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 become aged and how these elements affect their health conditions. Moreover, various strategies are implemented by the hospitals and policymakers to reduce hospital admissions such as home care and nursing care, etc. 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
68 years old Jack lives alone in a small house to which he inherently belongs. 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 is living in Australia since he got married. Jack has worked for forty years as a bus driver and after his recent retirement, he is not seeing his friends as well. Although Jack feels very healthy, a few days back he had a fall at home which resulted in his stay at the hospital where it was found that he has 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 their social behaviour of Jack and consequently his poor health conditions. The following section will explain the different theories that describe such behaviour of 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 in explaining the unique behaviour of the people when they become age.
Disengagement Theories
Disengagement Theory
The disengagement theory was proposed by Cumming and Henry in 1961 which 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 when older people are completely disintegrated from society, they do not disengage but there are various other reasons, for instance, their family background, medical conditions, etc. that more strongly explain their such behaviour. Therefore, this theory has been highly criticized by many researchers who did not find any direct evidence that supports 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 the 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 feeling comfortable living alone in the house and spending time on his own-built model railway train 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 less to offer to society due to their poor economic as well as 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 have less contribution to society in terms of money etc. but they do have the intellect, knowledge and experience that can serve society in a lot of other ways that money cannot service at all. Applying this theory to our case study, it can be observed that to some extent that the poor economic condition has caused loneliness in Jack but he himself was completely satisfied and thus was not feeling disconnected from society opposite to what the theory proposed. Moreover, if the community or government provides them with a platform to share their knowledge with others, they can easily be engaged in the mainstream activities of the society that itself will acknowledge the importance of their existence.
Gerotranscendance
Gerotranscendance, according to Tornstam is the transition that people begin to adopt about 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 to gerotranscendence. The first level is the cosmic level which increases the individuals’ experience to be a part of the unity that contains all the universe and all the generations of 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 the decline of self-centeredness and material interests. Finally, the third level ends all the superfluous social contracts with an increase in the time spent in meditation.
Although the theory does not directly imply the case study, its direct inferences can be observed from the behaviour of Jack who spends most of their time alone in his house and still has the intended feelings. Perhaps he is no more 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 which 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 that their ageing process will delay as they begin to participate in such activities and increase their social interactions. Similarly, such interactions can help people to 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 generic 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 the patients is important while assessing their behaviours in old age. In this regard, early age events such as marriage, divorce, education status, and other incidences can greatly influence the future decisions of people. Similarly, many other social factors such as gender, race and class etc., political factors such as the government legislation and policies and the timing of the events in the life cycle of the people 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. But in the light of insufficient information about his early life, more knowledge deems necessary to draw valuable conclusions about his current behaviour based on the theory of life course. 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 considered three components as an integral part of the successfully ageing process. These components include avoiding high cognitive and physical function, avoiding disease and disability and engaging with life. The theory has gained tremendous attraction by 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 the people to explain the successful ageing process and hence does not consider the different events that happened in the lives of the people over their entire course of life as discussed by the life course theory.
In our case study Jack who does not have any social interactions and has recently been identified to have 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 the patients and their families but also for the hospitals and other healthcare authorities because they are the direct indicator of the quality of the healthcare system in a country. In this regard, the hospital readmission term 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 the admission for cancer, specialist obstetric or mental health services. Such unplanned hospital admissions are often linked to the poor healthcare system or lack of necessary care after the 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 the older people in society.
There are primarily two reasons for frequent hospital readmissions. First related to the first stay of the patient at the hospital during which he was not provided with effective treatment either in the form of poor health care or lack of identification of the right disease. Secondly related to poor rehabilitation once the patient is discharged. Therefore, the service provider intended to reduce hospital admissions deals with either of these two factors. The following sections will elaborate further on such strategies that can potentially reduce hospital admissions.
Home Care
Domiciliary care is another name for the home care service which allow people to have complete care at their homes. This further helps people to maintain their independence at home. Therefore, more than 80% of the adults ageing 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. And even in case of negligence from 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, they have assessments by expert medical professionals regarding their choice of home care, and their medical conditions are complex and require 24 hrs specialised attention.
Intermediate Services
Intermediate services are the intensive services that are usually delivered to people who either have disabilities or have slow recovery from any injury or illness. These services are often provided at home so that the patients can quickly regain their strength by providing the necessary support. These services have often generated better results as compared to general home care as patients observe more 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, the nurse staff provides 24 hours of care support to the patients to deal with unforeseen situation and avoid the risk of serve health damage. This is also a common way to reduce hospital admissions as patients can get all the necessary care at 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 in improving their mental conditions as they get easily work on other things and need not worry about any unforeseen circumstances.
In our case study Jack, who has just received a medical service, should opt for nursing care because living alone in his house cannot have any support from his family members in case of an emergency. However, this is also dependent on the other assessments about his health so that medical staff can prescribe the optimum way for him.
Conclusion
Various theories describe the ageing process in quite different ways and therefore has a different recommendation to improve the quality of life for older people. All these recommendations are important to make policies that best counter the frequent hospital admissions of old 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 two mostly adopted services by older patients. Therefore, based on other health assessments of Jack, one of these can be recommended.
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
