Answer

Family Healthcare Nursing

Costs and Economic Effects of Diabetes Mellitus in Elderly

             Diabetes mellitus is a major chronic illness diagnosed in millions of adults across the world. Reports indicate that millions of people across the globe are believed to have undiagnosed diabetes (Lai, 2012). The direct family caregiving costs of diabetes and its complications such as stroke, heart disease, hypertension, visual impairment, amputation, and kidney disease have been estimated at $44 billion annually while the indirect costs; those connected to lost productivity because of premature mortality and morbidity have been approximated at $54 billion annually (Lai, 2012). Other costs involved with family caregiving linked to diabetes encompass the amount of time spent by the unpaid caregivers who offer daily help with diabetes care (including helping with medications, diet, and checking the glucose level), and caring for diabetes related challenges such as limitations in mobility due to stroke, heart failure, and lower extremity amputations.

            The economic impacts of diabetes on the resources of family caregiving over time can be examined at family, societal, and individual levels. Some of the impacts encompass decline in available financial resources of the caregivers due to out of pocket expenses. As already explained, the direct cost (out of pocket expenses) is a critical source of cost of family caregivers of the aged individuals. The estimated monthly cost is relatively high and given that most caregivers often have low income, they spend most of their monthly salaries on caregiving for an elderly individual in the household (Nortey, Aryeetey,  Aikins,  Amendah, & Nonvignon, 2017). Clearly, this indicates a huge financial stress and may consequently imply the increased burden and depletion of the resources for most caregivers and their families.

Another economic burden of diabetes on the resources of family caregiving is associated with employment related expenses for the caregivers who are forced to minimize work hours, leave labour force, and forego benefits, income and career opportunities to provide the necessary care (Nortey et al., 2017). Also, critical impact includes employment related expenses to the employer who is compelled to look for suitable employees to replace those who have exited the labour force or reduce hours.

Preparing For a Good End of Life

             End of life decision making in a palliative care is challenging since it involves difficult decisions on whether to start or discontinue life support. Therefore, there should be a good rapport between advance practice nurses and families in establishing effective outcomes in palliative and end of life care. To attain this, there should be clear and honest communication between advanced practice nurses and families. Aziz, Miller and Curtis (2012) reported that clear communication about end of life care among patients suffering from chronic diseases is linked to better quality of life and decrease in intensive life sustaining medications and minimal medical expenses at the end of life. Similarly, advanced practice nurse should also adopt the supporter role in palliative and end of life care by establishing trusting relationships with families as they navigate the end of life decision making process and by depicting empathy for family members, patient, and physicians. Another intervention approach that advanced practice nurses should use is to take time and build trusting relationships. Family members contended that had trust in advanced practice nurses who introduced themselves to the family, explained equipment, and were willing to talk (Aziz et.al, 2012). Similarly, nurses identified the benefit of establishing trust and rapport with families. Therefore, advanced practice nurses should take their time to introduce the family to looming shift nurse to demonstrate trust that.

            To assist parents in preparing for a discussion about the death and dying, I would first seek to understand the family values, structure, and functioning so that supportive and medical care can be offered to the entire family. Precisely, I will pay attention to children’s developmental stage and family’s circumstances and needs to prepare for a discussion regarding end of life period. Given the manner in which death or dying is usually displayed on the screen, it may be challenging for children to take death seriously. Aziz et al. (2012) reported that children tend to view death as reversible and short lived event the same way they view characters in video games that comes back to life. Similarly, older people, older children may start to understanding the fact that death is complex and serious.  However, it may be challenging for them to understand that death may influence a person who is close to them.

            Prepare for a good end of life is an important documentary that everyone should watch so that they prepare for the end of life they desire. A person can manage his or her end of life experiences in order to maintain a high quality of life. Essentially, individuals should formulate appropriate plan and get the correct mix of people during their old periods as they can promote a good end of life (Johnston, 2013). Personally, a good end of life is one that a person is contended at accepting and willing to share with friends and families following their diagnosis or intuition.

            To prepare for a better end of life, Johnson suggested several interventions and strategies that include formulating a plan in which an individual comes with unique questions. Other critical strategies include having advocates, preparing for the hospital, selecting caregivers and deliberating on the last words. Essentially, these strategies and interventions would be essential in my work as geriatrician, I would use these strategies to assist the elderly prepare for a better end of life thereby minimizing the burden for themselves and others. 

             As a geriatrician, I have helped many people to prepare for the end of life they desired. Because of developments in medical technologies, health usually deteriorates over a long periods prompting advance care planning more imperative. As such, some of the interventions that I used to assist these people include advance care planning.