Research Topics: Elder Care

Anatomical and Physiological Changes

Anatomical and Physiological Changes   Structure and Posture             According to  (1981) and  (1996) one loses one and half to 3 inches or 1.2 cm. of height every 20 years as aging occurs. Obvious manifestations, which are an interaction of many factors such as age, sex, race, and environment, occur in the fifth decade of life. Long bones take on the appearance of disproportionate size because the stature decreases. Vertebral disks become thin due to dehydration, causing a shortening of the trunk. Many aged persons assume a stooped, forward-bent posture, with hips and knees somewhat flexed and arms bent at the elbows, raising the level of the arms. Posture and structural changes occur primarily because of calcium loss from bone and as a result of atrophic processes of cartilage and muscle. Excessive leaching of calcium from the bone matrix creates the condition called osteoporosis. This type of degeneration is four times more prevalent in women ( 1985), becoming apparent as estrogen declines in older women.   Skin, Hair, and Nails             Epidermal cell renewal time increases by one third after 50 years of age. The normal young adult renews epithelium every 20 days, whereas an older person requires 30 or more days because of diminished mitotic epidermal activity. Because of this slow replacement of epidermal cells, wound healing is approximately 50% slower than at 35 years of age ( 1978). The amount of collagen decreases approximately 1% per year, causing the skin to “give” less under stress and tear more easily ( 1988). The dermis becomes thinner in the absence of subcutaneous fat ( 1983).             Hair becomes gray because of the decrease in melanin production in hair follicles. Regardless of sex, 50% of the population over 50 years of age has gray or partly gray scalp hair. Body and facial hair becomes gray later. Hair loss is prominent in men, beginning in the second decade for some.   Facial Changes             Facial changes occur as a result of altered subcutaneous fat, dermal thickness, decreased elasticity, and lateral surface compression of underlying muscle contractions. Loss of bone mass, particularly the mandibular bone, accentuates the size of the upper mouth, nose, and forehead. Indented “loss of lip” appearance of the mouth occurs with tooth loss when uncorrected by dentures or other oral prostheses. Eyelids appear swollen as a result of the redistribution of fat deposits. Conversely, eyes that look sunken are the result of the loss of orbital subcutaneous fat. Loss of elasticity accentuates jowls and elongated ears and contributes to the formation of a “double” chin.   Loss of Tissue Elasticity             Tissue elasticity is most easily observed in skin integrity and reflects the progressive, universal, and intrinsic nature of age changes. The aged skin loses resilience and moisture, taking on a characteristic dryness.       Anesthesia in the Elderly             Many geriatric surgeries are performed as a result of increasing longevity. In geriatric patients there is reduction of cardiovascular, respiratory, renal and liver functions, These in very little functional reserve which is safety margin available to the patient during anesthesia and the post-operative period and contributes to the increased morbidity and mortality. The major risk factors in the elderly are: <ul style="margin-top: 0in; margin-bottom: 0in" type="circle"> <li class="MsoNormal"> Poor general condition </li> <li class="MsoNormal"> Severity of co-morbid conditions </li> <li class="MsoNormal"> Major surgery </li> <li class="MsoNormal"> Emergency surgery </li> </ul> Anesthesia should be safe with smooth induction, maintenance and quick reversal without producing any CVS, RS, and CNS complications. The choice of anesthesia depends on the general condition of the patient, the nature of surgical procedure and the experience of the Anesthetist.   Type of Anesthesia             Regional Anesthesia             Regional anesthesia is commonly administered in elective surgeries in the elderly. Regional anesthesia involves blockade of major nerve trunks which innervates the site of surgery. The two types of regional anesthesia are spinal and epidural. In spinal anesthesia the drug is injected into the subarachnoid space and in epidural anesthesia the drug is injected into epidural space. In elderly surgery, regional anesthesia is preferred for the following reasons: <ul style="margin-top: 0in; margin-bottom: 0in" type="circle"> <li class="MsoNormal"> Advantageous in debilitating respiratory disease patients </li> <li class="MsoNormal"> Reduces bleeding, postoperative respiratory problems and deep vein thrombosis </li> <li class="MsoNormal"> Diminishes stress response and CNS complications </li> <li class="MsoNormal"> Decreases convalescence time and facilities early ambulation </li> <li class="MsoNormal"> Minimizes requirements of postoperative analgesia </li> <li class="MsoNormal"> Reduces mortality  </li> </ul>               Disadvantages include:   <ul style="margin-top: 0in; margin-bottom: 0in" type="circle"> <li class="MsoNormal"> Technically difficult </li> <li class="MsoNormal"> Epidural is less reliable </li> <li class="MsoNormal"> Supplemental sedation carries great dangers like air way obstruction, pulmonary aspiration and agitation </li> </ul>   General Anesthesia   Causes of Failure to Breath after General Anesthesia <ul style="margin-top: 0in; margin-bottom: 0in" type="circle"> <li class="MsoNormal"> Obstruction of the airways </li> <li class="MsoNormal"> Central sedation from opium drugs or anesthetic agents </li> <li class="MsoNormal"> Hypoxia or hyoercarbia of any cause </li> <li class="MsoNormal"> Persistent neuromuscular blockade </li> <li class="MsoNormal"> Pneumothorax from pleural damage during anesthesia surgery </li> <li class="MsoNormal"> Circulatory failure leading to respiratory arrest </li> </ul>       Credit:ivythesis.typepad.com

Anatomical and Physiological Changes

Anatomical and Physiological Changes Structure and Posture According to (1981) and (1996) one loses one and half to 3 inch...

Elderly and Falls

Fear of Falling Falls by the elderly are prevalent and costly, not only financially but also in terms of quality of life. Many falls are preventable, and they should never be assumed to be a natural outcome of the aging process. The cause of a fall is often multifactor, and every effort must be made to address as many of these causes as possible.               There are numerous studies discussing fear of falling and these studies explored the different factors related to falling and how falling can be prevented. This journal analysis will critically analyzed three related articles on falls and will identify the following: identifying the researchers of the studies, the problem or question to be determined by the research, the subjects or respondents of the research, the significance of the number and gender of the respondents, the findings or the results of the study and finally, the conclusions of each studies. The studies that this paper will discuss are the following: “Fear of Falling: An Emerging Public Health Problem” and “Incidence and Risk Factors for Developing Fear of Falling in Older Adults”  by , and  “Breaking the Fall Factor,” by   .               The studies Fear of Falling: An Emerging Public Health Problem and Incidence and Risk Factors for Developing Fear of Falling in Older Adults were all conducted by a credible researcher,  a graduate pf PhD, a registered Nurse and at the same time an assistant professor of the School of Nursing,. Her works were all supported by the National Institute of Nursing Research. The problem of the first study is identifying the prevailing physical and psychological consequences of falling to older adults and its interventions (:2005). , also discussed the case of Mrs. M as an example in her research. She discussed numerous researchers that present the clinical assessment on falling among older adults. The researches were a review and discussion of the studies of health professionals working with older adults and routinely checking older individuals. According to research, fear of falling is the most common cause of disability among older adults. She also added that there should be more studies identifying intercessions in order to avoid and treat fear of falling, this includes, falls, fractures and a poor quality of life.               In the second article of  (2005), Incidence and Risk Factors for Developing Fear of Falling in Older Adults, she explored fear of falling in a longitudinal study of falls to distinguish incidence occurrence, and risk factors for developing fear of falling as the problem of her study. The study was conducted in an urban metropolitan area, with subjects of about 800 older adults in the age group of 45. The study stated that the age of the older adults are very significant in their incidence of falls because of their health, physical mobility, balance, health and cognition. The results of the study are the following: the prevalence of fear of falling has augmented over 2 years from 23-23%; the average incidence is 22.5% during the 2 follow up years. In conclusion, incidence and prevalence of fear of falling is noteworthy between community dwelling older adults and has the latent effect on the purpose and value of life. Nurses put into practice fear of falling, in enhancing selection and health programs for older adults.               Finally, the study of  (2002), Breaking the Fall Factor can also be considered very credible because of the fact that Sue specializes on the topic of Fall and at the same time she is also a nurse like . She is also supported by the Nursing Management. The problem of her research is identifying fall prevention and distinguishing at risk patients and at the same suggests ways of minimizing patient injury. The subjects of her study are community dwelling older adults but did not stated the number of her respondents. According to her study, there were 4 to 12 falls per 1,000 bed days in a hospital, while 30% of community dwelling older adults and 50% of long term care patients fall every year. In conclusion,  it is the responsibility of the nurses and the nursing management to begin interventions of fall.               The three articles or studies are related because of the following reasons: they are all conducted by nurses and health professionals; they all believed that falls and fear of falling are prevailing among older adults and age and gender are all significant factors. Lastly, they all believe that nurses and health professional are the ones responsible to the promotion of falls intervention.                 Credit:ivythesis.typepad.com

Elderly and Falls

Fear of Falling Falls by the elderly are prevalent and costly, not only financially but also in terms of quality of life. Many falls are ...

Health Promotion

Health Promotion               Health Promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health. Optimal health is defined as a balance of physical, emotion, social, spiritual and intellectual health. It is more than lifestyle change, it is also about changing environments so they are more supportive of making healthy decisions.   Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior, and create environments that support the good health practices.     Prevention of Falls in Elderly               “Stay on Your Feet”  is a community-based health promotion program that aimed to increase awareness of risks factors that causes falls in elderly, injuries and even death and then reducing incidence of falls and injuries among older people dwelling in communities aged 65 years and above.     Section 1   Falls in Elderly             Falls have come to be recognized as a major threat to the safety, health and independence of elderly persons. Awareness of various factors associated with falls in elderly persons and an understanding of some of the methods of preventing falls can help safety professionals in making appropriate decisions about necessary interventions. The elderly are increasing faster than any other age group and are particularly vulnerable to many social and health problems. A serious threat to the older population is loss of mobility. For many reasons, older people are more likely to suffer from injuries and infections than other age group because of age-associated physiological decrements and drug side effects. Falls are the leading cause of accidents in persons 65 years of age or older. Falls are also the main cause of serious injuries and deaths in older people. Falls account for 70 percent of accidental deaths in persons 75 years of age and older. More than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age. One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year ( 2000). Even older people who appear to be strong and well also can fall. Falling is a threat to your living on your own. The normal changes of aging can cause fall in elderly such as poor eyesight or poor hearing. Physical conditions and illness can affect strength and balance.             In additional, the side effects of medication can also affect balance and make the elderly fall. Medicines like for depression, sleep problems and high blood pressure often cause falls. And even some medicines for diabetes and heart problems can cause someone unsteady on his feet. Moreover, falls are due to environmental hazards and disorders of balance or gait. Falls occur wherever individuals spend most of their time, usually in or near the home. The causes of fall are known as risk factors. The greater the number of risk factors to which an elderly individual is exposed the greater the probability of a fall and the more likely the results of the fall will threaten the person’s independence. But these risk factors can be prevented. A lack of knowledge about risk factors and how to prevent them contributes to many falls. Some people believe that falls are a normal part of aging, and as such are not to be prevented. Lack of knowledge leads to lack of preventive action and would result to falls. Prevention of falls in the elderly should be directed at identification and evaluation of hazards that predispose them to falls. Most falls are primarily caused by behavior environment interactions. The home of an elderly person should be equipped with nonskid rugs, night lights, guard rails and bathroom safety equipment. Walkways should be kept clear of toys, cords and clutter. Individuals who have recurrent falls benefit most from a multidisciplinary evaluation, including medical diagnosis, functional status evaluation and home visits. A treatment plan is then formulated to address intervention strategies to reduce the combined effects of multiple factors. This prevention/treatment plan should emphasize interventions that maintain function.   General Objective             The main objective of this program is to increase community knowledge of risks factors that may cause falls in community-dwelling elderly people and at the same time reduce the incidence of falls.   Specific Objectives 1.      Promote and strengthen community action 2.      Promote positive aging 3.      Establish and enhance physical activity programs <li class="MsoNormal" style="line-height: 200%"> Provide training, and link with health professionals, community personnel and home health care providers in an aim to prevent falls and the impact of falling.</li> <li class="MsoNormal" style="line-height: 200%"> Empower older people to take personal action to reduce the risk of falling.</li> <li class="MsoNormal" style="line-height: 200%"> Work collaboratively with health providers such as physiotherapists, occupational therapists, pharmacists, general practitioners, secondary care providers and vision services to promote fall risk assessment and information sharing for self management.</li> <li class="MsoNormal" style="line-height: 200%"> Work collaboratively with local government to create safe public environments</li> <li class="MsoNormal" style="line-height: 200%"> Provide home safety checklists.</li> <li class="MsoNormal" style="line-height: 200%"> Encourage careful use of medication and provide information on medication reviews.</li> The target of the fall-related program of elderly are community-dwelling elderly people because studies shows that approximately 90 percent of the older people aged 65 and above live independently in the community or residents of nursing homes ( 2000). Section 2 Health Promotion Model and Approaches             The aging population will be living one third of their lives after retirement. It is important that effective health promotion should be developed for this last one third of their lives so that those living longer are healthy. Physical and social activities are independently and diversely associated with mortality and morbidity (1998). What the older people do affects health outcomes.             Numerous programs have been developed to enhance older people behavior.  Urban settings are positioned to lead the way in creating community-based programs through which critical mass of older adults, from diverse background could help solve unmeet social needs of the elderly. There are organizations that could effectively harness older adults’ time, and skills and at the same time increase activity levels and provide broad-based health promoting and generative opportunities for aging society.             A social approach to health promotion is designed for elder people, the “Stand on your Feet”. This program is designed to increase elderly people physical, social and cognitive activity that improvement would have health benefits.           Section 3 Ethical Issues                 As the number of people 65 years and older increases, so does the number of people who fall. Those who fall suffer moderate to severe injuries such as hip fractures or head traumas that reduce mobility and independence, and increase the risk of premature death. Hip fractures cause the greatest number of deaths and lead to the most severe health problems and reduced quality of life (1997, 2000). Most patients with hip fractures are hospitalized for about one week ( 2001). Up to 25% of community-dwelling older adults who sustain hip fractures remain institutionalized for at least a year ( 2000).             The causes of the fall as the researchers have identified are lower body weaknesses ( 1996), Problems with walking and balance (1996;  2001) Taking four or more medications or any psychoactive medications ( 1989; 1990;  1993;  1998).             Physical incapability could lead to person to immobile and more dependence to others. With this program, this enhances physical activity to elder people to make them move freely and be independent. The sense of control and freedom an individual has is critical to both physical and psychological health. Perceived locus of control and competence are two important aspects of a sense of independence.  If one can freely move, he can exercise his independence.             To be able to exercise control over one’s life has often been described as the pillar of human functioning. To be able to exercise control over one’s life has often been described as the pillar of human functioning and living. “At the core of one’s psychological functioning is the belief that he/she is able to undertake various tasks and activities and is capable of performing them successfully” (1984). It follows that a sense of control and freedom becomes critical to both psychological and physical health (1985).             This was demonstrated in now-classic experiments by  (1976),  (1977), (1976),  (1978). Nursing home patients’ psychological and physical health were significantly improved by enhanced perceived control and freedom. Most dramatically, the mortality rate was reduced by the experimental manipulation that stressed enhancement of a sense of personal control and freedom. These experiments and their findings demonstrated that a sense of control is fundamental to human life, even to the very end of it. When people give up personal control, they become helpless and lose the sense of purpose in life as well as the will to live ( 1975).             This importance of personal control and freedom suggests that people want to be able to live their lives independently. It is not surprising that a greater sense of control over life correlates positively with lower rates of illness and better health ( 1993;, 1987).             The biggest constraint to independent living and psychological well-being is the belief that one is not able to undertake tasks and activities and complete them successfully. In other words, a sense of lack of personal control and competence critically undermines one’s desire to live independently.             If independent living is psychologically the essence of human functioning, because it promotes physical and psychological health, it then becomes important for society to create the environment and programs that are likely to enhance a sense of control and competence in its citizens, especially among those whose sense of independent living has eroded due to various factors and circumstances.             Erosion of a sense of personal control and competence is acute among the elderly ( 1990). Physical ailments alone can lead to such undermining effects. This program would enhance older’s physical health and one’s sense of self control and independence as well as social well being.           Section 4 Outline of the Health Promotion Program Health Promotion Program : Stand On your Feet Methods             A volunteer sample composed of 80 subjects of 65 years and older people from Winnipeg, Manitoba derived from a pool of participants who are willing to participate in the research.             Then they are called by telephone if they are willing to undergo the research. The subjects are told if they would participate they would undergo a program in 12 weeks. If the subject agreed to participate in the program they would fill out an informed consent form.             Then, subjects that agreed to participate are then randomly group into either an experimental or control group. The final sample was consisted of 30 subjects, with 15 control and 15 in the experimental group.Both groups were pre-tested and post-tested on a number of dependent variables. Section 5 Evaluation             The intervention for this study was a modified version of the Community Reintegration Program (CRP) (1991). This intervention was originally developed as a transitional therapeutic recreation program for persons who have recently moved from a rehabilitation program back into their home community.  (1991) reported that participants involved in the CRP program successfully re-engaged in activities participated in before their accident, and/or initiated new, alternative activities. The program was modified to ensure that all of the activities, discussions and exercises were appropriate for an older adult population. The original CRP program did, however, have some subjects who were older adults. The CRP is described by  (1991) as being conceptually framed in the principle of normalization and social role valorization ( 1972, 1985).  (1991) indicate that, “… social role valorization theory identifies the individual’s right and responsibility to assume a valued role in society and society’s obligation to allow the individual to pursue that role without constraint.” The intervention was also based on social learning theory and social exchange theory. With regards to social learning theory,  postulated a theory of self-efficacy which suggested that a primary motivator for an individual is the perception of competence or personal mastery. But (1992, p. 305) suggests that “self-determination refers to the attitudes and abilities required to act as the primary causal agent in one’s life and to make choices regarding one’s actions free from undue external influence or interference.” Concepts of social role valorization, self-determination, and interdependence helped to drive the leisure education process within the present study. In addition, the dependent variables were closely tied to both the conceptual framework and the intervention. The interdependent nature of the intervention was designed to foster a greater sense of control in each subject. This was facilitated by the self-study nature of the intervention, and tire fact that the Therapeutic Recreation Specialist was trained to foster a reciprocal relationship between herself and each subject. In addition, the process of identifying barriers and ways in which to overcome barriers, and the development of a personal action plan were also designed to foster control in the subjects. The intervention was also designed to facilitate greater feelings of competence and enhanced participation. The CRP model allowed subjects to take a realistic look at their present repertoire of leisure activities and assess the extent to which they are still meeting their leisure needs. This process is very important for older adults who may have declining health or who may in fact be in the process of disablement. Since most of the subjects in the study had significantly more dexterity problems and more illness symptoms than the rest of the original needs assessment sample, this was particularly important. The present intervention helped subjects to determine what was the most realistic, yet desirable leisure plan for their present abilities. As such, it was individualized to address the unique challenges facing each experimental group subject and designed to ensure that these subjects perceived themselves as competent to achieve their leisure plan, thereby increasing the probability of enhanced participation. The intervention consisted of a minimum of 12 units conducted by a Therapeutic Recreation Specialist (TRS). Each of the units consisted of a variety of activities such as: discussion exercises, paper and pencil exercises, role playing, and recreation activity participation (See Figure 1). Though each unit had a specific objective and activities to be initiated with all subjects, the leisure education process was individualized to meet the needs of each subject. In some cases the TRS was able to complete more than one unit during an intervention session, while other subjects required more than one session to complete a given unit. The speed at which subjects proceeded through the process depended upon the personal issues that they and the TRS felt were important to address in relation to each unit. For example, some subjects had a substantial number of real and perceived barriers to leisure participation, while others did not. Those who had a significant number of barriers spent a longer amount of time in Unit 6, Barriers.         Credit:ivythesis.typepad.com

Health Promotion

Health Promotion Health Promotion is the science and art of helping people change their lifestyle to move toward a state...

Lifestyle Factors for Promoting Bone Health in Older Women

Lifestyle Factors for Promoting Bone Health in Older Women               It has been reported that an estimated 3 million people in the United Kingdom suffer from osteoporosis, as 1 in 3 women and 1 in 12 men over the age of 50 will develop the disease (2006). Without treatment, osteoporosis can cause painful and disabling fractures, particularly in the wrist, hip and spine (2006). It also costs the NHS and government over £15 million a day or, £1.9 billion each year (2006). In relation to this, it is accepted practice to recommend a calcium-rich diet, weight-bearing exercise, cessation of smoking and limited alcohol intake to promote bone health (2004). In addition, although 1 in 3 women over 50 years old are at risk of osteoporosis, the lifestyle practices of older women in Scotland are not well documented (2004). With this data, a study was conducted to investigate the lifestyle practices of a group of older women who had received lifestyle advice a year previously while participating in research identifying the individual risk of osteoporosis (2004). This study would help arouse further researches regarding the importance of knowledge in osteoporosis and the consequences of having the disease. It would also help increase awareness of the citizens for greater prevention and cure of the disease. In relation to the problem of the increase in incidence of having osteoporosis in the United Kingdom is the increase in incidence of the disease in the United States. It has been reported that osteoporosis affects as many as 30% of post-menopausal women and about 5% of older men in the United States (2005). In addition, more than 1.2 million fractures (primarily of the hip, spine or wrist) occur each year as a direct result of osteoporosis (2005). Since our genes have not changed much during the past century, environmental factors are likely responsible for this epidemic of thin bones (2005). However, there are still various non-drug strategies for preventing and treating the disease (2005). These non-drug strategies include exercise, proper diet, increased intake of calcium, and other vitamins. It has been reported that weight bearing and some non-weight-bearing exercise can strengthen bones and reduce the risk of developing osteoporosis, and includes swimming, walking, jogging, jumping and weight lifting (2005). In addition, dietary factors that may cause thinning of bones include excessive consumption of refined sugar, caffeine, alcohol, and animal proteins, and cigarette smoking appears to promote osteoporosis, and should be avoided (2005). It has been pointed out that one of the most effective trials of calcium supplementation in elderly patients used tricalcium phosphate as the calcium source (2005). While calcium has received most of the attention most doctors, there is good evidence that many other micronutrients are involved in promoting bone health, and includes magnesium, manganese, zinc, copper, boron, strontium, silicon, vitamin D, vitamin C, folic acid, vitamin B6, and vitamin K (2005). Many of these nutrients are in short supply in the typical processes Western diet (2005), which can be one good reason why many elderly suffer from the thinning of bones that could lead to osteoporosis. While none of these nutrients has been studied as extensively as calcium, the available evidence suggests that some of them (particularly vitamin K, vitamin D, copper, and magnesium) are at least as important as calcium, and consuming whole foods that are high in micronutrients, and taking a broad-spectrum nutritional supplement, will often be more effective than taking calcium by itself (2005). The method of the study is mainly a quantitative approach, which was taken from the perspective of the empirical-analytical paradigm (2004). A descriptive survey research design was used and the primary method of data collection was postal questionnaire (2004). Additional qualitative data obtained from a telephone interview of a small interview of a small number of respondents were content analyzed (2004). The questionnaire was sent to 320 women (2004). The majorities of women was non-smokers, had no alcohol problems and were participating in regular weight-bearing exercise (2004). However, most had not been taking a calcium-rich diet in the previous year, and only 21.2% had changed their diet following identification of risk of osteoporosis (2004). The findings in relation to diet, smoking, exercise and alcohol were supported by previous research (2004). A statistically significant finding was that women at high risk of osteoporosis were the least likely to have made changes in lifestyles (2004). As a proof, in the United States also, among those with osteoporosis, approximately 80% are women and 20% are men ( 2002). As an explanation, women are more susceptible because they have less total bone mass or a smaller reservoir, and the rate of bone loss accelerates during menopause ( 2002). After age 50, one in two women and one in eight men will suffer one or more osteoporotic fractures ( 2002). The study recommends that further research with larger samples in the United Kingdom explores the reasons why older women do not have adequate calcium intake (2004). In addition, further research is required to address the information needs and lifestyle practices of older women who are at high risk of osteoporosis (2004). In relation to the study’s aim, it would take a long time to accomplish the study for every participant must be examined and evaluated to completely and accurately investigate their lifestyle practices. The study must also provide nurses or medical workers to each of the participant, to facilitate the investigation and obtain accurate results and observation. This would not only be time-consuming but not cost-effective as well. In addition, further evaluation of the methods of the study must be done to ensure producing accurate results.       Credit:ivythesis.typepad.com

Lifestyle Factors for Promoting Bone Health in Older Women

Lifestyle Factors for Promoting Bone Health in Older Women It has been reported that an estimated 3 million people in the...

AGED CARE ASSESSMENT

Aged Care Assessment               Aged patients vary in physical needs, psychosocial needs including family involvement, and pathophysiological disorders that influence the person’s nursing care. In this case, an aged stroke patient is described whereas rapid assessment and early intervention is a requirement ( 1999).   1.         In terms of physical needs, aged patients need more assistance. Diet, nutrition, and eating are given special attention since the patient not able to chew and swallow foods. Since the patient is not capable of normal locomotion, his ability to dress and groom himself is no longer possible. Thus, assistance is always needed. In the same manner, a satisfactory nursing care is based on the need to maintain the skin care, feeding, hydration, positioning, and monitoring vital signs such as temperature, pulse, and blood pressure of the patient. On the other hand, psychosocial needs include attention, care, understanding, and continuous support from other people. The patient may have the tendency of having sudden changes in emotion. Depression is prevalent as a cause of self-acceptance of the disability. This is the reason why family involvement matters a lot especially in the recovery and therapy of the patient. Pathophysiological disorders that influence the person’s nursing care may range from the kind of stroke that the patient had experienced. In general, the risk of another stroke occurrence is recognized. The death of brain tissue may elicit several conditions.   2.         The person who reaches the ageing stage of life biologically changes over time due to cellular senescence. Cellular senescence is the ageing of cells and characterized by the loss of its ability to divide. According to (2004), “the aging process may derive from changes occurring in parallel in different tissues due to intrinsic cellular mechanisms or changes in one tissue may be predominant”. Cell and tissues are considered to be significant reasons on why people age as described with the presence of strong genetic components that (2004;   2000). In the programmed based theories of aging, it was indicated that aging is not a result of random or stochastic process but rather driven by genetically regulated processes (2004). This means that the aging of an individual is natural.   Credit:ivythesis.typepad.com

AGED CARE ASSESSMENT

Aged Care Assessment Aged patients vary in physical needs, psychosocial needs including family involvement, and pathophy...

Aged care study

AGED CARE   1.         Mrs.  is diagnosed as having congestive heart failure caused by excessive fluid overload and leading to foot edema and acute cellulites on the leg. Other than that, she also feels anxiety caused by frequent admission and decreased in physical mobility and uncertainty of the disease.             Congestive heart failure is a clinical syndrome in which the heart fails to maintain an adequate output, resulting in diminished blood flow to the tissues, and congestion in the pulmonary and/or the systemic circulation. The causes of congestive heart failure are diverse. Adverse consequences of the series of physiologic events that initially compensate for the reduced performance of the heart as a pump lead to the symptoms and signs of clinical congestive heart failure (2004).             Congestive heart failure can best be understood by first reviewing normal heart function. The amount of blood pumped per minute (the cardiac output), is controlled by an intricate balance of variables including stroke volume, heart rate, preload or inflow volume and pressure, myocardial contractility, afterload or systolic pressure, and the sequence of ventricular activation and contraction.  showed that cardiac stroke work is directly proportional to the length or degree of stretch of the myocardial fiber, and it is useful to describe cardiac function in terms of the ventricular function curve, the  relationship (2000).             The manifestations of heart failure range from sudden death, through cardiogenic shock, to chronic congestive heart failure depending upon the degree of circulatory inadequacy and the rapidity with which it develops. The manifestations include edema, particularly of the dependent portions of the body; a prolonged circulation time; hepatic enlargement (hepatomegaly); a sensation of shortness of breath and suffocation (dyspnea); and distention of the neck veins ( 2001). A detailed clinical history is crucial and should address not only current signs and symptoms of heart failure but also signs and symptoms that point to a specific cause of the syndrome, such as coronary artery disease, hypertension or valvular heart disease. It is important to determine whether the patient has had a previous cardiac event, in particular a myocardial infarction (2000). Hypertension and a history of congestive heart failure are two clinical histories that could point out why Mrs.  has at present the condition.             Early diagnosis of heart failure is essential for successfully addressing underlying diseases or causes and, in some patients, preventing further myocardial dysfunction and clinical deterioration. However, initial diagnosis may be difficult because the presentations of heart failure can ge from no symptoms to pulmonary edema with cardiogenic shock. Mrs. ’s feeling of anxiety is understandable given her situation. Anxiety is uneasiness or uncertainty resulting from anticipating a threat or a danger (2004). On study examined the prevalence of anxiety and its impact on clinical outcomes in patients with congestive heart failure. Clinical implications of the study show that identifying congestive heart failure patients with moderate to high levels of anxiety, using a standard diagnostic tool, may be helpful in improving their long-term prognosis.   2.         Aging is a general physiologic process that is as yet poorly understood. Aging affects cells and the systems made up of them, as well as tissue components such as collagen, and numerous theories have been advanced to explain the phenomenon. In aging humans, there are declines in the circulating levels of some sex hormones, the adrenal androgen dehydroepiandrosterone and its sulfate, and growth hormone (2001).             The aging process affects all cells, organs and systems of the body. The earliest noticeable signs of the process are usually exhibited by the muscoloskeletal system; thinning and wrinkling of the skin, graying and/or loss of hair, loss of bone mass, increase in body fat, decrease in muscle mass and strength, and joint pains and stiffness that is worse in the morning. The sensory organs become less acute; reading glasses become necessary; the ear is unable to hear high pitch sounds: food tastes more bland; and the sense of smell becomes less discriminating.             The liver which is the major metabolic organ in the body show levels of activity drop in relation to aging. This decreased activity could result in slowed detoxification of some compounds and reduced excretion rates, which can result in higher effective circulating levels and longer half-lives (2005). The reflexes become duller and motor responses get delayed. The deterioration of the heart and lungs manifest as increasing difficulty to perform strenuous activities; climbing stairs become an ordeal. All the other organs also weaken. They lose most of their reserve capacities and are unable to perform their assigned functions as efficiently. The immune system becomes less active and the person becomes more susceptible to infection ( 2004).             Digestion becomes less effective the person is unable to tolerate many foodstuffs and becomes susceptible to malnutrition. Females go into menopause and lose their ability to reproduce. Males retain their reproductive capacity but develop erectile and/or other sexual dysfunctions. The elimination of toxicants and their metabolites is affected by age-related ges in hepatic function, described above, and by decreased kidney function. A decrease in the rate of renal clearance results in an increase in the elimination half-life of a compound. Renal ges observed with age include a decrease in mass of the kidneys, a reduction in the size and number of nephrons, a decrease in renal blood flow, and reductions in glomerular filtration rate, renal plasma flow, and tubular function. In addition, the alterations in pulmonary function that affect absorption of gases and volatile compounds also will affect their excretion through the pulmonary route. There is also evidence that bile flow and biliary transport is reduced with aging, thus reducing excretion through that route ( 2005).        Another potential area of concern is ges in the blood-brain barrier with aging, resulting in increased permeability of the cerebral microvasculature to toxicants that could result in neurodegenerative disease. Most data currently indicate that there are no significant ges in permeability with normal aging. Diseases often associated with aging, however, such as diabetes, hypertension, and cerebral ischemic events, may compromise this barrier function. This may be important in understanding the environmental etiology of conditions such as Parkinsonism, which has been linked to exposure to some compounds that ordinarily show limited penetration of the blood-brain barrier (2005).             Major physiologic ges occur with aging of the heart. Heart functions begin to slow down with age. The aging process reduces the heart muscle strength. So its pumping power declines, and the maximal heart rate also decreases. When the amount of blood pumped by the heart in a minute declines, systolic blood pressure tends to rise. The left ventricular wall thickens, systolic function decreases, and heart rate response to exercise is blunted. Maximal oxygen consumption declines, left ventricular filling declines, cardiac output remains normal or declines and the cardiothoracic ratio increases ( 1998).             There are some common problems associated with the heart as an effect of the aging process. One of these is atherosclerosis. Arteriosclerosis is the hardening or clogging of the arteries due to excessive build up of fat and cholesterol known as plaque. Fatty plaque deposits inside the blood vessels cause it to narrow and can totally block blood vessels and also cause the valves that control the direction of blood flow to thicken and become stiff. Arteriosclerosis in turn is the underlying cause of most cardiovascular diseases (2001).             With aging, the heart has to work harder due to decreased blood supply (2001). Greater force is necessary to push blood through narrowed vessels due to plaque build up. So high blood pressure develops and this buildup and shortage of oxygenated blood over time, leads to heart attacks. In a heart attack, a part of the heart muscle becomes starved for oxygen and dies.             Congestive heart failure, that which Mrs.  experienced, is also very common in the aging population. In people older than 75, heart failure occurs 10 times more often than in younger adults ( 1998).   3.                     The assessment of heart function involves a review of signs and symptoms from the medical history, pulse assessment, and direct examination of the heart. A patient who has signs and symptoms of cardiac problems may be suffering a life-threatening condition requiring immediate attention.             When such is the case, health care professionals should act quickly and decide on the portions of examination that are absolutely necessary for the patient. When the patient’s condition is stable, a more thorough assessment can reveal baseline heart function and any risks for heart disease.             To establish the diagnosis of congestive heart failure, a physical examination should be performed which should include exam for jugular venous distention, cardiac auscultation, pulmonary exam and peripheral edema. Jugular venous distention and bilateral leg edema are both observed in Mrs. , clearly indicating a possible congestive heart failure. Initial diagnostic tests to confirm the diagnosis includes an echocardiogram performed for patients with symptoms highly suggestive of congestive heart failure due to the lack of sensitivity of physical findings in some patients with congestive heart failure. Patients with mild symptoms such as fatigue or peripheral edema should only undergo echocardiography if there are physical or radiologic findings suggestive of heart failure. The constellation of the patient’s symptoms and the findings from a physical examination, chest radiograph, and echocardiogram clearly establish a diagnosis of congestive heart failure ( 2003).             The performance of a 12-lead electrocardiogram (ECG) is essential in the evaluation of a patient with congestive heart failure. Evidence of myocardial infarction or conduction abnormalities such as left bundle-branch block and other abnormalities serve to heighten the suspicion of left ventricular systolic dysfunction. An ECG evaluation also is needed to role out arrhythmias that can worsen symptoms of congestive heart failure or predict potential complications such as sudden cardiac death. Since atrial tachyarrhythmias such as atrial fibrillation with uncontrolled ventricular response may be the sole cause of congestive heart failure and left ventricular dysfunction, the early identification of this arrhythmia is crucial (Tavel, 2003). Patients with a confirmed diagnosis of congestive heart failure should have the following tests performed to screen for the underlying causes of the heart failure: ECG, CBC, UA, serum creatinine, serum albumin, and echocardiogram. If the patient has an atrial fibrillation or flutter or is over 65 years old, a T4 or TSH should also be obtained. A newer tool being used in the diagnosis and assessment of CHF is the measurement of blood levels of B-type natriuretic peptide (BNP). BNP is a peptide that is secreted by the left ventricle in response to stretch and can be used to differentiate dyspnea due to congestive heart failure from that caused by COPD, obesity, or other chronic illnesses. The patient presented, however, has fairly classic signs and symptoms of congestive heart failure, so a BNP level would predictably be elevated and would add little to the diagnosis. On the other hand, a BNP level at the time of this patient’s initial presentation would likely have allowed for an earlier diagnosis ( 2003).             The management of heart failure is based on its physiologic concepts. Therapy includes rest, oxygenation, measures to improve myocardial contractility, correction of arrhythmias, diuresis, sodium restriction, and reduction of afterload if possible. Even in the most urgent situation, the cause of the heart failure must be determined, any correctable conditions searched for, and contributing factors eliminated (2003). Robust clinical trials have demonstrated the benefits of therapy with various [beta]-blockers in patients with congestive heart failure. Bisoprolol, long-acting metoprolol, and carvedilol have all been shown to improve survival and to decrease hospitalizations for heart failure. In the instance of severe congestive heart failure, only carvedilol thus far has been demonstrated to improve survival and is also well-tolerated. Although several small trials have demonstrated differences among patient responses to these agents, a large, randomized direct comparison trial demonstrating the superiority of one over another has not yet been completed ( 2003). For a patient with congestive heart failure, left ventricular dysfunction, the same approach to the initial medical management should be taken. The consideration of surgical revascularization, however, should be undertaken soon after the patient presents, especially if the patient has chest pain or objective evidence of ischemia. The assessment of myocardial viability using the noninvasive techniques described above is important, particularly since the patient’s risk of surgery is usually quite high. If extensive myocardial scarring were found with little evidence of viability, surgical or meical revascularization would be inadvisable. If the expected improvement does not occur and the patient’s symptoms worsen, other therapies, including transplantation should be considered. If Mrs. ’s ECG findings demonstrate a marked intraventricular conduction delay, cardiac resynchronization with a biventricular pacing device may be beneficial. Should transplantation prove to be the only viable option, evaluation for any concomitant diseases that would preclude transplantation (eg, cancer and severe renal dysfunction) should be undertaken. The decision regarding listing the patient for cardiac transplantation can be facilitated by an assessment of a patient’s exercise-induced maximal oxygen uptake. A peak oxygen uptake of < 14 mL/kg/min (or < 50% of predicted normal values) or the need for continuous therapy with IV inotropic agents generally identifies the need for transplantation. The placement of an implantable left ventricular assist device is sometimes needed as a “bridge” to cardiac transplantation for a patient who requires a greater degree of hemodynamic support ( 2003).     Credit:ivythesis.typepad.com

Aged care study

AGED CARE 1. Mrs. is diagnosed as having congestive heart failure caused by excessive fluid overload and leading to foot ed...

Medicating the Elderly

Medicating the Elderly   This paper discusses the theories and concepts of medications. Specifically, it provides literature-based references on the notion of medications among elderly, legal considerations, usage, general advice on medication, as well as compliance, noncompliance, and adherence.   The World Health Organization’s (WHO) study suggests that only about half of people with chronic illnesses regularly take their medication (2003). With this fact alone, there is a constantly great need for health care practitioners as well as people to pay particular attention to patient’s observance to proper medications. The worldwide standards in health care practice are overly affected with various mechanisms that emerged form the modern ways of living today. Globalization and technological advancements are among the phenomena that contribute to the changes in the mainstream principles and practices of health care. As the world progresses and explores wider and better horizons in all areas of human life, the concern for health and well-being is also preferential. The continuous development of scientific and medical explorations and experimentations are apparent evidences that health is still important. One of the most sought-after areas of research and inquiry is medication and its related aspects like administration, compliance, noncompliance, and adherence. On this case, it is medication among the elderly patients. Medication have been known and used since antiquity (2006). It has been widely accepted that medication is the ultimate response to the curative needs of known diseases. The purposes of medication are directed to the lessening if not curing the suffering brought about by such diseases. Over the centuries, the number of drugs available for people has increased greatly, and knowledge about these drugs has become correspondingly more accurate and detailed. As people recognized the importance of medication, a variety of chronic illnesses are also growing. Thus, several standards and underlying principles about medication like the idea and practice of proper administration, compliance and adherence are taken into strict consideration.   Medication – its definition             Patients with specific illnesses can restore or maintain their health through a variety of strategies aided by a health care provider (e.g. nurse, physician, etc.). From time to time, patients require medications to maintain or stabilize their health. A medication is a substance used in diagnosis, treatment, relief, cure, or prevention of health alterations ( 2004). It is a approved drug that is taken in various ways for the purposes of reducing symptoms of a given illness or any medical condition. Medications include whether it is likely to relieve symptoms, cure disease, or have unpleasant side effects (1994). Also, it can be prescribed by a health care professional or simply purchased over-the-counter (OTC).   Types of medication             Medication can be usually categorized in various ways, for instance by its chemical properties, mode of administration, or biological system affected, or plainly according to age (for children, adult or elderly). In this case, the type of medication to de discussed is generic and brand name medications.   <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Generic – Generics are types of drug that are not patented. Popularly gives the thought that they are cost effective, generic drugs have the equivalent active medicinal ingredients, value, potency, purity, and strength as brand name drugs ( 2003). Generic drugs are copies of brand name drugs. Generics are generally assumed to be equal in dose, strength, route of administration, safety, efficacy, and intended use. Generic drugs typically cost pharmacies 50 to 80 percent less than brand-name counterparts (1991). Examples of generic name are chloramphenicol, paracetamol, phenylpropanolamine, etc. or any other name that refers basically to the chemical component of the drug. </li> </ul>   <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Brand name – These drugs are manufactured by pharmaceutical companies and are often patented. They are given specific brand names. An example of a generic drug for diabetes, for instance, is metformin, while brand name for metformin is Glucophage. Another practical reminder to identify a generic from brand drug is that most brand names start with capital letter.</li> </ul>     Legal considerations             Medications are generally divided into two groups by mostly all laws governing medication administration and application – prescription only medicine (POM) and over-the-counter (OTC).   <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Prescription only medicines (POM) are drugs that are essentially prescribed or approved by licensed health care professionals. Parrott noted the four issues guided consideration of the general knowledge exchanged about the prescribed medications were the name of the medication, other references to the medication (e.g., “the prescription,” “the medicine”), dosage, and appearance (e.g., pill, lotion).</li> </ul>   <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Over-the-counter (OTC) medicines are often available in pharmacies and supermarkets without the need of presenting prescription order or particular restriction. </li> </ul>   Medication Standards             Standards are those actions that ensure safe medication practice. For instance, registered mental health nurses should be aware of nursing standards called the six rights of medication administration in order to ensure safe medication administration to mental health patients ( 2004). All medication administration errors can be linked in some way to any inconsistency in adhering strictly to the six rights of medication administration. Generally, these six rights are applied to almost all medication administration processes. These six rights are as follows: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The right medication</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The right dose</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The right patient</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The right route</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The right time</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The right documentation</li> </ul>   Medication usage among the elderly             The administration of drugs to the elderly patients require the understanding of physiologic and pharmacokinetic changes that may alter appropriate drug usage, cause common adverse reactions, or create compliance problems (Abel et al., 2003). Abel and colleagues noted the following considerations particularly on physiologic changes affecting drug action on elderly. <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Body composition – It is noted that body composition varies from person to person. These changes in the body composition affect the relationship between a drug’s concentration and distribution in the body. </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Gastrointestinal (GI) function – In the elderly patients, decrease in gastric acid secretion and GI motility slow the emptying of stomach contents and movement through the entire intestinal tract. Similarly, research suggests that elderly patients may have more difficulty absorbing drugs than that of younger patients. This is particularly significant problem with drugs that have a narrow therapeutic range in which any change in absorption can be crucial.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Hepatic function – The patient’s liver ability to metabolize certain drugs decreases with age. This decrease is caused by diminished blood flow to the liver that results from an age-related decrease in cardiac output and from the diminished activity of certain liver enzymes. Decreased hepatic function may cause more intense drug effects caused by higher blood levels, longer-lasting drug effects caused by prolonged blood levels, and a greater risk to drug toxicity.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Renal function – Although an elderly person’s renal function is usually sufficient to eliminate excess body fluid and waste, the ability to eliminate some drugs may be reduced by 50% or more. Many drugs commonly used by elderly patients are excreted primarily through the kidneys. Also, drug dosages can be modified to compensate for age-related decreases in renal function. Aided by laboratory tests, prescribers may adjust drug doses so the patient receives therapeutic benefits without the risk of toxicity. Observe the patient for evidence of toxicity. </li> </ul> Meanwhile, aging is usually accompanied by decline in organ function that can profoundly affect drug administration and clearance. This physiologic decline is likely to be intensified by a disease or chronic disorder. Together, these factors can significantly increase the risk of adverse reactions and drug toxicity, as well as noncompliance. Be aware of these changes particularly in giving a drug to an elderly patient. The following are important considerations in special administration of medications among the elderly specifically on the management of side effects or adverse reactions. Compared with the younger population, elderly patients experience twice as many adverse drug reactions relating to greater drug consumption, noncompliance, and physical changes. Signs and symptoms of adverse drug reactions, on the other hand, are often mistakenly attributed to senility or disease. If the adverse reaction is not identified, the patient may continue to receive the drug. Furthermore, he/she may receive unnecessary additional drugs to treat complications caused by the original drug. This regimen can sometimes result in a pattern of inappropriate and excessive drug use. Although any drug can cause adverse reactions, most of the serious reactions in the elderly are caused by relatively few drugs. Be particularly alert for toxicities from diuretics, antihypertensives, digoxin, corticosteroids, anticoagulants, sleeping aids, and OTC drugs.   Maintaining Patient’s Rights             Because of the potential risks related to medication administration, the patient is also given rights. It is the patient’s right to be informed of the medication’s name, purpose, action, and potential undesired effects. The patient can also refuse medication regardless of consequences. The patient also has the right to be properly advised of the experimental nature of medication therapy and to give written consent for its use. The patient has the right to receive appropriate supportive therapy in relation to medication therapy. However, in the case of the mental health patient who may have impaired reasoning, the family of the patient can decide instead and take over the right of the patient.   Ways to Prevent Medication Administration Errors             The table below can help serve as a guide for nurses in avoiding errors in medication administration. PRECAUTION RATIONALE   Read medication labels carefully.     Be aware of medications with similar names.   When new or unfamiliar medication is ordered, consult resource.     Do not administer medication ordered by a nickname or unofficial abbreviation.   Do not attempt to decipher illegible handwriting.       Know patients with same last names. Also have the patients state their full names, or ask their families if you cannot talk to the patient.   Many products come in similar containers, colors, and shapes.   There are many medication names that sound alike.   If prescriber is also unfamiliar with the drug, there is greater risk for inaccurate being ordered.   Many prescribers refer to commonly ordered medications by nicknames or unofficial abbreviations.   When in doubt, ask the prescriber. Unless nurse questions order that is difficult to read, chance of misinterpretation is very high.   It is common to have two or more patients in the hospital with the same or similar last names. Special labels n a medication book can warn off potential problems.     General advice on elderly medications              (1997) provided a general list of suggestions on effective drug administration among elderly patients as follows: ü  Don’t take a drug unless absolutely necessary. Try a change in diet or exercise instead. Ask your doctor if there’s anything else you can do besides drug therapy for the condition.   ü  Tell your doctor about all the drugs you take. If you have several doctors, make sure they all know what the others are prescribing, and ask one doctor (such as an internist or general practitioner) to coordinate your drugs.   ü  Ask for drugs that treat more than one condition. Blood pressure medicine might also be good for heart disease, for example.   ü  Keep track of side effects. New symptoms may not be from old age but from the drug you’re taking. Try another medication if possible until you find one that works for you.   ü  Learn about your drugs. Find out as much as you can by asking questions and reading the package inserts. Both your doctor and pharmacist should alert you to possible interactions between drugs, how to take any drug properly, and whether there’s a less expensive generic drug available.   ü  Have your doctor review your drugs. If you take a number of drugs, take them all with you on a doctor’s visit.   ü  Ask the doctor, “When can I stop taking this drug?” and, “How do we know this drug is still working?”   ü  Watch your diet. Some drugs are better absorbed with certain foods, and some drugs shouldn’t be taken with certain foods. Ask a pharmacist what foods to take with each drug.   ü  Follow directions. Read the label every time you take the medication to prevent mistakes, and be sure you understand the timing and dosage prescribed.   ü  Don’t forget. Use a memory aid to help you — a calendar, pill box, or your own system. Whatever works for you is best.     The Issue of Compliance             With increasing numbers of medications and other medical interventions shown to do more good than harm when taken or implemented, as prescribed, low compliance is a major problem in health care.  (no date) identified how big is the problem of medication noncompliance. According to him, an average of 60% of all prescribed medication is taken incorrectly or not at all.  Aside from the previously mentioned factors influencing compliance and adherence, the British National Formulary (2003) specified some causes for poor compliance. Such include the following: <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Forgetfulness </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Prescription not collected or not dispensed </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Purpose of treatment not clear </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Perceived lack of effect </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Real or perceived side-effects </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Instructions for administering not clear </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Physical difficulty in complying (e.g. with opening medicine containers, handling small tablets or swallowing difficulties, travel to place of treatment) </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Unattractive formulation (e.g. unpleasant taste) </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Complicated regimen</li> Similarly, various researches also identified the aforementioned causes of noncompliance (2005; 2004;  2001;  2001;  2001; 1990). There are also distinctions and exemptions as well as case-to-case basis in determining the causes of noncompliance. All in all, the provided list includes the most popular reasons on why people do not comply with prescribed medications.              Poor noncompliance can be a problem with patients of any aid. A significant number of hospitalization result to noncompliance with a medical regimen. In elderly patients, factors linked to aging such as diminished visual acuity, hearing loss, forgetfulness, the common need for multiple drug therapy, and socioeconomic factors can combine to make compliance a special problem. About one-third of elderly patients fail to comply with their prescribed drug therapy (2003). They may fail to take prescribed doses or to follow the correct schedule. They may take drugs prescribed for previous disorders, discontinue drugs prematurely, or indiscriminately use drugs that are to be taken as needed. Elderly patients may also have multiple prescriptions for the same drug and inadvertently take an overdose.             With this, review the patient’s drug regimen with him/her. Make sure he/she understands the dose amount, the time and frequency of doses, and why he/she is taking the drug. Also, explain in detail if a drug is to be taken with food, water, or without any other drugs. Help the patient avoid drug therapy problems by suggesting that he/she use drug calendars, pill sorters, or other aids to help him/her comply. Lastly, refer him/her to the prescriber or pharmacist if he/she needs further information.     Credit:ivythesis.typepad.com

Medicating the Elderly

Medicating the Elderly This paper discusses the theories and concepts of medications. Specifically, it provides literature-based refer...