Holistic Theme Flashcards

(47 cards)

1
Q

why is health of the older population important ?

A

grandparents caring for children
retirement age is increasing
burden on the healthcare system
polypharmacy - poeple on lots of medication are hard to manage

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2
Q

what approach should geriatric medicine have

A

holistic, integrated view - biopsychosocial model of health

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3
Q

what is the CGA

A

comprehensive geriatric assessment
- physical mental, social and functional environment
- nurses, doctors, physiotherapists, everyone contributes to this
- holistic assessment

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4
Q

what is primary prevention

A

reduce incidence of disease in the population by universal measures that reduce lifestyle risks by targeting high risk groups

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5
Q

what is secondary prevention

A

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

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6
Q

what is tertiary prevention

A

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

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7
Q

what is the care act?

A

local authorities ensure people who live in the area recieve services that prevent care from being more severe

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8
Q

what is frailty

A

loss of physiological reserve causing increased vulnerability and poor health outcomes
NOT disability (establishes loss of function)
slower recovery and increased fatigue

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9
Q

what are common presentations of frailty?

A

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

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10
Q

how can frailty be managed

A

stopping medication or lifestyle changes
standing up slowly
stockings
fluorocortisone (promotes Na+ and water retention)

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11
Q

what are clinical issues around dealing with the elderly

A

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

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12
Q

what is the Rockwood score

A

a frailty score
1 = very fit, 9 = terminally ill
9 = completely dependant and approaching end of life

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13
Q

what are risk factors to have a fall

A

age
previous falls
postural hypotension
loss of muscle mass (sarcopenia)
visual impairment
use of walking aid

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14
Q

how to prevent having a fall

A

multi-disciplinary approach
falls clinic, rationalise medications, visual/walking aids
home circumstance review

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15
Q

outline fractured neck of the femur

A

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

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16
Q

what is a method to distinguish between dementia, delirium and depression as they present similarily

A

PINCHME
pain
infection
nutrition
constipation
hydration
medication
environment

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17
Q

why are the elderly at particular risk of under-nutrition

A

basal metabolic rate and energy requirements are reduced
reduced muscle mass
% of body fat increased
but also:
decreased appetite, difficulty preparing food, financial difficulty

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18
Q

what are the implications of under nutrition

A

impaired immunity
muscle weakness
poor wound healing

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19
Q

how do we manage a fractured neck of the femur

A

analgesia - drugs for pain
surgery = total hip replacement or dynamic hip screw
need good holistic care

20
Q

how can frailty be prevented

A

healthy ageing
exercise
good nutrition
remaining engaged in the local community

21
Q

when was the NHS established

22
Q

what did the NHS say it would deliver

A

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

23
Q

how have the budgets of the NHS changed over time

A

now its 116 billion, compared to 437 million in 1948
today this would be 15 billion

24
Q

what are groups of the NHS

A

NHS england
CCGs = clinical commissioning groups

25
what is the NHS changing into now
personalised, sustainable and joined-up care depends on politics, people and unclear hierarchies
26
do people know how to use the NHS system
no there is poor health literacy in our society
27
what are implications of the ageing population on the NHS
multimorbidity with age, more likely to use all types of healthcare service medication use and cost is higher more likely to require coordination with other services e.g social care
28
what is the hierarchy of care
self care primary care secondary care
29
what type of care do older people need more of?
secondary care e.g many old people may need ambulance to access care and older people take longer to recover so use more levels of care
30
what are the hierarchies of care
A&E NHS walk in centre GP pharmacy NHS direct - phone call self-care
31
what could make care better
good communication with health professionals and better continuity of care (reviews, follow-up appointments, and attention to patients emotional needs) explaining things in lay language doctors should consider quality of life better links between physical and mental health e.g psychological support following diagnosis
32
what may an old person do which
if old people cant get hold of GP, they may call an ambulance
33
why would joined up care be good?
seeing lots of different health professionals is frustrating unnecessary time in hospital no coordination between Gp and social care = lack of support carer is given the responsibility of coordinating care - CARE PLAN care in own home - better use of resources, comforting, integrated care centred around the need of the patient
34
what is MDT
multi-disciplinary team use team skills to improve patient care regular meetings to discuss patients care plan patient is involved in the process as much as possible - they are central to care
35
what is disease
pathological process which is a deviation from biological norm what the doctor diagnoses the patient with
36
what is illness
personal experience of feeling unhealthy accompanied by disease but not always what the patient brings to the doctor
37
what is sickness
view of society on illness/disease and how this affects everything
38
what is the traditional biomedical model (19th century)
sole focus was physical/biological aspects of disease didnt acknowledge social and psychological factors doctor in full control of diagnosis and treatment
39
whats an advantage of the traditional biomedical model
lead to big improvement in life expectancy and quality of life and management of chronic illness
40
whats a disadvantage of the traditional biomedical model
reinforced hierarchy and paternalism incomplete diagnosis and treatments not appropriate for individuals
41
where can a CGA take place
inpatient community day hospital
42
what is person centred care
dignity, respect and compassion care coordination and transition personalised and enabling
43
what is paternalism
patient does what the doctor says, low patient input some patients do prefer to be told what to do, but this may lead to the patient not feeling adequately listened to
44
what is mutualism
patient and doctor agree on a plan gets to the root of problem - not always physical shared decision making greater patient input leads to improved satisfaction, medication adherence and patient understanding more ethical - promotes patient autonomy
45
what is consumerist consultation style
patient has fixed agenda high patient input, doctor is passive and compliant
46
what is shared decision making
ensures individuals are supported collaborative process the convo brings together clinican expertise, like treatment options, evidence, risks and benefits patient preferences, circumstances, values and beliefs important part of universal personalised care
47
outline CGA at the hospital
doctor physical assessment, discuss concerns and patient ideas physiotherapy assessment -> history of falls, examination of strength and gait occupational therapy assessment -> home visit to agree conditions and safety -> implement stair lift, carers, walking frame, voice-control lights