Complex Care Flashcards
What are the 6 main categories of elder abuse?
- Neglect
- Psychological abuse
- Sexual abuse
- Financial abuse
- Physical abuse
- Racial/cultural abuse
What are the risk factors for elderly abuse?
- Cognitive impairment
- Shared living
- Functional dependency
- Low income
What are the risk factors relating to the perpetrator for elderly abuse?
- Psychiatric illness (including dementia)
- Drug and alcohol dependency
- Caregiver burden and stress
What are the relationship risk factors for elderly abuse between the perpetrator and the abused?
- Family disharmony
- Conflicted relationships
What are the environmental risk factors for elderly abuse?
- Low social support
- Shared living
What do you in hospital if there is concern for an elderly patient’s home environment?
Inform the hospital safeguarding team
What are the 5 principles of the Mental Capacity Act?
- Presumption of capacity
- Support to make a decision
- Ability to make unwise decisions
- Best interests
- Least restrictive
What is NHS funded continuing healthcare?
Free care outside of hospital that is arranged and funded by the NHS. It is only available for people who need ongoing healthcare and meet the eligibility criteria.
How do you assess who is eligible for NHS funded continuing healthcare?
There are 2 parts:
- The local team looking after the patient complete a checklist to see if a person may be eligible
- The checklist has a scoring system to see if a person may need a full MDT continuing healthcare meeting that is chaired by a specialist assessor
What are the most common sites for pressure ulcers?
Bony prominences e.g. sacrum, ankle, heel, buttocks, elbows and bony shoulders
How do you prevent pressure ulcers? S SKIN
Surface - check the surface you sit/sleep on
Skin - always check the skin
Keep moving
Incontinence + increased moisture - makes the skin more fragile
Nutrition + hydration - good diet is important
What are the risk factors for pressure ulcers?
- Nutritional deficiency
- Significant cognitive impairment
- Significant loss of sensation
- Significantly limited mobility
- Incontinence
What does a grade 1 pressure ulcer look like?
Non-blanchable erythema of intact skin. Discolouration of the skin, warm oedema, induration or hardness (may also be used as indicators, particularly on individuals with darker skin).
What does a grade 2 pressure ulcer look like?
Partial thickness skin loss involving epidermis or dermis or both. The ulcer is superficial and presents clinically as an abrasion or blister.
What does a grade 3 pressure ulcer look like?
Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to but not through the underlying fascia.
What does a grade 4 pressure ulcer look like?
Extensive destruction, tissue necrosis or damage to muscle, bone or supporting structure with or without full thickness skin loss.
What is the management for pressure ulcers?
- A moist wound environment encourages ulcer healing. Hydrocolloid dressings and hydrogels may help facilitate this.
- Consider referral to tissue viability nurse
- Surgical debridement may be beneficial for selected wounds.
What are the bladder function changes in ageing men AND women?
- Frequency of involuntary bladder contraction increases
- Total bladder capacity decreases with voiding urge at lower volumes
- Bladder contractility decreases resulting in: increased post void residuals, increased sensation of urgency/fullness, increased incidence of nocturia, night awakenings
What are the bladder function changes in ageing females?
- Menopausal oestrogen decline
- Urogenital atrophy
- Decrease in sensitivity of receptors in the internal sphincter - less tone
What are the bladder function changes in ageing males?
- BPH
- Increased urethral resistance
- Varying degrees of urethral obstruction
- Higher frequency of urination, however unable to urinate much stream, not smooth
How common is urinary incontinence in ageing?
1:13 in women and 1:12 in men >65yrs.
It is associated with significant comorbidity including depression, falls and fractures, UTIs, social isolation and deconditioning.
How can you diagnose incontinence to guide management?
- Clinical hx
- Dietary assessment
- Symptom evaluation
What factors need to be considered when deciding management for incontinence?
- Co-morbidity
- Polypharmacy
- Physical and cognitive function
- Lower urinary tract dysfunction
How do you investigate for acute and reversible causes of incontinence?
Pelvic and rectal exam (symptomatic GU prolapse, GU syndrome of menopause, faecal loading and assessment of pelvic floor function)
