Contexts of Practice: The Older Person and Family

Discuss the biophysical processes pertinent to the case (200 words)

The individuals equal to or above the age of 60 years are termed as “Elderly” who comprise the fastest-growing category amongst the population of the world (WHO, 2018). Ageing is linked with a lot of neurological disorders in which the brain capacity to transmit signals reduces. With the advent of 60's there is a decrease in the general precision that advances gradually. Ageing also shows a progressive deterioration in the cognition along with some behaviour changes and decline in the day to day activity levels. Cognition decline results from proximal variables (various sequential intellectual cycles) including handling speed, memory, hindrance of incidental natural boosts and losses in the sensory perception (Amarya, 2018). Impaired cognition occurring in the older age group among is associated with more chances of risk of injuries to themselves or others, a retardation in the functional activities of daily living and an enhanced risk of mortality (Amarya, 2018; Leiknes, 2015) which was rightly observed in the fall encountered by Mr Lee at the age of 78. At this age, the brain gets reduced blood flow and there is a lower neurological function thereby increasing his chances of a fall. 

Since perceptual-motor skills also retard with age Mr Lee was expected to have slower reflexes and cognitive adaptation to the surroundings.

Ageing comprises of a downward pathway in accommodation (presbyopia), low-contrast activity, glare tolerance, visual fields, adaptation and colour discrimination (Amarya, 2018). Since he had weak eyesight and had not got it checked for 2 years, thereby it increased his chances of injury by manifold.

Functional sarcopenia or called as age-related changes in the musculoskeletal infrastructure influence 7% of older individuals over 70 years of age, and the pace of weakening increments with time, influencing over 20% of the old by the 80 years of age which is why Mr Lee was expected to have lower muscle mass and strength. A decrease in bulk and muscle quality leads to an increased chance of fractures, feebleness, and a decreased feeling of personal satisfaction and loss of freedom (Villa-Forte, 2015).

Majorly, the muscles and bones show an enhanced functional growth by using essential vitamins like vitamin D and vitamin C (Amarya, 2018) and Mr Lee having a very low Vitamin D, made him more prone to physiological injuries.

References

Leiknes, I., Lien, U.T., Severinsson, E. 2015. The relationship among caregiver burden, demographic variables, and the clinical characteristics of patients with Parkinson’s disease—A systematic review of studies using various caregiver burden instruments, Open Journal of Nursing, 5(10), pp. 855.

Amarya, S., Singh, K. Sabharwal, M. 2018. Ageing Process and Physiological Changes. Intech Open publisher. DOI: 10.5772/intechopen.76249.

Villa-Forte, A. 2015. Effects of aging on the musculoskeletal system. Last Full Review/Revision Dec. 2019. Avaialble on https://www.msdmanuals.com/home/bone,-joint,-and-muscle-disorders/biology-of-the-musculoskeletal-system/effects-of-aging-on-the-musculoskeletal-system.

World Health Organization. 2018. Management of Substance Abuse Unit. Global Status Report on Alcohol and Health, 2018. Available on https://www.who.int/substance_abuse/publications/global_alcohol_report/en/

Discuss the psychosocial processes pertinent to the case (200 words)

Psychosocial ageing, considered as a phenomenon which comes along with biological ageing. Changes that happen with age in the functioning of individual organs influence the temperament, mentality, state of being, social movement and physical activity of the elderly. Aging psychologically results when the elderly are unable to accept the past and reconcile with the present situation. There are numerous emotional and psychological phases associated with this phase of life making them highly susceptible to negative generalizations which are ordinarily connected with old age, such as, disability, inefficiency, sadness, disregard and neglect. These lead to the main fear in the elderly characterized as the fundamental dread: dependence, loss of nobility, loneliness, isolation and suffering and enduring that go before death, as opposed to death itself (Ferracioli, 2018). One such case was of Mr Lee who although staying with his wife, was away from his grandchildren as a result of travel inhibitions because of his age. A feeling of solitude sets in the individuals who travel less frequently cannot meet their families often leads to an immense impact on psychosocially as well as behaviourally. On the contrary, Bernoth and Winkler, 2017 have emphasized that there are positive aspects in ageing meaning that the individuals show aging in healthy ways yet progress to be a part and parcel in the lives of their families and communities. Ageing significantly affects patients' lives, as they bring about torment, loss of independence, inability, psychological and emotional changes identified with lack of confidence, self-esteem and social changes coming about because of hospitalizations and social withdrawal (Amarya, 2018). Similarly, as Mr Lee was living with his wife and was visited by his daughter yearly, a decline in his physical activities and meetings with his Chinese people in the Community Centre took a toll on his social well-being. Since his wife could not drive also and with retarding vision, a negative impact was observed on his ageing mind, making him more prone to falls and injuries. Care to injured patients who have wounds should include bio-physiological to emotional factors which ought to be given totally, that is only conceivable through the systematization of nursing care. The nurse's specific attention can furnish the old with better recovery, for example, autonomy, freedom and expanded confidence promoting a healthy way of life and encouraging the person's assets for the maintenance of his psychological well-being (Corrêa, 2017).

References

Bernoth, M. and Winkler, D. 2017. Healthy ageing and aged care, Nursing, Midwifery and Indigenous Health. Oxford University Press. Victoria, Australia.ISBN (Print) 9780195597585.

Corrêa, J.C., Ferreria, M.E.C., Ferreira, V.N., et al. 2017. Elderly’s perception of the role of the Psycohologist at Homes for the Aged, Revista Brasileira de Geriatria e Gerontologia,15(1), pp.127–136.

Ferracioli, N.G.M. 2018. Psychological aspects of aging and psychology’s contributions to gerontology: theoretical and technical interface. MOJ Gerontology & Geriatrics, 3(2), pp.115 – 116. DOI: 10.15406/mojgg.2018.03.00101.

 Amarya, S., Singh, K. and Sabharwal, M. 2018. Ageing Process and Physiological Changes. Intech Open publisher. DOI: 10.5772/intechopen.76249.

Identify a screening tool for assessment appropriate in this case and discuss key elements of the tool (200 words)

The objectives are to stabilize the injury, control and manage pain as well as restore function and stability by normalized preoperative appraisals and patient-focused administration conventions. The impact of such circumstances can be avoided by following three standards which are  timeliness i.e avoiding delay and deferral which are unwanted, secondly effectiveness i.e. focusing on ideal results utilizing the best accessible resources and  patient-centeredness which means care that is conscious of and receptive to singular needs of a patient (Jensen, 2018).

The above 3 priorities are to be followed by physical management of the wound in the elderly. To avoid the risk of infections, wound healing by secondary intention is also very important.

Wound debridement with 0.9% saline arrangement is fundamental. As per a few examinations, an absolute answer for wound cleansing ought not to be harmful to the human tissues, preserve the granulation tissue, decrease the number of microorganisms, not activate touchy reactions, and be broadly accessible and reasonable. The utilization of 0.9% saline arrangement meets these necessities as it is an isotonic arrangement, doesn't meddle with the recuperating cycle and doesn't harm tissue. Accordingly, it is the most ideal decision for water wounds (Olivieria et al., 2016). Since Mr Lee had fallen and scratched his knee and there was a tissue tear of the skin, the immediate action to be taken was wound debridement.

The intercession "Wound cleansing" was an incessant mediation action using a sterile cloth and wrap which is favoured in the lower extremities wounds, as it prevents the skins direct contact, whose expulsion can bring about fresh sores (Olivieria et al., 2016).

Timely assessment and effective care and singular attention to Mr Lee at his age were the first assessment tools to be worked on by the healthcare team.

References

Jensen, C.M., Hertz, K., Mauthner, O. 2018. Orthogeriatric Nursing in the Emergency and Perioperative In-Patient Setting. 2018 Jun 16. In: Hertz K, Santy-Tomlinson J, editors. Fragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient [Internet]. Cham (CH): Springer. Chapter 5. Available from: https://www.ncbi.nlm.nih.gov/books/NBK543818/ doi: 10.1007/978-3-319-76681-2_5

Lach, H.W., Harrison, B.E. and Phongphanngam, S., 2016. Falls and fall prevention in older adults with early-stage dementia: An integrative review, Research in Gerontological Nursing, 10(3), pp.139-148.

Oliveira, F. P., Oliveira, B. G. R. B., Santana, R. F., Silva, B. d. P., and Candido, J. S. C. 2016. Nursing interventions and outcomes classifications in patients with wounds: cross-mapping, Revista Gaúcha de Enfermagem, 37(2), p.e55033. Epub May 31, 2016.https://doi.org/10.1590/1983-1447.2016.02.55033

Discuss 3 priorities of care for this person (200 words)

The priority was to check for other fatality and injury to the legs as Mr Lee had a deficiency in Vitamin D. This was to be followed by pain management immediately and wound debridement and antibiotic medication.

Pain ought to be surveyed instantly upon presentation, within a span of 30 min of the administeration of initial analgesia, every hour until shifted to the ward and regularly in the regime of routine observations of the nurses throughout admission (Jensen, 2018).

The second nursing intercession was "Wound consideration". In such manner, it ought to be focused on that exercises identified with would purging with the saline arrangement (0.9% sodium chloride), the utilization of aseptic methods during the use of the dressing, estimation of the wound bed, documentation of wound size, site and perspective are nursing intercessions fundamental to the suitable treatment of tissue wounds (Pessanha, 2015). Similarly, evaluations of seepage (exudates), shading, size and scent, utilization of appropriate dressing and direction on legitimate injury care at home are additionally significant (Pessanha, 2015). Mr Lee had a wound injury on his knee which required immediate cleansing and wound debridement because of chances of contracting infection was fast at his age.

The ideal dressing ought to guarantee impermeability to water and different liquids, advance a wet climate, keep up the appropriate temperature, prevent and protect the wound from mechanical injury, inhibit infections and stabilize the movement of tissues around the injury. Moreover, it ought to likewise permit exchanges of gas, cause absorption of exudates and advance debridement, alleviating torment and reinforcing the patient's' everyday exercises positively (Stoica, 2020).

The third priority was antibiotic coverage to avoid Mr Lee from contracting any systemic infection.

References

Jensen, C.M., Hertz, K., Mauthner, O. 2018. Orthogeriatric Nursing in the Emergency and Perioperative In-Patient Setting. Jun. 16. In: Hertz K, Santy-Tomlinson J, editors. Fragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient [Internet]. Cham (CH): Springer; 2018. Chapter 5. Available from: https://www.ncbi.nlm.nih.gov/books/NBK543818/ doi: 10.1007/978-3-319-76681-2_5

Pessanha, F.S., Oliveira, B.G.R.B. 2015. Sociodemographic and clinical profile of ambulatory patients with leg ulcers. Revista de Enfermeria, UFPE Online, 9 (7), pp.8551-60. http://dx.doi.org/10.5205/reuol.7651-67144-1-SM.0907201507.

Stoica, A. E., Chircov, C., and Grumezescu, A. M. 2020. Hydrogel dressings for the treatment of burn wounds: An up-to-date overview, Materials (Basel, Switzerland), 13(12), pp. 2853. https://doi.org/10.3390/ma13122853.

Discuss any equity, rights and access issues relevant to the case (200 words)

In most of the areas of the world, the finish of-life is characterized by ageing, the stage which is represented by a decline in the physical and intellectual capacities, expanded danger of dismalness and inhibitions in social activities. We ought to expect the same irrespective of old. Multiple dimensions need to evaluated if one needs to describe the importance of health ethically and the concern about health inequalities – e.g. causes, results, differences in experiences and distribution patterns –to see where, when and what kind of social responsibility is required. While they can help manage singular activities, directions are needed for a social and worldwide activity that may need to target numerous social determinants of wellbeing and wellbeing imbalances inside and across nations (WHO, 2017). WHO also stated that to judge or evaluate effectively multiple dimensions need to conjured against the ethical standards that can provencially guide the social actions. Irrespective of his age, Mr Lee was entitled to equal rights in medical treatment.

Along with the equity rights in the elderly, Mr Lee’s was entitled to coverage of his medical costs due to his seniority. The cost of the ordinary wellbeing framework per one fall injury for individuals more established in the countries of Finland and Australia was at US$ 3611 (initially AUS$ 6500 of every 2001-2002) (WHO, 2017). The expense of medical clinic inpatient administrations incorporates the crisis and general holding ward cost, of those admitted to either the overall holding ward or to a clinic. The second most noteworthy is the long term care costs, adding to 9.4% to 41% of all wellbeing framework costs. Falls cause roundabout costs that are basic to the family for example the loss of profitability of family parental figure. In any event, when family parental figures are all the more ethically and socially acknowledged, falls stay a critical weight to the family unit economy (WHO, 2015). Mr Lee although staying away from his children and not interacting with the society due to less physical activity and a language program with his GP did not sign him to lesser rights than any other individual.

References

Bulletin of the World Health Organization, 2017,95, pp.791-792. doi: http://dx.doi.org/10.2471/BLT.16.187609

World Health Organization, 2015. WHO global report on falls prevention in older age. 2007. World Health Organization, pp.1-7.

World Health Organization, 2017. Ten years in public health, 2007–2017: report by Dr Margaret Chan, Director-General, World Health Organization. World Health Organization.

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