Promoting Excellence in Older People’s Care in Nursing

Running head: PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
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2PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
Introduction
In the context of the rapid aging population, Singapore is anticipating a rise of the
morbidity, disability and dependency that driven by physical fragility. According to Chan et
al., (2013), Singapore is facing one of the toughest economic and social challenges since it is
independent in the form of rapidly aging population. National survey of senior citizen
(NSSC) has been conducted a periodic survey for keeping track of the aged population and
health status of them. According to that survey report, in 2009 a total of 10000 households at
least one individual of 55 years or older were found where 15% of the households were
ineligible for older people focusing on the personal characteristics of the survey, in
Singapore, amongst those 55 years had above, 47% are male where as 53% of older
population are female (Ng et al., 2013). A country based cross sectional study suggested that
while Singapore is a highly developed country by worldwide standards, the older population
was suffering from certain health crisis that increases the burden of the disease had affected
the economic status. A study by, suggested that a considerate number of older individual in
Singapore suffered from health crisis such as major depressive disorder, anxiety,
cerebrovascular accidents and urinary incontinence. Depression impacts older population
different than younger population since the depression generally observed in older people in
Singapore often associated with medical illness and disability which last longer. Depression
often observed in elderly women if they lose their independence of working due to physical
disability or if the family member lives away or feel abundant which further leads to anxiety.
In older adults, cerebrovascular accidents often caused by blocked artery due to series health
disease such or due to sudden fall. In Singapore, prevalence of cerebrovascular accidents
often estimated at 3.65% for adults above 50 years which posing challenges to the health care
system (Chandran et al., 2013). Urinary incontinence is a normal part of aging which is more
common in women over 50 years and affects one woman out of three women in Singapore.

3PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
Therefore, in order to manage these health issues for physical and mental well-being of older
population, excellent nursing care is required which would provide them a sense of security,
comfort and enhance quality of life. The aim of the paper is to address health care theories
such as aging theory, nursing theory and health improvement theory in order provide
excellent nursing care to the elderly population of the Singapore. Therefore, in the first part
of the paper will illustrate a case study by applying the nursing theories for effective nursing
care. The second part of the paper will illustrate a care plan for the elderly patient with the
help of senses frame work.
Part 1
Case study
Ms. Maria is an 80 year old woman who is a subacute rehabilitation patient. She was referred
for a psychological evaluation as she had been suffering from anxiety and depression. Few
days back the patient Maria had suffered from right frontal lobe cerebrovascular accident
(CVA) due to which she developed a left-sided hemiparesis. One of her greatest health
concern was that her urinary incontinence along with the subsequent changes occurred in
privacy. The reports showed that the patient has never been married therefore had no
children. She was a successful and independent women however this changed after the
occurrence of CVA. She worked for the welfare of the low-income children as well as their
families. She had been involved in registered home health nursing. The patient reported of
worsening frequencies of urination along with incidences of recurrent urinary tract infections
(UTIs). She reported that this led to the decrease in the quality of her life which had taken
place about 10 years ago. As a result of this, over the years she was forced to focus on this
symptom which had affected her personal and professional life and this made her withdraw

4PROMOTING EXCELLENCE IN OLDER PEOPLE’S CARE IN NURSING
herself from several activities. This had made her more conscious of her disability. This often
made her feel abandoned increasing her stress and her concerns regarding urinary
incontinence which in turn increased her requests for help.
Due to the increasing number of senior citizens who are entering their silver years, the
government of Singapore is placing some special schemes in order to bring out social support
to help them get through their retirement years. One of this scheme is the Medisave which is
a national medical savings scheme. This helps the people to put aside a part of their income
into this medisave account, which in future will help them to pay for their personal and
immediate family’s hospitalizations costs and certain outpatient expenses in any hospital in
Singapore. Another scheme is the Enhancement for Active Seniors (EASE), which is a part of
the Home Improvement Programme (HIP) (Ng et al., 2015). This allows the patients to enjoy
subsidies from the government. Another is the ComCare Long Term Assistance which is also
known as Public Assistance along with Silver Support Scheme according to which the
government gives payout of $300 – $750 to the 20% of seniors having low incomes
throughout their life and little or no such support from the family. Several other schemes of
the government includes the Pioneer Generation Package (PGP), the Lease Buyback Scheme
(LBS) and finally the Senior Citizen Concession Card. According to this, the senior citizens
are able to enjoy lower fares on the trains and buses after the launch of the Off-Peak Pass
(OPP) (Feng et al., 2014).
Additionally the Singapore’s Ministry of Health (MOH) had established an outline for an
action plan with regards to successful ageing which is was involved of ten areas of focus.
These ten priorities included senior volunteerism, employability, health and wellness, lifelong
learning social engagement and inclusions, housing, transport, aged care services, public
places, and research on ageing (Ramjaun et al., 2013). It was also seen from the research