This guess blog was written by Chrissy Bishop, an Occupational Therapist.
The term ‘prevention’ in health and social care is promoted as a gold star, a cost saver, a key policy driver; but is it being practiced? Is this term applicable and realistic to apply to the oldest old population (85+)? Are those involved in care of the elderly prepared and sufficiently educated to focus on prevention for a very old individual?
These queries have materialised from my current work in a reablement project. Reablement services are a pivotal, well known incentive of the government’s continued efforts to save costs of long term care packages through enabling independence. But on a controversial note, is the heavy focus on cost saving as opposed to the patients needs?
From a professional experience reablement still seems like an ‘action on crisis’ approach, and highlights a gaping hole in services. Why is this when National Service Frameworks have drummed preventative strategies into health workers for years now? Additionally, studies continue to highlight the overwhelming consequences of the oldest old developing a health problem, which is usually followed by a ‘cascade effect’ with one condition triggering another problem, and another and so on. This downward spiral is a challenge for all health professionals involved, and the medical and nursing protocols are more black and white than the social and emotional support required.
If we are well aware of the ‘cascade effect’ experienced by the oldest old, why do we not have more emergency respite, or support for those at risk? Policy may ‘focus’ on prevention but where is the ‘action’?
There is a large group of the oldest old sitting in something I like to refer to as ‘no man’s land’, who are too independent to meet ‘fair access to care’ criteria, and too poor, unwilling or unable to access a service to provide so called non-essential support such as showering, escorted shopping services, support/befriending for loneliness or bereavement, and managing finances, to name a few. Limitations in these areas can lead to patients turning up at GP surgeries, feeling generally exhausted or unwell but with no specific treatable health problem, perhaps alongside bouts of depression or anxiety due to loss of independence or dealing with the ageing process. Untreated, these issues could lead to increased falls, self neglect or poor nutrition, increasing risk of infections; a small health problem on top of this is a prime example of a cascade effect occurring.
Preventative services should focus on these issues when considering initial treatment plans for the oldest old. With an ‘action on crisis’, approach care and treatment plans can be over complicated. So let’s avoid the cascade effect.
Possible solution? A ‘frequent flyer’, unkempt, anxious or underweight individual turns up at a GP surgery. Alarm bells ring, reablement services act fast.
Reablement could be integrated into GP surgeries and primary care, promoting its value and facilitating referrals. Individuals, personal preferences, personality and needs, are understood, avoiding a clouding of personality by illness and a ‘cascade effect’. Let’s generally get fastidious at the earliest stage possible, rather than react with a rushed ‘act on crisis’ approach. Yes, an older person’s level of physical ability may change, but this small shift in delivery of a service could intensify the chance of older individuals not just receiving fair access to care but who they are as a person.