for elderly services, runs the Aging and Disability Resource Center Program, which guides states in integrating long term care support. Information can be obtained through this system regarding both private and public assistance. This organization was formed in response to the Older Americans Act of 1965, which allows for grants to be given to States for community planning, social services, research and development projects, and personnel training in the field of aging (www.aoa.gov). The website Eldercare.gov offers searching ability and information on local sources of community services and is accessible to the public. Social workers and nurses can assist the elderly with obtaining information and resources. Individual states have many resources for the elderly population. For example, in California, the state Department of Aging offers the Multipurpose Senior Services Program, which provides social and health care management for frail elderly clients who are suitable for placement in institutions but want to remain in their home and community. Clients over 65, who must also be eligible for Medi-Cal, can receive adult day care, housing assistance, personal care, transportation, meal services, social services, and respite care (www.aging.ca.gov). The California Department of Aging also offers services for low-income seniors which include meals (home delivered and social setting), senior companion program (volunteers), health insurance counseling and advocacy (HICAP), adult day health care, legal assistance, and the long-term care ombudsmen program (http://www.aging.ca.gov/Programs/). The Volunteers of America have a Seniors program, which is one of the United State’s largest nonprofit providers of affordable housing for seniors. The organization is also a provider of long-term care (assisted living and home health). There are senior centers, transportation services, meal programs, and repair services offered by the Volunteers of America Senior program (www.VOA.org). There are State and local organizations that offer mental health services as well. Many social service programs and community resources can be found by nursing professionals and social workers working with elderly clients. End of Life Issues and Bioethics in Aging Bioethical issues concern the patient’s ability to make his or her own decisions, in particular, decisions about life-sustaining measures (Lawton, 2001). Although discussing the end of life process and dying is often uncomfortable for many people, it is something that should be addressed. Medicare does not reimburse a consultation with physicians about end of life care planning (Spetz, 2012). The reality is many people do not have this discussion, and some may not have the end of life experience they would want (Spetz, 2012). There are many cases of people experiencing unforeseen circumstances and ending up in a situation where they cannot speak their wishes and choose how they die. Court cases involving when to end life support or life extending measures are examples of the need for advance directives, living wills, or appointment of someone to speak on one’s behalf in the situation you one cannot make decisions. By law, and supported by supreme court cases, competent adults have the right to refuse and discontinue medical treatment and interventions. Yet the state governments have the duty to preserve life, prevent suicide, and supersede a patient’s decision to end treatment if it threatens the integrity of the medical profession (McGowan, 2011). Medical providers cannot assist suicide, yet should strive to honor an individual’s rights and wishes for the end of life. Those who become mentally incapacitated with advance directives have the right to have their preplanned wishes honored. Those without previously written instructions for their care will have their decision making capacity evaluated by a health care team and a surrogate decision maker can be utilized. This surrogate, often a spouse or family member, will make decisions for the individual based on what they believe his or her wishes would be. However, studies have shown that they do not often coincide with the patients’ actual wishes (McGowan, 2011). The importance of having this discussion as an older person about the end of life with family and care providers is evident. Futile care, brain death, and discussions over when to ‘let someone go’ are difficult issues. How long should a family or physician extend a loved one’s life on life support? Issues of dignity, autonomy, and whether or not the person can ever become independent of machines are centered in the discussion. The quality of life issue is a bioethical issue involving futile care, cancer therapy, do not resuscitate discussions, and physician-assisted suicide (Potter & Perry, 2009). Futile care refers to situations where there is no hope for recovery and interventions beyond pain management and comfort care is seen as futile (Potter & Perry, 2009). Hospice care has strict limits; medicare will only fund it if the patient has a six month prognosis to live and is not receiving any curative interventions (Spetz, 2012). This can bring up discrepancies between curative treatment and palliative care, and where the line is actually drawn is an issue of current discussion. The quality of someone’s life is hard to measure specifically, and is a very personal issue. Factors that go into this are age of the person, ability to live independently, and their ability to contribute to society (Potter & Perry, 2009). These factors leave room for developmentally challenged persons getting a label of ‘low quality of life’, and this is hard to decide as an outsider. End of life issues and bioethical issues are closely related and should be addressed by society and each individual of the elder population. |
