Geriatric Assessment and Long-term Care

Across the world, countless countries are facing the same difficult question: What is the most ethical, effective, and financially responsible way to provide care for the elderly? A number of different approaches have been tried, including socialized medicine, privatized insurance programs, and several variations of the two (TerMeulen, 1995). Attempts from all countries have failed to maintain a fully funded climate of quality long-term and acute care for its nation’s oldest citizens (Hanson, 1995).

For real reform to succeed, researchers, politicians, advocates and members of the geriatric community must unite to prioritize a discussion of what programs still provide promise and which have already failed. Considering this unmet healthcare need from an international perspective, Hanson (1995) identifies the commonalities across countries that are contributing to the growing need and dwindling resources for elderly care. The elderly population has increased and continues to grow across the world.

As a result of technologically driven medical improvements and a greater emphasis on medicalization to prolong life, the human life expectancy has increased (Moody, 1995). While life expectancies may be universally longer, the meaning of a longer life is not shared by all societies. Moody (1995) details four variations of the meaning behind a longer life. The first scenario, described as the prolongation of morbidity, equates the value of life to the quality of life. With this belief, right-to-die and other movements have risen.

It is the individual’s responsibility and freedom to make personal decisions about death. Compression of morbidity centers on successful aging with the goal to promote the longest lives for the greatest number of people. This attribution of meaning would place perhaps even greater strains on already unwilling governments. Most countries are not even recognizing the alarming need for improved elderly healthcare services, much less considering the possibility of expanding their offerings (Hanson, 1995; TerMeulen, 1995).

Moody (1995) addresses two additional variations in the meaning attached to a longer life. The third, called lifetime extension, is perhaps the most biomedically based. It prioritizes technological progress and ideally aims to extend life as long as possibly without infringement by a number of costly and debilitating conditions (Moody, 1995). This scenario is probably the least grounded in the reality of most systems because technology and advancements do not yet have the ability to cure most of these diseases, like dementia and arthritis, which limit the quality of life late in age.

The fourth meaning of longer life is the most sociologically sound as it shifts focus from cure to care and assigns the responsibility of discussing death and the end of life to the society as a group (Moody, 1995). With intergenerational involvement, a solution to this broken system is within reach. The use of psychosocial resources is an effective way to improve conditions for all people involved in the elderly healthcare crisis.

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