Nsn728 Health Care Context And Assessment Answers

The age structure of developing countries is changing rapidly and it is going to significantly affect the percentage of people above 6 years in the next several decades. According to the World Health Organization report, the number of people above sixty five years is likely to grow from 524 million in 2010 to 1.5 billion in 2050 (World Health Organization, 2017). This form of change in age distribution is translating to huge burden of CVD in elderly population.  The burden of CVD has been measured in terms of morbidity, mortality and cost of managing CVD. Hence, unless the prevalence of CVD in the population is controlled, it is going to present new challenges to the health care system.  It will automatically increase the burden for health care staff and the double the rate of hospital admission for Baby boomer (Beard et al., 2016). Hence, how health care system and health care professionals is going to deal with large number of patients with CVD is a debatable question for developing countries.

Impact of the issue on population health:

Population based statistics and incidence data can give idea regarding the burden of CVD in Australia. CVD is regarded as the one of the major cause of death in Australia and it has become biggest public health issue. The people above 65 years are the one who are currently living with long term CVD (Heart Foundation, 2017). With an increase in trend of worldwide ageing population, high rate of mortality in elderly people will be seen due to CVD. The risk of CVD is high in elderly people not only because of physiological changes due to ageing (Yazdanyar & Newman, 2009). However, the risk is high because of cumulative exposures and presence of other risk factors of CVD throughout their life. For example, hypertension is a common ailment among older adults and it is one of the vital risk factors for CVD. Wu et al. (2015) explains that 54% of strokes and 47% of coronary heart disease occurs due to hypertension. Hence, morbidity and mortality due to CVD is high in elderly people because of exposure to cumulative risk throughout their life. Unless the health care system is prepared to deliver age-appropriate services for CVD, complex morbidities in elderly people cannot be properly managed. Hence, future health care cost is mostly likely to cross health related expense (Prince et al., 2015).

The impact of CVD on population health is understood from the impact of CVD on successful ageing process. The diagnosis of CVD may intersect with successful ageing because of the presence of other disability like poor functional ability and cognitive issues in elderly population. Evidence suggest that prevention and management of CVD in elderly people is a challenging issue because of poor attitude towards medical treatment for people with limited life year, greater use of medication, high chance of drug interaction and change in risk-to-benefit intervention for older adults compared to younger adults (Greenlund et al. 2012). Jackson & Wenger (2011) supports the fact that care of elderly patient with CVD is not the same as care of young adults with the same condition. Gait and immobility issues are most common found in elderly population and sedentary lifestyle of elderly people because of these issues further exacerbates the medical condition of the elderly population. The burden of CVD has significantly shifted towards older person in the past few years and the frailty is one condition that can further make elderly people vulnerable to stressors after diagnosis of CVD. Frailty can further increase the risk of cardiac surgery and cardiovascular mortality in the population (Singh, Stewart & White, 2014).

Impact on health service provision:

A disease is considered a public health issue when it significantly alters health service provisions and creates additional burden on the health care system. The diagnosis and prevalence of CVD is one of those issues that has created burden on the health care staffs by increasing hospitalization rates as well as the cost associated with care (Roever, Tse & Biondi-Zoccai, 2018). Fayet-Moore et al. (2018) reports that CVD is one of the leading cause of illness, disability and mortality in Australia. Hence, increase in health expenditure due to increase in morbidity and mortality had led to loss of productivity. The significant impact of CVD prevalence on Australian health care system is understood from the fact that total health care expenditure has doubled since 2003 and it is expected to triple by 2031-32 (Fayet-Moore et al., 2018). Hence, effective interventions are required to reduce the burden of CVD on the Australian population.

As older people are more vulnerable to CVD risk, the responsibility of managing mortality and morbidity associated with CVD has fallen on the CVD caregivers. Elderly people are more like to be diagnosed with CVD because of accumulating morbidities, diminished homeostasis and long-term adverse effects of several CVD risk factors. Another issue for care provider is that clinical presentations for CVD may vary for each individual because aging related changes may vary in different individual (Forman et al., 2011). Hence, this creates challenges for the cardiologist and other health care staffs as developing individual preventive strategies would be difficult.

Another major impact of the prevalence of CVD in elderly population is that it has created many challenges for health service staffs as they have faced challenges in treating CVD because of poor medication adherence related issues. Medication adherence is crucial to save long term health care expenditure and reduce burden of the health care system. However, in relation to CVD management in older adults, it has been found that low medication adherence has significantly reduced the effectiveness of treatment for CVD conditions and its risk factors like hypertension and hyperglycemia. Cognitive impairment and memory problem in elderly population is one of the reasons for poor medication adherence in the elderly. Depression and social isolation also affect medication adherence rate in elderly people (Hennein et al., 2018). Hence, in response to the barriers faced in CVD management because of non-adherence to medication, health care providers should prioritize addressing non-adherence issues to improve population health. As non-adherence is a dominant risk factor for poor outcomes, there is a need for health care providers to identify people who are most prone towards non-adherence. This may help to implement tailor made intervention to resolve drug-specific issues for individual patient and lead to help improvement for people with CVD or those at risk of CVD (Kolandaivelu et al., 2014).

In response to the rising prevalence of CVD, the Australian government has taken many actions to deal with the issue. One of them was development of six actions to tackle CVD in Australia. This included development of a national health and stroke strategy, identifying people at risk, funding CVD research fellowships, helping Australians to remain physically active by development of a national physical action plan, reducing gap related to rheumatic heart disease and improving participating in cardiac rehabilitation services (National Heart Foundation of Australia, 2016). The above mentioned six actions identified the problems areas and looks to address them to prevent the CVD prevalence rate. To effectively implement the above mentioned actions, the contribution of the primary health care sector will be crucial as it can play an active role in identifying people at risk and managing CVD risk. However, the primary care sector need to collaborate with community based lifestyle modification services such as to provide adequate behaviour change support to people at risk. Volker et al. (2014) revealed that Medicare Locals is one primary health care organization in Australia that has played a key role in encouraging primary health care industry  to deal with chronic disease. Strategies like incentives can promote employment of more practice nurses and inclusion of community sector in community program has the potential to significantly reduce and prevent CVD in Australia.

Impact on nursing practice:

With the increase in morbidity and mortality associated with CVD worldwide, urgent need is required for special heart failure nurse to facilitate self-management of CVD in high risk population such as elderly people. Local nursing practice has been highly affected by the rise in number of CVD as majority of nurse come with experience in general practice and there is lack of nurse who have specialized skills in heart care.  Despite skill related gap, practice nurse also have the potential to assume wider role such as that of administrative role and providing guidance and education to clients regarding complex care needs for patients with CVD (O'connell, Gardner & Coyer, 2014). Skill expansion is also necessary because CVD is associated with many co-morbid conditions too which increases the complexity of CVD management process (Chamberlain et al., 2015). To overcome this issue, providing adequate support to practice nurse is important so that they can take adequate follow-up from multi-disciplinary team and optimize supportive care for elderly people with CVD. Fuller et al. (2015) supports the fact that increasing competence related to CVD management is necessary to effectively coordinate care and provide high quality care for chronic disease like CVD.

As nurses are the staffs who spend the maximum time in primary care, they are in the best position to provide round the clock care to patients with CVD. Based on the current evidence, some of the barriers faced by nurse in carrying their responsibility included work overload, lack of specialized skills for CVD management and shortage of nursing staffs. Skill training for existing Australian nurse needs to be prioritized so that they can smoothly handle cardiac events and cardiac emergencies in elderly population. In case of cardiac emergencies, there is a need to activate the emergency system and initiate resuscitation process. In the phase of cardiac rehabilitation too, more supportive action is needed by nurses. Australian nurses must be encouraged to take on wider roles such as that of a care provider, a counselor and educator for patients. This would help to resolve issues experienced during secondary prevention (Victor, Sommer & Khan, 2016). 

Record et al. (2015) states that people living in rural or remote areas have worse CVD outcome compared to those living in urban areas. Recent statistics reveal that mortality rate increases by remoteness and more number of Australians living in rural areas are going to die from coronary heart disease compared to other diseases. This trend gives the insight that pro-active preventive action is needed for people in regional communities. Hence, nurse-led management program is a cost-effective solution to reduce risk level, minimize hospital stay and prolong survival for people with CVD. The cost-effectiveness of the strategy has been tested by Carrington and Stewart (2015) conducting research to analyze the benefits of a nurse-led intervention on reducing risk of CVD in rural Australians. After risk assessment, multiple and tailor made intervention was implemented and after three months of intervention, significant improvement in risk factors was found. Physical activity measures improved in research participants and dietary changes were observed. This proves that nurse led management is an effective solution to deal with future burden of CVD in elderly population of Australia.

Conclusion:

The paper gave an insight into the issue of CVD prevalence in Australia and globally and presented the burden to the health care system because of the high likelihood of CVD risk in elderly population. The discussion regarding the impact of the issue on population health and health service provision reflected that CVD has increased health care expenditures, escalated hospitalization rate and increased the burden of care for health care staffs. In response to these issues, several strategies were implemented by the Australian government. To achieve the goals of the six actions, it is necessary to collaborate with community support agencies. The evolution of the nurse’s role in CVD management is also critical to promote self-management skills in high risk individual and improve health of the affected population. 

References:

Australian Institute of Health and Welfare (2017).Older Australia at a glance. Retrieved from: https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/demographics-of-older-australians/australia-s-changing-age-and-gender-profile

Beard, J. R., Officer, A., de Carvalho, I. A., Sadana, R., Pot, A. M., Michel, J. P., ... & Thiyagarajan, J. A. (2016). The World report on ageing and health: a policy framework for healthy ageing. The Lancet, 387(10033), 2145-2154.

Carrington, M. J., & Stewart, S. (2015). Cardiovascular disease prevention via a nurse-facilitated intervention clinic in a regional setting: the Protecting Healthy Hearts Program. European Journal of Cardiovascular Nursing, 14(4), 352-361.

Chamberlain, A. M., Sauver, J. L. S., Gerber, Y., Manemann, S. M., Boyd, C. M., Dunlay, S. M., ... & Roger, V. L. (2015). Multimorbidity in heart failure: a community perspective. The American journal of medicine, 128(1), 38-45.

Fayet-Moore, F., George, A., Cassettari, T., Yulin, L., Tuck, K., & Pezzullo, L. (2018). Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis. Nutrients, 10(1), 34. https://doi.org/10.3390/nu10010034

Forman, D. E., Rich, M. W., Alexander, K. P., Zieman, S., Maurer, M. S., Najjar, S. S., … Wenger, N. K. (2011). Cardiac Care for Older Adults: Time for a New Paradigm. Journal of the American College of Cardiology, 57(18), 1801–1810. https://doi.org/10.1016/j.jacc.2011.02.014

Fuller, J., Koehne, K., Verrall, C. C., Szabo, N., Bollen, C., & Parker, S. (2015). Building chronic disease management capacity in general practice: The South Australian GP plus practice nurse initiative. Collegian, 22(2), 191-197.

Greenlund, K. J., Keenan, N. L., Clayton, P. F., Pandey, D. K., & Hong, Y. (2012). Public health options for improving cardiovascular health among older Americans. American journal of public health, 102(8), 1498-1507.

Heart Foundation (2017). Heart disease in Australia. Retrieved from: https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia

Hennein, R., Hwang, S. J., Au, R., Levy, D., Muntner, P., Fox, C. S., & Ma, J. (2018). Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study. Internal medicine journal, 48(4), 414-421.

Jackson, C. F., & Wenger, N. K. (2011). Cardiovascular disease in the elderly. Revista Española de Cardiología (English Edition), 64(8), 697-712.

Kolandaivelu, K., Leiden, B. B., O'gara, P. T., & Bhatt, D. L. (2014). Non-adherence to cardiovascular medications. European heart journal, 35(46), 3267-3276.

National Heart Foundation of Australia (2016). Six actions the next Australian Government must take to tackle our biggest killer: Heart Disease. Retrieved from: https://www.heartfoundation.org.au/images/uploads/main/Your_heart/Federal-Election-2016-6-Actions-for-Tackling-Heart-Disease-HFN0892.pdf

O'connell, J., Gardner, G., & Coyer, F. (2014). Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing. Journal of advanced nursing, 70(12), 2728-2735.

Prince, M. J., Wu, F., Guo, Y., Robledo, L. M. G., O'Donnell, M., Sullivan, R., & Yusuf, S. (2015). The burden of disease in older people and implications for health policy and practice. The Lancet, 385(9967), 549-562.

Record, N. B., Onion, D. K., Prior, R. E., Dixon, D. C., Record, S. S., Fowler, F. L., ... & Pearson, T. A. (2015). Community-wide cardiovascular disease prevention programs and health outcomes in a rural county, 1970-2010. Jama, 313(2), 147-155.

Roever, L., Tse, G., & Biondi-Zoccai, G. (2018). Trends in cardiovascular disease in Australia and in the world. Retrieved from: https://journals.sagepub.com/doi/full/10.1177/2047487318778339

Singh, M., Stewart, R., & White, H. (2014). Importance of frailty in patients with cardiovascular disease. European Heart Journal, 35(26), 1726–1731. https://doi.org/10.1093/eurheartj/ehu197

Victor, G., Sommer, J., & Khan, F. H. (2016). 21st century nurse's role in decreasing the rising burden of cardiovascular disease. Anaesthesia, Pain & Intensive Care, 20(4).

Volker, N., Davey, R. C., Cochrane, T., Williams, L. T., & Clancy, T. (2014). Improving the Prevention of Cardiovascular Disease in Primary Health Care: The Model for Prevention Study Protocol. JMIR Research Protocols, 3(3), e33. https://doi.org/10.2196/resprot.2882

World Health Organization. 2017. Global health and ageing. Retrieved from: https://www.who.int/ageing/publications/global_health.pdf

Wu, C.-Y., Hu, H.-Y., Chou, Y.-J., Huang, N., Chou, Y.-C., & Li, C.-P. (2015). High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults. Medicine, 94(47), e2160. https://doi.org/10.1097/MD.0000000000002160

Yazdanyar, A., & Newman, A. B. (2009). The Burden of Cardiovascular Disease in the Elderly: Morbidity, Mortality, and Costs. Clinics in Geriatric Medicine, 25(4), 563–vii. https://doi.org/10.1016/j.cger.2009.07.007