Nursing Care of Elderly People at Home and Ethical Implications: an experience from Istanbul

Abstract

Elderly people are a particularly vulnerable group in society and have special health problems. The world population of older people is increasing. People who are 65 years or older constitute 6% of the Turkish population, 90% of whom have chronic health problems. In Turkey, there is a high possibility that elderly people's requirements are not met by today's health care system in the way they would wish. They prefer not to be hospitalized when they have health problems. From a wider perspective, various countries are still seeking how to provide the best care for elderly people. Our goal was to characterize home-based care for elderly people using an ethical approach as an area of interest for nurses and other health care professionals now and in the future, both for Turkey specifically and from a global perspective. We studied four case histories and then prepared a composite scenario and a short questionnaire for elderly people living in a specific district of Istanbul to evaluate their expectations from the health care system. We compared our findings with situations in other countries and have proposed some practical solutions. The results showed that these older people preferred to receive nursing care at home instead of in hospital in Turkey, and also in many other countries. In this article we discuss our findings, comparing them with those in the literature, and suggest that there should be nursing care at home with insurance coverage while using a proper ethical approach.

Home care for older people

“…Although this obviously solves the problem of parental care for well-off sons and daughters, these nurses cannot be employed by families who are less well-off, as their services are only partially covered by private insurance. 10 It is not only in Asian cultures that older people expect their sons and daughters to look after them. For instance, in France caring by sons and daughters has been 'a natural obligation'.…”

Quality of Life and Attitudes Toward Aging Among Older Women in Turkey

“…The existence of charity institutions in all periods throughout Turkish history shows that elderly people were always assisted and protected in Turkish society (State Planning Organization, 2007). These services have been provided mainly by the Association of Social Services and Child Protection and, to a lesser extent, by local administrations, foundations, associations, some public organizations, and private individuals with the aim of helping many old people at the same time (Doğan & Değer, 2004). However, in Turkey, professional home care foundations and services for elderly people are insufficient and rare.…”

Yaşlılara yönelik evde bakım hizmetleri sırasında gündeme gelen tıp etiği sorunları

“…Hastanın özerk olmasını destekleme ve bu özerkliğe saygı gösterme, çağdaş tıp anlayışının kuvvetle benimsediği ve onu geleneksel tıp anlayışından belirgin biçimde ayıran bir değerdir. Tıbbi ilişkiyle ilgili toplumsal beklenti de özerkliğe saygının esas olması gerektiği merkezindedir [21]. Bu değerin tıbbın gündelik yaşamında ortaya çıkışı en sık aydınlatma ve onam alma yaklaşımı çerçevesinde gerçekleşmektedir.…”

“…Özerklik gibi onur da tıbbi ilişki sırasında saygınlığının korunması ve zedelenmesinin önlenmesi gereken bir niteliktir [21,31]. Tıbbi uygulamalar, invaziv-agresif olma derecelerinin artışıyla doğru orantılı olarak hastayı hastalığın yol açtıklarından öte doğal dışı hallere ve kısıtlılıklara sürükleyebilmektedir.…”