The organizations discussed in this post are active in the state of New Jersey (my community) as well. However, Adult Protective Services (APS) follow different rules depending on the particular state. This factor may significantly impact their effectiveness and their ability to introduce new policies to the protection of and support for senior citizens. For instance, in New Jersey, APS has a stricter definition of a vulnerable adult. It has to be a person of 18 years or older, residing in the community, and having a disability, physical or mental illness, deficiency, or limited cognitive capacity to make their own health-related decisions (New Jersey Department of Human Services, 2019). Therefore, cases of abuse reported to this entity in the state of my community will be neglected if an older person does not fit the description perfectly.
Policies related to food support are very important to seniors in New Jersey. Major organizations working with impoverished state residents note that a significant part of older adults has food insecurity. According to CUMAC (n.d.), more than eight percent of seniors have food-related problems, and the rate continues to grow. The Center for Food Action (n.d.) find that the number of seniors in positions of food insecurity has doubled in the last two decades. They also state that around ten percent of all older adults had nutritional problems, but less than half of them were considered eligible for a food stamps program SNAP (Center for Food Action, n.d.). Thus, the introduced policy of financing and using crowdfunding resources to solve elder food insecurity in the state may not be enough to resolve all issues related to people’s ineligibility for support or unclear acceptance standards.
Similar to the poster’s community, New Jersey has offices of Area Agencies of Aging, and the Division of Aging Services (DoAS) acts in the same way as Ohio’s Department of Aging. DoAS helps low-income older adults and people with disabilities, assisting them with Medicare premiums and other expenses. They get federal funding through the Older Americans Act as well (New Jersey Department of Human Services, n.d.). Nonetheless, the policy of extending such financial help to people in the community may be challenged with New Jersey’s increasing senior poverty problem. Some recent statistics show that, while New Jersey’s senior poverty level is lower than the national rate on average, several communities experience more financial problems than others. For example, almost one-fourth of Hispanic older adults live in poverty in New Jersey, while the overall US rate of poverty among Hispanic seniors is below 18 percent (America’s Health Rankings, 2019). This calculation reveals a lack of outreach to minority groups and an insufficient number of programs targeting particular populations.
Other problems are also connected to New Jersey’s younger and older residents. New Jersey has a low percentage of volunteerism, which puts any community-based projects at risk of being ineffective (America’s Health Rankings, 2019). The participation of senior leaders in the decision-making process can contribute to the improvement of programs targeting older adults (Dilworth-Anderson, Pierre, & Hilliard, 2012). In the discussed community, the failure to engage older volunteers can be detrimental to any positive changes. At the same time, if patients’ caregivers are inactive in their community work as well, the education of families may be ineffective. To sum up, New Jersey has to tackle the problems of poverty and caregiver education, while engaging more residents in community work and addressing health disparities in minority populations.
Center for Food Action. (n.d.). Hunger in New Jersey. Web.
CUMAC. (n.d.). Hunger in NJ. Web.
Dilworth-Anderson, P., Pierre, G., & Hilliard, T. S. (2012). Social justice, health disparities, and culture in the care of the elderly. Journal of Law, Medicine & Ethics, 40(1), 26–32.
A lower socioeconomic position aggravates the disadvantaged status of the disabled population, making this group especially vulnerable since their needs rarely get satisfied. The research at hand is devoted to low-income, lower-class people with disabilities, whose number is rapidly increasing worldwide. The study will provide a description of the population, account for its vulnerability, assess the unique health concerns the group has, and investigate the ways it uses the health care system. It will also dwell upon the attempts made by healthcare specialists across the country to meet the needs of disabled people with a low-income level and provide recommendations to improve the outcomes.
Introduction
There a lot of factors that make different population groups vulnerable or underserved. The major ones include a low-income level, lower class, job loss, serious or terminal diseases, race, ethnicity, the absence of insurance coverage, old age, homelessness, and disability. The health care needs of these groups are typically unmet or largely neglected (Social Security Administration, Office of Policy & Office of Research, 2013).
Despite some efforts made by the government of the United States and other countries to reduce disparities in health care through numerous policies and programs aimed to eliminate or mitigate risk factors, decrease morbidity and mortality rates, and increase access to health care, there are still millions of people living in extreme poverty, which cannot help producing a detrimental impact on their state of health (Krahn, Walker, & Correa-De-Araujo, 2015).
The relevance of the research at hand is supported by the fact that the number of people with disabilities is rapidly increasing worldwide. This worrying trend is associated with plenty of factors, including longer life expectancy, an increasing number of people suffering from cardiovascular diseases and diabetes, and environmental conditions. However, unlike other underserved groups, this one is not homogeneous since its members are not equally disabled. Those that have severe impairments (excluding them from the labor market) experience a sharp drop in income, which leads to deterioration of the condition (Krahn et al., 2015).
Thus, the paper at hand is going to prove that a lower socioeconomic position aggravates the disadvantaged status of the disabled population, making this group especially vulnerable since their needs rarely get satisfied. The study will provide a description of the population, account for its vulnerability, assess the unique health concerns the group has, and investigate the ways it uses the health care system. It will also dwell upon the attempts made by healthcare specialists across the country to meet the needs of disabled people with a low-income level and provide recommendations to improve their outcomes.
Description of the Population
According to the International Classification of Functioning Disability and Health (ICF), disability is a comprehensive term that designates many kinds of activity limitations, physical and mental impairments, and participation restrictions (Mackelprang & Salsgiver, 2016). The term was chosen to emphasize the nature of the interaction between the individual having certain health conditions and the environment (inaccessibility of public transportation and buildings, negative attitude of the society, limited or no job opportunities, limited or no financial and health support).
Currently, there are more than a billion people across the globe living with various forms of disability, which means that 15% of the world population is disadvantaged to this or that extent owing to this factor only. Approximately 110-190 million of them have significant functioning restrictions that do not allow them to earn their living (Social Security Administration, Office of Policy & Office of Research, 2013).
As a result, their disability gets aggravated due to a lower socioeconomic status and a low level of income as their health care needs are more extensive and often uncovered by the insurance (Brucker & Houtenville, 2015). The connection between poverty and disability is also supported by the fact that over 80% of the disabled come from developing countries, which allows stating that the population is affected disproportionately and there is a greater prevalence of different forms of disability among low-income people.
It is evident from the description of this disadvantaged group that the problem must be included on the list of national development activities for the following reasons (Mackelprang & Salsgiver, 2016):
Demographic arguments:
There are more than 53 million disabled people in the US, which means that the needs of the group cannot be ignored.
Poverty is both the cause and the consequence of disability.
The population of the US is aging, which increases the risks of disability.
Social arguments:
To ensure sustainable development of the nation, it is essential to eliminate inequalities between various population groups in terms of health care as one of the decisive components of well-being.
The society cannot make any progress if a considerable part of its members is excluded from its activities due to disabilities.
Economic arguments:
Since disability affects the financial status of numerous individuals, it inevitably produces an impact on the economy of the country.
Legal arguments:
Disabled people have the same rights as all other citizens and therefore their problems must be addressed to promote equality.
What Makes the Group Vulnerable or Underserved
In most general terms, people with disabilities representing the lower class have a larger number of unmet needs also because they cannot earn their living and improve their condition resorting to expensive treatment and rehabilitation therapies. The major disadvantages they have to experience include (Brucker & Houtenville, 2015):
Hazardous and unhealthy living conditions. Due to their low level of income, disabled people often have inadequate housing with poor sanitation, which poses a considerable threat to their health.
Limited employment opportunities. Disability is typically linked to unemployment: 47% of disabled men and 80% of disabled women have no jobs. This makes it practically impossible for them to improve their social status.
Social exclusion from public spaces. Physical barriers prevent disabled people from participating in social events and collective decision-making.
Furthermore, the population has to deal with plenty of health care barriers when they attempt to receive the necessary medical assistance. These are (García-Gómez et al., 2015):
Inaccessibility of timely medical aid due to extra costs. Since the majority of disabled people need additional personal assistance from a health care professional or an assistive device, they are constantly confronted with the increased health expenditure. This makes them even poorer than before, trapping them in a never-ending circle.
Unavailability or restricted availability of services. Although most specific health care services required for disabled people are provided in large hospitals situated in big cities, the situation is quite different in small towns and villages, where they can receive only the basic health due to the lack of specialists or equipment.
Physical barriers. There are a lot of physical barriers not only in public places but also in health care units. They include narrow doorways, inadequate bathroom facilities, uneven access to buildings, internal steps and the absence of elevators, no special parking places, non-adjustable equipment, etc.
Insufficient knowledge or skills of the staff. It is not a rare case that people with disabilities report that health care specialists are unable to satisfy their needs or, what is even more frequent, that they are denied care. Moreover, such patients are often treated without due respect and attention.
Unique Health Concerns of the Group
As it has already been mentioned, owing to a low level of income the group experiences deficiencies in health care services covered by their insurance. Their health concerns mostly stem from this problem and include (Social Security Administration, Office of Policy & Office of Research, 2013):
Secondary conditions. The majority of disabled people who have no money to address their primary condition properly suffer from secondary conditions related to it (e.g. osteoporosis, pressure ulcers, pain, urinary infections, etc.). They are mostly predictable and preventable; however, the lack of finances usually deprives them of this opportunity. The most frequently met secondary conditions are:
bowel and bladder (typically affected by spinal cord injuries);
fatigue (lack of energy and increased tiredness due to the necessity to overcome pain and physical obstacles);
injuries (both unintentional and intentional self-harm);
depression or other mental and psychological conditions (owing to higher stress levels);
obesity (since a lot of disabilities make it impossible to be active);
pain (associated with the majority of disabilities but can range from short-term to chronic pain);
pressure ulcers (developing in bedridden patients or those who use a wheelchair).
Co-morbid conditions. It is also typical of disabled individuals to acquire diseases that are not related to their primary condition causing disability. For instance, patients with schizophrenia are 15% more likely to have diabetes than those who do not have this mental disability.
Age-related diseases. The combination of disability and poverty significantly increases the chances of premature aging (at approximately 40-50). Since this process begins earlier, the state of health quickly deteriorates.
Risk behaviors. Since low-income disabled individuals often cannot afford proper nutrition, their diet is unbalanced. Also, to reduce pain and stress, they often smoke or drink alcohol. In most cases, their disability limits physical activity.
Higher mortality rates. Due to all the enumerated factors, the disabled population usually has a lower life expectancy.
Unique Ways the Group Uses Health Care System
Besides the fact that the proportion of individuals without health insurance is much higher in the low-income, disabled populations, the sources of it also vary to a great extent. Most people under 65 without any disabilities have private insurances provided by their or their spouse’s employer. Only 4% receive public coverage provided by Medicaid or Medicare. The rest 15% are uninsured, mostly due to being disadvantaged by their race, ethnicity, socioeconomic status, or other factors.
On the contrary, the coverage pattern of the disabled is usually provided by public plans. The more severe the level of disability is, the fewer chances there are for the population to have private insurance. That is why disabled individuals can use only those services that are covered by Medicare and Medicaid (Soni, Burns, Dague, & Simon, 2017). Also, there are a lot of eligibility criteria that they have to meet to receive benefits from insurance programs. They depend on the level of income and extended to those who receive AFDC and disability payments (Riley & Rupp, 2015).
The utilization of health care services is unique for all categories of low-income disabled individuals, from children to the elderly. The level of disability is the decisive factor determining how often people resort to health care services. Nearly 2 in 3 disabled patients identify their level of health as poor or very poor as compared to 5 in 6 patients without disability assessing their condition as good or fair (Soni et al., 2017).
Another difference is the number of days spent in bed. Disabled people spent 10 times more days in bed as compared to people of the same age without disabilities. As far as visits to hospitals are concerned, disabled individuals attend physicians 3.5 times more often than regular patients (Social Security Administration, Office of Policy & Office of Research, 2013). The highest levels of disability also account for 40% of hospital stays ranging from 5 to 10 days (as compared to the average 1 day among the non-disabled) (Mackelprang & Salsgiver, 2016).
This allows stating that disabled people who have public insurance coverage due to their financial status are mostly heavy users of health care services, even even though the number of them is scarce. Both inpatient and outpatient care is more popular among this population as compared to privately covered, non-disabled patients. During the last year, more than 10% of the disabled in the United States had multiple hospital stays, mostly owing to the limited access to primary care and high health care costs (Social Security Administration, Office of Policy & Office of Research, 2013).
However, the picture is quite different from preventive care. Disabled patients are less likely to use preventive services, such as blood pressure screenings, Pap smear, dental care, flu shots, and others. Immunization is one of the services that fell short of all set national targets since less than 40% of the disabled, low-income population get shots (Social Security Administration, Office of Policy & Office of Research, 2013). The problem is that due to the obstacles enumerated in the previous sections, this vulnerable group tries to avoid visits that are not decisive for the development of their major source of disability, which is their primary (although far from being the only) health concern.
What is Done to Better Meet the Needs of the Population
To meet the needs of disabled, low-income patients by improving their access to the required health services, the World Health organization currently implements the following steps (Mackelprang & Salsgiver, 2016):
Disseminating information. The organization encourages all member states to increase awareness of the problem emphasizing how it may be aggravated by economic disadvantages experienced by the group. WHO currently insists on including the population into some national programs and policies.
Guiding research. The organization facilitates the collection of information on the topic to compare statistics from various countries and select the most effective techniques they implement in dealing with the issue.
Developing guidelines. The organization provides normative tools needed to prepare health care organizations for handling disability.
Involving policymakers. WHO encourages innovative solutions, programs, and policies that could facilitate the process of service provision to health care specialists.
Providing patient education. WHO ensures that disabled people have sufficient knowledge about their condition and rights.
However, the efforts are made not only on the global but also at the national level. In the United States, there are currently two major programs that address this problem. Social Security Disability Insurance (SSDI) was specially designed for those who lost their jobs after becoming disabled. The insurance is provided under the condition that the person paid Social Security taxes for 40 quarters or more (Drake et al., 2013). Yet, the level of provision directly depends on the level of the former income, which again is not the way to solve the problem of those who did not earn a lot in the past.
As for Supplemental Security Income (SSI), this program is more general as it addresses all people having low income, no or an abbreviated history of employment, and restricted living resources. Those utilizing the program receive $735 per month and qualify for Medicaid in the majority of states (Riley & Rupp, 2015).
Nevertheless, these efforts are insufficient, which is supported by the fact that the majority of disabled people have poor living conditions and cannot find any employment even if their disability allows them to work.
Recommendations for How the Country Can/Should Better Meet the Needs of This Population
The following recommendations can be made to better address the problems of the described population (Sherlaw, Lucas, Jourdain, & Monaghan, 2014):
Disabled people must receive access to all educational and employment opportunities (as long as their conditions permit) both in the private and public sectors.
Social organizations should foster the development of support services, cooperatives, and other social enterprises that would render due assistance to the population.
Access to healthcare facilities needs to be improved especially in rural areas where disabled people commonly dwell.
Income security and health protections must be guaranteed to those who cannot provide for themselves.
Principles of equal opportunity, general accessibility, and non-discrimination should be promoted by policymakers.
It is essential to ensure international cooperation of organizations that have been established to address the needs of the disabled population to develop disability-specific standards and policies of poverty reduction and job creation.
Population-specific programs and measures should be introduced along with those that address the general population for disabled people not to feel outcasts from society.
During the implementation of new programs, it is necessary to provide effective consultations to the population so as the disabled are aware of their opportunities, benefits, and rights.
Nurses and other health care professionals must receive due training on the disability issue to be able to ensure the best quality of care for disabled patients.
Research needs to be conducted on the global level to compare data on the living standards of disabled people as well as on the labor market situation to monitor the progress of new policies and acts.
Conclusion
Since disability puts people in the condition of limited work opportunities, the majority of them are unable to earn their living, which aggravates their state of health. Low-income individuals with different forms of disabilities are disadvantaged by several factors simultaneously.
This makes the group highly vulnerable and underserved both socially and medically. Unfortunately, despite the steps taken by the US government to eliminate the existing disparities, it is insufficient to guarantee economic stability to the disabled. Thus, both national and international efforts are required to address the health care and socioeconomic needs of those who are now at the margins of society due to their psychical or mental condition. It is crucial to remove financial, physical, and other barriers that the population has to encounter to ensure the security and well-being of the group.
References
Brucker, D. L., & Houtenville, A. J. (2015). People with disabilities in the United States. Archives of Physical Medicine and Rehabilitation, 96(5), 771-774.
Drake, R. E., Frey, W., Bond, G. R., Goldman, H. H., Salkever, D., Miller, A.,… & Milfort, R. (2013). Assisting Social Security Disability Insurance beneficiaries with schizophrenia, bipolar disorder, or major depression in returning to work. American Journal of Psychiatry, 170(12), 1433-1441.
García-Gómez, P., Hernández-Quevedo, C., Jiménez-Rubio, D., & Oliva-Moreno, J. (2015). Inequity in long-term care use and unmet need: Two sides of the same coin. Journal of Health Economics, 39(1), 147-158.
Krahn, G. L., Walker, D. K., & Correa-De-Araujo, R. (2015). Persons with disabilities as an unrecognized health disparity population. American Journal of Public Health, 105(S2), S198-S206.
Mackelprang, R. W., & Salsgiver, R. (2016). Disability: A diversity model approach in human service practice. Oxford, UK: Oxford University Press.
Riley, G. F., & Rupp, K. (2015). Cumulative expenditures under the DI, SSI, Medicare, and Medicaid programs for a cohort of disabled working‐age adults. Health Services Research, 50(2), 514-536.
Sherlaw, W., Lucas, B., Jourdain, A., & Monaghan, N. (2014). Disabled people, inclusion and policy: Better outcomes through a public health approach? Disability & Society, 29(3), 444-459.
Social Security Administration, Office of Policy, & Office of Research. (2013). Fast Facts and Figures About Social Security 2013. Washington, DC: Government Printing Office.
Soni, A., Burns, M. E., Dague, L., & Simon, K. I. (2017). Medicaid expansion and state trends in Supplemental Security Income Program participation. Health Affairs, 36(8), 1485-1488.
Brief Introduction with Identification of the Subpopulation You Have Chosen
The indigenous population of Australia is represented by two major ethnic groups – the Aborigines and Torres Strait Islanders. According to the data presented by the Australian Bureau of Statistics (ABS) (2017), the indigenous groups comprise about 2.8% of the entire Australian population. The Northern Territory of Australia is home to the largest segment of Aboriginal and Torres Strait Islander populations in regard to their ratio to the other groups as the indigenous people represent over one-quarter of the NT population. At the same time, New South Wales is known to host the biggest segment of the indigenous population that is as large as 216000 people (Australian Bureau of Statistics, 2017).
Aboriginal and Torres Strait Islander populations are recognized to face multiple inequalities and are known to be the most underprivileged ethnic groups in the country. The average weekly income of an indigenous household estimates $990 to $1200 (Australian Bureau of Statistics, 2017). Health-related challenges faced by Aboriginal and Torres Strait Islander populations can be caused by their socioeconomic status, cultural and language differences, and geographical location.
Identify and Describe the Specific Health and Wellbeing Status of the Subgroup. Provide a Reference to Support This
Aboriginal and Torres Strait Islander populations are affected by a variety of conditions and diseases. The most common long-term conditions from which these groups tend to suffer include heart and vascular diseases, hypertensive disease, kidney disease, and diabetes (“Summary of Aboriginal and Torres Strait Islander health,” 2016). Life expectancy at birth among the indigenous populations is lower than that of nonindigenous groups (Markwick, Ansari, Sullivan, Parsons, & McNeil, 2014).
The leading causes of death among Aboriginal and Torres Strait Islander populations include coronary heart disease, chronic lower respiratory disease, diabetes, and lung and related forms of cancer (“Summary of Aboriginal and Torres Strait Islander health,” 2016; “Indigenous health,” n.d.).
Some of the main health risk factors experienced by these populations are tobacco smoking, excessive weight and obesity, high blood pressure, insufficient amounts of fruits and vegetables in diets, and such socioeconomic characteristics as high rates of unemployment, low level of education, and low level of income (“Overview of Aboriginal and Torres Strait Islander health status,” 2016; Australian Human Rights Commission, n.d.).
Identify and Explain the Barriers That the Sub-population May Face When Accessing Health Services. Be Specific. Provide a Reference to Support This
The allocation of health service providers and resources in Australia can be quite uneven in some areas. To be more precise, compared to urban regions, rural areas usually face the scarcity of health service providing facilities (“Equity of access for all Australians,” 2016). Many Aboriginal and Torres Strait Islander groups of the population reside in rural areas and locations situated far away from city centers; as a result, their access to healthcare services is limited (“Why does the health gap exist?” n.d.).
Another barrier to access is presented by the cultural differences such as language and vision of health and health behaviors (“Equity of access for all Australians,” 2016). Namely, a large percentage of Aboriginal and Torres Strait Islander populations belong to a culture that differs significantly from the Western culture dominant in Australia. As a result, the views and perceptions of health held by these groups can be very different and require a culture-sensitive approach.
One more barrier to access to care occurs due to the lack of information known about the aforementioned populations due to their mobility (van Gaans, D’Onise, Taylor, & McDermott, 2016). Because of this barrier, the collection of health-related data about these groups is complicated.
Select one of the Barriers Identified Above and Explain Two Aspects of Existing Health Service Provision That are Already in Place to Remove the Barrier and Support the Sub-Population. Provide a Reference to Support This
One of the major barriers to access to health care services faced by the indigenous populations of Australia is posed by their geographical location. However, there exist specialized health services that attempt to address the problem and match the existing need for care. The University of Queensland has created its own Indigenous Health Mobile Training Unit that targets the population of Aboriginal and Torres Strait Islander communities dwelling around the Toowoomba area (“Mobile indigenous health clinic reaches out to underserviced communities,” 2017).
The two aspects targeted by this service are the provision of culturally sensitive holistic care and the delivery of well-trained service providers to rural locations. This form of service pursues such goals as the prevention of risks and early detection of health threats. These goals are similar to those of telehealth services that provide care using communication technology (Caffery, Bradford, Wickramasinghe, Hayman, & Smith, 2017; Kabene, 2010). However, the interaction with healthcare providers in real life can be more beneficial for the recipients of care.
Identify and Explain Any Deficits in the Health Provisions for this Sub-Group and Make a Brief Proposal about How This Might Be Better Addressed by Your Fictitious Service
The proposed fictitious service is a mobile clinic that will provide culturally sensitive screening, consultation, education, and examination services, as well as carry out the collection of statistical data of different kinds for the purposes of research. The clinic will address three different needs of the target population – the need for accessible health care, information, culturally sensitive approach, and statistical data collection helping the Australian medical professionals research the specificity of the aforementioned groups, their needs, and health risk factors they experience. While the needs for care and information are actively addressed by several different mobile and telehealth services, not all geographical areas are covered equally.
Also, the mobility and location of Aboriginal and Torres Strait Islander populations complicate and limit the collection of health-related statistics and data that could help address some of their existing needs (van Gaans et al., 2016). The proposed clinic would be beneficial due to its mobility and the ability to reach out to underserved populations, provide them with necessary services and information, and gather specific information to assist various types of research.
Identify the Name of Your Fictitious Health Service
The name of the proposed mobile clinic will be the Accessible Care Mobile Unit.
Explain What the Service Aims to Do and How Your Service Will Address the Identified Needs of the Target Population Outlined in Question 5
The proposed service aims to address the need for accessible primary care among Aboriginal and Torres Strait Islander populations. Also, it will offer culturally sensitive examination, consultation, and health promotion services working with the help of staff members speaking the native languages of targeted groups, as well as knowledgeable about the unique features of their cultures. The mobile clinic will be transported by a van and will be comprised of three tents made of rainproof materials.
One room will be equipped for the provision of GP consults and examinations; another room will provide nursing services and health promotion, and the third tent-room will serve for research purposes and data collection in the form of questionnaires and interviews. The staff traveling with the clinic will include one GP, two primary health practitioners, two or three nurses familiar with the cultural specificity of the target populations, one translator, and a research group whose composition will vary depending on the type of data and the issues in focus.
The Following Topics Relate to the Infrastructure and Procedures Needed for Your Service
Type of venue
The proposed venue is a mobile primary care clinic.
Funding source(s)
Private sponsorship from organizations and individual donations will start the venue, and in the case of its success, the sponsorship from research facilities using the data collection services, as well as state funding will be requested.
Number of staff and their profession
The unit will include 7 to 8 medical professionals plus a research group whose size and composition may vary but may not exceed more than 3 people.
Relevant accreditation of the staff and service etc
The unit will include volunteering medical students (nursing, GP, and primary care) or volunteering practitioners of the same specialties. The accreditation of the staff may vary from undergraduate to master level.
Provider payment type. Explain the reason for your choice in 1 sentence.
The volunteers will not be paid but will be provided with resources and equipment necessary for their work; for the volunteering students, hands-on practice will be a form of payment.
Will those seeking your service be referred to as patients, clients, consumers, service seekers, or others? Explain your reasoning in 1 sentence.
The people seeking the service of the Accessible Care Mobile Unit will be referred to as service recipients since the provided services will be delivered for free.
Will the users of your service be expected to pay the full cost of the service, a co-payment (what amount), or will the service be free to all or some of your clients? Explain your reasoning in 1sentence.
The service will be free to all the recipients, the unit will not provide complex and expensive procedures but instead will refer the seekers of such services to the respective medical facilities
Will there be a consumer representative on your board? Explain your reasoning in 1 sentence.
A consumer representative will be a desired member of the board and staff; however, in case if such person is unavailable, their tasks will be fulfilled by the culturally sensitive nurses and the translator.
How will you measure the success of your service? Explain this in one sentence.
The first indicator of the success of the service will be the minimization of health risks in the targeted population; the second – the completed data collection missions driving medical research targeting the needs of Aboriginal and Torres Strait Islander populations.
Conclusion: Brief Summation
The proposed mobile care unit will target underserved areas populated with indigenous people providing necessary types of primary care. Also, it will accomplish health promotion and collect health-related data for medical research. These activities will help tackle some of the risk factors and conditions experienced by the target population and move forward research exploring its specific health needs.
Caffery, L. G., Bradford, N. K., Wickramasinghe, S. I., Hayman, N., & Smith A. C. (2017). Outcomes of using telehealth for the provision of healthcare to Aboriginal and Torres Strait Islander people: A systematic review. Australian and New Zealand Journal of Public Health, 41(1), 48-53.
Equity of access for all Australians. (2016). Web.
Health performance framework 2014 report. (n.d.). Web.
Kabene, S. (2010). Healthcare and the effect of technology: Developments, challenges and advancements: developments, challenges and advancements. Hershey, PA: IGI Global.
Markwick, A., Ansari, Z., Sullivan, M., Parsons, L., & McNeil, J. (2014). Inequalities in the social determinants of health of Aboriginal and Torres Strait Islander People: A cross-sectional population-based study in the Australian state of Victoria. International Journal for Equity in Health, 13(91), 1-12.
Summary of Aboriginal and Torres Strait Islander health. (2016). Web.
van Gaans, D., D’Onise, S., Taylor, K., & McDermott, R. (2016). Managing Aboriginal and Torres Strait Islander data for public health research. Online Journal for Public Health Informatics, 8(3), e202.
The established evidence shows that the use of Xenical with lifestyle interventions can lead to better results; at the same time, the side effects of Xenical need to be taken into consideration as well. Some of the authors point out that online communities have a particular perception of the medication; it is seen as a “lifestyle drug” that is regarded as a reflection of their image and life. However, the evidence of such a perception is limited and needs to be investigated further to understand if it is applicable. A positive correlation between the use of Xenical and the reduced chance of diabetes incidence was also established.
A study conducted by Al-Tabakha, Obaid, Fahelelbom, and Sadek (2016) on Xenical and other (illegal) medications for weight loss
The authors conclude that Xenical is the only medication that is approved by the FDA and sold legally in the UAE; they also argue it is quite effective, especially when supported by a specific diet (Al-Tabakha et al., 2016)
A study conducted by Fox, Ward, and O’Rourke (2005) about the link between medications for weight loss and anorexia
The authors claim that online communities perceive Xenical as a lifestyle drug (improves life and users’ experience); therefore, sensible and reflective approach to it is not always granted (Fox et al., 2005)
A study on the connection between obesity and diabetes type 2 where participants were treated with Xenical and lifestyle interventions to avoid the incidence of type 2 diabetes.
The authors state that Xenical and lifestyle interventions produced greater weight loss and reduced the chance of diabetes incidence (Torgerson, Hauptman, Boldrin, & Sjöström, 2004)
A study that examined the effect of orlistat on obese adults with diabetes also supported the evidence that there are several side effects of this medication.
Aldekhail, Logue, McLoone, and Morrison (2015) claim that Xenical can cause abdominal pain, incontinence, and defecation urgency.
A study conducted by Nwobodo (2015) on the toxicity profile of the medication shows that Xenical can be toxic.
Nwobodo (2015) stresses that the use of Xenical can lead to the incidence of renal stone formation.
A study of antiobesity medicine shows that Xenical can be effective but has specific side effects.
Del Re, Frayne, and Harris (2014) support the evidence that Xenical can cause steatorrhea, incontinence, and frequent bowel movements.
Causal Criteria
Xenical and diets or lifestyle interventions are more efficient than Xenical alone.
Online communities see Xenical as a sign of a specific lifestyle.
Limited
Xenical can lead to renal stone formation.
Limited
As can be seen from the table, the evidence supports the findings that Xenical is more efficient in those treatments and strategies where lifestyle interventions are included as well. The research on the perception of Xenical by online communities is limited; therefore, statements about Xenical’s perception as a lifestyle drug need to be reviewed with caution.
Conceptual Diagram
Financial limitations
Contextual factors include access to this type of medication in the UAE, the available cheaper substitutes, and environmental/societal influences (quality of food, possible stigmatization of overweight people, quality of care). Individual factors comprise the potential financial limitations of users of Xenical, past and present illnesses such as diabetes, disabilities related to decreased functionality, asthma, other chronic conditions, and obesity.
Aims and Hypotheses
The general aim of this paper is to understand how the use of Xenical influences the population of the UAE if it brings more advantages or disadvantages, and how the use of this medication is influenced by the local specifics.
The specific aims are to understand whether Xenical is as effective in the UAE as it was proven to be in the various studies if it is preferred to other medications (even illegal), what groups of citizens use it frequently, and if it can be seen as a “conditional recommendation for the management of overweight… adults” (Alfadda et al., 2016, p. 1152).
The hypotheses are the following: The effectiveness of Xenical is seen as sufficient by the population of the UAE. The effectiveness of Xenical is seen as insufficient by the same population. The number of medications for weight loss sold online indicates that Xenical is not the most widely used medication for the treatment of obesity. The availability of weight loss alternatives results in decreased utilization of Xenical as a pharmacotherapy for obesity (Gotthardt & Bello, 2016).
References
Aldekhail, N. M., Logue, J., McLoone, P., & Morrison, D. S. (2015). Effect of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes mellitus: A systematic review and meta‐analysis of randomized controlled trials. Obesity Reviews, 16(12), 1071-1080.
Alfadda, A. A., Al-Dhwayan, M. M., Alharbi, A. A., Al Khudhair, B. K., Al Nozha, O. M., Al-Qahtani, N. M., & Brożek, J. L. (2016). The Saudi clinical practice guideline for the management of overweight and obesity in adults. Saudi Medical Journal, 37(10), 1151-1162.
Al-Tabakha, M. M., Obaid, D. E. E., Fahelelbom, K. M., & Sadek, B. (2016). The impact of modern pharmacy curriculum on the student attitude towards weight loss product advertisements: A case study. Journal of Young Pharmacists, 8(4), 456.
Del Re, A. C., Frayne, S. M., & Harris, A. H. (2014). Antiobesity medication use across the veterans’ health administration: Patient‐level predictors of receipt. Obesity, 22(9), 1968-1972.
Fox, N., Ward, K., & O’Rourke, A. (2005). Pro-Anorexia, weight-loss drugs and the internet: An “anti-recovery” explanatory model of anorexia. Sociology of Health and Illness, 27(5), 944–971.
Gotthardt, J. D., & Bello, N. T. (2016). Can we win the war on obesity with pharmacotherapy? Expert Review of Clinical Pharmacology, 9(10), 1289-1297.
Nwobodo, N. N. (2015). Toxicity and safety concerns in orlistat therapy for obesity: A critical evaluation. Asian Journal of Biomedical and Pharmaceutical Sciences, 5(47), 1-4.
Torgerson, L., Hauptman, J., Boldrin, M., & Sjöström, L. (2004). XENical in the prevention of diabetes in obese subjects. American Diabetes Association, 13(2), 25-30.
Convenience sampling will be used because of the specific study design and its aims. The researcher plans to choose the study participants using online resources, information from clinics, and private contacts to have the needed number of participants.
All possible participants of the study will be contacted by the researcher; the researcher will provide them with the information about the study, its aims, and objectives, as well as papers needed for ethical considerations (such as forms to provide written consent or right to withdraw). The participants will also be asked to explain their refusal but only if they find this appropriate (the information can be useful for the research as a future reference when conducting a study).
The researcher plans to use SPSS Statistics 21.0 for data analysis (Assi, Thomas, Haffar, & Osselton, 2016).
Study Design
A retrospective observational study design is used for this paper. Observational studies are used to understand the effects of the treatment and its influence on participants (Howell, 2016). An observational study is not an experiment but rather research on the current issues and its outcomes or influences. Furthermore, the retrospective design of the study implies that the participants will not be controlled during their treatment but rather interviewed about the treatment outcomes (Howell, 2016).
It is a descriptive, cross-sectional study that will focus on surveying and interviewing the participants about Xenical, the process of weight loss, and Xenical’s influence or lack of influence on weight loss. Furthermore, the researcher also aims to interview the participants about the impact of local features and context on the use of this medication.
Variables and Factors
The main variables observed in this study will be the following: the efficiency of Xenical for weight loss in the UAE populations and the preferences linked to the use of Xenical compared to other medications for weight loss. The secondary variables are the influence of local context on the availability of Xenical and the use of other medications (legal and illegal) by the population of the UAE and the influence of combined therapy (Xenical plus physical activity) on the efficiency of the treatment.
The factors observed in this research are the following: gender, height, weight, age, location, the duration of treatment using or not using Xenical, the availability of Xenical in the area, the availability of other medications for weight loss (legal and illegal) in the area, the availability of other means used for weight loss in the area (medical interventions at clinics, sports facilities, etc.). The factors that can influence the main variables are the social and financial backgrounds of the participants, the pharmacists’ attitude towards weight loss medications, the presence or lack of physical exercises, and lifestyle interventions. According to Shamsher et al. (2016), many pharmacists in the UAE do not recommend clinically tested weight loss medications due to the existing belief that they cause severe adverse side effects. This can negatively influence participants’ decision to use Xenical or any other tested and approved medication.
Contextual Conditions
The contextual conditions include access to medicine, the availability of cheaper substitutes, cultural/religious, and societal attitudes to weight loss medications, and weight loss in general (Tomoaia-Cotisel et al., 2013). The researcher aims to gather information about these factors to evaluate how they influence the use of Xenical.
Study Procedure
The study procedure will be the following: the participants for the study will be selected; the participants will be provided with information about the study and the researcher. After providing their written consent, the participants will be interviewed and surveyed about Xenical, other weight loss medicine, and their impact on the process of weight loss. The researcher aims to analyze the data using the software presented above and individually studying answers to open questions.
Definitions
According to the CDC (2017), “weight that is higher than what is considered as a healthy weight for a given height is described as overweight or obese”. To evaluate whether or not a patient is obese, BMI (Body Mass Index) is used.
Xenical (Orlistat) is clinically tested and approved medication for the treatment of obesity (Azadbakht, Gojani, & Heidari-Beni, 2015). Surveys are structured sets of data that allow the researcher to use statistical controls in data analysis (Greenfield, 2016).
Examinations and Data Gathering
When the potential participants agree to participate in the study, the author aims to begin the surveys and interviews one week after all papers containing written consent from participants are received. The interviews and surveys will be conducted within two to ten days, depending on the participants’ ability to take part in them. The qualitative and quantitative data collected for the research will be analyzed within three to seven days; after that, the researcher aims to review the analysis to ensure that there are a few biases as possible. This will be the end-point of data-gathering.
Time Schedule
The first patient will be included in the study within two days after the preparations for the research are complete. The last patient will be included approximately on the seventh or tenth day after the study preparations. Each patient will be the understudy for one to three days. The last patient is estimated to finalize the study in two or three weeks after the study preparations are complete. The estimated total duration is approximately two months.
Flow Diagram
References
Assi, S., Thomas, J., Haffar, M., & Osselton, D. (2016). Exploring consumer and patient knowledge, behavior, and attitude toward medicinal and lifestyle products purchased from the internet: A web-based survey. JMIR Public Health and Surveillance, 2(2), 1-16.
CDC. (2017). Defining adult overweight and obesity. Web.
Greenfield, T. (2016). Research methods for postgraduates. New York, NY: John Wiley & Sons.
Howell, D. C. (2016). Fundamental statistics for the behavioral sciences. Toronto, Canada: Nelson Education.
Shamsher, A. A., Nadeem, N., Nadeem, V., Mutib, K. O., Mutib, N. O., & Charoo, N. A. (2016). Herbal and prescription weight loss products: Awareness among pharmacists about efficacy and safety. Journal of Pharmacy Practice and Research, 46(4), 331-337.
Tomoaia-Cotisel, A., Scammon, D. L., Waitzman, N. J., Cronholm, P. F., Halladay, J. R., Driscoll, D. L., & Shih, S. C. (2013). Context matters: The experience of 14 research teams in systematically reporting contextual factors important for practice change. The Annals of Family Medicine, 11(1), 115-123.
Vaccination is a life-saving procedure that prevents long-term health consequences of infectious diseases. Despite the proven efficiency of vaccines against such severe illnesses as measles or mumps, part of the world population refuses or delays immunization. It has caused a measles outbreak in New York and an increased number of measles cases in Europe. According to WHO, vaccine hesitancy has become one of the major threats to global health (Altman, 2019).
Problem subtopic
Although low immunization is characteristic of developing countries, now it is becoming prevalent among U.S. and European citizens. However, if in low-income countries, people may have problems with access to vaccines, some U.S. residents refuse this procedure voluntarily. Generally, if there are enough vaccinated people in the community, it leads to the development of herd immunity that prevents outbreaks of diseases.
Due to vaccine refusal, the number of vaccinated people in the U.S. has decreased, and by the summer of 2019, there had been over a thousand cases of measles reported. This illness has been considered eliminated in America since 2000, but people seem to have revived it by rejecting immunization. If the situation does not change for the better, the world will see more outbreaks of vaccine-preventable diseases (Children’s Defense Fund, 2019).
Possible Causes and Maintaining Forces
Cause
One reason for vaccine hesitancy is the shift from the fear of diseases to the fear of vaccination. Generally, before a vaccine is invented, people suffer from an illness and observe its consequences. After a preventive preparation is introduced, disease rates decrease, and individuals start to forget its effects. Against a background of a declining illness, adverse effects of vaccination become more prominent, and people switch their attention from the gained benefits of the vaccine to its rare side effects.
This has happened in the U.S. and other developed countries. After such diseases as measles ceased to trouble people, they stopped considering them a real threat. At the same time, the news about possible negative consequences of vaccination became widespread and influenced individuals’ attitudes toward immunization (Omer, Amin, & Limaye, 2017).
Cause
Another reason for vaccine refusal is misinformation and distrust of medicine. The public opposes immunization because of faulty beliefs in vaccine toxicity, its harm to the immune system, and the existence of “Big Pharma” that infects children intentionally to gain profits from selling medications. The spread of misleading arguments has been promoted by physicians, such as Andrew Wakefield and Robert Sears, as well as celebrities, activists, and bloggers. These thought influencers base their assertions on the information from the Internet, without bothering to search for scientific proof or consult experienced healthcare professionals (Smith, 2017).
Why the problem persists
The continuing dissemination of erroneous information about vaccination maintains the rate of people refusing or delaying immunization. Much misinformation is placed on the Internet and in social media, where anyone has the opportunity of publishing whatever they want. Therefore, websites and forums are continuously refilled with the information that vaccines cause diseases and are ineffective or that vaccination is a political or medical conspiracy. Since around 80% of people look for health information on the Internet, these misleading assumptions keep confusing individuals and prevent medical professionals from overcoming vaccine hesitancy in patients (Smith, 2017).
Why the problem persists, a lack of sound judgment also hinders individuals from objectively evaluating information that they see on websites or hear from other people. As a rule, people use mental shortcuts when they have to make on-the-spot decisions. These mental shortcuts are formed based on the information that a person encounters frequently. Since there is much misinformation about vaccination available on the Internet, it affects people’s decisions when they are asked to undergo immunization during a regular visit to a doctor. The situation could be different if individuals took time and effort to research scientific proofs of vaccination benefits and their potential harm (Omer et al., 2017).
Background and Justification
Prior attempts and previously proposed solutions
The problem of vaccine refusal was addressed at the government level. Each of 50 states, as well as the District of Columbia, have adopted the legislation that obliges children of school-age and those attending child-care facilities to undergo immunization. Throughout the U.S., it is also permitted not to vaccinate children for medical reasons, such as the weakened immune system or intolerance to the components of a vaccine. The CDC has listed all possible conditions that serve as a reason for medical exemptions (Children’s Defense Fund, 2019).
Deficiencies in the solution paradigm
The adopted legislation has one significant drawback: it allows for exemptions based on religious, philosophical, or personal beliefs. Only in California, West Virginia, Mississippi, New York, and Maine are children not allowed to be excused from vaccination due to their parent’s religious beliefs. In sixteen states, parents are permitted not to vaccinate their children if it disagrees with their personal opinions not related to religion. Furthermore, officially established medical exemptions are often not followed. Although there is a list of conditions under which vaccines should not be administrated, physicians frequently exempt children from immunization for medical reasons that do not serve as contraindications to vaccines. (Children’s Defense Fund, 2019).
Newly Proposed Deliverable
Deliverable overview
My proposal is a series of posters devoted to vaccine-preventable diseases. However, my posters will not be just pictures; I am planning to make them both appealing and informative. The main feature of this deliverable will be photos of people who contracted an illness that is normally prevented by vaccines. The purpose of this work will be to familiarize individuals with the potential consequences of vaccine refusal.
Significance to the student
When people refuse or postpone immunization, they risk not only their health and lives but also that of other community members. The more individuals refuse immunization, the weaker herd immunity becomes, and the more outbreaks of severe diseases happen. I want to live in a healthy world where people do not die from preventable illnesses. I also want my future children to be born into a safe environment where schools are not under quarantine because of numerous unvaccinated students. Therefore, I aim at preventing the aggravation of threats to global health-related vaccine refusal.
Target audience
My project will be targeted at parents, especially mothers since they are responsible for getting their children vaccinated. It makes sense to appeal not only to those who refuse vaccines but also to those who agree with the necessity of immunization. In this case, proponents of vaccination may be encouraged to share their attitudes with other parents. Thus, they would serve as an additional force that could help healthcare professionals to persuade hesitant parents of the need for immunization.
External dissemination platform
Posters should be placed in children’s healthcare facilities in rooms where they can attract the attention of the target audience. For example, a suitable place for them would be the office of a physician who receives pediatric patients accompanied by their parents. Perhaps, digital copies of posters could be disseminated via social media, such as Facebook or Twitter.
It proposed length and justification
I am planning to make two posters related to several vaccine-preventable diseases. I will inform the public about such illnesses as measles, mumps, poliomyelitis, rubella, hepatitis B, and diphtheria. Photos and short descriptions of symptoms and potential complications will accompany each disease. Probably, the description of each illness will take about one page. At the bottom of the posters, there will be a call to action. Such a format is justified because it will familiarize people with health problems that can occur in case of vaccine refusal.
Supplemental material
For the project, I will use photos of patients with the mentioned illnesses. I will also conduct research to identify the symptoms and complications of these diseases.
Evaluation
The goal of the new deliverable
The goal of this deliverable is to inform the target audience that unless they get their children vaccinated, they risk confronting the mentioned diseases.
Success outcome measures
The project will be considered successful if posters manage to attract the attention of the target audience, and at least some of them change their mind in favor of vaccination.
Enhancement of global awareness
Nowadays, such organizations as WHO, the CDC, and the UN Foundation, are highly concerned about vaccine hesitancy. They aim at increasing the global awareness of the problem and providing more people with access to vaccines. The proposed deliverable can help to achieve this goal by informing individuals about the necessity of vaccination and persuading them to protect their health and that of their children with vaccines (Altman, 2019).
Enhancement of global perspective-taking
WHO defines vaccine hesitancy as one of the obstacles to global immunization coverage. It connects this problem with continuous misinformation that is spread through social media. The proposed project can contribute to addressing this problem by testing a new way of delivering information about vaccines. I hope that the knowledge about diseases will encourage people to take care of their health and distrust the anti-vaccine information spread by social media (Branigan, 2019).
The pollution of the elderly people in the world is increasingly growing at a rapid pace. This is with regard to its percentage in relation to that of the young people, as well as an increase in absolute numbers. Current population estimates has it that the percentage of the elderly people who are in the ager bracket above 65 years stands at 55 percent. A majority of these have also been shown to reside in the developed countries. There is a net increase of about 1.2 million people on the world’s elderly people, and the third world countries have been shown to contribute close to 80 percent of this increase (Abyad, 2001).
Statistics also indicates that by the year 2025, the overall population of the elderly people in the world shall have hit the 976 million mark. Of these, 72 percent shall be from the developing regions (Abyad 1994). The developing countries have lately been experiencing higher and faster rates of aging, thanks to a decline in the fertility rates of the population, in comparison to the developed countries (Eysa 2006). Notably, Asia, the Caribbean, as well as the Latin American countries have been recognized as the three regions currently experiencing the fastest aging rates amongst their population (Abyad, 2001).
Further, it is estimated that between the year 2000 and 2030, the population of the elderly in these regions shall also have doubled (Abyad 1996). The west has also been shown to have a high growth rate for its elderly populace. Sadly, these are also vulnerable to chronic disease and so the more reason why health care services should be provided to them. Indeed, the problems facing the frail and old, as well as the development of programs targeted at them, and the understanding of the principles applicable to such programs, is turning out to be a problem of international dimensions (Lipson, 1983).
Issues in the healthcare program of the elderly in Middle East
In comparison to their western counterparts, the issue of healthcare provision for the elderly in the eastern countries appears to be strongly under the influence of cultural values and the applied communication styles (Abyad 1994). Despite the variations amongst the members of Middle East with regard to ethnicity, they nevertheless appear to have some common behaviors and values. Such include the issue of strength affiliations amongst the members of a family, the styles used to interact, space and time orientations, and the attitudes held with regard to ill health (Abyad, 1995).
There are numerous problems that are faced by these countries in their attempt at providing adequate healthcare to their most vulnerable members of the society. Amongst these is a lack of the acquiring of the relevant and timely information, the issue of ‘demanding behavior’ usually exhibited by some the family members, as well as some conflicting beliefs concerning planned healthcare. There is also the issue of communication, in which it is usually regarded as a bad omen to issue a diagnosis (Lipson, 1983).
In the last couple of years, there has sprung up a number of models that are aimed at providing health care to the elderly community at a community level. This has not only been envisioned, but it is also being implemented with recorded success in a number of the developed countries (Diamond & Orzag, 2004). Some of these services include home-based health care, nursing homes, and hospice care (Eysa 2006).
In Iran, which is ranked as a developing country, has failed to closely followed system that offers health and social services to the elderly members of this country. It is only during the sunset years of an elder, or when they are gravely ill with a terminal illness, that there seems to be a consideration, even then this is mostly in the form of conventional methods. In the next couple of decades, it is expected that there shall be a rapid development of the elderly population in the Middle East. This means that for those less developed countries located in this region, then episodes of lowered economic development may also become a common occurrence (Diamond & Orzag, 2004).
The result of this is that it shall become increasingly hard fro this group of the elderly people to have access to adequate health care. The challenge then shall be on the respective countries to try and meet the health care needs of its rapidly increasing elderly people. This is expected to happen against a backdrop of a break down in the traditional support system that families in the Middle East have been providing to their elderly population (Eysa 2006). For this reason there is a need for policymaker’s to these developing countries to commit their resources towards the establishment of formal structures that offers support to the aged, in a bid to meet the prevailing challenges in the years to come.
The Middle East region is currently going through a ‘transition phase’ in health care provision, as evidenced by the unique rise in proportions and numbers of both the adults and the aged (Abyad, 1994). Given the fact that the elderly are more vulnerable to disease as well as disabilities, the rise in population of this group thus creates a sense of urgency towards the establishment of a system of healthcare for the group. Thus far, the available systems have proved that they are not adequately prepared to handle the prevailing situation.
Close to 50 percent of the global; disease burden is attributed to chronic diseases. When you combine this with the all too common infectious disease that are a characteristic of the developing countries, then a double disease burden comes into being (Abyad, 2001). The developing countries are this faced with a challenge of making a paradigm shift in their health care systems, to create room for the provision of health care for their elderly population, as well as in the management of the now too common chronic diseases.
From the perspective of the policymakers, it is expected that they shall give priority to the prevention of chronic disease, while at the same time also investing in health programs meant to assist the elderly. Particular attention should be directed towards prevention planning, through programs that are meant to delay the chronic disease from occurring in the first place (Abyad 1994). In addition, there should be an enhanced health care for the aged who are already victims of the chromic disease. There should also be an attempt to advance the daily life and functioning of the rising population of the elderly (Abyad 1996).
Political/socio/economic factors
According to the culture of the Middle East, the elderly are to be respected, while the existing natural family bonds are highly valued. The elderly family members are often seen as source of love, spiritual blessings, wisdom, and religious faith. There is also a generally regarded feeling amongst the population in the Middle East that by sending an elderly member of the population to a home for the elderly, this is tantamount to the violation of the community’s sacred duty.
Nevertheless, a lot of individual as well as groups are increasingly being challenged by this issue, and at times have no choice but to send their loved elders to a nursing home. Clearly, most of the elderly people that are either found in psychiatric or nursing homes found themselves there not because their families had abandoned them but rather as a result of their inability to attend to them. This group is made up of the elderly lot whose families have gone abroad, the elderly from financially challenged households, unmarried women, and those with disease that needs to be attended to by professionals.
Owing to a shift in morbidity patterns, chronic disease are now characterized by exceedingly prolonged states, a loss in the autonomy of the rising number of the old populace in the Middle East region, as well as dependency (Abyad 1994). In the Middle East, the elderly often receive economic and social support courtesy of a network of extended kinship, and especially from their children. The trend in the region now is shifting towards fewer children in a household, meaning that in the near future, there shall be a drastic decline in the number of children who can potentially support the aged. According to studies carried out in the developed countries, it has emerged that in a case whereby children are economically capable of looking after their aged parents, most of them do not hesitate to do this. Nevertheless, it is expected that with economic development comes a decline in the conventional models of family responsibility (Abyad, 2001).
Those youngsters that have assumed the city life may tend to be more preoccupied with worrying about their children’s future, as opposed to the difficulties that their parents are facing. Traditionally, women have chiefly been concerned with providing for the care of their families. The trend seems to be now changing though, as more women enter into the labor market both for economic and personal reasons. As such, they are no longer quite capable of acting as health care givers to the elderly in the family (Abyad, 1996).
The governments in the Middle East have made an assumption that the families of the elderly people shall still continue offering the care. Thanks to a shift in migration patterns, coupled with a shift in their economic conditions, it has thus been postulated that long-term healthcare provision shall occupy a central position in as far as the planning of healthcare is concerned (Abyad, 1994). The role played by the private sector in the provision of healthcare for the elderly cannot be ignored either. If the fragile nature of the governments finance is anything to go by, then the role of the private sector in as far as the provision of healthcare insurance for the elderly is concerned becomes necessary.
Social services and healthcare development for the elderly population in the middle-east
Thanks to medical technology advancement, the wellness and longevity revolution of the world population has been propelled in the Middle East region. The percentage of the elderly people in the Middle East region is rising at a faster rate, more than that of the sane population in the developed countries. It has also been projected that within the next ten years, there shall also be an increase in the number of those elderly people who shall be seeking fro care services. In the Middle East region, the systems of healthcare seem to have turned a deaf year to the needs of its elderly population (Abyad 2001).
In addition, the number of programs that offer health care to the elderly appears to be sporadic. A majority of these are also an initiative of either the private sector, or the community. Perhaps a categorization of the countries in this region suffices here. The first group consists of those countries that are experiencing rapid development, are endowed with substantial amounts of capital, and also have indigenous populations that are small.
Such countries include Kuwait, a majority of the states in the Persian Gulf, and Saudi Arabia. The second group consists of countries with less capital, medical infrastructure that is quantitatively large, as well as medical personnel that have been adequately trained. These countries include Israel, Egypt, and Algeria. The third group is made up of the nations that have had their extensive medical services brought to a halt, or reduced greatly in terms of scope, by civil war. These countries include Lebanon, Iraq, and Iran (Abyad, 2001).
Social security strategies
The issue of an aging populace is a source of challenge to the countries in the Middle East. The idea behind having strategies in social security is to enable a balance adjustment between revenues and benefits. This is in keeping with the standards that were put in place by the reforms introduced into the sector in the early 1980s. The book, ‘Saving social security-a balanced approach’ by Diamond and Orszag (2004) is both thought-provoking and well-written.
The authors persuasively argue that for there to be sound reforms, their must be a balance between the enhancement of revenues on one hand, and benefit reduction on the other hand. At the same time, this should all be accomplished without appearing to neglect the members of a community who are in dire need of social insurance. The suggestion by the two authors acts to restore sustainable solvency, as well as long-term balance for this plan, while; without subjecting any added strain to the reminder of a government’s budget. Additionally, the proposal offers protection to the benefits of young survivors and the disabled, while at the same time also cementing the social security protection for widows and the low income earning individuals (Diamond & Orszag, 2004).
Of importance too is the fact that this plan aids in the preservation of the central role played by social insurance. This is achieved through the provision of a base-level that ensures there is income for workers, as well as their families at such a time as when they might need it. In a bid to help us understand better the financial woes and achievements of social security, Diamond and Orszag (2004) have also provided a framework for such a program, and also the basis of there being a long-term deficiency.
The authors have also proposed a number of alternatives to the reform plan, and which they have suggested that they be explained upon evaluation, so that the shortcomings for such a program can be unearthed. This is aimed at helping in the replacement of the social security account with individual ones. As can be seen, the idea of social security savings is worth the effort of policymakers reading it, especially in the area of analysis, and reforms.
Social security debate is increasingly turning into an ideology. As such, unrealistic promises and scary strategies are slowly becoming the norm in as far as the issue is concerned. Diamond and Orszag (2004) have attempted to usher in decency and realism into the raging debate. They have helped shed light on those areas where the state may be at fault, while at the same time also offering ways and means through which to improve and strengthen the system, with minimal disruption of the livelihoods of its current beneficiaries, the future workers. The most vulnerable group here; the elderly, have also been considered
Political life vs. Medicare
According to Obelander (2003), the nature of the American political life has been such that it has come to regard Medicare as a cherished institution. As such, the program has earned itself the honor of being one amongst the few success stories of the American welfare society in the United States. Obelander (2003) further opines that its popularity stems mainly from the large number of families in the United States that it has thus far assisted. So much so that by 1995, statistics have indicated that close to 33 million elderly people were benefiting from it, and a further 4 million disabled individuals were also taken care of by the program.
In terms of reach, the Medicare program goes beyond its primary benefit; that of assisting the retirees. This has been achieved by way of relieving the children of its beneficiaries, as well as their grandchildren from the troubles of having to take care of their aged parents. In addition, the Medicare program, unlike some of the other government projects that only addresses the plight of the poor, also recognizes the place of the middle class, as all the retirees have an equal opportunity to become eligible member of the program.
Conclusion
It has been projected that by the year 20025, the population of the elderly people, that is, this in the age bracket beyond 65 years, shall have drastically risen. Currently, the population of this group in some of the developed countries appears to be greater than that of the youngsters. In addition, there is also evidence that in the coming few decades, the population of the elderly in the developing countries shall also have increased. A majority of the countries in the Middle East falls under this category. The culture if the Middle East population is such that the elderly members of the community and more specifically, in a family, are supposed to be taken care of.
As such the sending of such elderly people to a home for the aged is not look at too kindly. However, with more women getting formal employment, and children settling abroad, the elderly are left alone, and the alternative of a healthcare center is the only option. There seems to be a laxity on the part of the governments in this region to support health care for the elderly. Policymakers and the private sector are thus called upon to offer their assistance. Perhaps the nations in this region could borrow from the example of the American Medicare plan that has successfully supported its populace.
Works cited
Abyad A. “The Lebanese healthcare system”. Family practices, 1994; 11(2): 159-161.
Abyad A. “Geriatric in Lebanon the beginning’. International journal of aging human development, 1995; 41(4): 299-309.
Abyad A. “Family Medicine in the Middle East: reflection on the experiences of several countries”. Journal of the American board of family physician, 1996, 9 (4): 289-297.
Abyad A.” healthcare services fro the elderly: a country profile-Lebanon.” Journal of the American geriatrics society, 2001, 49: 1366-70
Diamond, Peter & Orzag, Peter. Saving social security-a balanced approach. Washington, D. C: Brooking institution press, 2004.
Eysa, Mohammadi. “Development of a Community-based care System Model for Senior Citizens in Tehran” middle east journal of family medicine, 2006, 4(1).
The United States’ healthcare delivery system is currently benefiting from advanced medical technologies, evidence-based procedures, and drugs. Unfortunately, the country’s baby boomer generation is aging very fast. This new change indicates that a superior healthcare model is required to meet the needs of these elderly citizens. The essay presented below discusses how this aging baby boomer population will affect health care organizations and services.
Baby Boomers: Health Care Delivery and Organizations
Health Care Services and Delivery
Health care delivery is a complex procedure aimed at addressing the changing medical needs of different people in a given population. According to Canizares, Gignac, Hogg-Johnson, Glazier, and Badley (2016), the number of aging baby boomers in the US will increase to over 70 million within the next few years. The first potential effect is the increased demand for specialized geriatric care and support. This means that America’s healthcare sector will require more skilled aged-care and geriatric nurses to deliver high-quality medical services.
Elderly members of the society might not be able to travel from point A to B to get the required medical services. The second effect is that the role and importance of nursing informatics will become more critical than ever before. Health professionals will have to combine new technologies, applications, and systems to monitor these citizens and provide exemplary medical services (Knickman & Kovner, 2015). The third one is that volunteer care will become relevant in an attempt to address the unique needs of this population.
The fourth effect on health care services is the increased levels of multidisciplinary practices. This means that many professionals from different fields will collaborate to transform the health experiences of the targeted baby boomers, including social workers, nurses, clinical officers, volunteers, surgeons, psychiatrists, massage therapists, and dieticians (Kahana & Kahana, 2014). Another outcome is that many experts in medical practice will also be expected to put more emphasis on care delivery instead of treatment. Finally, existing healthcare delivery models will start to focus on terminal conditions associated with the elderly, including heart disease, cancer, diabetes, hypertension, and arthritis.
Health Organizations
The increasing number of baby boomers is catalyzing new changes in specific health organizations. The first one is that of nursing homes. The country will be forced to establish new nursing homes and create superior care delivery models to support these individuals. The nature of community health clinics will also change significantly in an attempt to provide exemplary geriatric services (National Prevention Council, 2018). Another possible effect is that many hospitals and dispensaries will also introduce new departments that can provide exemplary health services.
Medicare and Medicaid are other organizations or programs that will be transformed to meet this population’s health needs. For example, Medicare program is being diversified to promote the establishment of patient-centered health homes. This model is expected to result in improved or high-quality reimbursements. This aging population will also affect psychological organizations or units in the country. This is true since more institutions will be established to provide mental services to these individuals (Canizares et al., 2016). Finally, state departments and non-governmental organizations will have to expand their services to address the needs of all elderly citizens.
Conclusion
The above discussion has indicated that the United States’ aging baby boomer population will trigger numerous procedures and changes in its healthcare sector. With such developments, chances are high that other members of the public will receive high-quality medical services. The introduction of new organizations and programs will also meet the health needs of these citizens.
References
Canizares, M., Gignac, M., Hogg-Johnson, S., Glazier, R. H., & Badley, E. M. (2016). Do baby boomers use more healthcare services than other generations? Longitudinal trajectories of physician service use across five birth cohorts. BMJ Open, 6(9), e013276. Web.
Kahana, E., & Kahana, B. (2014). Baby boomers’ expectations of health and medicine. Virtual Mentor, 16(5), 380-384. Web.
Knickman, J. R., & Kovner, A. R. (Eds). (2015). Jonas and Kovner’s health care delivery in the United States (11th ed.). New York, NY: Springer Publishing Company.
An aging process is an ordinary physiological process that is characterized by specific health changes and unpredictable behaviors. The elderly require individual care, and primary prevention strategies reduce the chances of new disease development and remove its causes (Duplaga, Grysztar, Rodzinka, & Kopec, 2016). In the chosen group, primary prevention is defined as a magic bullet, the goal of which is the creation of supportive living conditions (Lionis & Midlöv, 2017). Among the examples of primary prevention, the best strategies for caring for the aging population include vaccination, health education, and the promotion of a healthy lifestyle.
An old-age patient is vulnerable to various infections that result in serious health complications. Lionis and Midlöv (2017) recommended vaccination to predict epidemics of influenza or pneumonia in people aged 65 and more. Geriatric hospitals and nursing homes support the idea of immunization for the elderly because it is a change to reduce the number of chronic diseases. Although older people are better aware of the peculiarities of their health and can predict some changes, they are still in need of health education and explanations of new conditions. Therefore, education has to be a part of primary prevention (Duplaga et al., 2016). This strategy prepares people for old age and life with its risk factors and increased responsibility. Finally, the promotion of a healthy lifestyle and the removal of unfavorable behaviors are recommended (Lionis & Midlöv, 2017). The aging population needs to know how such habits as smoking or alcohol use raise the chances of new cardiac or lung diseases. Physical exercises, healthy diets, and physical protection may improve the quality of life.
All these strategies are important for older patient care and have to be properly developed because the number of threats and unpredictable traumas is usually increased with age. Nurses need to support patients in their intentions to learn better the peculiarities of their health. Education, immunization, and healthy behaviors contribute to the decrease in serious problems and complications in the aging population.
References
Duplaga, M., Grysztar, M., Rodzinka, M., & Kopec, A. (2016). Scoping review of health promotion and disease prevention interventions addressed to elderly people. BMC Health Services Research, 16(5), 278. Web.
Lionis, C., & Midlöv, P. (2017). Prevention in the elderly: A necessary priority for general practitioners. European Journal of General Practice, 23(1), 203-208.
Dementia is not a specific disease and rather is a group of symptoms caused by brain disorders that usually affect the elderly population. While the condition is common for people over 65, dementia is not a part of the aging process. Dementia is diagnosed when patients show signs of problems with two or more brain functions, including memory and language. Among frequent causes, researchers mention Alzheimer’s disease and stroke. Although drugs can improve symptoms and slow down the disease, contemporary medicine cannot cure the illness and repair brain damage.
Group Characteristics
People over 65 is a vulnerable population usually characterized by suffering from an increased number of chronic diseases. The elderly are in need of special attention from health care authorities due to their health and functional status. This population group is more likely to suffer from economic hardships, depression, and loneliness (Kales, Gitlin, & Lyketsos, 2015). Moreover, people over 65 are more at risk of experiencing the symptoms of dementia, vision impairment, and heart conditions (Kales et al., 2015). Therefore, the population group demonstrates a need for a shift towards addressing chronic diseases rather than treating acute illnesses.
Describing the Condition
Dementia is a universal problem for healthcare systems around the globe as the number of people suffering from its symptoms is snowballing. According to Baumgart et al. (2015), 47 million people worldwide live with dementia, and the number is estimated to triple by 2050. Approximately 90% of the cases start among patients older than 65. The characteristics of the condition can be summarized as “people not acting like themselves” and can include behavioral, language, emotional, and movement symptoms (“Dementia,” n.d.). The behavioral conditions are perseveration, social disinhibition, and compulsive eating (“Dementia,” n.d.).
Aphasia, dysarthria, apathy, dystonia, tremor, and apraxia can also be the signs of dementia (“Dementia,” n.d.). In short, the illness is a crucial healthcare issue that should be addressed on the international level.
Dementia is usually caused by brain damage, lifestyle, and cardiovascular diseases. While the most significant risk factors are age and genetic susceptibility genes, such conditions as obesity, diabetes, hypertension, and hyperlipidemia are common risk factors for dementia (Baumgart et al., 2015). Moreover, smoking, alcohol, unhealthy diet, low physical activity, and social engagement are also considered possible causes of the condition (Baumgart et al., 2015).
However, the most frequent source of dementia is Alzheimer’s disease. The illness is characterized by an irreversible and progressive brain disorder that is gradually destroying memory and ability to think and, eventually, the ability to carry out simplest tasks (“Alzheimer’s Disease,” n.d.). In brief, dementia is a group of symptoms that can be the consequences of inappropriate lifestyle, cardiovascular conditions or Alzheimer’s disease.
Article Review
For a greater appreciation of the condition, it is beneficial to review at least one of theoretical approaches towards treating dementia. In the literature review conducted by Kales et al. (2015), the authors describe the physical and psychological difficulties that dementia patients face and ways of assessing, addressing and treating the issues. The article focuses its attention on the mental problems of people who have dementia. The research states that depression, aggression, agitation, apathy, and psychosis may occur on all stages of the illness, although their type and prominence depend on the stage (Kales et al., 2015).
While cognitive symptoms are the crucial indicators of the conditions, psychological and behavioral traits are the source of the difficulties for patients and their family (Kales et al., 2015). Therefore, the emotional problems of the people who have dementia need the most attention from caregivers.
Dementia treatment is symptomatic and focuses on slowing down the decline in cognitive ability, as there is no cure for the condition. Due to the complexity of the issue, no universal approach fits all cases; however, there are guidelines for pharmacologic and non-pharmacologic treatment. Pharmacologic treatment includes anti-depressants, antipsychotic medications, mood stabilizers, cholinesterase inhibitors, and memantine (Kales et al., 2015).
The drugs of dementia symptoms are expensive and are often reported as a source of financial hardships by the elderly (Kales et al., 2015). Care providers and family members should consider all the adverse events of the medications before elaborating pharmacologic treatment plan. In brief, the cost-efficiency and effectiveness of current drugs for dementia symptoms are the sources of continuous disputes, therefore, healthcare providers are advised to focus on non-pharmacologic treatment of the illness.
Numerous guidelines propose non-pharmacologic strategies as the primary method for addressing dementia except emergencies, where there is an imminent danger to patient’s or other people’s lives. Kales et al. (2015), provide a thorough review of interventions targeting the patients, caregivers, and the environment. The study shows that while acupuncture, light therapy, reminiscence therapy, and aromatherapy may be beneficial for the people who have dementia, education provided to the family has a more significant potential for improving the patient’s quality of life (Kales et al., 2015).
Tailored Activity Program (TAP) for family members has shown a significant reduction in the frequency of behavioral and psychological problems (Kales et al., 2015). Moreover, modifying the environment where dementia patients spend most of their time through establishing their daily routine, ensuring their safety, and organizing their activity is crucial for improving the outcomes (Kales et al., 2015). In summary, non-pharmacologic approaches to treatment should be the central aspect of therapy.
As mentioned above, the research method utilized by Kales et al. (2015) is a literature review, and it has proven to be most effective for covering all the aspects of the condition. While randomized control trials are the golden standard for contemporary studies, they have a narrow focus. As the purpose of the article is to provide a holistic picture of the issue, a randomized control trial would be inappropriate in the situation. Therefore, the research method used by the authors of the article is adequate and has proven to be most beneficial for their objectives.
Personal Recommendation
As emotional problems have proven to be a decisive source of hardships for a dementia patient and their families, caregivers are advised to focus on the psychological aspect of the illness. First, families should realize that people over 65 being diagnosed with the condition is not a unique situation, and there is no reason for panic. Second, the primary way of addressing the issue should be increasing the physical and mental activity of the patient.
A simple act of thoughtful talking with a family member can improve the condition of the older adults than prescribed drugs. Third, drugs should always be available for emergency use, however, a systematic medication intake should be avoided as long as possible. Non-pharmacologic interventions are to stay the primary method of addressing dementia symptoms. Finally, stress management is equally important for patients and their relatives. As long as family members are affectionate and compassionate to the patient, there is less risk for aggravation of symptoms. In short, people who have dementia are more in need of comfort from their relatives and friends rather than drugs and specialized care.
Resources for Addressing Dementia
The US government provides informational resources to support individuals and families in addressing dementia. National Institute on Aging (NIA) created a website where patients and caregiver can find sources for self-education about the condition (“Alzheimer’s Disease,” n.d.).
The website provides information about the symptoms, risk factors, and treatment of Alzheimer’s disease and dementia. Moreover, the NIA website provides the contacts of Alzheimer related and Dementias Educational and Referral (ADEAR) Center that can answer any relevant questions. The institution can be reached on Monday through Friday, from 8:30 a.m. to 5 p.m. by phone or email (“Alzheimer’s Disease,” n.d.). The phone number is 1-800-438-4380 the email is [email protected] (“Alzheimer’s Disease,” n.d.). In essence, the NIA and the ADEAR Center are the first institutions to be reached when a case of dementia is discovered.
Conclusion
While dementia is not a part of the aging process, people over 65 often suffer from its physical, psychological, and behavioral symptoms. The risk factor for the condition includes age, genetic susceptibility genes, inappropriate lifestyle, cardiovascular conditions or Alzheimer’s disease. Although medications are appropriate for emergency purposes, drugs are often considered inefficient and too expensive for the elderly population.
Therefore, non-pharmacologic treatment is advised for addressing depression, apathy, and agitation in dementia patients. National government organizations can be reached to acquire additional informational support concerning the matter. In conclusion, even though dementia is a source of considerable hardships and lifestyle changes, there are ways of addressing the issue effectively without spending an excessive amount of financial resources.
Baumgart, M., Snyder, H., Carrillo, M., Fazio, S., Kim, H., & Johns, H. (2015). Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimer’s & Dementia, 11(6), 718-726. Web.
Dementia. (n.d.). Web.
Kales, H., Gitlin, L., & Lyketsos, C. (2015). Assessment and management of behavioral and psychological symptoms of dementia. BMJ, 350(7), h369-h369. Web.