Impact Of Community Health Workers On Care And Management Of Elderly Condition

1.0 INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Ageing is often accompanied by chronic illnesses and continuous deterioration of mental and physical independence, which makes care giving more complex and challenging. Many older adults are frail and have co-existing disabilities and co-morbidities, conditions that can influence the clinical presentation and assessment of urinary continence, as well as patient’s responsiveness to interventions (Wagg, et al., 2015). An estimated 100,000 people worldwide die each day of age related causes (Aubrey de Grey, 2017). According to National Population Commission (NPC, 2006), persons who are old enough to receive pension who are between ages of 60-65 years are regarded as the elderly. The elderly are classified by age into young old for those aged 60-74years, middle old for those aged 75-84years, old for those aged 85-94 years and oldest old for those 95years and above (Barman, Snyder, Kozier &Erb , 2018). Many elderly patients do not have access to knowledge of evidence based medical therapy and their quality of life suffers because of the stigma inherent, this is where care giving plays a big role.

Care giving is the act of assisting with the care and wellbeing of another person. Care giving is a common phenomenon; health workers have the responsibility to assist older adults in performing activities and preventing elderly abuse. More generally, they play a role in the physical, emotional, psychosocial, and sometimes financial assistance of the elderly who cannot care for themselves. In present times, health workers take the attitude that some diseases are a natural consequence of ageing. So assessment and treatment is often overlooked (Resnick et al., 2016). There also seems to be lack of knowledge and compliance as to whether or not guidelines are followed appropriately by members of different levels of staff hierarchy (Lin, et al., 2012). There are several problems associated with deficit in understanding the impacts of disease conditions and problems peculiar older adults (Tuinissen, et al., 2016)

In most developing countries including Nigeria the population of the elderly is increasing rapidly but the government does not seem to be making any major commitments to elderly healthcare (Adio-Moses, 2011). The government is still assuming that families should take care of their elderly without recognizing that the extended family system is at the verge of collapse. Currently most families find it difficult to manage their own homes and face their challenges. This is gradually leading to neglect and abuse of the elderly (Gubrium, 2012). Care of the elderly requires adequate knowledge of the ageing process, nutrition and daily needs of the elderly. In Nigeria, marginalization of the elderly especially in their care is a common episode (Abdulraheem&Parakoyi, 2015). Those involved in the provision of health care have important roles to play in programmes relating to elderly care especially in screening and detecting abuse. A study of practitioners revealed weakness in commitment, time and knowledge, and raised awareness of the beliefs that comorbidity, low motivation and older person’s acceptance of the problem existence. Similar results emerged among registered nurses, where Urinary incontinence problems were seen as a symptom of aging that can be addressed using incontinence protection. However, as mentioned previously, nurses/health workers focus was on the choice of incontinence protection instead of the investigation of underlying causes (Dingwall &Mclafferty, 2016). These results are also supported by earlier research in which medical diagnosis were put before urinary incontinence problems.

Care givers showed lack of understanding of problems and failed to ask older adults about urinary incontinence (Norhein, and Guttormsenvinsnes, 2015). Care givers have different educational needs and require different levels of support depending on what level of urinary incontinence they have to deal with, whether mild, moderate, or catheter managed (Wagg A, et al., 2015). Earlier research about care givers revealed deficits in time and prioritization of tasks; staff did not take the older adults to lavatory in time. However, there was no expectation that urinary incontinence could be improved because urinary incontinence problems were seen as a normal consequence of ageing (Resnick et al., 2016).

Nursing staff who worked most closely with older adults exhibited weaknesses in recognizing some health problems like urinary incontinence sufficiently to undertake investigative measures (Davis, 2012). Care givers fail to understand that some disease conditions are not just caused by ageing but also certain factors such as infections etc. although it is mostly caused by ageing. Deficiencies in documentation where also found, whereby documentation of bladder and bowel movements was overlooked. Instead being described as incontinence occurring but with no investigation being conducted (Mangall et al., 2016). Incontinence in present times can be managed by instilling toilet habits based on the client’s need. This can be beneficial for maintaining health and well being (Orem D 2011). Also, involvement of hea;th workers in the care of the elderly patients will ensure that the elderly could be assisted to access health care services given the important social and psychological costs of health care. A review of research relating to the management of the elderly identified lack of qualitative research that sought the views of elderly people (Wyman et al., 2012). Incontinence is a pressing issue because it may result to elderly abuse, and can affect an individual’s physical, emotional, psychosocial, and sometimes financial wellbeing.

Promotion of health forms part of the remit of community nurses and they include health visitors for the elderly with training, support and clinic services provided by specialist nurses. In the past, an assessment of disease conditions was carried out in general practice annually as part of the over “15 years check”. However, following health policy changes, this health check is no longer a requirement for general practice and there is variation in the extent to which it is carried out by primary care staff. Recent initiatives have attempted to promote high standard of care and access to services for older people, including the promotion of best practices in healthcare services.

1.2 STATEMENT OF PROBLEM

The population of the elderly in the world is increasing rapidly (United Nations, 2014) and the rate of increase is higher in developing countries including Nigeria. Currently, Nigeria has the highest number of the elderly people in Africa estimated to be about 5.6% of the Nigeria population (NPC, 2012). With this increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase. Donatelle (2011) posited that in most curricula for health professionals, little or nothing is indicated about the care of the elderly showing absolute neglect in this area. Health care services are a major component towards providing quality living, however, it is a common problem that such services have posed a greater challenge on the health seeking behavior of the aged individuals. 

Majority of the aged persons had age associated illnesses such as blood pressure, cardiac problems, diabetes, joint pains, kidney infections, cancer and tuberculosis that take a long time to treat which particularly affect their health seeking behavior. Aged individuals are found to have patronized traditional healers, resorted to self-medication using local herbs or visit chemists’ shops whenever they are sick. However, involvement of professionally trained health workers such as nurses, doctors, physicians among others will help to provide adequate healthcare services to them that will prove effective and increase their health outcome. Therefore, this study seeks to investigate the impact of community health workers on care and management of elderly condition.

1.3 RESEARCH OBJECTIVES 

The main purpose of this study is to assess the impact of community health workers on care and management of elderly condition. Specifically, the following objectives will guide the study;

1. To determine the level of knowledge of the care of the elderly among health workers in Enugu State University Teaching Hospital

2. To determine the attitude of the health workers towards the care of the elderly in Enugu State University Teaching Hospital

3. To determine the extent to which health workers practice the provision of care for the elderly in Enugu State University Teaching Hospital

1.4 RESEARCH QUESTIONS

1. What is the level of knowledge of the care of the elderly among health workers in Enugu State University Teaching Hospital?

2. What is the attitude of the health workers towards the care of the elderly in Enugu State University Teaching Hospital?

3. To what extent do health workers practice the provision of care for the elderly in Enugu State University Teaching Hospital??

1.4 RESEARCH QUESTIONS

HO: There is no significant relationship between community health workers and effective management of elderly condition

1.6 SIGNIFICANCE OF THE STUDY

The findings of this study will be of great use to the elderly, health care workers and the general public. To the elderly, this study will be of good use to the elderly people having health problems leading to adverse effects not only on their health but also on their psychosocial life. To the health care workers, it will also help to promote high standards of care for the elderly with training and support and promoting best practices in healthcare services. Finally, information gathered from this study will serve as a source of literature and guide for future research and as well serve as empirical reference for further studies.

1.7 DEFINITION OF TERMS

HEALTH WORKERS: refers to the professionally trained health personnel that provide care for the elderly; they include nurses, doctors and pharmacists for the purpose of this study.

ELDERLY: are the individuals attending Enugu State University Teaching Hospital who are 60 years and above

CARE GIVING: Is the act of assisting with the care and wellbeing of the elderly by the health workers.

1.8 ORGANIZATION OF STUDY

The study comprises of 5 chapters. In chapter one, the concepts are introduced and the problem of the study is established with the research objectives and questions. Chapter two presents the literature review while chapter three presents the research methodology. The fourth chapter presents the results and discussion, and the last chapter presents the conclusion and recommendation.