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Aged Care Services and Interdisciplinary Care

The patient and his wife are old and have various health complications, such as the patient are suffering from hypertension, arthritis, and myocardial infarction, while his wife has dementia. They both are underweight, and no one can provide them with adequate care. The patient also has an ulcer in his left leg, and he has not consulted any doctor, and this has worsened his health conditions. A registered nurse can recommend some good health care homes for the couple. The home cares for senior citizens have many services for older people, especially the ones who do not have anyone to look after them. The home care services help senior citizens to improve their physical fitness, health outcomes, and daily functions (Muramatsu, 2017).

It has been observed that these provide motivational enhancement to older citizens. The home care workers provide regular assistance to older adults and also provide emotional and mental support to them. They give long-term, quality services to older adults, which improves their overall health outcomes. Dementia is a medical condition that affects the mental health, cognitive health, and physical health of the person. It leads to various neuropsychiatric symptoms, such as forgetfulness. The home care services are highly beneficial to the patients of dementia as they improve their quality of life by providing a safe environment. According to certain studies and reports, the behavioural symptoms of dementia are low in the patients availing home care services (Eriksen et al., 2019). Thus, home cares are one of the best aged care services that can be recommended to the patient and his wife.

However, there are other aged care services also that can be provided to the couple. For example, a good dietician can help the patient and his wife as they both are underweight... Poor nutrition can be more harmful to older adults than adults because they have poor absorption capability. A dietician can be the primary health professional that can treat age-related malnutrition in older adults (Fleurke, Voskuil, & Kolmer, 2019). The role of a dietician is to provide nutritional support to the underweight or malnourished patients by recommending them a healthy, nutritious diet plan. Care take care can also be suggested to the couple as they do not have anyone to look after them. Both the patient and his wife have their health problems due to which they cannot take appropriate care of each other.

The caretaker can look after the physical fitness, medications, and other requirements of the elderly couple. It builds a positive and supportive environment around the couple and can improve their health outcomes. The caretaker can provide proper care to both the patient and his wife, and in this way, the home caretaker would be highly beneficial to them. A therapist can also help monitor the mental status of older adults by interacting with them. Most of the aged people face loneliness and depression as they lose their close ties with many of their friends and family members (Vakili, Mirzaei & Modarresi, 2017). Thus, home care services, dieticians, caretakers, and therapists are some of the aged care services that can provide interdisciplinary care to the aged couple.

Age-Related Changes and Patient Assessments

The patient has arthritis that is a type of inflammation observed in the joints. This indicates that the musculoskeletal system of the patient is affected, and this can lead to pain in the joints. The patient consumes around ten to fifteen cigarettes in a day as per the medical history, which implies that the person is at a very high risk of respiratory disorders. Smoking is harmful to people of all age groups and especially for the ones above the age of 60 years as the respiratory system gets weakened with age. Smoking is one of the mortality determinants observed in the people above 70 years of age (Nash et al. 2017). It affects the respiratory system of the patients and can lead to several disorders such as lung cancer and dyspnea. The respiratory system is associated with the circulatory system, and older adults with the respiratory system also have the chances of suffering from cardiovascular diseases. The patient has an untreated lesion or ulcer in the lower left leg, which affects the integumentary system of the body.

As per Diegel, Danilenko and Wojcinski (2018), the integumentary system is the organ system that provides the first line of defence to the body from environmental factors such as chemical agents, UV rays and temperature variations. This untreated lesion can be harmful as it can lead to other harmful integumentary diseases. Aging affects all the organ systems and especially the gastrointestinal system, as it decreases the rate of absorption and digestion in older people (Dumic et al., 2018). It causes a reduction in the gastric blood flow, affects the microbiota and muscle layer of the stomach. All these affect the process of digestion and absorption in older adults due to which they are at higher risks of malnourishment. Thus, the body systems that can be affected adversely in the patient could be the respiratory system, integumentary system, circulatory system, gastrointestinal system, and musculoskeletal system.

The assessments that can help assess the health conditions of the patient can be appetite assessment, and sleep pattern assessment. The patient is underweight and at high chances of suffering from malnourishment. Thus, there is a need for assessing the appetite of the patient to detect the type of diet that could be healthy for the patient. Appetite (GATE assessment) can be performed by a dietician by monitoring the patient's rate of digestion. This can help the dietician to plan a diet that is beneficial for the patient. The patient is also at risk of respiratory diseases due to chronic smoking. According to medical history, patients consumers tend to fifteen cigarettes daily. This implies the need for a lung functioning test, a type of diagnostic test for monitoring the functioning of the lungs. The other assessment could be a sleep pattern test because the patient faces a broken sleep.

Sleep assessment is essential for older adults because they generally have poor sleep efficiency that can result in sleep disorders. Many types of sleepiness test can be used by registered nurses and healthcare professionals for sleep pattern assessment of older people. The patient had a myocardial infarction around ten years ago, which reflects poor conditions of the heart and circulatory system. Thus, there is a need for cardiac assessment to observe the functioning of the heart and for detecting any type of heart-related disorders. The stress test, electrocardiogram, and echocardiogram are some of the tools that are used for cardiac assessments. The patient also has arthritis that implements the need for tests for assessing the conditions of the patient's musculoskeletal system. The laboratory-based tests, such as the erythrocyte sedimentation rate, can be used for this type of assessment. Patient assessment is beneficial for people of all age groups as it improves their quality of life.

Medication Management

There is a change in the pharmacokinetics of drugs with aging. The metabolism and absorption of drugs decrease with aging. The older people take more time to metabolize and absorb drugs than adults This is because of the age-related changes in the stomach, increased gastric pH, and decreased surface area for bowel-movement (Cantlay, Glyn & Barton, 2016). For example, there is a decrease in the absorption of calcium-containing drugs because of the increased gastric pH. The distribution of drugs also changes with aging due to increased fat levels, decreased water content, and decreased serum albumin. This leads to an increase in the volume of distribution of the fat-soluble drugs and a decrease in the volume of distribution of the water-soluble drugs. The metabolism rate of drugs also decreases by 30 per cent with aging due to the decreased mass of hepatic parenchyma and reduced blood flow.

Moreover, the excretion of drugs also starts decreasing after the age of 40 years because of the decreased glomerular filtration rate and reduced renal blood flow (Gujjarlamudi, 2016). The older peoples are generally more vulnerable to the adverse effects of drugs as they have a decreased rate of drug absorption and metabolism. Moreover, they also have a reduced rate of renal elimination and drug distribution. The patient in the given case study is also on the higher risks of adverse drug effects. This is because the patient is consuming many drugs, such as aspirin, ibuprofen, perindopril, and many others. The consumption of many drugs concomitantly can lead to drug-drug interactions that are harmful to the health of older adults (Höchel, 2019). As per Gallan and Gallagher (2016), there is an increase in the prevalence of adverse drug events in the elders above the age of 65 years. The people suffering from arthritis are at risk of these events. Smoking can also increase the prevalence of adverse drug events. The patient is 85 years of age, suffers from arthritis, and has smoking habits, which imply that there are high chances of him suffering from adverse drug events.

The patient takes many medications, such as 100 mg aspirin, which is used to reduce the chances of a second heart attack. It is recommended to the patients who had a heart attack in the past. However, there are certain complications associated with the frequent use of low-dose aspirin, such as it increases bleeding risks in the patients. For example, it can lead to extracranial bleeding and gastrointestinal bleeding (Rodrìguez et al. 2016). Patients take 2 mg perindopril to treat hypertension. The role of this medication is to reduce high blood pressure to prevent the chances of heart failure and strokes. The side effects of this drug include vision changes, stomach pain, dizziness, appetite loss, breath shortness, and depression. The patient also takes GTN 400 mcg spray for treating chest pain or angina. It relaxes the heart and the blood vessels to decrease chest pain. However, its overuse may lead to myocardial infarction, headache, hypotension, and tachycardia.

The medical experts have recommended the patient to take 20 mg omeprazole to treat Gastro-oesophageal reflux disease (GORD). It is beneficial for treating symptoms of GORD, such as acid regulations. It also has certain medical complications such as swelling of feet, headache, nausea, rashy skin, and allergic reactions. These are some of the commonly observed side effects of GORD in older adults. The patient is also suffering from arthritis, and to treat the pain caused by this disease, the doctor has recommended Panadol Osteo 2 tablets. It also treats muscle pain but has specific side effects such as shortness of breath, itching, rashes on the skin, and brushing. As per Ershad and Vearrier (2019), Ibuprofen is recommended to the patients of arthritis and the ones suffering from painful muscosketal conditions. The patient in the given study also has arthritis, and this drug, ibuprofen 400 mg, is given to him to treat the pain caused by arthritis. However, like most of the drugs, ibuprofen also has specific health issues such as it causes gastrointestinal and renal toxicity, and its overuse can cause the toxicity of the central nervous system. All these medications have severe health complications, but they are essential for the patient.

Reflection

Being a registered nurse, I come across various case studies involving older adults. I feel bad for the patients who do not have anyone to look after them. They suffer from various mental and emotional stresses, such as depression and loneliness. However, I learn that these patients can give better patient outcomes if they are treated with affection, positivity, and quality care. I feel sad for the patients as he has to take care of his dementia suffering wife. Although he is suffering from various diseases such as arthritis, GORD, angina, and myocardial infarction, it has worsened the physical conditions of the patient. The patient is not able to treat his ulcer in the left leg due to the responsibilities of his wife. He has been dressing the ulcer by home for the last three months and was unable to consult a doctor due to his wife's responsibilities. However, I have decided to provide the best care to the patient and his wife. I recommended the elderly couple to move to good home care where they can avail of all the medical facilities.

Moreover, they can get care taken in the home care who can provide quality and long term care to the couple. This will also help them in improving their communication skills as they will get the company of other older adults. As a result, their feeling of loneliness will be reduced, and this will eventually improve the quality of their life. I also recommended a good dietician and therapist to the patient and his wife so that they can improve their physical and mental health conditions. The dietician could improve the diet plan of the patient, which will prevent them from being malnourished.

On the other hand, the therapist can help the patient in coping up with depression. I learned that family and friends play a vital role in improving the health conditions of older adults. Thus, I have decided to join some programs where I can learn better treatment methods and improved patient care techniques for older adults. This will help me in treating elderly patients suffering from loneliness with a better approach and mindset.

References

Cantlay, A., Glyn, T. & Barton, N. (2016). Polypharmacy in elderly. SAGE Journals, 9(2), 69-77. https://doi.org/10.1177/1755738015614038

Diegel, L. K., Danilenko, M. D. & Wojcinski, W. Z. (2018). Fundamentals of Toxicological Pathology. Cambridge, Massachusetts: Academic Press

Dumic, I., Nordin, T., Jecmenica, M., Lalosevic, S. M., Milosavlijevic, T. & Milovanovic, T. (2019). Gastrointestinal tract disorders in older age. Canadian Journal of Gastroenterology and Hepatology, 2019. https://doi.org/10.1155/2019/6757524

Eriksen, S., Pedersen, I., Taranrød, B. L., Ellingsen-Dalskau, H. L., Garshol, F. B., Ibsen, L. T., Kirkevold, Ø., Strandli, E. & Patil, G. G. (2019). Farm-based day care services – a prospective study protocol on health benefits for people with dementia and next of kin. Journal of Multidisciplinary Healthcare, 12(n.d.), 643-653. doi: 10.2147/JMDH.S212671

Fleurke, M., Voskuil, W. D. &Kolmer, D. (2019). The role of the dietitian in the management of malnutrition in the elderly: A systematic review of current practices. Nutrition & Dietetics, 7(1), 60-75. https://doi.org/10.1111/1747-0080.12546

Gujjarlamudi, B. H. (2016). Polytherapy and drug interactions in elderly. Journal of Mid-Life Health, 7(3), 105-107. doi: 10.4103/0976-7800.191021

Höchel, J. (2019). Does Everything Get Slower with Age? Pharmacokinetics in the Elderly. Drug Res (Stuttg), 69(1), S7-S8. doi: 10.1055/a-0982-5043

Lavan, H. A. & Gallagher, P. (2016). Predicting risk of adverse drug reactions in older adults. Therapeutic Advances in Drug Safety, 7(1), 11-22. doi: 10.1177/2042098615615472

Muramatsu, N., Yin, L., Berbaum, L. M., Marquez, X. D., Jurivich, A. D., Zanoni, P. J., Madrid, K., Walton, M. S. (2017). Promoting Seniors’ Health With Home Care Aides: A Pilot. The Gerontologist, 58(4), 779–788. https://doi.org/10.1093/geront/gnx101

Nash, H. S., Liao, M. L., Harris, B. T. & Freedman, D. N. (2017). Cigarette Smoking and Mortality in Adults Aged 70 Years and Older: Results From the NIH-AARP Cohort.

American Journal of Preventive Medicine, 52(3), 276-283. https://doi.org/10.1016/j.amepre.2016.09.036

Rodrìguez, L., Pèrez, M., Hennekens, H. C., Rothwell, M. P &Lanas, A. (2016). Bleeding risk with long-term low-dose aspirin: a systematic review of observational studies. PLoS One, 11(8). 10.1371/journal.pone.0160046

Vakili, M., Mirzaei, M. & Modarresi, M. (2017). Loneliness and its related factors among elderly people in Yard. Elderly Health Journal, 3(1), 10-15. http://ehj.ssu.ac.ir/article-1-74-en.pdf

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