Statement 10 Flashcards
Statement 10
‘The roles of practitioners and specialists and specialists who provide geriatric care and support for service users’
Practitioners and Specialists Involved in the Care and Support of Older People
A wide range of health and social care practitioners and specialists, provide invaluable care and support for older people in Northern Ireland. The roles and responsibilities of professionals vary widely, therefore; it is important to understand the contribution they each make to supporting older people in Northern Ireland.
General Practitioner (GP)
A GP is the first point of contact for an older person if they have any concerns about their health. They have various roles that help support the needs of older people in society.
This includes:
1. A GP can give medical advice, treatment and prescribe medication for any issues an older person may suffer with such as high blood pressure. The GP may advise older people about changes they can make to their lifestyle and discuss whether they think they would benefit from medicine such as Amlodipine (also used for vascular dementia).
2. A GP will refer older people to other professionals, such as specialists or nurses to diagnose or treat specific aspects of a condition. For example, they may refer older people to a podiatrist, for bunion treatment. An audiologist for a hearing assessment, or to other local services such as the m community falls prevention service (interventions for those identified at risk of falling) or the continence service (support with bowel/bladder difficulties). These other health professionals may visit older people in their home or hold clinics at a local practice, health centre or hospital.
3. A GP can also provide health education and advice on healthy lifestyle choices, such as nutrition, exercise, and mental health. They can also provide information on available community resources that can support older people in maintaining their health and wellbeing e.g. information on companies who supply fresh homecooked ‘meals on wheels’ to older people e.g. Whiltshire Farm Foods.
4. A GP will also recommend and administer vaccinations to help prevent the occurrence of diseases in older people e.g. influenza. For example, the GP may invite older people to attend the clinic and receive their Flu Vaccine or Autumn Booster for COVID 19. This is because older people are at a higher risk of developing complications associated with diseases e.g. by getting the flu, older people are at more risk of pneumonia and in serious cases inflammation of the heart and brain. Flu —> pneumonia
5. A GP can also help older people help manage chronic diseases which are common in their age group such as diabetes, heart disease, and arthritis. For example, a GP may prescribe mefformin to help keep blood sugar levels as normal as possible, provide advice on lifestyle changes and carry out regular check-ups with older people who suffer from Type 2 diabetes.
Geriatrician
Geriatricians are specialists in the care of older people and the conditions and disabilities associated with old age. They have various roles.
1. A geriatrician diagnoses and treats acute illnesses, chronic diseases, disability, and frailty. This is particularly relevant for older people who often have several medical conditions and take a number of different medicines. Common conditions treated by a geriatrician include:
• *fractures
• delirium
• *dementia
• *incontinence
• poor mobility
•frailty/ osteoporosis
As well as treating a variety of conditions, it is likely that a geriatrician will work in a variety of care settings including, outpatient departments, A&E, acute care wards (e.g. coronary care, high dependence, intensive care and acute stroke care), rehabilitation wards, day-care centres, care homes and hospices.
2. Geriatricians will work as part of a multidisciplinary team, working closely with other professionals such as GPs, Occupational Therapists, as well as experts in the community such as Social workers. They will work with these professionals to develop and implement strategies and/or care. plans to help older adults maintain their independence, mobility, and quality of life. In doing so, this will ensure coordinated and comprehensive care is provided for older adults.
(Providing person centred care)
3. A Geriatrician will carry out comprehensive assessments of physical, mental, and functional health to identify potential health risks and concerns. E.g. in cancer care, a geriatric assessment may be used to discuss treatment options e.g. Surgery.
4. Geriatricians prescribe and manage medications that are appropriate for older adults, considering potential interactions and side effects. Older people may react differently to drugs so the role of the Geriatrician is essential in understanding the adverse reactions that can happen and how these might be further affected by a patient’s condition.
E.g. *Risperidone used to treat Alzheimer’s can cause adverse reactions in older people in the form of tremors.
5. Geriatricians also help older people, and their families deal with palliative and end-of-life care. For example, they will discuss with patients and carers the likely sequence of events in the late stages of illness e.g. bowel cancer, in order to anticipate the wishes of the older people and their carers.
6. Due to the nature of the work carried out by a Geriatrician they must also be able to provide guidance on the legal and ethical issues surrounding working with older people, e.g. power of attorney, mental health legislation and DNR orders (resuscitation).
Social Worker
Social workers assess the social care needs of older people and their carers. They work with a range of other professionals and agencies to arrange care packages to assist those who require care to remain living at home, or access care in a residential setting when this is no longer possible. Gerontological social work is specialist social work with older people.
1. Following referral on from the GP, or other heath professional such as the Geriatrician, the Social Worker main role surrounds and initial social work assessment. This will assess an older person’s needs and leads to a care plan/ care package being devised to meet those needs eg, the need for caters to come in and hoist an older adults with MS out of bed. The care plan will be regularly monitored and reviewed by the social worker.
2. Social workers will also assist older adults and their carers when making decisions regarding permanent placements in residential care e.g. if an older adult has suffered from a stroke, has been paralysed down the left hand side of their body and requires 24/7 care, a social worker may strongly recommend that the older adult is placed in a care home to ensure their needs are met. In some cases they will also act as advocate or arrange advocacy services for an older person who may lack the capacity to do so.
3. A social worker will also liaise and work within a multi-disciplinary team. This may be with other professionals s uch as the GP and the OT to ensure that an older person’s needs are being appropriately addressed.
E.g. They have appropriate rails in the bathroom/ a commode to ensure safety when accessing the toilet.
4. A social worker may also help to provide therapeutic intervention,
supporting older people through significant life changes, for example, dealing the loss of a spouse/social isolation. This could be through direct emotional support or advice on local support groups they could attend e.g. The dementia support group in Ballyclare Town Hall for those recently diagnosed with dementia.
5. Social workers can also provide support and resources to family members and caregivers who may be caring for older people e.g., by completing a carers assessment, and providing information on available support groups and finances they can receive e.g. a Carer’s Allowance.
6. Social workers can help older people navigate complex healthcare and social service systems, connect with resources, and overall help to provide a coordinated approach to their care. E.g. through referral to voluntary organisations such as Age NI.
7. Social workers often develop and coordinate a discharge plan for older people when the time comes for them to transition from one care setting to another. For example, from inpatient to outpatient care, or from residential care to home care.
Occupational Therapist
An occupational therapist (OT) helps in the care and support of older people who have difficulties carrying out day-to-day activities. This may be because of a disability, illness, trauma, ageing, or other long-term conditions e.g. arthritis.
As people age, they may experience a range of physical, cognitive, and emotional changes that can impact their ability to engage in activities that are important to them, such as self-care, leisure, and social groups e.g. bowls. An Occupational Therapist (OT) can help older people maintain or regain their independence and improve their overall quality of life.
An OT can help support older people by:
1. Firstly, an OT will carry out an assessment to evaluate an older person’s needs. This will include a risk assessment as well as recommendations of what the older person requires to safely and independently carry out their everyday activities e.g., a Hospital waterbed for an older adult who has limited movement, to reduce the risk of bed sores occurring. After the needs assessment the OT may organise suitable activities e.g., practice dressing activities using a button hook/zipper pull device.
2. If the older person lives in their own home and is adapting to life after major surgery, an OT will recommend adaptations to the older service users’ homes to accommodate any specific needs, e.g., wider doorways to accommodate an electric wheelchair.
3. An OT may also provide aids to support daily living such as a hoist, stair lift or cutlery. For example, providing a hoist for an older person who has stage 4 multiple sclerosis.
4. An OT will teach older people the skills needed to regain or maintain independence, e.g., shaving and dressing for an older man who has had a stroke. They will also provide information and advice to the older people to support their independent living at home, e.g.. giving advice on the safe use of equipment/positions of comfort.
5. An OT make referrals to or liaise with other professionals for extra support, e.g., to social worker if the OT believes the older person needs extra assistance in their own home in the form of domiciliary carers.
Likewise, it could be a referral to the memory assessment service if the OT suspects the older adult is showing signs of dementia.
6. The nature of frailty in older people means that people present with numerous issues which in turn require a team-based approach to be managed. Therefore, an OT will work as part of a multi-disciplinary team with other professionals such as social workers, nurses and geriatricians to ensure a holistic, person-centred and coordinated approach to care and support.
District Nurse
District nurses provide a wide range of person-centred nursing care and support to patients based on the assessed needs of the older person. A named district nurse is aligned to each GP practice and works in partnership with other professionals within the primary care team including social workers and occupational therapists. A district nurse will often provide healthcare services to patients in their own homes or within their local community.
A district nurse will:
1. Provide direct nursing care to older people by changing any dressings on sores and emptying catheters for those who e.g., have limited movement because of a stroke.
2. Take blood and urine samples from older people to check for infection/ monitor blood glucose levels. For example, older people who have a catheter installed are at a greater risk of developing urinary tract infections. The district nurse may take a urine sample to check for this infection.
3. Hypertension is a common problem in older adults. The district nurse may check for vital signs (something that is useful in detecting/ monitoring a medical problem) such as blood pressure, pulse or temperature.
4. A district nurse may administer medication via injection or orally. For example, if an older adult suffered from bowel cancer and was receiving palliative care they may receive morphine orally or via something like a syringe driver. In terms of palliative care, a district nurse is frequently the identified key worker responsible for co-ordinating the care of older people in terms of end-of-life care needs.
5. A district nurse will also liaise with other healthcare professionals such as the social worker or GP. For example, if the mobility of an older patient with Multiple sclerosis was deteriorating, the district nurse will liaise with the social worker and OT to for example to ensure the older person is provided with carers and specialist equipment such as a hoist.
6. A district nurse will provide advice to an older adult and their family. This could be specific advice relating to their illness or condition such as Type 2 diabetes and the lifestyle changes older adults could make to assist with its control. It could also be in relation to accident prevention in the home such as showing the family/carers how to operate equipment such as a hoist safely.
7. If they have undertaken a specialist qualification, a District Nurse can also prescribe some types of medication. The drugs able to be prescribed are listed on a Nursing Formulary for Community Practitioners and mainly include over-the-counter drugs e.g. laxatives and things like wound dressings and saline solutions etc. for cleaning.
Physiotherapist
Physiotherapists help to restore movement and function when an older person is affected by injury, illness, or disability. Physiotherapy can be helpful with a wide range of health conditions including movement problems resulting from a stroke, multiple sclerosis (MS), Parkinson’s disease, back pain or rehabilitation after a heart attack.
Physiotherapists assist in the care and support of older people by:
1. Assessing an older person’s physical abilities and identifying any impairments that may be affecting their mobility or function. From this they will develop a personalised treatment plan that may include exercises to improve strength, balance, and flexibility e.g. ankle rotations in the treatment of arthritis to delay joint deterioration.
2. Offering manual therapy e.g. where the physio uses their hands to help relieve pain and stiffness, and to encourage better movement of the body. Manual techniques are often used to help with lung conditions that older people may suffer from e.g. COPD.
**3. Falls are a significant concern for older adults, as they can lead to serious injuries and loss of independence. Physiotherapists can help prevent falls by assessing an older person’s risk of falling and developing a personalised exercise program to improve balance, strength, and coordination.
4. Older adults may experience chronic pain related to conditions such as arthritis or osteoporosis. Physiotherapists can help manage pain through a combination of exercises, manual therapy, and education on pain management strategies.
5. Physiotherapists play a critical role in helping older adults recover from a stroke. They can develop a personalised rehabilitation program to help regain movement and function, as well as provide education and support to the older person and their family.
6. Physiotherapists can provide education and training on mobility aids, such as a Rollator and work with older people to develop strategies to overcome physical limitations e.g., weakness after a stroke to help the older adult maintain their independence.
Dietician
Dieticians assess, diagnose, and treat dietary and nutritional problems in older adults, aiming to promote good health and prevent disease. Dieticians can help support older people by:
- Assessing an older adult’s nutritional status to determine if they are getting enough essential nutrients from their diet e.g. Vitamin B12 (Older people are more likely to get vitamin B12 deficiencies because it is absorbed from food by stomach acid, and as you age, your acid levels start to decline).
- Based on the nutritional assessment, a dietician can help an older adult plan a balanced and healthy diet that meets their specific dietary needs and preferences. For example, if an older person has recently been diagnosed with Hypertension, the dietician may recommend how to reduce salt in the diet e.g. through the use of herbs/spices.
- A dietician can provide advice and support for older adults who need to manage their weight, whether it’s to lose or gain weight. They can also help older adults develop healthy habits around food and physical activity.
- A dietician will work with the Geriatrician, Speech and Language Therapist, Physiotherapist and other health and care professionals to support the nutritional needs of older adults. They may help in the development of a nutrition/meal plan for an older adult who e.g. suffers from Dysphagia and may recommend that meals are pureed with milk or cream to ensure an appropriate protein and energy intake.
Pharmacist
A pharmacist dispenses prescriptions, sells over-the-counter medicines and gives advice on treating minor ailments and certain health conditions common with older people e.g.. Heartburn. Pharmacists may work in the hospital, community. Health Centre or the Nursing home.
- Pharmacists give expert advice on medicines and many common conditions, without an appointment and sometimes outside usual hours. E.g. The pharmacist may advise against the use of a sedative that was prescribed for sleep issues as it increases the older persons risk of falls.
Note: Older people may take multiple medications and these may interact with one another.
- A Pharmacist reviews prescriptions from doctors to ensure accuracy and suitability for the older person, including the dosage and the ingredients required. This is particularly important for older people as they may react differently to drugs.
- A Pharmacist can also provide advice on specialist health care issues affecting older people such as blood pressure, smoking cessation, cholesterol monitoring and diabetes screening.
- Pharmacists can also provide support for carers of older adults, such as advice on medication management e.g. through the use of blister packs and information on local support services.
- Pharmacists can also supply drugs to patients in ways that are accessible to them, such as providing easy open bottles or pills without wrappers for those who suffer from arthritis.
- Pharmacists can also support older people by ensuring drug labels and printed material are in large-type and in the patient’s native language, so they are easy to read.
Optometrist
An optometrist is trained to provide specialist eye care services, including sight tests. Their role is to detect defects in vision, signs of injury, eye diseases or abnormality, and problems with general health. They can work in a variety of settings, including hospitals, high street optometrists or other health settings.
Optometrists can play a crucial role in supporting older adults in maintaining their visual health and quality of life.
1 Optometrists can perform detailed eye exams to detect any changes in vision and identify any underlying eye conditions or diseases such as glaucoma, *macular degeneration, *cataracts, or diabetic retinopathy. Older adults should have an eye exam every one to two years, depending on their overall health and medical history.
Note: They refer onto specialists for treatments such as injections for muscular degeneration.
- Optometrists can prescribe corrective lenses such as glasses or contact lenses to help older adults see more clearly and comfortably.
They can also recommend specialised lenses for specific needs such as reading glasses. - For older adults with low vision, Optometrists can provide specialised devices and aids such as magnifiers, or digital devices to help them see better and perform daily activities with greater ease.
- Optometrists can educate and counsel older adults about proper eye care, including the importance of protecting the eyes from the sun, maintaining a healthy diet, and avoiding smoking, which can contribute to eye disease.
Podiatrists
Podiatrists specialise in the assessment, diagnosis and treatment of diseases and conditions affecting the feet and lower limbs, including nail surgery and wound management.
- Podiatrists assess and plan treatment for any feet related issues in older people such as bunions, to ensure they restore and maintain functionality.
- Following assessment, the older person will be issued with a personalised foot health plan where the podiatrist will recommend advice on how the older person can maintain their own foot health e.g. the use of a urea based cream on cracked heels.
- Podiatrists play a key role in the early detection and treatment of foot problems in older people who suffer with diabetes. Podiatrists therefore help older people maintain their health and social wellbeing and live independently within their own community.
Care Assistant
Care Assistants play a vital role in supporting older people in settings such as nursing homes, day centres, residential care homes and hospitals.
Their role in supporting older people often entails:
1 Helping older people with personal care, including bathing, dressing, and toileting e.g., Changing continence pads and removing wet or soiled clothing to help provide dignity.
- They also assist with eating and drinking and encourage residents to maintain their independence where possible.
- They also clean equipment such as wheelchairs or commodes used for the personal care of older adults.
- Care assistants provide emotional suppont to older people by engaging them in conversation, listening to their concerns, and providing companionship. Having a ‘named’ care worker responsible for each resident in a nursing home will ensure they feel cared for - valued
- They also encourage residents in nursing homes, to participate in activities and social events e.g. completing crosswords or knitting.
- Care assistants help residents with mobility issues, including using walking aids and transferring to and from their bed or chairs. They also ensure that older adults are comfortable and positioned correctly to prevent pressure ulcers.
- Care assistants communicate with other members of the care team, including nurses, doctors, and physiotherapists, to ensure that residents receive the best possible care.
- Care assistants take measures to ensure the safety of older people, such as using bed rails, monitoring wandering residents, and ensuring the environment is free of hazards e.g., loose wires/leads from a hoist that could cause a fall.
Domiciliary Care Worker
A Domiciliary care worker helps to support an older person in their own home, helping with household tasks, personal care or any other activity that allows them to maintain their quality of life and independent living.
Domiciliary carers may come from a private agency, funded by the older adult or their family, or they may be funded by state i.e., the local health and social care trust. In this case, a social worker will have carried out an assessment of the older adult in their own home and put a care package in place.
Their role is very similar to a care assistant; they often help an older person with:
• Getting out of bed in the morning
• Help with washing and dressing e.g., putting on support stockings
• Brushing of hair
• Using the toilet
• Preparing meals/ snacks and helping them with eating e.g., cutting up the food
•Helping older adults take their medication as directed in the care plan.
• Household jobs, like washing clothes and shopping. - privately funded
• Getting ready for bed.
Domiciliary carers complete a daily record of the task undertaken and the care provided for the older person. They also report important information or causes for concern to their team leader.
Speech and Language Therapist
Speech and Language Therapists (SLTs) work with older adults who have communication and swallowing difficulties. These difficulties can arise from a range of conditions, such as stroke, dementia, Parkinson’s disease, and head and neck cancer. SLTs may work in a community health centre, a hospital ward, an outpatients department within the hospital, a day centre, an independent practice or even in an older persons own home.
The SLT works to improve the older person’s quality of life, promote independence, and enable them to participate fully in their social and personal relationships.
- The SLT will carry out assessments to identify the nature and severity of the older person’s difficulties. This may involve conducting tests of language, speech, memory, and problem-solving skills, as well as assessing the person’s ability to swallow safely.
- Based on the assessment, the SLT will develop a treatment plan that addresses the older person’s specific needs and goals. Treatment may include exercises to improve speech and language skills e.g. side to side tongue movements for stroke patients. Strategies to help with memory and cognitive skills e.g. memory card games, and advice on adapting the environment to support communication and swallowing e.g. the use of picture cards to support communication.
- The SLT may also work with the older person’s carers and family members to provide education and training on how to support the person’s communication and swallowing needs. This may include teaching safe swallowing techniques e.g. how to modify the textures of foods using thickeners to make food/drinks easier to swallow for Dysphagia patients. This is common in older adults who suffer from Motor neurone disease, Dementia or have survived a stroke.
- The SLT will work closely with other healthcare professionals, such as doctors, nurses, occupational therapists, and physiotherapists, to ensure that the person’s needs are addressed holistically and to provide recommendations if a patient cannot safely swallow food and drink.
