Elder Health Flashcards
research physiological changes in ageing
- Special senses
- GI system
- Body composition and stature • Endocrine/bone
- Immune system
- Respiration
- Liver
- Kidney
- Skin
- Muscle and Joints
home care
Home support packages to facilitate in home care for as long as practicable.
Shift in government funding over 2016-7
Money in
residential aged care
Permanent or respite placement options available.
Shift in government funding over 2016-7
Money out
Client characteristics and usage rates
- Limited data available
- 1/3 people in Home Care were aged over 85 years.
- Age specific usage rates show that below age 75 years, people receiving services from outlets located in remote and very remote areas had higher usage rates than people in other remoteness areas.
levels of care
Level 1: basic care needs
Level 2: low level care needs
Level 3: intermediate care needs
Level 4: high care needs
resident characteristics
In Australia during 2014-15:
• Almost $16billion dollars spent on aged care services.
• Over 2/3 of people in permanent RAC were women.
• 1% of people in RAC identified as ATSI compared to 3% of Australians overall.
• 3/5 non indigenous people were aged 85 and over, compared with 1/5 indigenous people in care.
• 31% of people in RAC were born overseas with 18% of those coming from NES countries.
• 1/4 people in RAC were assessed as requiring a HIGH level of care across all three ACFI domains.
funding of aged care placement
Accommodation deposits/bonds Aged Care Funding Instrument (ACFI)
ADL Domain – nutrition, mobility, personal hygiene, toileting, continence
Cognitive and Behaviour Domain – cognitive skills, behaviours (wandering, physical, verbal), depression
Complex Health Care Domain – medication, management of complex health issues/problems
Weekly fees
physiotherapy role
Assessment
Admission assessment
Quarterly care plan review assessment
Significant change in function assessment (post fall, acute illness/episode, post hospital)
Intervention Falls prevention Pain management Cardiorespiratory function Optimisation and maintenance of mobility (strength, ROM, balance) and function Facilitation of participation Palliative care
Staff education
Manual handling, positioning,
have a review of the assessment slides
22-24
assessment guidelines
Reason for assessment: new admission, acute condition, post falls, recent hospital admission
History of current presenting condition Medical and Surgical History
Current Medications (and past long term meds) Social History
Falls History
Current reported level of function
Cognitive condition/state: ?hx of dementia
Pain: acute, persistent, acute exacerbation on background of persistent pain
Assessment
Basic Observations: HR, BP (lying, sitting and standing), Temp, O2 Sats.
Current functional level: physical mobility scale, bed mobility, STS, transfers, sitting balance, standing balance, mobility, UL and hand function,
Basic MSK screening – posture, AROM/PROM, contractures, strength, etc
Basic neurological screening - sensation, coordination, tone, spasticity, clonus, motor planning, visuospatial ability, cognition, response, vestibular, vision, etc
Basic cardiorespiratory screening – AE, auscultation, observation, cough, cyanosis, clubbing, general respiratory function including dyspnoea, WOB, acc mm use., etc
Outcome measures
Physical mobility scale
Falls risk screen: high 28-36/45 total PMS score
Provides useful information about mobility, balance impairments and safety Barker 2008
TUG
More an indication of mobility than a grading of falls risk in RAC
< 15 s some indication of low fall risk Nordin 2008
Abbey Pain Scale
Non verbal people with dementia
Modified Residents Verbal Pain Inventory – Brief Patient Specific Functional Scale
goals of intervention
Resident goals Therapist goals Family goals Organisational Goals
Mobility and transfers
- Mobility
- Aid prescription and fitting
- Determination of assistance required, maximum distance, safe environments • Rehabilitation of mobility
- Advice and instruction on transfers (staff, resident and family) • Stand pivot
- Stand transfer
- Sara Steady
- Stand up hoist • Full sling hoist
intrinsic risk factors + extrinsic risk factors =
falls risk
falls, fractures and depression
Significant problems in RACFs
àdecreased physical activity and quality of life
Rate of falls is 5 times higher in RACFs than in the community for the over 65 yr subgroup
Approximately 22% of all falls related hospital admissions involve people aged over 65 years and living in RAC.
Incidence of depression in RACFs is high
Often associated with higher rate of falls due to use of anti- depressants.
fracture burden
• Loss of mobility
– Walking independently: 95% pre fracture to 32% post fracture
(Maggio, 2001) – “Post-fall” syndrome
• Health care utilisation
– Hip fracture treatment costs AUD$20,000 to $50,000 (McClure, 2005)
• Death
– 35.5% of residents admitted to hospital with a fall-related hip
fracture die within 1 year
• Compared with 20.6% for those who live in the community (Fisher, 2001)
post fall syndrome
- Self perpetuating spiral of functional decline
- Loss of independence
- Increased carer burden • Increased social isolation
- Altered self imageà increased perception of frailty and decreased confidence
mobility and falls risk in RAC
A non-linear relationship between risk of falling and risk of sustaining a fracture
• Highest risk Mild to moderate mobility impairment (PMS total score 28–36) (Barker, 2008)
• Fall rates
ü Highest in those with fair standing balance ü Intermediate in those with the best standing balance ü Lowest in those with the worst standing balance
interventions
Environment – clear pathways, rooms free from clutter, appropriate levels of light, path of least resistance, bed sheets, etc
Alert systems – out of bed sensors, floor sensor mats, room motion sensors, etc
Equipment – bed rails (covers), transfer aids, mobility aids, beds (style, height, position), crash mats, hip protectors, footwear, eyewear, etc
Medical – pain management, medications, MSK management, etc
Physiotherapy specific interventions – rehabilitation of functional movement
ASSESSMENT AND REHABILITATION OF FUNCTIONAL MOVEMENT
- Bed mobility
- Sitting balance
- STS
- Standing balance
- Mobility – indoors, outdoors and community ambulation • Steps/stairs and obstacles
- Upper limb function
ASSESSMENT OF BED MOBILITY
Bridging Up/down bed Across the bed (L and R) Rolling L and R Supine to sitting on edge of bed
ASSESSMENT OF SITTING BALANCE
Sitting unsupported
Sitting and turning to look over L and R shoulders Sitting and reaching outside BOS
Sitting and retrieving an object from the floor Response to external perturbations
ASSESSMENT OF SIT TO STAND
Deviations from normal movement sequence – push through, pull up, Weight bearing – symmetry
Control of stand to sit
Repetitions
Completion posture
