Review Of Literature On The Elderly As A Community

Running head: REVIEW OF LITERATURE 1

Review of Literature on the Elderly as a Community

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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, 131–168

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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