1 an overview of geriatric health care dr. m.l. donnelly division of community geriatrics...
TRANSCRIPT
1
An Overview of An Overview of Geriatric Health Geriatric Health
CareCare
Dr. M.L. DonnellyDivision of Community Geriatrics
Vancouver-Fraser Medical ProgramDepartment of Family PracticeUniversity of British Columbia
2
Today’s ScheduleToday’s Schedule• 1:00 – 2:001:00 – 2:00
– An Overview of Geriatric Health CareAn Overview of Geriatric Health Care• Dr. M.L. Donnelly (VFMP)Dr. M.L. Donnelly (VFMP)
• 2:15 – 3:152:15 – 3:15– local site: Geriatric Health Care resourceslocal site: Geriatric Health Care resources
• VFMP: Dr. M.L. DonnellyVFMP: Dr. M.L. Donnelly• IMP: Dr. David Evans, Clinical Instructor, UBC Dept. of IMP: Dr. David Evans, Clinical Instructor, UBC Dept. of
Family PracticeFamily Practice– Division of Geriatric Psychiatry – VIHADivision of Geriatric Psychiatry – VIHA
» Medical Consultant to Seniors Mental Health and Medical Consultant to Seniors Mental Health and Addictions ProgramsAddictions Programs
• NMP: Dr. Ian SchokkingNMP: Dr. Ian Schokking– Clinical Associate Professor – UBC Dept. Family Clinical Associate Professor – UBC Dept. Family
PracticePractice
3
Asking questions in Asking questions in today’s lecturetoday’s lecture
““4 words or 4 words or less” less”
otherwise otherwise use the mikeuse the mike
4
5
An Overview of An Overview of Geriatric Health CareGeriatric Health Care
1. Demography
2. Normal aging
3. Disability and frailty
4. Values (theirs & ours)
5. Epidemiology
6
An Overview of Geriatric An Overview of Geriatric Health Care (cont’d)Health Care (cont’d)
6. Comprehensive geriatric assessment
7. Caregiver issues
8. Health promotion & prevention for
seniors
7
8
9
Health, illness and disease may overlap, but they are uniquely different facets of experience.Labonte, 1993
10
11
12
13
14
15
Statistic Canada’s 1986 Health Statistic Canada’s 1986 Health and Activity Limitation Surveyand Activity Limitation Survey
• 83% of those 75 to 84 and 89% of those 85+ reported mobility and agility related disabilities
• 47% of those 75 to 84 and 65% of those 85+ reported hearing disabilities
16
17
The CSHA Clinical Frailty Scale
1. Very fit – robust, active, energetic, well motivated and fit; these people commonly exercise regularly and are in the most fit group for their age.
2. Well – without active disease, but less fit than people in category 1
3. Well, with treated comorbid disease – disease symptoms controlled compared with those in category 4.
18
The CSHA Clinical Frailty Scale
4. Apparently vulnerable – although not frankly dependent, these people commonly complain of being ‘slowed up’ or have disease symptoms
5. Mildly frail – with limited dependence on others for instrumental activities of daily living.
6. Moderately frail – help is needed with both instrumental and noninstrumental activities of daily living
7. Severely frail – completely dependent on others for the activities of daily living or terminally ill
19
20
Three Greatest Fears of SeniorsThree Greatest Fears of Seniors
1. Poor health
2. Loss of independence
3. Inadequate income
21
Determinants of IndependenceDeterminants of IndependenceMarshall, 1995
• Health
• Wealth
• Social integration
22
23
Predictors of InstitutionalizationPredictors of Institutionalization
• Availability of long-term care beds• Absence of caregiver• Functional incapacity• Advancing age• Presence of dementia• Recent hospital admission• Physical health deteriorationNote: lack of informal support is main predictor
24
The average age of
admission into a long-
term care facility rose
from 75 in 1977 to 85
in 1997
25
26
Geriatric GiantsGeriatric Giants
1. Delirium2. Dementia3. Depression4. Incontinence5. Falling6. Medications7. Illness interactions8. Atypical presentations in the elderly
27
Incidence of Delirium in the Incidence of Delirium in the Acute Care Hospital >65Acute Care Hospital >65
1988 Francis 25.4% med
1992 Francis 22% med
1995 Chonchubhair 10% elderly gen/sx
20% elderly ortho/sx
1991 Levkoff up to 51% med/sx
28
Canadian Study of HealthCanadian Study of Health and Aging and Aging
Prevalence of DementiaPrevalence of Dementia
29
Common Causes of DementiaCommon Causes of Dementia
• Alzheimer’s disease
• Vascular dementia
• Frontal temporal dementia
• Dementia with Lewy Bodies
• Parkinson’s disease with dementia
30
Prevalence of DepressionPrevalence of Depression
31
32
Typical Altered Presentations of Typical Altered Presentations of Specific Illness in the ElderlySpecific Illness in the Elderly
• Depression without sadness• Infectious disease without leukocytosis,
fever, or tachycardia• Silent surgical abdomen• Silent malignancy (“mass without
symptoms”)• Nondyspneic pulmonary edema• Apathetic thyrotoxicosis
33
34
35
36
Comprehensive Comprehensive Geriatric AssessmentGeriatric Assessment
37
Comprehensive Geriatric Comprehensive Geriatric AssessmentAssessment
• HX• Collateral• Fe• Pex• Msex
38
Comprehensive Geriatric Comprehensive Geriatric AssessmentAssessment (cont’d)
• Functional assessment• Informal supports• Formal supports• DRUG review• Nutritional review
39
Activities of Daily LivingInstrumental ADL Scale
• Ability to use telephone• Mode of transportation• Responsibility of own medications• Ability to handle finances• Shopping• Food preparation• Housekeeping• Laundry
40
Activities of Daily LivingPhysical Self-Maintenance Scale
• Toileting
• Feeding
• Dressing
• Physical ambulation
• Bathing
• Hobbies, leisure activities
41
42
43
Comprehensive Geriatric Comprehensive Geriatric AssessmentAssessment (cont’d)
• Investigations• HOME assessment• Risk assessment• Health prevention/
promotion issues• Advance directives
44
Information obtainedInformation obtained from a home visit from a home visit
• Suitability and safety of home for patient’s functional level
• Attitudes and presence of other persons at home
• Proximity and helpfulness of neighbors and relatives
• Emergency assistance arrangements
45
Information obtained from a Information obtained from a home visit home visit (cont’d)(cont’d)
• Nutritional and alcohol habits• Actual and required daily living skills• Hygiene habits• Safety and convenience
modifications needed• Problems in getting to local
stores and service
picture
46
RISK RISK
47
Comprehensive Geriatric Comprehensive Geriatric AssessmentAssessment (cont’d)
1. Problems
2. Priorities
3. Goals
4. Care Plan
48
Quality of LifeQuality of Life
49
Informal CaregivingInformal Caregiving
• 80% of care provided for seniors is informal care by family and friends
• Government policies shifting care to the community increase caregiver responsibilities
• The majority of informal caregivers are women (most are either the spouse or daughters)
50
Informal caregiving Informal caregiving (cont’d)(cont’d)
• Women find caregiving more stressful than men
• Most caregivers are over 60 themselves and suffer from their own health care problems
• Care for the caregiver” “talk or action”
51
Informal Caregiving Informal Caregiving (cont’d)(cont’d)
• In a US study 52% of caregivers were under significant strain (Marchi-Jones 1996)
• Caregiver groups and education• Respite care
52
Prevention and Health Promotion Prevention and Health Promotion for Seniorsfor Seniors
1. Health Enhancement• exercise• diet• coping skills (eg. stress reduction techniques, assertiveness
skills)• Socialization
2. Risk Avoidance• oral health• driving competency assessments• flu shots, pneumococcal vaccines• powers of attorney, advanced directives, levels of intervention• foot care• falls risk assessment
53
Prevention and Health Promotion Prevention and Health Promotion for Seniors for Seniors (cont’d)(cont’d)
3. Risk Reduction• smoking• alcohol• medication knowledge, management• mobility aids• home safety• sun screens• optimize sensory input (sigh, hearing)• incontinence• osteoporosis management
54
Prevention and Health Promotion Prevention and Health Promotion for Seniors for Seniors (cont’d)(cont’d)
4. Early Identification• pap smears• mammograms• rectal examinations• blood pressure• thyroid status
5. Complication reduction
55
Friend or EnemyI can look
At my bodyAs an old friend
Who needs my helpOr an enemy who frustrates me
In every wayWith its frailty
And inability to cope.
Old friend,I shall try
To be of comfort to youTo the end.
May Sarton, Coming into Eighty
56
Geriatrics Mentoring Group
Interested? Contact Martha Donnelly (
[email protected]) or Jacquie Bailey ([email protected])