Tutorial 4 - Ageing and Multimorbidity Flashcards
What does ‘successful ageing’ depend on?
- managing limitations in physical or other abilities
- addressing negative impact of significant life changes on social support and social networks e.g. retirement
- maintaining and improving performance in areas the older person values
What is ageism?
a process of systematically stereotyping and discrimination against people just because they are old
What does a ‘stable’ population pyramid say about a population?
shows unchanging patterns of fertility and mortality
What does a ‘stationary’ population pyramid say about a population?
(looks like a parabola) typical of countries with low fertility and low mortality, very similar to a constrictive pyramid
What does an ‘expansive’ population pyramid say about a population?
very wide base indicating high birth and death rates
What does a ‘constrictive’ population pyramid say about a population?
- cones in at bottom
- the general population is older on average as the country has long life expectancy and low death and birth rates
What are some reasons why the number of old persons is expected to exceed the number of young by 2050?
- migration
- decreasing fertility
- decreasing premature mortality
- health education programmes
- malaria prevention
- improvements in public health in relation to housing, clean water and nutrition
What is the fastest growing age group in the world?
80+
Why is there expected to be a dramatic shift in population age pyramid by 2031 in Scotland?
- baby boomers born after WW2 will be in their 80s
- overall mortality rates are expected to continue to improve
What health implications will there be of having a larger aged population?
- need more geriatricians and other healthcare professionals involved in care of elderly
- increased elderly health care facilities
- shift of care of long term conditions from secondary care to primary care
What social implications will their be of having a larger aged population?
- as the population ages, they will become increasingly dependent on families/ carers who are also ageing
- demand for home carers and nursing home places increase
- role of elderly as grandparents and carers of grandchildren is likely to change
- housing demands change as more elderly people live alone
What economic implications will their be of having a larger aged population?
- retirement/pension age increase
- finding employment may become harder for young people
- less people paying into tax and pension funds
- lacking a private pension fund may disadvantage elderly by relying on state fund only
- increasing cost of ‘free personal care for the elderly’ policy in Scotland
What political implications will their be of having a larger aged population?
- current decision making and workforce planning must take account of ageing population
- increasing elderly population may have power to influence political decision making in relation to their specific concerns
What is ‘multi morbidity’?
the co-existence of 2 or more long term conditions in an individual
What is an anticipatory care plan?
Anticipatory care planning involves discussing an individual’s goals and wishes, and recording these decisions so that in the event of a gradual or sudden decline , those providing care have clear guidance on what that person would wish to happen.
The should an anticipatory care plan be made?
- at any time in life that seems appropriate
- continuously
Who should make the anticipatory care plan?
by anyone with an appropriate relationship
How should an anticipatory care plan be formulated?
- thinking ahead and making plans
- carefully
How can an anticipatory care plan be shared?
- key information summary (KIS)
- other communication
What may happen if there is no anticipatory care plan in place? (reactive journey)
- go to GPs, district nurses and have ad hoc arrangements
- no discussion with patient or family on condition, outlook, anticipated problems, place of care
- problems with pain, sickness, constipation, anxiety
- crisis calls out of hours-no plan or drugs in the home
- admitted to hospital 999
- dies in hospital after failed CPR
- family given minimal grief support
- no reflection by professional team on care
What is positive about being proactive and seeking an anticipatory care plan?
- on GP register - discussed at team meeting
- social, financial support and info given to patients and carers
- usual GP and district nurse proactive support visits/phone calls
- assessment of symptoms, partnership with specialists
- 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 used
- dies in preferred place, family bereavement support
- staff reflect
What are the 3 main sections to an anticipatory care plan?
- legal
- personal
- medical
What are secondary preventative medications for CVS?
- antiplatelets
- statin
- additional hypertensive if BP not controlled
What drug classes have been shown to increase survival in heart failure?
- ACEI
- beta blockers
Why might the elderly not take diclofenac for joint pains?
- other nephrotoxins
- history of heart disease
What blood monitoring is required if you are on spironolactone?
potassium must be monitored
What is the role of a care manager?
responsible for planning and coordinating care of the elderly and others with physical and/or mental impairments to meet their long term care needs, improve their quality of life and maintain independence for as long as possible
How can professional care managers help individuals, families and other caregivers adjust and cope with the challenges of ageing and disability?
- conduct care plan assessments
- screen, arrange and monitor in-home help and other services
- review financial, legal or medical issues
- offer referrals to specialists to avoid future problems and conserve assets
- assist with moving clients to or from retirement complex
- provide client and family education and advocacy
- offer counselling and support
