Community Medicine Flashcards
(34 cards)
Define impairment
Give some examples
- An impairment is the loss or abnormality of a body function that can be anatomical, physiological or psychological
- Examples:
- Poor sight
- Diagnosed mental disorder
- Balance disorder
Define disability
Give some examples
- A disability is an inability or restricted ability to perform an activity within the normal human range/restriction of functional ability due to impairment
- Examples:
- Unable to walk
- Unable to see/blind
- Major depression
- Missing a limb
Define handicap
Give some examples
- A mental, physical or social disadvantage as a result of disability
- Examples:
- Being unable to work or live somewhere due to limited access
- Being unable to take part in particular sport
Impairment, handicap and disability are interlinked; describe the link between them
Impairment can reduce your functional ability and hence you have a disability. Your disability (inability to perform an activity within normal human range/restriction on functional ability) may mean you have a handicap (disadvantage) in certain situations
What do we mean by deconditioning?
Deconditioning is a complex process of physiological change following a period of inactivity, bedrest or sedentary lifestyle that results in decreased functional ability
State some factors that could contribute to deconditioning in the elderly
Anything that may case prolonged period of inactivity/rest/sedentary lifestyle:
- Hospital admission (for whatever reason)
- Injury (impacting mobility)
- Surgery
- Stroke
- Falls
- Mental disorders that impair functioning e.g. dementia
- Chronic conditions that lead to pt feeling unwell
State some potential consequences of deconditioning in the elderly
- Muscle weakness → falls, decreased endurance
- Pneumonia (weak muscles → weakened cough & not using lungs as much. Also greater risk of aspiration if on prolonged bedrest)
- Constipation
- Incontinence
- Decreased appetite
- Impaired digestion (slower digestion, impaired absorption)
- Disorientation
- Depression
- Increased heart rate
- Postural hypotension
- Pressure ulcers
Discuss how we can decrease the risk of deconditioning in the elderly
- Early mobilisation
- Adequate nutrition
- Promoting independence
Discuss the role of community hospitals in the management of older people
Play a major part in rehabilitation and allowing early transfer from acute hosptials
???FIND OUT MORE COALVILLE
Who usually leads care in community hospitals?
Care is usually led by local General Practitioners (GP), and less commonly by geriatric medicine specialists, sometimes supported by non-
consultant career grade doctors or doctors in training.
State some examples of medical cases community hospitals receive and where they receive them from
????? Complete after coalville
What types of services are available in community hospitals?
- In-patient rehabilitation
- End of life care
- Outpatient clinics
- Sexual health clinics
- Phlebotomy
CHECK AFTER COALVILLLE
Discuss some limitations of hospital based care
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Discuss what we mean by ‘rehabilitation for older persons’
Multidisciplinary set of evaluative, diagnostic and therapeutic interventions whose purpose is to restore functional ability or enhance residual functional capacity in older people with disabling impairments or complex medical backgrounds
*****WHO definition of rehabilitation: ‘a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”.
What are the aims of rehabiliation?
- Reduce negative impact of the acute illness
- Slow down decline of physical, psychological, social and functional abilities
Where does the majority of rehabilitation take place for elderly pts?
- Majority takes place in community hospitals
- But other common alternatives include:
- Care homes
- Acute medical hospitals
- Home
- Outpatient clinics (e.g. falls prevention programme)
Geriatric rehabilitation begins at _____ and __
Begins at admission and continues beyond discharge
State some alternatives to hospital care (i.e. what community teams are available)
- Nursing home
- Residential home
- “Hospital at home”/district nurses
- Increased support at home
????CHECK AFTER COALVILLE
Discuss how health & social care interact in the provision of long term care
Much of their work is linked hence there must be effective collaboration & communication:
- Health care: treatment of medical conditions, physio to help mobilisation, occupational therapy to help with adaptations in exisiting home
- Social care: carers, housing, funding
E.g. at Coalville they complete a home first form which details what pt can and cannot do. They send this to social care who then look at information to decide what care package person needs and they put that in place.
Discharge planning should be started as soon as the patient is admitted and this is often carried out with MDT in a continuous, ongoing process; true or false?
True
For optimal individualised discharge planning, what elements of a patient’s case are important to know?
In summary you need to know information about current needs and support so that you can determine what needs to be arranged for them in preparation for discharge.
- Where they live and type of accommodation
- Who do they live with
- Is their accommodation in a suitable state
- What patient is able to do and what they need support with
- Support in place (e.g. from family/carers, care workers etc..)
- Equipment they have at home
- Finances
- What activities they enjoy and are or could be involved in
- Medications & compliance
- Patient/s wishes/preferences
- Concerns
- Aims
- What’s important to them
State some example discharge destinations
- Community hospital
- Own home (+/- package of care/equipment)
- Specialist accommodation (e.g. assisted living, warden control/sheltered accommodation)
- D2A bed
- Residential care home
- Nursing home
- Family members home
Briefly outline the roles of the following allied health professionals and discuss how they can facilitate rehabilitation/safer discharge of an older person:
- Physiotherapist
- Occupational therapist
- Speech & language therapist
- Dietician
- Hospital nursing staff
- Hospital healthcare assistant
- Social worker
- Care home manager
- Relatives/live-in carers
- Pharmacist
- District nurse
- Physiotherapist: assess mobility and offer guidance on how to improve mobility aswell as giving equipment
- Occupational therapist: assess what ADLs pt may need help with and offer guidance, equipment, home adaptations etc…
- Speech & language therapist: assess swallowing and suggest ways to increase safety of swallow
- Dietician: assess nutritional intake and suggest ways to ensure adequate intake e.g. supplements
- Hospital nursing staff: nurse patient to be medically fit, plan for discharge…????
- Hospital healthcare assistant: assist with basic care needs and try to promote independence with these. Can feed back to other professionals about what pt struggles with
- Social worker: arrange funding, housing, care package
- Care home manager: ???
- Relatives/live-in carers: help prepare home, mentally prepare pt, support in initial transition period
- Pharmacist: review medications, supply medications, dosette box
- District nurse: attend to any nursing needs in community e.g. IV abx, dressing changes etc… to allow quicker discharge home
Briefly outline the Discharge to Assess (DtA)/discharge to assessment bed process
Where people who are clinically optimised/medically fit and do not require an acute hospital bed, but may still require care services are provided with short term, funded support to be discharged to their own home (where appropriate) or another community setting; this prevents then waiting in acute hospital for assessments. Assessment for longer-term care and support needs is then undertaken in the most appropriate setting and at the right time for the person. Commonly used terms for this are: ‘discharge to assess’, ‘home first’, ‘safely home’, ‘step down’.
