Assessment of Older People's Health and Social Care Needs and ...

Assessment of Older People's Health and Social Care Needs and PreferencesAgeismAgeism is the quadruple whammy. Old people themselves can be ageist. They absorb ageist attitudestowards disability in later life and say 'What do you expect? I'm 71'. Their advocacy organisationsmay be so obsessed with promoting positive ageing that they cannot adequaltely incorporateappropriate attitudes to frail ageing. Society and families are similarly ageist. Finally, it is wellestablished that our healthcare professionals and health structures are ageist. The underdevelopedstate of popular advocacy on ageing issues may explain the relatively low level of outcry at deficits incommunity care and long-term care, as well as the indifference to some of the overt ageism in thehealth care system. These include a breast cancer screening programme (www.nbsp.ie) that has anupper cut-off age of 65 (despite protestations from geriatricians) and clear evidence of lessaggressive treatment for older people with many forms of cancer' true of health care professionalsand health structures._r----------------------------------The Value of Screening ToolsScreening tools are of value for a number of reasons:they are educational• they raise awareness, for example, with pressure sore risk assessments, it doesn't matter whichtool is used because its real role in the ward is to make everybody think about pressure sore riskand develop a philosophy of care• they are good support for advocacy. It is advantageous when pressing for appropriate resourcesto be able to quantify unmet need. For example, the nurse manager of an elderly care ward canmake a much better case for resources if he/she is able to say, for example, that sixteen out ofthirty on the ward scored critical on pressure sore risk assessmentthey are systematic. As older people may not present spontaneously with their agerelated diseaseand disability and some care settings are insensitive to their need, use of a screening tool canbreak down some of these barriers to detection• they enable comparison, internationally and with other community or institutional settings. It iscritical to use published tools for this reason, rather than to invent new ones. For cognition, use theMini Mental test or the Abbreviated Mental Test should be used. For functional assessment, theBarthel Index is widely accepted. For screening in primary care, EASYCARE is rapidly becoming aEuropean standard. It has high patient and practitioner acceptability and is cost effective. Keybeneficial features are the assessment of mental health and sources of support goal settinggeneration of a disability score and high patient satisfaction from contact with nursing staff'·8. Keeler E B , Robalino, D A , Frank J C , Hirsch S H , Maly RC, Reuben DC, Cost-effectiveness of outpatient geriatricassessment with an intervention to increase adherence Med. Care. 1999 Dec; 37(12): 1199-206.9. National Cancer Registry of Ireland. Cancer in Ireland, 1994-1998 : Incidehce, Mortality, Treatment and Survival. Cork:National Cancer Registry of Ireland, 2002. www.ncri.ie10. Philp, I., Newton, P., McKee, K., Dixon, S./ Rowse, G., Bath P" 'Geriatric assessment in primary care: formulating bestpractice'. Br. J. Community Nursing. 2001 Jun; 6(6): 290-5.