Ageing and Multi-Morbidity - Tutorial 4 Flashcards
Define ageism
A process of systematic stereotyping and discrimination against people because they are old
True or false, homeostatic reserve (the ability of an organism to stabilise its normal internal environment) is the same in the elderly as in early and middle adult life?
False
True or false, disease always presents in the same way in the elderly as it does in younger adults?
False
True or false, normal ranges e.g. peak flow rate are affected by age?
True
True or false, drug handling alters with age?
True
True or false, lifestyle changes in old age are not worthwhile as they produce no significant health benefits?
False
In 2000, the proportion of the world’s population over 60 years was 11%, by 2050 it is expected to be what?
22%
In the period 2000-2050, the number of people aged 80+ will increase by how much?
4 fold
By 2050, what percentage of older people will live in low and middle income countries?
80%
True or false, older people in low income and middle income countries carry a greater disease burden than those in the rich world?
True
By 2050, the number of older people who are no longer able to look after themselves is forecast to increase by how much?
4 fold
What do current population pyramids show?
Increases in the proportions of older persons (60 +) being accompanied by declines in the proportions of the young (< 15)
The demographic transition form high to low levels of fertility and mortality is increasing the older population
By 2050, the number of older persons in the world will exceed the young for the first time in history
What are some factors, other than decreasing fertility, which might be relevant?
Migration
Health education programmes such as those relating to AIDS
Malaria prevention
Improvement in public health in relation to housing, clean water, nutrition
The steady increase of older age groups in national populations, both in absolute numbers and in relation to the working age population, has a direct bearing on what?
The intergenerational equity and solidarity that are the foundations of current society
In the more developed regions, almost 20% of the population was aged 60+ in the year 2000, what is this proportion predicted to be in the year 2050?
33%
Why will developing countries have less time to adjust to the consequences of population ageing?
As the pace of population ageing is much faster in developing countries than in developed countries
Population ageing in the developing countries is taking place at much lower levels of socio-economic development than was the case in developed countries
What is the fastest growing age group in the world?
80+ age band
In Scotland, life expectancy at birth is projected to increase from 74.3 years for males and 79.4 years for females for those born around 2004 to what by 2031?
To 79.2 years for males and 83.7 years for females
Scotland’s ageing population is similar to the rest of Europe, but it faces a larger increase in the number of people in what age group than the rest of the UK?
Age 65 and over
Between 2004 and 2031:
The number of children aged < 16 is projected to decrease by what?
The number of people aged 16-29 is projected to decrease by what?
The number of people aged 30-49 is projected to decrease by what?
The number of people aged 50+ is projected to increase by what?
The number of people aged 65+ is projected to increase by what?
The number of people aged 75+ is projected to rise by what?
15%
12%
17%
28%
58%
75%
What are the main reasons for the large projected rises?
The baby boomers born after the Second World War will be entering their early 80s by 2031 and overall mortality rates are expected to continue to improve
Older people are increasingly healthy and there is an increasing emphasis on preserving health and fitness into old age
Many feel that this will not reduce the eventual need for healthcare but will merely postpone it
Although older people have poorer health than younger people, ageing does not cause disease; older people with better health habits live healthier for longer
What are the health implications of the ageing population?
Increased numbers of geriatricians and health professionals involved in care of the elderly will be required
Increased facilities for elderly health care will be required
The care of many long term conditions e.g. diabetes, renal disease is moving from secondary care to primary/community care - the end stage of these diseases requires as much palliative care as cancer, the prevalence of such diseases will increase as the population ages
Specific health promotion campaigns aimed at the elderly
What are the social implications of the ageing population?
As the population ages, they will be increasingly dependent on families and/or carers who are also ageing
The demand for home carers and nursing home places is likely to increase
Within local communities, there will be increasing emphasis on providing social activities for the elderly
The role of the elderly as grandparents and carers of grandchildren is likely to change
Housing demands are likely to change as more elderly people live alone
What are the economic implications of the ageing population?
Retirement/pension age is already increasing
Finding employment may become harder for young people as older people are required to work for longer blocks in the top end of the employment sector
Proportionately less people will be paying into tax and pension funds, making it increasingly difficult to obtain an adequate return from pension funds
Those elderly who have not contributed to a private pension fund may find that state pension is inadequate, resulting in poverty
Increasing cost of “free personal care for the elderly” policy (Scotland)
What are the political implications of the ageing population?
Current decision making and workforce planning must take account of the ageing population
The increasing elderly population will potentially have the power to influence political decision making in relation to their specific concerns
What is multi-morbidity?
The co-existence of two or more long-term conditions in an individual
It is the norm rather than the exception in primary care patients
What adds complexity to the management of an older patient?
Older patients may have more than one chronic health condition
The preferred treatment for one condition may worsen another
What are the options for care for older people with multi-morbidity?
Living in own home with support from family
Living in own home with support from social services
Sheltered housing
Residential home
Nursing home care
When is sheltered housing often useful?
Often a useful option for people who wish to live independently, but to know there are others nearby when help is needed
What are the advantages and disadvantages of residential homes and nursing homes?
Residential homes
- greater 24 hour support
- no medical cover on site
Nursing homes
- resident nurses on site
- can be extremely expensive
What is anticipatory care planning?
Advance and anticipatory care planning, as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care
When should anticipatory care planning be done?
At any time that seems appropriate
Continuously
Who can carry out anticipatory care planning?
Anyone with an appropriate relationship
How should anticipatory care planning be done?
Thinking ahead and making plans
Carefully - written down
How can anticipatory care planning be shared?
KIS - Key Information Summary
Other communication
What are the legal features of anticipatory care planning?
Welfare power of attorney
Financial power of attorney
Guardianship
What are the personal features of anticipatory care planning?
Statement of wishes regarding treatment/advance directive
Next of kin
Consent to pass on information to relevant others
Preferences and priorities regarding treatment
Who else to consult/inform
Preferred place of death
Religious and cultural beliefs re death
Current level of support e.g. family, carers
What are the medical features of anticipatory care planning?
Potential problems Home care package Wishes re DNA CPR Scottish Palliative Care Guidelines Communication which has occurred with other professionals Details of "just in case" medicines Electronic care summary Assessment of capacity/competence Current aids and appliances (helps assess current functional level)
What kind of journey is demonstrated in the following patient journey?
GPs, district nurses ad hoc arrangements
No discussions with patient or family on condition, outlook, anticipated problems, place of care
Problems with pain, sickness, constipation and anxiety
Patient crisis call - no plan or drugs in the home
Admitted to hospital after calling 999
Dies in hospital after failed CPR
Family given minimal support in grief
No reflection by professional team on care
Reactive journey
What kind of journey is demonstrated in the following patient journey?
On GP Register - discussed at Team meeting
Social, Financial Support & info given to patient + carers
Usual GP & DN proactive support-visits/’phone calls
Assessment of symptoms, partnership with specialists - customised care to patient and carer needs
Care assessed including respite & psychosocial needs
Preferred place of care noted and organised
Care plan & Medication issued for home
End of Life pathway
Dies in preferred place; Family bereavement support
Staff reflect-SEA, audit gaps improve care, learn
Proactive journey
What are the 3 major sections of the anticipatory care plan?
Legal
Personal
Medical
In an interview with a patient and carer, what should you find out?
Find out what the issues are for the carer;
- what is it like to be a carer
- what help is available
- what gaps are there in the service
- what is the impact of being a carer on the carer’s own physical and mental health
Find out what the issues are for the patient;
- find out from the patient how they feel about being dependent on others for care needs
- what would they like from the service that is not available
