Community Health Nurse
Introduction
A community is defined as a group of people that work, live and play in a particular environment at any given time. This group of people share common attributes and interests. Therefore a community assessment can be elaborated to mean the process of collection, analysis and use of data to facilitate a change in the collective health of a community. The process involves developing proprieties, assemblage of resources and the elaboration of a plan of actions garnered towards the improvement of the health system of the community.
In this paper, a community health assessment would be done in the Scarborough community in Toronto with the aim of developing an action plan that would be beneficial to the people of the community in order to improve their health.
Community Assessment
The Community - Demographics
Immigrants and their descendants make up a large chunk of inhabitants of Scarborough. According to the 2006 census figures, 57% of inhabitants are born in foreign countries. Minority populations make up a whopping 67.4% of the population.
Scarborough is one of the four community councils in Toronto. It has a total population of 625, 930 according to 2011 estimates. This represents a 3% increase from the 2006 population census figures. There are four major types of housing structures utilized by the people of the community. 51% of the inhabitants of the community live in houses, as compared to 37.6% of inhabitants of Toronto; while 33.7% of the inhabitants of Scarborough live in apartment building that have five or more storey compared to 41% of Toronto inhabitants that live in similar houses. Moreover, 6% of inhabitants of the community live in buildings less than five storey as compared with 15.6% of the total inhabitants of Toronto that live in similar housing conditions. Furthermore, 9.3% of inhabitants of Scarborough live in row or town houses as compared with 5.8% of the total inhabitants of Toronto that live in similar conditions. Also, according to the 2001 population estimates, the age group 45 to 64 years of age constitutes the highest percentage of inhabitants of scar, with about 24% of the inhabitants which is closely followed by the 24 to 44 years age group. This shows that the population is an active one with a lot of individuals falling within the active workforce age group. A survey of the size of households also indicates that one-family households constitute 70% of household types. moreover, a survey of household sizes also indicate that 2 person households constitute the highest group of household sizes with 26.7% of the population being within this group, this is closely followed by the 4-5 person households which has about 26.6% in this group.
Geography
Scarborough has as its borders; Lake Ontario on the southern end and at the western part, Victoria Park Avenue borders it. The north is bordered by Steels Avenue East, Pickering and the Rogue River. Lake Ontario borders it at the southern end.
Scarborough is a large city characterized by cultural diversity.
Economy
The Economy of Scarborough is akin to that of Toronto, because Scarborough is section of the former Toronto. Industrial setting is said to be similar in all the categories of the labor force. The manufacturing industry has a higher percentage in Scarborough than in Toronto. However, the segment of the working population which are professionals, including workers that provide scientific and technical services are also lower when compared to the proportion of the working population of Toronto. Several manufacturing corporations have their headquarters in Scarborough.
Religion
Scarborough is home to a diverse range of religions and places of worship. This is not farfetched considering the fact that the people that reside in the city come from a wide range of cultures that have a strong religious affiliation to their cultures. Religions that have a strong presence in Scarborough include Christianity of which Catholicism is the most prominent, Islam and Buddhism.
Community Diagnosis
Target Population
The target population that I will be writing about include the group of individuals that are at risk of Type II diabetes Mellitus. Although there is no age limit to the development of Type II diabetes Mellitus, the elderly population especially those people aged 65 years and above are especially susceptible to the disease condition and its attending complications.
Health Issue
The old adult age group is contributing an increase in the proportion of individuals with Diabetes in the general population. This would no doubt lead to the increase in the incidence of complications attributed to diabetes. Vascular complications remains the most common widely known complication of diabetes mellitus. However, the risk for cognitive impairment, physical decline, depression, falls and fractures have also been highlighted as serious complications that the elderly can suffer from having type II diabetes mellitus. It is therefore important that clinicians and public health professionals alike find a solution to the scourge of diabetes mellitus in the elderly so that the quality of life of these older adults would be optimized. Diabetes Mellitus has become a major chronic medical condition that has gained epidemic dimensions in developed countries, of which Canada is one of them. (Harris et al, 1998) in fact it has been said that the epidemic dimensions which diabetes mellitus is assuming is posing a threat to undoing the success made in the management of coronary artery disease and cerebrovascular accident which have been made over several decades in the past.(Geiss, 1997). As it has been mentioned earlier, Diabetes Mellitus affects all age groups. However, the highest absolute increase in the prevalence of diabetes is seen among the elderly (aged 65 years and above) (Boyle JP et al, 2001). at present, 42% of individuals with Diabetes Mellitus in the United States include the age group above 65 years and there is a projection that this figure will increase to 53% by 2025 and will further increase to 58% by the year 2050 (Boyle et al 2001).
The Cause for the Health Issue
The increase in the incidence and prevalence of Diabetes mellitus among the elderly population should be a source of concern (Edward & Brown, 2001). This is because dangerous complications of the disease including hypoglycemic and hyperglycemic events, vascular complications, loss of vision, renal impairment and failure, development of foot ulcers and some other cardiac complications are all recognized complications of diabetes mellitus. moreover, in addition to all these well known complications of diabetes mellitus, cognitive decline, falls and fractures, physical disability and other geriatric medical conditions all have a link with diabetes mellitus (Gregg et al, 2002),(Strachan, 2003) . Therefore, the need to manage the disease appropriately in the elderly cannot be overemphasized. This disease has a direct effect on the quality of life of the elderly.
Diet control is an integral aspect of the management of Diabetes Mellitus. However, in the elderly, this mode can pose a great challenge to the managing physician. This is because the elderly have unique problems that can impair their nutrition. the absence of teeth or well fitting dentures, the inability to afford food that is nutritious, the inability to understand instructions on the appropriate diet to take are some factors that can make dietary compliance difficult for the elderly. Moreover, some social factors like living and eating alone, which would reduce the motivation of cooking an elaborate meal, or leading to the decision to eat food that has a high calorie and fat content, may all interfere with maintaining a proper diet which is central to the control of diabetes mellitus in these individuals. Moreover, other factors like impaired perception of taste (most especially the sense of saltiness or sweetness) may lead to over-sweetening or over-salting food. (Bohannom, 1988).
Signs and Symptoms of the health issue
Signs and Symptoms of dietary indiscretion in patients with type II diabetes would include frequent episodes of hyperglycemic and hypoglycemic events. Also Diabetic Ketoacidosis is a dangerous complication of Diabetes that the elderly are particularly prone to. Moreover, an increase in the prevalence and severity of the complications of diabetes in the elderly, including cognitive decline, falls and fractures, physical disability among other things, would point to uncontrolled blood glucose (Gregg et al, 2002), (Strachan, 2003).
Strengths of the Community
Scarborough is a community that has strong cultural values. The community is home to a large number of individuals of foreign nationality. This fact fosters a strong sense of belonging among the individuals of each ethnic subgroup. This is a strong point because individuals in this subgroup have a strong sense of family and are always ready to support each other through whatever they are going through.
Moreover, as part of benefits of living in a diverse community, there is high level of tolerance among the members of the community and they readily accept each other. Because of this, it is easy for members of the community to come together to achieve a common purpose. In this case, cooperating to improve the health of the community will not be a strange thing for members of the community.
Another strength that the community possesses is its deep religiousness. The different cultural groups have a strong affiliation to the various religions that they practice. Because of this, it will not be too difficult to approach each sub-culture through their religious groups.
Planning
In order to address the issue of dietary indiscretion among the elderly who have diabetes mellitus, a number of steps will be taken.
The action plan includes the creation of awareness about the extent of the problem. This involves giving information to the general population about the extent of the problem through the mass media. also it should be noted that health care professionals also need to be informed about the extent of the problem since they are the ones who are directly involved in the management of these patients. By having up-to-date information about the management of the condition, they would be able to give the same information to individual patients thereby engineering a paradigm shift in the management of the condition.
It is important that the strengths of the community be harnessed in tackling the problem.
The Scarborough community, being a hugely multicultural community has a strong sense of family. Therefore it will not be out of place to tap into this particular strength of the community in order to bring about the required change needed to tackle the health issue.
Planning would also include tailoring the specific interventions to be in tandem with the various cultural groups that are present in the community. This will go a long way in increasing the acceptability of such interventions among the different cultural subgroups in the community.
Implementation
In raising awareness about the dangers of diabetes mellitus and its complications in the elderly, the mass media will be utilized. This would consist of publishing articles in newspapers aimed at creating the awareness. There are local newspapers printed in different languages in the community: English language, French, and Chinese are some of the languages in which newspapers are printed. Articles will be written in these languages for the consumption of the generality of the people.
Moreover, as part of mass media sensitization, leaflets containing information about the specific interventions will also be produced in the major languages spoken in the community. These leaflets will also be distributed to people in the community.
The local council will also be contacted in order to expand the existing public nursing homes which house the elderly so that the special needs of people with diabetes will be catered for.
Evaluation
A community intervention project is not complete until an assessment of the success of the project is done.
At regular intervals, all the stakeholders involved in the development of the specific interventions would be called together for a round-table meeting in order to seek their continued commitment towards the success of the programme. These stakeholders would include the health care professionals involved in developing the project, community leaders, and representatives of the local council and partners who sponsored the project.
A survey would be carried out before the commencement of the intervention program to gauge the knowledge and attitude of people of the community towards the health issue. Moreover, a similar survey would also be carried out at the end of the phases of implementation of the project. A comparison of these sequential surveys would give an overview of the change in the attitude and behavior of individuals in the community towards the specific interventions aimed at improving the eating habits of the elderly in the community.
Moreover, a downward trend in the statistics of the prevalence and incidence of the disease in the population would also point to the fact that the interventions have been successful.
Conclusion
A community health assessment is aimed towards addressing a specific health issue in the community. The process of performing this assessment includes identifying the demographics of the community, developing a diagnosis, proposing specific projects, implanting and evaluating them. I have gone through these processes with the aim of finding a solution to the problem of dietary indiscretion among the elderly who are suffering from Type II diabetes Mellitus.
References
Boyle JP, et al (2001). Impact of changing demography and disease prevalence in the U.S. Diabetes Care 24:1936–1940, 2001
Geiss L (Ed) (1997). Diabetes Surveillance, 1997. Atlanta, Ga., U.S. Department of Health and Human Services, 1997
Harris MI, et al (1998): Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults: the Third National Health and Examination Survey, 1988–1994. Diabetes Care 21:518–524, 1998
E W Gregg & A Brown, (2003). Cognitive and Physical Disabilities and Aging-Related Complications of Diabetes. Clinical Diabetes vol 21 no.3 113-118 doi: 10.23337/diaclin.21.3.113
Gregg EW, et al (2002). Cognitive decline, physical disability, and other unappreciated outcomes of diabetes and aging (Editorial). BMJ 325:916–917, 2002
Strachan MW Jet al (1988): Type 2 diabetes and cognitive impairment. Diabet Med 20:1–2, 2003
N Bohannom (1988). Diabetes in The Elderly A unique set of management challenges.
Statistics Canada (2013). Area D - Scarborough. City of Toronto Community Council Profiles. Statistics Canada, Census 2011.
