Case Management Of Bedridden Geriatric Patient

Introduction

In Malaysia, the number of elderly will be double from 7% to 14% within 28 years as opposed to Sweden who has been for 112 years with the same change (United Nations, 2007). Senior citizens defined as individual who aged 60 and above (United Nations, 1982). The senior citizens issues are discussed through a variety of ways, especially through health aspects. Health problems of the elderly will occur when if the need for healthy life cannot be met or achieved. Bedridden elderly patients not only suffer physical changes, but even changed from the social, economic and emotional. For family members, they also felt the challenge in terms of patient care and management of these bedridden patients. At Hospital Kuala Lumpur, the number of bedridden elderly patient cases that has been refereed to Medical Social Work Department is 83 cases on 2014. The number has been increased 19% compared on 2013. The factor that affect the elderly bedridden cases are stroke, cancer, fall incident and ageing. The medical field related to disease of the elderly is Geriatric.

The Assistance For Geriatric Bedridden Patient

Social Aspect

Case management for the geriatric bedridden patient are inclusive the process of treatment and rehabilitation when the patient is in the hospital even after being discharged from the ward. There is a need to increase awareness and vigilance towards geriatric bedridden patient care in order to avoid the increasing number of nursery entrance.

The involvement of Medical Social Worker (MSW) in multidisciplinary geriatric team in particular responsible to give comprehensive treatment to the patient through the two service are supportive therapy (individual/ family counselling, consultation, service advisor and crisis intervention) & practical assistance (medical equipment, instant aid, trace family member and institutional placement). MSW gain basic demographic information of patients, a clear understanding of the ability of patients, especially for patients who are bedridden to perform daily activities and function is important. The ability to perform daily activities such as dressing, bathing, eating, drinking, grooming, mobility to toilets, medication management and other functional level is very different for geriatric bedridden patients.

Discussions between multidisciplinary team with the patient’s family members called family conference should be held. The multidisciplinary team include doctors, nurses, occupational therapist, physiotherapists, dietitians, pharmacists and MSW too. Through this discussions with the various information sharing and information about patients, such as social support and family dynamics are obtained. Social support is an important element in the care of geriatric patients who are bedridden, especially after discharge from hospital. Social support refers to a group of family members and friends who help patients to competitive action in line with the current limit capability and the ability to share resources with patients to help them adapt to changes in the quality of life experienced.

Home visits could also be held at appropriate time. The purpose of the home visit are:

1. To identify dysfunction patients and family members
2. To verify information to enable patients to get the assistance
3. To know the physical condition of the patients home
4. To create good rapport with patient and care giver / family member
5. To identify problem issues and seek related assistance

In addition, the MSW is also responsible for connecting the patient with the resources of existing community programs such as Home Help, Hospice and etc. While in primary health care level, MSW involved in service as a member of the team domiciliary, the home care team.

Economy Aspect

One of the challenges in dealing with geriatric bedridden patients is an economy issue. Furthermore, if the guardian of the patient is the family’s main breadwinner. The patient who lost the ability to ambulate is really need of care and supervision from the family members/ caregivers in order to avoid more serious complications. In addition, as part of the recovery process, an geriatric bedridden patient also need medical equipment such as ripple mattress, ryles tube, special milk, infusion pump, oxygen concentrator etc. All these are burden and a problem for those who have less fortunate.

Socioeconomic assessment done by MSW to identify patient’s financial resources. All the information from caregivers/ family members,  inter multidisciplinary team and home visit will be used in preparation of socio economic report to be referred to certain agencies such as Tabung Bantuan Perubatan (TBP) under the Ministry Of Health (MOH), Tabung Kebajikan Perubatan Malaysia (TKPM) under the association of Malaysian Medical Social Work Officer, Jabatan Kebajikan Masyarakat (JKM) under the Ministry Of Woman Development, Family & Community, BaitulMal/ Pusat Urus Zakat, Buddhist Tzu Chi Foundation and etc.

Emotion Aspect

In the management of geriatric patients bedridden, caregivers/ family members should be prepared with whatever most likely to reduce health risks for patients with more serious. They need to be aware that geriatric bedridden patient will having problems of stress and depression for failing adapting with the consequences of lifestyles changes, unable manage themselves and the inability to continue social life as usual. They will feel lonely, useless and quickly gave up. This will cause them to suffer from sleep disorders (insomnia) and often think of suicide. MSW will help the caregivers/ family members through supportive therapy to overcome the emotional issues. The purposes of supportive therapy are:

1. Reduce sadness, feeling of anxiety, anger and stress and even guard the patient/ family member
2. Provide accurate information about the status of the disease, complications and treatments which is recommended for caregivers/ family members of patients
3. To listen the needs of caregiver/ family members of patients without penalizing
4. Provide information about community resources available that can help during the process of treatment and rehabilitation to the caregiver/ family member
5. Give encouragement and support to caregivers/ family members so that they understand and help the patients compliance with the recommended treatment
6. Discuss with the caregivers/ family members regarding patient care issues that impacting the quality of patient care (caregivers stress). Example:
   1. Are you stress/ worrying?
   2. Is there other people who help you in taking care of patients?
   3. Are you yourself having health problem?
   4. Is there any issue that affect your ability to care for patients?

Conclusion

MSW will help to manage the case of bedridden geriatric patient through practical assistance and supportive therapy to ease the burden among the caregivers and family members. Placement into elderly care centre/ institution are the last choice by MSW if unable to trace the family members.

References

1. Alan M. Adelman & Mel P. Daly (2003). 20 Common Problems Geriatrics. McGraw Hill International Edition. Health Professions Series.
2. Barbara Berkman & Linda Harootyan (2003). Social Work and Health Care in an Aging Society. Sringer Publishing Company.
3. Giselda Quintana marques & Ivani Bueno de Almeida freitas (2009). Pilot-experience in Home Care: bedridden Aged Patients of an basic Health Unit, Porto Alegre, Brazil.
4. Siti Marziah Zakaria, Khadijah Alavi & nasrudin Subhi (2013), Risiko Kesunyian Dalam Kalangan Warga Tua Di Rumah Seri Kembangan. Journal of Psychology and Human Development.