adolescent health Flashcards
• Understand key aspects of adolescent brain development • Appreciate the unique social, psychological and behavioural challenges present during adolescence • Discuss how young people may present within healthcare settings, including health outcomes • Be familiar with the impact of adolescence on chronic conditions such as diabetes • Consider important systemic and communication adaptations to enable the delivery of high quality, effective and person-centred care
how common are adolescents in GP and inpatient care
~70% of adolescents visit their GP in any one year
account for ~12% of inpatient activity
mortality in adolescence
increased mortality in adolescents compared to other groups 20-40/100 000
higher than in earlier childhood 10-15/100 000
causes of mortality in adolescents
non intentional injuries and poisoning
cancer
RTA
congenital infection cancer nervous system and development endocrine, nutritional and metabolic circulatory respiratory other
chronic disease in adolescence - graft failure
highest graft failure rates
~35% lose kidney
1.8x the rate of people <17 and >24 y/o
substantial costs to individuals and NHS
chronic disease in adolescence - DM
deterioration in HbA1c in DM
associated w/ lasting complications e.g. CV disease, neuropathy, retinopathy
patterns of chronic disease in adolescence
poorer outcomes are consistent across medical conditions
what is adolescence
specific, unique developmental stage - biological, psychological and social changes
11-25yrs (not teenagers, not just puberty)
brain changes in adolescence
undergoes significant development during period of adolescence
how are adolescent brains different
brain matures
pre-frontal cortex matures later on towards the end of adolescence
features of prefrontal cortex in early adolescence
here and now focus
winging it
bullet-proof mindset
risk taking and impulsivity
egocentricity
difficulty controlling emotions
features of prefrontal cortex in adulthood
abstract thinking
planning and organising
decision making
reasoning
cognitive flexibility
emotion regulation
social development in adolescents
developing self-identity - increased self-consciousness
growing independence from parents and increased focus on peer relationships
questioning of different views and developing - can lead to increased family conflict
development of romantic relationships/sexual orientation
seeking new experiences and increased risk taking behaviours
prevalence of mental health disorders in adolescence
critical period for mental health and wellbeing
1/7 11-16y/o have a diagnosable mental health disorder
over 50% of mental health problems are established by age 14 and 75% by age 24
prevalence may be rising
differences in healthcare provisions for adolescents
may have different priorities to us/parents
skills necessary to manage LT conditions still developing
growing independence from parents
navigating multiple changes often with competing demands
developing identity - sensitive to criticism
setting up consultations for adolescents
offer to see adolescent pts on their own
- easier if standard practice
- easier if follow up appointment
- consider chaperones
- follow up by bringing parents/carers into consultation
introductions
agenda setting - what does the young person want to discuss
adapting communications for adolescents
conversation rather than interrogation
avoid jargon
open and closed questions
- offer choice of answers if necessary
explore their priorities and concerns
- validate concerns and tailor management to acknowledge their priorities
discuss adherence to treatment
- accept this will never be 100%
- non-judgemental e.g. how often do you forget to take your medication
- likely to differ between treatments even in the same individual
explore their understanding of their disease and treatments
assess motivation
what is the HEADSS model
makes sure we ask about the right things in adolescent SHx
allows us to identify challenges pressures and any supportive factors in place
home education/employment activities drugs/alcohol sexuality suicide/self harm (sleep)
HEADSS - home
where do you live
who do you live with
how do you get on with the people you live with
who would you talk to if you had a problem
HEADSS - education/employment
which school do you go to
what year are you in
which subjects do you enjoy, what are you good at
who do you spend time with at school
HEADSS - activities
what do you enjoy doing outside of school
are you in any clubs or teams
who do you meet up with at weekends
HEADSS - drugs and alcohol
do any of your friends smoke cigarettes or drink alcohol
how about you
how much do you smoke/drink
have you ever tried cannabis
HEADSS - sexuality
do any of your friends have boyfriends/girlfriends
how about you
have you ever had sex
do you use condoms/the pill
HEADSS - suicide/self harm
how would you describe your mood
do you ever get really down
some people who fell really down often feel like hurting themselves or even killing themselves, have you ever felt like that
HEADSS - sleep
do you have difficulty falling asleep tiredness during the day/difficulty waking up what time do you go to bed what time do you fall asleep electronic screens before bed napping during the day
