Adolescent Health Flashcards
Part 1
You will look after Adolescent patients - how commonly?
What hospital department are adolescents admitted to?
many
__________ Mortality in Adolescents
Increased
Often think of this as a healthy age group
Something different about adolescents that means the risk of dying is higher than it is in children despite thinking of them as a healthy age group
what are the causes of mortality in adolescents?
Things more due to behavior that comes into play in adolescents
What is Chronic Disease like in Adolescence?
Highest graft failure rates:
- ~35% lose kidney
- 1.8 times the rate of people <17 and >24 years
- Substantial costs to individuals & NHS
Deterioration in HbA1c in diabetes:
•Associated with lasting complications (e.g., cardiovascular disease, neuropathjy, retinopathy)
Diabetes control drops off in adolescents
Consistent across medical conditions
Outcomes worse in adolescents than they are earlier on in childhood or later in life
Photo: Kidney Transplants in Adolescents
Kidney transplant graft survival rate
Obvious dip in adolescents
Diabetes Control in Adolescents - what is it like?
Something about adolescents that means disease control is not as good and mortality is higher and some of that is due to specific behavioural challenges of adolescents
Part 2
What is Adolescence?
- Specific, unique developmental stage
- Occurs between 11-25 years - Not “teenagers”, not just puberty
- Period of unique and significant development - biological, psychological, social
Understanding Adolescence - Brain Changes:
what brain changes occur?
- Brain undergoes significant development during period of adolescence
- Many ways this helps to explain the myriad social, emotional and behavioural changes often attributed to adolescence
Peak grey matter volume in prefrontal cortex in adolescents
Synapses that are being used are strengthened and ones that arnt are pruned away
It’s the prefrontal cortex that is maturing later on towards end of adolescents – this associated with higher levels functions
How Are Adolescents Different?
What things change as Brain Development occurs?
what is abstract and concrete thinking?
With more advanced abstract thinking skills you can see indirect relationships that are not immediately apparent in younger adolescents
what Social Development occurs in adolescents?
- Developing self-identity - increased self-consciousness
- Growing independence from parents and increased focus on peer relationships
- Problems such as bullying - can have significant impact
- Questioning of different views & developing (can lead to increased family conflict)
- Development of romantic relationships/sexual orientation
- Seeking new experiences and increased risk taking behaviours
Mental Health - what is it like in Adolescence?
- Critical period for a YP’s mental health and wellbeing
- Recent data one in seven 11 to 16 year olds have a diagnosable mental health disorder
- Over half of mental health problems are established by age 14 and 75% by age 24
- Some data suggests prevalence may be rising
As adolescents are still developing - What does this mean for Healthcare Provision?
- May have different priorities to us/their parents - LT (long term) health my not be of paramount importance at this stage
- Skills necessary to manage LT conditions still developing
- Growing independence from parents
- Navigating multiple changes with often competing demands
- Developing identity - sensitive to criticism
- May be developing ideas around self in relation to condition & self-management
- Opportunities to build confidence lay foundation for longer-term self-care
Providing Better Adolescent Healthcare:
Adapting the consultation - how?
- Setting up the consultation
- How we talk to the young person
- Conducting an assessment
how do we set up the consultation with a adolescent?
•Offer to see adolescent patients on their own:
- Easier if standard practice
- Easier if follow up appointment
- Consider chaparones
- Follow by bringing parents/carers into consultation
Sometimes easier to see them on their own as they may feel more comfortable
- Introductions - First name or Dr Chalmers?
- Agenda setting - what does YP want to discuss?
how do you adapt your communication style for adolescents?
- Aim for a conversation, rather than interrogation
- Avoid medical jargon
- Judge when to used open/closed questions:
- Are all adolescents “fine”?
- Offer choices of answers if necessary
•Explore their priorities/concerns:
- Validate concerns
- Tailor management to acknowledge their priorities
•Discuss adherence to treatment:
- Accept that this will never be 100%
- “How often do you forget to take your medicine?” rather than “Do you ever 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 (at this stage these people may have other priorities)
Adapting Communication - what is the Decisional Matrix
When missed, tricky because higher glucose levels
how should you Adapt Consultations?
- Building rapport (allows them to communicate openly)
- Providing right environment for young person to share more sensitive issues/ problems
- Demonstrating understanding/ nonjudgement/ empathy
- Finding out what is important to the young person & tailoring advice accordingly - May not be long term (or medium term!) health at this point
- Be mindful they may not have the basic understanding of their condition
- Finding out where the young person is from a motivational perspective & addressing this initially
Supporting the Developing Brain:
- Normalising challenges
- Supporting problem solving/goal setting
- Exploring and negotiating support - school/home
- Reminders (e.g., phone)
- Finding opportunities to recognise successes
Part 3
Asking About the Right Things
HEADSS – Adolescent Social History
what is involved in HEADSS?
- Home
- Education (or Employment)
- Activities
- Drugs/Alcohol
- Sexuality
- Suicide/Self Harm
(Tend to do another S on the end which is sleep)
Order of these things important – start with easier things to talk about and end on things harder to talk about for the doctor and the patient
Establish rapport first
Gives you an idea of how they interact with you before you move onto move difficult topics
Remember not everyone has an easy home environment and for some people may find it very difficult to talk about
Same with education – may not be something they enjoy talking about
This is not a fixed order
Asking About the Right Things - HEADSS
what things do you ask about in relation to Home?
- Where do you live? Who lives with you?
- How do you get on with the people you live with?
- Who would you talk to if you had a problem?
Asking About the Right Things - HEADSS
what things do you ask about in relation to Education (or 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?
Knowing where their strengths are at is helpful
Asking About the Right Things - HEADSS
what things do you ask about in relation to Activities?
- What do you enjoy doing outside of school?
- Are you in any clubs or teams?
- Who do you meet up with at weekends?
Asking About the Right Things - HEADSS
what things do you ask about in relation to Drugs?
- Do any of your friends smoke cigarettes or drink alcohol? How about you?
- Have you ever tried cannabis?
- How much do you smoke/drink?
Asking About the Right Things - HEADSS
what things do you ask about in relation to Sexuality?
- Do any of your friends have boyfriends/girlfriends? How about you?
- Have you ever had sex? Do you use condoms/the pill?
Asking About the Right Things - HEADSS
what things do you ask about in relation to Suicide/Self-harm?
- How would you describe your mood? Do you ever get really down?
- Some people who feel really down often feel like hurting themselves or even killing themselves. Have you ever felt like that?
Asking About the Right Things - HEADSS
what things do you ask about in relation to Sleep?
Transition from Paediatric to Adult Services:
•Move from paediatric to adult services around age 16 years
what things change?
Adolescents don’t fit nicely into either box here
Transition from Paediatric to Adult Services:
The time we think about transitioning them is in the mid of this ___________
development
Transition from Paediatric to Adult Services:
In middle of the time of rate of mortality is _________
increasing
Improving Transition - how can it be improved?
- Treat transition as a process rather than an event
- Begin process early - 11-12 years
- Ensure good understanding of condition and medications
- Initial joint appointments with adult and paediatric teams
- Use checklists/toolkits to improve
Transition – What is Ready, Steady, Go?
Ready, steady, go tool kit
Traffic light set up
These checklists to make sure the patients have a good understanding of their condition appropriate to their age
Summary:
- Adolescence is a specific developmental _____ with its own unique changes and challenges
- Adolescence adversely affects health _________
- For adolescents to achieve the best from healthcare, we need to tailor our approach and _____________ style
stage
outcomes
communication
