Aged Care Nursing in Australia Despite

Running head: AGED CARE NURSING
Aged Care Nursing
Author Name(s)
Institution
Author Note

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Abstract
Older people in the society experience health deterioration due to presence of different
conditions. Most of these conditions affect them physically, psychologically and emotionally.
Health policies in Australia have come up with approaches addressing these growing health
demands of the aging population. With the policies in place, health care management plans are
targeted at alleviating pain and restoring the patients to their functional state. This paper will be
an analysis of the past literature on health issues facing older persons. The paper will also discuss
management plans as presented by the literature. In the scope of this discussion, the paper will
also discuss in details these management plans. The paper will finish by illustrating how the
gained knowledge is helpful in a healthcare work environment.
Keywords: Geriatrics, Gerontology, Nutrition, Polypharmacy, Frailty, pathophysiology

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Aged Care Nursing
Both Geriatrics and Gerontology are the two main disciplines that deal with the care of
the aged people in the nursing practice. Both programs emphasize providing nurses with
competence and knowledge in provision of care in an aged-care environment. However, the
complexities of this practice extended beyond the usual bedside nursing. With this, both the
aged care nursing and services have evolved in response to policies, reforms and increasing
clients’ expectations thus creating two main environments. These environments are either
rehabilitation of the aged within a nursing care facility or providing care within a community-
based setting. This paper will mainly focus on the principles and management of clients in
rehabilitation care settings.
Aged Care Nursing in Australia
Despite its smaller proportion when compared to other developed countries, the
population of the aged in Australia was expected to rise from 15% in 2015 to about 22.5% by the
mid-century (McPake & Mahal, 2017). The Australian Institute of Health and Welfare confirmed
on June 2015 that there were roughly 176,967 aged people living in residential care settings with
96% of them being above 65 years old (Australian Institute of Health and Welfare[AIHW],
2015). The current Australian policy for aging encourages independent living within the
community through the provision of care under community-based care services (Aged Care
(Living Longer Living Better) Act, 2013). The rise of the Australian aged population can be
attributed to two main factors. The first one is the decline in the mortality rate among adults
together with the low fertility rates (McPake & Mahal, 2017).

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Health issues with Ageing
Among these issues of health that older people face include increasing frailty and
disability, and deterioration of health (Hillen, Vitry, & Caughey, 2017). In a study conducted in
(Hillen et al., 2017), the authors sought to analyze the burden of disease among the Australian
aged people under residential care. Using a cross-sectional analysis, the authors found that there
were 48% of people living with dementia, 22.5% living with depression, and 14.2% living with
arthritis. The authors also found 17.1% of unclassified conditions which included falls, urinary
incontinence and falls to name a few. According to Hillen et al. (2017), all these issues come due
to presence of geriatric syndrome and other long-term comorbidities. For instance, most older
people experience problems such as cardiovascular, cerebrovascular, musculoskeletal,
neurological, endocrinological, respiratory, cancer, injuries from falls and psychological
problems (Hillen et al., 2017).
In pathophysiology in aging, geriatric syndromes (GS) is regarded as the main cause of
disability and frailty (Hillen et al., 2017). This condition includes various condition associated
with aging which among them is incontinence, delirium, falls, dementia, visual impairment,
auditory impairment, pressure ulcers, sarcopenia, frailty, malnutrition, immobility, depression
and gait disturbances (Ates Bulut, Soysal, & Isik, 2018). According to Hillen et al. (2017),
having multiple chronic conditions and geriatric syndrome creates secondary problems such as
continued multifocal pain.
The work of Sieck (2017) enlightens that aging is the main factor in the multiple chronic
conditions involved. While looking at this rationale, the interdisciplinary field of geroscience
aims to enlighten on the relationship between people’s aging and chronic-related diseases
(ACDs) and all GSs (Kennedy et al., 2014). Many of the scholars in geroscience have concluded

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that age is the main risk factor for ACDs which also limits the healthspan (Kennedy et al., 2014;
Sonntag & Ungvari, 2016). In proof of this, many studies have come out to highlight different
age-related pathologies. Most of these conditions have involved molecular mechanisms which
are believed to accelerate aging in various ARDs and GSs. For instance, while looking at frailty
syndrome and Sarcopenia, studies have shown that any typical GSs will have frailty, impairment,
mild cognitive and metabolic syndrome (Davies et al., 2018). In particular, clinician studies
define frailty with multidimensional syndrome in elderly which involve decline of physiological
reserves. This condition causes increased vulnerability to diseases and has morbidity and
mortality.
Sarcopenia, on the other hand, is one of the most prevalent conditions in the aging
population which causes progressive declining of body functioning, strength and skeletal muscle.
In the study of Davies et al., (2018), the authors analyzed data from people with over 65 years
who had sarcopenia and frailty. The study revealed that there was prevalence (8.2 to 15.7%,) of
cases of frailty among people who had sarcopenia. Likely, both conditions cause further
deterioration in morbidities. Chronic Obstructive Pulmonary Disease (COPD) is another
condition associated with aging. That is, as people progress through age, organs like lungs reduce
their functioning, people start developing pulmonary inflammation, high rate gas trapping, lungs
lose elasticity lung elastic recoil and distal air spaces start to enlarge. In the work of Vaz Fragoso
and Gill (2012), the authors revealed that most of the pathological signs in COPD slowly
progress with age and the disease is prevalent among the population above 65 years old.
Cancer is also considered as a condition that comes with age. Many cases of cancer are
basically ARDs since their incidences dramatically upsurge with age. Besides, age represents a
single powerful risk factor in the occurrence of cancer. Conversely, there is enormous evidence

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suggesting that most processes of mutations occur in old age where there is more environment
the chances of DNA damage in the transformation of cells (Hanahan & Weinberg, 2011). Just
like cancer, most neurodegenerative disorders such as Parkinson’s disease (PD) and Alzheimer’s
disease (AD) are age-associated diseases. Both conditions are called “protein misfolding”
diseases since they make improper deposition of folded and modified proteins in specific
sections in the brain (Majd, Power, & Grantham, 2015). In a study conducted in conducted on
2,500 aged persons for an assessment of Parkinsonism, the results revealed that 744 of the
subjects without diagnosis of PD at an age of 88.5 years (Olanow, 2014). The study also revealed
case of mild or very severe nigral neuronal loss (Olanow, 2014). In addition, the study showed
that 17% of the subjects had traces of Lewy bodies (Olanow, 2014).
Management of Aged People in Community Health Care Settings
The Australian National Standards for Disability Services (NSDS) acts as the main
framework for supporting older Australians (Australia Government Department of Social
Services, 2013). Along with NSDS, Geriatrics Evaluation and Management (GEM) which is a
framework for the assessment, management, and negotiation of healthcare goals for older adults
(Department of Health & Human Services, 2018). GEM strategies are to provide maximum
management of GS by providing individualized care (Harvey et al., 2014; Van Craen et al.,
2010). Regardless of the status of the conditions, care for elderly management plan combines the
assessment, mitigation of complications arising with comorbidities and/or disabilities, promoting
positive lifestyle adjustments, promotion of the quality of life, enhancing safety to prevent
accidents, mental health, and general wellbeing by addressing existence of limitations in the
daily functioning of the patient. Any management plan involves assessment of the patient,
planning of the care, implementation, and reassessment to prevent relapse.

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Assessment Plan
The GEM plan is dynamic with its main goal as providing safety, ensuring quality care,
improving and/or maintaining quality of life. Under the assessment plan, the work of Singh
(2016) states that the assessment of older persons should be holistic. More importantly, the
assessment should be carried out by the geriatricians accompanied by a multidisciplinary team
(MDT) made up of nurses, doctors, occupational therapist (OT), physiotherapist (PT), clinical
pharmacist, dietician, social worker (SW), specialist nurses, carers and the hospital discharge
team (Singh, 2016). All these experts must carry out individual assessment to individual’s needs
in terms of healthcare, psychosocial needs, functional status, financial matters, family
involvement, living environment, nutrition, and other concerns.
Care Plan
Once the experts accomplish their assessment, they will devise a care plan to address
both the current and any future potential problems coupled with recommendations and other
necessary support. It is this stage GEM manager will decide whether the patient would be
discharged for acute care or will be rehabilitated for long term care. The plan also involves
structural changes, medication, stabilization, coordination with care providers such as physician,
nutritionist, recreational therapists, psychiatrists etc.
Implementation Plan
In GEM, implementation would involve beginning the care plan, and coordinating
services all the services involved in a safe and cost-effective manner. The implementation should
also consider the patient’s wishes and that of the family. An important concept in the
implementation is polypharmacy. Studies have established that elderly persons especially those
under LTC in rehabilitation facilities often face multimorbidity most of them taking lots of

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medication (Turner, Edwards, Stanners, Shakib, & Bell, 2016). In elderly health, polypharmacy
deals with situations where the patient is hospitalizations as a result of unintentional medication
poisoning, falls, adverse reaction from drugs interactions, cognitive and functional impairment
(Turner et al., 2016). An effective medication management method should be included in the
implementation method to prevent polypharmacy. At some times, implementation may also
include helping the older adults and their families with relocation or even preparation for end-of-
life care.
Reassessment Plan
Reassessment requires an understanding that situations are dynamic. Therefore, there is a
need to keep monitoring the patients after the implementation of care to prevent a relapse. The
anticipation of changes in the future needs and assisting the family members of the diseased
understand the trajectory of their loved one’s illness is a factor in reassessment. In addition,
reassessment will also be holistic just like the assessment in order to identify a disease at an early
stage.
Evaluations of the management plans presented in the literature
The combined efforts of the geriatricians and MDT provide medical assessment,
assessment of patient’s mental health, assess physical performance, assess functional status,
conduct continence assessment, and carry out a nutritional assessment. For instance, the
assessment of frailty phenotype would look at least five epidemiologically-derived factors which
include deterioration of muscle strength, slowed gait speed, patients’ exhaustion, their sedentary
behavior, and evidence of involuntary weight loss among others (Cesari, Marzetti, Canevelli, &
Guaraldi, 2016).

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The concept of polypharmacy is a factor in aging medication that needs consideration.
According to Singh (2016), drugs prescriptions increase with age. However, studies have also
revealed that a lot of older people those over 65 years get severe effects of polypharmacy
including conventional and complementary medicines (Cesari et al., 2016; Singh, 2016).
Polypharmacy leads to adverse outcomes such as hospital admissions, delirium, falls, mortality
and cognitive impairment (Cesari et al., 2016; Singh, 2016). Therefore, although administration
of drugs is important to the care, it should be monitored to prevent its harm.
Another important aspect of the management plan is the preventative approach. Any
primary healthcare must involve means to prevent the burden of disease. For preventative to
work, it has to be established and implemented before the disease manifests itself. According to
Liddle et al. (2018), adopting “lifestyle clinics” that is focused on preventing chronic disease
among adults could be an effective approach in the implementation of preventative interventions
which can go by in preventing burden of various chronic diseases. There have been also
significant evidence that vaccines can also be an effective intervention in the prevention of some
age-related diseases. The work of Weinberger (2018) states that vaccination against some
diseases such as Streptococcus pneumonia and influenza is recommended for people and elderly
who are at risk of contracting those diseases.
Critical Analysis on How the Gained Knowledge Will Assist Workplace
In my profession, the knowledge gathered from this research would help me in executing
my duty of care by delivering best practices in the management of healthcare cases that involve
older people. Unlike other patients, this research has enriched my understanding that older
patients specialized health care needs due to the complexity of conditions that accompany old
age and the comorbidities. This knowledge allows me to recognize any critical illness fast by

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taking a holistic approach to the care of older patients. The research has also enriched my critical
thinking skills which is a requirement for minimizing adverse events or prolonged admission in
long term care. For instance, understanding the issues of polypharmacy is critical in an effective
plan of care. Whereas all nurses may be proficient in their area of specialization, experience in
those areas does not provide automatic knowledge of dealing with older patients. Therefore, this
research provides me with special knowledge and skills in dealing with complex interventions
that involve older patients.
Conclusion
Aging comes with different chronic conditions together described as geriatric syndrome.
Management of these conditions is complex and requires comprehensive assessment to provide
effective care. This paper intended to provide ana analysis of the current literature describing
health issues, pathophysiology involved, explanation of major concepts based on findings aging
health. The paper started by covering the scope of health on aging people and analyzed different
conditions which are risk factors to aged health. After discussing these conditions, the paper
moved to present management plan based on the available literature. Here the paper discusses
the process of assessment, care, implementation and reassessment plans. The paper then moved
forward to evaluate the literature on these plans. The paper finished by evaluating the
application of the knowledge gained in a healthcare workplace.

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