wk 12_2015.11.25_home care management

7/24/2019 Wk 12_2015.11.25_Home Care Management

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Managing specific conditions of

older people at home

Professor Diana Lee

Professor of Nursing

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Nutritional assessment and care for

older people at home

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Central Educational Unit (2006)4


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Causes of under nutrition in older adults

Sensory losses- loss of taste and smell affect

appetite

Functional problems e.g. feeding problem;

dentures, loss of teeth

Disease conditions such as COPD, heart disease

SOB

Conditions/ diseases (cancer , pneumonia,pressure sore) that increase the nutritional needs

but older adult is unable to meet the need

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Causes of under nutrition in older adults

Cognitive and behavoural problems such as

dementia

Social problem- living alone or poverty

Common nutrient deficiencies in older people

Vitamin B, CProtein

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Nutritional Assessment

Purposes

To identify nutritional practices

To identify nutritional risks To provide information in the development of

health care plan to manage altered nutrition

status To evaluate the effectiveness of nutritional

programs or interventions

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Nutritional Assessment

Components

Health History

Physical Examinationanthropometric assessment

Biochemical Examination

Other assessments

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Height / Weight / Appetite

Body height: ________ Body weight: _________

Weight Fluctuations: None Gain Loss (>5 Kg in last 3 months)Appetite: Normal Increased Decreased Decreased taste

Nausea Vomiting (>3 days)* Stomatitis

Minimal PO intake (>5 days)*

Diet

Meals/Snacks (#/day): __________________

Special Diet/Supplement: Yes (please specify: __________________)No

Previous Dietary Instruction Yes No

Compliance Yes No

Typical Daily Diet:

Breakfast: ____________________________________________________________

Lunch: ______________________________________________________________Dinner: ______________________________________________________________

Snacks: _____________________________________________________________

Fluid Intake: (8-oz glasses/day) Restricted 0-5 Glasses

5-10 Glasses >10 Glasses

Food Allergies: Yes (please specify: ___________________) No

Food Dislikes: Yes (please specify: ___________________) No

The Health History

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Anthropometric Assessment

To evaluate the clients physical growth,development, and nutritional status

Measure height and weight

Body Mass Index (BMI) evaluation

Measure Waist-to-Hip ratio

Measure midarm circumference (MAC)

Measure triceps skinfold

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Body mass Index (BMI)BMI = weight in kilograms / height in meters squared

(Kg/M)

Source: Asia-Pacific Regional Obesity Guidelines, WHO

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The New Asia-Pacific RegionalObesity Guidelines on BMI

(2000)

The WHO Guidelines on BMI(1997 Guidelines)

Normal 18.5 - 22.9 18.5 - 24.9

Overweight 23 - 24.9 25 - 29.9

Obese > 25 > 30


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Waist-to-hip ratio

Waist-to-hip ratio = waist circumference / hip

circumference

Normal findings:

Female < 0.8 Male < 1.0

e.g.

Waist 68cm (27inch)

Hip 91cm (35.8 inch)

Waist to hip ratio

(68/91) = 0.74 12


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Midarm Circumference

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Skinfold Caliper

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Triceps Skinfold

To estimate body fat stores

Standard References for TSF (Norms may be 10% lower for Asian Populations

Adult TSF (mm)

Standard reference

90% of Standard

Moderately Malnourished

60% Standard

Severely Malnourished

Men 12.5 11.3 7.5

Women 16.5 14.9 9.9 15


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Biochemical Examination and

Other Assessments

Serum albumin

Cholesterol

Haemoglobin

Serum transferrin: Fe transport protein Blood glucose

Other assessment

e.g. oral condition, skin condition, medication,home environment, relevant psychosocialassessments

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Nursing management of nutritional

problem

Identify the underlying causes

Identify food preference

Promote happy eating atmosphere and environment

Suggest to have supplement added between meals

Record of Intake with calorie count are useful

indicators

Refer to home meal service for home bound patients Refer to dentist for dental problems

Consult dietitian if necessary

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Medication management in older adults

Specific considerations

Polypharmacy: multiple prescribed

medications

Increased sensitivity to the effects of

medicationsincreased possibility of adverse

drug reactions

Impaired renal and liver functions

Decreased excretion

Changes in drug response with age 18


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Medication management in older adults

Problems of vision, hearing, memory and

cognitive function decline

Therefore

More drug interaction and unwanted or

adverse reactions e.g. dizziness, confusion,decreased mobility

Non-adherence: intentional or unintentional

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Vulnerable older adults

Cognitively impaired

Less educated

Living alone Taking many drugs

Those with visual disturbances

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Promoting medication adherence

in older adults

Active & positive partnership: older adults andtheir caregivers

More time to explain

Provide adequate information related to name ofdrug, drug reaction and what should be reported

Ensure the information is well understood

Encourage the older client to prepare a written listof all medication (with time, reason, dosage,frequency, side effect)- memory aids

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Promoting medication adherence

in older adults

Common problems: knowing which drug totake, what time to take and remember whethera drug has been taken

Tool to help: self monitoring check off chartColor coding system to quickly identify their

medication

Daily & weekly container small medicationholders with a different compartment for eachday of the week.

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Special considerations for the

visually impaired

Evaluate clients capacity (visual acuity, visual field)

to follow the medication instruction.

Position medications in the clients visual field.

Keep adequate light in the drug preparation area.

Teach to use optical device such as magnifying glass

if needed.

Improve signage: e.g. large font size, color coding ,colored caps

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Special considerations for the

visually impaired

Instruct the proper methods of drug

administration such as eye drop, ear drop.

Listen to clients concerns such as side effects

of dizziness, consider any possibility of drug-

drug reaction.

Remind client to discard outdated medicine.

Observe home environment and suggest

improvement

Refer to eye specialist for poor vision if any.26


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Patient and family education on

medication management at home

Inform for any allergy or keep a record of allergyor symptoms experienced if not severe.

Ensure understanding of all medications

especially new medicationsUse a system for keeping track record of drugs

supposed to take and what drugs have takeneveryday.

If a dose is missed, take it ASAP. If it is almosttime for the next dose, skip the missed dose. Donot take double doses at one time .

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Patient and family education on

medication management at home

keep drug in air-tight containers and store

them properly

Dont stop taking a drug without checking

with physician even if feeling better

Dont mix drugs with alcohol

Check expiry dates and discard leftover drugs

Know the number for further contact for

questions concerning the medications

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References

Hong Kong Social Welfare Department. Statistical report of services for the elders. 2011

[cited 2011 December 07]. Available from http://www.swd.gov.hk/doc/res-stat/2010fig.pdf

Chui, E. Long term care policy in Hong Kong: challenges and future directions. Home

Health care services quarterly. 2011; 20:119-132.

Sau Po centre on aging and department of social work & social administration. Consultancy

study on community care services for the elderly. The University of Hong Kong.2011.

Low, L.F. , Yap, M., & Brodaty ,H. A systematic review of different models of home and

community care services for older persons. BMC Health Services Research 2011, 11:93

http://www.biomedcentral.com/1472-6963/11/93

Allender, J.A. & Spradley, B.W. (2005). Community Health Nursing: Promoting and

Protecting the Publics Health (6thEd.) Philadelphia: Lippincott Williams & Wilkins.

Hunt, R. (2005). Introduction to community-based nursing. (3rd ed.). Philadelphia: Lippincott

Miller, C. A. (2009). Nursing for wellness in older adults (5th Ed.). Philadephia: Lippincoot

Roach, S. (2001). Introductory Gerontological Nursing . (Eds) Philadephia: Lippincott.

Stanhope, M. & Lancaster, J. (2008). Community and public health nursing (7th ed.). St.

Louis, MO: Mosby.

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http://www.swd.gov.hk/doc/res-stat/2010fig.pdfhttp://www.biomedcentral.com/1472-6963/11/93http://www.biomedcentral.com/1472-6963/11/93http://www.swd.gov.hk/doc/res-stat/2010fig.pdf

wk 12_2015.11.25_home care management

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