Geriatrics and the Role of the Geriatrician
See "What
is Geriatrics?" to learn about the role of the Geriatrician.
Geriatrics in the Rural Context
For a general discussion of the
advantages and barriers associated with rural health care practice,
visit: Rural
Medicine
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Nursing and the Role of the Nurse
For a general description of the Registered Nurse reference the Occupational
Outlook Handbook.
RURAL
COMMUNITY NURSING
Health
is not solely the absence of illness. Health is a state of
"complete, physical, mental, and social-well being" (World
Health Organization ). Central to the maintenance or improvement of
the health of individuals are those health promotion and disease
prevention activities that focus on:
-
reduction
of risks or threats to health
-
detection
and treatment of early stage illness
-
restoration
and rehabilitation to retain optimal level of functioning
Being a
community health nurse focuses on the foregoing as well as acute care
and can present many challenges and rewards. We are, out of necessity,
well versed in virtually all fields of nursing and are given unique
autonomy in the nursing profession. Although we work under the orders of
a licensed physician, we are often the frontline professional who
assesses the patient's needs and develop a plan of care to meet these
needs. We have established a strong rapport with our local physicians by
historically providing appropriate, timely, knowledgeable, empathetic
care for their patients.
Our rural
patients tend to be fiercely independent, have multiple diagnoses, be
socially isolated due to distances to neighbors and lack of public
transportation. They customarily do not seek medical help until they are
in acute distress. Many are
living on the edge of poverty.
The care of
such individuals is multidimensional.
It includes not only their physical needs, but also their social,
cultural, behavioral, economic and environmental factors that can affect
their total overall safety and health.
We are
tasked with meeting these needs and sometimes the spiritual needs of our
patients. We are expected to assess and care for their physical needs,
find ways to comfort them, be readily familiar with all community based
programs which might help cover the cost of their medical / physical /
therapeutic requirements and be a friendly visitor who helps with their
socialization needs.
We enter a
case because a patient needs acute care, but we also provide preventive
health care. This includes intervention at primary, secondary and
tertiary levels of care:
- Primary
prevention is focused on intervention to prevent the occurrence
of a disease, condition, or injury.
- Secondary
prevention activities are concerned with early detection and
intervention in the potential development or the existence of a
disease.
- Tertiary
prevention is focused on treatment of a disease state to lessen
its effects and to prevent further deterioration.
We are able
to accomplish the quality of care that we provide with physician
guidance and the help of other community professionals -- physical
therapists, occupational
therapists, social workers, recreation
therapists, speech
pathologists and dietitians.
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Occupational Therapy Profession
(from American
Occupational Therapy Assoc.)
"Occupational therapy is a health and rehabilitation profession
that helps people regain, develop, and build skills that are important
for independent functioning, health, well-being, security, and
happiness. Occupational therapy practitioners work with people of all
ages who, because of illness, injury, or developmental or psychological
impairment, need specialized assistance in learning skills to enable
them to lead independent, productive, and satisfying lives.
Occupational therapy can prevent injury or the worsening of existing
conditions or disabilities and it promotes independent functioning in
individuals who may otherwise require institutionalization or other
long-term care. Because of this, occupational therapy keeps health care
costs down and maximizes the quality of life for the individual, their
family, and other caregivers.
OT practitioners can be credentialed at either the professional
(occupational therapist) or technical (occupational therapy assistant)
level after completing an educational program at one of over 300
accredited programs at colleges and universities throughout the United
States. Additionally there are programs in other countries. OT
practitioners in the United States must complete a supervised fieldwork
program and pass a national certification exam. The professional program
has recently become a master’s level entry. The technical program can
usually be completed in 2 years as an associated degree.
AOTA (The American Occupational Therapy Association) has established
standards for the profession that have been adopted by many states in
their laws and regulations. AOTA also has accredited the nation’s OT
educational programs since 1935."
Occupational therapy and Aging
(Lewis, S.C., 1989. Elder care in occupational therapy, Thoroughfare,
NJ: Slack, Inc)
Only a small percentage of the elderly are institutionalized in
long-term care settings. The vast majority of elderly persons live in
the community and have support from family and friends. Many older
adults do experience some type of limitation in completing functional
tasks. With an ever increasing elderly population, it is anticipated
that there will be an increasing need for therapeutic programs to
address these limitations to allow adults to continue to live in least
restrictive environments.
There are a variety of settings (e.g., private practice, consultancy,
geriatric day hospitals, adult day treatment centers, community mental
health centers, senior centers, programs to prevent institutionalization,
neighborhood center programs, home health care, retirement communities,
church-based volunteer programs, environmental mobility, pre-retirement
planning, etc.) in which occupational therapists can serve the elderly
in the community.
S.J. Taylor says in the book, Elder Care in Occupational Therapy
"....the occupational therapist's knowledge enables him/her to
address the cause(s) of dysfunction, suggest methods to maximize
independence and self-care, work and leisure...occupational therapists
evaluate...the following: independent living/daily skills, cognitive
function, judgment, home safety, home evaluation, adaptive equipment,
role changes, work capacity, and leisure activities. After determining
the reason(s) for the dysfunction and the client's/patient's assets, the
therapist is in a position to provide input regarding the person's
functioning level, treatment planning, placement options and
services."
Occupational Therapy with the Elderly in a
Rural Context
It is difficult to discuss occupational therapy as a separate
identity because it is in a rural setting because the goals of therapy
continue to relate to the individual and not all clients living in a
rural area are the same.
However, there are some areas that should be especially considered
when working with persons in rural settings. These are areas that more
typically may present problems.
- Research shows that lifestyles are influenced more by social class
than any other characteristic. Many people living in rural areas are
from a lower socioeconomic status. This may mean that they do not
have sufficient resources to manage health care needs.
- Homes may be older and community resources for
repair/modifications may not be as available as in urban areas.
- Larger turnover of professionals in rural areas means that often
the professionals are not as knowledgeable of community resources
and ability to access networking referrals.
- More travel distance is required between home and both health care
provider services and places of social outlet. This is compounded by
access to transportation.
Occupational
Outlook Handbook
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Physical Therapists, or PT’s, are health care
professionals who evaluate and treat people with health problems
resulting from injury or disease.
PTs assess joint motion, muscle strength and endurance,
function of heart and lungs, and performance of activities required in
daily living, among others. Treatments include therapeutic exercise,
cardiovascular endurance training, training in activities of daily
living, modalities, and patient education. (www.apta.org/Consumer/whatisPT).
More than 120,000 physical therapists are licensed in the U.S.
today, treating nearly 1 million people every day.
Physical therapists practice in acute-care or sub-acute care
hospitals, private physical therapy offices, community health centers,
industrial health centers, sports facilities, rehabilitation centers,
nursing homes, home health agencies, schools and pediatric centers;
work in research institutions; or teach in colleges and universities. www.apta.org/Research/survey_stat/pt_demo/pt_fac,
www.apta.org/Research/survey_stat/pt_demo/pt_cont_care.
For more information
regarding physical therapy see American Physical Therapy Association
Physical Therapy in Rural Settings
Providing Physical Therapy services for the
elderly in rural settings presents many challenges as well as rewards. Health care services are not as readily available to the
elderly living in rural settings. They may have to travel to nearby
towns to access health services. Transportation presents a significant
barrier to receiving outpatient physical therapy services, as
accessible public transportation is not available and generally family
members are either working or have moved away.
In rural settings, homes tend to be older and less accessible
to individuals with disabilities.
This requires the physical therapists to be more aware of the
discharge environment and may require additional modifications in
order for the patient to be independent in the home environment.
Studies have shown that patient progress is enhanced when there
is an active support system for the patient.
This is challenging in the rural environment.
Houses are further apart making access to neighbors more
challenging, as mentioned before transportation is an issue, and many
younger people have moved away from the rural areas removing the
support system for the elders.
Recent changes in the healthcare environment
impact physical therapy services to the rural elderly.
Due to changes in reimbursement, job opportunities have
declined in the skilled nursing facilities.
Generally physical therapists will also receive a lower salary
in geriatric rural areas creating a shortage of physical therapists to
meet the demands. This
shortage of physical therapists has further limited the access of the
rural elderly to needed health care services.
American Physical Therapy Association
Occupational
Outlook Handbook
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Therapeutic Recreation
Therapeutic Recreation is defined by the American
Therapeutic Recreation Association as, "….the provision
of Treatment Services and the provision of Recreation Services to persons
with illnesses or disabling conditions. The primary purposes of Treatment
Services which are often referred to as Recreational Therapy, are to
restore, remediate or rehabilitate in order to improve functioning and
independence as well as reduce or eliminate the effects of illness or
disability. The primary purposes of Recreational Services are to provide
recreation resources and opportunities in order to improve health and
well-being. Therapeutic Recreation is provided by professionals who are
trained and certified, registered and/or licensed to provide Therapeutic
Recreation".
Therapeutic Recreation Practitioners are credentialed by the National
Council for Therapeutic Recreation Certification . Certified
Therapeutic Recreation Specialists must meet academic and practical
standards to secure eligibility to sit for a national computer based exam
administered by Educational Testing Services – Chancey Group.
Therapeutic Recreation for the Geriatric
Population
The American Therapeutic Recreation Association Gerontology Treatment
Network provides the following explanation of services for the geriatric
population.
Hospitals, sub-acute care, long term care/nursing
homes; supported living facilities; residential facilities; adult day
care; home-based care
Functioning Areas Addressed: Behaviors, activities of daily
living; psychosocial well-being; quality of life; physical functioning;
cognitive functioning.
Interventions: Behavior management, falls prevention programs,
walking programs, diversional and therapeutic activities, activity
facilitation and adaptation including small and large group games and
activities; special events; reminiscence; reality orientation; sensory
stimulation; exercise; therapeutic humor; animal assisted therapy; arts
and crafts.
Therapeutic Recreation in Rural Gerontology
The geriatric population in rural environments face numerous barriers
the acquisition of therapeutic recreation services. These barriers include
decreased accessibility to treatment and recreation programs due to
geographic distance, lower tax bases that minimize the amount of programs
provided for the older adult, transportation, social isolation, lack of
awareness regarding program availability, social and cultural
predispositions regarding the credibility and value of therapeutic
recreation programs and services, strong work ethics, and physical
limitations that make travel to program settings uncomfortable or
threatening.
The role of the recreation therapist is rural settings is to attempt to
reduce or eliminate these barriers. Needs assessments need to be
implemented in the rural communities and programs reflecting the
socio-cultural context of the environment need to be implemented.
Transportation services need to be developed to enable easier access to
therapeutic recreation program services. Settings in which the services
are provided need to be viewed as safe, barrier free environments where
individuals can express their individuality. Costs for these programs need
to be adjusted to reflect the economic status of the individuals in need
of these services.
American
Therapeutic Recreation Association
Occupational
Outlook Handbook
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Social work profession
(from Social
Work Careers)
Social work is a profession devoted to helping people function the best
they can in their environment. This can mean providing direct services or
therapy directly to people (called "clients"). It also can mean
working for change to improve social conditions.
The phrase "in their environment" points to a distinguishing
characteristic of social work—one that sets it apart from other helping
professions. Social workers help clients deal not only with how they feel
about a situation but also with what they can do about it. For example, a
man suffering stress stemming from single parenting may be referred by a
social worker to a child care agency. The social worker also might help
him explore flextime with his employer and might work with a coalition of
local employers to make flextime and child care more available. In
addition, the social worker might provide therapy to help him handle the
immediate stress.
Many social workers work for social change as well. The victim of an
assault benefits not only from therapy but also from efforts to curb
neighborhood crime. The client under stress because illness has devastated
the family finances benefits from efforts to reform the nation’s health
care system.
The social work profession has its own body of knowledge, code of
ethics, practice standards, credentials, state licensing, and a nationwide
system of accredited education programs. These equip the professional
social worker to combine the desire to help others with the knowledge,
skill, and ethics needed to provide that help.
For sheer variety, few occupations can match social work, which offers
the broadest range of opportunities and settings. Social workers are found
in public agencies, private businesses, hospitals, clinics, schools,
nursing homes, private practices, police departments, courts, and
countless other interesting workplaces.
Social workers serve individuals, families, and communities. They are
managers, supervisors, and administrators. They serve at all levels of
government. They are educators. They are therapists and researchers. More
and more, they are also elected political leaders and legislators.
Social work and aging
The U.S. population is aging. We live in a country where people over 65
outnumber teenagers. This translates into a tremendous need - and a
variety of opportunities - for social work with older persons and their
families.
Working with older adults can mean involvement with active, healthy
clients as well as those who are ill in settings that range from adult day
care centers and nursing homes to hospitals, public agencies, and private
corporations. Social workers form an important link between seniors and
the services designed to help them.
Often, social workers will have direct contact with elderly people,
providing counseling; helping them maintain their independence at home;
arranging income assistance, transportation, and medical treatment;
organizing recreational activities and support groups; and generally
improving their quality of life. Social workers may also work with family
members caring for elderly members and may help them obtain services and
make plans for future care.
Social Work with the Elderly in a Rural Context
"Social work practice in rural areas calls for special adaptation
and attention to contextual factors.... According to Horner and
O'Neill (1981), these factors include greater geographic distances to
travel to clients, social structures and power bases differing from urban
areas, scarcity of formal resources, sense of powerlessness over policies
made in urban centers, high visibility of social workers, professional and
social isolation, and extended role demands. Other human service workers
such as special education teachers, mental health professionals, and
school psychologists face common challenges of rural service delivery:
lack of specialists; difficulty recruiting and retaining professional
service providers; lack of adequate supervision and administrative
support; lack of access to processional tools and materials; limited
availability of alternatives for professional development; and a high
concentration of at-risk populations (Merrell, Pratt, Forbush, Jentzsch,
Nelson, Odell, and Smith, 1994)"
. (Quoted from: USING INTERACTIVE MULTIMEDIA TO ADDRESS RURAL SOCIAL WORK
EDUCATION NEEDS).
References
Horner, B., & O'Neil, J.F. (1981). Child welfare practice in rural
areas and small communities. U.S. Department of Education: ERIC Document
ED 239783.
Merrell, K.E., Pratt, S., Forbush, D., Jentzsch, C., Nelson, S., Odell,
C., and Smith, M. (1994). Special education, school psychology, and
community mental health practice in rural settings: Common problems and
overlapping solutions for training. Rural Special Education Quarterly,
13, pp. 28-36
National Association
of Social Workers
Occupational
Outlook Handbook
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