The assessment of the demand for medical care among elderly care

● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2016 ●
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 2/2016 (32-38)
●
The assessment of the demand for medical care
among elderly care home residents
(Ocena zapotrzebowania na opiekę medyczną pacjentów w starszym
wieku w warunkach Domu Pomocy Społecznej)
M Starczewska 1,A,D, J Tysa 2,B, K Augustyniuk 1,C, J Owsianowska1,B, A Jurczak1,B,
E Grochans1,E,F
Abstract – Introduction. In the nearest 20 years almost every
fourth citizen of our country will cross the threshold of senility.
The forms of institutional aid for the elderly include care homes
providing nursing and medical services.
The aim of this study is to determine the demand for medical care
among care home residents.
Materials and methods. The study involved 150 residents of the
General Mieczysław Boruta-Spiechowicz ‘Veteran’s Home’ in
Szczecin. This survey-based study was performed using an original questionnaire.
Results. The study group included 48% of women and 52% of
men. The most numerous (57%) were residents between the ages
of 80 and 89. Nearly one-third of respondents were not visited by
their closest relatives, and as many as 83% lived a solitary life. In
the study group, views on medical care in the care home were
divided: 51% claimed that it was adequate, and 49% held an opposite opinion. According to 41%, the best providers of medical
care were physiotherapists and carers, and the worst – physicians.
Over two thirds of respondents had a very good opinion both
about respect for their intimacy and assistance with personal care
activities rendered by nurses.
Conclusions. 1. The vast majority of care home residents expect
more interest from medical staff (especially physicians and nurses). 2. The demand for medical care increases with age and the
length of stay in a care home. It is also more common among
residents who are not visited by the closest family members.
nariusza ankiety. Wyniki: Badaną grupę stanowiło 48% kobiet i
52% mężczyzn. Największą część (57%) stanowili pensjonariusze
w przedziale wiekowym od 80 do 89 lat. Zdecydowana większość
badanych tj. 83% była osobami samotnymi. Blisko jedną trzecią
badanych pensjonariuszy stanowiły osoby, których nie odwiedzała najbliższa rodzina.
Wyniki. badanej grupie opinie dotyczące opieki medycznej na
terenie Domu Pomocy Społecznej były podzielone, 51% odpowiedziało, że opieka jest wystarczająca, natomiast 49% było
odmiennego zdania. Według 41% pensjonariuszy najlepiej opiekę
medyczną sprawowali rehabilitant i opiekun, natomiast najniżej
oceniono opiekę świadczoną przez lekarza. Ponad dwie trzecie
badanych oceniło świadczoną przez pielęgniarki pomoc w czynnościach pielęgnacyjnych jako bardzo dobrą i dobrą. Większość
badanych pensjonariuszy (77%) oceniło poszanowanie intymności podczas zabiegów pielęgnacyjnych bardzo dobrze i dobrze.
Wnioski. 1. Zdecydowana większość pensjonariuszy Domu Pomocy Społecznej oczekuje większego zainteresowania ze strony
personelu medycznego, przede wszystkim ze strony lekarza i
pielęgniarki. 2. Zapotrzebowanie na opiekę medyczną zwiększało
się wraz z wiekiem, czasem pobytu, a ponadto występowało częściej u pensjonariuszy, których nie odwiedzali członkowie najbliższej rodziny.
Słowa kluczowe – pensjonariusz, Dom Pomocy Społecznej, opieka pielęgnacyjno-medyczna.
Key words - resident, care home, nursing and medical care.
Author Affiliations:
Streszczenie – Wstęp. W ciągu najbliższych 20 lat niemal co
czwarty mieszkaniec naszego kraju przekroczy próg starości.
Jedną z form pomocy instytucjonalnej dla osób w podeszłym
wieku są Domy Pomocy Społecznej, które świadczą opiekę pielęgnacyjno-medyczną.
Celem pracy jest określenie zapotrzebowania na opiekę medyczną
wśród pensjonariuszy Domu Pomocy Społecznej.
Materiał i metody. W badaniu wzięło udział 150 pensjonariuszy
Domu Pomocy Społecznej „Dom Kombatanta” im. Gen. Mieczysława Boruty-Spiechowicza w Szczecinie. Zastosowano metodę
sondażu diagnostycznego z wykorzystaniem autorskiego kwestio-
1. Nursing Department, Pomeranian Medical University in
Szczecin
2.Students’ Research Club at the Nursing Department of
the Pomeranian Medical University in Szczecin
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
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E. Critical review of the article
F. Final approval of the article
Correspondence to:
Małgorzata Starczewska MD, Nursing Department, Pomeranian Medical University in Szczecin Żołnierska 48 Str.,
PL-71-210 Szczecin, Poland, e-mail: [email protected]
The calculations and statistical analysis have been conducted using the STATISTICA 10 PL package. For qualitative variables, percentage values have been calculated. The
correlation between qualitative variables has been assessed
using the Chi-square test (χ2). In all the analyses, held to be
significant were those effects for which significance level p
amounted to 0.05 (p ≤ 0.05).
Accepted for publication: March 18, 2016.
III.
I. INTRODUCTION
n the nearest 20 years almost every fourth citizen of our
country will cross the threshold of senility. Such a rapid
grow in the population of Polish seniors in the nearest
future results from the fact that the ‘baby boom’ generation
born in the 1950s will be entering the age of senility [1].
The increase in senior population is the effect of, among
others, the development of medical sciences, easier access
to medical services and an improvement in living conditions [2-5]. The transformation brought about mainly by
demographic processes requires preparing actions and new
forms of support and assistance for the growing group of
the elderly who are often viewed as disabled and inactive.
The forms of institutional aid for the elderly include care
homes providing residential, nursing and support services
[6].
The aim of this study is to determine the demand for medical care among care home residents.
I
II. MATERIAL AND METHODS
The study was conducted in 2012 and involved 150 residents of the General Mieczysław Boruta-Spiechowicz
‘Veteran’s Home’ in Szczecin. The research programme
has obtained a positive opinion from the Bioethical Committee at the Pomeranian Medical University.
This survey-based study was performed using an original
questionnaire. The questionnaire included 21 questions and
was composed of two parts. Part one concerned demographic data, i.e. sex, age, education, civil status, children,
visits by relatives and family and the duration of stay at the
care home. Part two included questions concerning the subject of the study, i.e. the assessment of medical care provided at the care home in terms of kindness and understanding of the medical personnel, assistance in personal
care activities and respect for intimacy.
RESULTS
The study group of care home residents comprised 48%
of women (72 people) and 52% of men (78 people) aged
from 60 to over 90. The largest group of 57% (86) consisted of seniors aged 80 to 89, then 27 % (40) were in the age
from 70 to 79. The least numerous group were residents
60-69 years old - 1%. One-third of the respondents had a
secondary education, whereas 31% had an elementary education. A higher education was declared by 13% (20) of
respondents. The vast majority of respondents - 83% (124)
lived a solitary life. Nearly two-thirds (98) of the respondents had children.
The largest group of the residents surveyed - 32%, were
people not visited by their closest family members. The
remaining ones - 31% (46) of respondents had visitors several times a week, whereas 23% (35) saw guests several
times a month. The groups of respondents visited several
times a year and fewer were represented by 7% of the respondents each. The average duration of stay among the
care
home
residents
surveyed
ranged
from
1 year to over 5 years. Most respondents stayed there 4-5
years or more.
In the study group, views on medical care in the care
home were divided; 51% (77) claimed that it was adequate,
and 49% (73) held an opposite view. The vast majority of
care home residents 76% (114) expected more interest from
medical staff. They had the greatest expectations in relation
to the physician - 102 residents, and in relation to the nurse
- 73 people.
According to the respondents, medical care was provided
the best by the physiotherapist and carer – such was the
opinion of 41% (61) of respondents. According to over
one-third of seniors, the nurse administered care very well.
Also one-third believed that she did it well. Evaluated the
lowest was the care provided by the physician, since 29%
found that it was average and 22% viewed it as poor or
very poor.
The greatest politeness, understanding and interest assessed as very good and good were shown, according to
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86% (129) of those surveyed, by the nurses and carers;
somewhat lower were assessed therapists - 84% (126) and
physiotherapists - 80% (120). The worst were assessed
doctors, who obtained very good and good marks from
65% of the residents.
Over two-thirds of the respondents - 69% (103) evaluated the assistance in personal care provided by nurses as
very good and good. None found it to be very bad. In the
eyes of 51% (77) of the respondents, the nurses reacted to
calls very fast or fast. Yet, a similar number, 49%, found
that the nurses reacted in an average, bad or even very bad
manner. The vast majority of residents - 72% (109) were of
the opinion that the nurses reacted very well or well to requests. Barely 12% (17) of seniors believed that the nurse
reacted in a bad or very bad manner.
Most of the respondents - 77% (115 people) assessed the
respect for intimacy during nursing activities as very good
and good. Few people, i.e. 13% (19) considered it as average, and merely 10% as bad or very bad.
In terms of providing information on the type and manner of treatment planned, the best were assessed in the
opinion of 86% (129) of the respondents their carers, and
in the opinion of 85% (128) their therapists; whereas 78%
(116) of the respondents pointed to the physiotherapists
and 71% (106) to nurses. The smallest percentage of 59%
(89) gave doctors the mark of very good and good. This
professional group obtained the most negative opinions in
the scope of providing information. The vast majority of
residents, as many as 93% (140) evaluated the ability to
perform nursing activities such as drawing blood, making
injections or dressings as very good and good and barely
1% (1) found it to be poor.
Almost three-fourths of the respondents - 73% (109)
found that a beneficial influence may be exerted on health
by sport, physical exercise, dancing, and Nordic walking.
59% (88) of the respondents mentioned going for a walk,
whereas 50% of the seniors mentioned entertainment in the
form of playing chess, cards, draughts, solving crosswords,
going to the cinema or theatre and watching television.
Analysed was the influence of selected factors such as
sex, age, education, civil status, having children, visits by
the closest family and duration of stay in the care home on
opinions concerning: nurses’ assistance in personal care
activities and the rapidity of their reaction to calls; information furnished by the medical personnel on the type and
manner of treatment planned; respect for intimacy, politeness, understanding and interest shown by the medical personnel. The analysis of the research material has shown a
statistically significant correlation between the assessment
of nursing assistance and the age of the residents studied
(p≤0.05) (Table 1). In the scope of rapidity of reaction to
calls or respect for intimacy, no statistically relevant correlations have been found (p>0.05).
Table 1. Analysis of the assessment of assistance in nursing
activities, rapidity of reaction to calls and respect for intimacy in relation to selected variables
Assistance
in nursing
activities
χ2
p
Rapidity of
reaction to
calls
χ2
p
Sex
2.40
>0.05
8.10
Age
17.00
≤0.05
Education
3.28
Civil status
Number of
children
Visits by
close family
Duration
of stay
Respect for
intimacy
χ2
P
>0.05
2.58
>0.05
18.66
>0.05
11.55
>0.05
>0.05
14.93
>0.05
10.03
>0.05
1.39
>0.05
1.41
>0.05
2.20
>0.05
2.06
>0.05
1.34
>0.05
6.22
>0.05
8.90
>0.05
11.29
>0.05
24.86
>0.05
3.10
>0.05
12.35
>0.05
19.93
>0.05
χ2 – Chi-square test; p – significance level calculated for χ2
The analysis of the assessment of politeness, showing
understanding and interest by the medical personnel has
demonstrated a statistically significant correlation between
the assessment of the physician and the respondents’ sex
(p≤0.05) and duration of stay (p≤0.01). There is also a correlation between the assessment of the nurse and the duration of stay (p≤0.05) as well as the assessment of the physical therapist and the frequency of visits by the closest family (p≤0.05) and duration of stay (p≤0.05) (Table 2)
The assessment of the carer’s politeness depended significantly on the frequency of visits by the closest family
(p≤0.05). In turn, the assessment of the therapist’s politeness depended significantly on the education of the residents surveyed (p≤0.05), on the fact of having children
(p≤0.01), the frequency of visits by the closest family
(p≤0.05) and the duration of stay in the care home (p≤0,05)
(Table 2).
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p
>0.05
χ2
1.47
p
>0.05
χ2
3.73
P
>0.05
3.07
>0.05
χ2
Therapist
21.05
>0.05
25.39
>0.05
29.16
≤0.05
28.82
≤0.05
30.04
≤0.05
Duration of
stay
≤0.01
21.23
≤0.05
22.32
≤0.05
18.74
>0.05
20.99
≤0.05
χ2 – Chi-square test; p – significance level calculated for χ2
The analysis of the assessment of information provided
by the medical personnel on the type and manner of treatment planned has revealed a statistically significant correlation between the assessment of the physical therapist and
education (p=0.05) as well as between the assessment of
the carer and the frequency of visits by the closes family
(p=0.05) as well as between the assessment of the therapist
and education (p≤0.05) and duration of stay (p≤0.001)
(Table 3).
>0.05
≤0.05
>0.05
>0.05
≤0.001
>0.05
5.20
12.10
1.69
5.85
22.71
1.32
>0.05
>0.05
>0.05
=0.05
>0.05
>0.05
10.91
14.16
8.06
26.28
10.81
0.75
>0.05
=0.05
>0.05
>0.05
>0.05
>0.05
12.46
20.55
5.68
25.43
1.33
>0.05
3.48
15.38
>0.05
>0.05
>0.05
12.55
>0.05
>0.05
>0.05
15.74
Duration
of stay
>0.05
Visits by
the closest
family
17.20
≤0.05
>0.05
≤0.01
17.76
1.23
8.23
>0.05
>0.05
>0.05
16.36
5.84
3.99
>0.05
>0.05
>0.05
16.99
6.15
4.48
>0.05
>0.05
>0.05
13.29
7.57
3.29
>0.05
>0.05
>0.05
Number
of children
χ2 – Chi-square test; p – significance level calculated for χ2
IV.
Visits
by
closest
family
28.83
Number of
children
3.09
Civil
status
5.36
Education
9.44
Civil
status
7.03
Education
2.13
>0.05
14.35
>0.05
8.13
>0.05
16.12
>0.05
10.22
>0.05
9.39
Age
Age
p
Carer
>0.05
3.73
>0.05
5.90
>0.05
5.65
>0.05
4.22
≤0.05
Sex
10.46
Sex
χ2
1.38
p
22.84
χ2
Physical
therapist
Nurse
15.55
p
>0.05
χ2
>0.05
p
>0.05
χ2
>0.05
p
>0.05
2
Physician
χ
p
2
Therapist
6.63
χ
Carer
9.46
p
Physical
therapist
3.15
χ2
Nurse
2.98
Physician
Table 3. Analysis of the assessment of information provided by the medical personnel on the type and manner of
treatment planned in relation to selected variables
2.34
Table 2. Analysis of the assessment of politeness, showing
understanding and interest by the personnel in relation to
selected variables
DISCUSSION
In 2011, according to the Central Statistical Office of
Poland, there were over 5 million people aged 65 and more
in Poland, who constituted approx. 14% of the entire population. It is estimated that within the nearest 20 years almost
every fourth inhabitant of Poland will cross the threshold of
senility, thus joining the group of 8.5 million senior Polish
citizens [1]. The ageing of society brings about social, economic, and political consequences. The ageing generation
become the main clients of medical and social care, and
they constitute a population with a particularly high risk of
old-age diseases and geriatric syndromes [1, 7].
According to Kryszkiewicz, education is one of the factors influencing the condition of health and extending life
expectancy [8]. Well-educated people evince a greater
awareness of a healthy lifestyle and more often engage in
positive health-oriented behaviours. They are equally eager
to engage in activities demanding mental effort, which
slows down dementia and enhances their mental capacity
[9].
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The authors’ own study demonstrated that one-third of the
respondents had a secondary education - 34%, whereas
31% of the respondents had an elementary education and
higher education was declared by 13% of the care home
residents. The results of research conducted by Nowak et
al. considerably differ from the authors’ own study in terms
of secondary education – 21.4% of respondents and higher
education, which did not exceed 1% [10].
In the own study, it has been demonstrated that the vast
majority of residents surveyed - 83% were single people
without a wife or husband. At the same time, the largest
group of respondents - 32%, i.e. nearly one-third, was made
up of people who were not visited by any member of the
close family. Similar results have been presented by Kurowska, who indicated that most care home residents were
solitary people – widows and widowers comprised 57.4%
of the respondents, whereas single people accounted for
20.4%. Furthermore, 70.4% of the respondents did not
have children. According to the same author, the activity of
care home residents always increased following contacts
with family and friends [11], which demonstrates how contact with the closest ones positively leads to
a considerable increase in the physical and mental activity
of care home residents.
According to Chmiel-Perzyńska et al., the politeness of
nursing personnel was assessed the highest by pensioners –
84.9% of good and very good marks, and the assessment
rose with the frequency of using nursing care [12]. The
authors’ own study shows that the greatest kindness, understanding and interest assessed as very good and good were
expressed by nurses according to 86% of the respondents.
The analysis of the authors’ own study concerning the assessment of politeness, showing understanding and interest
by the medical personnel has demonstrated a statistically
significant correlation between the assessment of the physician and the sex of the residents surveyed (p≤0.05). Moreover, a statistically significant correlation has been observed between the assessment of the physician and the
duration of stay at the care home (p≤0.01). Worth paying
attention to is the research by Nowak [10], which has
demonstrated that people who were helped in making a
decision on moving into a care home expected the medical
personnel to show understanding much more than those
who made the decision themselves. In the research by Marcinowicz et al. it has been noticed that both the characteristics of the physician, i.e. age or sex, and the sociodemographic characteristics of the patient: age, sex, education and economic status are broadly considered in quantitative research as variables influencing the satisfaction with
medical care and its evaluation [13].
It results from the authors’ own study that the majority of
residents, i.e. 93%, assessed the skill at performing nursing
activities as very good and good. According to ChmielPerzyńska et al., people who took advantage of a nurse’s
services more often assessed better not only her kindness
but also her skills and competence. This probably results
from the creation of a bond between patients and medical
personnel and the increase in trust concerning their competence [12].
In the authors’ own study, a correlation exists between
the assessment of the nurse and the duration of stay among
the respondents (p≤0.05). According to the research by
Nowak et al., in the case of people staying one month at the
care home, the need for help in everyday activities was the
smallest because those people did not know who to ask for
assistance and what kind of assistance they may use. Similarly, the least help was needed by residents staying 10
months at the care home. It was caused by the fact that they
had already settled in the new place and made friends with
other residents. People who have made such friendships
had significantly smaller expectations in relation to the
medical personnel than those who remained solitary, which
may be the result of peer assistance [10].
According to Kurowska, the purpose of care of the elderly is not so much attempting to restore their former vitality
and health, even though such a result is undoubtedly desirable, as improving the quality of the residents’ life, providing them with the necessary assistance and care without
leading to their incapacitation at the same time [11].
The results of the authors’ own study have shown that
the respondents expected, above all, the physician to take
greater interest in them - 102 people, and then the nurses 73 people. In turn, in the results of the research by Nowak
et al., the respondents consider the nurse to be the most
helpful person in care home conditions and they have the
greatest expectations in relation to her [10].
Based on the research by Grywalska et al., it has been
found that the availability of medical help is one of the
most essential measures of quality in healthcare, which is
why it should be continuously improved [14]. According to
Kurowska, the task of carers is especially to educate and
promote actions leading to self-sufficiency, stimulating
understanding and acceptance of the situation in which the
patients found themselves and convincing them that in spite
of illness and disability they can and ought to lead a wholesome lifestyle [11].
The research conducted by Głowacka et al. among seniors from the Tuchola County proves that the elderly adopt
a negative attitude towards senility, which results mainly
from somatic ailments causing mobility and functional re36
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strictions. It has been found that senior citizens spend too
little time on physical activity [15]. Research by Drobnik et
al. has demonstrated that the consequence of reduced physical activity is the reduction in the quality of seniors’ life,
and therefore the rehabilitation of a senior citizen should be
multi-faceted, and thus effective in raising the quality of
life in that period [16]. Grzegorczyk et al. provide that
conducting a rehabilitation programme for seniors depends
on multiple factors. First of all, it is necessary to win the
patient’s trust by constantly caring for his or her health and
to convince that person that it is purposeful to systematically exercise and engage in physical activity – this is best
achieved by showing an example from that person’s environment [17].
The results obtained in the present study demonstrate
that care was administered the best by the physiotherapist,
as 41% of the respondents believe. Consequently, we may
assume that a properly conducted rehabilitation programme, apart from having a positive influence on the resident, also leads to a better assessment of the physical therapist.
Based on the own research, assessed the best by the residents in terms of providing information about the type and
manner of planned therapy have been carers – 86% and
therapists – 85 %. Then, very good and good marks have
been obtained by physiotherapists – 78 % and nurses –
71%. The smallest percentage of respondents, i.e. 59%,
evaluated physicians as very good and good. Patients ought
to be informed about the course of treatment as well as all
activities performed in relation to them by the entire medical personnel. According to Kamińska et al., it is the obligation of the medical personnel to inform the patient about
his or her rights. It is a reason for concern that in the research of the above authors, only 44% of the respondents
were familiar with patients’ rights. Most respondents - 83%
replied that it was the doctor that had a conversation with
them concerning treatment; in turn, half of the patients admitted that nurses talked to them about personal care. Research has shown that doctors talk to patients more often
about treatment than nurses about personal care [18], which
is a considerable difference in relation to the own study.
The study conducted has shown that the vast majority of
respondents, i.e. 73% believed that active rest could have a
positive influence on health: sport, physical exercise, dancing, Nordic walking, whereas 59% pointed to going for a
walk, and 50% of residents mentioned entertainment, i.e.
chess, playing cards, draughts, crosswords, going to the
cinema or theatre and watching TV. In research by Kurowska et al., it has been demonstrated that 16.7% of the respondents participated in the proposed occupational thera-
py such as handicraft and painting, then 14.8% took part in
walking trips, coach trips, outings to the theatre, philharmonic or cinema, whereas further 11.1% of the respondents
took part in events organized in the care home such as
dancing parties, and finally 55.5% visited their family and
friends [11]. The conclusion is that care home residents
know what has a positive influence on their health, but they
do not make use of their knowledge in practice.
The own study and research by other authors have shown
the importance of a proper attitude of the medical personnel, i.e. understanding, respect for dignity, maintaining intimacy during care and therapeutic activities as well as politeness and interest expressed in relation to care home residents, and what benefit it brings. The residents expect acceptance and assistance in everyday activities, and when
they receive it, they show gratitude and satisfaction with the
care provided. It is necessary to become familiar with their
expectations and wishes, which is an individual issue
shaped by multiple factors. The provision of top-quality
nursing and medical services to seniors ought to spring
from not only the progress of medical sciences and civilizational development, but also from a moral obligation to that
effect.
V.
CONCLUSIONS
 The vast majority of care home residents expected
greater interest from the medical personnel, especially from the physician and nurse.
 The need for medical care increased with age and
duration of stay. Furthermore, it concerned more
often those residents who were not visited by the
closest family
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