Module 6 - Older People and Complex Care in Practice

Question 1

What percentage of Australians are estimated to have chronic conditions?

Answer 1

50%

Question 2

Identify common chronic conditions.

Name at least 5.

Answer 2

1. cancer
2. cardiovascular disease
3. mental health conditions
4. arthritis
5. back pain and problems
6. chronic obstructive pulmonary disease
7. asthma
8. diabetes

Question 3

What was the leading cause of deaths for older Australians in 2015?

Answer 3

Cancer - 76%

Question 4

What was the most common cancer to cause death in 2015?

Answer 4

Lung Cancer

Question 5

After cancer, what is was the second leading cause of deaths in older Australians?

Answer 5

Coronary heart disease 13%

Question 6

What percentage of deaths was attributed to Dementia is 2015?

Answer 6

10%

Question 7

___________________ accounts for 7.8% of deaths and refers to any disorder related to the blood vessels that supply the brain and covering membranes. Stroke is the most common cause of death from cerebrovascular disease.

Answer 7

Cerebrovascular disease

Question 8

What is frailty?

Answer 8

Frailty is a process of age-related decline in multiple bodily systems that predisposes an older person to sudden health status changes.

Question 9

How many points are their on the clinical Frailty Scale?

Answer 9

9

Question 10

What are some interventions to support people with frailty?

Answer 10

• Encouraging exercise, namely strength and balance training (which not only have benefits in maintaining a healthy weight, but also can improve mental health and preserve cognitive function)
• Referral to members of the interdisciplinary team; dietitian, speech pathologist, physiotherapist, occupational therapist, social worker
• Cognitive activities and training programs designed to stimulate short term memory, problem solving and information recall
• Consider nutritional supplementation

Question 11

What happens to the Pulmonary System when we age?

Answer 11

1. Efficiency is reduced
2. Decrease in muscle fibres
3. The amount of air moving in and out of the lungs is reduced (tidal volume).
4. Dyspnoea when physical activity is increased.
5. Mucus secretion collect more readily in the lungs, increasing risk of infection.

Question 12

How would you promote health and maintaining function of the pulmonary system?

Answer 12

1. Encourage to stop smoking
2. Infection control practices, such as washing hands and avoiding people who are sick.
3. Influenza and pneumococcal pnuemonia vaccinations

Question 13

What happens to the Cardiovascular System when we age?

Answer 13

• Working capacity of the heart decreases as the rigidity and thickness of heart valves increase.
• lower resting heart rate
• slower response to stress (emotional or physical) and slower ability to return to normal
• reduced arterial elasticity, effecting bloody supply to extremities
• orthostatic/postural hypotension
• slight increase in systolic blood pressure.

Question 14

How would you promote health and maintaining function of the Cardiovascular System?

Answer 14

• Encourage regular checking of blood pressure and cholesterol levels
• Maintaining an ideal body weight and physical exercise
• Ceasing smoking
• Promoting a healthy food intake (avoiding foods high in sodium and fat, eating plenty of fruit and vegetables)
• Avoiding stress, anxiety and depression; ensuring appropriate mental health support strategies are in place
• Considering the use of low dose aspirin .

Question 15

Thickening of the heart muscle is also called___________.

Answer 15

Hypertrophy.

Question 16

What is polypharmacy?

Answer 16

Polypharmacy is the use of more medications than are clinically indicated. Sometimes described as 10+ medications.

Question 17

How does polypharmacy happen?

Answer 17

• Medications are prescribed when they are not necessary.
• Additional medications are prescribed to treat side effects of other medications, rather then reviewing the original medication and alternatives.
• Medication regimes can be complex and confusing, requiring an investment of time by the prescribing practitioner.
• Due to the nature and treatment of certain illnesses, many prescribing practitioners may be involved in an older person’s care who all prescribe from different specialty areas and don’t review or change each other’s medications.

Question 18

____________________ is associated with a significantly increased risk of adverse drug reactions, even though it is largely preventable.

Answer 18

Polypharmacy

Question 19

What is the nurse’s role in polypharmacy?

Answer 19

• Facilitation of a medication review by a prescribing practitioner or pharmacist.
• Encouragement of older people to self-administer medications while in hospital
• Empower an older person to ask questions of their prescriber
• Evaluation and assessment as to how an older person manages and understands their medication regime
• Being alert to unexpected drug interactions, and side effects of medications
• Providing written medication information materials with larger print and good colour contrast
• Advising on lifestyle changes that may reduce the need for medication and combat the side-effects of necessary medications
• At times of illness, older people may experience temporary cognitive problems, and nurses must be acutely aware of the need to provide prompts and aids so the patient can revise, rehearse and remind themselves about their medicines.
• Alternatively, carers may take responsibility and will need information and advice as to how to support the older person.

Question 20

What are some common challenges that can impact the mental wellbeing of older Australians?

Answer 20

• Grief and loss of independence,
• working life and mobility.
• Chronic physical ailments
• Changes in brain function

Question 21

What are areas of stress for older people in regards to mental ill-health?

Answer 21

• physical health struggles
• social isolation
• lack of access to treatment
• changing living arrangements
• financial stresses

Question 22

Mental illness in later life is associated with:

Answer 22

• increased rates of chronic or serious health conditions,
• reduced capacity for independent living
• increased suicide risk.

Question 23

_________________ has been compared with smoking in terms of impact on health of Older Australian.

Answer 23

Social Isolation

Question 24

What screening tools can you use to assess older person and their mental health, as well as substance use?

Answer 24

• Suicide Risk Assessment
• Cornell Scale of Depression in Dementia
• Alcohol Use Tool
• Assessing Nicotine Dependence