Geriatrics: connect health, function and the person’s priorities
Geriatrics encompasses the health and well-being of older adults. The diagnosis of an older adult's condition does not provide a full picture of this situation. Daily activities, medication use, cognitive function (thinking), physical movement and the amount of support required at home can influence what objectives an effective care plan should aim to accomplish.
Function gives health information a practical meaning
Two older adults who are of the same chronological age can experience vastly differing levels of health, abilities, and require completely different types and amounts of care. Therefore, assessments look beyond the chronological age of the individual. Assessments may examine medical conditions, mobility, cognitive function, mood, nutritional status, and the activities an individual desires to continue performing/needs to perform. Identifying the prior level of functioning of an individual allows for identifying what has changed and why that change is important.
When developing a teaching case, select an activity relevant to daily living (e.g., preparing meals or managing medications). Identify what an individual was capable of doing previously; what they find challenging currently; and what supports exist. Relating clinical information to real-world scenarios assists in avoiding assumptions regarding specific diagnoses that older adults will have or whether they will desire similar goals for their care as other patients.
Review the complete combination and its effects
Older adults typically take multiple prescription and/or over-the-counter products/supplements. Medications taken concurrently can interact or result in adverse side effects. An objective of a medication review is to evaluate both the effectiveness/usefulness of each product and the combinations of products being utilized along with the current life situations of the older adult. Taking multiple medications is not, on its own, justification for stopping those medications without consulting with a healthcare provider or pharmacist.
A revised medication list should include only items actually taken by the individual along with the issues/problems the regimen is attempting to solve/address. There should be an understanding of the difference between an actual problem experienced by an individual versus a conclusion drawn based on an assumed cause-and-effect relationship between a medication and a problem experienced by that individual. Questions related to simplifying treatment regimens should be directed to a clinician/pharmacist. Changes made to treatment plans may require monitoring and some treatments may require gradual tapering under appropriate observation.
A new change needs attention rather than an age-based assumption
Memory concerns and other changes in thinking can be due to various potential causes such as disease processes, medication adverse effects, emotional/mood disorders, and dementia. A short screening tool can assist in providing additional information for assessing an individual; however, a single screening tool is insufficient for diagnosing dementia or other cognitive impairments. Additional information that may assist in determining the necessity for further evaluation includes when the change first occurred; how the decline impacts on the individual's daily routine; and if others have observed any changes in the individual's behavior. Communicate clearly and allow sufficient time for responses. Visual/hearing impairments may interfere with interactions and should not be presumed to indicate lack of understanding.
In your educational account, distinguish between an acute onset of a problem versus a long-standing trend in an individual's cognitive decline and detail evidence presented. A sudden change in thinking needs prompt medical assessment; discuss other new or worsening symptoms with a healthcare service.
Several factors can contribute to one difficulty
Falls can be attributed to factors such as impaired balance; visual impairment; adverse effects from prescribed medications; medical conditions; improper fitting shoes/footwear; and environmental hazards. Thus, assessment should focus on identifying factors contributing to falls that were present at the time of the incident as well as other environmental/situational factors that might influence a fall risk. Additionally, confidence in moving safely after experiencing a slip/fall also represents an important aspect of evaluating risks.
A care plan connects the needs identified with support and review. Rehabilitation, practical changes at home and help from different professionals may each contribute. Include the person’s own priorities and involve family or other supporters appropriately. A teaching example cannot determine the safest change in a particular home or which treatment adjustment is right for an individual.
Check your understanding
A short quiz, with an explanation after each answer.
What can two people of the same age have?
Return to the section you found hardest and explain its example without looking at the page. Check the explanation, then repeat the quiz later. Being able to describe the reasoning is more useful than remembering the position of a correct answer.