Principles of Public Health – Aged Care Case Study

Natalie Woodrow

Consider the case study in order to


demonstrate you understanding of key


principals of Public Healt


h

Emma is a 74 year old Caucasian female and lives alone in a large property. She took retirement several years ago from a local high school as a head teacher and moved with her husband to a seaside town. Her partner died last year from cancer. Emma feels increasingly isolated and lonely. Her children live many miles away and although she keeps in contact with one, the relationship with the other has become strained. She is drinking increasingly large amounts of alcohol and is finding it increasingly difficult to look after herself. Her house is a mess and she survives on snacks.

Introduction

The world’s population as a whole are living longer, this aging population resulting in a significant higher demand for health and social care services. This has resulted in a governmental agenda attempting to reduce the risks and behaviours thatnegatively affect our health. There is an increasing frequency of public health issuesthat dominate the media; alcohol consumption, obesity and smoking are examples,with the public are bombarded with information of how these issues are regularly affecting our physical and mental health. Public health is concerned with how illhealth can be prevented through mass education, often through providinginformation or shock tactics, and promoting good health practice (Naidoo &Wills,2005). Prolonged life expectancy combined with poor health choices has culminatedin increased effort from the government and public health policy to improveoutcomes and reduce the burden on the health service.

In relation to the case study there are several public health concerns that arehighlighted for Emma. As an elderly lady living alone this is a risk factor in itself(Punch et al, 2013), but coupled with Emma’s increasing alcohol consumption, hersocial isolation, lack of support networks, bereavement, and poor diet demonstratesEmma is experiencing a range of health risks and issues. This assignment will address the public health issues of Emma’s alcohol misuse and social isolation, andwill consider the associated risks and impact such issues are having on her health.Finally the assessment will look at what is being done to address these public healthissues.

Alcohol related disease amongst elderly ages groups is an increasing public healthconcern due to the rapidly aging population of not only in the UK, but in manycountries worldwide (WHO, 2012). With links to over 200 illnesses includingdementia, cancer and anxiety (Mortimer, 2011), and the annual cost on societytotalling approximately 21 billion (Home Office, 2012), the government have beenkeen to address this as a series health issue. Continuous and prolonged misuse ofalcohol can have a detrimental effect on any person, however as individuals age thiseffect is increased as they are typically less able to handle the same levels andpatterns of alcohol consumption; their liver is unable to detoxify the body aseffectively as a younger person. A main risk of alcohol misuse in elderly years is ahigher burden of unintentional injuries such as alcohol related falls (Sorock et al,2006; Grunstorm et al 2012). Such a risk could affect Emma, increasing her chanceof becoming immobile restricting her ability to care for herself.

Alcohol is a depressant substance, although it causes intoxication that may producean artificial high, its side effect often consist of irritability and low mood; there areconsiderable links between alcohol use and mental health with each having adetrimental effect on the other (Stephens &Somes, 2014). Individuals havecommonly used alcohol as a way of dealing with depressive episodes, suggestingEmma may be using alcohol to cope with her mood. This is a negative copingstrategy and may poses many health risks for Emma. Furthermore prolonged alcoholconsumption can lead to individuals experiencing or extending depressive disorders,suggesting Emma may be involved in a dangerous circle (Stephens &Somes, 2014).In addition to the harm to Emma’s physical and mental health, alcohol consumptioncan also be associated with social and economic consequences. Her behaviour mayhave negative responses from others, with Emma potentially feeling judged by herpeers or community (WHO, 2014). This in turn could exacerbate Emma’s feelings ofloneliness and increase he social isolation. Moreover, intoxication or alcohol withdrawal can impair performance in social roles, with this reducing Emma’sopportunity to develop any new or future roles (Schmidt et al 2010). Those with amultitude of health issues often experience overlap between them. Emma is alreadyexperiencing productivity loss as she is not looking after herself effectively; herhouse is becoming unclean and she has a poor diet and is surviving on snacks, withthese indicating signs of self-neglect which often derive from feelings of low moodand/or depressive episodes, but this could also be an indicator of her impairmentfrom continued alcohol consumption.

Government policy in this area is vast and robust, a full Alcohol Strategy (HomeOffice, 2012) has been produced to determine where the problem lies and way totackle this. Large scale advertising campaigns, health warnings and healthpromotions have been implemented in order to raise public awareness, as well asgreater enforcement on laws around drink driving limits and age restrictions ondrinking. However, considering the strategy and advertising campaigns, it appearsthere has been a tendency for the health messages to be targeted at young people(Mortimer, 2011), potentially due to media induced ‘moral panics’ around problematicyouth ‘binge drinking culture’. Although research has now demonstrated aconsiderable increase and escalation of alcohol misuse in the elderly population(Blow & Barry, 2012), a general appreciation of the problem has remained negligible,with this being referred to an ‘invisible epidemic’ (Stephens &Somes, 2014, pg 178).

Social isolation is a further public health issue affecting the older adult population. Agrowing number of elderly people are living in and experiencing marginalisation andsocial isolation, with such issues being linked to mental health, suicide risk and self-neglect (Macdonald et al, 2013).Nevertheless, addressing the social isolation of theelderly are slowly becoming present in both National and Local initiatives: the’Fulfilling Lives; Ageing Better’ (Big Lottery Fund, 2013) fundingthat aims to tackleloneliness and social isolation to enable the elderly population to be happier andhealthier, will enable the elderly people in the Sheffield area to contribute to thecommunity in tackling. Such an initiative could allow Emma’s situation to be highlightand interventions to be made to avoid further problems developing. Anotherrecent initiative within the Sheffield area, the ‘Rethink Good Health Programme’ (BigLottery Fund UK, 2013), aims to tackle alcohol related harm in later life. This initiativeallows support and alternatives for those entering retirement who are turning toalcohol to combat social change, boredom or depression. This type of service wouldbe beneficial to Emma to allow her to deal with her pattern of drinking. Nationalpolicy initiatives, such as ‘Improving Opportunities for Older People’ (Department ofWork and Pensions, 2013) which focuses on building purpose into individuals elderlyyears by enabling elderly people to remain active, or remain in employment orvolunteering positions. Research has suggested that retirement from an importantrole can lead to feelings of loss of purpose and identity (Curtis & Barnes 1994)(Brown, 1996). Therefore the ‘Improving Opportunities for Older People’ initiativewould be beneficial for providing Emma with purpose and self-esteem.

Emma currently has a very poor social support network; she has lost her partner,she is cut off from her children and has a strained relationship with her family, shemoved to a new area after retirement suggesting she doesn’t have long standing tieswith her community. The combination of all these vulnerabilities leads Emma tobeing at high risk of developing mental health issues such as depressive episodes,as well as a risk of suicide (Cherpiter, 2013). Emma doesn’t seem to have any strongprotective factors within her life and this is often a risk factor of suicide within theelderly population (Clarke,2005). A high level of social integration and involvement insociety, and access to family, friends and community networks of social supporthave been shown to have a significant impact on health (Naidoo &Wills, 2009). Itappears that Emma has very little contact with others, having limited structure andpurpose within her retirement have led to her becoming low in mood and increasinglymarginalized. Deterioration of mobility can occur in old age and can leave torestrictions in lifestyle, many older people often, due to pride, don’t want to ask forhelp and therefore are more difficult to identify by services.

Social and health care services can make a significant contribution to improvinghealth through tackling loneliness and social isolation, by supporting people toconnections to their family, friends and communities (Sheffield City Council, 2013).However, as Punch and Sugden (2012) suggests, there is a reduced supportnetwork for older people within today’s society. Such traditional patterns of caring areaffected as family networks are commonly fractured through children moving awayfor employment opportunities, resulting in family support reduced for older parents.Although Emma has children they have relocated and therefore this has had animpact on her pattern of care, the breakdown of relationship with her familydemonstrates further loss and distress for Emma. Having closer family ties and apurpose within the family network would offer Emma a role and a focus (Punch et al,2013) such roles can combat some depressive symptoms and loss of purpose whichEmma may be experiencing.

Emma is evidently experiencing a range of issues that will be greatly affecting hermental health; there may be many barriers to breakdown when working with anindividual such as Emma. Cowley (2005) suggests that when emotional distress isseen as a source of shame individuals may hide their needs from others or notreveal things that are worrying them, pride can often be a barrier that can affect thelevel of detail shared with others. Following Emma’s pervious senior employmentposition it may be difficult and embarrassing for her to be in a position which requiresher to ask for help. ThusEmma may not be expressing her issues or concerns dueto feeling ashamed and embarrassed of her current situation (Clarke 2005), with thiscontributing to Emma’s low mood and her social isolation. These barriers would berequired to be broken down to enable Emma to get the level of service she requires.

As Punch et al. (2013: 230) suggests the social construction of old age is often atime of loss ‘experienced as a time of loneliness’ individuals can greatly experienceloss during elderly years, retirement can be difficult for those who have nothing to fill the void that work life leaves them. Bereavement loss of partner and friends maylead to periods of grievance and may also be detrimental to mental health, throughreducing motivation, reduction of structure and a reduction of social support.

Changing behaviours in older adults can be challenging due to older individual’soften declining interventions or being resistant and unwilling to change due to being’set in their ways’ (Naidoo and Wills, 2009). There are a variety of models andapproaches used when attempting to improve and change behaviour, one approachthat could be employed with Emma is the educational approach. The purpose of thisapproach is to increase knowledge and exploration of Emma’s attitudes around herhealth issues, with the aim that this would develop and lead to an adjustment in herbehaviour. This approach may be beneficial as even through it is expert led it canstill allow the patient to make an informed choice (Ewles&Simnett, 2003); offeringchoices may be empowering for Emma, and may help with raising her self-esteem.

However, this approach can ignore the constraints that both social and economicfactors can place on behaviour when making change. Education on alcohol misuse,and the great understanding of how her life choices are effecting health, may not address other factors that may be causing Emma to drink in the first place. Socialstressors and can impact and cause complexities when making health relateddecisions (Naidoo &Wills, 2009). Therefore, this as a standalone approach may notrobust enough for all individuals, and further support may be required to enablebehaviour change. Motivational interviewing may also be useful with Emma. Thistechnique aims to help patients explore their uncertainty about changing and abouttheir readiness of change (Naidoo &Wills, 2009). Providing information andeducation alone may not be enough to induce change in Emma’s behaviour, furtherexploration of her situation and her other health risks would too be required.

Conclusion

Emma has complex health issues which are all entwined and all need robustlyexploring. To enable her to make positive changes her situation needs to beassessed holistically. Making contact with individuals like Emma may be difficult asher situation puts her in a disadvantaged grouping which can be extremely difficult toreach and engage with. The increase in life expectancy has led to a significantlyhigher demand for health and social care services. More elderly people like Emmaare experiencing complex care needs, and a focus on early intervention enablingfrontline staff to be able to identify such issues and refer individuals to theappropriate service is essential. Public health messages displayed throughadvertising campaigns cannot in itself be responsible for driving people to changetheir attitudes or behaviours. As noted often campaigns can be seen to be targetingcertain populations: alcohol misuse towards younger generations; and socialisolation to the elderly generation, but as discussed these issues are too effectingother ‘hidden’ groups, and without the media/government attention these hiddengroups can often be left to feel that the problem isn’t a health issue for them.(Mortimer, 2011). Change can be a complex decision and all factors that affect thebehaviour need to be addressed.

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