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Globalization has reduced the entire planet to a small village, since people can easily interact with each other regardless of their geographical location. This term is utilized in the description of the global interdependence or interconnectedness of humanity, which comprises health of the entire human race in the world. According to Holtz (2016), in the last two decades globalization was substantially impacted by international financial investment, tourism, travel, trade, and most importantly, migration. Unfortunately, globalization has had a devastating effect on human health, since diseases and many other health-related issues have become an international phenomenon. Health globalization can be traced to the movement of European conquerors and explorers who spread measles, smallpox, influenza, and the plague. Similarly to modern times, poor and minority populations lived in unhealthy conditions compared to the wealthiest majority groups that had better nutrition, sanitation, and access to healthcare services (Holtz, 2016). In this respect, older people are vulnerable to different diseases, which is the major cause of apparent health disparities in this population group. Therefore, it is a matter of great significance to understand the history of global health for adults, the disparities in health, moral issues and available guidelines, availability of healthcare providers, as well as economic and productivity costs to improve their overall health state.
Historical Perspectives of Elder Care for Learning in Nursing
Many countries have been undergoing through transformations in gerontology for many years, which made elder care a historical phenomenon. Initially, elder care was left to the families and friends of older people. In the United States, the plight of this population evoked sympathy in civic leaders and town officials, which resulted in the 1642 town meeting that provided relief by offering essential commodities for poor aging people (Achenbaum & Carr, 2014). During this time, the health system had not prioritized geriatric care as a matter of concern, since aging was seen as an illness with the aged population comprising a small part compared to its current number. Additionally, many facts about treatment modalities remained to be unknown, especially for the elderly people in the traditional system of health. Elliot (2016) explains that before 1935 the European society used to ignore older adults, especially when suffering from different disabilities and illnesses. The European modernization of elder care began in 1935 in Britain when Warren, an English physician, started to care for the seniors (Elliott, 2016). Therefore, geriatric care became a focal point of the healthcare system in the previous century.
However, much of the progress was made in the second half of the 20th century, primarily due to the increasing number of elderly population and the subsequent understanding of their health problems as well as the treatment modalities. According to Liu et al. (2017), despite a significant impact on the care of the elderly population, geriatric nursing became an independent specialty in 1900. Nevertheless, it was during the second half of the 20th century that health professionals started to understand the process of aging, its link to various disparities and illnesses, and treatment approaches to this group of people (Elliott, 2016). Liu et al. (2017) conclude that during this historical period geriatric nursing was taught in different countries. While the formalization of this specialty varied from one nation to the other, in China it became independent more than 20 years ago. The 20th century was marred by an American upsurge in the number of older adults; in 1900, 1950, and 2000, the United States had 3.1 million, 12.3 million, and 35 million of older adults respectively (Holtz, 2016). Primarily, an increase in the number of seniors as well as their health problems and the treatment modalities were the primary causes of formalization and modernization of gerontology.
The creation of global organizations such as the World Health Organization fueled the globalization of gerontology both in formal and informal institutions. For instance, the United Nations (2013) assumes that the elderly population will increase from 11.7% in 2013 to more than 21.1% in 2050, with 80% of the people living in less developed regions. In 2005, Alma-Ata declaration was renewed by the World Health Organization’s commission since aging had become a significant subject in global health (Holtz, 2016). As a result, the entire world is focusing on gerontology similarly to many other specialties, such as pediatrics and psychiatry. According to Elliott (2016), efforts to advance elder care through nursing education, research, and the subsequent improvements of health care provider competencies are much needed. The reasons for an increase in a number of the elderly population have been analyzed through research, which helps the world to institute plans for future care. For instance, the United Nations (2013) explains that in future, the proportion of older people will increase due to the declining fertility rates and rising life expectancies across the planet. Therefore, the global history of gerontology indicates marked improvements coupled with ever increasing elderly population, understanding of various health challenges, and most importantly, finding remarkable solutions to the health issues.
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Importance of Health Care Disparities
Disparities in older adults determine the risk of disease occurrence, health-seeking behaviors, access to high-quality care, and the social status among others. Holtz (2016) states that socioeconomic status is a significant indicator of healthcare access, health population health outcomes, and acquisition of high-quality care. For instance, poor older adults may not afford better health services, which is associated with unhealthy living and inability to seek treatment from formal institutions of care (Emlet, 2016). Additionally, the poor suffer most from preventable illnesses as a result of living in poor neighborhoods with sanitation challenges compared to their wealthy counterparts. Moreover, disparities in older adults vary from one country to another. For instance, American older people are more likely to acquire better health services compared to their Chinese colleagues, which occurs due to the better organization of American health system (Zhang et al., 2016). Furthermore, people from developing African countries experience severe challenges of accessing healthcare services because of underdeveloped healthcare systems (Mpondo, 2016). Therefore, the socioeconomic disparities are among the major causes of elder care inequalities across the globe.
That notwithstanding, different groups of seniors experience severe health disparities. For instance, females who have a longer lifespan experience higher levels of poverty than their male counterparts (Zhang et al., 2016). As a result, female older adults are less likely to access better healthcare services than male older adults. Similarly, lesbian, gay, bisexual, and transgender (abbreviated as LGBT) seniors face numerous obstacles in accessing housing, healthcare, and other services. According to Healthy People 2020 (2017a), LGBT populations have higher risks of suicide, homelessness, HIV infections, victimization, and mental health illnesses among others. In addition to higher levels of poverty compared to their colleagues, these people are less healthy due to the high prevalence rates of acute and chronic illnesses (Emlet, 2016). Apart from this, LGBT seniors experience high levels of stigma and social segregation as well as victimization, all of which have an adverse health impact. Therefore, disparities associated with gender, socioeconomic status, sexual affiliation, and many other factors are detrimental to elder care.
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Regulatory guidelines have majorly boosted the efforts of health care providers in addressing the health needs of elderly populations both in the United States and in the world as a whole. For instance, Healthy People 2020 guidelines (2017b) provide practical strategies for identifying the healthcare needs of older adults in addition to the most appropriate solutions, such as disease treatment and prevention. To improve the health outcomes in the elderly population, professional care providers should use the guidelines to perform health screening, disease treatment, and prevention activities (Healthy People 2020, 2017b). Additionally, these guidelines provide an insight into how different stakeholders of the health care system can approach elder care issues in different populations including women, poor people, and the LGBT groups. For instance, improving the health of LGBT elderly populations can be achieved through the collection of “sexual orientation and gender identity (SOGI) data” to identify health disparities, formulate appropriate supportive behaviors, educate medical students on the provision of culturally competent care, implement anti-discrimination policies, and curb the menace of mental health illnesses among others (Healthy People 2020, 2017a). Principally, these guidelines are aimed at improving health of different groups of the older adults from the global perspective.
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Additional guidelines from different local and global agencies are being developed to enhance elder care provision. For instance, the Farrington et al.’s (2016) regulatory clinical guidelines provide the strategies of managing patients with chronic renal diseases across populations including older adults. According to these guidelines, the management of kidney conditions should commence early as a result of the frailty of older adults and the high probability of developing renal complications. Moreover, Qaseem et al. (2017) and many other scholars provide hypertension management guidelines for older adults. The American Society on Aging also provides guidelines for educating professional care providers on how to impact elder care through webinar technology, print material, and conferences (Smith, 2014). Similarly, the World Health Education provides guidelines for regulating elder care delivery including the procedures of treating illnesses. Basically, all the regulatory guidelines are targeted at improving the health of older adults as well as mitigating the prevalent healthcare disparities.
Moral, Legal, or Ethical Issues in Elder Care
Eldercare is coupled with many moral issues, which all healthcare providers should uphold when delivering high-quality care. Holtz (2016) explains that culturally-competent care providers are endowed with the responsibility of protecting the values and preferences of older adults according to the culture-specific morals. The only solution to the societal cultural variations and morals for nurses and other healthcare professionals is to respect the choices of their patients and to allow them to participate in making self-care decisions. For example, older adults from some cultural or religious backgrounds may find it difficult to have care providers perform physical examination procedures if they belong to the opposite gender. In such cases, nurses and other care professionals should allow the older adults to make choices and respect their preferences and values (Stapleton et al., 2014). Eventually, cultural barriers can be mitigated, which is a massive step towards the provision of quality geriatric care and better health outcomes.
Further, elder care and the associated disparities as well as end-of-life issues pose a significant challenge as an ethical and legal issue that concerns the principles of justice and social equality. According to Holtz (2016), disparities in end-of-life issues are associated with human values of flourishing, health, and respect. In some cases, clinicians are faced with ethical dilemmas in such matters as euthanasia, patients’ willingness to commit suicide to stop suffering from terminal illnesses, etc. Additionally, Stapleton et al. (2014) posit that in elder care, some older adults are unable to make decisions concerning their care. Under such circumstances, clinicians should refrain from imposing their decisions but rather incorporate the family members in the care of their loved one. That notwithstanding, older people in impoverished communities are deprived of their fundamental human right to better health and life as they lack necessary resources to pay for healthcare services, which is a legal concern (Holtz, 2016). What is more, all health care providers should adhere to the moral imperative ensuring that elderly patients are relieved from spiritual, psychological, and social suffering in addition to the efforts of reducing health care disparities. Holtz (2016) asserts that these issues are inspired by the moral concern for justice. Therefore, despite the health disparities concerning older adults, this group of people is entitled to have better non-discriminative geriatric care, which should meet the moral and legal standards.
Burden of Chronic Care in Older Adults
The burden of chronic disease in the elderly people and the subsequent care pose an enormous challenge to the healthcare system and the entire society. According to Prince et al. (2015), cardiovascular illnesses, cancer, mental disorders, musculoskeletal diseases, and chronic respiratory conditions are complicated health issues that contribute to the chronic care burden in older adults. Multiple chronic conditions further complicate the already exacerbated menace; for instance, 25% out of 117 million Americans with chronic diseases have multiple chronic conditions with 36.4% and 68.4% of the elderly population having at least four or two chronic illnesses respectively (Sambamoorthi, Tan, & Deb, 2015). In addition to causing increased morbidity and mortality in the elderly, the chronic disease burden manifests itself through the healthcare expenditures in care facilities. Gerteis et al. (2014) reiterate that in 2010, 86% of the American healthcare spending covered costs of care for people with one or more chronic illnesses. Hence, chronic illnesses place a considerable burden on the care of older adults by not only causing suffering and mortalities in the seniors but also consuming substantial amounts of funds.
Economic and Health Productivity Costs
Eldercare and the healthcare challenges faced by older adults are linked to economic and health productivity costs. The World Health Organization (2014) posits that most of the older people lose their ability to live independently as a result of reduced mobility and reduced physical and cognitive functional capacities, which compels some of their family members to take care of their beloved ones. Taking care of this vulnerable group, these family members lose a substantial amount of their productive time, which results in a financial distress in the family and economic loss of productive individuals (Nortey, Aryeetey, Aikins, Amendah, & Nonvignon, 2017). To make it worse, these home caregivers spend some of their income on caring for the elderly. Nortey et al. (2017) state that in Ghana the majority of caregivers earn an average income of US$240 from which they spend US$115.72 on elder care. Apart from the fact that the productivity of the health individuals is decreased, the health care systems spend much money on addressing seniors’ diseases and disabilities. For instance, chronic diseases in this population resulted in US$20-US$30 million of economic losses in both Ethiopia and Vietnam – an amount that was higher (US$1 billion) in China and India (World Health Organization, 2014). Basically, the economic and health care productivity costs of elder care are significant. This phenomenon is likely to worsen in future years due to the projected rise in the number of older adults and the subsequent healthcare problems.
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Global health and healthcare issues in geriatric care have become the center of focus for the healthcare system across the planet as the number of older people continues to increase. Traditionally, elder care was not a significant specialty, but with the recent modernization of care, the gerontology gap has been filled to realize marked improvements. Unfortunately, many problematic issues including the healthcare disparities in this population remain to pose a challenge; other problems comprise the moral and legal issues faced by care providers when delivering the health services. In spite of this, the burden of chronic care and the associated economic and health productivity costs have an adverse impact not only on the health system but also on the economy and the society as a whole. However, the presence of regulatory guidelines offered by different scholars and agencies such as the World Health Organization are developed to mitigate most of the elder care issues.