Impact Of Community Health Workers On Care And Management Of Elderly Condition
ABSTRACT
The study was carried out on the impact of community health workers on care and management of elderly condition. The study was limited to community health workers in University of Calabar Teaching Hospital, Calabar, Cross River State. The study adopted a cross sectional descriptive design. The population of the study was 1023 community health workers, which was made up of 402 Doctors, 600 Nurses, 10 Dentists and 11 Physiotherapists that provided direct clinical care of elderly patients. The sample was calculated using Taro-Yamane (1967) simplified formula for finite population giving a sample of 461 community health workers. The instrument for data collection was questionnaires, the reliability of the instrument was done using test retest method and a reliability co-efficient of 0.91 was obtained. Attitude, practice and section E elicited information on factors influencing the care of the elderly. The completed questionnaire was coded and analyzed using E.P.I info-7. Descriptive statistics of percentage, mean, standard deviation were used for data analysis. The criterion mean of 2.5 was also used and results of the study revealed that 95% of the community health workers had good knowledge of care of the elderly. Majority of the community health workers had positive attitude above rating scale of 2.5. The community health workers moderately practiced care of the elderly. The factors that positively influenced community health workers attitude to the care of the elderly were years of experience, age and mental state of the elderly. There was significant association (P<0.05) between attitude of Community health workers and mean years of experience. Workers with less years of experience had negative attitude, while those with more years of experience had positive attitude, towards the care of the elderly. In conclusion, health care professionals need to have the right skills to manage a more demanding role in the future. In order to offer effective services for the elderly, a skilled workforce of health professionals is therefore very necessary. The study recommended that Geriatric Nursing content in the curriculum be strengthened and also geriatric wards be established in all general hospitals.
CHAPTER ONE
INTRODUCTION
Background to the Study
Ageing is the accumulation of changes in a person over time (Bowen and Atwood 2004). It involves a multidimensional process of physical, psychological and social change. Some dimensions of aging grow and expand over time, while others decline. Research shows that even in late life, potentials exist for physical, mental and social growth and development (Papalia, Sterns, Feldman, and Camp, 2002). It is not a disease; but phase of life where there is retrograde biological process in growth and development which leads to decreased powers for survival and adjustment. Aging is an important part of all human societies reflecting the biological changes that occur and also reflecting cultural and societal convention.
An estimated 100,000 people worldwide die each day of age related causes (Aubrey de Grey, 2007). According to National Population Commission (NPC, 2006), persons who are old enough to receive pension who are between ages of 60-65 years are regarded as the elderly. The elderly are classified by age into young old for those aged 60-74years, middle old for those aged 75-84years, old for those aged 85-94 years and oldest old for those 95years and above. (Barman, Snyder, Kozier & Erb , 2008).
Care of the elderly is the fulfillment of the special needs and requirements that are unique to senior citizens. It covers such services as assisted living, adult day care, long term care, nursing homes, hospice care and home care. Elderly care emphasizes the social and personal requirements of senior citizens who need some assistance with daily activities and health care, but who desire to age with dignity. The care of the elderly is multidimensional and these include physical, emotional, spiritual and social care (Ayres, 2008).
However, improvement in primary health care with focus on prevention of childhood diseases through immunization did not highlight the care of the elderly which should be one of the components of primary health care programme in most developing countries (Olise, 2011). A cursory look at the implementation of Millennium Development Goals (MDGs) by the federal government shows that there is little or no consideration of this very important segment of the population – the elderly. Also most curricula for training Health Manpower in Nigeria do not highlight the care of the elderly (Donatelle, 2011). Yet the population of this segment of the society is increasing in developing countries with their special care needs. Traditionally, in Nigeria elderly care has been the responsibility of family members and was provided within the extended family system (Ting and Woo, 2009).But with modernization, elderly care is now being provided by state or charitable institutions. This is attributable to decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home (Lee, 2009).
In most developing countries including Nigeria the population of the elderly is increasing rapidly but the government does not seem to be making any major commitments to elderly healthcare (Adio-Moses, 2001). The government is still assuming that families should take care of their elderly without recognizing that the extended family system is at the verge of collapse.
Currently most families find it difficult to manage their own homes and face their challenges. This is gradually leading to neglect and abuse of the elderly (Gubrium, 2002). Care of the elderly requires adequate knowledge of the ageing process, nutrition and daily needs of the elderly. In Nigeria, marginalization of the elderly especially in their care is a common episode (Abdulraheem & Parakoyi, 2005). Those involved in the provision of health care have important roles to play in programmes relating to elderly care especially in screening and detecting abuse.
Unfortunately doctors do not diagnose abuse because it is not part of their formal or professional training hence does not feature in their list of differential diagnosis (Donatelle, 2011). The health worker, according to Abdulrahem & Parakoyi (2005) plays major roles in determining and implementing desirable standards of health care, acting as a professional in developing core of professional knowledge and should have ability to impart same to others. They are often the providers of services designed to maintain health and prevent illness. Research has also shown that the quality of health care service provided to older population is strongly influenced by care givers attitude towards older people (Gallaghar, Bennet & Halford, 2006). This underscores the impact of community health workers on care and management of elderly condition in University of Calabar, Calabar Cross River State.
Statement of the Problem
The population of the elderly in the world is increasing rapidly (United Nations, 2004) and the rate of increase is higher in developing countries including Nigeria. Currently, Nigeria has the highest number of the elderly people in Africa estimated to be about 5.6% of the Nigeria population (NPC, 2008). With this increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase. Donatelle (2011) posited that in most curricula for health professionals, little or nothing is indicated about the care of the elderly showing absolute neglect in this area Mclafferly and Morrison (2004) stated also that most community health workers have very poor knowledge of mental health conditions which are common with the elderly and as such community health workers come to service with deep seated, negative, diluted and superstitious belief about caring for the elderly. This lack of adequate knowledge and negative attitude towards the care of the elderly may result in serious problems in our society in the near future. In a recent study of the elderly in Ibadan by Oyetunde, Ojo & Ojewale (2013) show that attitudinal relational gaps exist, resulting in negative patient outcome. From my clinical practice in different hospitals in Calabar, frequent misunderstanding between elderly patients and health care providers especially the young ones, was observed. Based on these, the researcher seeks to find out the the impact of community health workers on care and management of elderly condition in the only tertiary health facility in Calabar, University of Calabar Teaching hospital.
Purpose of the study
The purpose of the study is to determine the impact of community health workers on care and management of elderly condition in University of Calabar Teaching Hospital, Calabar, Cross River State.
Objectives of the study
Specifically the objectives of the study include to:
- determine the community health workers level of knowledge of the physical, emotional and social care of the elderly in University of Calabar Teaching Hospital ,Calabar, Cross River State
- determine the attitude of the community health workers towards the care of the elderly.
- determine the community health workers practices in the provision of care for the elderly.
- identify the factors that influence community health workers attitude of care towards the elderly in
University of Calabar Teaching Hospital, Calabar.
Research Questions
- What is the level of knowledge of the care of the elderly among community health workers in a tertiary health facility in Calabar, Cross River State?
- What is the attitude of community health workers towards care of the elderly in a tertiary health facility in Calabar?
- What are the community health workers practices in the provision of care of the elderly in a tertiary health facility in Calabar, Cross River State?
- What are the factors that influence community health workers attitude of care towards the elderly?
Hypothesis.
- There is no association between years of experience of community health workers and their attitude towards care of the elderly in UCTH, Calabar.
Significance of Study
The result will help to provide basic information for designing structures and programmes for the care of the elderly in the community. It will also provide evidence based information for health education on graceful ageing. It will serve as a reference material to other researchers in the field of community health practice.
Findings of the study will help in showing the level of knowledge and attitude of the community health workers towards the care of the elderly and will help improve the decision making. The result will also help in building up knowledge base on the care of the elderly patients. Improving data base on elderly health nutrition and standard of living which will help for further research, advocacy, policy dialogue and programming.
Scope of Study
The study focused on the impact of community health workers on care and management of elderly condition in University of Calabar Teaching Hospital, Calabar. The study was delimited to only community health workers providing direct clinical care (hand on care to the elderly) consisting of nurses, doctors, dentists and physiotherapists in University of Calabar Teaching Hospital.
Operational Definition of Terms
Knowledge of physical care are expressing understanding of bed bath, skin care, oral hygiene, feeding, elimination and ambulation.
Knowledge of Emotional care; refers to expressing attention, acceptance and love.
Knowledge of social care; means financial support and visitation by family members and friends (co-workers, church member’s, social club, and neighbors).
Practice of physical care expressing competence in providing skin care, oral hygiene, feeding, ambulation and elimination.
Attitude means community health workers’ expression of cheerfulness, listening to patient’s complaints and prompt attention, positive attitude while negative attitude means expression of harsh words, lack of respect and “stone face”.
Community health workers refers only to Nurses, Doctors, Physiotherapists and dentists that are directly involved in the clinical care of the elderly.
Elderly refers to people aged 60 years and above.
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