Health Literacy Issues For Elderly: Case Study Of Fiona

Fiona is 76. She lives alone in a small coastal town where she moved with her husband Ted when he retired. It’s a lovely place, but most of the services including the hospital are in the city which is 45 kilometres away.

Ted died suddenly 18 months ago. She’s been lonely since, but doesn’t like to talk about her problems. She worries she’ll bother people. Fiona worked in a shop but stopped when she had children. Her two daughters live interstate but often visit over summer and ring regularly.

Ted used to do most of the driving. Fiona is ok to get around locally but prefers not to drive at night as her eyes play up. Fiona has enjoyed an active, healthy life generally, but in the past few years has slowed down a lot. The vegetable garden is hard to keep up with, but she’s not so interested in cooking now anyway with Ted gone. Her joints hurt with arthritis. Her left knee is particularly bad.

Fiona likes to read, and goes to the local library once a fortnight when she does her shopping. However, she finds papers about her pension, or legal and health information confusing with all the different terms and details. Fiona saw Dr Huxtable for many years and felt comfortable with her. Dr Huxtable retired last year and Fiona doesn’t know the other doctors so well. She saw one when she had the flu and felt like he talked down to her. Health Literacy Issues For Elderly: Case Study Of Fiona

Her father had a stroke when he was in his 70s which affected his mobility and speech. Fiona doesn’t want this to happen to her as she wants to be independent. She’s not quite sure what causes strokes.

1. Identify the key health literacy issues for your chosen person and the population group they belong to

2.Describe two important health literacy issues that may impact on the health of your case study person

3.Outline actions that could be taken to improve this person’s health literacy.

Key Health Literacy Issues For Elderly

“Health literacy is the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course.” (Rootman, 2008). Health literacy enables people with a disease to understand the disease better and seek medical help at the right time. The aged may suffer from loneliness, chronic disease and debilitating conditions. Being health literate can help them seek treatment and improve health outcomes. But it has been observed that lack of information about possible treatment often impacts their health outcomes negatively.

Subject of the case study, Fiona, an elderly person suffers from loneliness, lives remotely, is socially isolated and has problems with vision and suffers from arthritis. She has a problem understanding legal and medical terminology. And does not know how to approach or find a physician whom she can trust. Loneliness among the elderly has an impact on their mental and physical health. Diminished social contact can cause social distress (Richard, et al., 2017). Due to generation gap there may be a sense of embarrassment when trying to communicate making it difficult for the elderly to meet health literacy goals (Chesser, et al., 2016). Individuals with low health literacy are less likely to take preventive steps and so are more likely to suffer from chronic disease. It is difficult for them to navigate the healthcare system and prevent illnesses because they may not have had the literacy to get an annual influenza vaccine or undergo cancer screenings. Health literacy indicates good self management skills, good utilisation of health services for emergencies and preventive healthcare. Patients with health literacy are more likely to adhere to medication, knowledge about disease, and thus there is reduced premature mortality (Bush, et al., n.d.). Health literacy helps individuals to obtain information about health and use it for their own benefit (McCaffery, et al., 2016). Educational intervention trials have been made with the goal of improving health literacy among the elderly in Australia. The study tried to improve self efficacy by imparting knowledge about complementary and alternative medicine and to see whether the lessons improved the uptake of alternative medicine among them (Smith, et al., 2017). The intervention made use of the internet or a DVD and a booklet, while the control group received only a booklet. Another study reviewed the effect of complex educational interventions in the area of self management of patients suffering from osteoarthritis with the aim of improving the management of the chronic condition and promoting reduction in pain and discomfort. The self-management programs were meant to supplement the medical treatment and improve patient outcomes. It was found that self management following the educational interventions may alleviate pain in patients but not to a clinically significant level (Kroon, et al., 2014). Many health inequalities are due to low health literacy. An educational intervention that sought to remove health inequalities through an educational program was found to be effective in raising the levels of health literacy among the participants (Muscat, et al., 2016). The use of internet may reduce the social isolation of remotely located people to some extent. It is also possible to reduce their sense of helplessness in accessing medical if they remain in contact with friends, family or healthcare professionals through the online mode.

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Important Health Literacy Issues For Fiona

In Fiona’s case two health issues may need immediate attention. According to her ”her eyes play up”, so she avoids driving. Her eyesight needs to be checked and she should be advised a detailed eye exam. Also, her blood sugar levels should be examined to check if she has diabetes. If left untreated it could lead to problems with visual acuity, macular degeneration or retinal disorders. Eye problems have also been studied as precursors of dementia among the elderly. Studies have found n association between eyesight problems and the onset of Alzheimer’s (Rogers, 2010). So it is important that vision problems be treated as soon as possible. The correlation between eyesight problems and cognitive decline is particularly alarming. Fiona also suffers from osteoarthritis and it has worsened in her knee joint. Treatment for osteoarthritis is a high priority for her because she is pain all the time. There are several risk factors for osteoarthritis and these range from old age, belonging to the female gender, being obese or overweight, excessive use of joints, weak muscles, low bone density and lax joints. The progression of these problems causes osteoarthritis and more so, when the joints are of the weight bearing type (Zhang, 2010). The severe pain caused by osteoarthritis can often be the reason why patients seek treatment. It can restrict movement and can lead to other problems, such as, obesity. The affected find it difficult to walk and the pain makes climbing stairs very difficult. Treatment may include pain medication and many patients may have to undergo a joint replacement surgery. Restriction of movement means that the affected cannot remain socially active and this affects their mental health and well being (Wright?St Clair, et al., 2017) . In Fiona’s case, she is in regular telephonic contact with only her children. Having poor health literacy means that she cannot access medical care. She finds herself incapable of booking an appointment with an ophthalmologist and an orthopedician. She has little idea about how to go about it. There are many health services in Australia tailored to the needs of remotely located elderly but one needs health literacy to be able to avail those services. She is among the 60% Australians who lack adequate skills to navigate the healthcare system (Bush, et al., n.d.). Policy options that are meant to solve the problem include availability of simpler and easy to understand material, using multimedia to spread awareness, making the health care providers aware of the problem of low levels of health literacy and developing their professional skills and developing stronger partnerships between primary health care services with not-for-profit organisations (Bush, et al., n.d.).

Actions To Improve Fiona’s Health Literacy

Fiona’s major problem is that she has a poor social support system and so has not been able to seek medical help for her weakening eye sight and the arthritis pain. She can rely on occasional family support and can avail services of visiting nurse service, and community support, because her loneliness and social isolation also need to be addressed . These interventions will be able to help her access health services regularly and seek eye treatment and treatment for joint pain and knee pain. She cannot use public transport with ease due to the pain but once the pain is managed through medication her mobility will improve. Fiona is also a good candidate for receiving multimedia based education about the medication that she will be prescribed by the clinicians, so that she can adhere to the prescription and not miss doses (Ciciriello, et al., 2013). Another intervention that can be made is messaging through the mobile phone. This can help the patient to carry out more effective self management of chronic condition (de Jongh, et al., 2012). Widely known as mHealth interventions these have been successfully used to help patients with self management of diabetes and hypertension among other chronic diseases. Smartwatches have also been found to be effective in remote monitoring of health parameters of patients. But the effectiveness remains to be tested for people with osteoarthritis (King & Sarrafzadeh, 2018 ). Knee monitoring devices that are wearable are being devised to instruct patients on exercise and for unobtrusive monitoring of the condition of the knee. Thus the use of technology can be successfully done to advice, monitor and help remotely located patients. But the help of social healthcare workers is also required to support people in distressing health conditions so that they can seek advice about medication, pain relief and access available resources from their homes. A mix of human and technological intervention is required to help elderly patients like Fiona.

In conclusion, it is evident that elderly patients with low levels of health literacy need help to access medical care so that they can get information about available health services. Loneliness can be particularly distressing for individuals with chronic health conditions. Added to it in Fiona’s case she is remotely located and her movement is restricted due to osteoarthritis- a painful and debilitating condition that needs prolonged treatment and self management. Visits from healthcare workers can advice patients on the need to carry out eye examination for eyesight issues and take timely treatment so that further complications can be minimized. A mix of technological interventions can be used to improve the health literacy of patients and enable monitoring from a distance. Since addressing transport difficulties of elderly patients is also a priority. It is important to impart some health literacy so that the patient can self manage pain and chronic diseases through proper medicatio

References

Bush, R., Boyle, F., Ostini, R., Ozolins, I., Brabent M.E., Jimenez, Soto, L., Eriksson, L., n.d. policy_options_14846.pdf. [Online]
Available at: https://openresearch-repository.anu.edu.au/bitstream/1885/119189/3/policy_options_14846.pdf
[Accessed 7 September 2018].

Chesser, A. K., Keene Woods, N., Smothers, K. & Rogers, N., 2016. Health Literacy and Older Adults: A Systematic Review. Gerontology and Geriatric Medicine, Volume 2, p. 2333721416630492.

Ciciriello, S., Johnston, R.V., Osborne, R.H., Wicks, I., dKroo, T., Clerehan, R., Oneil, C., Buchbinder, R., 2013. Multimedia educational interventions for consumers about prescribed and over-the-counter medications. The Cochrane Database of Systematic Review. , Volume 4, p. CD008416.

de Jongh, T., Gurol-Urganci, I., Vodopivec-Jamsek, V. C. J. & Atun, R., 2012. Mobile phone messaging for facilitating self-management of long-term illnesses.. The Cochrane Database of Systematic Review. , Volume 12, p. CD007459.

King, C. & Sarrafzadeh, M., 2018 . A Survey of smartwatches in remote health monitoring. Journal of healthcare informatics research, 2(1-2), pp. 1-24.

Kroon, F. et al., 2014. Self-management education programmes for osteoarthritis.. Cochrane Database of Systematic Reviews. , 15(1), p. CD008963..

McCaffery, K. J., Morony, S., Muscat, D.M., Smith, S.K., Shepherd, H.L., Dhillon, H.M., Nutbeam, D., et al., 2016. Evaluation of an Australian health literacy training program for socially disadvantaged adults attending basic education classes: study protocol for a cluster randomised controlled trial. BMC Public Health, 16(454). Health Literacy Issues For Elderly: Case Study Of Fiona