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Yr4: OPIC > Community Medicine > Flashcards

Community Medicine Flashcards

1
Q

Define impairment

Give some examples

A
  • An impairment is the loss or abnormality of a body function that can be anatomical, physiological or psychological
  • Examples:
    • Poor sight
    • Diagnosed mental disorder
    • Balance disorder
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2
Q

Define disability

Give some examples

A
  • A disability is an inability or restricted ability to perform an activity within the normal human range/restriction of functional ability due to impairment
  • Examples:
    • Unable to walk
    • Unable to see/blind
    • Major depression
    • Missing a limb
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3
Q

Define handicap

Give some examples

A
  • A mental, physical or social disadvantage as a result of disability
  • Examples:
    • Being unable to work or live somewhere due to limited access
    • Being unable to take part in particular sport
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4
Q

Impairment, handicap and disability are interlinked; describe the link between them

A

Impairment can reduce your functional ability and hence you have a disability. Your disability (inability to perform an activity within normal human range/restriction on functional ability) may mean you have a handicap (disadvantage) in certain situations

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5
Q

What do we mean by deconditioning?

A

Deconditioning is a complex process of physiological change following a period of inactivity, bedrest or sedentary lifestyle that results in decreased functional ability

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6
Q

State some factors that could contribute to deconditioning in the elderly

A

Anything that may case prolonged period of inactivity/rest/sedentary lifestyle:

  • Hospital admission (for whatever reason)
  • Injury (impacting mobility)
  • Surgery
  • Stroke
  • Falls
  • Mental disorders that impair functioning e.g. dementia
  • Chronic conditions that lead to pt feeling unwell
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7
Q

State some potential consequences of deconditioning in the elderly

A
  • Muscle weakness → falls, decreased endurance
  • Pneumonia (weak muscles → weakened cough & not using lungs as much. Also greater risk of aspiration if on prolonged bedrest)
  • Constipation
  • Incontinence
  • Decreased appetite
  • Impaired digestion (slower digestion, impaired absorption)
  • Disorientation
  • Depression
  • Increased heart rate
  • Postural hypotension
  • Pressure ulcers
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8
Q

Discuss how we can decrease the risk of deconditioning in the elderly

A
  • Early mobilisation
  • Adequate nutrition
  • Promoting independence
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9
Q

Discuss the role of community hospitals in the management of older people

A

Play a major part in rehabilitation and allowing early transfer from acute hosptials

???FIND OUT MORE COALVILLE

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10
Q

Who usually leads care in community hospitals?

A

Care is usually led by local General Practitioners (GP), and less commonly by geriatric medicine specialists, sometimes supported by non-
consultant career grade doctors or doctors in training.

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11
Q

State some examples of medical cases community hospitals receive and where they receive them from

A

????? Complete after coalville

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12
Q

What types of services are available in community hospitals?

A
  • In-patient rehabilitation
  • End of life care
  • Outpatient clinics
  • Sexual health clinics
  • Phlebotomy

CHECK AFTER COALVILLLE

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13
Q

Discuss some limitations of hospital based care

A

???

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14
Q

Discuss what we mean by ‘rehabilitation for older persons’

A

Multidisciplinary set of evaluative, diagnostic and therapeutic interventions whose purpose is to restore functional ability or enhance residual functional capacity in older people with disabling impairments or complex medical backgrounds

*****WHO definition of rehabilitation: ‘a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”.

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15
Q

What are the aims of rehabiliation?

A
  • Reduce negative impact of the acute illness
  • Slow down decline of physical, psychological, social and functional abilities
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16
Q

Where does the majority of rehabilitation take place for elderly pts?

A
  • Majority takes place in community hospitals
  • But other common alternatives include:
    • Care homes
    • Acute medical hospitals
    • Home
    • Outpatient clinics (e.g. falls prevention programme)
17
Q

Geriatric rehabilitation begins at _____ and __

A

Begins at admission and continues beyond discharge

18
Q

State some alternatives to hospital care (i.e. what community teams are available)

A
  • Nursing home
  • Residential home
  • “Hospital at home”/district nurses
  • Increased support at home

????CHECK AFTER COALVILLE

19
Q

Discuss how health & social care interact in the provision of long term care

A

Much of their work is linked hence there must be effective collaboration & communication:

  • Health care: treatment of medical conditions, physio to help mobilisation, occupational therapy to help with adaptations in exisiting home
  • Social care: carers, housing, funding

E.g. at Coalville they complete a home first form which details what pt can and cannot do. They send this to social care who then look at information to decide what care package person needs and they put that in place.

20
Q

Discharge planning should be started as soon as the patient is admitted and this is often carried out with MDT in a continuous, ongoing process; true or false?

A

True

21
Q

For optimal individualised discharge planning, what elements of a patient’s case are important to know?

A

In summary you need to know information about current needs and support so that you can determine what needs to be arranged for them in preparation for discharge.

  • Where they live and type of accommodation
  • Who do they live with
  • Is their accommodation in a suitable state
  • What patient is able to do and what they need support with
  • Support in place (e.g. from family/carers, care workers etc..)
  • Equipment they have at home
  • Finances
  • What activities they enjoy and are or could be involved in
  • Medications & compliance
  • Patient/s wishes/preferences
    • Concerns
    • Aims
    • What’s important to them
22
Q

State some example discharge destinations

A
  • Community hospital
  • Own home (+/- package of care/equipment)
  • Specialist accommodation (e.g. assisted living, warden control/sheltered accommodation)
  • D2A bed
  • Residential care home
  • Nursing home
  • Family members home
23
Q

Briefly outline the roles of the following allied health professionals and discuss how they can facilitate rehabilitation/safer discharge of an older person:

  • Physiotherapist
  • Occupational therapist
  • Speech & language therapist
  • Dietician
  • Hospital nursing staff
  • Hospital healthcare assistant
  • Social worker
  • Care home manager
  • Relatives/live-in carers
  • Pharmacist
  • District nurse
A
  • Physiotherapist: assess mobility and offer guidance on how to improve mobility aswell as giving equipment
  • Occupational therapist: assess what ADLs pt may need help with and offer guidance, equipment, home adaptations etc…
  • Speech & language therapist: assess swallowing and suggest ways to increase safety of swallow
  • Dietician: assess nutritional intake and suggest ways to ensure adequate intake e.g. supplements
  • Hospital nursing staff: nurse patient to be medically fit, plan for discharge…????
  • Hospital healthcare assistant: assist with basic care needs and try to promote independence with these. Can feed back to other professionals about what pt struggles with
  • Social worker: arrange funding, housing, care package
  • Care home manager: ???
  • Relatives/live-in carers: help prepare home, mentally prepare pt, support in initial transition period
  • Pharmacist: review medications, supply medications, dosette box
  • District nurse: attend to any nursing needs in community e.g. IV abx, dressing changes etc… to allow quicker discharge home
24
Q

Briefly outline the Discharge to Assess (DtA)/discharge to assessment bed process

A

Where people who are clinically optimised/medically fit and do not require an acute hospital bed, but may still require care services are provided with short term, funded support to be discharged to their own home (where appropriate) or another community setting; this prevents then waiting in acute hospital for assessments. Assessment for longer-term care and support needs is then undertaken in the most appropriate setting and at the right time for the person. Commonly used terms for this are: ‘discharge to assess’, ‘home first’, ‘safely home’, ‘step down’.

25
Q

What is the meaning of fast track discharge?

A

When patients are rapidly deteriorating, fast-track assessments, also known as rapid discharges, are used to gain immediate access to NHS continuing healthcare funding. Fast-track applications allow health professionals to arrange urgent care packages to enable patients to be cared for, and eventually die, in their preferred place. This could be their own home or a care setting such as a nursing home or hospice.

Things that need to be considered done:

  • Communication with pt and family
  • Refer to OT for assessment so they can organise any home adapations/equipment
  • Write TTO’s (including anticipatory medicines)
  • DNA-CPR paperwork
  • Inform GP
26
Q

What’s the difference between nursing home & residential home?

A

A nursing home is for people who are requiring nursing care combined with residential/social care. A team of registered nurses will be available 24 hours a day whereas in residential homes nurses would only be called in at certain times of day when required. Nursing homes provide specialist care for those with more complex clinical needs, for example those living with dementia and Parkinson’s disease.

27
Q

What do we mean by intermediate care?

A

Intermediate care services provide support for a short time to help people recover and increase independence. Intermediate care may help patients:

  • recover after a fall, an acute illness or an operation
  • avoid going into hospital unnecessarily
  • return home more quickly after a hospital stay
  • remain at home when they start to find things more difficult
28
Q

What is interim care?

A

Interim Care is when a long-term care facility offers immediate, short-term service to a patient who is awaiting placement in a different long-term care facility.

29
Q

What is:

  • Assisted living
  • Sheltered accomodation
A
  • Assisted living: pt lives in a self-contained flat, with own front door, but staff are usually available up to 24 hours per day to provide personal care and support services. They can help with washing, dressing, going to the toilet and taking medication. Domestic help, such as shopping and laundry, and meals may also be provided.
  • Sheltered housing: less support than assisted living. Often have warden/support staff present, 24hr emergency help through alarm system, communal areas & social activities
30
Q

What is NHS Continuing Healthcare?

A

NHS Continuing Healthcare (NHS CHC) is a package of care for adults aged 18 or over which is arranged and funded solely by the NHS. In order to receive NHS CHC funding individuals have to be assessed by Clinical Commissioning Groups (CCGs). The team’s assessment will consider your needs under the following headings:

  • breathing
  • nutrition (food and drink)
  • continence
  • skin (including wounds and ulcers)
  • mobility
  • communication
  • psychological and emotional needs
  • cognition (understanding)
  • behaviour
  • drug therapies and medicine
  • altered states of consciousness
  • other significant care needs
31
Q

What is the comprehensive geriatric assessment (CGA)?

A

Multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail older person in order to develop a coordinated and integrated plan for treatment and long term follow up.

*It emphasises quality of life and functional status, prognosis and outcome

32
Q

State some domains of the comprehensive geriatric assessment (CGA)

*Poor Frail Elderly Men Need More Sugar

A
  • Physical problems
  • Medication review
  • Nutritional status
  • Mental health: cognition, mood, anxiety and fears
  • Functional capacity: basic acitivities of daily living, gait & balance, activity/exercise status, instrumental activities of daily living
  • Social circumstances: informal support available from family or friends, social network such as visitors or daytime activities, eligibility for offered care resources
  • Environment: home environment, facilities and safety within home, transport facilities, accessibility to local resources

Use all of the above to create a problem list (can have current & potential future problem list) and use this to develop a coordinated care plan.

33
Q

What members of MDT does CGA usually involve

A
  • Geriatrician
  • Nurse specialist
  • Occupational therapist
  • Physiotherapist
  • Pharmacist
  • Others e.g. speech & language, dietician etc..
34
Q

Why do we use CGA in clinical practise/what are the benefits?

A

Improves outcomes for elderly people including:

  • Reduced readmissions
  • Reduced long term care
  • Greater patient satisfaction
  • Lower costs

Yr4: OPIC (11 decks)

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