Our communities and nation’s aging population calls for some radical changes in geriatric care. Until only a generation or two ago, most families remained physically close together, and it was not unusual for three generations (grandparents, parents, children) to live in the same house or, at least, in the same neighborhood or city.
Whereas it was once common for children to remain at home until marriage (or even longer, if they don’t get married), parents now cannot wait to eject their children out of their homes and into the workplace or college as soon as possible (and children cannot wait to escape parental supervision also). Whereas, not so long ago, nearly every family had at least one “maiden aunt” or “bachelor uncle” and one or more widowed grandparents living together with the younger generations of the same family all of whom helped to raise the children and care for the home and garden. We now consign the elderly to isolation and loneliness wherein they often feel useless, sad, and unwanted. (And we send our children off to be raised by strangers in day-care centers as soon as possible). It is not surprising that, under these circumstances, the suicide rate and incidence of alcoholism and serious depression are rapidly rising in the older generation.
Ways to care better for our aged ones: Firstly, we need to acknowledge that for too long, society has conveniently grouped “older Nigerians” into one standardized bucket without close inspection; we find that the bucket has leaks. As healthy baby boomers start getting older while at the same time the number of centenarians is growing to numbers once thought unimaginable, it is time to accept that all aged persons are not alike. Nobody would argue that the lifestyle and health care needs of a 25-year-old are far different from those of a 50-year-old. Yet, for some unexplainable reason, our society has failed to adequately recognize the same 25-year difference between a 65-year-old and a 90-year-old. It’s time we did and, in doing so, we should develop programmes that affect seniors at various stages in their life cycles, their wants and needs when it comes to their health care.
Secondly, we need a better system of caring for the poor, chronically ill elders who, in their overwhelming numbers, want to remain in the comfort of their own homes. This means the creation of support and funding of a special-needs plan that targets home- and community-based services for low-income aged persons who need assistance with basic activities of daily living. Enabling these elderly persons to remain in the community by providing them the support they need and working out a social welfare system plan (if available in Nigeria), which already have a demonstrated competency in other developed nations will significantly improve the quality of life for these seniors and their families while simultaneously delivering savings to both the state and federal governments.
Thirdly, we need to confront the caregiver crisis in Nigeria: A large percentage of today’s home caregivers are seniors themselves. Spending days and nights caring for a loved one, perhaps a spouse of 50 years or above can take a heavy physical and mental toll on those delivering the care. In many cases that toll is so great that the caregiver’s own health is compromised. The result is a household of two ailing adults not only challenged by their physical illnesses, but suddenly in need of assistance with normal daily activities such as transportation, recreation, shopping, hospital visits, cooking and bathing. This caregiver crisis requires an incentivized system that supports people who take on this very important role. In a places like the USA, the ideas being suggested for caregivers’ expenses and expanding family and medical leave benefits and broadening tax deductions or tax credits, these suggestions have merit as do many others. Most importantly, they send a message that our society recognizes and values the important role caregivers play in making our communities whole.
Fourthly, we need to focus aged care on the right care in the right setting at the right time, and that includes avoiding costly and uncomfortable hospitalizations or emergency hospitals visits whenever possible. For those aged persons who need hospitalization, we need to take a new look at transition planning: What happens to them upon discharge? What are we doing to really understand not only the aged persons’ physical condition but also every detail about their prior level of functioning and living arrangements. How do we ensure that the aged will take (and can afford) the prescribed medication? How will they get to their doctor’s office for follow-up care?
Fifthly, let’s all agree with unquestioned certainty that coordinated care works. The stark truth is that fee-for-service is often not fragmented, not redundant and not wasteful it helps you, the doctors and hospitals to maximize services because it has not failed in advanced countries. It is time to shift to a model that rewards organizations and providers who embrace coordinated care and high-quality performance. Such a model not only reduces human and economic costs for the family and their aged parents, taxpayers and the government, but is the most balanced, ethical and humane way to care for the aged persons.
Path to coordinated care
With many older adults living longer, it is relatively common for the aged or patients to have six or more chronic conditions and to routinely take more than a dozen medications. The complex interactions between these chronic conditions and medications requires geriatric health specialists to emphasize health management, disease management and medication management programmes. That’s where care coordination is most effective. Repeated studies have shown that aged persons enrolled in managed care experience fewer hospital admissions and re-admissions, fewer emergency visits, and lower overall medical costs.
The key is emphasizing primary prevention, early intervention and effective care coordination throughout the spectrum of care. At-risk aged persons can be part of geriatric health-management or disease-management programmes and can benefit from a medication-management programme that focuses on the correct match between diagnosis and drugs. Above & Beyond Home Health Care helps to ensure the appropriate use of services, improve the coordination of care with different providers, and improve clinical outcomes every step of the way.
Today about 15 percent of our country is 65 years or older and, in just two decades, one in every five Nigerian will be elderly. Many of the facts that we have known to be true need to be reexamined through fresh lenses. Only then can we appropriately treat and maintain the health of this growing population in ways that make us a people proud.
Hon. Ottih Ezuma Nwaka, (DR.G) is a gerontologist, behavior specialist and a social worker.