Older Australians Living in Aged Care Facilities

Addressing vulnerable populations’ needs and health problems through effective nursing care is an essential task of any modern healthcare system. Interaction with those categories of citizens who require particular assistance due to their status, for instance, age, place of residence, or other criteria, implies creating an adequate practical plan. Such a guideline should meet the standards of nursing care and manage the health issues of the target audience. As the chosen vulnerable population, older Australians living in aged care facilities will be reviewed. The assessment of their health determinants, including social and clinical factors, can help formulate an effective care plan based on the Registered Nurse Standards to address these citizens’ problems as effectively and safely as possible.

Characteristics of the Chosen Population

Australian citizens living in aged care facilities make up a significant proportion of the country’s elderly population. According to Warburton and Mahoney (2020), as of 2020, about 336,000 residents used these facilities. These statistics confirm that Australia, along with many other countries, has succeeded in building a sustainable economic model, which, in turn, is reflected in the increased life expectancy of its residents. The diversity perspective is also essential to take into account, “with older people varying enormously in terms of their health and well-being” (Warburton & Mahoney, 2020, p. 122). These criteria are decisive for this category of citizens since patients at aged care facilities need constant care due to various health issues. Based on these differences, some inequalities arise, and while service environments play an important role, health indicators are critical factors to consider. Warburton and Mahoney (2020) note that corresponding financial initiatives by the authorities in the second half of the 20th century contributed to a significant increase in aged care institutions. As a result, a wide range of factors has emerged, which divide the category under consideration by status, including social and clinical determinants of health.

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Social Determinants of Health

Living in aged care facilities for older Australians is directly related to the social determinants of health. Jeong et al. (2021) examine the relevant criteria and note that income, employment conditions, and a social environment play a significant role in the well-being of the target population. The inability to spend large sums of money on medicines and skilled medical care on an outpatient basis is one of the reasons why older people live in such facilities. In terms of employment, some citizens cannot afford to live on a pension to ensure a normal standard of living. As a result, they have to ask for help from municipal institutions to meet basic life needs and to be cared for competently. Otherwise, health risks increase, and older people cannot cope with these challenges on their own.

A social environment is a critical determinant of health, having a psychological rather than physical effect. Warburton and Mahoney (2020) provide an example of older patients in rural areas who, due to limited access to healthcare services and distance from large cities, are forced to end up in aged care facilities. The lack of social contacts affects the psyche of these citizens negatively, which manifests itself in the form of psycho-emotional disorders. The inability to meet the daily needs on their own prompts older adults to seek institutional care. Thus, not only material factors are associated with social determinants of health but also some psychological nuances.

Health Inequalities: Clinical Perspective

As already mentioned, the factor of diversity among the population under consideration suggests differences in well-being and health. From a clinical perspective, in today’s Australia, the healthcare system is able to address the urgent needs of the elderly population, including aged care facilities. High life expectancy is one of the factors that Warburton and Mahoney (2020) mention. However, despite the age parameter, other clinical criteria reflecting citizens’ well-being are associated with issues. Walker and Paliadelis (2016) state that older adults are characterized “by increased prevalence of comorbidities, chronic illness, dementia and disabilities” (p. E6). The principle of aged care facilities’ operation largely explains a high mortality rate since patients of these institutions end their lives in them. Unlike standard hospitals, the practices of geriatric care are promoted in this environment, and older people tend to recover from diseases and disorders slowly due to age and social constraints.

In addition to health perspectives, the principles of treatment and care for the elderly at aged-care facilities are also associated with inequalities. Rayner and Bauer (2016) review pain management practices in these institutions and note that their patients face this problem more often than patients in ordinary clinics. Pain relief is directly related to well-being, and in the case of the inability to receive adequate assistance for financial or other reasons, senior citizens are forced to experience severe distress (Rayner & Bauer, 2016). As a result, the considered clinical aspects of inequalities affect the health of the target population negatively and are urgent problems to address.

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Health Inequities: Social Perspective

The social conditions that determine health inequities among older Australians living in aged care facilities are generally associated with access to health services and income. According to van Gaans and Dent (2018), one of the critical factors holding back adequate care for the target audience is “limited proficiency in English,” particularly for indigenous and migrant populations (p. 13). However, this factor is compounded by the accompanying social challenges caused by an ineffectively constructed care delivery system. Temple and Williams (2018) argue that one of the key barriers to accessing healthcare among older people is the unavailability of appointments. High costs of medical services that are not covered by insurance also constrain effective care provision (Temple & Williams, 2018). As a result, income is a crucial aspect in determining the quality of healthcare for older Australians.

These constraints largely determine the attitude of the elderly towards assistance in aged care facilities. As Temple and Williams (2018) remark, according to their research, older people who have faced dishonest treatment from providers tend to trust the healthcare system less. The discrimination they experience is a consequence of social stigma based on the belief that the youth deserve more attention than the elderly. This approach is a testament to the existing health inequities and requires taking objective measures by providers to establish sustainable care delivery and equal access to medical services. Otherwise, older patient outcomes will deteriorate, which, despite a high life expectancy, may be the consequence of ignoring the target audience’s needs.

Health Outcomes

The vulnerability of the elderly population living in Australian aged care facilities is due to a number of health issues, and many of them are the result of the aforementioned social and clinical problems. The morale of these patients is often depressed, and negative emotions affect their well-being. According to Greenfield et al. (2021), anergia and anhedonia are the common symptoms experienced by older adults. Passivity and the lack of initiative are due to a limited communication circle and the loss of interest in any activities and are fraught with an increase in the mortality rate among this population (Greenfield et al., 2021). As a result, concomitant psycho-emotional disorders develop, caused by depressive conditions, and nurses face hard cases in the workplace.

Mental disorders are the most common health issues of patients at aged care facilities. In accordance with the study conducted by Amare et al. (2020), more than half (57.8%) of a large sample of the participants involved and living in these institutions were diagnosed with at least one psycho-emotional disorder (p. 1200). At the same time, in these citizens, there is a direct relationship between mental and physical health. As the authors note, “mental health conditions were reported most in individuals with musculoskeletal disorders 60.4%” (Amare et al., 2020, p. 1203). Low mobility due to frequent weakness, in turn, leads to related problems, such as pressure ulcers, which cause significant discomfort to patients. Hill (2021) highlights frequent injuries in older adults and mentions falls and fractures, which are also due to musculoskeletal disorders. As a result, the population in question is at risk of a number of health issues that affect well-being.

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Nursing Practice Plan

The aforementioned challenges that older Australians living in aged care facilities face are an objective reason to provide high-quality care and create an environment in which the needs of this population are met. Since the issues identified relate to both physical and mental disorders, addressing these problems requires a comprehensive assessment of patients’ conditions to provide them with adequate support. For registered nurses working in such institutions, the task is not limited to simply meeting the daily needs of the elderly. Comprehensive assistance involves following the relevant principles of interaction, which are determined at the legal level.

In particular, the Registered Nurse Standards are those norms that define the practical requirements for the work of medical personnel in this profile. According to Cashin et al. (2017), these standards were first introduced in 2006 and became a guideline for defining different aspects of interaction with patients. The authors state that these norms “are an important policy mechanism to convey professional standing and assist in defining practice and behaviour for regulation purposes, by government, regulatory authorities, education providers, employers and consumers” (Cashin et al., 2017, p. 256). This means that the standards are included in the spectrum of state supervision and concern not only professional but also legal aspects of registered nurses’ work. For older adults in aged care facilities, applying appropriate standards can help build sustainable care plans based on meeting the needs of this audience and productive interaction. In this case, Standard 2, with its subcategories, will be involved, which implies involving target patients in professional and therapeutic relationships.

Engaging in Therapeutic and Professional Relationships

Building therapeutic and professional relationships with older Australians living in aged care facilities requires providing full diagnostics to obtain a comprehensive picture. Interaction with an individual from such an institution should be based on his or her clinical problems and social aspects that affect health. Hartley et al. (2019) note that improving patient engagement can be achieved by organizing team-based training. This recommendation is valid because improving the skills of staff is an essential condition for providing highly qualified care. Given the wide range of health issues that aged care facilities patients have, such an initiative can foster a sustainable therapeutic collaboration. In these conditions, the provider is aware of all patient concerns and is willing to apply knowledge and skills to address them. Such relationships, in addition, increase patients’ trust, which is also a valuable perspective to achieve due to the audience’s concerns and worries about the ineffectiveness of care.

The importance of engaging target patients in these relationships is due to a number of reasons. Older adults at aged care facilities can have many symptoms related to different diseases and disorders. As DeLaune et al. (2019) argue, “a patient’s knowledge deficit may hinder their recovery and prevent them from engaging in self-care practices and healthpromoting behaviours” (p. 426). In other words, the inability to perceive their own condition adequately can be a reason for the aggravation of a patient’s condition. Therefore, the task of a registered nurse is to maintain constant interaction to explain all the aspects of the care process. This work implies building professional relationships when both sides understand each other, and the provider can address the patient’s needs comprehensively. Thus, the standard in question addresses such a form of interaction and advocates for patient rights to qualified care and support.

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Effective Communication and Ethical Behavior

Establishing productive communication with patients of aged care facilities is an important standard of registered nurse practice. This is because the target audience often has mental health problems. Therefore, in addition to common care principles, interaction should be built on ensuring that patients with not only physical but also cognitive and behavioral disorders have a favorable stay. Hamiduzzaman et al. (2020) highlight the value of person-centered communication as a mechanism to address the challenges of patient social adaptation. The interaction algorithm may involve constant counseling of residents at aged care facilities to create a sense of security in them. Anxiety disorders are common symptoms caused by loneliness and the lack of communication. Thus, registered nurses should be the initiators of interaction with older adults in such institutions while taking into account ethical factors as the integral components to respect the population’s dignity.

Respect is critical to the work of registered nurses at aged care facilities. In Australian institutions, representatives of different nationalities reside, including migrants and the indigenous population of the country. To build an effective care process, respect for patients’ cultural backgrounds is essential to promote among the staff. Along with the legal right to receive qualified assistance, these people have the right to expect that their values ​​and beliefs will be taken into account. As Hodge and Varndell (2020) note, psychological factors largely shape the nature of the provider-patient interaction, and any bias reduces the quality of nursing care. Registered nurses need to be familiar with patient history, marital status, and other individual factors to establish an effective communication regime. The target audience, in turn, is grateful to the medical staff for their attentive attitude, and the interaction process is more successful. As a result, the personal dignity in aged care facilities and taking into account their individual histories are the crucial attributes of interpersonal interaction in addressing older adults’ physical and mental health problems.

Support and Assistance Provision

Promoting health-related decisions among patients at aged care facilities is important for the aforementioned reasons, particularly the lack of knowledge among the target audience about the principles of self-help and overcoming physical and mental health problems. According to MacLeod et al. (2017), the challenges of many older adults are often caused by their ignorance of the principles of the care environment in which they reside. Therefore, one of the practical tasks of registered nurses is to help these patients by explaining to them the motives and potential outcomes of corresponding interventions. To follow ethically appropriate working principles, nursing staff should consider the health inequities of target patients and assist them in adaptation. As a relevant step, healthcare professionals can help older people in choosing insurance strategies and other financial considerations, which, as MacLeod et al. (2017) argue, is directly related to health outcomes. In addition, self-help advice should also be given regarding current health issues, such as adult mobility principles or nutritional basics.

Since mental health problems are common among patients at aged care facilities, registered nurses should pay attention to cognitive restorative practices. Desai and Grossberg (2017) suggest considering special intellectual activities that encourage older adults to keep their brains in good shape. The authors also draw attention to alternative physical assistance programs and mention training in yoga and other traditional practices designed to strengthen the vitality of patients in such institutions (Desai & Grossberg, 2017). Moreover, registered nurses should work to increase the medication literacy of the target population. Errors related to medication intake can be the cause of severe health outcomes. Therefore, to avoid dangerous consequences, targeted work should be carried out to increase the knowledge of elderly patients about the specifics of drugs taken and precautions. All these guidelines can help registered nurses at Australian aged care facilities create a supportive environment for interaction with patients and promote health-related behaviors to make older adults’ lives easier.

References

Amare, A. T., Caughey, G. E., Whitehead, C., Lang, C. E., Bray, S. C., Corlis, M., Visvanathan, R., Wesselingh, S., & Inacio, M. C. (2020). The prevalence, trends and determinants of mental health disorders in older Australians living in permanent residential aged care: Implications for policy and quality of aged care services. Australian & New Zealand Journal of Psychiatry, 54(12), 1200-1211.

Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., Kerdo, E., Kelly, J., Thoms, D., & Fisher, M. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266.

DeLaune, S. C., McTier, L., Tollefson, J., Lawrence, J., & Ladner, P. K. (2019). Fundamentals of nursing: Australia & New Zealand (2nd ed.). Cengage AU.

Desai, A., & Grossberg, G. (2017). Psychiatric consultation in long-term care: A guide for healthcare professionals (2nd ed.) Cambridge University Press.

Greenfield, L., Mathews, S., & Toukhsati, S. R. (2021). Anhedonia and anergia predict mortality in older Australians living in residential aged care. Aging & Mental Health, 1-9.

Hamiduzzaman, M., Kuot, A., Greenhill, J., Strivens, E., & Isaac, V. (2020). Towards personalized care: Factors associated with the quality of life of residents with dementia in Australian rural aged care homes. PloS One, 15(5), e0233450.

Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2019). Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102, 103490.

Hill, T. (2021). Understanding unmet aged care need and care inequalities among older Australians. Ageing & Society, 1-30.

Hodge, A., & Varndell, W. (2020). Professional transitions in nursing: A guide to practice in the Australian healthcare system. Routledge.

Jeong, S. Y. S., Hunter, S., & McIntyre, L. (2021). Nursing in aged care contexts. In N. J. Wilson, P. Lewis, L. Hunt, & L. Whitehead (Eds.), Nursing in Australia: Contemporary professional and practice insights (pp. 117-127). Routledge.

MacLeod, S., Musich, S., Hawkins, K., & Armstrong, D. G. (2017). The growing need for resources to help older adults manage their financial and healthcare choices. BMC Geriatrics, 17(1), 1-9.

Rayner, J. A., & Bauer, M. (2016). “I wouldn’t mind trying it. I’m in pain the whole time”: Barriers to the use of complementary medicines by older Australians in residential aged-care facilities. Journal of Applied Gerontology, 36(9), 1070-1090.

Temple, J. B., & Williams, R. (2018). Multiple health conditions and barriers to healthcare among older Australians: Prevalence, reasons and types of barriers. Australian Journal of Primary Health, 24(1), 82-89.

van Gaans, D., & Dent, E. (2018). Issues of accessibility to health services by older Australians: A review. Public Health Reviews, 39(1), 1-16.

Walker, H., & Paliadelis, P. (2016). Older peoples’ experiences of living in a residential aged care facility in Australia. Australasian Journal on Ageing, 35(3), E6-E10.

Warburton, J., & Mahoney, A. M. (2020). The aged care sector: Residential and community care. In W. Willis, L. Reynolds, & H. Keleher (Eds.), Understanding the Australian health care system (3rd ed.) (pp. 121-138). Elsevier.

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