FPC2 Tutorial 3 Ageing Well or Not so Well Flashcards
Homeostatic reserve (the ability of an organism to stabilise its normal internal environment) is the same in the elderly as in early and middle adult life: True or False
false
Disease always presents in the same way in the elderly as it does in younger adults: True or False
false
Normal ranges e.g. peak flow rate, are affected by age: True or False
true
Drug handling alters with age: True or False
true
Treatable disease in the elderly is frequently ascribed to “normal ageing”: True or False
true
Define “Ageism”
A process of systematic stereotyping and discrimination against people just because they are old.
Lifestyle changes in old age are not worthwhile as they produce no significant health benefits: True or False
false
In 2000, the proportion of the world’s population over 60years was 11%. By 2050, it is expected to be:
A 8% B 15% C 22% D 40%
C
22%
In the period 2000 to 2050, the number of people aged 80 and older will increase:
A 2-fold B 3-fold C 4-fold D 5-fold
C
4-fold
By 2050, what percentage of older people will live in low-income and middle-income countries?
A 80% B 65% C 50% D 35%
A 80%
In the world’s poorest countries, the “biggest killers” are:
A) Cholera and dysentery
B) Heart disease, stroke and chronic lung disease
C) Malaria
D) Sleeping sickness
B Heart disease, stroke and chronic lung disease
Older people in low-income and middle-income countries carry a greater disease burden than those in the rich world: True or false?
true
By 2050, the number of older people who are no longer able to look after themselves is forecast to increase:
A Not at all B Two-fold C Three-fold D Four-fold
D
4-fold
Worldwide, most training for health professionals includes instruction about specific care for older people: True or False
false
Creating “age-friendly” physical and social environments does not improve the active participation and independence of older people: True or False
false
A 63 year old patient who gives up smoking will decrease their risk of premature death by:
A 50% B 40% C 30% D 20%
A
50%
what are happening to the shape of population pyramids?
beocming more top heavy as the numbers of the eldery population is increasing
what is the fastest growing age group in the world?
80+ age group
Scotland 2004-2031:
The number of children aged under 16 is projected to decrease by 15%
The number of people aged 16-29 is projected to fall by 12%
The number of people aged 30-49 is projected to decrease by 17%
The number of people aged 50 and over is projected to increase by 28%
The number of people aged 65 and over is projected to rise by 58% and the number aged 75 and over is projected to rise by 75%.
what are some health implications of this demographic change?
Increased numbers of geriatricians and health professionals involved in care of the elderly will be required
Increased facilities for elderly health care will be required
The care of many long term conditions e.g. diabetes, CVD, neurological conditions, renal disease is moving from secondary care to primary/community care. The end stage of these diseases requires as much palliative care as cancer. The prevalence of such diseases will increase as the population ages
Specific health promotion campaigns aimed at the elderly
Scotland 2004-2031:
The number of children aged under 16 is projected to decrease by 15%
The number of people aged 16-29 is projected to fall by 12%
The number of people aged 30-49 is projected to decrease by 17%
The number of people aged 50 and over is projected to increase by 28%
The number of people aged 65 and over is projected to rise by 58% and the number aged 75 and over is projected to rise by 75%.
What are some social implications of this demographic change?
As the population ages, they will be increasingly dependent on families and/or carers who are also ageing
The demand for home carers and nursing home places is likely to increase
Within local communities, there will be increasing emphasis on providing social activities for the elderly
The role of the elderly as grandparents and carers of grandchildren is likely to change
Housing demands are likely to change as more elderly people live alone
Scotland 2004-2031:
The number of children aged under 16 is projected to decrease by 15%
The number of people aged 16-29 is projected to fall by 12%
The number of people aged 30-49 is projected to decrease by 17%
The number of people aged 50 and over is projected to increase by 28%
The number of people aged 65 and over is projected to rise by 58% and the number aged 75 and over is projected to rise by 75%.
What are the political implications of this demographic change?
Current decision making and workforce planning must take account of the ageing population
The increasing elderly population will potentially have the power to influence political decision making in relation to their specific concerns
Scotland 2004-2031:
The number of children aged under 16 is projected to decrease by 15%
The number of people aged 16-29 is projected to fall by 12%
The number of people aged 30-49 is projected to decrease by 17%
The number of people aged 50 and over is projected to increase by 28%
The number of people aged 65 and over is projected to rise by 58% and the number aged 75 and over is projected to rise by 75%.
What are the economic implications of this demographic change?
Retirement/Pension age is already increasing
Finding employment may become harder for young people, as older people being required to work for longer blocks the “top end” of the employment sector
Proportionately less people will be paying into tax and pension funds, making it increasingly difficult to obtain an adequate return from pension funds
Those elderly who have not contributed to a private pension fund may find that the state pension is inadequate, resulting in poverty
Increasing cost of “free personal care for the elderly” policy (Scotland)
From 1951 to 2001, how have the births and deaths changed in scotland?
births decreased
deaths stayed around the same
how have life expentancies for males and females changed over recent decades?
what is the leading cause of death for women in england?
2015
dementia and alzheimers disease
what is the leading cause of death of men in england?
2015
heart disease
what is the life expectancy in england?
Provisional data for 2016 indicate that life expectancy at birth has now reached 79.5 years for males and 83.1 years for females
Since 2000 to 2002, both life expectancy and healthy life expectancy have increased; the population is now living longer and spending more years in good health.
Since 2000 to 2002, life expectancy has increased by more years than healthy life expectancy and therefore the number of years lived in poor health has also increased slightly; in 2013 to 2015 it was 16.1 years for males and 19.0 years for females. However, the proportion of life spent in poor health has remained stable and these data do not take into account trends in the types and severity of diseases over time
for both sexes, have years in poor health increased?
what is inequity?
The following graphs give an indication that not only life expectancy, but also healthy life expectancy can vary depending on the socioeconomic status of the person affected
how is poor health related to ageing and what is its effect?
The combined effect of the higher prevalence of Long Term Conditions (Tutorial 1, Year 2) and a population which is proprotionately older and spending more years in poor health is placing considerable pressure on Health Care and Social Care systems in the UK
It is important to work with _______________ such as Age Concern to help patients live healthier and better quality lives
Third Sector Organisations
are the number of family/friend carers increasing or decreasing?
6.5 million people in the UK are carers and this number continues to rise
There will be 9 million carers in the UK by 2037
Every year over 2.1 million adults become carers and almost as many people find that their caring responsibilities come to an end
This ‘turnover’ means that caring will touch the lives of most of the population, as we all need or provide care or support family members caring for loved ones at some point in our lives
3 in 5 people will be carers at some point in their lives
1.4 million people provide over 50 hours of unpaid care per week
The care provided unpaid, by the nations’ carers is worth an estimated £119bn per year – considerably more than total spending on the NHS in England
27% of carers were in receipt of Disability Living Allowance as a result of their own disability or ill health
who do family/friend carers care for?
Most carers (40%) care for their parents or parents-in-law
Over a quarter (26%) care for their spouse or partner
People caring for disabled children under 18 account for 8% of carers and 5% of carers are looking after adult children
A further 4% care for their grandparents and 7% care for another relative
Whilst the majority care for relatives, one in ten carers (9%) care for a friend or neighbour
Most carers care for just one person (83%), but 14% care for two people and 3% are caring for at least three people
what is the impact of caring?
Half of working age carers live in a household where no-one is in paid work
Almost 1 in 3 (30%) carers had seen a drop of £20,000 or more a year in their household income as a result of caring
A third of carers had cut back on essentials like food and heating (32%)
45% of carers said their financial circumstances were affecting their health
42% of carers have missed out on financial support as a result of not getting the right information and advice
Carers providing round the clock care are more than twice as likely to be in bad health than non-carers
61% of carers said that they were worried about the impact of caring on their relationships with friends and family
In 2014, half of carers (49%) said they feel society does not think about them at all
what is multimorbidity?
“the co-existence of two or more long-term conditions in an individual“
It is the norm, rather than the exception, in primary care patients
what are some examples of drug classes for different conditions?
what makes the management of older patients more complex?
Older patients may have more than one chronic health condition
This adds complexity to management
For example the preferred treatment for one condition may worsen another
what are different options for care?
Living in own home with support from family - Different families have different levels of support they are willing or able to provide
Living in own home with support from social services - Social work often can only provide care for a short spell up to three times a day, leaving her alone for long periods of time
Sheltered Housing - Sheltered housing is often a useful option for people who wish to live independently, but to know there are others nearby to help when needed.
Residential Home - have greater 24 hr support but no medical cover on site
Nursing Home Care - have resident nurses on site. They can be extremely expensive, perhaps up to £1500 per week if funding the stay privately
What are Anticipatory Care Plans?
“Advance and anticipatory care planning, as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care”
When should ACP be done?
At any time in life that seems appropriate
Continuously
Who should do the ACP?
by anyone with an appropriate relationship
how should the ACP be done?
Thinking Ahead & Making Plans
Carefully! Write it down
How can the ACP be shared?
KIS (Key Information Summary)
Other communication
what is some legal information that can be in a ACP?
Welfare power of attorney
Financial power of attorney
Guardianship
what is some personal information that can be in a ACP?
Statement of wishes regarding treatment/advance directive
Next of kin
Consent to pass on information to relevant others
Preferences and priorities regarding treatment
Who else to consult/inform
Preferred place of death
Religious and cultural beliefs re death
Current level of support e.g. family/carers
what is some medical information that can be in a ACP?
Potential problems
Home care package
Wishes re DNA CPR
Scottish Palliative Care Guidelines
Communication which has occurred with other professionals
Details of “just-in-case” medicines
Electronic care summary
Assessment of capacity/competence
Current aids and appliances (helps assess current functional level)
what are some wuestions to consider in regards to home care?
What are the true costs of home care?
Is care always available?
What Care options are available?
Rapid response; respite e.g. Rosewell.
What is care planning?
Discuss how the service has had to be redesigned
when interviewing a patient and a carer, what is important information to gather?
Find out what the issues are for the carer:
What is it like to be a carer? What help is available? What gaps are there in the service? What is the impact of being a carer on the carer’s own physical and mental health?
Find out from the patient how they feel about being dependent on others for care needs? What would they like from the service that is not available?
Find out from the patient how they feel about being dependent on others for care needs?
Work through a scenario of patient who lives at home but is in progressive decline and requires increasing amounts of care
Demonstrate what is meant by anticipatory care. How can this improve outcomes?
what questions owuld be asked in an interview with a care manager?
What is the role of a care manager? (Will be discussed in Tutorial 4 also)
How can they ensure that patients are receiving the appropriate level of care?
How do they deal with “rationing” decisions?
What can the service realistically provide?
What enables them or prevents them from providing the level of care they wish to provide?
What services can the access?
How do they co-ordinate care?
