Introduction
Care of older people has become an important issue due to increased life expectancy and improved healthcare and health education (WHO, 2004). However, due to health deterioration as a person ages, their functional ability reduces and they depend on others. It means that the elderly require more attention in terms of social care, economic care and health care, which should be focused on the reduction of health risk factors (WHO, 2004). The need for older people is global as they have a vast experience of different life issues, which the community can benefit from. Older people require attention, therefore there is a need for an anticipatory care approach and steps should be taken to ensure that they have healthy aging because aging is a stage in life (Robinson, 2007).
In Oman, where the author is working, the total life expectancy is an average of 72 years (WHO, 2010). One of the important factors that affect the health of older people in Oman is the development of long-term conditions. It is necessary to undertake an anticipatory care approach to help improve the lives of individuals. On the other hand, this plan may help reduce the cost of health services by preventing admissions and readmissions (The Health Foundation, 2008).
As an anticipatory care approach, the author proposed a Health Promotion Action Plan for Al Buraimi Governorate in Oman (appendix 1). The plan may look very broad and ambitious. However, it is devised for a specific area of the country, which is the Al Buraimi Governorate, with a population of 72,443 (Oman Census, 2010).
Discussion
Stott (1981) defined Anticipatory Care as “planned interventions to achieve early diagnosis and/or treatment of a condition which may not yet be producing symptoms or be recognized as caring symptoms”. It includes all measures carried out for the purpose of promoting good health and for the prevention or delay of the onset of diseases or their complications. The anticipatory care core principle is supporting people to improve their health and manage their conditions (RCGP, 1981a). WHO health promotion defines health promotion as a plan that encourages individuals together with communities to take certain actions to gain control over factors that determine their health in order to promote their health (1998). Thus, anticipatory care is all about promoting health and wellbeing. The following sections of this paper will discuss the strategies and steps to be carried out for implementing a successful anticipatory care approach towards promoting the health and wellbeing of older people and raising community awareness.
Health Promotion Models
It is always beneficial to plan and work within a theoretical framework. Models are like a bridge between theory and the reality of practice. Numerous attempts have been made by different researchers to provide a comprehensive model for health promotion (Holland 1990). Some of the influential models include Beattie (1991), Ewles and Simnet (1985), and Beattie (1980), to mention but a few. For the purpose of this paper, the author will only select Beattie’s Health Promotion Model, to examine and implement in the proposed plan for promoting the health and well-being of the older people at Al Buraimi Governorate.
Beattie’s model of 1991 gives a number of approaches in a structural analysis. He suggests that there are four paradigms of health promotion approaches presented (figure 1) adopted from Naidoo J & Wills J (2000). Those paradigms arise from two types of aspects; the first is a mode of intervention, which is ranges from authoritative – negotiated, the second aspect relates to intervention focus of the root causes of an individual’s ill health.
Health Education, Health Promotion and Health Improvement
Giving the elderly health education are important. The education aims to enable them to act in a way that helps them to attain and maintain good health (Armour, 2007). For instance, they can be educated about nutrition because this knowledge helps a great deal in reducing and preventing occurrences of LTCs. Older people even though they are more likely to eat healthier than the younger, still need education on nutrition so that they can incorporate it into their lifestyle. The education can be conducted in a community-based set up by the healthcare practitioners. The education can also help the elderly in identifying potential health problems at an early stage, which is a good way of avoiding chronic problems in the future. The healthcare experts can educate the families of older people about nutrition so that they can help them to observe healthy eating in a family-centered approach. Older people should also be given information about access to community services. They should be given the contacts of nutritionists so that they can ask any questions they may have or for follow-up purposes.
Older people can also be given information and support about exercise. Exercise is important because it helps one become healthy and avoid diseases that are caused by a sedentary lifestyle (Brown, 2001). They should be given information on disease management. This will help them to manage the illnesses that they suffer in old age to become bearable (Kennett, 2004). For example management of diabetes and hypertension. A holistic program should be implemented, therefore it is very essential for healthcare workers to accurately identify a program that suits the social, physical and emotional/psychological determinants of elderly health.
All people regardless of age need health promotion to lead quality lives (Haber, 2010). The elderly are no exception and need a health promotion strategy. Health is a basic human right and in the elderly health determines the kind of old age they will have Moreover, the elderly require good health and well-being if they are to be independent in their old age because diseases make them dependent (Robinson, 2007). Elderly people with good health continue to make positive contributions in the family and society for instance; they can help in looking after the young ones or sharing their experiences hence they will not feel useless and of no value. If people have health it ensures that they remain competitive and have a secure financial future because they can work for longer and in this case, it decreases the need for early retirement due to diseases giving the elderly ample time to plan for their future. LTCs take a toll on a family’s finances in healthcare costs thus if the elderly have health promotion they will lead a more disease-free life and reduce the cost in healthcare which also burdens the healthcare system of a country (Haber, 2010).
Health Inequalities
For healthcare managers to effectively make decisions on service planning, commissioning and delivery, they need to identify the health inequalities. It helps policymakers address the gaps and target areas for improvements across all the social determinants of health not just within the healthcare system (LHO, 2010). Health inequalities vary from one nation to another but remain a great challenge in health promotion. The causes of inequality also vary from one country to another (Evans et al, 2001). Many countries have come up with policies to try to address the issue of health inequality. The causes of inequalities have been identified in many studies conducted but interventions have not been effective in reducing the inequalities in healthcare and this creates a dilemma for many governments (Macintyre, 2003).
Policymaking is a political process that is determined by the political needs of a particular time and thus some inequalities in health might not be addressed if they are not in line with the political needs. Thus, the inequalities in health among older people vary from one geographical perspective to another. They also differ in terms of needs, resources both material and social. The focus should be given to the most vulnerable group of older people (Skelton & Beyer, 2003). The aged people living in rural areas have poor access to health services unlike their counterparts living in the urban areas. Therefore, it is important to ensure that the inequalities are addressed and every aged person gets access to healthcare regardless of their race, social status or geographic area because health is a fundamental human right (LHO, 2010). Health promotion involves strengthening a person’s health by improving the conditions of life (Haber, 2010). Health promotion activities should include promoting mental, Physical psychological and social healthcare, which will be covered separately in the coming sections of this paper.
Mental Health
Throughout life, a person experiences losses and changes that affect one’s life. the elderly are no exception and the losses of family members and jobs when they reach retirement age can leave them with feelings of despair. Some may cope with their new situation with fear or even denial. Studies show that old people who go into retirement the first few days may be good as they enjoy their new freedom of not having to go to work. However, as days pass by feelings of emptiness and frustrations begin to manifest. The feelings make the elderly too long for the days when they used to work because they become increasingly frustrated and irritated with their lives. Others feel useless, unwanted, and unvalued. And yet these feelings or mental health issues are largely ignored and the elderly fail to talk about them due to stigma associated with aging (Nagourney, 2008).
The families of the elderly should also be involved in the relocation to ease the burden on the elderly of having to deal with the situation alone. It is not always possible to involve the family because some elderly persons may not have close relatives. More importantly, the elderly need to be helped to develop the ability to cope with loss and to be able to receive support from others. This will help the elderly in their mental health and help them cope with old age more gracefully and at the same time reduce the mortality and morbidity rate (Norman & Redfarn, 1997).
Psychological Care
As people age they experience psychological changes. It means that the cares should put the changes into considerations when caring for them to take care of their mind. For instance, their ability for expression diminishes therefore one should be patient when communicating with them.
Social Care
Governments of various countries have a social care plan for the elderly that involves other people in the community such as nurses or the young people among others in taking care of the elderly and helping to improve their health. Social care is paid for using public funds, it aims to improve the quality of life for the elderly in many countries, and the cost keeps rising. However, in some cases, programs supported by the social care sector have failed to function properly and many homes have been offering poor services to the elderly. In others, the services provided are poor because of a lack of adequate finances. The UK for example has a policy that provides for the cost of running homes (Social Enterprise Guide, 2002). There is a need to provide financially for elderly institutions and service programs so that they can provide quality services. Some aged people get improved care in homes, which leads to a better quality of life (Caro & Blank, 1989).
Evaluation
Evaluation is vital to ascertain whether the anticipatory care plan for the elderly is workable. It helps to determine if the plan is successful whether goals will be reached. One tool that can be used to determine the success of the plan is integrated impact assessment (IIA). This tool will predict the outcome of the plan on the social and economic front for example predict the cost-effectiveness of providing domiciliary services versus residential care. It is examining how a proposal can affect a community and how these effects can be distributed between different groups within the community. The aim of IIA is to make necessary recommendations for enhancing potential positive outcomes and minimizing the negative impacts of a proposal. The focus of this tool is on equality and diversity, health and wellbeing, environment and economy (HDA, 2005). The process of this tool is composed of five steps each step has a series of action steps (figure 2). The other tool is the health equity audit (HEA), which will help to determine the causes of inequalities and ill health that hinder the elderly from accessing effective services. This will help to know the best way of addressing the inequalities to ensure that the elderly age peacefully. The HEA identifies how fairly the services and resources are distributed between communities in relation to health needs. The main aim of this tool is to reduce inequalities caused by inequities (DOH, 2003). The health equity audit is a cycle composed of six steps each step composed of six actions steps that identify the gap in the whole cycle (figure 3).
Rehabilitation and Enablement
In the elderly the word rehabilitation means improving the quality of their lives and rallying stakeholders in meeting their needs. Various services can be organized to meet the elderly rehabilitation needs such as psychiatric care, residential care, geriatric care, and daycare. The above services are mostly available in urban areas and it is therefore important to organize services for the rural-based elderly people (Sawhney, 2005).
Community-based rehabilitation programs can help in early intervention and improvement of the life quality of the elderly. The services help to improve the functionality of the elderly give them independence (Shapiro & Taylor, 2002). For instance, outpatient clinics are very helpful in aiding mobile patients thus follow-ups become easier (Wilcock & Bucks, 1999). The other type is domiciliary visits. It is a very convenient and relevant method of assessment because the health experts bridge the gap between specialists and primary care. Moreover, the visits reduce the costs of hospital admissions (Gelder et al, 2001). The elderly with multiple health problems require or are most suited for residential care where they receive attention from trained assistants, thus also helping in cost containment and efficient utilization of resources allocated for health promotion and disease prevention.
Conclusion
Care for older people is a significant challenge in the healthcare system because the increasing number of the aged places a bigger demand on the healthcare budget. The resources to address the needs will become strained as more people develop LTCs. However, increased community engagement will help to improve the quality of elderly life. Promoting the health and well-being of older people may be supported by a number of initiatives starting by raising the awareness of the community on the needs of older people. It is important to involve the community in the planning and implementation of all health promotion approaches because older people will require most of the time to be taken care of within the community and in nursing homes. Health promotion approaches may include health education, and the promotion of mental, psychological and social healthcare. Using a scientific health promotion model allows the healthcare planners to implement, analyze and follow up the health promotion approaches like the Beattie health promotion model (Naidoo, J. & Wills, J., 2000). For any program to be effective, it needs to be evaluated using a scientifically tested evaluation tool like the integrated impact assessment and the health equity audit. The health promotion plan for Al Buraimi Governorate proposed by the author is attached as an appendix (1) in this document.
References
Armour, J. (2007) Early perceptions of the role of community matrons. Nursing Times. 103(23): pp. 32-33
Beattie, A. 1980. A structural repertoire of the models of health education. Exeter: Health Certificate Tutors Workshop
Beattie, A. (1991) Knowledge and control in health promotion: a test case for social policy and theory. In Gabe, J., Calnan, M. and Bury, M. (eds), The Sociology of the Health Service. Routledge, London.
Black, N. 2001.Evidence-based policy: proceed with care. British Medical Journal, Vol, Vol, 323, pp. 275–279.
Blackburn, R. 2006. Age shock: how finance is failing us. New York: Verso.
Brown, S. 2001. Introduction to exercise science. Philadelphia: Lippincott Williams & Wilkins.
Caro, GF & Blank, AE. 1989. Quality Impact of Home Care for the Elderly. Routledge, New York.
Department of Health, 2003. Health Equity Audit. Tackling Health Inequalities: A Programme for Action. Web.
Evans, T, et al. 2001. Challenging inequalities in health: from ethics to action. Oxford University Press, Oxford.
Ewles, L. & Simnet, I. 1995. Promoting Health: a practical guide to health education. Wiley.
Gelder, M, Mayou, R & Cowen, P. 2001. Psychiatry of the elderly. Oxford University Press, Oxford.
Haber, D. 2010. Health Promotion and Aging: Practical Applications for Health Professionals. Springer Publishing Company, New York.
Hansen-Kyle., L. 2005. A concept analysis of healthy aging. Nursing Forum, 40 (2): 45-57.
Health Development Agency, 2005. Clarifying approaches to health needs assessment, health impact assessment, integrated impact assessment, health equity audit, and race equality impact assessment. London: HAD.
Health Foundation of Greater Cincinnati (2008). The Grantee Guide to Evaluation. Cincinnati, OH: Author.
Klausner, EJ, Alexopoulos GS. 1999. The future of psychological treatments for elderly patients. Psychiatrist Services, Vol, 50, pp. 1198-1204.
London Health Observatory (LHO), 2010. Health Inequalities. Web.
Macintyre, S. 2003. Evidence-based policymaking. British Medical Journal, Vol 326, pp 5-6.
Nagourney, E. 2008. Aging: Mental Health Overlooked in Care of Elderly Patients. Web.
Naidoo, J. & Wills, J. 2000. Health Promotion – Foundations for Practice. Bailliere-Tindall
Norman & Redfarn. 1997. Mental health care for elderly people. Elsevier Health Sciences, New York.
Oliver, T. 2006. The politics of public health policy. Annual Review of Public Health, 27: 195-233.
Oman Census, 2010. The Preliminary Results of Census 2010. Web.
Popay, J., Escorel, S., Hernandez, M., Johnston, H., Mathieson, J. & Rispel, L. 2008.
Final Report to the WHO Commission on Social Determinants of Health From the Social Exclusion Knowledge Network. Web.
Quigley, Cavanagh & Taylor, 2004. Clarifying health impact assessment, integrated impact assessment and health needs assessment. Web.
Robinson, M. 2007. Global health and global aging. New Jersey: John Wiley and Sons.
Rosdahl, B. & Kowalski, M. 2008. Textbook of basic nursing. Philadelphia: Lippincott Williams & Wilkins.
Ross, T. 2010. One in five nursing homes fail to offer ‘good’ care. Web.
Royal College of General Practitioners, 1981a. Health and Prevention in Primary Care. Report from General Practice 18. London: RCGP.
Sawhney, M. 2005. The Non-Governmental organization’s commitment to the elderly in India. In Liebig PS & Rajan SI eds. An Aging India: Perspectives, prospects and Policies New Rawat, New Delhi.
Shapiro, A & Taylor M. 2002. Effects of a community-Based Early Intervention Program on the Subjective Well-Being, Institutionalization, and Mortality of Low-Income Elders. The Gerontologist 42:pp. 334-341.
Skelton, D & Beyer, N. 2003. Exercise and injury prevention in older people. Scandinavia Journal of medical Science Sports, Vol, 13 No. 1, pp. 1-47.
Social Enterprise Guide, 2002. Web.
Stott, N. 1981. Anticipatory care in Teacher General Practice. Kluwer Publishing Ltd.
Tolson, D., Booth. J & Schofield, I. 2011. Evidence-informed nursing with older people. Jersey: John Wiley and Sons
Truswell, T. & Wall, P. 2003. ABC of nutrition.New Jersey: John Wiley and Sons.
Turner, FJ. 1992. Mental health and the elderly: a social work perspective Mental health and the elderly: a social work perspective. Francis Joseph Turner, New York.
Wilcock, GK & Bucks RS. Eds. 1999. Diagnosis and management of dementia: a manual for memory disorder teams. Oxford University Press, Oxford.
World Health Organization (WHO), 2010. EMRO Country Profiles. Web.
World Health Organization (WHO), 2004. Comparative Quantification of Health Risks. Web.
World Health Organization (WHO), 1998. Health Promotion Glossary. WHO, Geneva.