Critical Review: Impact of CVD on Elderly Healthcare in Australia

This report provides a critical review of cardiovascular disease (CVD) within the context of elderly healthcare and service provision in Australia. It begins by highlighting the increasing global trend of an aging population and the associated rise in CVD morbidity and mortality. The report then delves into the causes and rationale for CVD as a contemporary issue, emphasizing the changing age structure of developing countries and the subsequent burden on healthcare systems. It explores the impact of CVD on population health, including increased mortality rates and the intersection of CVD diagnosis with successful aging. Furthermore, the report examines the impact of CVD on health service provision, detailing the increased burden on healthcare staff and the challenges in managing CVD due to factors like medication adherence. Finally, the report assesses the impact of CVD on nursing practice, discussing the need for specialized skills and the importance of nurse-led management programs to address the growing prevalence of CVD in the elderly population, particularly in rural and remote areas. The report concludes by emphasizing the importance of proactive preventive actions and skill training for nurses to effectively manage cardiac events and emergencies.

Running head: HEALTH CARE CONTEXT AND SERVICE PROVISION
Critical review
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Introduction:
With the increase in life expectancy and advancement of health care technology, the
percentage of older people above sixty five years is increasing globally. Ageing population or
increase in the proportion of elderly people is becoming a global phenomenon now. In
Australia, about 3.7 million people or 15% of the total population were older than sixty five
years in 2016. The rate at which the older population is growing, it is estimated that the 22%
of the Australian population will comprise elderly people by 2056 (Australian Institute of
Health and Welfare, 2017). Despite advancement in health care service provision, age related
increase in cardiovascular disease (CVD) morbidity and mortality is one major issue for the
ageing population. The life expectancy of people has improved and large numbers of older
people are living with CVD. It has significantly affected quality of life and direct medical
cost per year (Greenlund et al., 2012). The main aim of the report is to provide more detailed
insight into the main cause behind the prevalence of CVD in elderly and evaluate the
influence of CVD diagnosis on population, health services provisions and local nursing
practice in Australia.
Cause and rational for CVD as a contemporary issue:
The age structure of developing countries is changing rapidly and it is going to
significantly affect the percentage of people above 6 years in the next several decades.
According to the World Health Organization report, the number of people above sixty five
years is likely to grow from 524 million in 2010 to 1.5 billion in 2050 (World Health
Organization, 2017). This form of change in age distribution is translating to huge burden of
CVD in elderly population. The burden of CVD has been measured in terms of morbidity,
mortality and cost of managing CVD. Hence, unless the prevalence of CVD in the population
is controlled, it is going to present new challenges to the health care system. It will
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automatically increase the burden for health care staff and the double the rate of hospital
admission for Baby boomer (Beard et al., 2016). Hence, how health care system and health
care professionals is going to deal with large number of patients with CVD is a debatable
question for developing countries.
Impact of the issue on population health:
Population based statistics and incidence data can give idea regarding the burden of
CVD in Australia. CVD is regarded as the one of the major cause of death in Australia and it
has become biggest public health issue. The people above 65 years are the one who are
currently living with long term CVD (Heart Foundation, 2017). With an increase in trend of
worldwide ageing population, high rate of mortality in elderly people will be seen due to
CVD. The risk of CVD is high in elderly people not only because of physiological changes
due to ageing (Yazdanyar & Newman, 2009). However, the risk is high because of
cumulative exposures and presence of other risk factors of CVD throughout their life. For
example, hypertension is a common ailment among older adults and it is one of the vital risk
factors for CVD. Wu et al. (2015) explains that 54% of strokes and 47% of coronary heart
disease occurs due to hypertension. Hence, morbidity and mortality due to CVD is high in
elderly people because of exposure to cumulative risk throughout their life. Unless the health
care system is prepared to deliver age-appropriate services for CVD, complex morbidities in
elderly people cannot be properly managed. Hence, future health care cost is mostly likely to
cross health related expense (Prince et al., 2015).
The impact of CVD on population health is understood from the impact of CVD on
successful ageing process. The diagnosis of CVD may intersect with successful ageing
because of the presence of other disability like poor functional ability and cognitive issues in
elderly population. Evidence suggest that prevention and management of CVD in elderly
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people is a challenging issue because of poor attitude towards medical treatment for people
with limited life year, greater use of medication, high chance of drug interaction and change
in risk-to-benefit intervention for older adults compared to younger adults (Greenlund et al.
2012). Jackson & Wenger (2011) supports the fact that care of elderly patient with CVD is
not the same as care of young adults with the same condition. Gait and immobility issues are
most common found in elderly population and sedentary lifestyle of elderly people because
of these issues further exacerbates the medical condition of the elderly population. The
burden of CVD has significantly shifted towards older person in the past few years and the
frailty is one condition that can further make elderly people vulnerable to stressors after
diagnosis of CVD. Frailty can further increase the risk of cardiac surgery and cardiovascular
mortality in the population (Singh, Stewart & White, 2014).
Impact on health service provision:
A disease is considered a public health issue when it significantly alters health service
provisions and creates additional burden on the health care system. The diagnosis and
prevalence of CVD is one of those issues that has created burden on the health care staffs by
increasing hospitalization rates as well as the cost associated with care (Roever, Tse &
Biondi-Zoccai, 2018). Fayet-Moore et al. (2018) reports that CVD is one of the leading cause
of illness, disability and mortality in Australia. Hence, increase in health expenditure due to
increase in morbidity and mortality had led to loss of productivity. The significant impact of
CVD prevalence on Australian health care system is understood from the fact that total health
care expenditure has doubled since 2003 and it is expected to triple by 2031-32 (Fayet-Moore
et al., 2018). Hence, effective interventions are required to reduce the burden of CVD on the
Australian population.
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As older people are more vulnerable to CVD risk, the responsibility of managing
mortality and morbidity associated with CVD has fallen on the CVD caregivers. Elderly
people are more like to be diagnosed with CVD because of accumulating morbidities,
diminished homeostasis and long-term adverse effects of several CVD risk factors. Another
issue for care provider is that clinical presentations for CVD may vary for each individual
because aging related changes may vary in different individual (Forman et al., 2011). Hence,
this creates challenges for the cardiologist and other health care staffs as developing
individual preventive strategies would be difficult.
Another major impact of the prevalence of CVD in elderly population is that it has
created many challenges for health service staffs as they have faced challenges in treating
CVD because of poor medication adherence related issues. Medication adherence is crucial to
save long term health care expenditure and reduce burden of the health care system.
However, in relation to CVD management in older adults, it has been found that low
medication adherence has significantly reduced the effectiveness of treatment for CVD
conditions and its risk factors like hypertension and hyperglycemia. Cognitive impairment
and memory problem in elderly population is one of the reasons for poor medication
adherence in the elderly. Depression and social isolation also affect medication adherence
rate in elderly people (Hennein et al., 2018). Hence, in response to the barriers faced in CVD
management because of non-adherence to medication, health care providers should prioritize
addressing non-adherence issues to improve population health. As non-adherence is a
dominant risk factor for poor outcomes, there is a need for health care providers to identify
people who are most prone towards non-adherence. This may help to implement tailor made
intervention to resolve drug-specific issues for individual patient and lead to help
improvement for people with CVD or those at risk of CVD (Kolandaivelu et al., 2014).
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In response to the rising prevalence of CVD, the Australian government has taken
many actions to deal with the issue. One of them was development of six actions to tackle
CVD in Australia. This included development of a national health and stroke strategy,
identifying people at risk, funding CVD research fellowships, helping Australians to remain
physically active by development of a national physical action plan, reducing gap related to
rheumatic heart disease and improving participating in cardiac rehabilitation services
(National Heart Foundation of Australia, 2016). The above mentioned six actions identified
the problems areas and looks to address them to prevent the CVD prevalence rate. To
effectively implement the above mentioned actions, the contribution of the primary health
care sector will be crucial as it can play an active role in identifying people at risk and
managing CVD risk. However, the primary care sector need to collaborate with community
based lifestyle modification services such as to provide adequate behaviour change support to
people at risk. Volker et al. (2014) revealed that Medicare Locals is one primary health care
organization in Australia that has played a key role in encouraging primary health care
industry to deal with chronic disease. Strategies like incentives can promote employment of
more practice nurses and inclusion of community sector in community program has the
potential to significantly reduce and prevent CVD in Australia.
Impact on nursing practice:
With the increase in morbidity and mortality associated with CVD worldwide, urgent
need is required for special heart failure nurse to facilitate self-management of CVD in high
risk population such as elderly people. Local nursing practice has been highly affected by the
rise in number of CVD as majority of nurse come with experience in general practice and
there is lack of nurse who have specialized skills in heart care. Despite skill related gap,
practice nurse also have the potential to assume wider role such as that of administrative role
and providing guidance and education to clients regarding complex care needs for patients
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with CVD (O'connell, Gardner & Coyer, 2014). Skill expansion is also necessary because
CVD is associated with many co-morbid conditions too which increases the complexity of
CVD management process (Chamberlain et al., 2015). To overcome this issue, providing
adequate support to practice nurse is important so that they can take adequate follow-up from
multi-disciplinary team and optimize supportive care for elderly people with CVD. Fuller et
al. (2015) supports the fact that increasing competence related to CVD management is
necessary to effectively coordinate care and provide high quality care for chronic disease like
CVD.
As nurses are the staffs who spend the maximum time in primary care, they are in the
best position to provide round the clock care to patients with CVD. Based on the current
evidence, some of the barriers faced by nurse in carrying their responsibility included work
overload, lack of specialized skills for CVD management and shortage of nursing staffs. Skill
training for existing Australian nurse needs to be prioritized so that they can smoothly handle
cardiac events and cardiac emergencies in elderly population. In case of cardiac emergencies,
there is a need to activate the emergency system and initiate resuscitation process. In the
phase of cardiac rehabilitation too, more supportive action is needed by nurses. Australian
nurses must be encouraged to take on wider roles such as that of a care provider, a counselor
and educator for patients. This would help to resolve issues experienced during secondary
prevention (Victor, Sommer & Khan, 2016).
Record et al. (2015) states that people living in rural or remote areas have worse CVD
outcome compared to those living in urban areas. Recent statistics reveal that mortality rate
increases by remoteness and more number of Australians living in rural areas are going to die
from coronary heart disease compared to other diseases. This trend gives the insight that pro-
active preventive action is needed for people in regional communities. Hence, nurse-led
management program is a cost-effective solution to reduce risk level, minimize hospital stay
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and prolong survival for people with CVD. The cost-effectiveness of the strategy has been
tested by Carrington and Stewart (2015) conducting research to analyze the benefits of a
nurse-led intervention on reducing risk of CVD in rural Australians. After risk assessment,
multiple and tailor made intervention was implemented and after three months of
intervention, significant improvement in risk factors was found. Physical activity measures
improved in research participants and dietary changes were observed. This proves that nurse
led management is an effective solution to deal with future burden of CVD in elderly
population of Australia.
Conclusion:
The paper gave an insight into the issue of CVD prevalence in Australia and globally
and presented the burden to the health care system because of the high likelihood of CVD
risk in elderly population. The discussion regarding the impact of the issue on population
health and health service provision reflected that CVD has increased health care
expenditures, escalated hospitalization rate and increased the burden of care for health care
staffs. In response to these issues, several strategies were implemented by the Australian
government. To achieve the goals of the six actions, it is necessary to collaborate with
community support agencies. The evolution of the nurse’s role in CVD management is also
critical to promote self-management skills in high risk individual and improve health of the
affected population.
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