Tuesday, June 7, 2016

What Makes a Difference to Healthy Aging?

The following is from a report called: Living up to the promise put out a few years ago by the BC Health Coalition. When seniors have meaningful social he world health Organization and the Public Health Agency of Canada recognize social support as a key deter- connections, they “develop their resilience and ability to bounce back after adversity, as well as an ability to gain strength from stress rather than be diminished by it.” In contrast, feeling isolated from others can “disrupt sleep, raise blood pressure, lower immunity, increase depression, lower overall subjective wellbeing, and increase the stress hormone cortisol.”

In addition to experiencing poorer emotional and physical health, socially isolated seniors are also at a higher risk of over-consumption of alcohol, falling, and suffering from poor nutrition. The risks of social isolation are highest among poor and visible minority senior populations.

Researchers recently quantified what they refer to as the effects of the ‘loneliness disease’, warning that lonely people are nearly twice as likely to die prematurely compared to those who do not suffer feelings of isolation.

In a similar vein, a 2011 report from Vancouver Coastal Health’s SMART Fund highlights the key findings from a number of studies on the health benefits of social support for an aging population. In these studies, social support proved effective in slowing cognitive decline, the onset of dementia, and the progression of physical disability.

As people age they are increasingly likely to suffer from one or more chronic conditions; their mobility often becomes more restricted and personal support networks begin to shrink. For these reasons, preventing isolation in this population may require intervention by a medical/nursing professional, home sup- port and/or a community agency.

Recent longitudinal research with older adults in the UK shows that older adults can recover from loneliness with all the potential health, social, and quality of life benefits that this can bring. Two interventions were identified as important in facilitating this recovery: enhanced social networks and improved treatment and management of chronic health problems – both mental and physical.

Many studies document the benefits of good nutrition in maintaining health and preventing disease, particularly for frail seniors. Well-nourished seniors have “fewer medical complications and diseases, faster wound healing, and fewer infections,” whereas malnourished seniors experience “decreased quality of life, decreased independence, deterioration in overall health status, increased use of health-care resources, and in- creased morbidity and mortality.

Mobility also promotes healthy aging and facilitates independence and longevity, yet almost half of older adults living in the community report some type of limitation in mobility. Fortunately, mobility in older adults can be significantly improved with physical activity programs that include a combination of aerobic exercise and resistance training aimed at increasing balance, walking endurance and muscle strength.

In Australia, a restorative approach to home care has proven more effective than regular home support at improving self-rated health, confidence, and well-being, and at reducing mortality and the need for residential care. Care programs required less ongoing support and used fewer emergency and/or in-hospital services, and as a result, overall healthcare costs were lower, workers, who were provided with additional training in care co-ordination, played a key role in making this program successful.

A restorative care philosophy differs from the BC model of regular home support in some specific ways. Instead of simply having the home support worker do specific tasks for the individual, the older adult is supported by an interdisciplinary team to be as independent as possible. The goal is to support the older adult to develop or redevelop the skills and confidence needed to do things for them- selves (perhaps in new ways) and to build connections with new networks of social support.

There is also international evidence of the benefits of offering home support services to people with more moderate needs: for example, people who only require assistance with things like meal preparation, laundry and housekeeping. These early interventions operate as “an early warning system” for the health system, helping to monitor changes in health status, avert health crises and delay admission to residential care
For people living with dementia and their families, there is very compelling evidence that appropriately delivered early interventions can extend the time that a person living with dementia can remain in their own home.  To be effective, these early interventions must be multi-pronged, include psycho-educational support, active engagement and specialized training for home health services staff, and comprehensive monitoring by a case manager. With these elements in place, it is possible to alleviate symptoms and behavioural problems in persons with dementia, and reduce the negative effects of caregiving (e.g. depression and social isolation).

The stated goal of BC’s Ministry of Health is “to help individuals to remain independent in their own homes for as possible In reality services have declined significantly in recent years. From 2001/02 to 2009/10, access to support home services for people 75 and over declined by 30 percent and services were increasingly restricted to those with higher, more complex needs.

In 2013-14 the number of clients receiving home support was virtually identical to the number receiving services in 2001-02 and yet, over those 12 intervening years in BC, there was a 40 percent increase in the number of seniors 65 and over, and a 49 percent increase in those 80+ years. Moreover, people are now discharged from hospital ‘sicker and quicker’ and access to residential care is more restricted, contributing to the increased reliance on home support services.

To cope with growing demand for limited resources, eligibility criteria for home support services are becoming increasingly restrictive and seniors with moderate needs are much less likely to be able to access publicly funded home support services

The shortfall in BC’s home support services is thoroughly documented by the provincial Ombudsperson in her four-year system- investigation into care services for seniors. In her final report, Best of Care: Getting itRight for Seniors,(PDF file) the Ombudsperson criticizes the Ministry of Health for not providing the leadership and oversight needed to ensure that they are, in fact, meeting their stated goal of supporting seniors to stay at home for as long as possible

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