The Geriatric Challenge - A Paper Illustrating Various Principles of Geriatric Care

The Geriatric Challenge - A Paper Illustrating Various Principles of Geriatric Care

Abstract

In our professional world the number of people 65 and older requiring respiratory care for both chronic and acute conditions clearly comprises an enourmous percentage of of the workload of a Respiratory Care Practitioner. This patient population demands an extraordinary level of empathy for their unique and challenging requirements. The respiratory care practitioner must go into this business knowing very well that an unusually high amount of maintenance will be required as well as a high level of professional understanding and patience in all aspects of their field. As we are their trusted caregivers, no level of professionalism but the highest will ensure both excellent delivery of care to our patients and minimal on-the-job stress for the therapists themselves.

Perhaps the most basic and human needs, those shared by all people of every race and philosophy, are the needs so pronounced in patients of advanced age. What appears to be a cranky, unpleasant, uncooperative man or woman is quite frequently an otherwise intelligent, caring and understanding individual. The change comes about when as age advances, physical and psychological limitations lead to feelings of uselessness, irrelevance, and obsolescence.

It may be very easy for an individual caregiver to accidentally lapse into a state of chronic annoyance with the elderly. We therefore must vigilantly remind ourselves that they have lived full, long lives and are very clearly deserving of a higher level of patience and understanding. Critical to this goal, focus on the positive whenever possible and avoid a few common pitfalls right from the beginning.

Geriatrics is itself a completely distinct branch of internal medicine. Aside again from these is gerontology, which is the study of the aging process itself. This difference is very similar to the distinction between neonatology and the much more general pediatrics. A special appreciation of nuanced and subtle differences is required.

The elderly have particular physical and mental characteristics in need of close attention. Essential is the deliberate self-divorcement from the preconcieved notion that the elderly condition is innate to those people. The elderly condition is better viewed as a collection of treatable sub-conditions and by treating their pathology one may effect vast improvements in both the patient's quality of life and consequently their outlook on life. (Sorensen,H. 2005)

Clearly dispelling a common misconception regarding the elderly condition is paramount at this point. Mental capacity does degrade as age increases but only slightly and then only after the age of approximately seventy. The human brain's synapses and neurological pathways continue to form, reform, and repair effectively far into old age, barring disease processes which specifically target cognitive areas of the brain. (Winston, R. 2004) Several implications are therefore made.

Firstly, make no mistake in clearly recognizing your elderly patient as a reasonable and adult person, though it may be true that the elderly frequently suffer conditions of confusion and dementia. Dismissing an unpleasant or uncooperative patient as mentally defective serves no good purpose and complicates matters further. always appeal to the underlying intelligence and reason first. These elderly people will expect to be treated with this dignity and will certainly resent it if it is assumed without reflection that they are mentally incompetent.

Secondly, one can easily sympathize with the phenomenon of frustration and anger that frequently accompanies feelings of inadequacy. An elderly person may be experiencing a personal loss over which they feel they have no control. They may feel inadequate because of an elevated reliance on others for the activities of daily living that younger people take for granted. (Zuckerman,R. 2003.) It is only professional to bear these possibilities in mind before, during and after encounters with an elderly patient.

Many people in the healthcare field will have recieved a significant exposure to elder care. The reason being that prior to formal education in the medical profession, very nearly all of us will have had elder parents or grandparents. These likely needed more or less of the same understanding and empathy that is now required of us as a job skill.

Most of us have experienced parents or children who may have become sick or incapacitated and required care of one degree or another. Again very nearly all of us have at one time or another found ourselves in charge of an infant or toddler. These family members may be severely or mildly needy. In nearly all cases of legitimate sickness or injury, these people would never have wished the burden they perceive they have become upon the ones to whom it falls to provide care. A parallell may be drawn between these personal caregivers' experiences and the patients we find in our ERs and ICU beds. Just as everyone begins an unwilling burden on parents and other caregivers, it seems very much so our destination at the waning of life as well.

Having made that observation, one must beware of taking the concept too literally. No adult should ever be treated like a child or be made to feel as if they've been so reduced. (Zukerman, R. (2004). A great many of the older generation were every bit as vigorous, intelligent and successful as the best of the younger generation are now. Firemen, police officers, homemakers, soldiers and hard workers are not necessarily appreciable in a room of retired and aging men and women, but that is precisely who they must be treated as. Despite the tragedy of age robbing dignity with incontinence, easily breaking bones, and immunological failures allowing easy succeptibility to pathogens, there must be deference paid and dignity returned whenever possible.

Since the ultimate goal of patient care is to return a dignified, valuable member of society who has fallen ill or become otherwise disabled back to their previous lives, a concerted effort must be made to avoid the so-called "tolerance trap". (Ozbourne, O. 2009) This describes a state of mind wherein the goal is far from productive, merely the passing the time instead until the problem simply goes away as the old addage goes. Viewing onesself as the problem that "just needs to go away" is a frightenly easy thing for an elderly patient whos caregivers, rather than plan, execute , and follow up on a productive care plan simply try to get thru one more shift. The caregivers' reasons for wishing to minimize pt contact because of that patient's perceived attitude or noncompliant mindset are understandable. The willingness to abandon one's professional responsibility to provide excellent patient care and advocacy is not. There are a myriad of ways to approach a difficult patient but the goal is very similar from one to the next. Identify and overcome personality barriers, which may stem from the patient or the caregivers preconceived notions about the hospital setting. The Caregiver does not outrank the patient! And most reasonable people will concede that the patient is not always right. Once these barriers are breached, the road through all other varieties of care will undoubtably become less strewn with pitfalls. Elsewhere in other civilized cultures of our world, the elderly are not only accepted despite their needs, but celebrated and indulged. A worthy goal for western medical culture.

References

Sundowners Syndrome; Dont Jump to Conclusions. (2002, June 22). The San Francisco Chronicle, p. C12.

Sorensen,H, Respir Care Clin N Am. 2005 Sep;11(3):449-60.http://www.ncbi.nlm.nih.gov/pubmed/16168913

Zukerman, R. (2004). Eldercare for Dummies (Rev. ed.). Hoboken: Wiley Publishing

Winston, R. (2006). Human. New York: DK Publishing

Perricone, N. (2010). Forever Young: Introducing The Metabolic Diet New York: Atria Books.

Ozbourne, O. (2009). I Am Ozzy New York: Grand Central Publishing