Literature review on challenges faced in managing the health care of the elderly


 In the 21st Century, it is a fact that people are now living longer than was the case in the past. Consequently, as the baby boomers get old, the number of people who can be categorized as elderly or even older adults in some quarters has drastically increased. However, it can also be pointed out that the increasing number of elderly people in society will pose major challenges in society unless the issue can be effectively addressed before it becomes hard to control. On the other hand, health professionals such as nurses will have a major role to play in the coming years to ensure that the health of elderly people is effectively managed (Grady, 2011). This literature review focuses on the topic of health care for the elderly with a specific focus on the increasing need for drastic measures to be adopted to ensure that the increasing population of the elderly is provided with quality health care services.

Literature Review

Challenges Faced In Managing The Health Care Of The Elderly

In this section of the literature review, some of the challenges that are currently faced and are anticipated to be still faced in the future are expounded

Shortage Of Nurses

As highlighted by Kimball and O’Neill (2002), two factors pertaining to the nursing workforce affect the provision of health care to the elderly both in present times and in the future. To be precise, the two factors discussed by the scholars entail a lack of enough registered nurses and an increasing number of aging nurses. Even though various reasons have been put forward for the shortage of registered nurses, Scanlon (2001) noted that the most common reasons are; the low compensation that is offered to the nurses compared to other careers, thus leaving potential nurses to pursue other careers where they are assured of higher compensation, increased complexity of patient care and ease of access to other alternative careers.

On the other hand, as pointed out by Scanlon, the increased turnover rates among nurses can be attributed to the high rates of job dissatisfaction among the nurses. On a broader perspective, the low staffing levels among the nurses and the nursing aids result to poor quality health care as the nurses offering health care have a high number of patients to care for, unlike would be the case if there were to be high numbers of registered nurses. Since the number of the elderly is expected to increase in the future, there is a need for ideal measures to be put in place to ensure that the number of registered nurses country-wide is increased.

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Shortage of elderly care education and training

As discussed by Kovner et al. (2002), even though a body of knowledge given elderly care in the context of elderly healthcare settings exists, it is a known fact that this specific knowledge is yet to be fully transmitted into primary nursing education and training programs. One of the major reasons that is the case is the shortage of competent individuals to teach geriatrics. For instance, from a study that involved some of the nursing schools in the country, only 42% of the nursing schools were found to have full-time departments that focused on geriatrics, while 20% of the nursing schools have geriatric departments that were functioning on a part-time basis. On the other hand, 38% of the nursing schools had no geriatric departments (Kovner et al. 2002). From that view, it is obvious that unless something is done urgently, the management of elderly health care will become out of control shortly.

Multiple Chronic illnesses

Even though the number of years that people are living nowadays has increased, the chances of the elderly living with various chronic diseases are increasing.  Indeed, according to the U.S. Department of Health and Human Services (2010), it is estimated that nearly 80% of people who are over 65 years of age have one chronic illness or even more with the common chronic illness comprising; diabetes, heart disease, and arthritis among others. On the other hand, such chronic illness illnesses often entail discomfort, functional restrictions, and the requirements for long-term personal management of the conditions. Apart from that, chronic illnesses do not impact the quality of life of the elderly but are also of major economic cost to the elderly.  Considering that the number of the elderly is expected to skyrocket in the coming years, there is a need for proper measures to be put in place to ensure that the elderly who are suffering from various chronic illnesses receive quality medical care that can help them age peacefully. 

Measures to adopt to ensure effective management of health care needs of an aging population

Improve the nurses working environment

As already pointed out, registered nurses have a very high turnover rate, mainly because they are not fully satisfied with their jobs. In that view, there is a need to ensure that the ideal measures are adopted so that the working environment becomes more satisfying to the nurses, as that is the only way to improve their satisfaction rates of the nurses. Therefore, a nationwide survey that involves the registered nurses and focuses on what the nurses believe should be done to improve the working environment should be carried out. Once the research has been carried out and the responses analyzed, it would be vital that the findings are implemented.

Provision of nursing care

According to Mion (2003), the fact that there is a shortage of registered nurses countrywide demands that those who are in charge of nursing, both in perspective of the service provision as well as the academia field, reconsider models of care as well as how the care is provided. For instance, researching on how non-licensed personnel can undertake non-nursing roles to improve nurses’ aptitude to deliver quality care is something that can be considered. For example, as noted by Mion (2003), a study that was carried out at Cleveland Clinic Foundation, which is a one-thousand-bed tertiary care facility, found that all the nurses that were working in the facility were all exasperated with the amount of time that it took then to getting equipment and supplies that they required in the process of giving care.

To address that problem, Mion (2003) explained that a new role that was named equipment technician was created with the individual who was hired for the role being handed the responsibility of ensuring that all tools and equipment are in good working order and that any supplies that might be needed by the supplies are readily available to the nurses. By adopting such changes, the nurses were satisfied, while the quality of care that was to be provided by the nurses also improved. Therefore, an audit of how nursing care is provided must be conducted to find new quality care provisions models.

Establishing sufficient systems of long-term care

The anticipated increase in the aging population will obviously have key impacts on the long-term care sector hence why there is a need for a sufficient look into the issues so that both the health and the residential needs of the elderly population are looked into (Kendrick and Conway, 2006).

According to Kunemund and Rein (1999), various alternatives can be used to ensure that the mechanisms of long-term care are strengthened. Moreover, Kunemund and Rein (1999) have pointed out that the most significant entails assisted self-care and home-based services, implying that the elderly could either remain in their own homes or an environment they perceive to be similar to their homes. Thus, long-term care mechanisms can assist those related to the elderly, thus making it easier for them to continue to offer help and assistance to the elderly without minimal interruptions to their health and economic commitments, among other commitments.  

A critical question, in this case, would be whether offering more formal assistance will diminish the family care or, contrary, it will enhance the provision of the care by the family.  An analysis of this question from research that was carried out by the Commonwealth Fund established that Germany and Austria have a very strong level of family assistance as well as a moderately substantial provision of formal help, while in the case of the United States, the formal and family assistance was found to be weak (Kunemund and Rein, 1999). From those findings, the scholars came to the conclusion that formal and family support had to impact to either type of assistance that is offered. In addition, it can be explained that in another research, it was also found that formal and informal caregivers both tend to work together and do not in any way harm either type of care afforded to the elderly (Penning and Keating, 2000). In the case of the US, researchers noted that as far as the long-term care of the elderly was concerned, there was an increase in the application of formal services, with the increase mainly being attributed to the increased funding that was not available in the past (Penning and Keating, 2000).

Ethical Consideration

For any given research, the research must explain in detail the ethical issues that were considered and how those issues were addressed to ensure that the research can be considered to have been carried out ethically since research that has not been carried out ethically cannot be considered to be credible.

In the case of this specific research, the study mainly relied on secondary sources as the researcher did not have access to numerous resources that would have been required to carry out a primary study. In that view, the only ethical aspect that the researcher was required to address was the aspect of plagiarism, as it would have been unethical for the researcher to use information from another source and claim it to be her work. In that view, the researcher ensured that whenever information from another source was used, the source was cited per the APA referencing style.

 In view of the ethical issues about the journal articles that were mainly used in the literature review, it can be explained that all the journal articles did address all the ethical issues since informed consent was collected from the research subjects while the privacy of all the research subjects was not disclosed to the public.  


In conclusion, it can be explained that from the literature review, it is evident that there is a need for the topic of management of elderly health care to be addressed since the issue is now becoming more crucial than ever before. From the literature review, it has been found that some of the challenges that need to be addressed to ensure that the health care of the elderly is managed effectively entail; the lack of enough registered nurses as well as nursing assistants and the shortage of geriatric education and training at a time when experts in this field are highly needed with the two reasons having a severe impact the elderly health care. In that view, measures must be adopted to address the situation before the situation gets out of control in a few years. Some of the measures that have been discussed that can be adopted to address the issue comprise work environment changes, a review of the service delivery models, and the establishment of sufficient long-term care systems. Nevertheless, the suggestions were made many years ago, implying that their validity and feasibility might be questionable. In that view, this research was advanced so that the accurate and up-to-date measures that need to be adopted to ensure that the health care needs of the elderly are effectively managed can be established.

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Grandy, A. P. (2011). Advancing the health of our aging population: A lead role for nursing science. Nurse Outlook 59, 207 – 209

U.S. Department of Health and Human Services (2010). Multiple chronic conditions – a strategic framework :optimum health and quality of life for individuals with multiple chronic conditions. Retrieved from: Accessed February 24, 2011.

Kendrick, S., Conway,  M. (2006). Demographic and social change: implication for use

of acute care services by older people in Scotland. European Journal of Population, 2006, 22:281–307.

Kimball, B., O’Neil, E. (2002). Health care’s human crisis: The American nursing

shortage. Retrieved From:

Kunemund, H., Rein M. (1999). There is more to giving than receiving: theoretical arguments and empirical explorations of crowding in and crowding out. Ageing and Society, 1999, 19:93–121.

Kovner, C.T., Mezey, M., Harrington, C. (2002). Who cares for older adults? Workforce implications of an aging society. Health Affairs, 21(5), 78-89.

Mion, L. (2003). Care Provision for Older Adults: Who Will Provide? Journal of Issues in Nursing. Vol. 8 No. 2, Manuscript 3

Penning, M., Keating,  N. (2000).  Self, informal and formal care: partnerships in Community-based and residential long-term care settings. Canadian Journal on Aging, 2000, 19:75–100.

Scanlon, W.J. (2001). Nursing workforce: Recruitment and retention of nurses and nurse aides is a growing concern. Washington, DC: Government Accounting Office. GAO-01-750T