Healthy Ageing

Aged Care Services and Interdisciplinary Care

An interdisciplinary approach for the care of the patient in the given case scenario will be involving a team of members that belong from different disciplines but work together in a collaborative manner (Ritchie et al., 2016). They will share a common goal, work on the set goals and will share the resources and responsibilities of the patient together. The aged care services and interdisciplinary care for Alexander would be based the issues he is facing with his would, by keeping his medical history of hypertension, myocardial infarction, GORD, angina, arthritis (knees) in mind. Along with this his habit of smoking and the psychological stress that he might go through because of her wife also needs attention. The interdisciplinary team and aged care services for the patient in the given case scenario will have the following members:

Geriatricians: Geriatricians are those doctors that are specialised in the field of healthcare for older people. The patient is of 85years of age and it has been considered that older adults have unique care requirements as compared to the young population, more recurrent neuropsychiatric challenges, different intensity of symptoms, etc (Santivasi, Partain & Whitford, 2020). The reason a geriatrician is must for the patient is that the patient is having ulcer in his left lower leg and is treating it with an ointment without being prescribed from any clinician. The patient also has a medical history of myocardial infarction and smokes 10-15 cigarettes daily and according to Elkhader, Abdulla & Omer, (2016) smoking is considered as a risk factor for myocardial infarction. The patient has also not visited any physician in the past 3 years for himself and has been taking certain medications on daily basis. The geriatrician here will be helpful in treating patient’s ulcer, his counselling regarding smoking and making him understand how dangerous it is for him, and in reviewing the medications that he has been taking from a long time so that if any changes are needed then it could be done.

Nurse: As the patient is an elderly patient, nurses would be helpful in patient’s clinical assessment, critical thinking, care coordination, and supporting the patient (Nhongo et al., 2018).

Social workers: social workers are the part of aged care services; they provide the elderly people emotional support and help them to be emotionally stable.

Dietician: The patient remains indulged in taking care of his wife. His wife also needs prompting to eat and drink. This is the reason they might need a dietician to get to know about their nutritional requirements. It has been reportedly seen that age-related malnutrition has been increasing and involving dieticians in an interdisciplinary team would help in the management of nutrition among the patient (Fleurke, Voskuil & Beneken Genaamd Kolmer, 2020). 

Occupational therapist: Patient’s wife has dementia and an occupational therapist will help her in assisting tasks related to her daily activity. This will help in reducing the burden of the patient as he handles her wife alone.

Aged Related Changes and Patient Assessment

According to the given case scenario, the five important body systems of patients that require assessment will be: 

  1. The patient’s left lower leg: Patient’s left lower leg is having ulcer and a wound has appeared over 3 months for which patient has not met any consultant and has been treating it with an ointment. So, assessment of his unhealed wound must be done in order to avoid any other medical complications.
  2. Patient’s knee: Patient has arthritis and has been reported with pain in his knee so, a physical assessment regarding patient’s musculoskeletal system is needed and if required an x-ray should also be done (Vitaloni et al., 2019). 
  3. Chest assessment: Patient had angina so, chest assessment is required. A physical examination or electrocardiogram would work (Ayerbe et al., 2016). 
  4. Stomach assessment: Patient had GORD i.e., Gastro-oesophageal reflux disease so, an assessment is required for this and endoscopy will help in assessing this disease (Keung & Hebbard, 2016). 
  5. Heart assessment: Patient has a history of myocardial infarction and continuously smokes 10-15 cigarettes a day. And, in a study presented by Elkhader, Abdulla & Omer, (2016) smoking is a prominent risk factor for myocardial infarction. This is the reason; the patient’s heart assessment is needed to be done. 

Other five assessments apart from the body system that is needed will be:

  1. Blood glucose level (BGL): Patient has an un-healed wound and it has been seen that in case of diabetes wounds take a long time to get healed (Okonkwo & DiPietro, 2017) so, measurement of BGL is required. 
  2. Psychological stress: The patient takes care of his wife, who has dementia alone. Though, the patient has stated that he is managing fine and there is no stress. In addition to this, he has also stated that there are people who are worse off than him. The patient is aged and he might have been hiding his stress so, a psycho-geriatrician will help the patient in opening up with his psychological stress. 
  3. Pain assessment: Patient is reported with the pain of 6/10 so, after pain medication, a re-assessment is required. 
  4. Blood pressure: Patient has a history of hypertension so, his BP should be assessed. 
  5. Diet assessment: Patient is on an unbalanced diet and to avoid age-related malnutrition; a diet/nutrition assessment is required.

Medication Management

Pharmacokinetics is all about how the drug absorbs, distributes, metabolise, and excrete from the blood. Drug absorption is when the drug enters the body and crosses the tissues members and enters the blood. When it enters the blood the drug gets distributed by moving with blood in the body. From the blood, the drugs cross the capillary walls in order to enter the blood. The drugs are then chemically altered in order to become water-soluble so that it could be excreted out in the form of urine or faeces. This is the metabolism process that occurs in various tissues of the human body. Later on, the drug leaves the body. Those that are considered water-soluble excreted out through urine while, the lipid-soluble drugs get modified into the water-soluble metabolites with the help of kidney and then, excretes out (Li et al., 2019).

The issue of adverse drug reactions has been found most commonly in the elderly people, with falls, delirium, orthostatic hypotension, intracranial and gastrointestinal bleeding being one of the most common clinical manifestations among them. The risk of adverse drug reactions augments with the age-related changes in the pharmacokinetics as well as dynamics. This increases the burden of polypharmacy, comorbidity, and suboptimal observation of the drugs (Lavan & Gallagher, 2016). The patient in the case study have not visited or taken any consultancy from a physician and has been using the same medications for a long time. Consulting and reviewing his medication will help him to prevent any adverse drug reactions.

  • Aspirin- Patient has osteoarthritis because of which he has pain and aspirin is used by him for pain management.
  • Perindopril- The patient has an issue of hypertension and perindopril is given to him to reduce his blood pressure to normal. According to Nair et al., (2017) usage of this drug for a long time can cause some cardiac issue.
  • Panadol- Panadol is used for pain management of musculoskeletal pain.
  • Ibuprofen- Ibuprofen is used for reducing the pain and inflammation in the patient’s body.

Taking Panadol and Ibuprofen together for a long time can have gastrointestinal side effects (Kanabar, 2017).

Description of Alexander Case Study

During my practice, I came across a person named Alexander who visited the GP settings because of her wife as she has dementia. He was only worried about his wife while he himself was dealing with multiple comorbidities. During the discussion regarding his wife, I came to know that he is the full-time carer of his wife and look after her every moment. Alexander also said that he is managing his wife alone totally fine. After the regular checkup of her wife and some alterations in her medications when the couple was leaving I found that Alexander was having difficulty in walking. And, when I asked him about him finding difficulty in walking he told me about the ulcer he had in his left leg and he also said he is having this unhealed wound since the past 3 months. When I asked him whether he has consulted regarding this to anybody, I got to know that he has not consulted regarding this with any physician and is treating it by using an ointment.

Feelings

Since Alexander started telling me about him caring for his wife alone, I truly felt sympathetic towards him. The patient was of 85 years of age and taking care of a dementia patient in the age where he, himself needs care and support is truly commendable. I also get inspired by him as when I asked him if he feels like getting overwhelmed by looking after to his wife alone and he replied with so much of positivity that there are people who are dealing with worse than this and he is managing fine. Though, I also felt somewhere that he needs consultancy regarding his wound. Later on, he lit a cigarette and I asked him not to do that as it is prohibited and he told me that he smoke almost 10-15 cigarettes daily, I felt that he need some counselling for the same as per his age it can be a reason behind his health deterioration.

Evaluation

The experience with this patient and the whole scenario had both good and bad elements. Good element was that I was able to understand patient’s perspective well. My critical thinking enhanced. But, somewhere I thought there was a lack of interdisciplinary team work at our settings which should be focused and enhanced because in case of elderly people and their complexity an effective interdisciplinary team work is a must. This would help in addressing patient’s multiple comorbidity with ease and in an effective way.

Analysis of Alexander Case Study

It was analysed that the patient had some psychological stress but was not much open up regarding that. I asked a psycho-geriatrician for his counselling and it revealed that he has a financial burden as he is taking care of all the expenses of his daily living along with fulfilling his wife’s medical requirements. And, everything is done by him from the money he gets from his pension. His wife walks off often and he always remains cautious and stressed regarding this. The psycho-geriatrician counselled him and calmed him regarding his situation by his empathetic behaviour. He also counselled him regarding his habit of smoking. The patient has a history of myocardial infarction. So, the counsellor helped him in understanding how harmful his habit of smoking can turn out for him. It could lead to serious cardiovascular issues and at this age and point of time where he is alone and has nobody who can look after him this can lead to even fatal crisis.

Conclusion on Alexander Case Study

It is concluded that the patient needs a regular check-up for him too and his comorbidities should be taken care of. The patient should also be helped with the care management of his wife. The patient at the age of 85 years when having medical issues with him is still managing his wife alone. So, the care management plan for the patient’s wife should be easily accessible, achievable, and manageable by him. Patient’s medications and his habits need to be focused in order to avoid serious medical risks. The patient does not have any emotional support so, the professionals should always be supportive, compassionate, and empathetic towards him.

Action Plan

If something similar to this case happens with me I will prefer a consultative and collaborative approach that includes the interdisciplinary team. The reason behind this is that the older people have complex and multiple needs as compared to the patients of young age and to obtain optimal health outcomes of elderly patients, consultative and collaborative approach will work the best. Involving an interdisciplinary team will help me to minimise the risk that can potentially adverse the situation of the patient.

References for Alexander Case Study

Ayerbe, L., González, E., Gallo, V., Coleman, C. L., Wragg, A., & Robson, J. (2016). Clinical assessment of patients with chest pain; A systematic review of predictive tools. BMC Cardiovascular Disorders, 16, 18. https://doi.org/10.1186/s12872-016-0196-4

Fleurke, M., Voskuil, D. W., & Beneken Genaamd Kolmer, D. M. (2020). The role of the dietitian in the management of malnutrition in the elderly: A systematic review of current practices. Nutrition & Dietetics: The Journal of the Dietitians Association of Australia, 77(1), 60–75. https://doi.org/10.1111/1747-0080.12546

Kanabar D. J. (2017). A clinical and safety review of paracetamol and ibuprofen in children. Inflammopharmacology25(1), 1–9. https://doi.org/10.1007/s10787-016-0302-3

Keung, C., & Hebbard, G. (2016). The management of gastro-oesophageal reflux disease. Australian Prescriber, 39(1), 6–10. https://doi.org/10.18773/austprescr.2016.003

Lavan, A. H., & Gallagher, P. (2016). Predicting risk of adverse drug reactions in older adults. Therapeutic Advances in Drug Safety7(1), 11–22. https://doi.org/10.1177/2042098615615472

Li, Y., Meng, Q., Yang, M., Liu, D., Hou, X., Tang, L., Wang, X., Lyu, Y., Chen, X., Liu, K., Yu, A. M., Zuo, Z., & Bi, H. (2019). Current trends in drug metabolism and pharmacokinetics. Acta Pharmaceutica Sinica. B9(6), 1113–1144. https://doi.org/10.1016/j.apsb.2019.10.001

Nhongo, D., Hendricks, J., Bradshaw, J., & Bail, K. (2018). Leadership and registered nurses (RNs) working after-hours in Residential Aged Care Facilities (RACFs): A structured literature review. Journal of Clinical Nursing, 27(21-22), 3872–3881. https://doi.org/10.1111/jocn.14565

Okonkwo, U. A., & DiPietro, L. A. (2017). Diabetes and wound angiogenesis. International Journal of Molecular Sciences18(7), 1419. https://doi.org/10.3390/ijms18071419

Parameswaran Nair, N., Chalmers, L., Bereznicki, B. J., Curtain, C., Peterson, G. M., Connolly, M., & Bereznicki, L. R. (2017). Adverse drug reaction-related hospitalizations in elderly Australians: A prospective cross-sectional study in two Tasmanian hospitals. Drug Safety40(7), 597–606. https://doi.org/10.1007/s40264-017-0528-z

Ritchie, C., Andersen, R., Eng, J., Garrigues, S. K., Intinarelli, G., Kao, H., Kawahara, S., Patel, K., Sapiro, L., Thibault, A., Tunick, E., & Barnes, D. E. (2016). Implementation of an interdisciplinary, team-based complex care support health care model at an academic medical center: Impact on health care utilization and quality of life. PloS One, 11(2), e0148096. https://doi.org/10.1371/journal.pone.0148096

Santivasi, W. L., Partain, D. K., & Whitford, K. J. (2020). The role of geriatric palliative care in hospitalized older adults. Hospital Practice (1995), 48(sup1), 37–47. https://doi.org/10.1080/21548331.2019.1703707

Vitaloni, M., Botto-van Bemden, A., Sciortino Contreras, R. M., Scotton, D., Bibas, M., Quintero, M., Monfort, J., Carné, X., de Abajo, F., Oswald, E., Cabot, M. R., Matucci, M., du Souich, P., Möller, I., Eakin, G., & Verges, J. (2019). Global management of patients with knee osteoarthritis begins with quality of life assessment: A systematic review. BMC Musculoskeletal Disorders, 20(1), 493. https://doi.org/10.1186/s12891-019-2895-3

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