Review of Literature on the Elderly as a Community

Running head: REVIEW OF LITERATURE 1
Review of Literature on the Elderly as a Community
Name:
Institution:
LITERATURE 2
Abstract
The following report seeks to find in a series of studies of the elderly the common
communication issues in diverse areas of concern to the old as a distinct community. Special
attention will be paid to such issues as mortality, dementia, and quality of life, looking for
underlying communication issues and suggestions for improved communications among elderly
patients, care givers, and health practitioners. Among many interesting suggestions, there will be
evidence of female medical- skills, possibly gender- based communication skills, increasing as
consequence the quality and length of life of the elderly. How depression works to lower the
quality of life of the old and of over-medication ruining it is also considered. The report will
conclude with a recommendation for an improvement in the format and content of
communications with the elderly requiring further research in this area.
LITERATURE 3
Introduction
The following report deals with communication with a population not easily seen outside
the car windows of a Windshield Survey. They are rare on the streets, in cafes, parks, or places
of entertainment, and yet possessed of a distinct culture regardless of race, gender, or nationality-
-- the elderly. We need to critically examine the needs of the elderly in the community in order to
improve its quality of life, for on the community’s conscience may be the frailty of the elderly,
their balance and fall risk, the high mortality rate inevitable with this target population and the
ever higher rates of dementia among them. All these should make all of us think carefully about
their needs, quality of life and, above all, the best way to give guidance to those with diminished
but real capabilities on which we need build a healing relationship. Recent literature on these
themes encourages a continuing interest in scientific studies as a means to get a handle on a
challenging population with special needs and ways of articulating them. Of these, the fear of
death, quality of life, and dementia deserve special consideration as issues most likely to be
raised by health professionals , care givers, and the patients in this large and steadily growing
community, always remembering that the first wave of baby boomers have now reached their
seventies. Their problems will serve as a major test of our work as health professionals.
Mortality
Certainly, loss of life is of greater concern for the elderly than for those of us feeling the
invulnerability of youth. A particularly intriguing study in this regard , published just recently,
examined the elderly being treated by male and female internists for 8 different acute care
LITERATURE 4
medical conditions such as arrhythmia or sepsis with traditionally high mortality rates. Tsugawa
et al. (2016) examined data from hospitalized Medicare patients seeking three objectives:
mortality and readmission primarily, but also factoring in the severity of the illness. A very large
data of 1, 583, 028 hospitalizations were used for analyses of 30-day mortality and readmission
rates, followed by a sensitivity analysis, focusing on hospital care (hospitalists), among whom
patients randomized to specific work schedules, and asking as well whether differences in patient
outcomes varied by specific condition or by underlying severity of illness. The conclusion is
definitive and startling. It was found that patients treated by female doctors had lower 30-day
readmissions (15.02% vs. 15.57%) and lower 30-day mortality across all of the medical
conditions, including those which were most severe (11.07% vs. 11.49%).
Indeed, survival rates
were higher for the more severe and life-threatening medical conditions. The sensitivity analysis
confirmed better outcomes for patients treated by female physicians, and absolutely no
difference in the severity of the illness being treated by either gender.
It is regrettable that as a conclusion Tsugawa et al.
(2016) believe that female physicians’
greater reliance on clinical guidelines may be the cause of such results favoring female
physicians, somewhat reinforcing the stereotype of the free-spirited male and the rule-bound
female while underlying by implication as a female quality, never proven, the need to follow
guidelines. It may well be that some other female quality, a more patient-centered
communication style for instance and a caring attitude attentive to the particularly caring and
attentive communication style of the elderly may be responsible for the superior performance of
female internists. After all, it has been found that among nurses, still predominantly female, the
attention is more to the person and less to the diagnosis or the setting. From that, McHugh et al.
(2009) conclude that it is nurses, not doctors, who must take the lead as caring advocates of the
LITERATURE 5
elderly, a judgment that may be extended to the gender distinction among doctors treating the
elderly. In sum, the lesson seems to be to learn a style of communication with patients
characteristic of females, though the true content of that style has not been determined.
Depression and the Quality of Life
Sivertsen et al. (2015) identify depression as the most prevalent and disabling condition
in older persons with extremely negative influence on their quality of life (QOL). This research
is the consequence of an extensive literature review to assess the relationship between depression
and the quality of life employing 74 studies (52 cross-sectional and 22 longitudinal), all in all
involving 24 different assessment instruments. There was found a significant association
between depression and poorer quality of life for the elderly. Yet there is a severe shortcoming
found in the lack of clear definition of just what quality of life means, as well as a problem
involved in such literature-based surveys which make a direct comparison between the studies
difficult. Sarin et al. (2016) had tested the level of depression and its relationship to attitude
toward life of elderly Indians in New Jersey residing in institutions of the elderly by
administering the Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS) on
residents of different old age homes across New Delhi. There was found a prevalence of
depression and a positive, strong correlation between depression and a hopeless, apathetic
response to life-events. The problem is that family ties and responsibility for the care and upkeep
of elders may be more readily found in the culture of the Indian sub-continent than in Western
countries. Put simply, the ties which bind the elders to the family may be greater in cultures in
which living alone is less prevalent, making comparisons difficult. Then again, what constitutes a
positive attitude like the quality of life is not easy to define, though much of these findings
depend precisely on the definition of these terms. It should also be noted, although it seems
LITERATURE 6
counter-intuitive, that depression is less prevalent among older adults than among younger
adults, often starting in old age (Fiske et al., 2009).
How we can best get our message out, a continuing concern in our course ,was given a
very interesting study by Bertolotti et al. (2016) who instituted and tested a very valuable
communication program designed to effectively motivate the elderly to change their habits
regarding meat consumption by framing how the message is conveyed differently. Their
interesting hypothesis concerning how persuasive a message may be to a generation raised on red
meat may depend less on the specific concerns of the content of the message, and more on what
is called the message’s factual or pre-factual framing . The group points out how such messages
are given in factual form in which the specific scientific consequences are baldly stated
according to the different health conditions, somewhat ignoring if life itself is worthwhile for the
patient. This approach pays careful attention to the well-being or the quality of life of the frail
elderly who may benefit by increased sense of happiness and well-being as a consequence of
improved health habits. The latter phrasing promising a better life had excellent results,
presumably producing in the long run more robust elderly lifestyles. As well, coronary artery
disease, myocardial infarction, stroke, hypertension, and still other illness can be effectively
prevented by reducing cholesterol, triglycerides, and salt and sugars (WHO, 2014). This may be
a good way to get the message out emphasizing a happier life in the message dealing with
depression as well.
Dementia
Dementia affects over 5 million people in the United States, presently with a potential to strike
16 million by 2050. Although it can strike in youth, it is statistically more likely with age (This&
LITERATURE 7
Bleiler, 2012). In this respect, Kales et al. (2016) believed and sought through structured
interviews with caregivers to establish that, despite the seriousness of an illness, inevitably
leading to all kinds of negative outcomes, pharmacological solutions so often applied may not at
all be the best solution. There was by contrast a need to have a single source of up-to-date
information giving alternatives to medication. Their support web-site, soon to be tested,
combined information gained from caregivers and evidence-based testing instruments should
provide an interesting route to possible means to give support to caregivers at reasonable cost.
That the elderly suffering from dementia tend to be over-medicated is confirmed by Mast
et al. (2016). This was a retrospective, population-based Canadian cohort study employing as
research instrument administrative data, including dispensing records from a provincial public
drug program from Ontario, Canada between 2009 and 2012. Elderly dementia patients given
antipsychotics were followed for two years with competing risk analysis performed to determine
if the regime was discontinued within the assigned time limit to prevent many negative
symptoms associated with long-term usage of anti-psychotic drugs. Dosage levels were also
taken into account. It was found that almost half of the patients suffering from Alzheimer’s
disease discontinued usage within the two year period, with those receiving higher doses quitting
sooner than those receiving stronger doses. There remains the problem that at least half of those
receiving pharmaceutical treatment continue beyond the recommended two-year period of safe
administration of the medicine, raising the risk of troubling side-effects.
Recommendation
Clearly, there needs to be in the health-care of the elderly special attention paid to good
communication all around. Indeed, there should be a smoother communication flow from
LITERATURE 8
patients to caregivers and healers, and back again to the elderly patients. That conversation
among all stake-holders needs to develop new channels and different, more effective ways to
format the message so that all sides speak each other’s language and understand their individual
circumstances. That is the chief lesson these studies convey.
LITERATURE 9
References
Bertolotti, M., Chirchiglia, G., & Catellani, P. (2016). Promoting change in meat consumption
among the elderly: Factual and prefactual framing of health and well-being. Appetite.
Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual Review of
Clinical Psychology, 5, 363-389.
Kales, H. C., Gitlin, L. N., Stanislawski, B., Marx, K., Turnwald, M., Watkins, D. C., &
Lyketsos, C. G. (2016). Assess and Manage Behavioral and Psychological Symptoms of
Dementia. Researchgate.
Mast, G., Fernandes, K., Tadrous, M., Martins, D., Herrmann, N., & Gomes, T. (2016).
Persistence of Antipsychotic Treatment in Elderly Dementia Patients: A Retrospective,
Population-Based Cohort Study. Drugs-Real World Outcomes, 1-8.
McHugh, M. E., Arnold, J., & Buschman, P. R. (2012). Nurses leading the response to the crisis
of palliative care for vulnerable populations. Nursing Economics, 30(3), 140.
Sarin, K., Punyaapriya, P., Sethi, S., & Nagar, I. (2016). Depression and Hopelessness in
Institutionalized Elderly: A Societal Concern. Open Journal of Depression, 5(03), 21.
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A. S. (2015). Depression and
quality of life in older persons: a review. Dementia and Geriatric Cognitive Disorders,
40(5-6), 311-339.
Thies W, and Bleiler L. Alzheimer’s Association report: 2012 Alzheimer’s Disease Facts and
Figures. Alzheimers Dementia 8, 131168
Tsugawa, Y., Jena, A. B., Figueroa, J. F., Orav, E. J., Blumenthal, D. M., & Jha, A. K. (2016).
Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated
by Male vs. Female Physicians. JAMA Internal Medicine.
LITERATURE 10
WHO (World Health Organization) ( 2014). Global Status Report on Non -communicable
Diseases. Geneva Switzerland. WHO Press.

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