Class Week 2 - Complexity and Healthy Aging PDF

COMPLEXITY AND AGING “GROWING OLD AS A C O U N T RY” (SINHA, 2020) The contextual factors and complexity of Older Adult transitions in Canada NURS 4740 - Week 2  Learning Outcomes Analyze how health...

COMPLEXITY AND AGING “GROWING OLD AS A C O U N T RY” (SINHA, 2020) The contextual factors and complexity of Older Adult transitions in Canada NURS 4740 - Week 2  Learning Outcomes Analyze how health Analyze client Examine contextual care for older adults centered care in a 1 components of older 2 is influenced by variety of aging adult care in Canada context environments. 3 Advocate to address Demonstrate critical Integrate the the changing needs thinking, decision determinants of at local, community, making, and clinical health, promotion of and global levels to 4 5 reasoning when wellness and social meet the unique care assessing health care justice in older adult needs for older for older adults in care adults. Canada W H AT I S G O I N G O N W I T H A G I N G RIGHT NOW? “ B I RT H I N G I N AND AGING OUT” RAT I O  What is Context? Context is defined as the interrelated conditions in which something exists or occurs (Merriam-Webster, n.d.) Understanding context means understanding both the external and internal influences on a patient, healthcare provider or organization. Requires Systems Thinking! Why consider the contexts of Canadian Older Adults? This population requires specific consideration within Canada’s healthcare system. because the growth in the older population and the associated increase in chronic health management, the healthcare needs are greater in this population sector than other population segments (Lewis et al, 2019)  Clay Clay is a 70-year-old man born and raised in rural British Columbia. In his youth and young adulthood, he was actively involved in 4-H and rodeo, and he had a strong connection to the rodeo lifestyle and community. He has never married and has two children, Kim and Ben. For many decades, Clay worked as a farmhand on various farms, but when he turned 55, the work became too physically demanding for him to manage and make a decent income. Recently, his friend Ray hired him as a caretaker on a small piece of land approximately 2 hours from a small town, where Clay now lives in a small trailer, enjoying a quiet, rural lifestyle.  Size of older adult population Ability to extend life with advanced The Older Adult chronic illness Healthcare systems focused on providing “Care care for acute illnesses Complexity” Increasing number of medical diagnoses Phenomenon Creates the “care complexity” (McNabney et al, phenomenon 2021) Socioeconomic, race, ethnicity, cognitive, functional, and organizational factors play a significant role. Phenomenon affects family caregivers, providers, and healthcare systems.  Aging in Canada As class prep, you were asked to watch Dr. Samir Sinha, a leading Canadian gerontologist, describe the current context of health and healthcare for older Canadians. This Photo by Unknown Author is licensed under CC BY-SA We are going to complete a complexity analysis from the information he shared in only 15 mins. PERSPECTIVES Source Perspectives shared by Dr. Sinha Society - Anti-aging culture - Get old and live in hospital - Blame older adults for system issues - System is unprepared for aging population and change is needed Policy-Makers - Worried healthcare system cannot handle increasing older population The Hospital - A lot of older adults here (42%) - 10% of older adults costing a lot of money (60%) - Makes health worse, some say I am a hostile environment - Works better for single use problems - Are inflexible, scheduled, routinized The Older Adult - Feel unsupported with needs (27%) - Want to go home - Immigrated from other countries - Unable to express identity, depersonalization Health care professionals - “bed blockers” - Our needs (the HCPs) direct patient care schedule - “aging is a triumph” Dr. Sinha Government - Health care acts do not include specific older adult care needs, so not required to provide it Older Adult Advocates - Hospitals are demoralizing to older adults BOUNDARIES Boundaries Spatial (Space) Hierarchal Process Temporal (Time) (Systems/Structur (Responsibility) e) Hospitals are fixed 42% older adults Older adult care and Hospitals are spaces are using health needs not regimented services but they considered in health Older adults need to are only 16% of acts Hospitals are get out of the home population inflexible to access a majority In 2016, 7500 older of care Healthcare system adults stuck in does not have right hospitals Biggest piece of mix of home and furniture is the bed community care Government is not services, rehab, required to provide nursing home beds older adult specific care Hospitals designed for care of single issue I N T E R- R E L AT I O N S H I P S Inter-relationships What is connected To what Medical Advancement Increased life expectancy Aging Increased hospital stay length Healthcare acts & policies Dependent on needs of those creating it Intergenerational living Declining at time progresses Money saved for retirement Dependent on one’s own thoughts expected life expectancy Multiple health challenges Loss of ADL’s -> Need for hospitalization Being charming Needs get met ( my favorite) Hospitals Worsen health of older adults (hostile environment) More successful with single use problems Increased med use, nutritional and mental health decline Use of hospital bed Daily loss of function (5%)  What have you seen that works? Your experiences Where have you noted of older adult care challenges? and context? Do these perspectives, boundaries and relationships match your experiences?  Inter-relationships? Let’s brainstorm Clay with Complexity in Boundaries? mind Perspectives? What do we need to consider in supporting Clay’s aging? LET’S DIVE DEEPER IN THIS COMPLEXITY?  Forecasting the Future In 2030 - Canadians over 65 will double - $93 billion dollars added to our healthcare costs - 912,000 older adults will be living with dementia (a 61% increase from 2020) 2.5 million people will be over 85 in 2046 - Institutionalizing and medicalizing care will not handle this population  Medicalizing and Institutionalizing Aging What do these terms mean? How do these philosophies impact older adults? The ‘1 in 9’ who are Institutionalized…. Could have potentially been cared for at home. Why do they enter early? “GROWING OLD AS A C O U N T RY ” Whose perspectives are not often heard? What are the solutions needed in Canada?  W H AT H AV E W E UNCOVERED DIVING A LITTLE DEEPER AND WITH SOME NEW LENSES What statistic from the National Seniors strategy or from our discussions stood out to you?  Complexities of Aging so far… Cost and Social Isolation Impact of Limited Strain on Resources to & Infectious gerontology Caregiver healthcare Discrimination Disease specialists system Lack of Advanced Care Financial Independence ADL’s and Elder Abuse Planning and resources & Support unmet needs health literacy complications  Indigenous Older Canadians and health transitions One of the fastest growing demographics Higher risk for developing many health conditions Risk for frailty due to multiple social and physical determinants of health. Food and financial insecurity Face more chronic health problems (such as high blood pressure, arthritis, heart disease, diabetes and depression) than non-Indigenous seniors. Values held by Indigenous seniors include connection to land, traditional medicine, spirituality, traditional foods and activities and language. (Employment and Social Development Canada, 2018) Let’s consider Canada’s institutionalization and medicalization of aging for an Indigenous older adult Themes: Social Expectations Quality of Care  - More diverse than any other generation before. - 30% of seniors living in Canada are foreign-born. - Immigrant seniors may face: Foreign-born Older - - cultural differences language barriers Canadians - racism - decreased income or socioeconomic status - Social isolation and loneliness more challenging and complex  There are three main classes of immigrants to Canada: (1) economic class immigrants are selected for their ability to contribute to the nation’s Immigrating economy, based on a points system; to Canada (2) family class immigrants are sponsored by a family member who is either a Canadian citizen or a permanent resident; (3) refugees are accepted into Canada on the basis of a well- founded fear of returning to their country of origin  Low or no access to pensions Older Adults and Immigrant Unmet care needs due to language barriers, populations can no waitlist for multicultural care longer be Family provided care expected and cannot always considered separate be done * stereotypes and assumptions very demographics evident * Care provided by family adds additional burdens on an already disadvantaged population of second- This population is generation Canadians resulting in financial challenges and caregiver stress and burnout unique and needs to Support services have focused on language but not poverty and systemic racism be addressed in healthcare as unique Immigrant seniors do not only require care; they also provide it. Immigrant grandparents fill gaps in Canada’s childcare system and are underrecognized and undervalued  AGING WITH PRIDE- THINKING B E YO N D AG E F R I E N D LY T O I N C LU S I V E AG E - F R I E N D LY ENVIRONMENTS  Friends are their Intimacy and sexual chosen families and needs in the last Greater risk of for them to play an stages of life needs physical and mental active role in their go unmet because of health conditions care and end-of-life negative attitudes decision-making. Dementia increases Fear discrimination Limited knowledge vulnerability to within formal care and preparedness for stigma and settings and do not end-of-life care discrimination due to trust that the increases risk of the intersection of medical or legal lower quality care in age, cognitive systems will carry their final stages of status, and sexual out their end-of-life life. identity. wishes. SOGI Nursing in Canada soginursing.ca  These considerations can be used as guidance to build more supportive and inclusive environments for 2SLGTBQIA+ older adults  Being diverse and intergenerational  Being free from harassment and discrimination  Having inclusive programs and services  Supporting systemic inclusion and visibility  Being encompassing and compassionate (DEAR Collaborative, 2022)  Aging Rurally and Remotely 25% of seniors in Canada live in rural areas and small towns. Increasing proportion of seniors migrating from cities to the country. Rural living presents unique social and environmental challenges What are they?  C L I M AT E CHANGE & AGING Twin extensional threats creates a perfect storm for our older adults CHRONIC DISEASE  Social Frailty People who are frail Inactivity, usually have poor nutrition, three or more and social Minor of five Limited ability symptoms isolation or stressors may to cope with that often loneliness, trigger rapid minor travel and multiple and dramatic illnesses together. medications deterioration. contribute to unintentional weight loss (10 or frailty. more pounds within the past year) muscle loss and weakness a feeling of fatigue, slow walking speed  THE 10% Chronic Health Issues Who are the 10% of older adults Bermu utilizing healthcare da Triangl using 60% of e Loss of Activities healthcare of Daily Living Social Frailty resources?  1. Dignity and Respect W H AT 2. Choice S O LU T I O N S DO OLDER “As soon as my hair started CANADIANS going white, I became WA N T ? invisible” “Our mom spent her last years lonely. She should have been in a residence in her community so she could have been in her community… where she had roots.” 3. Seamless care journeys- Transitions support “The main barrier I experienced was navigating the processes required to receive proper care. I found it daunting to have meetings with so many people and not have my daughter there to help take all the information and make decisions. It was very overwhelming.” 4. Financial Autonomy and Empowerment CLASS DISCUSSION What could the future look like?  Part C The Future of Older Adult Care in Canada How can we navigate our way out of a very complex healthcare situation? Remember our course agreement? Complexity can lead to transformations. Let’s look at ways to transform older adult care  Denmark Australia Ireland What is being done There are many others! globally? Any that you can share? How can Canada be the best place in the world to age? We must consider  Dignity  Choice  Seamless Care Journeys  Empowerment  Meaningful Relationships  Diversity and Inclusivity  Fulfilling experiences  Supporting care providers  Supporting aging at home Health Aging Environments for Older Adults in Canada Co-housing or The concept of Acute Care of Home sharing- Village living the Elder Units “Golden Girls Dementia in Hospitals Model” Multicultural “Shared care intentionally” “Aging in Indigenized – Place” – living older adult Intergeneratio at home care nal care Group Activity on your selected care strategy Share one aspect of the model you think work well Take 20 minutes to share and you support AND a Let’s hear it! What direction critical thinking about the priority limitation – should Canadian policy- innovative care remember complex contexts makers go to prepare us for environments to your peers. do not have perfect 2030 and beyond solutions!  Clay Thoughts on how to support his aging journey? N E X T W E E K C L AY ’ S JOURNEY OF AGING CONTINUES AND GETS A LITTLE MORE COMPLEX!