Introduction
An aging population affects society, influencing the labor force and financial markets, the demand for goods and services, family structures, and intergenerational ties. The aging and growth of older adults are often cited as a problem. Nevertheless, the issue of adjusting to change lies in the community and its attitudes and norms, not in older people themselves.
Although aging is most advanced in high-income countries, even there, the number of isolated older people is increasing. There is a real risk that millions of people will not receive the services, opportunities, and support they require. This article explores the impact of establishing positive change and its role for socially isolated older adults. Their involvement in therapy and a person-centered approach can contribute to the resolution and dignity of older adults.
Background
While the forms of organization of national health care systems are diverse, their main goal is to improve the quality and accessibility of medical care and increase life expectancy. Scotland’s healthcare system is no exception; based on the principle of respect for human rights, national healthcare aims to ensure equal and free access to healthcare services (Cheruvu and Chiyaka, 2019). The Scottish National Health Service is part of the UK National Health Service, funded from general tax revenues. The Scottish Public Health Authority, established by the Public Services Reform Act 2010, supports the Scottish Government’s priority programs, particularly the Health Quality Strategy program (Abo-Leyah, 2021). Human rights provide the basis for all health reforms and decisions.
A rights-based approach to health care is a promising way of rethinking and addressing many of today’s pressing issues. Among the significant subjects driving reform in Scotland are persistent inequalities, aging populations, and pandemic recovery. The approach to health care is to identify the causes of inequalities that hinder development and address discriminatory practices that often marginalize whole groups (Human Rights Act, 1998).
The Ministry of Health and Social Welfare is implementing government programs to protect the interests of citizens. Among its priorities is the transformation of primary, community, and social care for a long and independent life in a healthy society (Health and Social Care Act, 2016). The fulfillment of these tasks is linked to creating new integrated care systems to provide more coherent, coordinated, and integrated health and social care services for older people in municipalities.
Furthermore, a significant role is given to the support system for those who have lost the ability to function, which is especially common for elderly isolated people. If people lose their legal capacity, they can no longer decide how to handle their financial and personal affairs. Adults with Incapacity Act (2000) establishes certain situations in which an individual is incapacitated, including the inability to act to communicate and understand decisions. This law is the legal possibility for such individuals to receive qualified assistance in everyday life.
Other regulations, particularly the Adult Safeguarding and Protection Act, guarantee the possibility of receiving support. The Department of Social Assistance allocates a certain amount for adult care services (Adult Safeguarding and Protection Act, 2007). Moreover, the measures taken by the law help to protect the rights and interests of adults and to ensure an adequate standard of living. Undoubtedly, a focus on human rights and exceptional attention to vulnerable people is a priority for public health in Scotland. This approach directly and positively impacts isolated older people by ensuring they access equal health care (Chilton and Bay, 2017). Furthermore, the Scottish Government has legislative measures to provide unique and additional support to those who require it.
One of the conditions for the successful social adaptation of older people is their need for social activity for a positive view of old age, which represents the second half of life as healthy, active, and energetic. The participation of older people in the development of society increases the well-being of older people and society as a whole. The World Health Organization defines active aging as optimizing opportunities for health, participation, and security to improve quality of life (El-Yousfi et al., 2019). The agents of integrating older people into society are health professionals who facilitate their social, economic, and intellectual contributions to the public sphere and their inclusion in decision-making at all levels. Active longevity is optimizing opportunities for health, participation, and security.
Promoting positive change will help to slow physical aging and reduce the prevalence of chronic diseases. Moreover, the process will confirm that the nurse has one of the most critical roles in the care and treatment of patients. It, in turn, will lead to an increase in the number of specialists in geriatrics and social work, developments in funding, and implementation of community-based home care services for patients (Chen and Xu, 2020). Thus, promoting positive change creates new opportunities for individual and community development.
The next few years will bring significant changes affecting nurse practitioners and their patients. Numerous of these modifications are the result of the transition to value-based care. Patient choice, opinion, and service satisfaction have become critical points in the healthcare system (Brown and Calnan, 2012). This empowerment allows patients to choose where, when, and from whom they receive care. When patients deal with health problems, they are at their most vulnerable, and their expectations for pain-free, responsive care increase. Thus, the objective measure of adequate treatment is often the patient’s experience (Thornton et al., 2017). For that experience to be positive, healthcare organizations must develop a culture that puts people at the center of the care process, including human resource management.
The most effective model of the physician-patient relationship is a partnership and facilitation of positive change. Following it, the physician and patient walk the path of socialization and treatment together, sharing responsibility for the outcome. The patient’s challenge along the way is not only to take the medications on time but also to change their attitude and how they respond to the condition. It is the core value of promoting positive change.
The doctor’s task is to increase motivation, and the patient’s task is to take action. In this way, the primary thing changes, the mindset, and the facilitation of positive change affect the patient. The doctor and patient form a team that explores the patient’s lifestyle together (Chilton and Bain, 2017). Including the patient in the process helps him to feel more empowered to make changes, as he was actively involved in finding a solution. Therefore, supporting positive behavior leads to improved quality of life and gaining support, directly influencing behavior improvements. It is essential for isolated older adults, for whom facilitating positive change can be an intelligent solution to full social participation.
Challenges
Despite the apparent advantages, the process of introducing self-help and the transition to positive change is characterized by some difficulties. The behavior change process involves three main elements: ability, opportunity, and motivation. When all three factors are present, behavior change occurs quickly and successfully, but an entirely different situation arises when these elements are wholly or partially unmet (Schenker and Costa, 2019). Successful interventions to address capacity gaps often involve face-to-face or online training. However, increased capacity may not lead to behavior change if individuals lack the necessary level of self-efficacy. If individuals have low levels of self-efficacy, this is a significant barrier to implementing change.
Furthermore, an equally important barrier is physical constraints. These may include time, resources, or affordability. No less important are age-old characteristics because poorly developed mental reductions that affect decision-making can hinder good intentions and cause prejudice (Beale, 2017). Thus, some barriers relate directly to physical and psychological peculiarities, particularly characteristic of isolated older people.
The awareness of the inevitability of aging, associated with the loss of social status, physical limitations, and mental changes, leads older people to narrow the circle of communication, emergency a sense of harmony and uselessness, and sometimes to severe depressive states (Tod and Hirst, 2014). With age, psychological flexibility and adaptability are lost, and a desire for stability and reliability replaces interest in the new and unknown. This means it is much more difficult for older people to adapt to new conditions, and most reject changes.
Social connections are a fundamental human need for well-being and survival. However, as people age, they spend more time alone, which increases their sense of isolation. Moreover, the lack of social connections increases the physical and mental health risks of people experiencing social isolation (Southwick et al., 2011). Some researchers question whether social isolation is a common human experience or whether some people experience loneliness more than others. Regardless, however, a significant proportion of people experience isolation. Isolation usually refers to unhealthy and unwanted loneliness, leading to negative self-esteem, loneliness, and fear of others (Pice, 2022). It can be a potential symptom or cause of emotional and psychological problems.
Socially isolated people show weaker ventral striatum activation in response to positive or pleasant stimuli, including images of objects, events, or people. Thus, it is evident that coming out of such a state is a long and time-consuming process. All parties involved must apply a great deal of effort for positive change to begin while maintaining the results, which is also difficult because of the psychological characteristics of older and isolated people (Schneider et al., 2019). In older age, the person has to adapt to the new status, which often has problems. Feelings of being unwanted, loneliness, resentment, or guilt worsen the emotional state and can provoke withdrawal, unsociability, and weak commitment to change.
Furthermore, there are barriers to self-care that concern physical and psychological aspects. The loss of independence occurs due to decreased physical abilities, often exacerbated by a weakening of memory (Hamiduzzaman et al., 2021). Performing everyday tasks and caring for oneself becomes too complex for older people. Self-care deficits can also be explained through Orem’s medical theory, which identifies lack of knowledge, inability to perform certain activities, or lack of understanding of the importance of self-care as the main barriers to its implementation (Thompson, 2014). The reasons cited in theory are rational; a survey among isolated older adults found that 65 percent had insufficient self-care knowledge. Moreover, fear of harm, lack of understanding of the role of self-care, and reduced motivation are barriers to promoting self-care.
The need for self-care is related to the level and stage of development and the patient’s past life experiences. While loneliness and depression may result from or coexist with social isolation, they represent only the tip of the iceberg of potential harm (Price, 2022). Many older adults’ health is affected more by their daily lives than by medical interventions. Changes in the types of foods eaten due to changes in food availability, for example, can accelerate heart failure exacerbation (Thornton et al., 2020).
Lack of exercise due to isolation at home can lead to deterioration, followed by weakness and falls. Reduced cognitive stimulation related to socialization and interaction with the broader world can worsen cognitive and behavioral symptoms of dementia. Older adults with medical, cognitive, or social weaknesses have fewer reserves to compensate for the threat to their homeostasis (Barry, 2018). Faced with problems of social isolation, they are especially vulnerable to rapid decline.
The barriers are related to the direct specificity of health care, which is treatment-oriented. At the same time, a lack of attention to prevention or the promotion of complacency harms the promotion of self-help. Such policies often result in patients ignoring the first symptoms of illness and going to the hospital when the situation becomes serious (Palfrey, 2018). Self-care often has no place in the daily routine, which increases the burden on the healthcare system and harms the health of the nation as a whole.
Nowadays, self-care must become the basis of the healthcare system and the primary orientation of individuals and healthcare workers. At the same time, self-care is often not included in the formal medical system, and thus, regulation by the government is almost impossible (Fagan et al., 2019). Thus, there are several barriers to self-care and the co-creation of positive changes, and their elimination is an essential step in reforming the healthcare system that meets the needs of vulnerable groups.
Strategies
Many older, isolated individuals in the world are denied their human rights. It has led to the development of strategies to address the crisis. Positive behavior change strategies are being developed at three levels: international, regional, and local. In 2015, the world came together in a global movement of governments, civil society, and others to adopt the Sustainable Development Goals (Thornton et al., 2020). They aim to end poverty, protect the planet, and ensure prosperity for all by 2030. It commits everyone to ensuring that the world’s most marginalized people, particularly the socially excluded elderly, are not left behind.
Moreover, a strategy for a Decade of Healthy Aging has been adopted internationally that builds on global commitments and calls for action. The basis for the Decade of Healthy Ageing is the Global Strategy on Ageing and Health, developed through extensive consultations and based on the World Report on Ageing and Health (Wernly et al., 2021). The Global Strategy encompasses multisectoral actions on a lifelong approach to healthy aging to promote longer and healthier lives.
The activities of the Decade will be carried out in four directions. First, it includes changing attitudes, beliefs, and behaviors about aging and providing an enabling environment in local communities to empower older persons. It also includes providing person-centered, integrated primary health care and age-friendly services and ensuring older people’s access to long-term care (Talukder et al., 2020). The most appropriate or urgent measures will be determined according to the context. Nevertheless, all measures should be conducted to address, rather than reinforce, inequalities.
Equally important in the context of the strategy is the regional level. The Department of Health and Social Care runs government programs to protect the interests of British citizens, and providing services to older people is one of its priorities (Scriven, 2017). Age UK workers are critical of the quality of life of older people in the UK. The problem of loneliness of older people is a separate issue, and the Joining Forces strategy offers help in solving this problem. Above all, it aims to ensure all citizens have equal access to health care services (Chambers, 2019). The strategy provides special assistance to vulnerable citizens. Age UK, which works on overcoming loneliness, also promotes equality for isolated elderly individuals.
The organization’s staff and volunteers are in personal contact with older people to better understand their needs and to help navigate the complex situations of social welfare and health services by providing these counseling services in the home. Up to 30% of all face-to-face counseling services are provided (Heaslip and Ryden, 2013). Age UK Advice is available 365 days a year as a national telephone advice service; the Age UK website and the websites of local partners in the municipalities provide details of the services available in their own homes.
Special mention should be made of counseling assistance for older people accessing benefits. Older people often find it challenging to understand what benefits they are entitled to (Alaszewski, 2013). Age UK statistics show that over 40% of inquiries relate specifically to this issue: some £3.8 billion in pension credit and housing benefit payments are not claimed by older people yearly (Health and Social Care Act, 2016). The pension credit supplements the state pension and aims to help pensioners whose weekly income is less than the minimum allowed.
At the same time, the National Health Service strategies in Scotland primarily involve funding. In particular, projects aimed at improving the quality of life of older people are funded. In the same direction, activities are proposed within the framework of social entrepreneurship, which is based on affordable prices for services and essential goods for older people, seen as a tool to ensure sustainable development (Liu et al., 2019). It should be emphasized that in Scotland, the scientific discussion does not include such an essential aspect of older people receiving services as their involvement in the service sector, using the industry’s achievements (Traynor, 2019). It is an issue that has received considerable attention and is the basis of further developments to ensure that older people are fully included in society.
Tools and Techniques
There are several tools and techniques to promote a person-centered approach, but the core of the nursing activity is self-knowledge and dialogue. Nurses cannot only be consumers of information and passive observers but must think for themselves and become people who produce ideas and knowledge. The registered nurse is no longer perceived as a carrier and transmitter of information but takes a unique position as a navigator and facilitator interested in patients’ success (Naidoo and Wills, 2016). It relieves the healthcare system and paradoxically makes it more efficient.
Person-centered care is not a model or a way to achieve goals quickly but rather to treat patients as loved ones. The point is to treat the patient as an individual with their personality rather than as a set of symptoms and diagnoses. The patient has always been the healthcare system’s focus, but this approach suggests treating the patient equally (Elbeddini et al., 2021). There are several principles of person-centered care; firstly, it is necessary to determine how the patient endures their illness and their care needs (Ydirin, 2021)—secondly, inviting the patient to cooperate in care planning so that the patient’s opinion is no less important than that of the physician.
The 4 plus 1 questions’ person-centered thinking tool should be applied during the implementation of the person-centered approach. It facilitates the preparation for the treatment process and is the stage of getting to know the patients (Roig et al., 2019). It includes getting to know the client, observing them, diagnosing them, and developing a program based on the information obtained from the research. This biographical method is based on the fact that the person’s past influences their present and future.
Photographs and clippings from magazines and newspaper articles related to the patient or a family member are used (Percy and Richardson, 2018). This method is precious for working with isolated podiatrists. It can be viewed from two angles: the patient’s examination of their family tree or the historical period in which their ancestors lived (Traynor, 2017). As a result, the person starts to realize their importance, sees the meaning of life, wants to preserve the memories of their family, and transfers this knowledge to the younger generation. Besides, the importance of the tool consists of the possibility of making a plan of change based on the approaches to one question from different sides.
Moreover, the nurse can use an engagement technique called the relationship circle. The tool involves working with the patient’s closest connections with others. However, drawing up and working with the closest relationship circle is often insufficient (Rankin, 2013). Therefore, it is most reasonable to use the inclusion technique in a social group together with the technique. The technique is especially relevant for isolated older adults because it assists in selecting a social group suitable for the older adult and in adapting to the new environment (Traynor, 2017). This technology provides for using other narrower technologies such as social rehabilitation, individual counseling, and timely prevention of conflict cases and their resolution. Consideration of the interests and features of the patient will allow the realization of the person-oriented approach (Delf, 2013). At the same time, working equally with the nurse and the patient is the primary key to success.
Occupational therapy techniques deserve special attention in increasing involvement. Occupational therapy is one of the methods of rehabilitation aimed at restoring the former way of life and returning to the usual activities by making valuable products (Roig et al., 2019). At the same time, it is essential to understand that occupational therapy is divided into several types, and choosing the one that best meets the patient’s interests is especially important.
In particular, for the elderly and socially isolated, occupational therapy is most suitable, the essence of which is the restoration of the ability to look after oneself (Britnell, 2019). Occupational therapy does not apply to everyone; it is essential to consider patients’ physical abilities. According to research, using this tool in practice can increase engagement by more than 40 percent (Szabo et al., 2020). The technique directly influences the individual’s motivation, increasing their aspirations and interest in therapy.
Thus, when forming patient-centered management and increasing involvement in the medical organization, it is necessary to be guided in decision-making primarily by the patient’s interests. The primary goal is to increase the patient’s trust in the doctor and the medical organization. Interaction in this system is carried out on mutually beneficial terms and partnerships, which should be reflected in the population’s medical services planning and implementation.
Assessment of Instruments
To evaluate the tools of the medical organization and the health care system as a whole, it is necessary to consider citizens’ opinions about the quality control system of medical services and the efficiency of management. The founder of a medical organization should regularly initiate an independent survey of attached patients, which should be the basis for planning the volume and type of medical services. If properly implemented, the patient-oriented approach leads to an increase in the population’s referrals and adherence to treatment (Neenan, 2018). It, in turn, will be reflected in the rates of disease detection, duration of remissions, reduction of morbidity, and the broader coverage of the population with preventive measures.
Prolonged work with the patient needs constant monitoring of instruments. Adherence to therapy has recently caught the attention of physicians of all specialties (Naidoo and Wills, 2016). Early detection of the degree of adherence will help the nurse navigate and determine directions to work with the patient and prescribe drug therapy. Assessment of adherence and its control during the long-term observation and treatment will reduce the frequency of exacerbations (Olmedo-Aguirre et al., 2022). Moreover, it will improve the patient’s quality of life and reduce the progression of the disease due to control over the adequacy of therapy and its intake.
Assessment of adherence in actual clinical practice is possible in several ways. The first of them consists of interviewing patients directly during the visit. The interview method is relatively simple, but if the patient has any reason to hide noncompliance with medication recommendations, the information obtained in the interview may be biased (Imran et al., 2021). If the patient does not want to offend the physician by not following recommendations, their answers may not be entirely candid (Milne-Ives et al., 2020). Thus, the survey must be supplemented with other tests and techniques. One of them consists of questions with the help of special tests. Such tests include, in particular, the Moriski-Green questionnaire, which consists of 4 questions (Naidoo and Wills, 2016). Patients who score 4 points are considered compliant. Questionnaires administered every six months will provide data on the patient’s adherence dynamics.
Improving the patient’s state of health is paramount for the clinician. Consequently, searching for methods that allow the best assessment of improvements in the state of health is essential in today’s conditions. Adherence assessment is any assessment of a patient’s health status given by the patient (Riley et al., 2019). It assesses symptoms, health status, daily activity or functioning, psychological well-being, quality of life, and health-related quality of life and their dynamics in comparison, which are directly related to the disease, as well as treatment satisfaction.
Central to developing instrument assessment strategies through adherence assessment is constructing a model of outcomes and endpoints by clearly defining the interaction between the health assessment and other patient-associated domains. The clinical outcome may not always entirely reflect the outcome of a treatment or intervention perceived positively by the patient (Han et al., 2019). For a particular group of diseases, the leading symptoms may only be patients’ feelings, which objective research methods cannot measure.
Conclusion
Population aging is one of the most critical aspects of global demographic change, but few countries have adequate systems to adapt to this trend. At the same time, Scotland’s health care system is an example of implementing effective practices to improve the quality of life of older, isolated people. Focusing on human rights and addressing inequalities directly affects older people as one of the largest and most vulnerable populations. The need for change is clear, which is why many international, national, and regional policies promote the integration of older people into society.
One of the principal guarantees of integrating and eliminating inequalities is the promotion of positive changes. Despite the barriers, it is difficult to overemphasize the role of facilitating change. Positive change based on patient-centeredness can significantly improve isolated older adults’ quality of life and self-care. It is, therefore, necessary to support positive change through modern techniques. Equally meaningful is the evaluation of the tools used, which facilitates deep insight into the torture and feelings of the vulnerable group and the adjustment of therapy based on an individualized approach. Behavioral interventions are an integral part of the therapeutic process, and implementing them will allow the nurse to take a more active role in delivering PBS plans, thereby improving future practice.
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