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Clinical Ageing > Holistic Theme > Flashcards

Holistic Theme Flashcards

1
Q

why is health of the older population important ?

A

grandparents caring for children
retirement age is increasing
burden on the healthcare system
polypharmacy - poeple on lots of medication are hard to manage

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2
Q

what approach should geriatric medicine have

A

holistic, integrated view - biopsychosocial model of health

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3
Q

what is the CGA

A

comprehensive geriatric assessment
- physical mental, social and functional environment
- nurses, doctors, physiotherapists, everyone contributes to this
- holistic assessment

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4
Q

what is primary prevention

A

reduce incidence of disease in the population by universal measures that reduce lifestyle risks by targeting high risk groups

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5
Q

what is secondary prevention

A

systematically detecting early stages of disease and intervening before symptoms develop
e.g prescribing statins to reduce cholesterol and taking measures to reduce high BP

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6
Q

what is tertiary prevention

A

softening the impact of an ongoing illness that has lasting effects - help people manage long-term complex health problems to improve their ability to function

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7
Q

what is the care act?

A

local authorities ensure people who live in the area recieve services that prevent care from being more severe

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8
Q

what is frailty

A

loss of physiological reserve causing increased vulnerability and poor health outcomes
NOT disability (establishes loss of function)
slower recovery and increased fatigue

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9
Q

what are common presentations of frailty?

A

postural hypotension - fall in systolic BP >20mmHg
fall in diastolic BP >10mmHg from lying to standing up
caused by ageing , hypoglycaemia, diuretics, it autonomic dysfunction
can cause falls, delirium, neck of femur fracture and poor nutrition

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10
Q

how can frailty be managed

A

stopping medication or lifestyle changes
standing up slowly
stockings
fluorocortisone (promotes Na+ and water retention)

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11
Q

what are clinical issues around dealing with the elderly

A

multi-morbidities
non-specific symptoms e.g loss of function
atypical/late presentation
lack of physiological reserve (illness comes on quicker, longer recovery and more complications)
altered drug metabolism - doses need altering, more likely to have side effects

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12
Q

what is the Rockwood score

A

a frailty score
1 = very fit, 9 = terminally ill
9 = completely dependant and approaching end of life

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13
Q

what are risk factors to have a fall

A

age
previous falls
postural hypotension
loss of muscle mass (sarcopenia)
visual impairment
use of walking aid

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14
Q

how to prevent having a fall

A

multi-disciplinary approach
falls clinic, rationalise medications, visual/walking aids
home circumstance review

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15
Q

outline fractured neck of the femur

A

common, 10% mortality within 1 month
occurs with minor trauma in elderly
bone density decreases with age - osteoporosis
results from falls
painful shortened, externally rotated leg

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16
Q

what is a method to distinguish between dementia, delirium and depression as they present similarily

A

PINCHME
pain
infection
nutrition
constipation
hydration
medication
environment

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17
Q

why are the elderly at particular risk of under-nutrition

A

basal metabolic rate and energy requirements are reduced
reduced muscle mass
% of body fat increased
but also:
decreased appetite, difficulty preparing food, financial difficulty

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18
Q

what are the implications of under nutrition

A

impaired immunity
muscle weakness
poor wound healing

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19
Q

how do we manage a fractured neck of the femur

A

analgesia - drugs for pain
surgery = total hip replacement or dynamic hip screw
need good holistic care

20
Q

how can frailty be prevented

A

healthy ageing
exercise
good nutrition
remaining engaged in the local community

21
Q

when was the NHS established

A

1948

22
Q

what did the NHS say it would deliver

A

it was made to meet the needs of everyone, free at the point of delivery and based on clinical need
NOT the ability to pay

23
Q

how have the budgets of the NHS changed over time

A

now its 116 billion, compared to 437 million in 1948
today this would be 15 billion

24
Q

what are groups of the NHS

A

NHS england
CCGs = clinical commissioning groups

25
Q

what is the NHS changing into now

A

personalised, sustainable and joined-up care
depends on politics, people and unclear hierarchies

26
Q

do people know how to use the NHS system

A

no there is poor health literacy in our society

27
Q

what are implications of the ageing population on the NHS

A

multimorbidity with age, more likely to use all types of healthcare service
medication use and cost is higher
more likely to require coordination with other services e.g social care

28
Q

what is the hierarchy of care

A

self care
primary care
secondary care

29
Q

what type of care do older people need more of?

A

secondary care e.g many old people may need ambulance to access care
and older people take longer to recover so use more levels of care

30
Q

what are the hierarchies of care

A

A&E
NHS walk in centre
GP
pharmacy
NHS direct - phone call
self-care

31
Q

what could make care better

A

good communication with health professionals and better continuity of care (reviews, follow-up appointments, and attention to patients emotional needs)
explaining things in lay language
doctors should consider quality of life
better links between physical and mental health e.g psychological support following diagnosis

32
Q

what may an old person do which

A

if old people cant get hold of GP, they may call an ambulance

33
Q

why would joined up care be good?

A

seeing lots of different health professionals is frustrating
unnecessary time in hospital
no coordination between Gp and social care = lack of support
carer is given the responsibility of coordinating care - CARE PLAN
care in own home - better use of resources, comforting,
integrated care centred around the need of the patient

34
Q

what is MDT

A

multi-disciplinary team
use team skills to improve patient care
regular meetings to discuss patients care plan
patient is involved in the process as much as possible - they are central to care

35
Q

what is disease

A

pathological process which is a deviation from biological norm
what the doctor diagnoses the patient with

36
Q

what is illness

A

personal experience of feeling unhealthy
accompanied by disease but not always
what the patient brings to the doctor

37
Q

what is sickness

A

view of society on illness/disease and how this affects everything

38
Q

what is the traditional biomedical model (19th century)

A

sole focus was physical/biological aspects of disease
didnt acknowledge social and psychological factors
doctor in full control of diagnosis and treatment

39
Q

whats an advantage of the traditional biomedical model

A

lead to big improvement in life expectancy and quality of life
and management of chronic illness

40
Q

whats a disadvantage of the traditional biomedical model

A

reinforced hierarchy and paternalism
incomplete diagnosis and treatments not appropriate for individuals

41
Q

where can a CGA take place

A

inpatient
community
day hospital

42
Q

what is person centred care

A

dignity, respect and compassion
care coordination and transition
personalised and enabling

43
Q

what is paternalism

A

patient does what the doctor says, low patient input
some patients do prefer to be told what to do, but this may lead to the patient not feeling adequately listened to

44
Q

what is mutualism

A

patient and doctor agree on a plan
gets to the root of problem - not always physical
shared decision making
greater patient input leads to improved satisfaction, medication adherence and patient understanding
more ethical - promotes patient autonomy

45
Q

what is consumerist consultation style

A

patient has fixed agenda
high patient input, doctor is passive and compliant

46
Q

what is shared decision making

A

ensures individuals are supported
collaborative process
the convo brings together clinican expertise, like treatment options, evidence, risks and benefits
patient preferences, circumstances, values and beliefs
important part of universal personalised care

47
Q

outline CGA at the hospital

A

doctor physical assessment, discuss concerns and patient ideas
physiotherapy assessment -> history of falls, examination of strength and gait
occupational therapy assessment -> home visit to agree conditions and safety -> implement stair lift, carers, walking frame, voice-control lights

Clinical Ageing (1 decks)

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