Health Care Essay
Within the health care arena there is a growing concern about the needs of the elderly. Families wonder if their loved ones are getting the proper care that they need With the growing costs of health care and the decreasing resources of primary care physicians it is feared that only the physical needs of the patient are met. Concerns rise about the social psychological and environmental needs or the elderly.
A study by Barbara Berkman and associates tries to provide some answers to people concerned with this issue According to the study many people are not aware of the social services they may have available to them. Because of this, many elderly people are not getting the care they need outside of the physical care necessary to “live.” It is felt that screening a patient for social or emotional needs is becoming increasingly important. The focus of this study was to devise a questionnaire to identify the psychological, social and environmental needs of elderly patients.
Three hospitals from different geographic locations were chosen for this study. At each hospital a care coordinator was chosen to be responsible for questionnaire review, communication with physicians, and further assessment and intervention when deemed necessary. Lists of patients 65 and older were generated from the caseloads of primary care physicians from the three hospital sites. The questionnaires were mailed out with physicians cover letters and consent forms in the summer of 1993.
In the questionnaire patients were asked to assess their self-percieved notions of there medical and psychosocial needs, as well as the level of their functioning. Upon reciept of the completed questionnaires the care coordinators from each hospital assess the results of the survey. Those patients assessed as being high risk received follow up phone calls. Depending on the situation, high risk patients were given information only, indirect referrals, or direct referrals.
The findings for the study indicate that approximately 56% of all people surveyed were in need of intervention. The three highest relative risks for all three sights were: difficulty with food preparation, difficulty in doing house work, and difficulty getting around the home. All three hospital settings agree that patients who reported having problems in the survey were judged to need intervention more than those who did not report having problems.
Although the study had good intentions, I feel the study was unclear in its objectives. The study was to design an assessment tool that would identify the psychosocial and environmental needs of elderly patients. Clearly the questionnaire did identify these needs. What is unclear is the purpose of proposing a questionnaire. Is this a first time attempt to assess the psychosocial and environmental needs of the elderly, or is it an improvement on past assessment tools? The study appears to present a new assessment procedure rather than focus on the quality of the questionnaire.
Although I feel there are discrepancies in the focus of the study, I do find it to be very thorough and accurate. This is a study of current concerns. With the cutting of health benefits and the rise of health costs many of the elderly do not get the social and emotional help that they may need. I do agree that it appears that there ! is not enough assessment being done. The authors of the study did an accurate job in preparing for this study. They consulted with prime focus groups, such as physicians and social workers. A review of past literature and studies were used to identify which psychosocial and environmental needs should be addresses in the questionnaire.
This article proved very easy to read. I felt that the language was readable for scholar and layman alike. I do feel that this article assumes that you have a background in geriatrics. Although it is not necessary to be an expert in the field, geriatric knowledge would be an advantage. A few of the terms and concepts were aimed primarily at a professional reader, but not so much to have a student or family of an elderly person perplexed as to the general concept.
The design of this study was well planned. The methodology is clearly mapped out and in my view acceptable for an accurate study. The sample size approximately 3200 was sufficient. The study used three different geographical sights across the United States. This sufficiently covers the possibility that research could be flawed by geographic discrepancies. According to the data given the questionnaire returned data on mark to the information targeted.
There are a few problems with the design of the research however. There appears to be no control group on which to test the data . A study cannot accurately gauge its impact when researchers have nothing to which to compare. Second, the researchers cannot be sure that it was their questionnaire that helped identify high risk elderly. It can not be shown that the questionnaire of the study was the cause or that any questionnaire at all was the cause. If these elderly patients had not been assessed before the study, who is to say that the questionnaire is accurate?
The results of this article, in the opinions of the researchers are clear; increased assessment of elderly patients is necessary. With this research data it is shown that the psychosocial and environmental needs of many of our elderly citizens are not being met. The article did not try to lay fault or error. It statistically shows a need for further steps to be taken that will insure that the non medical needs of the elderly are met.
The limits to this study were minimal and explained thoroughly. The first limit was that the study used mail- in questionnaires. Only those people who answered the questionnaires were involved in the study. The researchers sent out second questionnaires to non respondents, and followed through with phone calls to those who did not respond a second time. Also the study was limited by the cognitive ability of the eldrly questioned. If the elderly patient was not cognitivly capable to answer the questionnaire he/she was not used in the study. This leads to the question of an even greater need of those who are not cognitivly competent. A question that the survey admittedly does not answer. Finally the survey admits a problem of not having standardized training for the care coordinators. This could lead to an inconsistency of the assessment of responses. The researches hope to fix this problem in any further studies.
I do not feel that the research questions were answered satisfactory. The scope of the research was to develop an affective assessment questionnaire. The research does not show what effects their questionnaire had on identifying the psychosocial and environmental needs of those studied. A surplus of information was found that identified the needs of elderly people. The article did not make clear if this information was a goal of the study or not. The study does not show if the questionnaire accurately assessed the psychosocial needs of the elderly.
The conclusions clearly show that the needs of the elderly are not being met as well as they should be. The data is well formulated and appears to be accurate the deviation for error is<.01 according to the study. The conclusion states that in these days of Medicare and HMO’s a tool for assessing the non medical needs of the elderly is necessary. The conclusion is unclear whether the study questionnaire is an accurate assessment tool, or if further assessment is needed. The suggested applications for the research study are feasible. The authors state that the need for psychosocial and environmental assessment should be used. The authors realize that cost and availability would be factors and suggest that an assessment tool sensitive to the availability of resources should be used.
Over all this research provides some valuable data showing the needs of the elderly. Although the article has some flaws, I think the research is sound and the information useful. I feel with a clearer sense of purpose this would have been an excellent research article.