Tutorial 4: Ageing and Multi-Morbidity Flashcards
What happens to homeostatic reserve in later life?
Decreases
What is ageism?
A process of systematic stereotyping and discrimination against people because of their age.
Demographics of old people
2000 - 11% of population over 60
2050 - 22% of population over 60
2000-2050: 4-fold increase in population over 80
By 2050 80% of over 60s will live in lower or middle income countries
From 2000-2050 number of people unable to care for themselves will increase 4-fold
What features make up a population demographics charts?
X-Axis: Percentage Y-Axis: Age 2000 looks like a labia majora 2050 looks like a penis Less young people More old people
Why are we undergoing a change in population demographics?
Low levels of fertility
Low levels of mortality
By 2050 what significant event is to have happened?
Number of old people (>60) is to have surpassed the number of young people (<15)
What is the fastest growing age group?
Over 80s
…
Between 2004 and 2031:
Age groups between 0-49 are projected to decrease
Age groups 50+ are projected to increase
This is due to baby boomers born post WW-II will be reaching their 80s whilst mortality rates remain to fall and life expectancy increases
What effect does an ageing population have on health?
- Increased number of geriatricians
- Increased facilities for care of the elderly required
- Care of long-term conditions moving from secondary to primary care
- Prevalence of chronic disease will increase
- Increase in specific health promotion campaigns aimed at the elderly
What are the social effects of an ageing population?
- Increasing dependence of elderly relatives on families
- The demand for home carers and nursing home places increasing
- Increasing emphasis on provision of social activities for the elderly
- Role between grandparents and grandchildren likely to change - grandchildren acting as carers
- Housing demands are likely to change as an increased number of elderly people live alone
What are the economic effects of an ageing population?
- Retirement/pension ages increasing
- More difficulty in finding employment for younger people
- Proportionately less people paying taxes and into pension funds
- Elderly people who haven’t 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
What are the political effects of an ageing population?
- Current decision-making and workforce planning has to take the ageing population into account
- Increased proportion of elderly people could potentially have the power to influence political decision making in relation to their specific concerns
What is ‘multi-morbidity’?
The co-existence of two or more long-term conditions in an individual
What are the options for care in elderly patients who are unable to care for themselves at home?
Own home with support from family Own home with support from social services Sheltered housing Residential home Nursing care home
What is an anticipatory care plan?
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 an anticipatory care plan be organised?
Any time that it seems appropriate
Continuously
Who should be involved in an anticipatory care plan?
Anyone with an appropriate relationship
How should an anticipatory care plan be made?
Thinking ahead and making plans
It should be written
How can it be shared amongst the relevant care providers?
Key information summary
What aspects are there to an anticipatory care plan?
Legal:
- Power of attourney
- Guardianship
Personal:
- Statement of values
- Preferences and priorities
- Advance decision to refuse treatment
- Who else to consult
Medical
List some of the stages of a reactive care journey
- GPs, district nurses, ad hoc arrangements
- No discussion with family on condition, outlook anticipated problems, place of care
- Problems with pain, sickness, constipation, anxiety
- Crisis call to Out of Hours Service
- Admission to hospital
- Death in hospital post CPR
- Family given minimal support in grief
- No reflection by professional care team
List some of the stages of a proactive care journey
- On GP register - discussed at team meeting
- Social, financial support and information given to patient and carers
- Usual GP and DN proactive support visits
- Assessment of symptoms, partnership with specialists - customised care for patient needs
- Care assessed including respite and psychosocial needs
- Preferred place of care noted and organised
- Care plan and medication issued for home
- End of life pathway
- Dies in preferred place, family bereavement support
- Staff reflect SEA, audit gaps improve care
