NUR341: Health Ageing – Case Study

Aged care services and interdisciplinary care

The case is focused on an 85 year old male who has an ulcer on his left leg. Despite rigorous therapy, the wound is not healing. The patient has a plethora of pathologies that are involved in the lack of effectiveness of drug therapy. He is taking several drugs to control the severity of the symptoms he is having. He is hypertensive and suffers from complications of hypertension. Interdisciplinary care teams are important to negotiate the associated symptoms with the present illness. He must be referred to a core medical team who will look after him. The medicines prescribed by the doctor are useful in controlling the damage caused by the ulcer on his leg. An ulcer is the erosion of the superficial part of the skin that may lead to inflammation and necrosis of the nearby area (Sun & Sosnoff, 2018). Anti-inflammatory drugs prescribed by the medical care team will help him recover from the ulcer, and it may prevent any adverse outcome resulting from ulcers (Sun & Sosnoff, 2018). The ulcer may lead to deep wound. Infection of the bone may lead to necrotic fasciitis. Necrotic fasciitis is a medical emergency that may even require the computation of the limb. This is the main concern of the nursing and medical care staff (Sun & Sosnoff, 2018). So, the patient must be referred to the medical care team so that they may look after him and observe the wound. If there are any chances of infection, the medical care staff would look after and administer antibiotics so that the infection could be controlled in time and the complications like a deep ulcer or necrotic fasciitis could be controlled in time (Piers, Versluys, Devoghel, Vyt, & Van Den Noortgate, 2019).

The patient must be referred to a dietitian so that his nutrition could be controlled. An optimum nutritional intake balanced in carbohydrates, proteins, fats, low salt, vitamins, and fibers, is essential for the patient’s health (Simpson et al., 2017). The patient is diabetic, so he must avoid a high salt diet. The salt intake leads to a greater volume of blood, and hypervolemia causes an increase in blood pressure (Jensen et al., 2018). His dietary habits need to be improved so that the complications of hypertension would be controlled. Wound healing requires the health condition of the patient to be optimum. Optimum health condition is achieved by a well-balanced diet. So, the patient must be referred to a dietitian. The dietitian will make a diet chart by asking the existing dietary intake, and he would make necessary changes that would help him attain good health and help him heal the wound.

[hbupro_banner id=”6299″]

Age related changes and Patient assessments

Old age is often characterized by difficulty in movement and locomotion. The old patients frequently experience weakness and lethargy. The muscles get fatigued too quickly with little exertion. If the patient suffers from the musculoskeletal problem, as the present case, the weakness can be treated by a physiotherapy team (Piers, Versluys, Devoghel, Vyt, & Van Den Noortgate, 2019). The physiotherapy team is specialized in helping the patient who feel difficulty in walking. Walking exercise and muscular support help the patient to restore his locomotion. The support from the family and the physiotherapy team will benefit the patient. The problem is his wife gets irritated when he cannot move to help himself. The physiotherapy team may help him in this regard too. As are registered nurse, I feel it compulsory to refer the patient to the resort physiotherapy team (Sun & Sosnoff, 2018).

He is a heart patient, and he underwent an episode of myocardial infarction about 10 years ago. The patient must be assessed for any risk of development of another episode of myocardial infarction in the future. The nursing care staff assesses the functioning of his cardiovascular system. Hypertension is the main risk factor for the development of cardiovascular disease (Jensen et al., 2018). Atherosclerosis resulting from hypertension causes the partial or complete occlusion of blood vessels in various parts of the body (Piers, Versluys, Devoghel, Vyt, & Van Den Noortgate, 2019). The arteries supplying blood to the heart, known as coronary arteries, are among the most susceptible vessels to be affected by atherosclerosis. The same is the case with the patient. He is a heart patient, so he suffers from chest pain that is also known as angina. Thus, the patient may be referred to as the cardiovascular care team. This team will assess the risk of development of a novel episode of myocardial infarction. Physical exertion and risk factors like diabetes, age, smoking, and hypertension are being eliminated. This would help him get rid of ischemic heart pain or angina.

The body systems that need assessment are those that are affected mostly by age-related changes. One of the most severely affected systems is the cardiovascular system. With age, the wall of the arteries stiffens. Due to the blood pressure, the resilience of the blood vessels decreases with time (Recio-Saucedo et al., 2017). The compliance of the vessel decreases too. In this way, the blood pressure of the patient rises, and it cannot be managed—the hypertension results due to age-related changes in the blood vessels. Hypertension is the mother of many diseases. It leads to several problems involving the central nervous system and cardiovascular system. Stroke and myocardial infarction are the main consequences of hypertension-related pathologies (Sun & Sosnoff, 2018).

The second system that is needed to be assessed for age-related changes in vision or sight. With advancing age, the accommodation of the lens of the eye decreases. The lens of the eye is an elastic structure that can change its curvature and shape (James, 2019). The zonules and fibers attached to the ciliary muscle contraction and relaxation, leading to a decrease and increase in the curvature of the lens, respectively (James, 2019). Due to age-related changes, the resilience of the lens decreases. The lens becomes inflexible, and the accommodation of the eye decreases (James, 2019). Near distance of the eye is normally 25cm (Recio-Saucedo et al., 2017). The near distance of the eye becomes almost 40 to 50 cm in old age (Recio-Saucedo et al., 2017).

The third system that suffers from age-related changes is the musculoskeletal system. The bones become weak, and they become brittle (Collins, Laakkonen, & Lowe, 2019). There is a risk of falls due to old age and weakness. The tensile strength of the bone also decreases. The bones become brittle, so they are fractured easily (Collins, Laakkonen, & Lowe, 2019). The bones are maintained by osteoblast and osteoclast activity. Old bone is resorbed, and new bone is laid down in harmony. At old age, the balance between bone formation and bone resorption is lost, and the bones become weak (Recio-Saucedo et al., 2017). This relationship is known as osteoporosis. This is more frequently seen in females. The main reason behind osteoporosis in females is the loss of estrogen after menopause (Collins, Laakkonen, & Lowe, 2019). Males are less affected by osteoporosis. There may be age-related arthritis, as the present case scenario shows that the patient is suffering from arthritis. Arthritis is characterized by inflammation of bones and joints; resultantly, the bones are deformed. The fingers may bend. The joints may develop swelling, and immobility of joints may occur. There may be a pain while moving the joint (Recio-Saucedo et al., 2017).

The fourth system that suffers from age-related changes is the central nervous system. As time passes, the ability to process the information and recall things decreases to a noticeable level (Hernandez, & Burke, 2018). The loss of memory is natural. It is stated that with age, the death of neurons, storing the information occurs. The loss of neurons leads to the inability to recall information (Hernandez, & Burke, 2018). This is known as dementia. Dementia is one of the commonest complain in old age (Chern, & Golub, 2019). The elderly people are severely affected by the loss of memory. Sarah suffers from loss of memory. This loss of memory is related to age. Her inability to recall things is a problem for the patient. Her wife is dependent on him. That put an extra burden on him. He is supposed to help her in almost everything she does. Loss of memory can be so catastrophic for her social relationship. She requires to be reminded of literally everything (Recio-Saucedo et al., 2017). She forgets about the diseases his husband is suffering from. She gets angry when he is unable to perform the task. So, the whole central nervous system must be assessed for age-related changes like dementia, Alzheimer’s disease, or Parkinson’s disease.

The fifth system that should be looked upon age-related changes is the endocrine system. The endocrine system involves the formation and release of specific hormones that control different activities in the body (Liew et al., 2019). The most affected portion of the endocrine system is the loss of production of insulin. Insulin is a hormone that mediates the entry of glucose inside the cells so that the glucose can be used by the cells for their growth and metabolism (Sun & Sosnoff, 2018). The loss of beta cells of the pancreas leads to loss of the ability of the pancreas to produce insulin (Sun & Sosnoff, 2018). This leads to diabetes mellitus. Diabetes mellitus may also occur due to the loss of effectiveness of insulin on insulin receptors. This is commonly known as insulin resistance. Several studies show that insulin resistance is associated with an age-related constellation of pathologies (Chow et al., 2019).

Among the assessments, I would like to make an assessment of the orientation of the patient. It is done to investigate the level of understanding of the patient about his or her surroundings. The second assessment I would like to make will be the risk of fall assessment (Liew et al., 2019). The risk of fall assessment is crucial in old age (Recio-Saucedo et al., 2017). Pathology like arthritis may lead to the risk of falls. Due to old age, the bones are brittle, and the healing of the bones is low; that is, the fall may lead to serious injury or fracture. The bone fractures in old age are difficult to fuse. The third assessment will be the risk of a heart attack. The patient is a chronic heart patient. He had an episode of myocardial infection 10 years ago. He may easily be affected by atherosclerosis; that is why the risk of development of heart attack must be assessed. Pain assessment is also important in old age (Devik, 2018). The commonest complaint in old age is pain. The pain may be related to any other complications of the disease. Due to pain, the patient gets irritated. Sarah and Alexander must be assessed for pain. Nutritional assessment of the patient is also important as a part of interdisciplinary and person-centered care. Person-centered care is very important in order to find out the cause of pathology (Liew et al., 2019).

[hbupro_banner id=”6296″]

Medication Management

The age-related changes in the pharmacokinetics occur in such a way that the absorption of the drugs decreases (Höchel, J. 2019). This happens due to an increase in the pH of the stomach. Gastric emptying is also reduced. Intestinal CYP 450 is also reduced (Höchel, J. 2019). Intestinal P-glycoprotein is also reduced. All of these factors decrease the absorption of the drug. The age-related effects on the distribution of the drug depending upon the nature of the drug. The lipophilic drugs have a larger volume of distribution in old age (Höchel, J. 2019). In contrast, hydrophilic dogs have less volume of distribution (Höchel, J. 2019). This is due to the loss of albumin and loss of lean body mass and body water. P glycoprotein formation and expression decrease with age. The relative body fat increases. All of these factors affect the distribution of drugs. Slowed hepatic metabolism and hepatic blood flow may lead to decreased metabolism. Age affects the excretion of drugs so that the renal and hepatic clearance other drug decreases (Recio-Saucedo et al., 2017).

Reflection

Sarah and Alexander suffer from a number of diseases. They require continuous care by the nursing care staff. The changes related to old age require special management. Interdisciplinary and person-centered care must be administered so that the time-dependent living of the patient becomes established—the defects of dementia and old age can be minimized by intense care.

References:

  1. Collins, B. C., Laakkonen, E. K., & Lowe, D. A. (2019). Aging of the musculoskeletal system: How the loss of estrogen impacts muscle strength. Bone, 123, 137-144.
  2. Hernandez, A. R., & Burke, S. N. (2018). Age-related changes in’hub’neurons. Aging (Albany NY), 10(10), 2551.
  3. Chern, A., & Golub, J. S. (2019). Age-related hearing loss and dementia. Alzheimer Disease & Associated Disorders, 33(3), 285-290.
  4. Chow, H. M., Shi, M., Cheng, A., Gao, Y., Chen, G., Song, X., … & Herrup, K. (2019). Age-related hyperinsulinemia leads to insulin resistance in neurons and cell-cycle-induced senescence. Nature neuroscience, 22(11), 1806-1819.
  5. Devik, S. A., Olsen, R. M., Fiskvik, I. L., Halbostad, T., Lassen, T., Kuzina, N., & Enmarker, I. (2018). Variations in drug-related problems detected by multidisciplinary teams in Norwegian nursing homes and home nursing care. Scandinavian journal of primary health care, 36(3), 291-299.
  6. Höchel, J. (2019). Does Everything Get Slower with Age? Pharmacokinetics in the Elderly. Drug research, 69(S 01), S7-S8.
  7. James, O. D. (2019). Impacts of the Aging Process on the Eyesight and its treatment by Avastin.
  8. Jensen, P. N., Bao, T. Q., Huong, T. T. T., Heckbert, S. R., Fitzpatrick, A. L., LoGerfo, J. P., … & Mokdad, A. H. (2018). The association of estimated salt intake with blood pressure in a Viet Nam national survey. PloS one, 13(1), e0191437.
  9. Liew, N. Y., Chong, Y. Y., Yeow, S. H., Kua, K. P., San Saw, P., & Lee, S. W. H. (2019). Prevalence of potentially inappropriate medications among geriatric residents in nursing care homes in Malaysia: a cross-sectional study. International journal of clinical pharmacy, 41(4), 895-902.
  10. Piers, R. D., Versluys, K., Devoghel, J., Vyt, A., & Van Den Noortgate, N. (2019). Interprofessional teamwork, quality of care, and turnover intention in geriatric care: A cross-sectional study in 55 acute geriatric units. International Journal of Nursing Studies, 91, 94-100.
  11. Recio‐Saucedo, A., Dall’Ora, C., Maruotti, A., Ball, J., Briggs, J., Meredith, P., … & Griffiths, P. (2018). What impact does nursing care left undone have on patient outcomes? Review of the literature. Journal of clinical nursing, 27(11-12), 2248-2259.
  12. Simpson, S. J., Le Couteur, D. G., Raubenheimer, D., Solon-Biet, S. M., Cooney, G. J., Cogger, V. C., & Fontana, L. (2017). Dietary protein, aging and nutritional geometry. Ageing Research Reviews, 39, 78-86.
  13. Sun, R., & Sosnoff, J. J. (2018). Novel sensing technology in fall risk assessment in older adults: a systematic review. BMC geriatrics, 18(1), 14.
[citationic]