Holistic Theme Flashcards
(47 cards)
why is health of the older population important ?
grandparents caring for children
retirement age is increasing
burden on the healthcare system
polypharmacy - poeple on lots of medication are hard to manage
what approach should geriatric medicine have
holistic, integrated view - biopsychosocial model of health
what is the CGA
comprehensive geriatric assessment
- physical mental, social and functional environment
- nurses, doctors, physiotherapists, everyone contributes to this
- holistic assessment
what is primary prevention
reduce incidence of disease in the population by universal measures that reduce lifestyle risks by targeting high risk groups
what is secondary prevention
systematically detecting early stages of disease and intervening before symptoms develop
e.g prescribing statins to reduce cholesterol and taking measures to reduce high BP
what is tertiary prevention
softening the impact of an ongoing illness that has lasting effects - help people manage long-term complex health problems to improve their ability to function
what is the care act?
local authorities ensure people who live in the area recieve services that prevent care from being more severe
what is frailty
loss of physiological reserve causing increased vulnerability and poor health outcomes
NOT disability (establishes loss of function)
slower recovery and increased fatigue
what are common presentations of frailty?
postural hypotension - fall in systolic BP >20mmHg
fall in diastolic BP >10mmHg from lying to standing up
caused by ageing , hypoglycaemia, diuretics, it autonomic dysfunction
can cause falls, delirium, neck of femur fracture and poor nutrition
how can frailty be managed
stopping medication or lifestyle changes
standing up slowly
stockings
fluorocortisone (promotes Na+ and water retention)
what are clinical issues around dealing with the elderly
multi-morbidities
non-specific symptoms e.g loss of function
atypical/late presentation
lack of physiological reserve (illness comes on quicker, longer recovery and more complications)
altered drug metabolism - doses need altering, more likely to have side effects
what is the Rockwood score
a frailty score
1 = very fit, 9 = terminally ill
9 = completely dependant and approaching end of life
what are risk factors to have a fall
age
previous falls
postural hypotension
loss of muscle mass (sarcopenia)
visual impairment
use of walking aid
how to prevent having a fall
multi-disciplinary approach
falls clinic, rationalise medications, visual/walking aids
home circumstance review
outline fractured neck of the femur
common, 10% mortality within 1 month
occurs with minor trauma in elderly
bone density decreases with age - osteoporosis
results from falls
painful shortened, externally rotated leg
what is a method to distinguish between dementia, delirium and depression as they present similarily
PINCHME
pain
infection
nutrition
constipation
hydration
medication
environment
why are the elderly at particular risk of under-nutrition
basal metabolic rate and energy requirements are reduced
reduced muscle mass
% of body fat increased
but also:
decreased appetite, difficulty preparing food, financial difficulty
what are the implications of under nutrition
impaired immunity
muscle weakness
poor wound healing
how do we manage a fractured neck of the femur
analgesia - drugs for pain
surgery = total hip replacement or dynamic hip screw
need good holistic care
how can frailty be prevented
healthy ageing
exercise
good nutrition
remaining engaged in the local community
when was the NHS established
1948
what did the NHS say it would deliver
it was made to meet the needs of everyone, free at the point of delivery and based on clinical need
NOT the ability to pay
how have the budgets of the NHS changed over time
now its 116 billion, compared to 437 million in 1948
today this would be 15 billion
what are groups of the NHS
NHS england
CCGs = clinical commissioning groups