Case study of the determinants of health and their contribution to ADL practices.
The determinants of health are responsible for evaluating a person’s likelihood of maintaining a good health. These include the situations or the environment in which people were born, raised, living, working, and growing old. They are sometimes also known as 'the causes of the causes', as it is established that though health of populations is influenced by activities or exposure to risk, social and economic factors also play major roles (Anon n.d.).
Activities of daily living (ADLs) are essentially the fundamental or basic self-care skills or abilities one needs to properly care for oneself (Lawrence et al. 2014). These tasks are one of the most important measurements used to assess an individual's care plan (Klimczuk 2016). It may be used as a guide to determine if people qualify for certain services or if they need an increased level of care. The dependency on others for ADLs may negatively impact the well-being of a person and influence the quality of life (QoL) (Giebel et al. 2015).
Even the medication and substance use may be influenced and need to be previewed well before providing nursing care to such patients.
To illustrate this, a questionnaire – based case study was done to identify how the activities of daily living (ADLs) affect the determinants of health. This may be used as a guide in nursing practice to determine the health status of the patient. A 65 –year old woman, suffering from chronic high blood pressure, high blood cholesterol, diabetes, arthritis, urinary incontinence, and hearing problems was interviewed at an old- age home after taking informed consent and maintaining the privacy of the interviewee.
Care was taken so as not to include any offending questions. The questions included in the questionnaire were linked to the basic ADLs performed by the patient/interviewee and tried to summarize the capabilities of the patient in terms of movement, cognition, personal care, social compatibility, and work limitations. As per the ‘Code of Ethics for Nurses in Australia’ (2008) the interviewee was given full freedom to take an independent deciding to participate and confidentiality of the information was assured.
Findings from the interview
The patient told that though she was able to walk slowly, she needed assistance for coming out of bed and to transfer from seated to standing position. She managed this with the walkers. For climbing up and down the stairs also she needed assistance. She managed this with the aid of railings in the stairs.
She was unable to prepare food and it was being provided by the old-age home, which took care of including all necessary nutritional ingredients. She could feed by herself, though very slowly. As she needed different medications for her different ailments, she asked someone to prepare a medication chart for her, which she displayed in her room, to aid her in taking all medicines on time. She had also kept duplicate hearing aids in her room in case she forgets or misplaces her hearing aid.
Though she could take bath independently, she had made certain alterations in the bathroom to help her with this. She maintained personal hygiene practices by herself, such as brushing her teeth and grooming herself, though the speed was very slow.
She chose her dresses herself, though she needed aid in managing fasteners etc. while putting the clothes on and off. She took aid from her inmates in the old-age home. She was able to operate and use other assistive devices like her hearing aids, walker, etc. by herself, though at times she needed assistance.
She could use the toilet independently as she had made alterations in the toilet for the same. However, he had urinary incontinence because of which her body and clothes gave a bad odour. Bowel movements were still under control.
She had not been doing any domestic work since 4-5 years since she was in the old age home. However, she felt that she could do it but at a very slow pace. She was not able to operate a phone owing to the development of latest technology phones.
Health is determined by physical, mental, social, and economic factors. The determinants of health can be associated with the ADLs and then used to assess the QoL (Kim et al. 2014). In case of the above patient ADLs are greatly determined by these factors. Though the woman is under medication and has a very cooperative environment in the old-age home, she still needs nursing care and support and the old-age home should provide for a nurse for helping her regain her confidence. She has favourable social and economic conditions in the old-age home, however, personalized care is needed.
Though she has found out ways to counter her needs using physical aids, like walker and altering the bathroom and toilet, still she needs proper supervision and aid to deal with her physical, mental, and social introversion she is undergoing due to urinary incontinence. Proper nutrition and timely medication is necessary to prevent her health from deteriorating further. Moreover, the chronic conditions she is suffering from, limitations in ADLs, and the advancing age, demand more care to improve her QoL (George et al. 2014).
As she is suffering from arthritis, taking bath and climbing the stairs by herself may prove risky for her. So, an all-time nurse should be provided to her. This may be considered as need for long-term care services. These services are often needed for chronic ailments and needed from onset of these conditions and for the remaining lifetime, thus making it of great important to better understand the factors associated with long-term care to provide appropriate care and alleviate the societal burden caused by increasing age (Wu et al. 2014).
Moreover, though at present her cognitive level is fine, due to advancing age, diabetes, midlife hypertension, that are the most widely accepted risk factors, there may be mild changes in cognition that can manifest as delays in memory and impairments in ADLs (Miu et al. 2016). The modifiable mid-life risk factors (like diabetes, hypertension, cholesterolemia) should be taken care of early in life to prevent ADL disability in old age. If these risk factors are given adequate attention in the middle age, there can be substantial increase in the old age period that one can live a healthy and independent life (Wong et al. 2015).
The social determinants of health are partially lacking in this case as though the woman has neighbourhood trust, support, cohesion, and participation within the old-age home, her interaction with the outside world through phone or any other means is missing. This has great impact on the older person’s ability to age in place (Norstrand et al. 2014). As the current process of care transitions for people with disabling conditions is both ineffective and inefficient (Camicia et al. 2014), the nurses need to be provided the necessary knowledge and skills to facilitate transitions that prove to be valuable for patients, their families, and the healthcare system.
Ignorance and neglect of ADL assessment and unawareness about handling them may lead to poor long-term outcomes of treatment being given (Kerkhoff et al. 2014). Nurses need to be still more involved with geriatric patients who are undergoing psychosocial changes and may have adverse effects on their mental health as well (Liebel & Powers 2015).
The above interview thus brings to the fore the need for proper and adequate nursing care to people who are having limitations in ADLs. The health determinants which lead to these conditions need to be assessed early in life and treated accordingly. If these are presented at later stages, adequate preventive and curative measures need to be applied by the nurse, so that the patient can lead a life worth living.
Anon, Determinants of Health.
Camicia, M. et al., 2014. The Essential Role of the Rehabilitation Nurse in Facilitating Care Transitions: A White Paper by the Association of Rehabilitation Nurses. Rehabilitation Nursing, 39(1), pp.3–15.
George, P.P. et al., 2014. Determinants of health-related quality of life among community dwelling elderly. Annals of the Academy of Medicine, Singapore, 43(1), pp.3–10.
Giebel, C.M., Sutcliffe, C. & Challis, D., 2015. Activities of daily living and quality of life across different stages of dementia: a UK study. Aging & Mental Health, 19(1), pp.63–71.
Kerkhoff, G. et al., 2014. Smooth Pursuit “Bedside” Training Reduces Disability and Unawareness During the Activities of Daily Living in Neglect A Randomized Controlled Trial. Neurorehabilitation and Neural Repair, p.1545968313517757.
Kim, K., Kim, Y.M. & Kim, E.K., 2014. Correlation between the Activities of Daily Living of Stroke Patients in a Community Setting and Their Quality of Life. Journal of Physical Therapy Science, 26(3), pp.417–419.