Rebecca Winsor : CNS Gerontology BA, BN, PG Dip HealSci

Transcription

1 Rebecca Winsor : CNS Gerontology BA, BN, PG Dip HealSci

2 To identify some of the challenges facing the older adult in hospital To begin to understand some of the complexities of caring and assessing the older adult in the health care setting Begin to understand some of the assessments that may be indicated for the elderly person in hospital using critical thinking

3 Ageing concerns each and every one of us whether young or old, male or female, rich or poor no matter where they live. (World Health Organisation, 2012, as cited in Dewan, Zheng & Xia, 2012) Normal Ageing: Ageing in the absence of any biological or mental pathology

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5 Easy to make negative assumptions and be overcritical with elderly patients Generalisations can often be made to the detriment of older patients Primary diagnoses are more important than secondary concerns or issues

6 Elderly people may live healthy lives, but have a diminished capacity or physiological reserve to be able to manage and/or maintain homeostasis Therefore, an increased vulnerability to disease Frailty = an inability to maintain or regain homeostasis effectively causing a cumulative decline across multiple systems of functioning

7 Physiological changes prevalence of cognitive decline prevalence of physical disability and comorbidity falls polypharmacy and adverse drug reactions prevalence of pressure injury hospitalisations and length of stay Lengthier recovery time Inadequate dietary intake admissions to long term care mortality

8 Identification between: Short stay Sick specialty Sick frail Complex (very frail) Looks at improving patient flow through our healthcare system in order to bring about timely and appropriate interventions and subsequent discharge and prevent negative outcomes for patients Timely assessment and planning, and constant review against plan

9 Consider Baseline functioning and the deviation from this Includes Current presentation including medication use and polypharmacy- don t forget smoking and AOD Past medical history- chronic conditions Current life situation and social functioning including supports ADLs and IADLs

10 Cognitive and mental functioning Physical Assessment Risk assessments Continence- DIAPPERS (Resnick, 1996 as cited in Eustice, Kennedy & Haslam, 2007) Delirium, Infection, Atrophic urethritis/vaginitis, Pharmaceuticals, Psychological, Excessive UO, Restricted mobility, Stool impaction) Falls risk Nutrition Braden scale Developmental assessment Self assessment

11 More likely in hospitalised elderly Significant impact on life satisfaction and quality of life Several intrinsic and extrinsic factors contributing to falls risk Falls risk assessment- how often? Interventions??

12 Several risks of malnutrition in terms of perioperative recovery, wound healing, infections and complications 2004 study % in acute inpatients found to be malnourished (Rosenthal, 2004, as cited in Dewan, Zheng & Xia, 2012). Consider lab values, food and fluid chart, bowel habits, diet, recent weight loss or change, physical assessments such as mucous membranes, skin turgor, capillary refill etc. Interventions??

13 Occurs in 25-60% hospitalised patients but often unrecognised Severity of delirium linked to poorer outcomes Risk factors (often multifactorial): Elderly Hypoxia Dehydration/malnutrition Polypharmacy Acute illness/trauma/surgical interventions Infection Electrolyte imbalances Pre-existing cognitive dysfunction Four main distinguishing features of delirium: Acute onset (1) Inattention (2) Disorganised thinking (3) Altered LOC (4)

14 Prevention is the best cure! Sleep patterns Enhanced communication Reorientation Exercise Restraint reduction Vigilance around changes in health status- early detection of symptoms Pain management Medication review Falls prevention strategies Consider urine output, use of IDCs, bowel habits

15 Ruby is 75 years old. She is admitted to hospital with cellulitis in her left lower leg and is currently being treated with IV flucloxacillin. Prior to her admission she had been living independently in her own home. She has no local family but has a neighbour she is close with who visits regularly. Her neighbour prompted Ruby to visit her GP about her leg. Regular medications include aspirin, citalopram, metoclopramide, simvastatin, omeprazole, cilazapril, frusemide and paracetamol. What are some questions you could ask of Ruby? What are some of the assessments that you could make? What are some protective factors for her? What are the risks of her hospitalisation?

16 Regular medication review How is the patient functioning? What is their oral intake? How is their mental health? How is their mobility? Does the patient need all these attachments? What is the discharge plan and destination? Can anything be done early in regards to this? Are the family aware? Consider direction of care and quality of life

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18 Best Practice Journal (October 2012). Managing medicines in older people. Issue 47. Retrieved from: Bickley, L. (2009). Bates pocket guide to physical examination and history taking (6 th ed.). Philadelphia, USA: Wolters Kluwer Health/ Lippincott Williams & Wilkins. Clegg, A., Young, J., Iliffe, S., Rikkert, M., & Rockwood, K. (2013). Frailty in elderly people. The Lancet, 381, doi: /S (12) Dewan, S., Zheng, S., & Xia, S. (2012). Preoperative geriatric assessment: Comprehensive, multidisciplinary and proactive. European Journal of Internal Medicine,23, doi: /j.ejim Eustice, S., Kennedy, M., & Haslam, C. (2007). Vulnerable groups. In Getliffe, K., & Dolman, M. (Eds.). (2007) Promoting continence: A clinical and research resource (3 rd ed.). (pp ). Philadelphia, USA: Bailliére Tindall Elsevier. Hendrich, A. (2007). Predicting patient falls: Using the Hendrich II fall risk model in clinical practice. The American Journal of Nursing, 107(11), Kim, K., Park, K., Koo, K., Han, H., & Kim, C. (2013). Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery. Archives of Gerontology and Geriatrics, 56, doi: /j.archger

19 Malaguarnera, M., Vacante, M., Frazzetto, P., & Motta, M. (2013). What is frailty in elderly? Value and significance of the multidimensional assessments. Archives of Gerontology and Geriatrics, 56, doi: /j.archger Muszalik, M., Dijkstra, A., Kędziora-Kornatowska, K., & Zielińska-Więczkowska, H. (2012). Health and nursing problems of elderly patients related to bio-psycho-social need deficiencies and functional assessment. Archives of Gerontology & Geriatrics, 55, doi: /j.archger Nay, R., & Garratt, S. (2004). Nursing older people: Issues and innovations (2 nd ed.). Marrickville, NSW: Elsevier Australia. Phillips, L. (2013). Delirium in geriatric patients: Identification and prevention. Medsurg Nursing, 22(1), Segal, D., Qualls, S., & Smyer, M. (2011). Aging and mental health (2 nd ed.). West Sussex, UK: Wiley-Blackwell. Stenhagen, M., Ekstöm, H., Nordell, E., & Elmståhl, S. (2014). Accidental falls, health related quality of life and life satisfaction: A prospective study of the general elderly population. Archives of Gerontology and Geriatrics, 58, doi: /j.archger Voyer, P., McCusker, J., Cole, M., St-Jacques, S., & Khomenko, L. (2007). Factors associated with delirium severity among older patiemts. Journal of Clinical Nursing, 16, doi: /j x