L3 Care for Older People v3 May 2023.pdf

Care for Older People in the Emergency & Urgent Care Setting Component 6 © Department of Clinical Education & Standards 1  Welfare Subjects covered during this training may evoke memories of incidents that you hav...

Care for Older People in the Emergency & Urgent Care Setting Component 6 © Department of Clinical Education & Standards 1  Welfare Subjects covered during this training may evoke memories of incidents that you have witnessed or been involved in. If you have any concerns please discuss with your Course Director/staff at the education centre. Support is available to all staff, more information is available on The Pulse LINC emergency on Call – 0207 922 7539 Staff Counselling Referral Line – 0800 882 4102 MIND Blue Light Infoline – 0300 303 5999 TRiM Assessment Wellbeing Hub – 0203 162 7554 2 © Department of Clinical Education & Standards  Care for Older People – Component 6 Objectives Understand the National Framework for older people Anatomy and Physiology of Ageing Understand the factors associated with ageing Contributions made by older people Understanding communication barriers Understanding a person centered approach © Department of Clinical Education & Standards  Care for Older People – Component 6 How old is old? Older people are generally defined as those aged over 65. © Department of Clinical Education & Standards  Care for Older People – Component 6 National Framework From Department of Health Challenges age discrimination Prevent unnecessary Hospital admissions Reduce long term illness Specialist care Promote health and independence Local initiatives can also in place around the county with a focus on the care of older people. © Department of Clinical Education & Standards  Care for Older People – Component 6 Ageing & the body’s systems Cardiovascular System Respiratory System Neurological System Gastrointestinal System Musculoskeletal System Renal System Integumentary System © Department of Clinical Education & Standards  Care for Older People – Component 6 Neurological System Brain weight shrinks by 5-10% by over a lifetime Greater chance of head trauma Loss of approx. 10% of neurons by the age of 75yrs Peripheral nerve function slows This affects sensory perception Greater chance of falls © Department of Clinical Education & Standards  Care for Older People – Component 6 Respiratory System Steady decline from age 25 Loss of elastic tissues results in small airways collapsing Increased chance of infection Thicker mucous, increased cough Rib cage becomes stiff, chest wall more rigid Less capacity to respond to increased levels of ventilation, when required. © Department of Clinical Education & Standards  Care for Older People – Component 6 Cardiovascular System Blood vessels lose elasticity Blood pressure increases Hypertrophy of the heart Heart Failure Decreased cardiac output Electrical conductivity changes Increase chance of arrhythmias © Department of Clinical Education & Standards  Care for Older People – Component 6 Gastrointestinal System Decrease in taste bud sensitivity Decrease in saliva secretion Slowing of peristalsis Missing teeth, ill-fitting dentures Decrease in food intake Decline in efficiency of liver © Department of Clinical Education & Standards  Care for Older People – Component 6 Renal System Filtration function falls Kidney mass decreases by 20% and there is a loss of nephrons Less efficient response to stress, fluid and electrolyte imbalances Dysfunction = the cause of many drug interaction problems in older patients. © Department of Clinical Education & Standards  Care for Older People – Component 6 Musculoskeletal System The muscle system atrophies and weakens Ligaments and cartilage loose their elasticity and flexibility Bone density decreases Intervertebral disks lose fluid causing kyphosis Osteoporosis occurs as the skeleton ages © Department of Clinical Education & Standards  Care for Older People – Component 6 Integumentary System The skin wrinkles & loses it’s resilience. Decrease in subcutaneous fat Decrease in elastin and collagen Skin layers become thinner Reduction of nutrient exchange Reduction in blood vessels Radiation from the sun increases the ageing process © Department of Clinical Education & Standards  Care for Older People – Component 6 Sensory Changes Loss of sight Loss of hearing Disturbance of balance Deterioration of senses of smell and taste Impaired memory / forgetfulness Reduced learning capability Personality changes, with existing traits emphasized.  Care for Older People – Component 6 Communication Ascertain their requirements Get their attention Use their name Reduce ambient noise Keep things simple Don’t rush Keep calm © Department of Clinical Education & Standards  Care for Older People – Component 6 Others Factors Associated with Aging Emotional Social Environmental Financial/Economic 16  Care for Older People – Component 6 Everyone’s experience of aging is different, but a positive attitude towards ageing is fundamental for ageing well. Current attitudes towards ageing in society and the media may be discriminating against the older population. © Department of Clinical Education & Standards  Care for Older People – Component 6 Person Centred Approach Respect for the persons values and needs Personalised care and support Equal partnership between professionals and patients Involvement of family, carers, patients Continuity of care Education and information © Department of Clinical Education & Standards  Care for Older People – Component 6 Person Centred Approach - Scenario You are called to 84 year old female fallen suspected # wrist. On arrival primary survey comes back normal, patient is with her relative who states the patient has moderate dementia and that she is usually very confused. Last time she went to A+E she went by herself and was extremely scared, it took her weeks to recover from the emotional trauma. You believe the patients wrist is fractured and requires treatment. © Department of Clinical Education & Standards  Care for Older People – Component 6 Care plans There are a number of common medical conditions associated with aging that may occur in combination and so become harder to assess. However we have access to Mobile SCRa tools which can be helpful to plan patient care. © Department of Clinical Education & Standards  Care for Older People – Component 6 Dementia An umbrella term covering a range of conditions Result is a gradual death of cells within the brain Every sufferer will have an individual disease progression Alzheimer’s, Vascular Dementia, Dementia with Lewy Bodies, Frontotemporal Dementia Care for Older People – Component 6 Dementia  Care for Older People – Component 6 Parkinson’s Disease Parkinson’s disease patients do not produce enough of the neurotransmitter dopamine, due to the death of brain cells. The disease will effect approximately 1 in every 350 people in the UK and there is currently no cure. Possible causes include genetic and environmental factors, but the exact cause is still unclear. The main symptoms include:  Tremor, slowness of movement  Constipation, pain, tiredness  Depression  Care for Older People – Component 6 Stroke/TIA Stroke is a common cause of death and disability, especially in older people. Causes include: - Hypertension - Atheroma - Cigarette smoking - Diabetes mellitus Strokes result from infarction (approx. 85%) or haemorrhage (15%). TIA- Signs and symptoms suggest a stroke, but will resolve within 24 hours (usually they resolve within minutes or a few hours). © Department of Clinical Education & Standards  Care for Older People – Component 6 Arthritis Defined as inflammation within a joint. Osteoarthritis – bones in joints can rub together. Rheumatoid arthritis – swollen, inflamed synovial membrane. Symptoms – pain, tiredness, depression, flu-like symptoms, irritability. © Department of Clinical Education & Standards  Care for Older People – Component 6 Osteoporosis Peak bone mass occurs around 35 years and then gradually declines in both sexes. Lowered oestrogen levels post menopause are linked to accelerated bone loss in women. Thereafter bone density in women is less than in men for any given age. © Department of Clinical Education & Standards  Care for Older People – Component 6 Mental Health Depression in the elderly is a major health problem. The incidence increases with the progressive ageing of the population. Causes include polypathology, psychosocial stress, and ageing-related changes in the brain. This may lead to cognitive impairment with an increased risk of mental illness. There is an increased dependence on health care services… and more suicide attempts © Department of Clinical Education & Standards  Care for Older People – Component 6 Learning Disabilities More chance of developing conditions such as epilepsy and pneumonia May find it harder to access health care May have a lack of understanding or communication problems, which may lead to a delay in asking for help with health problems Remember the person centered approach © Department of Clinical Education & Standards  Care for Older People – Component 6 Falls in older people An event which results in a person coming to rest inadvertently on the ground or other lower level.’(Gibson et al 1987) Each month the LAS attends approximately 6,500 elderly fallers. Currently 67% of these patients are conveyed to an ED, with 29% of them being not conveyed/left at home. Cause of falls are varied and can be difficulty to ascertain. © Department of Clinical Education & Standards  Care for Older People – Component 6 How to Assess a Faller AAP’s can only assist a more senior clinician in assessing a faller Good History Ask - How did you fall? Did you have any dizziness/LOC? What did you slip/trip on? Remember to Were you able to get up off the floor? consider spinal Previous history of falls? injuries, even Establish - Previous health history from minor falls Medical and drug history © Department of Clinical Education & Standards  Care for Older People – Component 6 Falls Referrals Falls referrals may be made by staff. Advice may also be sought by direct contact with a GP. Without this, patients must not be left at home. To refer a faller: Contact Referral Support Team (RST) via airwave or 0207 407 7181. Provide all referral details : name, date of birth, address, GP details. Use destination code 9500 on the PRF. AAP’s can only assist a more senior clinician in completing a falls referral © Department of Clinical Education & Standards Care for Older People – Component 6 Falls Referrals © Department of Clinical Education & Standards  Care for Older People – Component 6 Remember You may need to make adaptions when caring for older people, including: Allowing more time for Treat the patient how movement and speech you would like to be treated… Providing support as required Using suitable methods of with patience, communication respected and understanding. © Department of Clinical Education & Standards  Care for Older People – Component 6 As a final thought, does a Safeguarding referral need to be made to RST? Remember: Not all falls are accidental! Any Questions? © Department of Clinical Education & Standards