ELDERLY, NEURO&MSK Flashcards
Members of an MDT you would expect to see in the chronic neurological conditions?
PDNS
Consultant neurologist
PT
OT
SALT
Specialist nurses
Social worker
Nutritionist/dietician/GI
Pharmacist
Primary care physician
Clinical neuropsychologist
Stroke liaison sister
Caters
Case manager
Charities for neurological conditions to be aware of?
MS society
Parkinson’s UK
Motor Neurone disease Assocation
The Huntingtons Disease Assocation
Spinal Injuries Assocation
Stroke Association
the Neurological Alliance
Muscular Dystophy UK
Dementia UK
What does a clinical neuropsychologist do?
See people making problems with their thinking, emotions or behaviour after a stroke or neurological condition, complete assessments, carry out therapeutic interventions or advise on rehabilitation strategies to help people cope better
Psychosocial impact of cancer on the individual, family and society?
Anxiety & depression
Grief and loss
Body image concerns - loss of hair, mastectomy
Destruction of assumption world theory
Fatigue
Chemo brain - cognitive impairment
Stigma and social isolation
Emotion burden and role changes for care givers
Relatives misunderstanding
Balancing work and caregiving for relatives
Caregivers may neglect their own health due to demands of caregiving
Strained relationships
Uncertainty
What are the 5 stages of grief?
Denial
Anger
Bargaining
Depression
Acceptance
What is prolonged/complicated grief?
when intense, long-lasting symptoms of grief, together with ongoing problems and difficulties in coping with life, go on for more than six months after someone dies
What is mourning?
An outward expression of grief, including cultural and religious customs surrounding the death
Its also the process of adapting to life after loss
What is bereavement?
A period of grief and mourning after a loss
Factors that increase the risk for prolonged grief?
Traumatic circumstances e.g. death of a child, death of parent in early childhood, deaths by murder
Vulnerable people e.g. low self esteem, previous psychiatric disorders, dependant attachment to deceased person, insecure attachment to parents in childhood
What is the destruction of assumptive world theory?
when individuals experience an event that damages their worldview (i.e., traumatic material that cannot be easily integrated with previously held worldviews), they no longer perceive the world as benevolent and predictable or themselves as competent and invulnerable.
Acute grief reactions?
Somatic or bodily distress
Preoccupation with image of the deceased
Guilt relating to the deceased or circumstances of the death
Hostile reactions
Inability to function as one had before the loss of
Worden’s task of mourning?
Accept the reality of loss
Work through the pain of grief
Adjust to na environment in which the deceased is missing
Emotionally relocate the deceased and move on with life
Pathological grief reactions?
Extended grief reaction
Mummification
Major depressive disorder >2 months after the loss o
What is anticipatory grief?
A type of grief for a loss you know is coming e.g. when a loved one is diagnosed with a terminal illness
What is disenfranchised grief?
Grief that happens after a loss that others dont see as valid e.g. lacking sympathy for deaths by suicide
Arguments opposing physician-assisted dying?
It is currently a criminal offence under the 1961 Suciide Act to help someone take their own life
Laws send social messages e.g. would alters society’s attitude towards the elderly, seriously ill and disabled
Potential for abuse - It is impossible to ensure that decisions are truly voluntary and that any coercion or family pressure is detected
For most pt, high-quality palliative care can alleviate all distressing symptoms associated with dying so what is the need for physician-assisted death?
May undermine trust in the doctor-patient relationship as pt will worry about raising their worries without a doctor considering bringing about their death
The process of death will become normalised and it will become easier to accept wider eligibility criteria = slippery slope
Religious concerns - life is the ultimate gift - sanctity of life
Medical prognosis is not always accurate so individuals would have to potential to make irreversible decisions based on flawed information
Arguments for supporting physician-assisted dying?
Relief from suffering: Even with access to specialist palliative care, some dying people will still experience severe unbearable physical or emotional distress that cannot be relieved
It is lawful in many places around the world
In the UK we have safegaurding to ensure decisions are voluntary, not coercive and potentially vulnerable people are protected - there is no reason why these safegaurds could not be used effectively in assisted dying legislation
Current law is not working as UK citizens travel to Switzerland if they have the funds too. Often leads to people ending their lives sooner than they would have wishes
Patients who know they are dying want to be able to exercise their autonomy and determine for themselves when and how they die, but need medical advice and support to achieve this
The existence of legislation for assisted dying allows for reassurance and peace of mind for many with terminal illness
where is physician assisted death legal in the world?
Switzerland
Oregon USA
The Netherlands
Belgium
Canada
New Zealand and Australia
Euthanasia and assisted suicide law UK?
Assisted suicide is illegal under The Suicide Act 1961 and is punishable by up to 14 years imprisonment
Euthanasia is regarded as mansluaghter or murder
What is voluntary vs non-voluntary euthanasia?
voluntary euthanasia – where a person makes a conscious decision to die and asks for help to do so
non-voluntary euthanasia – where a person is unable to give their consent e.g. in a coma and another person takes the decision on their behalf, perhaps because the ill person previously expressed a wish for their life to be ended in such circumstances
What do palliative care clinical nurse specialists do?
Support pt and families who are experiencing life-limiting illnesses
They are registered nurses with specialist knowledge and qualifications in cancer and palliative care
Who can refer to the specialist palliative care team?
Community referrals by GP, district nurses ans consultants
Urgent referrals can be made by ward doctors and clinical nurse specialists
In hopsital referrals can be made by ward teams and specialist services
What was the Gold Standards Framework?
A model that enabled good practice to be available to all people nearing the end of their lives, irrespective of their diagnosis
A way to raise the level of care to the standard of the best
It also had a prognostic indicator to help identify pt that require supportive and palliative care
What is the National service framework?
The first ever comprehensive strategy to ensure fair, high hollistic, integrated health and social care services for older people
A 10 year programme of action linking services to support independence, promote good health, provide specialised services for key conditions and aid culture change so older people and their carers are always treated with respect, dignity and fairness
How to assess the mental capacity of a person with dementia?
Step 1: are you concerned that a person with dementia is unable to make a certain decision? If yes move on
Step 2: can the person make the decision with help and support e.g. give more time and communicate appropriately. If no then move on
Step 3: does the person meet all the following - they understand the information, they can retain the information for long enough to make the decision, they can weight it up and they can communicate a decision in some way. If not then the person lacks capacity for this decision at this time
What is the mental capacity act 2005?
It provides a comprehensive framework for decision making on behalf of adults aged 16 and over who lack capacity to make decisions on their own behalf.
The Act applies to all decisions taken on behalf of people who permanently or temporarily lack capacity to make such decisions themselves, including decisions relating to medical treatment.
What are the 5 principles of the MCA 2005?
A person must be assumed to have capacity unless it is established that he lacks capacity
A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
A person is not to be treated as unable to make a decision merely because he makes an unwise decision
An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests
Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action
How do you assess capacity?
Do they have an impairment of, or disturbance in the functioning of the mind or brain AND unable to understand the information, retain it, weight it up and communicate a decision
Note it’s time and decision-specific!
What should be considered when assessing what is in the patient’s best interests?
Consider…
Are they likely to regain capacity and can the decision wait?
How to encourage and optimise the participation of the person in the decision
Their past and present wishes, feelings, beliefs, values of a person and any other relavent factors
Views of other relevant people e.e. Family, friends or carers
What is a lasting power of attorney?
This is when a person appoints an attorney to act on their behalf should they lose capacity in the future
These can be for property and finance, or health and welfare decisions
What are advanced decisions?
Advance decisions can be drawn up by anybody with capacity to specify treatments they would not want if they lost capacity. They may be made verbally unless they specify refusing life-sustaining treatment (e.g. Ventilation) in which case they need to be written, signed and witnessed to be valid. Advance decisions cannot demand treatment
What are the exceptions to the best interests principle of the MCA?
When a person has previously made an advanced decision to refuse medical treatment whilst they had capacity and it is still valid and applicable, then it should be respected
Involvement in research
Types of restraints?
Physical
Mechanical e.g. mittens or bed rails
Chemical e.g. sedating meds
Psychological e.g. telling them they are not able to do something o removing their walking aids
When are restrictive measures lawful?
Must be the last resort and alternatives to restraint must always be considered
Must have objective reasons to justify it is necessary and the pt is likely to suffer harm unless used
You must use the least intrusive type and minimum amount of restraint
The restraint must not amount to a deprivation of liberty
What is deprivation of liberty?
When a person has their freedom limited in someway e.g. the person is under continous supervision and control and is not free to leave and the person lacks capacity to consent to these arrangements
What is an independant mental capacity advocate?
These work to support and represent particularly vulnerable adults who lack capacity to make certain decisions where there are no family members or friends available or willing to be consulted about those decisions
They are independant of the HCP making the decision and represent the pt in discussion about whether the decisions is in the pt best interests
mental health act vs mental capacity act?
MHA applies if you have a mental health problem and sets out your rights if you’re sectioned under this act
The MCA applies if you have a mental health problems and you dont have the mental capacity to make certain decisions
The psychological and emotional impact of dementia?
Emotional effects - mood changes, depression, anxiety, shock, disbelief, grief, helplessness, isolated, and some may feel relieved to have received a diagnosis
May cause feelings of insecurity and loss of confirndece in themselves and their abilities
Impact on family and friends - sadness, fear, irritation, embarrassment, confusion about role reversal, sense of loss, anger, rejection
Caregiving burden amongst caregivers of people with dementia
Family caregivers are often called the invisible second patients
Studies have shown that compared to other caregivers, dementia caregivers are more likely to consider the caregiving activities as highly stressful, have higher levels of burden & psychological distress and report higher levels of burdens on finance/emotions/physical health
Common daily issues for caregivers: health decline, exhaustion, fear of the future, violence, financial issues
economic burden dementia uk
It’s a significant public health issue in the Uk and is projected to be the costliest health condition by 2030
In 2021 the estimated cost was £25 billion and this is expected to reach £47 billion by 2050
£10.2 billion is the total cost of informal care for dementia in the UK
