Physical Wellbeing of Senior Citizens in Washington

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Physical Wellbeing of Senior Citizens in Washington

Introduction: Physical Wellbeing of Senior Citizens in Washington DC, Ward 1    

It has been recently been said that Americans are the most obese people in the world. As part of my research, I decided to line up my research alongside this declaration. I found that in Ward 1, Washington DC, with a population of 5246 senior citizens (65 years and old) according to Suburban Stats (2016), more than 15% of the sampled aged people were obese. In an attempt to dig deep into the problem, my study found that a third of the senior citizens prefer sit-in activities which do not involve mobility: this includes exercises and therapy. The role of diet was also investigated and it was found that close to 32% of the sampled population admitted to having not had healthy diets consciously in the previous day. From the same population, 35% admitted to being regular smokers while about 20% admitted to abusing alcohol. The rate of alcohol abuse among widowed seniors was however higher than those living with their spouses. Mobility and functional health are major determinants of physical wellbeing of senior citizens. This study found out that among the surveyed senior citizens, more than a fifth of then reported to have had a serious fall. It is reported by Binder (2002) that one in every four falls is tragic and led to an almost permanent mobility problem. Most of the seniors who live by their own or with the support of busy youngsters reported that they experience hygiene difficulties especially when it comes to routine activities like bathing. 

The obesity and weight-related aspects of the physical well-being of the senior citizen is a key issue that deserves great consideration. The issue of obesity was found to be more pronounced in Ward 7 and 8 of the Districts of Colombia with a record high of 21% and 32% respectively. Overweight were a more messy issue in Wards 4 and 5 with a rate of 36% and 37% respectively. This indicates that in the DC wards, the issue of obesity and overweight should not be downplayed but should make a top priority. The same worrying trend is observed for the senior citizens (Chandra et al. 2013). Statistics for Ward 1 indicate that 39% of the population is overweight and 19% are obese. The other worrying trend is that only 37% of the people were found to consuming five servings of fruits and vegetables (CYITC, 2011).

As part of the components of hygiene, oral health should be given a forefront consideration. In the DC, it has been observed that 48% of the individuals have removed a tooth as a result of tooth decay. The District recorded a high rate of regular cleaning teeth at 73% as compared to the average rate of US at 69%. The rate of teeth removal was found to be higher among the senior citizens at a 70 for the aged people above 65 years (Chandra et al. 2013).

The general average life expectancy for the residents of District of Colombia is said to be high levels of 77.5 years as at 2010. The department of Health notes that the life expectancy at the DC Ward increased to a high of 77.5 years in 2010. With such high life expectancy, it was projected that the senior citizens would increase in population by 17.4% as at 2030. The surge in the number of vulnerable senior citizens calls for need for an enhanced healthcare to promote the wellbeing of these individuals (Department of Health, 2013).

Chronic Illnesses

A study conducted in Washington identified that among the leading causes of mortality amongst the senior citizens and the elder is chronic infections. Leading on the list is heart disease, chronic lower respiratory disease, Alzheimer’s disease, as well as cancer. There was a slight reduction in the age based mortality rates for some of these diseases (Washington State Department of Health, 2013). The lives of the senior citizens in Ward 1 are also at risk. The chronic illnesses are bringing their precious lives closer to the grave. The issue needs more attention to promote management and care practices to help our senior citizens get some bonus years in their timeline.

Literature review

Exercises

Haselwandter et al. (2015) note that majority of the aged citizens do not engage in exercises despite being in possession of the knowledge that the same is vital and necessary for their wellbeing. On this note, Haselwandter et al. (2015) observe that the aged are concerned about their safety (lighting, likelihood of health response team getting to them in case of the worst, crime, and traffic), others are worried about disturbing people around them with taking care of them during the exercises while others are worried about barriers (falling, crossing roads and climbing stairs). The weather also got a share of the blame; seniors are worried about rain, direct sunshine, and winds. Out of the recommended 150 minutes of moderate and 75 minutes of high intensity exercises weekly, Haselwandter et al. (2015) report that on average, majority of the senior citizens fail to click 10 minutes weekly. The study by Haselwandter et al. (2015), however, fails to elaborate on how seniors can be encouraged to be physically active when away from built environments. 

Diet

A study conducted by Shatenstein et al. (2013) to determine the collective and individual attributes that determine diet quality. The participants of the study were aged (67-84 years). Their previous meals going back for 24 hours were recalled and recorded and the diet quality recorded. The study found out that among men, higher education, diet knowledge, and their perception of good health were found to be the affirmative determinants of diet quality. On the other hand, dentures, alcohol abuse and taking meals from commercial establishments like restaurants and fast foods to be on the negative. With women, higher education, knowledge of the diet, hunger and number of meals were good influencers of diet quality. On the contrary, chewing problems and high Basal Metabolic Index were identified as negative influencers of diet quality. The study did not endeavor to explain how the identified positive and negative factors often change with age. 

Injuries

Chang and Do (2015) carried out a study that aimed at determining the extent at which sociodemographic, medical, gender and lifestyle factors contribute to falls and other related injuries. The sample population was people aged 65 years or older. The study determined that falls and other related injuries were highly associated with stroke, eye disorder, marital status, nutritional risk and arthritis among men. In women, there was the aspect of stroke, alcohol, diabetes, nutritional risk, arthritis and more medications were the identified as the main factors leading to falls and other related injuries among women. Higher physical activity and household income were two factors in both genders that were identified as protective factors according to Chang & Do (2015). The study failed to account for how each of the identified factor contributes to falls and other related injuries given that the seniors are always superimposed to the said factors and how each of the said factors can be reduced when it comes to reducing falls.

Drug and Substance Abuse

Alcohol and substance abuse are some of the major detriments when it comes to aged population physical wellbeing. Blow & Barry (2012) and Wang &Andrade (2013) agree that for the senior citizens especially in the developed world, abuse of alcohol, prescribed drugs and other substances is on the rise. The National Council of Alcoholism and Drug Dependence (2016) estimates that four out of five of people aged 65 years or older seeking medical attention due to substance abuse have a problem with alcohol. Besides, 16% and 4% men and women respectively who are Medicare beneficiaries who are older than 65 were reported to be abusing alcohol. 

Hygiene

Hygiene (personal) and physical wellbeing are two things which are highly correlated and inseparable. The Centers for Disease Control and Prevention (2013), noted that aged citizens are often not in a position to effectively carry out hygiene related activities. The reason attributes to this is that the citizens under consideration here have lost their independence and the excise requires energy, steady hands, safety, time and patience which often lack with this population. It is advised by the Centers for Disease Control and Prevention (2013), that some aspects to be considered include, hair care, bathing, shaving and grooming, beauty and oral health. The physical wellbeing of senior citizens is influenced by the hygiene level that they maintain. It was found out that about 1.43 million older citizens are catered for in centers approved by Medicare and Medicaid. 3-15% of these patients are said to acquire infections for these facilities. Such infection levels can be controlled by promoting hygiene levels for these senior citizens. Contamination of hands plays a major role of transmitting pathogenic bacteria amongst the elderly group in the acute care hospitals and nursing homes. Promoting hand hygiene among the senior citizens is an effective and least expensive means of controlling the transmission of the infectious illnesses among the aged. (Moody, 2007). Oral hygiene among the older people is more necessary due to the risk posed by teeth loss and periodontal disease among this older population. Oral hygiene contributes to the sense of wellbeing the aged. Where the aged citizen is unable to carry out their own hygiene practices, the nursing staff has the responsibility of taking care of the aged personal care need such as bathing, toileting and oral care (Salamone et al. 2013).

Chronic Illness

The senior citizens in the US are more susceptible to chronic diseases. Over seventy million Americans are aged fifty years and above. It has been observed that among this population, four in every five aged adults suffer from at least one chronic condition (Agency for Healthcare Research and quality, 2008). The rise in the chronic illness among the senior citizens has been associated to the increases age, changes in the lifestyle and longer life expectancy. Chronic illnesses are diseases which usually last longer than a year and requiring an ongoing medical affecting and it affects a person’s day to day life. The most prevalent chronic diseases among the aged in the US include arthritis, asthma; cancer, cardiovascular diseases, diabetes and depression.  The agency for healthcare research and quality identified that more than half of the older adults suffer from more than one chronic illness while about 11 million have 5 or more chronic diseases. The senior American found to suffer from high blood pressure was over 40% of their population. More than 1 in every 4 has high cholesterol level. About 15% of the senior citizens suffer from diabetes which was found to increase by more than 50% for the senior citizens above the age 65 between the years 1997 to 2006 (AHRQ, 2008).

Life Expectancy

The average life expectancy for the senior citizens above 65 year in the US in 2012 was found to be 19.3 year for women and 17.9 for men (Copeland, 2012). The major cause of death for these senior is the chronic and infectious diseases.  Life expectancy for these senior citizens is affected by cognitive impairment. It cause disability and reduces an individual’s ability to take care of them at an older age. It was observed that adults above the age of 70 years with high education experience a life expectancy of 14.1 years while those with low education has life expectancy of 11.6 years (Lievre et al, 2008).

Obesity and Weight Issues

It has been observed that the proportion of the senior citizen who are obese have doubled for the past thirty years.  Obesity is said to occur when an individual’s caloric intake is higher than the body consumes. For the senior citizens above 50-65 years, there is a remarkable decrease in the level of energy expenditure. For those above the age of 65 years, hormonal changes in their bodies is likely to contribute to the accumulation of fat. Aging is known to lead to reduce the growth of hormone secretions, low response to thyroid hormone, reduction in the production of serum and testosterone and resistance to leptin. The decrease resistance to leptin cause one to be unable to control appetite downward. (Newman, 2009).

Obesity rate for older adults have increased over the recent years. The obesity rates for older males have shifted from 8.4% to 37.1% between 1960 and 2008 while that of women have increased from 23.6% to 33.6% for the same period (Felix & West, 2013). The obesity for this age group is closely linked to the chronic illnesses, cancers and cognitive and function reduction and has led to an increased rate of home admission. The increased obesity rate for the senior citizens has posed challenges to the US health care and long-term care systems. There is minimal weight loss intervention program being promoted to these senior citizens. Only 44.5% if the obese people between 60-69 years and 32.4% of the obese individuals between past 70 years participate in weight loss profession counseling form physician (Felix & West, 2013). 

Sleep

Sleep forms an important aspect of physical wellbeing of an individual. Aging is closely connected to changes in the sleeping patterns of individuals. There is a tendency for older people to retire to sleep up and at the same time wake up early. Aged people also develop a pattern of waking up frequently leading fragmented sleep. The older citizens above the age of 60 years were found to sleep for about 6.5 hours daily as compared to 7-8 hours for average aged adults (Wolkove, 2007). The following sleep based disorders are experienced by older citizens: Insomnia; Senior citizens were reported to have difficulty in sleeping with elderly women having more trouble as compared to the men. Insomnia among these older aged people is associated to depression as well as anxiety disorders. Senior citizens suffering from Alzheimer’s disease also have sleep disturbance. REM-sleep behavior disorder; Aged people with this disorder experience loss of normal muscle atonia. These people are likely to exhibit movement such as getting up, walking, throwing limbs and other vigorous activities. These movements pose a great danger to the physical wellbeing of the patients and even their bed partners. Narcolepsy; Patients with this disorder experience daytime somnolence and fatigue. They experience sleep attack with a short-lived irresistible urge to sleep, hallucination, sleep paralysis and cataplexy.

Intersection of Literature Review and Own Observations and Findings

From my observation in Ward 1 of Washington DC, and the literature review that there is an aspect of symmetry between the two. To begin with, it has been noted in both cases that there are many determinants of the physical wellbeing of the aged in our society. It therefore follows that these identified problems, can be used as windows by social workers to make a difference. Many of the senior citizens in the ward are not interested in physical exercises which, according to the literature review, reduce the chances of falls and other related injuries which are a detriment to the wellbeing of the aged. The literature review has identified the main reasons that could be inhibiting the aged from engaging in physical exercises. 

When it comes to diet, it can be noted that the majority of the aged are consciously consuming unhealthy foods which as a consequence becomes problematic due to their ability to perpetuate some chronic illnesses like diabetes, arthritis and heart failure among the aged. Some factors which are gender specific were identified to be contributing to the unhealthy nutrition as a trend among the aged. Alcoholism and substance abuse also featured as one of the factors rubbing the physical wellbeing of the seniors the wrong way. The said study population was reported to be abusing prescribed drugs too. Smoking, which apparently endangers the lives of the aged on a very high proportion, is a common phenomenon. A combination of alcoholism (which was higher in widowed seniors), smoking and abuse of prescribed drugs is potent yet happening. 

Falls have the potential to put the physical wellbeing of the aged in jeopardy for a long time. They claim that the mobility and independence of the aged render them disabled, sickly, and burdening to their guardians when the intensity is high. The aspect of hygiene featured and it was discovered that hygiene tasks being repetitive, energy sapping as well as requiring time, concentration and patience, something that the aged clearly don’t have, makes it easy for the physical wellbeing of the elderly to be undermined by circumstances. 

Roles of Non-Profit Organizations and Government Agencies in Addressing the Plight of Physical Wellbeing of the Elderly and What Is Not Being Done

The government has programs for the elderly in Ward 1 as a part of the larger District of Colombia. The Older Americans Act (OAA) ensures funding for the District of Columbia Office on Aging (DCOA) which falls under the State Unit on Aging (SUA). The DCOA, therefore, is the government agency that is concerned with the general wellbeing of the aged in the ward. As part of their activities, DCOA carries out home and community based care services and programs. The mission of the governmental agency is “to advocate, plan, implement, and monitor programs in health, education, employment, and social services which promote longevity, independence, dignity, and choice for our senior citizens.” Services carried out by the agency include care for the seniors, who are disabled, health management of the seniors, social legal, and nutrition services. The agency covers Ward 1 with its two nursing centers that are established by it. The governmental agency also finances more than 20 nonprofit organizations that continue with its mandate especially if it considers the activities under consideration better to be handled by the private sector. 

Organizations have introduced the concept of social marketing principle in their integral marketing plan. This means that in their attempt to fulfill their mission, either profit making or philanthropic, they use techniques that are more beneficial to the society and the target group in a wide array of ways. The major social marketing approaches focus on issues on health, environment, social mobilization and injury prevention. In dealing with health promotion-related issues, the organizations create forum and show that helps the society gain more knowledge on obesity, high cholesterol level, cancer, oral health, blood sugar levels, and diabetes (Cheng et al.).

With the increased number of senior citizens due to a higher life expectancy, organizations, NGOs, for profit and government organization has more avenues to channel their corporate social responsibility. Some organization normally hold medical camps for the older citizens, where diagnosis, prevention and treatment for chronic illnesses and infectious disease. The CSR policy also sees these organization plan charity events to nursing homes for the elderly where they donate food stuff and keep these senior citizens engaged and socially active.

Organizations have been known to help the senior citizens access better care. They help these individuals get access to personal health services in the required time so as to achieve the best positive potential outcomes. The senior citizens require different kind of care depending on where they lie in their three categories. These old-aged citizens may either be functionally dependent, frail, or those that are entirely dependent. Organization facilitates the access to healthcare through establishment of nursing homes for the aged, sponsoring already existing care facilities, and participating in charity events in the organizations.

Most organizations, in pursuit of their core aims of operation, engage in activities which eventually cause negatively affect the physical wellbeing of the people. These organization produce and market goods which put people at a risk of becoming obese or acquiring an infectious disease. The same organizations will later engage in counteractive CSR programs in the name of giving back to the society. These organizations’ products put the senior citizens at a high risk of having a reduced life expectancy.

Nonprofit organizations in the Ward are numerous and are all concerned with the welfare of the senior citizens. For the purposes of this paper, I will look at some of the organizations and what they basically do for the aged in Ward 1 seniors and their physical wellbeing. The first to be considered is the Emmaus Services for the Aging. The foundation is responsible for the provision of educational, social programs, nutrition, and advocacy programs for the aged. The Medical House Call Program run by the Medstar Washington Hospital Center has tasked itself with the responsibility of providing home based care for to the frail and elderly until the end of life for individuals in the program. Medical House Call Program is particular especially with the aspect of falls and other associated injuries and other chronic conditions. It has a diverse array of staff, ranging from nurse practitioners to social workers and geriatricians. Lastly, the Seabury Resources for the Aged is on the frontline in ensuring that the aged get the best of Medicare and as such, live gracefully. 

It is evident that the government and the nonprofit organizations are evidently concerned with the wellbeing of the aged members of the society. However, the aged are not all is being done. Issues like health and nutrition are heavily favored and as such, make other aspects of physical wellbeing of the aged disregarded. For instance, the aspect of exercises, mitigation of alcohol and substance abuse need to be considered and campaigns addressing the same be established. 

Recommendations

To ensure that the seniors in Ward 1 age gracefully and with dignity, I recommend the following. 

• The government authority in consultation with nonprofit organizations concerned with the physical wellbeing of the aged, come up with codes of construction in the built environment to take into consideration the wellbeing of the aged.
• The families living with the aged to be concerned about the physical exercises for the aged and do something about it. On this regard, the nonprofits can step in and provide motivation for the same by way of organizing for such events. 
• The concerned agencies should continuously conduct research to establish the areas of concern regarding the physical wellbeing of the seniors. 
• Control programs for alcohol and substance abuse should be well catered for. None of the nonprofit organizations is concerned with the same. 
• The government of the Washington State should establish a register to help identify the number of senior citizens in the state. The register should record the health records of each senior citizen. This will facilitate a close monitoring of the physical wellbeing of the senior citizens. It will help reduce the neglect that these heroes for the nation, who were once vibrant and steered the state and the country, undergo as they attain an age where they become dependent.
• Organizations should develop corporate social responsibility programs aimed at reaching out to these aged citizens. Most organizations only carry out one extensive program as their CSR which is normally short-lived. To help make a more permanent contribution to the lives of the senior citizens, organization should establish an on-going program to support these groups.
• The government has a mandate of ensuring that the healthcare facilities are well equipped in terms of resources and staff. The NGOs and the private sector may ship in and provide some funding to help the government make the nursing home a good place for the senior citizens.
• More research may be required in this field to provide new insight on better ways of caring for the senior citizens. Management of the chronic diseases that greatly reduce the ability of the senior citizens and make them more dependent should be on the researcher’s heart so that they may generate solutions which may grant the senior citizens an extra day in life.
• More research is required to determine the effectiveness of the government’s policy that aim to promote the wellbeing of the senior citizens. The policy makers will then be better informed when formulating policies to fill the existing gaps in the physical wellbeing of the senior citizens. Such policies on insurance schemes need review to ensure that the senior citizens are fully covered. 

References

Agency for Healthcare Reaseacrh and Quality. (2008). Chronic Conditions Among Older Americans. Retrieved from http://www.aa.ahrq.org

Binder, S. (2002). Injuries among older adults: the challenge of optimizing safety and minimizing unintended consequences. Injury prevention, 8(supply 4), iv2-iv4.

Blow, F. C., & Barry, K. L. (2012). Alcohol and substance misuse in older adults. Current psychiatry reports, 14(4), 310-319.

Centers for Disease Control and Prevention. (2013).The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services.

Chandra, A., Blanchard, J., & Ruder, T. (2013). DIstrict Columbia Community Health Needs Assessment. Retrieved from http://www.rand.org

Chang, V. C., & Do, M. T. (2015). Risk factors for falls among seniors: implications of gender. American journal of epidemiology, 181(7), 521-531.

Cheng, H., Kotler, P., & Lee, N. (n.d.). Social Marketing for Public Health. Jones and Bartlett Publishers.

Copeland, L. (2014). Life expectancy in the USA hits a Record High. Retrieved from http://www.usatoday.com

CYITC. (2011). Needs and Assets Assessment of Washington, DC Youth. 

Department of Health. (2013). District Colombia COmmunity Health Needs Assessment. Retrieved from http://doh.dc.gov

Felix, H., & West, D. (2013). Effectiveness of Weight Loss Interventions for Obese Older Adults. American Journal of Health Promotion, 191-199.

Haselwandter, E. M., Corcoran, M. P., Folta, S. C., Hyatt, R., Fenton, M., & Nelson, M. E. 

Lievre, A., Alley, D., & Crimmiins, E. (2008). Educational Differentials in Life Expectancy with Cognitive Impairement Among the Elderly in the United States. Journal of Aging and Health, 456-477.

Moody, L. (2007). Infection Control Issues in Older Adults. Clinics in Geriatric Medicine, 499.

National Council of Alcoholism and Drug Dependence. (2016)Alcohol, Drug Dependence and Seniors. Retrieved https://www.ncadd.org/about-addiction/seniors/alcohol-drug-dependence-and-seniors June 11, 2016. 

Newman, A. (2009). Obesity in Older Adults. The Online Journal of Issues in Nursing.

Salamone, K., Yacoub, E., Mahoney, A., & Edward, K. (2013). Oral Care of Hospitalised Older Patients in the Acute Medical Setting. Nursing Research and Practice.

Shatenstein, B., Gauvin, L., Keller, H., Richard, L., Gaudreau, P., Giroux, F., & Payette, H. 

Suburban Stats. (2016).Population Demographics for Ward 1, Washington DC in 2016 and 2015. Retrieved, https://suburbanstats.org/population/washington-dc/how-many-people-live-in-ward-1 June 12, 2016.

Wang, Y. P., & Andrade, L. H. (2013). Epidemiology of alcohol and drug use in the elderly. Current opinion in psychiatry, 26(4), 343-348.

Washington State Department of Health. (2013). Mortality amd LIfe Expectancy. Retrieved from http://doh.dc.gov

Wolkove, N., Elkholy, O., Baltzan, M., & Palayew, M. (2007). Sleep and Aging: Sleep Disordes Commonly Found in Older People. Canadian Medical Association Journal, 1299-1304.