Healthy Ageing

1a. Interdisciplinary approach in aged care involves a collaboration of healthcare professionals from different disciplines to provide the best possible care for the patient. The professionals have a common objective and set goals accordingly. The decision-making process is a collaborative team effort with the resources and responsibilities shared among them. The patient and caregivers are also involved in the process and some of the tasks undertaken by this group include assessment of the condition, diagnosis and creating a recovery plan. This kind of approach is important for aged individuals as they tend to have complex needs, issues about social and psychological areas and complicated comorbidities (Olotu, et al., 2019). An interdisciplinary approach also helps eliminate or minimise risks, with the sole focus being on patient welfare.

Some of the interdisciplinary services that would benefit Alexander and Sarah to are physical therapy, consultation with a general physician as well as a pharmacist, psychological care and proper nursing care. Both Alexander and Sarah require patient-centred care, proper documentation of their issues and progress, a proper diet and good sleep.

Since Sarah is diagnosed with dementia and tends to get agitated and upset, a psychological evaluation and treatment plan is important for her. Along with psychological interventions and drug therapy, she also requires physiotherapy as staying active will help her condition. A proper schedule should be made for her daily activities and she should stick to this routine. Since she is underweight, an appointment with a dietician would also benefit her as she needs to be put on a nutritious diet. Finally, joining a support group with other patients suffering from the same condition as hers would be beneficial for her wellbeing, as it would provide an opportunity for her as well as her caregiver (her husband) to share their experiences and find relevant information as well as resources (West & Hogan, 2020).

Coming to Alexander, he needs to consult a physician and the focus should be on his venous and circulatory system, given his history of hypertension and heart attack and current diagnosis involving an ulcer on the leg. As he too is underweight, an appointment with a dietician and change in diet would help him. Alexander has been the sole caretaker for his wife and that comes with its share of stress, even though he denies it. He also has a history of hypertension. An appointment with a psychologist to access stress levels and ways of coping need to be made. Encouraging him to be mobile and active would help him recover faster. In addition to this, joining a support group or socialising with others his age would help him open up, talk about his issues and benefit him.

2a. The five body systems to be assessed are – the cardiovascular/circulatory system, the digestive system, immune system, muscular system and skeletal system. Since Alexander has a history of hypertension as well as myocardial infarction, it is important to check his cardiovascular and circulatory function. He also has a history of GORD or acid reflux which is linked to the digestive system. So, getting it checked would be a sensible approach. Despite trying to fix his leg and get better by using ointment, he does not seem to be recovering, which is why getting his immune system checked would be required. Another reason for this would be to see if stress has not adversely affected his immunity. He has been diagnosed with arthritis as well, so getting his muscular as well as skeletal systems checked would be necessary to avoid issues related to pain or mobility.

Due to increasing age, there are changes which begin to occur in the various body systems which have an impact on one’s health. In the cardiovascular system, a degeneration of the heart muscles takes place and the valves tend to thicken due to old age (Alama, 2017). This harms the blood circulation which could explain the cause behind Alexander’s ulcer on the leg. The digestive system stiffens and slows down with age, causing problems such as acid reflux. The intestinal mucosa reduces in thickness for older individuals (Merchant et al., 2016). Age of an individual does impact their immune system as there is a reduction in immunity due to lack of production of B and T cells. As a result, old people are more susceptible to illnesses and take longer time to recover (Muller, Di Benedetto & Pawelec, 2019). Old people tend to lose muscle tone suffer from rigid muscles and the breaking down of joints. These characteristics of the muscular system later cause issues like stiffening of joints, joint pain and swelling or inflammation-related problems. Age also impacts bone mass and bone density. Bones tend to lose out on calcium and other minerals, making them brittle and resulting in conditions like osteoporosis (Boskey & Imbert, 2017). Overall movement tends to become slow. These changes affect the quality of life of aged persons, as it interferes with their everyday functioning, making it difficult to navigate through tasks which they were once able to easily and increasing their dependence on their caregivers. They also become vulnerable to illnesses and require constant care and attention. Their struggles may cause them to feel isolated and even depressed. 

Numerous assessments can be carried out to check if the above-mentioned boy systems are functioning perfectly or not. Regularly checking blood pressure can help with monitoring issues such as hypertension. A blood test can be used to determine to check the immunoglobulin levels in the blood which enhance one’s immunity. An ECG (electrocardiogram) test can be carried out to monitor one’s heart rate and check for problems due to hypertension or a previous case of myocardial infarction (as is the case with Alexander). Also, a Doppler test can be performed to check blood flow and circulation as it would provide a better understanding of the ulcer on the leg. An endoscopy can be conducted to help diagnose and examine GORD. For the muscular and skeletal systems, physical examinations and X-ray tests can be carried out for checking inflammation or pain.

3a. Pharmacokinetics is referred to how drugs move in and out of the human body. With age, there are changes in this process (van der Anker et al., 2018). As a person ages, the composition of body fat in their body increases and there is a decrease in the amount of water in the body. The change in body weight and composition harms distribution, as they cause the drug to have a longer period of action and an increased effect. Slow circulation of blood reduces the volume of distribution as well as affects absorption. Ageing of various bodily systems such as the digestive system and gastrointestinal tract weakens and slows down gastric movements resulting in the drugs staying in the body for a longer duration or the incomplete absorption of the drug, which leads to the ineffective working of the drug. The slow reaction and movements also decrease metabolism and produce toxic drug reactions. Drug metabolism mostly occurs in the liver and the life tends to eliminate the drugs before they reach the system they are supposed to, rendering them ineffective. With illness and age, the size of the liver and hepatic blood flow decrease, which means adjustments need to be made on the dosage of the drugs. Reduced renal and kidney functionality due to age slows down the process of expulsion and elimination of drugs from the body. If frequent changes to the dosage are not made by the physician, it will end up increasing chances of toxic reactions in the body due to prolong the presence of the drugs in the system.

  1. Alexander smokes around 10-15 cigarettes a day, which is contributing to his disturbed sleeping pattern (Boakye et al., 2018). Not only are these factors indicative of stress, but they also adversely affect the drug metabolism and pharmacokinetic mechanisms of the body. This can cause adverse drug events and reactions in the body upon consumption of drugs. Moreover, he has multimorbidity which has led him to polypharmacy, which can also trigger adverse reactions, especially in older adults (Rodrigues & Oliveira, 2016).
  2. The drugs that have been administered to Alexander are - Aspirin, Perindopril, GTN, Omeprazole, Panadol Osteo and Ibuprofen. Aspirin and Ibuprofen are both used for similar purposes. They reduce fever, headaches and are administered as mild painkillers as well. Alexander does experience pain due to arthritis and at present, due to the wound on his leg. The consumption of these medicines might help him by reducing pain and providing relief. However, some of the complications which can arise by their consumption are internal bleeding due to bursting of blood vessels, strokes, gastric troubles, stomach ache, vomiting, nausea and allergic reactions. Perindopril is another medicine which he is on and it is administered to treat high blood pressure and heart failure. It is also commonly prescribed after someone has experienced a heart attack, like Alexander, and helps improve chances of survival, reducing chances of heart failures in future. The complications that could arise on its use could lead to dizziness, weakness, stomach upset and pain, cough and diarrhoea. GTN is prescribed to a person to treat and prevent the occurrence of angina or chest pain. Alexander has a history of angina and is put on this medication for its treatment. The complications that could arise from the consumption of GTN is headache, dizziness, vomiting and feeling nauseous. Omeprazole helps reduce stomach acid, heartburn and is commonly used for issues like GORD, which is something Alexander has been known to suffer from, and protection of the food pipe. Adverse effects of omeprazole on a patient include a deficiency of vitamin B12, kidney damage as well as damages to the bone. Panadol Osteo works as a painkiller and is used in cases of headaches, tension and also for conditions like flu or cold. The negative impact of its consumption causes stomach upset, diarrhoea, stomach ache and vomiting.

From the given information, it can be seen that the common complications that Alexander is vulnerable to are headaches, stroke, vomiting and feelings of nausea, stomach pain, diarrhoea or upset stomach. He has not been to a general physician for a check-up in 3 years which frankly, is quite alarming, given his medical history and the medications he is on. He needs to be counselled and explained about the importance of getting routine check-ups.

  1. As a registered nurse, having patients like Alexander and his wife would make me sad as well as concerned for their wellbeing, as it is quite clear from their appearance that they are neglected and could use help. Alexander is the sole individual who is responsible for his wife’s care and wellbeing. He is old, has had a history of heart disease, GORD and arthritis, is a smoker and requires serious care instead of taking on the challenge of looking after his wife alone. It also appears that their food intake has been neglected, as they are underweight and there is nobody to monitor them. Alexander also has difficulty sleeping, which is another concern. As a nurse, I am highly concerned about the wellbeing of this aged couple, especially Alexander, as there is nobody to monitor or look after him. Some of the changes and suggestions which I would like to make are firstly getting both of them admitted until they achieve at least some level of independence. I would encourage them to join support groups and get involved in the lives of other aged individuals with similar problems as them, to deal with issues regarding isolation and neglect. Their children also need to start being more involved in their lives. Another matter that requires immediate attention is Alexander’s smoking patterns. He needs to be counselled on positive coping mechanisms and how can he deal with stress better and on why he should reduce, if not completely give up on his smoking since it will have a major impact on his health. Sarah is completely dependent on her husband so she requires to achieve some level of independence. She would benefit from a psychological evaluation, physical therapy, drug therapy as well as group therapy, where she can meet others and receive social support. Both Alexander and Sarah could benefit from social support, either from their families or support group allies. Alexander also needs to be advised on going in for regular check-ups to his doctor given his medical history, as a precautionary measure as well as to stay healthy. They both require monitoring concerning diet and sleep. Again, for this concern, they may initially require someone to monitor their food and medicine intake, but after gathering some amount of independence, they could maybe take turns preparing food or prepare it together. As bleak as the situation seems, I am hopeful that, with a dedicated team of health practitioners and adequate social support, both of them will show signs of improvement concerning their overall quality of life, become healthy and go back to living their lives normally.

References for Developmental Changes in Pharmacokinetics

Boakye, D., Wyse, C. A., Morales-Celis, C. A., Biello, S. M., Bailey, M. E. S., Dare, S., Ward, J., Gill, J. M. R., Pell, J. P., & Mackay, D. F. (2017). Tobacco exposure and sleep disturbance in 498 208 UK Biobank participants. Journal of Public Health, 40(3), 517–526. https://doi.org/10.1093/pubmed/fdx102

Boskey, A. L., & Imbert, L. (2017). Bone quality changes associated with aging and disease: a review. Annals of the New York Academy of Sciences, 1410(1), 93–106. https://doi.org/10.1111/nyas.13572

Merchant, H. A., Liu, F., Orlu Gul, M., & Basit, A. W. (2016). Age-mediated changes in the gastrointestinal tract. International Journal of Pharmaceutics, 512(2), 382–395. https://doi.org/10.1016/j.ijpharm.2016.04.024

Müller, L., Di Benedetto, S., & Pawelec, G. (2019). The immune system and its dysregulation with aging. In Biochemistry and Cell Biology of Ageing: Part II Clinical Science (pp. 21-43). Springer, Singapore. https://doi.org/10.1007/978-981-13-3681-2_2

Nabil Alama, M. (2017). Aging-Related Changes of the Cardiovascular System. Journal of Health and Environmental Research, 3(2), 27. https://doi.org/10.11648/j.jher.20170302.12

Olotu, C., Weimann, A., Bahrs, C., Schwenk, W., Scherer, M., & Kiefmann, R. (2019). The perioperative care of older patients. Deutsches Aerzteblatt Online, 116(5), 63. https://doi.org/10.3238/arztebl.2019.0063

Rodrigues, M. C. S., & Oliveira, C. (2016). Drug-drug interactions and adverse drug reactions in polypharmacy among older adults: an integrative review. Revista Latino-Americana de Enfermagem, 24(0), 24. https://doi.org/10.1590/1518-8345.1316.2800

van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental Changes in Pharmacokinetics and Pharmacodynamics. The Journal of Clinical Pharmacology, 58, S10–S25. https://doi.org/10.1002/jcph.1284

West, M., & Hogan, K. F. (2020). Carers’ experiences of dementia support groups: A qualitative exploration. Counselling and Psychotherapy Research, 20(1), 136–142. https://doi.org/10.1002/capr.12253

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