E6 Care of the older patient Flashcards
what is an ‘older person’ classified as?
- generally someone over 65 might be considered an older person
- ‘frailty’ also has a bigger impact on likelihood to require care and support and how we provide this care and support
- in the future, elderly may be classified as an older age
define frailty
‘the group of older people who are at highest risk of adverse outcomes such as falls, disability, admission to hospital or the need for long-term care’
- related to ageing process
- relates to how well a patient will recover from a health problem
- combination of mobility, sight, hearing or memory issues
what are frail patients vulnerable to?
changes in health triggered by previously minor problems eg. UTI
- may cause confusion or falls or other serious events
- impacts how quickly the person recovers
- can affect confidence
- hospital beds are used for a long time baby frail patients
physiological changes of the heart in older patients
- heart has to work a bit harder
- blood vessels lose elasticity (less bendy and fluid, this can be reduced with a less fatty diet)
- accumulation of fatty deposits (heart has to work harder as it wears out)
physiological changes of the bones, muscles and joints in older patients
- bones shrink in size and density
- osteoblasts are responsible for bone turnover (their function reduces with age which leads to shrinking, reduced density and weakening)
- weaker bones leads to more fractures
physiological changes of the digestive system in older patients
swallowing and digestive reflexes slow down
physiological changes of the kidneys in older patients
- less efficient at removing waste as kidneys shrink with age
- function declines quite significantly as you age
- may develop urinary incontinence as muscles are less effective
physiological changes of the brain / nervous system in older patients
- number of brain cells decreases
- reflexes slow down and coordination becomes harder
- memory does degrade but this is very different to having dementia
why is it important to consider that older patients may have multiple comorbidities?
- these require multiple medications (polypharmacy)
- drug-drug interactions
- drug-disease interactions
- increased risk of side effects
what communication differences do older patients have?
sight loss
hearing impairment
memory
language (generational differences)
what is dementia?
- a general term fro the impaired ability to remember, think or make decisions that interferes with doing everyday activities (it is a deterioration in cognitive function)
is dementia a normal part of ageing?
no, age-related memory changes are different
risk factors of dementia
age
family history
cognitive reserve
ethnicity
lifestyle (smoking, alcohol, lack of physical activity)
comorbidities
TBI (traumatic brain injury)
what comorbidities are risk factors for dementia?
hypertension
atherosclerosis
hypercholesteremia
obesity
type 2 diabetes
depression
common early symptoms of dementia (umbrella term)
- memory loss
- confusion which may make it hard to carry out daily tasks
- difficulty concentrating
- mood changes
- struggling to follow conversations
symptoms of Alzheimer’s specifically
- word finding difficulty
- repetitive questioning
- forgetting names, places and faces
- confused / scared in unfamiliar environments
symptoms of vascular dementia specifically
- movement difficulties / changes
- difficulty with planning and reasoning
- mood changes - depression and very emotional
symptoms of Lewy body specifically
- fluctuating levels of confusion
- repeated falls / fainting
- slowing of physical movements
- sleep disturbances
what are some later stage symptoms of dementia as a whole?
- significant memory impairment (unable to recognise family members)
- communication difficulties (unable to adequately express feelings, non-verbal communication only)
- inability to mobilise safely and independently
- behavioural difficulties (agitation, anxiety, wandering, depressive, aggression)
- incontinence
what are some other conditions (not dementia) that older patients often suffer with?
- type 2 diabetes
- hypertension
- heart failure
- osteoporosis (due to reduced bone turnover)
- osteoarthritis (inflammation of bones and joints)
- hearing impairment (can affect balance and lead to falls)
- visual impairment eg. macular degeneration
- mental health issues
what needs to be considered when (de)prescribing in the older person?
pharmacokinetics
- what is their kidney function like?
- do we need to lower dose?
- do we need to stop drug use for a while so kidney function can improve?
- liver function might decline and lead to lingering of drugs in the brain (can lead to sedation and further problems)
adverse drug reactions
STOPP / START
- optimising of prescribing, reducing polypharmacy, reducing falls
what is a frailty score?
Rockwood Clinical Frailty Scale (CFS)
- a tool used to estimate an individual’s degree of frailty on a scale of 1 (very fit) to 9 (terminally ill)
- patients that score 5 or higher are considered to be frail
what must be considered surrounding how an older patient takes their medicines and accesses medical care?
- is the patient still independent with their medicines?
- do they use any aids to help them to remember to take their medicines?
- if the patient is not responsible, liaise with the appropriate carer / family representative
who could be involved in an older patient’s care?
family member
friend
paid carer
describe how older patients with reduced capacity may make medical decisions
- initially patients will be able to make these decisions with the help of loved ones
- may eventually lose this ability so need to be clear on who is the legal guardian / power of attorney
how can communication difficulties cause complications for healthcare of older patients?
- they may be unable to hear when discussing health issues with HCP
- this can result in poor understanding of advice / counselling
- they may also be unable to read any written instructions or complete repeat prescriptions correctly
why may older patients be more likely to have falls?
- visual impairment may lead to more trips
- hearing impairments can affect balance
- there is a higher risk of fracture and poor outcomes if they have a high frailty score and they fall
