Three Areas of Focus for Improving Care of the Older Adult

1. Comprehensive Geriatric Assessments (CGA) Upon Hospital Admission

As the Australian population continues to age, it is undeniable that there is a need for nursing care to focus on how best to improve the care of older adults.

Ellis' et al. (2017) systematic review found that older adults who underwent a comprehensive geriatric assessment (CGA) upon hospital admission were more likely to be 'alive and in their own homes at follow-up' compared to people who had only received routine care.

Whilst there is a need for further investigation into the cost-efficacy of this approach (Ellis et al. 2017), it is evident that there are clear benefits to clients and positive health outcomes.

A CGA refers to a coordinated approach by a specialist geriatric team on a general ward or geriatric ward. This interdisciplinary approach involves assessing the medical, social, physical and psychological needs of the client to improve their recovery and independence.

Ellis' et al. review examined 29 trials from 9 countries with a total of 13,766 participants (aged over 65 years) recruited. Follow-up was up to one year from admission (2017).

2. Mindfulness Stress-Reduction for Carers of People with Dementia

Another area of interest for improving care in the older adult is utilising mindfulness for reducing stress in family carers of people with dementia (Liu, Sun & Zhong 2017).

Liu, Sun and Zhong (2017) aim to study the benefits versus harms of this approach, which is clearly a priority considering that dementia figures are increasing (Prince 2015 cited in Liu, Sun & Zhong 2017).

Mindfulness is described as being non-judgmentally aware of the present moment (Kabat-Zinn 2013 cited in Liu, Sun & Zhong 2017), which may reduce worry and rumination (Borders 2010, cited in Liu, Sun & Zhong, 2017; Jain 2007, cited in Liu, Sun & Zhong 2017). Mindfulness for stress reduction may involve activities such as yoga, meditation or body scanning (Liu, Sun & Zhong 2017).

Liu, Sun & Zhong put forward that carers of people with dementia can become distressed as a result of worry or rumination. Worry or rumination may stem from former experiences or the unknown or uncontrollable future that may develop as dementia progresses (Liu, Sun & Zhong 2017).

3. Reducing Sedentary Behaviours in Community-Dwelling Older Adults

Chastin et al. (2017) have developed a protocol for examining interventions for reducing sedentary behaviour in community-dwelling older adults.

The objectives are to identify strategies to diminish time spent being sedentary, and the cost-efficiency of these interventions (Chastin et al. 2017). Furthermore, Chastin et al. aim to look at interventions in terms of their effects on quality of life, depression and health. They highlight that reducing sedentary behaviour means:

‘getting people on their feet (if able)… but not necessarily asking them to perform activity to level that is moderate or vigorous’.

Chastin et al. (2017) put forward that sedentary behaviours are focused on sitting or lying postures in the daytime. Interventions to reduce sedentary behaviours can thereby be aimed at individuals or groups/communities, and may include strategies such as standing desks, access to outdoor areas, or using technology to track activity (Chastin et al. 2017).

The study raises an interesting point that some sedentary behaviours such as reading, eating, resting or socialising, offer mental or cognitive benefits for older adults, and should therefore not be discouraged or limited. However, ongoing sedentary behaviours can be detrimental to health in terms of: physical functioning (Rosenberg 2015 cited in Chastin et al. 2017), frailty (Song, 2015 cited in Chastin et al. 2017), and ‘less successful ageing’ (Dogra 2012, cited in Chastin et al. 2017).

Fascinatingly, evidence indicates that health detriments of prolonged sedentary behaviours may not be overcome by exercise protocols (Biswas, 2015 cited in Chastin et al. 2017).

Older adults are the most sedentary population group, with the ‘highest chronic disease burden’ (Harvey 2013 cited in cited in Chastin et al. 2017; Harvey 2015 cited in Chastin et al. 2017). Greenwood-Hickman (2015 cited in Chastin et al. 2017) express that older adults may prefer interventions to reduce sedentary behaviours, rather than interventions that are focused on exercising.

Conclusion

As evident, there are three interesting and unique strategies in this article for improving care in the older adult. Perhaps these will serve as ideas for quality improvement activities within various healthcare settings, or as suggestions for further research in care for older adults. These three approaches for improving aged care combine to consider and contribute to the holistic wellbeing of the older person.

Evidently, interventions to improve healthcare for older adults must be person-centred, interdisciplinary, coordinated, and evidence-based. Moreover, strategies must consider the complex nature of ageing, and the several facets of wellbeing (i.e. quality of life, mental health, independence, physical function, social needs, cognition, psychology, medical needs).

It is apparent that much research is necessary at present and in the future to continue to address the changing needs of individuals, communities, and the ageing population.

References

• Chastin S, Gardiner PA, Ashe MC, Harvey JA, Leask CF, Balogun S, Helbostad JL, Skelton DA 2017, ‘Interventions for reducing sedentary behaviour in community-dwelling older adults’, Cochrane Database of Systematic Reviews, Iss. 9, viewed 25 October 2017, http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012784/full.
• Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, O’Neill D, Robinson D, Shepperd S 2017, ‘Comprehensive geriatric assessment for older adults admitted to hospital’, Cochrane Database of Systematic Reviews, Iss. 9, viewed 25 October 2017, http://www.cochrane.org/CD006211/EPOC_comprehensive-geriatric-assessment-older-adults-admitted-hospital.
• Liu Z, Sun YY, Zhong BL 2017, ‘Mindfulness-based stress reduction for family carers of people with dementia’, Cochrane Database of Systematic Reviews, Iss. 9, viewed 25 October 2017, http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012791/full.