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  • Subject Name : Nursing

Healthy Ageing

This case is based on the interview session of Mr. Brady who is 78 years old living in retirement village after the death of his wife 5 years ago. He lives in the rural area of Queensland and is a patient of chronic illness. This older person is diabetic and hypertensive. He was diagnosed with arthritis when he was 38 years old and still his physical movement is affected due to chronic pain in his joints. He is a smoker and has been smoking 15 cigarettes on an average each day from past 50 years. He has a normal lifestyle in which he stays at home most of the time but regularly goes on walk each morning. He makes attempts to live a healthy life by going for walk and exercising each day in evening but he describes that his body does not allow so. He has lost prominent weight in past 12 years and looks weak. He was mentally well until the time his wife left him. He was in depression post his wife’s death and had sleeping issues due to this. He feels lonely sometimes and other days he just looks at people in park to feel normal. The feeling of loneliness draws him to a level that somedays he feels no pleasure in waking up and working out because he feels pathetic.

He pulls out himself each day in order to go for walk but the degraded mental health does not allow him most of the days. He experiences frequent episodes of thirst and this makes him feel more tired. He feels that he needs assistance in carrying out daily activities but he has never tried to get one. He has an easy access to community health care services which he sees only for his mental health because he believes that his BP and diabetes are in control. He gets himself checked up for his physical health once in six months where all his vital signs are checked. He is not satisfied with the community services provided for his mental health thus this draws him back from accessing in regular intervals. The major risk factors for his condition are his unhealthy lifestyle that are his habit of smoking and diet. Most of the days he skips the meal and this becomes dangerous for his body because he is diabetic. This has made him lose a lot of weight and he has become weak. His eyesight is weak due to ageing and has no hearing problem. He receives few community services like meals on weekends and home help. This does not satisfy him because he feels extreme loneliness and he has low social life. His body does not allow him to go in a social gathering and also he does not feel like going because of his degraded mental health, He is under hypertensive medication and the medication for diabetes type 2. He is consistent with his medications because he believes that they always support him in his condition. His medications are:

Ageing for Mr. Brady refers to the feeling of loneliness. He believes that it is a time of ill- health and this age makes the person spends most of the time alone. He is lonely at home but this age does not allow him to attend social gatherings or to go to park. Most of the older people equates the onset of ageing as a period of infirmity. They feel that this is the age of inevitable bodily changes and still an older person can enjoy this phase only when he/ she has a well- functioning mind and body. According to MacLeod, Musich, Keown & Yeh (2019), there exists a direct relationship between psychosocial aspects of ageing and positive perceptions of ageing. Mr. Brady also feels that if he had better mental health then he would have enjoyed this phase better. He feels that good quality of life can be obtained even in this age if one has better mental health because the physical growing is inevitable.

The ageing experience of this older person is not good not only because of the worsened health condition but because he gets too much time to spend by himself (Wu et al., 2016). He also believed that retirement is a time of leisure but he when he experienced it he states that it is the time of loneliness and pain. In my view, ageing is a weak phase of living life that can be enjoyed when one has an aged partner. This man also believes so because loneliness has worsened his condition. I think old people are not grumpy or miserable and they have the best of life experiences. The only thing worst about ageing is the degraded health conditions that are inevitable and I do not believe that old people do not get respect in society (Kim, Lee & Sims, 2017). Mr. Brady too believes that he gets respect in his society and he has no issues with people.

Assessment

Findings

Healthy ageing

Assessment of aspects of health

Personal well- being:

Home safety assessment:

Personal nutrition assessment:

Mr. Brady has been anxious and unhappy for a long time now. There is a requirement of Geriatric Depression Scale (GDS) for screening the symptoms of depression in him. He is highly depressed and has no pleasure in living life or performing daily activities (Markin et al., 2020).

He exercises on alternate days and tries to go for a walk each morning. Persistent pain in joints makes it difficult for him to walk and exercise.

He has chronic pain in his joints and has difficulty in sleeping. He is depressed and has hypertension and type 2 diabetes.

He has no issues in bowel and bladder continence.

He has discomfort due to pain because he is a patient of arthritis so he regularly experience the pain in joints and back.

He is a smoker and smokes around 15 cigarettes per day and has been doing it for long time. He does not intake alcohol at all and has o history of substance abuse.

He has not fallen yet and has no history of fall. The fall risk assessment is not required because there is least risk of fall.

No issues found in the home.

No he does not eat three good sized meals a day. He is more dependent on fruits and beverages and often skips meal as he lives alone and does not wish to cook. He gets food through community services on weekend and this is the time when eats three good sized meals. He eats two times a day on weekdays and only uncooked and poorly cooked meals.

He has no health problem in which there is food restriction. He is not given any food restricted diet for this man and he is allowed to have anything that he wants provided it is healthy.

He drinks only water and coffee most time of the day. Coffee is a caffeine containing beverage and most of the days when he does not cook he relies on this caffeine containing beverage.

In last six months he has lost significant weight and the main reason for this skipping of meal plans and not eating regularly. He has chronic pain that does not allow his to cook food for himself and he also feels that there is no point in cooking for one person. This made him loss significant weight in an unhealthy manner.

Cognition

Good memory and has no dementia. He remembers everything from past and never forgets to take his medication. He always adheres to his medication regime.

Mood/ behaviour

He is depressed most of the time and behaves grumpy at times. He gets emotional when he talks about his loneliness.

He feels lonely most time of the day and is unhappy from past many years after the death of his wife.

He has a nice behavior overall and is soft in talking but gets emotional too often. Due to this he faces difficulty in speaking and then he takes his time and returns to normal self and tell his details.

Appearance

His posture is straight and overall hygiene and grooming is good. He is clean and maintains good hygiene. He wears loose clothes and that are not well- maintained. The hair looks normal grey and he has clean hands.

According to World Health Organization healthy ageing is defined as the process by which the functional ability of an individual is developed and maintained that helps in enabling well- being in the older age (Sims, 2017). They must have functional ability so that they can do what they want and live the life independently. As per the information revealed through the interview, narrative summary, ageing perception of the man and older person assessments it has been observed that the patient is both physically and mentally not well. As per the definition of healthy ageing, the person must have good functionality to be able to carry out throughout this phase of age. This older man has chronic diseases but still the older person’s assessments states that he is able to carry out most of his daily activities independently despite having arthritis and constant pain in joints. He is ageing well in this aspect but his mental health has a negative effect of his functional capabilities (Koelen et al., 2017). He is not able to perform most of his work that would help him in keeping himself healthy like walking, exercises and attending social gatherings because his mental health has taken over his mind.

The mental health disease can create societal issues because they lead to functional impairment. Depression is the most burdensome psychological disorder that has maximum indication of substantial daily life functional impairment. This causes functional impairment and the same has been affected in Mr. Brady. He is not ageing well mentally and this has direct impact on his functional impairment and it can be stated that he is not ageing well mentally because the mental disorder is not allowing him to enjoy this well- being. This old man is ageing well in some areas but not in others like he is able to perform his daily activities well. Healthy ageing involves good quality of life and good functional capabilities of an older individual. Retirement age is considered good as it allows the leisure time but this man feels lonely and this has led him into depression. He has no pleasure in doing daily activities and is more dependent on the medication. He does not engage himself in pleasant activities and his depression is adversely affecting the human functioning. His health behavior like smoking 15 cigarettes per day, non- participation in social activities, no care giving behavior all contributes to unhealthy ageing. Some of his positive health behaviour like adhering to medication regime, attempting to walk or carry out physical activities also indicates healthy ageing factors. Thus, it can be concluded that he is ageing healthy in some areas whereas he is not in other areas.

From the evaluation of his assessments it can be said that he is ageing healthy in some areas and there are few areas of concern in relation to ageing well. His mental health is one of the biggest area of concern because that is leading to functional impairment (Barr et al., 2016). He was diagnosed with depression after the loss of his wife and this information is valuated from the collected data and processing. This is the present concern because the old man is not enjoying this phase of ageing and feels his mental health is a burden on him. He gets no pleasure in carrying out daily activities and feels alone. The second area of concern is his loneliness and no interest in involving himself in social gatherings (Andrew & Meeks, 2018). He spends most of time alone in his home apart for some time when he access community health services and he goes out for walk.

He avoids social gatherings and does not feel like attending them. The third potential area of concern is his lost weight that is associated with not eating properly and smoking 15 cigarettes per day. The unhealthy lifestyle and health behaviors have direct impact on the physical and mental well- being of an individual (Cassidy & Hinds, 2019). Weight loss in elderly is contributed by various reasons such as chronic illness, no proper eating habits, weakness in the body and constant pain in body that does not allow enough movement in older adults. This older man also has constant pain in his joints that has an impact on functional ability of him but still he manages well (Caneiro et al., 2017). The major concern is his significant weight loss and no desire to eat.

The table below shows the two most relevant person centered problems that are identified in respect to Mr. Brady.

The care problem

The goal

The interventions and rationales

Problem 1: Depression and loneliness after the loss of his wife

1. To facilitate cognitive therapy to bring behavioural change within a month through an easy process.

1a. Cognitive behavioural therapy is structured psychotherapy in which the main focus is placed on cognition and behavior of elderly people that is highly efficient in modifying the behavior of people (Hummel et al., 2017). This will be given to Mr. Brady as it will help him in modifying his behavior of not attending social gatherings and will address his loneliness. In this patient, the latter years of his life are characterized by the loss and transitions. CBT will help this older man in recognizing the methods of thinking about circumstances that will help in enabling him in adapting to this loss and transition (Zhao et al., 2018).

1b. The second intervention is music therapy that is delivered to the patients to make them relax and calm down so that depression can be reduced (Gok et al., 2017). This is associated with improving functioning that is it improves the patient’s involvement in the activities (Erner et al., 2017).

Problem 2: Chronic pain in joints and back due to arthritis

2. To manage the chronic pain in the patient’s joints with pain management interventions within a month so that the patient can return to normal walking and exercises.

2a. The first intervention for chronic pain management in the patient having arthritis is administration of pain management medication through IV route like morphine. Morphine is an opioid that helps in pain management especially in the patients who have chronic pain (Volkow et al., 2018). This is an effective pain management medication that will be only administered after the prescription of the doctor (Noori et al., 2019).

2b. The second intervention is that the nurse will give referral to the dietitian and physiotherapist. The physiotherapy sessions will help in appropriate movement of the body parts that will help in relieving the pain (Nordstrom et al., 2020). This will have a direct impact on improving the physical and cognitive ability of the patient. This therapy will help in relieving acute pain in the joints and back. The referral to dietitian is important because the patient has lost significant weight and the meal as per diet is very important for this older man (Venchiarutti et al., 2019).

References for Healthy Ageing

Andrew, N., & Meeks, S. (2018). Fulfilled preferences, perceived control, life satisfaction, and loneliness in elderly long-term care residents. Aging & Mental Health22(2), 183-189.

Barr, B., Taylor-Robinson, D., Stuckler, D., Loopstra, R., Reeves, A., & Whitehead, M. (2016). ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. Journal of Epidemiol Community Health70(4), 339-345.

Caneiro, J. P., Smith, A., Rabey, M., Moseley, G. L., & O'Sullivan, P. (2017). Process of change in pain-related fear: Clinical insights from a single case report of persistent back pain managed with cognitive functional therapy. Journal of Orthopaedic & Sports Physical Therapy47(9), 637-651.

Cassidy, T., & Hinds, M. (2019). Family health culture and young adult health behaviors and wellbeing. Journal of Family Medicine Forecast2(3), 1023-1028.

Gök Ugur, H., Yaman Aktaş, Y., Orak, O. S., Saglambilen, O., & Aydin Avci, İ. (2017). The effect of music therapy on depression and physiological parameters in elderly people living in a Turkish nursing home: A randomized-controlled trial. Aging & Mental Health21(12), 1280-1286.

Hummel, J., Weisbrod, C., Boesch, L., Himpler, K., Hauer, K., Hautzinger, M., ... & Dutzi, I. (2017). AIDE–acute illness and depression in elderly patients. Cognitive behavioral group psychotherapy in geriatric patients with comorbid depression: A randomized, controlled trial. Journal of the American Medical Directors Association18(4), 341-349.

Kim, J., Lee, J., & Sims, O. T. (2017). The productive aging concept and social work students’ perceptions toward an older population. Journal of Social Service Research43(2), 149-155.

Koelen, M., Eriksson, M., & Cattan, M. (2017). Older people, sense of coherence and community. In The handbook of salutogenesis (pp. 137-149). Springer, Cham.

MacLeod S, Musich S, Keown K, Yeh CS (2019). Practical technological solutions to support successful aging. Journal of Aging Geriatric Medicine, 3(2).

Merkin, A. G., Medvedev, O. N., Sachdev, P. S., Tippett, L., Krishnamurthi, R., Mahon, S., ... & Doborjeh, M. G. (2020). New avenue for the geriatric depression scale: Rasch transformation enhances reliability of assessment. Journal of Affective Disorders264, 7-14.

Noori, S. A., Aiyer, R., Yu, J., White, R. S., Mehta, N., & Gulati, A. (2019). Nonopioid versus opioid agents for chronic neuropathic pain, rheumatoid arthritis pain, cancer pain and low back pain. Pain Management9(2), 205-216.

Nordström, K., Ekhammar, A., & Larsson, M. E. (2020). Physiotherapist-guided Free Movement Dance for patients with persistent pain is empowering in everyday living. A qualitative study. European Journal of Physiotherapy22(1), 2-13.

Sims, J. (2017). Healthy ageing. Australian family physician46(1/2), 26.

Venchiarutti, R. L., Byth, K., Marks, J. L., Chand, A., & Blumenthal, C. S. (2019). Comparing the effectiveness of general dietary advice versus a very low energy diet in an obese outpatient population in Australia. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity24(4), 739-747.

Volkow, N., Benveniste, H., & McLellan, A. T. (2018). Use and misuse of opioids in chronic pain. Annual Review of Medicine69, 451-465.

Werner, J., Wosch, T., & Gold, C. (2017). Effectiveness of group music therapy versus recreational group singing for depressive symptoms of elderly nursing home residents: pragmatic trial. Aging & Mental Health21(2), 147-155.

Wu, Y. H., Cristancho-Lacroix, V., Fassert, C., Faucounau, V., de Rotrou, J., & Rigaud, A. S. (2016). The attitudes and perceptions of older adults with mild cognitive impairment toward an assistive robot. Journal of Applied Gerontology35(1), 3-17.

Zhao, Y., Jin, M., Cao, J., Bai, X., Wang, F., Long, H., & Zhu, Z. (2018). Effect of cognitive behavior therapy and acceptance commitment therapy on anxiety and depression in the elderly. Chinese Journal of Behavioral Medicine and Brain Science27(2), 108-114.

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