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... in the chromosomes, which are complexes of DNA and protein. At the end of the chromosomes there are regions of DNA that do not code for any of our characteristics but which appear to protect the chromosome. (Amador, 2000). As cells age, these regions of DNA, known as telomeres, become shorter.
It is not known whether this is a cause or an effect of ageing. However, in cancer cells the length of the telomeres remains constant and they have high levels of an enzyme called telomerase, which repairs the telomeres. This could be the explanation for the immortality of cancer cells. Carcinogenesis, the process which leads to the development of cancer, is influenced by the genetic makeup of the individual and environmental factors. Carcinogenesis occurs over a long period and it may be 20 years before symptoms become evident. The relationship between the individual and the environment explains why cancer is more common in the older person.
The development of cancer needs time and a susceptible host. It is believed that the alterations in the older person's immune function and DNA repair efficiency may both make the older person more susceptible to the development of malignant cells. But there is still some dispute over the role of immunodeficiency and cancer susceptibility. Some scientists believe that exposure time to environmental carcinogens and chronological age advances are a greater influence. (Amador, 2000). It has been reported that patients in their 70 s and 80 s can tolerate a full dose of radiotherapy. Olmi et al (1997) state that radiotherapy can be used in curative or palliative treatment in nearly all cases, with minimal toxicity, although they say that despite vast improvements in delivery systems there is still limited data on the impact of radiation on the normal and malignant cells of the older person.
Older patients and their carers often find the traveling more arduous than the treatment and its side effects. Patients who are undergoing radiotherapy may need accommodation close to the radiotherapy unit as they will usually be having treatment every day for up to three weeks. Skin care is particularly important due to the ageing process, which delays the healing and lacks a defence against radiation damage. Discussing the needs of these patients with the tissue viability nurse and the radiotherapy clinical nurse specialist prior to the commencement of treatment may help to minimise complications. It is most important to emphasise to the patient the importance of not using creams and lotions on irradiated areas and reporting any symptoms immediately. (Morgan, 2001). The protective actions of others can create as many risks to life and well-being as those they are aimed at preventing.
Well-meaning relatives or practitioners may persuade an older person to move closer to a relative or into care. Lieberman points to the radical changes in life space that this can involve, often requiring new learning for adaptive purposes. He discusses the implications of loss of local community links and familiar surroundings and suggests that this 'closure of social space' makes it difficult to undo such radical decisions. A priority should exist for public education about rights and risk management; for example, rights of assessment and access to appropriate support services. People who are moved to residential care for their 'protection', at the behest of relatives, can and do deteriorate rapidly. Earlier guidance before such difficulties become a crisis may result in less radical solutions.
The problem is that this is difficult to achieve in organizations that prioritize crisis intervention and where there occurs a failure of recognition that the desire to reduce risks carries risks of its own. Norman states: 'Compulsory removal from home entails bereavement and loss which a less robust person may not survive. [Often] it is much easier for an elderly person to become a hospital patient than to cease to be one'. For example, there is evidence that people in care are equally or more prone to falls than those living at home. (Morgan, 2001). A study by Neill et al (1988) found many people in residential care were there at the instigation of others and lacked adequate medical and functional assessment. It had been the concerns of relatives that had contributed to or directly led to admission. This suggests that older people may be frequently intimidated and dis empowered, making it difficult for them to make decisions for themselves.
Neill refers aptly to 'the Authority of Officialdom', which reduces empowerment and silences the service user's voice. (Johnson, 1993). Legally, the right to remove people from their own home without their consent does not exist. The Mental Health Act 1983 and the National Assistance Act 1948 are the only legislation that permit compulsory committal to care. The legal approach is technical and is invoked to protect people regarded as incapable or at risk. In practice, insensitive and archaic laws are often in conflict with the medical / social emphasis on personal circumstances and the alleviation of distress. The unsuitability of applying law in many cases could be said to contribute to the coercion often involved in 'persuading' older people to sacrifice their liberty unlawfully.
Recommendations were made that attempted to address this anomaly between legal concerns and those of caring agencies. Central to these recommendations are the rights and welfare of vulnerable people, the need for early intervention and guidance, the provision of resources and the rights of supported appeal. Placing the interests of the older person as paramount would mean all other interventions and support would have to be exhausted before redress to legal responses would be considered. It is worth recalling that under the Community Care Act 1990 professionals are charged with putting the needs of users and careers first. (Hutchins, 1999).
There is some difficulty in marrying client-centered care with role responsibility. Practitioners charged with an equal partnership agenda with users and carets are also answerable to their employers and bound by policy decisions and resource availability. The different agendas of those 'doing' the assessing will also carry weight. Conflicting values often underpin practice; for example; a bias towards one's own professional status and reputation. Multi-agency professional teams moderate against the tendency of agencies to meet their own needs before those of their clients. In addition, professionals do not operate in a vacuum; prevalent social values will also influence the acceptable balance between rights and risks.
When things go wrong, censure may well be the result. (Grimley Evans, 2001). The concerns of relatives and neighbors will have some impact. They too have rights and may be unwilling to accept responsibility for an older person. The outcome of hospital or care home admission reduces confidence, increases confusion, particularly in those with dementia, and often confirms people in their patient status.
There is a strong synergy between risk and quality. Good risk analysis and assessment, as part of practice, would provide better quality care. Achieving this would involve a shift in practice to a more equal partnership between practitioners and users. (Hodgson, 2002). One of the most important issues in deciding active treatment for any patient, but more importantly in the older patient, is that the effects of treatment should not destroy quality of life. An older person may not want to live for three extra months if 11 weeks of it are to be spent in hospital. Commencement and continuation of treatment must be based on the premise that it is for the benefit of the patient and the patient's choice in this is paramount.
A multi-professional approach to the management of the side effects of treatment will ensure that symptoms are managed well. (Maxwell, 2000). Words: 2, 782. Bibliography: Amador LF, Cohen HJ (2000) Cancer and ageing. Home Health Care Consultant. 7, 5, 1 A- 7 A.
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Research essay sample on Department Of Health Older Person
