The Top Challenges Facing the Elderly in California

Purpose statement 

The purpose of this assessment is to analyze the challenges facing the elderly in California, MD, to develop an intervention plan to improve the quality of life for the elderly. 

• Define community including the name of the city, state 

The community I have chosen is California, Maryland. This city lies in St. Mary’s County but borders Calvert and Charles Counties. The city is 14.8 square miles, with 928 people per square mile. 

• Population 

The total population was 11,857 as of 2010 census. The population is growing steadily, and it is estimated to be 12,386 in 2019, making it the 3,331st largest city in the US (Areavibes, 2019). The population in California is 103% higher than the Maryland average.  

• Demographics 

More than 57.2% of the population is married, and the average household size is 3.31 people (California CDP, 2012). 93% speak English, and 4% speak Spanish. Caucasians make up 73.74% of the population, whereas 18.11% are black. Two or more races make up 3.50%, while Asians are at 3.07%.  

• Education Level 

24.69% of individuals over the age of 25 have some college degree, while 20.69% have some a high school degree. 23.71% have a bachelor’s degree, while 13.46% have a graduate degree.  

• Unemployment rate 

According to California CDP (2012), the median household income was $85,240. The unemployment rate is 5%, which is slightly higher than the national unemployment rate of 4%. California’s poverty rate is 8%, lower than the national average by 4%.  

Aggregate of Interest 

• Describe aggregate (the vulnerable population) in more detail 

Elderly persons present unique health and social problems. The elderly are classified as vulnerable individuals because of the increased risk of health problems. Older people require horizontal, problem-based, and integrative health services rather than a vertical, disease-oriented system of care. Aging brings many health issues, particularly chronic health conditions such as diabetes, cancer, hypertension, and stroke (Moore et al., 2017). Cognitive health issues such as dementia and Alzheimer’s disease are also common among the elderly. Aside from these diseases, older people experience declining physical energy and sensory impairments, putting them at risk for more injuries. Community health workers play an essential role in the health of the elderly.  

· Windshield survey 

California is a small city with beautifully landscaped businesses, as well as many new housing units. The area has many grocery stores, clinics, and a hospital within ten miles. There is a navy base here; this brings in lots of transient population. Driving through the neighborhood, you encounter well-dressed people walking and much traffic. Most vehicles are well maintained or new. There is see no evidence of poverty. What is observable is that most households are multi-generational.  

· Data collection/research 

The initial data collection/research is a web search of peer-reviewed articles and other sources on elderly health. A study by van de Pol et al. (2015) explores the quality care provision of older people. The authors interview older people and health professionals. They conclude that effective care intervention for older patients’ calls for mutual understanding of the expectations of the parties involved. Another study by Condelius & Andersson (2015) explores factors that determine access to care among old patients. General health deterioration and medical conditions make the elderly to seek care. The study classified factors that enable access into three: organization of care, next of kin, and the older person (Condelius & Andersson, 2015). Other online sources, particularly California CDP (2012) was a source of the critical population and demographic statistics. 

· Interview with the health department 

I interviewed a general practitioner (GP) attached to a nursing home. The GP talked about his routine and the challenges of working with elderly people. Here are some of the interview questions: 

Interviewer: Describe how it is like working with elderly patients.  

GP: I would be inclined to say working with the elderly in a nursing home is like trying to fight many fires. There are many follow-up appointments for many cases. Sometimes, I take calls at home when something goes wrong.  

Interviewer: What are the challenges of working with the elderly in a nursing home? 

GP: Patients in nursing homes have lower levels of autonomy because of their age and their medical conditions. All of the patients also have severe medical conditions, and some of them are incapable of discussing their problems adequately. The patients are reliant on nurses to meet almost all needs; thus, they are not in control of their medical arrangements. I believe that nurses need more training to handle the pressures of working with the elderly. 

o interview with a member of this vulnerable population 

I also interviewed Mrs. Williams*, a 71-year old Caucasian woman. Mrs. Williams lives with a 76-year old husband, and they have three children and 7 grandchildren. Only one child is in California, while the rest are far away from home. The interview took place on 13th Nov. 2019, in her family home, a 4-bedroom house in Verbena Lane. After seeking consent, I notified Mrs. Williams that the purpose of the interview was to evaluate elderly health/social life in the community. The interview is classified into three parts: Personal details, quality of life, and open-ended questions on available health and social services. Below is a portion of the interview:  

Interviewer: Do you have someone to turn to when you need support? 

Mrs. Williams: I have my husband, though he does not do much to help around the house. When I am unwell, I call my daughter to come and take me to the hospital, even though I can go on my own. The housekeeper comes on Mondays, Wednesdays, and Saturdays to help with cleaning and pick up groceries and prescriptions. I am still capable of doing household chores by myself even though my children say we are better off in a retirement home. My husband has diabetes, and he is on a strict diet and medication, and they do not think I can handle it. I like my independence and the life I have here. There is only one retirement home in the community, and I have not heard good things about it.  

Interviewer: How can you describe your social life? 

Mrs. Williams: I meet up with my friends regularly to catch up over food and share stories. I do not go out as much as I used to, but I also visit friends to talk or play games. I like staying indoors to watch my TV programs.  

Interviewer: Do you feel that the people in your care take your opinion into account? 

Mrs. Williams : My doctor is the one who prescribes the medication and tells me what to do. However, when I have a problem with my blood pressure, I talk to the doctor to change my prescription. I feel like the doctor has a tendency to tell me what I should do rather than listen to me.  

Interviewer : In the last six months, were there times when your physical or emotional health suffered because your healthcare was poorly organized? 

Mrs. Williams : I am responsible for my health and my husband’s health because he is forgetful. We take medication every day because my husband has diabetes. Sometimes we forget to take medications because there is no one around to remind us. 

Gaps in Resources 

• Windshield survey 

A windshield survey is an informal survey. Health professionals use windshield surveys to familiarize themselves with community. It is hard to identify the real problem and the extent of the problem from driving around. Health professionals have to interact with the community members to explore their problems as they cannot understand the real community problems or the extent of the problems through observation.  

· Data collection/research 

The data collection method used was the analysis of sources on the topic. The research provided a background to the problem. However, the research was general in nature, and it does not cover the specific issues of the elderly in California.  

· Interview with the health department 

The interview with the GP was enlightening. It deepened my understanding of the experiences of health professionals working with the elderly. The GP gave details about his experiences of working with the elderly in nursing homes. The main gap is that not all elderly individuals are in a nursing home. The elderly subject which I interviewed is not in a nursing home. Therefore, the information applies explicitly to care for the elderly in nursing homes. The interviewee also gave his personal opinion and the challenges he experienced, which might not be the case for other GPs working with elderly patients.  

· Interview with a member of this vulnerable population 

From the interview with Mrs. Williams, we explored various issues affecting elderly people. Issues of increasing health conditions and physical problems coupled with a lack of support from kin and health professionals are some of the issues. The interview with Mrs. Williams is not a reflection of the condition of all elderly people in California. Mrs. Williams’ situation is different from the situations of other elderly people. There is a need for a larger sample for future research to give a real picture of the challenges facing the elderly in California.  

Community Health Problem 

The community of California is doing well as per the health measures of diseases/injury, mortality, and other factors. The community also has adequate resources to meet its health needs in the form of fully equipped hospitals. The only challenge is with the elderly population. There is no adequate resources/personnel to offer the right support to elderly citizens, such as Mrs. Williams.   One of the Healthy People 2020 objectives is to increase the proportion of older adults who are up to date on a core set of clinical preventative services  (OA-2). There are many older people in California with chronic diseases, while others are developing these conditions because they are not aware of preventative services. Community health workers and health professionals, in general, have to educate the elderly on the availability of these services.  

Theoretical Framework 

Nightingale’s framework is an excellent guide to follow to address the issues of the community of California. According to the theory, the environment plays a vital role in the patient’s health. External factors such as a clean environment, fresh air, and the right food play a role in elderly health. Elderly people should be put in the right environment for healing to occur (Rector, 2018). Health professionals should not rely on medication only; rather, they should help the elderly in creating the right environment to prevent diseases and fasten the healing process. 

Conclusion 

Community health nurses must broaden their data collection strategies so that they can get a clear picture of the health issue. A community assessment is about seeking information from individuals, groups, organizations, media, and other sources. The information can be achieved using different strategies; thus, community health nurses should educate themselves on how to interact with different individuals while being respectful of their situations. 

References 

Areavibes. (2019). California, MD Demographics. Retrieved from: https://www.areavibes.com/california-md/demographics/ 

California CDP (2012), Maryland Quicklinks-Demographic Characteristics. State and County quick facts. U.S. Census Bureau. Retrieved October 2019. 

Condelius, A., & Andersson, M. (2015). Exploring access to care among older people in the last phase of life using the behavioural model of health services use: a qualitative study from the perspective of the next of kin of older persons who had died in a nursing home.  BMC geriatrics ,  15 (1), 138. 

Moore, A., Patterson, C., Nair, K., Oliver, D., Brown, A., Keating, P., & Riva, J. J. (2015). Minding the gap: Prioritization of care issues among nurse practitioners, family physicians and geriatricians when caring for the elderly.  Journal of interprofessional care ,  29 (4), 401-403. 

Office of Disease Prevention & Health Promotion. (2019). Healthy People 2020: Older Adults . Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/older- adults/objectives 

Rector, C. (2018). Community and public health nursing: Promoting the public’s health (9 th ). Philadelphia, PA: Wolters Kluwer 

van de Pol, M. H. J., Fluit, C. R. M. G., Lagro, J., Niessen, D., Rikkert, M. G. M. O., & Lagro-Janssen, A. L. M. (2015). Quality care provision for older people: an interview study with patients and primary healthcare professionals.  Br J Gen Pract ,  65 (637), e500-e507.