Introduction
There has been a significant increase in hospital admissions over the last few decades. According to Gillam (2010), there was an average increase of 6% for elective and emergency care between 2007-2008 in England, with a growth of 4.6% annually as compared to the previous three years. Very similar numbers of hospital admissions have been observed in Wales and Northern Ireland (Gillam, 2010). Another important issue is that admissions mostly result from emergencies. This invites researchers to investigate the factors behind such an increase in the number of admissions and to devise different ways that can significantly reduce them.
In this regard, many theories have been presented by healthcare scholars to analyze the elements that cause the changing behaviour of people as they age and how these elements affect their health conditions. Moreover, various strategies, such as home care and nursing care, are implemented by hospitals and policymakers to reduce hospital admissions. To analyze all these theories and service provisions intended to reduce hospital admissions, the following report discusses a case study from the perspective of these ageing theories.
Summary Of The Case Study
Sixty-eight-year-old Jack lives alone in a small house that belongs to him. He has lived all his life in the same house. However, he has no social contact with his neighbours because the people he used to know have either passed away or moved to other cities. His wife also passed away four years ago, and their only son has been living in Australia since he got married. Jack worked for forty years as a bus driver, and after his recent retirement, he does not see his friends either. Although Jack feels very healthy, a few days ago, he had a fall at home, which resulted in his stay at the hospital, where it was found that he has a Urinary Tract Infection (UTI). In order to prescribe the complete treatment, the hospital staff needs to conduct more assessments.
The primary factors that are highlighted in the case are Jack’s social behaviour and, consequently, his poor health conditions. The following section will explain the different theories that describe such behaviour in aged people and, consequently, the efforts that can be utilized by the community to improve their experiences and behaviours.
Ageing Theories
There are many ageing theories available that are intended to explain the behaviour of elderly people. These theories can be categorized as disengagement theories and successful ageing theories. The following sections will describe in detail their propositions for explaining the unique behaviour of people when they become older.
Disengagement Theories
Disengagement Theory
The disengagement theory was proposed by Cumming and Henry in 1961 and explains that elderly people gradually disengage from their personal as well as social relations, which results in their marginalization in society. Although the theory seems to have very practical importance, as we can observe many cases around us where older people are completely disengaged from society, there are various other reasons, for instance, family background and medical conditions, that may more strongly explain such behaviour. Therefore, this theory has been highly criticized by many researchers who have not found any direct evidence to support the disengagement theory. They further highlighted that elderly people often develop deeper relationships with their surroundings, and if they are perceived to be disengaged from society, it is merely because there are other factors, such as their disability, retirement, poverty, or widowhood, that influence their behaviour.
This can be easily assessed from the case study of Jack, who, after his retirement, was no longer interested in joining meetings with his friends. Similarly, since he was living alone, he perhaps was not able to make active efforts to grow his social circle and, therefore, was comfortable living alone in the house and spending time on his self-built model railway in the guest room.
Exchange Theory Of Ageing
According to the Exchange theory of ageing proposed by Dowd in 1975, the interaction between society and older people remains effective as long as it is profitable for both parties. When people are young, they are an integral component of society because they work at their optimum potential to contribute to society in several ways, and in return, society gives them a privileged position to form strong relations with other factions of the community. But when people become old, they have very little to offer society due to their poor economic and health conditions. This makes them very passive members of society.
Similar to the disengagement theory, this theory also does not present all aspects of elderly people while defining their position in society. Older people indeed make less contribution to society in terms of money, etc., but they do have the intellect, knowledge, and experience to serve society in a lot of other ways that money cannot serve at all. Applying this theory to our case study, it can be observed that, to some extent, poor economic conditions caused loneliness in Jack, but he was completely satisfied and thus did not feel disconnected from society, which is the opposite of what the theory proposed. Moreover, if the community or government provides older people with a platform to share their knowledge with others, they can easily be engaged in the mainstream activities of society, which itself will acknowledge the importance of their existence.
Gerotranscendence
Gerotranscendence, according to Tornstam, is the transition that people begin to adopt in terms of their perspective of life as they become older and older. This transition involves the redefinition of time, place, life, death, and self, which liberates them from the materialistic perspective of life and presents them with a more cosmic experience of living. He further explains that there are three levels of this development toward gerotranscendence. The first level is the cosmic level, which increases individuals’ experience of being part of the unity that contains the entire universe and all the generations of the past, present, and future. This also provides a unique perception of life and death far beyond their materialistic aspects. The second level involves the redefinition of self, which further results in a decline in self-centeredness and material interests. Finally, the third level ends all the superfluous social contacts with an increase in the time spent in meditation.
Although the theory does not directly apply to the case study, its inferences can be observed from the behaviour of Jack, who spends most of his time alone in his house and still feels content. Perhaps he is no longer interested in materialistic interests and wants to establish more integrated contact with the universe as a whole.
Successful Ageing Theories
In response to disengagement theory, several successful ageing theories have been developed, as explained in the following sections.
Activity Theory
The activity theory was proposed by Havighurst in 1961 and states that successful ageing is directly related to active social interactions. This way, older people can easily improve their lives by engaging in different social activities. Moreover, they can also experience a delay in their ageing process as they begin to participate in such activities and increase their social interactions. Similarly, such interactions can help people adjust to their lives, especially after retirement.
However, as observed in the case study, Jack was satisfied even when he had very little interaction with others after his retirement and even after the death of his wife. Thus, the theory does not provide a very general cause of people’s satisfaction during their ageing process, although social interactions evidently improve the lives of older people.
Life Course Theory
Neugarten and Hagestad, in 1976, put forward the life course theory by incorporating structural, social, and cultural contexts to analyse the lives of people. According to this approach, the entire life history of patients is important while assessing their behaviours in old age. In this regard, early-age events such as marriage, divorce, educational status, and other incidents can greatly influence people’s future decisions. Similarly, many other social factors such as gender, race, and class; political factors such as government legislation and policies; and the timing of events in people’s life cycles have a great impact on the ageing process. This way, the life course theory uses socio-cultural and historical contexts to explain the physical, mental, and social health of individuals.
In the case of Jack, it is evident that certain events in his life have influenced his later behaviour. However, in light of insufficient information about his early life, more knowledge is deemed necessary to draw valuable conclusions about his current behaviour based on the life course theory. Therefore, the medical research by Prof. Jane Elliott was focused on understanding the ageing process from an individual’s perspective to investigate the relationship between life history and healthy ageing (Medical Research Council, 2010).
Successful Ageing Theory
The successful ageing theory was proposed by Rowe and Kahn in 1997 (Stowe & Cooney, 2014). The theory considers three components to be an integral part of the successful ageing process. These components include maintaining high cognitive and physical function, avoiding disease and disability, and engaging with life. The theory has gained tremendous attention from both researchers and policymakers due to its effectiveness in improving the lives of older people. However, as explained by Stowe & Cooney (2014), the theory only focuses on the later stage of people’s lives to explain the successful ageing process and hence does not consider the different events that happened in people’s lives over their entire life course, as discussed by the life course theory.
In our case study, Jack, who does not have any social interactions and has recently been identified as having an infection, is not going through the successful ageing process based on the propositions of the successful ageing theory.
Service Provision Intended To Reduce Hospital Admissions
Frequent hospital admissions are a great concern not only for patients and their families but also for hospitals and other healthcare authorities because they are a direct indicator of the quality of the healthcare system in a country. In this regard, the term hospital readmission is often utilized to measure this frequency. According to NHS Digital (2017), emergency readmissions are unwanted admissions occurring within 30 days of the last hospital discharge. This does not include admissions for cancer, specialist obstetric, or mental health services. Such unplanned hospital admissions are often linked to a poor healthcare system or lack of necessary care after hospital discharge. Older people are even more prone to such incidents, and therefore, the frequency of their hospital admissions can significantly indicate the health conditions of older people in society.
There are primarily two reasons for frequent hospital readmissions. The first is related to the patient’s initial stay at the hospital, during which he was not provided with effective treatment, either in the form of poor health care or a failure to identify the correct disease. Secondly, it is related to poor rehabilitation once the patient is discharged. Therefore, services intended to reduce hospital admissions deal with either of these two factors. The following sections will elaborate further on strategies that can potentially reduce hospital admissions.
Home Care
Domiciliary care is another name for home care services, which allow people to receive complete care in their homes. This further helps people maintain their independence at home. Therefore, more than 80% of adults aged over 65 years are utilizing home care services. Thus, this service is predominantly used by older people. However, certain factors limit the effectiveness of such services. For example, sometimes, it becomes very difficult to deal with an emergency due to a lack of necessary equipment or medicine. Even in the case of negligence by any of the family members, who are usually not trained to provide health care, the consequences can be alarming. However, certain factors make care homes the best choice for elderly patients. These include patients who are struggling to live alone, who have assessments by expert medical professionals regarding their choice of home care, and whose medical conditions are complex and require 24-hour specialised attention.
Intermediate Services
Intermediate services are intensive services that are usually delivered to people who either have disabilities or have a slow recovery from any injury or illness. These services are often provided at home so that patients can quickly regain their strength by receiving the necessary support. These services have often generated better results as compared to general home care, as patients observe quick improvements in their physical functioning (Dahl et al., 2015; Melis et al., 2004).
Nursing Care
Nursing care is another effective way to help patients regain their skills after a certain injury or disease. In nursing care, nursing staff provide 24-hour care and support to patients to deal with unforeseen situations and avoid the risk of severe health damage. This is also a common way to reduce hospital admissions, as patients can get all the necessary care in their homes. More importantly, elderly people who are at severe risk of developing any unwanted medical conditions can get specialised care this way. Nursing care can also help patients improve their mental conditions, as they can easily work on other things and need not worry about any unforeseen circumstances.
In our case study, Jack, who has just received medical services, should opt for nursing care because, living alone in his house, he cannot receive support from his family members in case of an emergency. However, this is also dependent on the other assessments of his health so that medical staff can prescribe the optimum option for him.
Conclusion
Various theories describe the ageing process in quite different ways and, therefore, have different recommendations for improving the quality of life for older people. All these recommendations are important for making policies that best counter the frequent hospital admissions of older people. However, in order to improve their health conditions, continuous care in any form is extremely important. In this regard, home care and nursing care are the two services most commonly adopted by older patients. Therefore, based on other health assessments, one of these can be recommended for Jack.
References
Dahl, U., Johnsen, R., Sætre, R., & Steinsbekk, A. (2015). The influence of an intermediate care hospital on health care utilization among elderly patients – a retrospective comparative cohort study. BMC Health Services Research, 15(1). https://doi.org/10.1186/s12913-015-0708-4
Gillam, S. (2010). Rising hospital admissions. BMJ, 340(feb02 3), c636–c636. https://doi.org/10.1136/bmj.c636
Medical Research Council. (2010). HALCyon Work Package 3 — Prof Jane Elliott [YouTube Video]. In YouTube. https://www.youtube.com/watch?v=NOYhDj1Id3A&feature=youtu.be
Melis, R. J. F., Rikkert, M. G. M. O., Parker, S. G., & van Eijken, M. I. J. (2004). What is intermediate care? BMJ, 329(7462), 360–361. https://doi.org/10.1136/bmj.329.7462.360
NHS Digital. (2017). Emergency readmissions within 30 days of discharge from hospital – Specification v1.4 – NHS Digital. NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/ccg-outcomes-indicator-set/specifications/3.2-emergency-readmissions-within-30-days-of-discharge-from-hospital_1_4
Stowe, J. D., & Cooney, T. M. (2014). Examining Rowe and Kahn’s Concept of Successful Aging: Importance of Taking a Life Course Perspective. The Gerontologist, 55(1), 43–50. https://doi.org/10.1093/geront/gnu055
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