NCM 114 Lecture 2nd Exam Coverage PDF

NCM 114 (LECTURE) – 2ND EXAM COVERAGE (2) demonstrate improved ability to detect changes in the environment, Nursing care of the older adult in chronic illness...

NCM 114 (LECTURE) – 2ND EXAM COVERAGE (2) demonstrate improved ability to detect changes in the environment, Nursing care of the older adult in chronic illness (3) interact appropriately with the A. DISTURBANCE IN SENSORY PERCEPTION environment, (4) demonstrate the ability to compensate for NURSING PROCESS FOR DISTURBANCE IN deficits by using prosthetic devices and SENSORY PERCEPTION alternative senses. ASSESSMENT/ DATA COLLECTION Has the person mentioned any changes in NURSING INTERVENTIONS/ the taste or smell of food? IMPLEMENTATIONS Can the person detect whether something Ensure that all caregivers are aware of the is cold or warm? Smooth or rough? person’s sensory problems. Does the person have known vision Make appropriate sensory contact before problems (e.g. glaucoma, macular beginning care. degeneration, cataracts, refractive errors)? Determine the best methods for Does the person see small details or communicating with older adults. shadows? Modify the environment to reduce risks. Does the person frequently walk into or trip HEMIANOPSIA- portion of the visual field is over objects? lost Can the person read? If not, why not? If yes, Verify that prostheses such as eyeglasses and can he or she read newsprint or only large hearing aids are functional. print headlines? How close does the person sit to the The following interventions should take television? place in home: Does the person wear eyeglasses? If yes, 1. Modify the home environment to are they single lens, bifocal or trifocal? compensate for sensory changes. When was the last vision examination? 2. Assist sensorially impaired people in Does the person respond when people developing techniques or acquiring devices speak to him or her at normal volumes? that will help compensate for losses. Can the person hear a whisper from ✓ Hearing impaired people someone behind or to the side of him or her ✓ Visually impaired people who cannot be seen? Does the person turn the volume of the Individual sensory impairments are common television or radio to a very loud level? ✓ hearing loss (33%) Does the person turn hir or her head to ✓ vision impairment (18%) age 70 and hear? Wearing a hearing aid? older Does the person respond appropriately or ✓ deficits in smell (24%) inappropriately to questions? ✓ taste (up to 61%) common in adults 70 Can the person follow directions? and older NURSING DIAGNOSIS EFFECTS OF SENSORY IMPAIRMENT IN ELDERLY ADULTS: Risk for injury related to altered sensory perception ✓ Visual, hearing and olfactory Impaired verbal communication related to impairment. They have difficulty disturbance in sensory input adjusting to their sensory loss. Non- correctable visual impairment typically results from the major age-related eye NURSING GOALS/ OUTCOMES diseases (cataract and glaucoma). IDENTIFICATION The nursing goals for older individuals with disturbances in sensory perception are to: (1) remain free from injury (safety), NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN SENSORY LOSS IN ELDERLY placement, increased disability, and LOSS OF TOUCH – as a person ages, premature death reduced or changed sensations results Increased risk of depression This may be an effect of decreased Increased difficulty identifying blood flow to the nerve endings or to medications, which can lead to the spinal cord or brain. medication-related adverse events It can be affected by brain surgery or Declines in activities of daily living nerve damage from chronic disease such as diabetes. NURSING MANAGEMENT FOR ELDERLY CLIENT WITH VISUAL IMPAIRMENT Changes in sensory function occur due to aging because of: APPROACH AND ATTITUDE DECLINE IN THEIR FIVE SENSES – Always treat a blind person normally- while the sense of smell, taste and speak first and introduce yourself. touch all change with age, noticeable Shake hands but only if a hand is changes affect our vision and hearing. offered Senses changes, elderly find it difficult It is also politeness to look at him/her to socialize and participate in activities. during conversation and adopt the same level of position – sit or stand. In terms of social and mental well-being, vision loss and hearing loss have each been CARE INTERVENTIONS shown to be associated with: Sleep pattern control 1. Depression Mobility therapy 2. Social isolation Compliance with diet 3. Anxiety infection control 4. Paranoia alcohol abuse control 5. Decreased self-esteem positioning therapy energy conservation COMMON VISION PROBLEMS OF ELDERLY The risk of low vision (i.e. where some COMMON HEARING PROBLEMS OF ELDERLY usable vision remains) and blindness Hearing loss occurs to 80% of people increases significantly with age, those over over of 85 the age of 65.2 Common sensory deficit Lead to severe social and health- The most common age-related eye diseases include the following: related problems. ✓ GLAUCOMA – peripheral vision loss Its problematic in the elderly with ✓ AGE-RELATED MACULAR hearing loss- impairs the exchange of DEGENERATION – leads to central information, thus significantly vision loss impacting everyday life: ✓ DIABETIC RETINOPATHY – spotty field ✓ Loneliness of vision ✓ Isolation ✓ CATARACTS – lead to blurring, clouding ✓ Dependence of images, sensitivity to light ✓ Frustration ✓ DRY EYE – creates insufficient tear ✓ Communication disorders production, vision-related activities more difficult. COMMON PROBLEMS: ✓ Tinnitus (ringing in the ears) EFFECTS OF VISUAL PROBLEM WITH ✓ Hearing loss (bilateral or unilateral) ELDERLY: ✓ Dizziness Increase risk of falls and fractures, ✓ Incoordination in movements leading to hospital or nursing home ✓ Unsteadiness of gait NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  ✓ Oscillating or bouncing vision ✓ Speak clearly and loudly (vertigo) ✓ Repeat yourself ✓ Rephrase your question or statement SIGNS OF HEARING LOSS ✓ Appearances and visual cues matter Have trouble hearing over telephone ✓ Be understanding Find it hard to follow conversations when two or more people are talking Often ask people to repeat what they B. CHRONIC CONFUSION are saying Need to turn up the TV volume so loud CONFUSION – is defined as a mental that others complain state characterized by any disorientation Have a problem hearing because of regarding time, place or person that leads background noise to bewilderment, perplexity, lack of orderly Think that others seem to mumble thought, and the inability to choose or act Can’t understand when women and decisively and to perform ADLs. children speak NANDA international identifies the 2 CATEGORIES OF HEARING LOSS following nursing diagnosis that relate to confusion: 1. SENSORINEURAL HEARING LOSS – ✓ acute confusion occurs where there is damage to the inner ✓ chronic confusion ear or the auditory nerve. This type of ✓ ineffective impulse control, and hearing loss is usually permanent. ✓ impaired memory. 2. CONDUCTIVE HEARING LOSS – occurs ACUTE CONFUSION, often called delirium, is when sound waves cannot reach the inner characterized by disturbances in cognition, ear. The cause may be earwax buildup, attention, memory and perception. fluid, or punctured eardrum. Medical This type of confusion is usually caused by a treatment or surgery can usually restore physiologic process that affects the autonomic conductive hearing loss. nervous system. Conditions that can cause delirium include COMMON DISORDERS OF HEARING AMONG ✓ uncontrolled pain, ELDERLY PATIENT: ✓ infection, ✓ Sudden hearing loss ✓ metabolic disturbances, ✓ Age-related hearing loss (presbycusis) ✓ vitamin deficiencies, ✓ Ringing in the ears (Tinnitus) ✓ uremia, ✓ hypoxia, COMMUNICATING WITH PEOPLE WHO HAS ✓ hypercalcemia, HEARING LOSS ✓ endocrine imbalance, ✓ Face the hearing-impaired person ✓ myocardial infarction, directly, on the same level in the good ✓ constipation, light wherever possible ✓ drug toxicity, and drug withdrawal. ✓ Do not talk from another room ✓ Speak clearly, slowly, distinctly but ACUTE DELIRIUM has a sudden onset of hours naturally, without shouting or to days. It is characterized by: exaggerating mouth movements ✓ rapid mood swings, ✓ Say the person’s name before beginning ✓ disorganized sleep cycles, a conversation. ✓ changes in psychomotor activity ✓ Get their attention. Respectfully get the (hypoactivity, hyperactivity, or both), senior’s attention before speaking ✓ tremors, or spasmodic activity, ✓ Reduce background noises ✓ rapid speech patterns, ✓ Speak one at a time ✓ loss of attention, and NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  ✓ a wide range of cognitive changes. signs and symptoms) in which affected areas of cognition may be: MNEMONIC ASSESSMENT FOR DELIRIUM ✓ memory, COMPONENT CONSIDERATIONS ✓ attention, DRUG USE – any recent change in ✓ language and medications, increase or decrease in ✓ problem solving. dosage, change from specific brand to a Cognitive dysfunction, that has been seen generic. Pay special attention to only over shorter times. sedative-hypnotics (including alcohol, antidepressants, opioids, CAUSES OF DIMENTIA SYNDROME antipsychotics, anticholinergics, There are many potential dementia anticoagulants, antiparkinsonian causes. The most common us medication and H2 blocker Alzheimer’s disease, which is medications. responsible for more than half of all ELECTROLYTE IMBALANCE – abnormal dementia cases. levels of calcium, sodium or Other common causes of the magnesium often related to condition include a brain tumor, brain malnutrition or dehydration cancer, hypothyroidism, and vitamin LACK OF DRUGS – missed medication B12 deficiency. doses Some of the less-common cause INFECTION – check for urinary tract include Huntington’s diseases, infection (UTI), signs of inflammation, Creutzfeldt-Jakob disease, and respiratory congestion, etc. neurosyphilis. remembering that the signs may be subtle in the older adult. Many different diseases states can produce REDUCED SENSORY INPUT – visual or the clinical syndrome of dementia. These hearing impairment, failure to use can be divided into two groups: glasses or hearing aids, social isolation INTRACRANIAL PROBLEMS – recent DEMENTIAS can be reversible or irreversible, head injury, history of stroke, depending upon the cause. They can be fixed meningitis, history of seizure and static, as in from trauma, or progressive, as URINARY INFECTION AND OR FECAL in the case of a disease caused dementia. In IMPACTION – recent anesthesia, any case, all dementias are potentially history of benign hyperplasia, recent treatable. There may not be an actual cure, or a catheter removal means to reduce the symptoms, but MYOCARDIAL PROBLEMS – anginal professional are able to provide such patients symptoms, abnormal and their families with some kind if useful electrocardiogram (ECG), recent assistance. DEMENTIA can be caused by more cardiac surgery. than 50 illnesses. C. DEMENTIA A. REVERSIBLE Used to define a cognitive disorder in DEMENTIA – is a permanent decline cognitive which normal or nearly normal function function and memory from a previous level of may be restored function. The potential to reverse or delay Dementia is a far more common in the deterioration emphasizes the geriatric population, it can occur before importance of an early diagnosis of a the age of 65, in which case it is termed reversible dementia. as “early onset of dementia” the most common causes of reversible Dementia is not a single disease, but rather a dementia are depression, delirium, and non-specific illness syndrome (i.e., sets of drug toxicity NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  other causes include normal pressure Nutritional supplement hydrocephalus, neoplasm’s metabolic disorders, trauma, medications and STAGES OF DEMENTIA infections. EARLY SYMPTOMS Less than 10% of cases of dementia are early indications that someone may be due to causes that may presently be suffering from the inset of dementia reversed with treatment. include: B. IRREVERSIBLE ✓ Difficulty with regular tasks The most common causes of IR ✓ Forgetfulness at work, having negative dementia include: consequences. Such as frequently ✓ Alzheimer’s disease forgetting appointments or deadlines ✓ Vascular dementia ✓ Becoming apathetic, losing the ability, These accounts for at least 70-80% of or desire to take initiative on tasks, or all cases. take part in hobbies and activities. Less common, and more difficult to ✓ Problems remembering familiar recognize clinically are: locations, such as where the patient ✓ Dementia of Lewy body type lives or what year it is. ✓ Pick’s disease (dementia of the ✓ Problems with abstract thinking, which frontal lobe-type DFT) is the ability to make and understand generalization. Could lead to difficulty SYMPTOMS OF DEMENTIA handling money. HALLUCINATIONS – people with ✓ Trouble remembering simple words: dementia often hallucinate. It is not often dementia sufferers will substitute clear if this is an indication that the inappropriate words without realizing, dementia is getting worse. But most making them difficult to understand. dementia does worsen over time. ✓ Sudden mood swings with no obvious Hallucinations can also be a symptom causes. Changes in personality and of specific types if dementia, such as increased irritability are also possible. Lewy body disease. ✓ Dementia sufferers will experience diminished judgement, often doing or ASSESSMENT AND DIAGNOSTIC FINDINGS saying completely inappropriate things. CBC ✓ Losing things and blaming others for Liver enzyme test “stealing” from them. TSH levels (thyroid-stimulating hormones) MODERATE DEMENTIA Rapid plasma reagent (to roll out during this phase the dementia syphilis) symptoms will likely become more HIV serology obvious. They may include: Paraneoplastic antibodies CSF proteins (to roll out Creutzfeldt- ✓ Forgetting recent events, becoming Jakob disease) confused about times and places, remembering events from the past as though they are the present. PHARMACOLOGICAL MANAGEMENT ✓ Forgetting names and faces, confusing Cholinesterase inhibitors – this would family members with each other. rebel the breakdown of acetylcholine. ✓ Becoming lost, wandering outdoors, ▪ Donepezil (Aricept) often at inappropriate times or in ▪ Rivastigmine (Exelon) inappropriate clothing. ▪ Galantamine (Razadyne) ✓ Forgetting to eat or maintain proper N- methyl d- aspartate receptor hygiene. antagonist (NMDA) ✓ Auditory and visual hallucinations ▪ Memantine NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  ✓ Getting frustrated and becoming upset PROGRESSIVE DEMENTIA or angry. ▪ This dementia is a type that gets worse over time, gradually SEVERE DEMENTIA interfering with more and more This is the final stage of dementia; cognitive abilities. Lewy body patients will likely be unable to care for dementia is an example of themselves and need round the clock progressive dementia. care. PRIMARY DEMENTIA ✓ Uncontrollable movements ▪ (Alzheimer’s disease) A type ✓ Incontinence that does not result from any ✓ Failure to recognize even objects that other disease. we use every day ✓ Restlessness, inability to sleep SECONDARY DEMENTIA ✓ Symptoms worsen at night ▪ This occurs as a result of a ✓ No longer recognize family or friends; physical disease or injury may search for long-dead relatives ✓ Need help using the toilet, washing or UMBRELLA OF DEMENTIA getting dressed. (Used to describe a collection of brain diseases ✓ Difficulty walking and getting around. and their symptoms, which include memory ✓ Become aggressive and easily loss, impaired judgement, personality changes, threatened. and an inability to perform ADLs. CLASSIFICATION SYSTEM FOR TYPES OF 1. ALZHEIMER’S DISEASE DEMENTIA ✓ (PREVALENCE) – 60-70% of Example of dementia types include: dementia cases ▪ Cortical dementia ✓ (CHARACTERIZED BY) – amyloid ▪ Subcortical dementia plaques and beta tangles ▪ Progressive dementia ✓ (SYMPTOMS INCLUDE): ▪ Primary dementia ▪ impairment in memory ▪ Secondary dementia ▪ language ▪ visuospatial skills. CORTICAL DEMENTIA ▪ Refers to dementia in which 2. VASCULAR DEMENTIA brain damage primarily affects ✓ (PREVALENCE) - 10-20 % of cases the brain’s cortex, or outer layer. ✓ (CHARACTERIZED BY) - Disease or This tends to cause problems injury to the blood vessels leading with memory, language, thinking to the brain and social behavior. ✓ (SYMPTOMS INCLUDE) ▪ Impaired motor skills SUBCORTICAL DEMENTIA ▪ Impaired judgement. ▪ This affects parts of the brain below the cortex. This dementia 3. FRONTOTEMPORAL DEMENTIA type tends to cause changes in emotions and movements in ✓ (PREVALENCE) - 10% of dementia addition to problems with cases memory. One example of this ✓ (CHARACTERIZED BY) - dementia type is Binswanger’s Deterioration of frontal and disease. temporal lobes of the brain ✓ (SYMPTOMS INCLUDE): ▪ Personality changes and ▪ issues with language NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  4. LEWY BODY DEMENTIA concomitant stimulation of the relevant ✓ (PREVALENCE) - 5% of dementia sensory organ. cases ILLUSIONS – misinterpretation of visual stimuli ✓ (CHARACTERIZED BY) - Lewy body from distorted perception. protein deposits on nerve cells IRRITABILITY – susceptibility to easily ✓ (SYMPTOMS INCLUDE): provoked anger or annoyance. ▪ Hallucinations OBSESSIVE COMPULSIVE BEHAVIOR – ▪ disordered sleep recurrent thoughts, repetitive acts, or ▪ impaired thinking and compulsive purposeless behavior. ▪ motor skills. LEWY BODIES – Lewy bodies are abnormal microscopic protein deposits in the brain that 5. OTHER DEMENTIAS disrupts the brain’s normal functioning causing ✓ (PREVALENCE) - 5% of dementia it to slowly deteriorate. cases ✓ DEMENTIAS RELATED TO: NURSING DIAGNOSIS ▪ Parkinson’s disease Risk for trauma related to ▪ Huntington’s disease disorientation or confusion ▪ HIV Risk for self-directed or other- ▪ Creutzfeldt-Jakob disease directed violence related to delusional ▪ Korsakoff syndrome thinking Chronic confusion related to alteration ROLE AS A CAREGIVER in structure/function of brain tissue ✓ learn to recognize the warnings signs of Self-care deficit related to cognitive frustrations impairment ✓ intervene to calm yourself down Risk for falls related to cognitive physically impairment. ✓ modify your thoughts in a way that reduces your stress KEY POINTS ✓ learn to communicate assertively DEMENTIA – is a disorder of memory ✓ learn to ask for help impairment coupled with other cognitive defects. It has a gradual onset and progressive DEMENTIA course (DEFINITION OF TERMS) It may be causes by a variety of illnesses DEMENTIA predisposes to DELIRIUM ABERRANT MOTOR BEHAVIOR – excessive motor activity such as pacing, wandering, FACTS AND TIPS ABOUT DEMENTIA fidgeting, handwringing, inability to sit still, etc. DEMENTIA is a group of symptoms cause AGITATION – excessive motor activity by disorders that affected the brain and associated with feeling of inner tension. loss of mental abilities and most ANXIETY – excessive and unjustified commonly occurs late in life. apprehension. Feeling of foreboding and This characterized by the progressive thoughts of impending doom. decline in cognitive function due to APATHY – lack of motivation and diminished damage of disease in the body beyond what goal-directed behavior, reduced goal-directed might be expected from normal aging. cognition and decreased emotional People with dementia may not be able to engagement. think well adequate to do normal activities, DELUSIONS – false beliefs based on incorrect for examples getting dressed or eating. references about external reality that are firmly MEMORY LOSS is a common symptom of held despite evidence to the contrary. dementia. Though, memory loss by itself HALLUCINATIONS – sensory perceptions with does not mean you have dementia. compelling sense of reality but without NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  RISK FACTORS of dementia are: 1 in 6 women over 55; 1 in 10 men over ✓ Genetics/ family history 55 ✓ Smoking and alcohol use ✓ Atherosclerosis CAUSES ✓ Cholesterol ▪ Unknown ✓ Diabetes ▪ But advanced age ✓ Mild cognitive impairment ▪ Female ▪ Family history AD Generally seen in the older people whose ▪ Head trauma with loss of age after 60 and they loss their intellectual consciousness and social abilities, healthy brain tissue ▪ Virus degenerates, causing a steading decline in ▪ Environmental toxin memory and mental abilities. ▪ Cerebrovascular disease ALZHEIMERS DISEASE PATHOPHYSIOLOGY Is a degenerative brain disorder of unknown a) Due to the etiological factors etiology which is the most common form of b) Changes occurs in the proteins of the dementia, that usually starts in late middle age nerve cells of the cerebral cortex or in old age, results in: c) Accumulation of neurofibrillary tangles ✓ Progressive memory loss and plaques ✓ Impaired thinking d) Granulo vascular degeneration ✓ Disorientation e) Loss of cholinergic nerve cells ✓ Changes in personality and mood f) Loss of memory, function and cognition There is degeneration of brain neurons TYPES especially in the CEREBRAL CORTEX and 1. MILD COGNITIVE IMPAIRMENT presence of neurofibrillary tangles and ✓ DURATION: 7 years plaques containing beta-amyloid cells. ✓ Disease begins in medial temporal lobe A chronic, irreversible disease that affects ✓ SYMPTOM: short-term memory loss the cells of the brain and causes impairment of intellectual functioning. 2. MILD ALZHEIMER’S ✓ DURATION: 2 years This is a brain disorder which gradually ✓ Disease spreads to lateral temporal destroys the ability to: and parietal lobes ✓ Reason ✓ SYMPTOMS: ✓ Remember ▪ reading problems ✓ Imagine ▪ poor object recognition ✓ Learn ▪ poor direction sense First described by GERMAN PSYCHIATRIST: 3. MODERATE ALZHEIMER’S Alois Alzheimer (1906) ✓ DURATION: 2 years ✓ Disease spreads to frontal lobe Generally, diagnoses in people over 65 years ✓ SYMPTOMS: of age: ▪ Poor judgement early onset before 65; only 5-10% of ▪ Impulsivity patients ▪ Short attention Several genetic causes 4. SEVERE ALZHEIMER’S ✓ DURATION: 3 years 4.5 million American suffer from it: ✓ Disease spreads to occipital lobe 5% of 65-74 years of age ✓ SYMPTOMS: visual problems nearly 50% of 85+ NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  Mental status examination and ALZHEIMERS TOP 10 EARLY SIGNS neuropsychological assessment ✓ Memory loss Laboratory tests ✓ Change in mood Brain imaging ✓ Misplacing belongings o CT scan ✓ Hard to complete familiar task o MRI ✓ Confusion of time and place o PET ✓ Changes in vision o SPECT ✓ Struggling to communicate CSF examination ✓ Poor judgement Electro-encephalogram (EEG) ✓ Social withdrawal Electromyogram CLINICAL MANIFESTATIONS MANAGEMENT (MILD ALZHEIMER’S DISEASE) (PHARMACOLOGICAL INTERVENTION) ✓ Memory loss for recent events ✓ Difficulty with problem solving complex 1. ACETYLCHOLINESTERASE INHIBITORS – tasks and sound judgements prevent the breakdown of acetylcholine, a ✓ changes in personality chemical messenger important for learning ✓ difficulty organizing and expressing and memory. thoughts o Donepezil (Aricept) ✓ Getting loss and or may wander, and o Rivastigmine (Exelon) misplacing belongings o Galantamine (Razadyne) (MODERATE ALZHEIMER’S DISEASE) 2. N-methyl d-aspartate Receptor ✓ showing increasingly poor judgment Antagonist (NMDA) and deepening confusion’ o Memantine – blocks the NMDS ✓ experience even greater memory loss receptor and inhibit their ✓ need help with some daily activities overstimulation by glutamate ✓ undergo significant changes in (neurotransmitter) personality and behavior. o Antidepressants o anxiolytics (SEVERE ALZHEIMER’S DISEASE) o antipsychotics ✓ lose the ability to communicate o anticonvulsant coherently ✓ require daily assistance with personal 3. Nutritional supplement care ✓ experience a decline in physical NURSING DIAGNOSIS abilities Disturbed thought processes related to physiologic disease process GENERAL CLINICAL MANIFESTATIONS Risk for injury due to loss of cognitive Impairment of the ability to remember abilities information acquired in the past Insomnia secondary to disease gradual impairment of memory process short- and long-term memory lost Caregiver role stain related to physical apraxia needs and behavioral manifestations of aphasia the disease process depression inability to perform skilled motor activity NURSING INTERVENTION (dressing and walking) Orient client Improving cognitive response DIAGNOSTIC EVALUATION Reduce noise and social interaction to a Psychiatric assessments level tolerable for the patient NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  Provide physical activity b) free skills training and education, Preventing injury among others. Avoid restraints but maintain observation The administrative order issued by Provide adequate lighting to avoid DOH was done to guide drug stores, misinterpretation of the environment hospitals and other medical Remove unneeded furniture and equipment establishments in providing health form the room care to senior citizens. Ensuring adequate rest Supporting care 3. RA 9994: Expaned Senior Citizens Act of Encourage caregiver to discuss feeling 2010 amending RA No. 7432 Assess caregivers stress and refer for counselling OBJECTIVE – to give full support to the improvement of the total well-being of Stress the need for relaxation time or the elderly and their full participation in respite care society, considering that senior citizens are Explain simply integral part of Philippine society and to Discourage suspiciousness to others provide a comprehensive health care and Avoid the cultivation of false ideas rehabilitation system for disabled senior citizens to foster their capacity to attain a ETHICO LEGAL CONSIDERATIONS IN THE CARE more meaningful and productive ageing. OF OLDER ADULT a) The law defined “INDIGENT SENIOR 1. RA 7432 – Senior’s Citizen Act of 1997 CITIZEN” – as refers to any elderly who - An act establishing a senior citizens is frail, sickly or with disability and center in all cities and municipalities of the without pension or permanent source Philippines and appropriating funds for its of income, compensation or financial implementation. assistance from his/her relatives to support his/her basic needs. a) 20% discounts from all b) INDIGENT & DISABLED senior citizens establishments shall be entitled to a MONTHLY b) A minimum of 20% discount on STIPEND (Php 500) to augment their admission fees by theaters, cinema daily subsistence and other medical houses and other similar places of needs. culture, leisure and amusement. c) ADDITIONAL BENEFITS c) Exemption from the payment of ✓ 20% discount and exemption individual income taxes – provided from the value-added tax (VAT) that their annual taxable income - Medicines does not exceed the property level - Vaccinations (NEDA standard). - Medical d) Exemption from training fees for supplies/equipment socioeconomic programs - Private hospitals undertaken by the OSCA. e) Free medical and dental services 4. RA 344 – An act to Enhance the Mobility of in government establishments, Disabled persons by requiring certain subject to guidelines by (DOH, buildings, institutions, establishments and GSIS, & SSS). public utilities to install FACILITIES and OTHER DEVICES (ramps, elevators, etc.) 2. RA 9257 – Grants additional privileges 5. RA 10645 – An act providing for the such as: Mandatory PhilHealth coverage for All Senior Citizens was approved in 2014. The a) provision of employment law states that all senior citizens shall be NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  covered the national health insurance A good example is the interaction program of PhilHealth. between ASPIRIN & BLOOD THINNERS. Unless a doctor tells you 6. RA 10868 – “Centenarian Act of 2016” – otherwise, taking these medicines An act honoring and granting additional together SHOULD BE AVOIDED. benefits and privileges to Filipino centenarians and for other purposes. COMMONLY USED MEDICATIONS FOR OLDER ADULTS a) SEC 3: Letter of Felicitation and Cash Gift – All Filipinos who reach 1. AMLODIPINE BESYLATE the age of 100 years old, whether ✓ This is used alone or together with residing in the Philippines or other medicines to treat high blood abroad, shall be honored with: pressure (hypertension). High blood pressure overworks the heart ✓ A letter of Felicitation from the and puts pressure on the arteries. President of the Philippines These organs may be negatively congratulating the celebrant for affected if the blood pressure his or her longevity; and remains high for extended periods. ✓ A centenarian gift in the amount of 100,000. 2. AZITHROMYCIN ✓ (Elderly with pneumonia) lowers 7. Presidential Proclamation No. 470 series the risk of 90-day mortality in of 1994 exchange for slightly increased ▪ First week of October (Elderly Filipino odds of myocardial infarction (MI) week) compared to other antibiotic ▪ The celebration underscores the vital regimens. role of the elderly sector in nation- ✓ However, elderly patients are more building and the advocacy for the likely to have heart rhythm promotion of their rights and welfare. problems (e.g. torsade’s de pointes) which may require 8. The Philippine Plan of Action for Senior CAUTION in patients receiving Citizens (2011-2016) azithromycin. Ensures giving priority to community- based approaches that are gender- 3. LEVOTHYROXINE responsive, with effective leadership ✓ If older patients have symptoms of and meaningful participation of senior HYPOTHYROIDISM and treatment citizens in decision-making processes, is needed, the dose of levothyroxine both in the context of family and is started gradually and increased community. cautiously, so as not to put any strain on the heart and central MEDICATIONS OF OLDER ADULTS nervous system. RISK OF MEDICATION FOR OLDER ADULTS Changes in your digestion affect how 4. LISINOPRIL quickly medicines travel through your ✓ A new long-acting angiotensin- body. converting enzyme inhibitor also If your circulatory system slows has been shown to be an effective down, medications can take longer to antihypertensive agent in older reach the liver and kidneys. patients. These factors increase the risk of different medications interacting and producing unwanted effects. NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  5. METFORMIN activities, also called ADLs. These activities ✓ Metformin is usually prescribed as include bathing, dressing, grooming, using first line therapy for type 2 the toilet, eating and moving around – for diabetes mellitus (DM2). example, getting out of bed and into a chair. 6. OMEPRAZOLE Long term care also includes COMMUNITY ✓ Reduces the amount of acid your SERVICES such as meals, adult day care, stomach makes. It's widely used to and transportation services. These services treat indigestion and heartburn, may be provided free or for a fee. and acid reflux. ✓ It's also taken to prevent and treat People often need LONG-TERM CARE stomach ulcers. Omeprazole is a when they have serious, ongoing health type of medicine called a proton conditions or disabilities. The need for pump inhibitor (PPI). long-term care can arise suddenly, such as after a heart attack or stroke. Most often, 7. SIMVASTATIN however, it develops gradually, as people ✓ Statins therapy in patients aged get older and frailer or as an illness or more than 65 years old decreases disability gets worse. the risk of major cardiovascular events. WHO NEEDS LONG TERM CARE? It is difficult to predict how much or what RISK OF COMBINING MEDICATIONS FOR type of long-term care a person might need. OLDER ADULTS Several things increase the risk of When you get older, it is normal to needing long-term care. be using more than one medication – usually a combination of a. AGE: The risk generally increases as the prescriptions and over-the-counter people get older medications. Although this is not a b. GENDER: Women are at higher risk than problem in itself, some potential men, primarily because they often live risks should be noted. longer. Use of more than one medicine at c. MARITAL STATUS: Single people are more a time increases the likelihood of likely than married people to need care the following problems: from a paid provider. o Falls and fractures d. LIFESTYLE: Poor diet and exercise habits o Dehydration can increase a person’s risk. o Difficulty carrying out tasks e. HEALTH AND FAMILY HISTORY: These you used to be able to do factors also affect risk. o Problems related to thinking and reasoning PALLIATIVE CARE FOR THE ELDERLY o Confusion and decreased awareness of your Palliative care is a specialized medical surroundings care for people living with a serious o Nutrient deficiencies illness. This type of care is focused on o Adverse reactions or side providing relief from the symptoms and effects from drugs stress of the illness the goal is to improve o Hospitalization quality of life both for both the patient and o Risk of death the family. LONG TERM CARE FOR THE ELDERLY Palliative care is provided by a specially- trained team of doctors nurses and other The most common type of long-term care is specialists who work together with a PERSONAL CARE – help with everyday NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  patient’s other doctors provide an extra ADVANCE DIRECTIVES/ DNR layer of support. Advance directives are written or oral Palliative care is based on the needs of decisions the patient has made that help the patient not on the patient’s guide healthcare personnel with respect to prognosis. It is appropriate up at any age the patient’s medical treatment in the event and at any stage in a serious illness and it the patient loses the ability to make his or her can be provided along with curative decision known. treatment. Three main types of these advanced Palliative care specialists improve quality directives are: of life for the patients whose needs are most complex. Working in partnership 1. DURABLE POWER OF ATTORNEY FOR with the primary physician, the palliative HEALTH CARE care team provides: o The durable power of attorney for health care is synonymous with the ✓ Time to devote to intensive family term medical power of attorney. meetings and patient or family counseling. o This legal document requires an ✓ Skilled communication about individual to make decisions for what to expect in the future in order the patient’s future and goes into to ensure that care is matched to effect and the patient becomes the goals and priorities of the incompetent or incapacitated. patient and the family. ✓ Expert management of complex o It does not require the patient to be physical and emotional symptoms terminally ill. Occasionally, the including: person may be a guardian - complex pain appointed by the courts. - depression - anxiety ✓ Proxy directives - fatigue ✓ Medical power of attorney - shortness of breath ✓ Surrogate decision maker - constipation ✓ Health care proxy - nausea ✓ Attorney in fact - loss of appetite - difficulty sleeping 2. LIVING WILLS o Living wills are legally recognized ✓ Coordination and documents which delineate the communication of care plans patient’s wishes regarding his or among all providers across all her medical care should they settings. become permanently incapacitated or terminally ill and are unable to Numerous studies show that palliative speak for themselves. care significantly improves patient quality of life and lower symptom o It specifies the patient's desire to burden. Apart from being the right thing to have or to withhold any life do for patients, this improved quality of life sustaining measures including also means that an encounter with the nutrition and hydration. health care system is less stressful and traumatic for families. o In contrast to the durable power of attorney for healthcare, the living will be seldom used to assist in NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN  clinical decision making because it requires the patient to be terminally ill in a coma or on life support before it can go into effect. o Ideally, a durable power of attorney for health care and a living will are executed together so that the proxy is given specific directions about the patient’s preferences. ✓ Instructional directive ✓ End-of-life care preferences NCM 114 (LECTURE) | Apple Jane Peresores, UM-SN