Nursing Care for Poor Essay

Excerpt from Essay :

Polypharmacy Low Income Elderly

Poly-Pharmacy Low Income Elderly

The author of this report will offer a brief treatise on several social theories, one relating to nursing and one of them not related to nursing, and how they related to poly-pharmacy low income elderly patients. After describing the low income elderly group and what makes the vulnerable, there will be a description, compare and contrast of the theories. The theories that shall be covered are the Imogene King theory and the Erikson theory. While painting with too broad a brush as it relates to the vulnerability of low income elderly patients or social and cultural theories in general is unwise, some general trends and outcomes are fairly consistent and easy to spot with a little observation and analysis.


The group up for analysis in this report is poly-pharmacy low-income elderly patients. Poly-pharmacy is typically defined as a patient that takes four or more medications at the same time and the medications are usually for one or more chronic conditions that are being managed and controlled. The phenomenon of poly-pharmacy is seen as a growing problem. Indeed, it is seen as a problem around the world and not just in the United States. The three mains reasons for the rise in poly-pharmacy are co-morbidity, longer life expectancy and the general habit of using evidence-based practices when diagnosing and treating diseases. The latter of that last would obviously include a fair amount of prescribed medications. The poly-pharmacy trend is prevalent across all income levels but seems to manifest as more of a problem for the poor and frail (Sergi et al., 2011). Beyond that, there is an elevated level of concern as it relates to dimensions such as after-discharge care for the low income frail elderly, sometimes referred to as AD-LIFE. The overall portion of the United States elderly population that can be classified as impoverished is a scant ten to fifteen percent but the portion of the population that is elderly has skyrocketed in the last few decades and will continue to do so because of the post-WWII baby boom that then swooned in the 1960's (Allen et al., 2011).

The topic above dovetails quite nicely with the two social theories mentioned in the introduction. The first, and the one that pertains to nursing, is the Imogene King theory of goal attainment. The theory interweaves and interlaces the concepts of interaction, development, growth and stress into a singular model that has its main goal as being the setting and attainment of goals. While it may not be intuitive to some that this theory correlates even to people that are heavily medicated or near death, this is absolutely the case. Indeed, a recently scholarly work in the field of nursing cited that home care personnel in Brazil can and should use the Imogene King theory as the basis of their care practices (Vieira, 2013).

In comparison and contrast, there is the Erikson model. The Erikson model is not specifically related to nursing but it can absolutely be used with nursing as its prism. The eighth stage of Erikson's model happens to be the one that corresponds to what is being spoken of in this report. The eighth stage relates to the age bracket of sixty-five years and older. The two main expected outcomes and happenstances during such a stage is integrity or despair. The catalyst for which one occurs and which one does not is how a person assesses their life's work of actions and deeds as well as their current state. Their current state could include things such as family and hobbies but often it links very closely to health status and economic resources and both of those are directly related to low income elderly that are in poly-pharmacy status as there is both a correlation and a causality between older age and the need to manage one or more chronic condition. Whether it be heart disease, diabetes, or something else, eighty-five percent of all people over sixty-five years old have at least one chronic disease that is being managed. Compare this to the fact that two of the major parts of the eighth stage of Erikson's hierarchy are perceived health and geriatric depression scale, it is easy to see how Erikson's model could be applied to poly-pharmacy low income elderly even though Erikson's model is not a nursing model specifically (Hearn et al., 2012).

To combine the two models, this would be a melding of goal setting and attainment and focusing on integrity by reduction depression symptoms and including the perceptions that low income elderly people on multiple medications have about themselves. The former of those two would be the application of the Imogene King model and the latter would be the Erikson model. There are obvious and easy-to-see applications for both of these models separately as well as in concert given the psychological concerns that are omnipresent and prevalent with the elderly. Examples of these considerations include wisdom and intelligence, cognition and creativity, mentoring, emotions and aging, bereavement and grief, and a focus on longevity through increase activity and engagement. Example of the longevity focus would include shoveling the snow rather than using a snow blower or take a quite walk to reduce stress. The implications of elder care as well as the proper use of the two social models in this report are staggering given that roughly a quarter of all elderly have at least one major psychological disorder. These disorders run the gamut from anxiety and depression to panic and somatic issues such as stomach cramps (Eckstein, Eckstein & Mullener, 2010).

Given the above, the author of this report will now synthesize how the two theories above can be used when servicing and assisting the poly-pharmacy low income elderly. Obviously, income and resources are issues for these patients and they are likely taking the medications for good reason. The two theories mentioned in this report can both be used to get patients on the right track and to keep them healthy and happy as possible. When speaking of the Imogene King theory, the goals should be centered on remaining active and taking the right medications at the right time. This would include homecare specialists making sure that medication is being taken and at the right intervals. Keeping activity upbeat and consistent, even if it is just walking slowly on a path, can be a great way to life one's spirits and to help mitigate at least some of their health issues.

When thinking of the Erikson model, the focus would be similar but would also be different. The Erikson model states that integrity or despair will take hold and that perceived or actual health if a huge part of that. When coupled with the Imogene King theory, proper medications being prescribed as well as general medication management is a great way to improve both perceived and actual health. Filling information voids with tangible knowledge and proof of improvements in body levels such as cholesterol or blood sugar can help boost the spirits of the patient because they are attaining goals and their perceived health is improving. The former of those two speaks to the Imogene King theory and the latter speaks to the Erikson model.

The elderly population group is growing by leaps and bounds but the invective and demagoguery also seems to be growing. Indeed, health care always seems to be front and center in the political and social spheres and the recent years have been no exception with the passage of the Patient Protection and Affordable Care Act and the ensuing implications on Medicare, Medicaid and Social Security. Combine this with the fact that the demographics of the United States, as noted before, are getting quite top heavy with elderly people taking up more and…

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