Care of Older People Flashcards
Currently, how many people are aged >80 years?
3 million people are in aged over 80 years in the UK (10 million over 65) This will double by 2050 There are more people aged over 60 in the UK than under 18 A baby boy is expected to live until 84
Bio-Psycho-Social Model of Health
Emotional aspects to ageing Social aspects Environmental Financial/economic
Appropriate Admission
Frail older people must be able to access the same standard of urgent care irrespective of where it is delivered (Cooke et al., 2012) Do not deny older people a hospital attendance if required Do consider if you could achieve a good urgent care response at home
Inappropriate Admissions What are the consequences of an inappropriate admission to hospital? [make a list]
Also, did you know… Functional Decline in Hospital: Inactivity, 20% loss of muscle strength per week Bed rest, 3% muscle loss in thighs per 7 days Result Increasing dependency Reducing mobility
Making Decisions Older people are complex in their presentation. Those over the age of 85 are often considered as a high risk group for deterioration and/or further illness/injury.
As an AAP you must seek support in making decisions. Calculate the EWS Refer to EMAS Pathfinder Utilsie the Clinical Assessment Team (CAT) Always ensure a clinician to clinician discussion/handover
Hospital can be bad news for older people. This said, acute/deteriorating older people must not be denied appropriate admission. AAP’s should consider how a person might receive the same standard of care in their home. The tutor must reinforce the use of EWS, pathfinder and clinician to clinician advice/handover. Older people get ‘sucked into’ the emergency and urgent care system – making if difficult to get out. The 4 hours target in A&E does not help with the number of older people being admitted. Popping a person down to A&E for an MoT can exacerbate this problem. Consider alternative care pathways.
Hospital can be bad news for older people. This said, acute/deteriorating older people must not be denied appropriate admission. AAP’s should consider how a person might receive the same standard of care in their home. The tutor must reinforce the use of EWS, pathfinder and clinician to clinician advice/handover. Older people get ‘sucked into’ the emergency and urgent care system – making if difficult to get out. The 4 hours target in A&E does not help with the number of older people being admitted. Popping a person down to A&E for an MoT can exacerbate this problem. Consider alternative care pathways.
Risk
Risk and Benefit, Balanced Decision Making Risk = Consequence x Likelihood Control Measures Risk v Benefit
Controlled Risk Taking
The assessment of risk has often raised difficult questions for practitioners balancing empowerment with duty of care. The rights of adults to live independent lives and to take the risks they choose need to be weighed carefully against the likelihood of significant harm arising from the situation in question (SCIE, 2010) Note – Shared Decision Making
Mental Capacity Image Reference: (Marion Dakin Associates, 2014)
This slide requires AAP’s to think about Risk. Every decision has associated risks and benefits. We can mitigate risks with control measures (clinical actions – usually referrals). Pose a range of situations and ask the AAP’s to explore the potential risks and benefits. Examples: -Staying at home rather than attending hospital -Making a hot drink -Sleeping in a chair
Physiological Changes with Age
Physiological Changes with Ages with Age
CNS
Physiological Changes with Age
endocrine
Physiological Changes with Age
eyes
Physiological Changes with Age
pulmonary
•http://www.bgs.org.uk/elearning-900-resource/sectrainees/elearning
What is Frailty?
Frailty is a syndrome and is a collection of conditions/presentations. AAP’s should identify frailty in practice.
Issue students with the Rockwood Clinical Frailty Scale. This will help to identify how frailty might present alongside acute or chronic presentations.
Frailty means than an older person has very little reserve when they become ill. This means they can deteriorate rapidly.
Rockwood Clinical Frailty Scale
What Should a AAP Consider?
- Pain
- Depression
- Skin Integrity
- Falls/Mobility [FRAT]
- Continence
- Safeguarding Issues
- Delirium/Dementia
- Nutrition/Hydration
- Sensory Loss
- ADL’s
- Vital Signs
- End of Life Issues
Take confusion seriously. Consider:
Acute Physical Cause *
Delirium *
Dementia
*You need to have a good idea about source
A Word About Confusion
should always considered what
red flag
AAP’s should consider
Delirium
A temporary mental state with a sudden onset, usually reversible, including symptoms of poor attention, inability to concentrate, disorientation, anxiety and sometimes hallucinations
AAP’s should consider:
Hypoxia
Blood Glucose
Sepsis
Issue Sepsis Tool
A Word About Confusion…reasons for confusion
delirium. mnoemonic
